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Scoten O, Tabi K, Paquette V, Carrion P, Ryan D, Radonjic NV, Whitham EA, Hippman C. Attention-Deficit / Hyperactivity Disorder in pregnancy and the postpartum period. Am J Obstet Gynecol 2024:S0002-9378(24)00376-4. [PMID: 38432409 DOI: 10.1016/j.ajog.2024.02.297] [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: 12/04/2023] [Revised: 02/10/2024] [Accepted: 02/26/2024] [Indexed: 03/05/2024]
Abstract
Attention-deficit/hyperactivity disorder (ADHD) is a childhood-onset neurodevelopmental disorder that frequently persists into adulthood, with 3% of adult women having a diagnosis of ADHD. Many women are diagnosed and treated during their reproductive years, resulting in management implications across pregnancy and postpartum. We know from clinical practice that ADHD symptoms frequently become challenging to manage during the perinatal period, requiring additional support and attention. There is often uncertainty among healthcare providers regarding the management of ADHD in the perinatal period, particularly the safety of pharmacotherapy for the developing fetus. This guideline is focused on best practices in managing ADHD in the perinatal period. We recommend: 1) mitigation of risks associated with ADHD worsening during the perinatal period via individualized treatment planning; 2) delivery of psychoeducation, self-management strategies/coaching, and psychotherapies; and, for those with moderate/severe ADHD, 3) consideration of ADHD pharmacotherapy, which has largely reassuring safety data. Specifically, providers should work collaboratively with patients and their support networks to balance the risks of perinatal ADHD medication with the risks of inadequately treated ADHD in pregnancy. The risks and impacts of ADHD in pregnancy can be successfully managed through preconception counselling and appropriate perinatal planning, management, and support.
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Affiliation(s)
- Olivia Scoten
- University of British Columbia (UBC), Vancouver, BC, Canada
| | - Katarina Tabi
- University of British Columbia (UBC), Vancouver, BC, Canada; Reproductive Mental Health Program, BC Women's Hospital, Vancouver, BC, Canada; BCCH Centre for Mindfulness, BC Children's Hospital, Vancouver, BC, Canada; BC Women's Health Research Institute, Vancouver, BC, Canada
| | | | - Prescilla Carrion
- University of British Columbia (UBC), Vancouver, BC, Canada; Reproductive Mental Health Program, BC Women's Hospital, Vancouver, BC, Canada
| | - Deirdre Ryan
- University of British Columbia (UBC), Vancouver, BC, Canada; Reproductive Mental Health Program, BC Women's Hospital, Vancouver, BC, Canada
| | - Nevena V Radonjic
- Department of Psychiatry, SUNY Upstate Medical University, Syracuse, NY, USA
| | | | - Catriona Hippman
- University of British Columbia (UBC), Vancouver, BC, Canada; Reproductive Mental Health Program, BC Women's Hospital, Vancouver, BC, Canada; BC Women's Health Research Institute, Vancouver, BC, Canada; University of Calgary, Calgary, AB, Canada.
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Mohn SF, Reimer R, Mar N, Katelieva A, Paquette V, Albert AYK, Roberts A, Tilley P, McClymont E, Ting J, Boucoiran I, Elwood C. Empiric antibiotics for peripartum bacteremia: A chart review from a quaternary Canadian centre. Int J Gynaecol Obstet 2024; 164:786-792. [PMID: 37658607 DOI: 10.1002/ijgo.15048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 07/18/2023] [Accepted: 08/01/2023] [Indexed: 09/03/2023]
Abstract
OBJECTIVE To evaluate the effectiveness of empiric antibiotic protocols for peripartum bacteremia at a quaternary institution by describing incidence, microbial epidemiology, clinical source of infection, susceptibility patterns, and maternal and neonatal outcomes. METHODS Retrospective chart review of peripartum patients with positive blood cultures between 2010 and 2018. RESULTS The incidence of peripartum bacteremia was 0.3%. The most cultured organisms were Escherichia coli (51, 26.7%), Streptococcus spp. (52, 27.2%), and anaerobic spp. (35, 18.3%). Of the E. coli cases, 54.9% (28), 19.6% (10), and 19.6% (10) were resistant to ampicillin, first- and third-generation cephalosporins, respectively. Clinical sources of infection included intra-amniotic infection/endometritis (115, 67.6%), upper and/or lower urinary tract infection (23, 13.5%), and soft tissue infection (8, 4.7%). Appropriate empiric antibiotics were prescribed in 137 (83.0%) cases. There were 7 ICU admissions (4.2%), 18 pregnancy losses (9.9%), 9 neonatal deaths (5.5%), and 6 cases of neonatal bacteremia (3.7%). CONCLUSION Peripartum bacteremia remains uncommon but associated with maternal morbidity and neonatal morbidity and mortality. Current empiric antimicrobial protocols at our site remain appropriate, but continuous monitoring of antimicrobial resistance patterns is critical given the presence of pathogens resistant to first-line antibiotics.
