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An Unusual Source of Sepsis in Two Previously Healthy Children.
Frazier SB, Katz S, Wood JB, Cassat JE
(2018) Clin Pediatr (Phila) 57: 1120-1122
MeSH Terms: Anti-Bacterial Agents, Bacteremia, Child, Combined Modality Therapy, Disease Progression, Emergency Service, Hospital, Fluid Therapy, Follow-Up Studies, Humans, Infant, Male, Pneumonia, Bacterial, Pyelonephritis, Risk Assessment, Sampling Studies, Severity of Illness Index, Streptococcal Infections, Treatment Outcome
Added April 3, 2018
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18 MeSH Terms
Utility of Blood Culture Among Children Hospitalized With Community-Acquired Pneumonia.
Neuman MI, Hall M, Lipsett SC, Hersh AL, Williams DJ, Gerber JS, Brogan TV, Blaschke AJ, Grijalva CG, Parikh K, Ambroggio L, Shah SS, Pediatric Research in Inpatient Settings Network
(2017) Pediatrics 140:
MeSH Terms: Adolescent, Anti-Bacterial Agents, Bacteremia, Bacteria, Blood Culture, Child, Child, Preschool, Community-Acquired Infections, Cross-Sectional Studies, Female, Hospitalization, Humans, Infant, Male, Microbial Sensitivity Tests, Penicillins, Pneumonia, Bacterial, Retrospective Studies
Show Abstract · Added July 27, 2018
BACKGROUND AND OBJECTIVES - National guidelines recommend blood cultures for children hospitalized with presumed bacterial community-acquired pneumonia (CAP) that is moderate or severe. We sought to determine the prevalence of bacteremia and characterize the microbiology and penicillin-susceptibility patterns of positive blood culture results among children hospitalized with CAP.
METHODS - We conducted a cross-sectional study of children hospitalized with CAP in 6 children's hospitals from 2007 to 2011. We included children 3 months to 18 years of age with discharge diagnosis codes for CAP using a previously validated algorithm. We excluded children with complex chronic conditions. We reviewed microbiologic data and classified positive blood culture detections as pathogens or contaminants. Antibiotic-susceptibility patterns were assessed for all pathogens.
RESULTS - A total of 7509 children hospitalized with CAP were included over the 5-year study period. Overall, 34% of the children hospitalized with CAP had a blood culture performed; 65 (2.5% of patients with blood cultures; 95% confidence interval [CI]: 2.0%-3.2%) grew a pathogen. accounted for 78% of all detected pathogens. Among detected pathogens, 50 (82%) were susceptible to penicillin. Eleven children demonstrated growth of an organism nonsusceptible to penicillin, representing 0.43% (95% CI: 0.23%-0.77%) of children with blood cultures obtained and 0.15% (95% CI: 0.08%-0.26%) of all children hospitalized with CAP.
CONCLUSIONS - Among children without comorbidities hospitalized with CAP in a non-ICU setting, the rate of bacteremia was low, and isolated pathogens were usually susceptible to penicillin. Blood cultures may not be needed for most children hospitalized with CAP.
Copyright © 2017 by the American Academy of Pediatrics.
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MeSH Terms
Multisite external validation of a risk prediction model for the diagnosis of blood stream infections in febrile pediatric oncology patients without severe neutropenia.
Esbenshade AJ, Zhao Z, Aftandilian C, Saab R, Wattier RL, Beauchemin M, Miller TP, Wilkes JJ, Kelly MJ, Fernbach A, Jeng M, Schwartz CL, Dvorak CC, Shyr Y, Moons KGM, Sulis ML, Friedman DL
(2017) Cancer 123: 3781-3790
MeSH Terms: Bacteremia, Child, Child, Preschool, Datasets as Topic, Febrile Neutropenia, Gram-Negative Bacterial Infections, Humans, Immunocompromised Host, Models, Statistical, Neoplasms, Predictive Value of Tests, Retrospective Studies, Risk, Staphylococcal Infections, Staphylococcus aureus, Uncertainty
Show Abstract · Added April 3, 2018
BACKGROUND - Pediatric oncology patients are at an increased risk of invasive bacterial infection due to immunosuppression. The risk of such infection in the absence of severe neutropenia (absolute neutrophil count ≥ 500/μL) is not well established and a validated prediction model for blood stream infection (BSI) risk offers clinical usefulness.
