Doug Brunk

SAN DIEGO – Health care–associated meningitis or ventriculitis continues to occur despite well established preventive methods and is associated with significant morbidity and mortality, a long-term analysis at two hospitals showed.

“Health care–associated meningitis or ventriculitis remains challenging for providers in terms of diagnosis, treatment, and prevention,” Dr. Chanunya Srihawan said at an annual scientific meeting on infectious diseases. “Even though there are a lot of well described methods to minimize the risk of infection, we still see patients with health care–associated meningitis or ventriculitis in the hospital, and most of them have a poor outcome.”

Dr. Srihawan, of the division of infectious diseases in the department of internal medicine at the University of Texas, Houston, and her associates set out to describe the clinical characteristics of patients with health care–associated meningitis or ventriculitis, and to identify risk factors associated with clinical outcomes. They examined data from adult and pediatric patients with a diagnosis of health care–associated meningitis or ventriculitis based on the 2015 Centers for Disease Control and Prevention/National Healthcare Safety Network surveillance definition who were treated at two large tertiary care hospitals in Houston from July 2003 to November 2014.

Patients were prospectively identified by infection control clinicians and by screening of all cerebrospinal fluid samples sent to a central laboratory. The researchers collected patient information on demographics, clinical presentations, laboratory results, imaging studies, treatments, and clinical outcomes. They used Pearson chi-square and Fischer’s exact test for bivariate analysis between baseline variables and outcomes, followed by logistic regression analysis with bootstrap.

Dr. Srihawan reported results from 166 adult and 49 pediatric patients. The median age of patients was 45 years, 45% were white, 26% were Hispanic, 20% were African American, and the remainder were from other ethnic groups. The two most common indications for neurosurgical intervention were hemorrhage (49%) and hydrocephalus (48%), followed by trauma (18%), and brain tumor (11%). The top three neurological signs and symptoms reported were headache (48%), changes in mental status (41%), and nausea/vomiting (39%), followed by focal neurological deficits (33%), neck stiffness (19%), seizures (10%), and photophobia (6%). Nearly three quarters of patients (71%) were admitted to the ICU and 43% received mechanical ventilation for a median of 9 days.

A positive cerebrospinal fluid culture was observed in 106 patients (49%), with the majority of the etiologies being Staphylococcus and Gram-negative rods. An adverse clinical outcome occurred in 167 patients (78%) and was defined as death in 20 patients (9%), persistent vegetative state in 31 patients (14%), severe disability in 77 patients (36%), and moderate disability in 39 patients (18%).

Baseline variables associated with adverse clinical outcomes included age 45 years or older (odds ratio, 11.39), CNS bleeding (OR, 4.37), abnormal neurological exam (OR, 6.51), ICU admission (OR, 5.81), and use of mechanical ventilation (OR, 12.59; P less than .001 for all comparisons). Use of a ventriculoperitoneal shunt was found to be a protective variable (OR, 0.17), which, Dr. Srihawan said, could be explained by the fact most patients who received a ventriculoperitoneal shunt were children who had fewer comorbidities “and tended to be less sick.”

After logistic regression, only three variables remained significantly associated with adverse clinical outcomes: age 45 years or older (OR, 6.47), abnormal neurological exam (OR, 3.04), and use of mechanical ventilation (OR, 5.34).

IDWeek marks the combined annual meetings of the Infectious Diseases Society of America, the Society for Healthcare Epidemiology of America, the HIV Medicine Association, and the Pediatric Infectious Diseases Society. The researchers reported having no financial disclosures.

dbrunk@frontlinemedcom.com

SAN DIEGO – Health care–associated meningitis or ventriculitis continues to occur despite well established preventive methods and is associated with significant morbidity and mortality, a long-term analysis at two hospitals showed.

“Health care–associated meningitis or ventriculitis remains challenging for providers in terms of diagnosis, treatment, and prevention,” Dr. Chanunya Srihawan said at an annual scientific meeting on infectious diseases. “Even though there are a lot of well described methods to minimize the risk of infection, we still see patients with health care–associated meningitis or ventriculitis in the hospital, and most of them have a poor outcome.”

Dr. Srihawan, of the division of infectious diseases in the department of internal medicine at the University of Texas, Houston, and her associates set out to describe the clinical characteristics of patients with health care–associated meningitis or ventriculitis, and to identify risk factors associated with clinical outcomes. They examined data from adult and pediatric patients with a diagnosis of health care–associated meningitis or ventriculitis based on the 2015 Centers for Disease Control and Prevention/National Healthcare Safety Network surveillance definition who were treated at two large tertiary care hospitals in Houston from July 2003 to November 2014.

Patients were prospectively identified by infection control clinicians and by screening of all cerebrospinal fluid samples sent to a central laboratory. The researchers collected patient information on demographics, clinical presentations, laboratory results, imaging studies, treatments, and clinical outcomes. They used Pearson chi-square and Fischer’s exact test for bivariate analysis between baseline variables and outcomes, followed by logistic regression analysis with bootstrap.

Dr. Srihawan reported results from 166 adult and 49 pediatric patients. The median age of patients was 45 years, 45% were white, 26% were Hispanic, 20% were African American, and the remainder were from other ethnic groups. The two most common indications for neurosurgical intervention were hemorrhage (49%) and hydrocephalus (48%), followed by trauma (18%), and brain tumor (11%). The top three neurological signs and symptoms reported were headache (48%), changes in mental status (41%), and nausea/vomiting (39%), followed by focal neurological deficits (33%), neck stiffness (19%), seizures (10%), and photophobia (6%). Nearly three quarters of patients (71%) were admitted to the ICU and 43% received mechanical ventilation for a median of 9 days.

A positive cerebrospinal fluid culture was observed in 106 patients (49%), with the majority of the etiologies being Staphylococcus and Gram-negative rods. An adverse clinical outcome occurred in 167 patients (78%) and was defined as death in 20 patients (9%), persistent vegetative state in 31 patients (14%), severe disability in 77 patients (36%), and moderate disability in 39 patients (18%).

Baseline variables associated with adverse clinical outcomes included age 45 years or older (odds ratio, 11.39), CNS bleeding (OR, 4.37), abnormal neurological exam (OR, 6.51), ICU admission (OR, 5.81), and use of mechanical ventilation (OR, 12.59; P less than .001 for all comparisons). Use of a ventriculoperitoneal shunt was found to be a protective variable (OR, 0.17), which, Dr. Srihawan said, could be explained by the fact most patients who received a ventriculoperitoneal shunt were children who had fewer comorbidities “and tended to be less sick.”

After logistic regression, only three variables remained significantly associated with adverse clinical outcomes: age 45 years or older (OR, 6.47), abnormal neurological exam (OR, 3.04), and use of mechanical ventilation (OR, 5.34).

IDWeek marks the combined annual meetings of the Infectious Diseases Society of America, the Society for Healthcare Epidemiology of America, the HIV Medicine Association, and the Pediatric Infectious Diseases Society. The researchers reported having no financial disclosures.

dbrunk@frontlinemedcom.com

SAN DIEGO – Health care–associated meningitis or ventriculitis continues to occur despite well established preventive methods and is associated with significant morbidity and mortality, a long-term analysis at two hospitals showed.

“Health care–associated meningitis or ventriculitis remains challenging for providers in terms of diagnosis, treatment, and prevention,” Dr. Chanunya Srihawan said at an annual scientific meeting on infectious diseases. “Even though there are a lot of well described methods to minimize the risk of infection, we still see patients with health care–associated meningitis or ventriculitis in the hospital, and most of them have a poor outcome.”

Dr. Srihawan, of the division of infectious diseases in the department of internal medicine at the University of Texas, Houston, and her associates set out to describe the clinical characteristics of patients with health care–associated meningitis or ventriculitis, and to identify risk factors associated with clinical outcomes. They examined data from adult and pediatric patients with a diagnosis of health care–associated meningitis or ventriculitis based on the 2015 Centers for Disease Control and Prevention/National Healthcare Safety Network surveillance definition who were treated at two large tertiary care hospitals in Houston from July 2003 to November 2014.

Patients were prospectively identified by infection control clinicians and by screening of all cerebrospinal fluid samples sent to a central laboratory. The researchers collected patient information on demographics, clinical presentations, laboratory results, imaging studies, treatments, and clinical outcomes. They used Pearson chi-square and Fischer’s exact test for bivariate analysis between baseline variables and outcomes, followed by logistic regression analysis with bootstrap.

Dr. Srihawan reported results from 166 adult and 49 pediatric patients. The median age of patients was 45 years, 45% were white, 26% were Hispanic, 20% were African American, and the remainder were from other ethnic groups. The two most common indications for neurosurgical intervention were hemorrhage (49%) and hydrocephalus (48%), followed by trauma (18%), and brain tumor (11%). The top three neurological signs and symptoms reported were headache (48%), changes in mental status (41%), and nausea/vomiting (39%), followed by focal neurological deficits (33%), neck stiffness (19%), seizures (10%), and photophobia (6%). Nearly three quarters of patients (71%) were admitted to the ICU and 43% received mechanical ventilation for a median of 9 days.

A positive cerebrospinal fluid culture was observed in 106 patients (49%), with the majority of the etiologies being Staphylococcus and Gram-negative rods. An adverse clinical outcome occurred in 167 patients (78%) and was defined as death in 20 patients (9%), persistent vegetative state in 31 patients (14%), severe disability in 77 patients (36%), and moderate disability in 39 patients (18%).

Baseline variables associated with adverse clinical outcomes included age 45 years or older (odds ratio, 11.39), CNS bleeding (OR, 4.37), abnormal neurological exam (OR, 6.51), ICU admission (OR, 5.81), and use of mechanical ventilation (OR, 12.59; P less than .001 for all comparisons). Use of a ventriculoperitoneal shunt was found to be a protective variable (OR, 0.17), which, Dr. Srihawan said, could be explained by the fact most patients who received a ventriculoperitoneal shunt were children who had fewer comorbidities “and tended to be less sick.”

After logistic regression, only three variables remained significantly associated with adverse clinical outcomes: age 45 years or older (OR, 6.47), abnormal neurological exam (OR, 3.04), and use of mechanical ventilation (OR, 5.34).

IDWeek marks the combined annual meetings of the Infectious Diseases Society of America, the Society for Healthcare Epidemiology of America, the HIV Medicine Association, and the Pediatric Infectious Diseases Society. The researchers reported having no financial disclosures.

dbrunk@frontlinemedcom.com

SAN DIEGO – Between 2005 and 2013, the number of anesthesia-related medical malpractice payments decreased by 41%, and the reduction in payments was more significant in inpatient settings, compared with outpatient settings.

