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Donovan A, Quilty R, Joy BK, Seddigh S, Coatsworth H, Gauthier L, Comeau JL, Lang B, Leblanc J, Hatchette T, Stringer E. Retrospective validation of a rapid Lyme fluorescent immunoassay in differentiating Lyme arthritis from other musculoskeletal presentations in children in a Lyme-endemic region. Microbiol Spectr 2024:e0359323. [PMID: 38682930 DOI: 10.1128/spectrum.03593-23] [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] [Received: 11/17/2023] [Accepted: 03/12/2024] [Indexed: 05/01/2024] Open
Abstract
Lyme arthritis can present similarly to other causes of joint pain and swelling including septic arthritis and other acute and chronic arthropathies of childhood. Septic arthritis, although rare, constitutes an orthopedic emergency and requires early surgical intervention to reduce the risk of permanent joint damage. Currently, results of standard serologic tests to diagnose Lyme disease take days to weeks, which is unhelpful in acute clinical decision-making. Thus, some children with Lyme arthritis are treated empirically for septic arthritis undergoing unnecessary invasive procedures and hospital admission while on inappropriate antibiotic therapy. We retrospectively validated the Quidel Sofia Lyme Fluorescent Immunoassay, a rapid serologic assay that can detect IgG and/or IgM antibodies to Borrelia burgdorferi in 10 minutes, in residual serum samples collected from 51 children who had Lyme arthritis and 55 children with musculoskeletal presentations who were Lyme negative. The sensitivity and specificity of the Sofia IgG to identify cases of Lyme arthritis in children were 100% (95% confidence interval [CI] of 93.0%-100%) and 96.4% (95% CI: 87.5%-99.6%), respectively. The positive likelihood ratio (LR) was 27.5 (95% CI 7-107), and the negative LR was 0.00 (95% LR 0.00-0.15). We propose that the Sofia IgG, a rapid method for identifying Lyme arthritis, may be useful in differentiating Lyme arthritis from other forms of arthritis. Used in conjunction with readily available clinical and laboratory variables, it could help to rapidly identify children who are at low risk of septic arthritis in Lyme-endemic regions. IMPORTANCE Lyme arthritis is a common manifestation of Lyme disease in children, with clinical features overlapping with other causes of acute and chronic joint pain/swelling in children. We have demonstrated that the Sofia IgG is a reliable test to rule in and rule out the diagnosis of Lyme arthritis in children with musculoskeletal presentations in a Lyme-endemic region. When used in conjunction with clinical and laboratory variables routinely considered when differentiating Lyme arthritis from other diagnoses, the Sofia IgG has the potential to fill an important gap in care, especially when acute decision-making is necessary. The Sofia IgG should be included in prospective research studies examining clinical prediction tools to identify children at low risk of septic arthritis.
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Affiliation(s)
| | - Rebecca Quilty
- The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Bryn K Joy
- Dalhousie University, Halifax, Nova Scotia, Canada
| | - Shahriar Seddigh
- Division of Orthopedic Surgery, Nova Scotia Health, Halifax, Canada
| | - Heather Coatsworth
- National Microbiology Laboratory Branch, Public Health Agency of Canada, Winnipeg, Manitoba, Canada
| | - Luke Gauthier
- Division of Orthopedic Surgery, IWK Health, Halifax, Nova Scotia, Canada
| | - Jeannette L Comeau
- Division of Pediatric Infectious Diseases, IWK Health, Halifax, Nova Scotia, Canada
| | - Bianca Lang
- Division of Pediatric Rheumatology, IWK Health, Halifax, Nova Scotia, Canada
| | - Jason Leblanc
- Department of Pathology and Laboratory Medicine, Nova Scotia Health, Halifax, Canada
| | - Todd Hatchette
- Department of Pathology and Laboratory Medicine, Nova Scotia Health, Halifax, Canada
| | - Elizabeth Stringer
- Division of Pediatric Rheumatology, IWK Health, Halifax, Nova Scotia, Canada
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MacKinnon HM, Slayter KL, Comeau JL, King C, Black EK. Evaluating the impact of incorporating clinical practice guidelines for the management of infectious diseases into an electronic application (e-app). Infect Control Hosp Epidemiol 2023; 44:1417-1422. [PMID: 36594425 PMCID: PMC10507496 DOI: 10.1017/ice.2022.286] [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: 08/10/2022] [Revised: 10/06/2022] [Accepted: 11/01/2022] [Indexed: 01/04/2023]
Abstract
OBJECTIVES To improve dissemination and accessibility of guidelines to healthcare providers at our institution, guidance for infectious syndromes was incorporated into an electronic application (e-app). The objective of this study was to compare empiric antimicrobial prescribing before and after implementation of the e-app. DESIGN This study was a before-and-after trial. SETTING A tertiary-care, public hospital in Halifax, Canada. PARTICIPANTS This study included pediatric patients admitted to hospital who were empirically prescribed an antibiotic for an infectious syndrome listed in the e-app. METHODS Data were collected from medical records. Prescribing was independently assessed considering patient-specific characteristics using a standardized checklist by 2 members of the research team. Assessments of antimicrobial prescribing were compared, and discrepancies were resolved through discussion. Empiric antimicrobial prescribing before and after implementation of the e-app was compared using interrupted time-series analysis. RESULTS In total, 237 patients were included in the preimplementation arm and 243 patients were included in the postimplementation arm. Pneumonia (23.8%), appendicitis (19.2%), and sepsis (15.2%) were the most common indications for antimicrobial use. Empiric antimicrobial use was considered optimal in 195 (81.9%) of 238 patients before implementation compared to 226 (93.0%) 243 patients after implementation. An immediate 15.5% improvement (P = .019) in optimal antimicrobial prescribing was observed following the implementation of the e-app. CONCLUSIONS Empiric antimicrobial prescribing for pediatric patients with infectious syndromes improved after implementation of an e-app for dissemination of clinical practice guidelines. The use of e-apps may also be an effective strategy to improve antimicrobial use in other patient populations.
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Affiliation(s)
- Holly M. MacKinnon
- Dalhousie University, Halifax, Canada
- IWK Health, Halifax, Canada
- Lawton’s Drugs, Halifax, Canada
| | | | | | | | - Emily K. Black
- Dalhousie University, Halifax, Canada
- IWK Health, Halifax, Canada
- Nova Scotia Health, Halifax, Canada
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Choi KB, Du T, Silva A, Golding GR, Pelude L, Mitchell R, Rudnick W, Hizon R, Al-Rawahi GN, Chow B, Davis I, Evans GA, Frenette C, Johnstone J, Kibsey P, Katz KC, Langley JM, Lee BE, Longtin Y, Mertz D, Minion J, Science M, Srigley JA, Stagg P, Suh KN, Thampi N, Wong A, Comeau JL, Hota SS. Trends in Clostridioides difficile infection rates in Canadian hospitals during the coronavirus disease 2019 (COVID-19) pandemic. Infect Control Hosp Epidemiol 2023; 44:1180-1183. [PMID: 35978535 PMCID: PMC9433867 DOI: 10.1017/ice.2022.210] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 07/28/2022] [Accepted: 08/03/2022] [Indexed: 11/06/2022]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has placed significant burden on healthcare systems. We compared Clostridioides difficile infection (CDI) epidemiology before and during the pandemic across 71 hospitals participating in the Canadian Nosocomial Infection Surveillance Program. Using an interrupted time series analysis, we showed that CDI rates significantly increased during the COVID-19 pandemic.
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Affiliation(s)
- Kelly B. Choi
- Public Health Agency of Canada, Ottawa, Ontario, Canada
| | - Tim Du
- National Microbiology Laboratory, Winnipeg, Manitoba, Canada
| | - Anada Silva
- Public Health Agency of Canada, Ottawa, Ontario, Canada
| | | | - Linda Pelude
- Public Health Agency of Canada, Ottawa, Ontario, Canada
| | | | | | - Romeo Hizon
- National Microbiology Laboratory, Winnipeg, Manitoba, Canada
| | - Ghada N Al-Rawahi
- British Columbia Children’s Hospital, Vancouver, British Columbia, Canada
| | - Blanda Chow
- Alberta Health Services, Calgary, Alberta, Canada
| | - Ian Davis
- Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia, Canada
| | | | | | | | - Pamela Kibsey
- Royal Jubilee Hospital, Victoria, British Columbia, Canada
| | - Kevin C. Katz
- North York General Hospital, Toronto, Ontario, Canada
| | - Joanne M. Langley
- Dalhousie University, Halifax, Nova Scotia, Canada
- IWK Health Centre, Halifax, Nova Scotia, Canada
| | - Bonita E. Lee
- Stollery Children’s Hospital, Edmonton, Alberta, Canada
| | - Yves Longtin
- Jewish General Hospital, Montréal, Quebec, Canada
| | | | | | | | | | - Paula Stagg
- Western Memorial Regional Hospital, Corner Brook, Newfoundland, Canada
| | | | - Nisha Thampi
- Children’s Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Alice Wong
- Royal University Hospital, Saskatoon, Saskatchewan, Canada
| | | | - Susy S. Hota
- University Health Network, Toronto, Ontario, Canada
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Rudnick W, Conly J, Thirion DJG, Choi K, Pelude L, Cayen J, Bautista J, Beique L, Comeau JL, Dalton B, Delport J, Dhami R, Embree J, Émond Y, Evans G, Frenette C, Fryters S, Happe J, Katz K, Kibsey P, Langley JM, Lee BE, Lefebvre MA, Leis JA, McGeer A, McKenna S, Neville HL, Slayter K, Suh KN, Tse-Chang A, Weiss K, Science M. Antimicrobial use among paediatric inpatients at hospital sites within the Canadian Nosocomial Infection Surveillance Program, 2017/2018. Antimicrob Resist Infect Control 2023; 12:35. [PMID: 37072874 PMCID: PMC10111695 DOI: 10.1186/s13756-023-01219-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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 02/16/2023] [Indexed: 04/20/2023] Open
Abstract
BACKGROUND Antimicrobial resistance threatens the ability to successfully prevent and treat infections. While hospital benchmarks regarding antimicrobial use (AMU) have been well documented among adult populations, there is less information from among paediatric inpatients. This study presents benchmark rates of antimicrobial use (AMU) for paediatric inpatients in nine Canadian acute-care hospitals. METHODS Acute-care hospitals participating in the Canadian Nosocomial Infection Surveillance Program submitted annual AMU data from paediatric inpatients from 2017 and 2018. All systemic antimicrobials were included. Data were available for neonatal intensive care units (NICUs), pediatric ICUs (PICUs), and non-ICU wards. Data were analyzed using days of therapy (DOT) per 1000 patient days (DOT/1000pd). RESULTS Nine hospitals provided paediatric AMU data. Data from seven NICU and PICU wards were included. Overall AMU was 481 (95% CI 409-554) DOT/1000pd. There was high variability in AMU between hospitals. AMU was higher on PICU wards (784 DOT/1000pd) than on non-ICU (494 DOT/1000pd) or NICU wards (333 DOT/1000pd). On non-ICU wards, the antimicrobials with the highest use were cefazolin (66 DOT/1000pd), ceftriaxone (59 DOT/1000pd) and piperacillin-tazobactam (48 DOT/1000pd). On PICU wards, the antimicrobials with the highest use were ceftriaxone (115 DOT/1000pd), piperacillin-tazobactam (115 DOT/1000pd), and cefazolin (111 DOT/1000pd). On NICU wards, the antimicrobials with the highest use were ampicillin (102 DOT/1000pd), gentamicin/tobramycin (78 DOT/1000pd), and cefotaxime (38 DOT/1000pd). CONCLUSIONS This study represents the largest collection of antimicrobial use data among hospitalized paediatric inpatients in Canada to date. In 2017/2018, overall AMU was 481 DOT/1000pd. National surveillance of AMU among paediatric inpatients is necessary for establishing benchmarks and informing antimicrobial stewardship efforts.
