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McPherson C, Lockowitz CR, Newland JG. Balanced on the Biggest Wave: Nirsevimab for Newborns. Neonatal Netw 2024; 43:105-115. [PMID: 38599778 DOI: 10.1891/nn-2023-0056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/12/2024]
Abstract
Respiratory syncytial virus (RSV) is the leading cause of hospitalization in infancy in the United States. Nearly all infants are infected by 2 years of age, with bronchiolitis requiring hospitalization often occurring in previously healthy children and long-term consequences of severe disease including delayed speech development and asthma. Incomplete passage of maternal immunity and a high degree of genetic variability within the virus contribute to morbidity and have also prevented successful neonatal vaccine development. Monoclonal antibodies reduce the risk of hospitalization from severe RSV disease, with palivizumab protecting high-risk newborns with comorbidities including chronic lung disease and congenital heart disease. Unfortunately, palivizumab is costly and requires monthly administration of up to five doses during the RSV season for optimal protection.Rapid advances in the past two decades have facilitated the identification of antibodies with broad neutralizing activity and allowed manipulation of their genetic code to extend half-life. These advances have culminated with nirsevimab, a monoclonal antibody targeting the Ø antigenic site on the RSV prefusion protein and protecting infants from severe disease for an entire 5-month season with a single dose. Four landmark randomized controlled trials, the first published in July 2020, have documented the efficacy and safety of nirsevimab in healthy late-preterm and term infants, healthy preterm infants, and high-risk preterm infants and those with congenital heart disease. Nirsevimab reduces the risk of RSV disease requiring medical attention (number needed to treat [NNT] 14-24) and hospitalization (NNT 33-63) with rare mild rash and injection site reactions. Consequently, the Centers for Disease Control and Prevention has recently recommended nirsevimab for all infants younger than 8 months of age entering or born during the RSV season and high-risk infants 8-19 months of age entering their second season. Implementing this novel therapy in this large population will require close multidisciplinary collaboration. Equitable distribution through minimizing barriers and maximizing uptake must be prioritized.
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Walsh TJ, Kalb LG, Gemmell M, Liu J, Caburnay CA, Gurnett CA, Newland JG. Assessment of COVID-19 Messaging Strategies to Increase Testing for Students With Intellectual and Developmental Disabilities. J Sch Health 2024. [PMID: 38551064 DOI: 10.1111/josh.13448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 02/19/2024] [Accepted: 03/04/2024] [Indexed: 04/13/2024]
Abstract
BACKGROUND Students with intellectual and developmental disabilities (IDD) were disproportionately impacted by the COVID-19 pandemic. This study's goal was to assess the effectiveness of 2 messaging strategies on participation in SARS-CoV-2 weekly testing. METHODS Cluster randomized trials were conducted at 2 school systems, the special school district (SSD) and Kennedy Krieger Institute (Kennedy) to assess messaging strategies, general versus enhanced, to increase weekly screening for SARS-CoV-2. Testing was offered to staff and students from November 23, 2020 to May 26, 2022. The primary outcomes were percentage of students and staff consented weekly and percentage of study participants who had a test performed weekly. Generalized estimating equation models were utilized to evaluate the primary outcomes. RESULTS Increases in enrollment and testing occurred during study start up, the beginning of school years, and following surges in both systems. No statistical difference was observed in the primary outcomes between schools receiving standard versus enhanced messaging. IMPLICATIONS FOR SCHOOL HEALTH POLICY, PRACTICE, AND EQUITY Frequent and consistent communication is vital for families and staff. Weekly screening testing within schools is possible and highlighted the importance of utilizing equitable protocols to provide important testing to students with IDD. CONCLUSION Enhanced messaging strategies did not increase the number of participants enrolled or the percentage of enrolled participants being tested on a weekly basis.
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Affiliation(s)
- Tyler J Walsh
- Department of Pediatrics, Division of Pediatric Infectious Diseases, Washington University in St. Louis, 660 S Euclid Ave, St. Louis, 63110, MO, USA
| | - Luther G Kalb
- Kennedy Krieger Institute, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, 3901 Greenspring Ave, Baltimore, 21211, MD, USA
| | - Michael Gemmell
- Department of Pediatrics, Division of Pediatric Infectious Diseases, Washington University in St. Louis, 660 S Euclid Ave, St. Louis, 63110, MO, USA
| | - Jingxia Liu
- Department of Surgery, Washington University in St. Louis, 4921 Parkview Pl, St. Louis, 63110, MO, USA
| | - Charlene A Caburnay
- Brown School of Social Work, Washington University in St. Louis, 6350 Forsyth Blvd, St. Louis, 63105, MO, USA
| | - Christina A Gurnett
- Department of Neurology, Division of Pediatric and Developmental Neurology, Washington University in St. Louis, 660 S Euclid Ave, St. Louis, 63110, MO, USA
| | - Jason G Newland
- Department of Pediatrics, Division of Pediatric Infectious Diseases, Washington University in St. Louis, 660 S Euclid Ave, St. Louis, 63110, MO, USA
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3
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Plattner AS, Lockowitz CR, Dumm R, Banerjee R, Newland JG, Same RG. Practice Versus Potential: The Impact of the BioFire FilmArray Pneumonia Panel on Antibiotic Use in Children. J Pediatric Infect Dis Soc 2024; 13:196-202. [PMID: 38332718 PMCID: PMC10949437 DOI: 10.1093/jpids/piae014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 02/06/2024] [Indexed: 02/10/2024]
Abstract
BACKGROUND The BioFire FilmArray Pneumonia Panel (BFPP), a multiplex PCR panel for the diagnosis of lower respiratory tract infections, has been proposed as a tool for antimicrobial stewardship. Few studies evaluate real-world implementation of the BFPP and no studies focus exclusively on children. Our institution implemented BFPP testing without restrictions. METHODS We conducted a retrospective cohort study in children hospitalized at St. Louis Children's Hospital to (1) characterize the use of the BFPP in pediatric patients and (2) assess how results impacted antibiotic use. We included all BFPP tests obtained during the first year after the introduction of the test, September 2021 through August 2022. The primary outcome was change in antibiotic therapy within 24 hours of results, which was compared to the potential change in antibiotic therapy determined by two infectious diseases clinicians. RESULTS One hundred sixty-nine tests from 126 patients were included. Nine patients were immunocompromised and 19 had chronic tracheostomy. The majority of tests were sent from tracheal aspirate specimens (92%) and from patients in an intensive care unit (94%). Only 51% of tests were obtained due to respiratory failure or suspected pneumonia. For 80% of test results, there was potential to change antibiotics, but change occurred in only 46% of tests in practice. Antibiotic escalation was more common (26%) than de-escalation (15%) or discontinuation (4.1%). CONCLUSIONS In a cohort of pediatric patients tested with the BFPP, the majority of tests were sent from tracheal aspirates and less than half of tests were associated with a change in antibiotics.
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Affiliation(s)
- Alexander S Plattner
- Department of Pediatrics, Division of Infectious Diseases, Washington University in St. Louis School of Medicine, St. Louis, MO, USA
- Institute for Informatics, Data Science, and Biostatistics (IDB), Washington University in St. Louis School of Medicine, St. Louis, MO, USA
| | - Christine R Lockowitz
- Department of Pharmacy, St. Louis Children’s Hospital, Washington University in St. Louis School of Medicine, St. Louis, MO, USA
| | - Rebekah Dumm
- Department of Pathology and Immunology, Division of Microbiology, Washington University in St. Louis School of Medicine, St. Louis, MO, USA
| | - Ritu Banerjee
- Department of Pediatrics, Division of Infectious Diseases, Vanderbilt University, Nashville, TN, USA
| | - Jason G Newland
- Department of Pediatrics, Division of Infectious Diseases, Washington University in St. Louis School of Medicine, St. Louis, MO, USA
| | - Rebecca G Same
- Department of Pediatrics, Division of Infectious Diseases, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
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4
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Vestal LE, Schmidt AM, Dougherty NL, Rolf L, Newland JG, Mueller NB. COVID-19 Related Facilitators and Barriers to In-Person Learning for Children With Intellectual and Development Disabilities: A Follow-Up. J Sch Health 2024; 94:105-116. [PMID: 37853427 DOI: 10.1111/josh.13404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 09/21/2023] [Accepted: 09/23/2023] [Indexed: 10/20/2023]
Abstract
BACKGROUND Students with intellectual and developmental disabilities (IDD) and the staff who support them were largely in-person during the 2021-2022 school year, despite their continued vulnerability to infection with SARS-CoV-2. This qualitative study aimed to understand continued perceptions of weekly SARS-CoV-2 screening testing of students and staff amidst increased availability of vaccinations. METHODS Twenty-three focus groups were held with school staff and parents of children with IDD to examine the perceptions of COVID-19 during the 2021-2022 school year. Responses were analyzed using a directed thematic content analysis approach. RESULTS Four principal themes were identified: strengths and opportunities of school- and district-level mitigation policies; experience at school with the return to in-person learning; facilitators and barriers to participation in SARS-CoV-2 screening testing; and perceptions of SARS-CoV-2 testing in light of vaccine availability. IMPLICATIONS FOR SCHOOL HEALTH POLICY, PRACTICE, AND EQUITY Despite the increased availability of vaccines, school staff and families agreed that saliva-based SARS-CoV-2 screening testing helped increase comfort with in-person learning as long as the virus was present in the community. CONCLUSION To keep children with IDD in school during the pandemic, families found SARS-CoV-2 screening testing important. Clearly communicating school policies and mitigation strategies facilitated peace of mind and confidence in the school district.
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Affiliation(s)
- Liz E Vestal
- Evaluation Center, Brown School at Washington University in St. Louis, Campus Box 1196, One Brookings Drive, St. Louis, MO, 63130
| | - Ann M Schmidt
- Evaluation Center, Brown School at Washington University in St. Louis, Campus Box 1196, One Brookings Drive, St. Louis, MO, 63130
| | - Nikole L Dougherty
- Evaluation Center, Brown School at Washington University in St. Louis, MSC 1196-0251-46, One Brookings Drive, St. Louis, MO, 63130
| | - Liz Rolf
- Evaluation Center, Brown School at Washington University in St. Louis, MSC 1196-0251-46, One Brookings Drive, St. Louis, MO, 63130
| | - Jason G Newland
- Pediatric Infectious Diseases, Washington University School of Medicine, 620 South Taylor, Northwest Tower 10113, St. Louis, MO, 63130
| | - Nancy B Mueller
- Institutional Effectiveness, Office of the Provost, Washington University in St. Louis, Campus Box 1196-0251-46, One Brookings Drive, One Brookings Drive, St. Louis, MO, 63130
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Nelson GE, Narayanan N, Onguti S, Stanley K, Newland JG, Doernberg SB. Principles and Practice of Antimicrobial Stewardship Program Resource Allocation. Infect Dis Clin North Am 2023; 37:683-714. [PMID: 37735012 DOI: 10.1016/j.idc.2023.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/23/2023]
Abstract
Antimicrobial Stewardship Programs (ASP) improve individual patient outcomes and clinical care processes while reducing antimicrobial-associated adverse events, optimizing operational priorities, and providing institutional cost savings. ASP composition, resources required, and priority focuses are influenced by myriad factors. Despite robust evidence and broad national support, individual ASPs still face challenges in obtaining appropriate resources. Though understanding the current landscape of ASP resource allocation, factors influencing staffing needs, and strategies required to obtain desired resources is important, acceptance of recommended staffing levels and appropriate ASP resource allocation are much needed to facilitate ASP sustainability and growth across the complex and diverse health care continuum.
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Affiliation(s)
- George E Nelson
- Department of Medicine, Division of Infectious Diseases, Vanderbilt University Medical Center, 1161 21st Avenue South, A2200 MCN, Nashville, TN 37232-2582, USA.
| | - Navaneeth Narayanan
- Department of Pharmacy Practice and Administration, Rutgers University Ernest Mario School of Pharmacy, 160 Frelinghuysen Road, Piscataway, NJ 08854, USA
| | - Sharon Onguti
- Department of Medicine, Division of Infectious Diseases, Vanderbilt University Medical Center, 1161 21st Avenue South, A2200 MCN, Nashville, TN 37232-2582, USA
| | - Kim Stanley
- Department of Quality and Patient Safety, Division of Hospital Epidemiology and Infection Prevention, University of San Francisco, California, San Francisco, CA, USA
| | - Jason G Newland
- Department of Pediatrics, Division of Infectious Diseases, Washington University School of Medicine, 660 South Euclid Avenue, St Louis, MO 63110, USA
| | - Sarah B Doernberg
- Department of Medicine, Division of Infectious Diseases, University of San Francisco, California, 513 Parnassus Avenue, Box 0654, San Francisco, CA 94143, USA
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Marschall J, Snyders RE, Sax H, Newland JG, Guimarães T, Kwon JH. Erratum: Perspectives on research needs in healthcare epidemiology, infection prevention, and antimicrobial stewardship: what's on the horizon-Part I - CORRIGENDUM. Antimicrob Steward Healthc Epidemiol 2023; 3:e218. [PMID: 38156207 PMCID: PMC10753485 DOI: 10.1017/ash.2023.513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2023]
Abstract
[This corrects the article DOI: 10.1017/ash.2023.473.].
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Affiliation(s)
- Jonas Marschall
- Division of Infectious Diseases, Washington University School of Medicine, St. Louis, MO, USA
- BJC Healthcare, St. Louis, MO, USA
| | | | - Hugo Sax
- Bern University Hospital, University of Bern, Bern, Switzerland
| | - Jason G Newland
- Division of Infectious Diseases, Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, USA
| | - Thais Guimarães
- Infection Control Department, Hospital das Clínicas, University of São Paulo, São Paulo, Brazil
| | - Jennie H Kwon
- Division of Infectious Diseases, Washington University School of Medicine, St. Louis, MO, USA
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Marschall J, Snyders RE, Sax H, Newland JG, Guimarães T, Kwon JH. Perspectives on research needs in healthcare epidemiology, infection prevention, and antimicrobial stewardship: what's on the horizon-Part II. Antimicrob Steward Healthc Epidemiol 2023; 3:e212. [PMID: 38156221 PMCID: PMC10753481 DOI: 10.1017/ash.2023.474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Indexed: 12/30/2023]
Abstract
In this overview, we articulate research needs and opportunities in the field of infection prevention that have been identified from insights gained during operative infection prevention work, our own research in healthcare epidemiology, and from reviewing the literature. The 10 areas of research need are: 1) Transmissions and interruptions, 2) personal protective equipment and other safety issues in occupational health, 3) climate change and other crises, 4) device, diagnostic, and antimicrobial stewardship, 5) implementation and deimplementation, 6) healthcare outside the acute care hospital, 7) low- and middle-income countries, 8) networking with the "neighbors," 9) novel research methodologies, and 10) the future state of surveillance. An introduction and chapters 1-5 are presented in part I of the article and chapters 6-10 and the discussion in part II. There are many barriers to advancing the field, such as finding and motivating the future IP workforce including professionals interested in conducting research, a constant confrontation with challenges and crises, the difficulty of performing studies in a complex environment, the relative lack of adequate incentives and funding streams, and how to disseminate and validate the often very local quality improvement projects. Addressing research gaps now (i.e., in the post-pandemic phase) will make healthcare systems more resilient when facing future crises.
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Affiliation(s)
- Jonas Marschall
- Division of Infectious Diseases, Washington University School of Medicine, St. Louis, MO, USA
- BJC Healthcare, St. Louis, MO, USA
| | | | - Hugo Sax
- Bern University Hospital, University of Bern, Bern, Switzerland
| | - Jason G. Newland
- Division of Infectious Diseases, Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, USA
| | - Thais Guimarães
- Infection Control Department, Hospital das Clínicas, University of São Paulo, São Paulo, Brazil
| | - Jennie H. Kwon
- Division of Infectious Diseases, Washington University School of Medicine, St. Louis, MO, USA
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8
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Marschall J, Snyders RE, Sax H, Newland JG, Guimarães T, Kwon JH. Perspectives on research needs in healthcare epidemiology and antimicrobial stewardship: what's on the horizon - Part I. Antimicrob Steward Healthc Epidemiol 2023; 3:e199. [PMID: 38028931 PMCID: PMC10654935 DOI: 10.1017/ash.2023.473] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 06/07/2023] [Indexed: 12/01/2023]
Abstract
In this overview, we articulate research needs and opportunities in the field of infection prevention that have been identified from insights gained during operative infection prevention work, our own research in healthcare epidemiology, and from reviewing the literature. The 10 areas of research need are: 1) transmissions and interruptions, 2) personal protective equipment and other safety issues in occupational health, 3) climate change and other crises, 4) device, diagnostic, and antimicrobial stewardship, 5) implementation and de-implementation, 6) health care outside the acute care hospital, 7) low- and middle-income countries, 8) networking with the "neighbors", 9) novel research methodologies, and 10) the future state of surveillance. An introduction and chapters 1-5 are presented in part I of the article, and chapters 6-10 and the discussion in part II. There are many barriers to advancing the field, such as finding and motivating the future IP workforce including professionals interested in conducting research, a constant confrontation with challenges and crises, the difficulty of performing studies in a complex environment, the relative lack of adequate incentives and funding streams, and how to disseminate and validate the often very local quality improvement projects. Addressing research gaps now (i.e., in the postpandemic phase) will make healthcare systems more resilient when facing future crises.
