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Schlapbach LJ, Goertz S, Hagenbuch N, Aubert B, Papis S, Giannoni E, Posfay-Barbe KM, Stocker M, Heininger U, Bernhard-Stirnemann S, Niederer-Loher A, Kahlert CR, Natalucci G, Relly C, Riedel T, Aebi C, Berger C, Agyeman PKA. Organ Dysfunction in Children With Blood Culture-Proven Sepsis: Comparative Performance of Four Scores in a National Cohort Study. Pediatr Crit Care Med 2024; 25:e117-e128. [PMID: 37878412 PMCID: PMC10904004 DOI: 10.1097/pcc.0000000000003388] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2023]
Abstract
OBJECTIVES Previous studies applying Sepsis-3 criteria to children were based on retrospective analyses of PICU cohorts. We aimed to compare organ dysfunction criteria in children with blood culture-proven sepsis, including emergency department, PICU, and ward patients, and to assess relevance of organ dysfunctions for mortality prediction. DESIGN We have carried out a nonprespecified, secondary analysis of a prospective dataset collected from September 2011 to December 2015. SETTING Emergency departments, wards, and PICUs in 10 tertiary children's hospitals in Switzerland. PATIENTS Children younger than 17 years old with blood culture-proven sepsis. We excluded preterm infants and term infants younger than 7 days old. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS We compared the 2005 International Pediatric Sepsis Consensus Conference (IPSCC), Pediatric Logistic Organ Dysfunction-2 (PELOD-2), pediatric Sequential Organ Failure Assessment (pSOFA), and Pediatric Organ Dysfunction Information Update Mandate (PODIUM) scores, measured at blood culture sampling, to predict 30-day mortality. We analyzed 877 sepsis episodes in 807 children, with a 30-day mortality of 4.3%. Percentage with organ dysfunction ranged from 32.7% (IPSCC) to 55.3% (pSOFA). In adjusted analyses, the accuracy for identification of 30-day mortality was area under the curve (AUC) 0.87 (95% CI, 0.82-0.92) for IPSCC, 0.83 (0.76-0.89) for PELOD-2, 0.85 (0.78-0.92) for pSOFA, and 0.85 (0.78-0.91) for PODIUM. When restricting scores to neurologic, respiratory, and cardiovascular dysfunction, the adjusted AUC was 0.89 (0.84-0.94) for IPSCC, 0.85 (0.79-0.91) for PELOD-2, 0.87 (0.81-0.93) for pSOFA, and 0.88 (0.83-0.93) for PODIUM. CONCLUSIONS IPSCC, PELOD-2, pSOFA, and PODIUM performed similarly to predict 30-day mortality. Simplified scores restricted to neurologic, respiratory, and cardiovascular dysfunction yielded comparable performance.
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Affiliation(s)
- Luregn J Schlapbach
- Department of Intensive Care and Neonatology, and Children`s Research Center, University Children`s Hospital Zurich, Zurich, Switzerland
- Child Health Research Centre, University of Queensland, Brisbane, QLD, Australia
| | - Sabrina Goertz
- Division of Infectious Diseases, and Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland
| | - Niels Hagenbuch
- Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Blandine Aubert
- Clinic of Neonatology, Department Mother-Woman-Child, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Sebastien Papis
- Pediatric Infectious Diseases Unit, Department of Woman, Child and Adolescent, Children's Hospital of Geneva, University Hospitals of Geneva and Faculty of Medicine, Geneva, Switzerland
| | - Eric Giannoni
- Clinic of Neonatology, Department Mother-Woman-Child, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Klara M Posfay-Barbe
- Pediatric Infectious Diseases Unit, Department of Woman, Child and Adolescent, Children's Hospital of Geneva, University Hospitals of Geneva and Faculty of Medicine, Geneva, Switzerland
| | | | - Ulrich Heininger
- Infectious Diseases and Vaccinology, University Children's Hospital Basel, Basel, Switzerland
| | | | | | | | | | - Christa Relly
- Division of Infectious Diseases, and Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland
| | - Thomas Riedel
- Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Department of Pediatrics, Cantonal Hospital Graubuenden, Chur, Switzerland
| | - Christoph Aebi
- Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Christoph Berger
- Division of Infectious Diseases, and Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland
| | - Philipp K A Agyeman
- Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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Uka A, Bressieux-Degueldre S, Buettcher M, Kottanattu L, Plebani M, Niederer-Loher A, Schöbi N, Hofer M, Tomasini J, Trück J, Villiger R, Wagner N, Wuetz D, Ritz N, Zimmermann P. Cardiac involvement in children with paediatric multisystem inflammatory syndrome temporally associated with SARS-CoV-2 (PIMS-TS): data from a prospective nationwide surveillance study. Swiss Med Wkly 2023; 153:40092. [PMID: 37852002 DOI: 10.57187/smw.2023.40092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2023] Open
Abstract
BACKGROUND Paediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 (PIMS-TS) may occur 4 to 8 weeks after SARS-CoV-2 infection. The acute presentation of PIMS-TS has been well described, but data on longer-term outcomes, particularly cardiac, is scarce. METHODS This prospective nationwide surveillance study included children and adolescents less than 18 years of age who were hospitalised with PIMS-TS in Switzerland between March 2020 and March 2022. Data was collected from all 29 paediatric hospitals through the Swiss Paediatric Surveillance Unit (SPSU) during hospitalisation and approximately six weeks after discharge. The data was analysed after categorising the participants into three groups based on their admission status to the intensive care unit (ICU) (non-ICU, ICU-moderate) and the requirement for invasive ventilatory and/or inotropic support (ICU-severe). RESULTS Overall, 204 children were included of whom 194 (95.1%) had follow-up data recorded. Median age was 9.0 years (interquartile range [IQR] 6.0-11.5) and 142 (69.6%) were male. In total, 105/204 (51.5%) required ICU admission, of whom 55/105 (52.4%) received inotropic support and 14/105 (13.3%) mechanical ventilation (ICU-severe group). Echocardiography was performed in 201/204 (98.5%) children; 132 (64.7%) had a cardiac abnormality including left ventricular systolic dysfunction (73 [36.3%]), a coronary artery abnormality (45 [22.4%]), pericardial effusion (50 [24.9%]) and mitral valve regurgitation (60 [29.9%]). Left ventricular systolic dysfunction was present at admission in 62/201 (30.8%) children and appeared during hospitalisation in 11 (5.5%) children. A coronary artery abnormality was detected at admission in 29/201 (14.2%) children and developed during hospitalisation or at follow-up in 13 (6.5%) and 3 (1.5%) children, respectively. None of the children had left ventricular systolic dysfunction at follow-up, but a coronary abnormality and pericardial effusion were found in 12 (6.6%) and 3 (1.7%) children, respectively. School absenteeism at the time of follow-up was more frequent in children who had been admitted to the ICU (2.5% in the non-ICU group compared to 10.4% and 17.6% in the ICU-moderate and ICU-severe group, respectively) (p = 0.011). CONCLUSION Cardiac complications in children presenting with PIMS-TS are common and may worsen during the hospitalisation. Irrespective of initial severity, resolution of left ventricular systolic dysfunction is observed, often occurring rapidly during the hospitalisation. Most of the coronary artery abnormalities regress; however, some are still present at follow-up, emphasising the need for prolonged cardiac evaluation after PIMS-TS.
