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Article ; Online: Pediatric Utilization of Methicillin-resistant Staphylococcus aureus Nasal Swabs for Antimicrobial Stewardship.

Braga, Shienna / Rajapakse, Nipunie / Heyliger, Jamie / Dierkhising, Ross / Dinnes, Laura

The Pediatric infectious disease journal

2023 Volume 42, Issue 12, Page(s) e466–e469

Abstract: Background: Methicillin-resistant Staphylococcus aureus (MRSA) can cause serious infections and empiric treatment regimens in children frequently include an anti-MRSA antibiotic. Studies in adults have demonstrated a high negative predictive value (NPV) ...

Abstract	Background: Methicillin-resistant Staphylococcus aureus (MRSA) can cause serious infections and empiric treatment regimens in children frequently include an anti-MRSA antibiotic. Studies in adults have demonstrated a high negative predictive value (NPV) of MRSA nasal swabs (MNS) in a variety of infectious syndromes. Negative MNS have been utilized as a tool to guide de-escalation of anti-MRSA antibiotics in adults, especially in those with lower respiratory tract infections, but data in children is minimal. The primary objective of this study was to determine the NPV and positive predictive value (PPV) of MNS in children hospitalized for treatment of an infection. Methods: This was a single-site, retrospective cohort study of pediatric patients admitted with a suspected infectious diagnosis who had an MNS performed during their hospitalization between June 1, 2018 and November 25, 2022. Results: This study identified 172 patients who met the inclusion criteria. Eleven (6.4%) nasal swabs were positive for MRSA and 10 (5.8%) microbiological cultures from suspected sources of infection were identified to be positive for MRSA. The MNS was found to have a sensitivity of 20%, specificity of 94%, PPV of 18% and NPV of 95% for all sites of infection. Conclusion: MNS has a high NPV and low PPV in children. MNS can be utilized as an antimicrobial stewardship tool to guide the safe de-escalation of anti-MRSA antibiotics in children.
MeSH term(s)	Adult ; Humans ; Child ; Methicillin-Resistant Staphylococcus aureus ; Retrospective Studies ; Antimicrobial Stewardship ; Nose/microbiology ; Anti-Bacterial Agents/therapeutic use ; Staphylococcal Infections/diagnosis ; Staphylococcal Infections/drug therapy ; Staphylococcal Infections/microbiology
Chemical Substances	Anti-Bacterial Agents
Language	English
Publishing date	2023-10-05
Publishing country	United States
Document type	Journal Article
ZDB-ID	392481-6
ISSN	1532-0987 ; 0891-3668
ISSN (online)	1532-0987
ISSN	0891-3668
DOI	10.1097/INF.0000000000004129
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Zs.A 1852: Show issues

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Article ; Online: Human and novel coronavirus infections in children: a review.

Rajapakse, Nipunie / Dixit, Devika

Paediatrics and international child health

2020 Volume 41, Issue 1, Page(s) 36–55

Abstract: Coronaviruses, seven of which are known to infect humans, can cause a spectrum of clinical presentations ranging from asymptomatic infection to severe illness and death. Four human coronaviruses (hCoVs)-229E, HKU1, NL63 and OC43-circulate globally, ... ...