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Affiliation(s)
- Wallis Rudnick
- Public Health Agency of Canada, 130 Colonnade Rd, Ottawa, ON, K2E 7L9, Canada
| | - John Conly
- University of Calgary, 3330 Hospital Dr NW, Calgary, AB, T2N 4N1, Canada
- Foothills Medical Centre, Alberta Health Services, 3330 Hospital Dr. NW, Calgary, AB, T2N 2T9, Canada
| | - Daniel J G Thirion
- Université de Montréal, 2900 Boulevard Edouard-Montpetit, Montréal, QC, H3T 1J4, Canada
- McGill University Health Centre, 1001 Boulevard Décarie, Montréal, QC, H4A 3J1, Canada
| | - Kelly Choi
- Public Health Agency of Canada, 130 Colonnade Rd, Ottawa, ON, K2E 7L9, Canada
| | - Linda Pelude
- Public Health Agency of Canada, 130 Colonnade Rd, Ottawa, ON, K2E 7L9, Canada
| | - Joelle Cayen
- Public Health Agency of Canada, 130 Colonnade Rd, Ottawa, ON, K2E 7L9, Canada
| | - John Bautista
- Central Newfoundland Regional Health Centre, 50 Union, Grand Falls-Windsor, NL, A2A 2E1, Canada
| | - Lizanne Beique
- Public Health Agency of Canada, 130 Colonnade Rd, Ottawa, ON, K2E 7L9, Canada
| | | | - Bruce Dalton
- Alberta Health Services, 1620 29 St NW, Calgary, AB, T2N 4L7, Canada
| | - Johan Delport
- London Health Sciences Centre, 800 Commissioners Rd E, London, ON, N6A 5W9, Canada
| | - Rita Dhami
- London Health Sciences Centre, 800 Commissioners Rd E, London, ON, N6A 5W9, Canada
- University of Waterloo, 200 University Ave W, Waterloo, ON, N2L 3G1, Canada
- University of Western Ontario, 1151 Richmond St, London, ON, N6A 3K7, Canada
| | - Joanne Embree
- University of Manitoba, Winnipeg, MB, R3T 2N2, Canada
- Shared Health Manitoba, Winnipeg, MB, R3T 2N2, Canada
- Children's Hospital Winnipeg, 840 Sherbrook St, Winnipeg, MB, R3E 0Z3, Canada
| | - Yannick Émond
- Hôpital Maisonneuve-Rosemont, 5415 Boulevard de l'Assomption, Montréal, QC, H1T 2M4, Canada
| | - Gerald Evans
- Kingston Health Sciences Centre, 76 Stuart St, Kingston, ON, K7L 2V7, Canada
| | - Charles Frenette
- McGill University Health Centre, 1001 Boulevard Décarie, Montréal, QC, H4A 3J1, Canada
| | - Susan Fryters
- Alberta Health Services, 10240 Kingsway Avenue, Edmonton, AB, T5H 3V9, Canada
| | - Jennifer Happe
- Infection Prevention and Control Canada, Red Deer, AB, T4N 6R2, Canada
| | - Kevin Katz
- North York General Hospital, 4001 Leslie St, North York, ON, M2K 1E1, Canada
| | - Pamela Kibsey
- Royal Jubilee Hospital, 1952 Bay St, Victoria, BC, V8R 1J8, Canada
| | - Joanne M Langley
- IWK Health Centre, 5980 University Ave, Halifax, NS, B3K 6R8, Canada
- Dalhousie University, 6299 South St, Halifax, NS, B3H 4R2, Canada
| | - Bonita E Lee
- Stollery Children's Hospital, Edmonton, AB, T6G 2B7, Canada
- University of Alberta, Edmonton, AB, T6G 2R7, Canada
| | - Marie-Astrid Lefebvre
- McGill University Health Centre, 1001 Boulevard Décarie, Montréal, QC, H4A 3J1, Canada
| | - Jerome A Leis
- Department of Medicine, University of Toronto, 1 King's College Cir, Toronto, ON, M5S 1A8, Canada
- Sunnybrook Health Sciences Centre, 2075 Bayview Ave, Toronto, ON, M4N 3M5, Canada
| | - Allison McGeer
- Sinai Health System, 600 University Ave, Toronto, ON, M5G 1X5, Canada
- University of Toronto, 27 King's College Cir, Toronto, ON, M5S 1A1, Canada
- Dalla Lana School of Public Health, University of Toronto, 155 College St, Toronto, ON, M5T 3M7, Canada
| | - Susan McKenna
- Kingston Health Sciences Centre, 76 Stuart St, Kingston, ON, K7L 2V7, Canada
| | - Heather L Neville
- Nova Scotia Health, 1276 South Park St, Halifax, NS, B3H 2Y9, Canada
| | - Kathryn Slayter
- IWK Health Centre, 5980 University Ave, Halifax, NS, B3K 6R8, Canada
| | - Kathryn N Suh
- The Ottawa Hospital, 501 Smyth Rd, Ottawa, ON, K1H 8L6, Canada
| | - Alena Tse-Chang
- Stollery Children's Hospital, Edmonton, AB, T6G 2B7, Canada
- University of Alberta, Edmonton, AB, T6G 2R7, Canada
| | - Karl Weiss
- SMBD-Jewish General Hospital, 3755 Chemin de la Côte-Sainte-Catherine, Montréal, QC, H3T 1E2, Canada
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Mitchell R, Cayen J, Thampi N, Frenette C, Bartoskzo J, Choi KB, Comeau JL, Conly J, Ellis C, Ellison J, Embil J, Evans G, Johnston L, Johnstone J, Katz KC, Kibsey P, Lee B, Lefebvre MA, Longtin Y, McGeer A, Mertz D, Minion J, Rudnick W, Silva A, Smith SW, Srigley JA, Suh KN, Tomlinson J, Wong A, Pelude L. Trends in Severe Outcomes Among Adult and Pediatric Patients Hospitalized With COVID-19 in the Canadian Nosocomial Infection Surveillance Program, March 2020 to May 2022. JAMA Netw Open 2023; 6:e239050. [PMID: 37079304 PMCID: PMC10119741 DOI: 10.1001/jamanetworkopen.2023.9050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/21/2023] Open
Abstract
Importance Trends in COVID-19 severe outcomes have significant implications for the health care system and are key to informing public health measures. However, data summarizing trends in severe outcomes among patients hospitalized with COVID-19 in Canada are not well described. Objective To describe trends in severe outcomes among patients hospitalized with COVID-19 during the first 2 years of the COVID-19 pandemic. Design, Setting, and Participants Active prospective surveillance in this cohort study was conducted from March 15, 2020, to May 28, 2022, at a sentinel network of 155 acute care hospitals across Canada. Participants included adult (aged ≥18 years) and pediatric (aged 0-17 years) patients hospitalized with laboratory-confirmed COVID-19 at a Canadian Nosocomial Infection Surveillance Program (CNISP)-participating hospital. Exposures COVID-19 waves, COVID-19 vaccination status, and age group. Main Outcomes and Measures The CNISP collected weekly aggregate data on the following severe outcomes: hospitalization, admission to an intensive care unit (ICU), receipt of mechanical ventilation, receipt of extracorporeal membrane oxygenation, and all-cause in-hospital death. Results Among 1 513 065 admissions, the proportion of adult (n = 51 679) and pediatric (n = 4035) patients hospitalized with laboratory-confirmed COVID-19 was highest in waves 5 and 6 of the pandemic compared with waves 1 to 4 (77.3 vs 24.7 per 1000 patient admissions). Despite this, the proportion of patients with positive test results for COVID-19 who were admitted to an ICU, received mechanical ventilation, received extracorporeal membrane oxygenation, and died were each significantly lower in waves 5 and 6 when compared with waves 1 through 4. Admission to the ICU and in-hospital all-cause death rates were significantly higher among those who were unvaccinated against COVID-19 when compared with those who were fully vaccinated (incidence rate ratio, 4.3 and 3.9, respectively) or fully vaccinated with an additional dose (incidence rate ratio, 12.2 and 15.1, respectively). Conclusions and Relevance The findings of this cohort study of patients hospitalized with laboratory-confirmed COVID-19 suggest that COVID-19 vaccination is important to reduce the burden on the Canadian health care system as well as severe outcomes associated with COVID-19.
