The Role ofClostridium difficileand Viruses as Causes of Nosocomial Diarrhea in Children

2002 ◽  
Vol 23 (11) ◽  
pp. 660-664 ◽  
Author(s):  
Joanne M. Langley ◽  
John C. LeBlanc ◽  
Martha Hanakowski ◽  
Olga Goloubeva
Keyword(s):  
Respiratory Infections ◽  
Care Center ◽  
Tertiary Care ◽  
Personal Contact ◽  
First Episode ◽  
Causative Organism ◽  
Older Children ◽  
Maritime Provinces ◽  
Viral Diarrhea ◽  
Nosocomial Diarrhea

Objective:We report surveillance of nosocomial diarrhea in children at our institution during the past decade and note different epidemiology of diarrhea due to viruses andClostridium difficile.Design:A prospective cohort study.Setting:A university-affiliated pediatric hospital with 180 beds serving an urban area and providing referral care for the Maritime Provinces of Canada.Participants:Children younger than 18 years.Methods:Surveillance was conducted from 1991 to 1999 using personal contact with personnel and review of microbiology and medical records. Nosocomial diarrhea was defined as loose stools occurring more than 48 hours after admission, with at least two loose stools in 12 hours and no likely non-infectious cause.Results:Nosocomial diarrhea was the third most common nosocomial infection (217 of 1,466; 15%), after bloodstream and respiratory infections, with from 0.5 to 1 episode per 1,000 patient-days. Of 217 nosocomial diarrhea episodes, 122 (56%) had identified pathogens:C. difficile(39 of 122; 32%), rotavirus (38 of 122; 31%), adenovirus (36 of 122; 30%), and other viral (9 of 122; 7%). The median age was 1.3 years (range, 11 days to 17.9 years), 0.80 year for children with viral diarrhea, 3.9 years for children withC. difficile, and 1.5 years for children with diarrhea without a causative organism identified (P< .0001). Most children with nosocomial diarrhea were incontinent (diapered) at the time of their first episode (138 of 185; 75%), but preexisting incontinence was more common in those with viral diarrhea (93%) compared with those with no organism identified (71%) or those withC. difficile-associated diarrhea (CDAD) (49%) (P< .0001).Conclusions:C. difficileis the single most common cause of nosocomial diarrhea in our tertiary-care center, although all viral pathogens account for 69% of cases. Diapered status appears to be a risk factor for CDAD in children, and CDAD occurs more often in older children than viral nosocomial diarrhea. Further characterization of risk factors for, and morbidity associated with, nosocomial CDAD in children is warranted.

A 10-Year Review of Necrotizing Fasciitis in the Pediatric Population: Delays to Diagnosis and Management

2016 ◽  
Vol 56 (7) ◽  
pp. 627-633 ◽  
Author(s):  
Heather VanderMeulen ◽  
Jeffrey M. Pernica ◽  
Madan Roy ◽  
April J. Kam
Keyword(s):  
Necrotizing Fasciitis ◽  
Chart Review ◽  
Pediatric Population ◽  
Care Center ◽  
Tertiary Care ◽  
Length Of Hospital Stay ◽  
Retrospective Chart Review ◽  
Causative Organism ◽  
Antibiotic Administration ◽  
Large Variability

Objective. To assess the promptness and appropriateness of management in pediatric cases of necrotizing fasciitis (NF). Methods. A retrospective chart review examined cases of pediatric NF treated at a pediatric tertiary care center over a 10-year period. Results. Twelve patients were identified over the 10-year period. The median (25th to 75th centile) times to appropriate antibiotic administration, infectious disease consults, surgical consults and debridement surgeries were 2.6 (2.1-3.2), 7.7 (3.4-24.4), 4.6 (1.7-21.0), and 22.1 (10.3-28.4) hours following assessment at triage. The initial antibiotic(s) administered covered the causative organism in 9 of 12 cases. The median (25th to 75th centile) length of hospital stay was 21 (14.0-35.5) days. Conclusions. The large variability in the care of these patients speaks to the range of their presenting symptomatology. The lack of a standardized approach to the pediatric patient with suspected NF results in delays in management and suboptimal antibiotic choice.