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Affiliation(s)
- Sarah F Mohn
- UBC Faculty of Medicine, Vancouver, British Columbia, Canada
| | - Renee Reimer
- UBC Faculty of Medicine, Vancouver, British Columbia, Canada
| | - Nicole Mar
- UBC Faculty of Medicine, Vancouver, British Columbia, Canada
| | | | - Vanessa Paquette
- BC Women's Hospital and Health Centre, Vancouver, British Columbia, Canada
| | | | - Ashley Roberts
- BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada
| | - Peter Tilley
- BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada
| | - Elisabeth McClymont
- Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Joseph Ting
- UBC Faculty of Medicine, Vancouver, British Columbia, Canada
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Isabelle Boucoiran
- Mother and Child Infectious Disease Centre, CHU Sainte, Justine, Montreal, Quebec, Canada
- Department of Obstetrics and Gynecology and School of Public Health, Université de Montréal, Montreal, Quebec, Canada
| | - Chelsea Elwood
- UBC Faculty of Medicine, Vancouver, British Columbia, Canada
- Women's Health Research Institute, Vancouver, British Columbia, Canada
- Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, British Columbia, Canada
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Wong JMH, Wooding DJ, Leung SE, Paquette V, Roberts A, Elwood C. Establishing obstetrics-specific metrics and interventions for antimicrobial stewardship. J Assoc Med Microbiol Infect Dis Can 2023; 8:116-124. [PMID: 38250287 PMCID: PMC10795696 DOI: 10.3138/jammi-2022-0032] [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: 11/22/2022] [Accepted: 11/28/2022] [Indexed: 01/23/2024]
Abstract
Background To describe baseline antimicrobial stewardship (AMS) metrics and apply AMS interventions in an inpatient obstetrical population. Methods From October 2018 to October 2019, our tertiary-care obstetrical center reviewed components of our AMS program, which included: (1) antimicrobial consumption data, (2) point prevalence surveys (PPS), and (3) prospective audit and feedback. We reviewed institutional data for antimicrobial consumption from the pharmacy database. Detailed point prevalence surveys were conducted for all antimicrobial prescriptions on two predefined dates each month. Daily audits and feedback assessed the appropriateness of all non-protocolized antimicrobials. Results Our average antimicrobial length of therapy (LOT) was 12 days per 100 patient-days, where erythromycin (2.33), amoxicillin (2.28), and ampicillin (1.81) were the greatest contributors. Point prevalence surveys revealed that 28.8% of obstetrical inpatients were on antimicrobials, of which 11.2% were inappropriate. Protocolized antimicrobials were 62% less likely (p = 0.027) to be inappropriate. From 565 audited prescriptions, 110 (19.5%) resulted in feedback, where 90% of recommendations were accepted and implemented. The most common reasons for interventions include incorrect dosage, recommending a diagnostic test before continuing antimicrobials, and changing antimicrobials based on specific culture and sensitivity. Conclusions Antimicrobial use in obstetrics is unique compared to general inpatients. We provide a baseline set of metrics for AMS at our obstetrical center intending to lay the groundwork for AMS programming in our discipline. Antimicrobial protocolization, as well as audit and feedback, are feasible interventions to improve antimicrobial prescribing patterns.
