Pediatric Infectious Diseases Society Research Articles

Update From the Advisory Committee on Immunization Practices.

The Advisory Committee on Immunization Practices (ACIP), a group of medical and public health experts, normally meets 3 times per year to develop recommendations for vaccine use in the U.S. Because of the SARS-CoV-2 pandemic, there are several SARS-CoV-2 vaccines currently in late stage clinical trials, so the ACIP is now meeting monthly for single day meetings, with plans to continue standard 2-3 day meetings as per usual (February, June, and October). Emergency meetings of ACIP may occur if a vaccine candidate receives an Emergency Use Authorization (EUA) from the FDA. This Update provides a combined summary of the August 26 and September 22, 2020, meetings, both of which focused completely on COVID-19 vaccines. Representatives from the American Academy of Pediatrics (YAM, DWK) and the Pediatric Infectious Diseases Society (STO) are present as liaisons to the ACIP

Long-Term Safety and Efficacy of Sutimlimab in Patients with Chronic Immune Thrombocytopenia

Long-Term Safety and Efficacy of Sutimlimab in Patients with Chronic Immune Thrombocytopenia

Executive summary with focus on pediatrics: therapeutic monitoring of vancomycin for serious methicillin-resistant Staphylococcus aureus infections: a revised consensus guideline and review by the American Society of Health-System Pharmacists, the Infectious Diseases Society of America, the Pediatric Infectious Diseases Society and the Society of Infectious Diseases Pharmacists

Executive summary with focus on pediatrics: therapeutic monitoring of vancomycin for serious methicillin-resistant Staphylococcus aureus infections: a revised consensus guideline and review by the American Society of Health-System Pharmacists, the Infectious Diseases Society of America, the Pediatric Infectious Diseases Society and the Society of Infectious Diseases Pharmacists

A tribute to some of the doctors who died from COVID-19

A tribute to some of the doctors who died from COVID-19

Executive Summary: Therapeutic Monitoring of Vancomycin for Serious Methicillin-Resistant Staphylococcus aureus Infections: A Revised Consensus Guideline and Review of the American Society of Health-System Pharmacists, the Infectious Diseases Society of America, the Pediatric Infectious Diseases Society, and the Society of Infectious Diseases Pharmacists.

Background Recent vancomycin PK/PD and toxicodynamic studies enable a reassessment of the current dosing and monitoring guideline in an attempt to further optimize the efficacy and safety of vancomycin therapy. The area-under-the-curve to minimum inhibitory concentration (AUC/MIC) has been identified as the most appropriate pharmacokinetic/pharmacodynamic (PK/PD) target for vancomycin. The 2009 vancomycin consenus guidelines recommended specific trough concentrations as a surrogate marker for AUC/MIC. However, more recent toxicodynamic studies have reported an increase in nephrotoxicity associated with trough monitoring. Methods and results This is the executive summary of the new vancomycin consensus guidelines for dosing and monitoring vancomycin therapy and was developed by the American Society of Health-Systems Pharmacists, Infectious Diseases Society of America, Pediatric Infectious Diseases Society and the Society of Infectious Diseases Pharmacists vancomycin consensus guidelines committee. Conclusions The recommendations provided in this document are intended to assist the clinician in optimizing vancomycin for the treatment of invasive MRSA infections in adult and pediatric patients. An AUC/MIC by broth microdilution (BMD) ratio of 400 to 600 (assuming MICBMD of 1 mg/L) should be advocated as the target to achieve clinical efficacy while improving patient safety for patients with serious MRSA infections. In such cases, AUC-guided dosing and monitoring is the most accurate and optimal way to manage vancomycin therapy.

Therapeutic Monitoring of Vancomycin for Serious Methicillin-resistant Staphylococcus aureus Infections: A Revised Consensus Guideline and Review by the American Society of Health-system Pharmacists, the Infectious Diseases Society of America, the Pediatric Infectious Diseases Society, and the Society of Infectious Diseases Pharmacists.