scholarly journals Serial Procalcitonin Levels Correlate with Microbial Etiology in Hospitalized Patients with Pneumonia

2017 ◽  
Vol 4 (suppl_1) ◽  
pp. S351-S351 ◽  
Author(s):  
Pierre Ankomah ◽  
Suzanne Mccluskey ◽  
Michael Abers ◽  
Benjamin Bearnot ◽  
Shreya Patel ◽  
...  
Keyword(s):  
Respiratory Infections ◽  
Statistical Significance ◽  
Care Center ◽  
Tertiary Care ◽  
Pneumococcal Infections ◽  
Significant Difference ◽  
Prognostic Utility ◽  
Microbial Etiology ◽  
Hospital Days ◽  
The Relationship

Abstract Background Procalcitonin (PCT) is a biomarker that is finding increasing diagnostic and prognostic utility in lower respiratory infections. It remains unclear, however, whether it can be helpful in predicting the bacterial etiology of pneumonia, with a view to informing antibiotic choice and duration. This study examines the relationship between serial PCT measurements and microbial etiology in patients hospitalized for pneumonia to determine whether changes in PCT levels provide discriminatory information on microbial etiology. Methods We performed a subgroup analysis of data from a prospective cohort study of 505 patients admitted to a tertiary care center with findings concerning for pneumonia. Microbial etiology of pneumonia was determined from high quality respiratory samples, blood cultures or other relevant diagnostic tests according to standard protocols. Procalcitonin levels were measured serially during the first four days of hospitalization. We compared procalcitonin levels between different bacterial etiologies over the first four days of admission, using the Mann–Whitney-U test to assess for statistical significance. Results Out of 505 patients, the diagnosis of pneumonia was adjudicated in 317, and bacterial etiology determined in 62 cases. The predominant pathogens were Staphylococcus aureus (N = 18), Streptococcus pneumoniae (N = 6), Pseudomonas aeruginosa (N = 11) and Haemophilus influenza (N = 5). Admission levels of PCT were lowest in Pseudomonas infections and highest in pneumococcal infections, though not reaching statistical significance. On hospital days two and three, pneumococcal procalcitonin levels were significantly higher than all other etiologies, but on day four, there was no statistically significant difference in PCT values for different microbial etiologies. Conclusion Serial procalcitonin levels during the early course of bacterial pneumonia reveal a difference between pneumococcal and other bacterial etiologies, and may have an adjunct role in guiding antibiotic choice and duration. Disclosures All authors: No reported disclosures.

Infection and Predictors of Outcome of Cirrhotic Patients after Emergency Care Hospital Admission

2018 ◽  
Vol 17 (5) ◽  
pp. 0-10
Author(s):  
Wajima Safi ◽  
Mayada Elnegouly ◽  
Raphael Schellnegger ◽  
Katrin Umgelter ◽  
Fabian Geisler ◽  
...  
Keyword(s):  
Cox Regression ◽  
Care Center ◽  
Tertiary Care ◽  
Multivariable Analysis ◽  
Scoring Systems ◽  
First Episode ◽  
Care Hospital ◽  
Cox Regression Analysis ◽  
Cirrhotic Patients ◽  
The Impact