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Affiliation(s)
- Jeffrey Man Hay Wong
- Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Denise J Wooding
- Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Sarah E Leung
- Department of Pharmacy, Children’s and Women’s Health Centre of BC, Vancouver, British Columbia, Canada
| | - Vanessa Paquette
- Department of Pharmacy, Children’s and Women’s Health Centre of BC, Vancouver, British Columbia, Canada
| | - Ashley Roberts
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Chelsea Elwood
- Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, British Columbia, Canada
- Women’s Health Research Institute, Vancouver, British Columbia, Canada
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Patricelli CJ, Chai J, Gordon S, Gouin IJ, Carter N, Stewart K, Paquette V, Urbanoski K, Albert A. Perinatal Injectable Opioid Agonist Therapy (iOAT) Administration: A Case Series. J Addict Med 2023; 17:431-438. [PMID: 37579103 PMCID: PMC10417207 DOI: 10.1097/adm.0000000000001152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 01/14/2023] [Indexed: 02/22/2023]
Abstract
OBJECTIVES Untreated opioid use disorder (OUD) in pregnancy may lead to adverse outcomes for the individual and fetus. Injectable opioid agonist therapy (iOAT) is the highest intensity treatment for severe refractory OUD currently available; however, research on perinatal administration is limited. We present the first known case series of 13 pregnant or postpartum participants who received intravenous hydromorphone while admitted to the Families in Recovery (FIR) unit, an in-patient perinatal stabilization unit in Canada. METHODS Patients who received iOAT at FIR between 2019 and 2022 were invited to participate. Prospectively enrolled participants completed a self-report sociodemographics and exposures survey. Medical/social backgrounds of participants at admission, iOAT and other opioid agonist therapy administration, and health/social outcomes of mother and infant at discharge were collected on all participants via retrospective maternal and infant medical chart review. RESULTS Participants initiated iOAT while pregnant (n = 5) or postpartum (n = 8) and received iOAT for 23 days on average. At discharge, 8 participants underwent planned transition to community with infant in their care and a discharge plan including outpatient prescriptions, housing arrangements, follow-up appointments, and supportive programming. All infants received oral morphine after delivery and were discharged in good health. CONCLUSIONS This is the first known case series of iOAT administration in the peripartum. The cases illustrate iOAT as an option that can achieve OUD stabilization in perinatal individuals to support patient engagement and retention in care.
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Saravanabavan S, Aulakh A, Douglas J, Elwood C, Erdle S, Grant J, Kang KT, Kwan N, Lacaria K, Lau TTY, Lee C, Leung V, Lin YC, Mah A, Nguyen A, Paquette V, Roberts A, Watt M, Van Schalkwyk J, Zhang BY, Mak R, Wong T. Penicillin de-labelling in vancouver, British Columbia, Canada: comparison of approaches, outcomes and future directions. Allergy Asthma Clin Immunol 2023; 19:30. [PMID: 37072861 PMCID: PMC10114447 DOI: 10.1186/s13223-023-00777-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 02/27/2023] [Indexed: 04/20/2023]
Abstract
BACKGROUND Inaccurate penicillin allergy labels lead to inappropriate antibiotic prescriptions and harmful patient consequences. System-wide efforts are needed to remove incorrect penicillin allergy labels, but more health services research is required on how to best deliver these services. METHODS Data was extracted from five hospitals in Vancouver, British Columbia, Canada from October 2018-May 2022. The primary outcomes of this study were to outline de-labelling protocol designs, identify the roles of various healthcare professionals in de-labelling protocols and identify rates of de-labelling penicillin allergies and associated adverse events at various institutions. Our secondary outcome was to describe de-labelling rates for special populations, including pediatric, obstetric and immunocompromised subpopulations. To achieve these outcomes, participating institutions provided their de-labelling protocol designs and data on program participants. Protocols were then compared to find common themes and differences. Furthermore, adverse events were reviewed and percentages of patients de-labelled at each institution and in total were calculated. RESULTS Protocols demonstrated a high level of variability, including different methods of participant identification, risk-stratification and roles of providers. All protocols used oral and direct oral challenges, heavily involved pharmacists and had physician oversight. Despite the differences, of the 711 patients enrolled in all programs, 697 (98.0%) were de-labelled. There were 9 adverse events (1.3%) with oral challenges with mainly minor symptoms. CONCLUSIONS Our data demonstrates that de-labelling programs effectively and safely remove penicillin allergy labels, including pediatric, obstetric and immunocompromised patients. Consistent with current literature, most patients with a penicillin allergy label are not allergic. De-labelling programs could benefit from increasing clinician engagement by increasing accessibility of resources to providers, including guidance for de-labelling of special populations.