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Affiliation(s)
- Jonas Marschall
- Division of Infectious Diseases, Washington University School of Medicine, St. Louis, MO, USA
- BJC Healthcare, St. Louis, MO, USA
| | | | - Hugo Sax
- Bern University Hospital, University of Bern, Bern, Switzerland
| | - Jason G. Newland
- Division of Infectious Diseases, Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, USA
| | - Thais Guimarães
- Infection Control Department, Hospital das Clínicas, University of São Paulo, São Paulo, Brazil
| | - Jennie H. Kwon
- Division of Infectious Diseases, Washington University School of Medicine, St. Louis, MO, USA
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Diggs DT, Tribble AC, Same RG, Newland JG, Lee BR. Appropriateness of antibiotic prescribing varies by clinical services at United States children's hospitals. Infect Control Hosp Epidemiol 2023; 44:1711-1717. [PMID: 37905378 PMCID: PMC10665883 DOI: 10.1017/ice.2023.56] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 02/23/2023] [Accepted: 02/24/2023] [Indexed: 11/02/2023]
Abstract
OBJECTIVE To describe patterns of inappropriate antibiotic prescribing at US children's hospitals and how these patterns vary by clinical service. DESIGN Serial, cross-sectional study using quarterly surveys. SETTING Surveys were completed in quarter 1 2019-quarter 3 2020 across 28 children's hospitals in the United States. PARTICIPANTS Patients at children's hospitals with ≥1 antibiotic order at 8:00 a.m. on institution-selected quarterly survey days. METHODS Antimicrobial stewardship physicians and pharmacists collected data on antibiotic orders and evaluated appropriateness of prescribing. The primary outcome was percentage of inappropriate antibiotics, stratified by clinical service and antibiotic class. Secondary outcomes included reasons for inappropriate use and association of infectious diseases (ID) consultation with appropriateness. RESULTS Of 13,344 orders, 1,847 (13.8%) were inappropriate; 17.5% of patients receiving antibiotics had ≥1 inappropriate order. Pediatric intensive care units (PICU) and hospitalists contributed the most inappropriate orders (n = 384 and n = 314, respectively). Surgical subspecialists had the highest percentage of inappropriate orders (22.5%), and 56.8% of these were for prolonged or unnecessary surgical prophylaxis. ID consultation in the previous 7 days was associated with fewer inappropriate orders (15% vs 10%; P < .001); this association was most pronounced for hospitalist, PICU, and surgical and medical subspecialty services. CONCLUSIONS Inappropriate antibiotic use for hospitalized children persists and varies by clinical service. Across 28 children's hospitals, PICUs and hospitalists contributed the most inappropriate antibiotic orders, and surgical subspecialists' orders were most often judged inappropriate. Understanding service-specific prescribing patterns will enable antimicrobial stewardship programs to better design interventions to optimize antibiotic use.
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Affiliation(s)
- Devin T. Diggs
- College of Science, University of Notre Dame, Notre Dame, Indiana
| | - Alison C. Tribble
- Division of Pediatric Infectious Diseases, Department of Pediatrics, University of Michigan, Ann Arbor, Michigan
| | - Rebecca G. Same
- Division of Infectious Diseases, Department of Pediatrics, Children’s Hospital of Philadelphia
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jason G. Newland
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Washington University in St. Louis, St. Louis, Missouri
| | - Brian R. Lee
- Division of Health Services and Outcomes Research, Department of Pediatrics, Children’s Mercy Kansas City, Kansas City, Missouri
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Evans NJ, Arakkal AT, Cavanaugh JE, Newland JG, Polgreen PM, Miller AC. The incidence, duration, risk factors, and age-based variation of missed opportunities to diagnose pertussis: A population-based cohort study. Infect Control Hosp Epidemiol 2023; 44:1629-1636. [PMID: 36919206 PMCID: PMC10587384 DOI: 10.1017/ice.2023.31] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 01/27/2023] [Accepted: 02/02/2023] [Indexed: 03/16/2023]
Abstract
OBJECTIVE To estimate the incidence, duration and risk factors for diagnostic delays associated with pertussis. DESIGN We used longitudinal retrospective insurance claims from the Marketscan Commercial Claims and Encounters, Medicare Supplemental (2001-2020), and Multi-State Medicaid (2014-2018) databases. SETTING Inpatient, emergency department, and outpatient visits. PATIENTS The study included patients diagnosed with pertussis (International Classification of Diseases [ICD] codes) and receipt of macrolide antibiotic treatment. METHODS We estimated the number of visits with pertussis-related symptoms before diagnosis beyond that expected in the absence of diagnostic delays. Using a bootstrapping approach, we estimated the number of visits representing a delay, the number of missed diagnostic opportunities per patient, and the duration of delays. Results were stratified by age groups. We also used a logistic regression model to evaluate potential factors associated with delay. RESULTS We identified 20,828 patients meeting inclusion criteria. On average, patients had almost 2 missed opportunities prior to diagnosis, and delay duration was 12 days. Across age groups, the percentage of patients experiencing a delay ranged from 29.7% to 37.6%. The duration of delays increased considerably with age from an average of 5.6 days for patients aged <2 years to 13.8 days for patients aged ≥18 years. Factors associated with increased risk of delays included emergency department visits, telehealth visits, and recent prescriptions for antibiotics not effective against pertussis. CONCLUSIONS Diagnostic delays for pertussis are frequent. More work is needed to decrease diagnostic delays, especially among adults. Earlier case identification may play an important role in the response to outbreaks by facilitating treatment, isolation, and improved contact tracing.
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Affiliation(s)
- Nicholas J. Evans
- Department of Internal Medicine, University of Iowa, Iowa City, Iowa
| | - Alan T. Arakkal
- Department of Biostatistics, University of Iowa, Iowa City, Iowa
| | | | - Jason G. Newland
- Department of Pediatrics, Washington University in St. Louis, St. Louis, Missouri
| | | | - Aaron C. Miller
- Department of Internal Medicine, University of Iowa, Iowa City, Iowa
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11
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Gemmell M, Walsh T, Sherby M, Imbeah A, Bono K, Baldenweck M, Gurnett C, Newland JG. Clusters of SARS-CoV-2 Infection Across Six Schools for Students with Intellectual and Developmental Disabilities. Infect Dis Ther 2023; 12:2289-2294. [PMID: 37704799 PMCID: PMC10581949 DOI: 10.1007/s40121-023-00855-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 08/04/2023] [Indexed: 09/15/2023] Open
Abstract
INTRODUCTION Individuals with intellectual and developmental disabilities are at increased risk for adverse outcomes from coronavirus disease 2019. Clusters of COVID-19 infections can be used to track SARS-CoV-2 transmission. This is particularly important in environments frequently used for individuals with intellectual and developmental disabilities, such as schools. The objective of this study was to compare the number of clusters of student and staff cases identified during three distinct periods (pre-Delta, Delta, and Omicron) of the COVID-19 pandemic. METHODS Weekly COVID-19 testing occurred from November 23, 2020 to May 27, 2022 during three phases of the COVID-19 pandemic: pre-Delta, Delta, and Omicron. Structured interviews were conducted with positive cases to determine if they contracted COVID-19 in the school environment, and interviews with school administrators responsible for contact tracing determined school-based clusters. RESULTS 160 cases of COVID-19 were identified and 55 cluster positives were recorded during the study period. 0 (0%) cluster positives were recorded during the pre-Delta variant wave, 3 (5%) cluster positives were recorded during the Delta variant wave, and 52 (95%) cluster positives were recorded during the Omicron variant wave. Additionally, 23 (85%) of all positives during pre-Delta, 12 (50%) of all positives during Delta, 66 (61%) of all positives during Omicron, and 36 (69%) of cluster positives during Omicron did not receive CDC-recommended dosages of the COVID-19 vaccine. CONCLUSION The Omicron variant led to an increase in cluster-based transmission, and staying up to date with vaccination guidelines was crucial in limiting transmission. CLINICAL TRIAL REGISTRATION Prior to enrollment, this study was registered at ClinicalTrials.gov on September 25, 2020 (identifier NCT04565509; titled "Supporting the Health and Well-being of Children with Intellectual and Developmental Disability During COVID-19 Pandemic").
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Affiliation(s)
- Michael Gemmell
- Division of Infectious Diseases, Department of Pediatrics, Washington University School of Medicine, 660 S Euclid Ave, St. Louis, MO, 63110, USA.
| | - Tyler Walsh
- Division of Infectious Diseases, Department of Pediatrics, Washington University School of Medicine, 660 S Euclid Ave, St. Louis, MO, 63110, USA.
| | - Michael Sherby
- Department of Neurology, Washington University School of Medicine, 660 S Euclid Ave, St. Louis, MO, 63110, USA
| | - Adwoa Imbeah
- Division of Infectious Diseases, Department of Pediatrics, Washington University School of Medicine, 660 S Euclid Ave, St. Louis, MO, 63110, USA
| | - Kelly Bono
- Division of Infectious Diseases, Department of Pediatrics, Washington University School of Medicine, 660 S Euclid Ave, St. Louis, MO, 63110, USA
| | - Megan Baldenweck
- Division of Infectious Diseases, Department of Pediatrics, Washington University School of Medicine, 660 S Euclid Ave, St. Louis, MO, 63110, USA
| | - Christina Gurnett
- Department of Neurology, Washington University School of Medicine, 660 S Euclid Ave, St. Louis, MO, 63110, USA
| | - Jason G Newland
- Division of Infectious Diseases, Department of Pediatrics, Washington University School of Medicine, 660 S Euclid Ave, St. Louis, MO, 63110, USA
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12
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Lake JG, Durkin MJ, Polgreen PM, Beekmann SE, Hersh AL, Newland JG. Pediatric infectious disease physician perceptions of antimicrobial stewardship programs. Infect Control Hosp Epidemiol 2023; 44:1155-1158. [PMID: 35938450 PMCID: PMC10369220 DOI: 10.1017/ice.2022.183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 06/23/2022] [Accepted: 06/24/2022] [Indexed: 11/07/2022]
Abstract
Pediatric antimicrobial stewardship programs (ASPs) improve antibiotic use for hospitalized children. Prescriber surveys indicate acceptance of ASPs, but data on infectious diseases (ID) physician opinions of ASPs are lacking. We conducted a survey of pediatric ID physicians, ASP and non-ASP, and their perceptions of ASP practices and outcomes.
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Affiliation(s)
- Jason G. Lake
- Division of Pediatric Infectious Diseases, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah
| | - Michael J. Durkin
- Division of Adult Infectious Diseases, Department of Internal Medicine, Washington University in St Louis, St Louis, Missouri
| | - Philip M. Polgreen
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, Iowa
- Department of Internal Medicine, University of Iowa, Iowa City, Iowa
| | - Susan E. Beekmann
- Department of Internal Medicine, University of Iowa, Iowa City, Iowa
| | - Adam L. Hersh
- Division of Pediatric Infectious Diseases, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah
| | - Jason G. Newland
- Division of Infectious Diseases, Department of Pediatrics, Washington University in St. Louis, St. Louis, Missouri
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13
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Uthappa DM, Mann TK, Goldman JL, Schuster JE, Newland JG, Anderson WB, Dozier A, Inkelas M, Foxe JJ, Gwynn L, Gurnett CA, McDaniels-Davidson C, Walsh T, Watterson T, Holden-Wiltse J, Potts JM, D’Agostino EM, Zandi K, Corbett A, Spallina S, DeMuri GP, Wu YP, Pulgaron ER, Kiene SM, Oren E, Allison-Burbank JD, Okihiro M, Lee RE, Johnson SB, Stump TK, Coller RJ, Mast DK, Haroz EE, Kemp S, Benjamin DK, Zimmerman KO. Common Data Element Collection in Underserved School Communities: Challenges and Recommendations. Pediatrics 2023; 152:e2022060352N. [PMID: 37394503 PMCID: PMC10312277 DOI: 10.1542/peds.2022-060352n] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/04/2023] [Indexed: 07/04/2023] Open
Abstract
OBJECTIVES To provide recommendations for future common data element (CDE) development and collection that increases community partnership, harmonizes data interpretation, and continues to reduce barriers of mistrust between researchers and underserved communities. METHODS We conducted a cross-sectional qualitative and quantitative evaluation of mandatory CDE collection among Rapid Acceleration of Diagnostics-Underserved Populations Return to School project teams with various priority populations and geographic locations in the United States to: (1) compare racial and ethnic representativeness of participants completing CDE questions relative to participants enrolled in project-level testing initiatives and (2) identify the amount of missing CDE data by CDE domain. Additionally, we conducted analyses stratified by aim-level variables characterizing CDE collection strategies. RESULTS There were 15 study aims reported across the 13 participating Return to School projects, of which 7 (47%) were structured so that CDEs were fully uncoupled from the testing initiative, 4 (27%) were fully coupled, and 4 (27%) were partially coupled. In 9 (60%) study aims, participant incentives were provided in the form of monetary compensation. Most project teams modified CDE questions (8/13; 62%) to fit their population. Across all 13 projects, there was minimal variation in the racial and ethnic distribution of CDE survey participants from those who participated in testing; however, fully uncoupling CDE questions from testing increased the proportion of Black and Hispanic individuals participating in both initiatives. CONCLUSIONS Collaboration with underrepresented populations from the early study design process may improve interest and participation in CDE collection efforts.
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Affiliation(s)
- Diya M. Uthappa
- Duke University School of Medicine, Doctor of Medicine Program
| | - Tara K. Mann
- Duke Clinical Research Institute, Duke University School of Medicine
| | - Jennifer L. Goldman
- Division of Pediatric Infectious Diseases, Children’s Mercy Kansas City, University of Missouri-Kansas City, Kansas City, Missouri
| | - Jennifer E. Schuster
- Division of Pediatric Infectious Diseases, Children’s Mercy Kansas City, University of Missouri-Kansas City, Kansas City, Missouri
| | | | | | | | - Moira Inkelas
- Department of Health Policy and Management, UCLA Fielding School of Public Health UCLA Clinical and Translational Science Institute, Los Angeles, California
| | - John J. Foxe
- The Del Monte Institute for Neuroscience and The Department of Neuroscience, University of Rochester School of Medicine, Rochester, New York
| | - Lisa Gwynn
- Department of Pediatrics, University of Miami Miller School of Medicine, Miami, Florida USA
| | - Christina A. Gurnett
- Department of Neurology, Washington University in St. Louis, St. Louis, Missouri
| | | | - Tyler Walsh
- Department of Pediatrics, Division of Infectious Diseases
| | | | | | | | | | | | | | | | - Gregory P. DeMuri
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Yelena P. Wu
- Department of Dermatology
- Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah
| | | | - Susan M. Kiene
- School of Public Health, San Diego State University, San Diego, California
| | - Eyal Oren
- School of Public Health, San Diego State University, San Diego, California
| | | | - May Okihiro
- Department of Pediatrics, John A. Burns School of Medicine, University of Hawaii Manoa, Honolulu, Hawaii
| | - Rebecca E. Lee
- Edson College of Nursing & Health Innovation, Center for Health Promotion and Disease Prevention, Senior Global Futures Scientist, Julie Ann Wrigley Global Futures Laboratory, Arizona State University, Phoenix, Arizona
| | - Sara B. Johnson
- Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Tammy K. Stump
- Department of Dermatology
- Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah
| | - Ryan J. Coller
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | | | - Emily E. Haroz
- Department of International Health & Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Steven Kemp
- Duke Clinical Research Institute, Duke University School of Medicine
| | - Daniel K. Benjamin
- Duke Clinical Research Institute, Duke University School of Medicine
- Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina
- The ABC Science Collaborative, Durham, North Carolina
| | - Kanecia O. Zimmerman
- Duke Clinical Research Institute, Duke University School of Medicine
- Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina
- The ABC Science Collaborative, Durham, North Carolina
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14
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Schuster JE, Erickson TR, Goldman JL, Benjamin DK, Brookhart MA, Dewhurst S, Fist A, Foxe J, Godambe M, Gwynn L, Kiene SM, Keener Mast D, McDaniels-Davidson C, Newland JG, Oren E, Selvarangan R, Shinde N, Walsh T, Watterson T, Zand M, Zimmerman KO, Kalu IC. Utilization and Impact of Symptomatic and Exposure SARS-CoV-2 Testing in K-12 Schools. Pediatrics 2023; 152:e2022060352I. [PMID: 37394504 PMCID: PMC10312273 DOI: 10.1542/peds.2022-060352i] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/04/2023] [Indexed: 07/04/2023] Open
Abstract
OBJECTIVES The Centers for Disease Control and Prevention recommend that schools can offer severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) diagnostic (on-demand) testing for students and staff with coronavirus disease 2019 symptoms or exposures. Data related to the uptake, implementation, and effect of school-associated on-demand diagnostic testing have not been described. METHODS The Rapid Acceleration of Diagnostics Underserved Populations Return to School program provided resources to researchers to implement on-demand SARS-CoV-2 testing in schools. This study describes the strategies used and uptake among the different testing programs. Risk of positivity was compared for symptomatic and exposure testing during the δ and ο variant periods. We estimated the number of school absence days saved with school-based diagnostic testing. RESULTS Of the 16 eligible programs, 7 provided school-based on-demand testing. The number of persons that participated in these testing programs is 8281, with 4134 (49.9%) receiving >1 test during the school year. Risk of positivity was higher for symptomatic testing compared with exposure testing and higher during the ο variant predominant period compared with the δ variant predominant period. Overall, access to testing saved an estimated 13 806 absent school days. CONCLUSIONS School-based on-demand SARS-CoV-2 testing was used throughout the school year, and nearly half the participants accessed testing on more than 1 occasion. Future studies should work to understand participant preferences around school-based testing and how these strategies can be used both during and outside of pandemics.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Maya Godambe
- Division of Pediatric Infectious Diseases, Washington University in St Louis, St Louis, Missouri
| | - Lisa Gwynn
- Department of Pediatrics, Miller School of Medicine, University of Miami, Miami, Florida
| | - Susan M. Kiene
- Division of Epidemiology and Biostatistics, School of Public Health, San Diego State University, San Diego, California
| | | | - Corinne McDaniels-Davidson
- Division of Epidemiology and Biostatistics, School of Public Health, San Diego State University, San Diego, California
| | - Jason G. Newland
- Division of Pediatric Infectious Diseases, Washington University in St Louis, St Louis, Missouri
| | - Eyal Oren
- Division of Epidemiology and Biostatistics, School of Public Health, San Diego State University, San Diego, California
| | - Rangaraj Selvarangan
- Pathology and Laboratory Medicine, Children’s Mercy Kansas City, University of Missouri-Kansas City, Kansas City, Missouri
| | - Nidhi Shinde
- Division of Pediatric Infectious Diseases, Washington University in St Louis, St Louis, Missouri
| | - Tyler Walsh
- Division of Pediatric Infectious Diseases, Washington University in St Louis, St Louis, Missouri
| | - Treymayne Watterson
- Division of Pediatric Infectious Diseases, Washington University in St Louis, St Louis, Missouri
| | - Martin Zand
- Division of Nephrology, School of Medicine and Dentistry, University of Rochester, Rochester, New York
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Gemmell M, Sherby MR, Walsh TJ, Kalb LG, Johnson SB, Coller RJ, DeMuri GP, Nuthals E, McBride J, Newland JG, Gurnett CA. Recommendations for SARS-CoV-2 Testing in Children With Disabilities and Medical Complexity. Pediatrics 2023; 152:e2022060352G. [PMID: 37394506 PMCID: PMC10312279 DOI: 10.1542/peds.2022-060352g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/04/2023] [Indexed: 07/04/2023] Open
Abstract
Schools provide important services that cannot be provided virtually to children with medical complexity and children with intellectual and developmental disabilities, yet these children are among the most at risk from coronavirus disease 2019 (COVID-19). To keep schools open for children with medical complexity and/or intellectual and developmental disabilities during the COVID-19 pandemic, we implemented severe acute respiratory syndrome coronavirus 2 testing at 3 sites across the United States. We evaluated testing strategies for staff and students at each site, including specimen source (nasopharyngeal or saliva), test type (polymerase chain reaction or rapid antigen), and frequency and type (screening versus exposure/symptomatic) of testing provided. Among the greatest barriers to severe acute respiratory syndrome coronavirus 2 testing in these schools was the engagement of caregivers and challenges navigating legal guardianship for consenting adult students. Additionally, variability in testing strategies nationally and in the community, as well as surges in viral transmission across the United States during the course of the pandemic, led to testing hesitancy and variable participation rates. Essential to the successful implementation of testing programs is building a trusted relationship with school administrators and guardians. Leveraging our experiences with COVID-19 and forming lasting school partnerships can help keep schools for vulnerable children safe in future pandemics.
