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Kociolek LK, Shane AL, Simonsen KA, Zerr DM. Infection Prevention and Control Implications of Special Pathogens in Children. Pediatr Clin North Am 2024; 71:431-454. [PMID: 38754934 DOI: 10.1016/j.pcl.2024.01.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/18/2024]
Abstract
Special pathogens are broadly defined as highly transmissible organisms capable of causing severe disease in humans. Children's hospital healthcare personnel (HCP) should be prepared to identify patients possibly infected with a special pathogen, isolate the patient to minimize transmission, and inform key infection prevention, clinical, and public health stakeholders. Effective preparedness requires resources and practice with attention to education, policies and procedures, drills and training, and supplies. Successfully preparing for special pathogens is an important measure toward keeping communities, HCP, and patients and families safe in this global age that brings pathogens from across the world to our doorstep.
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Affiliation(s)
- Larry K Kociolek
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 East Chicago Avenue, Box 20, Chicago, IL 60611, USA.
| | - Andi L Shane
- Department of Pediatrics, Emory University School of Medicine and Children's Healthcare of Atlanta, Emory Children's Center, 2015 Uppergate Drive Northeast, Room 504A, Atlanta, GA 30322, USA
| | - Kari A Simonsen
- Department of Pediatrics, University of Nebraska Medical Center, 982162 Nebraska Medical Center, Omaha, NE 68198, USA
| | - Danielle M Zerr
- Department of Pediatrics, University of Washington, Seattle Children's Hospital, Mailstop MA7.226, 4800 Sand Point Way, Seattle, WA 98105, USA
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2
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Alisoltani A, Simons LM, Agnes MFR, Heald-Sargent TA, Muller WJ, Kociolek LK, Hultquist JF, Lorenzo-Redondo R, Ozer EA. Resurgence of SARS-CoV-2 Delta after Omicron variant superinfection in an immunocompromised pediatric patient. Virol J 2023; 20:246. [PMID: 37891657 PMCID: PMC10604949 DOI: 10.1186/s12985-023-02186-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 09/18/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND Persistent SARS-CoV-2 infection in immunocompromised hosts is thought to contribute to viral evolution by facilitating long-term natural selection and viral recombination in cases of viral co-infection or superinfection. However, there are limited data on the longitudinal intra-host population dynamics of SARS-CoV-2 co-infection/superinfection, especially in pediatric populations. Here, we report a case of Delta-Omicron superinfection in a hospitalized, immunocompromised pediatric patient. METHODS We conducted Illumina whole genome sequencing (WGS) for longitudinal specimens to investigate intra-host dynamics of SARS-CoV-2 strains. Topoisomerase PCR cloning of Spike open-reading frame and Sanger sequencing of samples was performed for four specimens to validate the findings. Analysis of publicly available SARS-CoV-2 sequence data was performed to investigate the co-circulation and persistence of SARS-CoV-2 variants. RESULTS Results of WGS indicate the patient was initially infected with the SARS-CoV-2 Delta variant before developing a SARS-CoV-2 Omicron variant superinfection, which became predominant. Shortly thereafter, viral loads decreased below the level of detection before resurgence of the original Delta variant with no residual trace of Omicron. After 54 days of persistent infection, the patient tested negative for SARS-CoV-2 but ultimately succumbed to a COVID-19-related death. Despite protracted treatment with remdesivir, no antiviral resistance mutations emerged. These results indicate a unique case of persistent SARS-CoV-2 infection with the Delta variant interposed by a transient superinfection with the Omicron variant. Analysis of publicly available sequence data suggests the persistence and ongoing evolution of Delta subvariants despite the global predominance of Omicron, potentially indicative of continued transmission in an unknown population or niche. CONCLUSION A better understanding of SARS-CoV-2 intra-host population dynamics, persistence, and evolution during co-infections and/or superinfections will be required to continue optimizing patient care and to better predict the emergence of new variants of concern.
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Affiliation(s)
- Arghavan Alisoltani
- Department of Medicine, Division of Infectious Diseases, Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, USA
- Center for Pathogen Genomics and Microbial Evolution, Northwestern University Havey Institute for Global Health, Chicago, IL, 60611, USA
| | - Lacy M Simons
- Department of Medicine, Division of Infectious Diseases, Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, USA
- Center for Pathogen Genomics and Microbial Evolution, Northwestern University Havey Institute for Global Health, Chicago, IL, 60611, USA
| | - Maria Francesca Reyes Agnes
- Department of Medicine, Division of Infectious Diseases, Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, USA
- Center for Pathogen Genomics and Microbial Evolution, Northwestern University Havey Institute for Global Health, Chicago, IL, 60611, USA
| | | | - William J Muller
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, 60611, USA
| | - Larry K Kociolek
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, 60611, USA
| | - Judd F Hultquist
- Department of Medicine, Division of Infectious Diseases, Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, USA
- Center for Pathogen Genomics and Microbial Evolution, Northwestern University Havey Institute for Global Health, Chicago, IL, 60611, USA
| | - Ramon Lorenzo-Redondo
- Department of Medicine, Division of Infectious Diseases, Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, USA
- Center for Pathogen Genomics and Microbial Evolution, Northwestern University Havey Institute for Global Health, Chicago, IL, 60611, USA
| | - Egon A Ozer
- Department of Medicine, Division of Infectious Diseases, Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, USA.
- Center for Pathogen Genomics and Microbial Evolution, Northwestern University Havey Institute for Global Health, Chicago, IL, 60611, USA.
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Yokoe DS, Advani SD, Anderson DJ, Babcock HM, Bell M, Berenholtz SM, Bryant KA, Buetti N, Calderwood MS, Calfee DP, Dubberke ER, Ellingson KD, Fishman NO, Gerding DN, Glowicz J, Hayden MK, Kaye KS, Klompas M, Kociolek LK, Landon E, Larson EL, Malani AN, Marschall J, Meddings J, Mermel LA, Patel PK, Perl TM, Popovich KJ, Schaffzin JK, Septimus E, Trivedi KK, Weinstein RA, Maragakis LL. Executive Summary: A Compendium of Strategies to Prevent Healthcare-Associated Infections in Acute-Care Hospitals: 2022 Updates. Infect Control Hosp Epidemiol 2023; 44:1540-1554. [PMID: 37606298 PMCID: PMC10587377 DOI: 10.1017/ice.2023.138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 06/01/2023] [Indexed: 08/23/2023]
Affiliation(s)
- Deborah S. Yokoe
- University of California San Francisco School of Medicine, UCSF Health-UCSF Medical Center, San Francisco, California, United States
| | - Sonali D. Advani
- Duke University School of Medicine, Durham, North Carolina, United States
| | | | - Hilary M. Babcock
- BJC Healthcare, Washington University School of Medicine, St. Louis, Missouri, United States
| | - Michael Bell
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States
| | | | - Kristina A. Bryant
- Norton Healthcare, University of Louisville School of Medicine, Louisville, Kentucky, United States
| | - Niccolò Buetti
- Infection Control Programme, Geneva University Hospitals and Faculty of Medicine, World Health Organization Collaborating Center, Geneva, Switzerland
- IAME-U1137, Université Paris-Cité, INSERM, Paris, France
| | | | | | - Erik R. Dubberke
- Washington University School of Medicine, St. Louis, Missouri, United States
| | | | - Neil O. Fishman
- Penn Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Dale N. Gerding
- Edward Hines Jr. Veterans’ Affairs Hospital, Hines, Illinois, United States
| | - Janet Glowicz
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States
| | - Mary K. Hayden
- Rush University Medical Center, Chicago, Illinois, United States
| | - Keith S. Kaye
- Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, United States
| | - Michael Klompas
- Harvard Medical School, Brigham and Women’s Hospital, Boston, Massachusetts, United States
| | - Larry K. Kociolek
- Northwestern University Feinberg School of Medicine, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois, United States
| | - Emily Landon
- The University of Chicago Medical Center, MacLean Center for Clinical Medical Ethics, Chicago, Illinois, United States
| | | | | | - Jonas Marschall
- Washington University School of Medicine, St. Louis, Missouri, United States
- Bern University Hospital, University of Bern, Bern, Switzerland
| | - Jennifer Meddings
- University of Michigan Medical School, Ann Arbor, Michigan, United States
- Veterans’ Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan, United States
| | - Leonard A. Mermel
- Warren Alpert Medical School of Brown University, Providence, Rhode Island, United States
- Lifespan Hospital System, Providence, Rhode Island, United States
| | - Payal K. Patel
- Intermountain Healthcare, Salt Lake City, Utah, United States
| | - Trish M. Perl
- University of Texas Southwestern Medical Center, Dallas, Texas, United States
| | - Kyle J. Popovich
- Rush University Medical Center, Chicago, Illinois, United States
| | - Joshua K. Schaffzin
- Children’s Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada
| | - Edward Septimus
- Texas A&M College of Medicine, Houston, Texas, United States
- Harvard Pilgrim Healthcare, Boston, Massachusetts, United States
| | - Kavita K. Trivedi
- Alameda County Public Health Department, San Leandro, California, United States
| | - Robert A. Weinstein
- Rush University Medical Center, Chicago, Illinois, United States
- Cook County Health, Chicago, Illinois, United States
| | - Lisa L. Maragakis
- Johns Hopkins University School of Medicine, The Johns Hopkins Hospital, Baltimore, Maryland, United States
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Yokoe DS, Advani SD, Anderson DJ, Babcock HM, Bell M, Berenholtz SM, Bryant KA, Buetti N, Calderwood MS, Calfee DP, Deloney VM, Dubberke ER, Ellingson KD, Fishman NO, Gerding DN, Glowicz J, Hayden MK, Kaye KS, Kociolek LK, Landon E, Larson EL, Malani AN, Marschall J, Meddings J, Mermel LA, Patel PK, Perl TM, Popovich KJ, Schaffzin JK, Septimus E, Trivedi KK, Weinstein RA, Maragakis LL. Introduction to A Compendium of Strategies to Prevent Healthcare-Associated Infections In Acute-Care Hospitals: 2022 Updates. Infect Control Hosp Epidemiol 2023; 44:1533-1539. [PMID: 37855077 PMCID: PMC10587365 DOI: 10.1017/ice.2023.158] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 06/06/2023] [Indexed: 10/20/2023]
Abstract
Since the initial publication of A Compendium of Strategies to Prevent Healthcare-Associated Infections in Acute Care Hospitals in 2008, the prevention of healthcare-associated infections (HAIs) has continued to be a national priority. Progress in healthcare epidemiology, infection prevention, antimicrobial stewardship, and implementation science research has led to improvements in our understanding of effective strategies for HAI prevention. Despite these advances, HAIs continue to affect ∼1 of every 31 hospitalized patients, leading to substantial morbidity, mortality, and excess healthcare expenditures, and persistent gaps remain between what is recommended and what is practiced.The widespread impact of the coronavirus disease 2019 (COVID-19) pandemic on HAI outcomes in acute-care hospitals has further highlighted the essential role of infection prevention programs and the critical importance of prioritizing efforts that can be sustained even in the face of resource requirements from COVID-19 and future infectious diseases crises.The Compendium: 2022 Updates document provides acute-care hospitals with up-to-date, practical expert guidance to assist in prioritizing and implementing HAI prevention efforts. It is the product of a highly collaborative effort led by the Society for Healthcare Epidemiology of America (SHEA), the Infectious Disease Society of America (IDSA), the Association for Professionals in Infection Control and Epidemiology (APIC), the American Hospital Association (AHA), and The Joint Commission, with major contributions from representatives of organizations and societies with content expertise, including the Centers for Disease Control and Prevention (CDC), the Pediatric Infectious Disease Society (PIDS), the Society for Critical Care Medicine (SCCM), the Society for Hospital Medicine (SHM), the Surgical Infection Society (SIS), and others.
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Affiliation(s)
- Deborah S. Yokoe
- School of Medicine, UCSF Health-UCSF Medical Center, University of California, San Francisco, California, United States
| | - Sonali D. Advani
- Duke University School of Medicine, Durham, North Carolina, United States
| | | | - Hilary M. Babcock
- BJC Healthcare, Washington University School of Medicine, St. Louis, Missouri, United States
| | - Michael Bell
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States
| | | | - Kristina A. Bryant
- University of Louisville School of Medicine, Norton HealthcareLouisville, Kentucky, United States
| | - Niccolò Buetti
- Infection Control Programme, Geneva University Hospitals and Faculty of Medicine, World Health Organization Collaborating Center, Geneva, Switzerland
- IAME-U1137, Université Paris-Cité, INSERM, Paris, France
| | | | | | - Valerie M. Deloney
- Society for Healthcare Epidemiology of America, Arlington, Virginia, United States
| | - Erik R. Dubberke
- Washington University School of Medicine, St. Louis, Missouri, United States
| | | | - Neil O. Fishman
- Hospital of the University of Pennsylvania, Penn Medicine, Philadelphia, Pennsylvania, United States
| | - Dale N. Gerding
- Edward Hines Jr. Veterans’ Affairs Hospital, Hines, Illinois, United States
| | - Janet Glowicz
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States
| | - Mary K. Hayden
- Rush University Medical Center, Chicago, Illinois, United States
| | - Keith S. Kaye
- Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, United States
| | - Larry K. Kociolek
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States
- Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois, United States
| | - Emily Landon
- The University of Chicago Medical Center, MacLean Center for Clinical Medical Ethics, Chicago, Illinois, United States
| | | | | | - Jonas Marschall
- Washington University School of Medicine, St. Louis, Missouri, United States
- Bern University Hospital, University of Bern, Bern, Switzerland
| | - Jennifer Meddings
- University of Michigan Medical School, Veterans’ Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan, United States
| | - Leonard A. Mermel
- Warren Alpert Medical School of Brown University, Lifespan Hospital System, Providence, Rhode Island, United States
| | - Payal K. Patel
- Intermountain Healthcare, Salt Lake City, Utah, United States
| | - Trish M. Perl
- University of Texas Southwestern Medical Center, Dallas, Texas, United States
| | - Kyle J. Popovich
- Rush University Medical Center, Chicago, Illinois, United States
| | - Joshua K. Schaffzin
- Children’s Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada
| | - Edward Septimus
- Texas A&M College of Medicine, Houston, Texas, United States
- Harvard Pilgrim Health Care, Boston, Massachusetts, United States
| | - Kavita K. Trivedi
- Alameda County Public Health Department, San Leandro, California, United States
| | - Robert A. Weinstein
- Rush University Medical Center, Chicago, Illinois, United States
- Cook County Health, Chicago, Illinois, United States
| | - Lisa L. Maragakis
- Johns Hopkins University School of Medicine, The Johns Hopkins Hospital, Baltimore, Maryland, United States
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5
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Sandora TJ, Kociolek LK, Williams DN, Daugherty K, Geer C, Cuddemi C, Chen X, Xu H, Savage TJ, Banz A, Garey KW, Gonzales-Luna AJ, Kelly CP, Pollock NR. Baseline stool toxin concentration is associated with risk of recurrence in children with Clostridioides difficile infection. Infect Control Hosp Epidemiol 2023; 44:1403-1409. [PMID: 36624698 PMCID: PMC10330943 DOI: 10.1017/ice.2022.310] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND In adults with Clostridioides difficile infection (CDI), higher stool concentrations of toxins A and B are associated with severe baseline disease, CDI-attributable severe outcomes, and recurrence. We evaluated whether toxin concentration predicts these presentations in children with CDI. METHODS We conducted a prospective cohort study of inpatients aged 2-17 years with CDI who received treatment. Patients were followed for 40 days after diagnosis for severe outcomes (intensive care unit admission, colectomy, or death, categorized as CDI primarily attributable, CDI contributed, or CDI not contributing) and recurrence. Baseline stool toxin A and B concentrations were measured using ultrasensitive single-molecule array assay, and 12 plasma cytokines were measured when blood was available. RESULTS We enrolled 187 pediatric patients (median age, 9.6 years). Patients with severe baseline disease by IDSA-SHEA criteria (n = 34) had nonsignificantly higher median stool toxin A+B concentration than those without severe disease (n = 122; 3,217.2 vs 473.3 pg/mL; P = .08). Median toxin A+B concentration was nonsignificantly higher in children with a primarily attributed severe outcome (n = 4) versus no severe outcome (n = 148; 19,472.6 vs 429.1 pg/mL; P = .301). Recurrence occurred in 17 (9.4%) of 180 patients. Baseline toxin A+B concentration was significantly higher in patients with versus without recurrence: 4,398.8 versus 280.8 pg/mL (P = .024). Plasma granulocyte colony-stimulating factor concentration was significantly higher in CDI patients versus non-CDI diarrhea controls: 165.5 versus 28.5 pg/mL (P < .001). CONCLUSIONS Higher baseline stool toxin concentrations are present in children with CDI recurrence. Toxin quantification should be included in CDI treatment trials to evaluate its use in severity assessment and outcome prediction.
