4 results
Clostridioides difficile infection (CDI) treatment outcomes and recurrence factor at a pediatric hospital
- Martin Tuan Tran, Jasjit Singh, Wendi Gornick, Beth Huff, Negar Ashouri
-
- Journal:
- Antimicrobial Stewardship & Healthcare Epidemiology / Volume 2 / Issue S1 / July 2022
- Published online by Cambridge University Press:
- 16 May 2022, p. s28
-
- Article
-
- You have access Access
- Open access
- Export citation
-
Background: CDI is the single most common cause of nosocomial diarrhea in both adults and children. Available data regarding treatment outcomes in hospitalized children remain limited. CDI recurrence in children has been reported in 20%–30% of cases. Consensus regarding the best testing method for CDI is lacking. The 2018 IDSA guideline recommends a multistep algorithm with detection of glutamate dehydrogenase antigen plus toxin, followed by detection of toxigenic C. difficle with nucleic acid amplification test (NAAT) if results are discordant. Methods: We included patients aged 1–26 years admitted from July 2020 through June 2021 with CDI symptoms and positive toxin or NAAT. Healthcare facility-onset CDI (HO-CDI) was defined as positive specimen collected >3 days after admission. Community-onset CDI (CO-CDI) was defined as positive specimen collected ≤3 days after admission. Community-onset healthcare facility-associated CDI (CO-HCFA-CDI) was defined as positive specimen from a patient who was discharged from the facility ≤4 weeks prior. Recurrence was defined as an episode of CDI occurring within 60 days after onset of a previous infection. Results: Mean age of the 63 patients meeting inclusion criteria was 11.2 years (range, 1–21 years). Most patients (n = 37; 58.7%) were male, tested negative for C. difficile toxins (n = 39; 61.9%), and had mild-to-moderate disease (n = 61; 96.8%). Patients with immunocompromising conditions were common, including malignancy (n = 38; 60.3%), inflammatory bowel disorder (n = 8; 12.7%), and history of solid organ transplant (n = 5; 7.9%). Previously healthy without chronic medical conditions were uncommon (n = 4; 6.3%). CO-CDI was most common (n = 26; 41.3%) followed by HO-CDI (n = 23; 36.5%). Also, 34 patients (53.9%) were exposed to antibiotics within the previous 30 days, 16 (47.0%) of whom received 2 or more antibiotics. Sulfamethoxazole–trimethoprim was the most prescribed agent (13; 38%), most (12; 92.3%) as prophylaxis for Pneumocystis jirovecii pneumonia. Furthermore, 42 patients (66.7%) were receiving gastric acid suppressant agents. Laxatives were given to 14 patients (22.2%) within 72 hours of testing, despite electronic reminders. Most were treated with oral vancomycin (n = 46; 73.0%). In addition, 5 patients (7.9%) did not receive CDI treatment at the discretion of the treating physician; all were toxin negative. CDI was cured in 58 patients (92.1%) with only 5 (7.9%) experiencing recurrence infection. Patients testing positive for C. difficile toxin were more likely to experience infection recurrence compared to those with a negative toxin screen: 4 of 24 (16.7%) versus 1 of 39 (2.6%) (P = .044). Conclusions: Most patients with CDI were treated with oral vancomycin at our institution. We observed significantly lower rate of recurrence than previously reported. Toxin-positive patients experienced higher recurrence rate. Prospective studies are needed to confirm our findings.