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Affiliation(s)
| | | | | | - Luther G. Kalb
- Center for Autism and Related Disorders, Kennedy Krieger Institute, Baltimore, Maryland
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Sara B. Johnson
- Division of General Pediatrics, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Ryan J. Coller
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Gregory P. DeMuri
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Erin Nuthals
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Joseph McBride
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
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16
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Anandalwar SP, Milliren C, Graham DA, Newland JG, He K, Hills-Dunlap JL, Kashtan MA, Rangel SJ. Quantifying Procedure-level Prophylaxis Misutilization in Pediatric Surgery: Implications for the Prioritization of Antimicrobial Stewardship Efforts. Ann Surg 2023; 278:e158-e164. [PMID: 35797034 DOI: 10.1097/sla.0000000000005480] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To quantify procedure-level inappropriate antimicrobial prophylaxis utilization as a strategy to identify high-priority targets for stewardship efforts in pediatric surgery. BACKGROUND Little data exist to guide the prioritization of antibiotic stewardship efforts as they relate to prophylaxis utilization in pediatric surgery. METHODS This was a retrospective cohort analysis of children undergoing elective surgical procedures at 52 children's hospitals from October 2015 to December 2019 using the Pediatric Health Information System database. Procedure-level compliance with consensus guidelines for prophylaxis utilization was assessed for indication, antimicrobial spectrum, and duration. The relative contribution of each procedure to the overall burden of noncompliant cases was calculated to establish a prioritization framework for stewardship efforts. RESULTS A total of 56,845 cases were included with an overall inappropriate utilization rate of 56%. The most common reason for noncompliance was unindicated utilization (43%), followed by prolonged duration (32%) and use of excessively broad-spectrum agents (25%). Procedures with the greatest relative contribution to noncompliant cases included cholecystectomy and repair of inguinal and umbilical hernias for unindicated utilization (63.2% of all cases); small bowel resections, gastrostomy, and colorectal procedures for use of excessively broad-spectrum agents (70.1%) and pectus excavatum repair and procedures involving the small and large bowel for prolonged duration (57.6%). More than half of all noncompliant cases were associated with 5 procedures (cholecystectomy, small bowel procedures, inguinal hernia repair, gastrostomy, and pectus excavatum). CONCLUSIONS Cholecystectomy, inguinal hernia repair, and procedures involving the small and large bowel should be considered high-priority targets for antimicrobial stewardship efforts in pediatric surgery.
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Affiliation(s)
- Seema P Anandalwar
- Department of Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA
| | - Carly Milliren
- Center for Applied Pediatric Quality Analytics, Boston Children's Hospital, Boston, MA
| | - Dionne A Graham
- Center for Applied Pediatric Quality Analytics, Boston Children's Hospital, Boston, MA
| | - Jason G Newland
- Department of Pediatrics, Washington University in St. Louis School of Medicine, St. Louis, MO
| | - Katherine He
- Department of Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA
| | - Jonathan L Hills-Dunlap
- Department of Pediatric Surgery, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, CO
| | - Mark A Kashtan
- Department of Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA
| | - Shawn J Rangel
- Department of Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA
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17
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Whittington KJ, Malone SM, Hogan PG, Ahmed F, Flowers J, Milburn G, Morelli JJ, Newland JG, Fritz SA. Staphylococcus aureus Bacteremia in Pediatric Patients: Uncovering a Rural Health Challenge. Open Forum Infect Dis 2023; 10:ofad296. [PMID: 37469617 PMCID: PMC10352649 DOI: 10.1093/ofid/ofad296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 05/30/2023] [Indexed: 07/21/2023] Open
Abstract
Background Staphylococcus aureus bacteremia poses significant risk for morbidity and mortality. This may be exacerbated in rural populations facing unique health challenges. Methods To investigate factors influencing S. aureus bacteremia outcomes, we conducted a retrospective cohort study of children admitted to St. Louis Children's Hospital (SLCH) from 2011 to 2019. Exposures included rurality (defined by the Rural-Urban Continuum Code), Area Deprivation Index, and outside hospital (OSH) admission before SLCH admission. The primary outcome was treatment failure, a composite of 90-day all-cause mortality and hospital readmission. Results Of 251 patients, 69 (27%) were from rural areas; 28 (11%) were initially admitted to an OSH. Treatment failure occurred in 39 (16%) patients. Patients from rural areas were more likely to be infected with methicillin-resistant S. aureus (45%) vs urban children (29%; P = .02). Children initially admitted to an OSH, vs those presenting directly to SLCH, were more likely to require intensive care unit-level (ICU) care (57% vs 29%; P = .002), have an endovascular source of infection (32% vs 12%; P = .004), have a longer duration of illness before hospital presentation (4.1 vs 3.0 days; P = .04), and have delayed initiation of targeted antibiotic therapy (3.9 vs 2.6 days; P = .01). Multivariable analysis revealed rural residence (adjusted odds ratio [aOR], 2.3; 95% CI, 1.1-5.0), comorbidities (aOR, 2.9; 95% CI, 1.3-6.2), and ICU admission (aOR, 3.9; 95% CI, 1.9-8.3) as predictors of treatment failure. Conclusions Children from rural areas face barriers to specialized health care. These challenges may contribute to severe illness and worse outcomes among children with S. aureus bacteremia.
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Affiliation(s)
- Kyle J Whittington
- Correspondence: Stephanie A. Fritz, MD, MSCI, 660 S. Euclid Avenue, MSC 8116-43-10, St Louis, MO 63110-9872 (); or Kyle Whittington, MD, 660 S. Euclid Avenue, MSC 8116-43-10, St Louis, MO 63110-9872 ()
| | - Sara M Malone
- Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri, USA
- Department of Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Patrick G Hogan
- Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Faria Ahmed
- Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri, USA
| | - JessieAnn Flowers
- Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Grace Milburn
- Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri, USA
| | - John J Morelli
- Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Jason G Newland
- Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Stephanie A Fritz
- Correspondence: Stephanie A. Fritz, MD, MSCI, 660 S. Euclid Avenue, MSC 8116-43-10, St Louis, MO 63110-9872 (); or Kyle Whittington, MD, 660 S. Euclid Avenue, MSC 8116-43-10, St Louis, MO 63110-9872 ()
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18
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Goldman JL, Kalu IC, Schuster JE, Erickson T, Mast DK, Zimmerman K, Benjamin DK, Kalb LG, Gurnett C, Newland JG, Sherby M, Godambe M, Shinde N, Watterson T, Walsh T, Foxe J, Zand M, Dewhurst S, Coller R, DeMuri GP, Archuleta S, Ko LK, Inkelas M, Manuel V, Lee R, Oh H, Murugan V, Kramer J, Okihiro M, Gwynn L, Pulgaron E, McCulloh R, Broadhurst J, McDaniels-Davidson C, Kiene S, Oren E, Wu Y, Wetter DW, Stump T, Brookhart MA, Fist A, Haroz E. Building School-Academic Partnerships to Implement COVID-19 Testing in Underserved Populations. Pediatrics 2023; 152:e2022060352C. [PMID: 37394512 PMCID: PMC10312280 DOI: 10.1542/peds.2022-060352c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/04/2023] [Indexed: 07/04/2023] Open
Abstract
OBJECTIVE In April 2021, the US government made substantial investments in students' safe return to school by providing resources for school-based coronavirus disease 2019 (COVID-19) mitigation strategies, including COVID-19 diagnostic testing. However, testing uptake and access among vulnerable children and children with medical complexities remained unclear. METHODS The Rapid Acceleration of Diagnostics Underserved Populations program was established by the National Institutes of Health to implement and evaluate COVID-19 testing programs in underserved populations. Researchers partnered with schools to implement COVID-19 testing programs. The authors of this study evaluated COVID-19 testing program implementation and enrollment and sought to determine key implementation strategies. A modified Nominal Group Technique was used to survey program leads to identify and rank testing strategies to provide a consensus of high-priority strategies for infectious disease testing in schools for vulnerable children and children with medical complexities. RESULTS Among the 11 programs responding to the survey, 4 (36%) included prekindergarten and early care education, 8 (73%) worked with socioeconomically disadvantaged populations, and 4 focused on children with developmental disabilities. A total of 81 916 COVID-19 tests were performed. "Adapting testing strategies to meet the needs, preferences, and changing guidelines," "holding regular meetings with school leadership and staff," and "assessing and responding to community needs" were identified as key implementation strategies by program leads. CONCLUSIONS School-academic partnerships helped provide COVID-19 testing in vulnerable children and children with medical complexities using approaches that met the needs of these populations. Additional work is needed to develop best practices for in-school infectious disease testing in all children.
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Affiliation(s)
- Jennifer L Goldman
- Division of Pediatric Infectious Diseases, Children's Mercy Kansas City, Kansas City, Missouri
- Department of Pediatrics, University of Missouri-Kansas City, Kansas City, Missouri
| | - Ibukunoluwa C Kalu
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
- Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina
| | - Jennifer E Schuster
- Division of Pediatric Infectious Diseases, Children's Mercy Kansas City, Kansas City, Missouri
- Department of Pediatrics, University of Missouri-Kansas City, Kansas City, Missouri
| | - Tyler Erickson
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
| | | | - Kanecia Zimmerman
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
- Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina
| | - Daniel K Benjamin
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
- Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina
| | - Luther G Kalb
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Department of Neuroscience, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Christina Gurnett
- Department of Pediatrics, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin
| | - Jason G Newland
- Department of Pediatrics, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin
| | - Michael Sherby
- Department of Pediatrics, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin
| | - Maya Godambe
- Department of Pediatrics, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin
| | - Nidhi Shinde
- Department of Pediatrics, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin
| | - Treymayne Watterson
- Department of Pediatrics, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin
| | - Tyler Walsh
- Department of Pediatrics, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin
| | - John Foxe
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 31 Baltimore, Maryland
| | - Martin Zand
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 31 Baltimore, Maryland
| | - Stephen Dewhurst
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 31 Baltimore, Maryland
| | - Ryan Coller
- Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, Washington
| | - Gregory P DeMuri
- Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, Washington
| | - Shannon Archuleta
- Department of Pediatrics, Washington University in St Louis, St Louis, Missouri
| | - Linda K Ko
- Fred Hutchinson Cancer Research Center, Seattle, Washington
- UCLA Clinical and Translational Science Institute, Los Angeles, California
| | - Moira Inkelas
- Center for Health Promotion and Disease Prevention, Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, Arizona
| | - Vladimir Manuel
- Center for Health Promotion and Disease Prevention, Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, Arizona
| | | | - Hyunsung Oh
- Center for Personalized Diagnostics, ASU Biodesign Clinical Testing Laboratory, Biodesign Institute, Arizona State University, Tempe, Arizona
| | - Vel Murugan
- Division of Primary, Complex, and Adolescent Medicine, Phoenix Children's Hospital, Phoenix, Arizona
| | | | - May Okihiro
- Department of Pediatrics, University of Miami Miller School of Medicine, Miami, Florida
| | - Lisa Gwynn
- University of Nebraska Medical Center, Omaha, Nebraska
| | | | - Russell McCulloh
- Division of Epidemiology and Biostatistics, San Diego State University School of Public Health, San Diego, California
| | - Jana Broadhurst
- Division of Epidemiology and Biostatistics, San Diego State University School of Public Health, San Diego, California
| | | | - Susan Kiene
- Department of Dermatology, University of Utah, Salt Lake City, Utah
| | - Eyal Oren
- Department of Dermatology, University of Utah, Salt Lake City, Utah
| | - Yelena Wu
- Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah
- Department of Population Health Sciences, University of Utah, Salt Lake City, Utah
| | - David W Wetter
- Department of Population Health Sciences, University of Utah, Salt Lake City, Utah
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina
| | - Tammy Stump
- Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah
| | | | - Alex Fist
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
- Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina
| | - Emily Haroz
- Johns Hopkins Center for Indigenous Health, Baltimore, Maryland
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19
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Smith GD, Thomas SL, Orscheln RC, Reyes SM, Reyes SA, Rosen DA, Terrill CM, Dodd S, Plax K, Newland JG. Listserv to Support Community Pediatric Clinicians During the COVID-19 Pandemic. J Pediatric Infect Dis Soc 2023; 12:254-255. [PMID: 36915192 PMCID: PMC10146920 DOI: 10.1093/jpids/piad016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Indexed: 03/16/2023]
Affiliation(s)
- Gabrielle D Smith
- Department of Pediatrics, Division of Pediatric Infectious Diseases, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Sheridan L Thomas
- Department of Pediatrics, Division of Pediatric Infectious Diseases, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Rachel C Orscheln
- Department of Pediatrics, Division of Pediatric Infectious Diseases, Washington University School of Medicine, St. Louis, Missouri, USA
- Department of Pediatrics, Washington University Pediatric & Adolescent Ambulatory Research Consortium, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Summer M Reyes
- Department of Pediatrics, Division of Pediatric Infectious Diseases, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Sydney A Reyes
- Department of Pediatrics, Division of Pediatric Infectious Diseases, Washington University School of Medicine, St. Louis, Missouri, USA
| | - David A Rosen
- Department of Pediatrics, Division of Pediatric Infectious Diseases, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Cindy M Terrill
- Department of Pediatrics, Division of Pediatric Infectious Diseases, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Sherry Dodd
- Department of Pediatrics, Washington University Pediatric & Adolescent Ambulatory Research Consortium, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Katie Plax
- Department of Pediatrics, Washington University Pediatric & Adolescent Ambulatory Research Consortium, Washington University School of Medicine, St. Louis, Missouri, USA
- Department of Pediatrics, Division of Adolescent Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Jason G Newland
- Department of Pediatrics, Division of Pediatric Infectious Diseases, Washington University School of Medicine, St. Louis, Missouri, USA
- Department of Pediatrics, Washington University Pediatric & Adolescent Ambulatory Research Consortium, Washington University School of Medicine, St. Louis, Missouri, USA
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Butler AM, Brown DS, Newland JG, Nickel KB, Sahrmann JM, O’Neil CA, Olsen MA, Zetts RM, Hyun DY, Durkin MJ. Comparative Safety and Attributable Healthcare Expenditures Following Inappropriate Versus Appropriate Outpatient Antibiotic Prescriptions Among Adults With Upper Respiratory Infections. Clin Infect Dis 2023; 76:986-995. [PMID: 36350187 PMCID: PMC10226742 DOI: 10.1093/cid/ciac879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 10/28/2022] [Accepted: 11/03/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Little is known about the clinical and financial consequences of inappropriate antibiotics. We aimed to estimate the comparative risk of adverse drug events and attributable healthcare expenditures associated with inappropriate versus appropriate antibiotic prescriptions for common respiratory infections. METHODS We established a cohort of adults aged 18 to 64 years with an outpatient diagnosis of a bacterial (pharyngitis, sinusitis) or viral respiratory infection (influenza, viral upper respiratory infection, nonsuppurative otitis media, bronchitis) from 1 April 2016 to 30 September 2018 using Merative MarketScan Commercial Database. The exposure was an inappropriate versus appropriate oral antibiotic (ie, non-guideline-recommended vs guideline-recommended antibiotic for bacterial infections; any vs no antibiotic for viral infections). Propensity score-weighted Cox proportional hazards models were used to estimate the association between inappropriate antibiotics and adverse drug events. Two-part models were used to calculate 30-day all-cause attributable healthcare expenditures by infection type. RESULTS Among 3 294 598 eligible adults, 43% to 56% received inappropriate antibiotics for bacterial and 7% to 66% for viral infections. Inappropriate antibiotics were associated with increased risk of several adverse drug events, including Clostridioides difficile infection and nausea/vomiting/abdominal pain (hazard ratio, 2.90; 95% confidence interval, 1.31-6.41 and hazard ratio, 1.10; 95% confidence interval, 1.03-1.18, respectively, for pharyngitis). Thirty-day attributable healthcare expenditures were higher among adults who received inappropriate antibiotics for bacterial infections ($18-$67) and variable (-$53 to $49) for viral infections. CONCLUSIONS Inappropriate antibiotic prescriptions for respiratory infections were associated with increased risks of patient harm and higher healthcare expenditures, justifying a further call to action to implement outpatient antibiotic stewardship programs.