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Affiliation(s)
- Thomas J. Sandora
- Division of Infectious Diseases, Department of Pediatrics, Boston Children’s Hospital and Harvard Medical School, Boston, MA, 02115, USA
| | - Larry K. Kociolek
- Division of Infectious Diseases, Department of Pediatrics, Ann & Robert H. Lurie Children’s Hospital of Chicago and Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, USA
| | - David N. Williams
- Institutional Centers for Clinical and Translational Research, Boston Children’s Hospital, Boston, MA, 02115, USA
| | - Kaitlyn Daugherty
- Division of Gastroenterology (K.D., C.G., C.C., C.K) and Division of Infectious Diseases (N.R.P.), Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, 02115, USA
| | - Christine Geer
- Institutional Centers for Clinical and Translational Research, Boston Children’s Hospital, Boston, MA, 02115, USA
- Division of Gastroenterology (K.D., C.G., C.C., C.K) and Division of Infectious Diseases (N.R.P.), Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, 02115, USA
| | - Christine Cuddemi
- Division of Gastroenterology (K.D., C.G., C.C., C.K) and Division of Infectious Diseases (N.R.P.), Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, 02115, USA
| | - Xinhua Chen
- Division of Gastroenterology (K.D., C.G., C.C., C.K) and Division of Infectious Diseases (N.R.P.), Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, 02115, USA
| | - Hua Xu
- Division of Gastroenterology (K.D., C.G., C.C., C.K) and Division of Infectious Diseases (N.R.P.), Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, 02115, USA
| | - Timothy J. Savage
- Division of Infectious Diseases, Department of Pediatrics, Boston Children’s Hospital and Harvard Medical School, Boston, MA, 02115, USA
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, 02120, USA
| | - Alice Banz
- bioMerieux, Marcy L’Etoile, 69280, France
| | - Kevin W. Garey
- Department of Pharmacy Practice and Translational Research, University of Houston College of Pharmacy, Houston, TX, 77204, USA
| | - Anne J. Gonzales-Luna
- Department of Pharmacy Practice and Translational Research, University of Houston College of Pharmacy, Houston, TX, 77204, USA
| | - Ciarán P. Kelly
- Division of Gastroenterology (K.D., C.G., C.C., C.K) and Division of Infectious Diseases (N.R.P.), Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, 02115, USA
| | - Nira R. Pollock
- Division of Gastroenterology (K.D., C.G., C.C., C.K) and Division of Infectious Diseases (N.R.P.), Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, 02115, USA
- Department of Laboratory Medicine, Boston Children’s Hospital and Harvard Medical School, Boston, MA, 02115, USA
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Gonzales-Luna AJ, Skinner AM, Alonso CD, Bouza E, Cornely OA, de Meij TGJ, Drew RJ, Garey KW, Gerding DN, Johnson S, Kahn SA, Kato H, Kelly CP, Kelly CR, Kociolek LK, Kuijper EJ, Louie T, Riley TV, Sandora TJ, Vehreschild MJGT, Wilcox MH, Dubberke ER. Redefining Clostridioides difficile infection antibiotic response and clinical outcomes. Lancet Infect Dis 2023; 23:e259-e265. [PMID: 37062301 DOI: 10.1016/s1473-3099(23)00047-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 01/04/2023] [Accepted: 01/09/2023] [Indexed: 04/18/2023]
Abstract
With the approval and development of narrow-spectrum antibiotics for the treatment of Clostridioides difficile infection (CDI), the primary endpoint for treatment success of CDI antibiotic treatment trials has shifted from treatment response at end of therapy to sustained response 30 days after completed therapy. The current definition of a successful response to treatment (three or fewer unformed bowel movements [UBMs] per day for 1-2 days) has not been validated, does not reflect CDI management, and could impair assessments for successful treatment at 30 days. We propose new definitions to optimise trial design to assess sustained response. Primarily, we suggest that the initial response at the end of treatment be defined as (1) three or fewer UBMs per day, (2) a reduction in UBMs of more than 50% per day, (3) a decrease in stool volume of more than 75% for those with ostomy, or (4) attainment of bowel movements of Bristol Stool Form Scale types 1-4, on average, by day 2 after completion of primary CDI therapy (ie, assessed on day 11 and day 12 of a 10-day treatment course) and following an investigator determination that CDI treatment can be ceased.
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Affiliation(s)
- Anne J Gonzales-Luna
- Department of Pharmacy Practice and Translational Research, University of Houston College of Pharmacy, Houston, TX, USA
| | - Andrew M Skinner
- Department of Medicine, Loyola University Medical Center, Maywood, IL, USA; Department of Medicine and Department of Research, Edward Hines Jr Veterans Administration Hospital, Hines, IL, USA
| | - Carolyn D Alonso
- Division of Infectious Diseases, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Emilio Bouza
- Department of Microbiology and Infectious Diseases, Universidad Complutense, Madrid, Spain
| | - Oliver A Cornely
- Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Disease, Translational Research, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany; Department of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf and Excellence Center for Medical Mycology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany; Clinical Trials Centre Cologne, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany; German Centre for Infection Research, Partner Site Bonn-Cologne, Cologne, Germany
| | - Tim G J de Meij
- Department of Pediatric Gastroenterology, Emma Children's Hospital, Amsterdam University Medical Centers, Amsterdam, Netherlands
| | - Richard J Drew
- Clinical Innovation Unit, Rotunda Hospital and Children's Health Ireland, Dublin, Ireland; Irish Meningitis and Sepsis Reference Laboratory, Children's Health Ireland at Temple Street, Dublin, Ireland; Department of Microbiology, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Kevin W Garey
- Department of Pharmacy Practice and Translational Research, University of Houston College of Pharmacy, Houston, TX, USA
| | - Dale N Gerding
- Department of Medicine and Department of Research, Edward Hines Jr Veterans Administration Hospital, Hines, IL, USA
| | - Stuart Johnson
- Department of Medicine and Department of Research, Edward Hines Jr Veterans Administration Hospital, Hines, IL, USA
| | - Stacy A Kahn
- Division of Gastroenterology, Hepatology & Nutrition, Boston Children's Hospital, Boston, MA, USA
| | - Haru Kato
- Antimicrobial Resistance Research Center, National Institute of Infectious Diseases, Tokyo, Japan
| | - Ciaran P Kelly
- Division of Gastroenterology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Colleen R Kelly
- Department of Medicine, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Larry K Kociolek
- Division of Pediatric Infectious Diseases, Ann & Robert H Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Ed J Kuijper
- Department of Medical Microbiology, Leiden University Medical Centre, Leiden, Netherlands
| | - Thomas Louie
- Infectious Diseases, Department of Medicine, University of Calgary, Calgary, AB, Canada
| | - Thomas V Riley
- School of Biomedical Sciences, The University of Western Australia, Crawley, WA, Australia
| | - Thomas J Sandora
- Department of Pediatrics, Boston Children's Hospital, Boston, MA, USA
| | - Maria J G T Vehreschild
- Infectious Diseases, Department of Internal Medicine, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Mark H Wilcox
- Microbiology, Old Medical School, Leeds General Infirmary, Leeds, UK
| | - Erik R Dubberke
- Division of Infectious Diseases, Washington University School of Medicine, St Louis, MO, USA.
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7
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Kusma JD, Macy ML, Kociolek LK, Davis MM, Ramgopal S. Seasonality in Respiratory Syncytial Virus Hospitalizations and Immunoprophylaxis. JAMA Health Forum 2023; 4:e231582. [PMID: 37389862 DOI: 10.1001/jamahealthforum.2023.1582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/01/2023] Open
Affiliation(s)
- Jennifer D Kusma
- Division of Advanced General Pediatrics and Primary Care, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Michelle L Macy
- Mary Ann & J. Milburn Smith Child Health Outcomes, Research, and Evaluation Center, Stanley Manne Children's Research Institute, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Larry K Kociolek
- Division of Infectious Disease, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Matthew M Davis
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Sriram Ramgopal
- Division of Emergency Medicine, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
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8
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Icho S, Ward JS, Tam J, Kociolek LK, Theriot CM, Melnyk RA. Intestinal bile acids provide a surmountable barrier against C. difficile TcdB-induced disease pathogenesis. Proc Natl Acad Sci U S A 2023; 120:e2301252120. [PMID: 37126691 PMCID: PMC10175849 DOI: 10.1073/pnas.2301252120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 04/04/2023] [Indexed: 05/03/2023] Open
Abstract
Intestinal bile acids play an essential role in the Clostridioides difficile lifecycle having been shown in vitro to modulate various aspects of pathogenesis, including spore germination, vegetative growth, and more recently the action of the primary virulence determinant, TcdB. Here, we investigated whether physiological levels of the total pool of intestinal bile acids in mice and humans protect against TcdB action. Small molecules extracted from the lumenal contents of the small intestine, cecum, colon, and feces were found to inhibit TcdB in accordance with the differential amounts of total bile acids in each compartment. Extracts from antibiotic-treated and germ-free mice, despite harboring dramatically altered bile acid profiles, unexpectedly also prevented TcdB-induced cell rounding to similar extents. We show that protection, however, is surmountable and can be overcome at higher doses of TcdB-typical to those seen during severe C. difficile infection-suggesting that the protective properties of intestinal bile acids are operant primarily under low to moderate toxin levels. Taken together, these findings demonstrate a role for intestinal bile acids in attenuating virulence, provide insights into asymptomatic carriage of toxigenic C. difficile, and inform strategies to manipulate bile acid levels for therapeutic benefit.
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Affiliation(s)
- Simoun Icho
- Molecular Medicine Program, The Hospital for Sick Children Research Institute, Toronto, ONM5G 0A4
- Department of Biochemistry, University of Toronto, Toronto, ONM5S 1A8
| | - Jennifer S. Ward
- Molecular Medicine Program, The Hospital for Sick Children Research Institute, Toronto, ONM5G 0A4
- Department of Biochemistry, University of Toronto, Toronto, ONM5S 1A8
| | - John Tam
- Molecular Medicine Program, The Hospital for Sick Children Research Institute, Toronto, ONM5G 0A4
| | - Larry K. Kociolek
- Ann & Robert H. Lurie, Children’s Hospital of Chicago, Chicago, IL60611
- Department of Pediatrics, Division of Pediatric Infectious Diseases, Northwestern University Feinberg School of Medicine, Chicago, IL60611
| | - Casey M. Theriot
- Department of Population Health and Pathobiology, College of Veterinary Medicine, North Carolina State University, Raleigh, NC27606
| | - Roman A. Melnyk
- Molecular Medicine Program, The Hospital for Sick Children Research Institute, Toronto, ONM5G 0A4
- Department of Biochemistry, University of Toronto, Toronto, ONM5S 1A8
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9
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Saiman L, Coffin SE, Kociolek LK, Zerr DM, Milstone AM, Aldrich ML, Vargas CY, Zapata G, Zalot MA, Reyna ME, Adler A, Voskertchian A, Egbert ER, Alba L, Gollerkeri S, Ruggieri M, Finelli L, Choi Y. Healthcare-associated Respiratory Syncytial Virus in Children's Hospitals. J Pediatric Infect Dis Soc 2023:7152989. [PMID: 37144945 DOI: 10.1093/jpids/piad030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Indexed: 05/06/2023]
Abstract
BACKGROUND Outbreaks of healthcare-associated respiratory syncytial virus (HA-RSV) infections in children are well described, but less is known about sporadic HA-RSV infections. We assessed the epidemiology and clinical outcomes associated with sporadic HA-RSV infections. METHODS We retrospectively identified hospitalized children <18 years old with HA-RSV infections in six children's hospitals in the United States during the respiratory viral seasons October-April in 2016-2017, 2017-2018, and 2018-2019 and prospectively from October 2020 through November 2021. We evaluated outcomes temporally associated with HA-RSV infections including escalation of respiratory support, transfer to the pediatric intensive care unit (PICU), and in-hospital mortality. We assessed demographic characteristics and comorbid conditions associated with escalation of respiratory support. RESULTS We identified 122 children (median age 16.0 months [IQR 6, 60 months]) with HA-RSV. The median onset of HA-RSV infections was hospital day 14 (IQR 7, 34 days). Overall, 78 (63.9%) children had two or more comorbid conditions; cardiovascular, gastrointestinal, neurologic/neuromuscular, respiratory, and premature/ neonatal comorbidities were most common. Fifty-five (45.1%) children required escalation of respiratory support and 18 (14.8%) were transferred to the PICU. Five (4.1%) died during hospitalization. In the multivariable analysis, respiratory comorbidities (aOR: 3.36 [CI95 1.41, 8.01]) were associated with increased odds of escalation of respiratory support. CONCLUSIONS HA-RSV infections cause preventable morbidity and increase healthcare resource utilization. Further study of effective mitigation strategies for HA-respiratory viral infections should be prioritized; this priority is further supported by the impact of the COVID-19 pandemic on seasonal viral infections.
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Affiliation(s)
- Lisa Saiman
- NewYork-Presbyterian Morgan Stanley Children's Hospital, Columbia University Irving Medical Center, New York, NY
| | - Susan E Coffin
- Children's Hospital of Philadelphia, Philadelphia, PA, Perelman School of Medicine at UPenn, Philadelphia, PA
| | - Larry K Kociolek
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
| | | | | | | | - Celibell Y Vargas
- NewYork-Presbyterian Morgan Stanley Children's Hospital, Columbia University Irving Medical Center, New York, NY
| | - Giovanny Zapata
- Mailman School of Public Health, Columbia University Irving Medical Center, New York, NY
| | - Morgan A Zalot
- Children's Hospital of Philadelphia, Philadelphia, PA, Perelman School of Medicine at UPenn, Philadelphia, PA
| | - Megan E Reyna
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
| | | | | | - Emily R Egbert
- Johns Hopkins University School of Medicine, Baltimore, MD
| | - Luis Alba
- NewYork-Presbyterian Morgan Stanley Children's Hospital, Columbia University Irving Medical Center, New York, NY
| | - Sonia Gollerkeri
- NewYork-Presbyterian Morgan Stanley Children's Hospital, Columbia University Irving Medical Center, New York, NY
| | - Madelyn Ruggieri
- Center for Observational and Real-World Evidence, Merck & Co., Inc., Rahway, NJ
| | - Lyn Finelli
- Center for Observational and Real-World Evidence, Merck & Co., Inc., Rahway, NJ
| | - Yoonyoung Choi
- Center for Observational and Real-World Evidence, Merck & Co., Inc., Rahway, NJ
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10
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Heffernan ME, Bendelow A, Kociolek LK, Smith TL, Menker CG, Davis MM. Targeted Vaccine Messaging to Promote COVID-19 Vaccines for Children and Youth. Pediatrics 2023:191239. [PMID: 37144291 DOI: 10.1542/peds.2022-059191] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/27/2023] [Indexed: 05/06/2023] Open
Abstract
OBJECTIVES To assess the effectiveness of distinct message types in promoting coronavirus disease 2019 (COVID-19) vaccination intentions for parents of children and adolescents. METHODS We collected data through the Voices of Child Health in Chicago Parent Panel Survey from October to November 2021. Parents were randomly assigned to read 1 of 4 vaccine message types and then report their intentions to vaccinate each COVID-19-unvaccinated child (0-17 years) in their household (n= 1453). RESULTS The sample included 898 parents. Compared with a control group (37.5%), the proportion of parents who were very likely to vaccinate their children was higher when messages highlighted that other trusted parents have vaccinated their children (53.3%) or that the vaccine is safe and thoroughly tested (48.9%) but not when messages highlighted that the vaccine is well-tolerated (41.5%). After adjusting for parent and child characteristics, the odds of being very likely to vaccinate remained higher in the trusted parents group but not in the safe/thoroughly tested group. Unlike the control and well-tolerated groups, there were no racial/ethnic disparities in the unadjusted proportion of parents who were very likely to vaccinate in the trusted parents and safe/thoroughly tested groups. Message types affected the unadjusted proportion of COVID-19-unvaccinated parents who were very likely to vaccinate their children. CONCLUSIONS Messages that focus on trusted parents choosing to vaccinate their children were more effective at promoting parents' COVID-19 vaccination intentions for their children than alternative messages. These findings have implications for public health messaging and pediatric providers' communications with parents.