Recent clinical data on vancomycin pharmacokinetics and pharmacodynamics suggest a reevaluation of current dosing and monitoring recommendations. The previous 2009 vancomycin consensus guidelines recommend trough monitoring as a surrogate marker for the target area under the curve over 24 hours to minimum inhibitory concentration (AUC/MIC). However, recent data suggest that trough monitoring is associated with higher nephrotoxicity. This document is an executive summary of the new vancomycin consensus guidelines for vancomycin dosing and monitoring. It was developed by the American Society of Health-System Pharmacists, the Infectious Diseases Society of America, the Pediatric Infectious Diseases Society, and the Society of Infectious Diseases Pharmacists vancomycin consensus guidelines committee. These consensus guidelines recommend an AUC/MIC ratio of 400-600 mg*hour/L (assuming a broth microdilution MIC of 1 mg/L) to achieve clinical efficacy and ensure safety for patients being treated for serious methicillin-resistant Staphylococcus aureus infections.

After the First Wave of COVID-19: Reflections From Italy.

After the First Wave of COVID-19: Reflections From Italy.

Current regional consensus recommendations on infant vaccination of the Latin American pediatric infectious diseases society (SLIPE)

ABSTRACT Introduction The 1st Regional Experts on Infant Vaccination (REIV) meeting generated updated consensus recommendations to improve the control of various major vaccine preventable diseases (VPD) in Latin America. Areas covered Workshops highlighted recent changes in immunization schedules within the region, experience of countries incorporating combined acellular pertussis vaccines schedules and parenteral inactivated polio vaccine (IPV). The need to definitively replace oral polio vaccine (OPV) by IPV, and potential benefits of introducing new combined vaccines, were extensively discussed. Expert opinion REIV strongly advised immediate adoption of either complete IPV schedules for all Latin America or schedules including at least two initial doses of IPV. Use of fractional doses of intradermally administered IPV (fIPV ID) was not recommended due to lower immunogenicity, lack of evidence on long-term protection, and technical difficulty to implement. Routine pertussis vaccination of pregnant women in addition to health workers of neonatology units and any previously unimmunized parent was encouraged. Administration of HBV vaccine to newborns within the first 24 hours of life, and then at 2, 4, and 6 months, and of a booster dose of conjugate Hib vaccine at age 12 through 15 months, was also recommended. Incorporation of combined vaccines (CV) was considered potentially advantageous.

Therapeutic monitoring of vancomycin for serious methicillin-resistantStaphylococcus aureusinfections: A revised consensus guideline and review by the American Society of Health-System Pharmacists, the Infectious Diseases Society of America, the Pediatric Infectious Diseases Society, and the Society of Infectious Diseases Pharmacists

Recent clinical data on vancomycin pharmacokinetics and pharmacodynamics suggest a reevaluation of current dosing and monitoring recommendations. The previous 2009 vancomycin consensus guidelines recommend trough monitoring as a surrogate marker for the target area under the curve over 24 hours to minimum inhibitory concentration (AUC/MIC). However, recent data suggest that trough monitoring is associated with higher nephrotoxicity. This document is an executive summary of the new vancomycin consensus guidelines for vancomycin dosing and monitoring. It was developed by the American Society of Health-System Pharmacists, the Infectious Diseases Society of America, the Pediatric Infectious Diseases Society, and the Society of Infectious Diseases Pharmacists vancomycin consensus guidelines committee. These consensus guidelines recommend an AUC/MIC ratio of 400-600 mg*hour/L (assuming a broth microdilution MIC of 1 mg/L) to achieve clinical efficacy and ensure safety for patients being treated for serious methicillin-resistant Staphylococcus aureus infections.

