2 results
Pediatric research priorities in healthcare-associated infections and antimicrobial stewardship
- Susan E. Coffin, Francisca Abanyie, Kristina Bryant, Joseph Cantey, Anthony Fiore, Stephanie Fritz, Judith Guzman-Cottrill, Adam L. Hersh, W. Charles Huskins, Larry K. Kociolek, Matthew Kronman, Ebbing Lautenbach, Grace Lee, Matthew Linam, Latania K. Logan, Aaron Milstone, Jason Newland, A. Christine Nyquist, Debra L. Palazzi, Sameer Patel, Karen Puopolo, Sujan C. Reddy, Lisa Saiman, Thomas Sandora, Andi L. Shane, Michael Smith, Pranita D. Tamma, Theoklis Zaoutis, Danielle Zerr, Jeffrey S. Gerber, for the CDC Prevention Epicenters Program
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- Journal:
- Infection Control & Hospital Epidemiology / Volume 42 / Issue 5 / May 2021
- Published online by Cambridge University Press:
- 26 November 2020, pp. 519-522
- Print publication:
- May 2021
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- Article
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Objective:
To develop a pediatric research agenda focused on pediatric healthcare-associated infections and antimicrobial stewardship topics that will yield the highest impact on child health.
Participants:The study included 26 geographically diverse adult and pediatric infectious diseases clinicians with expertise in healthcare-associated infection prevention and/or antimicrobial stewardship (topic identification and ranking of priorities), as well as members of the Division of Healthcare Quality and Promotion at the Centers for Disease Control and Prevention (topic identification).
Methods:Using a modified Delphi approach, expert recommendations were generated through an iterative process for identifying pediatric research priorities in healthcare associated infection prevention and antimicrobial stewardship. The multistep, 7-month process included a literature review, interactive teleconferences, web-based surveys, and 2 in-person meetings.
Results:A final list of 12 high-priority research topics were generated in the 2 domains. High-priority healthcare-associated infection topics included judicious testing for Clostridioides difficile infection, chlorhexidine (CHG) bathing, measuring and preventing hospital-onset bloodstream infection rates, surgical site infection prevention, surveillance and prevention of multidrug resistant gram-negative rod infections. Antimicrobial stewardship topics included β-lactam allergy de-labeling, judicious use of perioperative antibiotics, intravenous to oral conversion of antimicrobial therapy, developing a patient-level “harm index” for antibiotic exposure, and benchmarking and or peer comparison of antibiotic use for common inpatient conditions.
Conclusions:We identified 6 healthcare-associated infection topics and 6 antimicrobial stewardship topics as potentially high-impact targets for pediatric research.
Escherichia coli Antibiotic Susceptibility Patterns for Infants Admitted to NICUs Across the United States from 2009 to 2017
- Dustin Flannery, Ibukun Akinboyo, Sagori Mukhopadhyay, Alison Tribble, Lihai Song, Feiyan Chen, Jeffrey Gerber, Karen Puopolo
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- Journal:
- Infection Control & Hospital Epidemiology / Volume 41 / Issue S1 / October 2020
- Published online by Cambridge University Press:
- 02 November 2020, pp. s34-s35
- Print publication:
- October 2020
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- Article
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Background:Escherichia coli (E. coli) is a leading cause of infections among term and preterm newborn infants. Continued surveillance of neonatal E. coli antibiotic susceptibility patterns is important to optimize empiric antibiotic prescription for infants at risk for infection, in light of evolving reports of multidrug-resistant gram-negative bacteria in all settings. Our objective was to determine E. coli epidemiology and antibiotic susceptibility patterns among a large sample of infants admitted to neonatal intensive care units (NICUs) across the United States from 2009 to 2017. Methods: Retrospective observational study using the Premier Database, including infants born from 2009 to 2017 and admitted to academic or community NICUs contributing microbiology data during the study period. We analyzed antibiotic susceptibilities for E. coli isolated from blood, cerebrospinal fluid, and urine. We focused on clinically relevant and priority susceptibility categories: (1) ampicillin nonsusceptible; (2) aminoglycoside nonsusceptible; (3) carbapenem nonsusceptible; and (4) extended-spectrum β-lactamase (ESBL; phenotypic definition). We determined the proportion of infants with nonsusceptible organisms in each category by year and tested for changes over time. Lastly, we assessed susceptibility patterns by specimen source, birthweight, and timing of infection. Results: Of the 117,484 included infants, 733 (0.6%) had at least 1 E. coli episode, of which 721 (98.4%) had available susceptibility results, from 69 centers. Patient and center characteristics of infants with E. coli are shown in Table 1. Most organisms were tested against ampicillin (99.9%), gentamicin (99.6%), and ceftriaxone (91.5%). Figure 1 shows nonsusceptibility rates for the categories of interest. Overall, ampicillin nonsusceptibility ranged from 63.3% to 68.6% per year (mean, 66.8%±1.5%); aminoglycoside nonsusceptibility ranged from 10.7% to 23.2% (mean, 16.8%±4.5%); carbapenem nonsusceptibility was 0% for all years; and ESBL ranged from 1.2% to 11.3% (mean, 5.1%±3.4%). We detected no statistically significant trends for any of the categories of interest over time (all P > .05), and susceptibility trends were consistent when repeated by specimen source, birthweight, and timing of infection. Conclusions: We found stable, yet concerning, patterns of E. coli antibiotic nonsusceptibility among infants admitted to NICUs across the United States from 2009 to 2017. Rates of ampicillin nonsusceptibility and aminoglycoside nonsusceptibility were higher than previous reports. ESBL E. coli rates were low but present among neonatal patients. No carbapenem nonsusceptible E. coli was identified. These findings can inform empiric antibiotic prescription for infants admitted to NICUs across the United States.
Funding: None
Disclosures: None