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Affiliation(s)
- Sujen Saravanabavan
- Department of Pediatrics, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada.
| | | | | | - Chelsea Elwood
- B.C. Women's Hospital and Health Centre, Vancouver, BC, Canada
| | | | - Jennifer Grant
- Vancouver General Hospital, Vancouver, BC, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | | | | | - Katie Lacaria
- Vancouver General Hospital, Vancouver, BC, Canada
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Tim T Y Lau
- Vancouver General Hospital, Vancouver, BC, Canada
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Colin Lee
- Providence Health Care, Vancouver, BC, Canada
| | - Victor Leung
- Providence Health Care, Vancouver, BC, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Yu-Chen Lin
- Lions Gate Hospital, Vancouver, BC, Canada
- Lower Mainland Pharmacy Services, Vancouver, BC, Canada
| | - Allison Mah
- Vancouver General Hospital, Vancouver, BC, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Anne Nguyen
- Lions Gate Hospital, Vancouver, BC, Canada
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada
| | | | | | - Melissa Watt
- B.C. Women's Hospital and Health Centre, Vancouver, BC, Canada
| | | | - Bei Yuan Zhang
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Raymond Mak
- BC Children's Hospital, Vancouver, BC, Canada
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Assen KH, Paquette V, Albert AY, Shi G, Srigley JA, Osiovich H, Roberts AD, Ting JY. Effectiveness of a neonatal intensive care unit-specific antimicrobial stewardship program: A ten-year review. Infect Control Hosp Epidemiol 2023; 44:1-7. [PMID: 36734094 DOI: 10.1017/ice.2022.318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To evaluate the change in consumption of specific antibiotics in a neonatal intensive care unit after the implementation of an antimicrobial stewardship program (ASP). DESIGN Retrospective cohort study between January 1, 2010, and December 31,2019. SETTING The neonatal intensive care unit at British Columbia Women's Hospital (Vancouver Canada), a tertiary-care center. PATIENTS Admitted neonates prescribed antibiotics. METHODS We implemented an ASP with an early implementation phase starting in January 2014 (period 2) and a later phase starting in January 2017 (period 3). Patient demographics were collected, including birth weight, gestational age, history of necrotizing enterocolitis (NEC), and surgical operations from existing databases. Interrupted time-series analysis was used, and comparison of antibiotic days of therapy (DOT) averages were conducted across the preimplementation period (period 1), period 2, and period 3 regarding total patients and subgroups. RESULTS We identified 4,512 infants. There was a significant decrease in DOT from 472 (95% confidence interval [CI], 431-517) in period 1 to 405 (95% CI, 367-446) in period 2 to 313 (95% CI, 280-350) in period 3. We detected a significant decrease in the use of ampicillin, aminoglycosides, cloxacillin, and linezolid but not in vancomycin or cefotaxime. Subgroup analyses of infants <1,500 g and those without NEC or surgery showed decreases in the use of cloxacillin, aminoglycosides, and linezolid. CONCLUSIONS The implementation of an ASP was associated with a significant decrease in the overall DOT and use of certain antibiotics. This study presents important targets for ongoing ASP work.