METHODS - A 6-site retrospective external validation was conducted using a previously published risk prediction model for BSI in febrile pediatric oncology patients without severe neutropenia: the Esbenshade/Vanderbilt (EsVan) model. A reduced model (EsVan2) excluding 2 less clinically reliable variables also was created using the initial EsVan model derivative cohort, and was validated using all 5 external validation cohorts. One data set was used only in sensitivity analyses due to missing some variables.
RESULTS - From the 5 primary data sets, there were a total of 1197 febrile episodes and 76 episodes of bacteremia. The overall C statistic for predicting bacteremia was 0.695, with a calibration slope of 0.50 for the original model and a calibration slope of 1.0 when recalibration was applied to the model. The model performed better in predicting high-risk bacteremia (gram-negative or Staphylococcus aureus infection) versus BSI alone, with a C statistic of 0.801 and a calibration slope of 0.65. The EsVan2 model outperformed the EsVan model across data sets with a C statistic of 0.733 for predicting BSI and a C statistic of 0.841 for high-risk BSI.
CONCLUSIONS - The results of this external validation demonstrated that the EsVan and EsVan2 models are able to predict BSI across multiple performance sites and, once validated and implemented prospectively, could assist in decision making in clinical practice. Cancer 2017;123:3781-3790. © 2017 American Cancer Society.
© 2017 American Cancer Society.
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Heart rate characteristic index monitoring for bloodstream infection in an NICU: a 3-year experience.
Coggins SA, Weitkamp JH, Grunwald L, Stark AR, Reese J, Walsh W, Wynn JL
(2016) Arch Dis Child Fetal Neonatal Ed 101: F329-32
MeSH Terms: Bacteremia, Blood Culture, Cohort Studies, Electronic Health Records, Female, Heart Rate, Humans, Infant, Newborn, Infant, Premature, Intensive Care Units, Neonatal, Male, Monitoring, Physiologic, Neonatal Sepsis, Retrospective Studies, Statistics as Topic, United States
Show Abstract · Added February 21, 2016
BACKGROUND - Bloodstream infection (BSI) among neonatal intensive care unit (NICU) infants is a frequent problem associated with poor outcomes. Monitoring for abnormal heart rate characteristics (HRCs) may decrease infant mortality by alerting clinicians to sepsis before it becomes clinically apparent.
METHODS - HRC scores were acquired using the HRC (HeRO) monitor system from Medical Predictive Science Corporation and entered into the electronic medical record by bedside staff. We retrospectively analysed HRC scores recorded twice daily in the medical record during a 30-month period (1 January 2010 through 30 June 2012) for infants in the NICU at the Monroe Carell Jr. Children's Hospital at Vanderbilt. We identified infants that met Centers for Disease Control criteria for late-onset BSI (>3 days of life) during the study period.
RESULTS - During the study period, we recorded 127 673 HRC scores from 2384 infants. We identified 46 infants with BSI. Although 8% (9701/127 673) of the HRC scores were ≥2 and 1% (1387/127 673) were ≥5, BSI (at any time) was observed in just 5% of patients with HRC scores ≥2, and 9% of patients with HRC scores ≥5. Of infants with BSI, 5/46 (11%) had at least one HRC score ≥5 and 17/46 (37%) had at least one score ≥2 recorded in the 48 h period prior to the evaluation that resulted in the first positive blood culture of the episode.
CONCLUSIONS - In our single-centre retrospective study, elevated HRC scores had limited ability to detect BSI. BSI was infrequent at any time during hospitalisation in infants with significantly elevated HRC scores.
Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/
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16 MeSH Terms
CMOs look at need for blood cultures before prescribing antibiotics.
Ikizler TA
(2015) Nephrol News Issues 29: 32-3
MeSH Terms: Algorithms, Ambulatory Care Facilities, Anti-Bacterial Agents, Bacteremia, Humans, Physician Executives, Practice Patterns, Physicians', Renal Dialysis, United States
Added November 5, 2015
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9 MeSH Terms
Altered neutrophil counts at diagnosis of invasive meningococcal infection in children.