Funding: None
Disclosures: None
Healthcare-Associated Viral Respiratory Infections in a Pediatric Intensive Care Unit and Cardiovascular Intensive Care Unit
- Kelly Feldman, Jasjit Singh, Wendi Gornick
-
- Journal:
- Antimicrobial Stewardship & Healthcare Epidemiology / Volume 1 / Issue S1 / July 2021
- Published online by Cambridge University Press:
- 29 July 2021, pp. s75-s76
-
- Article
-
- You have access Access
- Open access
- Export citation
-
Background: Healthcare-associated infections (HAIs) affect patient health and are tracked closely by infection prevention. Patients in a pediatric intensive care unit (PICU) acquired viral respiratory infections had longer use of respiratory support. We sought to determine the types of viral respiratory HAIs (VR-HAIs) acquired in the PICU and the characteristics of those affected. Methods: CHOC Children’s Hospital is a 334-bed tertiary-care center. Charts were reviewed on patients with VR-HAIs from fiscal years (FY) 2005–2020. High-risk VR-HAI (HR-VR-HAI) were influenza A and B, respiratory syncytial virus (RSV), adenovirus, parainfluenza, and human metapneumovirus (hMPV, added in FY 2014). Patients in the PICU, cardiovascular ICU (CVICU), and oncology ICU (OICU) with HR-VR-HAIs were reviewed. Patients were categorized according to underlying pathology, immunosuppression, and isolation prior to HR-VR-HAI. Increased respiratory support was defined as any increase from a patient’s baseline support ±24 hours of viral diagnosis: increase in oxygen flow or transition from nasal cannula to high-flow nasal cannula or ventilator support. Antibiotic escalation, defined as initiation of antibiotic therapy for ≥2 days ±24 hours of viral diagnosis or broadening the spectrum of antimicrobials for ≥2 days ±24 hours of viral diagnosis. Results: During FY 2005–2020, there were 204 VR-HAIs: 143 HR-VR-HAIs (70%), of which 39 (27.2%) occurred in ICUs (Figure 1). Most of the HR-VR-HAIs were RSV, parainfluenza, and hMPV (Figure 2). Of 39 patients, 10 (25.6%) had underlying oncologic conditions, 9 of whom were immunosuppressed. Of 39 patients, 16 (41%) had structural cardiac disease, 4 (10.3%) had pulmonary disease, 5 (12.8%) had neurologic disease, and the remaining 4 (10.3%) had other comorbidities. Of 39 patients, 12 (31%) required an increase in respiratory support and 13 (33%) had escalation of antibiotics. Of 39 HR-VR-HAI patients, 2 died within 2 weeks of acquisition. Conclusions: HR-VR-HAIs are uncommon in ICUs. RSV, parainfluenza, and hMPV are the most common, and 1 of 3 of patients required escalation in respiratory support and/or escalation in antibiotics. All patients had underlying comorbidities. In our series, there were 2 deaths within 2 weeks of infection.
Funding: No
Disclosures: None
Figure 1.
Figure 2.
No Device, No Problem? Healthcare-Associated Bloodstream and Urinary Tract Infections in a Children’s Hospital
- Wendi Gornick, Beth Huff, Jasjit Singh
-
- Journal:
- Infection Control & Hospital Epidemiology / Volume 41 / Issue S1 / October 2020
- Published online by Cambridge University Press:
- 02 November 2020, pp. s73-s74
- Print publication:
- October 2020
-
- Article
-
- You have access Access
- Export citation
-
Background: Central-line–associated bloodstream infection (CLABSI) and catheter-associated urinary tract infection (CAUTI) definitions continue to be refined to ensure accuracy. As facilities decrease CLABSI and CAUTI, and as midline catheters become more widely utilized, we sought to understand our non–central-line bloodstream infections (NCLBSI) and non–catheter-associated urinary tract infections (NCAUTI). Total healthcare-associated bloodstream infections (HABSIs) and urinary tract infections (HAUTIs) may provide more objective measures. Methods: The CHOC Children’s Hospital is a 334-bed quaternary-care hospital in Orange, California, with 146 intensive care unit (ICU) beds. We retrospectively reviewed all HABSIs (CLABSIs + NCLBSIs) and HAUTIs (CAUTIs + NCAUTIs) from July 1, 2016, to June 30, 2019, for demographic and microbiologic data. Both HABSI and HAUTI were defined as healthcare-associated infection when the date of event occurs on or after the third calendar day of admission. CLABSI and CAUTI were both