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Affiliation(s)
- Marie E Heffernan
- Department of Pediatrics
- Mary Ann & J. Milburn Smith Child Health Outcomes, Research, and Evaluation Center, Stanley Manne Children's Research Institute
| | | | - Larry K Kociolek
- Department of Pediatrics
- Division of Infectious Disease, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
- Departments of Pediatrics, and
| | | | - Carly G Menker
- Mary Ann & J. Milburn Smith Child Health Outcomes, Research, and Evaluation Center, Stanley Manne Children's Research Institute
| | - Matthew M Davis
- Department of Pediatrics
- Mary Ann & J. Milburn Smith Child Health Outcomes, Research, and Evaluation Center, Stanley Manne Children's Research Institute
- Medicine, Medical Social Sciences, and Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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11
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Conover KR, Absah I, Ballal S, Brumbaugh D, Cho S, Cardenas MC, Knackstedt ED, Goyal A, Jensen MK, Kaplan JL, Kellermayer R, Kociolek LK, Michail S, Oliva-Hemker M, Reed AW, Weatherly M, Kahn SA, Nicholson MR. Fecal Microbiota Transplantation for Clostridioides difficile Infection in Immunocompromised Pediatric Patients. J Pediatr Gastroenterol Nutr 2023; 76:440-446. [PMID: 36720105 PMCID: PMC10627107 DOI: 10.1097/mpg.0000000000003714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVES We sought to evaluate the safety and effectiveness of fecal microbiota transplantation (FMT) for recurrent Clostridioides difficile infection (CDI) in pediatric immunocompromised (IC) patients. METHODS This is a multicenter retrospective cohort study of pediatric participants who underwent FMT between March 2013 and April 2020 with 12-week follow-up. Pediatric patients were included if they met the definition of IC and were treated with FMT for an indication of recurrent CDI. We excluded patients over 18 years of age, those with incomplete records, insufficient follow-up, or not meeting study definition of IC. We also excluded those treated for Clostridioides difficile recurrence without meeting the study definition and those with inflammatory bowel disease without another immunocompromising condition. RESULTS Of 59 pediatric patients identified at 9 centers, there were 42 who met inclusion and no exclusion criteria. Included patients had a median age of 6.7 years. Etiology of IC included: solid organ transplantation (18, 43%), malignancy (12, 28%), primary immunodeficiency (10, 24%), or other chronic conditions (2, 5%). Success rate was 79% after first FMT and 86% after 1 or more FMT. There were no statistically significant differences in patient characteristics or procedural components when patients with a failed FMT were compared to those with a successful FMT. There were 15 total serious adverse events (SAEs) in 13 out of 42 (31%) patients that occurred during the follow-up period; 4 (9.5%) of which were likely treatment-related. There were no deaths or infections with multidrug resistant organisms during follow-up and all patients with a SAE fully recovered. CONCLUSIONS The success rate of FMT for recurrent CDI in this pediatric IC cohort is high and mirrors data for IC adults and immunocompetent children. FMT-related SAEs do occur (9.5%) and highlight the need for careful consideration of risk and benefit.
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Affiliation(s)
- Katie R Conover
- From the Department of General Pediatrics, Vanderbilt University Medical Center, Nashville, TN
| | - Imad Absah
- the Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Mayo Clinic Children's Center, Rochester, MN
| | - Sonia Ballal
- the Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Boston Children's Hospital, Boston, MA
| | - David Brumbaugh
- the Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Children's Hospital Colorado, Aurora, CO
| | - Stanley Cho
- the Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Texas Children's Hospital, Houston, TX
| | - Maria C Cardenas
- the Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Mayo Clinic Children's Center, Rochester, MN
| | - Elizabeth Doby Knackstedt
- the Division of Pediatric Infectious Disease, University of Utah, Primary Children's Hospital, Salt Lake City, UT
| | - Alka Goyal
- the Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Lucile Packard Children's Hospital, Palo Alto, CA
| | - M Kyle Jensen
- the Division of Pediatric Gastroenterology, Hepatology, and Nutrition, University of Utah, Primary Children's Hospital, Salt Lake City, UT
| | - Jess L Kaplan
- the Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Mass General Hospital for Children, Boston, MA
| | - Richard Kellermayer
- the Division of Pediatric Infectious Disease, University of Utah, Primary Children's Hospital, Salt Lake City, UT
| | - Larry K Kociolek
- the Division of Pediatric Infectious Diseases, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
| | - Sonia Michail
- the Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Children's Hospital Los Angeles, Los Angeles, CA
| | - Maria Oliva-Hemker
- the Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Johns Hopkins Children's Center, Baltimore, MD
| | - Anna W Reed
- the Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Johns Hopkins Children's Center, Baltimore, MD
| | - Madison Weatherly
- the Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Boston Children's Hospital, Boston, MA
| | - Stacy A Kahn
- the Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Boston Children's Hospital, Boston, MA
| | - Maribeth R Nicholson
- the Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Monroe Carell Jr. Children's Hospital, Nashville, TN
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12
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Kociolek LK, Gerding DN, Carrico R, Carling P, Donskey CJ, Dumyati G, Kuhar DT, Loo VG, Maragakis LL, Pogorzelska-Maziarz M, Sandora TJ, Weber DJ, Yokoe D, Dubberke ER. Strategies to prevent Clostridioides difficile infections in acute-care hospitals: 2022 Update. Infect Control Hosp Epidemiol 2023; 44:527-549. [PMID: 37042243 PMCID: PMC10917144 DOI: 10.1017/ice.2023.18] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/13/2023]
Affiliation(s)
- Larry K. Kociolek
- Northwestern University Feinberg School of Medicine, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois, United States
| | - Dale N. Gerding
- Edward Hines Jr. Veterans’ Affairs (VA) Hospital, Hines, Illinois, United States
| | - Ruth Carrico
- Norton Healthcare, Louisville, Kentucky, United States
| | - Philip Carling
- Boston University School of Medicine, Boston, Massachusetts, United States
| | - Curtis J. Donskey
- Case Western Reserve University School of Medicine, Cleveland VA Medical Center, Cleveland, Ohio, United States
| | - Ghinwa Dumyati
- University of Rochester Medical Center, Rochester, New York, United States
| | - David T. Kuhar
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, United States
| | - Vivian G. Loo
- McGill University, McGill University Health Centre, Montréal, Québec, Canada
| | - Lisa L. Maragakis
- Johns Hopkins University School of Medicine, The Johns Hopkins Hospital, Baltimore, Maryland, United States
| | | | - Thomas J. Sandora
- Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts, United States
| | - David J. Weber
- School of Medicine, University of North Carolina, Chapel Hill, North Carolina, United States
| | - Deborah Yokoe
- University of California San Francisco, UCSF Health-UCSF Medical Center, San Francisco, California, United States and
| | - Erik R. Dubberke
- Washington University School of Medicine, St. Louis, Missouri, United States
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13
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Cherny KE, Muscat EB, Balaji A, Mukherjee J, Ozer EA, Angarone MP, Hauser AR, Sichel JS, Amponsah E, Kociolek LK. Association Between Clostridium innocuum and Antibiotic-Associated Diarrhea in Adults and Children: A Cross-sectional Study and Comparative Genomics Analysis. Clin Infect Dis 2023; 76:e1244-e1251. [PMID: 35724319 PMCID: PMC10169446 DOI: 10.1093/cid/ciac483] [Citation(s) in RCA: 3] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 06/03/2022] [Accepted: 06/09/2022] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND A recent study from Taiwan suggested that Clostridium innocuum may be an unrecognized cause of antibiotic-associated diarrhea (AAD) and clinically indistinguishable from Clostridioides difficile infection. Our objective was to compare C. innocuum prevalence and strain between those with AAD and asymptomatic controls. METHODS In this cross-sectional study, we collected stool from 200 individuals with AAD and 100 asymptomatic controls. We evaluated the association between AAD and C. innocuum in stool using anaerobic culture and quantitative polymerase chain reaction (qPCR). To identify strain-specific associations with AAD, we performed whole-genome sequencing of C. innocuum isolates using Illumina MiSeq and constructed comparative genomics analyses. RESULTS C. innocuum was isolated from stool of 126/300 (42%) subjects and more frequently from asymptomatic controls than AAD subjects (50/100 [50%] vs 76/200 [38%], respectively; P = .047). C. innocuum isolation frequency was not associated with AAD in either the adult or pediatric subgroups. C. innocuum and C. difficile were frequently co-prevalent in individuals with and without diarrhea. There were no phylogenetic differences or accessory genome associations between C. innocuum isolates from AAD subjects and asymptomatic controls. CONCLUSIONS C. innocuum was frequently isolated and at a greater frequency in asymptomatic controls than those with AAD. We did not identify strain lineages or accessory genomic elements associated with AAD. These data highlight that differentiating C. innocuum-associated diarrhea from asymptomatic colonization, and differentiating diarrhea caused by C. difficile from C. innocuum, are clinical microbiology challenges that require additional investigation to identify host-specific factors and/or biomarkers that distinguish these conditions.
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Affiliation(s)
- Kathryn E Cherny
- Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA
| | - Emily B Muscat
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Aakash Balaji
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Jayabrata Mukherjee
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Egon A Ozer
- Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA
| | - Michael P Angarone
- Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA
| | - Alan R Hauser
- Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA
| | - Joseph S Sichel
- Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA
| | - Emmanuel Amponsah
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Larry K Kociolek
- Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA.,Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
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14
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Edwards PT, Thurm CW, Hall M, Busing JD, Kahn SA, Kellermayer R, Kociolek LK, Oliva-Hemker MM, Sammons JS, Weatherly M, Edwards KM, Nicholson MR. Clostridioides difficile Infection in Hospitalized Pediatric Patients: Comparisons of Epidemiology, Testing, and Treatment from 2013 to 2019. J Pediatr 2023; 252:111-116.e1. [PMID: 36027981 PMCID: PMC9771922 DOI: 10.1016/j.jpeds.2022.08.030] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 08/15/2022] [Accepted: 08/18/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVES To compare the incidence, epidemiology, testing patterns, treatment, and outcomes of Clostridioides difficile infection (CDI) among hospitalized pediatric patients from 2013 to 2019. STUDY DESIGN The Pediatric Health Information System database was queried for patient admissions (age 0-17 years) with International Classification of Diseases, 9th and 10th edition, codes for diagnoses of CDI with a billing code for a CDI-related antibiotic treatment. RESULTS We identified 17 142 pediatric patients, representing 23 052 admissions, with CDI. The adjusted annual CDI incidence decreased over the study period from 7.09 cases per 10 000 patient-days (95% CI, 6.15-8.18) in 2013 to 4.89 cases per 10 000 patient-days (95% CI, 4.03-5.93) in 2019 (P < .001). C difficile-specific testing also decreased during the study period (P < .001). Chronic gastrointestinal conditions (36%) and malignancy (32%) were the most common comorbidities in CDI encounters. Oral metronidazole use decreased during the study period (P < .01) and oral vancomycin use increased (P < .001). CONCLUSIONS Our study demonstrates a decrease in CDI incidence in hospitalized pediatric patients, a notable change from prior studies, although this may have been influenced by altered testing patterns. We found a high incidence of CDI in patients with cancer and gastrointestinal conditions: groups that warrant targeted evaluation of CDI prevention and treatment.
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Affiliation(s)
- Price T Edwards
- Section of Gastroenterology, Hepatology, & Nutrition, Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, TX
| | | | | | - Jordan D Busing
- D. Brent Polk Division of Gastroenterology, Hepatology, and Nutrition, Vanderbilt University Medical Center, Nashville, TN
| | - Stacy A Kahn
- Division of Gastroenterology and Nutrition, Inflammatory Bowel Disease Center, Boston Children's Hospital, Harvard Medical School, Boston, MA
| | - Richard Kellermayer
- Section of Gastroenterology, Hepatology, & Nutrition, Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, TX
| | - Larry K Kociolek
- Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Maria M Oliva-Hemker
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Julia S Sammons
- Division of Infectious Diseases, Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Madison Weatherly
- Division of Gastroenterology and Nutrition, Inflammatory Bowel Disease Center, Boston Children's Hospital, Harvard Medical School, Boston, MA
| | - Kathryn M Edwards
- Division of Infectious Diseases, Department of Pediatrics, Vanderbilt University Medical School, Nashville, TN
| | - Maribeth R Nicholson
- Division of Infectious Diseases, Department of Pediatrics, Vanderbilt University Medical School, Nashville, TN.