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Affiliation(s)
- Anita Uka
- Department of Community Health, Faculty of Science and Medicine, University of Fribourg, Fribourg, Switzerland
- Department Women-Mother-Child, Lausanne University Hospital, Lausanne, Switzerland
| | - Sabrina Bressieux-Degueldre
- Paediatric Cardiology Unit, Department Women-Mother-Child, University Hospital of Lausanne, Lausanne, Switzerland
| | - Michael Buettcher
- Paediatric Infectious Diseases, Children's Hospital Lucerne, Lucerne Cantonal Hospital, Lucerne, Switzerland
- Department of Health Science and Medicine, University Lucerne, Lucerne, Switzerland
- Paediatric Pharmacology and Pharmacometrics Research Centre, University Children's Hospital Basel, Basel, Switzerland
| | - Lisa Kottanattu
- Clinic of pediatrics, Pediatric Institute of Southern Switzerland, Ente Ospedaliero Cantonale (EOC), Bellinzona, Switzerland
| | - Margerita Plebani
- Pediatric Infectious Diseases and Vaccinology Unit, Department Women-Mother-Child, Lausanne University Hospital, Lausanne, Switzerland
| | - Anita Niederer-Loher
- Divison of Infectious Diseases and Hospital Hygiene, Children's Hospital of Eastern Switzerland, St. Gallen, Switzerland
| | - Nina Schöbi
- Division of Pediatric Infectious Disease, Department of Pediatrics, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland
| | - Michael Hofer
- Pediatric Immuno-Rheumatology of Western Switzerland, Department Women-Mother-Child, Lausanne University Hospital, Lausanne, and University Hospitals of Geneva, Geneva, Switzerland
| | - Julie Tomasini
- Department of Community Health, Faculty of Science and Medicine, University of Fribourg, Fribourg, Switzerland
| | - Johannes Trück
- Division of Immunology and Children's Research Center, University Children's Hospital Zurich, University of Zurich (UZH), Zurich, Switzerland
| | - Reto Villiger
- Department of Paediatrics, Hospital Center of Biel, Biel, Switzerland
| | - Noémie Wagner
- Department of Paediatrics, Gynaecology and Obstetrics, General Paediatrics Division, Geneva University Hospitals, Geneva, Switzerland
| | - Daniela Wuetz
- Division of Pediatric Cardiology, Pediatric Heart Center, University Children's Hospital Zurich, Zurich, Switzerland
| | - Nicole Ritz
- Paediatric Infectious Diseases, Children's Hospital Lucerne, Lucerne Cantonal Hospital, Lucerne, Switzerland
- Mycobacterial and Migrant Health Research, University Children's Hospital Basel and Department for Clinical Research, University of Basel, Basel, Switzerland
- Department of Paediatrics, The University of Melbourne, Australia
| | - Petra Zimmermann
- Department of Community Health, Faculty of Science and Medicine, University of Fribourg, Fribourg, Switzerland
- Department of Paediatrics, The University of Melbourne, Australia
- Department of Paediatrics, Fribourg Hospital, Fribourg, Switzerland
- Infectious Diseases Research Group, Murdoch Children's Research Institute, Parkville, Australia
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3
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Endrich O, Triep K, Schlapbach LJ, Posfay-Barbe KM, Heininger U, Giannoni E, Stocker M, Niederer-Loher A, Kahlert CR, Natalucci G, Relly C, Riedel T, Aebi C, Berger C, Agyeman PKA. Sensitivity of ICD coding for sepsis in children-a population-based study. Intensive Care Med Paediatr Neonatal 2023; 1:5. [PMID: 37342815 PMCID: PMC10261837 DOI: 10.1007/s44253-023-00006-1] [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] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 05/16/2023] [Indexed: 06/23/2023]
Abstract
Background International Classification of Diseases 10th edition (ICD-10) is widely used to describe the burden of disease. Aim To describe how well ICD-10 coding captures sepsis in children admitted to the hospital with blood culture-proven bacterial or fungal infection and systemic inflammatory response syndrome. Methods Secondary analysis of a population-based, multicenter, prospective cohort study on children with blood culture-proven sepsis of nine tertiary pediatric hospitals in Switzerland. We compared the agreement of validated study data on sepsis criteria with ICD-10 coding abstraction obtained at the participating hospitals. Results We analyzed 998 hospital admissions of children with blood culture-proven sepsis. The sensitivity of ICD-10 coding abstraction was 60% (95%-CI 57-63) for sepsis; 35% (95%-CI 31-39) for sepsis with organ dysfunction, using an explicit abstraction strategy; and 65% (95%-CI 61-69) using an implicit abstraction strategy. For septic shock, the sensitivity of ICD-10 coding abstraction was 43% (95%-CI 37-50). Agreement of ICD-10 coding abstraction with validated study data varied by the underlying infection type and disease severity (p < 0.05). The estimated national incidence of sepsis, inferred from ICD-10 coding abstraction, was 12.5 per 100,000 children (95%-CI 11.7-13.5) and 21.0 per 100,000 children (95%-CI 19.8-22.2) using validated study data. Conclusions In this population-based study, we found a poor representation of sepsis and sepsis with organ dysfunction by ICD-10 coding abstraction in children with blood culture-proven sepsis when compared against a prospective validated research dataset. Sepsis estimates in children based on ICD-10 coding may thus severely underestimate the true prevalence of the disease. Supplementary Information The online version contains supplementary material available at 10.1007/s44253-023-00006-1.
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Affiliation(s)
- Olga Endrich
- Department of Clinical Chemistry, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Medical Directorate, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Karen Triep
- Medical Directorate, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Luregn J. Schlapbach
- Department of Intensive Care and Neonatology, and Children’s Research Center, University Children’s Hospital Zurich, Zurich, Switzerland
- Child Health Research Center, University of Queensland, Brisbane, Australia
| | - Klara M. Posfay-Barbe
- Pediatric Infectious Diseases Unit, Children’s Hospital of Geneva, University Hospitals of Geneva, Geneva, Switzerland
| | - Ulrich Heininger
- Infectious Diseases and Vaccinology, University of Basel Children’s Hospital, Basel, Switzerland
| | - Eric Giannoni
- Clinic of Neonatology, Department Mother-Woman-Child, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | | | | | | | - Giancarlo Natalucci
- Family Larsson-Rosenquist Foundation Centre for Neurodevelopment, Growth and Nutrition of the Newborn, Department of Neonatology, University Hospital Zurich, Zurich, Switzerland
| | - Christa Relly
- Division of Infectious Diseases and Hospital Epidemiology, Children’s Research Center, University Children’s Hospital Zurich, Zurich, Switzerland
| | - Thomas Riedel
- Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Department of Pediatrics, Cantonal Hospital Graubuenden, Chur, Switzerland
| | - Christoph Aebi
- Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Christoph Berger
- Division of Infectious Diseases and Hospital Epidemiology, Children’s Research Center, University Children’s Hospital Zurich, Zurich, Switzerland
| | - Philipp K. A. Agyeman
- Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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4
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van der Velden FJS, de Vries G, Martin A, Lim E, von Both U, Kolberg L, Carrol ED, Khanijau A, Herberg JA, De T, Galassini R, Kuijpers TW, Martinón-Torres F, Rivero-Calle I, Vermont CL, Hagedoorn NN, Pokorn M, Pollard AJ, Schlapbach LJ, Tsolia M, Elefhteriou I, Yeung S, Zavadska D, Fink C, Voice M, Zenz W, Kohlmaier B, Agyeman PKA, Usuf E, Secka F, de Groot R, Levin M, van der Flier M, Emonts M, Cunnington A, De T, Herberg J, Kaforou M, Wright V, Baumard L, Bellos E, D’Souza G, Galassini R, Habgood-Coote D, Hamilton S, Hoggart C, Hourmat S, Jackson H, Maconochie I, Menikou S, Lin N, Nichols S, Nijman R, Powell O, Pena Paz I, Shah P, Shen CF, Vito O, Wilson C, Abdulla A, Ali L, Darnell S, Jorgensen R, Mustafa S, Persand S, Stevens MM, Kim N, Kim E, Fidler K, Dudley J, Richmond V, Tavliavini E, Shen CF, Liu CC, Wang SM, Martinón-Torres F, Salas A, González FÁ, Farto CB, Barral-Arca R, Castro MB, Bello X, García MB, Carnota S, Cebey-López M, Curras-Tuala MJ, Suárez CD, Vicente LG, Gómez-Carballa A, Rial JG, Iglesias PL, Martinón-Torres F, Martinón-Torres N, Sánchez JMM, Pérez BM, Pardo-Seco J, Rodríguez LP, Pischedda S, Vázquez SR, Calle IR, Rodríguez-Tenreiro C, Redondo-Collazo L, Ora MS, Salas A, Fernández SS, Trasorras CS, Iglesias MV, Zavadska D, Balode A, Bārzdiņa A, Deksne D, Gardovska D, Grāvele D, Grope I, Meiere A, Nokalna I, Pavāre J, Pučuka Z, Selecka K, Rudzāte A, Svile D, Urbāne UN, Usuf E, Bojang K, Zaman SMA, Secka F, Anderson S, Sarr AR, Saidykhan M, Darboe S, Ceesay S, D’alessandro U, Moll HA, Vermont CL, Borensztajn DM, Hagedoorn NN, Tan C, Zachariasse J, Dik W, Agyeman PKA, Berger C, Giannoni E, Stocker