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Lampidi S, Maritsi D, Charakida M, Eleftheriou I, Farmaki E, Spyridis N, Charisi K, Vantsi P, Filippatos F, Skourti K, Papadopoulou-Alataki E, Papadopoulou-Legbelou K, Kampouridou P, Grivea IN, Vergadi E, Gkentzi D, Dimou D, Koletsi P, Fotis L, Liakopoulou T, Agrafiotou A, Kourtesi K, Tsolas G, Kafetzis D, Papaevangelou V, Dimitriou G, Galanakis E, Syrogiannopoulos GA, Spoulou V, Michos A, Roilides E, Tsolia MN. Multisystem inflammatory syndrome in children (MIS-C): A nationwide collaborative study in the Greek population. Eur J Pediatr 2024; 183:1693-1702. [PMID: 38214810 PMCID: PMC11001744 DOI: 10.1007/s00431-023-05383-5] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 12/05/2023] [Accepted: 12/10/2023] [Indexed: 01/13/2024]
Abstract
Multisystem inflammatory syndrome in children (MIS-C) is a rare but severe hyperinflammatory condition that may occur following SARS-CoV-2 infection. This retrospective, descriptive study of children hospitalized with multisystem inflammatory syndrome in children (MIS-C) in 12 tertiary care centers from 3/11/2020 to 12/31/2021. Demographics, clinical and laboratory characteristics, treatment and outcomes are described. Among 145 patients (95 males, median age 8.2 years) included, 123 met the WHO criteria for MIS-C, while 112 (77%) had serological evidence of SARS-CoV-2 infection. Fever was present in 99%, gastrointestinal symptoms in 77%, mucocutaneous involvement in 68% and respiratory symptoms in 28%. Fifty-five patients (38%) developed myocarditis, 29 (20%) pericarditis and 19 (13%) coronary aneurysms. Among the above cases 11/55 (20%), 1/29 (3.4%) and 5/19 (26.3%), respectively, cardiac complications had not fully resolved at discharge. Underlying comorbidities were reported in 18%. Median CRP value was 155 mg/l, ferritin 535 ng/ml, PCT 1.6 ng/ml and WBC 14.2 × 109/mm3. Most patients had elevated troponin (41.3%) and/or NT-pro-BNP (49.6%). Intravenous immunoglobulin plus corticosteroids were used in 117/145 (80.6%), monotherapy with IVIG alone in 13/145 (8.9%) and with corticosteroids alone in 2/145 (1.3%). Anti-IL1 treatment was added in 15 patients (10.3%). Thirty-three patients (23%) were admitted to the PICU, 14% developed shock and 1 required ECMO. Mortality rate was 0.68%. The incidence of MIS-C was estimated at 0.69/1000 SARS-CoV-2 infections. Patients who presented with shock had higher levels of NT-pro-BNP compared to those who did not (p < 0.001). Acute kidney injury and/or myocarditis were associated with higher risk of developing shock. CONCLUSION MIS-C is a novel, infrequent but serious disease entity. Cardiac manifestations included myocarditis and pericarditis, which resolved in most patients before discharge. Timely initiation of immunomodulatory therapy was shown to be effective. NT-pro-BNP levels may provide a better prediction and monitoring of the disease course. Further research is required to elucidate the pathogenesis, risk factors and optimal management, and long-term outcomes of this clinical entity. WHAT IS KNOWN • MIS-C is an infrequent but serious disease entity. • Patients with MIS-C present with multi-organ dysfunction, primarily involving the gastrointestinal and cardiovascular systems. WHAT IS NEW • NT-pro-BNP levels may provide a better prediction and monitoring of the disease course. • Acute kidney injury and/or myocarditis were associated with higher risk of developing shock.
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Affiliation(s)
- Stavroula Lampidi
- Second Department of Paediatrics, National and Kapodistrian University of Athens, "P. and A. Kyriakou" Children's Hospital, 11527, Athens, Greece
| | - Despoina Maritsi
- Second Department of Paediatrics, National and Kapodistrian University of Athens, "P. and A. Kyriakou" Children's Hospital, 11527, Athens, Greece
| | - Marietta Charakida
- Second Department of Paediatrics, National and Kapodistrian University of Athens, "P. and A. Kyriakou" Children's Hospital, 11527, Athens, Greece
| | - Irini Eleftheriou
- Second Department of Paediatrics, National and Kapodistrian University of Athens, "P. and A. Kyriakou" Children's Hospital, 11527, Athens, Greece
| | - Evangelia Farmaki
- First Department of Paediatrics, Aristotle University of Thessaloniki, Hippokration General Hospital, 54642, Thessaloniki, Greece
| | - Nikos Spyridis
- Second Department of Paediatrics, National and Kapodistrian University of Athens, "P. and A. Kyriakou" Children's Hospital, 11527, Athens, Greece
| | - Konstantina Charisi
- Third Department of Paediatrics, Aristotle University of Thessaloniki, Hippokration General Hospital, 54642, Thessaloniki, Greece
| | - Petrina Vantsi
- Third Department of Paediatrics, Aristotle University of Thessaloniki, Hippokration General Hospital, 54642, Thessaloniki, Greece
| | - Filippos Filippatos
- First Department of Paediatrics, National and Kapodistrian University of Athens, 'Aghia Sophia' Children's Hospital, 11527, Athens, Greece
| | - Kleopatra Skourti
- First Department of Paediatrics, National and Kapodistrian University of Athens, 'Aghia Sophia' Children's Hospital, 11527, Athens, Greece
| | - Efimia Papadopoulou-Alataki
- Fourth Department of Pediatrics, Aristotle University of Thessaloniki, Papageorgiou General Hospital, 56429, Thessaloniki, Greece
| | - Kyriaki Papadopoulou-Legbelou
- Fourth Department of Pediatrics, Aristotle University of Thessaloniki, Papageorgiou General Hospital, 56429, Thessaloniki, Greece
| | | | - Ioanna N Grivea
- Department of Paediatrics, Faculty of Medicine, School of Health Sciences, University of Thessaly, 41500, Larissa, Greece
| | - Eleni Vergadi
- Department of Paediatrics, Medical School, University of Crete, 71003, Heraklion, Greece
| | - Despoina Gkentzi
- Department of Paediatrics, University of Patras, University General Hospital of Patras, 26504, Patra, Greece
| | - Despina Dimou
- Paediatric Department, Penteli Children's Hospital, 15236, Athens, Greece
| | - Patra Koletsi
- Paediatric Department, Penteli Children's Hospital, 15236, Athens, Greece
| | - Lampros Fotis
- Third Department of Paediatrics, National and Kapodistrian University of Athens, General University Hospital "Attikon", 12462, Athens, Greece
- Department of Paediatrics, Metropolitan Hospital, 18547, Athens, Greece
- IASO Children's Hospital, 15123, Athens, Greece
| | | | | | - Katerina Kourtesi
- Third Department of Paediatrics, National and Kapodistrian University of Athens, General University Hospital "Attikon", 12462, Athens, Greece
| | - Georgios Tsolas
- Department of Paediatrics, Metropolitan Hospital, 18547, Athens, Greece
| | | | - Vassiliki Papaevangelou
- Third Department of Paediatrics, National and Kapodistrian University of Athens, General University Hospital "Attikon", 12462, Athens, Greece
| | - Gabriel Dimitriou
- Department of Paediatrics, University of Patras, University General Hospital of Patras, 26504, Patra, Greece
| | - Emmanouil Galanakis
- Department of Paediatrics, Medical School, University of Crete, 71003, Heraklion, Greece
| | - George A Syrogiannopoulos
- Department of Paediatrics, Faculty of Medicine, School of Health Sciences, University of Thessaly, 41500, Larissa, Greece
| | - Vassiliki Spoulou
- First Department of Paediatrics, National and Kapodistrian University of Athens, 'Aghia Sophia' Children's Hospital, 11527, Athens, Greece
| | - Athanasios Michos
- First Department of Paediatrics, National and Kapodistrian University of Athens, 'Aghia Sophia' Children's Hospital, 11527, Athens, Greece
| | - Emmanuel Roilides
- Third Department of Paediatrics, Aristotle University of Thessaloniki, Hippokration General Hospital, 54642, Thessaloniki, Greece
| | - Maria N Tsolia
- Second Department of Paediatrics, National and Kapodistrian University of Athens, "P. and A. Kyriakou" Children's Hospital, 11527, Athens, Greece.