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Affiliation(s)
- Robyn Mitchell
- Centre for Communicable Diseases and Infection Control, Public Health Agency of Canada, Ottawa, Ontario, Canada
| | - Joelle Cayen
- Centre for Communicable Diseases and Infection Control, Public Health Agency of Canada, Ottawa, Ontario, Canada
| | - Nisha Thampi
- Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Charles Frenette
- Division of Infectious Diseases, Department of Medicine, McGill University Health Centre, Montréal, Québec, Canada
| | - Jessica Bartoskzo
- Centre for Communicable Diseases and Infection Control, Public Health Agency of Canada, Ottawa, Ontario, Canada
| | - Kelly Baekyung Choi
- Centre for Communicable Diseases and Infection Control, Public Health Agency of Canada, Ottawa, Ontario, Canada
| | - Jeannette L Comeau
- Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada
| | - John Conly
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Chelsey Ellis
- Department of Laboratory Medicine, The Moncton Hospital, Moncton, New Brunswick, Canada
| | - Jennifer Ellison
- Infection, Prevention and Control, Alberta Health Services, Calgary, Alberta, Canada
| | - John Embil
- Infection Prevention and Control, Health Sciences Centre, Winnipeg, Manitoba, Canada
| | - Gerald Evans
- Division of Infectious Diseases, Queen's University, Kingston, Ontario, Canada
| | - Lynn Johnston
- Division of Infectious Diseases, Department of Medicine, Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia, Canada
| | - Jennie Johnstone
- Infection Prevention and Control, Sinai Health, Toronto, Ontario, Canada
| | - Kevin C Katz
- Infection Prevention and Control, North York General Hospital, Toronto, Ontario, Canada
| | - Pamela Kibsey
- Department of Pathology and Laboratory Medicine, Royal Jubilee Hospital, Victoria, British Columbia, Canada
| | - Bonita Lee
- Department of Pediatrics, Stollery Children's Hospital, Edmonton, Alberta, Canada
| | - Marie-Astrid Lefebvre
- Montreal Children's Hospital, McGill University Health Centre, Montréal, Québec, Canada
| | - Yves Longtin
- Infection Prevention and Control, SMBD Jewish General Hospital, Montréal, Québec, Canada
| | - Allison McGeer
- Infection Prevention and Control, Sinai Health, Toronto, Ontario, Canada
| | - Dominik Mertz
- Division of Infectious Diseases, Department of Medicine, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Jessica Minion
- Department of Laboratory Medicine, Saskatchewan Health Authority, Regina, Saskatchewan, Canada
| | - Wallis Rudnick
- Centre for Communicable Diseases and Infection Control, Public Health Agency of Canada, Ottawa, Ontario, Canada
| | - Anada Silva
- Centre for Communicable Diseases and Infection Control, Public Health Agency of Canada, Ottawa, Ontario, Canada
| | - Stephanie W Smith
- Faculty of Medicine, University of Alberta Hospital, Edmonton, Alberta, Canada
| | - Jocelyn A Srigley
- Infection Prevention and Control, BC Women's and BC Children's Hospital, Vancouver, British Columbia, Canada
| | - Kathryn N Suh
- Infection Prevention and Control, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Jen Tomlinson
- Infection Prevention and Control, Health Sciences Centre, Winnipeg, Manitoba, Canada
| | - Alice Wong
- Division of Infectious Diseases, Department of Medicine, Royal University Hospital, Saskatoon, Saskatchewan, Canada
| | - Linda Pelude
- Centre for Communicable Diseases and Infection Control, Public Health Agency of Canada, Ottawa, Ontario, Canada
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Silva A, Du T, Choi KB, Pelude L, Golding GR, Hizon R, Lee BE, Chow B, Srigley JA, Hota SS, Comeau JL, Thampi N. Epidemiology of primary and recurrent healthcare-associated and community-associated pediatric Clostridioides difficile infection in Canada, 2015-2020. J Pediatric Infect Dis Soc 2023; 12:222-225. [PMID: 36718660 PMCID: PMC10146919 DOI: 10.1093/jpids/piad003] [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: 10/04/2022] [Accepted: 01/30/2023] [Indexed: 02/01/2023]
Abstract
Clostridioides difficile infection (CDI) among children remains a concerning cause of morbidity in hospital settings. We present epidemiological and molecular trends in healthcare- and community-associated CDI among children in Canadian inpatient and outpatient settings, including those who experienced recurrent infections.
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Affiliation(s)
| | - Tim Du
- National Microbiology Laboratory, Winnipeg, CA
| | | | | | | | - Romeo Hizon
- National Microbiology Laboratory, Winnipeg, CA
| | | | | | | | | | | | - Nisha Thampi
- Children's Hospital of Eastern Ontario, Ottawa, CA
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MacDonald NE, Dube E, Comeau JL. Have vaccine hesitancy models oversimplified a complex problem to our detriment? The Adapted Royal Society of Canada vaccine uptake framework. Vaccine 2022; 40:3927-3930. [PMID: 35637069 PMCID: PMC9142183 DOI: 10.1016/j.vaccine.2022.05.052] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 04/19/2022] [Accepted: 05/19/2022] [Indexed: 11/29/2022]
Affiliation(s)
- N E MacDonald
- Department of Paediatrics, Dalhousie University and IWK Health Centre, Halifax, Canada.
| | - E Dube
- Institut National de Sante Publique du Quebec, Université Laval, Quebec, Canada
| | - J L Comeau
- Department of Paediatrics, Dalhousie University and IWK Health Centre, Halifax, Canada
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8
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Du T, Choi KB, Silva A, Golding GR, Pelude L, Hizon R, Al-Rawahi GN, Brooks J, Chow B, Collet JC, Comeau JL, Davis I, Evans GA, Frenette C, Han G, Johnstone J, Kibsey P, Katz KC, Langley JM, Lee BE, Longtin Y, Mertz D, Minion J, Science M, Srigley JA, Stagg P, Suh KN, Thampi N, Wong A, Hota SS. Characterization of Healthcare-Associated and Community-Associated Clostridioides difficile Infections among Adults, Canada, 2015-2019. Emerg Infect Dis 2022; 28:1128-1136. [PMID: 35470794 PMCID: PMC9155897 DOI: 10.3201/eid2806.212262] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
We investigated epidemiologic and molecular characteristics of healthcare-associated (HA) and community-associated (CA) Clostridioides difficile infection (CDI) among adult patients in Canadian Nosocomial Infection Surveillance Program hospitals during 2015–2019. The study encompassed 18,455 CDI cases, 13,735 (74.4%) HA and 4,720 (25.6%) CA. During 2015–2019, HA CDI rates decreased by 23.8%, whereas CA decreased by 18.8%. HA CDI was significantly associated with increased 30-day all-cause mortality as compared with CA CDI (p<0.01). Of 2,506 isolates analyzed, the most common ribotypes (RTs) were RT027, RT106, RT014, and RT020. RT027 was more often associated with CDI-attributable death than was non-RT027, regardless of acquisition type. Overall resistance C. difficile rates were similar for all drugs tested except moxifloxacin. Adult HA and CA CDI rates have declined, coinciding with changes in prevalence of RT027 and RT106. Infection prevention and control and continued national surveillance are integral to clarifying CDI epidemiology, investigation, and control.
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Quinn HE, Comeau JL, Marshall HS, Elliott EJ, Crawford NW, Blyth CC, Kynaston JA, Snelling TL, Richmond PC, Francis JR, Macartney KK, McIntyre PB, Wood NJ. Pertussis Disease and Antenatal Vaccine Effectiveness in Australian Children. Pediatr Infect Dis J 2022; 41:180-185. [PMID: 34711785 DOI: 10.1097/inf.0000000000003367] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Population-level studies of severe pertussis extending beyond infancy are sparse, and none in the context of antenatal vaccination. We compared hospitalized pertussis cases from birth to 15 years of age before and after introduction of antenatal immunization. METHODS Active surveillance of laboratory-confirmed pertussis hospitalizations in a national network of pediatric hospitals in Australia January 2012 to June 2019. Impact of maternal vaccination was assessed by vaccine effectiveness (VE) in cases and test-negative controls with <2 months of age and by before-after comparison of age distribution of cases. Among cases eligible for one or more vaccine doses, we examined proportions age-appropriately immunized and with comorbidities by age group. RESULTS Among 419 eligible cases, the proportion <2 months of age significantly decreased from 33.1% in 2012 to 2014 compared with 19.6% in 2016 to 2019 when mothers of only 4 of 17 (23.5%) cases <2 months of age had received antenatal vaccination. VE was estimated to be 84.3% (95% CI, 26.1-96.7). Across all years (2012-2019), of 55 cases 4-11 months of age, 21 (38%) had ≥2 vaccine doses, whereas among 155 cases ≥12 months of age, 122 (85.2%) had ≥3 vaccine doses. Prevalence of comorbidities (primarily cardiorespiratory) increased from 5 (2.1%) <6 months of age to 36 (24.2%) ≥12 months of age (P < 0.001), with 6/16 (38%) cases ≥12 months of age who required intensive care having comorbidities. CONCLUSIONS Below the age of 12 months, prevention of severe pertussis will be maximized by high maternal antenatal vaccine uptake and timeliness of infant vaccine doses. Despite full immunization, we found children ≥12 months of age accounted for 27% of hospitalizations <15 years, with 24% having comorbities, suggesting new vaccine strategies, such as additional doses or more immunogenic vaccines, require evaluation.
