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Geraerds AJLM, van Herk W, Stocker M, El Helou S, Dutta S, Fontana MS, Schuerman FABA, van den Tooren-de Groot RK, Wieringa J, Janota J, van der Meer-Kappelle LH, Moonen R, Sie SD, de Vries E, Donker AE, Zimmerman U, Schlapbach LJ, de Mol AC, Hoffman-Haringsma A, Roy M, Tomaske M, Kornelisse RF, van Gijsel J, Visser EG, van Rossum AMC, Polinder S. Cost impact of procalcitonin-guided decision making on duration of antibiotic therapy for suspected early-onset sepsis in neonates. Crit Care 2021; 25:367. [PMID: 34670582 PMCID: PMC8529813 DOI: 10.1186/s13054-021-03789-x] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 10/08/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUNDS The large, international, randomized controlled NeoPInS trial showed that procalcitonin (PCT)-guided decision making was superior to standard care in reducing the duration of antibiotic therapy and hospitalization in neonates suspected of early-onset sepsis (EOS), without increased adverse events. This study aimed to perform a cost-minimization study of the NeoPInS trial, comparing health care costs of standard care and PCT-guided decision making based on the NeoPInS algorithm, and to analyze subgroups based on country, risk category and gestational age. METHODS Data from the NeoPInS trial in neonates born after 34 weeks of gestational age with suspected EOS in the first 72 h of life requiring antibiotic therapy were used. We performed a cost-minimization study of health care costs, comparing standard care to PCT-guided decision making. RESULTS In total, 1489 neonates were included in the study, of which 754 were treated according to PCT-guided decision making and 735 received standard care. Mean health care costs of PCT-guided decision making were not significantly different from costs of standard care (€3649 vs. €3616). Considering subgroups, we found a significant reduction in health care costs of PCT-guided decision making for risk category 'infection unlikely' and for gestational age ≥ 37 weeks in the Netherlands, Switzerland and the Czech Republic, and for gestational age < 37 weeks in the Czech Republic. CONCLUSIONS Health care costs of PCT-guided decision making of term and late-preterm neonates with suspected EOS are not significantly different from costs of standard care. Significant cost reduction was found for risk category 'infection unlikely,' and is affected by both the price of PCT-testing and (prolonged) hospitalization due to SAEs.
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Affiliation(s)
- A J L M Geraerds
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands.
| | - Wendy van Herk
- Division of Paediatric Infectious Diseases & Immunology, Department of Paediatrics, Erasmus MC University Medical Centre - Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Martin Stocker
- Department of Paediatrics, Neonatal and Paediatric Intensive Care Unit, Children's Hospital Lucerne, Lucerne, Switzerland
| | - Salhab El Helou
- Division of Neonatology, McMaster University Children's Hospital, Hamilton Health Sciences, Hamilton, ON, Canada
| | - Sourabh Dutta
- Division of Neonatology, McMaster University Children's Hospital, Hamilton Health Sciences, Hamilton, ON, Canada
| | - Matteo S Fontana
- Department of Paediatrics, Neonatal and Paediatric Intensive Care Unit, Children's Hospital Lucerne, Lucerne, Switzerland
| | - Frank A B A Schuerman
- Neonatal Intensive Care Unit, Isala Women and Children's Centre, Isala Hospital, Zwolle, The Netherlands
| | | | - Jantien Wieringa
- Department of Paediatrics, Haaglanden Medical Center, 's Gravenhage, The Netherlands
| | - Jan Janota
- Neonatal Unit, Department of Obstetrics and Gynaecology, Motol University Hospital, Second Medical Faculty, Charles University, Prague, Czech Republic.,Institute of Pathological Physiology, First Medical Faculty, Charles University, Prague, Czech Republic
| | | | - Rob Moonen
- Department of Neonatology, Zuyderland Medical Centre, Heerlen, The Netherlands
| | - Sintha D Sie