Abstract	Coronaviruses, seven of which are known to infect humans, can cause a spectrum of clinical presentations ranging from asymptomatic infection to severe illness and death. Four human coronaviruses (hCoVs)-229E, HKU1, NL63 and OC43-circulate globally, commonly infect children and typically cause mild upper respiratory tract infections. Three novel coronaviruses of zoonotic origin have emerged during the past two decades: severe acute respiratory syndrome coronavirus (SARS-CoV-1), Middle East respiratory syndrome coronavirus (MERS-CoV) and the recently discovered severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) which is the cause of the ongoing coronavirus disease 2019 (COVID-19) pandemic. These novel coronaviruses are known to cause severe illness and death predominantly in older adults and those with underlying comorbidities. Consistent with what has been observed during the outbreaks of SARS and MERS, children with COVID-19 are more likely to be asymptomatic or to have mild-to-moderate illness, with few deaths reported in children globally thus far. Clinical symptoms and laboratory and radiological abnormalities in children have been similar to those reported in adults but are generally less severe. A rare multisystem inflammatory syndrome in children (MIS-C) which has resulted in critical illness and some deaths has recently been described. Clinical trials for therapeutics and vaccine development should include paediatric considerations. Children may play an important role in the transmission of infection and outbreak dynamics and could be a key target population for effective measures to control outbreaks. The unintended consequences of the unprecedented scale and duration of pandemic control measures for children and families around the world should be carefully examined.
MeSH term(s)	Adolescent ; COVID-19/complications ; COVID-19/epidemiology ; COVID-19/etiology ; COVID-19/therapy ; COVID-19/transmission ; COVID-19 Vaccines/immunology ; Child ; Child, Preschool ; Coronavirus Infections/epidemiology ; Disease Outbreaks ; Humans ; Infant ; Infant, Newborn ; SARS-CoV-2/pathogenicity ; Severe Acute Respiratory Syndrome/epidemiology ; Systemic Inflammatory Response Syndrome/etiology
Chemical Substances	COVID-19 Vaccines
Keywords	covid19
Language	English
Publishing date	2020-06-25
Publishing country	England
Document type	Journal Article ; Review
ZDB-ID	2649065-1
ISSN	2046-9055 ; 2046-9047
ISSN (online)	2046-9055
ISSN	2046-9047
DOI	10.1080/20469047.2020.1781356
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article: First-Generation Cephalosporins for Treatment of Acute Hematogenous Osteomyelitis in Children: A Study of Efficacy and Adverse Effects.

Hiskey, Lisa / Saifuddin, Hiba / Levy, Emily R / Hentz, Roland / Rajapakse, Nipunie S / Dinnes, Laura M / Ristagno, Elizabeth H

Open forum infectious diseases

2023 Volume 10, Issue 12, Page(s) ofad610

Abstract: Background: Acute hematogenous osteomyelitis (AHO) is a relatively infrequent but significant infection in pediatric patients. As : Methods: We reviewed pediatric patients admitted to Mayo Clinic between March 2002 and September 2020 for management ... ...

Abstract	Background: Acute hematogenous osteomyelitis (AHO) is a relatively infrequent but significant infection in pediatric patients. As Methods: We reviewed pediatric patients admitted to Mayo Clinic between March 2002 and September 2020 for management of AHO who received treatment with a first-generation cephalosporin. We reviewed timing of oral therapy transition, therapy-associated adverse effects, and recurrence of disease after completion of therapy. Results: There were 59 patients included in the study. There was similar occurrence of adverse effects in patients receiving cefadroxil and cephalexin, although use of cefadroxil coincided with more gastrointestinal adverse effects and leukopenia and use of cephalexin with more rash and neutropenia. One secondary treatment failure occurred in our study, in a patient receiving cephalexin for treatment of septic arthritis. Conclusions: Cefadroxil may be a reasonable alternative oral therapy for methicillin-susceptible
Language	English
Publishing date	2023-12-14
Publishing country	United States
Document type	Journal Article
ZDB-ID	2757767-3
ISSN	2328-8957
ISSN	2328-8957
DOI	10.1093/ofid/ofad610
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Article ; Online: A Quality Improvement Project Aimed at Standardizing the Prescribing of Fluconazole Prophylaxis in a Level IV Neonatal Intensive Care Unit.

Smith, Brandi / Rajapakse, Nipunie / Sauer, Hannah E / Ellsworth, Kevin / Dinnes, Laura / Madigan, Theresa

Pediatric quality & safety

2022 Volume 7, Issue 4, Page(s) e579

Abstract: Introduction: Invasive candidiasis has a high morbidity and mortality among premature neonates. Antifungal prophylaxis with fluconazole significantly lowers the risk of invasive fungal infection in this population. We noted the use of fluconazole ... ...