Those are key findings from an analysis of national data presented by lead author Dr. Richard J. Kelly at an annual meeting of the American Society of Anesthesiologists.

“It was gratifying to see that overall, the trends of anesthesia-related claims have gone down over the years,” said Dr. Kelly of the department of anesthesiology and perioperative care at the University of California, Irvine. “We did see that because the number of inpatient payments has fallen faster than outpatient payments, the proportion of outpatient payments has increased relative to inpatient claims.”

For the study, the researchers used the U.S. National Practitioner Data Bank to compare inpatient and outpatient anesthesia-related medical malpractice claims made against physicians during 2005-2013. They looked at the number and size of inpatient and outpatient payments over time and compared patient age, patient sex, clinical outcome, and type of medical error for each type of these payments.

Over the 9-year period the frequency of anesthesia-related payments decreased 41.4% (4.6%/year). Payments for inpatient claims decreased a total of 45.5% (5.1%/year) while outpatient payments decreased 24.3% (2.7%/year). The most common patient age group was 40-49 years (40.1% of anesthesia-related claims) and slightly more than half of claims involved females (54.4%). Court judgments made up only 2.7% of claims, while the remainder were settlements.

Cumulative payments for malpractice claims decreased by 47.8% during the study period, from $174.4 million in 2005 to $91.1 million in 2013, and the decrease was greater for inpatient claims (51.4%, compared with 25.9% for outpatient claims). The median payment for all claims was $245,000, and inpatient payments were significantly more expensive than were outpatient claims ($261,742 vs. $189,349; P less than .001).

Death was the most common clinical outcome for all of the paid claims (38.4%) and made up a larger proportion of inpatient than outpatient payments (39.8% vs. 33.9%, respectively). Major injury represented 29.8% of all payments, with no significant difference observed between treatment settings. Compared with inpatient payments, outpatient payments were more likely to involve minor injuries (31.2% vs. 18.2%) and were less likely to involve debilitating injuries (6.4% vs. 9.9%). The study findings “tell us that there are a lot more surgeries being done in an outpatient arena now,” Dr. Kelly said. “And, because of that, surgeons and anesthesia providers should be careful to make sure that patients are appropriately selected for an outpatient setting.”

Dr. Kelly reported having no financial disclosures.

dbrunk@frontlinemedcom.com

SAN DIEGO – Between 2005 and 2013, the number of anesthesia-related medical malpractice payments decreased by 41%, and the reduction in payments was more significant in inpatient settings, compared with outpatient settings.

Those are key findings from an analysis of national data presented by lead author Dr. Richard J. Kelly at an annual meeting of the American Society of Anesthesiologists.

“It was gratifying to see that overall, the trends of anesthesia-related claims have gone down over the years,” said Dr. Kelly of the department of anesthesiology and perioperative care at the University of California, Irvine. “We did see that because the number of inpatient payments has fallen faster than outpatient payments, the proportion of outpatient payments has increased relative to inpatient claims.”

For the study, the researchers used the U.S. National Practitioner Data Bank to compare inpatient and outpatient anesthesia-related medical malpractice claims made against physicians during 2005-2013. They looked at the number and size of inpatient and outpatient payments over time and compared patient age, patient sex, clinical outcome, and type of medical error for each type of these payments.

Over the 9-year period the frequency of anesthesia-related payments decreased 41.4% (4.6%/year). Payments for inpatient claims decreased a total of 45.5% (5.1%/year) while outpatient payments decreased 24.3% (2.7%/year). The most common patient age group was 40-49 years (40.1% of anesthesia-related claims) and slightly more than half of claims involved females (54.4%). Court judgments made up only 2.7% of claims, while the remainder were settlements.

Cumulative payments for malpractice claims decreased by 47.8% during the study period, from $174.4 million in 2005 to $91.1 million in 2013, and the decrease was greater for inpatient claims (51.4%, compared with 25.9% for outpatient claims). The median payment for all claims was $245,000, and inpatient payments were significantly more expensive than were outpatient claims ($261,742 vs. $189,349; P less than .001).

Death was the most common clinical outcome for all of the paid claims (38.4%) and made up a larger proportion of inpatient than outpatient payments (39.8% vs. 33.9%, respectively). Major injury represented 29.8% of all payments, with no significant difference observed between treatment settings. Compared with inpatient payments, outpatient payments were more likely to involve minor injuries (31.2% vs. 18.2%) and were less likely to involve debilitating injuries (6.4% vs. 9.9%). The study findings “tell us that there are a lot more surgeries being done in an outpatient arena now,” Dr. Kelly said. “And, because of that, surgeons and anesthesia providers should be careful to make sure that patients are appropriately selected for an outpatient setting.”

Dr. Kelly reported having no financial disclosures.

dbrunk@frontlinemedcom.com

SAN DIEGO – Between 2005 and 2013, the number of anesthesia-related medical malpractice payments decreased by 41%, and the reduction in payments was more significant in inpatient settings, compared with outpatient settings.

Those are key findings from an analysis of national data presented by lead author Dr. Richard J. Kelly at an annual meeting of the American Society of Anesthesiologists.

“It was gratifying to see that overall, the trends of anesthesia-related claims have gone down over the years,” said Dr. Kelly of the department of anesthesiology and perioperative care at the University of California, Irvine. “We did see that because the number of inpatient payments has fallen faster than outpatient payments, the proportion of outpatient payments has increased relative to inpatient claims.”

For the study, the researchers used the U.S. National Practitioner Data Bank to compare inpatient and outpatient anesthesia-related medical malpractice claims made against physicians during 2005-2013. They looked at the number and size of inpatient and outpatient payments over time and compared patient age, patient sex, clinical outcome, and type of medical error for each type of these payments.

Over the 9-year period the frequency of anesthesia-related payments decreased 41.4% (4.6%/year). Payments for inpatient claims decreased a total of 45.5% (5.1%/year) while outpatient payments decreased 24.3% (2.7%/year). The most common patient age group was 40-49 years (40.1% of anesthesia-related claims) and slightly more than half of claims involved females (54.4%). Court judgments made up only 2.7% of claims, while the remainder were settlements.

Cumulative payments for malpractice claims decreased by 47.8% during the study period, from $174.4 million in 2005 to $91.1 million in 2013, and the decrease was greater for inpatient claims (51.4%, compared with 25.9% for outpatient claims). The median payment for all claims was $245,000, and inpatient payments were significantly more expensive than were outpatient claims ($261,742 vs. $189,349; P less than .001).

Death was the most common clinical outcome for all of the paid claims (38.4%) and made up a larger proportion of inpatient than outpatient payments (39.8% vs. 33.9%, respectively). Major injury represented 29.8% of all payments, with no significant difference observed between treatment settings. Compared with inpatient payments, outpatient payments were more likely to involve minor injuries (31.2% vs. 18.2%) and were less likely to involve debilitating injuries (6.4% vs. 9.9%). The study findings “tell us that there are a lot more surgeries being done in an outpatient arena now,” Dr. Kelly said. “And, because of that, surgeons and anesthesia providers should be careful to make sure that patients are appropriately selected for an outpatient setting.”

Dr. Kelly reported having no financial disclosures.

dbrunk@frontlinemedcom.com

SAN DIEGO – In households of children with methicillin-resistant Staphylococcus aureus (MRSA) infection, pet dogs and cats often were colonized with S. aureus. In addition, the S. aureus strains colonizing the pets were likely to be concordant with those found on humans and/or their environmental surfaces within the household.

Those are key findings from a study that set out to determine the molecular epidemiology of S. aureus colonization of pets in the context of their human contacts and household environments, in households of children with community-associated MRSA infections.

“S. aureus is a significant pathogen in both health care and community settings and causes a spectrum of infections ranging from superficial skin and soft tissue infections (SSTIs) to invasive, life-threatening infections,” Ryley M. Thompson said at an annual scientific meeting on infectious diseases. “Due to the enormous clinical and economic burden posed by S. aureus, transmission prevention is essential.”

According to traditional dogma, “humans are the source of S. aureus for their pets and … pets are not a natural reservoir for S. aureus,” said Mr. Thompson, a clinical research study assistant in the Clinical and Translational Research Laboratory of Dr. Stephanie Fritz in the department of pediatrics at Washington University, St. Louis. “This is supported by the fact that pets often clear colonization without antimicrobial treatment. Risk factors for pet colonization include veterinary health care contact, contact with children, and using their mouths to interact with their environment. To date, directionality of S. aureus transmission between humans and pets is unclear.”

Between 2012 and 2015, the researchers enrolled 100 households of children with active or recent community-associated MRSA SSTIs who had been treated at St. Louis Children’s Hospital or other pediatric practices in the area. Over the course of 1 year, five study visits were conducted in each of the patient’s homes. Every 3 months, cultures were obtained from index patients and their household contacts, indoor dogs and cats, and 21 household environmental surfaces. The index patients and household contacts were swabbed at their axillae, nares, and inguinal folds; indoor dogs and cats were swabbed at their nares and dorsal fur; and household surfaces thought to be frequently touched by multiple household members were swabbed, such as TV remote controls, refrigerator door handles, and toilet seats. Researchers also administered a detailed survey to evaluate health, hygiene, and activities that may be associated with S. aureus infection transmission.

Molecular typing of all S. aureus strains was performed by repetitive-sequence polymerase chain reaction to determine strain relatedness, and staphylococcal cassette chromosome mec (SCCmec) characterization was performed by multiplex PCR.

Of 100 households, 49 had a total of 89 pets: 63 dogs and 26 cats. Of the 63 dogs, 13 (21%) were colonized with S. aureus (9 with MRSA) and 2 of 26 cats (8%) were colonized with MRSA. Eleven isolates were SCCmec type IV (MRSA), one was type II (MRSA), and two were type III (MRSA). At baseline, the researchers recovered 16 S. aureus isolates from 15 pets: 13 from the nares and 3 from pet dorsal fur.

One dog was colonized at both sites with concordant strains. In the three households that had two colonized pets, one household had two colonized dogs with matching strain types, the second had two dogs with nonmatching strain types, and the third had a dog and a cat with nonmatching strain types, Mr. Thompson reported at the combined annual meetings of the Infectious Diseases Society of America, the Society for Healthcare Epidemiology of America, the HIV Medicine Association, and the Pediatric Infectious Diseases Society.

Pet characteristics significantly associated with S. aureus colonization at study enrollment were older age (P = .04) and advanced number of years living in the home (P = .03), but sleeping in the same bed as a household member was not (P =. 96).

Molecular analysis revealed that the primary caretaker for 10 of the 15 colonized pets (67%) also was colonized with S. aureus, and 70% of these strains were concordant with the pet strain. In addition, seven of eight humans (88%) who shared a bed with a colonized pet also were colonized with S. aureus, and 43% of these strains were concordant with the pet strain.

