A multicenter retrospective study of childhood brucellosis in Chicago, Illinois from 1986 to 2008

SummaryObjectivesTo determine risk factors in children for the acquisition of Brucella, clinical presentation, treatment, and disease outcomes.MethodsA retrospective multicenter chart review was undertaken of children identified with brucellosis from 1986 to 2008 at three tertiary care centers in Chicago, Illinois, USA. The charts were reviewed for data regarding risk factors for acquisition, clinical presentation, and outcomes.ResultsTwenty-one charts were available for review. The median age was 6.5 years (range 2–14 years); 62% were female. Ethnic background was 67% Hispanic and 24% Arabic. Risk factors included travel to an endemic area (86%), particularly Mexico, and consumption of unpasteurized milk products (76%). Common findings included fever (95%), bacteremia (86%), elevated liver transaminases (80%), constitutional symptoms (76%), splenomegaly (60%), and hepatomegaly (55%). Relapse occurred in three of six subjects started on single drug treatment, but in only one of 15 subjects who started on two or more drugs (p=0.053). No relapses occurred in children whose initial therapy included rifampin or those administered three-drug regimens.ConclusionsBrucella is an infrequent pathogen but should be considered in children with compatible epidemiologic and clinical characteristics. Blood cultures should be obtained, and initial therapy with two or more drugs may decrease the risk of relapse

Resistance Determinants and Factors associated with Multi-drug Resistant Enterobacteriaceae in Children

Background: National studies have found an increase in multi-drug resistant (MDR) Enterobacteriaceae (Ent) infections in children over the last decade; however, there is a paucity of literature on the antibiotic resistance determinants associated with these increases, and, regarding the children most impacted by these dangerous pathogens. Objectives: 1) To determine the genetic basis of extended-spectrum beta-lactam (ESBL), carbapenem, and fluoroquinolone resistance (FQR) phenotypes in Enterobacteriaceae isolates from children cared for by multiple centers in the Chicago area; 2) To identify which exposures and host factors serve as predictors of infection within dominant genotypes of resistant Enterobacteriaceae recovered from children from multiple centers. Methods: Objective 1: A retrospective cohort study of 276 GNB isolates from unique patients, phenotypically identified as beta-lactamases producers, was performed. Isolates from 5 Chicago hospitals were recovered from children ages 0-18 years hospitalized between 2011- 2015. DNA microarray (Check-Points™) was used to query the genetic background associated with beta-lactam resistance. Determinants of quinolone resistance (e.g., QRDR and PMFQR) were investigated. Objective 2: A case-control study of children cared for by 3 Chicago area hospitals during 2011-14 was performed. Cases were 53 children diagnosed with PMFQR containing beta-lactam resistant isolates. Controls were 131 children with antibiotic susceptible Ent infections matched by hospital, age and source. Demographics; comorbidities; device, antibiotic, and healthcare exposures; and the impact of location of patient residence were evaluated. Race categories were white, black, Hispanic, and other. Multivariable logistic regression was used to explore associations between predictors and PMFQR infection. Data were analyzed in SAS 9.4. Results: Median age was 4.8 years, 59% were female, and 46% were outpatients. Most isolates (69%) were from urine. E. coli (62%) was most frequently recovered; and of 272 bla genes detected, the most common was blaCTX-M-1 (49%); 1.9% were CRE (4- blaKPC and 1- blaIMP-13). PMFQR was found in 56/82 (66%) and associated with QRDR mutations in 84% of cases. Overall, pAmpC were found in 12% (34/276). The blaKPC harboring K. pneumoniae were mainly non-ST258 strains, which differs from adults. Children with PMFQR Ent infections were more likely to be diagnosed in an outpatient clinic (OR 33.1; CI 7.1, 154.7) and of race “other” (OR 6.5; CI 1.9, 22.2). Residents of Southwest Chicago were 5 times more likely to have a PMFQR Ent infection than those residing in other regions (OR 5.3; CI 1.8, 15.2); while residence in Central Chicago was associated with a 97% decreased risk (OR 0.03; CI 0.002, 0.3). Significant differences in other demographics; comorbidities; invasive devices; antibiotic use; or recent healthcare were not found. Conclusions: Complex bla genotypes were responsible for the beta-lactam resistant phenotypes in children. Transmissible plasmid mediated resistance may be the underlying reason for this emerging health threat. Regional differences associated with PMFQR Ent are observed. Environmental influences may contribute to acquisition of MDR organisms showing FQR. A significant number of PMFQR strains are found in the community, which may reflect linkage to blaCTX-M harboring plasmids which are endemic in some communities

COXIELLA BURNETII ENDOCARDITIS IN A CHILD CAUSED BY A NEW GENOTYPE

International audienceCoxiella burnetii endocarditis is a rare diagnosis in children. We present a case of Q fever endocarditis due to a new genotype, MST 54, and review recent literature on Q fever infections in children. Practitioners should consider Q fever in culture-negative endocarditis, particularly in children with congenital heart disease and history of travel or residence in endemic regions

Asymptomatic screening for severe acute respiratory coronavirus virus 2 (SARS-CoV-2) as an infection prevention measure in healthcare facilities: Challenges and considerations

Testing of asymptomatic patients for severe acute respiratory coronavirus virus 2 (SARS-CoV-2) (ie, asymptomatic screening) to attempt to reduce the risk of nosocomial transmission has been extensive and resource intensive, and such testing is of unclear benefit when added to other layers of infection prevention mitigation controls. In addition, the logistic challenges and costs related to screening program implementation, data noting the lack of substantial aerosol generation with elective controlled intubation, extubation, and other procedures, and the adverse patient and facility consequences of asymptomatic screening call into question the utility of this infection prevention intervention. Consequently, the Society for Healthcare Epidemiology of America (SHEA) recommends against routine universal use of asymptomatic screening for SARS-CoV-2 in healthcare facilities. Specifically, preprocedure asymptomatic screening is unlikely to provide incremental benefit in preventing SARS-CoV-2 transmission in the procedural and perioperative environment when other infection prevention strategies are in place, and it should not be considered a requirement for all patients. Admission screening may be beneficial during times of increased virus transmission in some settings where other layers of controls are limited (eg, behavioral health, congregate care, or shared patient rooms), but widespread routine use of admission asymptomatic screening is not recommended over strengthening other infection prevention controls. In this commentary, we outline the challenges surrounding the use of asymptomatic screening, including logistics and costs of implementing a screening program, and adverse patient and facility consequences. We review data pertaining to the lack of substantial aerosol generation during elective controlled intubation, extubation, and other procedures, and we provide guidance for when asymptomatic screening for SARS-CoV-2 may be considered in a limited scope