Abstract	Introduction: Invasive candidiasis has a high morbidity and mortality among premature neonates. Antifungal prophylaxis with fluconazole significantly lowers the risk of invasive fungal infection in this population. We noted the use of fluconazole prophylaxis in our level IV neonatal intensive care unit (NICU) was variable and sought to standardize prescribing of prophylactic fluconazole. Methods: We formed a multidisciplinary team to develop an evidence-based protocol using literature and expert consensus to guide appropriate use of fluconazole prophylaxis in our level IV NICU. After determining baseline fluconazole prophylaxis prescribing before protocol implementation, we used plan-do-study-act (PDSA) cycles to introduce protocolized prescribing and incorporate it into daily practice. A 6-month intervention phase was followed by a 2-year control phase, in which monthly audits were performed to evaluate protocol adherence. Results were displayed in a statistical process control chart. Results: Before protocol implementation, fluconazole prophylaxis prescribing adhered to the protocol in 81% of patients. During the first PDSA cycle, adherence increased significantly to 94.5% (86/91 patients), which further increased to 98.7% (74/75 patients) during the second PDSA cycle and remained at 96% (120/125 patients) during the control phase ( Conclusions: A multidisciplinary group-designed protocol was successful in standardizing fluconazole prophylaxis prescribing for infants in the level IV NICU. Adherence to protocol was high following implementation and was sustained for the duration of the project. There were no cases of invasive candidiasis noted.
Language	English
Publishing date	2022-07-18
Publishing country	United States
Document type	Journal Article
ISSN	2472-0054
ISSN (online)	2472-0054
DOI	10.1097/pq9.0000000000000579
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article: Human and novel coronavirus infections in children: a review

Rajapakse, Nipunie / Dixit, Devika

Paediatr Int Child Health

Abstract	Coronaviruses, seven of which are known to infect humans, can cause a spectrum of clinical presentations ranging from asymptomatic infection to severe illness and death. Four human coronaviruses (hCoVs)-229E, HKU1, NL63 and OC43-circulate globally, commonly infect children and typically cause mild upper respiratory tract infections. Three novel coronaviruses of zoonotic origin have emerged during the past two decades: severe acute respiratory syndrome coronavirus (SARS-CoV-1), Middle East respiratory syndrome coronavirus (MERS-CoV) and the recently discovered severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) which is the cause of the ongoing coronavirus disease 2019 (COVID-19) pandemic. These novel coronaviruses are known to cause severe illness and death predominantly in older adults and those with underlying comorbidities. Consistent with what has been observed during the outbreaks of SARS and MERS, children with COVID-19 are more likely to be asymptomatic or to have mild-to-moderate illness, with few deaths reported in children globally thus far. Clinical symptoms and laboratory and radiological abnormalities in children have been similar to those reported in adults but are generally less severe. A rare multisystem inflammatory syndrome in children (MIS-C) which has resulted in critical illness and some deaths has recently been described. Clinical trials for therapeutics and vaccine development should include paediatric considerations. Children may play an important role in the transmission of infection and outbreak dynamics and could be a key target population for effective measures to control outbreaks. The unintended consequences of the unprecedented scale and duration of pandemic control measures for children and families around the world should be carefully examined. ABBREVIATIONS: 2019-nCoV, 2019 novel coronavirus; ADEM, acute demyelinating encephalomyelitis; AAP, American Academy of Pediatrics; ACE-2, angiotensin-converting enzyme 2; ARDS, acute respiratory distress syndrome; BCG, bacillus Calmette-Guérin; BNP, brain natriuretic peptide; CDC, Centers for Disease Control and Prevention; CRP, C-reactive protein; CSF, cerebrospinal fluid; COVID-19, coronavirus disease 2019; CT, computed tomography; CXR, chest X-ray; DOL, day of life; hCoV, human coronavirus; ICU, intensive care unit; IL, interleukin; IVIG, intravenous immunoglobulin; KD, Kawasaki disease; LDH, lactate dehydrogenase; MERS, Middle East respiratory syndrome; MERS-CoV, Middle East respiratory syndrome coronavirus; MEURI, monitored emergency use of unregistered and experimental interventions; MIS-C, multi-system inflammatory syndrome in children; PCR, polymerase chain reaction; PICU, paediatric intensive care unit; RNA, ribonucleic acid; RCT, randomised-controlled trial; RSV, respiratory syncytial virus; SARS, severe acute respiratory syndrome; SARS-CoV-1, severe acute respiratory syndrome coronavirus 1; SARS-CoV-2, severe acute respiratory syndrome coronavirus 2; TNF-alpha, tumour necrosis factor alpha; UK United Kingdom; UNICEF, United Nations Children's Fund; USA, United States of America; WHO, World Health Organization.
Keywords	covid19
Publisher	WHO
Document type	Article
Note	WHO #Covidence: #613741
Database	COVID19

