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  1. Article: A Review of Extended and Continuous Infusion Beta-Lactams in Pediatric Patients.

    Imburgia, Taylor A / Kussin, Michelle L

    The journal of pediatric pharmacology and therapeutics : JPPT : the official journal of PPAG

    2022  Volume 27, Issue 3, Page(s) 214–227

    Abstract: Intravenous beta-lactam antibiotics are the most prescribed antibiotic class in US hospitalized patients of all ages; therefore, optimizing their dosing is crucial. Bactericidal killing is best predicted by the time in which beta-lactam drug ... ...

    Abstract Intravenous beta-lactam antibiotics are the most prescribed antibiotic class in US hospitalized patients of all ages; therefore, optimizing their dosing is crucial. Bactericidal killing is best predicted by the time in which beta-lactam drug concentrations are maintained above the organism's minimum inhibitory concentration (MIC), rather than achievement of a high peak concentration. As such, administration of beta-lactam antibiotics via extended or continuous infusions over a minimum of 3 hours, rather than standard infusions over approximately 30 minutes, has been associated with improved achievement of pharmacodynamic targets and improved clinical outcomes in adult medical literature. This review summarizes the pediatric medical literature. Applicable studies include pharmacodynamic models, case series, retrospective analyses, and prospective studies on the use of extended infusion and continuous infusion penicillins, cephalosporins, carbapenems, and monobactams in neonates, infants, children, and adolescents. Specialized patient populations with unique pharmacokinetics and high-risk infections (neonates, critically ill, febrile neutropenia, cystic fibrosis) are also reviewed. While more studies are needed to confirm prospective clinical outcomes, the current body of evidence suggests extended and continuous infusions of beta-lactam antibiotics are well tolerated in children and improve achievement of pharmacokineticpharmacodynamic targets with similar or superior clinical outcomes, particularly in infections associated with high MICs.
    Language English
    Publishing date 2022-03-21
    Publishing country United States
    Document type Journal Article
    ZDB-ID 3028543-4
    ISSN 1551-6776
    ISSN 1551-6776
    DOI 10.5863/1551-6776-27.3.214
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article ; Online: Cidofovir for Viral Infections in Immunocompromised Children: Guidance on Dosing, Safety, Efficacy, and a Review of the Literature.

    Riggsbee, Daniel L / Alali, Muayad / Kussin, Michelle L

    The Annals of pharmacotherapy

    2023  Volume 58, Issue 3, Page(s) 286–304

    Abstract: Objective: To describe the use of cidofovir (CDV) for viral infections in immunocompromised children (IC) and provide guidance on dosing and supportive care.: Data sources: A PubMed search was conducted for literature published between 1997 and ... ...

    Abstract Objective: To describe the use of cidofovir (CDV) for viral infections in immunocompromised children (IC) and provide guidance on dosing and supportive care.
    Data sources: A PubMed search was conducted for literature published between 1997 and January 2022 using the following terms: cidofovir, plus children or pediatrics.
    Study selection and data extraction: Limits were set to include human subjects less than 24 years of age receiving intravenous (IV) or intrabladder CDV for treatment of infections due to adenovirus, polyomavirus-BK (BKV), herpesviruses, or cytomegalovirus.
    Data synthesis: Data were heterogeneous, with largely uncontrolled studies. Conventional dosing (CDV 5 mg/kg/dose weekly) was commonly used in 60% (31/52) of studies and modified dosing (CDV 1 mg/kg/dose 3 times/week) was used in 17% (9/52) of studies, despite being off-label. Nephrotoxicity reported across studies totaled 16% (65/403 patients), which was higher for conventional dosing 29 of 196 patients (15%) than modified dosing 1 of 27 patients (4%). Saline hyperhydration and concomitant probenecid remain the cornerstones of supportive care, while some regimens omitting probenecid are emerging to target BKV.
    Relevance to patient care and clinical practice: To our knowledge, this is the first comprehensive review of CDV use (indications, dosing, supportive care, response, and nephrotoxicity) in pediatric IC.
    Conclusions: Effective utilization of CDV in IC remains challenging. Further prospective studies are needed to determine the optimal CDV dosing; however, less aggressive dosing regimens such as modified thrice weekly dosing or low dosing once weekly omitting probenecid to enhance urinary penetration may be reasonable alternatives to conventional dosing in some IC.
    MeSH term(s) Humans ; Child ; Cidofovir/adverse effects ; Antiviral Agents/therapeutic use ; Probenecid ; Organophosphonates/therapeutic use ; Cytosine/adverse effects ; Virus Diseases/drug therapy
    Chemical Substances Cidofovir (JIL713Q00N) ; Antiviral Agents ; Probenecid (PO572Z7917) ; Organophosphonates ; Cytosine (8J337D1HZY)
    Language English
    Publishing date 2023-06-05
    Publishing country United States
    Document type Journal Article ; Review
    ZDB-ID 1101370-9
    ISSN 1542-6270 ; 1060-0280
    ISSN (online) 1542-6270
    ISSN 1060-0280
    DOI 10.1177/10600280231176135
    Database MEDical Literature Analysis and Retrieval System OnLINE