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Affiliation(s)
- Anne M Butler
- Department of Medicine, Division of Infectious Diseases, Washington University School of Medicine, St. Louis, Missouri, USA
- Department of Surgery, Division of Public Health Sciences, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Derek S Brown
- Brown School, Washington University, St. Louis, Missouri, USA
| | - Jason G Newland
- Department of Pediatrics, Washington University School of Medicine, St. Louis, St. Louis, Missouri, USA
| | - Katelin B Nickel
- Department of Medicine, Division of Infectious Diseases, Washington University School of Medicine, St. Louis, Missouri, USA
| | - John M Sahrmann
- Department of Medicine, Division of Infectious Diseases, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Caroline A O’Neil
- Department of Medicine, Division of Infectious Diseases, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Margaret A Olsen
- Department of Medicine, Division of Infectious Diseases, Washington University School of Medicine, St. Louis, Missouri, USA
- Department of Surgery, Division of Public Health Sciences, Washington University School of Medicine, St. Louis, Missouri, USA
| | | | | | - Michael J Durkin
- Department of Medicine, Division of Infectious Diseases, Washington University School of Medicine, St. Louis, Missouri, USA
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Rolf LR, Vestal L, Moore AC, Lobb Dougherty N, Mueller N, Newland JG. Psychosocial work environment stressors for school staff during the COVID-19 pandemic: Barriers and facilitators for supporting wellbeing. Front Public Health 2023; 11:1096240. [PMID: 36992895 PMCID: PMC10040557 DOI: 10.3389/fpubh.2023.1096240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 02/24/2023] [Indexed: 03/14/2023] Open
Abstract
IntroductionAfter periods of remote and/or hybrid learning as a result of the COVID-19 global pandemic, the return to in-person learning has been beneficial for both students and teachers, but it has not been without challenges. This study was designed to assess the impact of the return to in-person learning on the school experience, and efforts made to ease the transition in furthering a positive in-person learning environment.Materials and methodsWe conducted a series of listening sessions with 4 stakeholder groups: students (n = 39), parents (n = 28), teachers/school staff (n = 41), and a combination of listening sessions and semi-structured interviews with building level and district administrators (n = 12), focusing on in-school experiences during the 2021–2022 school year amidst the COVID-19 pandemic. A primarily deductive qualitative analysis approach was employed to code the data followed by a primarily inductive thematic analysis, followed by thematic aggregation, thus providing depth and identification of nuances in the data.ResultsThree main themes emerged around school staff experiences: (1) increased levels of stress and anxiety manifested in key ways, including students' challenges with personal behavior management contributing to increased aggression and staff shortages; (2) school staff described key contributors to stress and anxiety, including feeling excluded from decision making and challenges with clear and consistent communication; and (3) school staff described key facilitators that supported their management of anxiety and stress, including adaptability, heightened attention and resources to wellbeing, and leveraging interpersonal relationships.DiscussionSchool staff and students faced significant stress and anxiety during the 2021–2022 school year. Further exploration and identification of approaches to mitigate key contributors to increased stress and anxiety for school staff, along with increased opportunities for implementing key facilitators that were identified as important in managing and navigating the increased stress and anxiety offer valuable opportunities for helping to create a supportive work environment for school staff in the future.
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Affiliation(s)
- Liz R. Rolf
- Brown School Evaluation Center, Washington University in St. Louis, Saint Louis, MO, United States
- *Correspondence: Liz R. Rolf
| | - Liz Vestal
- Brown School Evaluation Center, Washington University in St. Louis, Saint Louis, MO, United States
| | - Ashley C. Moore
- Brown School Evaluation Center, Washington University in St. Louis, Saint Louis, MO, United States
| | - Nikole Lobb Dougherty
- Brown School Evaluation Center, Washington University in St. Louis, Saint Louis, MO, United States
| | - Nancy Mueller
- Office of the Provost, Washington University in St. Louis, Saint Louis, MO, United States
| | - Jason G. Newland
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Washington University School of Medicine, Saint Louis, MO, United States
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Vestal LE, Schmidt AM, Dougherty NL, Rolf L, Newland JG, Mueller NB. COVID-19-Related Facilitators and Barriers to In-Person Learning for Children With Intellectual and Development Disabilities. J Sch Health 2023; 93:176-185. [PMID: 36404403 PMCID: PMC10586430 DOI: 10.1111/josh.13262] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 09/28/2022] [Accepted: 11/02/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Schools provide essential functions for children with intellectual and developmental disabilities (IDD), but their vulnerability to infection with SARS-CoV-2 are a barrier to in-person learning. This qualitative study aimed to understand how weekly SARS-CoV-2 screening testing of students and staff could best facilitate in-school learning during the pandemic. METHODS Thirty-one focus groups were held with school staff and parents of children with IDD to examine the perceptions of COVID-19 during the 2020-2021 school year. Responses were analyzed using a directed thematic content analysis approach. RESULTS Five principal themes were identified: risks of returning to in-person learning; facilitators and barriers to participation in SARS-CoV-2 screening testing; messaging strategies; and preferred messengers. IMPLICATIONS FOR SCHOOL HEALTH POLICY, PRACTICE, AND EQUITY Staff and families agreed that saliva-based SARS-CoV-2 screening testing helps increase comfort with in-person learning. Screening testing increased family and school staff comfort with in-person learning particularly because many students with special needs cannot adhere to public health guidelines. CONCLUSION To keep children with IDD in school during the pandemic, families found SARS-CoV-2 screening testing important, particularly for students that cannot adhere to mitigation guidelines.
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Affiliation(s)
- Liz E. Vestal
- Brown School Evaluation Center at Washington University in St. Louis
| | - Ann M. Schmidt
- Brown School Evaluation Center at Washington University in St. Louis
| | | | - Liz Rolf
- Brown School Evaluation Center at Washington University in St. Louis
| | - Jason G Newland
- Department of Neurology, Washington University in St. Louis
- Department of Pediatrics, Division of Infectious Diseases, Washington University in St. Louis
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He K, Iwaniuk M, Goretsky MJ, Cina RA, Saito JM, Hall B, Grant C, Cohen ME, Newland JG, Ko CY, Rangel SJ. Procedure-level Misutilization of Antimicrobial Prophylaxis in Pediatric Surgery: Implications for Improved Stewardship and More Effective Infection Prevention. J Pediatr Surg 2023; 58:1116-1122. [PMID: 36914463 DOI: 10.1016/j.jpedsurg.2023.02.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 02/10/2023] [Indexed: 02/23/2023]
Abstract
BACKGROUND The objective of this study was to quantify prophylaxis misutilization to identify high-priority procedures for improved stewardship and SSI prevention. METHODS This was a multicenter analysis including 90 hospitals participating in the NSQIP-Pediatric Antibiotic Prophylaxis Collaborative from 6/2019 to 6/2020. Prophylaxis data were collected from all hospitals and misutilization measures were developed from consensus guidelines. Overutilization included use of overly broad-spectrum agents, continuation of prophylaxis >24 h after incision closure, and use in clean procedures without implants. Underutilization included omission (clean-contaminated cases), use of inappropriately narrow-spectrum agents, and administration post-incision. Procedure-level misutilization burden was estimated by multiplying NSQIP-derived misutilization rates by case volume data obtained from the Pediatric Health Information System database. RESULTS 9861 patients were included. Overutilization was most commonly associated with overly broad-spectrum agents (14.0%), unindicated utilization (12.6%), and prolonged duration (8.4%). Procedure groups with the greatest overutilization burden included small bowel (27.2%), cholecystectomy (24.4%), and colorectal (10.7%). Underutilization was most commonly associated with post-incision administration (6.2%), inappropriate omission (4.4%), and overly narrow-spectrum agents (4.1%). Procedure groups with the greatest underutilization burden included colorectal (31.2%), gastrostomy (19.2%), and small bowel (11.1%). CONCLUSION A relatively small number of procedures account for a disproportionate burden of antibiotic misutilization in pediatric surgery. TYPE OF STUDY Retrospective Cohort. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Katherine He
- Department of Surgery, Boston Children's Hospital, Boston, MA, USA
| | | | - Michael J Goretsky
- Department of Surgery, Children's Hospital of the King's Daughters, Norfolk, VA, USA
| | - Robert A Cina
- Department of Surgery, The Medical University of South Carolina, Charlestown, SC, USA
| | - Jacqueline M Saito
- Department of Surgery, Washington University St. Louis School of Medicine and BJC Healthcare, St. Louis, MO, USA
| | - Bruce Hall
- American College of Surgeons, Chicago, IL, USA; Department of Surgery, Washington University St. Louis School of Medicine and BJC Healthcare, St. Louis, MO, USA
| | | | | | - Jason G Newland
- Department of Pediatrics, Washington University St. Louis School of Medicine, St. Louis, MO, USA
| | | | - Shawn J Rangel
- Department of Surgery, Boston Children's Hospital, Boston, MA, USA.
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McGrath LJ, Frost HM, Newland JG, O’Neil CA, Sahrmann JM, Ma Y, Butler AM. Utilization of nonguideline concordant antibiotic treatment following acute otitis media in children in the United States. Pharmacoepidemiol Drug Saf 2023; 32:256-265. [PMID: 36269007 PMCID: PMC9877117 DOI: 10.1002/pds.5554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 10/10/2022] [Accepted: 10/14/2022] [Indexed: 01/28/2023]
Abstract
PURPOSE Acute otitis media (AOM) is a common indication for antibiotics in children. We sought to characterize the frequency of nonguideline concordant antibiotic therapy for AOM in the United States, by agent and duration. METHODS Using national administrative claims data (2016-2019), we identified children aged 6 months to 17 years with an oral antibiotic dispensed within 3 days of a new diagnosis of suppurative AOM. Use of nonguideline concordant agents and durations, defined based on national treatment guidelines, were summarized by age, race, rurality, region, and insurance type. Subsequent oral antibiotic dispensing within the year after AOM diagnosis was also evaluated. We created sunburst diagrams to visualize longitudinal patterns of within-person antibiotic utilization for AOM, by agent and duration. RESULTS We identified 789 424 eligible commercially-insured and 502 239 medicaid-insured children. Among commercially insured children, 35% received nonguideline concordant agents for AOM, including cefdinir (16%), amoxicillin-clavulanate (12%), and azithromycin (7%). Fewer children age <2 years received a nonguideline concordant initial agent (27%) compared to age ≥6 years (41%). More children age <2 years received three or more antibiotics over the following year (34% vs. 3% for children age ≥6 years). The most common treatment duration was 10 days for all ages; treatment duration for the initial antibiotic was nonguideline concordant for 95% and 89% of children age 2-5 years and ≥6 years, respectively. Patterns were similar for medicaid-insured children. CONCLUSIONS Nonguideline concordant antibiotic use is common when treating AOM in children, including use of broad-spectrum agents and longer-than-recommended antibiotic durations.
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Affiliation(s)
| | - Holly M. Frost
- Department of Pediatrics, Denver Health Medical Center, Denver, Colorado
- Office of Research, Denver Health Medical Center, Denver, Colorado
- Department of Pediatrics, School of Medicine, University of Colorado, Aurora, Colorado
| | - Jason G. Newland
- Department of Pediatrics, School of Medicine, Washington University, St. Louis, MO, USA
| | - Caroline A. O’Neil
- Department of Medicine, School of Medicine, Washington University, St. Louis, MO, USA
| | - John M. Sahrmann
- Department of Medicine, School of Medicine, Washington University, St. Louis, MO, USA
| | - Yinjiao Ma
- Department of Medicine, School of Medicine, Washington University, St. Louis, MO, USA
| | - Anne M. Butler
- Department of Medicine, School of Medicine, Washington University, St. Louis, MO, USA
- Department of Surgery, School of Medicine, Washington University, St. Louis, MO, USA
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25
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He K, Nayak RB, Allori AC, Brighton BK, Cina RA, Ellison JS, Goretsky MJ, Jatana KR, Proctor MR, Grant C, Thompson VM, Iwaniuk M, Cohen ME, Saito JM, Hall BL, Newland JG, Ko CY, Rangel SJ. Correlation Between Postoperative Antimicrobial Prophylaxis Use and Surgical Site Infection in Children Undergoing Nonemergent Surgery. JAMA Surg 2022; 157:1142-1151. [PMID: 36260310 PMCID: PMC9582965 DOI: 10.1001/jamasurg.2022.4729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 07/24/2022] [Indexed: 01/11/2023]
Abstract
Importance Use of postoperative antimicrobial prophylaxis is common in pediatric surgery despite consensus guidelines recommending discontinuation following incision closure. The association between postoperative prophylaxis use and surgical site infection (SSI) in children undergoing surgical procedures remains poorly characterized. Objective To evaluate whether use of postoperative surgical prophylaxis is correlated with SSI rates in children undergoing nonemergent surgery. Design, Setting, and Participants This is a multicenter cohort study using 30-day postoperative SSI data from the American College of Surgeons' Pediatric National Surgical Quality Improvement Program (ACS NSQIP-Pediatric) augmented with antibiotic-use data obtained through supplemental medical record review from June 2019 to June 2021. This study took place at 93 hospitals participating in the ACS NSQIP-Pediatric Surgical Antibiotic Prophylaxis Stewardship Collaborative. Participants were children (<18 years of age) undergoing nonemergent surgical procedures. Exclusion criteria included antibiotic allergies, conditions associated with impaired immune function, and preexisting infections requiring intravenous antibiotics at time of surgery. Exposures Continuation of antimicrobial prophylaxis beyond time of incision closure. Main Outcomes and Measures Thirty-day postoperative rate of incisional or organ space SSI. Hierarchical regression was used to estimate hospital-level odds ratios (ORs) for SSI rates and postoperative prophylaxis use. SSI measures were adjusted for differences in procedure mix, patient characteristics, and comorbidity profiles, while use measures were adjusted for clinically related procedure groups. Pearson correlations were used to examine the associations between hospital-level postoperative prophylaxis use and SSI measures. Results Forty thousand six hundred eleven patients (47.3% female; median age, 7 years) were included, of which 41.6% received postoperative prophylaxis (hospital range, 0%-71.2%). Odds ratios (ORs) for postoperative prophylaxis use ranged 190-fold across hospitals (OR, 0.10-19.30) and ORs for SSI rates ranged 4-fold (OR, 0.55-1.90). No correlation was found between use of postoperative prophylaxis and SSI rates overall (r = 0.13; P = .20), and when stratified by SSI type (incisional SSI, r = 0.08; P = .43 and organ space SSI, r = 0.13; P = .23), and surgical specialty (general surgery, r = 0.02; P = .83; urology, r = 0.05; P = .64; plastic surgery, r = 0.11; P = .35; otolaryngology, r = -0.13; P = .25; orthopedic surgery, r = 0.05; P = .61; and neurosurgery, r = 0.02; P = .85). Conclusions and Relevance Use of postoperative surgical antimicrobial prophylaxis was not correlated with SSI rates at the hospital level after adjusting for differences in procedure mix and patient characteristics.
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Affiliation(s)
- Katherine He
- Department of Surgery, Boston Children’s Hospital, Boston, Massachusetts
| | | | - Alexander C. Allori
- Division of Plastic, Maxillofacial & Oral Surgery, Department of Surgery, Duke University Health System, Durham, North Carolina
| | - Brian K. Brighton
- Department of Orthopedic Surgery, Levine Children's Hospital/Carolinas HealthCare System, Charlotte, North Carolina
| | | | - Jonathan S. Ellison
- Department of Urology, Medical College of Wisconsin & Children’s Wisconsin, Milwaukee
| | | | - Kris R. Jatana
- Department of Otolaryngology-Head and Neck Surgery, Nationwide Children’s Hospital, Columbus, Ohio
| | - Mark R. Proctor
- Department of Neurosurgery, Boston Children’s Hospital, Boston, Massachusetts
| | | | | | | | | | - Jacqueline M. Saito
- Department of Surgery, Washington University St Louis School of Medicine, and BJC Healthcare, St Louis, Missouri
| | - Bruce L. Hall
- American College of Surgeons, Chicago, Illinois
- Department of Surgery, Washington University St Louis School of Medicine, and BJC Healthcare, St Louis, Missouri
| | - Jason G. Newland
- Department of Pediatrics, Washington University St Louis School of Medicine, St Louis, Missouri
| | | | - Shawn J. Rangel
- Department of Surgery, Boston Children’s Hospital, Boston, Massachusetts
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Whittington KJ, Ma Y, Butler AM, Hogan PG, Ahmed F, Flowers J, Milburn G, Morelli JJ, Newland JG, Fritz SA. The impact of infectious diseases consultation for children with Staphylococcus aureus bacteremia. Pediatr Res 2022; 92:1598-1605. [PMID: 35982140 PMCID: PMC9789160 DOI: 10.1038/s41390-022-02251-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 07/14/2022] [Accepted: 07/27/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND Despite clear benefit of improved outcomes in adults, the impact of infectious diseases (ID) consultation for Staphylococcus aureus bacteremia in children remains understudied. METHODS To assess the impact of pediatric ID consultation on management and outcomes, we conducted a cohort study of children with S. aureus bacteremia at St. Louis Children's Hospital from 2011 to 2018. We assessed adherence to six established quality-of-care indicators (QCIs). We applied propensity score methodology to examine the impact of ID consultation on risk of treatment failure, a composite of all-cause mortality or hospital readmission within 90 days. RESULTS Of 306 patients with S. aureus bacteremia, 193 (63%) received ID consultation. ID consultation was associated with increased adherence to all QCIs, including proof-of-cure blood cultures, indicated laboratory studies, echocardiography, source control, targeted antibiotic therapy, and antibiotic duration. Obtaining proof-of-cure blood cultures and all indicated laboratory studies were associated with improved outcomes. In propensity score-weighted analyses, risk of treatment failure was similar among patients who did and did not receive ID consultation. However, the number of events was small and risk estimates were imprecise. CONCLUSIONS For children with S. aureus bacteremia, ID consultation improved adherence to QCIs, some of which were associated with improved clinical outcomes. IMPACT In children with Staphylococcus aureus bacteremia, consultation by an infectious diseases (ID) physician improved adherence to established quality-of-care indicators (QCIs). The current literature regarding ID consultation in pediatric S. aureus bacteremia is sparse. Three prior international studies demonstrated improved quality of care with ID consultation, though results were disparate regarding clinical outcomes. This article impacts the current literature by strengthening the evidence that ID consultation in children improves adherence to QCIs, and demonstrates that adherence to QCIs improves clinical outcomes.