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Kopsidas I, Dasoula FE, Kourkouni E, Krepi A, Mystakelis HΑ, Spyridis N, Vartzelis G. Management of children with febrile seizures: a Greek nationwide survey. Eur J Pediatr 2023:10.1007/s00431-023-05004-1. [PMID: 37160780 DOI: 10.1007/s00431-023-05004-1] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 04/24/2023] [Accepted: 04/25/2023] [Indexed: 05/11/2023]
Abstract
The purpose of this study was to investigate knowledge, principles, and practices concerning the management of children with febrile seizures among pediatricians in Greece. A cross-sectional study was performed across Greece. Pediatricians completed an anonymous and voluntary 11-item questionnaire about their knowledge, attitudes, and practices with respect to the management of febrile seizures; the survey also collected demographic data. It was first administered in paper form in October 2017. This was followed by an online survey performed between June and August of 2018 and publicized by medical boards across Greece. Descriptive statistics and comparisons between groups were conducted with the significance level set at p ≤ 0.05. We recorded 457 responses. Pediatricians admitted to modifying their advice to the parents of children with febrile seizures by suggesting more "aggressive" fever management at low temperatures or systematically (63%), referral to a specialist after any episode of febrile seizures (63%), or hospitalization in a subsequent episode (67%), even though 72% admitted these practices were of no efficacy. Almost one in three pediatricians (28%) believed aggressive management of fever could delay the onset of febrile seizures; increasing age was associated with this perception. A minority (28%) would make parents aware of febrile seizures before a first episode regardless of family history; 38% would do so in the event of family history. CONCLUSIONS Several pediatricians in Greece use outdated and ineffective practices for the management of febrile seizures, despite the availability of updated evidence-based guidelines. Further training of practitioners is needed to bridge this gap. WHAT IS KNOWN •Aggressive management of fever at low temperatures with antipyretics, referral to a neurologist, and hospitalization are not supported by evidence or recent guidelines on childhood febrile seizures. •Febrile seizures are especially disturbing to uninformed parents, who may be inclined to pursue aggressive but ineffective treatments as a result. WHAT IS NEW •Pediatricians in Greece use non-evidence-based practices for the management of febrile seizures, even when they are aware that these practices are not effective. •Older age increases the likelihood that a pediatrician will pursue guideline non-compliant practices in Greece. At the same time, physicians with over 20 years of experience are more likely to inform parents in advance about febrile seizures.
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Affiliation(s)
- Ioannis Kopsidas
- Second Department of Pediatrics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.
- Center for Clinical Epidemiology and Outcomes Research, Athens, Greece.
| | - Foteini Eleni Dasoula
- Second Department of Pediatrics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Eleni Kourkouni
- Center for Clinical Epidemiology and Outcomes Research, Athens, Greece
| | - Adamantia Krepi
- Second Department of Pediatrics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Harry Α Mystakelis
- Second Department of Pediatrics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Nikos Spyridis
- Second Department of Pediatrics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - George Vartzelis
- Second Department of Pediatrics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
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Dimopoulou D, Liaska M, Eleftheriou I, Kourkouni E, Tsolia M, Spyridis N. Favorable Outcome in Infants Hospitalized With COVID-19: Single Center Experience from Athens, Greece. Indian Pediatr 2022. [PMID: 35751373 PMCID: PMC9518936 DOI: 10.1007/s13312-022-2604-4] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
This study aims to describe the clinical characteristics and outcome of 92 infants (aged <12 months) with community-acquired coronavirus disease 2019 (COVID-19) between March, 2020 and June, 2021 at a single center in Athens. Infants with COVID-19 developed mild disease (89, 96.7%), and were infected mostly by their household contacts (74, 80.4%). Disease complications were rare, indicating that hospitalization is the result of low threshold for admission rather than disease severity.
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Affiliation(s)
- Dimitra Dimopoulou
- Second Department of Paediatrics, National and Kapodistrian University of Athens, School of Medicine, 'P. and A. Kyriakou' Children's Hospital, Athens, Greece.
| | - Marianthi Liaska
- Second Department of Paediatrics, National and Kapodistrian University of Athens, School of Medicine, 'P. and A. Kyriakou' Children's Hospital, Athens, Greece
| | - Irini Eleftheriou
- Second Department of Paediatrics, National and Kapodistrian University of Athens, School of Medicine, 'P. and A. Kyriakou' Children's Hospital, Athens, Greece
| | - Eleni Kourkouni
- Center for Clinical Epidemiology and Outcomes Research (CLEO), Non-Profit Civil Partnership, 5 Chatzigianni Mexi str.,11528 Athens, Greece
| | - Maria Tsolia
- Second Department of Paediatrics, National and Kapodistrian University of Athens, School of Medicine, 'P. and A. Kyriakou' Children's Hospital, Athens, Greece
| | - Nikos Spyridis
- Second Department of Paediatrics, National and Kapodistrian University of Athens, School of Medicine, 'P. and A. Kyriakou' Children's Hospital, Athens, Greece
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Dimopoulou D, Tsolia MN, Spyridis N, Maritsi DN. Immunogenicity 6 months post COVID-19 mRNA vaccination among adolescents with juvenile idiopathic arthritis on treatment with TNF inhibitors. Rheumatology (Oxford) 2022; 62:SI205-SI209. [PMID: 35788275 PMCID: PMC9278208 DOI: 10.1093/rheumatology/keac352] [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: 03/14/2022] [Revised: 05/12/2022] [Accepted: 06/06/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Mass vaccination is the most effective strategy for controlling the COVID-19 pandemic. This study aimed to evaluate the 6-month immunogenicity after BNT162b2-COVID-19 vaccination in adolescents with JIA on TNFi treatment. METHODS This single-centre study included adolescents with JIA treated with TNFi for at least 18 months. Patients received two doses of COVID-19 vaccine (Pfizer-BioNTech) from 15 April to 15 May 2021. Quantitative measurement of IgG antibodies to SARS-CoV-2-spike-protein-1 was performed at 1, 3 and 6 months post-vaccination. RESULTS Overall, 21 adolescents with JIA in clinical remission at the time of vaccinations were enrolled. None of them discontinued TNFi/MTX treatment at the time of vaccine administration or during the follow-up period. All patients developed a sustained humoral response against SARS-CoV-2 at 1 and 3 months after vaccination (P < 0.05). The antibody levels decreased significantly at 6 months post-vaccination (P < 0.01). The type of JIA did not reveal any differences in the humoral response at 3 (P = 0.894) or 6 months post-vaccination (P = 0.72). No difference was detected upon comparison of the immunogenicity between the different treatment arms (adalimumab vs etanercept) at 3 (P = 0.387) and 6 months (P = 0.526), or TNFi monotherapy vs combined therapy (TNFi plus methotrexate) at 3 (P = 0.623) and 6 months (P = 0.885). CONCLUSIONS Although mRNA vaccines develop satisfactory immunogenicity at 1 month and 3 months post-vaccination in adolescents with JIA on TNFi, SARS-CoV-2 antibody titres decrease significantly overtime, remaining at lower levels at 6 months. Further collaborative studies are required to determine long-term immunogenicity, real duration of immune protection and the need for a booster vaccine dose.
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Affiliation(s)
- Dimitra Dimopoulou
- Correspondence to: Dimitra Dimopoulou, Second Department of Pediatrics, ‘P. & A. Kyriakou’ Children's Hospital, Thivon and Leivadias Str, 11526, Athens, Greece. E-mail:
| | - Maria N Tsolia
- Infectious Diseases, Immunology and Rheumatology Unit, Second Department of Paediatrics, ‘P. & A. Kyriakou’ Children's Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Nikos Spyridis
- Infectious Diseases, Immunology and Rheumatology Unit, Second Department of Paediatrics, ‘P. & A. Kyriakou’ Children's Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Despoina N Maritsi
- Infectious Diseases, Immunology and Rheumatology Unit, Second Department of Paediatrics, ‘P. & A. Kyriakou’ Children's Hospital, National and Kapodistrian University of Athens, Athens, Greece
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Mantadakis E, Kopsidas I, Coffin S, Dimitriou G, Gkentzi D, Hatzipantelis E, Kaisari A, Kattamis A, Kourkouni E, Papachristidou S, Papakonstantinou E, Polychronopoulou S, Roilides E, Spyridis N, Tsiodras S, Tsolia MN, Tsopela GC, Zaoutis T, Tragiannidis A. A national study of antibiotic use in Greek pediatric hematology oncology and bone marrow transplant units. Antimicrob Steward Healthc Epidemiol 2022; 2:e71. [PMID: 36483391 PMCID: PMC9726537 DOI: 10.1017/ash.2022.43] [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] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 03/09/2022] [Accepted: 03/10/2022] [Indexed: 06/17/2023]
Abstract
OBJECTIVE We surveyed antimicrobials used in Greek pediatric hematology-oncology (PHO) and bone marrow transplant (BMT) units before and after an intervention involving education regarding the 2017 clinical practice guidelines (CPG) for the management of febrile neutropenia in children with cancer and hematopoietic stem-cell transplant recipients. DESIGN Antibiotic prescribing practices were prospectively recorded between June 2016 and November 2017. INTERVENTION In December 2017, baseline data feedback was provided, and CPG education was provided. Prescribing practices were followed for one more year. For antibiotic stewardship, days of therapy, and length of therapy were calculated. SETTING Five of the 6 PHO units in Greece and the single pediatric BMT unit participated. PARTICIPANTS Admitted children in each unit who received the first 15 new antibiotic courses each month. RESULTS Administration of ≥4 antibiotics simultaneously and administration of antibiotics with overlapping activity for ≥2 days were significantly more common in PHO units in general hospitals compared to children's hospitals. Use of at least 1 antifungal was recorded in ∼47% of the patients before and after the intervention. De-escalation and/or discontinuation of antibiotics on day 6 of initial treatment increased significantly from 43% to 53.5% (P = .032). Although the number of patients requiring intensive care support for sepsis did not change, a significant drop was noted in all-cause mortality (P = .008). CONCLUSIONS We recorded the antibiotic prescribing practices in Greek PHO and BMT units, we achieved improved prescribing with a simple intervention, and we identified areas in need of improvement.