- Department of Neonatology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Esther de Vries
- Department of Paediatrics, Jeroen Bosch Hospital, 's-Hertogenbosch, The Netherlands
| | - Albertine E Donker
- Department of Paediatrics, Maxima Medical Centre, Veldhoven, The Netherlands
| | - Urs Zimmerman
- Department of Paediatrics, Kantonsspital Winterthur, Winterthur, Switzerland
| | - Luregn J Schlapbach
- Department of Paediatrics, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland.,Paediatric Critical Care Research Group, Mater Research Institute, University of Queensland, Brisbane, QLD, Australia.,Paediatric Intensive Care Unit, Lady Cilento Children's Hospital, Brisbane, QLD, Australia
| | - Amerik C de Mol
- Department of Neonatology, Albert Schweitzer Hospital, Dordrecht, The Netherlands
| | | | - Madan Roy
- Department of Neonatology, St. Josephs Healthcare, Hamilton Health Sciences, Hamilton, ON, Canada
| | - Maren Tomaske
- Department of Paediatrics, Stadtspital Triemli, Zürich, Switzerland
| | - René F Kornelisse
- Division of Neonatology, Erasmus MC University Medical Centre-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Juliette van Gijsel
- Julius Training General Practitioner, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Eline G Visser
- Division of Paediatric Infectious Diseases & Immunology, Department of Paediatrics, Erasmus MC University Medical Centre - Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Annemarie M C van Rossum
- Division of Paediatric Infectious Diseases & Immunology, Department of Paediatrics, Erasmus MC University Medical Centre - Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Suzanne Polinder
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
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Stocker M, van Herk W, El Helou S, Dutta S, Schuerman FABA, van den Tooren-de Groot RK, Wieringa JW, Janota J, van der Meer-Kappelle LH, Moonen R, Sie SD, de Vries E, Donker AE, Zimmerman U, Schlapbach LJ, de Mol AC, Hoffman-Haringsma A, Roy M, Tomaske M, F Kornelisse R, van Gijsel J, Visser EG, Plötz FB, Heath P, Achten NB, Lehnick D, van Rossum AMC. C-Reactive Protein, Procalcitonin, and White Blood Count to Rule Out Neonatal Early-onset Sepsis Within 36 Hours: A Secondary Analysis of the Neonatal Procalcitonin Intervention Study. Clin Infect Dis 2021; 73:e383-e390. [PMID: 32881994 DOI: 10.1093/cid/ciaa876] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [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: 03/30/2020] [Accepted: 06/19/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Neonatal early-onset sepsis (EOS) is one of the main causes of global neonatal mortality and morbidity, and initiation of early antibiotic treatment is key. However, antibiotics may be harmful. METHODS We performed a secondary analysis of results from the Neonatal Procalcitonin Intervention Study, a prospective, multicenter, randomized, controlled intervention study. The primary outcome was the diagnostic accuracy of serial measurements of C-reactive protein (CRP), procalcitonin (PCT), and white blood count (WBC) within different time windows to rule out culture-positive EOS (proven sepsis). RESULTS We analyzed 1678 neonates with 10 899 biomarker measurements (4654 CRP, 2047 PCT, and 4198 WBC) obtained within the first 48 hours after the start of antibiotic therapy due to suspected EOS. The areas under the curve (AUC) comparing no sepsis vs proven sepsis for maximum values of CRP, PCT, and WBC within 36 hours were 0.986, 0.921, and 0.360, respectively. The AUCs for CRP and PCT increased with extended time frames up to 36 hours, but there was no further difference between start to 36 hours vs start to 48 hours. Cutoff values at 16 mg/L for CRP and 2.8 ng/L for PCT provided a sensitivity of 100% for discriminating no sepsis vs proven sepsis. CONCLUSIONS Normal serial CRP and PCT measurements within 36 hours after the start of empiric antibiotic therapy can exclude the presence of neonatal EOS with a high probability. The negative predictive values of CRP and PCT do not increase after 36 hours.
