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Gravel J, Grandjean-Blanchet C, Demean-Loghin A, Noyon B, Ostrow O, Vallières É. Validation of the Hospital for Sick Children Algorithm for Discriminating Bacteremia From Contaminants in Children With a Preliminary Positive Blood Culture. Ann Emerg Med 2024; 84:490-499. [PMID: 38888530 DOI: 10.1016/j.annemergmed.2024.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Revised: 05/01/2024] [Accepted: 05/06/2024] [Indexed: 06/20/2024]
Abstract
STUDY OBJECTIVE Children with positive blood cultures obtained in the emergency department (ED) prompt urgent actions due to the risk of bacteremia. This study aimed to validate the Hospital for Sick Children algorithm used for discriminating bacteremia from contaminants and identified variables associated with bacteremia in children with positive blood cultures. METHODS We conducted a retrospective cohort study of all children with positive blood cultures from a tertiary care, pediatric ED between 2018 and 2022. A 2-step standardized approach defined true bacteremia as the primary outcome based on 1) the bacteria involved and 2) the clinical outcome assessed by 2 reviewers. We evaluated multiple independent variables. We used multiple logistic regression to analyze the association between independent variables and outcome. RESULTS Among the 375,428 ED visits, 574 participants were identified, including 286 (49.8%; 95% confidence interval [CI] 45.8% to 53.9%) with bacteremia and 288 (50.2%; 95% CI 46.1% to 54.3%) with contaminants. The algorithm identified 364 children (63.4%) at high risk of bacteremia, 178 (31.0%) at medium risk, and 32 (5.6%) at low risk. The corresponding bacteremia proportions were 62%, 34%, and 0%, respectively, for a sensitivity of 100% and a specificity of 11%. Suspicion of osteoarticular infection (aOR=43.6; 95% CI 16.2 to 118), presence of internal hardware (aOR=24.9; 95% CI 7.2 to 83.5), and presence of Gram-negative bacteria or Gram-positive cocci in chains/pairs (aOR=21.7; 95% CI 11.7 to 40.3) were the most significant predictors of true bacteremia. CONCLUSION The Hospital for Sick Children algorithm exhibits 100% sensitivity to detect children with bacteremia but demonstrated low specificity at 11%. We identified predictors to discriminate contaminants from bacteremia.
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Renaud C, Lewin A, Gregoire Y, Simard N, Vallières É, Paquette M, Drews SJ, O'Brien SF, Di Germanio C, Busch MP, Germain M, Bazin R. SARS-CoV-2 immunoassays in a predominantly vaccinated population: Performances and qualitative agreements obtained with two analytical approaches and four immunoassays. Vox Sang 2024; 119:533-540. [PMID: 38577957 DOI: 10.1111/vox.13625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 01/18/2024] [Accepted: 03/15/2024] [Indexed: 04/06/2024]
Abstract
BACKGROUND AND OBJECTIVES Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) serosurveys are typically analysed by applying a fixed threshold for seropositivity ('conventional approach'). However, this approach underestimates the seroprevalence of anti-nucleocapsid (N) in vaccinated individuals-who often exhibit a difficult-to-detect anti-N response. This limitation is compounded by delays between the onset of infection and sample collection. To address this issue, we compared the performance of four immunoassays using a new analytical approach ('ratio-based approach'), which determines seropositivity based on an increase in anti-N levels. MATERIALS AND METHODS Two groups of plasma donors and four immunoassays (Elecsys total anti-N, VITROS total anti-N, Architect anti-N Immunoglobulin G (IgG) and in-house total anti-N) were evaluated. First-group donors (N = 145) had one positive SARS-CoV-2 polymerase chain reaction (PCR) test result and had made two plasma donations, including one before and one after the PCR test (median = 27 days post-PCR). Second-group donors (N = 100) had made two plasma donations early in the Omicron wave. RESULTS Among first-group donors (97.9% vaccinated), sensitivity estimates ranged from 60.0% to 89.0% with the conventional approach, compared with 94.5% to 98.6% with the ratio-based approach. Among second-group donors, Fleiss's κ ranged from 0.56 to 0.83 with the conventional approach, compared with 0.90 to 1.00 with the ratio-based approach. CONCLUSION With the conventional approach, the sensitivity of four immunoassays-measured in a predominantly vaccinated population based on samples collected ~1 month after a positive test result-fell below regulatory agencies requirement of ≥95%. The ratio-based approach significantly improved the sensitivities and qualitative agreement among immunoassays, to the point where all would meet this requirement.