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15
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Gonzales-Luna AJ, Skinner AM, Alonso CD, Cornely OA, Garey KW, Gerding DN, Johnson S, Kahn SA, Kelly CP, Kelly CR, Kociolek LK, Kuijper EJ, Kuijper EJ, Louie TJ, Riley TV, Sandora TJ, Vehreschild M, Wilcox MH, Dubberke ER. 221. Assessment and Proposed Revision of Clinical Trial Clostridioides difficile Infection Clinical Response and Outcomes Definitions. Open Forum Infect Dis 2022. [PMCID: PMC9751887 DOI: 10.1093/ofid/ofac492.299] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Background Clostridioides difficile infection (CDI) research is limited by a lack of standardized definitions for clinical response and disease outcomes, which impacts clinical drug development and results comparison between studies. We aimed to assess outcome definitions in CDI therapeutic trials to propose new versions that are clinically relevant, discrete and objective. Methods A multidisciplinary group of CDI experts met monthly to review response endpoints from published clinical trials of antibiotic therapy for CDI. Previously published phase III or IV trials were assessed for outcome definitions. Discussions were held to reach a consensus on new clinical trial endpoints for adults and children to improve the accuracy and clinical relevance of measures of treatment success. Results Significant heterogeneity was noted amongst the primary endpoints in phase III and IV CDI antibiotic treatment trials. Initial clinical cure (ICC), strictly defined as < 3 unformed bowel movements/24 hour, and sustained clinical cure (SCC) were primary outcome measures for recent clinical trials. The strict ICC definition incompletely measures treatment success as assessed in clinical practice and, since ICC is necessary to achieve SCC, may lead to type II error for SCC. A set of proposed alternative outcome definitions was developed using the terms initial response (IR) and sustained response (SR) (Figure 1). IR allows for investigator assessment of overall improvement in CDI response more analogous to clinical practice and will lead to more patients eligible to meet SR. Achievement of SR requires both IR and no need for retreatment of CDI by day 30 after antibiotic completion and is the more relevant endpoint for CDI therapeutic development. The use of a less restrictive IR definition will more accurately capture early responses to treatment and importantly increase the validity of SR. The shortening of follow-up period by 30 days is also anticipated to reduce costs and efforts associated with conducting trials. Timeline of CDI outcome assessments for clinical trials
![]() Conclusion The set of definitions proposed here will more accurately capture clinical success and standardize the approach to outcome assessment in trials of CDI therapeutics. Disclosures Carolyn D. Alonso, MD, Cidara Therapeutics: Advisor/Consultant|Merck: Advisor/Consultant Oliver A. Cornely, Prof. Dr., Abbott: Honoraria|Abbvie: Advisor/Consultant|Actelion: Board Member|Al-Jazeera Pharmaceuticals: Honoraria|Allecra Therapeutics: Board Member|Amplyx: Advisor/Consultant|Amplyx: Grant/Research Support|Astellas: Honoraria|Basilea: Advisor/Consultant|Basilea: Grant/Research Support|Biocon: Advisor/Consultant|Biosys: Advisor/Consultant|BMBF: Grant/Research Support|Cidara: Advisor/Consultant|Cidara: Board Member|Cidara: Expert Testimony|Cidara: Grant/Research Support|CoRe Consulting: Stocks/Bonds|Da Volterra: Advisor/Consultant|DLR: Grant/Research Support|DZIF: Grant/Research Support|Entasis: Board Member|EU Directorate-General for Resarch and Innovation: Grant/Research Support|F2G: Grant/Research Support|German Patent and Trade Mark Office: German patent (DE 10 2021 113 007.7)|Gilead: Advisor/Consultant|Gilead: Grant/Research Support|Grupo Biotoscana/United Medical/Knight: Honoraria|Hikma: Honoraria|IQVIA: Board Member|Janssen: Board Member|Matinas: Advisor/Consultant|Matinas: Grant/Research Support|MedPace: Advisor/Consultant|MedPace: Grant/Research Support|MedScape: Honoraria|MedUpdate: Honoraria|Menarini: Advisor/Consultant|Merck/MSD: Grant/Research Support|Merck/MSD: Honoraria|Molecular Partners: Advisor/Consultant|MSG-ERC: Advisor/Consultant|Mundipharma: Grant/Research Support|Mylan: Honoraria|Noxxon: Advisor/Consultant|Octapharma: Advisor/Consultant|Octapharma: Grant/Research Support|Paratek: Board Member|Pardes: Advisor/Consultant|Pfizer: Grant/Research Support|Pfizer: Honoraria|Projektträger Jülich: Grant/Research Support|PSI: Advisor/Consultant|PSI: Board Member|Pulmocide: Board Member|Scynexis: Advisor/Consultant|Scynexis: Grant/Research Support|Seres: Advisor/Consultant|Shionogi: Board Member|Wiley (Blackwell): Editor-in-Chief, Mycoses Kevin W. Garey, PharmD, MS, Acurx Pharmaceuticals: Grant/Research Support|Paratek Pharmaceuticals: Grant/Research Support|Seres Therapeutics: Grant/Research Support|Summit Pharmaceuticals: Grant/Research Support Dale N. Gerding, MD, Destiny Pharma plc.: Advisor/Consultant Stuart Johnson, M.D., Ferring Pharmaceuticals: Membership on Ferring Publication Steering Committee|Ferring Pharmaceuticals: Employee|Summit Plc: Advisor/Consultant Stacy A. Kahn, MD, Lilly: Stocks/Bonds Ciaran P. Kelly, n/a, Artugen: Advisor/Consultant|Facile Therapeutics: Advisor/Consultant|Ferring Pharma: Advisor/Consultant|Finch: Advisor/Consultant|Finch: Advisor/Consultant|First Light Biosciences: Advisor/Consultant|First Light Biosciences: Ownership Interest|Milky Way Biosciences: Advisor/Consultant|Milky Way Biosciences: Grant/Research Support|Pfizer: Advisor/Consultant|Seres Therapeutics: Advisor/Consultant|Summit Therapeutics: Advisor/Consultant Larry K. Kociolek, MD, MSCI, Merck: Grant/Research Support Thomas J. Louie, MD, Artugen: Advisor/Consultant|Artugen: Grant/Research Support|Crestone: Advisor/Consultant|Crestone: Grant/Research Support|Finch Therapeutics: Advisor/Consultant|Finch Therapeutics: Grant/Research Support|Rebiotix: Advisor/Consultant|Rebiotix: Grant/Research Support|Seres Therapeutics: Advisor/Consultant|Seres Therapeutics: Grant/Research Support|summit plc: Advisor/Consultant|summit plc: Grant/Research Support|Vedanta Biosciences: Advisor/Consultant|Vedanta Biosciences: Grant/Research Support Maria Vehreschild, Prof. Dr., 3M: speaker fee|Astellas: Advisor/Consultant|Astellas: speaker fee|biologische heilmittel heel gmbh: Grant/Research Support|BioNtech: Grant/Research Support|EUMEDICA: Advisor/Consultant|Farmak International Holding: Advisor/Consultant|Ferring: Advisor/Consultant|Ferring: Speaker fee|Gilead Sciences: Advisor/Consultant|Immunic AG: Advisor/Consultant|MaaT: Advisor/Consultant|Merck: Advisor/Consultant|Merck: speaker fee|MSD: Advisor/Consultant|MSD: Grant/Research Support|MSD: speaker fees|Pfizer: speaker fee|Roche Molecular Systems: Grant/Research Support|Roche Molecular Systems: speaker fees|SocraRTec R&D GmbH: Advisor/Consultant|Takeda California: Grant/Research Support Professor Mark H. Wilcox, MD, FRCPath, GSK: Advisor/Consultant|GSK: Board Member|GSK: Grant/Research Support|Pfizer: Advisor/Consultant|Phico Therapeutics: Board Member|Seres: Advisor/Consultant|Seres: Board Member|Seres: Grant/Research Support|Summit: Advisor/Consultant|Summit: Grant/Research Support Erik R. Dubberke, MD, MSPH, Abbott: Advisor/Consultant|Ferring: Advisor/Consultant|Ferring: Grant/Research Support|Merck: Advisor/Consultant|Pfizer: Advisor/Consultant|Pfizer: Grant/Research Support|Seres: Advisor/Consultant|Summit: Advisor/Consultant|Synthetic Biologics: Grant/Research Support.
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Affiliation(s)
| | - Andrew M Skinner
- Loyola University Chicago Stritch School of Medicine, Maywood, Illinois
| | | | - Oliver A Cornely
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Nordrhein-Westfalen, Germany
| | - Kevin W Garey
- University of Houston College of Pharmacy, Houston, Texas
| | - Dale N Gerding
- Edward Hines, Jr. Veterans Affairs Hospital, Hines, Illinois
| | - Stuart Johnson
- Hines VA Hospital and Loyola University Medical Center, Hines, Illinois
| | - Stacy A Kahn
- Boston Children’s Hospital and Harvard Medical School, Boston, Massachusetts
| | - Ciaran P Kelly
- Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Colleen R Kelly
- Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Larry K Kociolek
- Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois
| | - Ed J Kuijper
- Leiden University Medical Center and RIVM, Leiden, Zuid-Holland, Netherlands
| | - Ed J Kuijper
- Leiden University Medical Center and RIVM, Leiden, Zuid-Holland, Netherlands
| | | | - Thomas V Riley
- The University of Western Australia, Nedlands, Western Australia, Australia
| | | | - Maria Vehreschild
- Department of Internal Medicine, Infectious Diseases, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt am Main, Germany, Frankfurt, Hessen, Germany
| | - Mark H Wilcox
- University of Leeds; Leeds Teaching Hospitals NHS Trust, Leeds, England, United Kingdom
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16
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Sandora TJ, Kociolek LK, Williams DN, Daugherty K, Geer C, Cuddemi C, Chen X, Xu H, Savage TJ, Banz A, Garey KW, Gonzales-Luna AJ, Kelly CP, Pollock NR. 883. Stool Toxin Concentrations Are Higher in Children with Baseline Severe Disease, Severe Outcomes, and Recurrence. Open Forum Infect Dis 2022. [DOI: 10.1093/ofid/ofac492.076] [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: 12/23/2022] Open
Abstract
Abstract
Background
In adults with C. difficile infection (CDI), higher baseline stool concentrations of toxins A and B are associated with severe baseline disease, CDI-attributable severe outcomes, and recurrence. We evaluated whether stool toxin concentration predicts these presentations in children with CDI.
Methods
We performed a prospective cohort study from 2016-2019. Participants were inpatients ≤17 years old at two pediatric hospitals with diarrhea and positive C. difficile testing who received therapy. Patients were followed for 40 days after baseline stool sample for severe outcomes (intensive care unit admission, colectomy, or death, categorized as CDI primarily attributable, CDI contributed, or CDI not contributing) and recurrence (resolution followed by new diarrhea and re-initiation of therapy). Baseline stool toxin A & B concentrations were measured using ultrasensitive single molecule array assay (cutoff for positive result = 20 pg/mL). Median baseline toxin concentrations were compared between groups using Wilcoxon tests.
Results
We enrolled 206 patients [median age 8.9 years (IQR, 4.7–13.2)]. Children with severe baseline disease by IDSA-SHEA criteria (n = 39) had higher median stool toxin A+B concentration than those without severe disease (n = 131) (2,912.6 vs. 500.5 pg/mL, P=0.05). Of the cohort, 40 (19%) had a severe outcome (4 primarily attributed to CDI, 19 with contribution from CDI, and 17 unrelated to CDI). Median toxin A+B concentration was non-significantly higher in children with a primarily-attributed severe outcome versus those without severe outcome (19,473 vs. 429.1 pg/mL, P=0.317) (Figure 1). Of 197 children with eligible data, recurrence occurred in 18 (9.1%); baseline toxin A+B concentration was significantly higher in patients with versus without recurrence (3,946.7 vs. 283.3 pg/mL, P=0.026) (Figure 2).
Conclusion
Higher stool toxin concentrations are present in children with baseline severe CDI, a CDI-attributable severe outcome, or recurrence compared with children without these presentations. Quantification of stool toxin concentration may be helpful in identifying severe CDI and predicting CDI outcomes, which could help guide decisions about clinical management.
Disclosures
Larry K. Kociolek, MD, MSCI, Merck: Grant/Research Support Timothy J. Savage, MD, MPH, MSc, UCB: Contract to Brigham and Women's Hospital Alice Banz, PhD, biomerieux: Simoa assays were performed by bioMerieux, and A.B. is an employee of bioMerieux Kevin W. Garey, PharmD, MS, Acurx: Grant/Research Support|cidara: Advisor/Consultant|cidara: Grant/Research Support|Paratek: Grant/Research Support|Seres Health: Grant/Research Support|Summit: Grant/Research Support Ciaran P. Kelly, n/a, Artugen: Advisor/Consultant|Facile Therapeutics: Advisor/Consultant|Ferring Pharma: Advisor/Consultant|Finch: Advisor/Consultant|Finch: Advisor/Consultant|First Light Biosciences: Advisor/Consultant|First Light Biosciences: Ownership Interest|Milky Way Biosciences: Advisor/Consultant|Milky Way Biosciences: Grant/Research Support|Pfizer: Advisor/Consultant|Seres Therapeutics: Advisor/Consultant|Summit Therapeutics: Advisor/Consultant.
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Affiliation(s)
| | - Larry K Kociolek
- Ann & Robert H. Lurie Children’s Hospital of Chicago , Chicago, Illinois
| | | | | | | | | | - Xinhua Chen
- Beth Israel Deaconess Medical Center , Boston, Massachusetts
| | - Hua Xu
- Beth Israel Deaconess Medical Center , Boston, Massachusetts
| | - Timothy J Savage
- Boston Children's Hospital / Brigham and Women's Hospital , Boston, Massachusetts
| | - Alice Banz
- biomerieux , Marcy L’Etoile, Auvergne , France
| | | | | | - Ciaran P Kelly
- Beth Israel Deaconess Medical Center , Boston, Massachusetts
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17
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Reyna ME, Edward PR, Ozer EA, Simons LM, Hultquist JF, Lorenzo-Redondo R, Patel AB, Kociolek LK. Incidence and Clinical Characteristics of Severe Acute Respiratory Syndrome Coronavirus 2 Infection After Vaccination in Children. J Pediatr 2022; 251:196-201.e4. [PMID: 35961427 PMCID: PMC9361575 DOI: 10.1016/j.jpeds.2022.07.056] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 07/05/2022] [Accepted: 07/21/2022] [Indexed: 01/14/2023]
Abstract
The objective of this single-center cohort study was to characterize the frequency, clinical characteristics, and molecular epidemiology of pediatric severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection after vaccination. Between May 15, 2021, and January 1, 2022, 171 children experienced SARS-CoV-2 infection postvaccination, 146 (86%) following the Omicron variant predominance. Outcomes were generally mild and comparable before and after Omicron predominance.
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Affiliation(s)
- Megan E Reyna
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
| | - Priya R Edward
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
| | - Egon A Ozer
- Division of Infectious Diseases, Northwestern University Feinberg School of Medicine, Chicago, IL; Center for Pathogen Genomics and Microbial Evolution, Northwestern University Havey Institute for Global Health, Chicago, IL
| | - Lacy M Simons
- Division of Infectious Diseases, Northwestern University Feinberg School of Medicine, Chicago, IL; Center for Pathogen Genomics and Microbial Evolution, Northwestern University Havey Institute for Global Health, Chicago, IL
| | - Judd F Hultquist
- Division of Infectious Diseases, Northwestern University Feinberg School of Medicine, Chicago, IL; Center for Pathogen Genomics and Microbial Evolution, Northwestern University Havey Institute for Global Health, Chicago, IL
| | - Ramon Lorenzo-Redondo
- Division of Infectious Diseases, Northwestern University Feinberg School of Medicine, Chicago, IL; Center for Pathogen Genomics and Microbial Evolution, Northwestern University Havey Institute for Global Health, Chicago, IL
| | - Ami B Patel
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL; Division of Infectious Diseases, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Larry K Kociolek
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL; Division of Infectious Diseases, Northwestern University Feinberg School of Medicine, Chicago, IL.
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18
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Edward PR, Lorenzo-Redondo R, Reyna ME, Simons LM, Hultquist JF, Patel AB, Ozer EA, Muller WJ, Heald-Sargent T, McHugh M, Dean T, Dalal RM, John J, Manz SC, Kociolek LK. Severity of Illness Caused by Severe Acute Respiratory Syndrome Coronavirus 2 Variants of Concern in Children: A Single-Center Retrospective Cohort Study. J Pediatric Infect Dis Soc 2022; 11:440-447. [PMID: 35924454 PMCID: PMC9384683 DOI: 10.1093/jpids/piac068] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 06/29/2022] [Indexed: 01/27/2023]
Abstract
BACKGROUND Recent COVID-19 surges are attributed to emergence of more transmissible SARS-CoV-2 variants of concern (VOCs). The relative severity of VOCs in children is unknown. METHODS We performed a single-center retrospective cohort study of children ≤18 years old diagnosed with COVID-19 from October 2020-February 2022 and whose SARS-CoV-2 isolate underwent Illumina sequencing. We measured the frequency of five markers of COVID-19 severity. Logistic regression models were fitted to estimate the odds of each severity marker with each VOC. RESULTS Among 714 children, 471 (66.0%) were infected with a VOC: 96 (13.4%) alpha, 38 (5.3%) gamma, 119 (16.7%) delta, and 215 (30.1%) omicron. High-risk medical conditions and increasing age were independently associated with COVID-19 severity. After adjusting for age, race, ethnicity, high-risk medical conditions, and COVID-19 community incidence, neither alpha, delta, nor omicron was associated with severe COVID-19. Gamma was independently associated with hospitalization (OR 6.7, 95% CI 2.0-22.1); pharmacologic treatment (OR 5.7, 95% CI 1.2-26.8); respiratory support (OR 11.9, 95% CI 2.7-62.4); and severe disease per the WHO Clinical Progression Scale (OR 11.7, 95% CI 2.1-90.5). Upon subgroup analyses, omicron was independently associated with ICU admission and severe disease per the WHO Clinical Progression Scale in children without SARS-CoV-2 immunization or prior COVID-19 infection. CONCLUSIONS Compared to non-VOC COVID-19, the gamma VOC was independently associated with increased COVID-19 severity, as was omicron in children without SARS-CoV-2 immunization or prior COVID-19 infection. SARS-CoV-2 vaccination and prior COVID-19 prevented severe outcomes during the omicron surge.