Thank you to our reviewers in 2019

At Health Science Reports, we aim to publish scientifically sound research from across the medical sciences. For this, the feedback from experts in the field is essential, who, through detailed, fair, and unbiased evaluation of the work under consideration, have contributed tremendously not only to the strengthening of the submitted articles, but also, to the success of the journal as a unified and comprehensive resource of health science research. As such, we are extremely grateful to all reviewers who generously give their time and expertise to evaluate the research submitted to Health Science Reports, and ultimately, help advance scientific communication and open access medical research. The names of all reviewers who contributed during 2019 are listed below (the list includes those who reviewed manuscripts submitted between January 1 and December 31, 2019). Starting this year, we will honor two outstanding reviewers with our Reviewer of the year Award. Nominations for the Award were put forward and discussed by the Chief Editors during a recent meeting. The key criteria for nomination included high quality of the submitted reviews (both critical and constructive, highlighting both the positive aspects of the study as well as those that may require improvement, and providing authors with specific comments on how the article may be revised), timely responses, and supporting the journal, by being generally available for reviews when invited. After careful consideration, we are pleased to recognize Dr. Flor Muñoz and Dr. Hidenori Toyoda as the recipients of this year's Award. Flor Muñoz, MD, is an associate professor of Pediatrics and Infectious Diseases at Baylor College of Medicine, and Director of Transplant Infectious Diseases at Texas Children's Hospital in Houston, TX. She is a clinician-investigator with various projects supported by the US NIH, Centers for Disease Control and Prevention (CDC), Bill & Melinda Gates Foundation, and industry, focusing on vaccines, the epidemiology of respiratory infections in healthy and immunocompromised hosts, and the evaluation of safety and immunogenicity of vaccines in pregnant women, children, and transplant recipients. She has published extensively on topics related to influenza, RSV, vaccines, and maternal immunization. Dr Muñoz is a member of the American Academy of Pediatrics (AAP) Committee on Infectious Diseases (COID), the CDC's Advisory Committee on Immunization Practices (ACIP) influenza and pertussis working groups, and the American College of Obstetrics and Gynecology (ACOG) Immunization Expert Work Group. Dr Muñoz serves as chair of the Institutional Review Board (IRB) at Baylor College of Medicine, and is a member of various academic societies, including the Infectious Diseases Society of America (IDSA), the Pediatric Infectious Diseases Society (PIDS) and the PIDS Transplant Committee, the Society for Pediatric Research (SPR), and the Research Committee of the European Society of Pediatric Infectious Diseases (Figure 1). Hidenori Toyoda, MD, PhD, FACP is Director of Gastroenterology and Hepatology at Ogaki Municipal Hospital, Japan. He currently works as an hepatologist and clinical investigator, and his research is focused on liver disease. Dr Toyoda has published over 350 scientific articles, mostly on topics related to viral hepatitis and hepatocellular carcinoma. Dr Toyoda is a member of the American College of Physicians (ACP), American Association of the Study of Liver Diseases (AASLD), and American College of Gastroenterology (ACG) (Figure 2). Alexopoulou, Alexandra Bailey, Cathy Brito, Juan P. Butsashvili, Maia Chaturvedi, Shruti Chiesi, Francesca Cortez-Pinto, Helena Damen, Johanna A. A. G. de Hertogh, Willem de Velasco, Guillermo Emmerechts, Jan Fix, Gemmae Fortune, Brett Ganger, Daniel Gist, Katja Greeley, Christopher S. Griffin, Benjamin R. Haddy, Nadia Hain, Timothy Hort, Krishna Im, Gene Ingiliz, Patrick Innos, Kaire Iyer, Hari Jackson, Rod Kennecke, Hagen Kestens, Luc Kingstone, Tom Lall, Dorothy Leslie, Hannah H. Lin, Lifeng Liu, Dandan Mahmud, Nadim Mammen, Jennifer Martinello, Marianne Mayo-Gamble, Tilicia Mehata, Suresh Muñoz, Flor Paranhos-Baccalà, Gláucia Penk, Jamie S. Progovac, Ana M. Razvi, Salman Sammour, Tarik Sayani, Farzana Shepperd, James Stanhope, Victoria Street, Richard L. Sung, Shih-Hsien Takahashi, Masayuki Toyoda, Hidenori van Leeuwen, Flora E. van Smeden, Maarten Wang, Ji-Guang Wu, Han-Ping Wyss, Richard Zimbudzi, Edward Zini, Gina

Sticking by an Imperfect Standard: Chest Radiography for Pediatric Community-Acquired Pneumonia.