Introduction and aims: We aimed to explore the impact of infection diagnosed upon admission and of other clinical baseline parameters on mortality of cirrhotic patients with emergency admissions. Material and Methods: We performed a prospective observational monocentric study in a tertiary care center. The association of clinical parameters and established scoring systems with short-term mortality up to 90 days was assessed by univariate and multivariable Cox regression analysis. Akaike’s Information Criterion (AIC) was used for automated variable selection. Statistical interaction effects with infection were also taken into account. Results: 218 patients were included. 71.2% were male, mean age was 61.1 ± 10.5 years. Mean MELD score was 16.2 ± 6.5, CLIF-consortium Acute on Chronic Liver Failure-score was 34 ± 11. At 28, 90 and 365 days, 9.6%, 26,0% and 40.6% of patients had died, respectively. In multivariable analysis, respiratory organ failure (Hazard Ratio (HR) = 0.15), albumin substitution (HR = 2.48), non-HCC-malignancy (HR = 4.93), CLIF-C-ACLF (HR = 1.10), HCC (HR = 3.70) and first episode of ascites (HR = 0.11) were significantly associated with 90-day mortality. Patients with infection had a significantly higher 90-day mortality (36.3% vs 20.1%, p = 0.007). Cultures were positive in 32 patients with resistance to cephalosporins or quinolones in 10, to ampicillin/sulbactam in 14 and carbapenems in 6 patients. Conclusion: Infection is common in cirrhotic ED admissions and increases mortality. The proportion of resistant microorganisms is high. The predictive capacity of established scoring systems in this setting was low to moderate.

Paediatric echocardiography by telemedicine-nine years' experience

1997 ◽  
Vol 3 (4) ◽  
pp. 200-204 ◽  
Author(s):  
J. P. Finley ◽  
G. P. Sharratt ◽  
M. A. Nanton ◽  
R. P. Chen ◽  
P. Bryan ◽  
...  
Keyword(s):  
Video Transmission ◽  
Tertiary Care ◽  
Care Hospital ◽  
Older Children ◽  
Maritime Provinces ◽  
Paediatric Cardiology ◽  
Telephone Companies ◽  
Network Equipment ◽  
Equipment Leasing ◽  
The Cost

In 1987 we established a realtime echocardiography service by telemedicine from the paediatric cardiology department of a tertiary-care hospital in Halifax. The service was initially provided to a single regional hospital but was expanded to six regional hospitals in the three Canadian Maritime Provinces. The system used a dialup broadband video-transmission service provided by the telephone companies. Records of all transmissions were kept prospectively and reviewed to January 1997. A total of 324 transmissions were made. During 1995- 96 there were 135 studies: 69 51 were urgent examinations of newborn children and 30 22 were urgent examinations of older children; repeat studies and postoperative checks usually for pericardial effusion accounted for the other 36 studies 27 . The images were of broadcast quality except in five cases where problems with transmission or poor sedation occurred. A comparison of 26 transmitted studies with repeat, in person' studies showed no important discrepancies in diagnosis. During the two-year study period, the cost of the network equipment leasing costs and telecommunications costs was C 90,000. Use of the telemedicine network saved unnecessary patient transfer in 31 cases. The cost of the transportation avoided was C 100,000-C 118,000. This review confirms our preliminary findings that broadband echocardiography transmission provides a service comparable in availability and accuracy to that provided in our paediatric cardiology division.

scholarly journals LL-37 levels in nasal secretions are associated with the severity of acute bronchiolitis

2020 ◽  
Author(s):  
Maria Papadaki ◽  
Antonios Marmarinos ◽  
Maria Tsolia ◽  
Dimitrios Gourgiotis ◽  
Alexandra Soldatou
Keyword(s):  
Care Center ◽  
Tertiary Care ◽  
Serum Vitamin ◽  
Nasal Secretion ◽  
First Episode ◽  
Acute Bronchiolitis ◽  
Infants And Toddlers ◽  
Serum Vitamin D ◽  
Nasal Secretions ◽  
Length Of Hospitalization