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Affiliation(s)
- Martin Stocker
- Department of Paediatrics, Neonatal and Paediatric Intensive Care Unit, Children's Hospital Lucerne, Lucerne, Switzerland
| | - Wendy van Herk
- Department of Paediatrics, Division of Paediatric Infectious Diseases & Immunology, Erasmus Medical Centre, University Medical Centre-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Salhab El Helou
- Division of Neonatology, McMaster University Children's Hospital, Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Sourabh Dutta
- Division of Neonatology, McMaster University Children's Hospital, Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Frank A B A Schuerman
- Department of Neonatal Intensive Care Unit, Isala Women and Children's Hospital, Zwolle, The Netherlands
| | | | - Jantien W Wieringa
- Department of Paediatrics, Haaglanden Medical Centre, "s Gravenhage, The Netherlands
| | - Jan Janota
- Department of Obstetrics and Gynocology, Second Medical Faculty, Motol University Hospital, Prague, Czech Republic.,First Medical Faculty, Czech Republic and Institute of Pathological Physiology, Prague, Czech Republic
| | | | - Rob Moonen
- Department of Neonatology, Zuyderland Medical Centre, Heerlen, The Netherlands
| | - Sintha D Sie
- Department of Neonatology, Amsterdam University Medical Centre, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Esther de Vries
- Department of Paediatrics, Jeroen Bosch Hospital, "s-Hertogenbosch, The Netherlands
| | - Albertine E Donker
- Department of Paediatrics, Maxima Medical Centre, Veldhoven, The Netherlands
| | - Urs Zimmerman
- Department of Paediatrics, Kantonsspital Winterthur, Winterthur, Switzerland
| | - Luregn J Schlapbach
- Paediatric Critical Care Research Group, Child Health Research Centre, University of Queensland, Brisbane, Australia.,Padiaitric Intensive Care Unit, Queensland Children's Hospital, Brisbane, Australia.,University Children's Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Amerik C de Mol
- Department of Neonatology, Albert Schweitzer Hospital, Dordrecht, The Netherlands
| | | | - Madan Roy
- Department of Neonatology, St. Josephs Healthcare, Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Maren Tomaske
- Department of Paediatrics, Stadtspital Triemli, Zürich, Switzerland
| | - René F Kornelisse
- Department of Paediatrics, Division of Neonatology, Erasmus Medical Centre, University Medical Centre-Sophia Children's Hospital, Rotterdam, The Netherlands
| | | | - Eline G Visser
- Department of Paediatrics, Division of Paediatric Infectious Diseases & Immunology, Erasmus Medical Centre, University Medical Centre-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Frans B Plötz
- Department of Pediatrics, Tergooi Hospital, Blaricum, The Netherlands
| | - Paul Heath
- Department of Paediatric Infectious Disease, St George's University Hospital, London, United Kingdom
| | - Niek B Achten
- Department of Pediatrics, Tergooi Hospital, Blaricum, The Netherlands
| | - Dirk Lehnick
- Department of Health Sciences and Medicine, Head Biostatistics and Methodology, University of Lucerne, Lucerne, Switzerland
| | - Annemarie M C van Rossum
- Department of Paediatrics, Division of Paediatric Infectious Diseases & Immunology, Erasmus Medical Centre, University Medical Centre-Sophia Children's Hospital, Rotterdam, The Netherlands
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3
