Outcome of pediatric acute myeloid leukemia patients receiving intensive care in the United States.

Objective: Children with acute myeloid leukemia are at risk for sepsis and organ failure. Outcomes associated with intensive care support have not been studied in a large pediatric acute myeloid leukemia population. Our objective was to determine hospital mortality of pediatric acute myeloid leukemia patients requiring intensive care.

Antifungal prophylaxis associated with decreased induction mortality rates and resources utilized in children with new-onset acute myeloid leukemia.

Background: Invasive fungal infections cause significant morbidity and mortality for children with acute myeloid leukemia (AML). Data on the comparative effectiveness of antifungal prophylaxis in this population are limited.

Methods: A pediatric AML cohort was assembled from the Pediatric Health Information System database using ICD-9 codes and pharmacy data.

Use of Administrative Data for the Identificationof Laboratory-Confirmed Influenza Infection: The Validity ofInfluenza-Specific ICD-9 Codes.

We used Pediatric Health Information System data and laboratory records from 3 children's hospitals to determine whether administrative data accurately identify children with laboratory-confirmed influenza. Among 23 282 inpatients, diagnosis codes for influenza detected 73% of laboratory-confirmed influenza cases, whereas <1% of patients without a diagnosis code had laboratory-confirmed influenza.

Variation in hospital antibiotic prescribing practices for children with acute lymphoblastic leukemia.

Antibiotic variation among pediatric oncology patients has not been well-described. Identification of significant variability in antibiotic use within this population would warrant evaluation of its clinical impact. We conducted a retrospective cohort study of newly diagnosed patients with pediatric acute lymophoblastic leukemia (ALL) hospitalized from 1999 to 2009 in 39 freestanding US children's hospitals within the Pediatric Health Information System.

Results from a prospective, international, epidemiologic study of invasive candidiasis in children and neonates.

Background: Candida species are the third most common cause of pediatric health care-associated bloodstream infection in the United States and Europe. To our knowledge, this report from the International Pediatric Fungal Network is the largest prospective, multicenter observational study dedicated to pediatric and neonatal invasive candidiasis.

Methods: From 2007 to 2011, we enrolled 196 pediatric and 25 neonatal patients with invasive candidiasis.

Oseltamivir shortens hospital stays of critically ill children hospitalized with seasonal influenza: a retrospective cohort study.

Background: Antiviral therapy reduces symptom duration and hospitalization risk among previously healthy and chronically ill children infected with seasonal influenza. The effect of oseltamivir on outcomes of hospitalized children is unknown. The primary objective of this study was to determine whether oseltamivir improves outcomes of critically ill children hospitalized with influenza.

Improving surveillance for pediatric Clostridium difficile infection: derivation and validation of an accurate case-finding tool.

Background: The incidence of Clostridium difficile infection (CDI) is increasing. Multicenter studies of CDI have been limited by the lack of valid case-finding tools. To facilitate pediatric studies of CDI, we constructed a case-finding tool using administrative data.

Risk factors for renal failure in pediatric patients with acute myeloid leukemia: a retrospective cohort study.

Background: In children receiving treatment for acute myeloid leukemia (AML) there is often concern for the development of acute renal failure (ARF). Despite this, data are limited to define the incidence of ARF in this population. This study aims to evaluate the rate of ARF in AML patients and to delineate the impact of age, race, various co-morbid conditions and antimicrobial agents on the development of ARF.

Risk factors for healthcare-associated, laboratory-confirmed influenza in hospitalized pediatric patients: a case-control study.

We conducted a case-control study of 46 hospitalized pediatric patients with healthcare-associated laboratory-confirmed influenza (HA-LCI). We sought to determine the characteristics and outcomes of children with HA-LCI and to identify risk factors for HA-LCI. Although we failed to identify any differences in clinical exposures during the 3 days prior to onset of HA-LCI, multivariate analysis showed that asthma was an independent risk factor for HA-LCI (odds ratio, 3.

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.

Use of antibiotics in children hospitalized with community-acquired, laboratory-confirmed influenza.

Many children with influenza are treated with antibiotics. In this report, we describe the rate and indications for antibacterial use in children hospitalized with influenza. A total of 333 of 729 (46%) patients received >2 days of treatment with antibacterial medications, of whom 36% did not have an apparent indication for therapy.

Cefepime and mortality in pediatric acute myelogenous leukemia: a retrospective cohort study.

Background: Based on 2 meta-analyses, the Food and Drug Administration issued a communication in 2009 regarding the potential risk of death in patients treated with cefepime. Pediatric patients with acute myelogenous leukemia (AML) have frequent episodes of fever necessitating the use of antibiotics such as cefepime. We evaluated the association of cefepime and other beta-lactam antibiotic exposures with all cause in-hospital mortality in pediatric AML patients.

Community acquired influenza requiring hospitalization: vaccine status is unrelated to morbidity in children with cancer.

Background: Community acquired influenza can be severe and there are few data regarding hospitalization for children with cancer and influenza. Association between prior vaccination and infection severity has not been studied, although vaccination is standard practice.

Procedure: Patients with malignancy or prior stem cell transplant (SCT) were identified using a database of children with laboratory confirmed influenza (2000-2005).

Treatment with oseltamivir in children hospitalized with community-acquired, laboratory-confirmed influenza: review of five seasons and evaluation of an electronic reminder.

Background: When initiated within 48 hours of the onset of symptoms, oseltamivir has been shown to reduce severity and length of influenza illness. Few studies have evaluated the use of oseltamivir in patients hospitalized with influenza.

Objective: To describe the prescribing practices for oseltamivir in children hospitalized with influenza and to evaluate a mechanism to improve the rate of appropriate prescription.

Prolonged intravenous therapy versus early transition to oral antimicrobial therapy for acute osteomyelitis in children.

Objectives: Early transition from intravenous to oral antimicrobial therapy for acute osteomyelitis in children has been suggested as a safe and effective alternative to traditional prolonged intravenous therapy via central venous catheter, but no studies have directly compared these 2 treatment modalities. We sought to compare the effectiveness of early transition from intravenous to oral antimicrobial therapy versus prolonged intravenous antimicrobial therapy for the treatment of children with acute osteomyelitis.

Methods: We conducted a retrospective cohort study of children aged 2 months to 17 years diagnosed with acute osteomyelitis between 2000 and 2005 at 29 freestanding children's hospitals in the United States to confirm the extent of variation in the use of early transition to oral therapy.

Epidemiological features of Clostridium difficile-associated disease among inpatients at children's hospitals in the United States, 2001-2006.

Objective: Clostridium difficile is the main cause of nosocomial and antibiotic-associated diarrhea in adults. Recently, the incidence and severity of C difficile-associated disease in adults have been increasing. Whether similar phenomena are occurring among children remains unknown.

Pediatric antifungal utilization: new drugs, new trends.

Background: The frequency and severity of invasive fungal infections in immunocompromised patients has increased steadily over the last 2 decades. In response to the increased incidence and high mortality rates, novel antifungal agents have been developed to expand the breadth and effectiveness of treatment options available to clinicians. Despite these therapeutic advances, the impact of the availability of new antifungal agents on pediatric practice is unknown.

Methicillin-resistant Staphylococcus aureus colonization in children with atopic dermatitis.

Children with atopic dermatitis are more frequently colonized with Staphylococcus aureus than children without atopic dermatitis. However, little epidemiological data exist regarding the prevalence of methicillin-resistant S. aureus among children with atopic dermatitis.