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Affiliation(s)
- Helen E Quinn
- From the National Centre for Immunisation Research and Surveillance, Westmead, New South Wales, Australia
- Discipline of Child and Adolescent Health, University of Sydney, Sydney, New South Wales, Australia
| | - Jeannette L Comeau
- From the National Centre for Immunisation Research and Surveillance, Westmead, New South Wales, Australia
- IWK Health Centre, Halifax, Nova Scotia, Canada
| | - Helen S Marshall
- Women's and Children's Hospital, Adelaide, South Australia, Australia
- Robinson Research Institute and Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia
| | - Elizabeth J Elliott
- Discipline of Child and Adolescent Health, University of Sydney, Sydney, New South Wales, Australia
- Australian Paediatric Surveillance Unit (APSU), Sydney, New South Wales, Australia
- The Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Nigel W Crawford
- Murdoch Children's Research Institute and The University of Melbourne, Parkville, Victoria, Australia
- Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Christopher C Blyth
- Wesfarmer's Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Perth, Western Australia, Australia
- Perth Children's Hospital, Perth, Western Australia, Australia
- Division of Paediatrics, School of Medicine, University of Western Australia, Perth, Western Australia, Australia
| | | | - Tom L Snelling
- Discipline of Child and Adolescent Health, University of Sydney, Sydney, New South Wales, Australia
- Wesfarmer's Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Perth, Western Australia, Australia
| | - Peter C Richmond
- Wesfarmer's Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Perth, Western Australia, Australia
- Perth Children's Hospital, Perth, Western Australia, Australia
| | - Joshua R Francis
- Global & Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
- Department of Paediatrics, Royal Darwin Hospital, Darwin, Northern Territory, Australia
| | - Kristine K Macartney
- From the National Centre for Immunisation Research and Surveillance, Westmead, New South Wales, Australia
- Discipline of Child and Adolescent Health, University of Sydney, Sydney, New South Wales, Australia
- The Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Peter B McIntyre
- From the National Centre for Immunisation Research and Surveillance, Westmead, New South Wales, Australia
- Discipline of Child and Adolescent Health, University of Sydney, Sydney, New South Wales, Australia
- Department of Womens and Childrens Health. University of Otago, Dunedin, New Zealand
| | - Nicholas J Wood
- From the National Centre for Immunisation Research and Surveillance, Westmead, New South Wales, Australia
- Discipline of Child and Adolescent Health, University of Sydney, Sydney, New South Wales, Australia
- The Children's Hospital at Westmead, Westmead, New South Wales, Australia
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10
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Patterson JW, Comeau JL, Khan N, Kulkarni K. A case of disseminated Candida krusei infection in a child with acute myeloid leukemia. Pediatric Hematology Oncology Journal 2021. [DOI: 10.1016/j.phoj.2020.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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11
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Walker KF, O'Donoghue K, Grace N, Dorling J, Comeau JL, Li W, Thornton JG. Authors' reply re: Maternal transmission of SARS-COV-2 to the neonate, and possible routes for such transmission: a systematic review and critical analysis. BJOG 2020; 128:769. [PMID: 33368961 DOI: 10.1111/1471-0528.16436] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 07/22/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Kate F Walker
- Division of Child Health, Obstetrics and Gynaecology, School of Medicine, University of Nottingham, Nottingham, UK
| | - Keelin O'Donoghue
- The Irish Centre for Maternal and Child Health, Cork University Maternity Hospital, University College Cork, Cork, Ireland
| | - Nicky Grace
- School of English, University of Nottingham, Nottingham, UK
| | - Jon Dorling
- Department of Pediatrics, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Jeannette L Comeau
- Department of Pediatrics, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Wentao Li
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Australia
| | - Jim G Thornton
- Division of Child Health, Obstetrics and Gynaecology, School of Medicine, University of Nottingham, Nottingham, UK
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12
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MacDonald NE, Comeau JL, Dubé È, Bucci LM. COVID-19 and missed routine immunizations: designing for effective catch-up in Canada. Can J Public Health 2020; 111:469-472. [PMID: 32761546 PMCID: PMC7408971 DOI: 10.17269/s41997-020-00385-4] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 07/08/2020] [Indexed: 12/14/2022]
Abstract
COVID-19 has led to disruption in routine immunization programs around the globe and here in Canada. The National Advisory Committee on Immunization (NACI) in Canada has indicated that this sets the stage for serious outbreaks of vaccine-preventable diseases. The World Health Organization has evidence-based guidance on how to address missed opportunities for vaccination, albeit predominately applicable for low- and middle-income countries. In Canada, immunization applies beyond infant and childhood immunization, with immunization across the life course being recommended by NACI. Three components stand out and must be integrated and used concurrently for best effect on catch-up in Canada: (1) Identify who has been missed across the life course; (2) detect delivery gaps, adapt and adjust, and develop multipronged tailored strategies for catch-up; and (3) communicate, document, evaluate and readjust the immunization programs. All must be adapted to the reality of the evolving COVID-19 pandemic. We cannot go back to a pre-COVID-19 world. However, ensuring that routine immunization and catch-up programs are done well during this pandemic strengthens the immunization foundation in Canada for when COVID-19 vaccines become available.
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Affiliation(s)
- Noni E MacDonald
- Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada. .,IWK Health Centre, Halifax, Nova Scotia, Canada.
| | - Jeannette L Comeau
- Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada.,IWK Health Centre, Halifax, Nova Scotia, Canada
| | - Ève Dubé
- Institut National de Santé Publique du Québec, Québec City, Québec, Canada.,Université Laval, Québec City, Québec, Canada
| | - Lucie M Bucci
- Immunize Canada, Canadian Public Health Association, Ottawa, Ontario, Canada
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13
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Walker KF, O'Donoghue K, Grace N, Dorling J, Comeau JL, Li W, Thornton JG. Maternal transmission of SARS-COV-2 to the neonate, and possible routes for such transmission: a systematic review and critical analysis. BJOG 2020; 127:1324-1336. [PMID: 32531146 PMCID: PMC7323034 DOI: 10.1111/1471-0528.16362] [Citation(s) in RCA: 166] [Impact Index Per Article: 41.5] [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] [Accepted: 06/03/2020] [Indexed: 12/15/2022]
Abstract
Background Early reports of COVID‐19 in pregnancy described management by caesarean, strict isolation of the neonate and formula feeding. Is this practice justified? Objective To estimate the risk of the neonate becoming infected with SARS‐CoV‐2 by mode of delivery, type of infant feeding and mother‐infant interaction. Search strategy Two biomedical databases were searched between September 2019 and June 2020. Selection criteria Case reports or case series of pregnant women with confirmed COVID‐19, where neonatal outcomes were reported. Data collection and analysis Data were extracted on mode of delivery, infant infection status, infant feeding and mother–infant interaction. For reported infant infection, a critical analysis was performed to evaluate the likelihood of vertical transmission. Main results Forty nine studies included information on mode of delivery and infant infection status for 655 women and 666 neonates. In all, 28/666 (4%) tested positive postnatally. Of babies born vaginally, 8/292 (2.7%) tested positivecompared with 20/374 (5.3%) born by Caesarean. Information on feeding and baby separation were often missing, but of reported breastfed babies 7/148 (4.7%) tested positive compared with 3/56 (5.3%) for reported formula fed ones. Of babies reported as nursed with their mother 4/107 (3.7%) tested positive, compared with 6/46 (13%) for those who were reported as isolated. Conclusions Neonatal COVID‐19 infection is uncommon, rarely symptomatic, and the rate of infection is no greater when the baby is born vaginally, breastfed or remains with the mother. Tweetable abstract Risk of neonatal infection with COVID‐19 by delivery route, infant feeding and mother‐baby interaction. Risk of neonatal infection with COVID‐19 by delivery route, infant feeding and mother‐baby interaction. This article includes Author Insights, a video abstract available at https://vimeo.com/rcog/authorinsights16362
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Affiliation(s)
- K F Walker
- Division of Child Health, Obstetrics and Gynaecology, School of Medicine, University of Nottingham, Nottingham, UK
| | - K O'Donoghue
- The Irish Centre for Maternal and Child Health, Cork University Maternity Hospital, University College Cork, Cork, Ireland
| | - N Grace
- School of English, University of Nottingham, Nottingham, UK
| | - J Dorling
- Department of Pediatrics, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
| | - J L Comeau
- Department of Pediatrics, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
| | - W Li
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Vic., Australia
| | - J G Thornton
- Division of Child Health, Obstetrics and Gynaecology, School of Medicine, University of Nottingham, Nottingham, UK
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14
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Rudnick W, Science M, Thirion DJG, Abdesselam K, Choi KB, Pelude L, Amaratunga K, Comeau JL, Dalton B, Delport J, Dhami R, Embree J, Émond Y, Evans G, Frenette C, Fryters S, German G, Grant JM, Happe J, Katz K, Kibsey P, Kosar J, Langley JM, Lee BE, Lefebvre MA, Leis JA, McGeer A, Neville HL, Simor A, Slayter K, Suh KN, Tse-Chang A, Weiss K, Conly J. Antimicrobial use among adult inpatients at hospital sites within the Canadian Nosocomial Infection Surveillance Program: 2009 to 2016. Antimicrob Resist Infect Control 2020; 9:32. [PMID: 32054539 PMCID: PMC7020554 DOI: 10.1186/s13756-020-0684-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Accepted: 01/23/2020] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Antimicrobial resistance is a growing threat to the world's ability to prevent and treat infections. Links between quantitative antibiotic use and the emergence of bacterial resistance are well documented. This study presents benchmark antimicrobial use (AMU) rates for inpatient adult populations in acute-care hospitals across Canada. METHODS In this retrospective surveillance study, acute-care adult hospitals participating in the Canadian Nosocomial Infection Surveillance Program (CNISP) submitted annual AMU data on all systemic antimicrobials from 2009 to 2016. Information specific to intensive care units (ICUs) and non-ICU wards were available for 2014-2016. Data were analyzed using defined daily doses (DDD) per 1000 patient days (DDD/1000pd). RESULTS Between 2009 and 2016, 16-18 CNISP adult hospitals participated each year and provided their AMU data (22 hospitals participated in ≥1 year of surveillance; 11 in all years). From 2009 to 2016, there was a significant reduction in use (12%) (from 654 to 573 DDD/1000pd, p = 0.03). Fluoroquinolones accounted for the majority of this decrease (47% reduction in combined oral and intravenous use, from 129 to 68 DDD/1000pd, p < 0.002). The top five antimicrobials used in 2016 were cefazolin (78 DDD/1000pd), piperacillin-tazobactam (53 DDD/1000pd), ceftriaxone (49 DDD/1000pd), vancomycin (combined oral and intravenous use was 44 DDD/1000pd; 7% of vancomycin use was oral), and ciprofloxacin (combined oral and intravenous use: 42 DDD/1000pd). Among the top 10 antimicrobials used in 2016, ciprofloxacin and metronidazole use decreased significantly between 2009 and 2016 by 46% (p = 0.002) and 26% (p = 0.002) respectively. Ceftriaxone (85% increase, p = 0.0008) and oral amoxicillin-clavulanate (140% increase, p < 0.0001) use increased significantly but contributed only a small component (8.6 and 5.0%, respectively) of overall use. CONCLUSIONS This study represents the largest collection of dispensed antimicrobial use data among inpatients in Canada to date. Between 2009 and 2016, there was a significant 12% decrease in AMU, driven primarily by a 47% decrease in fluoroquinolone use. Modest absolute increases in parenteral ceftriaxone and oral amoxicillin-clavulanate use were noted but contributed a small amount of total AMU. Ongoing national surveillance is crucial for establishing benchmarks and antimicrobial stewardship guidelines.