M, Posfay-Barbe KM, Heininger U, Bernhard-Stirnemann S, Niederer-Loher A, Kahlert CR, Natalucci G, Relly C, Riedel T, Aebi C, Schlapbach LJ, Carrol ED, Cocklin E, Jennings R, Johnston J, Khanijau A, Leigh S, Lewis-Burke N, Newall K, Romaine S, Tsolia M, Eleftheriou I, Tambouratzi M, Marmarinos A, Xagorari M, Syggelou K, Fink C, Voice M, Calvo-Bado L, Zenz W, Kohlmaier B, Schweintzger NA, Sagmeister MG, Kohlfürst DS, Zurl C, Binder A, Hösele S, Leitner M, Pölz L, Rajic G, Bauchinger S, Baumgart H, Benesch M, Ceolotto A, Eber E, Gallistl S, Gores G, Haidl H, Hauer A, Hude C, Keldorfer M, Krenn L, Pilch H, Pfleger A, Pfurtscheller K, Nordberg G, Niedrist T, Rödl S, Skrabl-Baumgartner A, Sperl M, Stampfer L, Strenger V, Till H, Trobisch A, Löffler S, Yeung S, Dewez JE, Hibberd M, Bath D, Miners A, Nijman R, Fitchett E, de Groot R, van der Flier M, de Jonge MI, van Aerde K, Alkema W, van den Broek B, Gloerich J, van Gool AJ, Henriet S, Huijnen M, Philipsen R, Willems E, Gerrits G, van Leur M, Heidema J, de Haan L, Miedema C, Neeleman C, Obihara C, Tramper-Stranders G, Pollard AJ, Kandasamy R, Paulus S, Carter MJ, O’Connor D, Bibi S, Kelly DF, Gurung M, Thorson S, Ansari I, Murdoch DR, Shrestha S, Oliver Z, Emonts M, Lim E, Valentine L, Allen K, Bell K, Chan A, Crulley S, Devine K, Fabian D, King S, McAlinden P, McDonald S, McDonnell A, Pickering A, Thomson E, Wood A, Wallia D, Woodsford P, Baxter F, Bell A, Rhodes M, Agbeko R, Mackerness C, Baas B, Kloosterhuis L, Oosthoek W, Arif T, Bennet J, Collings K, van der Giessen I, Martin A, Rashid A, Rowlands E, de Vries G, van der Velden F, Soon J, Valentine L, Martin M, Mistry R, von Both U, Kolberg L, Zwerenz M, Buschbeck J, Bidlingmaier C, Binder V, Danhauser K, Haas N, Griese M, Feuchtinger T, Keil J, Kappler M, Lurz E, Muench G, Reiter K, Schoen C, Mallet F, Brengel-Pesce K, Pachot A, Mommert M, Pokorn M, Kolnik M, Vincek K, Srovin TP, Bahovec N, Prunk P, Osterman V, Avramoska T, Kuijpers T, Jongerius I, van den Berg JM, Schonenberg D, Barendregt AM, Pajkrt D, van der Kuip M, van Furth AM, Sprenkeler E, Zandstra J, van Mierlo G, Geissler J. Correction to: Febrile illness in high-risk children: a prospective, international observational study. Eur J Pediatr 2023; 182:555-556. [PMID: 36689005 PMCID: PMC9899168 DOI: 10.1007/s00431-022-04788-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Affiliation(s)
- Fabian J. S. van der Velden
- grid.459561.a0000 0004 4904 7256Paediatric Immunology, Infectious Diseases & Allergy, Great North Children’s Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK ,grid.1006.70000 0001 0462 7212Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Gabriella de Vries
- grid.459561.a0000 0004 4904 7256Paediatric Immunology, Infectious Diseases & Allergy, Great North Children’s Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK ,grid.416135.40000 0004 0649 0805Department of General Paediatrics, Erasmus MC-Sophia Children’s Hospital, Rotterdam, The Netherlands
| | - Alexander Martin
- grid.459561.a0000 0004 4904 7256Paediatric Immunology, Infectious Diseases & Allergy, Great North Children’s Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK ,grid.1006.70000 0001 0462 7212Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Emma Lim
- grid.459561.a0000 0004 4904 7256Paediatric Immunology, Infectious Diseases & Allergy, Great North Children’s Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK ,grid.1006.70000 0001 0462 7212Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Ulrich von Both
- grid.5252.00000 0004 1936 973XDivision Paediatric Infectious Diseases, Dr. Von Hauner Children’s Hospital, University Hospital LMU Munich, Munich, Germany
| | - Laura Kolberg
- grid.5252.00000 0004 1936 973XDivision Paediatric Infectious Diseases, Dr. Von Hauner Children’s Hospital, University Hospital LMU Munich, Munich, Germany
| | - Enitan D. Carrol
- grid.10025.360000 0004 1936 8470Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK ,grid.417858.70000 0004 0421 1374Alder Hey Children’s NHS Foundation Trust, Liverpool, UK
| | - Aakash Khanijau
- grid.10025.360000 0004 1936 8470Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK ,grid.417858.70000 0004 0421 1374Alder Hey Children’s NHS Foundation Trust, Liverpool, UK
| | - Jethro A. Herberg
- grid.7445.20000 0001 2113 8111Section of Paediatric Infectious Disease, Wright-Fleming Institute, Imperial College London, London, UK
| | - Tisham De
- grid.7445.20000 0001 2113 8111Section of Paediatric Infectious Disease, Wright-Fleming Institute, Imperial College London, London, UK
| | - Rachel Galassini
- grid.7445.20000 0001 2113 8111Section of Paediatric Infectious Disease, Wright-Fleming Institute, Imperial College London, London, UK
| | - Taco W. Kuijpers
- grid.7177.60000000084992262Department of Pediatric Immunology, Rheumatology and Infectious Diseases, Amsterdam University Medical Center, Location Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Federico Martinón-Torres
- grid.411048.80000 0000 8816 6945Pediatrics Department, Translational Pediatrics and Infectious Diseases, Hospital Clínico Universitario de Santiago, Santiago de Compostela, Spain ,grid.11794.3a0000000109410645Grupo de Genetica, Vacunas, Infecciones y Pediatria, Instituto de Investigacion Sanitaria de Santiago, Universidad de Santiago, Santiago de Compostela, Spain ,grid.512891.6Consorcio Centro de Investigacion Biomedicaen Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - Irene Rivero-Calle
- grid.411048.80000 0000 8816 6945Pediatrics Department, Translational Pediatrics and Infectious Diseases, Hospital Clínico Universitario de Santiago, Santiago de Compostela, Spain
| | - Clementien L. Vermont
- grid.416135.40000 0004 0649 0805Department of Pediatrics, Division of Pediatric Infectious Diseases & Immunology, Erasmus MC-Sophia Children’s Hospital, Rotterdam, The Netherlands
| | - Nienke N. Hagedoorn
- grid.416135.40000 0004 0649 0805Department of General Paediatrics, Erasmus MC-Sophia Children’s Hospital, Rotterdam, The Netherlands
| | - Marko Pokorn
- grid.29524.380000 0004 0571 7705University Children’s Hospital, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Andrew J. Pollard
- grid.4991.50000 0004 1936 8948Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK
| | - Luregn J. Schlapbach
- grid.412341.10000 0001 0726 4330Neonatal and Pediatric Intensive Care Unit, Children’s Research Center, University Children’s Hospital Zürich, University of Zürich, Zurich, Switzerland
| | - Maria Tsolia
- grid.5216.00000 0001 2155 08002nd Department of Pediatrics, National and Kapodistrian University of Athens, Children’s Hospital ‘P, and A. Kyriakou’, Athens, Greece
| | - Irini Elefhteriou
- grid.5216.00000 0001 2155 08002nd Department of Pediatrics, National and Kapodistrian University of Athens, Children’s Hospital ‘P, and A. Kyriakou’, Athens, Greece
| | - Shunmay Yeung
- grid.8991.90000 0004 0425 469XClinical Research Department, Faculty of Infectious and Tropical Disease, London School of Hygiene and Tropical Medicine, London, UK
| | - Dace Zavadska
- grid.17330.360000 0001 2173 9398Department of Pediatrics, Rīgas Stradina Universitāte, Children’s Clinical University Hospital, Riga, Latvia
| | - Colin Fink
- grid.7372.10000 0000 8809 1613Micropathology Ltd, University of Warwick, Warwick, UK
| | - Marie Voice
- grid.7372.10000 0000 8809 1613Micropathology Ltd, University of Warwick, Warwick, UK
| | - Werner Zenz
- grid.11598.340000 0000 8988 2476Department of Pediatrics and Adolescent Medicine, Division of General Pediatrics, Medical University of Graz, Graz, Austria
| | - Benno Kohlmaier
- grid.11598.340000 0000 8988 2476Department of Pediatrics and Adolescent Medicine, Division of General Pediatrics, Medical University of Graz, Graz, Austria
| | - Philipp K. A. Agyeman
- grid.5734.50000 0001 0726 5157Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Effua Usuf
- grid.415063.50000 0004 0606 294XMedical Research Council Unit, Serrekunda, The Gambia
| | - Fatou Secka
- grid.415063.50000 0004 0606 294XMedical Research Council Unit, Serrekunda, The Gambia
| | - Ronald de Groot
- grid.461578.9Pediatric Infectious Diseases and Immunology, Amalia Children’s Hospital, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Michael Levin
- grid.7445.20000 0001 2113 8111Section of Paediatric Infectious Disease, Wright-Fleming Institute, Imperial College London, London, UK
| | - Michiel van der Flier
- grid.461578.9Pediatric Infectious Diseases and Immunology, Amalia Children’s Hospital, Radboud University Medical Center, Nijmegen, The Netherlands ,grid.7692.a0000000090126352Pediatric Infectious Diseases and Immunology, Wilhelmina Children’s Hospital University Medical Center Utrecht, Utrecht, The Netherlands
| | - Marieke Emonts
- Paediatric Immunology, Infectious Diseases & Allergy, Great North Children's Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK. .,Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK. .,NIHR Newcastle Biomedical Research Centre, Newcastle upon Tyne Hospitals NHS Trust and Newcastle University, Newcastle upon Tyne, UK.