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    In stock of ZB MED Cologne/Königswinter

    Zs.A 900: Show issues Location:
    Je nach Verfügbarkeit (siehe Angabe bei Bestand)
    bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular
    Jg. 1995 - 2021: Lesesall (1.OG)
    ab Jg. 2022: Lesesaal (EG)

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  3. Article ; Online: Unusual presentation of disseminated cryptococcal infection complicated by myocarditis in a heart transplant recipient.

    Barros, Kathryn / Tepper, John William / Ramchandani, Juhi / Kelley, Meagan Kristine / Kussin, Michelle L / Israel, Emily N / Tompkins, Madeline G / Alali, Muayad

    Pediatric transplantation

    2023  Volume 28, Issue 1, Page(s) e14585

    Abstract: Background: Cryptococcus neoformans is the third most common cause of invasive fungal infection in solid organ transplant (SOT) recipients. While cryptococcal infection can involve any organ, cases of myocarditis are exceedingly rare.: Methods: A ... ...

    Abstract Background: Cryptococcus neoformans is the third most common cause of invasive fungal infection in solid organ transplant (SOT) recipients. While cryptococcal infection can involve any organ, cases of myocarditis are exceedingly rare.
    Methods: A retrospective chart review was completed for this case report.
    Results: We present the case of a 21-year-old heart transplant recipient who developed disseminated cryptococcal infection with biopsy-proven cryptococcal myocarditis.
    Conclusions: Cryptococcal disease in SOT recipients poses diagnostic and therapeutic challenges. There are no current guidelines for the duration of cryptococcal myocarditis treatment. Repeat myocardial biopsy may play a role in guiding length of therapy.
    MeSH term(s) Humans ; Young Adult ; Adult ; Retrospective Studies ; Myocarditis/complications ; Myocarditis/diagnosis ; Cryptococcosis/complications ; Cryptococcosis/diagnosis ; Cryptococcosis/drug therapy ; Cryptococcus neoformans ; Heart Transplantation/adverse effects
    Language English
    Publishing date 2023-07-25
    Publishing country Denmark
    Document type Case Reports
    ZDB-ID 1390284-2
    ISSN 1399-3046 ; 1397-3142
    ISSN (online) 1399-3046
    ISSN 1397-3142
    DOI 10.1111/petr.14585
    Database MEDical Literature Analysis and Retrieval System OnLINE

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    In stock of ZB MED Cologne/Königswinter

    Zs.A 4947: Show issues Location:
    Je nach Verfügbarkeit (siehe Angabe bei Bestand)
    bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular
    Jg. 1995 - 2021: Lesesall (2.OG)
    ab Jg. 2022: Lesesaal (EG)

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  4. Article ; Online: Absolute Monocyte Count as Early and Safe Marker for Antibiotic Cessation in Febrile Neutropenia Without Etiology in Pediatric Oncology Patients.