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Thériault R, Ismail S, Bouchard F, Tétreault-Laflamme A, Richard P, Jeldres C, Morin C, Vallières É, Tu L. Retrospective study of mid- and long-term urinary complications in patients with prostate cancer treated with radiotherapy and/or radical prostatectomy. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)00303-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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Gagnon F, Gravel J, Duranceau C, Harman S, Bhatt M, Vallières É, Trottier ED. 65 XyloFUNS: Xylocaine to Freeze during Unpleasant Nasopharyngeal Swabs in Children – A Randomized Controlled Trial. Paediatr Child Health 2022. [PMCID: PMC9586090 DOI: 10.1093/pch/pxac100.064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Background Nasopharyngeal (NP) swabs have been recommended to detect SARS-CoV-2 since the beginning of the COVID-19 pandemic, but are reported to be at least moderately painful. Objectives To evaluate the efficacy of intranasal vaporized lidocaine compared to a sham treatment in reducing pain in children undergoing a NP swab in the Emergency Department (ED). Design/Methods A randomized double-blinded clinical trial was conducted in a pediatric ED. Both participants and the researcher evaluating the primary outcome were blinded. Children 6 to 17 years old requiring a NP swab were eligible. Participants were randomly allocated to receive intranasal lidocaine or a sham treatment prior to their NP swab. The primary outcome measure was pain during the swab as assessed by the visual analog scale. Secondary outcome measures were pain using the verbal numeric rating scale, fear using the children fear scale, and side effects of the intervention. Results Eighty-eight participants were enrolled: 45 to the lidocaine group and 43 to the control group. The mean visual analog scale scores for pain were 46 mm in the lidocaine group and 53 mm in the control group (mean difference 7 mm; 95%CI -5 to 19 mm). The numeric rating scale and children fear scale were not statistically different between groups. No serious adverse events were observed. Fear prior to the test and younger age were associated with higher pain scores. Conclusion Intranasal lidocaine administered prior to NP swabs in the ED did not lower pain scores for school-aged children and youth. ![]()
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Sédillot-Daniel È, Voizard B, Vallières É, Woods O, Quintal MC. Chronic suppurative otomastoiditis due to nontuberculous mycobacteria: A case series. Int J Pediatr Otorhinolaryngol 2020; 138:110375. [PMID: 33152966 DOI: 10.1016/j.ijporl.2020.110375] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Revised: 09/04/2020] [Accepted: 09/04/2020] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Eight new cases of chronic otomastoiditis due to nontuberculous mycobacteria were reported at Center Hospitalier Universitaire Sainte-Justine (CHUSJ) between 2008 and 2018. In the literature, only 89 cases have been described since 1972. This case series aims to define the clinical presentation, infectious pathogens, as well as diagnostic and therapeutic means employed in cases of nontuberculous mycobacteria otitis media encountered in our tertiary pediatric reference center. METHODS All cases of otitis media caused by nontuberculous mycobacteria diagnosed at Sainte-Justine between 2008 and 2018 were reviewed. Species identification was retrieved from the Laboratoire de Santé Publique du Québec, Quebec's provincial public health and reference laboratory. RESULTS All 8 cases occurred in immunocompetent children. Clinical features on presentation were chronic tympanostomy tube otorrhea with abundant granulation tissue in 7 cases. CT scan demonstrated coalescent mastoiditis in 3 cases. The median delay between initial presentation and identification of nontuberculous mycobacteria was 81 days. Seven patients had a Mycobacterium (M.) abscessus complex infection. Treatment consisted of weekly microscopic granulation debridement, a combined systemic antibiotic therapy for an average duration of 21 weeks, as well as instillation of boric acid into the middle ear. While 3 cases required at least one mastoidectomy, 2 cases were treated only medically. CONCLUSION Nontuberculous mycobacteria otitis media is a rare clinical entity, for which high clinical suspicion and specific microbiological analyses could minimize diagnostic delay. The use of boric acid as a desiccating agent may allow for a better local control.
