e2 39 Kreitmeyr K, von Both U, Pecar A, Borde JP, Mikolajczyk R, Huebner J Pediatric antibiotic stewardship successful interventions to reduce broad spectrum antibiotic use on general pediatric wards[.]
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154:582-587 98 Brilli RJ, Sparling KW, Lake MR, et al The business case for preventing ventilator-associated pneumonia in pediatric intensive care unit patients Jt Comm J Qual Pat Saf 2008;34:629-638 99 Iosifidis E, Pitsava G, Roilides E Ventilator-associated pneumonia in neonates and children: A systematic analysis of diagnostic methods and prevention Future Microbiol 2018;13:1431-1446 100 Matlow AG, Wray RD, Cox PN Nosocomial urinary tract infections in children in a pediatric intensive care unit: a follow-up after 10 years Pediatr Crit Care Med 2003;4(1):74-77 101 Samraj RS, Stalets E, Butcher J, et al The impact of catheterassociated urinary tract infection (CA-UTI) in critically ill children in the pediatric intensive care unit J Pediatr Intensive Care 2016; 5(1):7-11 102 Lo E, Nicolle LE, Coffin SE, et al Strategies to prevent catheterassociated urinary tract infections in acute care hospitals: 2014 update Infect Control Hosp Epidemiol 2014;35(5):464-479 103 Hooton TM, Bradley SF, Cardenas DD, et al Diagnosis, prevention, and treatment of catheter-associated urinary tract infection in adults: 2009 International Clinical Practice Guidelines from the Infectious Diseases Society of America Clin Infect Dis 2010;50(5):625-663 104 Dudeck MA, Edwards JR, Allen-Bridson K, et al National Healthcare Safety Network report, data summary for 2013, Device-associated Module Am J Infect Control 2015;43(3):206-221 105 Advani SD, Lee RA, Long M, Schmitz M, Camins BC The Impact of 2015 NHSN Catheter-associated Urinary Tract Infection (CAUTI) Definition Change on Central Line-associated Bloodstream Infection (CLABSI) Rates and CLABSI Prevention Efforts at an Academic Medical Center Infect Control Hosp Epidemiol 2018;39(7):878-880 106 Araujo da Silva AR, Marques AF, Biscaia di Biase C, Zingg W, Dramowski A, Sharland M Interventions to prevent urinary catheter-associated infections in children and neonates: a systematic review J Pediatr Urol 2018;14(6):556.e1-556.e9 107 Grant MJ, Hardin-Reynolds T Preventable health care-associated infections in pediatric critical care J Pediatr Intensive Care 2015;4(2):79-86 108 Bruny JL, Hall BL, Barnhart DC, et al American College of Surgeons National Surgical Quality Improvement Program Pediatric: A beta phase report J Pediatr Surg 2013;48:74-80 109 Schaffzin JK, Harte L, Marquett S, et al Surgical site infection reduction by the Solutions for Patient Safety Hospital Engagement Network Pediatrics 2015;136:e1353-e1360 110 Woltmann J, Schaffzin JK, Washam M, Connelly BL Pathogen and procedure trends among surgical site infections at a children’s hospital: A 20-year experience Infect Control Hosp Epidemiol 2017;38:380-382 111 Sparling KW, Ryckman FC, Schoettker PJ, et al Financial impact of failing to prevent surgical site infections Qual Manag Health Care 2007;16:219-225 112 Ryckman FC, Schoettker PJ, Hays KR, et al Reducing surgical site infections at a pediatric academic medical center Jt Comm J Qual Patient Saf 2009;35:192-198 113 Toltzis P, O’Riordan M, Cunningham DJ, et al A statewide collaborative to reduce pediatric surgical site infections Pediatrics 2014;134:e1174-e1180 114 Ngo QN, Ranger A, Singh RN, Kornecki A, Seabrook JA, Fraser DD External ventricular drains in pediatric patients Pediatr Crit Care Med 2009;10(3):346-351 115 Sorinola A, Buki A, Sandor J, Czeiter E Risk factors of external ventricular drain infection: proposing a model for future studies Front Neurol 2019;10:226 116 Miller C, Guillaume D Incidence of hemorrhage in the pediatric population with placement and removal of external ventricular drains J Neurosurg Pediatr 2015;16(6):662-667 117 Ramanan M, Lipman J, Shorr A, Shankar A A meta-analysis of ventriculostomy-associated cerebrospinal fluid infections BMC Infect Dis 2015;15:3 118 Jamjoom AAB, Joannides AJ, Poon MT, et al Prospective, multicentre study of external ventricular drainage-related infections in the UK and Ireland J Neurol Neurosurg Psychiatry 2018;89(2):120-126 119 Lozier AP, Sciacca RR, Romagnoli MF, Connolly ES, Jr Ventriculostomy-related infections: a critical review of the literature Neurosurgery 2002;51(1):170-181; discussion 181-172 120 Fried HI, Nathan BR, Rowe AS, et al The insertion and management of