Risk factors associated with laboratory-confirmed bloodstream infections in a tertiary neonatal intensive care unit.

Background: Bloodstream infections (BSI) remain a leading cause of morbidity and mortality among infants admitted to neonatal intensive care units (NICUs). At the time of evaluation for suspected BSI, presenting signs may be nonspecific. We sought to determine the clinical signs and risk factors associated with laboratory-confirmed BSI among infants evaluated for late-onset sepsis in a tertiary NICU.

Antibiotic sensitivity and resistance patterns in pediatric staphylococcal scalded skin syndrome.

Historical resistance patterns often guide empiric antibiotic choices in staphylococcal scalded skin syndrome (SSSS), but little is known about the difference in susceptibility between SSSS and other childhood staphylococcal infections. A retrospective chart review of culture-confirmed cases of SSSS seen in the inpatient dermatology consultation service at the Children's Hospital of Philadelphia between 2005 and 2011 was performed. Most cases of SSSS at our institution are due to oxacillin-susceptible Staphylococcus aureus, and approximately half of the cases are due to clindamycin-resistant strains.

Pediatric Risk Factors for Candidemia Secondary to Candida glabrata and Candida krusei Species.

This 13-year retrospective study investigated risk factors for candidemia secondary to Candida species with increased likelihood of fluconazole resistance. Of 344 candidemia cases, 23 were caused by C glabrata or C krusei (CGCK). Age >2 years, recent fluconazole exposure, and recent surgery were independent risk factors for CGCK.

Emergency department epidemiology of pneumococcal bacteremia in children since the institution of widespread PCV7 vaccination.

Background: The heptavalent pneumococcal conjugate vaccine (PCV7) has produced a shift in the epidemiology of invasive infections from Streptoccoccus pneumoniae.

Objective: Our aim was to determine the temporal changes in pneumococcal bacteremia (Streptococcus pneumoniae bacteremia [SPB]) in the emergency department (ED) since the introduction of PCV7.

Methods: This was a retrospective cohort study of children 0-18 years with SPB evaluated from 1998-2009 in a tertiary-care pediatric ED.

Rapid detection of methicillin-resistant Staphylococcus aureus (MRSA) and methicillin-susceptible Staphylococcus aureus (MSSA) using the KeyPath MRSA/MSSA blood culture test and the BacT/ALERT system in a pediatric population.

Context: Timely initiation of directed antimicrobial therapy for Staphylococcus aureus bacteremia is dependent on rapid identification of S. aureus to ascertain methicillin-susceptibility status.

Objectives: To investigate the performance of the rapid KeyPath (MicroPhage, Inc, Longmont, Colorado) methicillin-resistant S.

Epidemiology of bloodstream infections in children with sickle cell disease.

The incidence of invasive Streptococcus pneumoniae and Haemophilus influenzae type b infections in the sickle cell disease population has declined. In this report, we determine the predominant organisms responsible for bloodstream infections in a pediatric sickle cell disease population during the postheptavalent conjugate vaccine era. Central venous access device associated infections are a new burden to efforts aimed at preventing bloodstream infections in this population.

Genotyping of Candida parapsilosis from three neonatal intensive care units (NICUs) using a panel of five multilocus microsatellite markers: broad genetic diversity and a cluster of related strains in one NICU.

Candida parapsilosis (CP) (n = 40) isolated from an unselected patient population in the neonatal intensive care units (NICUs) of three US hospitals were collected over periods of 3.5-9 years. Two previously published microsatellite markers and three additional trinucleotide markers were used to produce multiplex genotypes, which revealed broad strain diversity among the NICU isolates with a combined index of discrimination (D) = 0.

Cerebrospinal fluid reference ranges in term and preterm infants in the neonatal intensive care unit.

Objective: To determine reference ranges of cerebrospinal fluid (CSF) laboratory findings in term and preterm infants in the neonatal intensive care unit.

Study Design: Data were collected prospectively as part of a multisite study of infants aged <6 months undergoing lumbar puncture for evaluation of suspected sepsis. Infants with a red blood cell count >500 cells/μL or a known cause of CSF pleocytosis were excluded from the analysis.

A writing group for female assistant professors.

Introduction: The number of female medical school faculty being promoted and the speed at which they are promoted have not kept pace with their male counterparts at many institutions. One of the reasons is that these women are not publishing peer reviewed manuscripts at an equivalent rate. This study evaluates the impact of a women's writing group on faculty publication rates.

Cerebrospinal fluid enrichment broth cultures rarely contribute to the diagnosis of bacterial meningitis.

This study included children undergoing lumbar puncture in the emergency department. Bacteria were isolated from 34 (1.7%) of 1898 cerebrospinal fluid (CSF) enrichment broth cultures; 30 were contaminants.

Clostridium difficile testing algorithms using glutamate dehydrogenase antigen and C. difficile toxin enzyme immunoassays with C. difficile nucleic acid amplification testing increase diagnostic yield in a tertiary pediatric population.

We evaluated the performance of the rapid C. diff Quik Chek Complete's glutamate dehydrogenase antigen (GDH) and toxin A/B (CDT) tests in two algorithmic approaches for a tertiary pediatric population: algorithm 1 entailed initial testing with GDH/CDT followed by loop-mediated isothermal amplification (LAMP), and algorithm 2 entailed GDH/CDT followed by cytotoxicity neutralization assay (CCNA) for adjudication of discrepant GDH-positive/CDT-negative results. A true positive (TP) was defined as positivity by CCNA or positivity by LAMP plus another test (GDH, CDT, or the Premier C.

Influence of antibiotic susceptibility patterns on empiric antibiotic prescribing for children hospitalized with community-acquired pneumonia.

