| Records |
| Author |
Hudgins, J.D.; Goldberg, V.; Fell, G.L.; Puder, M.; Eisenberg, M.A. |
| Title |
Reducing Time to Antibiotics in Children With Intestinal Failure, Central Venous Line, and Fever |
Type |
Journal Article |
| Year |
2017 |
Publication |
Pediatrics |
Abbreviated Journal  |
Pediatrics |
| Volume |
140 |
Issue |
5 |
Pages |
|
| Keywords |
Anti-Bacterial Agents/*administration & dosage; Bacteremia/diagnosis/drug therapy/epidemiology; Central Venous Catheters/microbiology; Child, Preschool; Cohort Studies; Female; Fever/diagnosis/*drug therapy/*epidemiology; Humans; Intestinal Diseases/diagnosis/drug therapy/epidemiology; Length of Stay/*trends; Male; Short Bowel Syndrome/diagnosis/*drug therapy/*epidemiology; Time-to-Treatment |
| Abstract |
BACKGROUND: Children with intestinal failure (IF) on parenteral nutrition (PN) are at high risk for bacteremia, and delays in antibiotic administration have been associated with increased morbidity and mortality. We designed an emergency department (ED) quality improvement (QI) initiative to reduce time to administration of intravenous antibiotics in febrile children with IF on PN. METHODS: Our aim was to decrease the mean time for febrile children with IF on PN to receive intravenous antibiotics by 50% to <60 minutes over a 12-month period. Secondary outcome measures were ED, hospital, and ICU length of stay (LOS). Our process measure was the rate of ordering recommended antibiotics, and our balancing measure was the rate of hypoglycemia. Interventions included increasing provider knowledge of IF, streamlining order entry, providing individualized feedback, and standardizing the triage process. Results were analyzed by using statistical process control methodology and time series analysis. RESULTS: We identified 149 eligible ED patients, of which 62 (41.6%) had bacteremia. The mean time to antibiotics decreased after the onset of the QI initiative from 112 to 39 minutes, and the ED LOS decreased from 286 to 247 minutes, but the total length of hospital and ICU stays were unchanged. The rate of hypoglycemia was also unchanged. CONCLUSIONS: Our QI intervention for febrile children with IF on PN shortened the time to receive antibiotics. Larger studies are needed to demonstrate the impact on overall LOS and mortality. |
| Address |
Division of Emergency Medicine and |
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Place of Publication |
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| Language |
English |
Summary Language |
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Original Title |
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Series Title |
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Abbreviated Series Title |
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Series Issue |
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Edition |
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| ISSN |
0031-4005 |
ISBN |
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Medium |
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Expedition |
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Conference |
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| Notes |
PMID:29066581 |
Approved |
no |
| Call Number |
ref @ user @ |
Serial |
98935 |
| Permanent link to this record |
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| Author |
Hudgins, J.D.; Goldberg, V.; Fell, G.L.; Puder, M.; Eisenberg, M.A. |
| Title |
Reducing Time to Antibiotics in Children With Intestinal Failure, Central Venous Line, and Fever |
Type |
Journal Article |
| Year |
2017 |
Publication |
Pediatrics |
Abbreviated Journal |
Pediatrics |
| Volume |
140 |
Issue |
5 |
Pages |
|
| Keywords |
Anti-Bacterial Agents/*administration & dosage; Bacteremia/diagnosis/drug therapy/epidemiology; Central Venous Catheters/microbiology; Child, Preschool; Cohort Studies; Female; Fever/diagnosis/*drug therapy/*epidemiology; Humans; Intestinal Diseases/diagnosis/drug therapy/epidemiology; Length of Stay/*trends; Male; Short Bowel Syndrome/diagnosis/*drug therapy/*epidemiology; Time-to-Treatment |
| Abstract |