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Lam LMT, Ismail A, Sedman J, Vallières É. 2167. Evaluation of Attenuated Total Reflectance Fourier Transform Infrared Spectroscopy for Rapid and Reagent-Free Identification of Burkholderia spp. Open Forum Infect Dis 2019. [PMCID: PMC6810090 DOI: 10.1093/ofid/ofz360.1847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background Burkholderia cepacia complex including B. gladioli are opportunistic pathogenic bacteria affecting the immunocompromised population. For prognosis and appropriate treatment, rapid and accurate species identification is particularly important for those diagnosed with cystic fibrosis (CF). Conventional biochemical identification techniques are insensitive and problematic for identifying Burkholderia spp., leading to common misidentification or inconclusive results. Recent studies have successfully employed attenuated total reflectance-Fourier transform infrared (ATR-FTIR) spectroscopy for rapid, reagent-free and cost-effective microbial identification. In the present study, identification of Burkholderia spp. by this technique is investigated. Methods A total of 59 isolates belonging to 7 species of Burkholderia were included in this study; all these isolates had been well-characterized by VITEK 2, 16S rRNA sequencing, random amplification of polymorphic DNA (recA typing) and/or matrix-assisted laser desorption/ionization time of flight mass spectrometry. ATR-FTIR spectra were acquired directly from colonies on 5% blood agar plates. Results A spectral database containing ATR-FTIR spectra of over 4300 bacterial isolates, encompassing over 70 genera and 190 species, was updated to include spectra of 39 isolates collected in this study and employed in the identification of the other isolates (n = 20). All isolates were correctly identified as Burkholderia by a multitier search approach. For Burkholderia species identification, spectra belonging to 39 isolates representative of all 7 species were used to construct a spectral database employed to identify the other 20 isolates [B. anthina (n = 2), B. gladioli (n = 8), B. multivorans (n = 7), and B. vietnamiensis (n = 3)]. Compared with VITEK 2 (30% correct species identification), ATR-FTIR spectroscopy correctly identified all but one isolate, resulting in overall correct species identification of 95%. Prospectively (10 months), 5 of 1100 isolates collected were identified as Burkholderia spp. by ATR-FTIR spectroscopy in concordance with VITEK 2. Conclusion ATR-FTIR spectroscopy can provide the means of rapid Burkholderia spp. identification for appropriate treatment of those diagnosed with CF. Disclosures All authors: No reported disclosures.
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ElBared J, Vallières É, Renaud C, Gravel J, Chartrand C, Rallu F, Ouyang Y. THE EPIDEMIOLOGY AND CLINICAL FEATURES OF SEPTIC ARTHRITIS CASES SECONDARY TO KINGELLA KINGAE IN COMPARISON TO SEPTIC ARTHRITIS FROM OTHER PATHOGENS. Paediatr Child Health 2018. [DOI: 10.1093/pch/pxy054.115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
BACKGROUND
In Europe, Kingella kingae (Kk) is considered as a significant pathogen in osteoarticular infections (OAI) in young children. Some authors suggest that a significant portion of ‘culture negative septic arthritis’ may be secondary to the inability to isolate K. kingae using conventional methods. However, its pathogenic role and prevalence remain controversial in North America. Since 2014, in order to optimize the microbiological diagnosis of OAI, all osteo-articular specimens submitted to our laboratory for bacteriology culture were simultaneously tested with a home brew multiplex PCR assay detecting Kk, Staphylococcus aureus, Streptococcus pyogenes, Streptococcus agalactiae and Streptococcus pneumoniae. Consequently, an important increase in Kk OAI proven cases was observed. The clinical presentation of Kk OAI comparatively to the other most common pathogens seen in paediatric OAI has yet to be described in North America.
OBJECTIVES
The aim of this study is to review all cases of acute septic arthritis (SA) in our institution to define the prevalence of Kk SA and to compare the clinical presentation of SA cases according to their bacterial etiology, with a deeper look at SA caused by Kk.