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Affiliation(s)
- Elpis Mantadakis
- Democritus University of Thrace Faculty of Medicine, University General Hospital of Alexandroupolis, Alexandroupolis, Greece
| | - Ioannis Kopsidas
- Center for Clinical Epidemiology and Outcomes Research (CLEO), Athens, Greece
| | - Susan Coffin
- Division of Infectious Diseases and Center for Pediatric Clinical Effectiveness, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, United States
| | - Gabriel Dimitriou
- Patras Medical School, University General Hospital of Patras, Patra, Greece
| | - Despoina Gkentzi
- Patras Medical School, University General Hospital of Patras, Patra, Greece
| | - Emmanouel Hatzipantelis
- Children & Adolescent Hematology–Oncology Unit, Second Pediatric Department, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Aikaterini Kaisari
- Stem Cell Transplant Unit, Aghia Sophia Children’s Hospital, Athens, Greece
| | - Antonis Kattamis
- First Department of Pediatrics, National and Kapodistrian University of Athens, Aghia Sophia Children’s Hospital, Athens, Greece
| | - Eleni Kourkouni
- Center for Clinical Epidemiology and Outcomes Research (CLEO), Athens, Greece
| | | | | | - Sophia Polychronopoulou
- Department of Pediatric Hematology–Oncology (T.A.O.), Aghia Sophia Children’s Hospital, Athens, Greece
| | - Emmanuel Roilides
- Third Department of Pediatrics, Aristotle University of Thessaloniki, Hipppokration General Hospital, Thessaloniki, Greece
| | - Nikos Spyridis
- Infectious Diseases Unit, Second Department of Pediatrics, National and Kapodistrian University of Athens (NKUA), Athens, Greece
| | - Sotirios Tsiodras
- Fourth Department of Internal Medicine, National and Kapodistrian University of Athens, Attikon Hospital, Athens, Greece
| | - Maria N. Tsolia
- Infectious Diseases Unit, Second Department of Pediatrics, National and Kapodistrian University of Athens (NKUA), Athens, Greece
| | | | - Theoklis Zaoutis
- Center for Clinical Epidemiology and Outcomes Research (CLEO), Athens, Greece
- Infectious Diseases Unit, Second Department of Pediatrics, National and Kapodistrian University of Athens (NKUA), Athens, Greece
| | - Athanasios Tragiannidis
- Children & Adolescent Hematology–Oncology Unit, Second Pediatric Department, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Kopsidas I, Molocha NM, Kourkouni E, Coffin S, Gkentzi D, Chorianopoulou E, Dimitriou G, Kapetanaki A, Karavana G, Lithoxopoulou M, Polychronaki M, Roilides E, Triantafyllidou P, Triantafyllou C, Tsopela GC, Tsouvala E, Tsolia MN, Zaoutis T, Spyridis N. Potential benefit from the implementation of the Kaiser Permanente neonatal early-onset sepsis calculator on clinical management of neonates with presumed sepsis. Eur J Pediatr 2022; 181:1001-1008. [PMID: 34664107 DOI: 10.1007/s00431-021-04282-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 05/25/2021] [Revised: 09/15/2021] [Accepted: 10/03/2021] [Indexed: 10/20/2022]
Abstract
To assess the potential benefit from the implementation of the Kaiser Permanente early-onset sepsis calculator (EOS-C), in terms of antibiotic use and requested laboratory tests, in a network of neonatal intensive care units (NICUs) in Greece, and to determine the incidence of early-onset sepsis (EOS) in Greek NICUs, a prospective surveillance study was conducted in 7 NICUs between April 2018 and June 2019. Data were collected for all newborns ≥ 34 weeks' gestation receiving empiric antibiotic therapy within the first 3 days of life. The number of live births and positive blood or cerebrospinal fluid cultures within the first 3 days of life were used for calculation of EOS incidence. Evaluation of possible impact of implementing the calculator was done by comparing the clinicians' recorded management to the calculator's suggested course of action. The unit-specific incidence of culture-proven EOS ranged between 0 and 2.99/1000 live births. The weighted incidence rate for all 7 units was 1.8/1000 live births. Management of EOS guided by the calculator could lead to a reduction of empiric antibiotic initiation up to 100% for the group of "well-appearing" neonates and 86% for "equivocal," lowering exposure to antibiotics by 4.2 and 3.8 days per neonate, respectively. Laboratory tests for blood cultures drawn could be reduced by up to 100% and 68%, respectively. Sensitivity of the EOS-C in identifying neonates with positive blood cultures was high.Conclusion: Management strategies based on the Kaiser Permanente neonatal sepsis calculator may significantly reduce antibiotic exposure, invasive diagnostic procedures, and hospitalizations in late preterm and term neonates. What is Known: • Neonates are frequently exposed to antibiotics for presumed EOS. • The Kaiser Permanente sepsis calculator can reduce antibiotic exposure in neonates.. What is New: • EOS calculator can be an effective antibiotic stewardship tool in a high prescribing country and can reduce invasive diagnostic procedures and mother-baby separation. • Incidence of EOS in Greece is higher compared to other European countries.
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Affiliation(s)
- Ioannis Kopsidas
- Center for Clinical Epidemiology and Outcomes Research (CLEO), Athens, Greece.,Second Department of Pediatrics, National and Kapodistrian, University of Athens, School of Medicine, Athens, Greece
| | | | - Eleni Kourkouni
- Center for Clinical Epidemiology and Outcomes Research (CLEO), Athens, Greece
| | - Susan Coffin
- Division of Infectious Diseases and Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia, Philadelphia, USA
| | - Despoina Gkentzi
- Department of Pediatrics, University General Hospital of Patras, Patras Medical School, Patras, Greece
| | | | - Gabriel Dimitriou
- Department of Pediatrics, University General Hospital of Patras, Patras Medical School, Patras, Greece
| | - Anastasia Kapetanaki
- Neonatal Intensive Care Unit, Elenas Venizelou Maternity Hospital, Athens, Greece
| | - Georgia Karavana
- Neonatal Intensive Care Unit, General Hospital of Nikaia and Piraeus "Aghios Panteleimon", Athens, Greece
| | - Maria Lithoxopoulou
- Second Department of Neonatology, Papageorgiou Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | - Emmanuel Roilides
- Third Department of Pediatrics, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | | | | | - Emmanouela Tsouvala
- Neonatal Intensive Care Unit, General University Hospital of Alexandroupolis, Alexandroupoli, Greece
| | - Maria N Tsolia
- Second Department of Pediatrics, National and Kapodistrian, University of Athens, School of Medicine, Athens, Greece
| | - Theoklis Zaoutis
- Center for Clinical Epidemiology and Outcomes Research (CLEO), Athens, Greece.,Division of Infectious Diseases and Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia, Philadelphia, USA
| | - Nikos Spyridis
- Second Department of Pediatrics, National and Kapodistrian, University of Athens, School of Medicine, Athens, Greece.