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Affiliation(s)
- Katrina H Assen
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Vanessa Paquette
- Department of Pharmacy, Children's and Women's Health Centre of British Columbia, Vancouver, British Columbia, Canada
| | - Arianne Y Albert
- Women's Health Research Institute, Vancouver, British Columbia, Canada
| | - Ginger Shi
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jocelyn A Srigley
- Department of Pathology & Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Horacio Osiovich
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Ashley D Roberts
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Joseph Y Ting
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
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Mak R, Yuan Zhang B, Paquette V, Erdle SC, Van Schalkwyk JE, Wong T, Watt M, Elwood C. Safety of direct oral challenge to amoxicillin in pregnant patients at a Canadian tertiary hospital. J Allergy Clin Immunol Pract 2022; 10:1919-1921.e1. [PMID: 35398550 DOI: 10.1016/j.jaip.2022.03.025] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 03/23/2022] [Accepted: 03/24/2022] [Indexed: 10/18/2022]
Affiliation(s)
- Raymond Mak
- Division of Allergy and Immunology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada; Division of Allergy and Immunology, Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada.
| | - Bei Yuan Zhang
- Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, BC, Canada; Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Vanessa Paquette
- Department of Pharmacy, Children's and Women's Health Centre of British Columbia, Vancouver, BC, Canada
| | - Stephanie C Erdle
- Division of Allergy and Immunology, Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | - Julie E Van Schalkwyk
- Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, BC, Canada; Women's Health Research Institute, BC Women's Hospital and Health Centre, Vancouver, BC, Canada
| | - Tiffany Wong
- Division of Allergy and Immunology, Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | - Melissa Watt
- Women's Health Research Institute, BC Women's Hospital and Health Centre, Vancouver, BC, Canada
| | - Chelsea Elwood
- Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, BC, Canada; Women's Health Research Institute, BC Women's Hospital and Health Centre, Vancouver, BC, Canada
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Zhang BY, Paquette V, McClymont E, Barlas A, Wong T, Watt M, Mak R, Elwood C. Implementing a penicillin allergy delabeling service for the obstetric population. The Journal of Allergy and Clinical Immunology: In Practice 2021; 9:2501-2502.e2. [DOI: 10.1016/j.jaip.2021.01.023] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 01/11/2021] [Accepted: 01/12/2021] [Indexed: 12/31/2022]
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Ting JY, Roberts A, Tilley P, Robinson JL, Dunn MS, Paquette V, Lee KS, Shah V, Yoon E, Richter LL, Lodha A, Shivananda S, Thampi N, Autmizguine J, Shah PS. Development of a national neonatal intensive care unit-specific antimicrobial stewardship programme in Canada: protocol for a cohort study. BMJ Open 2020; 10:e043403. [PMID: 33303471 PMCID: PMC7733165 DOI: 10.1136/bmjopen-2020-043403] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 11/23/2020] [Accepted: 11/27/2020] [Indexed: 12/17/2022] Open
Abstract
INTRODUCTION Early empiric treatment with broad-spectrum antimicrobials is common in neonatal intensive care units (NICU) due to the non-specific clinical presentation of infection. However, excessive and inappropriate antimicrobial use can lead to the emergence of drug-resistant organisms and adverse neonatal outcomes. This study aims to develop and implement a nationwide NICU-specific antimicrobial stewardship programme (ASP) to promote judicious antimicrobial use and control the emergence of multidrug-resistant organisms (MDROs) in Canada. METHODS AND ANALYSIS Our study population will include all very low-birth-weight neonates admitted to participating tertiary NICU in Canada. Based on the existing limited literature, we will develop consensus on NICU antimicrobial stewardship interventions to enhance best practices. Using an expanded Canadian Neonatal Network (CNN) platform, we will collect data on antimicrobial use and the susceptibility of organisms identified in clinical samples from blood and cerebrospinal fluid over a period of 2 years. These data will be used to provide all NICU stakeholders with benchmarked centre-adjusted antimicrobial use and MDRO prevalence reports. An ASP plan will be developed at both individual unit and national levels in the subsequent years. Knowledge translation strategies will be implemented through the well-established Evidence-based Practice for Improving Quality methodology. ETHICS AND DISSEMINATION Ethics for the study has been granted by the University of British Columbia Children's & Women's Research Ethics Board (H19-02490) and supported by CNN Executive Committee. The study results will be disseminated through national organisations and open access peer-reviewed publications. TRIAL REGISTRATION NUMBER NCT04388293.