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Affiliation(s)
- Wallis Rudnick
- Public Health Agency of Canada, 130 Colonnade Rd, Ottawa, ON K2E 7L9 Canada
| | | | - Daniel J. G. Thirion
- Université de Montréal, 2900 Boulevard Edouard-Montpetit, Montréal, QC H3T 1J4 Canada
- McGill University Health Centre, 1001 Boulevard Décarie, Montréal, QC H4A 3J1 Canada
| | - Kahina Abdesselam
- Public Health Agency of Canada, 130 Colonnade Rd, Ottawa, ON K2E 7L9 Canada
| | - Kelly B. Choi
- Public Health Agency of Canada, 130 Colonnade Rd, Ottawa, ON K2E 7L9 Canada
| | - Linda Pelude
- Public Health Agency of Canada, 130 Colonnade Rd, Ottawa, ON K2E 7L9 Canada
| | - Kanchana Amaratunga
- Public Health Agency of Canada, 130 Colonnade Rd, Ottawa, ON K2E 7L9 Canada
- The Ottawa Hospital, 501 Smyth Rd, Ottawa, ON K1H 8L6 Canada
| | - Jeannette L. Comeau
- IWK Health Centre, 5980 University Ave, Halifax, NS B3K 6R8 Canada
- Dalhousie University, 6299 South St, Halifax, NS B3H 4R2 Canada
| | - Bruce Dalton
- Alberta Health Services, 1620 29 St NW, Calgary, AB T2N 4L7 Canada
| | - Johan Delport
- London Health Sciences Centre, 800 Commissioners Rd E, London, ON N6A 5W9 Canada
| | - Rita Dhami
- London Health Sciences Centre, 800 Commissioners Rd E, London, ON N6A 5W9 Canada
- University of Waterloo, 200 University Ave W, Waterloo, ON N2L 3G1 Canada
- University of Western Ontario, 1151 Richmond St, London, ON N6A 3K7 Canada
| | - Joanne Embree
- University of Manitoba, Winnipeg, MB R3T 2N2 Canada
- Shared Health Manitoba, Winnipeg, MB R3T 2N2 Canada
- Children’s Hospital Winnipeg, 840 Sherbrook St, Winnipeg, MB R3E 0Z3 Canada
| | - Yannick Émond
- Hôpital Maisonneuve-Rosemont, 5415 Boulevard de l’Assomption, Montréal, QC H1T 2M4 Canada
| | - Gerald Evans
- Kingston General Hospital, 76 Stuart St, Kingston, ON K7L 2V7 Canada
| | - Charles Frenette
- McGill University Health Centre, 1001 Boulevard Décarie, Montréal, QC H4A 3J1 Canada
| | - Susan Fryters
- Alberta Health Services, 10240 Kingsway Avenue, Edmonton, AB T5H 3V9 Canada
| | - Greg German
- Health PEI, 16 Garfield St, Charlottetown, PEI C1A 6A5 Canada
| | - Jennifer M. Grant
- University of British Columbia, 2329 West Mall, Vancouver, BC V6T 1Z4 Canada
| | - Jennifer Happe
- Infection Prevention and Control Canada, Red Deer, AB T4N 6R2 Canada
| | - Kevin Katz
- North York General Hospital, 4001 Leslie St, North York, ON M2K 1E1 Canada
| | - Pamela Kibsey
- Royal Jubilee Hospital, 1952 Bay St, Victoria, BC V8R 1J8 Canada
| | - Justin Kosar
- Saskatchewan Health Authority, Saskatoon, SK S7N 0W8 Canada
| | - Joanne M. Langley
- IWK Health Centre, 5980 University Ave, Halifax, NS B3K 6R8 Canada
- Dalhousie University, 6299 South St, Halifax, NS B3H 4R2 Canada
| | - Bonita E. Lee
- Stollery Children’s Hospital, Edmonton, AB T6G 2B7 Canada
- University of Alberta, Edmonton, AB T6G 2R7 Canada
| | - Marie-Astrid Lefebvre
- McGill University Health Centre, 1001 Boulevard Décarie, Montréal, QC H4A 3J1 Canada
| | - Jerome A. Leis
- Sunnybrook Research Institute, 2075 Bayview Ave, Toronto, ON M4N 3M5 Canada
| | - Allison McGeer
- Sinai Health System, 600 University Ave, Toronto, ON M5G 1X5 Canada
- University of Toronto, 27 King’s College Cir, Toronto, ON M5S Canada
- Dalla Lana School of Public Health, University of Toronto, 155 College St, Toronto, ON M5T 3M7 Canada
| | - Heather L. Neville
- Nova Scotia Health Authority, 1276 South Park St, Halifax, NS B3H 2Y9 Canada
| | - Andrew Simor
- University of Toronto, 27 King’s College Cir, Toronto, ON M5S Canada
- Sunnybrook Health Sciences Centre, 2015 Bayview Ave, Toronto, ON M4N 3M5 Canada
| | - Kathryn Slayter
- IWK Health Centre, 5980 University Ave, Halifax, NS B3K 6R8 Canada
| | - Kathryn N. Suh
- The Ottawa Hospital, 501 Smyth Rd, Ottawa, ON K1H 8L6 Canada
| | - Alena Tse-Chang
- Stollery Children’s Hospital, Edmonton, AB T6G 2B7 Canada
- University of Alberta, Edmonton, AB T6G 2R7 Canada
| | - Karl Weiss
- SMBD-Jewish General Hospital, 3755 Chemin de la Côte-Sainte-Catherine, Montréal, QC H3T 1E2 Canada
| | - John Conly
- Alberta Health Services, 1620 29 St NW, Calgary, AB T2N 4L7 Canada
- University of Calgary, 3330 Hospital Dr NW, Calgary, AB T2N 4N1 Canada
| | - the Canadian Nosocomial Infection Surveillance Program
- Public Health Agency of Canada, 130 Colonnade Rd, Ottawa, ON K2E 7L9 Canada
- SickKids, 555 University Ave, Toronto, ON M5G 1X8 Canada
- Université de Montréal, 2900 Boulevard Edouard-Montpetit, Montréal, QC H3T 1J4 Canada
- McGill University Health Centre, 1001 Boulevard Décarie, Montréal, QC H4A 3J1 Canada
- The Ottawa Hospital, 501 Smyth Rd, Ottawa, ON K1H 8L6 Canada
- IWK Health Centre, 5980 University Ave, Halifax, NS B3K 6R8 Canada
- Dalhousie University, 6299 South St, Halifax, NS B3H 4R2 Canada
- Alberta Health Services, 1620 29 St NW, Calgary, AB T2N 4L7 Canada
- London Health Sciences Centre, 800 Commissioners Rd E, London, ON N6A 5W9 Canada
- University of Waterloo, 200 University Ave W, Waterloo, ON N2L 3G1 Canada
- University of Western Ontario, 1151 Richmond St, London, ON N6A 3K7 Canada
- University of Manitoba, Winnipeg, MB R3T 2N2 Canada
- Shared Health Manitoba, Winnipeg, MB R3T 2N2 Canada
- Children’s Hospital Winnipeg, 840 Sherbrook St, Winnipeg, MB R3E 0Z3 Canada
- Hôpital Maisonneuve-Rosemont, 5415 Boulevard de l’Assomption, Montréal, QC H1T 2M4 Canada
- Kingston General Hospital, 76 Stuart St, Kingston, ON K7L 2V7 Canada
- Alberta Health Services, 10240 Kingsway Avenue, Edmonton, AB T5H 3V9 Canada
- Health PEI, 16 Garfield St, Charlottetown, PEI C1A 6A5 Canada
- University of British Columbia, 2329 West Mall, Vancouver, BC V6T 1Z4 Canada
- Infection Prevention and Control Canada, Red Deer, AB T4N 6R2 Canada
- North York General Hospital, 4001 Leslie St, North York, ON M2K 1E1 Canada
- Royal Jubilee Hospital, 1952 Bay St, Victoria, BC V8R 1J8 Canada
- Saskatchewan Health Authority, Saskatoon, SK S7N 0W8 Canada
- Stollery Children’s Hospital, Edmonton, AB T6G 2B7 Canada
- University of Alberta, Edmonton, AB T6G 2R7 Canada
- Sunnybrook Research Institute, 2075 Bayview Ave, Toronto, ON M4N 3M5 Canada
- Sinai Health System, 600 University Ave, Toronto, ON M5G 1X5 Canada
- University of Toronto, 27 King’s College Cir, Toronto, ON M5S Canada
- Dalla Lana School of Public Health, University of Toronto, 155 College St, Toronto, ON M5T 3M7 Canada
- Nova Scotia Health Authority, 1276 South Park St, Halifax, NS B3H 2Y9 Canada
- Sunnybrook Health Sciences Centre, 2015 Bayview Ave, Toronto, ON M4N 3M5 Canada
- SMBD-Jewish General Hospital, 3755 Chemin de la Côte-Sainte-Catherine, Montréal, QC H3T 1E2 Canada
- University of Calgary, 3330 Hospital Dr NW, Calgary, AB T2N 4N1 Canada
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15
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Blackburn J, Bowes J, Harrison MA, Barrowman N, Roy H, Science M, Timberlake KE, Tse-Chang A, Roberts A, Paquette VC, Kwan N, Vayalumkal JV, Constantinescu C, Dersch-Mills D, Mertz D, Khan S, Al Matawah Y, Thibeault R, Gosselin L, Lefebvre MA, Fanella S, Walus AN, Barton M, Harris V, Comeau JL, Slayter K, Foo C, McConnell A, Seifert B, Leifso K, Viel-Thériault I, Le Saux N. 1143. Measuring Up! Benchmarking Antimicrobial Use in Canadian Children’s Hospitals. Open Forum Infect Dis 2019. [PMCID: PMC6809471 DOI: 10.1093/ofid/ofz360.1007] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background Inappropriate antimicrobial use (AU) is recognized as a leading cause of antimicrobial resistance. However, quantifying AU in hospitals is challenging due to variability in information systems. Point prevalence surveys (PPS) provide a means to quantify AU in a cross-sectional manner within and between institutions. The aim of the study was to describe and compare the prescription patterns of AU across pediatric hospitals in Canada using PPS. Methods Two PPS (November 2018 and February 2019) were conducted at each of the 15 Canadian pediatric hospitals. For each PPS, AU data were collected for all inpatients ≤ 18 years (excluded mental health and birthing units) on the survey date. Data, including admitting diagnosis, age, comorbidities, Infectious Diseases consult, admitting service, documented pathogen(s), and antimicrobial(s) prescribed, was collected and entered into a RedCap database. Results In total, we surveyed 3826 patient-days. The mean proportion of children receiving at least one antimicrobial was 35.2% [range 25.1% to 42.9%]. Of the 1951 antimicrobials prescribed, the most common were third-generation cephalosporins [3GC] (16%; 321), aminopenicillins (15%; 297), TMP-SMX (11%; 207), piperacillin–tazobactam (10%; 193) and first-generation cephalosporins (9%; 181). Overall, the frequency of carbapenems, quinolones and vancomycin use was 4% (79), 3% (65) and 8% (151), respectively. Of the antimicrobials used for targeted or empiric therapy (n = 1541), 373 (24.2%) were for pneumonia, 278 (18%) for intra-abdominal infections and 251 (16.3%) for fever without a source. For the treatment of community-acquired pneumonia (CAP) (n = 178), aminopenicillins and 3GC use was 31% and 37%, respectively. Conclusion Our study used a standardized approach to assess AU to obtain benchmarking data for Canadian pediatric hospitals. About one-third of children hospitalized in Canadian pediatric hospitals are prescribed at least one antimicrobial. Of patients on treatment for CAP, only 31% were prescribed aminopenicillins. More detailed analysis of the rationale for AU, and assessment of appropriateness is required to fully understand antimicrobial prescribing practices in pediatric hospitals and develop stewardship initiatives. Disclosures All authors: No reported disclosures.