Mr. Thompson also presented the longitudinal molecular epidemiology results in pets. In this analysis, 37 of the 89 pets were colonized with S. aureus at some point over the period of 12 months. Of these, 24 were colonized just once, while 13 were colonized at more than one of the samplings over time. Among these 13, two (15%) had concordant strains at all samplings, five (39%) had concordant and discordant strains, and six (46%) had discordant strains over the longitudinal study period.

Mr. Thompson and his associates intend to complete enrollment and analysis of 150 households in a 2-year longitudinal study. After this, he said, “we will be able to determine the directionality of human-pet S. aureus transmission as well as define the role of pets in S. aureus household transmission dynamics.”

The study was funded by the Children’s Discovery Institute of Washington University and St. Louis Children’s Hospital, the Agency for Healthcare Research and Quality, and the National Institutes of Health. The researchers reported having no financial disclosures.

dbrunk@frontlinemedcom.com

SAN DIEGO – In households of children with methicillin-resistant Staphylococcus aureus (MRSA) infection, pet dogs and cats often were colonized with S. aureus. In addition, the S. aureus strains colonizing the pets were likely to be concordant with those found on humans and/or their environmental surfaces within the household.

Those are key findings from a study that set out to determine the molecular epidemiology of S. aureus colonization of pets in the context of their human contacts and household environments, in households of children with community-associated MRSA infections.

“S. aureus is a significant pathogen in both health care and community settings and causes a spectrum of infections ranging from superficial skin and soft tissue infections (SSTIs) to invasive, life-threatening infections,” Ryley M. Thompson said at an annual scientific meeting on infectious diseases. “Due to the enormous clinical and economic burden posed by S. aureus, transmission prevention is essential.”

According to traditional dogma, “humans are the source of S. aureus for their pets and … pets are not a natural reservoir for S. aureus,” said Mr. Thompson, a clinical research study assistant in the Clinical and Translational Research Laboratory of Dr. Stephanie Fritz in the department of pediatrics at Washington University, St. Louis. “This is supported by the fact that pets often clear colonization without antimicrobial treatment. Risk factors for pet colonization include veterinary health care contact, contact with children, and using their mouths to interact with their environment. To date, directionality of S. aureus transmission between humans and pets is unclear.”

Between 2012 and 2015, the researchers enrolled 100 households of children with active or recent community-associated MRSA SSTIs who had been treated at St. Louis Children’s Hospital or other pediatric practices in the area. Over the course of 1 year, five study visits were conducted in each of the patient’s homes. Every 3 months, cultures were obtained from index patients and their household contacts, indoor dogs and cats, and 21 household environmental surfaces. The index patients and household contacts were swabbed at their axillae, nares, and inguinal folds; indoor dogs and cats were swabbed at their nares and dorsal fur; and household surfaces thought to be frequently touched by multiple household members were swabbed, such as TV remote controls, refrigerator door handles, and toilet seats. Researchers also administered a detailed survey to evaluate health, hygiene, and activities that may be associated with S. aureus infection transmission.

Molecular typing of all S. aureus strains was performed by repetitive-sequence polymerase chain reaction to determine strain relatedness, and staphylococcal cassette chromosome mec (SCCmec) characterization was performed by multiplex PCR.

Of 100 households, 49 had a total of 89 pets: 63 dogs and 26 cats. Of the 63 dogs, 13 (21%) were colonized with S. aureus (9 with MRSA) and 2 of 26 cats (8%) were colonized with MRSA. Eleven isolates were SCCmec type IV (MRSA), one was type II (MRSA), and two were type III (MRSA). At baseline, the researchers recovered 16 S. aureus isolates from 15 pets: 13 from the nares and 3 from pet dorsal fur.

One dog was colonized at both sites with concordant strains. In the three households that had two colonized pets, one household had two colonized dogs with matching strain types, the second had two dogs with nonmatching strain types, and the third had a dog and a cat with nonmatching strain types, Mr. Thompson reported at the combined annual meetings of the Infectious Diseases Society of America, the Society for Healthcare Epidemiology of America, the HIV Medicine Association, and the Pediatric Infectious Diseases Society.

Pet characteristics significantly associated with S. aureus colonization at study enrollment were older age (P = .04) and advanced number of years living in the home (P = .03), but sleeping in the same bed as a household member was not (P =. 96).

Molecular analysis revealed that the primary caretaker for 10 of the 15 colonized pets (67%) also was colonized with S. aureus, and 70% of these strains were concordant with the pet strain. In addition, seven of eight humans (88%) who shared a bed with a colonized pet also were colonized with S. aureus, and 43% of these strains were concordant with the pet strain.

Mr. Thompson also presented the longitudinal molecular epidemiology results in pets. In this analysis, 37 of the 89 pets were colonized with S. aureus at some point over the period of 12 months. Of these, 24 were colonized just once, while 13 were colonized at more than one of the samplings over time. Among these 13, two (15%) had concordant strains at all samplings, five (39%) had concordant and discordant strains, and six (46%) had discordant strains over the longitudinal study period.

Mr. Thompson and his associates intend to complete enrollment and analysis of 150 households in a 2-year longitudinal study. After this, he said, “we will be able to determine the directionality of human-pet S. aureus transmission as well as define the role of pets in S. aureus household transmission dynamics.”

The study was funded by the Children’s Discovery Institute of Washington University and St. Louis Children’s Hospital, the Agency for Healthcare Research and Quality, and the National Institutes of Health. The researchers reported having no financial disclosures.

dbrunk@frontlinemedcom.com

SAN DIEGO – In households of children with methicillin-resistant Staphylococcus aureus (MRSA) infection, pet dogs and cats often were colonized with S. aureus. In addition, the S. aureus strains colonizing the pets were likely to be concordant with those found on humans and/or their environmental surfaces within the household.

Those are key findings from a study that set out to determine the molecular epidemiology of S. aureus colonization of pets in the context of their human contacts and household environments, in households of children with community-associated MRSA infections.

“S. aureus is a significant pathogen in both health care and community settings and causes a spectrum of infections ranging from superficial skin and soft tissue infections (SSTIs) to invasive, life-threatening infections,” Ryley M. Thompson said at an annual scientific meeting on infectious diseases. “Due to the enormous clinical and economic burden posed by S. aureus, transmission prevention is essential.”

According to traditional dogma, “humans are the source of S. aureus for their pets and … pets are not a natural reservoir for S. aureus,” said Mr. Thompson, a clinical research study assistant in the Clinical and Translational Research Laboratory of Dr. Stephanie Fritz in the department of pediatrics at Washington University, St. Louis. “This is supported by the fact that pets often clear colonization without antimicrobial treatment. Risk factors for pet colonization include veterinary health care contact, contact with children, and using their mouths to interact with their environment. To date, directionality of S. aureus transmission between humans and pets is unclear.”

Between 2012 and 2015, the researchers enrolled 100 households of children with active or recent community-associated MRSA SSTIs who had been treated at St. Louis Children’s Hospital or other pediatric practices in the area. Over the course of 1 year, five study visits were conducted in each of the patient’s homes. Every 3 months, cultures were obtained from index patients and their household contacts, indoor dogs and cats, and 21 household environmental surfaces. The index patients and household contacts were swabbed at their axillae, nares, and inguinal folds; indoor dogs and cats were swabbed at their nares and dorsal fur; and household surfaces thought to be frequently touched by multiple household members were swabbed, such as TV remote controls, refrigerator door handles, and toilet seats. Researchers also administered a detailed survey to evaluate health, hygiene, and activities that may be associated with S. aureus infection transmission.

Molecular typing of all S. aureus strains was performed by repetitive-sequence polymerase chain reaction to determine strain relatedness, and staphylococcal cassette chromosome mec (SCCmec) characterization was performed by multiplex PCR.

Of 100 households, 49 had a total of 89 pets: 63 dogs and 26 cats. Of the 63 dogs, 13 (21%) were colonized with S. aureus (9 with MRSA) and 2 of 26 cats (8%) were colonized with MRSA. Eleven isolates were SCCmec type IV (MRSA), one was type II (MRSA), and two were type III (MRSA). At baseline, the researchers recovered 16 S. aureus isolates from 15 pets: 13 from the nares and 3 from pet dorsal fur.

One dog was colonized at both sites with concordant strains. In the three households that had two colonized pets, one household had two colonized dogs with matching strain types, the second had two dogs with nonmatching strain types, and the third had a dog and a cat with nonmatching strain types, Mr. Thompson reported at the combined annual meetings of the Infectious Diseases Society of America, the Society for Healthcare Epidemiology of America, the HIV Medicine Association, and the Pediatric Infectious Diseases Society.

Pet characteristics significantly associated with S. aureus colonization at study enrollment were older age (P = .04) and advanced number of years living in the home (P = .03), but sleeping in the same bed as a household member was not (P =. 96).

Molecular analysis revealed that the primary caretaker for 10 of the 15 colonized pets (67%) also was colonized with S. aureus, and 70% of these strains were concordant with the pet strain. In addition, seven of eight humans (88%) who shared a bed with a colonized pet also were colonized with S. aureus, and 43% of these strains were concordant with the pet strain.

Mr. Thompson also presented the longitudinal molecular epidemiology results in pets. In this analysis, 37 of the 89 pets were colonized with S. aureus at some point over the period of 12 months. Of these, 24 were colonized just once, while 13 were colonized at more than one of the samplings over time. Among these 13, two (15%) had concordant strains at all samplings, five (39%) had concordant and discordant strains, and six (46%) had discordant strains over the longitudinal study period.

Mr. Thompson and his associates intend to complete enrollment and analysis of 150 households in a 2-year longitudinal study. After this, he said, “we will be able to determine the directionality of human-pet S. aureus transmission as well as define the role of pets in S. aureus household transmission dynamics.”

The study was funded by the Children’s Discovery Institute of Washington University and St. Louis Children’s Hospital, the Agency for Healthcare Research and Quality, and the National Institutes of Health. The researchers reported having no financial disclosures.

dbrunk@frontlinemedcom.com

SAN DIEGO – Only 39% of patients hospitalized for pneumonia underwent HIV testing, even though federal recommendations for universal HIV screening in all health care settings have been in place since 2006, according to the results of a retrospective, single-center study.

“Despite universal recommendations for HIV screening in all health care settings, HIV testing rates remain low among patients hospitalized with pneumonia,” Dr. Dana C. Clifton said at an annual scientific meeting on infectious diseases. “A number of patients were subsequently diagnosed with HIV after a prolonged delay.”

