Impact of Cell-Free Next-Generation Sequencing on Management of Pediatric Complicated Pneumonia

BACKGROUND Community-acquired pneumonia (CAP) is common in pediatrics. More severe complicated CAP (cCAP) requires broad-spectrum empirical therapy. Cell-free plasma next-generation sequencing (cfNGS), a DNA-based diagnostic tool, could be used to guide therapy. We retrospectively compared the pathogen identification rate of cfNGS to that of standard culture methods and assessed the impact of cfNGS on antibiotic therapy in children hospitalized for cCAP. METHODS We conducted a retrospective review of children aged 3 months to 18 years hospitalized for cCAP with cfNGS results from January 24, 2018, to December 31, 2020. We compared the positivity rate of conventional microbiologic diagnostic testing with that of cfNGS and the impact on clinical management, including changes in antibiotic therapy. RESULTS We identified 46 hospitalized children with cCAP with cfNGS results. Of these children, 34 also had blood cultures (1 positive for pathogen; 3%) and 37 had pleural fluid cultures (10 positive for pathogen; 27%). Of the 46 children, positive cfNGS testing results were positive for pathogen in 45 (98%), with the causative pathogen identified in 41 (89%). cfNGS was the only method for pathogen identification in 32 children (70%). cfNGS results changed management in 36 (78%) of 46 children, with the antibiotic spectrum narrowed in 29 (81%). CONCLUSIONS cfNGS provided a higher diagnostic yield in our pediatric cCAP cohort compared with conventional diagnostic testing and affected management in 78% of children. Prospective studies are needed to better characterize the clinical outcome, cost-effectiveness, and antimicrobial stewardship benefits of cfNGS in pediatric cCAP. </jats:sec

Assessing Parental Discharge Readiness by Using the Ticket to Home Survey Tool

OBJECTIVES Ticket to Home (TTH), a survey tool designed to assess parental comprehension of their child’s hospitalization and postdischarge care needs, allows providers to address knowledge gaps before discharge. Our goal was to evaluate the impact of TTH on parents’ retention of discharge teaching. METHODS In this pilot study, we enrolled a convenience sample of families admitted to pediatric hospital medicine and randomly assigned families on the basis of team assignment. The intervention group received TTH before discharge. The control group received usual care (without TTH survey tool). Both groups were sent a survey 24 to 72 hours postdischarge to assess parental understanding of discharge teaching. A senior-level provider also completed a survey; responses were compared with evaluate parent level of understanding. Descriptive statistics and logistic regression were used for analysis. RESULTS Although 495 parents consented to participate, only 100 completed the necessary surveys (41 intervention and 59 control). Both groups showed high parent-provider concordance regarding reason for admission (92.7% intervention versus 86.4% control; P = .33). The intervention group had significantly higher concordance for return precautions (90.2% vs 58.2%; P &amp;lt; .001), which remained significant when controlling for covariates (odds ratio 6.24, 95% confidence interval 1.78–21.93). Most parents in the intervention group felt sharing TTH responses with their medical team was beneficial (95.0%). CONCLUSIONS Parents who received TTH before discharge were more likely to accurately recall return precautions and valued sharing TTH results with the team. Given that response bias may have affected pilot results, additional studies in which researchers use larger samples with more diverse patient populations is required. </jats:sec