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Stocker M, van Herk W, El Helou S, Dutta S, Fontana MS, Schuerman FABA, van den Tooren-de Groot RK, Wieringa JW, Janota J, van der Meer-Kappelle LH, Moonen R, Sie SD, de Vries E, Donker AE, Zimmerman U, Schlapbach LJ, de Mol AC, Hoffman-Haringsma A, Roy M, Tomaske M, Kornelisse RF, van Gijsel J, Visser EG, Willemsen SP, van Rossum AMC. Procalcitonin-guided decision making for duration of antibiotic therapy in neonates with suspected early-onset sepsis: a multicentre, randomised controlled trial (NeoPIns). Lancet 2017; 390:871-881. [PMID: 28711318 DOI: 10.1016/s0140-6736(17)31444-7] [Citation(s) in RCA: 141] [Impact Index Per Article: 20.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Revised: 03/15/2017] [Accepted: 03/28/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND Up to 7% of term and late-preterm neonates in high-income countries receive antibiotics during the first 3 days of life because of suspected early-onset sepsis. The prevalence of culture-proven early-onset sepsis is 0·1% or less in high-income countries, suggesting substantial overtreatment. We assess whether procalcitonin-guided decision making for suspected early-onset sepsis can safely reduce the duration of antibiotic treatment. METHODS We did this randomised controlled intervention trial in Dutch (n=11), Swiss (n=4), Canadian (n=2), and Czech (n=1) hospitals. Neonates of gestational age 34 weeks or older, with suspected early-onset sepsis requiring antibiotic treatment were stratified into four risk categories by their treating physicians and randomly assigned [1:1] using a computer-generated list stratified per centre to procalcitonin-guided decision making or standard care-based antibiotic treatment. Neonates who underwent surgery within the first week of life or had major congenital malformations that would have required hospital admission were excluded. Only principal investigators were masked for group assignment. Co-primary outcomes were non-inferiority for re-infection or death in the first month of life (margin 2·0%) and superiority for duration of antibiotic therapy. Intention-to-treat and per-protocol analyses were done. This trial was registered with ClinicalTrials.gov, number NCT00854932. FINDINGS Between May 21, 2009, and Feb 14, 2015, we screened 2440 neonates with suspected early-onset sepsis. 622 infants were excluded due to lack of parental consent, 93 were ineligible for reasons unknown (68), congenital malformation (22), or surgery in the first week of life (3). 14 neonates were excluded as 100% data monitoring or retrieval was not feasible, and one neonate was excluded because their procalcitonin measurements could not be taken. 1710 neonates were enrolled and randomly assigned to either procalcitonin-guided therapy (n=866) or standard therapy (n=844). 1408 neonates underwent per-protocol analysis (745 in the procalcitonin group and 663 standard group). For the procalcitonin group, the duration of antibiotic therapy was reduced (intention to treat: 55·1 vs 65·0 h, p<0·0001; per protocol: 51·8 vs 64·0 h; p<0·0001). No sepsis-related deaths occurred, and 9 (<1%) of 1710 neonates had possible re-infection. The risk difference for non-inferiority was 0·1% (95% CI -4·6 to 4·8) in the intention-to-treat analysis (5 [0·6%] of 866 neonates in the procalcitonin group vs 4 [0·5%] of 844 neonates in the standard group) and 0·1% (-5·2 to 5·3) in the per-protocol analysis (5 [0·7%] of 745 neonates in the procalcitonin group vs 4 [0·6%] of 663 neonates in the standard group). INTERPRETATION Procalcitonin-guided decision making was superior to standard care in reducing antibiotic therapy in neonates with suspected early-onset sepsis. Non-inferiority for re-infection or death could not be shown due to the low occurrence of re-infections and absence of study-related death. FUNDING The Thrasher Foundation, the NutsOhra Foundation, the Sophia Foundation for Scientific research.
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Affiliation(s)
- Martin Stocker
- Department of Paediatrics, Neonatal and Paediatric Intensive Care Unit, Children's Hospital Lucerne, Lucerne, Switzerland
| | - Wendy van Herk
- Department of Paediatrics, Division of Paediatric Infectious Diseases & Immunology, Erasmus MC University Medical Centre-Sophia Children's Hospital, Rotterdam, Netherlands.