external ventricular drains: an evidence-based consensus statement: a statement for healthcare professionals from the neurocritical care society Neurocrit Care 2016;24(1):61-81 e4 121 Bryant K, McDonald LC Clostridium difficile infections in children Pediatr Infect Dis J 2009;28(2):145-146 122 Debast SB, Bauer MP, Kuijper EJ, European Society of Clinical M, Infectious D European Society of Clinical Microbiology and Infectious Diseases: update of the treatment guidance document for Clostridium difficile infection Clin Microbiol Infect 2014; 20(suppl 2):1-26 123 Leffler DA, Lamont JT Clostridium difficile infection N Engl J Med 2015;372(16):1539-1548 124 Deshpande A, Pant C, Anderson MP, Donskey CJ, Sferra TJ Clostridium difficile infection in the hospitalized pediatric population: increasing trend in disease incidence Pediatr Infect Dis J 2013; 32(10):1138-1140 125 Enoch DA, Butler MJ, Pai S, Aliyu SH, Karas JA Clostridium difficile in children: colonisation and disease J Infect 2011;63(2): 105-113 126 Chang TH, Hsu WY, Yang TI, et al Increased age and proton pump inhibitors are associated with severe Clostridium difficile infections in children J Microbiol Immunol Infect 2018 S1684-1182(18)30183 127 Nylund CM, Goudie A, Garza JM, Fairbrother G, Cohen MB Clostridium difficile infection in hospitalized children in the United States Arch Pediatr Adolesc Med 2011;165(5):451-457 128 McDonald LC, Gerding DN, Johnson S, et al Clinical Practice Guidelines for Clostridium difficile Infection in Adults and Children: 2017 Update by the Infectious Diseases Society of America (IDSA) and Society for Healthcare Epidemiology of America (SHEA) Clin Infect Dis 2018;66(7):987-994 129 Anderson EJ, Rupp A, Shulman ST, Wang D, Zheng X, Noskin GA Impact of rotavirus vaccination on hospital-acquired rotavirus gastroenteritis in children Pediatrics 2011;127(2):e264-e270 130 Gleizes O, Desselberger U, Tatochenko V, et al Nosocomial rotavirus infection in European countries: a review of the epidemiology, severity and economic burden of hospital-acquired rotavirus disease Pediatr Infect Dis J 2006;25(1 suppl):S12-S21 131 Valentini D, Ianiro G, Di Bartolo I, et al Hospital-acquired rotavirus and norovirus acute gastroenteritis in a pediatric unit, in 2014-2015 J Med Virol 2017;89(10):1768-1774 132 Yi J, Sederdahl BK, Wahl K, et al Rotavirus and norovirus in pediatric healthcare-associated gastroenteritis Open Forum Infect Dis 2016;3(4):ofw181 133 World Health Organization WHO Guidelines on Hand Hygiene in Health Care: First Global Patient Safety Challenge: Clean Care Is Safer Care Geneva, Switzerland: World Health Organization, Patient Safety; 2009 134 Vonberg RP, Kuijper EJ, Wilcox MH, et al Infection control measures to limit the spread of Clostridium difficile Clin Microbiol Infect 2008;14(suppl 5):2-20 135 Gervasi G, Capanna A, Mita V, Zaratti L, Franco E Nosocomial rotavirus infection: An up to date evaluation of European studies Hum Vaccin Immunother 2016;12(9):2413-2418 e5 Abstract: Healthcare-associated infections (HAIs) remain a significant cause of morbidity and mortality in critically ill children Additionally, HAIs increase length of stay and overall healthcare costs Comprehensive improvement and infection control efforts over the past 101 years have made strides in decreasing the incidence of common HAIs, including central line–associated bloodstream infections, catheter-associated urinary tract infections, and ventilator-associated infections Yet these infections persist in pediatric intensive care units (PICUs) This chapter reviews the epidemiology of HAIs; infection control measures, including antimicrobial stewardship; and several specific HAIs that impact PICU patients along with recommended prevention strategies Key words: Healthcare-acquired infection, nosocomial infection, children, pediatric intensive care unit, antimicrobial stewardship, bloodstream infections, ventilator-associated pneumonia, catheterassociated urinary tract infection 110 Pediatric Sepsis MATTHEW N ALDER, LAUREN BODILLY, AND HECTOR R WONG • • Management of the patient with septic shock embodies the discipline of pediatric critical care medicine The typical patient with septic shock has simultaneous derangements of cardiovascular function, intravascular volume status, respiratory function, immune regulation, renal function, coagulation, hepatic function, and/or metabolic function The degree to which any one of these derangements manifests in a given patient