defined using CDC-NHSN criteria. Mucosal barrier injury laboratory-confirmed bloodstream infections were excluded. Results: In a 3-year period, there were 100 HABSIs, of which 26 (26%) were NCLBSIs. The mean age for HABSI was 81 months. Enteric gram-negative infections (42%) and Staphylococcus aureus (35%) were the most common etiology for NCLBSI. The most common etiologies for CLABSI were coagulase-negative staphylococci (23%), Staphylococcus aureus (22%), and enteric gram-negatives (22%). Pseudomonas aeruginosa accounted for 16% of CLABSIs, but no NCLBSIs (Fig. 1). There was 1 midline catheter NCLBSI. There were 49 HAUTIs, of which 39 (80%) were NCAUTIs. One asymptomatic bacteremic urinary tract infection was included with the CAUTIs. The mean age for HAUTI was 55 months. The most common etiology of CAUTI was Pseudomonas aeruginosa (50%), whereas for NCAUTI the most common etiology was enteric gram-negative organisms (69%) (Fig. 2). In total, 11 HAUTIs (22%) resulted in secondary sepsis. Most HABSIs and HAUTIs occurred in the ICU setting. There were 6 deaths (6%) among HABSI patients and 3 deaths (8%) among HAUTI patients within 2 weeks of infection (Fig. 3). Conclusions: A preponderance of HABSIs were CLABSIs, but most HAUTIs were NCAUTIs. Although patient demographic and microbiologic differences exist in CLABSIs and NCLBSIs as well as CAUTIs and NCAUTIs, S. aureus and P. aeruginosa are important pathogens, particularly in device-associated infections. Trending total numbers of HABSIs and HAUTIs may be less subjective and may avert the shifting of categories seen with increased use of midline catheters. In addition, non–device-associated infections are potential causes of morbidity and mortality.
Funding: None
Disclosures: None
Prevention of Central Venous Catheter-Associated Bloodstream Infections in Pediatric Intensive Care Units A Performance Improvement Collaborative
- Howard E. Jeffries, Wilbert Mason, Melanie Brewer, Katie L. Oakes, Esther I. Mufioz, Wendi Gornick, Lee D. Flowers, Jodi E. Mullen, Craig Harris Gilliam, Stana Fustar, Cary W. Thurm, Tina Logsdon, William R. Jarvis
-
- Journal:
- Infection Control & Hospital Epidemiology / Volume 30 / Issue 7 / July 2009
- Published online by Cambridge University Press:
- 02 January 2015, pp. 645-651
- Print publication:
- July 2009
-
- Article
- Export citation
-
Objective.
The goal of this effort was to reduce central venous catheter (CVC)-associated bloodstream infections (BSIs) in pediatric intensive care unit (ICU) patients by means of a multicenter evidence-based intervention.
Methods.An observational study was conducted in 26 freestanding children's hospitals with pediatric or cardiac ICUs that joined a Child Health Corporation of America collaborative. CVC-associated BSI protocols were implemented using a collaborative process that included catheter insertion and maintenance bundles, daily review of CVC necessity, and daily goals. The primary goal was either a 50% reduction in the CVC-associated BSI rate or a rate of 1.5 CVC-associated BSIs per 1,000 CVC-days in each ICU at the end of a 9-month improvement period. A 12-month sustain period followed the initial improvement period, with the primary goal of maintaining the improvements achieved.
Results.The collaborative median CVC-associated BSI rate decreased from 6.3 CVC-associated BSIs per 1,000 CVC-days at the start of the collaborative to 4.3 CVC-associated BSIs per 1,000 CVC-days at the end of the collaborative. Sixty-five percent of all participants documented a decrease in their CVC-associated BSI rate. Sixty-nine CVC-associated BSIs were prevented across all teams, with an estimated cost avoidance of $2.9 million. Hospitals were able to sustain their improvements during a 12-month sustain period and prevent another 198 infections.
Conclusions.We conclude that our collaborative quality improvement project demonstrated that significant reduction in CVC-associated BSI rates and related costs can be realized by means of evidence-based prevention interventions, enhanced communication among caregivers, standardization of CVC insertion and maintenance processes, enhanced measurement, and empowerment of team members to enforce adherence to best practices.