DESIGN/METHODS
We conducted a retrospective chart review of all cases of suspected SA who had a synovial fluid sample submitted for bacteriology culture and multiplex PCR analysis to our microbiology laboratory between May 2014 and May 2017. Only cases of acute SA (< 1 month symptom duration prior to diagnosis) were included. Children with final diagnosis that were not of infectious origin (e.g. rheumatoid arthritis, transient synovitis, etc) were excluded. Probable SA cases were defined as cases with a clinical presentation concordant with SA without any causative bacteria identified, that have received antibiotic treatment for >2 weeks. Eligible SA cases were then stratified into 4 groups according to the final microbiology diagnosis: Kk SA, S. aureus SA, “other bacteria” SA or probable SA. One-way ANOVA with Tukey’s multiple comparison test if appropriate was subsequently performed to compare demographics, clinical and biochemical data, duration of treatment and outcome between subgroups.
RESULTS
Of the 153 patients who submitted a synovial fluid sample, 71 met the inclusion criteria. A microorganism was found in 56 patients (79%): Kk was found in 37 cases (52%), S. aureus in 11 cases (15%), S. pyogenes in 7 patients (10%), and Salmonella in 1 patient (1%); and there were15 probable SA cases (21%). Interestingly, Kk cases were proven by PCR only in 86% (n=32/37) of cases (culture was negative).
One-way ANOVA showed a significant difference in age between subgroups [F(3, 67) = 13,60, p<0,0001]:patients infected by Kk were younger (M=1,50 years old, SD=0,68) than S. aureus (M=7.48, SD=4.84), “other bacteria” (M=5,86, SD=4,37) and probable SA subgroups (M=5,80, SD=4,90).
The duration of fever (days) was shorter [F(3, 67) = 14,07, p=0,028] in patients with Kk (M=4,1, SD=3,3) and probable SA (M=2,9 SD=3,6) in comparison to “other bacteria” cases (M=8,8, SD=8,3).
Also, maximal CRP values [F(3, 67) = 14,80, p<0,0001] were lower in Kk (M=42,7, SD=38,1) and probable SA (M=36,4, SD=34,6) than in SA caused by other bacteria (M=178,5, SD=98,8). Similarly, maximal neutrophil count [F(3, 67) = 6.71, p=0,0005] was lower in Kk cases (M=5,6 SD=2,3) in comparison to those infected by other bacteria (M=11,6, SD=4,1).
CONCLUSION
In our institution, since the implementation of multiplex PCR testing for OA samples, Kk has become the most prevalent pathogen causing SA. Children with Kk SA appear to be younger and to have a less inflammatory clinical presentation, as shown by a shorter duration of fever, lower CRP and lower neutrophil values in comparison to cases attributable to other bacteria. Prevalence of Kk SA is probably underestimated in settings where only bacteriology culture is performed.
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Piché-Renaud PP, Turcot J, Chartrand C, Gravel J, Labrecque M, Vallières É, Renaud C. Evaluation of a fluorescent immunoassay rapid test (Sofia™) for detection of influenza A+B and RSV in a tertiary pediatric setting. Diagn Microbiol Infect Dis 2015; 84:304-8. [PMID: 26827091 DOI: 10.1016/j.diagmicrobio.2015.10.025] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Revised: 09/17/2015] [Accepted: 10/29/2015] [Indexed: 11/30/2022]
Abstract
In response to the lack of sensitivity and reproducibility of previously marketed rapid antigen detection tests, a novel fluorescent immunoassay was recently developed. This new assay offers rapidity and automated reading. More characterization of this assay is needed. The aim of this study was to assess diagnostic performance of Sofia influenza A+B and respiratory syncytial virus (RSV) while compared to traditional viral cell culture. A total of 416 respiratory samples were analyzed prospectively with both methods in a tertiary pediatric center. Sensitivity and specificity of the Sofia™ test were 90.0% and 98.0% for influenza A, 90.9% and 98.9% for influenza B, and 87.7% and 94.7% for RSV compared to traditional cell culture. Overall, Sofia influenza A+B and RSV assays performed well in comparison to culture in a pediatric population.
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