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Affiliation(s)
- Priya R Edward
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Ramon Lorenzo-Redondo
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Center for Pathogen Genomics and Microbial Evolution, Northwestern University Institute for Global Health, Chicago, IL, USA
| | - Megan E Reyna
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Lacy M Simons
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Center for Pathogen Genomics and Microbial Evolution, Northwestern University Institute for Global Health, Chicago, IL, USA
| | - Judd F Hultquist
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Center for Pathogen Genomics and Microbial Evolution, Northwestern University Institute for Global Health, Chicago, IL, USA
| | - Ami B Patel
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Egon A Ozer
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Center for Pathogen Genomics and Microbial Evolution, Northwestern University Institute for Global Health, Chicago, IL, USA
| | - William J Muller
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Taylor Heald-Sargent
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Matthew McHugh
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Taylor Dean
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Center for Pathogen Genomics and Microbial Evolution, Northwestern University Institute for Global Health, Chicago, IL, USA
| | - Raj M Dalal
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Jordan John
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Shannon C Manz
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Larry K Kociolek
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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19
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Choudhary R, Webber BJ, Womack LS, Dupont HK, Chiu SK, Wanga V, Gerdes ME, Hsu S, Shi DS, Dulski TM, Idubor OI, Wendel AM, Agathis NT, Anderson K, Boyles T, Click ES, Da Silva J, Evans ME, Gold JA, Haston JC, Loga P, Maloney SA, Martinez M, Natarajan P, Spicer KB, Swancutt M, Stevens VA, Rogers-Brown J, Chandra G, Light M, Barr FE, Snowden J, Kociolek LK, McHugh M, Wessel DL, Simpson JN, Gorman KC, Breslin KA, DeBiasi RL, Thompson A, Kline MW, Boom JA, Singh IR, Dowlin M, Wietecha M, Schweitzer B, Morris SB, Koumans EH, Ko JY, Siegel DA, Kimball AA. Factors Associated With Severe Illness in Patients Aged <21 Years Hospitalized for COVID-19. Hosp Pediatr 2022; 12:760-783. [PMID: 35670605 PMCID: PMC9773098 DOI: 10.1542/hpeds.2022-006613] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVES To describe coronavirus disease 2019 (COVID-19)-related pediatric hospitalizations during a period of B.1.617.2 (Δ) variant predominance and to determine age-specific factors associated with severe illness. METHODS We abstracted data from medical charts to conduct a cross-sectional study of patients aged <21 years hospitalized at 6 United States children's hospitals from July to August 2021 for COVID-19 or with an incidental positive severe acute respiratory syndrome coronavirus 2 test. Among patients with COVID-19, we assessed factors associated with severe illness by calculating age-stratified prevalence ratios (PR). We defined severe illness as receiving high-flow nasal cannula, positive airway pressure, or invasive mechanical ventilation. RESULTS Of 947 hospitalized patients, 759 (80.1%) had COVID-19, of whom 287 (37.8%) had severe illness. Factors associated with severe illness included coinfection with respiratory syncytial virus (RSV) (PR 3.64) and bacteria (PR 1.88) in infants; RSV coinfection in patients aged 1 to 4 years (PR 1.96); and obesity in patients aged 5 to 11 (PR 2.20) and 12 to 17 years (PR 2.48). Having ≥2 underlying medical conditions was associated with severe illness in patients aged <1 (PR 1.82), 5 to 11 (PR 3.72), and 12 to 17 years (PR 3.19). CONCLUSIONS Among patients hospitalized for COVID-19, factors associated with severe illness included RSV coinfection in those aged <5 years, obesity in those aged 5 to 17 years, and other underlying conditions for all age groups <18 years. These findings can inform pediatric practice, risk communication, and prevention strategies, including vaccination against COVID-19.
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Affiliation(s)
- Rewa Choudhary
- COVID-19 Emergency Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Bryant J. Webber
- COVID-19 Emergency Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia
- Air Force Institute of Technology, Wright-Patterson AFB, Ohio
| | - Lindsay S. Womack
- COVID-19 Emergency Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
- United States Public Health Service, Commissioned Corps, Rockville, Maryland
| | - Hannah K. Dupont
- COVID-19 Emergency Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
- United States Public Health Service, Commissioned Corps, Rockville, Maryland
| | - Sophia K. Chiu
- COVID-19 Emergency Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Valentine Wanga
- COVID-19 Emergency Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Megan E. Gerdes
- COVID-19 Emergency Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Sophia Hsu
- COVID-19 Emergency Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
- United States Public Health Service, Commissioned Corps, Rockville, Maryland
| | - Dallas S. Shi
- COVID-19 Emergency Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Theresa M. Dulski
- COVID-19 Emergency Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Osatohamwen I. Idubor
- COVID-19 Emergency Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
- United States Public Health Service, Commissioned Corps, Rockville, Maryland
| | - Arthur M. Wendel
- COVID-19 Emergency Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
- United States Public Health Service, Commissioned Corps, Rockville, Maryland
| | - Nickolas T. Agathis
- COVID-19 Emergency Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Kristi Anderson
- COVID-19 Emergency Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Tricia Boyles
- COVID-19 Emergency Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Eleanor S. Click
- COVID-19 Emergency Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Juliana Da Silva
- COVID-19 Emergency Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Mary E. Evans
- COVID-19 Emergency Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jeremy A.W. Gold
- COVID-19 Emergency Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Julia C. Haston
- COVID-19 Emergency Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Pamela Loga
- COVID-19 Emergency Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Susan A. Maloney
- COVID-19 Emergency Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Marisol Martinez
- COVID-19 Emergency Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Pavithra Natarajan
- COVID-19 Emergency Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Kevin B. Spicer
- COVID-19 Emergency Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Mark Swancutt
- COVID-19 Emergency Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Valerie A. Stevens
- COVID-19 Emergency Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jessica Rogers-Brown
- COVID-19 Emergency Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Gyan Chandra
- COVID-19 Emergency Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Megan Light
- COVID-19 Emergency Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | | | - Larry K. Kociolek
- Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois
| | - Matthew McHugh
- Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois
| | | | | | | | | | | | - Aaron Thompson
- Children’s Hospital New Orleans, New Orleans, Louisiana
- Tulane University School of Medicine and LSU Health, New Orleans, Louisiana
| | - Mark W. Kline
- Children’s Hospital New Orleans, New Orleans, Louisiana
- Tulane University School of Medicine and LSU Health, New Orleans, Louisiana
| | - Julie A. Boom
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas
- Texas Children’s Hospital, Houston, Texas
| | - Ila R. Singh
- Texas Children’s Hospital, Houston, Texas
- Department of Pathology and Immunology, Baylor College of Medicine, Houston, Texas
| | - Michael Dowlin
- Department of Pathology and Immunology, Baylor College of Medicine, Houston, Texas
| | | | - Beth Schweitzer
- COVID-19 Emergency Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Sapna Bamrah Morris
- COVID-19 Emergency Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Emilia H. Koumans
- COVID-19 Emergency Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jean Y. Ko
- COVID-19 Emergency Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
- United States Public Health Service, Commissioned Corps, Rockville, Maryland
| | - David A. Siegel
- COVID-19 Emergency Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
- United States Public Health Service, Commissioned Corps, Rockville, Maryland
| | - Anne A. Kimball
- COVID-19 Emergency Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
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20
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Sandora TJ, Williams DN, Daugherty K, Geer C, Cuddemi C, Kociolek LK, Chen X, Xu H, Savage TJ, Banz A, Garey KW, Gonzales-Luna AJ, Kelly CP, Pollock NR. Stool Toxin Concentration Does Not Distinguish Clostridioides difficile Infection from Colonization in Children Less Than 3 Years of Age. J Pediatric Infect Dis Soc 2022; 11:454-458. [PMID: 35801632 PMCID: PMC9595052 DOI: 10.1093/jpids/piac059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Accepted: 06/10/2022] [Indexed: 11/14/2022]
Abstract
In a prospective cohort study, stools from children <3 years with and without diarrhea who were Clostridioides difficile nucleic acid amplification test-positive underwent ultrasensitive and quantitative toxin measurement. Among 37 cases and 46 controls, toxin concentration distributions overlapped substantially. Toxin concentration alone does not distinguish C. difficile infection from colonization in young children.
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Affiliation(s)
- Thomas J Sandora
- Corresponding Author: Thomas J. Sandora, MD MPH, Boston Children’s Hospital, 300 Longwood Avenue, Boston, MA 02115, USA. E-mail:
| | - David N Williams
- Institutional Centers for Clinical and Translational Research, Boston Children’s Hospital, Boston, Massachusetts, USA
| | - Kaitlyn Daugherty
- Division of Gastroenterology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Christine Geer
- Institutional Centers for Clinical and Translational Research, Boston Children’s Hospital, Boston, Massachusetts, USA,Division of Gastroenterology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Christine Cuddemi
- Division of Gastroenterology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Larry K Kociolek
- Division of Infectious Diseases, Department of Pediatrics, Ann & Robert H. Lurie Children’s Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Xinhua Chen
- Division of Gastroenterology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Hua Xu
- Division of Gastroenterology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Timothy J Savage
- Division of Infectious Diseases, Department of Pediatrics, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Kevin W Garey
- Department of Pharmacy Practice and Translational Research, University of Houston College of Pharmacy, Houston, Texas, USA
| | - Anne J Gonzales-Luna
- Department of Pharmacy Practice and Translational Research, University of Houston College of Pharmacy, Houston, Texas, USA
| | - Ciarán P Kelly
- Division of Gastroenterology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Nira R Pollock
- Department of Laboratory Medicine, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts, USA,Division of Infectious Diseases, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
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21
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Abstract
ABSTRACT Hepatic involvement in coronavirus disease 2019 (COVID-19) is typically characterized as mild hepatitis with preserved synthetic function in children. Severe hepatitis is a rare complication of COVID-19 infection that has not been extensively described in the pediatric population. We report a case series of four previously healthy children who presented with significant hepatitis as the primary manifestation of COVID-19 infection. Two of these patients met criteria for acute liver failure. None of the patients had respiratory symptoms. One patient was found to have complement dysfunction resulting in microangiopathic features and was treated successfully with eculizumab. This case is in line with adult post-mortem data showing that more severe cases of hepatic dysfunction secondary to COVID-19 infection may be associated with complement activation and microangiopathic features. Liver function should be evaluated in cases of severe COVID-19, and severe acute respiratory syndrome coronavirus 2 infection should be considered as a cause of acute severe hepatitis even in patients without significant respiratory or other systemic symptoms.
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Affiliation(s)
- Swati Antala
- Division of Gastroenterology, Hepatology and Nutrition, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Tamir Diamond
- Division of Gastroenterology, Hepatology and Nutrition, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Larry K. Kociolek
- Division ofinfectious Diseases, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Amit A. Shah
- Division of Gastroenterology, Hepatology and Nutrition, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Catherine A. Chapin
- Division of Gastroenterology, Hepatology and Nutrition, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL
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22
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Wanga V, Gerdes ME, Shi DS, Choudhary R, Dulski TM, Hsu S, Idubor OI, Webber BJ, Wendel AM, Agathis NT, Anderson K, Boyles T, Chiu SK, Click ES, Da Silva J, Dupont H, Evans M, Gold JA, Haston J, Logan P, Maloney SA, Martinez M, Natarajan P, Spicer KB, Swancutt M, Stevens VA, Brown J, Chandra G, Light M, Barr FE, Snowden J, Kociolek LK, McHugh M, Wessel D, Simpson JN, Gorman KC, Breslin KA, DeBiasi RL, Thompson A, Kline MW, Bloom JA, Singh IR, Dowlin M, Wietecha M, Schweitzer B, Morris SB, Koumans EH, Ko JY, Kimball AA, Siegel DA. Characteristics and Clinical Outcomes of Children and Adolescents Aged <18 Years Hospitalized with COVID-19 - Six Hospitals, United States, July-August 2021. MMWR Morb Mortal Wkly Rep 2021; 70:1766-1772. [PMID: 34968374 PMCID: PMC8736272 DOI: 10.15585/mmwr.mm705152a3] [Citation(s) in RCA: 70] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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23
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Kociolek LK, Zackular JP, Savidge T. Translational Aspects of the Immunology of Clostridioides difficile Infection: Implications for Pediatric Populations. J Pediatric Infect Dis Soc 2021; 10:S8-S15. [PMID: 34791392 PMCID: PMC8600028 DOI: 10.1093/jpids/piab089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Clostridioides difficile has become the most common healthcare-associated pathogen in the United States, leading the US Centers for Disease Control and Prevention (CDC) to classify C. difficile as an "urgent" public health threat that requires "urgent and aggressive action." This call to action has led to new discoveries that have advanced our understanding of Clostridioides difficile infection (CDI) immunology and clinical development of immunologic-based therapies for CDI prevention. However, CDI immunology research has been limited in pediatric populations, and several unanswered questions remain regarding the function of host immune response in pediatric CDI pathogenesis and the potential role of immunologic-based therapies in children. This review summarizes the innate and adaptive immune responses previously characterized in animals and humans and provides a current update on clinical development of immunologic-based therapies for CDI prevention in adults and children. These data inform the future research needs for children.
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Affiliation(s)
- Larry K Kociolek
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA,Division of Infectious Diseases, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois, USA,Corresponding Author: Larry K. Kociolek, MD, MSCI, Division of Pediatric Infectious Diseases, Ann & Robert H. Lurie Children’s Hospital of Chicago, 225 E. Chicago Ave, Box 20, Chicago, IL 60611, USA. E-mail:
| | - Joseph P Zackular
- Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA,Division of Protective Immunity, Department of Pathology and Laboratory Medicine, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA,Institute for Immunology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Tor Savidge
- Department of Pathology & Immunology, Baylor College of Medicine & Texas Children’s Hospital, Houston, Texas, USA
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24
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Kociolek LK, Burnham CAD, Nicholson MR, Zackular JP. Clostridioides difficile Infection in Children: Research Progress, Pitfalls, and Priorities. J Pediatric Infect Dis Soc 2021; 10:S1-S2. [PMID: 34791394 PMCID: PMC9432130 DOI: 10.1093/jpids/piab090] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Larry K Kociolek
- Corresponding Author: Larry K. Kociolek, MD, MSCI, Division of Pediatric Infectious Diseases, Ann & Robert H. Lurie Children’s Hospital of Chicago, 225 E. Chicago Ave, Box 20, Chicago, IL 60611, USA. E-mail:
| | - Carey-Ann D Burnham
- Department of Pathology & Immunology, Medicine, Molecular Microbiology, and Pediatrics, Washington University in St. Louis School of Medicine, St. Louis, Missouri, USA
| | - Maribeth R Nicholson
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA,Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Monroe Carell Jr. Children’s Hospital at Vanderbilt, Nashville, Tennessee, USA
| | - Joseph P Zackular
- Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA,Division of Protective Immunity, Department of Pathology and Laboratory Medicine, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA,Institute for Immunology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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25
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Edward PR, Lorenzo-Redondo R, Reyna ME, Simons LM, Hultquist JF, Patel AB, Ozer EA, Muller WJ, Heald-Sargent T, McHugh M, Dean TJ, Dalal RM, John J, Manz SC, Kociolek LK. Severity of Illness Caused by Severe Acute Respiratory Syndrome Coronavirus 2 Variants of Concern in Children: A Single-Center Retrospective Cohort Study. medRxiv 2021:2021.10.23.21265402. [PMID: 34729568 PMCID: PMC8562552 DOI: 10.1101/2021.10.23.21265402] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND Recent surges in coronavirus 2019 disease (COVID-19) is attributed to the emergence of more transmissible severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants of concern (VOCs). However, the relative severity of SARS-CoV-2 VOCs in children is unknown. METHODS This retrospective single-center cohort study was performed at the Ann & Robert H. Lurie Children's Hospital of Chicago, academic free-standing children's hospital. We included all children ≤ 18 years-old diagnosed with COVID-19 between October 15 th , 2020 and August 31 st , 2021 and whose SARS-CoV-2 isolate was sequenced using the Illumina platform. For each patient sample, we identified the SARS-CoV-2 lineage, which was assigned to one of the following groups: Non-VOC, alpha VOC, beta VOC, gamma VOC, or delta VOC. We measured frequency of 5 markers of COVID-19 severity: hospitalization; COVID-19 pharmacologic treatment; respiratory support; intensive care unit admission; and severe disease as classified by the COVID-19 World Health Organization (WHO) Clinical Progression Scale (severe disease; score ≥ 6). A series of logistic regression models were fitted to estimate odds of each severity marker with each VOC (in comparison to non-VOCs), adjusting for COVID-19 community incidence and demographic and clinical co-variates. RESULTS During the study period, 2,025 patients tested positive for SARS-CoV-2; 1,422 (70.2%) had sufficient viral load to permit sequencing. Among the 499 (35.1%) patients whose isolate was sequenced, median (inter-quartile range) age was 7 (1,12) years; 256 (51.3%) isolates were a VOC: 96 (37.5%) alpha, 38 (14.8%) gamma, and 119 (46.5%) delta. After adjusting for age, Black race, Hispanic ethnicity, high-risk medical conditions, and COVID-19 community incidence, neither alpha nor delta was associated with severe COVID-19. Gamma was independently associated with hospitalization (OR 5.9, 95% CI 1.6-21.5, p =0.007), respiratory support (OR 8.3, 95% CI 1.5-56.3, p =0.02), and severe disease as classified by the WHO Clinical Progression Scale (OR 7.7, 95% CI 1.0-78.1, p =0.05). CONCLUSIONS Compared to non-VOC COVID-19 infections, the gamma VOC, but not the alpha or delta VOCs, was associated with increased severity. These data suggest that recent increased in pediatric COVID-19 hospitalizations are related to increased delta COVID-19 incidence rather than increased delta virulence in children.