Demissie DE, Kaplan SL, Romero JR, Leake JA, Barson WJ, Halasa NB, Byington CL, Shetty AK, Tan TQ, Hoffman JA, Lin PL, Edwards KM, Mason EO, Cooperstock MS
(2013) Pediatr Infect Dis J 32: 1070-2
MeSH Terms: Adolescent, Bacteremia, Child, Child, Preschool, Humans, Infant, Leukocyte Count, Meningitis, Meningococcal, Meningococcal Infections, Neisseria meningitidis, Neutrophils, Prognosis, Young Adult
Show Abstract · Added May 28, 2014
BACKGROUND - Invasive meningococcal infections can be devastating. Substantial endotoxemia releases mature and immature neutrophils. Endothelial margination of mature neutrophils may increase the immature-to-total neutrophil ratio (ITR). These changes have not been previously well-described in invasive meningococcal disease.
METHODS - Using 2001 to 2011 data from the US Multicenter Meningococcal Surveillance Study, the diagnostic sensitivity and clinical correlates of white blood cell count, absolute neutrophil count (ANC), immature neutrophil count (INC) and ITR were evaluated alone and in combination at the time of diagnosis of invasive meningococcal disease.
RESULTS - Two hundred sixteen patients were evaluated: meningococcemia (65), meningitis (145) and other foci (6). ANC ≤1000/mm(3) or ≥10,000/mm(3) was present in 137 (63%), INC ≥500/mm(3) in 170 (79%) and ITR ≥0.20 in 139 (64%). One or more of these 3 criteria were met in 204 of the 216 (94%). Results were similar for meningococcemia and meningitis subgroups. All 13 cases with mildest disease met 1 or more of the 3 criteria. Eight children presented with ANCs <1000/mm(3): 3 of them died and a fourth required partial amputation in all 4 limbs.
CONCLUSIONS - Invasive meningococcal disease is characterized by striking abnormalities in ANC, INC and/or ITR. Neutropenia was associated with a poor prognosis. Notably, without INCs, 37% of cases would have been missed. Automated methods not measuring immature white blood cells should be avoided when assessing febrile children. Serious infection should be considered when counts meet any of the 3 criteria.
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13 MeSH Terms
Prevalence and outcomes of antimicrobial treatment for Staphylococcus aureus bacteremia in outpatients with ESRD.
Chan KE, Warren HS, Thadhani RI, Steele DJ, Hymes JL, Maddux FW, Hakim RM
(2012) J Am Soc Nephrol 23: 1551-9
MeSH Terms: Anti-Bacterial Agents, Bacteremia, Cefazolin, Comorbidity, Female, Humans, Kidney Failure, Chronic, Longitudinal Studies, Male, Methicillin-Resistant Staphylococcus aureus, Middle Aged, Outpatients, Prevalence, Renal Dialysis, Retrospective Studies, Risk Factors, Staphylococcal Infections, Staphylococcus aureus, Treatment Outcome, United States, Vancomycin
Show Abstract · Added May 20, 2014
Staphylococcus bacteremia is a common and life-threatening medical emergency, but it is treatable with appropriate antibiotic therapy. To identify opportunities that may reduce morbidity and mortality associated with S. aureus, we analyzed data from 293,094 chronic hemodialysis outpatients to characterize practices of antibiotic selection. In the study population, the overall rate of bacteremia was 15.4 per 100 outpatient-years; the incidence rate for methicillin-sensitive (MSSA) was 2.1 per 100 outpatient-years, and the incidence rate for methicillin-resistant (MRSA) S. aureus was 1.9 per 100 outpatient-years. One week after the collection of the index blood culture, 56.1% of outpatients with MSSA bacteremia were receiving vancomycin, and 16.7% of outpatients with MSSA were receiving cefazolin. Among MSSA-bacteremic patients who did not die or get hospitalized 1 week after blood culture collection, use of cefazolin was associated with a 38% lower risk for hospitalization or death compared with vancomycin (adjusted HR=0.62, 95% CI=0.46-0.84). In conclusion, vancomycin is commonly used to treat MSSA bacteremia in outpatients receiving chronic dialysis, but there may be more risk of treatment failure than observed among those individuals who receive a β-lactam antibiotic such as cefazolin.
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21 MeSH Terms
The severity of shock is associated with impaired rates of net alveolar fluid clearance in clinical acute lung injury.