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Affiliation(s)
- Kyle J. Whittington
- Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, 63110, USA
| | - Yinjiao Ma
- Department of Medicine Washington University School of Medicine, St. Louis, MO, 63110, USA
| | - Anne M. Butler
- Department of Medicine Washington University School of Medicine, St. Louis, MO, 63110, USA
| | - Patrick G. Hogan
- Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, 63110, USA
| | - Faria Ahmed
- Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, 63110, USA
| | - JessieAnn Flowers
- Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, 63110, USA
| | - Grace Milburn
- Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, 63110, USA
| | - John J. Morelli
- Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, 63110, USA
| | - Jason G. Newland
- Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, 63110, USA
| | - Stephanie A. Fritz
- Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, 63110, USA,Corresponding author: Stephanie A. Fritz, MD, MSCI, 660 S. Euclid Avenue, MSC 8116-43-10, St. Louis, MO 63110-9872, , Phone: (314) 454-6050
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Goggin K, Hurley EA, Lee BR, Bradley-Ewing A, Bickford C, Pina K, Donis de Miranda E, Yu D, Weltmer K, Linnemayr S, Butler CC, Newland JG, Myers AL. Let's Talk About Antibiotics: a randomised trial of two interventions to reduce antibiotic misuse. BMJ Open 2022; 12:e049258. [PMID: 36410835 PMCID: PMC9680140 DOI: 10.1136/bmjopen-2021-049258] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Children with acute respiratory tract infections (ARTIs) receive ≈11.4 million unnecessary antibiotic prescriptions annually. A noted contributor is inadequate parent-clinician communication, however, efforts to reduce overprescribing have only indirectly targeted communication or been impractical. OBJECTIVES Compare two feasible (higher vs lower intensity) interventions for enhancing parent-clinician communication on the rate of inappropriate antibiotic prescribing. DESIGN Multisite, parallel group, cluster randomised comparative effectiveness trial. Data collected between March 2017 and March 2019. SETTING Academic and private practice outpatient clinics. PARTICIPANTS Clinicians (n=41, 85% of eligible approached) and 1599 parent-child dyads (ages 1-5 years with ARTI symptoms, 71% of eligible approached). INTERVENTIONS All clinicians received 20 min ARTI diagnosis and treatment education. Higher intensity clinicians received an additional 50 min communication skills training. All parents viewed a 90 second antibiotic education video. MAIN OUTCOMES AND MEASURES Inappropriate antibiotic treatment was assessed via blinded medical record review by study clinicians and a priori defined as prescriptions for the wrong diagnosis or use of the wrong agent. Secondary outcomes were revisits, adverse drug reactions (both assessed 2 weeks after the visit) and parent ratings of provider communication, shared decision-making and visit satisfaction (assessed at end of the visit on Likert-type scales). RESULTS Most clinicians completed the study (n=38, 93%), were doctors (n=25, 66%), female (n=30, 78%) and averaged 8 years in practice. All parent-child dyad provided data for the main outcome (n=855 (54%) male, n=1043 (53%) <2 years). Inappropriate antibiotic prescribing was similar among patients who consulted with a higher intensity (54/696, 7.8%) versus a lower intensity (85/904, 9.4%) clinician. A generalised linear mixed effect regression model (adjusted for the two-stage nested design, clinician type, clinic setting and clinician experience) revealed that the odds of receiving inappropriate antibiotic treatment did not significantly vary by group (AOR 0.99, 95% CI: 0.52 to 1.89, p=0.98). Secondary outcomes of revisits and adverse reactions did not vary between arms, and parent ratings of satisfaction with quality of parent-provider communication (5/5), shared decision making (9/10) and visit satisfaction (5/5) were similarly high in both arms. CONCLUSIONS AND RELEVANCE Rate of inappropriate prescribing was low in both arms. Clinician education coupled with parent education may be sufficient to yield low inappropriate antibiotic prescribing rates. The absence of a significant difference between groups indicates that communication principles previously thought to drive inappropriate prescribing may need to be re-examined or may not have as much of an impact in practices where prescribing has improved in recent years. TRIAL REGISTRATION NUMBER NCT03037112.
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Affiliation(s)
- Kathy Goggin
- Health Services and Outcomes Research, Children's Mercy Hospitals and Clinics, Kansas City, Missouri, USA
- School of Medicine, University of Missouri - Kansas City, Kansas City, MO, USA
- School of Pharmacy, University of Missouri - Kansas City, Kansas City, MO, USA
| | - Emily A Hurley
- Health Services and Outcomes Research, Children's Mercy Hospitals and Clinics, Kansas City, Missouri, USA
- School of Medicine, University of Missouri - Kansas City, Kansas City, MO, USA
| | - Brian R Lee
- Health Services and Outcomes Research, Children's Mercy Hospitals and Clinics, Kansas City, Missouri, USA
- School of Medicine, University of Missouri - Kansas City, Kansas City, MO, USA
| | - Andrea Bradley-Ewing
- Health Services and Outcomes Research, Children's Mercy Hospitals and Clinics, Kansas City, Missouri, USA
- School of Medicine, University of Missouri - Kansas City, Kansas City, MO, USA
| | - Carey Bickford
- Health Services and Outcomes Research, Children's Mercy Hospitals and Clinics, Kansas City, Missouri, USA
| | - Kimberly Pina
- Health Services and Outcomes Research, Children's Mercy Hospitals and Clinics, Kansas City, Missouri, USA
| | - Evelyn Donis de Miranda
- Health Services and Outcomes Research, Children's Mercy Hospitals and Clinics, Kansas City, Missouri, USA
| | - David Yu
- Sunflower Medical Group, Kansas City, Kansas, USA
| | - Kirsten Weltmer
- School of Medicine, University of Missouri - Kansas City, Kansas City, MO, USA
- General Academic Pediatrics, Children's Mercy Hospitals and Clinics, Kansas City, MO, USA
| | | | - Christopher C Butler
- Nuffield Department of Primary Health Care Sciences, University of Oxford, Oxford, UK
| | - Jason G Newland
- Division of Infectious Diseases, Department of Pediatrics, Washington University in St. Louis, St. Louis, MO, USA
| | - Angela L Myers
- Pediatric Infectious Diseases, Children's Mercy Hospitals and Clinics, Kansas City, MO, USA
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Dawson P, Worrell MC, Malone S, Fritz SA, McLaughlin HP, Montgomery BK, Boyle M, Gomel A, Hayes S, Maricque B, Lai AM, Neidich JA, Tinker SC, Lee JS, Tong S, Orscheln RC, Charney R, Rebmann T, Mooney J, Rains C, Yoon N, Petit M, Towns K, Goddard C, Schmidt S, Barrios LC, Neatherlin JC, Salzer JS, Newland JG. Modifications to student quarantine policies in K-12 schools implementing multiple COVID-19 prevention strategies restores in-person education without increasing SARS-CoV-2 transmission risk, January-March 2021. PLoS One 2022; 17:e0266292. [PMID: 36264919 PMCID: PMC9584452 DOI: 10.1371/journal.pone.0266292] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 09/15/2022] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE To determine whether modified K-12 student quarantine policies that allow some students to continue in-person education during their quarantine period increase schoolwide SARS-CoV-2 transmission risk following the increase in cases in winter 2020-2021. METHODS We conducted a prospective cohort study of COVID-19 cases and close contacts among students and staff (n = 65,621) in 103 Missouri public schools. Participants were offered free, saliva-based RT-PCR testing. The projected number of school-based transmission events among untested close contacts was extrapolated from the percentage of events detected among tested asymptomatic close contacts and summed with the number of detected events for a projected total. An adjusted Cox regression model compared hazard rates of school-based SARS-CoV-2 infections between schools with a modified versus standard quarantine policy. RESULTS From January-March 2021, a projected 23 (1%) school-based transmission events occurred among 1,636 school close contacts. There was no difference in the adjusted hazard rates of school-based SARS-CoV-2 infections between schools with a modified versus standard quarantine policy (hazard ratio = 1.00; 95% confidence interval: 0.97-1.03). DISCUSSION School-based SARS-CoV-2 transmission was rare in 103 K-12 schools implementing multiple COVID-19 prevention strategies. Modified student quarantine policies were not associated with increased school incidence of COVID-19. Modifications to student quarantine policies may be a useful strategy for K-12 schools to safely reduce disruptions to in-person education during times of increased COVID-19 community incidence.
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Affiliation(s)
- Patrick Dawson
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, GA, United States of America
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA, United States of America
| | - Mary Claire Worrell
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, GA, United States of America
- * E-mail:
| | - Sara Malone
- Washington University in St. Louis, St. Louis, MO, United States of America
| | - Stephanie A. Fritz
- Washington University in St. Louis, St. Louis, MO, United States of America
| | - Heather P. McLaughlin
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, GA, United States of America
| | | | - Mary Boyle
- Washington University in St. Louis, St. Louis, MO, United States of America
| | - Ashley Gomel
- Saint Louis University, St. Louis, MO, United States of America
| | - Samantha Hayes
- Saint Louis University, St. Louis, MO, United States of America
| | - Brett Maricque
- Washington University in St. Louis, St. Louis, MO, United States of America
| | - Albert M. Lai
- Washington University in St. Louis, St. Louis, MO, United States of America
| | - Julie A. Neidich
- Washington University in St. Louis, St. Louis, MO, United States of America
| | - Sarah C. Tinker
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, GA, United States of America
| | - Justin S. Lee
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, GA, United States of America
| | - Suxiang Tong
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, GA, United States of America
| | | | - Rachel C. Orscheln
- Washington University in St. Louis, St. Louis, MO, United States of America
| | - Rachel Charney
- Saint Louis University, St. Louis, MO, United States of America
| | - Terri Rebmann
- Saint Louis University, St. Louis, MO, United States of America
| | | | - Jon Mooney
- Springfield-Greene County Health Department, Springfield, MO, United States of America
| | - Catherine Rains
- Springfield-Greene County Health Department, Springfield, MO, United States of America
| | - Nancy Yoon
- Springfield-Greene County Health Department, Springfield, MO, United States of America
| | - Machelle Petit
- Springfield-Greene County Health Department, Springfield, MO, United States of America
| | - Katie Towns
- Springfield-Greene County Health Department, Springfield, MO, United States of America
| | - Clay Goddard
- Springfield-Greene County Health Department, Springfield, MO, United States of America
| | - Spring Schmidt
- Saint Louis County Department of Public Health, Berkeley, MO, United States of America
| | - Lisa C. Barrios
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, GA, United States of America
| | - John C. Neatherlin
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, GA, United States of America
| | - Johanna S. Salzer
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, GA, United States of America
| | - Jason G. Newland
- Washington University in St. Louis, St. Louis, MO, United States of America
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Burnham JP, Kwon JH, Newland JG, McKay VR. Dissemination and implementation science and antimicrobial stewardship in solid organ transplantation: A perspective. Transpl Infect Dis 2022; 24:e13903. [DOI: 10.1111/tid.13903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 06/08/2022] [Indexed: 11/06/2022]
Affiliation(s)
- Jason P. Burnham
- Division of Infectious Diseases Washington University in St. Louis School of Medicine St. Louis Missouri USA
| | - Jennie H. Kwon
- Division of Infectious Diseases Washington University in St. Louis School of Medicine St. Louis Missouri USA
| | - Jason G. Newland
- Department of Pediatrics Washington University in St. Louis School of Medicine St. Louis Missouri USA
| | - Virginia R. McKay
- Brown School at Washington University in St. Louis St. Louis Missouri USA
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30
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Kwon J, Kong Y, Wade M, Williams DJ, Creech CB, Evans S, Walter EB, Martin JM, Gerber JS, Newland JG, Hofto ME, Staat MA, Chambers HF, Fowler VG, Huskins WC, Pettigrew MM. Gastrointestinal Microbiome Disruption and Antibiotic-Associated Diarrhea in Children Receiving Antibiotic Therapy for Community-Acquired Pneumonia. J Infect Dis 2022; 226:1109-1119. [PMID: 35249113 PMCID: PMC9492313 DOI: 10.1093/infdis/jiac082] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 03/02/2022] [Indexed: 11/14/2022] Open
Abstract
Antibiotic-associated diarrhea (AAD) is a common side effect of antibiotics. We examined the gastrointestinal microbiota in children treated with β-lactams for community-acquired pneumonia. Data were from 66 children (n = 198 samples), aged 6-71 months, enrolled in the SCOUT-CAP trial (NCT02891915). AAD was defined as ≥1 day of diarrhea. Stool samples were collected on study days 1, 6-10, and 19-25. Samples were analyzed using 16S ribosomal RNA gene sequencing to identify associations between patient characteristics, microbiota characteristics, and AAD (yes/no). Nineteen (29%) children developed AAD. Microbiota compositional profiles differed between AAD groups (permutational multivariate analysis of variance, P < .03) and across visits (P < .001). Children with higher baseline relative abundances of 2 Bacteroides species were less likely to experience AAD. Higher baseline abundance of Lachnospiraceae and amino acid biosynthesis pathways were associated with AAD. Children in the AAD group experienced prolonged dysbiosis (P < .05). Specific gastrointestinal microbiota profiles are associated with AAD in children.
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Affiliation(s)
- Jiye Kwon
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut, USA
| | - Yong Kong
- Department of Biostatistics, Yale School of Public Health, New Haven, Connecticut, USA.,Department of Molecular Biophysics and Biochemistry, W. M. Keck Foundation Biotechnology Resource Laboratory, Yale School of Medicine, New Haven, Connecticut, USA
| | - Martina Wade
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut, USA
| | - Derek J Williams
- Department of Pediatrics and the Vanderbilt Vaccine Research Program, Vanderbilt University School of Medicine and the Monroe Carell Jr Children's Hospital at Vanderbilt, Nashville, Tennessee, USA
| | - Clarence Buddy Creech
- Department of Pediatrics and the Vanderbilt Vaccine Research Program, Vanderbilt University School of Medicine and the Monroe Carell Jr Children's Hospital at Vanderbilt, Nashville, Tennessee, USA
| | - Scott Evans
- Biostatistics Center, Milken Institute School of Public Health, George Washington University, Washington, District of Columbia, USA
| | - Emmanuel B Walter
- Department of Pediatrics and Duke Human Vaccine Institute, Duke University School of Medicine, Durham, North Carolina, USA
| | - Judy M Martin
- Department of Pediatrics, University of Pittsburgh School of Medicine and the UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Jeffrey S Gerber
- Children's Hospital of Philadelphia, Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jason G Newland
- Department of Pediatrics, Washington University in St Louis School of Medicine, St Louis, Missouri, USA
| | - Meghan E Hofto
- Department of Pediatrics, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama, USA
| | - Mary Allen Staat
- Cincinnati Children's Hospital Medical Center; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Henry F Chambers
- Department of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Vance G Fowler
- Department of Medicine and Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina, USA
| | - W Charles Huskins
- Mayo Clinic College of Medicine and Science and Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Melinda M Pettigrew
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut, USA
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31
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Hayes S, Malone S, Bonty B, Mueller N, Reyes SM, Reyes SA, Evans C, Wilcher-Roberts M, Watterson T, Akuse S, Shelley J, Yuan G, Lackey I, Prater J, Montgomery B, Williams C, Butler-Barnes ST, Harris K, Caburnay C, Dougherty NL, Liu J, Lai A, Neidich J, Fritz S, Newland JG. Correction: Assessing COVID-19 testing strategies in K-12 schools in underserved populations: study protocol for a cluster-randomized trial. BMC Public Health 2022; 22:1655. [PMID: 36050666 PMCID: PMC9434065 DOI: 10.1186/s12889-022-14059-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- Samantha Hayes
- Department of Pediatrics, Washington University in St. Louis School of Medi- cine, St. Louis, MO, USA
| | - Sara Malone
- Department of Pediatrics, Washington University in St. Louis School of Medi- cine, St. Louis, MO, USA. .,Brown School, Washington University in St. Louis, St. Louis, MO, USA.
| | - Brittany Bonty
- Department of Pediatrics, Washington University in St. Louis School of Medi- cine, St. Louis, MO, USA
| | - Nancy Mueller
- Brown School, Washington University in St. Louis, St. Louis, MO, USA
| | - Summer M Reyes
- Department of Pediatrics, Washington University in St. Louis School of Medi- cine, St. Louis, MO, USA
| | - Sydney A Reyes
- Department of Pediatrics, Washington University in St. Louis School of Medi- cine, St. Louis, MO, USA
| | - Christina Evans
- Department of Pediatrics, Washington University in St. Louis School of Medi- cine, St. Louis, MO, USA
| | - Myisha Wilcher-Roberts
- Department of Pediatrics, Washington University in St. Louis School of Medi- cine, St. Louis, MO, USA
| | - Tremayne Watterson
- Department of Pediatrics, Washington University in St. Louis School of Medi- cine, St. Louis, MO, USA
| | - Sewuese Akuse
- Department of Pediatrics, Washington University in St. Louis School of Medi- cine, St. Louis, MO, USA
| | - Jamee Shelley
- Department of Pediatrics, Washington University in St. Louis School of Medi- cine, St. Louis, MO, USA
| | - Grace Yuan
- Department of Pediatrics, Washington University in St. Louis School of Medi- cine, St. Louis, MO, USA
| | - Ian Lackey
- Department of Pediatrics, Washington University in St. Louis School of Medi- cine, St. Louis, MO, USA
| | - Jasmine Prater
- Department of Pediatrics, Washington University in St. Louis School of Medi- cine, St. Louis, MO, USA
| | - Brock Montgomery
- Department of Pediatrics, Washington University in St. Louis School of Medi- cine, St. Louis, MO, USA
| | - Cynthia Williams
- Brown School, Washington University in St. Louis, St. Louis, MO, USA
| | | | - Kelly Harris
- Department of Occupational Therapy, Washington University in St. Louis School of Medicine, St. Louis, MO, USA
| | - Charlene Caburnay
- Brown School, Washington University in St. Louis, St. Louis, MO, USA
| | | | - Jingxia Liu
- Department of Surgery, Washington University in St. Louis School of Medicine, St. Louis, MO, USA
| | - Albert Lai
- Department of Medicine, Washington University in St. Louis School of Medicine, St. Louis, MO, USA
| | - Julie Neidich
- Department of Pathology and Immunology, Washington University in St. Louis School of Medicine, St. Louis, MO, USA
| | - Stephanie Fritz
- Department of Pediatrics, Washington University in St. Louis School of Medi- cine, St. Louis, MO, USA
| | - Jason G Newland
- Department of Pediatrics, Washington University in St. Louis School of Medi- cine, St. Louis, MO, USA
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32
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Donovan CV, Worrell MC, Steinberg J, Montgomery BK, Young R, Richardson G, Dawson P, Dinh TH, Botkin N, Fitzpatrick T, Fields A, Rains CM, Fritz S, Malone S, Tong S, Mooney J, Newland JG, Barrios LC, Neatherlin JC, Salzer JS. An Examination of SARS-CoV-2 Transmission Based on Classroom Distancing in Schools With Other Preventive Measures in Place—Missouri, January–March 2021. Public Health Rep 2022; 137:972-979. [PMID: 35848091 PMCID: PMC9357822 DOI: 10.1177/00333549221109003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objectives: Classroom layout plays a central role in maintaining physical distancing as
part of a multicomponent prevention strategy for safe in-person learning
during the COVID-19 pandemic. We conducted a school investigation to assess
layouts and physical distancing in classroom settings with and without
in-school SARS-CoV-2 transmission. Methods: We assessed, measured, and mapped 90 K-12 (kindergarten through grade 12)
classrooms in 3 Missouri public school districts during January–March 2021,
prior to widespread prevalence of the Delta variant; distances between
students, teachers, and people with COVID-19 and their contacts were
analyzed. We used whole-genome sequencing to further evaluate potential
transmission events. Results: The investigation evaluated the classrooms of 34 students and staff members
who were potentially infectious with COVID-19 in a classroom. Of 42 close
contacts (15 tested) who sat within 3 ft of possibly infectious people, 1
(2%) probable transmission event occurred (from a symptomatic student with a
longer exposure period [5 days]); of 122 contacts (23 tested) who sat more
than 3 ft away from possibly infectious people with shorter exposure
periods, no transmission events occurred. Conclusions: Reduced student physical distancing is one component of mitigation strategies
that can allow for increased classroom capacity and support in-person
learning. In the pre–Delta variant period, limited physical distancing
(<6 ft) among students in K-12 schools was not associated with increased
SARS-CoV-2 transmission.