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Affiliation(s)
- Joseph Y Ting
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Ashley Roberts
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Peter Tilley
- Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Joan L Robinson
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Michael S Dunn
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Vanessa Paquette
- School of Pharmaceutical Science, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kyong-Soon Lee
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Vibhuti Shah
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Eugene Yoon
- Maternal-Infant Care Research Centre, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Lindsay L Richter
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Abhay Lodha
- Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
| | - Sandesh Shivananda
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Nisha Thampi
- Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada
| | - Julie Autmizguine
- Department of Pediatrics, University of Montreal, Montreal, Québec, Canada
| | - Prakesh S Shah
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
- Maternal-Infant Care Research Centre, Mount Sinai Hospital, Toronto, Ontario, Canada
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Hay Wong J, Wooding D, Leung S, Paquette V, Elwood C. Establishing obstetrics-specific metrics and interventions for antimicrobial stewardship. Am J Obstet Gynecol 2020. [DOI: 10.1016/j.ajog.2020.08.169] [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]
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Zhang B, Mak R, Paquette V, Watt M, Albert A, Elwood C. Implementing a penicillin allergy de-labelling service for the obstetric population. Am J Obstet Gynecol 2020. [DOI: 10.1016/j.ajog.2020.08.117] [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: 11/30/2022]
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Reimer R, Paquette V, Albert A, McClymont E, Elwood C. Bacteremia in pregnant and postpartum women: Bacterial epidemiology, antibiotic use and neonatal outcomes. Am J Obstet Gynecol 2020. [DOI: 10.1016/j.ajog.2020.08.163] [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: 11/26/2022]
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Pillai A, Tan J, Paquette V, Panczuk J. Does probiotic bacteremia in premature infants impact clinically relevant outcomes? A case report and updated review of literature. Clin Nutr ESPEN 2020; 39:255-259. [PMID: 32859326 DOI: 10.1016/j.clnesp.2020.05.020] [Citation(s) in RCA: 4] [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] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 05/13/2020] [Accepted: 05/17/2020] [Indexed: 01/26/2023]
Abstract
Prophylactic use of probiotics decreases the incidence of necrotizing enterocolitis (NEC) in premature infants. However, there are ongoing concerns related to the routine use of probiotics including inconsistent literature regarding optimal dose and strain, lack of regulatory standards in production and reports regarding potential side effects. There is limited data regarding the incidence of probiotic bacteremia and its impact on relevant clinical outcomes in the premature population. We report the first case of Bifidobacterium longum bacteremia in our center since the routine introduction of probiotics. The neonate had NEC with perforation on day of life 7, which likely led to translocation of the probiotic strain to the blood stream. The neonate did not have any hemodynamic instability and the repeat blood culture was negative after starting antibiotic therapy. We also conducted a literature review and found 13 other cases of probiotic bacteremia in premature or very low birth weight neonates. Although the incidence of probiotic bacteremia is low, it can impact several clinical outcomes including prolonged exposure to antibiotics, removal of central lines and additional laboratory testing such as lumbar puncture. There has been no mortality attributable to probiotic bacteremia and there is no data regarding long term neurodevelopmental outcomes.
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Affiliation(s)
- Anish Pillai
- Division of Neonatology, Surya Mother and Child Super Specialty Hospital, Mumbai, Maharashtra, India.
| | - Jason Tan
- Department of Pharmacy, British Columbia Women's and Children's Hospital, Vancouver, BC, Canada; Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada.
| | - Vanessa Paquette
- Department of Pharmacy, British Columbia Women's and Children's Hospital, Vancouver, BC, Canada; Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada.
| | - Julia Panczuk
- Neonatal-Perinatal Medicine, Department of Pediatrics, British Columbia Women's Hospital and Health Centre, University of British Columbia, Vancouver, BC Canada.