Of patients newly diagnosed with HIV in the United States, 41% report no prior HIV testing and an estimated 14%-25% of those living with HIV are undiagnosed, said Dr. Clifton, an internist at Duke University Medical Center, Durham, N.C. In 2006, the Centers for Disease Control and Prevention recommended routine HIV screening in all health care settings for all patients aged between 13 and 64 years old. “Multiple studies have shown that routine screening is cost effective, compared with screening tests for colon cancer, diabetes, and breast cancer,” Dr. Clifton said. In addition, bacterial pneumonia “is a predictor of HIV infection, and the clinical manifestations of bacterial pneumonia are similar whether one has HIV or not. So the question is, how do you decide whom to screen for HIV at hospital admission for pneumonia?”

Dr. Clifton and her associates retrospectively evaluated patients admitted to Duke University Health System between Jan. 1, 1996 and Dec. 31, 2014 with a first primary diagnosis of pneumonia. They used ICD-9 codes for primary diagnosis of pneumonia at time of hospital admission, reviewed a subset of charts to validate the diagnosis, and conducted a random sample of those without prior HIV diagnosis to evaluate HIV testing. The primary outcome was HIV testing during pneumonia admission. Secondary outcomes were documented prior HIV testing in the electronic medical record and subsequent new HIV diagnosis following pneumonia admission.

During the time period studied, 6,858 patients were admitted with a primary diagnosis of pneumonia. Their median age was 50 years, 49% were male, 53% were white, 41% were African American, and the rest were from other ethnic groups. In all, 5,133 (75%) were discharged by general medicine or pulmonary service.

Of the 6,858 patients, 6,513 (95%) were not previously known to be HIV positive (95%), while 345 (5%) were previously known to be HIV positive. Of the 6,513 not previously known to be HIV positive, 19 (0.3%) were diagnosed with HIV during hospital admission and 46 (0.7%) were diagnosed with HIV a median of 807 days after admission.

When the researchers evaluated a random sample of 207 patients not previously known to be HIV positive, the researchers found that only 69 (33%) had an HIV test result ever documented before or during admission, while 16 (8%) were tested for HIV sometime after discharge.

The researchers noted a slight but nonsignificant improvement in the proportion of patients with pneumonia who were ever tested for HIV before or during admission, before and after implementation of the CDC guidelines in 2006 (from 28% to 39%; P = .09). Dr. Clifton pointed out that the 5% prevalence of HIV observed in patients admitted with pneumonia is 10 times higher than the prevalence of HIV in the general population (.47%).

Limitations of the study, she said, include its retrospective, single-center design and the fact that it relied on an administrative database. “There’s also potential for coding bias using ICD-9 codes,” she said. “However, prior studies using ICD-9 codes for diagnosis of pneumonia show reasonably good specificity.”

She concluded her presentation by calling for “more studies to evaluate HIV testing and diagnosis in this higher-risk population of patients admitted with pneumonia. Opt-out HIV testing among pneumonia inpatients should be implemented for earlier HIV diagnosis and improved outcomes.”

IDWeek marks the combined annual meetings of the Infectious Diseases Society of America, the Society for Healthcare Epidemiology of America, the HIV Medicine Association, and the Pediatric Infectious Diseases Society. The researchers reported having no financial disclosures.

The researchers reported having no financial disclosures.

dbrunk@frontlinemedcom.com

SAN DIEGO – Only 39% of patients hospitalized for pneumonia underwent HIV testing, even though federal recommendations for universal HIV screening in all health care settings have been in place since 2006, according to the results of a retrospective, single-center study.

“Despite universal recommendations for HIV screening in all health care settings, HIV testing rates remain low among patients hospitalized with pneumonia,” Dr. Dana C. Clifton said at an annual scientific meeting on infectious diseases. “A number of patients were subsequently diagnosed with HIV after a prolonged delay.”

Of patients newly diagnosed with HIV in the United States, 41% report no prior HIV testing and an estimated 14%-25% of those living with HIV are undiagnosed, said Dr. Clifton, an internist at Duke University Medical Center, Durham, N.C. In 2006, the Centers for Disease Control and Prevention recommended routine HIV screening in all health care settings for all patients aged between 13 and 64 years old. “Multiple studies have shown that routine screening is cost effective, compared with screening tests for colon cancer, diabetes, and breast cancer,” Dr. Clifton said. In addition, bacterial pneumonia “is a predictor of HIV infection, and the clinical manifestations of bacterial pneumonia are similar whether one has HIV or not. So the question is, how do you decide whom to screen for HIV at hospital admission for pneumonia?”

Dr. Clifton and her associates retrospectively evaluated patients admitted to Duke University Health System between Jan. 1, 1996 and Dec. 31, 2014 with a first primary diagnosis of pneumonia. They used ICD-9 codes for primary diagnosis of pneumonia at time of hospital admission, reviewed a subset of charts to validate the diagnosis, and conducted a random sample of those without prior HIV diagnosis to evaluate HIV testing. The primary outcome was HIV testing during pneumonia admission. Secondary outcomes were documented prior HIV testing in the electronic medical record and subsequent new HIV diagnosis following pneumonia admission.

During the time period studied, 6,858 patients were admitted with a primary diagnosis of pneumonia. Their median age was 50 years, 49% were male, 53% were white, 41% were African American, and the rest were from other ethnic groups. In all, 5,133 (75%) were discharged by general medicine or pulmonary service.

Of the 6,858 patients, 6,513 (95%) were not previously known to be HIV positive (95%), while 345 (5%) were previously known to be HIV positive. Of the 6,513 not previously known to be HIV positive, 19 (0.3%) were diagnosed with HIV during hospital admission and 46 (0.7%) were diagnosed with HIV a median of 807 days after admission.

When the researchers evaluated a random sample of 207 patients not previously known to be HIV positive, the researchers found that only 69 (33%) had an HIV test result ever documented before or during admission, while 16 (8%) were tested for HIV sometime after discharge.

The researchers noted a slight but nonsignificant improvement in the proportion of patients with pneumonia who were ever tested for HIV before or during admission, before and after implementation of the CDC guidelines in 2006 (from 28% to 39%; P = .09). Dr. Clifton pointed out that the 5% prevalence of HIV observed in patients admitted with pneumonia is 10 times higher than the prevalence of HIV in the general population (.47%).

Limitations of the study, she said, include its retrospective, single-center design and the fact that it relied on an administrative database. “There’s also potential for coding bias using ICD-9 codes,” she said. “However, prior studies using ICD-9 codes for diagnosis of pneumonia show reasonably good specificity.”

She concluded her presentation by calling for “more studies to evaluate HIV testing and diagnosis in this higher-risk population of patients admitted with pneumonia. Opt-out HIV testing among pneumonia inpatients should be implemented for earlier HIV diagnosis and improved outcomes.”

IDWeek marks the combined annual meetings of the Infectious Diseases Society of America, the Society for Healthcare Epidemiology of America, the HIV Medicine Association, and the Pediatric Infectious Diseases Society. The researchers reported having no financial disclosures.

The researchers reported having no financial disclosures.

dbrunk@frontlinemedcom.com

SAN DIEGO – Only 39% of patients hospitalized for pneumonia underwent HIV testing, even though federal recommendations for universal HIV screening in all health care settings have been in place since 2006, according to the results of a retrospective, single-center study.

“Despite universal recommendations for HIV screening in all health care settings, HIV testing rates remain low among patients hospitalized with pneumonia,” Dr. Dana C. Clifton said at an annual scientific meeting on infectious diseases. “A number of patients were subsequently diagnosed with HIV after a prolonged delay.”

Of patients newly diagnosed with HIV in the United States, 41% report no prior HIV testing and an estimated 14%-25% of those living with HIV are undiagnosed, said Dr. Clifton, an internist at Duke University Medical Center, Durham, N.C. In 2006, the Centers for Disease Control and Prevention recommended routine HIV screening in all health care settings for all patients aged between 13 and 64 years old. “Multiple studies have shown that routine screening is cost effective, compared with screening tests for colon cancer, diabetes, and breast cancer,” Dr. Clifton said. In addition, bacterial pneumonia “is a predictor of HIV infection, and the clinical manifestations of bacterial pneumonia are similar whether one has HIV or not. So the question is, how do you decide whom to screen for HIV at hospital admission for pneumonia?”

Dr. Clifton and her associates retrospectively evaluated patients admitted to Duke University Health System between Jan. 1, 1996 and Dec. 31, 2014 with a first primary diagnosis of pneumonia. They used ICD-9 codes for primary diagnosis of pneumonia at time of hospital admission, reviewed a subset of charts to validate the diagnosis, and conducted a random sample of those without prior HIV diagnosis to evaluate HIV testing. The primary outcome was HIV testing during pneumonia admission. Secondary outcomes were documented prior HIV testing in the electronic medical record and subsequent new HIV diagnosis following pneumonia admission.

During the time period studied, 6,858 patients were admitted with a primary diagnosis of pneumonia. Their median age was 50 years, 49% were male, 53% were white, 41% were African American, and the rest were from other ethnic groups. In all, 5,133 (75%) were discharged by general medicine or pulmonary service.

Of the 6,858 patients, 6,513 (95%) were not previously known to be HIV positive (95%), while 345 (5%) were previously known to be HIV positive. Of the 6,513 not previously known to be HIV positive, 19 (0.3%) were diagnosed with HIV during hospital admission and 46 (0.7%) were diagnosed with HIV a median of 807 days after admission.

When the researchers evaluated a random sample of 207 patients not previously known to be HIV positive, the researchers found that only 69 (33%) had an HIV test result ever documented before or during admission, while 16 (8%) were tested for HIV sometime after discharge.

The researchers noted a slight but nonsignificant improvement in the proportion of patients with pneumonia who were ever tested for HIV before or during admission, before and after implementation of the CDC guidelines in 2006 (from 28% to 39%; P = .09). Dr. Clifton pointed out that the 5% prevalence of HIV observed in patients admitted with pneumonia is 10 times higher than the prevalence of HIV in the general population (.47%).

Limitations of the study, she said, include its retrospective, single-center design and the fact that it relied on an administrative database. “There’s also potential for coding bias using ICD-9 codes,” she said. “However, prior studies using ICD-9 codes for diagnosis of pneumonia show reasonably good specificity.”

She concluded her presentation by calling for “more studies to evaluate HIV testing and diagnosis in this higher-risk population of patients admitted with pneumonia. Opt-out HIV testing among pneumonia inpatients should be implemented for earlier HIV diagnosis and improved outcomes.”

IDWeek marks the combined annual meetings of the Infectious Diseases Society of America, the Society for Healthcare Epidemiology of America, the HIV Medicine Association, and the Pediatric Infectious Diseases Society. The researchers reported having no financial disclosures.