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Affiliation(s)
| | - Jennifer Bowes
- Children’s Hospital of Eastern Ontario, Ottawa, ON, Canada
| | - Mary-Ann Harrison
- Children’s Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
| | - Nick Barrowman
- Children’s Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
| | | | | | | | | | | | | | | | | | | | | | | | - Sarah Khan
- McMaster University, Hamilton, Ontario, Canada
| | | | - Roseline Thibeault
- Centre Mère-Enfant Soleil du CHU de Quebec-Université Laval, Quebec, QC, Canada
| | - Louise Gosselin
- Centre Mère-Enfant Soleil du CHU de Quebec, Quebec, QC, Canada
| | - Marie-Astrid Lefebvre
- Montreal Children’s Hospital, McGill University Health Centre, Montreal, Quebec, Canada
| | | | - Ashley N Walus
- The Children’s Hospital of Winnipeg, Winnipeg, MB, Canada
| | - Michelle Barton
- Children’s Hospital at London Health Centre, London, ON, Canada
| | - Venita Harris
- Children’s Hospital at London Health Centre, London, ON, Canada
| | | | | | - Cheryl Foo
- Janeway Children’s Health and Rehabilitation Centre, St. John’s, NL, Canada
| | | | | | - Kirk Leifso
- Kingston Health Sciences Centre, Kingston, ON, Canada
| | | | - Nicole Le Saux
- Children’s Hospital of Eastern Ontario, Ottawa, ON, Canada
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16
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Lefebvre MA, Versporten A, Carrier M, Chang S, Comeau JL, Emond Y, Frenette C, Khan S, Landry DL, MacLaggan TD, Tien Nguyen T, Nguyen T, Valiquette L, Mertz D, Pauwels I, Goossens H. 1135. The 2018 Global Point Prevalence Survey of Antimicrobial Consumption and Resistance: Pediatric Results from 26 Canadian Hospitals. Open Forum Infect Dis 2019. [PMCID: PMC6811194 DOI: 10.1093/ofid/ofz360.999] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background Inappropriate antimicrobial use (AMU) is strongly associated with antimicrobial resistance. The Global Point Prevalence Survey (Global-PPS) is a standardized tool that is used worldwide to characterize inpatient AMU. We report pediatric results from 26 Canadian hospitals that participated in the Global-PPS in 2018. Methods The survey was completed by each site on the Global-PPS website for all patients aged 0–17 years hospitalized in a neonatal or pediatric ward on a chosen day between January and December 2018. Data collected included ward type, demographics, antimicrobials prescribed, diagnosis, type of indication (community-acquired [CA] vs. healthcare-associated [HA]) and type of therapy (empiric vs. targeted). Quality indicators included guideline compliance, medical record documentation of diagnosis, antimicrobial stop/review date, and surgical prophylaxis (SP) duration. Results Of the 26 sites, 23 were mixed and 3 were pediatric hospitals, with data on 767 inpatients. Overall, 25.8% (n = 198) of patients received at least one antimicrobial, and 21.9% (n = 168) were on at least one antibiotic. The highest AMU was found in Hematology-Oncology (84%), Pediatric Intensive Care (55.3%) and surgical (42.1%) units. Of the 330 antimicrobial prescriptions, 40.9% were for CA infections, 23% for medical prophylaxis, 20% for HA infections and 2.7% for SP. The most commonly treated infections were sepsis (16%) and lower respiratory tract infection (12.1%). The top five prescribed antibiotics were aminopenicillins (20.4%), aminoglycosides (16.1%), third-generation cephalosporins (15.4%), piperacillin–tazobactam (7.5%) and trimethoprim-sulfamethoxazole (7.5%). Diagnosis and stop/review date were documented for 88.1% and 65.1% of prescriptions, respectively. Compliance to local guidelines was found in 91.5% of therapies. SP exceeded 24 hours in 88.9% of courses. Conclusion The Global-PPS generated Canada-wide data on inpatient pediatric AMU, which will allow hospitals to benchmark and develop local quality improvement interventions to enhance appropriate AMU. Targets for improvement include suboptimal antimicrobial stop/review date documentation and prolonged SP. Disclosures All authors: No reported disclosures.
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Affiliation(s)
- Marie-Astrid Lefebvre
- Montreal Children’s Hospital, McGill University Health Centre, Montreal, Quebec, Canada
| | | | - Marie Carrier
- CIUSSS de la Mauricie et du Centre-du-Québec, Trois-Rivières, Quebec, Canada
| | - Sandra Chang
- Richmond Hospital, VCH, Richmond, British Columbia, Canada
| | | | - Yannick Emond
- Hôpital Maisonneuve-Rosemont, Université de Montréal, Montreal, Quebec, Canada
| | | | - Sarah Khan
- McMaster University, Hamilton, Ontario, Canada
| | - Daniel L Landry
- Dr. Georges-L.-Dumont University Hospital Centre, Vitalité Health Network, Moncton, New Brunswick, Canada
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Frankel C, Alghounaim M, McDonald J, Gunawan J, Robinson J, Khan S, Wong JK, Lopez A, Fanella S, Comeau JL, Bowes J, Slinger R, Kalia A, Roberts A, Leifso K, Barton M. 856. Invasive Haemophilus influenzae Disease in Children: A Canadian MultiCenter Study on Emerging Serotypes. Open Forum Infect Dis 2019. [PMCID: PMC6808838 DOI: 10.1093/ofid/ofz359.041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Background Our objective was to describe the serotype distribution and clinical spectrum of invasive Haemophilus influenza (Hi) disease in children admitted to participating centers within the Paediatric Investigator’s Collaborative Network on Infections in Canada (PICNIC). Methods All cases of Hi bacteremia were identified from the PICNIC Database of Gram-negative bacteremia (2013–2017). Disease was defined as complicated if the following occurred: (a) >2 sites were affected, (b) surgical intervention was required, (c) organ failure, (d) ICU admission, (e) seizures, (f) sensory or motor deficits, (g) treatment-related complications, or (h) death. Results There were 98 cases of Hi bacteremia. Male to female ratio was 64:34 and median age was 12 (IQR: 7–48; range 0–216) months. Hi serotypes included: a (N = 31; 32%), b (N = 9; 9%), f (N = 15; 13%), c (N = 1;1%), e (N = 1; 1%), nontypeable (N = 34; 35%) and unknown (N = 7; 7%). Clinical foci included: bacteremia without a focus (N = 19; 19%), meningitis (N = 29; 30%), cellulitis (N = 8; 8%), septic arthritis (N = 6; 6%), pneumonia (n = 33; 34%), epiglottitis (N = 1; 1%), and endovascular infection (n = 3; 3%). Complicated disease occurred in 29 (30%) cases; there was one (1%) death. Where serotyping was available, complication rates were: 42%, 22%, 100%, 0%, 33%, and 21% for Hia, Hib, Hic, Hie, Hif and nontypeable Hi, respectively. Factors associated with complicated disease were: age <5 years (P = 0.009), bacteremia without a focus (P = 0.006) and a CNS focus (P < 0.001). Hia was the leading serotype in meningitis (55%; P = 0.022). Nontypeable Hi was most frequent in pneumonia cases (56%; P = 0.003) and never caused cellulitis (0% vs. 14%; P = 0.023). Neonatal disease (N = 5) was predominantly caused by nontypeable Hi (80%; P = 0.040). Of note, 26 (27%) of our Hi isolates were ampicillin resistant. Conclusion In the era of efficacious conjugate Hib vaccines, serotype has emerged as the leading cause of typeable Hi disease in Canada and is highly associated with meningitis, especially in young children. Strategies for preventing Hi disease need to target this emerging serotype and efforts should be focused toward developing an effective vaccine for serotype a disease. Disclosures All Authors: No reported Disclosures.
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Affiliation(s)
| | | | | | - John Gunawan
- Stollery Children’s Hospital, Edmonton, ON, Canada
| | | | - Sarah Khan
- McMaster University, Hamilton, ON, Canada
| | | | - Alison Lopez
- Winnipeg Children’s Hospital, Winnipeg, MB, Canada
| | | | | | - Jennifer Bowes
- Children’s Hospital of Eastern Ontario, Ottawa, ON, Canada
| | - Robert Slinger
- Children’s Hospital of Eastern Ontario, Ottawa, ON, Canada
| | | | | | - Kirk Leifso
- Kingston Health Sciences Centre, Kingston, ON, Canada
| | - Michelle Barton
- Children’s Hospital at London Health Centre, London, ON, Canada
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Robbins M, Comeau JL, Mailman T, Top K. Looking for the "connection": A clinical vignette on pediatric chest wall masses. J Assoc Med Microbiol Infect Dis Can 2019; 4:193-196. [PMID: 36340653 PMCID: PMC9603034 DOI: 10.3138/jammi.2019.05.24.03] [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] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Accepted: 05/24/2019] [Indexed: 06/16/2023]
Abstract
Chest wall masses in the pediatric population are relatively rare, and the differential diagnosis predominantly includes neoplastic soft tissue or osseous tumours, either benign or malignant in etiology, although local infectious processes represent additional diagnostic possibilities. Among recent immigrants, a more diverse array of less commonly observed pathogens warrant consideration. Here, we present a case of a chest wall mass in an immunocompetent child who had recently immigrated from the Philippines.