    Alali, Muayad / Prather, Cassandra / Danziger-Isakov, Lara A / Kussin, Michelle L / Khalifeh, Malak / Al Othman, Nashwan / Bartlett, Allison H

    Journal of pediatric hematology/oncology

    2023  Volume 45, Issue 6, Page(s) e702–e709

    Abstract: Background: There is no practice standard regarding antibiotic duration in children with cancer and unexplained febrile neutropenia (FN). We hypothesized that absolute monocyte count (AMC) and absolute phagocyte count (APC= ANC + AMC + bands) are more ... ...

    Abstract Background: There is no practice standard regarding antibiotic duration in children with cancer and unexplained febrile neutropenia (FN). We hypothesized that absolute monocyte count (AMC) and absolute phagocyte count (APC= ANC + AMC + bands) are more sensitive, earlier, and safe markers of antibiotic cessation compared with absolute neutrophil count (ANC).
    Methods: A retrospective review of FN episodes (FNEs) in pediatric oncology patients was conducted between 2009 and 2016. Included patients were afebrile for 24 hours and without an identified infectious source at antibiotic cessation. Primary endpoints, including recurrent fever, readmission, bloodstream infection, microbiologically documented infection, and adverse outcomes, were assessed 10 days after antibiotic cessation and compared among different bone marrow recovery parameters (ANC, AMC, APC). Secondary endpoints included length of FN stay, antibiotic-free days, and cost.
    Results: Three hundred ninety-one FNEs in 235 patients were included. Three groups were compared based on ANC (cells/μL) at the time of antibiotic cessation: < 200 in 102 (26%), 200 to 500 in 111 (28%), and >500 in 178 (46%). No statistically significant differences in primary endpoints were identified among the 3 ANC groups; however, a trend toward unfavorable outcomes in the ANC ≤200 cells/μL group compared with the ANC >200 cells/μL was observed. Primary endpoints based on AMC >100 cells/μL at the time of antibiotic cessation showed statistically significant favorable outcomes compared AMC ≤100 cells/μL (80%, 88%, 90%, 89%, and 93% risk reduction in recurrent fever, readmission, new bloodstream infection, new microbiologically documented infection, and adverse events, respectively). Similar favorable results were seen when APC >300 cells/μL was used as a threshold for antibiotic cessation. The median length of stay for FN if discharged when AMC >100 cells/μL was 3 days shorter and associated with fewer unfavorable outcomes, thus resulting in fewer hospital days, fewer antibiotic days, and decreased cost.
    Conclusion: Our results suggest that AMC >100 cells/μL (regardless of ANC) or APC >300 cells/μL may be safe thresholds for empiric antibiotic cessation and result in reduced unfavorable clinical outcomes within 10 days postdischarge, reduced antibiotic days of therapy and reduced health care costs. Further prospective studies are needed to validate AMC as an accurate surrogate marker for antibiotic cessation in FNEs in children with cancer.
    MeSH term(s) Child ; Humans ; Anti-Bacterial Agents/therapeutic use ; Monocytes ; Aftercare ; Patient Discharge ; Neoplasms/complications ; Neoplasms/drug therapy ; Sepsis/drug therapy ; Febrile Neutropenia/drug therapy ; Febrile Neutropenia/etiology ; Retrospective Studies
    Chemical Substances Anti-Bacterial Agents
    Language English
    Publishing date 2023-06-26
    Publishing country United States
    Document type Journal Article
    ZDB-ID 1231152-2
    ISSN 1536-3678 ; 1077-4114 ; 0192-8562
    ISSN (online) 1536-3678
    ISSN 1077-4114 ; 0192-8562
    DOI 10.1097/MPH.0000000000002696
    Database MEDical Literature Analysis and Retrieval System OnLINE

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    In stock of ZB MED Cologne/Königswinter

    Zs.A 1537: Show issues Location:
    Je nach Verfügbarkeit (siehe Angabe bei Bestand)
    bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular
    Jg. 1995 - 2021: Lesesall (1.OG)
    ab Jg. 2022: Lesesaal (EG)

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  5. Article ; Online: Evaluation of a Rapid Fungal Detection Panel for Identification of Candidemia at an Academic Medical Center.