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Chiu M, Bao C, Vahedi Y, Paquette V, Osiovich H, Sadarangani M. 2466. Evaluation of Immunization on the Neonatal Intensive Care Unit at British Columbia Women’s Hospital. Open Forum Infect Dis 2018. [PMCID: PMC6255341 DOI: 10.1093/ofid/ofy210.2119] [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: 11/18/2022] Open
Abstract
Background Term and preterm infants in the neonatal intensive care unit (NICU) should be immunized at the same chronological age and on the same schedule as healthy term infants, but are often under-immunized. Reasons for under-immunization in this population have not been well-defined. The aim of this study was to assess the immunization rates of hospitalized term and preterm infants in the NICU and examine reasons for under-immunization. Methods Pharmacy and NICU databases were utilized to determine the immunization rates of eligible babies admitted to the NICU between 2011 and 2015. A retrospective review of unimmunized infants was undertaken to identify barriers to timely immunization. Patient demographics and transfers to other hospitals were recorded. Reasons for the delay in immunization were evaluated by detailed review of the hospital medical record. Results Of the 3,261 babies admitted to the NICU during the study period, 534 (16%) were hospitalized at ≥8 weeks of age, when first immunizations are administered. Of these, 142 (27%) received no immunizations in hospital. Sixty-five medical records were reviewed in detail. Thirty of the 65 (46%) medical records did not document that immunizations were due. In 21 (32%) of the 65 cases, there was no clear reason for lack of immunization. Of the remaining cases, infants were not vaccinated for 1 or more reasons. Infants deemed too unwell, including recovery from surgery, seizures/encephalopathy, severe immunocompromise, or palliative care, was one of the reasons for lack of vaccination in 35 (54%) of the 65 cases, parental refusal of vaccinations in 8 (12%) of cases, and deferral to discharging hospital in 7 (11%) of cases. Conclusion Significant comorbidity appeared to be the major reason behind vaccination delays, with 27% of highly vulnerable infants unimmunized. Significant improvements are required to ensure these babies receive vaccines upon recovery from their illness, and to ensure absence of immunization is clearly documented upon hospital discharge. Disclosures All authors: No reported disclosures.
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Affiliation(s)
- Melissa Chiu
- Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Carol Bao
- University of British Columbia, Vancouver, BC, Canada
| | - Yasmin Vahedi
- University of British Columbia, Vancouver, BC, Canada
| | | | | | - Manish Sadarangani
- Vaccine Evaluation Center, British Columbia Children’s Hospital, University of British Columbia, Vancouver, BC, Canada
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Paquette V, Culley C, Greanya ED, Ensom MHH. Lacosamide as adjunctive therapy in refractory epilepsy in adults: a systematic review. Seizure 2014; 25:1-17. [PMID: 25645629 DOI: 10.1016/j.seizure.2014.11.007] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [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: 09/30/2014] [Revised: 11/14/2014] [Accepted: 11/18/2014] [Indexed: 12/19/2022] Open
Abstract
PURPOSE To review the evidence for efficacy and safety of lacosamide in adult patients with refractory epilepsy and refractory status epilepticus (RSE). METHODS A systematic literature search of MEDLINE, PubMed, EMBASE, IPA, Google and Google Scholar (through October 2014) was performed. RESULTS Fourteen studies assessing lacosamide in 3509 refractory epilepsy patients were included. In 3 RCTs, more patients had at least 50% reduction in seizure frequency with lacosamide compared to placebo with 38.3-41.1%, 38.1-41.2%, and 18.3-25.8%, in the 400 mg/day, 600 mg/day, and placebo groups, respectively. In non-comparative trials, 18-69% of patients achieved at least 50% reduction in seizure frequency, and 1.7-26.2% achieved seizure freedom. Non-responders were documented in two trials, with 26.2-34% having no response. Thirteen studies assessing lacosamide in 390 RSE patients were included. When assessing lacosamide's ability to terminate RSE, one comparative cohort study found no improvement in SE duration or seizure control with addition of lacosamide. Another study documented no difference compared to use of phenytoin. Eleven descriptive studies using lacosamide as add-on RSE therapy revealed seizure termination rates of 0-100% (median 64.7%). In all patients receiving lacosamide, dizziness (21.8%), vision disturbances (10.4%), drowsiness (7.4%), headache (7.0%), nausea (6.5%), and coordination problems (5.8%) were the most common adverse effects. CONCLUSION Based on evidence to date, adjunctive lacosamide is a treatment option to reduce seizure frequency in patients with refractory epilepsy and terminate seizures in patients with RSE. The safety information summary can be used to advise patients of potential adverse effects.
