ABSTRACT
We describe a case of croup in a 14-month-old boy caused by severe acute respiratory syndrome coronavirus 2, the virus that causes coronavirus disease 2019. The patient presented with classic signs and symptoms consistent with croup. Workup was remarkable for a positive point-of-care test for severe acute respiratory syndrome coronavirus 2. This case represents recognition of a new clinical entity caused by coronavirus disease 2019.
Subject(s)
COVID-19/diagnosis , Croup/diagnosis , Laryngitis/diagnosis , Tracheitis/diagnosis , COVID-19/complications , COVID-19/therapy , Croup/etiology , Croup/therapy , Humans , Infant , Laryngitis/etiology , Laryngitis/therapy , Male , Tracheitis/etiology , Tracheitis/therapyABSTRACT
The prevalence of pediatric antimicrobial stewardship programs (ASPs) is increasing in acute care facilities across the United States. Over the past several years, the evidence base used to inform effective stewardship practices has expanded, and regulatory interest in stewardship programs has increased. Here, we review approaches for established, hospital-based pediatric ASPs to adapt and report standardized metrics, broaden their reach to specialized populations, expand to undertake novel stewardship initiatives, and implement rapid diagnostics to continue their evolution in improving antimicrobial use and patient outcomes.
Subject(s)
Anti-Bacterial Agents/therapeutic use , Antimicrobial Stewardship , Hospitals, Pediatric/organization & administration , Bacterial Infections/diagnosis , Bacterial Infections/drug therapy , Bacteriological Techniques , Child , Developed Countries , Hospitals, Pediatric/standards , Humans , Medical Staff, Hospital/education , United StatesABSTRACT
The intestinal microbiome is a complex ecosystem of microorganisms that colonize the human gastrointestinal tract. The microbiome evolves rapidly in early life with contributions from diet, genetics and immunomodulatory factors. Changes in composition of the microbiota due to antibiotics may lead to negative long-term effects including obesity and diabetes mellitus, as evidenced by both animal and large human studies. Inappropriate exposures to antibiotics occur frequently in early childhood. Therefore, an evidence-based system of antimicrobial use should be employed by all providers, especially those who care for pediatric patients. This article explores the natural evolution of the intestinal microbiome from the perinatal period into early childhood, the effect of antibiotics on the microbial ecology, and the implications for future health and disease.