BACKGROUND: Children with intestinal failure (IF) on parenteral nutrition (PN) are at high risk for bacteremia, and delays in antibiotic administration have been associated with increased morbidity and mortality. We designed an emergency department (ED) quality improvement (QI) initiative to reduce time to administration of intravenous antibiotics in febrile children with IF on PN. METHODS: Our aim was to decrease the mean time for febrile children with IF on PN to receive intravenous antibiotics by 50% to <60 minutes over a 12-month period. Secondary outcome measures were ED, hospital, and ICU length of stay (LOS). Our process measure was the rate of ordering recommended antibiotics, and our balancing measure was the rate of hypoglycemia. Interventions included increasing provider knowledge of IF, streamlining order entry, providing individualized feedback, and standardizing the triage process. Results were analyzed by using statistical process control methodology and time series analysis. RESULTS: We identified 149 eligible ED patients, of which 62 (41.6%) had bacteremia. The mean time to antibiotics decreased after the onset of the QI initiative from 112 to 39 minutes, and the ED LOS decreased from 286 to 247 minutes, but the total length of hospital and ICU stays were unchanged. The rate of hypoglycemia was also unchanged. CONCLUSIONS: Our QI intervention for febrile children with IF on PN shortened the time to receive antibiotics. Larger studies are needed to demonstrate the impact on overall LOS and mortality. |
| Address |
Division of Emergency Medicine and |
| Corporate Author |
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Thesis |
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| Publisher |
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Place of Publication |
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Editor |
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| Language |
English |
Summary Language |
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Original Title |
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| Series Editor |
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Series Title |
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Abbreviated Series Title |
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Series Issue |
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Edition |
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| ISSN |
0031-4005 |
ISBN |
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Medium |
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| Area |
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Expedition |
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Conference |
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| Notes |
PMID:29066581 |
Approved |
no |
| Call Number |
ref @ user @ |
Serial |
99965 |
| Permanent link to this record |
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| Author |
Rogers, A.E.J.; Eisenman, K.M.; Dolan, S.A.; Belderson, K.M.; Zauche, J.R.; Tong, S.; Gralla, J.; Hilden, J.M.; Wang, M.; Maloney, K.W.; Dominguez, S.R. |
| Title |
Risk factors for bacteremia and central line-associated blood stream infections in children with acute myelogenous leukemia: A single-institution report |
Type |
Journal Article |
| Year |
2017 |
Publication |
Pediatric Blood & Cancer |
Abbreviated Journal |
Pediatr Blood Cancer |
| Volume |
64 |
Issue |
3 |
Pages |
|
| Keywords |
Adolescent; Bacteremia/*etiology; Bacteria/isolation & purification; Case-Control Studies; Catheter-Related Infections/*etiology; Catheterization, Central Venous/*adverse effects; Child; Child, Preschool; Cross Infection/*etiology; Female; Follow-Up Studies; Humans; Infant; Intensive Care Units, Pediatric; Leukemia, Myeloid, Acute/*complications/microbiology; Male; Prognosis; Retrospective Studies; Risk Factors; Clabsi; acute myelogenous leukemia; bacteremia; pediatric oncology |
| Abstract |
BACKGROUND: Central line-associated blood stream infections (CLABSIs) are a source of high morbidity and mortality in children with acute myelogenous leukemia (AML). PROCEDURE: To understand the epidemiology and risk factors associated with the development of CLABSI in children with AML. METHODS: We retrospectively reviewed all patients with AML over a 5-year period between 2007 and 2011 at the Children's Hospital Colorado. Cases and controls were classified on the basis of the presence of a CLABSI as defined by the National Healthcare Safety Network. RESULTS: Of 40 patients in the study, 25 (62.5%) developed at least one CLABSI during therapy. The majority of CLABSIs were due to oral or gastrointestinal organisms (83.0%). Skin organisms accounted for 8.5%. In a multivariable analysis, the strongest risk factors associated with CLABSI were diarrhea (odds ratio [OR] 6.7, 95% confidence interval [CI] 1.6-28.7), receipt of blood products in the preceding 4-7 days (OR 10.0, 95%CI 3.2-31.0), not receiving antibiotics (OR 8.3, 95%CI 2.8-25.0), and chemotherapy cycle (OR 3.5, 95%CI 1.4-8.9). CLABSIs led to increased morbidity, with 13 cases (32.5%) versus two controls (1.9%) requiring transfer to the pediatric intensive care unit (P < 0.001). Three (7.5%) of 40 CLABSI events resulted in or contributed to death. CONCLUSIONS: Intensified line care efforts cannot eliminate all CLABSIs in the patients with AML. Exploring the role of mucosal barrier breakdown and/or the use of antibiotic prophylaxis may be effective strategies for further prevention of CLABSIs, supporting ongoing trials in this patient population. |