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Affiliation(s)
- Catherine V. Donovan
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, GA, USA
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Mary Claire Worrell
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Jonathan Steinberg
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, GA, USA
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Brock K. Montgomery
- Department of Pediatrics, School of Medicine, Washington University in St Louis, St Louis, MO, USA
| | - Randall Young
- Geospatial Research, Analysis, and Services Program, Centers for Disease Control and Prevention/Agency for Toxic Substances and Disease Registry, Atlanta, GA, USA
| | - Gabriele Richardson
- Department of Pediatrics, School of Medicine, Washington University in St Louis, St Louis, MO, USA
| | - Patrick Dawson
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, GA, USA
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Thu Ha Dinh
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | | | | | | | - Stephanie Fritz
- Department of Pediatrics, School of Medicine, Washington University in St Louis, St Louis, MO, USA
| | - Sara Malone
- Department of Pediatrics, School of Medicine, Washington University in St Louis, St Louis, MO, USA
| | - Suxiang Tong
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Jon Mooney
- Springfield-Greene County Health Department, Springfield, MO, USA
| | - Jason G. Newland
- Department of Pediatrics, School of Medicine, Washington University in St Louis, St Louis, MO, USA
| | - Lisa C. Barrios
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - John C. Neatherlin
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Johanna S. Salzer
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, GA, USA
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33
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Hayes S, Malone S, Bonty B, Mueller N, Reyes SM, Reyes SA, Evans C, Wilcher-Roberts M, Watterson T, Akuse S, Shelley J, Yuan G, Lackey I, Prater J, Montgomery B, Williams C, Butler-Barnes ST, Caburnay C, Dougherty NL, Liu J, Lai A, Neidich J, Fritz S, Newland JG. Assessing COVID-19 testing strategies in K-12 schools in underserved populations: study protocol for a cluster-randomized trial. BMC Public Health 2022; 22:1177. [PMID: 35698094 PMCID: PMC9189793 DOI: 10.1186/s12889-022-13577-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 06/02/2022] [Indexed: 11/15/2022] Open
Abstract
Background Since March 2020, COVID-19 has disproportionately impacted communities of color within the United States. As schools have shifted from virtual to in-person learning, continual guidance is necessary to understand appropriate interventions to prevent SARS-CoV-2 transmission. Weekly testing of students and staff for SARS-CoV-2 within K-12 school setting could provide an additional barrier to school-based transmission, especially within schools unable to implement additional mitigation strategies and/or are in areas of high transmission. This study seeks to understand the role that weekly SARS-CoV-2 testing could play in K-12 schools. In addition, through qualitative interviews and listening sessions, this research hopes to understand community concerns and barriers regarding COVID-19 testing, COVID-19 vaccine, and return to school during the COVID-19 pandemic. Methods/design Sixteen middle and high schools from five school districts have been randomized into one of the following categories: (1) Weekly screening + symptomatic testing or (2) Symptomatic testing only. The primary outcome for this study will be the average of the secondary attack rate of school-based transmission per case. School-based transmission will also be assessed through qualitative contact interviews with positive contacts identified by the school contact tracers. Lastly, new total numbers of weekly cases and contacts within a school-based quarantine will provide guidance on transmission rates. Qualitative focus groups and interviews have been conducted to provide additional understanding to the acceptance of the intervention and barriers faced by the community regarding SARS-CoV-2 testing and vaccination. Discussion This study will provide greater understanding of the benefit that weekly screening testing can provide in reducing SARS-CoV-2 transmission within K-12 schools. Close collaboration with community partners and school districts will be necessary for the success of this and similar studies. Trial Registration NCT04875520. Registered May 6, 2021.
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Affiliation(s)
- Samantha Hayes
- Department of Pediatrics, Washington University in St. Louis School of Medicine, St. Louis, MO, USA
| | - Sara Malone
- Department of Pediatrics, Washington University in St. Louis School of Medicine, St. Louis, MO, USA. .,Brown School, Washington University in St. Louis, St. Louis, MO, USA.
| | - Brittany Bonty
- Department of Pediatrics, Washington University in St. Louis School of Medicine, St. Louis, MO, USA
| | - Nancy Mueller
- Brown School, Washington University in St. Louis, St. Louis, MO, USA
| | - Summer M Reyes
- Department of Pediatrics, Washington University in St. Louis School of Medicine, St. Louis, MO, USA
| | - Sydney A Reyes
- Department of Pediatrics, Washington University in St. Louis School of Medicine, St. Louis, MO, USA
| | - Christina Evans
- Department of Pediatrics, Washington University in St. Louis School of Medicine, St. Louis, MO, USA
| | | | - Tremayne Watterson
- Department of Pediatrics, Washington University in St. Louis School of Medicine, St. Louis, MO, USA
| | - Sewuese Akuse
- Department of Pediatrics, Washington University in St. Louis School of Medicine, St. Louis, MO, USA
| | - Jamee Shelley
- Department of Pediatrics, Washington University in St. Louis School of Medicine, St. Louis, MO, USA
| | - Grace Yuan
- Department of Pediatrics, Washington University in St. Louis School of Medicine, St. Louis, MO, USA
| | - Ian Lackey
- Department of Pediatrics, Washington University in St. Louis School of Medicine, St. Louis, MO, USA
| | - Jasmine Prater
- Department of Pediatrics, Washington University in St. Louis School of Medicine, St. Louis, MO, USA
| | - Brock Montgomery
- Department of Pediatrics, Washington University in St. Louis School of Medicine, St. Louis, MO, USA
| | - Cynthia Williams
- Brown School, Washington University in St. Louis, St. Louis, MO, USA
| | | | - Charlene Caburnay
- Brown School, Washington University in St. Louis, St. Louis, MO, USA
| | | | - Jingxia Liu
- Department of Surgery, Washington University in St. Louis School of Medicine, St. Louis, MO, USA
| | - Albert Lai
- Department of Medicine, Washington University in St. Louis School of Medicine, St. Louis, MO, USA
| | - Julie Neidich
- Department of Pathology and Immunology, Washington University in St. Louis School of Medicine, St. Louis, MO, USA
| | - Stephanie Fritz
- Department of Pediatrics, Washington University in St. Louis School of Medicine, St. Louis, MO, USA
| | - Jason G Newland
- Department of Pediatrics, Washington University in St. Louis School of Medicine, St. Louis, MO, USA
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34
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Daniels EA, McPherson CC, Newland JG, Lee BR. Variation in ampicillin dosing for lower respiratory tract infections and neonatal bacterial infections in US children's hospitals. Antimicrob Steward Healthc Epidemiol 2022; 2:e85. [PMID: 36483411 PMCID: PMC9726562 DOI: 10.1017/ash.2022.221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 04/06/2022] [Accepted: 04/08/2022] [Indexed: 06/17/2023]
Abstract
OBJECTIVE We examined ampicillin dosing in pediatric patients across 3 conditions: (1) bacterial lower respiratory tract infections (LRTIs) in infants and children >3 months, (2) neonates with suspected or proven sepsis, and (3) neonates with suspected central nervous system (CNS) infections. We compared our findings to dosing guidance for these specific indications. DESIGN Retrospective cohort study. SETTING The study included data from 32 children's hospitals in the United States. METHODS We reviewed prescriptions from the SHARPS study of antimicrobials, a survey of antibiotic prescribing from July 2016 to December 2017. Prescriptions were analyzed for indication, total daily dose per kilogram, and presence of antimicrobial stewardship program (ASP) review. LRTI prescriptions were compared to IDSA recommendations for community-acquired pneumonia. Neonatal prescriptions were compared to recommendations from the American Academy of Pediatrics (AAP). Prescriptions were categorized as "optimal" (80%-120% of recommended dosing), "suboptimal" (<80% of recommended dosing), or "excessive" (>120% of recommended dosing). RESULTS Among 1,038 ampicillin prescriptions, we analyzed 88 prescriptions for LRTI, 499 prescriptions for neonatal sepsis, and 27 prescriptions for neonatal CNS infection. Of the LRTI prescriptions, 77.3%were optimal. Of prescriptions for neonatal sepsis, 81.6% were excessive compared to AAP bacteremia recommendations but 78.8% were suboptimal compared to AAP meningitis guidelines. Also, 48.1% of prescriptions for neonatal CNS infection were suboptimal, and 50.6% of prescriptions were not reviewed by the ASP. CONCLUSIONS LRTI dosing is generally within the IDSA-recommended range. However, dosing for neonatal sepsis often exceeds the recommendation for bacteremia but is below the recommendation for meningitis. This variability points to an important opportunity for future antimicrobial stewardship efforts.
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Affiliation(s)
- Elizabeth A. Daniels
- Department of Pediatrics, Washington University School of Medicine, St. Louis, MO
| | | | - Jason G. Newland
- Department of Pediatrics, Washington University School of Medicine, St. Louis, MO
| | - Brian R. Lee
- Department of Pediatrics, University of Missouri-Kansas City School of Medicine, Kansas City, MO
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35
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Kreienkamp RJ, Kreienkamp CJ, Terrill C, Halstead ME, Newland JG. Transmission risk of COVID-19 in high school and college water polo. BMC Infect Dis 2022; 22:450. [PMID: 35546389 PMCID: PMC9092321 DOI: 10.1186/s12879-022-07448-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 05/04/2022] [Indexed: 11/30/2022] Open
Abstract
Background Concerns that athletes may be at a higher risk for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmission has led to reduced participation in sports during the COVID-19 pandemic. We aimed to assess COVID-19 incidence and transmission during the spring 2021 high school and college water polo seasons across the United States. Methods This prospective observational study enrolled 1825 water polo athletes from 54 high schools and 36 colleges. Surveys were sent to coaches throughout the season, and survey data were collected and analyzed. Results We identified 17 COVID-19 cases among 1223 high school water polo athletes (1.4%) and 66 cases among 602 college athletes (11.0%). Of these cases, contact tracing suggested that three were water polo–associated in high school, and none were water polo–associated in college. Quarantine data suggest low transmission during water polo play as only three out of 232 (1.3%) high school athletes quarantined for a water polo–related exposure developed COVID-19. In college, none of the 54 athletes quarantined for exposure with an infected opponent contracted COVID-19. However, in both high school and college, despite the physical condition of water polo athletes, both high school (47%) and college athletes (21%) had prolonged return to play after contracting COVID-19, indicating the danger of COVID-19, even to athletes. Conclusions While COVID-19 spread can occur during water polo play, few instances of spread occurred during the spring 2021 season, and transmission rates appear similar to those in other settings, such as school environments. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-022-07448-6.
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Affiliation(s)
- Raymond J Kreienkamp
- Department of Pediatrics, St. Louis Children's Hospital, Washington University School of Medicine, 620 S. Taylor Ave, Northwest Tower 10113, St. Louis, MO, 63110, USA
| | | | - Cindy Terrill
- Department of Pediatrics, St. Louis Children's Hospital, Washington University School of Medicine, 620 S. Taylor Ave, Northwest Tower 10113, St. Louis, MO, 63110, USA.,Division of Infectious Diseases, St. Louis Children's Hospital, Washington University School of Medicine, St. Louis, MO, USA
| | - Mark E Halstead
- Department of Pediatrics, St. Louis Children's Hospital, Washington University School of Medicine, 620 S. Taylor Ave, Northwest Tower 10113, St. Louis, MO, 63110, USA.,Department of Orthopedic Surgery, St. Louis Children's Hospital, Washington University School of Medicine, St. Louis, MO, USA
| | - Jason G Newland
- Department of Pediatrics, St. Louis Children's Hospital, Washington University School of Medicine, 620 S. Taylor Ave, Northwest Tower 10113, St. Louis, MO, 63110, USA. .,Division of Infectious Diseases, St. Louis Children's Hospital, Washington University School of Medicine, St. Louis, MO, USA.
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Butler AM, Brown DS, Durkin MJ, Sahrmann JM, Nickel KB, O’Neil CA, Olsen MA, Hyun DY, Zetts RM, Newland JG. Association of Inappropriate Outpatient Pediatric Antibiotic Prescriptions With Adverse Drug Events and Health Care Expenditures. JAMA Netw Open 2022; 5:e2214153. [PMID: 35616940 PMCID: PMC9136626 DOI: 10.1001/jamanetworkopen.2022.14153] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
IMPORTANCE Nonguideline antibiotic prescribing for the treatment of pediatric infections is common, but the consequences of inappropriate antibiotics are not well described. OBJECTIVE To evaluate the comparative safety and health care expenditures of inappropriate vs appropriate oral antibiotic prescriptions for common outpatient pediatric infections. DESIGN, SETTING, AND PARTICIPANTS This cohort study included children aged 6 months to 17 years diagnosed with a bacterial infection (suppurative otitis media [OM], pharyngitis, sinusitis) or viral infection (influenza, viral upper respiratory infection [URI], bronchiolitis, bronchitis, nonsuppurative OM) as an outpatient from April 1, 2016, to September 30, 2018, in the IBM MarketScan Commercial Database. Data were analyzed from August to November 2021. EXPOSURES Inappropriate (ie, non-guideline-recommended) vs appropriate (ie, guideline-recommended) oral antibiotic agents dispensed from an outpatient pharmacy on the date of infection. MAIN OUTCOMES AND MEASURES Propensity score-weighted Cox proportional hazards models were used to estimate hazards ratios (HRs) and 95% CIs for the association between inappropriate antibiotic prescriptions and adverse drug events. Two-part models were used to calculate 30-day all-cause attributable health care expenditures by infection type. National-level annual attributable expenditures were calculated by scaling attributable expenditures in the study cohort to the national employer-sponsored insurance population. RESULTS The cohort included 2 804 245 eligible children (52% male; median [IQR] age, 8 [4-12] years). Overall, 31% to 36% received inappropriate antibiotics for bacterial infections and 4% to 70% for viral infections. Inappropriate antibiotics were associated with increased risk of several adverse drug events, including Clostridioides difficile infection and severe allergic reaction among children treated with a nonrecommended antibiotic agent for a bacterial infection (among patients with suppurative OM, C. difficile infection: HR, 6.23; 95% CI, 2.24-17.32; allergic reaction: HR, 4.14; 95% CI, 2.48-6.92). Thirty-day attributable health care expenditures were generally higher among children who received inappropriate antibiotics, ranging from $21 to $56 for bacterial infections and from -$96 to $97 for viral infections. National annual attributable expenditure estimates were highest for suppurative OM ($25.3 million), pharyngitis ($21.3 million), and viral URI ($19.1 million). CONCLUSIONS AND RELEVANCE In this cohort study of children with common infections treated in an outpatient setting, inappropriate antibiotic prescriptions were common and associated with increased risks of adverse drug events and higher attributable health care expenditures. These findings highlight the individual- and national-level consequences of inappropriate antibiotic prescribing and further support implementation of outpatient antibiotic stewardship programs.
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Affiliation(s)
- Anne M. Butler
- Division of Infectious Diseases, John T. Milliken Department of Medicine, Washington University School of Medicine, St Louis, Missouri
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St Louis, Missouri
| | | | - Michael J. Durkin
- Division of Infectious Diseases, John T. Milliken Department of Medicine, Washington University School of Medicine, St Louis, Missouri
| | - John M. Sahrmann
- Division of Infectious Diseases, John T. Milliken Department of Medicine, Washington University School of Medicine, St Louis, Missouri
| | - Katelin B. Nickel
- Division of Infectious Diseases, John T. Milliken Department of Medicine, Washington University School of Medicine, St Louis, Missouri
| | - Caroline A. O’Neil
- Division of Infectious Diseases, John T. Milliken Department of Medicine, Washington University School of Medicine, St Louis, Missouri
| | - Margaret A. Olsen
- Division of Infectious Diseases, John T. Milliken Department of Medicine, Washington University School of Medicine, St Louis, Missouri
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St Louis, Missouri
| | | | | | - Jason G. Newland
- Department of Pediatrics, Washington University School of Medicine, St Louis, Missouri
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37
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Vaz LE, Felder KK, Newland JG, Hersh AL, Rajapakse NS, Willis ZI, Banerjee R, Gerber JS, Schwenk HT, Wang ME. A National Survey of Outpatient Parenteral Antibiotic Therapy Practices. J Pediatric Infect Dis Soc 2022; 11:115-118. [PMID: 34939654 DOI: 10.1093/jpids/piab127] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 11/24/2021] [Indexed: 01/05/2023]
Abstract
We conducted a national survey of pediatric infectious diseases (ID) clinicians on outpatient parenteral antibiotic therapy (OPAT) practices and post-discharge ID follow-up. Only 15% of sites required ID consultation for all OPAT. ID division resources for post-discharge care varied. Opportunities exist to increase ID involvement in post-discharge management of serious infections.