| | - Salhab El Helou
- Division of Neonatology, McMaster University Children's Hospital, Hamilton Health Sciences, Hamilton, ON, Canada
| | - Sourabh Dutta
- Division of Neonatology, McMaster University Children's Hospital, Hamilton Health Sciences, Hamilton, ON, Canada
| | - Matteo S Fontana
- Department of Paediatrics, Neonatal and Paediatric Intensive Care Unit, Children's Hospital Lucerne, Lucerne, Switzerland
| | | | | | | | - Jan Janota
- Department of Neonatology, Thomayer Hospital, Prague, Czech Republic; Institute of Pathological Physiology, First Medical Faculty, Charles University in Prague, Czech Republic
| | | | - Rob Moonen
- Department of Neonatology, Atrium Medical Centre, Heerlen, Netherlands
| | - Sintha D Sie
- Department of Neonatology, VU University Medical Centre, Amsterdam, Netherlands
| | - Esther de Vries
- Department of Paediatrics, Jeroen Bosch Hospital, 's-Hertogenbosch, Netherlands
| | - Albertine E Donker
- Department of Paediatrics, Maxima Medical Centre, Veldhoven, Netherlands
| | - Urs Zimmerman
- Department of Paediatrics, Kantonsspital Winterthur, Winterthur, Switzerland
| | - Luregn J Schlapbach
- Department of Paediatrics, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland; Paediatric Critical Care Research Group, Mater Research Institute, University of Queensland, Brisbane, QLD, Australia; Paediatric Intensive Care Unit, Lady Cilento Children's Hospital, Brisbane, QLD, Australia
| | - Amerik C de Mol
- Department of Neonatology, Albert Schweitzer Hospital, Dordrecht, Netherlands
| | | | - Madan Roy
- Department of Neonatology, St. Josephs Healthcare, Hamilton Health Sciences, Hamilton, ON, Canada
| | - Maren Tomaske
- Department of Paediatrics, Stadtspital Triemli, Zürich, Switzerland
| | - René F Kornelisse
- Division of Neonatology, Erasmus MC University Medical Centre-Sophia Children's Hospital, Rotterdam, Netherlands
| | - Juliette van Gijsel
- Julius Training General Practitioner, University Medical Centre Utrecht, Netherlands
| | - Eline G Visser
- Department of Paediatrics, Division of Paediatric Infectious Diseases & Immunology, Erasmus MC University Medical Centre-Sophia Children's Hospital, Rotterdam, Netherlands
| | - Sten P Willemsen
- Department of Biostatistics, Erasmus MC University Medical Centre, Rotterdam, Netherlands
| | - Annemarie M C van Rossum
- Department of Paediatrics, Division of Paediatric Infectious Diseases & Immunology, Erasmus MC University Medical Centre-Sophia Children's Hospital, Rotterdam, Netherlands
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Grootens-Wiegers P, Visser EG, van Rossum AMC, van Waardhuizen CN, de Wildt SN, Sweep B, van den Broek JM, de Vries MC. Perspectives of adolescents on decision making about participation in a biobank study: a pilot study. BMJ Paediatr Open 2017; 1:e000111. [PMID: 29637137 PMCID: PMC5862224 DOI: 10.1136/bmjpo-2017-000111] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [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: 05/29/2017] [Revised: 07/27/2017] [Accepted: 07/28/2017] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVES To be able to truly involve adolescents in decision making about clinical research participation, we need more insight in the perspective of adolescents themselves. To this end, adolescents in an ongoing biobank study were consulted to test a tentative decision assessment tool. METHODS The perspectives of adolescents (n=8) concerning participation in decision making for research participation were explored in interviews with a tentative tool, which covered six topics: information material usage, understanding, disease perceptions, anxiety, decision-making process and role sharing. RESULTS All adolescents unequivocally expressed the desire to be involved in decision making, but also wanted advice from their parents. The extent of the preferred role of adolescent versus parents varied between individuals. In decision making, adolescents relied on parents for information. More than half hardly used the information material. CONCLUSIONS Adolescents in our study preferred a shared decision-making process. The extent of sharing varied between individuals. The decision assessment tool was a fruitful starting point to discuss adolescents' perspectives and may aid in tailoring the situation to the individual to achieve optimal participation practices. IMPLICATIONS Consulting adolescents about their preferences concerning decision making using the tool will facilitate tailoring of the shared decision-making process and optimising the developing autonomy of minors.