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Dimopoulou D, Spyridis N, Vartzelis G, Tsolia MN, Maritsi DN. Safety and tolerability of the COVID-19 mRNA-vaccine in adolescents with juvenile idiopathic arthritis on treatment with TNF-inhibitors. Arthritis Rheumatol 2021; 74:365-366. [PMID: 34492161 PMCID: PMC8653078 DOI: 10.1002/art.41977] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 08/16/2021] [Accepted: 08/23/2021] [Indexed: 11/10/2022]
Affiliation(s)
- Dimitra Dimopoulou
- Infectious Diseases, Immunology and Rheumatology Unit, Second Department of Paediatrics, National and Kapodistrian University of Athens, School of Medicine, 'P. and A. Kyriakou' Children's Hospital, Athens, Greece
| | - Nikos Spyridis
- Infectious Diseases, Immunology and Rheumatology Unit, Second Department of Paediatrics, National and Kapodistrian University of Athens, School of Medicine, 'P. and A. Kyriakou' Children's Hospital, Athens, Greece
| | - George Vartzelis
- Infectious Diseases, Immunology and Rheumatology Unit, Second Department of Paediatrics, National and Kapodistrian University of Athens, School of Medicine, 'P. and A. Kyriakou' Children's Hospital, Athens, Greece
| | - Maria N Tsolia
- Infectious Diseases, Immunology and Rheumatology Unit, Second Department of Paediatrics, National and Kapodistrian University of Athens, School of Medicine, 'P. and A. Kyriakou' Children's Hospital, Athens, Greece
| | - Despoina N Maritsi
- Infectious Diseases, Immunology and Rheumatology Unit, Second Department of Paediatrics, National and Kapodistrian University of Athens, School of Medicine, 'P. and A. Kyriakou' Children's Hospital, Athens, Greece
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8
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Affiliation(s)
- Irini Eleftheriou
- From the 2nd Department of Pediatrics, National and Kapodistrian University of Athens (NKUA), Children's Hospital "P.& A. Kyriakou," Athens, Greece
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Eleftheriou I, Dasoula F, Dimopoulou D, Lebessi E, Serafi E, Spyridis N, Tsolia M. Real-life evaluation of a COVID-19 rapid antigen detection test in hospitalized children. J Med Virol 2021; 93:6040-6044. [PMID: 34156112 PMCID: PMC8427014 DOI: 10.1002/jmv.27149] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [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: 06/04/2021] [Accepted: 06/19/2021] [Indexed: 12/21/2022]
Abstract
Rapid antigen detection (RAD) tests for the detection of SARS-CoV-2 are simpler, faster, and less expensive than the reverse-transcription polymerase chain reaction (RT-PCR) that is currently considered the gold standard for the diagnosis of coronavirus disease 2019 (COVID-19). The objective of this study was to determine the performance of the PANBIO COVID-19 Ag RAD (Abbott) test, a lateral flow immunoassay that detects the nucleocapsid protein, using as a reference RT-PCR method the Cobas®8800 System (Roche Diagnostics). This prospective study was conducted in a tertiary Children's Hospital and included individuals aged ≤16 years with COVID-19-related symptoms or epidemiological criteria for COVID-19. Two nasopharyngeal samples were collected to perform the PANBIO RAD test and RT-PCR. Of 744 children included, 51 (6.86%) had a positive RT-PCR result. The RAD test detected 42 of 51 PCR-positive children while there were no false-positive results. The overall sensitivity and specificity were 82.35% (95% CI, 71.9%-92.8%) and 100%, respectively. Sensitivity was >95% in symptomatic children. The assay performed poorly in asymptomatically infected children. In agreement with previous studies in adults, the PANBIO RAD test can be useful in screening for COVID-19 in children admitted with symptoms suggestive of the disease, especially in the first days of the illness.
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Affiliation(s)
- Irini Eleftheriou
- Second Department of Pediatrics, National and Kapodistrian University of Athens, "P. and A. Kyriakou" Children's Hospital, Athens, Greece
| | - Foteini Dasoula
- Second Department of Pediatrics, National and Kapodistrian University of Athens, "P. and A. Kyriakou" Children's Hospital, Athens, Greece
| | - Dimitra Dimopoulou
- Second Department of Pediatrics, National and Kapodistrian University of Athens, "P. and A. Kyriakou" Children's Hospital, Athens, Greece
| | - Evangelia Lebessi
- Department of Microbiology, "P. and A. Kyriakou" Children's Hospital, Athens, Greece
| | | | - Nikos Spyridis
- Second Department of Pediatrics, National and Kapodistrian University of Athens, "P. and A. Kyriakou" Children's Hospital, Athens, Greece
| | - Maria Tsolia
- Second Department of Pediatrics, National and Kapodistrian University of Athens, "P. and A. Kyriakou" Children's Hospital, Athens, Greece
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Krepis P, Spyridis N, Maritsi DN, Tsekoura V, Kossiva L. Eosinophilic leukaemoid reaction and myocardial involvement in a male adolescent with Toxocara canis infection. J Paediatr Child Health 2021; 57:935-937. [PMID: 32939897 DOI: 10.1111/jpc.15066] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 06/11/2020] [Accepted: 06/15/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Panagiotis Krepis
- Second Department of Paediatrics, "P. & A. Kyriakou" Children's Hospital, School of Medicine, National and Kapodistrian University of Athens (NKUA), Athens, Greece
| | - Nikos Spyridis
- Second Department of Paediatrics, "P. & A. Kyriakou" Children's Hospital, School of Medicine, National and Kapodistrian University of Athens (NKUA), Athens, Greece.,Department of Infectious Diseases, "P. & A. Kyriakou" Children's Hospital, School of Medicine, National and Kapodistrian University of Athens (NKUA), Athens, Greece
| | - Despina N Maritsi
- Second Department of Paediatrics, "P. & A. Kyriakou" Children's Hospital, School of Medicine, National and Kapodistrian University of Athens (NKUA), Athens, Greece
| | - Vasiliki Tsekoura
- Second Department of Paediatrics, "P. & A. Kyriakou" Children's Hospital, School of Medicine, National and Kapodistrian University of Athens (NKUA), Athens, Greece
| | - Lydia Kossiva
- Second Department of Paediatrics, "P. & A. Kyriakou" Children's Hospital, School of Medicine, National and Kapodistrian University of Athens (NKUA), Athens, Greece
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Maritsi DN, Kopsidas I, Vartzelis G, Spyridis N, Tsolia MN. Long-term preservation of measles and rubella specific-IgG antibodies in children with enthesitis related arthritis on anti-TNFα treatment: a prospective controlled study. Rheumatology (Oxford) 2020; 58:1686-1688. [PMID: 31323665 DOI: 10.1093/rheumatology/kez096] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Accepted: 02/20/2019] [Indexed: 11/14/2022] Open
Affiliation(s)
- Despoina N Maritsi
- Rheumatology Unit.,Rheumatology Unit, Archbishop Makarios III Children's Hospital, Nicosia, Cyprus
| | - Ioannis Kopsidas
- Infectious Diseases Unit, Second Department of Pediatrics, School of Medicine, National and Kapodistrian University of Athens, P. & A. Kyriakou Children's Hospital, Athens, Greece
| | | | - Nikos Spyridis
- Infectious Diseases Unit, Second Department of Pediatrics, School of Medicine, National and Kapodistrian University of Athens, P. & A. Kyriakou Children's Hospital, Athens, Greece
| | - Maria N Tsolia
- Infectious Diseases Unit, Second Department of Pediatrics, School of Medicine, National and Kapodistrian University of Athens, P. & A. Kyriakou Children's Hospital, Athens, Greece
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Gkentzi D, Kortsalioudaki C, Cailes BC, Zaoutis T, Kopsidas J, Tsolia M, Spyridis N, Siahanidou S, Sarafidis K, Heath PT, Dimitriou G. Epidemiology of infections and antimicrobial use in Greek Neonatal Units. Arch Dis Child Fetal Neonatal Ed 2019; 104:F293-F297. [PMID: 29954881 DOI: 10.1136/archdischild-2018-315024] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [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: 02/21/2018] [Revised: 06/07/2018] [Accepted: 06/09/2018] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To describe the epidemiology of neonatal infections and of antimicrobial use in Greek Neonatal Units (NNUs) in order to develop national, evidence-based guidelines on empiric antimicrobial use for neonatal sepsis in Greece. DESIGN Retrospective analysis of prospectively collected infection surveillance data from 2012 to 2015, together with a Point Prevalence Survey (PPS) on antimicrobial use and the collection of data on local empiric antimicrobial policies. SETTING 16 NNUs in Greece participating in the neonIN infection surveillance network PATIENTS: Newborns in participating NNUs who had a positive blood, cerebrospinal fluid or urine culture and were treated with at least 5 days of antibiotics. RESULTS 459 episodes were recorded in 418 infants. The overall incidence of infection was 50/1000 NNU-admissions. The majority of episodes were late-onset sepsis (LOS) (413, 90%). Coagulase-negative Staphylococci (80%) were the most common Gram-positive organisms causing LOS and Klebsiella spp (39%) the most common Gram-negative. Nearly half (45%) of the Klebsiella spp were resistant to at least one aminoglycoside. The PPS revealed that 196 of 484 (40%) neonates were on antimicrobials. The survey revealed wide variation in empiric antimicrobial policies for LOS. CONCLUSIONS This is the largest collection of data on the epidemiology of neonatal infections in Greece and on neonatal antimicrobial use. It provides the background for the development of national evidence-based guidelines. Continuous surveillance, the introduction of antimicrobial stewardship interventions and evidence-based guidelines are urgently required.