| Address |
Department of Infectious Disease, University of Colorado Denver School of Medicine and Children's Hospital Colorado, Aurora, Colorado |
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Thesis |
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Place of Publication |
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English |
Summary Language |
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Original Title |
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Series Title |
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Abbreviated Series Title |
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Series Issue |
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Edition |
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| ISSN |
1545-5009 |
ISBN |
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Medium |
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| Area |
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Expedition |
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Conference |
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| Notes |
PMID:27616655 |
Approved |
no |
| Call Number |
ref @ user @ |
Serial |
99291 |
| Permanent link to this record |
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| Author |
Rogers, A.E.J.; Eisenman, K.M.; Dolan, S.A.; Belderson, K.M.; Zauche, J.R.; Tong, S.; Gralla, J.; Hilden, J.M.; Wang, M.; Maloney, K.W.; Dominguez, S.R. |
| Title |
Risk factors for bacteremia and central line-associated blood stream infections in children with acute myelogenous leukemia: A single-institution report |
Type |
Journal Article |
| Year |
2017 |
Publication |
Pediatric Blood & Cancer |
Abbreviated Journal |
Pediatr Blood Cancer |
| Volume |
64 |
Issue |
3 |
Pages |
|
| Keywords |
Adolescent; Bacteremia/*etiology; Bacteria/isolation & purification; Case-Control Studies; Catheter-Related Infections/*etiology; Catheterization, Central Venous/*adverse effects; Child; Child, Preschool; Cross Infection/*etiology; Female; Follow-Up Studies; Humans; Infant; Intensive Care Units, Pediatric; Leukemia, Myeloid, Acute/*complications/microbiology; Male; Prognosis; Retrospective Studies; Risk Factors; Clabsi; acute myelogenous leukemia; bacteremia; pediatric oncology |
| Abstract |
BACKGROUND: Central line-associated blood stream infections (CLABSIs) are a source of high morbidity and mortality in children with acute myelogenous leukemia (AML). PROCEDURE: To understand the epidemiology and risk factors associated with the development of CLABSI in children with AML. METHODS: We retrospectively reviewed all patients with AML over a 5-year period between 2007 and 2011 at the Children's Hospital Colorado. Cases and controls were classified on the basis of the presence of a CLABSI as defined by the National Healthcare Safety Network. RESULTS: Of 40 patients in the study, 25 (62.5%) developed at least one CLABSI during therapy. The majority of CLABSIs were due to oral or gastrointestinal organisms (83.0%). Skin organisms accounted for 8.5%. In a multivariable analysis, the strongest risk factors associated with CLABSI were diarrhea (odds ratio [OR] 6.7, 95% confidence interval [CI] 1.6-28.7), receipt of blood products in the preceding 4-7 days (OR 10.0, 95%CI 3.2-31.0), not receiving antibiotics (OR 8.3, 95%CI 2.8-25.0), and chemotherapy cycle (OR 3.5, 95%CI 1.4-8.9). CLABSIs led to increased morbidity, with 13 cases (32.5%) versus two controls (1.9%) requiring transfer to the pediatric intensive care unit (P < 0.001). Three (7.5%) of 40 CLABSI events resulted in or contributed to death. CONCLUSIONS: Intensified line care efforts cannot eliminate all CLABSIs in the patients with AML. Exploring the role of mucosal barrier breakdown and/or the use of antibiotic prophylaxis may be effective strategies for further prevention of CLABSIs, supporting ongoing trials in this patient population. |
| Address |
Department of Infectious Disease, University of Colorado Denver School of Medicine and Children's Hospital Colorado, Aurora, Colorado |
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Thesis |
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Place of Publication |
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Editor |
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| Language |
English |
Summary Language |
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Original Title |
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Series Title |