The researchers reported having no financial disclosures.

dbrunk@frontlinemedcom.com

SAN DIEGO – An antibiotic stewardship program was associated with a threefold decline in Clostridium difficile infections in hospitalized children and a 20% savings in costs related to the use of antibiotics, based on a single-center study, Dr. Jean Wiedeman reported during a press briefing at an annual scientific meeting on infectious diseases.

The antibiotic stewardship program consisted of a prospective chart audit to determine if antibiotic prescribing was appropriate as well as the provision of immediate feedback to prescribing physicians. It also required prescribing physicians to obtain authorization from an on-call infectious diseases specialist prior to the use of certain restricted broad-spectrum or expensive antibiotics.

“That is an avenue of education for physicians because they can use a pager to call and ask questions about antimicrobial use,” Dr. Wiedeman commented. “We’ve found that’s one of the most well-liked components of the program.”

Examples of recommended interventions included halting use of antibiotics that were unnecessary, de-escalating therapy by prescribing a more narrow-spectrum antibiotic than what was being used; adjusting the dose based on obesity, kidney, or liver dysfunction; changing to an equally effective and less expensive antibiotic; and extending duration of the antibiotic or adding antibiotics.

Dr. Wiedeman, medical director of pediatric antimicrobial stewardship at the University of California, Davis, Medical Center, Sacramento, and study coauthor Dr. Natasha Nakra compared the rates of C. difficile and antibiotic-related costs at the 110-bed UC Davis Children’s Hospital between the pre–antibiotic stewardship era (2008-2010) and the antibiotic stewardship era (2011-2014).

Dr. Wiedeman reported that the rates of C. difficile at the hospital decreased from 9.2 per 10,000 patient days to 2.8 per 10,000 patient days, a more than threefold reduction (P = .003). In addition, the annual costs for antibiotics decreased from $277,620 to $221,590, which translated into a yearly savings of $56,030, she said in a video interview.

“We find that we have a highly acceptable program with over 90% of our physicians accepting an intervention. [The program] has expanded to the point where we are probably going to need another physician, because we’re also rounding with our intensivists, both in the pediatric ICU and in the neonatal ICU. There we help with prevention interventions such as looking at central-line catheters and Foley catheters, as well as making interventions for antimicrobial use,” she said.

IDWeek marks the combined annual meetings of the Infectious Diseases Society of America, the Society for Healthcare Epidemiology of America, the HIV Medicine Association, and the Pediatric Infectious Diseases Society. The researchers reported having no financial disclosures.

dbrunk@frontlinemedcom.com

SAN DIEGO – An antibiotic stewardship program was associated with a threefold decline in Clostridium difficile infections in hospitalized children and a 20% savings in costs related to the use of antibiotics, based on a single-center study, Dr. Jean Wiedeman reported during a press briefing at an annual scientific meeting on infectious diseases.

The antibiotic stewardship program consisted of a prospective chart audit to determine if antibiotic prescribing was appropriate as well as the provision of immediate feedback to prescribing physicians. It also required prescribing physicians to obtain authorization from an on-call infectious diseases specialist prior to the use of certain restricted broad-spectrum or expensive antibiotics.

“That is an avenue of education for physicians because they can use a pager to call and ask questions about antimicrobial use,” Dr. Wiedeman commented. “We’ve found that’s one of the most well-liked components of the program.”

Examples of recommended interventions included halting use of antibiotics that were unnecessary, de-escalating therapy by prescribing a more narrow-spectrum antibiotic than what was being used; adjusting the dose based on obesity, kidney, or liver dysfunction; changing to an equally effective and less expensive antibiotic; and extending duration of the antibiotic or adding antibiotics.

Dr. Wiedeman, medical director of pediatric antimicrobial stewardship at the University of California, Davis, Medical Center, Sacramento, and study coauthor Dr. Natasha Nakra compared the rates of C. difficile and antibiotic-related costs at the 110-bed UC Davis Children’s Hospital between the pre–antibiotic stewardship era (2008-2010) and the antibiotic stewardship era (2011-2014).

Dr. Wiedeman reported that the rates of C. difficile at the hospital decreased from 9.2 per 10,000 patient days to 2.8 per 10,000 patient days, a more than threefold reduction (P = .003). In addition, the annual costs for antibiotics decreased from $277,620 to $221,590, which translated into a yearly savings of $56,030, she said in a video interview.

“We find that we have a highly acceptable program with over 90% of our physicians accepting an intervention. [The program] has expanded to the point where we are probably going to need another physician, because we’re also rounding with our intensivists, both in the pediatric ICU and in the neonatal ICU. There we help with prevention interventions such as looking at central-line catheters and Foley catheters, as well as making interventions for antimicrobial use,” she said.

IDWeek marks the combined annual meetings of the Infectious Diseases Society of America, the Society for Healthcare Epidemiology of America, the HIV Medicine Association, and the Pediatric Infectious Diseases Society. The researchers reported having no financial disclosures.

dbrunk@frontlinemedcom.com

SAN DIEGO – An antibiotic stewardship program was associated with a threefold decline in Clostridium difficile infections in hospitalized children and a 20% savings in costs related to the use of antibiotics, based on a single-center study, Dr. Jean Wiedeman reported during a press briefing at an annual scientific meeting on infectious diseases.

The antibiotic stewardship program consisted of a prospective chart audit to determine if antibiotic prescribing was appropriate as well as the provision of immediate feedback to prescribing physicians. It also required prescribing physicians to obtain authorization from an on-call infectious diseases specialist prior to the use of certain restricted broad-spectrum or expensive antibiotics.

“That is an avenue of education for physicians because they can use a pager to call and ask questions about antimicrobial use,” Dr. Wiedeman commented. “We’ve found that’s one of the most well-liked components of the program.”

Examples of recommended interventions included halting use of antibiotics that were unnecessary, de-escalating therapy by prescribing a more narrow-spectrum antibiotic than what was being used; adjusting the dose based on obesity, kidney, or liver dysfunction; changing to an equally effective and less expensive antibiotic; and extending duration of the antibiotic or adding antibiotics.

Dr. Wiedeman, medical director of pediatric antimicrobial stewardship at the University of California, Davis, Medical Center, Sacramento, and study coauthor Dr. Natasha Nakra compared the rates of C. difficile and antibiotic-related costs at the 110-bed UC Davis Children’s Hospital between the pre–antibiotic stewardship era (2008-2010) and the antibiotic stewardship era (2011-2014).

Dr. Wiedeman reported that the rates of C. difficile at the hospital decreased from 9.2 per 10,000 patient days to 2.8 per 10,000 patient days, a more than threefold reduction (P = .003). In addition, the annual costs for antibiotics decreased from $277,620 to $221,590, which translated into a yearly savings of $56,030, she said in a video interview.

“We find that we have a highly acceptable program with over 90% of our physicians accepting an intervention. [The program] has expanded to the point where we are probably going to need another physician, because we’re also rounding with our intensivists, both in the pediatric ICU and in the neonatal ICU. There we help with prevention interventions such as looking at central-line catheters and Foley catheters, as well as making interventions for antimicrobial use,” she said.

IDWeek marks the combined annual meetings of the Infectious Diseases Society of America, the Society for Healthcare Epidemiology of America, the HIV Medicine Association, and the Pediatric Infectious Diseases Society. The researchers reported having no financial disclosures.

dbrunk@frontlinemedcom.com

SAN DIEGO – Antibiotic prescribing patterns for pediatric community-acquired pneumonia vary substantially across both children’s hospitals and facilities that are not children’s hospitals, a large analysis found.

Specifically, children’s hospitals are far more likely to prescribe in accordance with national guidelines than are other hospitals.

“Moving forward, I think there’s a need for further study to understand these differences, so we can begin to narrow this gap between children’s and non–children’s hospitals,” lead study author Dr. Alison Tribble said at an annual scientific meeting on infectious diseases. “Across the board, we need to continue efforts to improve guideline adherence for all children hospitalized with community-acquired pneumonia.”

In 2012, community-acquired pneumonia (CAP) accounted for 120,000 known pneumonia admissions among children in the United States and about 7% of all pediatric hospitalizations, said Dr. Tribble, a pediatric infectious disease specialist at C.S. Mott Children’s Hospital and the University of Michigan Medical Center, both in Ann Arbor. “We also know that pneumonia accounts for more days of antibiotic therapy than any other indication for admission to U.S. children’s hospitals,” she said.

In 2011, the Infectious Diseases Society of America and Pediatric Infectious Diseases Society released guidelines for pediatric CAP, which recommend a first-line therapy with penicillin, ampicillin, or amoxicillin for most children who are immunized and healthy. “Only in situations where there’s a significant concern for an atypical organism should we be adding coverage for that – even in older children,” Dr. Tribble said. Following the release of the guidelines, she continued, multiple studies have shown that the use of first-line therapy is increasing in children’s hospitals. “However, a substantial proportion of children with pneumonia are admitted to non–children’s hospitals,” she said. “Prior to release of the guidelines, one study showed that use of first-line therapy for pediatric CAP was low in non–children’s hospitals (J Pediatr. 2014 165[3]:585-91), but postguideline CAP therapy in non–children’s hospitals has not yet been evaluated.”

For the current study, Dr. Tribble and her associates set out to evaluate antibiotic prescribing patterns for pediatric CAP in non–children’s hospitals and to compare prescribing patterns between children’s and non–children’s hospitals. They conducted a retrospective cross-sectional study of children aged 1-17 years admitted for CAP in 2013 to 323 hospitals, captured via the Pediatric Health Information System (PHIS) and Premier Perspective databases. PHIS is an administrative database that includes billing data, diagnosis codes, and procedure codes for about 44 freestanding children’s hospitals nationwide, while Premier Perspective encompasses data from 522 hospitals nationwide. The researchers used a validated ICD-9 code-based algorithm to identify patients with CAP and excluded those with complicated pneumonia or complex chronic conditions, those who received intensive care, and those with methicillin-resistant Staphylococcus aureus infection or colonization.

Children’s hospitals were defined as those with pediatric admissions accounting for more than 75% of all admissions. “This was after excluding newborns and admission for childbirth, because many community hospitals will have a birthing center or a NICU, but otherwise would not be considered a children’s hospital,” Dr. Tribble explained. Any other hospital was considered a non–children’s hospital.

Three different outcomes for antibiotic use were examined: those who ever received penicillin, amoxicillin, or ampicillin (guideline therapy); those who ever received a macrolide, fluoroquinolone, or tetracycline (atypical therapy); and those who received anything other than penicillin, amoxicillin, or ampicillin (nonguideline therapy). The standardized probability of exposure to select antibiotics was compared between children’s and non–children’s hospitals, adjusted for age, sex, and insurance provider.