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5
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Roelens M, Martin A, Friker B, Sousa FM, Thiabaud A, Vidondo B, Buchter V, Gardiol C, Vonlanthen J, Balmelli C, Battegay M, Berger C, Buettcher M, Cusini A, Flury D, Heininger U, Niederer-Loher A, Riedel T, Schreiber PW, Sommerstein R, Troillet N, Tschudin-Sutter S, Vetter P, Bernhard-Stirnemann S, Corti N, Gaudenz R, Marschall J, Nussbaumer-Ochsner Y, Senn L, Vuichard-Gysin D, Zimmermann P, Zucol F, Iten A, Keiser O. Evolution of COVID-19 mortality over time: results from the Swiss hospital surveillance system (CH-SUR). Swiss Med Wkly 2021; 151:w30105. [PMID: 34843180 DOI: 10.4414/smw.2021.w30105] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND When the periods of time during and after the first wave of the ongoing SARS-CoV-2/COVID-19 pandemic in Europe are compared, the associated COVID-19 mortality seems to have decreased substantially. Various factors could explain this trend, including changes in demographic characteristics of infected persons and the improvement of case management. To date, no study has been performed to investigate the evolution of COVID-19 in-hospital mortality in Switzerland, while also accounting for risk factors. METHODS We investigated the trends in COVID-19-related mortality (in-hospital and in-intermediate/intensive-care) over time in Switzerland, from February 2020 to June 2021, comparing in particular the first and the second wave. We used data from the COVID-19 Hospital-based Surveillance (CH-SUR) database. We performed survival analyses adjusting for well-known risk factors of COVID-19 mortality (age, sex and comorbidities) and accounting for competing risk. RESULTS Our analysis included 16,984 patients recorded in CH-SUR, with 2201 reported deaths due to COVID-19 (13.0%). We found that overall in-hospital mortality was lower during the second wave of COVID-19 than in the first wave (hazard ratio [HR] 0.70, 95% confidence interval [CI] 0.63- 0.78; p <0.001), a decrease apparently not explained by changes in demographic characteristics of patients. In contrast, mortality in intermediate and intensive care significantly increased in the second wave compared with the first wave (HR 1.25, 95% CI 1.05-1.49; p = 0.029), with significant changes in the course of hospitalisation between the first and the second wave. CONCLUSION We found that, in Switzerland, COVID-19 mortality decreased among hospitalised persons, whereas it increased among patients admitted to intermediate or intensive care, when comparing the second wave to the first wave. We put our findings in perspective with changes over time in case management, treatment strategy, hospital burden and non-pharmaceutical interventions. Further analyses of the potential effect of virus variants and of vaccination on mortality would be crucial to have a complete overview of COVID-19 mortality trends throughout the different phases of the pandemic.
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Affiliation(s)
- Maroussia Roelens
- Institute of Global Health, Faculty of Medicine, University of Geneva, Switzerland
| | - Alexis Martin
- Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Switzerland
| | - Brian Friker
- Veterinary Public Health Institute, University of Bern, Switzerland
| | | | - Amaury Thiabaud
- Institute of Global Health, Faculty of Medicine, University of Geneva, Switzerland
| | - Beatriz Vidondo
- Veterinary Public Health Institute, University of Bern, Switzerland
| | | | - Céline Gardiol
- Swiss Federal Office of Public Health, Bern, Switzerland
| | | | - Carlo Balmelli
- Infection Control Programme, EOC Hospitals, Ticino, Switzerland
| | - Manuel Battegay
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Switzerland
| | - Christoph Berger
- Division of Infectious Diseases, and Children's Research Centre, University Children's Hospital Zurich, Switzerland
| | - Michael Buettcher
- Paediatric Infectious Diseases, Department of Paediatrics, Children's Hospital, Cantonal Hospital Lucerne, Switzerland
| | - Alexia Cusini
- Department of Infectious Diseases, Cantonal Hospital Graubuenden, Chur, Switzerland
| | - Domenica Flury
- Division of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital St Gallen, Switzerland
| | - Ulrich Heininger
- Infectious Diseases and Vaccinology, University of Basel Children's Hospital, Basel, Switzerland
| | | | - Thomas Riedel
- Department of Paediatrics, Cantonal Hospital Graubuenden, Chur, Switzerland
| | - Peter W Schreiber
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich and University of Zurich, Switzerland
| | - Rami Sommerstein
- Department of Infectious Diseases, Bern University Hospital (Inselspital), Bern, Switzerland.,Infectious Diseases and Hospital Hygiene Clinic St Anna, Department of Health Sciences and Medicine, University of Lucerne, Switzerland
| | - Nicolas Troillet
- Service of Infectious Diseases, Central Institute, Valais Hospitals, Sion, Switzerland
| | - Sarah Tschudin-Sutter
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Switzerland
| | - Pauline Vetter
- Geneva Centre for Emerging Viral Diseases, Geneva University Hospitals, Geneva, Switzerland
| | | | - Natascia Corti
- Unit of General Internal Medicine, Hirslanden Clinic, Zurich, Switzerland
| | - Roman Gaudenz
- Internal Medicine and Infectiology, Cantonal Hospital Nidwalden, Stans, Switzerland
| | - Jonas Marschall
- Department of Infectious Diseases, Bern University Hospital (Inselspital), Bern, Switzerland
| | | | - Laurence Senn
- Service of Preventive Medicine, Lausanne University Hospital, CHUV, Lausanne, Switzerland
| | - Danielle Vuichard-Gysin
- Division of Infectious Diseases and Hospital Hygiene, Thurgau Hospital Group Münsterlingen and Frauenfeld, Switzerland
| | - Petra Zimmermann
- Faculty of Science and Medicine, University of Fribourg, Switzerland.,Department of Paediatrics, Fribourg Hospital HFR, Fribourg, Switzerland
| | - Franziska Zucol
- Paediatric Infectious Diseases, Department of Paediatrics, Cantonal Hospital Winterthur, Switzerland
| | - Anne Iten
- Service of Prevention and Infection Control, Directorate of Medicine and Quality, University Hospital Geneva, HUG, Geneva, Switzerland
| | - Olivia Keiser
- Institute of Global Health, Faculty of Medicine, University of Geneva, Switzerland
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6
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Borghesi A, Trück J, Asgari S, Sancho-Shimizu V, Agyeman PKA, Bellos E, Giannoni E, Stocker M, Posfay-Barbe KM, Heininger U, Bernhard-Stirnemann S, Niederer-Loher A, Kahlert CR, Natalucci G, Relly C, Riedel T, Kuehni CE, Thorball CW, Chaturvedi N, Martinon-Torres F, Kuijpers TW, Coin L, Wright V, Herberg J, Levin M, Aebi C, Berger C, Fellay J, Schlapbach LJ. Whole-exome Sequencing for the Identification of Rare Variants in Primary Immunodeficiency Genes in Children With Sepsis: A Prospective, Population-based Cohort Study. Clin Infect Dis 2021; 71:e614-e623. [PMID: 32185379 PMCID: PMC7744985 DOI: 10.1093/cid/ciaa290] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [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: 03/29/2019] [Accepted: 03/15/2020] [Indexed: 11/15/2022] Open
Abstract
Background The role of primary immunodeficiencies (PID) in susceptibility to sepsis remains unknown. It is unclear whether children with sepsis benefit from genetic investigations. We hypothesized that sepsis may represent the first manifestation of underlying PID. We applied whole-exome sequencing (WES) to a national cohort of children with sepsis to identify rare, predicted pathogenic variants in PID genes. Methods We conducted a multicenter, population-based, prospective study including previously healthy children aged ≥28 days and <17 years admitted with blood culture-proven sepsis. Using a stringent variant filtering procedure, analysis of WES data was restricted to rare, predicted pathogenic variants in 240 PID genes for which increased susceptibility to bacterial infection has been reported. Results There were 176 children presenting with 185 sepsis episodes who underwent WES (median age, 52 months; interquartile range, 15.4–126.4). There were 41 unique predicted pathogenic PID variants (1 homozygous, 5 hemizygous, and 35 heterozygous) found in 35/176 (20%) patients, including 3/176 (2%) patients carrying variants that were previously reported to lead to PID. The variants occurred in PID genes across all 8 PID categories, as defined by the International Union of Immunological Societies. We did not observe a significant correlation between clinical or laboratory characteristics of patients and the presence or absence of PID variants. Conclusions Applying WES to a population-based cohort of previously healthy children with bacterial sepsis detected variants of uncertain significance in PID genes in 1 out of 5 children. Future studies need to investigate the functional relevance of these variants to determine whether variants in PID genes contribute to pediatric sepsis susceptibility.