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Affiliation(s)
- Despoina Gkentzi
- Department of Paediatrics, Patras Medical School, University Hospital of Patras, Patras, Greece
| | | | | | - Theoklis Zaoutis
- The Stavros Niarchos Foundation-Collaborative Centre for Clinical Epidemiology and Outcomes Research, School of Medicine, University of Athens, Athens, Greece
| | - John Kopsidas
- The Stavros Niarchos Foundation-Collaborative Centre for Clinical Epidemiology and Outcomes Research, School of Medicine, University of Athens, Athens, Greece
| | - Maria Tsolia
- Paediatric Infectious Diseases Unit, Aglaia Kyriakou Children's Hospital, Athens, Greece
| | - Nikos Spyridis
- Paediatric Infectious Diseases Unit, Aglaia Kyriakou Children's Hospital, Athens, Greece
| | - Soultana Siahanidou
- Neonatal Unit, First Department of Pediatrics, Athens University Medical School, Athens, Greece
| | - Kosmas Sarafidis
- 1st Department of Neonatology and Neonatal Intensive Care Unit, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Paul T Heath
- Paediatric Infectious Diseases Research Group, St George's University of London, London, UK
| | - Gabriel Dimitriou
- Department of Paediatrics, Patras Medical School, University Hospital of Patras, Patras, Greece
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Maritsi DN, Eleftheriou I, Vartzelis G, Spyridis N, Tsolia MN. Risk Factors Associated With Accelerated Rubella IgG Antibody Loss in Previously Vaccinated, Treatment‐Naive Patients With Juvenile Systemic Lupus Erythematosus: A Prospective Study. Arthritis Rheumatol 2019; 71:1022-1023. [DOI: 10.1002/art.40831] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Despoina N. Maritsi
- P & A Kyriakou Children's Hospital and National and Kapodistrian University of Athens Athens Greece
| | - Irene Eleftheriou
- P & A Kyriakou Children's Hospital and National and Kapodistrian University of Athens Athens Greece
| | - George Vartzelis
- P & A Kyriakou Children's Hospital and National and Kapodistrian University of Athens Athens Greece
| | - Nikos Spyridis
- P & A Kyriakou Children's Hospital and National and Kapodistrian University of Athens Athens Greece
| | - Maria N. Tsolia
- P & A Kyriakou Children's Hospital and National and Kapodistrian University of Athens Athens Greece
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Maritsi DN, Coffin S, Onoufriou M, Spyridis N, Tsolia MN. Decreased antibodies against rubella in previously vaccinated treatment-naïve childhood systemic lupus erythematous patients: a prospective case-control study. Scand J Rheumatol 2019; 48:74-76. [PMID: 29741129 DOI: 10.1080/03009742.2018.1446100] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Affiliation(s)
- D N Maritsi
- a Rheumatology and Infectious Diseases Unit, Second Department of Pediatrics, 'P and A Kyriakou' Children's Hospital, Medical School , National and Kapodestrian University of Athens , Athens , Greece.,b Rheumatology Unit , Archbishop Makarios III' Children's Hospital , Nicosia , Cyprus
| | - S Coffin
- c Division of Infectious Diseases, Center for Pediatric Clinical Effectiveness and Department of Infection Prevention , Children's Hospital of Philadelphia , Philadelphia , PA , USA
| | - M Onoufriou
- b Rheumatology Unit , Archbishop Makarios III' Children's Hospital , Nicosia , Cyprus
| | - N Spyridis
- a Rheumatology and Infectious Diseases Unit, Second Department of Pediatrics, 'P and A Kyriakou' Children's Hospital, Medical School , National and Kapodestrian University of Athens , Athens , Greece
| | - M N Tsolia
- a Rheumatology and Infectious Diseases Unit, Second Department of Pediatrics, 'P and A Kyriakou' Children's Hospital, Medical School , National and Kapodestrian University of Athens , Athens , Greece
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Maritsi DN, Vartzelis G, Kopsidas J, Spyridis N, Tsolia MN. Antibody status against measles in previously vaccinated childhood systemic lupus erythematosus patients: a prospective case-control study. Rheumatology (Oxford) 2018; 57:1491-1493. [DOI: 10.1093/rheumatology/key142] [Citation(s) in RCA: 3] [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: 12/31/2017] [Indexed: 11/14/2022] Open
Affiliation(s)
- Despoina N Maritsi
- Rheumatology Unit, Second Department of Pediatrics, P. & A. Kyriakou Children’s Hospital, Athens Medical School, National and Kapodistrian University of Athens, Greece
- Rheumatology Unit, Archbishop Makarios III Children’s Hospital, Nicosia, Cyprus
| | - George Vartzelis
- Rheumatology Unit, Second Department of Pediatrics, P. & A. Kyriakou Children’s Hospital, Athens Medical School, National and Kapodistrian University of Athens, Greece
| | - John Kopsidas
- Infectious Diseases Unit, Second Department of Pediatrics, P. & A. Kyriakou Children’s Hospital, Athens Medical School, National and Kapodistrian University of Athens, Greece
| | - Nikos Spyridis
- Infectious Diseases Unit, Second Department of Pediatrics, P. & A. Kyriakou Children’s Hospital, Athens Medical School, National and Kapodistrian University of Athens, Greece
| | - Maria N Tsolia
- Infectious Diseases Unit, Second Department of Pediatrics, P. & A. Kyriakou Children’s Hospital, Athens Medical School, National and Kapodistrian University of Athens, Greece
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Tsirigotis P, Liga M, Gkirkas K, Stamouli M, Triantafyllou E, Marangos M, Pessach I, Sarantopoulos A, Spyridis N, Spyridonidis A. Low-dose alemtuzumab for GvHD prevention followed by prophylactic donor lymphocyte infusions in high-risk leukemia. Bone Marrow Transplant 2016; 52:445-451. [PMID: 27941776 DOI: 10.1038/bmt.2016.272] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2016] [Revised: 08/09/2016] [Accepted: 08/16/2016] [Indexed: 12/19/2022]
Abstract
We analyzed the use of low-dose alemtuzumab in a cohort of 158 consecutive patients who underwent allogeneic PBSC transplantation. Patients with high-risk acute leukemia were prospectively screened for prophylactic donor lymphocyte infusion (pDLI). Lymphocytes were administered repeatedly at low and non-escalating doses (0.5-1 × 106/kg). Low-dose alemtuzumab was effective in prevention of acute GvHD after sibling or well-matched unrelated transplantation, whereas a more intensified approach was needed after mismatched transplantation. The cumulative incidence of chronic moderate/severe chronic-GvHD (cGvHD) was 15.6%. In total, 63 high-risk leukemia patients were eligible for pDLI. Only 1 out of the 39 pDLI recipients relapsed as compared with 7 out of the 24 recipients, who did not receive pDLI due to logistical hurdles. In multivariate analysis, the use of adjuvant lymphocyte therapy was significantly associated with reduced incidence of relapse and improved disease-free survival. In summary, low-dose alemtuzumab confers to a low cGvHD incidence and the administration of pDLIs in this context is very likely to reduce relapse risk in high risk leukemia patients. This is translated in an estimated 5-year probability of GvHD-free and relapse-free survival of 43.3% for the 136 leukemia patients.
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Affiliation(s)
- P Tsirigotis
- BMT Unit, Department of Internal Medicine, 'Attikon' University Hospital of Athens, Athens, Greece
| | - M Liga
- BMT Unit, Department of Internal Medicine, University Hospital of Patras, Rio, Greece
| | - K Gkirkas
- BMT Unit, Department of Internal Medicine, 'Attikon' University Hospital of Athens, Athens, Greece
| | - M Stamouli
- BMT Unit, Department of Internal Medicine, 'Attikon' University Hospital of Athens, Athens, Greece
| | - E Triantafyllou
- BMT Unit, Department of Internal Medicine, University Hospital of Patras, Rio, Greece
| | - M Marangos
- BMT Unit, Department of Internal Medicine, University Hospital of Patras, Rio, Greece
| | - I Pessach
- BMT Unit, Department of Internal Medicine, 'Attikon' University Hospital of Athens, Athens, Greece
| | - A Sarantopoulos
- BMT Unit, Department of Internal Medicine, University Hospital of Patras, Rio, Greece
| | - N Spyridis
- BMT Unit, Department of Internal Medicine, University Hospital of Patras, Rio, Greece
| | - A Spyridonidis
- BMT Unit, Department of Internal Medicine, University Hospital of Patras, Rio, Greece
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Spyridis N, Syridou G, Goossens H, Versporten A, Kopsidas J, Kourlaba G, Bielicki J, Drapier N, Zaoutis T, Tsolia M, Sharland M. Variation in paediatric hospital antibiotic guidelines in Europe. Arch Dis Child 2016; 101:72-6. [PMID: 26416900 DOI: 10.1136/archdischild-2015-308255] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [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: 01/16/2015] [Accepted: 09/08/2015] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To assess the availability and source of guidelines for common infections in European paediatric hospitals and determine their content and characteristics. DESIGN Participating hospitals completed an online questionnaire on the availability and characteristics of antibiotic prescribing guidelines and on empirical antibiotic treatment including duration of therapy for 5 common infection syndromes: respiratory tract, urinary tract, skin and soft tissue, osteoarticular and sepsis in neonates and children. RESULTS 84 hospitals from 19 European countries participated in the survey of which 74 confirmed the existence of guidelines. Complete guidelines (existing guidelines for all requested infection syndromes) were reported by 20% of hospitals and the majority (71%) used a range of different sources. Guidelines most commonly available were those for urinary tract infection (UTI) (74%), neonatal sepsis (71%) and sepsis in children (65%). Penicillin and amoxicillin were the antibiotics most commonly recommended for respiratory tract infections (RTIs) (up to 76%), cephalosporin for UTI (up to 50%) and for skin and soft tissue infection (SSTI) and bone infection (20% and 30%, respectively). Antistaphylococcal penicillins were recommended for SSTIs and bone infections in 43% and 36%, respectively. Recommendations for neonatal sepsis included 20 different antibiotic combinations. Duration of therapy guidelines was mostly available for RTI and UTI (82%). A third of hospitals with guidelines for sepsis provided recommendations for length of therapy. CONCLUSIONS Comprehensive antibiotic guideline recommendations are generally lacking from European paediatric hospitals. We documented multiple antibiotics and combinations for most infections. Considerable improvement in the quality of guidelines and their evidence base is required, linking empirical therapy to resistance rates.