In all, 323 hospitals contributed 15,495 CAP cases. Of the 323 hospitals, 49 were identified as children’s hospitals (44 from the PHIS database and 5 from the Premier database). Dr. Tribble reported results from 9,224 subjects admitted to children’s hospitals and 6,271 subjects admitted to non–children’s hospitals. The demographics between the two groups were similar: The patients’ mean age was 3 years, and 66% were younger than age 5 years.

After adjustment of data, patients admitted to children’s hospitals were found to be more likely to receive guideline therapy, compared with those admitted to non–children’s hospitals (46% vs. 15%, respectively), were less likely to received atypical therapy (36% vs. 51%), and were less likely to receive nonguideline therapy (78% vs. 94%; P less than .001 for all comparisons).

Dr. Tribble acknowledged certain limitations of the study, including the potential for misclassification of children’s hospitals in the Premier database, “although most likely I think we would have failed to identify a children’s hospital, and this would have biased us toward the null and made our difference less significant,” she said. “We are developing an absolute volume classification so we can look at this in another way.” Another limitation is that the study design did not account for the potential of combination therapy, “and you can’t account for change in therapy during hospitalization. Lastly, we compared data across different databases and across different hospital types.”

IDWeek marks the combined annual meetings of the Infectious Diseases Society of America, the Society for Healthcare Epidemiology of America, the HIV Medicine Association, and the Pediatric Infectious Diseases Society. The study was supported by a training grant from the National Institute of Child Health and Human Development. The researchers reported having no relevant financial disclosures.

SAN DIEGO – Antibiotic prescribing patterns for pediatric community-acquired pneumonia vary substantially across both children’s hospitals and facilities that are not children’s hospitals, a large analysis found.

Specifically, children’s hospitals are far more likely to prescribe in accordance with national guidelines than are other hospitals.

“Moving forward, I think there’s a need for further study to understand these differences, so we can begin to narrow this gap between children’s and non–children’s hospitals,” lead study author Dr. Alison Tribble said at an annual scientific meeting on infectious diseases. “Across the board, we need to continue efforts to improve guideline adherence for all children hospitalized with community-acquired pneumonia.”

In 2012, community-acquired pneumonia (CAP) accounted for 120,000 known pneumonia admissions among children in the United States and about 7% of all pediatric hospitalizations, said Dr. Tribble, a pediatric infectious disease specialist at C.S. Mott Children’s Hospital and the University of Michigan Medical Center, both in Ann Arbor. “We also know that pneumonia accounts for more days of antibiotic therapy than any other indication for admission to U.S. children’s hospitals,” she said.

In 2011, the Infectious Diseases Society of America and Pediatric Infectious Diseases Society released guidelines for pediatric CAP, which recommend a first-line therapy with penicillin, ampicillin, or amoxicillin for most children who are immunized and healthy. “Only in situations where there’s a significant concern for an atypical organism should we be adding coverage for that – even in older children,” Dr. Tribble said. Following the release of the guidelines, she continued, multiple studies have shown that the use of first-line therapy is increasing in children’s hospitals. “However, a substantial proportion of children with pneumonia are admitted to non–children’s hospitals,” she said. “Prior to release of the guidelines, one study showed that use of first-line therapy for pediatric CAP was low in non–children’s hospitals (J Pediatr. 2014 165[3]:585-91), but postguideline CAP therapy in non–children’s hospitals has not yet been evaluated.”

For the current study, Dr. Tribble and her associates set out to evaluate antibiotic prescribing patterns for pediatric CAP in non–children’s hospitals and to compare prescribing patterns between children’s and non–children’s hospitals. They conducted a retrospective cross-sectional study of children aged 1-17 years admitted for CAP in 2013 to 323 hospitals, captured via the Pediatric Health Information System (PHIS) and Premier Perspective databases. PHIS is an administrative database that includes billing data, diagnosis codes, and procedure codes for about 44 freestanding children’s hospitals nationwide, while Premier Perspective encompasses data from 522 hospitals nationwide. The researchers used a validated ICD-9 code-based algorithm to identify patients with CAP and excluded those with complicated pneumonia or complex chronic conditions, those who received intensive care, and those with methicillin-resistant Staphylococcus aureus infection or colonization.

Children’s hospitals were defined as those with pediatric admissions accounting for more than 75% of all admissions. “This was after excluding newborns and admission for childbirth, because many community hospitals will have a birthing center or a NICU, but otherwise would not be considered a children’s hospital,” Dr. Tribble explained. Any other hospital was considered a non–children’s hospital.

Three different outcomes for antibiotic use were examined: those who ever received penicillin, amoxicillin, or ampicillin (guideline therapy); those who ever received a macrolide, fluoroquinolone, or tetracycline (atypical therapy); and those who received anything other than penicillin, amoxicillin, or ampicillin (nonguideline therapy). The standardized probability of exposure to select antibiotics was compared between children’s and non–children’s hospitals, adjusted for age, sex, and insurance provider.

In all, 323 hospitals contributed 15,495 CAP cases. Of the 323 hospitals, 49 were identified as children’s hospitals (44 from the PHIS database and 5 from the Premier database). Dr. Tribble reported results from 9,224 subjects admitted to children’s hospitals and 6,271 subjects admitted to non–children’s hospitals. The demographics between the two groups were similar: The patients’ mean age was 3 years, and 66% were younger than age 5 years.

After adjustment of data, patients admitted to children’s hospitals were found to be more likely to receive guideline therapy, compared with those admitted to non–children’s hospitals (46% vs. 15%, respectively), were less likely to received atypical therapy (36% vs. 51%), and were less likely to receive nonguideline therapy (78% vs. 94%; P less than .001 for all comparisons).

Dr. Tribble acknowledged certain limitations of the study, including the potential for misclassification of children’s hospitals in the Premier database, “although most likely I think we would have failed to identify a children’s hospital, and this would have biased us toward the null and made our difference less significant,” she said. “We are developing an absolute volume classification so we can look at this in another way.” Another limitation is that the study design did not account for the potential of combination therapy, “and you can’t account for change in therapy during hospitalization. Lastly, we compared data across different databases and across different hospital types.”

IDWeek marks the combined annual meetings of the Infectious Diseases Society of America, the Society for Healthcare Epidemiology of America, the HIV Medicine Association, and the Pediatric Infectious Diseases Society. The study was supported by a training grant from the National Institute of Child Health and Human Development. The researchers reported having no relevant financial disclosures.

SAN DIEGO – Antibiotic prescribing patterns for pediatric community-acquired pneumonia vary substantially across both children’s hospitals and facilities that are not children’s hospitals, a large analysis found.

Specifically, children’s hospitals are far more likely to prescribe in accordance with national guidelines than are other hospitals.

“Moving forward, I think there’s a need for further study to understand these differences, so we can begin to narrow this gap between children’s and non–children’s hospitals,” lead study author Dr. Alison Tribble said at an annual scientific meeting on infectious diseases. “Across the board, we need to continue efforts to improve guideline adherence for all children hospitalized with community-acquired pneumonia.”

In 2012, community-acquired pneumonia (CAP) accounted for 120,000 known pneumonia admissions among children in the United States and about 7% of all pediatric hospitalizations, said Dr. Tribble, a pediatric infectious disease specialist at C.S. Mott Children’s Hospital and the University of Michigan Medical Center, both in Ann Arbor. “We also know that pneumonia accounts for more days of antibiotic therapy than any other indication for admission to U.S. children’s hospitals,” she said.

In 2011, the Infectious Diseases Society of America and Pediatric Infectious Diseases Society released guidelines for pediatric CAP, which recommend a first-line therapy with penicillin, ampicillin, or amoxicillin for most children who are immunized and healthy. “Only in situations where there’s a significant concern for an atypical organism should we be adding coverage for that – even in older children,” Dr. Tribble said. Following the release of the guidelines, she continued, multiple studies have shown that the use of first-line therapy is increasing in children’s hospitals. “However, a substantial proportion of children with pneumonia are admitted to non–children’s hospitals,” she said. “Prior to release of the guidelines, one study showed that use of first-line therapy for pediatric CAP was low in non–children’s hospitals (J Pediatr. 2014 165[3]:585-91), but postguideline CAP therapy in non–children’s hospitals has not yet been evaluated.”

For the current study, Dr. Tribble and her associates set out to evaluate antibiotic prescribing patterns for pediatric CAP in non–children’s hospitals and to compare prescribing patterns between children’s and non–children’s hospitals. They conducted a retrospective cross-sectional study of children aged 1-17 years admitted for CAP in 2013 to 323 hospitals, captured via the Pediatric Health Information System (PHIS) and Premier Perspective databases. PHIS is an administrative database that includes billing data, diagnosis codes, and procedure codes for about 44 freestanding children’s hospitals nationwide, while Premier Perspective encompasses data from 522 hospitals nationwide. The researchers used a validated ICD-9 code-based algorithm to identify patients with CAP and excluded those with complicated pneumonia or complex chronic conditions, those who received intensive care, and those with methicillin-resistant Staphylococcus aureus infection or colonization.

Children’s hospitals were defined as those with pediatric admissions accounting for more than 75% of all admissions. “This was after excluding newborns and admission for childbirth, because many community hospitals will have a birthing center or a NICU, but otherwise would not be considered a children’s hospital,” Dr. Tribble explained. Any other hospital was considered a non–children’s hospital.

Three different outcomes for antibiotic use were examined: those who ever received penicillin, amoxicillin, or ampicillin (guideline therapy); those who ever received a macrolide, fluoroquinolone, or tetracycline (atypical therapy); and those who received anything other than penicillin, amoxicillin, or ampicillin (nonguideline therapy). The standardized probability of exposure to select antibiotics was compared between children’s and non–children’s hospitals, adjusted for age, sex, and insurance provider.

In all, 323 hospitals contributed 15,495 CAP cases. Of the 323 hospitals, 49 were identified as children’s hospitals (44 from the PHIS database and 5 from the Premier database). Dr. Tribble reported results from 9,224 subjects admitted to children’s hospitals and 6,271 subjects admitted to non–children’s hospitals. The demographics between the two groups were similar: The patients’ mean age was 3 years, and 66% were younger than age 5 years.

After adjustment of data, patients admitted to children’s hospitals were found to be more likely to receive guideline therapy, compared with those admitted to non–children’s hospitals (46% vs. 15%, respectively), were less likely to received atypical therapy (36% vs. 51%), and were less likely to receive nonguideline therapy (78% vs. 94%; P less than .001 for all comparisons).

Dr. Tribble acknowledged certain limitations of the study, including the potential for misclassification of children’s hospitals in the Premier database, “although most likely I think we would have failed to identify a children’s hospital, and this would have biased us toward the null and made our difference less significant,” she said. “We are developing an absolute volume classification so we can look at this in another way.” Another limitation is that the study design did not account for the potential of combination therapy, “and you can’t account for change in therapy during hospitalization. Lastly, we compared data across different databases and across different hospital types.”