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Affiliation(s)
- Alessandro Borghesi
- Swiss Institute of Bioinformatics, Lausanne, Switzerland.,Global Health Institute, School of Life Sciences, École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland.,Neonatal Intensive Care Unit, Fondazione Institute for Research, Hospitalization and Health Care (IRCCS) Policlinico San Matteo, Pavia, Italy
| | - Johannes Trück
- University Children's Hospital Zurich and the Children's Research Center, Zurich, Switzerland.,University of Zurich, Zurich, Switzerland
| | - Samira Asgari
- Swiss Institute of Bioinformatics, Lausanne, Switzerland.,Global Health Institute, School of Life Sciences, École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland.,Division of Genetics and Rheumatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.,Program in Medical and Population Genetics, Broad Institute of Harvard and MIT, Cambridge, Massachusetts, USA
| | - Vanessa Sancho-Shimizu
- Section of Paediatrics, Imperial College London, London, United Kingdom.,Section of Virology, Imperial College London, London, United Kingdom
| | - Philipp K A Agyeman
- Department of Paediatrics, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland
| | - Evangelos Bellos
- Section of Paediatrics, Imperial College London, London, United Kingdom
| | - Eric Giannoni
- Service of Neonatology, Department Woman-Mother-Child, and Infectious Diseases Service, Department of Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | - Martin Stocker
- Department of Paediatrics, Children's Hospital Lucerne, Lucerne, Switzerland
| | - Klara M Posfay-Barbe
- Paediatric Infectious Diseases Unit, Children's Hospital of Geneva, University Hospitals of Geneva, Geneva, Switzerland
| | - Ulrich Heininger
- Infectious Diseases and Vaccinology, University of Basel Children's Hospital, Basel, Switzerland
| | | | | | | | | | - Christa Relly
- University Children's Hospital Zurich and the Children's Research Center, Zurich, Switzerland
| | - Thomas Riedel
- Department of Paediatrics, Cantonal Hospital Graubuenden, Chur, Switzerland
| | - Claudia E Kuehni
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Christian W Thorball
- Swiss Institute of Bioinformatics, Lausanne, Switzerland.,Global Health Institute, School of Life Sciences, École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - Nimisha Chaturvedi
- Swiss Institute of Bioinformatics, Lausanne, Switzerland.,Global Health Institute, School of Life Sciences, École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - Federico Martinon-Torres
- Translational Paediatrics and Infectious Diseases Section, Paediatrics Department, Santiago de Compostela, Spain.,Instituto de Investigación Sanitaria de Santiago, Genetics, Vaccines, Infectious Diseases and Paediatrics Research Group, Santiago de Compostela, Spain
| | - Taco W Kuijpers
- Academic Medical Center, Emma Children's Hospital, University of Amsterdam, Amsterdam, The Netherlands
| | - Lachlan Coin
- Institute of Molecular Biosciences, The University of Queensland, Brisbane, Australia
| | - Victoria Wright
- Section of Paediatrics, Imperial College London, London, United Kingdom
| | - Jethro Herberg
- Section of Paediatrics, Imperial College London, London, United Kingdom
| | - Michael Levin
- Section of Paediatrics, Imperial College London, London, United Kingdom
| | - Christoph Aebi
- Department of Paediatrics, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland
| | - Christoph Berger
- University Children's Hospital Zurich and the Children's Research Center, Zurich, Switzerland
| | - Jacques Fellay
- Swiss Institute of Bioinformatics, Lausanne, Switzerland.,Global Health Institute, School of Life Sciences, École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland.,Precision Medicine Unit, Lausanne University Hospital, Lausanne, Switzerland
| | - Luregn J Schlapbach
- University Children's Hospital Zurich and the Children's Research Center, Zurich, Switzerland.,Paediatric Critical Care Research Group, Child Health Research Centre, The University of Queensland, Brisbane, Australia.,Paediatric Intensive Care Unit, Queensland Children's Hospital, Children's Health Queensland, Brisbane, Australia
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7
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Thiabaud A, Iten A, Balmelli C, Senn L, Troillet N, Widmer A, Flury D, Schreiber PW, Vázquez M, Damonti L, Buettcher M, Vuichard-Gysin D, Kuhm C, Cusini A, Riedel T, Nussbaumer-Ochsner Y, Gaudenz R, Heininger U, Berger C, Zucol F, Bernhard-Stirnemann S, Corti N, Zimmermann P, Uka A, Niederer-Loher A, Gardiol C, Roelens M, Keiser O. Cohort profile: SARS-CoV-2/COVID-19 hospitalised patients in Switzerland. Swiss Med Wkly 2021; 151:w20475. [PMID: 33638351 DOI: 10.4414/smw.2021.20475] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND SARS-CoV-2/COVID-19, which emerged in China in late 2019, rapidly spread across the world with several million victims in 213 countries. Switzerland was severely hit by the virus, with 43,000 confirmed cases as of 1 September 2020. AIM In cooperation with the Federal Office of Public Health, we set up a surveillance database in February 2020 to monitor hospitalised patients with COVID-19, in addition to their mandatory reporting system. METHODS Patients hospitalised for more than 24 hours with a positive polymerase chain-reaction test, from 20 Swiss hospitals, are included. Data were collected in a customised case report form based on World Health Organisation recommendations and adapted to local needs. Nosocomial infections were defined as infections for which the onset of symptoms was more than 5 days after the patient’s admission date. RESULTS As of 1 September 2020, 3645 patients were included. Most patients were male (2168, 59.5%), and aged between 50 and 89 years (2778, 76.2%), with a median age of 68 (interquartile range 54–79). Community infections dominated with 3249 (89.0%) reports. Comorbidities were frequently reported, with hypertension (1481, 61.7%), cardiovascular diseases (948, 39.5%) and diabetes (660, 27.5%) being the most frequent in adults; respiratory diseases and asthma (4, 21.1%), haematological and oncological diseases (3, 15.8%) were the most frequent in children. Complications occurred in 2679 (73.4%) episodes, mostly respiratory diseases (2470, 93.2% in adults; 16, 55.2% in children), and renal (681, 25.7%) and cardiac (631, 23.8%) complications for adults. The second and third most frequent complications in children affected the digestive system and the liver (7, 24.1%). A targeted treatment was given in 1299 (35.6%) episodes, mostly with hydroxychloroquine (989, 76.1%). Intensive care units stays were reported in 578 (15.8%) episodes. A total of 527 (14.5%) deaths were registered, all among adults. CONCLUSION The surveillance system has been successfully initiated and provides a robust set of data for Switzerland by including about 80% (compared with official statistics) of SARS-CoV-2/COVID-19 hospitalised patients, with similar age and comorbidity distributions. It adds detailed information on the epidemiology, risk factors and clinical course of these cases and, therefore, is a valuable addition to the existing mandatory reporting.