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Affiliation(s)
- N Spyridis
- Department of Paediatric Infectious Diseases, Aglaia Kyriakou Children's Hospital, University of Athens, Athens, Greece
| | - G Syridou
- Department of Paediatric Infectious Diseases, Aglaia Kyriakou Children's Hospital, University of Athens, Athens, Greece
| | - H Goossens
- Laboratory of Medical Microbiology, Vaccine & Infectious Disease Institute (VAXINFECTIO), University of Antwerp, Antwerp, Belgium
| | - A Versporten
- Laboratory of Medical Microbiology, Vaccine & Infectious Disease Institute (VAXINFECTIO), University of Antwerp, Antwerp, Belgium
| | - J Kopsidas
- Stavros Niarchos Foundation-Collaborative Center for Clinical Epidemiology and Outcomes Research and Division of Infectious Diseases (CLEO), University of Athens School of Medicine, Athens, Greece
| | - G Kourlaba
- Stavros Niarchos Foundation-Collaborative Center for Clinical Epidemiology and Outcomes Research and Division of Infectious Diseases (CLEO), University of Athens School of Medicine, Athens, Greece
| | - J Bielicki
- Paediatric Infectious Diseases Research Group, St George's University of London, London, UK
| | - N Drapier
- Laboratory of Medical Microbiology, Vaccine & Infectious Disease Institute (VAXINFECTIO), University of Antwerp, Antwerp, Belgium
| | - T Zaoutis
- Stavros Niarchos Foundation-Collaborative Center for Clinical Epidemiology and Outcomes Research and Division of Infectious Diseases (CLEO), University of Athens School of Medicine, Athens, Greece The Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
| | - M Tsolia
- Department of Paediatric Infectious Diseases, Aglaia Kyriakou Children's Hospital, University of Athens, Athens, Greece
| | - M Sharland
- Paediatric Infectious Diseases Research Group, St George's University of London, London, UK
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Amanatidou V, Critselis E, Trochoutsou A, Soldatou A, Benetatou K, Spyridis N, Papadopoulos NG, Tsolia MN. Interferon gamma inducible protein-10 in the diagnosis of paediatric tuberculosis infection in a low TB incidence country. Int J Tuberc Lung Dis 2015; 19:1463-9. [DOI: 10.5588/ijtld.14.0945] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Argyri I, Korona A, Mougkou K, Vougiouka O, Tsolia M, Spyridis N. PHOTO QUIZ. An Infant With Purpuric Rash and Edema. Clin Infect Dis 2015; 61:1553, 1624-5. [PMID: 26494913 DOI: 10.1093/cid/civ546] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Maritsi D, Vartzelis G, Spyridis N, Garoufi A, Diamantopoulos S. SAT0500 The Immune Response to Hepatitis a Vaccine in Children with Pfapa Syndrome. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.3519] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Maritsi D, Vartzelis G, Metaxa Z, Vougiouka O, Spyridis N, Diamantopoulos S. THU0505 The Immune Response to Hepatitis a Vaccine in Children with Autoinflammatory Disorders. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.5252] [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: 11/04/2022]
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Kourlaba G, Kourkouni E, Spyridis N, Gerber JS, Kopsidas J, Mougkou K, Lourida A, Zaoutis TE. Antibiotic prescribing and expenditures in outpatient paediatrics in Greece, 2010-13. J Antimicrob Chemother 2015; 70:2405-8. [PMID: 25881618 DOI: 10.1093/jac/dkv091] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [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: 10/30/2014] [Accepted: 03/18/2015] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES The objectives of this study were to provide a nationally representative analysis of antibiotic prescribing in outpatient paediatrics and to assess overall and class-specific antibiotic costs in Greece. METHODS Data on antibiotic prescriptions for patients aged ≤19 years old between July 2010 and June 2013 in Greece were extracted from the IMS Health Xponent database. Antibiotics were grouped into narrow- and broad-spectrum agents. The number of prescribed antibiotics and census denominators were used to calculate prescribing rates. The total costs associated with prescribed antibiotics were calculated. RESULTS More than 7 million antibiotics were prescribed during the study period, with an annual rate of 1100 antibiotics/1000 persons. Prescribing rates were higher among children aged <10 years old. Acute respiratory tract infections (ARTIs) accounted for 80% of prescribed antibiotics, with acute otitis media (22.3%), acute tonsillitis (19.5%) and acute bronchitis/bronchiolitis (13.9%) being the most common clinical diagnoses. Cephalosporins (32.9%), penicillins (32.3%) and macrolides (32.1%) were the most commonly prescribed antibiotic classes. The majority (90.4%) of antibiotics were broad spectrum. Antibiotic expenditures totalled ∼€50 million. CONCLUSIONS Broad-spectrum antibiotic prescribing is common in outpatient paediatric patients. These data provide important targets to inform the development of an outpatient antimicrobial stewardship programme targeting specific practices, providers and conditions.
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Affiliation(s)
- Georgia Kourlaba
- The Stavros Niarchos Foundation - Collaborative Center for Clinical Epidemiology and Outcomes Research (CLEO), University of Athens School of Medicine, Athens, Greece
| | - Eleni Kourkouni
- The Stavros Niarchos Foundation - Collaborative Center for Clinical Epidemiology and Outcomes Research (CLEO), University of Athens School of Medicine, Athens, Greece
| | - Nikos Spyridis
- Aglaia Kyriakou Children's Hospital, Second Department of Pediatrics, University of Athens School of Medicine, Athens, Greece
| | - Jeffrey S Gerber
- Division of Infectious Diseases, Children's Hospital of Philadelphia, UPENN School of Medicine, Philadelphia, PA, USA
| | - John Kopsidas
- The Stavros Niarchos Foundation - Collaborative Center for Clinical Epidemiology and Outcomes Research (CLEO), University of Athens School of Medicine, Athens, Greece
| | - Katerina Mougkou
- The Stavros Niarchos Foundation - Collaborative Center for Clinical Epidemiology and Outcomes Research (CLEO), University of Athens School of Medicine, Athens, Greece
| | - Athanasia Lourida
- The Stavros Niarchos Foundation - Collaborative Center for Clinical Epidemiology and Outcomes Research (CLEO), University of Athens School of Medicine, Athens, Greece
| | - Theoklis E Zaoutis
- The Stavros Niarchos Foundation - Collaborative Center for Clinical Epidemiology and Outcomes Research (CLEO), University of Athens School of Medicine, Athens, Greece Division of Infectious Diseases, Children's Hospital of Philadelphia, UPENN School of Medicine, Philadelphia, PA, USA
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Katodritou E, Terpos E, Kelaidi C, Kotsopoulou M, Delimpasi S, Kyrtsonis MC, Symeonidis A, Giannakoulas N, Stefanoudaki A, Christoulas D, Chatziaggelidou C, Gastari V, Spyridis N, Verrou E, Konstantinidou P, Zervas K, Dimopoulos MA. Treatment with bortezomib-based regimens improves overall response and predicts for survival in patients with primary or secondary plasma cell leukemia: Analysis of the Greek myeloma study group. Am J Hematol 2014; 89:145-50. [PMID: 24123068 DOI: 10.1002/ajh.23600] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2013] [Accepted: 09/26/2013] [Indexed: 11/12/2022]
Abstract
Plasma cell leukemia (PCL) is a rare and aggressive plasma cell disorder, with poor outcome. Bortezomib-based regimens (BBR) are highly effective in myeloma, but there is limited information about their efficacy and safety in PCL. Thus, we retrospectively collected data from 42 consecutive PCL patients (25 with primary PCL-pPCL and 17 with secondary PCL-sPCL) to explore the role of BBR in this entity. BBR were administered in 29 of 42 patients, while 6 of 25 patients with pPCL underwent autologous transplantation. Objective response (≥partial response) was significantly higher in patients treated with BBR versus conventional therapies (69% vs. 30.8%, P = 0.04); 27.5% of patients treated with BBR achieved at least very good partial response (vgPR). The highest ORR was observed in pPCL patients treated with BBR (88.9%; ≥vgPR: 33.3%). In BBR-group, grade 3 of 4 hematological, neurological and renal toxicity and neutropenic infections were observed in 41.4%, 7%, 3.4%, and 31%, respectively. With a median follow-up of 51 months, median overall survival (OS) for patients treated with BBR versus conventional therapies was 13 versus 2 months (P < 0.007). Median OS of patients with pPCL and sPCL treated with BBR was 18 and 7 months, respectively (P < 0.001). In the multivariate analysis normal PLTs, treatment with BBR and high quality response were the only powerful predictors for survival. Our study carrying the longest reported median follow-up, demonstrated that treatment of PCL with BBR induces high response rates and prolongs survival over conventional therapies, regardless of additional autologous transplantation rescue or established high risk features, with manageable toxicity.