IDWeek marks the combined annual meetings of the Infectious Diseases Society of America, the Society for Healthcare Epidemiology of America, the HIV Medicine Association, and the Pediatric Infectious Diseases Society. The study was supported by a training grant from the National Institute of Child Health and Human Development. The researchers reported having no relevant financial disclosures.

SAN DIEGO – Antibiotic prescribing patterns for pediatric community-acquired pneumonia vary substantially across both children’s hospitals and facilities that are not children’s hospitals, a large analysis found.

Specifically, children’s hospitals are far more likely to prescribe in accordance with national guidelines than are other hospitals.

“Moving forward, I think there’s a need for further study to understand these differences, so we can begin to narrow this gap between children’s and non–children’s hospitals,” lead study author Dr. Alison Tribble said at an annual scientific meeting on infectious diseases. “Across the board, we need to continue efforts to improve guideline adherence for all children hospitalized with community-acquired pneumonia.”

In 2012, community-acquired pneumonia (CAP) accounted for 120,000 known pneumonia admissions among children in the United States and about 7% of all pediatric hospitalizations, said Dr. Tribble, a pediatric infectious disease specialist at C.S. Mott Children’s Hospital and the University of Michigan Medical Center, both in Ann Arbor. “We also know that pneumonia accounts for more days of antibiotic therapy than any other indication for admission to U.S. children’s hospitals,” she said.

In 2011, the Infectious Diseases Society of America and Pediatric Infectious Diseases Society released guidelines for pediatric CAP, which recommend a first-line therapy with penicillin, ampicillin, or amoxicillin for most children who are immunized and healthy. “Only in situations where there’s a significant concern for an atypical organism should we be adding coverage for that – even in older children,” Dr. Tribble said. Following the release of the guidelines, she continued, multiple studies have shown that the use of first-line therapy is increasing in children’s hospitals. “However, a substantial proportion of children with pneumonia are admitted to non–children’s hospitals,” she said. “Prior to release of the guidelines, one study showed that use of first-line therapy for pediatric CAP was low in non–children’s hospitals (J Pediatr. 2014 165[3]:585-91), but postguideline CAP therapy in non–children’s hospitals has not yet been evaluated.”

For the current study, Dr. Tribble and her associates set out to evaluate antibiotic prescribing patterns for pediatric CAP in non–children’s hospitals and to compare prescribing patterns between children’s and non–children’s hospitals. They conducted a retrospective cross-sectional study of children aged 1-17 years admitted for CAP in 2013 to 323 hospitals, captured via the Pediatric Health Information System (PHIS) and Premier Perspective databases. PHIS is an administrative database that includes billing data, diagnosis codes, and procedure codes for about 44 freestanding children’s hospitals nationwide, while Premier Perspective encompasses data from 522 hospitals nationwide. The researchers used a validated ICD-9 code-based algorithm to identify patients with CAP and excluded those with complicated pneumonia or complex chronic conditions, those who received intensive care, and those with methicillin-resistant Staphylococcus aureus infection or colonization.

Children’s hospitals were defined as those with pediatric admissions accounting for more than 75% of all admissions. “This was after excluding newborns and admission for childbirth, because many community hospitals will have a birthing center or a NICU, but otherwise would not be considered a children’s hospital,” Dr. Tribble explained. Any other hospital was considered a non–children’s hospital.

Three different outcomes for antibiotic use were examined: those who ever received penicillin, amoxicillin, or ampicillin (guideline therapy); those who ever received a macrolide, fluoroquinolone, or tetracycline (atypical therapy); and those who received anything other than penicillin, amoxicillin, or ampicillin (nonguideline therapy). The standardized probability of exposure to select antibiotics was compared between children’s and non–children’s hospitals, adjusted for age, sex, and insurance provider.

In all, 323 hospitals contributed 15,495 CAP cases. Of the 323 hospitals, 49 were identified as children’s hospitals (44 from the PHIS database and 5 from the Premier database). Dr. Tribble reported results from 9,224 subjects admitted to children’s hospitals and 6,271 subjects admitted to non–children’s hospitals. The demographics between the two groups were similar: The patients’ mean age was 3 years, and 66% were younger than age 5 years.

After adjustment of data, patients admitted to children’s hospitals were found to be more likely to receive guideline therapy, compared with those admitted to non–children’s hospitals (46% vs. 15%, respectively), were less likely to received atypical therapy (36% vs. 51%), and were less likely to receive nonguideline therapy (78% vs. 94%; P less than .001 for all comparisons).

Dr. Tribble acknowledged certain limitations of the study, including the potential for misclassification of children’s hospitals in the Premier database, “although most likely I think we would have failed to identify a children’s hospital, and this would have biased us toward the null and made our difference less significant,” she said. “We are developing an absolute volume classification so we can look at this in another way.” Another limitation is that the study design did not account for the potential of combination therapy, “and you can’t account for change in therapy during hospitalization. Lastly, we compared data across different databases and across different hospital types.”

IDWeek marks the combined annual meetings of the Infectious Diseases Society of America, the Society for Healthcare Epidemiology of America, the HIV Medicine Association, and the Pediatric Infectious Diseases Society. The study was supported by a training grant from the National Institute of Child Health and Human Development. The researchers reported having no relevant financial disclosures.

dbrunk@frontlinemedcom.com

SAN DIEGO – Antibiotic prescribing patterns for pediatric community-acquired pneumonia vary substantially across both children’s hospitals and facilities that are not children’s hospitals, a large analysis found.

Specifically, children’s hospitals are far more likely to prescribe in accordance with national guidelines than are other hospitals.

“Moving forward, I think there’s a need for further study to understand these differences, so we can begin to narrow this gap between children’s and non–children’s hospitals,” lead study author Dr. Alison Tribble said at an annual scientific meeting on infectious diseases. “Across the board, we need to continue efforts to improve guideline adherence for all children hospitalized with community-acquired pneumonia.”

In 2012, community-acquired pneumonia (CAP) accounted for 120,000 known pneumonia admissions among children in the United States and about 7% of all pediatric hospitalizations, said Dr. Tribble, a pediatric infectious disease specialist at C.S. Mott Children’s Hospital and the University of Michigan Medical Center, both in Ann Arbor. “We also know that pneumonia accounts for more days of antibiotic therapy than any other indication for admission to U.S. children’s hospitals,” she said.

In 2011, the Infectious Diseases Society of America and Pediatric Infectious Diseases Society released guidelines for pediatric CAP, which recommend a first-line therapy with penicillin, ampicillin, or amoxicillin for most children who are immunized and healthy. “Only in situations where there’s a significant concern for an atypical organism should we be adding coverage for that – even in older children,” Dr. Tribble said. Following the release of the guidelines, she continued, multiple studies have shown that the use of first-line therapy is increasing in children’s hospitals. “However, a substantial proportion of children with pneumonia are admitted to non–children’s hospitals,” she said. “Prior to release of the guidelines, one study showed that use of first-line therapy for pediatric CAP was low in non–children’s hospitals (J Pediatr. 2014 165[3]:585-91), but postguideline CAP therapy in non–children’s hospitals has not yet been evaluated.”

For the current study, Dr. Tribble and her associates set out to evaluate antibiotic prescribing patterns for pediatric CAP in non–children’s hospitals and to compare prescribing patterns between children’s and non–children’s hospitals. They conducted a retrospective cross-sectional study of children aged 1-17 years admitted for CAP in 2013 to 323 hospitals, captured via the Pediatric Health Information System (PHIS) and Premier Perspective databases. PHIS is an administrative database that includes billing data, diagnosis codes, and procedure codes for about 44 freestanding children’s hospitals nationwide, while Premier Perspective encompasses data from 522 hospitals nationwide. The researchers used a validated ICD-9 code-based algorithm to identify patients with CAP and excluded those with complicated pneumonia or complex chronic conditions, those who received intensive care, and those with methicillin-resistant Staphylococcus aureus infection or colonization.

Children’s hospitals were defined as those with pediatric admissions accounting for more than 75% of all admissions. “This was after excluding newborns and admission for childbirth, because many community hospitals will have a birthing center or a NICU, but otherwise would not be considered a children’s hospital,” Dr. Tribble explained. Any other hospital was considered a non–children’s hospital.

Three different outcomes for antibiotic use were examined: those who ever received penicillin, amoxicillin, or ampicillin (guideline therapy); those who ever received a macrolide, fluoroquinolone, or tetracycline (atypical therapy); and those who received anything other than penicillin, amoxicillin, or ampicillin (nonguideline therapy). The standardized probability of exposure to select antibiotics was compared between children’s and non–children’s hospitals, adjusted for age, sex, and insurance provider.

In all, 323 hospitals contributed 15,495 CAP cases. Of the 323 hospitals, 49 were identified as children’s hospitals (44 from the PHIS database and 5 from the Premier database). Dr. Tribble reported results from 9,224 subjects admitted to children’s hospitals and 6,271 subjects admitted to non–children’s hospitals. The demographics between the two groups were similar: The patients’ mean age was 3 years, and 66% were younger than age 5 years.

After adjustment of data, patients admitted to children’s hospitals were found to be more likely to receive guideline therapy, compared with those admitted to non–children’s hospitals (46% vs. 15%, respectively), were less likely to received atypical therapy (36% vs. 51%), and were less likely to receive nonguideline therapy (78% vs. 94%; P less than .001 for all comparisons).

Dr. Tribble acknowledged certain limitations of the study, including the potential for misclassification of children’s hospitals in the Premier database, “although most likely I think we would have failed to identify a children’s hospital, and this would have biased us toward the null and made our difference less significant,” she said. “We are developing an absolute volume classification so we can look at this in another way.” Another limitation is that the study design did not account for the potential of combination therapy, “and you can’t account for change in therapy during hospitalization. Lastly, we compared data across different databases and across different hospital types.”

IDWeek marks the combined annual meetings of the Infectious Diseases Society of America, the Society for Healthcare Epidemiology of America, the HIV Medicine Association, and the Pediatric Infectious Diseases Society. The study was supported by a training grant from the National Institute of Child Health and Human Development. The researchers reported having no relevant financial disclosures.

dbrunk@frontlinemedcom.com

SAN DIEGO – Antibiotic prescribing patterns for pediatric community-acquired pneumonia vary substantially across both children’s hospitals and facilities that are not children’s hospitals, a large analysis found.

Specifically, children’s hospitals are far more likely to prescribe in accordance with national guidelines than are other hospitals.

“Moving forward, I think there’s a need for further study to understand these differences, so we can begin to narrow this gap between children’s and non–children’s hospitals,” lead study author Dr. Alison Tribble said at an annual scientific meeting on infectious diseases. “Across the board, we need to continue efforts to improve guideline adherence for all children hospitalized with community-acquired pneumonia.”