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Affiliation(s)
- Priya R Edward
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL 60611, USA
| | - Ramon Lorenzo-Redondo
- Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
- Center for Pathogen Genomics and Microbial Evolution, Northwestern University Institute for Global Health, Chicago, IL 60611, USA
| | - Megan E Reyna
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL 60611, USA
| | - Lacy M Simons
- Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
- Center for Pathogen Genomics and Microbial Evolution, Northwestern University Institute for Global Health, Chicago, IL 60611, USA
| | - Judd F Hultquist
- Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
- Center for Pathogen Genomics and Microbial Evolution, Northwestern University Institute for Global Health, Chicago, IL 60611, USA
| | - Ami B Patel
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL 60611, USA
- Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
| | - Egon A Ozer
- Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
- Center for Pathogen Genomics and Microbial Evolution, Northwestern University Institute for Global Health, Chicago, IL 60611, USA
| | - William J Muller
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL 60611, USA
- Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
| | - Taylor Heald-Sargent
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL 60611, USA
- Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
| | - Matthew McHugh
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL 60611, USA
| | - Taylor J Dean
- Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
- Center for Pathogen Genomics and Microbial Evolution, Northwestern University Institute for Global Health, Chicago, IL 60611, USA
| | - Raj M Dalal
- Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
| | - Jordan John
- Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
| | - Shannon C Manz
- Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
| | - Larry K Kociolek
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL 60611, USA
- Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
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26
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Abstract
PURPOSE OF REVIEW The US Centers for Disease Control and Prevention (CDC) classified Clostridioides difficile as an 'urgent' public health threat that requires 'urgent and aggressive action'. This call to action has led to new discoveries that have advanced C. difficile infection (CDI) epidemiology, diagnosis and treatment, albeit predominantly in adults. In 2017, the Infectious Diseases Society of America and Society for Healthcare Epidemiology of America published clinical practice guidelines for both adults and children. At that time, recommendations in children were generally limited to relatively low-quality evidence. RECENT FINDINGS Since publication of this guidance, there have been many advancements in the understanding of CDI in children. These include better understanding of healthcare settings as uncommon sources of C. difficile acquisition in children; risk factors for recurrent and community-associated CDI; performance of diagnostic tests in children and strategies for optimizing their use; and a more rigorous evidence base for CDI treatment in children, including the first-ever randomized controlled trial of CDI treatment in children and the largest study of fecal microbiota transplantation in children. SUMMARY This review highlights the most recent salient advancements in paediatric CDI knowledge and practice that supplement published clinical guidance provided prior to these advancements.
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Affiliation(s)
- Larry K Kociolek
- Division of Infectious Diseases, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Jonathan D Crews
- Department of Pediatric Infectious Diseases, Baylor College of Medicine, Children's Hospital of San Antonio, San Antonio, Texas
| | - Hayden T Schwenk
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
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27
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Muller ML, Logan LK, Kociolek LK, Guzman-Cottrill JA, Bartlett AH, Schaffzin JK, Ravin KA, Rubin LG, Lake J, Caughell C, Ramirez-Avila L. SHEA Pediatric Leadership Council commentary: Personal protective equipment during care of children with multisystem inflammatory syndrome in children (MIS-C). Infect Control Hosp Epidemiol 2021; 42:1108-1110. [PMID: 34121639 PMCID: PMC8207550 DOI: 10.1017/ice.2021.242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 05/06/2021] [Indexed: 11/08/2022]
Affiliation(s)
- Martha L. Muller
- Department of Pediatrics, University of New Mexico, Albuquerque, New Mexico
| | - Latania K. Logan
- Section of Pediatric Infectious Diseases, Department of Pediatrics, Rush University Medical Center, Rush Medical College, Chicago, Illinois
| | - Larry K. Kociolek
- Department of Pediatrics, Ann & Robert H. Lurie Children’s Hospital of Chicago and Northwestern University Feinberg School of MedicineChicago, Illinois
| | | | - Allison H. Bartlett
- Section of Pediatric Infectious Diseases, The University of Chicago Medicine Comer Children’s Hospital, Chicago, Illinois
| | - Joshua K. Schaffzin
- Division of Infectious Diseases, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Karen A. Ravin
- Division of Infectious Diseases, Nemours/Alfred I. duPont Hospital for Children, Wilmington, Delaware
- Department of Pediatrics, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Lorry G. Rubin
- Department of Pediatrics, Cohen Children’s Medical Center, Northwell Health, New Hyde Park, New York
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
| | - Jason Lake
- Division of Pediatric Infectious Diseases, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah
| | - Carolyn Caughell
- Hospital Epidemiology and Infection Prevention, Department of Quality, University of California San Francisco Health, San Francisco, California
| | - Lynn Ramirez-Avila
- Division of Pediatric Infectious Diseases and Global Health, University of California San Francisco, San Francisco, California
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28
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Steele M, Hurtado RR, Rychlik K, Bonebrake A, Bovee MC, O'Donnell A, Perryman J, Kociolek LK. Impact of an automated multiple emitter whole-room ultraviolet-C disinfection system on hospital acquired infections: A quasi-experimental study. Am J Infect Control 2021; 49:1200-1203. [PMID: 33774103 DOI: 10.1016/j.ajic.2021.03.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 03/17/2021] [Accepted: 03/18/2021] [Indexed: 11/16/2022]
Abstract
A quasi-experimental study performed in a pediatric hematology-oncology unit demonstrated that whole-room ultraviolet-C disinfection was associated with a significant reduction in hospital-onset Clostridioides difficile infection (P< .01, trend and level), but not healthcare-associated viral respiratory infections (P= .06 for trend, P= .36 for level) or central line-associated bloodstream infections (P> 0.75, trend and level).
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Affiliation(s)
- Molly Steele
- Ann & Robert H. Lurie Children's Hospital of Chicago.
| | | | - Karen Rychlik
- Ann & Robert H. Lurie Children's Hospital of Chicago
| | | | - Maria C Bovee
- Ann & Robert H. Lurie Children's Hospital of Chicago
| | | | | | - Larry K Kociolek
- Ann & Robert H. Lurie Children's Hospital of Chicago; Department of Pediatrics, Northwestern University Feinberg School of Medicine
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29
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Cherny KE, Muscat EB, Reyna ME, Kociolek LK. Clostridium innocuum: Microbiological and clinical characteristics of a potential emerging pathogen. Anaerobe 2021; 71:102418. [PMID: 34332070 DOI: 10.1016/j.anaerobe.2021.102418] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 07/19/2021] [Accepted: 07/21/2021] [Indexed: 10/20/2022]
Abstract
Clostridium innocuum is an anaerobic, gram-positive, spore-forming bacterium identified by Smith and King in 1962 after being isolated from a patient with an appendiceal abscess. Its name, C. innocuum, reflected its clinically "innocuous" nature based on observed lack of virulence in animal models of infection. Since that time, C. innocuum has been identified as both part of the normal intestinal flora and the cause of a rare, intrinsically vancomycin-resistant opportunistic infection in immunocompromised patients. More recently, reports from Taiwan suggest that C. innocuum, in addition to being a known extraintestinal pathogen, may also be a diarrheal pathogen that causes a C. difficile infection-like antibiotic-associated diarrheal illness. However, unanswered questions about the clinical relevance of C. innocuum remain. Here we review the microbiological and clinical characteristics of this emerging pathogen.
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Affiliation(s)
- Kathryn E Cherny
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA; Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
| | - Emily B Muscat
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Megan E Reyna
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Larry K Kociolek
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA; Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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30
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Ozer E, Kociolek LK, Jhaveri R. Conversations With the Editors: The Emergence of Variants Amid Population-Wide SARS-CoV-2 Vaccination Efforts: How Much Should We Worry? Clin Ther 2021; 43:1630-1635. [PMID: 34391590 PMCID: PMC8310724 DOI: 10.1016/j.clinthera.2021.07.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 07/20/2021] [Indexed: 11/10/2022]
Affiliation(s)
- Egon Ozer
- Division of Infectious Diseases, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Larry K Kociolek
- Division of Infectious Diseases, Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Division of Pediatric Infectious Diseases, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Ravi Jhaveri
- Division of Infectious Diseases, Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Division of Pediatric Infectious Diseases, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois.
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31
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Racette SD, Lavin JM, Kociolek LK, Zheng XT, Haverkamp KS, Swibel Rosenthal LH. SARS‐CoV‐2 identified by universal preoperative COVID‐19 testing prior to emergency surgery: Case of an asymptomatic pediatric patient requiring emergency surgery. Clin Case Rep 2021. [DOI: 10.1002/ccr3.3844] [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: 01/19/2023] Open
Affiliation(s)
| | - Jennifer M. Lavin
- Northwestern UniversityFeinberg School of Medicine Chicago IL USA
- Division of Otolaryngology‐Head and Neck Surgery Ann & Robert H. Lurie Children's Hospital of Chicago Chicago IL USA
| | - Larry K. Kociolek
- Northwestern UniversityFeinberg School of Medicine Chicago IL USA
- Infectious Diseases Ann & Robert H. Lurie Children's Hospital of Chicago Chicago IL USA
- Pediatrics Ann & Robert H. Lurie Children's Hospital of Chicago Chicago IL USA
| | - Xiotian T. Zheng
- Northwestern UniversityFeinberg School of Medicine Chicago IL USA
- Microbiology Ann & Robert H. Lurie Children's Hospital of Chicago Chicago IL USA
| | | | - Laura H. Swibel Rosenthal
- Northwestern UniversityFeinberg School of Medicine Chicago IL USA
- Division of Otolaryngology‐Head and Neck Surgery Ann & Robert H. Lurie Children's Hospital of Chicago Chicago IL USA
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32
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Miceli AM, Sun S, Scardina TL, Bhasin A, Kociolek LK, Robison RG, Patel SJ. Prevalence and Characteristics of Non-Beta-Lactam Allergy Labeling at a Children's Hospital. J Pediatric Infect Dis Soc 2021; 10:702. [PMID: 33491089 DOI: 10.1093/jpids/piaa171] [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: 11/14/2022]
Affiliation(s)
- Amanda M Miceli
- Pediatric Infectious Diseases, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Shan Sun
- Data Analytics and Reporting, Pediatric Infectious Diseases, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Tonya L Scardina
- Pharmacy Antimicrobial Stewardship Coordinator, Department of Pharmacy, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Ajay Bhasin
- Pediatrics, Internal Medicine, Ann Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA.,Pediatrics, Internal Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Larry K Kociolek
- Pediatric Infectious Diseases, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA.,Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Rachel G Robison
- Pediatric Infectious Diseases, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA.,Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Sameer J Patel
- Pediatric Infectious Diseases, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA.,Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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33
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Webster G, Balmert LC, Patel AB, Kociolek LK, Gevitz M, Olson R, Chaouki AS, El-Tayeb O, Monge MC, Backer C. Surveillance Cultures and Infection in 230 Pacemaker and Defibrillator Generator Changes in Pediatric and Adult Congenital Patients. World J Pediatr Congenit Heart Surg 2021; 12:331-336. [PMID: 33942684 DOI: 10.1177/2150135120988631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Postoperative infections can occur during surgical replacement of pulse generators for pacemakers and implantable cardioverter-defibrillators. The incidence of infection is poorly documented in children and patients with adult congenital heart disease. The utility of surveillance cultures obtained from device pocket swabs is unknown in this group. METHODS We reviewed surgical replacements of cardiovascular implantable pulse generators from 2010 to 2017. Two cohorts were defined. In a surveillance cohort (123 patients), aerobic and anaerobic culture swabs of the device pocket were obtained at the time of generator change. In a nonsurveillance cohort (107 patients), generator change occurred without obtaining cultures. RESULTS During 230 generator changes (mean patient age 19 years; 77% with structural congenital heart disease), two clinical infections occurred at the surgical site (0.9% incidence). Neither infection occurred in the surveillance cohort. Cultures were positive in 12 (9.8%) of 123 patients in the surveillance cohort, but 11 of 12 were likely contaminants and none were subsequently associated with clinical disease. There was no association between clinical infection or positive surveillance cultures and the location of pulse generator, the presence of other concurrent surgeries, or a history of prior pocket infection. CONCLUSIONS Clinical infection was rare after pulse generator change in children and young adults. No cases required reintervention on the pocket. Surveillance cultures did not improve clinical care. These data extend current recommendations that surveillance cultures are not required during generator change to the pediatric and young adult population.
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Affiliation(s)
- Gregory Webster
- Division of Cardiology, 2429Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Lauren C Balmert
- Department of Preventive Medicine (Biostatistics), 12244Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Ami B Patel
- Division of Infectious Diseases, 572665Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Larry K Kociolek
- Division of Infectious Diseases, 572665Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Melanie Gevitz
- Division of Cardiology, 2429Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Rachael Olson
- Division of Cardiology, 2429Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Ahmed S Chaouki
- Division of Cardiology, 2429Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Osama El-Tayeb
- Division of Cardiovascular Surgery, 572665Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Michael C Monge
- Division of Cardiovascular Surgery, 572665Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Carl Backer
- Section of Pediatric Cardiovascular Surgery, Cincinnati Children's, 177468UK HealthCare Kentucky Children's Hospital, Lexington, KY, USA
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34
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Heald-Sargent T, Muller WJ, Kociolek LK. Viral Loads of SARS-CoV-2 in Young Children-Reply. JAMA Pediatr 2021; 175:530-531. [PMID: 33523126 DOI: 10.1001/jamapediatrics.2020.5551] [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: 11/14/2022]
Affiliation(s)
- Taylor Heald-Sargent
- Division of Infectious Diseases, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital, Chicago, Illinois
| | - William J Muller
- Division of Infectious Diseases, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital, Chicago, Illinois.,Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Larry K Kociolek
- Division of Infectious Diseases, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital, Chicago, Illinois.,Northwestern University Feinberg School of Medicine, Chicago, Illinois
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35
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Kociolek LK. Moving the Needle on Clostridioides difficile Research in Children: A Major Step Forward but Challenges Remain. Clin Infect Dis 2021; 71:2589-2591. [PMID: 31773137 DOI: 10.1093/cid/ciz1154] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2019] [Accepted: 11/25/2019] [Indexed: 11/12/2022] Open
Affiliation(s)
- Larry K Kociolek
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.,Division of Pediatric Infectious Diseases, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
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36
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Kociolek LK, Espinosa RO, Gerding DN, Hauser AR, Ozer EA, Budz M, Balaji A, Chen X, Tanz RR, Yalcinkaya N, Conner ME, Savidge T, Kelly CP. Natural Clostridioides difficile Toxin Immunization in Colonized Infants. Clin Infect Dis 2021; 70:2095-2102. [PMID: 31253983 DOI: 10.1093/cid/ciz582] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [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: 04/26/2019] [Accepted: 06/26/2019] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Clostridioides (Clostridium) difficile colonization is common among infants. Serological sequelae of infant C. difficile colonization are poorly understood. METHODS In this prospective cohort study of healthy infants, stools serially collected between ages 1-2 and 9-12 months were tested for non-toxigenic and toxigenic C. difficile (TCD). Cultured isolates underwent whole-genome sequencing. Serum collected at 9-12 months underwent measurement of IgA, IgG, and IgM against TCD toxins A and B and neutralizing antibody (NAb) titers against toxin B. For comparison, antitoxin IgG and NAb were measured in cord blood from 50 mothers unrelated to study infants. RESULTS Among 32 infants, 16 (50%) were colonized with TCD; 12 were first colonized >1 month before serology measurements. A variety of sequence types were identified, and there was evidence of putative in-home (enrolled siblings) and outpatient clinic transmission. Infants first colonized with TCD >1 month prior had significantly greater serum antitoxin IgA and IgG against toxins A (P = .02 for both) and B (P = .009 and .008, respectively) compared with non-TCD-colonized infants, and greater IgG compared with unrelated cord blood (P = .005). Five of 12 (42%) colonized infants had detectable NAb titers compared with zero non-TCD-colonized infants (P = .02). Breastfeeding was not associated with differences in serological measurements. CONCLUSIONS TCD colonization is associated with a humoral immune response against toxins A and B, with evidence of toxin B neutralization in vitro. The extent and duration of protection against CDI later in life afforded by natural C. difficile immunization events require further investigation.