Objective: Τo investigate the association of serum vitamin D and nasal secretion antimicrobial peptides (AMPs) levels with the severity of acute bronchiolitis. Study design: We conducted a prospective single pediatric tertiary care center cohort study of inpatients aged 0-18 months with a first episode of acute bronchiolitis from November 1st 2014 to April 30th 2017. Disease severity was determined by the length of hospitalization and supplemental hospital data. Qualitative measurements included serum 25(OH)D and nasal secretion LL-37 and β-defensin-2 levels. Correlations were examined with the Mann-Whitney and Kruskal-Wallis criteria for qualitative and the correlation coefficient Spearman’s rho for quantitative factors. Multiple linear and logarithmic regression were performed in order to adjust for confounding factors. Results: The study population consisted of 153 infants and toddlers with mean age 3.6 months (SD: +2.8). The median level of serum 25(OH)D was 51.4 nmol/L (IQR: 29.7-72.2). No association was found between serum 25(OH)D and AMPs nasal secretions levels. Serum 25(OH)D and nasal secretion β-defensin-2 levels were not associated with the severity of bronchiolitis. In contrast, LL-37 levels were inversely associated with the length of hospitalization (rho = -0.340, p = 0.001) and the need for medication use (p = 0.001) and this association remained significant after adjustment for potential confounders. Conclusion: A significant association between LL-37 nasal secretions levels with the severity of acute bronchiolitis was found in hospitalized infants and toddlers. The role of LL-37 in the pathogenesis of bronchiolitis merits further investigation.

scholarly journals Non-SARS Non-MERS Human Coronaviruses: Clinical Characteristics and Outcome

Pathogens ◽  
2021 ◽  
Vol 10 (12) ◽  
pp. 1549
Author(s):  
Israa Saib ◽  
Saud Aleisa ◽  
Husam Ardah ◽  
Ebrahim Mahmoud ◽  
Ahmad O. Alharbi ◽  
...  
Keyword(s):  
Respiratory Infections ◽  
Care Center ◽  
Tertiary Care ◽  
Respiratory Illness ◽  
Study Cohort ◽  
Invasive Ventilation ◽  
Respiratory Illnesses ◽  
Co Detection ◽  
The Common ◽  
Human Coronaviruses

Human coronaviruses (HCoVs) have become evident sources of human respiratory infections with new emerging HCoVs as a significant cause of morbidity and mortality. The common four coronaviruses (229E, HKU1, NL63, and OC43) are known to cause respiratory illness in humans, but their clinical impact is poorly described in the literature. We analyzed the data of all patients who tested positive for at least one of the four HCoVs from October 2015 to January 2020 in a tertiary care center. HCoVs were detected in 1062 specimens, with an incidence rate of 1.01%, out of all documented respiratory illnesses. Detection of these viruses was reported sporadically throughout the years, with a peak of occurrence during winter seasons. OC43 had the highest incidence (53.7%), followed by NL63 (21.9%), HKU1 (12.6%), and 229E (11.8%). Most of these infections were community-acquired, with symptoms of both upper and lower respiratory tract. Co-detection with other viruses were observed, mostly with rhinovirus. 229E was the most frequent (26.4%) HCoV in patients requiring intensive care, while NL63 and 229E were the most common in patients requiring invasive ventilation. The highest 30-day mortality rate was observed in patients infected with 229E (6.4%). HCoVs are common circulating pathogens that have been present for decades, with 229E being the most virulent in this study cohort.

scholarly journals 2406. Trends of Clostridioides difficile-Associated Diarrhea at a Tertiary Care Center in India

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S831-S831
Author(s):  
Swati Khullar ◽  
Rama Chaudhry ◽  
Sonu Agrawal ◽  
Lalit Kumar ◽  
Nitin Gupta ◽  
...  
Keyword(s):  
Pathological Condition ◽  
Care Center ◽  
Tertiary Care ◽  
Morbidity And Mortality ◽  
Care Hospital ◽  
Clostridioides Difficile ◽  
Nosocomial Diarrhea ◽  
Common Group ◽  
Stool Samples ◽  
High Index Of Suspicion