Zeyed YF, Bastarache JA, Matthay MA, Ware LB
(2012) Am J Physiol Lung Cell Mol Physiol 303: L550-5
MeSH Terms: Acute Lung Injury, Adult, Bacteremia, Body Fluids, Humans, Male, Middle Aged, Prospective Studies, Pulmonary Alveoli, Pulmonary Edema, Respiratory Distress Syndrome, Shock, Vasoconstrictor Agents
Show Abstract · Added May 19, 2014
The rate of alveolar fluid clearance (AFC) is associated with mortality in clinical acute lung injury (ALI). Patients with ALI often develop circulatory shock, but how shock affects the rate of AFC is unknown. To determine the effect of circulatory shock on the rate of AFC in patients with ALI, the rate of net AFC was measured in 116 patients with ALI by serial sampling of pulmonary edema fluid. The primary outcome was the rate of AFC in patients with shock compared with those without shock. We also tested the effects of shock severity and bacteremia. Patients with ALI and shock (n = 86) had significantly slower rates of net AFC compared with those without shock (n = 30, P = 0.03), and AFC decreased significantly as the number of vasopressors increased. Patients with positive blood cultures (n = 21) had slower AFC compared with patients with negative blood cultures (n = 96, P = 0.023). In addition, the edema fluid-to-plasma protein ratio, an index of alveolar-capillary barrier permeability, was highest in patients requiring the most vasopressors (P < 0.05). Patients with ALI complicated by circulatory shock and bacteremia had slower rates of AFC compared with patients without shock or bacteremia. An impaired capacity to reabsorb alveolar edema fluid may contribute to high mortality among patients with sepsis-induced ALI. These findings also suggest that vasopressor use may be a marker of alveolar-capillary barrier permeability in ALI and provide justification for new therapies that enhance alveolar epithelial and endothelial barrier integrity in ALI, particularly in patients with shock.
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13 MeSH Terms
STAT1-deficient mice are resistant to cecal ligation and puncture-induced septic shock.
Herzig D, Fang G, Toliver-Kinsky TE, Guo Y, Bohannon J, Sherwood ER
(2012) Shock 38: 395-402
MeSH Terms: Animals, Anti-Bacterial Agents, Bacteremia, Cecum, Cytokines, Disease Models, Animal, Hypothermia, Inflammation, Ligation, Mice, Mice, Knockout, STAT1 Transcription Factor, Shock, Septic, TYK2 Kinase
Show Abstract · Added October 18, 2015
STAT1 (signal transducer and activator of transcription 1) is a member of the JAK-STAT signaling family and plays a key role in facilitating gene transcription in response to activation of the types I and II interferon (IFN) receptors. TYK2 is essential for type I, but not type II, IFN-induced STAT1 activation. Previous studies show that STAT1-deficient mice are resistant to endotoxin-induced shock. The goal of the present study was to assess the response of STAT1- and TYK2-deficient mice to septic shock caused by cecal ligation and puncture (CLP). End points included survival, core temperature, organ injury, systemic cytokine production, and bacterial clearance. Results showed that survival rates were significantly higher in STAT1 knockout (STAT1KO) mice compared with wild-type controls (80% vs. 10%). The improved survival of STAT1KO mice was associated with less hypothermia, metabolic acidosis, hypoglycemia, and hepatocellular injury. Plasma interleukin 6, MIP-2, CXCL10, and IFN-α concentrations were significantly lower in STAT1KO mice than in wild-type mice. In the absence of antibiotic treatment, blood and lung bacterial counts were significantly lower in STAT1KO mice than in controls. However, treatment with antibiotics ablated that difference. A survival advantage was not observed in TYK2-deficient mice compared with control. However, CLP-induced hypothermia and systemic interleukin 6 and CXCL10 production were significantly attenuated in TYK2-deficient mice. These results indicate that STAT1 activation is an important factor in the pathogenesis of CLP-induced septic shock and is associated with the development of systemic inflammation and organ injury. TYK2 activation also appears to contribute to CLP-induced inflammation, but to a lesser extent than STAT1.
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14 MeSH Terms
Use of therapeutic drug monitoring to treat Elizabethkingia meningoseptica meningitis and bacteraemia in an adult.
Neuner EA, Ahrens CL, Groszek JJ, Isada C, Vogelbaum MA, Fissell WH, Bhimraj A
(2012) J Antimicrob Chemother 67: 1558-60
MeSH Terms: Adult, Aged, Anti-Bacterial Agents, Bacteremia, Cerebrospinal Fluid, Drug Monitoring, Flavobacteriaceae, Flavobacteriaceae Infections, Humans, Meningitis, Bacterial, Serum
Added August 21, 2013
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11 MeSH Terms