    Bomkamp, John P / Sulaiman, Rand / Hartwell, Jennifer L / Desai, Armisha / Winn, Vera C / Wrin, Justin / Kussin, Michelle L / Hiles, Jon J

    Journal of clinical microbiology

    2020  Volume 58, Issue 3

    Abstract: This study was conducted to assess the utility of the T2Candida panel across an academic health center and identify potential areas for diagnostic optimization. A retrospective chart review was conducted on patients with a T2Candida panel and mycolytic/ ... ...

    Abstract This study was conducted to assess the utility of the T2Candida panel across an academic health center and identify potential areas for diagnostic optimization. A retrospective chart review was conducted on patients with a T2Candida panel and mycolytic/fungal (myco/f lytic) blood culture collected simultaneously during hospitalizations from February 2017 to March 2018. The primary outcome of this study was to determine the sensitivity, specificity, and positive and negative predictive values of the panel compared to myco/f lytic blood culture. Secondary outcomes included
    MeSH term(s) Academic Medical Centers ; Candida ; Candidemia/diagnosis ; Candidemia/drug therapy ; Humans ; Micafungin ; Retrospective Studies
    Chemical Substances Micafungin (R10H71BSWG)
    Language English
    Publishing date 2020-02-24
    Publishing country United States
    Document type Journal Article
    ZDB-ID 390499-4
    ISSN 1098-660X ; 0095-1137
    ISSN (online) 1098-660X
    ISSN 0095-1137
    DOI 10.1128/JCM.01408-19
    Database MEDical Literature Analysis and Retrieval System OnLINE

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    In stock of ZB MED Cologne/Königswinter

    Zs.A 1188: Show issues Location:
    Je nach Verfügbarkeit (siehe Angabe bei Bestand)
    bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular
    Jg. 1995 - 2021: Lesesall (1.OG)
    ab Jg. 2022: Lesesaal (EG)

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  6. Article ; Online: Retrospective Analysis of Posaconazole Suspension Dosing Strategies in a Pediatric Oncology Population: Single-Center Experience.

    Mathew, Sherry / Kussin, Michelle L / Liu, Dazhi / Pozotrigo, Melissa / Seyboth, Brian / Thackray, Jennifer / Yan, Shirley Qiong / Hsu, Meier / Cohen, Nina / Seo, Susan K

    Journal of the Pediatric Infectious Diseases Society

    2007  Volume 6, Issue 3, Page(s) e149–e151

    Abstract: Limited data on optimal posaconazole dosing strategies for pediatric patients exist. In this study, we found that the median initial dose in patients who achieved a posaconazole plasma concentration of 0.7 μg/mL was 22.8 mg/kg per day whereas the median ... ...

    Abstract Limited data on optimal posaconazole dosing strategies for pediatric patients exist. In this study, we found that the median initial dose in patients who achieved a posaconazole plasma concentration of 0.7 μg/mL was 22.8 mg/kg per day whereas the median initial dose in those who did not reach the target concentration was 15.8 mg/kg per day; this result suggests that higher initial doses might be warranted.
    MeSH term(s) Adolescent ; Antifungal Agents/administration & dosage ; Antifungal Agents/blood ; Antifungal Agents/therapeutic use ; Child ; Child, Preschool ; Drug Administration Schedule ; Female ; Humans ; Male ; Neoplasms/complications ; Retrospective Studies ; Suspensions ; Triazoles/administration & dosage ; Triazoles/blood ; Triazoles/therapeutic use
    Chemical Substances Antifungal Agents ; Suspensions ; Triazoles ; posaconazole (6TK1G07BHZ)
    Language English
    Publishing date 2007-12-19
    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/pix058
    Database MEDical Literature Analysis and Retrieval System OnLINE

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