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Abbreviated Series Title |
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| Series Volume |
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Series Issue |
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Edition |
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| ISSN |
1545-5009 |
ISBN |
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Medium |
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| Area |
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Expedition |
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Conference |
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| Notes |
PMID:27616655 |
Approved |
no |
| Call Number |
ref @ user @ |
Serial |
100321 |
| Permanent link to this record |
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| Author |
Souza, R.L.; Mugabe, V.A.; Paploski, I.A.D.; Rodrigues, M.S.; Moreira, P.S.D.S.; Nascimento, L.C.J.; Roundy, C.M.; Weaver, S.C.; Reis, M.G.; Kitron, U.; Ribeiro, G.S. |
| Title |
Effect of an intervention in storm drains to prevent Aedes aegypti reproduction in Salvador, Brazil |
Type |
Journal Article |
| Year |
2017 |
Publication |
Parasites & Vectors |
Abbreviated Journal |
Parasit Vectors |
| Volume |
10 |
Issue |
1 |
Pages |
328 |
| Keywords |
Aedes aegypti; Arboviruses; Catch basin; Disease vectors; Entomology; Epidemiology; Insect vectors; Mosquitoes; Storm drain |
| Abstract |
BACKGROUND: Aedes aegypti, the principal vector for dengue, chikungunya and Zika viruses, is a synanthropic species that uses stagnant water to complete its reproductive cycle. In urban settings, rainfall water draining structures, such as storm drains, may retain water and serve as a larval development site for Aedes spp. reproduction. Herein, we describe the effect of a community-based intervention on preventing standing water accumulation in storm drains and their consequent infestation by adult and immature Ae. aegypti and other mosquitoes. METHODS: Between April and May of 2016, local residents association of Salvador, Brazil, after being informed of water accumulation and Ae. aegypti infestation in the storm drains in their area, performed an intervention on 52 storm drains. The intervention consisted of placing concrete at the bottom of the storm drains to elevate their base to the level of the outflow tube, avoiding water accumulation, and placement of a metal mesh covering the outflow tube to avoid its clogging with debris. To determine the impact of the intervention, we compared the frequency at which the 52 storm drains contained water, as well as adult and immature mosquitoes using data from two surveys performed before and two surveys performed after the intervention. RESULTS: During the pre-intervention period, water accumulated in 48 (92.3%) of the storm drains, and immature Ae. aegypti were found in 11 (21.2%) and adults in 10 (19.2%). After the intervention, water accumulated in 5 (9.6%) of the storm drains (P < 0.001), none (0.0%) had immatures (P < 0.001), and 3 (5.8%) contained adults (P = 0.039). The total number of Ae. aegypti immatures collected decreased from 109 to 0 (P < 0.001) and adults decreased from 37 to 8 (P = 0.011) after the intervention. Collection of immature and adult non-Aedes mosquitoes (mainly Culex spp.) in the storm drains also decreased after the intervention. CONCLUSION: This study exemplifies how a simple intervention targeting storm drains can result in a major reduction of water retention, and, consequently, impact Ae. aegypti larval populations. Larger and multi-center evaluations are needed to confirm the potential of citywide structural modifications of storm drains to reduce Aedes spp. infestation level. |
| Address |
Instituto de Saude Coletiva, Universidade Federal da Bahia, Salvador, Bahia, Brazil. guilherme.ribeiro@bahia.fiocruz.br |
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English |
Summary Language |
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Original Title |
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Series Title |
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Abbreviated Series Title |
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Series Issue |
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Edition |
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| ISSN |
1756-3305 |
ISBN |
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Medium |
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Expedition |
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Conference |
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| Notes |
PMID:28697811 |
Approved |
no |
| Call Number |
ref @ user @ |
Serial |
97633 |
| Permanent link to this record |