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Affiliation(s)
- Larry K Kociolek
- Department of Pediatrics, Northwestern University Feinberg School of Medicine.,Division of Infectious Diseases, Ann & Robert H. Lurie Children's Hospital of Chicago
| | - Robyn O Espinosa
- Division of Infectious Diseases, Ann & Robert H. Lurie Children's Hospital of Chicago
| | - Dale N Gerding
- Department of Medicine, Loyola University Chicago Stritch School of Medicine, Hines.,Department of Medicine, Edward Hines Jr Veterans Administration Hospital, Research Service, Hines
| | - Alan R Hauser
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago.,Department of Microbiology-Immunology, Northwestern University Feinberg School of Medicine, Chicago
| | - Egon A Ozer
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago
| | - Maria Budz
- Special Infectious Diseases Laboratory, Ann & Robert H. Lurie Children's Hospital of Chicago, Illinois
| | - Aakash Balaji
- Department of Pediatrics, Northwestern University Feinberg School of Medicine
| | - Xinhua Chen
- Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Robert R Tanz
- Department of Pediatrics, Northwestern University Feinberg School of Medicine.,Division of Academic General Pediatrics and Primary Care, Ann & Robert H. Lurie Children's Hospital of Chicago, Illinois
| | - Nazli Yalcinkaya
- Department of Pathology and Immunology, Baylor College of Medicine and Texas Children's Hospital, Houston
| | - Margaret E Conner
- Department of Molecular Virology and Microbiology, Baylor College of Medicine, Houston, Texas
| | - Tor Savidge
- Department of Pathology and Immunology, Baylor College of Medicine and Texas Children's Hospital, Houston
| | - Ciaran P Kelly
- Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
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37
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Affiliation(s)
- Jenna Rossoff
- Division of HematologyOncology and TransplantationAnn & Robert H. Lurie Children's Hospital of ChicagoChicagoIllinois,Department of PediatricsNorthwestern University Feinberg School of MedicineChicagoIllinois
| | - Ami B. Patel
- Department of PediatricsNorthwestern University Feinberg School of MedicineChicagoIllinois,Division of Infectious DiseasesAnn & Robert H. Lurie Children's Hospital of ChicagoChicagoIllinois
| | - Emily Muscat
- Division of Infectious DiseasesAnn & Robert H. Lurie Children's Hospital of ChicagoChicagoIllinois
| | - Larry K. Kociolek
- Department of PediatricsNorthwestern University Feinberg School of MedicineChicagoIllinois,Division of Infectious DiseasesAnn & Robert H. Lurie Children's Hospital of ChicagoChicagoIllinois
| | - William J. Muller
- Department of PediatricsNorthwestern University Feinberg School of MedicineChicagoIllinois,Division of Infectious DiseasesAnn & Robert H. Lurie Children's Hospital of ChicagoChicagoIllinois
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38
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Abstract
This is a single-center US case series of 18 infants <90 days old who tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). These infants had a mild febrile illness without significant pulmonary disease. One-half of the infants were hospitalized; 1 had bacterial urinary tract co-infection. Nasopharyngeal viral loads were notably high. Latinx ethnicity was overrepresented.
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Affiliation(s)
- Leena B. Mithal
- Division of Infectious Diseases, Department of Pediatrics, Ann and Robert H. Lurie Children's Hospital of Chicago and Feinberg School of Medicine, Northwestern University, Chicago, IL,Reprint requests: Leena B. Mithal, MD, MSCI, Division of Infectious Diseases, Department of Pediatrics, Ann and Robert H. Lurie Children's Hospital of Chicago and Feinberg School of Medicine, Northwestern University, 225 E Chicago Ave, Box #20, Chicago, IL 60611
| | - Kerri Z. Machut
- Division of Neonatology, Department of Pediatrics, Ann and Robert H. Lurie Children's Hospital of Chicago and Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - William J. Muller
- Division of Infectious Diseases, Department of Pediatrics, Ann and Robert H. Lurie Children's Hospital of Chicago and Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Larry K. Kociolek
- Division of Infectious Diseases, Department of Pediatrics, Ann and Robert H. Lurie Children's Hospital of Chicago and Feinberg School of Medicine, Northwestern University, Chicago, IL
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39
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Heald-Sargent T, Muller WJ, Zheng X, Rippe J, Patel AB, Kociolek LK. Age-Related Differences in Nasopharyngeal Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Levels in Patients With Mild to Moderate Coronavirus Disease 2019 (COVID-19). JAMA Pediatr 2020; 174:902-903. [PMID: 32745201 PMCID: PMC7393583 DOI: 10.1001/jamapediatrics.2020.3651] [Citation(s) in RCA: 214] [Impact Index Per Article: 53.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
This cohort study investigates age-related differences in nasopharyngeal severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) levels in patients with mild to moderate coronavirus disease 2019 (COVID-19).
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Affiliation(s)
- Taylor Heald-Sargent
- Division of Infectious Diseases, Department of Pediatrics, Ann & Robert H. Lurie Children’s Hospital, Chicago, Illinois
| | - William J. Muller
- Division of Infectious Diseases, Department of Pediatrics, Ann & Robert H. Lurie Children’s Hospital, Chicago, Illinois,Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Xiaotian Zheng
- Division of Infectious Diseases, Department of Pediatrics, Ann & Robert H. Lurie Children’s Hospital, Chicago, Illinois,Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Jason Rippe
- Division of Infectious Diseases, Department of Pediatrics, Ann & Robert H. Lurie Children’s Hospital, Chicago, Illinois
| | - Ami B. Patel
- Division of Infectious Diseases, Department of Pediatrics, Ann & Robert H. Lurie Children’s Hospital, Chicago, Illinois,Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Larry K. Kociolek
- Division of Infectious Diseases, Department of Pediatrics, Ann & Robert H. Lurie Children’s Hospital, Chicago, Illinois,Northwestern University Feinberg School of Medicine, Chicago, Illinois
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40
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Patel AB, Clifford A, Creaden J, Kato K, Malakooti MR, Muller WJ, O’Donnell A, Reynolds S, Richey K, Rippe J, Wheeler DS, Kociolek LK. Severe Acute Respiratory Syndrome Coronavirus 2 Point Prevalence Among Asymptomatic Hospitalized Children and Subsequent Healthcare Worker Evaluation. J Pediatric Infect Dis Soc 2020; 9:617-619. [PMID: 32857134 PMCID: PMC7499659 DOI: 10.1093/jpids/piaa102] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 08/27/2020] [Indexed: 11/17/2022]
Abstract
Asymptomatic severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) carriage among hospitalized children and risk of transmission to healthcare workers (HCWs) was evaluated by point prevalence survey. We estimated 1-2% prevalence of SARS-CoV-2 among children without coronavirus disease 2019 symptoms. There was no secondary transmission among HCWs exposed to these patients.
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Affiliation(s)
- Ami B Patel
- Ann & Robert H. Lurie Children’s Hospital of Chicago,Northwestern University Feinberg School of Medicine, Chicago IL,Corresponding Author: Ami B. Patel, MD MPH, Division of Pediatric Infectious Diseases, Ann & Robert H. Lurie Children’s Hospital of Chicago, 225 E. Chicago Ave, Box 20, Chicago, Illinois 60611, , Phone: (312) 227-4080
| | | | - Julie Creaden
- Ann & Robert H. Lurie Children’s Hospital of Chicago
| | - Kimberly Kato
- Ann & Robert H. Lurie Children’s Hospital of Chicago
| | - Marcelo R Malakooti
- Ann & Robert H. Lurie Children’s Hospital of Chicago,Northwestern University Feinberg School of Medicine, Chicago IL
| | - William J Muller
- Ann & Robert H. Lurie Children’s Hospital of Chicago,Northwestern University Feinberg School of Medicine, Chicago IL
| | | | - Sally Reynolds
- Ann & Robert H. Lurie Children’s Hospital of Chicago,Northwestern University Feinberg School of Medicine, Chicago IL
| | - Karen Richey
- Ann & Robert H. Lurie Children’s Hospital of Chicago
| | - Jason Rippe
- Ann & Robert H. Lurie Children’s Hospital of Chicago
| | - Derek S Wheeler
- Ann & Robert H. Lurie Children’s Hospital of Chicago,Northwestern University Feinberg School of Medicine, Chicago IL
| | - Larry K Kociolek
- Ann & Robert H. Lurie Children’s Hospital of Chicago,Northwestern University Feinberg School of Medicine, Chicago IL,Alternate Author: Larry K. Kociolek, MD MSCI, Division of Pediatric Infectious Diseases, Ann & Robert H. Lurie Children’s Hospital of Chicago, 225 E. Chicago Ave, Box 20, Chicago, Illinois 60611, , Phone: (708) 932-4593
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41
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Abstract
Fidaxomicin is an oral narrow-spectrum novel 18-membered macrocyclic antibiotic that was initially approved in 2011 by the US FDA for the treatment of Clostridioides difficile infections (CDI) in adults. In February 2020, the FDA approved fidaxomicin for the treatment of CDI in children age >6 months. In adults, fidaxomicin is as efficacious as vancomycin in treating CDI and reduces the risk of recurrent CDI. An investigator-blinded, randomized, multicenter, multinational clinical trial comparing the efficacy and safety of fidaxomicin with vancomycin in children was recently published confirming similar findings as previously reported in adults. Fidaxomicin is the first FDA-approved treatment for CDI in children and offers a promising option for reducing recurrent CDI in this population.
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Affiliation(s)
- Andrew M Skinner
- Department of Medicine, Division of Infectious Diseases, Loyola University Medical Center, Maywood, IL, USA
| | - Tonya Scardina
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Larry K Kociolek
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.,Department of Pediatrics, Division of Pediatric Infectious Diseases, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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42
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Scardina T, Stach L, Sun S, Kociolek LK, Reuter C, Vogt M, Patel S. Documentation of Indications: Agreement Between Order Entry and Clinical Notes and Effect on Time to Antibiotic Administration. J Pharm Pract 2020; 35:13-19. [PMID: 32643519 DOI: 10.1177/0897190020938225] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND/OBJECTIVES Antibiotic indication documentation at the time of order entry is mandated by the Joint Commission. Inclusion of indication at order entry may have an impact on the time to administration. Our primary objective was to evaluate agreement between indication selected during order entry and clinical notes. Our secondary objective was to observe if there was a change in time to administration after indications were required during order entry. METHODS Patients ≤18 years old who received ≥1 dose of vancomycin or ceftriaxone during a preintervention period and 3 postintervention periods were included. Indication for use, agreement between order and clinical note, and timing of antibiotic administration were collected. RESULTS Most common indication for vancomycin (total: 789) was sepsis (26%, n = 204). Common indications for ceftriaxone (total: 1071) were sepsis (12%, n = 127), perforated appendicitis (12%, n = 125), and urinary tract infection (10%, n = 107). Postintervention, agreement between the indication selected during order entry and indication documented in clinical note for ceftriaxone and vancomycin orders were 41% and 46%, respectively. Median time to administration decreased among patients who received ceftriaxone (P < .01) but had no significant impact on time to administration of vancomycin (P = .49). CONCLUSIONS Indication for ceftriaxone and vancomycin selected during order entry and reported in clinical notes inconsistently matched. Inclusion of antibiotic indication may impact time to administration.
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Affiliation(s)
- Tonya Scardina
- Ann & Robert H. Lurie Children's Hospital of Chicago, IL, USA
| | | | - Shan Sun
- Ann & Robert H. Lurie Children's Hospital of Chicago, IL, USA
| | - Larry K Kociolek
- Ann & Robert H. Lurie Children's Hospital of Chicago, IL, USA.,Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Caroline Reuter
- Ann & Robert H. Lurie Children's Hospital of Chicago, IL, USA
| | - Michael Vogt
- Ann & Robert H. Lurie Children's Hospital of Chicago, IL, USA
| | - Sameer Patel
- Ann & Robert H. Lurie Children's Hospital of Chicago, IL, USA.,Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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43
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Yin J, Kociolek LK, Same RG, Hsu AJ, Amoah J, Tamma PD. Corrigendum to: Oral Vancomycin May Be Associated With Earlier Symptom Resolution Than Metronidazole for Hospitalized Children With Nonsevere Clostridioides difficile Infections. Open Forum Infect Dis 2020; 7:ofaa041. [PMID: 32110682 PMCID: PMC7041126 DOI: 10.1093/ofid/ofaa041] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Jianyi Yin
- Division of Gastroenterology and Hepatology, Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Larry K Kociolek
- Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Rebecca G Same
- Division of Pediatric Infectious Diseases, Department of Pediatrics, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Alice J Hsu
- The Johns Hopkins Hospital, Department of Pharmacy, Baltimore, Maryland
| | - Joe Amoah
- Division of Pediatric Infectious Diseases, Department of Pediatrics, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Pranita D Tamma
- Division of Pediatric Infectious Diseases, Department of Pediatrics, The Johns Hopkins University School of Medicine, Baltimore, Maryland
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44
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Cotter JM, Nicholson MR, Kociolek LK. An Infectious Diseases Perspective on Fecal Microbiota Transplantation for Clostridioides difficile Infection in Children. J Pediatric Infect Dis Soc 2019; 8:580-584. [PMID: 31550348 PMCID: PMC7317149 DOI: 10.1093/jpids/piz062] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2019] [Accepted: 08/06/2019] [Indexed: 01/05/2023]
Abstract
Fecal microbiota transplantation (FMT) is efficacious for treatment of recurrent Clostridioides difficile infections (rCDIs). Pediatric experience with FMT for rCDIs is increasing, particularly at large centers. While retrospective studies suggest that FMT is generally safe in the short term, particularly in immunocompetent patients and with rigorous donor screening, additional large prospective studies are needed. This particularly includes those at high risk for infectious complications, such as immunocompromised hosts. Further, long-term implications of altering the intestinal microbiome with FMT are not well understood. The role of FMT in children, particularly in high-risk patients, will require continual reexamination with future availability of pediatric safety and efficacy data. This review summarizes key points for infectious diseases physicians to consider when evaluating a child for FMT.