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Affiliation(s)
- M Robbins
- Division of Infectious Diseases, Dalhousie University, Halifax, Nova Scotia, Canada
| | - JL Comeau
- Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada
| | - T Mailman
- Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada
| | - K Top
- Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada
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19
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Dubé E, Gagnon D, Clément P, Bettinger JA, Comeau JL, Deeks S, Guay M, MacDonald S, MacDonald NE, Mijovic H, Paragg J, Rubincam C, Sauvageau C, Steenbeck A, Wilson S. Challenges and opportunities of school-based HPV vaccination in Canada. Hum Vaccin Immunother 2019; 15:1650-1655. [PMID: 30633622 DOI: 10.1080/21645515.2018.1564440] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [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: 02/05/2023] Open
Abstract
Primary prevention of human papillomavirus (HPV) through vaccination is a high priority in Canada's cancer prevention efforts. All Canadian provinces and territories have introduced publicly funded, school-based vaccination programs against HPV, but vaccine uptake remains suboptimal in some jurisdictions. We conducted a descriptive qualitative study to better understand the determinants of low HPV vaccine uptake and identify strategies to enhance vaccine acceptance using the socio-ecological model. In Quebec, interviews and focus groups were held in 2015-2016 with 70 key informants including immunization managers, school nurses, school principals, teachers and parents of Grade 4 students (9 years of age). Our findings showed that HPV vaccine uptake was dependent on many interrelated factors at the individual and interpersonal level (e.g. knowledge and attitudes of the different players involved in the vaccination system), at the community level (e.g. social group values and norms, media coverage around the HPV vaccine), at the organizational level (e.g. allocated resources, information provision, consent process, immunization setting and environment) and at the policy level (e.g. changes in provincial HPV vaccine program). We are using the data collection and interpretation tools and approaches developed by our team and used in Quebec to expand our study to four other provinces (British Columbia, Alberta, Ontario and Nova Scotia). We are conducting environmental scans, semi-structured interviews and a survey to better understand the determinants of low HPV vaccine uptake and identify strategies to enhance vaccine acceptance. Having an in-depth understanding of the determinants of HPV vaccination in school settings is critical in order to identify root causes of the suboptimal vaccine uptake and to develop tailored interventions to address these on both supply- and demand-side issues.
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Affiliation(s)
- Eve Dubé
- a Département des risques biologiques et de la santé au travail, Institut national de santé publique du Québec (INSPQ) , Québec , QC , Canada.,b Axe maladies infectieuses et immunitaires, Centre de recherche du CHU de Québec-Université Laval , Québec , QC , Canada.,c Départements d'anthropologie et de médecine sociale et communautaire, Université Laval , Québec , QC , Canada
| | - Dominique Gagnon
- a Département des risques biologiques et de la santé au travail, Institut national de santé publique du Québec (INSPQ) , Québec , QC , Canada
| | - Paule Clément
- a Département des risques biologiques et de la santé au travail, Institut national de santé publique du Québec (INSPQ) , Québec , QC , Canada
| | - Julie A Bettinger
- d Vaccine Evaluation Center, BC Children's Hospital, University of British Columbia , Vancouver , British Columbia , Canada
| | - Jeannette L Comeau
- e Department of Pediatrics, Dalhousie University and IWK Health Centre , Halifax , Nova Scotia , Canada
| | - Shelley Deeks
- f Communicable Diseases, Emergency Preparedness and Response, Public Health Ontario , Toronto , Ontario , Canada.,g Dalla Lana School of Public Health, University of Toronto , Toronto , Ontario , Canada
| | - Maryse Guay
- a Département des risques biologiques et de la santé au travail, Institut national de santé publique du Québec (INSPQ) , Québec , QC , Canada.,h Centre de recherche CSIS, Université de Sherbrooke , Longueuil , QC , Canada
| | - Shannon MacDonald
- i Faculty of Nursing, University of Alberta , Edmonton , AB , Canada
| | - Noni E MacDonald
- e Department of Pediatrics, Dalhousie University and IWK Health Centre , Halifax , Nova Scotia , Canada
| | - Hana Mijovic
- d Vaccine Evaluation Center, BC Children's Hospital, University of British Columbia , Vancouver , British Columbia , Canada
| | - Jillian Paragg
- h Centre de recherche CSIS, Université de Sherbrooke , Longueuil , QC , Canada
| | - Clara Rubincam
- d Vaccine Evaluation Center, BC Children's Hospital, University of British Columbia , Vancouver , British Columbia , Canada
| | - Chantal Sauvageau
- a Département des risques biologiques et de la santé au travail, Institut national de santé publique du Québec (INSPQ) , Québec , QC , Canada.,b Axe maladies infectieuses et immunitaires, Centre de recherche du CHU de Québec-Université Laval , Québec , QC , Canada.,c Départements d'anthropologie et de médecine sociale et communautaire, Université Laval , Québec , QC , Canada
| | - Audrey Steenbeck
- e Department of Pediatrics, Dalhousie University and IWK Health Centre , Halifax , Nova Scotia , Canada
| | - Sarah Wilson
- f Communicable Diseases, Emergency Preparedness and Response, Public Health Ontario , Toronto , Ontario , Canada.,g Dalla Lana School of Public Health, University of Toronto , Toronto , Ontario , Canada
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Comeau JL, Ivany AM, Romeo T, Maxwell BS, Nymark N, MacKinnon B, Doon E, Mailman T. 1261. Utility of a Multiplex Molecular Gastrointestinal Panel in Rapid Identification and Control of a Norovirus Outbreak in a Pediatric Tertiary Care Center. Open Forum Infect Dis 2018. [PMCID: PMC6252859 DOI: 10.1093/ofid/ofy210.1094] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background Norovirus is one of the most common viral pathogens implicated in gastroenteritis outbreaks in community and healthcare settings. The virus’ short incubation period and high attack rate allow its rapid spread through inpatient wards to patients (Patients), staff and visitors. Early identification and appropriate implementation of infection prevention and control measures is essential to interrupt transmission. Methods The IWK Health Centre is a 250-bed tertiary care Pediatric and Women’s hospital serving the Maritime Provinces, Canada. We describe a norovirus outbreak in our Pediatric Medical Unit, a 24-bed, single room ward with individual bathrooms for patients and families. Hospital-acquired norovirus definition: Patients admitted ≥48 hours with lab-confirmed norovirus AND ≥ 1 of: (1) acute onset diarrhea (no noninfectious cause) or (2) ≥2 of: nausea, vomiting, abdominal pain, fever, or headache. In 2017 the FilmArray Gastrointestinal (GI) Panel was introduced in the Clinical Microbiology Laboratory as part of a prospective post-implementation study. Since then, stool samples sent for viral, bacterial, or parasitic testing are evaluated by PCR. The panel tests for 22 GI analytes, including five viruses, with a 2-hour turnaround time. Previously, in-house stool viral testing was limited to adeno- and rotavirus antigen. Patient characteristics were collected and analyzed for this study. Results Patients 1, 2, and 3 had new onset diarrhea and emesis; Pt 1 on day 0, and Patients 2 and 3 on day 1. Patient 3’s parents (likely source) had had diarrhea and emesis on days 3 and 2, and used the ward kitchen. Two care-givers of Patient 2, and 1 medical resident developed diarrhea and emesis over days 0 to 2. The outbreak was declared over on day 7. Patients 1, 2, and 3 all tested positive for norovirus in stool on day 1. On days 2–3, six other patients with diarrhea tested norovirus negative. All symptomatic patients were immediately placed on contact precautions, room/ward cleaning frequency increased and proper hand hygiene was reinforced. Common areas (playroom/kitchen) were closed until the outbreak was over. All patients with loose stool were tested during the outbreak. Conclusion FilmArrayGI panel enabled same-day identification of norovirus in this single-ward outbreak and permitted real-time identification of the termination of the outbreak. Disclosures All authors: No reported disclosures.
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Affiliation(s)
- Jeannette L Comeau
- Department of Pediatrics, Division of Infectious Diseases, IWK Health Centre, Halifax, NS, Canada
- Dalhousie University, Halifax, NS, Canada
- Infection Prevention and Control, IWK Health Centre, Halifax, NS, Canada
| | - Allana M Ivany
- Infection Prevention and Control, IWK Health Centre, Halifax, NS, Canada
| | - Terry Romeo
- Microbiology Laboratory, IWK Health Centre, Halifax, NS, Canada
| | - Bridget S Maxwell
- Infection Prevention and Control, IWK Health Centre, Halifax, NS, Canada
| | - Natalie Nymark
- Infection Prevention and Control, IWK Health Centre, Halifax, NS, Canada
| | | | - Erin Doon
- Microbiology Laboratory, IWK Health Centre, Halifax, NS, Canada
| | - Tim Mailman
- Department of Pediatrics, Division of Infectious Diseases, IWK Health Centre, Halifax, NS, Canada
- Dalhousie University, Halifax, NS, Canada
- Department of Microbiology and Immunology, IWK Health Centre, Halifax, NS, Canada
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21
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Comeau JL, Chan J, Macartney KK. New Vaccines on the Horizon. Curr Pediatr Rep 2016. [DOI: 10.1007/s40124-016-0109-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Comeau JL, Gagneur A, Quach C. Impact of a publicly funded monovalent rotavirus vaccination program in the Province of Quebec (Canada). Vaccine 2016; 34:893-8. [PMID: 26795368 DOI: 10.1016/j.vaccine.2016.01.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [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: 09/28/2015] [Revised: 01/01/2016] [Accepted: 01/04/2016] [Indexed: 11/28/2022]
Abstract
UNLABELLED In November 2011, the province of Quebec, Canada implemented a publicly funded rotavirus (RV) vaccination program using the monovalent RV vaccine (RV1). To assess its impact, trends in passive RV laboratory detection and Emergency Department (ED) visits for gastroenteritis (GE) at two pediatric centers were evaluated. METHODS RV tests performed were extracted from the virology laboratory databases and ED visits for GE between July 1, 2006 and June 30, 2013, from the ED databases of The Montreal Children's Hospital (MCH) and Centre Hospitalier Universitaire de Sherbrooke (CHUS). The percent positive RV tests over time and season duration were assessed using 5-week moving averages. We defined season start and end as the first two and the last two consecutive weeks where the percent positive RV tests were ≥ 10%, respectively. RESULTS Comparing the pre- and post-vaccination program periods, a decrease in the proportion of positive RV tests was seen: 15.9% vs. 5.1% (p<0.001). Pre-vaccination program, RV seasons started between December and February, peaked in March or April and ended in May. In 2011-2012, the season started in March, peaked in April, and ended in May. In 2012-2013, the season lasted 3 weeks in May. ED visits for GE decreased post-introduction of the RV1 program: from 4.8% to 3.4% in 2011-2012, and 4.2% in 2012-13 (p<0.001). In children <2 years of age, ED GE visits decreased from 7.5% to 4.8% in 2011-2012, and 5.2% in 2012-2013 (p<0.001). Admissions for GE also decreased significantly from 0.41% of all ED visits to 0.14% in 2011-2012 and 0.22% in 2012-2013 (p<0.005). CONCLUSION Implementation of a publicly funded RV vaccination program had a major impact on the epidemiology of RV infections in Quebec: RV seasons have started later and been of shorter duration, peak positives were fewer, and ED visits for GE decreased.