is highly variable and influenced by multiple host and nonhost factors, including developmental stage, presence or absence of comorbidities, causative agent of septic shock, immune status, genetic background, and variations in therapy These factors combine to profoundly influence the course and ultimate outcome of septic shock The complexity of septic shock warrants a systematic and multifaceted approach on the part of the pediatric intensivist Optimal management requires a strong working knowledge not just of cardiovascular physiology and infectious diseases but also of multiple-organ function and interaction, inflammation-related biology, immunity, coagulation, pharmacology, and molecular biology The pediatric intensivist also needs a working knowledge of genomic medicine for the future management of patients with septic shock This chapter provides a comprehensive description of the many aspects influencing the development and outcome of septic shock, pathophysiology at the physiologic and molecular levels, contemporary management of septic shock, and what we believe to be the next important future directions in the field • • • • The typical patient with septic shock has simultaneous derangements of cardiovascular function, intravascular volume status, respiratory function, immune/inflammatory regulation, renal function, coagulation, hepatic function, and/or metabolic function The complexity and heterogeneity of septic shock warrants a systematic and multifaceted approach on the part of the pediatric intensivist Although some overlap exists among the terms spanning the sepsis spectrum (systemic inflammatory response syndrome, sepsis, severe sepsis, and septic shock), each term is intended to define a particular patient population Sepsis is now viewed as a dysregulation of the immunologic and inflammatory pathways normally directed toward pathogen eradication and restoration of homeostasis • PEARLS From a clinical standpoint, the treatment of sepsis entails four important goals: initial resuscitation, pathogen eradication, maintenance of oxygen delivery, and (in the future) carefully directed modulation of the inflammatory response Genomic medicine and systems biology represent novel approaches for studying complex processes such as septic shock The development of robust stratification and phenotyping strategies has the potential to more effectively manage the intrinsic heterogeneity of septic shock and, thus, improve the effectiveness of both clinical research and individual patient care Ultimately, this information must be integrated with bedside experience and clinical acumen, which cannot be supplanted by a book chapter Epidemiology A true picture of the epidemiology of septic shock is clouded by the lack of a reliable case definition This is true for both the adult and pediatric populations A few pediatric-specific studies, however, illustrate the importance of sepsis in today’s modern intensive care unit (ICU) Proulx et al analyzed the incidence and outcome of the systemic inflammatory response syndrome (SIRS), sepsis, severe sepsis, and septic shock (see next section for definitions) in a single institution.1 A total of 1058 admissions were analyzed over a 1-year period SIRS was present in 82% of patients, 23% had sepsis, 4% had severe sepsis, and 2% had septic shock The overall mortality rate for this patient population was 6%, with the majority of deaths occurring in patients with multiple-organ dysfunction syndrome (MODS) Among the patients with MODS, distinct mortality rates were associated with SIRS (40%), sepsis (22%), severe sepsis (25%) and septic shock (52%) Later studies by Watson et al provided more comprehensive retrospective epidemiologic surveys of pediatric sepsis to date.2 By linking 1995 hospital records from seven large states (representing 24% of the US population) with census data, they estimated an 1293 ... ventilator-associated infections Yet these infections persist in pediatric intensive care units (PICUs) This chapter reviews the epidemiology of HAIs; infection control measures, including antimicrobial... a working knowledge of genomic medicine for the future management of patients with septic shock This chapter provides a comprehensive description of the many aspects influencing the development... thus, improve the effectiveness of both clinical research and individual patient care Ultimately, this information must be integrated with bedside experience and clinical acumen, which cannot be