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Affiliation(s)
- Amaury Thiabaud
- Institut de Santé Globale, Faculté de Médecine de l'Université de Genève, Geneva, Switzerland
| | - Anne Iten
- Service de prévention et contrôle de l'infection, Direction médicale et qualité, HUG, Geneva, Switzerland
| | - Carlo Balmelli
- Infection Control Programme, EOC Hospitals, Ticino, Switzerland
| | - Laurence Senn
- Service de médecine préventive hospitalière, CHUV, Lausanne, Switzerland
| | - Nicolas Troillet
- Service of Infectious Diseases, Central Institute, Valais Hospitals, Sion, Switzerland
| | - Andreas Widmer
- Department of Infectious Diseases, University Hospital Basel, Switzerland
| | - Domenica Flury
- Division of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital St Gallen, Switzerland
| | - Peter W Schreiber
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich and University of Zurich, Switzerland
| | - Miriam Vázquez
- Department of Infectious Diseases, Bern University Hospital (Inselspital), Bern, Switzerland
| | - Lauro Damonti
- Department of Infectious Diseases, Bern University Hospital (Inselspital), Bern, Switzerland
| | - Michael Buettcher
- Paediatric Infectious Diseases, Department of Paediatrics, Children's Hospital, Cantonal Hospital Lucerne, Switzerland
| | | | - Christoph Kuhm
- Department of Infectious Diseases, Thurgau Cantonal Hospital, Thurgau, Switzerland
| | - Alexia Cusini
- Department of Infectious Diseases, Cantonal Hospital Graubuenden, Chur, Switzerland
| | - Thomas Riedel
- Department of Paediatrics, Cantonal Hospital Graubuenden, Chur, Switzerland
| | | | - Roman Gaudenz
- Innere Medizin und Infektiologie, Kantonsspital Nidwalden, Stans, Switzerland
| | - Ulrich Heininger
- Infectious Diseases and Vaccinology, University of Basel Children's Hospital, Basel, Switzerland
| | - Christoph Berger
- Division of Infectious Diseases and Children's Research Centre, University Children's Hospital Zurich, Switzerland
| | - Franziska Zucol
- Paediatric Infectious Diseases, Department of Paediatrics, Cantonal Hospital Winterthur, Switzerland
| | | | - Natascia Corti
- Unit of General Internal Medicine, Hirslanden Clinic, Zurich, Switzerland
| | - Petra Zimmermann
- Faculty of Science and Medicine, University of Fribourg, Switzerland / Department of Paediatrics, Fribourg Hospital HFR, Fribourg, Switzerland
| | - Anita Uka
- Faculty of Science and Medicine, University of Fribourg, Switzerland / Department of Paediatrics, Fribourg Hospital HFR, Fribourg, Switzerland
| | | | - Céline Gardiol
- Swiss Federal Office of Public Health, Bern, Switzerland
| | - Maroussia Roelens
- Institut de Santé Globale, Faculté de Médecine de l'Université de Genève, Geneva, Switzerland
| | - Olivia Keiser
- Institut de Santé Globale, Faculté de Médecine de l'Université de Genève, Geneva, Switzerland
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8
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Buettcher M, Trueck J, Niederer-Loher A, Heininger U, Agyeman P, Asner S, Berger C, Bielicki J, Kahlert C, Kottanattu L, Meyer Sauteur PM, Paioni P, Posfay-Barbe K, Relly C, Ritz N, Zimmermann P, Zucol F, Gobet R, Shavit S, Rudin C, Laube G, von Vigier R, Neuhaus TJ. Correction to: Swiss consensus recommendations on urinary tract infections in children. Eur J Pediatr 2021; 180:675-677. [PMID: 33001233 PMCID: PMC7886751 DOI: 10.1007/s00431-020-03820-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The article “Swiss consensus recommendations on urinary tract infections in children”
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Affiliation(s)
- Michael Buettcher
- Paediatric Infectious Diseases, Lucerne Children's Hospital, Cantonal Hospital Lucerne, Spitalstrasse, 6000, Luzern 16, Switzerland.
| | - Johannes Trueck
- Division of Infectious Diseases and Hospital Epidemiology, University Children’s Hospital Zurich, Steinwiesstrasse 75, 8032 Zurich, Switzerland
| | - Anita Niederer-Loher
- Infectious Diseases and Hospital Epidemiology, Children’s Hospital of Eastern Switzerland, Claudiusstrasse 6, 9006 St. Gallen, Switzerland
| | - Ulrich Heininger
- Paediatric Infectious Diseases, University of Basel Children’s Hospital, Spitalstrasse 33, 4056 Basel, Switzerland
| | - Philipp Agyeman
- Department of Pediatric Infectious Diseases, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 15, 3010 Bern, Switzerland
| | - Sandra Asner
- Pediatric Infectious Diseases and Vaccinology Unit, Department Mother-Woman-Child, Lausanne University Hospital, Lausanne, Switzerland
| | - Christoph Berger
- Division of Infectious Diseases and Hospital Epidemiology, University Children’s Hospital Zurich, Steinwiesstrasse 75, 8032 Zurich, Switzerland
| | - Julia Bielicki
- Paediatric Infectious Diseases, University of Basel Children’s Hospital, Spitalstrasse 33, 4056 Basel, Switzerland
| | - Christian Kahlert
- Infectious Diseases and Hospital Epidemiology, Children’s Hospital of Eastern Switzerland, Claudiusstrasse 6, 9006 St. Gallen, Switzerland
| | - Lisa Kottanattu
- Pediatric Infectious Diseases, Pediatric Institute of Southern Switzerland, Ospedale Regionale di Bellinzona e Valli, Via Ospedale 12, 6500 Bellinzona, Switzerland
| | - Patrick M. Meyer Sauteur
- Division of Infectious Diseases and Hospital Epidemiology, University Children’s Hospital Zurich, Steinwiesstrasse 75, 8032 Zurich, Switzerland
| | - Paolo Paioni
- Division of Infectious Diseases and Hospital Epidemiology, University Children’s Hospital Zurich, Steinwiesstrasse 75, 8032 Zurich, Switzerland
| | - Klara Posfay-Barbe
- General Pediatrics & Pediatric Infectious Diseases Unit, Department of Woman, Child and Adolescent, University Hospitals of Geneva & Medical School of Geneva, 6, rue Willy-Donzé, 1211, Geneva 14, Switzerland
| | - Christa Relly
- Division of Infectious Diseases and Hospital Epidemiology, University Children’s Hospital Zurich, Steinwiesstrasse 75, 8032 Zurich, Switzerland
| | - Nicole Ritz
- Paediatric Infectious Diseases, University of Basel Children’s Hospital, Spitalstrasse 33, 4056 Basel, Switzerland
| | - Petra Zimmermann
- Department of Paediatrics, Fribourg Hospital HFR and Faculty of Science and Medicine, University of Fribourg, Fribourg, Switzerland
| | - Franziska Zucol
- Paediatric Infectious Diseases, Department of Paediatrics, Cantonal Hospital Winterthur, Brauerstrasse 15, 8401 Winterthur, Switzerland
| | - Rita Gobet
- Paediatric Urology, University Children’s Hospital Zurich, Steinwiesstrasse 75, 8032 Zurich, Switzerland
| | - Sandra Shavit
- Paediatric Surgery, Lucerne Children’s Hospital, Cantonal Hospital Lucerne, Spitalstrasse, 6000 Luzern 16, Switzerland
| | - Christoph Rudin
- Pediatric Nephrology, University Children’s Hospital Basel, Spitalstrasse 33, CH-4031 Basel, Switzerland
| | - Guido Laube
- Pediatric Nephrology, University Children’s Hospital Zurich, Steinwiesstrasse 75, 8032 Zurich, Switzerland
| | - Rodo von Vigier
- Pediatric Clinic, Wildermeth Children’s Hospital, Kloosweg 84, 2502 Biel-Bienne, Switzerland
| | - Thomas J. Neuhaus
- Paediatrics, Lucerne Children’s Hospital, Cantonal Hospital Lucerne, Spitalstrasse, 6000 Luzern 16, Switzerland