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Affiliation(s)
- Jeannette L Comeau
- Division of Infectious Diseases, Department of Pediatrics and Department of Medical Microbiology, The Montreal Children's Hospital, McGill University, E05-1954 - 1001 Decarie Blvd, Montreal (QC) H4A 3J1, Canada.
| | - Arnaud Gagneur
- Department of Pediatrics, Université de Sherbrooke, 3001 12e Avenue Nord, Sherbrooke (QC) J1H 5N4, Canada.
| | - Caroline Quach
- Division of Infectious Diseases, Department of Pediatrics and Department of Medical Microbiology, The Montreal Children's Hospital, McGill University, E05-1954 - 1001 Decarie Blvd, Montreal (QC) H4A 3J1, Canada; Division des risques biologiques et de la santé au travail - Institut national de santé publique du Québec, 190 Crémazie Blvd E., Montreal (QC) H2P 1E2, Canada; Department of Epidemiology, Biostatistics, and Occupational Health - McGill University, 1020 Pine Avenue W, Montreal (QC) H3A 1A2, Canada; MUHC Vaccine Study Centre, 14770 Pierrefonds Blvd, Suite 204, Montreal (QC) H9H 4Y6, Canada.
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Comeau JL, Tran TH, Moore DL, Phi CM, Quach C. Salmonella enterica serotype Typhi infections in a Canadian pediatric hospital: a retrospective case series. CMAJ Open 2013; 1:E56-61. [PMID: 25077103 PMCID: PMC4006666 DOI: 10.9778/cmajo.20120012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [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: 11/22/2022] Open
Abstract
BACKGROUND In developed countries, typhoid fever generally occurs in travellers or recent immigrants from endemic areas. Our aim was to describe the epidemiology of Salmonella enterica serotype Typhi infections among children presenting to a pediatric teaching hospital in Montréal, Quebec. METHODS We included all patients less than 18 years of age who presented to the Montreal Children's Hospital between 1991 and 2011 with a laboratory-confirmed diagnosis of typhoid fever (Salmonella enterica ser. Typhi isolated from blood or stool) in a retrospective case series. RESULTS During the study period, we identified 39 cases of typhoid fever (mean age of patient 7.5 yr). Four (10.3%) of these cases occurred in newly arrived immigrants shortly after their arrival in Canada (median 15.5 d). Most cases (76.9%) occurred in children who had visited friends and relatives in their home country. None of the travellers had received a vaccination against typhoid fever before their departure. All cases presented with high fever (mean temperature 40.4°C) that lasted for a mean of 15.8 days. Common accompanying symptoms included anorexia, abdominal pain, vomiting and diarrhea. All 39 isolates of S. enterica ser. Typhi were susceptible to third-generation cephalosporins, and 7 were resistant to ciprofloxacin. Ampicillin resistance occurred in 10 (25.6%) of the isolates. No deaths occurred among the study participants. INTERPRETATION Most cases of typhoid fever occurred in children who had travelled to endemic areas to visit friends and relatives. Thus, there is a role for increased awareness on the part of family physicians and pediatricians caring for these children to discuss travel-related infections during regularly scheduled appointments, because parents might not consult travel clinics or discuss their travel plans before travelling back to their home country.
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Affiliation(s)
- Jeannette L. Comeau
- Infectious Diseases Division, Department of Pediatrics, Montreal Children’s Hospital, McGill University, Montréal, Que
- Department of Pediatrics, Montreal Children’s Hospital, McGill University, Montréal, Que
| | - Thai Hoa Tran
- Infectious Diseases Division, Department of Pediatrics, Montreal Children’s Hospital, McGill University, Montréal, Que
| | - Dorothy L. Moore
- Infectious Diseases Division, Department of Pediatrics, Montreal Children’s Hospital, McGill University, Montréal, Que
| | - Chi-Minh Phi
- Department of Pediatrics, Montreal Children’s Hospital, McGill University, Montréal, Que
| | - Caroline Quach
- Infectious Diseases Division, Department of Pediatrics, Montreal Children’s Hospital, McGill University, Montréal, Que
- Department of Microbiology, Montreal Children’s Hospital, McGill University, Montréal, Que
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Nicolescu AC, Ji Y, Comeau JL, Hill BC, Takahashi T, Brien JF, Racz WJ, Massey TE. Direct mitochondrial dysfunction precedes reactive oxygen species production in amiodarone-induced toxicity in human peripheral lung epithelial HPL1A cells. Toxicol Appl Pharmacol 2007; 227:370-9. [PMID: 18191165 DOI: 10.1016/j.taap.2007.12.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2007] [Revised: 11/30/2007] [Accepted: 12/03/2007] [Indexed: 10/22/2022]
Abstract
Amiodarone (AM), a drug used in the treatment of cardiac dysrrhythmias, can produce severe pulmonary adverse effects, including fibrosis. Although the pathogenesis of AM-induced pulmonary toxicity (AIPT) is not clearly understood, several hypotheses have been advanced, including increased inflammatory mediator release, mitochondrial dysfunction, and free-radical formation. The hypothesis that AM induces formation of reactive oxygen species (ROS) was tested in an in vitro model relevant for AIPT. Human peripheral lung epithelial HPL1A cells, as surrogates for target cells in AIPT, were susceptible to the toxicity of AM and N-desethylamiodarone (DEA), a major AM metabolite. Longer incubations (> or =6 h) of HPL1A cells with 100 microM AM significantly increased ROS formation. In contrast, shorter incubations (2 h) of HPL1A cells with AM resulted in mitochondrial dysfunction and cytoplasmic cytochrome c translocation. Preexposure of HPL1A cells to ubiquinone and alpha-tocopherol was more effective than that with Trolox C or 5,5-dimethylpyrolidine N-oxide (DMPO) at preventing AM cytotoxicity. These data suggest that mitochondrial dysfunction, rather than ROS overproduction, represents an early event in AM-induced toxicity in peripheral lung epithelial cells that may be relevant for triggering AIPT, and antioxidants that target mitochondria may potentially have beneficial effects in AIPT.
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Affiliation(s)
- Adrian C Nicolescu
- Department of Pharmacology and Toxicology, Queen's University, Kingston, ON, Canada K7L 3N6.
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Nicolescu AC, Comeau JL, Hill BC, Bedard LL, Takahashi T, Brien JF, Racz WJ, Massey TE. Aryl radical involvement in amiodarone-induced pulmonary toxicity: Investigation of protection by spin-trapping nitrones. Toxicol Appl Pharmacol 2007; 220:60-71. [PMID: 17316728 DOI: 10.1016/j.taap.2006.12.031] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [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: 10/25/2006] [Revised: 12/20/2006] [Accepted: 12/20/2006] [Indexed: 11/24/2022]
Abstract
Amiodarone (AM), an antidysrrhythmic drug, can produce serious adverse effects, including potentially fatal AM-induced pulmonary toxicity (AIPT). AM-induced cytotoxicity and pulmonary fibrosis are well recognized, but poorly understood mechanistically. The hypothesis of aryl radical involvement in AM toxicity was tested in non-biological and biological systems. Photolysis of anaerobic aqueous solutions of AM, or N-desethylamiodarone (DEA) resulted in the formation of an aryl radical, as determined by spin-trapping and electron paramagnetic resonance (EPR) spectroscopy experiments. The non-iodinated AM analogue, didesiodoamiodarone (DDIA), did not form aryl radicals under identical conditions. The toxic susceptibility of human lung epithelioid HPL1A cells to AM, DEA, and DDIA showed time- and concentration-dependence. DEA had a more rapid and potent toxic effect (LC(50)=8 microM) than AM (LC(50)=146 microM), whereas DDIA cytotoxicity was intermediate (LC(50)=26 microM) suggesting a minor contribution of the iodine atoms. Incubation of human lung epithelial cells with the spin-trapping nitrones alpha-phenyl-N-t-butylnitrone (PBN, 10 mM) or alpha-(4-pyridyl N-oxide)-N-t-butylnitrone (POBN, 5.0 mM) did not significantly protect against AM, DEA, or DDIA cytotoxicity. Intratracheal administration of AM to hamsters produced pulmonary fibrosis at day 21, which was not prevented by 4 days of treatment with 150 mg/kg/day PBN or 164 mg/kg/day POBN. However, the body weight loss in AM-treated animals was counteracted by PBN. These results suggest that, although AM can generate an aryl radical photochemically, its in vivo formation may not be a major contributor to AM toxicity, and that spin-trapping reagents do not halt the onset of AM toxicity.
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Affiliation(s)
- Adrian C Nicolescu
- Department of Pharmacology and Toxicology, Queen's University, Kingston, ON, Canada K7L 3N6
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