ABSTRACT
BACKGROUND: Antimicrobial stewardship programs (ASP) are an effective strategy to ensure that antibiotics are used in accordance with scientific evidence to improve patient outcome, minimize antimicrobial (AM) resistance, and reduce hospital costs. The article describes the impact of the implementation of an ASP on AM prescription errors. METHODS: Prospective, single-center study performed at a tertiary pediatric teaching hospital that actively monitored 13 targeted AMs (amikacin, amphotericin B, cefepime, ceftriaxone, ciprofloxacin, fluconazole, levofloxacin, linezolid, meropenem, piperacillin-tazobactam, tobramycin, vancomycin, and voriconazole) and microbiology data. The ASP was implemented using CareNet and PharmNet. An infectious disease physician and pharmacist determined the need for intervention. RESULTS: The authors screened 5564 dispensed prescriptions of the 13 targeted AMs. The rate of AM errors associated with these was 0.09/1000 doses administered and 5 errors/1000 patient days. CONCLUSIONS: Active surveillance and optimization of computerized physician order entry system allows early detection and intervention of AMs prescriptions errors in hospitalized children.
Subject(s)
Anti-Infective Agents/therapeutic use , Clinical Pharmacy Information Systems , Medical Order Entry Systems , Medication Errors/prevention & control , Medication Errors/statistics & numerical data , Medication Systems, Hospital , Adolescent , Child , Child, Preschool , Cohort Studies , Female , Hospitalization , Humans , Infant , Infant, Newborn , Male , Program Evaluation , Retrospective Studies , Young AdultABSTRACT
Pelvic osteomyelitis is unusual in children. We retrospectively reviewed charts of patients with this infection seen at our institution. From 1998 to 2005, 31 patients with pelvic osteomyelitis were identified: 19 males and 12 females with an age range of 1.5 months to 17 years 9 months. Duration of illness prior to admission ranged from 1 day to 2.5 months. Chief complaints included nonspecific pain, fever, limp, and decreased weight bearing. Microorganisms isolated included Staphylococcus aureus, Pseudomonas aeruginosa, Salmonella, Enterobacter cloacae, and Kingella kingae. Bones involved were acetabulum/ilium (22 patients), ischium (7 patients), and pubis (4 patients); 2 patients had several bones involved. Imaging studies performed included magnetic resonance imaging (21 patients), computed tomography (14 patients), and nuclear bone scan (25 patients). Our study, the largest contemporary series of pediatric pelvic osteomyelitis from one institution, highlights the consequences of prolonged duration of illness and delayed diagnosis.
Subject(s)
Osteomyelitis/physiopathology , Pelvic Infection/physiopathology , Adolescent , Anti-Bacterial Agents/therapeutic use , Child , Child, Preschool , Female , Hospitals, Pediatric , Humans , Infant , Infant, Newborn , Male , Medical Records , Osteomyelitis/drug therapy , Osteomyelitis/microbiology , Pelvic Infection/drug therapy , Pelvic Infection/microbiology , Retrospective StudiesABSTRACT
Increasing concerns regarding smallpox as a biologic weapon have led to massive production of vaccinia vaccine and targeted vaccination campaigns. A regional mail survey was conducted among pediatricians to assess their knowledge and perceptions on smallpox and smallpox vaccine. Fifty-nine percent of the responders were unable to differentiate chickenpox from smallpox, and the majority would not accept vaccination in the absence of an outbreak and would not recommend smallpox vaccine to their patients. Even in previously vaccinated pediatricians, willingness to receive smallpox vaccine is poor and vaccination campaigns in the absence of a smallpox outbreak may not be successful.
Subject(s)
Clinical Competence , Pediatrics , Smallpox Vaccine , Smallpox/prevention & control , Chickenpox/diagnosis , Cross-Sectional Studies , Data Collection , Humans , Smallpox/diagnosis , Smallpox/therapy , Surveys and Questionnaires , VaccinationABSTRACT
Candida species are the most common cause of fungal infections in hospitalized patients. Recent studies have reported a relative reduction in the rates of infection caused by Candida albicans and a shift toward non-albicans Candida spp. Data on the distribution and susceptibility of Candida spp. from children's hospitals are limited. Clinical isolates of Candida were collected from 4 US children's hospitals in 2003. Broth dilution MICs for amphotericin B, fluconazole, voriconazole, caspofungin, posaconazole, and ravuconazole were performed according to National Committee for Clinical Laboratory Standards-approved methodology. A total of 179 clinical isolates were identified and included. Of 179, 77 (43%) were C. albicans. Candida parapsilosis isolates were the second most frequently identified (57/175, 32%), followed by Candida glabrata, Candida tropicalis, and Candida lusitaniae (approximately 8% each). Caspofungin was the most active agent in vitro against all Candida spp. Fluconazole resistance was seen among C. glabrata, C. tropicalis, and Candida krusei isolates. Newer azoles had improved activity against fluconazole-resistant isolates of Candida. Among isolates of C. parapsilosis, nearly 20% were resistant to amphotericin B. The current study highlights the emergence of C. parapsilosis as a distinct pediatric pathogen with clinical and therapeutic implications. Furthermore, our current susceptibility data include newer antifungal agents that appear to be quite active in vitro and may provide new therapeutic options for the treatment of serious yeast infections in children.
Subject(s)
Antifungal Agents/pharmacology , Candida/drug effects , Candida/isolation & purification , Hospitals, Pediatric , Population Surveillance , Antifungal Agents/standards , Candida/classification , Candidiasis/microbiology , Child , Child, Preschool , Drug Resistance, Fungal , Fungemia/microbiology , Humans , Infant , Infant, Newborn , Microbial Sensitivity TestsABSTRACT
We compared oropharyngeal cultures and fluconazole susceptibility for Candida in 100 healthcare workers (HCWs) and 100 non-HCWs. Isolates were identified using standard microbiological methods. Susceptibility was determined by Etest and microtiter method. There was no significant difference in prevalence or species of oropharyngeal Candida between HCWs and non-HCWs. Fluconazole resistance was infrequent.
Subject(s)
Allied Health Personnel , Antifungal Agents/pharmacology , Candida albicans , Fluconazole/pharmacology , Candida albicans/drug effects , Candida albicans/isolation & purification , Cross Infection/epidemiology , Cross Infection/microbiology , Humans , Microbial Sensitivity Tests , PrevalenceABSTRACT
This retrospective cohort analysis examined the risk factors, symptoms, and severity of disease associated with C. difficile in pediatric inpatients. Risk factors for a C. difficile-positive test were an oncologic diagnosis, diarrhea of more than 2 days' duration, and gastrointestinal symptoms, especially abdominal pain. Over a 3.5-year period, there was a total of 22 C. difficile-positive patients, and most had mild, self-limiting diarrheal illness. No cases of C. difficile diarrhea were identified. Seventy-eight percent of the C. difficile-positive patients were found to have alternate risk factors for diarrhea. Our data indicate that C. difficile rarely causes severe diarrhea in pediatric inpatients and that C. difficile testing should be limited to patients with severe prolonged diarrhea and abdominal pain.