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9
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Asner SA, Agyeman PKA, Gradoux E, Posfay-Barbe KM, Heininger U, Giannoni E, Crisinel PA, Stocker M, Bernhard-Stirnemann S, Niederer-Loher A, Kahlert CR, Hasters P, Relly C, Baer W, Aebi C, Schlapbach LJ, Berger C. Burden of Streptococcus pneumoniae Sepsis in Children After Introduction of Pneumococcal Conjugate Vaccines: A Prospective Population-based Cohort Study. Clin Infect Dis 2020; 69:1574-1580. [PMID: 30601988 DOI: 10.1093/cid/ciy1139] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [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: 07/15/2018] [Accepted: 12/31/2018] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Population-based studies assessing the impact of pneumococcal conjugate vaccines (PCV) on burden of pneumococcal sepsis in children are lacking. We aimed to assess this burden following introduction of PCV-13 in a nationwide cohort study. METHODS The Swiss Pediatric Sepsis Study (September 2011 to December 2015) prospectively recruited children <17 years of age with blood culture-proven sepsis due to Streptococcus pneumoniae, meeting criteria for systemic inflammatory response syndrome. Infection with vaccine serotype in children up to date with PCV immunization was defined as vaccine failure. Main outcomes were admission to pediatric intensive care unit (PICU) and length of hospital stay (LOS). RESULTS Children with pneumococcal sepsis (n = 117) accounted for a crude incidence of 2.0 per 100 000 children (95% confidence interval [CI] 1.7-2.4) and 25% of community-acquired sepsis episodes. Case fatality rate was 8%. Forty-two (36%) patients required PICU admission. Children with meningitis (29; 25%) were more often infected by serotypes not included in PCV (69% vs 31%; P < .001). Sixteen (26%) of 62 children up to date with PCV immunization presented with vaccine failure, including 11 infected with serotype 3. In multivariable analyses, children with meningitis (odds ratio [OR] 6.8; 95% CI 2.4-19.3; P < .001) or infected with serotype 3 (OR 2.8; 95% CI 1.1-7.3; P = .04) were more often admitted to PICU. Children infected with serotype 3 had longer LOS (β coefficient 0.2, 95% CI .1-1.1; P = .01). CONCLUSIONS The incidence of pneumococcal sepsis in children shortly after introduction of PCV-13 remained substantial. Meningitis mostly due to non-vaccine serotypes and disease caused by serotype 3 represented significant predictors of severity.
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Affiliation(s)
- Sandra A Asner
- Pediatric Infectious Diseases and Vaccinology Unit, Department Mother-Woman-Child, Switzerland.,Infectious Diseases Service, Department of Internal Medicine, Lausanne University Hospital, Switzerland
| | - Philipp K A Agyeman
- Department of Pediatrics, Inselspital, Bern University Hospital, Switzerland
| | - Eugénie Gradoux
- Pediatric Infectious Diseases and Vaccinology Unit, Department Mother-Woman-Child, Switzerland
| | - Klara M Posfay-Barbe
- Pediatric Infectious Diseases Unit, Children's Hospital of Geneva, University Hospitals of Geneva, Switzerland
| | - Ulrich Heininger
- Infectious Diseases and Vaccinology, University Children's Hospital Basel, Switzerland
| | - Eric Giannoni
- Infectious Diseases Service, Department of Internal Medicine, Lausanne University Hospital, Switzerland.,Clinic of Neonatology, Department Mother-Woman-Child, Lausanne University Hospital, Switzerland
| | - Pierre A Crisinel
- Pediatric Infectious Diseases and Vaccinology Unit, Department Mother-Woman-Child, Switzerland
| | - Martin Stocker
- Department of Pediatrics, Children's Hospital Lucerne, Switzerland
| | | | | | | | - Paul Hasters
- Department of Neonatology, University Hospital Zurich, Switzerland
| | - Christa Relly
- Division of Infectious Diseases and Children's Research Center, University Children's Hospital Zurich, Switzerland
| | | | - Christoph Aebi
- Department of Pediatrics, Inselspital, Bern University Hospital, Switzerland
| | - Luregn J Schlapbach
- Department of Pediatrics, Inselspital, Bern University Hospital, Switzerland.,Faculty of Medicine, Child Health Research Centre, The University of Queensland, Brisbane, Australia.,Paediatric Critical Care Research Group, Child Health Research Centre, The University of Queensland, Brisbane, Australia.,Intensive Care Unit, Queensland Children's Hospital, Children's Health Queensland, Brisbane, Australia
| | - Christoph Berger
- Division of Infectious Diseases and Children's Research Center, University Children's Hospital Zurich, Switzerland
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10
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Giannoni E, Agyeman PKA, Stocker M, Posfay-Barbe KM, Heininger U, Spycher BD, Bernhard-Stirnemann S, Niederer-Loher A, Kahlert CR, Donas A, Leone A, Hasters P, Relly C, Riedel T, Kuehni C, Aebi C, Berger C, Schlapbach LJ. Neonatal Sepsis of Early Onset, and Hospital-Acquired and Community-Acquired Late Onset: A Prospective Population-Based Cohort Study. J Pediatr 2018; 201:106-114.e4. [PMID: 30054165 DOI: 10.1016/j.jpeds.2018.05.048] [Citation(s) in RCA: 120] [Impact Index Per Article: 20.0] [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: 03/19/2018] [Revised: 05/09/2018] [Accepted: 05/30/2018] [Indexed: 01/04/2023]
Abstract
OBJECTIVE To assess the epidemiology of blood culture-proven early- (EOS) and late-onset neonatal sepsis (LOS). STUDY DESIGN All newborn infants admitted to tertiary care neonatal intensive care units in Switzerland and presenting with blood culture-proven sepsis between September 2011 and December 2015 were included in the study. We defined EOS as infection occurring <3 days after birth, and LOS as infection ≥3 days after birth. Infants with LOS were classified as having community-acquired LOS if onset of infection was ≤48 hours after admission, and hospital-acquired LOS, if onset was >48 hours after admission. Incidence was estimated based on the number of livebirths in Switzerland and adjusted for the proportion of admissions at centers participating in the study. RESULTS We identified 444 episodes of blood culture-proven sepsis in 429 infants; 20% of cases were EOS, 62% hospital-acquired LOS, and 18% community-acquired LOS. The estimated national incidence of EOS, hospital-acquired LOS, and community-acquired LOS was 0.28 (95% CI 0.23-0.35), 0.86 (0.76-0.97), and 0.28 (0.23-0.34) per 1000 livebirths. Compared with EOS, hospital-acquired LOS occurred in infants of lower gestational age and was more frequently associated with comorbidities. Community-acquired LOS was more common in term infants and in male infants. Mortality was 18%, 12%, and 0% in EOS, hospital-acquired LOS, and community-acquired LOS, and was higher in preterm infants, in infants with septic shock, and in those requiring mechanical ventilation. CONCLUSIONS We report a high burden of sepsis in neonates with considerable mortality and morbidity. EOS, hospital-acquired LOS, and community-acquired LOS affect specific patient subgroups and have distinct clinical presentation, pathogens and outcomes.