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Affiliation(s)
- Petronella Grootens-Wiegers
- Department of Science Communication and Society, Leiden University, Leiden, The Netherlands.,Committee of Medical Ethics, Leiden University Medical Center, Leiden, The Netherlands
| | - Eline G Visser
- Department of Pediatrics, Division of Infectious Diseases and Immunology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Annemarie M C van Rossum
- Department of Pediatrics, Division of Infectious Diseases and Immunology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Claudia N van Waardhuizen
- Theme Sophia, Sector Research Office-Theme Sophia Biobank, Erasmus MC University Medical Center, Rotterdam, The Netherlands.,Department of Epidemiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands.,Department of Radiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Saskia N de Wildt
- Intensive Care and Department of Pediatric Surgery, Erasmus MC University Medical Center, Leiden, The Netherlands.,Department of Pharmacology and Toxicology, Radboud University, Nijmegen, The Netherlands
| | - Boudewijn Sweep
- Department of Science Communication and Society, Leiden University, Leiden, The Netherlands
| | - Jos M van den Broek
- Department of Science Communication and Society, Leiden University, Leiden, The Netherlands
| | - Martine C de Vries
- Departments of Pediatrics and Ethics and Health Law, Leiden University Medical Center, Nijmegen, The Netherlands
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5
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Herk WV, Stocker M, Helou SE, Fontana M, Schuerman FA, Tooren HVD, Bolt J, Janota J, Meer LHVD, Moonen R, Sie SD, Vries ED, Donker A, Zimmermann U, Schlapbach LG, Mol ACD, Haringsma A, Madan R, Tomaske M, Kornelisse RF, Gijsel JV, Visser EG, Willemsen SP, Hop W, Rossum AMV. Efficacy and Safety of Procalcitonin-Guided Decision Making in Neonates Suspected of Early Onset Sepsis: The Neopins Study—An International, Multicenter Non-Inferiority Randomized Controlled Intervention Trial. Open Forum Infect Dis 2016. [DOI: 10.1093/ofid/ofw172.1051] [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: 11/12/2022] Open
Affiliation(s)
- Wendy Van Herk
- Pediatric Infectious Diseases, Immunology & Rheumatology, Erasmus MC Univ. Med. Ctr. - Sophia Children's Hosp., Rotterdam, Netherlands
| | - Martin Stocker
- Neonatology, Children's Hosp. Lucerne, Lucerne, Switzerland
| | - Salhab El Helou
- Neonatology, McMaster Univ. Children's Hosp., Hamilton Health Services, Hamilton, ON, Canada
| | - Matteo Fontana
- Neonatology, Children's Hosp. Lucerne, Lucerne, Switzerland
| | | | | | - Jantien Bolt
- Pediatrics, MC Haaglanden Westeinde, the Hague, Netherlands
| | - Jan Janota
- Thomayer Hosp., Prague, Czech Republic
- Neonatology, Charles Univ. First Med. Faculty, Prague, Czech Republic
| | | | - Rob Moonen
- Neonatology, Atrium Med. Ctr. Heerlen, Heerlen, Netherlands
| | - Sintha D. Sie
- Neonatology, VU Univ. Med Ctr., Amsterdam, Netherlands
| | - Esther De Vries
- Pediatrics, Jeroen Bosch Ziekenhuis, 's Hertogenbosch, Netherlands
| | | | - Urs Zimmermann
- Pediatrics, Kantonsspital Winterthur, Wintherthur, Switzerland
| | - Luregn G. Schlapbach
- Pediatrics, Inselspital Univ. of Bern, Bern, Switzerland
- Mater Res. Inst. Univ. of Queensland, South Brisbane Qld 4101, Australia
| | | | | | - Roy Madan
- Neonatology, St. Joseph Healthcare, Hamilton Health Services, Hamilton, ON, Canada
| | - Maren Tomaske
- Pediatrics, Univ. Children's Hosp., Zurich, Switzerland
| | - Rene F. Kornelisse
- Neonatology, Erasmus MC University Medical Center - Sophia Children's Hospital, Rotterdam, Netherlands
| | - Juliette Van Gijsel
- Julius Training General Practitioner, Univ. Med. Ctr. Utrecht, Utrecht, Netherlands