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Article: A Bundle of the Top 10 OPAT Publications in 2022.

Childs-Kean, Lindsey M / Beieler, Alison M / Coroniti, Ann-Marie / Cortés-Penfield, Nicolás / Keller, Sara C / Mahoney, Monica V / Rajapakse, Nipunie S / Rivera, Christina G / Yoke, Leah H / Ryan, Keenan L

Open forum infectious diseases

2023 Volume 10, Issue 6, Page(s) ofad283

Abstract: Outpatient parenteral antimicrobial therapy (OPAT) has become more common in clinical settings. Correspondingly, OPAT-related publications have also increased; the objective of this article was to summarize clinically meaningful OPAT-related publications ...

Abstract	Outpatient parenteral antimicrobial therapy (OPAT) has become more common in clinical settings. Correspondingly, OPAT-related publications have also increased; the objective of this article was to summarize clinically meaningful OPAT-related publications in 2022. Seventy-five articles were initially identified, with 54 being scored. The top 20 OPAT articles published in 2022 were reviewed by a group of multidisciplinary OPAT clinicians. This article provides a summary of the "top 10" OPAT publications of 2022.
Language	English
Publishing date	2023-05-23
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	2757767-3
ISSN	2328-8957
ISSN	2328-8957
DOI	10.1093/ofid/ofad283
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: Mediastinal Histoplasmosis With Esophageal Perforation Presenting as Recurrent Polymicrobial Empyema and Pericarditis in a Previously Healthy Child.

Madigan, Theresa / Fattahi, Sayeh / Rajapakse, Nipunie S / Ristagno, Elizabeth H

Journal of the Pediatric Infectious Diseases Society

2019 Volume 9, Issue 2, Page(s) 272–276

MeSH term(s)	Child ; Empyema/diagnosis ; Esophageal Perforation ; Histoplasmosis/complications ; Histoplasmosis/diagnosis ; Histoplasmosis/drug therapy ; Humans ; Pericarditis/diagnosis
Language	English
Publishing date	2019-06-12
Publishing country	England
Document type	Journal Article
ZDB-ID	2668791-4
ISSN	2048-7207 ; 2048-7193
ISSN (online)	2048-7207
ISSN	2048-7193
DOI	10.1093/jpids/piz042
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article: A Bundle of the Top 10 OPAT Publications in 2021.

Rivera, Christina G / Beieler, Alison M / Childs-Kean, Lindsey M / Cortés-Penfield, Nicolás / Idusuyi, Ann-Marie / Keller, Sara C / Rajapakse, Nipunie S / Ryan, Keenan L / Yoke, Leah H / Mahoney, Monica V

Open forum infectious diseases

2022 Volume 9, Issue 7, Page(s) ofac242

Abstract: As outpatient parenteral antimicrobial therapy (OPAT) becomes more common, it may be difficult to stay current with recent related publications. A group of multidisciplinary OPAT clinicians reviewed and ranked all OPAT publications published in 2021. ... ...