Abstract Background Clostridioides difficile has been recognized as a significant cause of morbidity and mortality globally. Its infection can range from asymptomatic carriage to antibiotic-associated diarrhea and colitis. Reports of outbreak with the hypervirulent strain (N1/NAP1 Ribotype 027) has raised the concern on the magnitude and severity of C. difficile infections. This study aimed to determine the prevalence of C. difficile-associated diarrhea (CDAD) among the patients at a tertiary care hospital in India. Methods A retrospective analysis from January 2015-December 2018 was done to determine the trends of C. difficile infection. ELISA for detection of toxins A and B was performed on stool samples. A diagnosis of CDAD was made in all patients with stool samples positive for toxins A and B. Results Samples from 1311 patients were received from January 2015-December 2018 from patients with suspected nosocomial diarrhea. 9/1311 were culture positive for C. difficile, 7/9 were both culture and ELISA positive. A total of 74 patients were positive for ELISA for detection of toxins A and B. The prevalence of CDAD in the years 2015–2018 were as follows: 4.01% (10/249) in 2015, 10.03% (26/259) in 2016, 4.7% (21/446) in 2017 and 5.32% (19/357) in 2018, respectively. Malignancy was found to be the most common underlying pathological condition 15/69. Most common group of antibiotics used in these patients of CDAD were carbapenems 20/64. Amongst 82.6% (57/69) of the patients were hospitalized. Diarrhea was associated with fever in 40.5% (28/69) of the patients. Conclusion Our results show over all variable prevalence of CDAD over the years and was higher in the year 2016. Timely appropriate diagnosis, high index of suspicion in high-risk patients and proper implementation of antimicrobial stewardship programs may help in reducing morbidity and mortality in patients of CDAD. Disclosures All authors: No reported disclosures.

scholarly journals Clinical profile, management and outcomes of class IV emphysematous pyelonephritis in a tertiary care center: A retrospective descriptive study

2021 ◽  
pp. 78-85
Author(s):  
R. Manjunath ◽  
M. Bennikal ◽  
S.K. Dasar ◽  
S.T. Patil
Keyword(s):  
Medical Management ◽  
Clinical Presentation ◽  
Care Center ◽  
Tertiary Care ◽  
First Episode ◽  
Tertiary Care Center ◽  
Long Term Outcomes ◽  
Emphysematous Pyelonephritis ◽  
Class Iv

Abstract. Class IV Emphysematous pyelonephritis (EPN) is a life-threatening infection of the kidney, and there is sparse data on immediate and long-term outcomes of medical management. The study aimed to review the clinical presentation, diagnosis, immediate and long-term outcomes of medical management, and outcome of patients presenting with class IV EPN Methods. This retrospective study was conducted in a tertiary care center in Dharwad, India. The study included class IV EPN patients admitted to the hospital between Jan 2012 to Dec 2019. The factors studied were demographics, comorbidities, radiological investigations, clinical presentation, urine, blood and pus culture, and sensitivity and treatment history. Immediate and long-term outcomes of medical management were determined. Descriptive analysis of the data was conducted. Continuous variables were presented as mean ± standard deviation and discrete variables in terms of number (%). Results. Twenty-one patients with class IV EPN, with a mean age of 55.7 ±13.5 years, were analyzed. The majority were males (M: F 15:6). The patients were followed up for 32.70±21.12 months. Fever, flank or abdominal pain, and acute kidney injury were observed in all 21 patients, while nausea and/or vomiting and dysuria were seen in 16 (76.2%) patients. E. Coli was the most common pathogen found. Double J stenting was done in 20 (95.2%) patients; Ultrasonography guided aspiration 8(38.1%) and percutaneous drainage in 5 (23.8%) patients. One (4.8%) patient died during the first episode and 3(19%) others due to recurrent infection and end-stage renal disease. Conclusions. Class IV Emphysematous pyelonephritis can be managed successfully by minimally invasive modalities. However, long-term morbidity and mortality risks are still negative.

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