| | - Eline G. Visser
- Pediatric Infectious Diseases, Immunology & Rheumatology, Erasmus MC Univ. Med. Ctr. - Sophia Children's Hosp., Rotterdam, Netherlands
| | | | - Wim Hop
- Biostatistics, Erasmus Univ. Med. Ctr., Rotterdam, Netherlands
| | - Annemarie M.C. Van Rossum
- Pediatric Infectious Diseases, Immunology & Rheumatology, Erasmus MC Univ. Med. Ctr. - Sophia Children's Hosp., Rotterdam, Netherlands
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Spuesens EBM, Fraaij PLA, Visser EG, Hoogenboezem T, Hop WCJ, van Adrichem LNA, Weber F, Moll HA, Broekman B, Berger MY, van Rijsoort-Vos T, van Belkum A, Schutten M, Pas SD, Osterhaus ADME, Hartwig NG, Vink C, van Rossum AMC. Carriage of Mycoplasma pneumoniae in the upper respiratory tract of symptomatic and asymptomatic children: an observational study. PLoS Med 2013; 10:e1001444. [PMID: 23690754 PMCID: PMC3653782 DOI: 10.1371/journal.pmed.1001444] [Citation(s) in RCA: 188] [Impact Index Per Article: 17.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2012] [Accepted: 04/04/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Mycoplasma pneumoniae is thought to be a common cause of respiratory tract infections (RTIs) in children. The diagnosis of M. pneumoniae RTIs currently relies on serological methods and/or the detection of bacterial DNA in the upper respiratory tract (URT). It is conceivable, however, that these diagnostic methods also yield positive results if M. pneumoniae is carried asymptomatically in the URT. Positive results from these tests may therefore not always be indicative of a symptomatic infection. The existence of asymptomatic carriage of M. pneumoniae has not been established. We hypothesized that asymptomatic carriage in children exists and investigated whether colonization and symptomatic infection could be differentiated by current diagnostic methods. METHODS AND FINDINGS This study was conducted at the Erasmus MC-Sophia Children's Hospital and the after-hours General Practitioners Cooperative in Rotterdam, The Netherlands. Asymptomatic children (n = 405) and children with RTI symptoms (n = 321) aged 3 mo to 16 y were enrolled in a cross-sectional study from July 1, 2008, to November 30, 2011. Clinical data, pharyngeal and nasopharyngeal specimens, and serum samples were collected. The primary objective was to differentiate between colonization and symptomatic infection with M. pneumoniae by current diagnostic methods, especially real-time PCR. M. pneumoniae DNA was detected in 21.2% (95% CI 17.2%-25.2%) of the asymptomatic children and in 16.2% (95% CI 12.2%-20.2%) of the symptomatic children (p = 0.11). Neither serology nor quantitative PCR nor culture differentiated asymptomatic carriage from infection. A total of 202 children were tested for the presence of other bacterial and viral pathogens. Two or more pathogens were found in 56% (63/112) of the asymptomatic children and in 55.5% (50/90) of the symptomatic children. Finally, longitudinal sampling showed persistence of M. pneumoniae in the URT for up to 4 mo. Fifteen of the 21 asymptomatic children with M. pneumoniae and 19 of the 22 symptomatic children with M. pneumoniae in this longitudinal follow-up tested negative after 1 mo. CONCLUSIONS Although our study has limitations, such as a single study site and limited sample size, our data indicate that the presence of M. pneumoniae in the URT is common in asymptomatic children. The current diagnostic tests for M. pneumoniae are unable to differentiate between asymptomatic carriage and symptomatic infection.
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Affiliation(s)
- Emiel B M Spuesens
- Department of Paediatric Infectious Diseases and Immunology, Erasmus MC-Sophia, Rotterdam, The Netherlands.
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