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Affiliation(s)
- Eirini Katodritou
- Hematology Department; Theagenion Cancer Hospital; Thessaloniki Greece
| | - Evangelos Terpos
- Department of Clinical Therapeutics; National and Kapodistrian University of Athens, School of Medicine; Athens Greece
| | - Charikleia Kelaidi
- Hematology Department; General Hospital “G. Papanikolaou,”; Thessaloniki Greece
| | - Maria Kotsopoulou
- Hematology Department; General Anticancer Hospital “Metaxa,”; Athens Greece
| | - Sossana Delimpasi
- Hematology Department; General Hospital of Athens “Evangelismos,”; Athens Greece
| | - Marie-Christine Kyrtsonis
- First Department of Propedeutic/Internal Medicine; National and Kapodistrian University of Athens, School of Medicine; Athens Greece
| | | | - Nikos Giannakoulas
- Hematology Department; University of Thessalia; School of Medicine; Larissa Greece
| | | | | | | | - Vassiliki Gastari
- Hematology Department; Theagenion Cancer Hospital; Thessaloniki Greece
| | - Nikos Spyridis
- Hematology Department; Theagenion Cancer Hospital; Thessaloniki Greece
| | - Evgenia Verrou
- Hematology Department; Theagenion Cancer Hospital; Thessaloniki Greece
| | | | - Kostas Zervas
- Hematology Department; Theagenion Cancer Hospital; Thessaloniki Greece
| | - Meletios A. Dimopoulos
- Department of Clinical Therapeutics; National and Kapodistrian University of Athens, School of Medicine; Athens Greece
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Maritsi D, Vartzelis G, Soldatou A, Garoufi A, Spyridis N. Markedly decreased antibody titers against hepatitis B in previously immunised children presenting with juvenile idiopathic arthritis. Clin Exp Rheumatol 2013; 31:969-973. [PMID: 23806191] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2012] [Accepted: 02/25/2013] [Indexed: 06/02/2023]
Abstract
OBJECTIVES Hepatitis B is a vaccine preventable disease with intermediate endemicity in Greece. Patients with juvenile idiopathic arthritis (JIA) on immunomodulating therapy are prone to infection or reactivation of hepatitis B virus (HBV). The aim of this study is to define the immune status against HBV in children newly-diagnosed with JIA. METHODS Case-control prospective study including 89 JIA patients and 89 controls matched for age and gender. Eighty-nine JIA patients were included in the study (22 males), with a mean age of 6.8 years. Sera were tested for hepatitis B surface antigen, hepatitis B core antibody, and anti-HBs. Patients with anti-HBs titers ≥10 IU/L were considered immune. Data were analysed with SPSS 18.0 version. RESULTS In the JIA group 55% were HBV immune (anti-HBs level ≥10 IU/L) while in the control group 92% were immune against HBV (p<0.001). Antibody levels in the patient group were significantly lower compared to the control group. The mean concentration of anti-HBs levels in JIA patients was 18.3 IU/L versus 82.6 IU/L in the control group (p<0.001). CONCLUSIONS Antibody titers against HBV in fully vaccinated JIA patients due to start treatment are significantly lower compared to matched healthy children in this study. Diagnosis of JIA and older age were associated with the absence of protective antibodies. Although there is no evidence to support the introduction of a booster HBV dose in healthy children who mount low antibody response following immunisation, further studies are required to address this question in patients with JIA.
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Affiliation(s)
- Despoina Maritsi
- 2nd Department of Academic Pediatrics, Medical Faculty, University of Athens, Athens, Greece.
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Maritsi D, Vartzelis G, Soldatou A, Spyridis N. AB1131 Hepatitis B immunity in children with juvenile idiopathic arthritis at disease onset. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2012-eular.1129] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Mougkou K, Michos A, Spyridopoulou K, Daikos GL, Spyridis N, Syriopoulou V, Zaoutis T. Colonization of high-risk children with carbapenemase-producing Enterobacteriaceae in Greece. Infect Control Hosp Epidemiol 2013; 34:757-9. [PMID: 23739084 DOI: 10.1086/670997] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- K Mougkou
- Stavros Niarchos Foundation-Collaborative Center for Clinical Epidemiology and Outcomes Research (CLEO), Athens, Greece.
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Abstract
Meningococcal disease remains a significant global cause of morbidity and mortality despite the availability of polysaccharide and conjugate vaccines. The implementation of monovalent meningococcal serogroup C vaccine in developed countries has significantly decreased the incidence of meningococcal disease, while the recent introduction of monovalent serogroup A conjugate vaccine in the African meningitis belt aims to reduce the incidence of high endemic disease in this area. Three quadrivalent meningococcal vaccines have already been licensed; a polysaccharide (MenACWY-PS) and two conjugated (MenACWY-DT and MenACWY-CRM) vaccines. An investigational MenACWY-TT vaccine is described in this article. Clinical trials in infants older than 9 months of age, toddlers, children, adolescents and adults have indicated that this vaccine is well tolerated and immunogenic. The inclusion of a spacer molecule coupled with the polysaccharide (for serogroups A and C) and tetanus toxoid as the carrier protein aims to elicit robust immune responses. The tolerability of this vaccine is comparable to that of polysaccharide quadrivalent vaccines and monovalent meningococcal serogroup C vaccines. More importantly, the immunogenicity, antibody persistence and induction of immune memory aim to provide protection to a wide range of susceptible subjects.
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Affiliation(s)
- Vassiliki Papaevangelou
- National and Kapodistrian University of Athens Medical School, Athens University, Goudi 11527, Athens, Greece.
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Syridou G, Mavrikou M, Amanatidou V, Spyridis N, Prasad P, Papaventsis D, Kanavaki S, Zaoutis T, Tsolia MN. Trends in the epidemiology of childhood tuberculosis in Greece. Int J Tuberc Lung Dis 2012; 16:749-55. [DOI: 10.5588/ijtld.10.0717] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- G. Syridou
- Second Department of Pediatrics, National and Kapodistrian University of Athens School of Medicine, Athens, Greece
| | - M. Mavrikou
- First Department of Paediatrics, P and A Kyriakou Children's Hospital, Athens, Greece
| | - V. Amanatidou
- Second Department of Pediatrics, National and Kapodistrian University of Athens School of Medicine, Athens, Greece
| | - N. Spyridis
- Second Department of Pediatrics, National and Kapodistrian University of Athens School of Medicine, Athens, Greece
| | - P. Prasad
- Division of Infectious Diseases, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - D. Papaventsis
- National Reference Laboratory for Mycobacteria, Sotiria Chest Diseases Hospital, Athens, Greece
| | - S. Kanavaki
- National Reference Laboratory for Mycobacteria, Sotiria Chest Diseases Hospital, Athens, Greece
| | - Th. Zaoutis
- Division of Infectious Diseases, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA; Department of Pediatrics and Epidemiology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA
| | - M. N. Tsolia
- Second Department of Pediatrics, National and Kapodistrian University of Athens School of Medicine, Athens, Greece
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30
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Porta A, Hsia Y, Doerholt K, Spyridis N, Bielicki J, Menson E, Tsolia M, Esposito S, Wong ICK, Sharland M. Comparing neonatal and paediatric antibiotic prescribing between hospitals: a new algorithm to help international benchmarking. J Antimicrob Chemother 2012; 67:1278-86. [PMID: 22378680 DOI: 10.1093/jac/dks021] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES The WHO anatomical therapeutic chemical (ATC)/defined daily dose (DDD) methodology is a standardized method of comparing antimicrobial use. The ATC/DDD is defined as the average maintenance daily dose of a drug used in a 70 kg adult, ignoring the considerable differences in body weight of neonates and children. The aim of this study was to develop a new standardized way of comparing rates of antimicrobial prescribing between European children's hospitals. METHODS This pilot study at four European children's hospitals (in the UK, Greece and Italy) collected data including demographics, antibiotic use, dosing and indication in children and neonates over a 14 day period. RESULTS A total of 1217 antibiotic prescriptions were issued with 47 different antibiotics used. Approximately half of all children and a third of all neonates received antibiotics, with wide variation between centres in the type and dose of antibiotic used. We propose a new pragmatic three-step algorithm. The first step includes a simple comparison of the proportion of hospitalized children on antibiotics by weight bands and the number of antimicrobials that account for 90% of total DDD drug usage (DU90%). The second step is a comparison of the dosing used (mg/kg/day). The third step is to compare overall drug exposure using DDD/100 bed days for standardized weight bands between centres. CONCLUSIONS This novel method has the potential to be a useful tool to provide antibiotic use comparator data and requires validation in a large prospective point prevalence study.