Objective: The aim of this study was to determine the influence of pneumococcal penicillin-nonsusceptibility patterns on individual antibiotic prescription among 33 children's hospitals using a multilevel, random- intercept, logistic regression analysis.

Methods: It was a multilevel cross-sectional study. The participants were children, 1-18 years of age, with community-acquired pneumonia (CAP) who were discharged in 2006.

Pneumococcal bacteremia in a vaccinated pediatric sickle cell disease population.

The incidence of pneumococcal disease in sickle cell disease declined significantly with penicillin prophylaxis as well as with the pneumococcal polysaccharide and heptavalent conjugate vaccines. In this report, we describe our experience with pneumococcal bacteremia in pediatric patients with sickle cell disease in the post-heptavalent pneumococcal conjugate vaccine era. Despite established prophylactic strategies, pneumococcal bacteremia continues to occur in patients with sickle cell disease.

Declining incidence of candidemia in a tertiary inpatient pediatric population.

We examined the incidence of candidemia, Candida species distribution, and antifungal susceptibility patterns in a pediatric institution. We identified 301 episodes of candidemia from 2001 to 2010 inclusive. Annual incidence decreased from 0.

Comparison of the Idaho Technology FilmArray system to real-time PCR for detection of respiratory pathogens in children.

The FilmArray Respiratory Panel (RP) multiplexed nucleic acid amplification test (Idaho Technology, Inc., Salt Lake City, UT) was compared to laboratory-developed real-time PCR assays for the detection of various respiratory viruses and certain bacterial pathogens. A total of 215 frozen archived pediatric respiratory specimens previously characterized as either negative or positive for one or more pathogens by real-time PCR were examined using the FilmArray RP system.

Diagnostic accuracy of cerebrospinal fluid gram stain in children with suspected bacterial meningitis.

This cross-sectional study included 1938 children undergoing lumbar puncture; 21 (1.1%) cases were classified as definite (n = 17) or probable (n = 4) bacterial meningitis. Gram stain sensitivity was 94.

Broad-range bacterial polymerase chain reaction in the microbiologic diagnosis of complicated pneumonia.

Background: A bacterial cause is not frequently identified in children with pneumonia complicated by parapneumonic effusion (ie, complicated pneumonia).

Objectives: To determine the frequency of positive blood and pleural fluid cultures in children with complicated pneumonia and to determine whether broad-range 16S rRNA polymerase chain reaction (PCR) improves identification of a microbiologic cause.

Methods: This prospective cohort study included children 1-18 years of age hospitalized with complicated pneumonia.

Mycobacterium chelonae-abscessus complex associated with sinopulmonary disease, Northeastern USA.

Members of the Mycobacterium chelonae-abscessus complex represent Mycobacterium species that cause invasive infections in immunocompetent and immunocompromised hosts. We report the detection of a new pathogen that had been misidentified as M. chelonae with an atypical antimicrobial drug susceptibility profile.

Prevalence of Trichomonas vaginalis infection in symptomatic adolescent females presenting to a pediatric emergency department.

Objectives: Adolescent females are disproportionately affected by sexually transmitted infections (STIs). Although Trichomonas vaginalis (TV) has been declared the most common nonviral STI, TV testing is not routinely conducted in the emergency department (ED), and when it is performed, insensitive testing methods are often used. Therefore, this study sought to determine the prevalence of TV and factors associated with TV infection among symptomatic adolescent females presenting to a pediatric ED.

Recurrence rate of clostridium difficile infection in hospitalized pediatric patients with inflammatory bowel disease.

Background: The incidence and associated morbidity of Clostridium difficile (CD) infection has been increasing at an alarming rate in North America. Clostridium difficile-associated diarrhea (CDAD) is the leading cause of nosocomial diarrhea in the USA. Patients with CDAD have longer average hospital admissions and additional hospital costs.

Ulceroglandular tularemia.

A 14-year-old boy presented with fevers and nonspecific flu-like symptoms, as well as an enlarging ulcerated plaque involving the upper back, lymphadenopathy, and bilateral pulmonary nodules. Bacterial cultures of ulcer tissue grew Francisella tularensis on enriched chocolate agar plates. Making the diagnosis requires a high index of suspicion, and communication with the laboratory to successfully and safely culture these highly pathogenic bacteria is imperative.

Blood culture contamination rates after skin antisepsis with chlorhexidine gluconate versus povidone-iodine in a pediatric emergency department.

Objective: To determine blood culture contamination rates after skin antisepsis with chlorhexidine, compared with povidone-iodine.

Design: Retrospective, quasi-experimental study.

Setting: Emergency department of a tertiary care children's hospital.

The brief CV review session: one component of a mosaic of mentorship for women in academic medicine.

Background: In the current climate of increasing demands on a disproportionately small number of senior female faculty, we implemented a brief curriculum vitae (CV) review session as an opportunity to expand the professional network of junior women faculty and provide them with additional formal career advice.

Methods: For 3 years, junior (mentees) and senior (mentors) faculty from different departments were paired in half-hour CV review sessions, as part of an annual conference focused on professional development for faculty women. Participating faculty received questionnaires to assess their experience with the sessions, and their feedback was combined over all 3 years and compared using chi2 and Fisher's tests.

Practice variation in screening for sexually transmitted infections with nucleic acid amplification tests during prepubertal sexual abuse evaluations.

Background: Although recent recommendations for children after suspected sexual abuse incorporate nucleic acid amplification tests (NAATs) in algorithms that detect sexually transmitted infections (STIs), screening practices in the community remain uncertain.

Study Objective: We examined screening practices over time and across a variety of pediatric settings for the evaluation of STIs in sexually abused children.

Methods: A consecutive cohort of prepubertal children younger than 11 years of age who were suspected to have been sexually abused were identified between May 2002 and April 2005 at a large tertiary children's hospital and its supporting primary care network.