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Affiliation(s)
- Louise E Vaz
- Department of Pediatrics, Oregon Health & Science University, Portland, Oregon, USA
| | - Kimberly K Felder
- Department of Pediatrics, Oregon Health & Science University, Portland, Oregon, USA
| | - Jason G Newland
- Department of Pediatrics, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Adam L Hersh
- Department of Pediatrics, Division of Infectious Diseases, University of Utah, Salt Lake City, Utah, USA
| | - Nipunie S Rajapakse
- Department of Pediatrics, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
| | - Zachary I Willis
- Department of Pediatrics, UNC School of Medicine, Chapel Hill, North Carolina, USA
| | - Ritu Banerjee
- Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Jeffrey S Gerber
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine and The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Hayden T Schwenk
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
| | - Marie E Wang
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
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38
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Williams DJ, Creech CB, Walter EB, Martin JM, Gerber JS, Newland JG, Howard L, Hofto ME, Staat MA, Oler RE, Tuyishimire B, Conrad TM, Lee MS, Ghazaryan V, Pettigrew MM, Fowler VG, Chambers HF, Zaoutis TE, Evans S, Huskins WC. Short- vs Standard-Course Outpatient Antibiotic Therapy for Community-Acquired Pneumonia in Children: The SCOUT-CAP Randomized Clinical Trial. JAMA Pediatr 2022; 176:253-261. [PMID: 35040920 PMCID: PMC8767493 DOI: 10.1001/jamapediatrics.2021.5547] [Citation(s) in RCA: 52] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
IMPORTANCE Childhood community-acquired pneumonia (CAP) is usually treated with 10 days of antibiotics. Shorter courses may be effective with fewer adverse effects and decreased potential for antibiotic resistance. OBJECTIVE To compare a short (5-day) vs standard (10-day) antibiotic treatment strategy for CAP in young children. DESIGN, SETTING, AND PARTICIPANTS Randomized double-blind placebo-controlled clinical trial in outpatient clinic, urgent care, or emergency settings in 8 US cities. A total of 380 healthy children aged 6 to 71 months with nonsevere CAP demonstrating early clinical improvement were enrolled from December 2, 2016, to December 16, 2019. Data were analyzed from January to September 2020. INTERVENTION On day 6 of their originally prescribed therapy, participants were randomized 1:1 to receive 5 days of matching placebo or 5 additional days of the same antibiotic. MAIN OUTCOMES AND MEASURES The primary end point was the end-of-treatment response adjusted for duration of antibiotic risk (RADAR), a composite end point that ranks each child's clinical response, resolution of symptoms, and antibiotic-associated adverse effects in an ordinal desirability of outcome ranking (DOOR). Within each DOOR rank, participants were further ranked by the number of antibiotic days, assuming that shorter antibiotic durations were more desirable. Using RADAR, the probability of a more desirable outcome was estimated for the short- vs standard-course strategy. In a subset of children, throat swabs were collected between study days 19 and 25 to quantify antibiotic resistance genes in oropharyngeal flora. RESULTS A total of 380 children (189 randomized to short course and 191 randomized to standard course) made up the study population. The mean (SD) age was 35.7 (17.2) months, and 194 participants (51%) were male. Of the included children, 8 were Asian, 99 were Black or African American, 234 were White, 32 were multiracial, and 7 were of unknown or unreported race; 33 were Hispanic or Latino, 344 were not Hispanic or Latino, and 3 were of unknown or unreported ethnicity. There were no differences between strategies in the DOOR or its individual components. Fewer than 10% of children in either strategy had an inadequate clinical response. The short-course strategy had a 69% (95% CI, 63-75) probability of a more desirable RADAR outcome compared with the standard-course strategy. A total of 171 children were included in the resistome analysis. The median (range) number of antibiotic resistance genes per prokaryotic cell (RGPC) was significantly lower in the short-course strategy compared with the standard-course strategy for total RGPC (1.17 [0.35-2.43] vs 1.33 [0.46-11.08]; P = .01) and β-lactamase RGPC (0.55 [0.18-1.24] vs 0.60 [0.21-2.45]; P = .03). CONCLUSIONS AND RELEVANCE In this study, among children responding to initial treatment for outpatient CAP, a 5-day antibiotic strategy was superior to a 10-day strategy. The shortened approach resulted in similar clinical response and antibiotic-associated adverse effects, while reducing antibiotic exposure and resistance. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02891915.
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Affiliation(s)
- Derek J. Williams
- Department of Pediatrics, Vanderbilt University School of Medicine, Monroe Carell Jr Children’s Hospital at Vanderbilt, Nashville, Tennessee
| | - C. Buddy Creech
- Department of Pediatrics, Vanderbilt University School of Medicine, Monroe Carell Jr Children’s Hospital at Vanderbilt, Nashville, Tennessee
| | - Emmanuel B. Walter
- Department of Pediatrics, Duke Human Vaccine Institute, Duke University School of Medicine, Durham, North Carolina
| | - Judith M. Martin
- Department of Pediatrics, University of Pittsburgh School of Medicine, the UPMC Children’s Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Jeffrey S. Gerber
- Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania,Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Jason G. Newland
- Department of Pediatrics, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Lee Howard
- University of Arkansas Medical School, Little Rock
| | - Meghan E. Hofto
- Department of Pediatrics, University of Alabama at Birmingham School of Medicine, Birmingham
| | - Mary A. Staat
- Cincinnati Children’s Hospital Medical Center, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | | | | | | | - Marina S. Lee
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
| | - Varduhi Ghazaryan
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
| | - Melinda M Pettigrew
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut
| | - Vance G. Fowler
- Department of Medicine, Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
| | - Henry F. Chambers
- Department of Medicine, University of California, San Francisco, San Francisco
| | - Theoklis E. Zaoutis
- Children’s Hospital of Philadelphia, Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Scott Evans
- Biostatistics Center, Milken Institute School of Public Health, George Washington University, Washington, DC
| | - W. Charles Huskins
- Mayo Clinic College of Medicine and Science, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota
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Janowski AB, Polgreen PM, Beekmann SE, Newland JG. Perceptions of risk of SARS-CoV-2 transmission in social and educational activities by infectious diseases and general pediatric healthcare providers, a pre-vaccine risk perception cross-sectional survey. PLoS One 2022; 17:e0263767. [PMID: 35148344 PMCID: PMC8836310 DOI: 10.1371/journal.pone.0263767] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 01/26/2022] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND The perception of the transmission risks of SARS-CoV-2 in social and educational settings by US healthcare providers have not been previously quantified. METHODS Respondents completed an online survey between September and October 2020 to estimate the risk of SARS-CoV-2 transmission on a scale of 0-10 for different social and educational activities prior to the availability of the SARS-CoV-2 vaccines. Demographic information and experiences during the pandemic were also collected. The risk assessment was emailed to three listservs of healthcare providers, including national listservs of pediatric (PID) and adult infectious diseases (AID) providers, and a listserv of general pediatric practitioners in the St Louis, USA metropolitan area. RESULTS Respondents identified the highest risk of SARS-CoV-2 transmission in spending time in a bar, eating at a restaurant, and attending an indoor sporting event. In the school setting, lower risk was identified in elementary and daycare students compared to high school or university-level students. Comparatively, the risk of transmission to students and teachers was lower than the identified high-risk social activities. Factors increasing risk perception in social activities included the absence of children in the respondent's household and female gender. For the school setting, AID providers perceived greater risk compared to PID providers or pediatric practitioners. CONCLUSIONS Respondents identified high risk activities that were associated with a high density of participants in an indoor space where masks are removed for eating and drinking. Differences were apparent in the school setting where pediatric providers perceived lower risks when compared to adult providers.
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Affiliation(s)
- Andrew B. Janowski
- Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri, United States of America
- * E-mail:
| | - Philip M. Polgreen
- Department of Internal Medicine, The University of Iowa, Iowa City, Iowa, United States of America
| | - Susan E. Beekmann
- Department of Internal Medicine, The University of Iowa, Iowa City, Iowa, United States of America
| | - Jason G. Newland
- Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri, United States of America
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40
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McLaughlin HP, Worrell MC, Malone S, Dawson P, Maricque B, Halpin JL, Lee S, Fritz SA, Tinker SC, Neidich JA, Towns K, Lee JS, Barrios LC, Neatherlin JC, Newland JG, Salzer JS. Acceptance of Saliva-Based Specimen Collection for SARS-CoV-2 Testing Among K-12 Students, Teachers, and Staff. Public Health Rep 2022; 137:557-563. [PMID: 35137643 PMCID: PMC9109545 DOI: 10.1177/00333549221074395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
OBJECTIVE Saliva specimens collected in school populations may offer a more feasible, noninvasive alternative to nasal swabs for large-scale COVID-19 testing efforts in kindergarten through 12th grade (K-12) schools. We investigated acceptance of saliva-based COVID-19 testing among quarantined K-12 students and their parents, teachers, and staff members who recently experienced a SARS-CoV-2 exposure in school. METHODS We surveyed 719 participants, in person or by telephone, who agreed to or declined a free saliva-based COVID-19 reverse-transcription polymerase chain reaction test as part of a surveillance investigation about whether they would have consented to testing if offered a nasal swab instead. We conducted this investigation in 6 school districts in Greene County (n = 3) and St. Louis County (n = 3), Missouri, from January 25 through March 23, 2021. RESULTS More than one-third (160 of 446) of K-12 students (or their parents or guardians), teachers, and staff members who agreed to a saliva-based COVID-19 test indicated they would have declined testing if specimen collection were by nasal swab. When stratified by school level, 51% (67 of 132) of elementary school students or their parents or guardians would not have agreed to testing if a nasal swab was offered. CONCLUSIONS Some students, especially those in elementary school, preferred saliva-based COVID-19 testing to nasal swab testing. Use of saliva-based testing might increase voluntary participation in screening efforts in K-12 schools to help prevent the spread of SARS-CoV-2.
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Affiliation(s)
- Heather P. McLaughlin
- COVID-19 Response Team, Centers for
Disease Control and Prevention, Atlanta, GA, USA,Heather P. McLaughlin, PhD, Centers for
Disease Control and Prevention, 1600 Clifton Rd NE, Atlanta, GA 30329, USA.
| | - Mary Claire Worrell
- COVID-19 Response Team, Centers for
Disease Control and Prevention, Atlanta, GA, USA
| | - Sara Malone
- Washington University in St. Louis, St.
Louis, MO, USA
| | - Patrick Dawson
- COVID-19 Response Team, Centers for
Disease Control and Prevention, Atlanta, GA, USA,Epidemic Intelligence Service, Centers
for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Jessica L. Halpin
- COVID-19 Response Team, Centers for
Disease Control and Prevention, Atlanta, GA, USA
| | - Sooji Lee
- COVID-19 Response Team, Centers for
Disease Control and Prevention, Atlanta, GA, USA
| | | | - Sarah C. Tinker
- COVID-19 Response Team, Centers for
Disease Control and Prevention, Atlanta, GA, USA
| | | | - Katie Towns
- Springfield-Greene County Health
Department, Springfield, MO, USA
| | - Justin S. Lee
- COVID-19 Response Team, Centers for
Disease Control and Prevention, Atlanta, GA, USA
| | - Lisa C. Barrios
- COVID-19 Response Team, Centers for
Disease Control and Prevention, Atlanta, GA, USA
| | - John C. Neatherlin
- COVID-19 Response Team, Centers for
Disease Control and Prevention, Atlanta, GA, USA
| | | | - Johanna S. Salzer
- COVID-19 Response Team, Centers for
Disease Control and Prevention, Atlanta, GA, USA
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41
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Haroz EE, Kalb LG, Newland JG, Goldman JL, Mast DK, Ko LK, Grass R, Shah P, Walsh T, Schuster JE. Implementation of School-Based COVID-19 Testing Programs in Underserved Populations. Pediatrics 2022; 149:e2021054268G. [PMID: 34737173 PMCID: PMC9647741 DOI: 10.1542/peds.2021-054268g] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/20/2021] [Indexed: 02/03/2023] Open
Abstract
Evidence suggests that coronavirus disease 2019 (COVID-19) testing in schools can add a layer of protection to reduce the spread of Severe Acute Respiratory Syndrome Coronavirus 2 and facilitate a safer return to in-person learning. Despite this evidence, implementation of testing in school settings has been challenging initially because of a lack of funding and limited availability of testing, but, as the pandemic has progressed and more funding and resources have been devoted to testing, other implementation challenges have arisen. We describe key implementation barriers and strategies that have been operationalized across 5 projects working to help schools with predominantly underserved populations who have faced significant COVID-19-related health disparities. We leveraged a key framework from the implementation science field to identify the challenges and used a matching tool to align implementation strategies to these challenges. Our findings suggest that the biggest obstacles to COVID-19 testing were the perceived relative advantages versus burden of COVID-19 testing, limited engagement with the target beneficiaries (eg, families, students, staff), and innovation complexity. Common strategies to overcome these challenges included identifying and preparing testing champions, altering incentive and allowance structures, assessing for readiness, and identifying barriers and facilitators. We aim to augment existing implementation guidance for schools by describing common barriers and recommended solutions from the implementation science field. Our results indicate a clear need to provide implementation support to schools to facilitate COVID-19 testing as an added layered mitigation strategy.
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Affiliation(s)
- Emily E. Haroz
- Johns Hopkins Center for American Indian Health, Baltimore, Maryland
| | - Luther G. Kalb
- Kennedy Krieger Institute, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | | | | | | | - Linda K. Ko
- University of Washington, Seattle, Washington
- Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Ryan Grass
- Johns Hopkins Center for American Indian Health, Baltimore, Maryland
| | - Parth Shah
- Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Tyler Walsh
- Washington University in St Louis, St Louis, Missouri
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42
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Sherby MR, Kalb LG, Coller RJ, DeMuri GP, Butteris S, Foxe JJ, Zand MS, Freedman EG, Dewhurst S, Newland JG, Gurnett CA. Supporting COVID-19 School Safety for Children With Disabilities and Medical Complexity. Pediatrics 2022; 149:e2021054268H. [PMID: 34737172 PMCID: PMC8926067 DOI: 10.1542/peds.2021-054268h] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/20/2021] [Indexed: 02/03/2023] Open
Abstract
Children with intellectual and developmental disabilities (IDDs) and children with medical complexity (CMC) have been disproportionally impacted by the coronavirus disease 2019 pandemic, including school closures. Children with IDDs and CMC rely on schools for a vast array of educational, therapeutic, medical, and social needs. However, maintaining safe schools for children with IDDs and CMC during the coronavirus disease 2019 pandemic may be difficult because of the unique challenges of implementing prevention strategies, such as masking, social distancing, and hand hygiene in this high-risk environment. Furthermore, children with IDDs and CMC are at a higher risk of infectious complications and mortality, underscoring the need for effective mitigation strategies. The goal of this report is to describe the implementation of several screening testing models for severe acute respiratory syndrome coronavirus 2 in this high-risk population. By describing these models, we hope to identify generalizable and scalable approaches to facilitate safe school operations for children with IDDs and CMC during the current and future pandemics.
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Affiliation(s)
| | - Luther G. Kalb
- Kennedy Krieger Institute, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | | | | | | | - John J. Foxe
- School of Medicine and Dentistry, University of Rochester, Rochester, New York
| | - Martin S. Zand
- School of Medicine and Dentistry, University of Rochester, Rochester, New York
| | - Edward G. Freedman
- School of Medicine and Dentistry, University of Rochester, Rochester, New York
| | - Stephen Dewhurst
- School of Medicine and Dentistry, University of Rochester, Rochester, New York
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43
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Zimmerman KO, Goldman JL, Schuster JE, Mena A, Quiriconi M, Butteris SM, Koval S, DeMuri GP, Mueller NB, Benjamin DK, Armstrong SC, Kalu IC, Boutzoukas A, Moorthy GS, Lane H, Weber DJ, Newland JG. Building a National Framework to Pair Scientists and Schools During a Global Pandemic. Pediatrics 2022; 149:e2021054268D. [PMID: 34737179 PMCID: PMC9647736 DOI: 10.1542/peds.2021-054268d] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/20/2021] [Indexed: 02/03/2023] Open
Abstract
The coronavirus disease 2019 (COVID-19) pandemic forced the suspension of in-person education in schools serving students in kindergarten through 12th grade (K-12) across the United States. As time passed, teachers, students, and parents struggled with remote education. With limited guidance at the federal level, physicians and school leaders across the country collaborated to develop local solutions for schools. This article describes the lessons learned from the development of 4 academic-community partnerships and collaboration among these partnerships to provide national leadership on managing COVID-19 mitigation in the K-12 environment. In addition, we describe a pathway forward for using academic-community partnerships to improve child health.