Abstract	As outpatient parenteral antimicrobial therapy (OPAT) becomes more common, it may be difficult to stay current with recent related publications. A group of multidisciplinary OPAT clinicians reviewed and ranked all OPAT publications published in 2021. This article provides a high-level summary of the OPAT manuscripts that were voted the "top 10" publications of 2021.
Language	English
Publishing date	2022-05-09
Publishing country	United States
Document type	Journal Article
ZDB-ID	2757767-3
ISSN	2328-8957
ISSN	2328-8957
DOI	10.1093/ofid/ofac242
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Article ; Online: A National Survey of Outpatient Parenteral Antibiotic Therapy Practices.

Vaz, Louise E / Felder, Kimberly K / Newland, Jason G / Hersh, Adam L / Rajapakse, Nipunie S / Willis, Zachary I / Banerjee, Ritu / Gerber, Jeffrey S / Schwenk, Hayden T / Wang, Marie E

Journal of the Pediatric Infectious Diseases Society

2021 Volume 11, Issue 3, Page(s) 115–118

Abstract: We conducted a national survey of pediatric infectious diseases (ID) clinicians on outpatient parenteral antibiotic therapy (OPAT) practices and post-discharge ID follow-up. Only 15% of sites required ID consultation for all OPAT. ID division resources ... ...

Abstract	We conducted a national survey of pediatric infectious diseases (ID) clinicians on outpatient parenteral antibiotic therapy (OPAT) practices and post-discharge ID follow-up. Only 15% of sites required ID consultation for all OPAT. ID division resources for post-discharge care varied. Opportunities exist to increase ID involvement in post-discharge management of serious infections.
MeSH term(s)	Aftercare ; Ambulatory Care ; Anti-Bacterial Agents/therapeutic use ; Child ; Communicable Diseases/drug therapy ; Humans ; Outpatients ; Patient Discharge
Chemical Substances	Anti-Bacterial Agents
Language	English
Publishing date	2021-12-22
Publishing country	England
Document type	Journal Article
ZDB-ID	2668791-4
ISSN	2048-7207 ; 2048-7193
ISSN (online)	2048-7207
ISSN	2048-7193
DOI	10.1093/jpids/piab127
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: Pediatric antimicrobial stewardship practices at discharge: A national survey.

Wang, Marie E / Felder, Kimberly / Newland, Jason G / Hersh, Adam L / Rajapakse, Nipunie S / Willis, Zachary I / Banerjee, Ritu / Gerber, Jeffrey S / Schwenk, Hayden T / Vaz, Louise E

Infection control and hospital epidemiology

2021 Volume 43, Issue 11, Page(s) 1686–1688

Abstract: We surveyed pediatric antimicrobial stewardship program (ASP) site leaders within the Sharing Antimicrobial Reports for Pediatric Stewardship collaborative regarding discharge stewardship practices. Among 67 sites, 13 (19%) reported ASP review of ... ...

Abstract	We surveyed pediatric antimicrobial stewardship program (ASP) site leaders within the Sharing Antimicrobial Reports for Pediatric Stewardship collaborative regarding discharge stewardship practices. Among 67 sites, 13 (19%) reported ASP review of discharge antimicrobial prescriptions. These findings highlight discharge stewardship as a potential opportunity for improvement during the hospital-to-home transition.
MeSH term(s)	Child ; Humans ; Antimicrobial Stewardship ; Patient Discharge ; Anti-Bacterial Agents/therapeutic use ; Anti-Infective Agents ; Prescriptions
Chemical Substances	Anti-Bacterial Agents ; Anti-Infective Agents
Language	English
Publishing date	2021-07-16
Publishing country	United States
Document type	Journal Article
ZDB-ID	639378-0
ISSN	1559-6834 ; 0195-9417 ; 0899-823X
ISSN (online)	1559-6834
ISSN	0195-9417 ; 0899-823X
DOI	10.1017/ice.2021.283
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