In 2012, community-acquired pneumonia (CAP) accounted for 120,000 known pneumonia admissions among children in the United States and about 7% of all pediatric hospitalizations, said Dr. Tribble, a pediatric infectious disease specialist at C.S. Mott Children’s Hospital and the University of Michigan Medical Center, both in Ann Arbor. “We also know that pneumonia accounts for more days of antibiotic therapy than any other indication for admission to U.S. children’s hospitals,” she said.

In 2011, the Infectious Diseases Society of America and Pediatric Infectious Diseases Society released guidelines for pediatric CAP, which recommend a first-line therapy with penicillin, ampicillin, or amoxicillin for most children who are immunized and healthy. “Only in situations where there’s a significant concern for an atypical organism should we be adding coverage for that – even in older children,” Dr. Tribble said. Following the release of the guidelines, she continued, multiple studies have shown that the use of first-line therapy is increasing in children’s hospitals. “However, a substantial proportion of children with pneumonia are admitted to non–children’s hospitals,” she said. “Prior to release of the guidelines, one study showed that use of first-line therapy for pediatric CAP was low in non–children’s hospitals (J Pediatr. 2014 165[3]:585-91), but postguideline CAP therapy in non–children’s hospitals has not yet been evaluated.”

For the current study, Dr. Tribble and her associates set out to evaluate antibiotic prescribing patterns for pediatric CAP in non–children’s hospitals and to compare prescribing patterns between children’s and non–children’s hospitals. They conducted a retrospective cross-sectional study of children aged 1-17 years admitted for CAP in 2013 to 323 hospitals, captured via the Pediatric Health Information System (PHIS) and Premier Perspective databases. PHIS is an administrative database that includes billing data, diagnosis codes, and procedure codes for about 44 freestanding children’s hospitals nationwide, while Premier Perspective encompasses data from 522 hospitals nationwide. The researchers used a validated ICD-9 code-based algorithm to identify patients with CAP and excluded those with complicated pneumonia or complex chronic conditions, those who received intensive care, and those with methicillin-resistant Staphylococcus aureus infection or colonization.

Children’s hospitals were defined as those with pediatric admissions accounting for more than 75% of all admissions. “This was after excluding newborns and admission for childbirth, because many community hospitals will have a birthing center or a NICU, but otherwise would not be considered a children’s hospital,” Dr. Tribble explained. Any other hospital was considered a non–children’s hospital.

Three different outcomes for antibiotic use were examined: those who ever received penicillin, amoxicillin, or ampicillin (guideline therapy); those who ever received a macrolide, fluoroquinolone, or tetracycline (atypical therapy); and those who received anything other than penicillin, amoxicillin, or ampicillin (nonguideline therapy). The standardized probability of exposure to select antibiotics was compared between children’s and non–children’s hospitals, adjusted for age, sex, and insurance provider.

In all, 323 hospitals contributed 15,495 CAP cases. Of the 323 hospitals, 49 were identified as children’s hospitals (44 from the PHIS database and 5 from the Premier database). Dr. Tribble reported results from 9,224 subjects admitted to children’s hospitals and 6,271 subjects admitted to non–children’s hospitals. The demographics between the two groups were similar: The patients’ mean age was 3 years, and 66% were younger than age 5 years.

After adjustment of data, patients admitted to children’s hospitals were found to be more likely to receive guideline therapy, compared with those admitted to non–children’s hospitals (46% vs. 15%, respectively), were less likely to received atypical therapy (36% vs. 51%), and were less likely to receive nonguideline therapy (78% vs. 94%; P less than .001 for all comparisons).

Dr. Tribble acknowledged certain limitations of the study, including the potential for misclassification of children’s hospitals in the Premier database, “although most likely I think we would have failed to identify a children’s hospital, and this would have biased us toward the null and made our difference less significant,” she said. “We are developing an absolute volume classification so we can look at this in another way.” Another limitation is that the study design did not account for the potential of combination therapy, “and you can’t account for change in therapy during hospitalization. Lastly, we compared data across different databases and across different hospital types.”

IDWeek marks the combined annual meetings of the Infectious Diseases Society of America, the Society for Healthcare Epidemiology of America, the HIV Medicine Association, and the Pediatric Infectious Diseases Society. The study was supported by a training grant from the National Institute of Child Health and Human Development. The researchers reported having no relevant financial disclosures.

dbrunk@frontlinemedcom.com

SAN DIEGO – Onchocerca lupi, a zoonotic parasite previously described as causing eye disease in cats and dogs, as well as in humans from Europe, Asia, and the Middle East, is emerging in the Southwestern United States.

“The life cycle of this organism is not yet clearly defined, but likely includes a canine and/or feline animal reservoir, as well as an insect vector,” Dr. Christiana Smith said in an interview at an annual scientific meeting on infectious diseases. “No specific risk factors for developing this disease have been identified, other than residing in or traveling through the Southwestern U.S.”

Sally Koch Kubetin/Frontline Medical News

To date, six cases of humans infected by Onchocerca lupi have come to the attention of health officials, including those at the Centers for Disease Control and Prevention, due to symptoms from a nodule containing the parasite, according to Dr. Smith, a pediatrician with the University of Colorado School of Medicine and Children’s Hospital Colorado, Aurora. The affected patients range in age from 22 months to 50 years of age; three of the six reside in Arizona, two in New Mexico, and one in Texas.

In three of the six cases, the nodule was located in the cervical spinal canal. In the remaining three cases, nodules were located on the scalp, the forearm, and the superior rectus muscle of the orbit. Two of the patients reported insect bites at the nodule site years prior to presentation, while another patient owned a dog with eye lesions.

“No previous Onchocerca parasites are known to have tropism for the central nervous system,” Dr. Smith said. “In addition, five of the six cases presented in children. It is not clear whether children are disproportionately affected by this disease, or whether they are diagnosed more frequently.”

Treatment included surgical excision and antiparasitic treatment for most cases. To date, all patients have remained asymptomatic following treatment. Dr. Smith said that more information about Onchocerca lupi will become available as additional cases are described. “Continued epidemiologic investigation will help define the life cycle of this organism, describe the spectrum of human disease, develop approaches to diagnosis and management, and design prevention strategies,” she said.

IDWeek marks the combined annual meetings of the Infectious Diseases Society of America, the Society for Healthcare Epidemiology of America, the HIV Medicine Association, and the Pediatric Infectious Diseases Society. The researchers reported having no financial disclosures.

dbrunk@frontlinemedcom.com

SAN DIEGO – Onchocerca lupi, a zoonotic parasite previously described as causing eye disease in cats and dogs, as well as in humans from Europe, Asia, and the Middle East, is emerging in the Southwestern United States.

“The life cycle of this organism is not yet clearly defined, but likely includes a canine and/or feline animal reservoir, as well as an insect vector,” Dr. Christiana Smith said in an interview at an annual scientific meeting on infectious diseases. “No specific risk factors for developing this disease have been identified, other than residing in or traveling through the Southwestern U.S.”

Sally Koch Kubetin/Frontline Medical News

To date, six cases of humans infected by Onchocerca lupi have come to the attention of health officials, including those at the Centers for Disease Control and Prevention, due to symptoms from a nodule containing the parasite, according to Dr. Smith, a pediatrician with the University of Colorado School of Medicine and Children’s Hospital Colorado, Aurora. The affected patients range in age from 22 months to 50 years of age; three of the six reside in Arizona, two in New Mexico, and one in Texas.

In three of the six cases, the nodule was located in the cervical spinal canal. In the remaining three cases, nodules were located on the scalp, the forearm, and the superior rectus muscle of the orbit. Two of the patients reported insect bites at the nodule site years prior to presentation, while another patient owned a dog with eye lesions.

“No previous Onchocerca parasites are known to have tropism for the central nervous system,” Dr. Smith said. “In addition, five of the six cases presented in children. It is not clear whether children are disproportionately affected by this disease, or whether they are diagnosed more frequently.”

Treatment included surgical excision and antiparasitic treatment for most cases. To date, all patients have remained asymptomatic following treatment. Dr. Smith said that more information about Onchocerca lupi will become available as additional cases are described. “Continued epidemiologic investigation will help define the life cycle of this organism, describe the spectrum of human disease, develop approaches to diagnosis and management, and design prevention strategies,” she said.

IDWeek marks the combined annual meetings of the Infectious Diseases Society of America, the Society for Healthcare Epidemiology of America, the HIV Medicine Association, and the Pediatric Infectious Diseases Society. The researchers reported having no financial disclosures.

dbrunk@frontlinemedcom.com

SAN DIEGO – Onchocerca lupi, a zoonotic parasite previously described as causing eye disease in cats and dogs, as well as in humans from Europe, Asia, and the Middle East, is emerging in the Southwestern United States.

“The life cycle of this organism is not yet clearly defined, but likely includes a canine and/or feline animal reservoir, as well as an insect vector,” Dr. Christiana Smith said in an interview at an annual scientific meeting on infectious diseases. “No specific risk factors for developing this disease have been identified, other than residing in or traveling through the Southwestern U.S.”

Sally Koch Kubetin/Frontline Medical News

To date, six cases of humans infected by Onchocerca lupi have come to the attention of health officials, including those at the Centers for Disease Control and Prevention, due to symptoms from a nodule containing the parasite, according to Dr. Smith, a pediatrician with the University of Colorado School of Medicine and Children’s Hospital Colorado, Aurora. The affected patients range in age from 22 months to 50 years of age; three of the six reside in Arizona, two in New Mexico, and one in Texas.

In three of the six cases, the nodule was located in the cervical spinal canal. In the remaining three cases, nodules were located on the scalp, the forearm, and the superior rectus muscle of the orbit. Two of the patients reported insect bites at the nodule site years prior to presentation, while another patient owned a dog with eye lesions.

“No previous Onchocerca parasites are known to have tropism for the central nervous system,” Dr. Smith said. “In addition, five of the six cases presented in children. It is not clear whether children are disproportionately affected by this disease, or whether they are diagnosed more frequently.”

Treatment included surgical excision and antiparasitic treatment for most cases. To date, all patients have remained asymptomatic following treatment. Dr. Smith said that more information about Onchocerca lupi will become available as additional cases are described. “Continued epidemiologic investigation will help define the life cycle of this organism, describe the spectrum of human disease, develop approaches to diagnosis and management, and design prevention strategies,” she said.

IDWeek marks the combined annual meetings of the Infectious Diseases Society of America, the Society for Healthcare Epidemiology of America, the HIV Medicine Association, and the Pediatric Infectious Diseases Society. The researchers reported having no financial disclosures.

dbrunk@frontlinemedcom.com