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Affiliation(s)
- Jillian M Cotter
- Department of Pediatrics, University of Colorado School of Medicine, Division of Hospital Medicine, Children’s Hospital Colorado, Aurora
| | - Maribeth R Nicholson
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Larry K Kociolek
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Division of Infectious Diseases, Ann & Robert H. Lurie Children’s Hospital of Chicago, Illinois
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45
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Yin J, Kociolek LK, Same RG, Hsu AJ, Amoah J, Tamma PD. Oral Vancomycin May Be Associated With Earlier Symptom Resolution Than Metronidazole for Hospitalized Children With Nonsevere Clostridiodes difficile Infections. Open Forum Infect Dis 2019; 6:ofz492. [PMID: 31950069 PMCID: PMC6954469 DOI: 10.1093/ofid/ofz492] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Accepted: 11/12/2019] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE National guidelines recommend oral vancomycin over oral metronidazole as first-line treatment for nonsevere Clostridioides difficile infection (CDI) in adults. Guidelines recommend metronidazole for children with nonsevere CDI, emphasizing that comparative effectiveness studies comparing the relative efficacy of vancomycin and metronidazole are lacking in children. METHOD We conducted an observational study of hospitalized children with nonsevere CDI treated with metronidazole versus vancomycin using an inverse probability of treatment-weighted propensity-score analysis. All of the following criteria had to be present for children with positive CDI testing for study eligibility: (1) ≥3 new-onset unformed stools within a 24-hour period; (2) 2-17 years of age; (3) hospitalization for ≥48 hours for CDI; (4) no laxative use ≤48 hours; (5) no alternate etiology for diarrhea; (6) no previous episode of CDI ≤3 months; (7) no concurrent non-CDI-targeted antibiotic therapy, and (8) no severe or fulminant CDI. RESULTS One hundred ninety-two patients met eligibility criteria; 141 (73.4%) received oral metronidazole and 51 (26.6%) children received oral vancomycin. Baseline characteristics were similar between the 2 groups in the weighted cohort. Of 141 patients, 101 (71.7%) children receiving metronidazole had clinical improvement by day 5, whereas 44 of 51 (86.3%) cases resolved with vancomycin (odds ratio, 0.40; 95% confidence interval, 0.17-0.97; P = .04). The odds of CDI recurrence within 12 weeks were similar between the groups. CONCLUSIONS Our study suggests that children with nonsevere CDI have earlier resolution of clinical symptoms when prescribed vancomycin compared with metronidazole. Large interventional studies are necessary to evaluate the reproducibility of our findings.
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Affiliation(s)
- Jianyi Yin
- Division of Gastroenterology and Hepatology, Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Larry K Kociolek
- Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Rebecca G Same
- Division of Pediatric Infectious Diseases, Department of Pediatrics, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Alice J Hsu
- The Johns Hopkins Hospital, Department of Pharmacy, Baltimore, Maryland
| | - Joe Amoah
- Division of Pediatric Infectious Diseases, Department of Pediatrics, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Pranita D Tamma
- Division of Pediatric Infectious Diseases, Department of Pediatrics, The Johns Hopkins University School of Medicine, Baltimore, Maryland
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46
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Kociolek LK, Gerding DN, Espinosa RO, Patel SJ, Shulman ST, Ozer EA. Clostridium difficile Whole Genome Sequencing Reveals Limited Transmission Among Symptomatic Children: A Single-Center Analysis. Clin Infect Dis 2019; 67:229-234. [PMID: 29370348 DOI: 10.1093/cid/ciy060] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2017] [Accepted: 01/20/2018] [Indexed: 01/05/2023] Open
Abstract
Background Although pediatric Clostridium difficile infections (CDIs) are increasing, C. difficile transmission patterns among children are poorly understood. Methods We performed whole genome sequencing (WGS) on C. difficile isolates collected from children diagnosed with CDI between December 2012 and December 2013 at a single academic medical center. Genome sequences of isolates from CDIs diagnosed ≥8 weeks after study initiation were compared to all study isolate genome sequences. Among patients with isogenic isolates (≤2-3 core genome single nucleotide variants [SNVs] identified by pairwise SNV analyses), common inpatient and/or outpatient healthcare exposures were investigated. Results Among 131 CDIs in 107 children, WGS identified 104 genetically distinct isolates. Of 84 incident CDIs occurring ≥8 weeks after study initiation, only 10 (11.9%) were caused by a strain isogenic to another cohort CDI isolate (putative transmission events). Proportions of each CDI class putatively associated with transmission were hospital-onset healthcare facility-associated (HCFA), 2/16 (12.5%); community-onset HCFA, 1/17 (5.9%); indeterminate, 1/11 (9.1%); community-associated (CA), 5/40 (12.5%); and recurrent, 1/21 (4.8%). Transmission events among CA and HCFA CDIs were similarly infrequent (5/40 [12.5%] vs 3/33 [9.1%]; P = .64). Shared healthcare facility exposures were only identified among 7/10 putative transmission events. Potential community transmission (same postal code) was not identified. Conclusions WGS identified a highly diverse group of C. difficile isolates among children with CDI, including those with HCFA CDI. Clostridium difficile transmission among symptomatic children was very uncommon. Among putatively transmitted cases, investigation of shared healthcare exposures often did not identify a potential transmission source.
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Affiliation(s)
- Larry K Kociolek
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago.,Division of Infectious Diseases, Ann & Robert H. Lurie Children's Hospital of Chicago
| | - Dale N Gerding
- Department of Medicine, Loyola University Chicago Stritch School of Medicine, Maywood.,Department of Medicine, Edward Hines, Jr. Veterans Administration Hospital, Hines
| | - Robyn O Espinosa
- Division of Infectious Diseases, Ann & Robert H. Lurie Children's Hospital of Chicago
| | - Sameer J Patel
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago.,Division of Infectious Diseases, Ann & Robert H. Lurie Children's Hospital of Chicago
| | - Stanford T Shulman
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago.,Division of Infectious Diseases, Ann & Robert H. Lurie Children's Hospital of Chicago
| | - Egon A Ozer
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Ochfeld E, Balmert LC, Patel SJ, Muller WJ, Kociolek LK. Risk factors for Clostridioides (Clostridium) difficile infection following solid organ transplantation in children. Transpl Infect Dis 2019; 21:e13149. [PMID: 31332916 DOI: 10.1111/tid.13149] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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: 04/08/2019] [Revised: 06/30/2019] [Accepted: 07/07/2019] [Indexed: 12/24/2022]
Abstract
BACKGROUND Clostridioides (Clostridium) difficile infection (CDI) in pediatric solid organ transplant (SOT) recipients is a growing problem, though CDI risk factors in this population are poorly understood. Our objective was to characterize CDI risk factors in pediatric SOT recipients. METHODS This retrospective case-control study, performed at a single freestanding academic children's hospital, included all SOT recipients age 1-22 years who were tested for C. difficile by toxin B gene PCR between August 2009 and August 2017. CDI risk factors were assessed by comparing PCR-positive and PCR-negative cases by generalized linear mixed models. RESULTS Between August 2009 and August 2017, 409 SOTs were performed of which 138 (33.7%), 134 (32.8%), 131 (32.0%), and 6 (1.5%) were kidney, liver, heart, and small intestine transplants, respectively. Of 205 SOT recipients were tested for CDI, with 723 C. difficile PCR tests performed among these patients. 68/205 (33%) patients developed CDI at least once during the study period. Median (interquartile range) time to diagnosis of first CDI following SOT was 8.9 (1.2, 19.6) months. CDI was independently associated with calcineurin inhibitor use at time of C. difficile testing (odds ratio [OR] 2.38, 95% confidence interval [CI] 1.08, 5.24, P = 0.03) and systemic antibiotic exposure within 30 days of C. difficile testing (OR 1.74, 95% CI 1.08, 2.79, P = 0.02). CONCLUSIONS CDI is a common, relatively late post-transplant complication and independently associated with calcineurin inhibitor and systemic antibiotic exposure. The potential impact of specific immunosuppressive drug and antibiotic selection on CDI risk reduction requires further investigation.
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Affiliation(s)
- Elisa Ochfeld
- Pediatric Allergy-Immunology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.,Division of Allergy-Immunology, Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Lauren C Balmert
- Department of Preventive Medicine-Biostatistics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Sameer J Patel
- Pediatric Infectious Diseases, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.,Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - William J Muller
- Pediatric Infectious Diseases, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.,Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Larry K Kociolek
- Pediatric Infectious Diseases, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.,Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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48
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Kociolek LK, Ozer EA, Gerding DN, Hecht DW, Patel SJ, Hauser AR. Whole-genome analysis reveals the evolution and transmission of an MDR DH/NAP11/106 Clostridium difficile clone in a paediatric hospital. J Antimicrob Chemother 2019; 73:1222-1229. [PMID: 29342270 DOI: 10.1093/jac/dkx523] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Accepted: 12/13/2017] [Indexed: 02/07/2023] Open
Abstract
Background Clostridium difficile strain DH/NAP11/106, a relatively antibiotic-susceptible strain, is now the most common cause of C. difficile infection (CDI) among adults in the USA. Objectives To identify mechanisms underlying the evolution and transmission of an MDR DH/NAP11/106 clone. Methods WGS (Illumina MiSeq), restriction endonuclease analysis (REA) and antibiotic susceptibility testing were performed on 134 C. difficile isolates collected from paediatric patients with CDI over a 2 year period. Results Thirty-one of 134 (23%) isolates were REA group DH. Pairwise single-nucleotide variant (SNV) analyses identified a DH clone causing seven instances of CDI in two patients. During the 337 days between the first and second CDI, Patient 1 (P1) received 313 days of antibiotic therapy. Clindamycin and rifaximin resistance, and reduced vancomycin susceptibility (MIC 0.5-2 mg/L), were newly identified in the relapsed isolate. This MDR clone was transmitted to Patient 2 (P2) while P1 and P2 received care in adjacent private rooms. P1 and P2 each developed two additional CDI relapses. Comparative genomics analyses demonstrated SNVs in multiple antibiotic resistance genes, including rpoB (rifaximin resistance), gyrB and a gene encoding PBP; gyrB and PBP mutations did not consistently confer a resistance phenotype. The clone also acquired a 46 000 bp genomic element, likely a conjugative plasmid, which contained ermB (clindamycin resistance). The element shared 99% identity with the genomic sequence of Faecalibacterium prausnitzii, an enteric commensal. Conclusions These data highlight the emergence of MDR in C. difficile strain DH/NAP11/106 through multiple independent mechanisms probably as a consequence of profound antibiotic pressure.
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Affiliation(s)
- Larry K Kociolek
- Ann & Robert H. Lurie Children's Hospital of Chicago, 225 E. Chicago Ave, Chicago, IL 60611, USA.,Northwestern University Feinberg School of Medicine, 320 E. Superior St, Chicago, IL 60611, USA
| | - Egon A Ozer
- Northwestern University Feinberg School of Medicine, 320 E. Superior St, Chicago, IL 60611, USA
| | - Dale N Gerding
- Loyola University Chicago Stritch School of Medicine, 2160 S. 1st Ave, Maywood, IL 60153, USA.,Edward Hines, Jr. Veterans Administration Hospital, 5000 S. 5th Ave, Hines, IL 60141, USA
| | - David W Hecht
- Loyola University Chicago Stritch School of Medicine, 2160 S. 1st Ave, Maywood, IL 60153, USA.,Loyola University Medical Center, 2160 S. 1st Ave, Maywood, IL 60153, USA
| | - Sameer J Patel
- Ann & Robert H. Lurie Children's Hospital of Chicago, 225 E. Chicago Ave, Chicago, IL 60611, USA.,Northwestern University Feinberg School of Medicine, 320 E. Superior St, Chicago, IL 60611, USA
| | - Alan R Hauser
- Northwestern University Feinberg School of Medicine, 320 E. Superior St, Chicago, IL 60611, USA
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49
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Forkpa H, Rupp AH, Shulman ST, Patel SJ, Gray EL, Zheng X, Bovee M, Kociolek LK. Association Between Children's Hospital Visitor Restrictions and Healthcare-Associated Viral Respiratory Infections: A Quasi-Experimental Study. J Pediatric Infect Dis Soc 2019; 9:240-243. [PMID: 30989226 PMCID: PMC7107505 DOI: 10.1093/jpids/piz023] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [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: 10/19/2018] [Accepted: 03/21/2019] [Indexed: 12/29/2022]
Abstract
We investigated the effect of annual winter visitor restrictions on hospital respiratory virus transmission. The healthcare-associated (HA) viral respiratory infection (VRI) transmission index (number of HA VRIs per 100 inpatient community-associated VRIs) was 59% lower during the months in which visitor restrictions were implemented. These data prompt consideration for instituting year-round visitor restrictions.
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Affiliation(s)
- Hawa Forkpa
- Departments of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Angela H Rupp
- Infection Prevention and Control, Ann & Robert H. Lurie Children’s Hospital of Chicago, Illinois
| | - Stanford T Shulman
- Departments of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois,Infection Prevention and Control, Ann & Robert H. Lurie Children’s Hospital of Chicago, Illinois
| | - Sameer J Patel
- Departments of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Elizabeth L Gray
- Departments of Preventive Medicine-Biostatistics, and Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Xiaotian Zheng
- Departments of Pathology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Maria Bovee
- Infection Prevention and Control, Ann & Robert H. Lurie Children’s Hospital of Chicago, Illinois
| | - Larry K Kociolek
- Departments of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois,Infection Prevention and Control, Ann & Robert H. Lurie Children’s Hospital of Chicago, Illinois,Correspondence: L. K. Kociolek, MD, MSCI, 320 E. Superior St, Searle 15–560, Chicago, IL 60611 ()
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50
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Kociolek LK, Perdue ER, Fawley WN, Wilcox MH, Gerding DN, Johnson S. Correlation between restriction endonuclease analysis and PCR ribotyping for the identification of Clostridioides (Clostridium) difficile clinical strains. Anaerobe 2018; 54:1-7. [PMID: 30009944 PMCID: PMC6924008 DOI: 10.1016/j.anaerobe.2018.07.004] [Citation(s) in RCA: 6] [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] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 07/03/2018] [Accepted: 07/12/2018] [Indexed: 01/05/2023]
Abstract
Restriction endonuclease analysis (REA) and PCR ribotyping are two typing systems that have been frequently utilized for molecular epidemiologic characterization of Clostridioides (Clostridium) difficile. To correlate typing data obtained from each method, we performed both REA and PCR ribotyping on a large and diverse set of historical and contemporary C. difficile infection clinical isolates. Eighty isolates were selected from each reference laboratory in the United States (Microbiology Reference Laboratory, Hines VA Medical Center) and United Kingdom (Clostridium difficile Network for England and Northern Ireland laboratory, University of Leeds). The 160 isolates were assigned to 82 unique ribotypes and 51 unique REA groups (116 unique REA types). In general, concordance between typing methods was good. Dendrogram analysis of PCR ribotype band patterns demonstrated close genetic relationships among strain types with discordant REA and ribotype assignments. While REA typing was more discriminatory, several REA types in this study were further discriminated by PCR ribotyping, indicating that discriminatory value of these typing methods may be strain dependent. These data will assist with molecular epidemiologic surveillance of strains identified by these two commonly used C. difficile typing systems.
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Affiliation(s)
- Larry K Kociolek
- Northwestern University Feinberg School of Medicine, 420 E. Superior St, Chicago, IL, 60611, USA; Ann & Robert H. Lurie Children's Hospital of Chicago, 225 E. Chicago Ave., Chicago, IL, 60611, USA.
| | - Eric R Perdue
- Edward Hines, Jr. Veterans Administration Hospital, 5000 5th Ave., Hines, IL, 60141, USA.
| | - Warren N Fawley
- Leeds Teaching Hospitals and University of Leeds, Leeds, LS2 9JT, UK.
| | - Mark H Wilcox
- Leeds Teaching Hospitals and University of Leeds, Leeds, LS2 9JT, UK.
| | - Dale N Gerding
- Edward Hines, Jr. Veterans Administration Hospital, 5000 5th Ave., Hines, IL, 60141, USA; Loyola University Chicago Stritch School of Medicine, 2160 S 1st Ave., Maywood, IL, 60153, USA.
| | - Stuart Johnson
- Edward Hines, Jr. Veterans Administration Hospital, 5000 5th Ave., Hines, IL, 60141, USA; Loyola University Chicago Stritch School of Medicine, 2160 S 1st Ave., Maywood, IL, 60153, USA.
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