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Affiliation(s)
- Alessandro Porta
- Department of Maternal and Paediatric Sciences, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
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31
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Papaventsis D, Ioannidis P, Karabela S, Nikolaou S, Syridou G, Marinou I, Konstantinidou E, Amanatidou V, Spyridis N, Kanavaki S, Tsolia M. Impact of the Gen-Probe Amplified MTD® Test on tuberculosis diagnosis in children. Int J Tuberc Lung Dis 2012; 16:384-90. [PMID: 22230051 DOI: 10.5588/ijtld.11.0276] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE To evaluate the performance of the Gen-Probe Amplified MTD® Test (AMTD) for childhood tuberculosis (TB) diagnosis compared to conventional culture. DESIGN We retrospectively studied 121 childhood cases (73 males; median age 7 years, range 1-16). Pulmonary samples (104/152, 68%) included gastric aspirates (n = 53), induced sputum samples (n = 43), bronchial aspirates and bronchoalveolar lavage (n = 8). Extra-pulmonary samples (48/152, 32%) included lymph nodes (n = 34) and other sterile fluids (n = 14). Specimens were examined using acid-fast bacilli (AFB) microscopy, AMTD and bacterial culture using BACTEC™ MGIT™ 960 and Löwenstein-Jensen (LJ) media. RESULTS A clinical diagnosis of TB was made in 50/121 (41%) children (43/50 pulmonary disease). AFB microscopy was positive in 6%; Mycobacterium tuberculosis was recovered by culture from 16/50 (32%) and AMTD was positive in 29/50 (58%). AMTD sensitivity, specificity, positive predictive value and negative predictive value compared to culture were respectively 100%, 85%, 50% and 100%. For pulmonary vs. extra-pulmonary disease, the performance of AMTD compared to culture was respectively 100%, 77%, 46% and 100% vs. 100%, 97.5%, 75% and 100%. CONCLUSIONS Nucleic acid amplification tests are more sensitive and very specific methods for the rapid detection of M. tuberculosis. The AMTD technique increases TB detection in children compared to conventional culture.
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Affiliation(s)
- D Papaventsis
- National Reference Laboratory for Mycobacteria, Sotiria Chest Diseases Hospital, Athens, Greece.
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Ahmed U, Spyridis N, Wong ICK, Sharland M, Long PF. Dosing of oral penicillins in children: is big child=half an adult, small child=half a big child, baby=half a small child still the best we can do? BMJ 2011; 343:d7803. [PMID: 22174326 DOI: 10.1136/bmj.d7803] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Umar Ahmed
- Centre for Paediatric Pharmacy Research, School of Pharmacy, University of London, London WC1H 9JP, UK
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Saxena S, Thompson P, Birger R, Bottle A, Spyridis N, Wong I, Johnson AP, Gilbert R, Sharland M. Increasing skin infections and Staphylococcus aureus complications in children, England, 1997-2006. Emerg Infect Dis 2010; 16:530-3. [PMID: 20202439 PMCID: PMC3322014 DOI: 10.3201/eid1603.090809] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [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: 11/19/2022] Open
Abstract
During 1997-2006, general practitioner consultations for skin conditions for children <18 years of age in England increased 19%, from 128.5 to 152.9/1,000 child-years, and antistaphylococcal drug prescription rates increased 64%, from 17.8 to 29.1/1,000 child-years. During the same time period, hospital admissions for Staphylococcus aureus infections rose 49% from 53.4 to 79.3/100,000 child-years.
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Spyridis N, Chakraborty R, Sharland M, Heath PT. Early diagnosis of tuberculosis using an INF-γ assay in a child with HIV-1 infection and a very low CD4 count. ACTA ACUST UNITED AC 2009; 39:919-21. [PMID: 17852915 DOI: 10.1080/00365540701481537] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [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: 10/22/2022]
Abstract
An 11-y-old girl diagnosed with HIV-1, presented with prolonged pyrexia and a non-reactive tuberculin skin test. An INF-gamma assay (ELISpot) was positive and led to administration of tuberculosis treatment. Positive cultures for Mycobacterium tuberculosis followed 6 weeks later. INF-gamma assays should be considered as first line investigations in HIV-1 infected subjects when TB is a diagnostic possibility.
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Affiliation(s)
- Nikos Spyridis
- Paediatric Infectious Diseases Unit, St. George's Hospital, London, UK.
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35
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Thompson PL, Spyridis N, Sharland M, Gilbert RE, Saxena S, Long PF, Johnson AP, Wong ICK. Changes in clinical indications for community antibiotic prescribing for children in the UK from 1996 to 2006: will the new NICE prescribing guidance on upper respiratory tract infections just be ignored? Arch Dis Child 2009; 94:337-40. [PMID: 19066174 DOI: 10.1136/adc.2008.147579] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.5] [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: 11/04/2022]
Abstract
OBJECTIVE To analyse changes in clinical indications for community antibiotic prescribing for children in the UK between 1996 and 2006 and relate these findings to the new NICE guidelines for the treatment of upper respiratory tract infections in children. STUDY DESIGN Retrospective cohort study. METHOD The IMS Health Mediplus database was used to obtain annual antibiotic prescribing rates and associated clinical indications in 0-18-year-old patients between 1 January 1996 and 31 December 2006 in the UK. RESULTS Antibiotic prescribing declined by 24% between 1996 and 2000 but increased again by 10% during 2003-2006. Respiratory tract infection was the most common indication for which an antibiotic was prescribed, followed by "abnormal signs and symptoms", ear and skin infections. Antibiotic prescriptions for respiratory tract infections have decreased by 31% (p<0.01) mainly because of reduced prescribing for lower respiratory tract infections (56% decline, p<0.001) and specific upper respiratory tract infections including tonsillitis/pharyngitis (48% decline, p<0.001) and otitis (46% decline, p<0.001). Prescribing for non-specific upper respiratory tract infection increased fourfold (p<0.001). Prescribing for "abnormal signs and symptoms" increased significantly since 2001 (40% increase, p<0.001). CONCLUSION There has been a marked decrease in community antibiotic prescribing linked to lower respiratory tract infection, tonsillitis, pharyngitis and otitis. Overall prescribing is now increasing again but is associated with non-specific upper respiratory tract infection diagnoses. General practitioners may be avoiding using diagnoses where formal guidance suggests antibiotic prescribing is not indicated. The new NICE guidance on upper respiratory tract infections is at risk of being ignored.
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Affiliation(s)
- P L Thompson
- Centre for Paediatric Pharmacy Research, School of Pharmacy, London, UK
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Affiliation(s)
- Nikos Spyridis
- Paediatric Infectious Diseases Unit, St George's Hospital, London, UK.
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Spyridis N, Georgouli H, Tsoukatou T, Sakou I, Tsolia M, Miriokefalitakis N, Spyridis P. Severe disseminated tuberculosis in a 4-month-old infant initially presenting with multiform cutaneous lesions. Scand J Infect Dis 2006; 38:306-8. [PMID: 16718936 DOI: 10.1080/00365540500361310] [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] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
A 4-month-old female infant presented with 1 month history of horizontal nystagmus and discrete multiform skin lesions. The patient was initially diagnosed with congenital nystagmus and staphylococcal skin infection not responding to antimicrobial agents. The development of severe systemic symptoms led to extensive investigations and the diagnosis of disseminated tuberculosis. Mycobacterium tuberculosis (MTB) was isolated from the skin and cerebrospinal fluid. The patient was treated with isoniazid, rifampicin, pyrizinamide, streptomycin and dexamethasone. Skin lesions resolved completely but severe neurological deficits persisted.
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Affiliation(s)
- Nikos Spyridis
- Department of General Paediatrics, St Thomas' Hospital, London, UK.
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Spyridis P, Tsolia M, Gelesme A, Moustaki M, Spyridis N, Sinaniotis C, Karpathios T. The impact of Greece's childhood tuberculosis screening programme on the epidemiological indexes in the greater Athens area. Int J Tuberc Lung Dis 2003; 7:248-53. [PMID: 12661839] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023] Open
Abstract
SETTING A hospital referral centre for childhood tuberculosis in Athens. OBJECTIVE To evaluate the effectiveness of the screening programme implemented for childhood tuberculosis, through its impact on the epidemiological index. DESIGN In Greece, tuberculosis has been systematically screened for in children since 1991 using the tuberculin skin test. The epidemiological and clinical profiles of all tuberculous children who attended the TB clinic were compared. The children were divided into those who attended in 1982-1990 and those who did so in 1991-1999. RESULTS A total of 1122 TB patients were screened. In the second period there was an increase in numbers of immigrant children (3% vs. 28%, P = 0.0001), the rate of extra-pulmonary TB decreased (16% vs. 7.6%, P = 0.0001), patients identified by the screening programme increased (19% vs. 57%, P = 0.0001) and the number of symptomatic children fell (51% vs. 16%, P = 0.0001). The proportion of children who failed to attend for regular follow-up was lower during the second period (20% vs. 7%, P = 0.0001). CONCLUSIONS Our study suggests that the screening programme applied in Greece during the last decade has contributed to the early identification of tuberculosis, and the limitation of symptomatic patients and extrapulmonary TB cases.
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Affiliation(s)
- P Spyridis
- 2nd Department of Pediatrics, P&A Kyriakou Children's Hospital, Athens, Greece.
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