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Affiliation(s)
- Kanecia O. Zimmerman
- Departments of Pediatrics
- Duke Clinical Research Institute, School of Medicine, Durham, North Carolina
- The ABC Science Collaborative, Durham, North Carolina
| | - Jennifer L. Goldman
- Department of Infectious Diseases, Children’s Mercy Kansas City, Kansas City, Missouri
| | - Jennifer E. Schuster
- Department of Infectious Diseases, Children’s Mercy Kansas City, Kansas City, Missouri
| | - Atenas Mena
- Children’s Mercy Kansas City, Kansas City, Missouri
| | | | - Sabrina M. Butteris
- Department of Pediatrics, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin
| | - Shawn Koval
- Healthy Kids Collaborative, University of Wisconsin Health, Madison, Wisconsin
| | - Gregory P. DeMuri
- Department of Infectious Diseases, Children’s Mercy Kansas City, Kansas City, Missouri
| | - Nancy B. Mueller
- Brown School Evaluation Center, Washington University in St Louis, St Louis, Missouri
| | - Daniel K. Benjamin
- Departments of Pediatrics
- Duke Clinical Research Institute, School of Medicine, Durham, North Carolina
- The ABC Science Collaborative, Durham, North Carolina
| | - Sarah C. Armstrong
- Departments of Pediatrics
- Duke Clinical Research Institute, School of Medicine, Durham, North Carolina
- The ABC Science Collaborative, Durham, North Carolina
| | - Ibukunoluwa C. Kalu
- Departments of Pediatrics
- The ABC Science Collaborative, Durham, North Carolina
| | - Angelique Boutzoukas
- Departments of Pediatrics
- Duke Clinical Research Institute, School of Medicine, Durham, North Carolina
- The ABC Science Collaborative, Durham, North Carolina
| | | | - Hannah Lane
- Population Health Sciences, School of Medicine, Duke University, Durham, North Carolina
| | - David J. Weber
- Departments of Internal Medicine and Pediatrics, Division of Infectious Diseases, University of North Carolina, Chapel Hill, North Carolina
| | - Jason G. Newland
- Department of Pediatrics, Washington University in St Louis, St Louis, Missouri
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44
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Hartman ME, Anabayan I, Jwa B, Pineda JA, Steed A, Newland JG, Friess SH. Early Antibiotic Exposure in Severe Pediatric Traumatic Brain Injury. J Pediatric Infect Dis Soc 2021:piab087. [PMID: 34555169 DOI: 10.1093/jpids/piab087] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Mary E Hartman
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Ilakkia Anabayan
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Brian Jwa
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Jose A Pineda
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Southern California Keck School of Medicine, Los Angeles, California, USA
| | - Ashley Steed
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Jason G Newland
- Division of Infectious Diseases, Department of Pediatrics, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Stuart H Friess
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Washington University in St. Louis, St. Louis, Missouri, USA
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Sherby MR, Walsh TJ, Lai AM, Neidich JA, Balls-Berry JE, Morris SM, Head R, Prener CG, Newland JG, Gurnett CA. SARS-CoV-2 screening testing in schools for children with intellectual and developmental disabilities. J Neurodev Disord 2021; 13:31. [PMID: 34465306 PMCID: PMC8407928 DOI: 10.1186/s11689-021-09376-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 08/03/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Transmission of SARS-CoV-2 in schools primarily for typically developing children is rare. However, less is known about transmission in schools for children with intellectual and developmental disabilities (IDD), who are often unable to mask or maintain social distancing. The objectives of this study were to determine SARS-CoV-2 positivity and in-school transmission rates using weekly screening tests for school staff and students and describe the concurrent deployment of mitigation strategies in six schools for children with IDD. METHODS From November 23, 2020, to May, 28, 2021, weekly voluntary screening for SARS-CoV-2 with a high sensitivity molecular-based saliva test was offered to school staff and students. Weekly positivity rates were determined and compared to local healthcare system and undergraduate student screening data. School-based transmission was assessed among participants quarantined for in-school exposure. School administrators completed a standardized survey to assess school mitigation strategies. RESULTS A total of 59 students and 416 staff participated. An average of 304 school staff and students were tested per week. Of 7289 tests performed, 21 (0.29%) new SARS-CoV-2 positive cases were identified. The highest weekly positivity rate was 1.2% (n = 4) across all schools, which was less than community positivity rates. Two cases of in-school transmission were identified, each among staff, representing 2% (2/103) of participants quarantined for in-school exposure. Mitigation strategies included higher than expected student mask compliance, reduced room capacity, and phased reopening. CONCLUSIONS During 24 weeks that included the peak of the COVID-19 pandemic in winter 2020-21, we found lower rates of SARS-CoV-2 screening test positivity among staff and students of six schools for children with IDD compared to community rates. In-school transmission of SARS-CoV-2 was low among those quarantined for in-school exposure. However, the impact of the emerging SARS-CoV-2 Delta variant on the effectiveness of these proven mitigation strategies remains unknown. TRIAL REGISTRATION Prior to enrollment, this study was registered at ClinicalTrials.gov on September 25, 2020, identifier NCT04565509 , titled Supporting the Health and Well-being of Children with Intellectual and Developmental Disability During COVID-19 Pandemic.
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Affiliation(s)
- Michael R Sherby
- Department of Neurology, Division of Pediatric and Developmental Neurology, Washington University in St. Louis, 660 S. Euclid Avenue Campus, Box 8111, St. Louis, MO, 63110, USA
| | - Tyler J Walsh
- Department of Pediatrics, Division of Pediatric Infectious Diseases, Washington University in St. Louis, St. Louis, MO, USA
| | - Albert M Lai
- Department of Medicine, Washington University in St. Louis, St. Louis, MO, USA
| | - Julie A Neidich
- Department of Pathology and Immunology, Washington University in St. Louis, St. Louis, MO, USA
| | - Joyce E Balls-Berry
- Department of Neurology, Division of Memory and Aging, Washington University in St. Louis, St. Louis, MO, USA
| | - Stephanie M Morris
- Department of Neurology, Division of Pediatric and Developmental Neurology, Washington University in St. Louis, 660 S. Euclid Avenue Campus, Box 8111, St. Louis, MO, 63110, USA
| | - Richard Head
- Department of Genetics, Washington University in St. Louis, St. Louis, MO, USA
| | - Christopher G Prener
- Department of Sociology and Anthropology, Saint Louis University, St. Louis, MO, USA
| | - Jason G Newland
- Department of Pediatrics, Division of Pediatric Infectious Diseases, Washington University in St. Louis, St. Louis, MO, USA
| | - Christina A Gurnett
- Department of Neurology, Division of Pediatric and Developmental Neurology, Washington University in St. Louis, 660 S. Euclid Avenue Campus, Box 8111, St. Louis, MO, 63110, USA.
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Plattner AS, Newland JG, Wallendorf MJ, Shakhsheer BA. Management and Microbiology of Perforated Appendicitis in Pediatric Patients: A 5-Year Retrospective Study. Infect Dis Ther 2021; 10:2247-2257. [PMID: 34287780 PMCID: PMC8572942 DOI: 10.1007/s40121-021-00502-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 07/12/2021] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION This study aims to assess the current epidemiology and microbiology of perforated appendicitis, how antibiotic choice and duration correlate with meaningful clinical outcomes, and whether serial white blood cell (WBC) counts provide clinical value. METHODS Five-year retrospective cohort study, 2015-2019, among 333 consecutive children, ages 0-18 years, treated at St. Louis Children's Hospital for perforated appendicitis. Main outcomes included length of stay (LOS), postoperative abscess formation, and readmission. Statistical analysis was performed with uni- and multi-variate analyses. RESULTS Intra-abdominal cultures most commonly grew Bacteroides fragilis (52%) and Escherichia coli (50%). Patients who initially received broad-spectrum antibiotics (meropenem, piperacillin-tazobactam, fourth-generation cephalosporins) for perforated appendicitis had greater rates of postoperative abscess formation (25% vs. 12%, p < 0.01) and LOS (7.0 vs. 5.7 days, p < 0.01). Similarly, antibiotics at time of discharge were associated with greater postoperative abscess formation (22% vs. 9%, p < 0.01) and LOS (6.4 vs. 5.6 days, p = 0.02). However, discharge with strictly oral antibiotics was not correlated with greater LOS, postoperative abscess formation, or readmission rates compared to discharge without antibiotics. Serial WBC counts had no predictive value for LOS, postoperative abscess formation, or readmission. CONCLUSIONS Bacteroides fragilis and E. coli were the most common intra-abdominal microbes for perforated appendicitis among our cohort. In non-critically ill children, the routine use of broad-spectrum antibiotics or continuation of antibiotics beyond discharge was not correlated with improved clinical outcomes. Additionally, WBC counts were not correlated with meaningful clinical outcomes.
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Affiliation(s)
- Alex S Plattner
- Division of Infectious Diseases, Department of Pediatrics, Washington University in St Louis School of Medicine, St Louis, MO, USA
| | - Jason G Newland
- Division of Infectious Diseases, Department of Pediatrics, Washington University in St Louis School of Medicine, St Louis, MO, USA
| | - Michael J Wallendorf
- Division of Biostatistics, Washington University in St Louis School of Medicine, St Louis, MO, USA
| | - Baddr A Shakhsheer
- Division of Pediatric Surgery, Department of Surgery, Washington University in St Louis School of Medicine, 1 Children's Place, Suite 6110-CB 8235, St Louis, MO, 63110, USA.
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Sherby MR, Walsh T, Lai AM, Neidich JA, Balls-Berry JE, Morris SM, Head R, Prener C, Newland JG, Gurnett CA. SARS-CoV-2 Screening Testing in Schools for Children with Intellectual and Developmental Disabilities. Res Sq 2021:rs.3.rs-700296. [PMID: 34312616 PMCID: PMC8312901 DOI: 10.21203/rs.3.rs-700296/v1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUNDTransmission of SARS-CoV-2 in schools primarily for typically developing children is rare. However, less is known about transmission in schools for children with intellectual and developmental disabilities (IDD), who are often unable to mask or maintain social distancing. The objectives of this study were to determine SARS-CoV-2 positivity and in-school transmission rates using weekly screening tests for school staff and students and describe the concurrent deployment of mitigation strategies in six schools for children with IDD.METHODSFrom 11/23/20 to 5/28/21, weekly voluntary screening for SARS-CoV-2 with a high sensitivity molecular-based saliva test was offered to school staff and students. Weekly positivity rates were determined and compared to local healthcare system and undergraduate student screening data. School-based transmission was assessed among participants quarantined for in-school exposure. School administrators completed a standardized survey to assess school mitigation strategies.RESULTSA total of 59 students and 416 staff participated. An average of 304 school staff and students were tested per week. Of 7,289 tests performed, 21 (0.29%) new SARS-CoV-2 positive cases were identified. The highest weekly positivity rate was 1.2% (n = 4) across all schools, which was less than community positivity rates. Two cases of in-school transmission were identified, each among staff, representing 2% (2/103) of participants quarantined for in-school exposure. Mitigation strategies included higher than expected student mask compliance, reduced room capacity, and phased reopening.CONCLUSIONSDuring 24 weeks that included the peak of the COVID-19 pandemic, we found no evidence for elevated SARS-CoV-2 screening test positivity among staff and students of six schools for children with IDD compared to community rates. In-school transmission of SARS-CoV-2 was low among those quarantined for in-school exposure.Clinical Trial RegistryPrior to enrollment, this study was registered at ClinicalTrials.gov on 9/25/2020, identifier NCT04565509, titled Supporting the Health and Well-being of Children with Intellectual and Developmental Disability During COVID-19 Pandemic (https://clinicaltrials.gov/ct2/show/NCT04565509?term=NCT04565509).
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Affiliation(s)
| | - Tyler Walsh
- Washington University in St Louis School of Medicine
| | - Albert M Lai
- Washington University in St Louis School of Medicine
| | | | | | | | - Richard Head
- Washington University in St Louis School of Medicine
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Gandra S, Ranga SK, Hendrixson DT, Nayakanti RR, Newland JG, Alvarez-Uria G, Jinka DR. Association of Intrapartum Risk Factors and Infant Clinical Indicators with Culture Confirmed Early Onset Neonatal Sepsis in a Secondary Care Rural Hospital in India. J Trop Pediatr 2021; 67:5897679. [PMID: 32853356 DOI: 10.1093/tropej/fmaa061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE The aim of this study is to determine the association of intrapartum risk factors and infant clinical indicators using the National Institute for Health and Care Excellence (NICE) criteria with culture-positive early-onset neonatal sepsis (EONS) from a rural secondary healthcare facility where intrapartum prophylactic antibiotics are routinely administered to high-risk mothers. METHODS A single-center prospective observational study was conducted between July 2017 and September 2018. All intramural neonates with at least one NICE criteria at less than 72 h of life, were included. Univariate logistic regression and multivariable logistic backward elimination analyses were conducted to investigate individual risk factors and predictive models for culture proven EONS. RESULTS Of 236 newborns who were at risk for EONS by NICE criteria, 32 (13.8%) had positive blood cultures. Klebsiella species (n = 13, 39.4%) and Acinetobacter species (n = 11, 33.3%) were the most common isolated bacteria. In univariate analysis, the number of infant clinical indicators were associated with culture positive EONS (OR 1.36; 95% CI 1.01-1.81), but not the number of intrapartum risk factors (OR 0.76; 95% CI 0.4-1.29). The multivariate logistic regression with backward elimination procedure suggested that a model including absolute neutrophil count [adjusted OR (aOR) 0.81; 95% CI 0.72-0.92], C-reactive protein (aOR 1.24; 95% CI 1.08-1.43) and the number of clinical indicators (aOR 1.29; 95% CI 0.93-1.80) could be useful to predict culture positive EONS in our setting. CONCLUSION In this maternal and neonatal cohort, infant clinical indicators rather than intrapartum risk factors were associated with culture confirmed EONS.
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Affiliation(s)
- Sumanth Gandra
- Department of Medicine, Division of Infectious Diseases, Washington University School of Medicine in St. Louis, St. Louis, MO 63110, USA
| | - Shravan K Ranga
- Department of Pediatrics, Rural Development Trust Hospital, Bathalapalle, Andhra Pradesh 515661, India
| | - D Taylor Hendrixson
- Department of Pediatrics, Division of Pediatric Infectious Diseases, Washington University School of Medicine in St. Louis, St. Louis, MO 63110, USA
| | - Raghuprakash R Nayakanti
- Department of Microbiology, Clinical Microbiology Laboratory, Rural Development Trust Hospital, Bathalapalle, Andhra Pradesh 515611, India
| | - Jason G Newland
- Department of Pediatrics, Division of Pediatric Infectious Diseases, Washington University School of Medicine in St. Louis, St. Louis, MO 63110, USA
| | - Gerardo Alvarez-Uria
- Division of Infectious Diseases, Rural Development Trust Hospital, Bathalapalle, Andhra Pradesh 515611, India *These authors contributed equally to this work
| | - Dasaratha R Jinka
- Department of Pediatrics, Rural Development Trust Hospital, Bathalapalle, Andhra Pradesh 515661, India
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Tribble AC, Lee BR, Flett KB, Handy LK, Gerber JS, Hersh AL, Kronman MP, Terrill CM, Sharland M, Newland JG. Appropriateness of Antibiotic Prescribing in United States Children's Hospitals: A National Point Prevalence Survey. Clin Infect Dis 2021; 71:e226-e234. [PMID: 31942952 DOI: 10.1093/cid/ciaa036] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Accepted: 01/13/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Studies estimate that 30%-50% of antibiotics prescribed for hospitalized patients are inappropriate, but pediatric data are limited. Characterization of inappropriate prescribing practices for children is needed to guide pediatric antimicrobial stewardship. METHODS Cross-sectional analysis of antibiotic prescribing at 32 children's hospitals in the United States. Subjects included hospitalized children with ≥ 1 antibiotic order at 8:00 am on 1 day per calendar quarter, over 6 quarters (quarter 3 2016-quarter 4 2017). Antimicrobial stewardship program (ASP) physicians and/or pharmacists used a standardized survey to collect data on antibiotic orders and evaluate appropriateness. The primary outcome was the percentage of antibiotics prescribed for infectious use that were classified as suboptimal, defined as inappropriate or needing modification. RESULTS Of 34 927 children hospitalized on survey days, 12 213 (35.0%) had ≥ 1 active antibiotic order. Among 11 784 patients receiving antibiotics for infectious use, 25.9% were prescribed ≥ 1 suboptimal antibiotic. Of the 17 110 antibiotic orders prescribed for infectious use, 21.0% were considered suboptimal. Most common reasons for inappropriate use were bug-drug mismatch (27.7%), surgical prophylaxis > 24 hours (17.7%), overly broad empiric therapy (11.2%), and unnecessary treatment (11.0%). The majority of recommended modifications were to stop (44.7%) or narrow (19.7%) the drug. ASPs would not have routinely reviewed 46.1% of suboptimal orders. CONCLUSIONS Across 32 children's hospitals, approximately 1 in 3 hospitalized children are receiving 1 or more antibiotics at any given time. One-quarter of these children are receiving suboptimal therapy, and nearly half of suboptimal use is not captured by current ASP practices.
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Affiliation(s)
- Alison C Tribble
- Department of Pediatrics, Division of Pediatric Infectious Diseases, University of Michigan, Ann Arbor, Michigan, USA
| | - Brian R Lee
- Department of Pediatrics, Division of Health Services and Outcomes Research, Children's Mercy Kansas City, Kansas City, Missouri, USA
| | - Kelly B Flett
- Novant Health Eastover Pediatrics, Charlotte, North Carolina, USA
| | - Lori K Handy
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Division of Infectious Diseases, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Jeffrey S Gerber
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Division of Infectious Diseases, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Adam L Hersh
- Department of Pediatrics, Division of Pediatric Infectious Diseases, University of Utah, Salt Lake City, Utah, USA
| | - Matthew P Kronman
- Department of Pediatrics, Division of Pediatric Infectious Diseases, University of Washington, Seattle, Washington, USA
| | - Cindy M Terrill
- Department of Pediatrics, Division of Pediatric Infectious Diseases, Washington University in St Louis, St Louis, Missouri, USA
| | - Mike Sharland
- Paediatric Infectious Disease Research Group, Institute of Infection and Immunity, St George's University of London, London, United Kingdom
| | - Jason G Newland
- Department of Pediatrics, Division of Pediatric Infectious Diseases, Washington University in St Louis, St Louis, Missouri, USA
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Dawson P, Worrell MC, Malone S, Tinker SC, Fritz S, Maricque B, Junaidi S, Purnell G, Lai AM, Neidich JA, Lee JS, Orscheln RC, Charney R, Rebmann T, Mooney J, Yoon N, Petit M, Schmidt S, Grabeel J, Neill LA, Barrios LC, Vallabhaneni S, Williams RW, Goddard C, Newland JG, Neatherlin JC, Salzer JS. Pilot Investigation of SARS-CoV-2 Secondary Transmission in Kindergarten Through Grade 12 Schools Implementing Mitigation Strategies - St. Louis County and City of Springfield, Missouri, December 2020. MMWR Morb Mortal Wkly Rep 2021; 70:449-455. [PMID: 33764961 PMCID: PMC7993558 DOI: 10.15585/mmwr.mm7012e4] [Citation(s) in RCA: 54] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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