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Affiliation(s)
- Eric Giannoni
- Clinic of Neonatology, Department Woman-Mother-Child, Lausanne University Hospital, Lausanne, Switzerland; Infectious Diseases Service, Department of Medicine, Lausanne University Hospital, Lausanne, Switzerland.
| | - Philipp K A Agyeman
- Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Martin Stocker
- Department of Pediatrics, Children's Hospital Lucerne, Lucerne, Switzerland
| | - Klara M Posfay-Barbe
- Pediatric Infectious Diseases Unit, Children's Hospital of Geneva, University Hospitals of Geneva, Geneva, Switzerland
| | - Ulrich Heininger
- Infectious Diseases and Vaccinology, University of Basel Children's Hospital, Basel, Switzerland
| | - Ben D Spycher
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | | | | | | | - Alex Donas
- Department of Pediatrics, Children's Hospital Lucerne, Lucerne, Switzerland
| | - Antonio Leone
- Department of Neonatology, University Hospital Zurich, Zurich, Switzerland
| | - Paul Hasters
- Department of Neonatology, University Hospital Zurich, Zurich, Switzerland
| | - Christa Relly
- Division of Infectious Diseases, and Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland
| | - Thomas Riedel
- Department of Pediatrics, Cantonal Hospital Graubuenden, Chur, Switzerland
| | - Claudia Kuehni
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Christoph Aebi
- Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Christoph Berger
- Division of Infectious Diseases, and Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland
| | - Luregn J Schlapbach
- Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; Faculty of Medicine, The University of Queensland, Brisbane, Australia; Paediatric Critical Care Research Group, Mater Research Institute, The University of Queensland, Brisbane, Australia; Paediatric Intensive Care Unit, Lady Cilento Children's Hospital, Children's Health Queensland, Brisbane, Australia
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11
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Dierig A, Berger C, Agyeman PKA, Bernhard-Stirnemann S, Giannoni E, Stocker M, Posfay-Barbe KM, Niederer-Loher A, Kahlert CR, Donas A, Hasters P, Relly C, Riedel T, Aebi C, Schlapbach LJ, Heininger U. Time-to-Positivity of Blood Cultures in Children With Sepsis. Front Pediatr 2018; 6:222. [PMID: 30135859 PMCID: PMC6092514 DOI: 10.3389/fped.2018.00222] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Accepted: 07/18/2018] [Indexed: 12/18/2022] Open
Abstract
Background: Blood cultures are essential for the diagnosis and further appropriate treatment in children with suspected sepsis. In most hospitals, children will be empirically treated or closely monitored for at least 48 h awaiting results of blood cultures. Several studies have challenged the optimal duration of empiric treatment in the era of continuously monitored blood culture systems. The aim of our study was to investigate time-to-positivity (TTP) of blood cultures in children with proven sepsis. Methods: The Swiss Pediatric Sepsis Study prospectively enrolled children 0-16 years of age with blood culture positive sepsis between September 2011 and October 2015. TTP was prospectively assessed in six participating academic pediatric hospitals by fully automated blood culture systems. Results: In 521 (93%) of 562 bacteremia episodes (493 children, median age 103 days, range 0 days-16.9 years) a valid TTP was available. Median TTP was 12 h (IQR 8-17 h, range 0-109 h). By 24, 36, and 48 h, 460 (88%), 498 (96%), and 510 (98%) blood cultures, respectively, were positive. TTP was independent of age, sex, presence of comorbidities, site of infection and severity of infection. Median TTP in all age groups combined was shortest for group B streptococcus (8.7 h) and longest for coagulase-negative staphylococci (16.2 h). Conclusion: Growth of bacteria in blood cultures is detectable within 24 h in 9 of 10 children with blood culture-proven sepsis. Therefore, a strict rule to observe or treat all children with suspected sepsis for at least 48 h is not justified.
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Affiliation(s)
- Alexa Dierig
- Infectious Diseases and Vaccinology, University of Basel Children's Hospital, Basel, Switzerland
| | - Christoph Berger
- Division of Infectious Diseases and Hospital Epidemiology, Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland
| | - Philipp K. A. Agyeman
- Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | | | - Eric Giannoni
- Department Mother-Woman-Child, Service of Neonatology, Lausanne University Hospital, Lausanne, Switzerland
- Infectious Diseases Service, Lausanne University Hospital, Lausanne, Switzerland
| | - Martin Stocker
- Department of Pediatrics, Children's Hospital Lucerne, Lucerne, Switzerland
| | - Klara M. Posfay-Barbe
- Pediatric Infectious Diseases Unit, Children's Hospital of Geneva, University Hospitals of Geneva, Geneva, Switzerland
| | | | | | - Alex Donas
- Department of Pediatrics, Children's Hospital Lucerne, Lucerne, Switzerland
| | - Paul Hasters
- Department of Neonatology, University Hospital Zurich, Zurich, Switzerland
| | - Christa Relly
- Division of Infectious Diseases and Hospital Epidemiology, Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland
| | - Thomas Riedel
- Department of Pediatrics, Cantonal Hospital Graubuenden, Chur, Switzerland
| | - Christoph Aebi
- Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Luregn J. Schlapbach
- Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
- Paediatric Critical Care Research Group, Mater Research Institute, University of Queensland, Brisbane, QLD, Australia
- Paediatric Intensive Care Unit, Lady Cilento Children's Hospital, Children's Health Queensland, Brisbane, QLD, Australia
| | - Ulrich Heininger
- Infectious Diseases and Vaccinology, University of Basel Children's Hospital, Basel, Switzerland
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Niederer-Loher A. [Vaccinations in pregnancy – Don’t miss the opportunity!]. Ther Umsch 2016; 73:269-73. [PMID: 27268451 DOI: 10.1024/0040-5930/a000791] [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: 11/19/2022]
Abstract
Pregnant women and neonates are prone to a variety of infections and often suffer from complicated courses of the disease. The growing knowledge on immunology and vaccinations during pregnancy has led to further development of already known strategies in protecting pregnant women and neonates in the most vulnerable moments of their lives. Vaccination during pregnancy against pertussis and influenza is safe and induces high levels of protecting antibodies in the mother. In addition, these specific antibodies are actively transferred to the fetus, protecting the newborn during the first weeks of life, when infections are often severe and associated with high morbidity and mortality. Viral infections like measles, rubella and varicella also may have devastating effects on mother and child when occurring during pregnancy. Available vaccinations (MMR, VZV) are inducing a stable and durable immunity, but are contraindicated during pregnancy, because of being live-vaccines. Therefore, every woman should be immune either by past infection or by vaccination before becoming pregnant. If susceptibility is only detected during pregnancy, vaccination should be started as soon as possible after birth. In conclusion, vaccinations during pregnancy offer a safe and efficient protection against dangerous infections for mother, fetus and newborn.
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Kahlert C, Barben J, Deggim V, Zellweger JP, Niederer-Loher A. Transmission of multidrug-resistant Mycobacterium tuberculosis is reality in Switzerland. J PEDIAT INF DIS-GER 2015. [DOI: 10.3233/jpi-120370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Christian Kahlert
- Infectious Diseases, Children's Hospital of Eastern Switzerland, St. Gallen, Switzerland
| | - Jürg Barben
- Pneumology, Children's Hospital of Eastern Switzerland, St. Gallen, Switzerland
| | - Vanessa Deggim
- Institute of Medical Microbiology, University of Zürich, Zürich, Switzerla
| | | | - Anita Niederer-Loher
- Infectious Diseases, Children's Hospital of Eastern Switzerland, St. Gallen, Switzerland
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Abstract
Perianal streptococcal dermatitis is a common disease. The typical clinical picture includes perianal erythema, pruritus, painful defaecation and bloody stools. The diagnosis is made by a swab taken from the affected skin with bacterial culture. Therapy consists of penicillin for 10 days. Screening for affected persons in contact with the patient is indicated because perianal streptococcal dermatitis is known to be highly contagious. Relapse is common and therefore follow-up visits are recommended. In case of relapse, a first or second generation cephalosporin may be considered.
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Affiliation(s)
- J Greisser
- Medizinische Universitätskinderklinik, Pädiatrische Infektiologie, Inselspital, Universitätsspital Bern.
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