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Affiliation(s)
- Vanessa Paquette
- Department of Pharmacy, Children's and Women's Health Center of British Columbia, 4480 Oak Street, Vancouver, British Columbia, Canada V6H 3V4.
| | - Celia Culley
- Department of Pharmacy, Royal Jubilee Hospital, 1352 Bay Street, Victoria, British Columbia, Canada V8R 1J8.
| | - Erica D Greanya
- Department of Pharmacy, Victoria General Hospital, 1 Hospital Way, Victoria, British Columbia, Canada V8Z 6R5; Faculty of Pharmaceutical Sciences, The University of British Columbia, 2405 Wesbrook Mall, Vancouver, British Columbia, Canada V6T 1Z3.
| | - Mary H H Ensom
- Department of Pharmacy, Children's and Women's Health Center of British Columbia, 4480 Oak Street, Vancouver, British Columbia, Canada V6H 3V4; Faculty of Pharmaceutical Sciences, The University of British Columbia, 2405 Wesbrook Mall, Vancouver, British Columbia, Canada V6T 1Z3.
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Egan G, Law E, Mailman J, Sunderland M, Dalen D, Amadio A, Lau W, MacKenzie M, Paquette V, Louie S. Should Accreditation Canada’s Required Organizational Practices and Standards Lead to Prioritization of Clinical Pharmacy Services over Distribution-Related Medication Safety Strategies? Can J Hosp Pharm 2013; 66:194-7. [DOI: 10.4212/cjhp.v66i3.1257] [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: 11/10/2022]
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Abstract
BACKGROUND Extravasation, the inadvertent leakage of intravenous (IV) medication from the vein into the surrounding tissue, is a iatrogenic cause of patient injury. Extravasation has been reported to occur in 0.1% to 6.5% of hospital inpatients. The incidence may be higher among children because they have multiple risk factors, including small and fragile veins, decreased peripheral circulation, capillary leakage, and flexible subcutaneous tissue. OBJECTIVES To describe the incidence of extravasation at a pediatric tertiary care hospital, to identify the agents causing extravasation, and to describe the use of antidotes to manage identified cases. A secondary objective was to describe adverse drug effects associated with the antidotes administered. METHODS The medical records of pediatric patients with documented extravasation of an IV medication between January 1, 2006, and August 31, 2008, were analyzed retrospectively. The appropriateness of antidote use was determined in terms of adherence to the institution's protocol for treatment of extravasation. RESULTS A total of 42 patients had documented extravasation, for an overall incidence of 0.04% per patient-day. Of the 40 cases in which location was documented, 12 (30%) occurred on the general pediatric wards, 10 (25%) on the surgical ward, 9 (22%) in the neonatal intensive care unit, 5 (12%) in the pediatric intensive care unit, 3 (8%) in day care, and 1 (2%) in the emergency department. The most common medications involved were fluids for IV administration (18 [43%]), potassium chloride (11 [26%]), antibiotics (8 [19%]), total parenteral nutrition (8 [19%]), calcium chloride (2 [5%]), and epinephrine (2 [5%]). Multiple drugs were involved in some cases of extravasation. The decision to administer an antidote and the choice of antidote (if required) were appropriate in 50% of the cases. No adverse drug effects were reported with use of antidotes. CONCLUSIONS The incidence of extravasation was low. The medications most commonly involved were similar to those reported in the literature. Antidotes were well tolerated but were appropriately used in only half of the events. Prospective trials are needed to determine the clinical severity of injury and to assess the effectiveness and safety of antidotes.
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Affiliation(s)
- Vanessa Paquette
- , BSc(Pharm), ACPR, is a Clinical Pharmacist, Neonatal Critical Care, in the Department of Pharmacy, Children's and Women's Health Centre of British Columbia, and a Clinical Instructor in the Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, British Columbia
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