* Abbreviations: CAP — : community-acquired pneumonia CXR — : chest radiography ED — : emergency department PCV13 — : 13-valent pneumococcal conjugate vaccine PHIS — : Pediatric Health Information System PIDS/IDSA — : Pediatric Infectious Diseases Society and Infectious Diseases Society of America For decades, chest radiography (CXR) was considered to be the reference standard for diagnosis of community-acquired pneumonia (CAP). Studies of CAP diagnostics in children have used CXR as both a reference standard and an index test, with disagreement over how and when it should be used.1 Although frequently obtained, CXR has low sensitivity and only fair interrater reliability in diagnosing CAP.2 Radiography cannot differentiate bacterial from viral CAP and does not have substantial impact on outcomes.3 Furthermore, access to CXR is limited in many settings. Given these limitations, the 2011 Pediatric Infectious Diseases Society and Infectious Diseases Society of America (PIDS/IDSA) pediatric CAP guideline recommends against routine CXR to confirm suspected CAP in children managed in the outpatient setting, a strong recommendation citing high-quality evidence.4 Despite this, among children 1 to 6 years of age managed as outpatients in the United States from 2008 to 2015, 83% of children with CAP received CXR in the emergency department (ED) compared with 22% in the primary care setting, with no change after guideline publication.5 This suggests that there is still room to improve, especially in the ED. In this issue of Pediatrics , Geanacopoulos et al6 used the Pediatric Health Information System (PHIS), an administrative database, to evaluate CXR use in 30 pediatric EDs from 2008 to 2018 … Address correspondence to Todd A. Florin, MD, MSCE, Division of Emergency Medicine, Department of Pediatrics, Ann and Robert H. Lurie Children’s Hospital of Chicago, Northwestern University Feinberg School of Medicine, 225 E Chicago Ave, Box 62, Chicago, IL 60611. E-mail: taflorin{at}luriechildrens.org

Update from the Advisory Committee on Immunization Practices.

The Advisory Committee on Immunization Practices (ACIP), a group of medical and public health experts, meets 3 times per year to develop recommendations for vaccine use in the United States. There are usually 15 voting members; members' terms are for 4 years. ACIP members and Centers for Disease Control and Prevention staff discuss the epidemiology of vaccine-preventable diseases and vaccine research, effectiveness, safety data, and results from clinical trials. Representatives from the American Academy of Pediatrics (Y. A. M., D. W. K.) and the Pediatric Infectious Diseases Society (S. T. O.) are present as liaisons to the ACIP. The ACIP met on 23-24 October 2019 to discuss pertussis vaccines, the child/adolescent and adult immunization schedule, influenza vaccine effectiveness and safety, Ebola vaccine, orthopoxvirus vaccines, Dengue vaccine, rabies vaccine, measles, and vaccine safety update.

Improving antibiotic prescribing in the emergency department for uncomplicated community-acquired pneumonia.

The Pediatric Infectious Disease Society (PIDS) and Infectious Disease Society of America (IDSA) published an evidence-based guideline for the treatment of uncomplicated community-acquired pneumonia (CAP) in children, recommending aminopenicillins as the first-line therapy. Poor guideline compliance with 10%-50% of patients admitted to the hospital receiving narrow-spectrum antibiotics has been reported. A new clinical practice guideline (CPG) was implemented in our emergency department (ED) for uncomplicated CAP. The aim of this study was to examine baseline knowledge and ED provider prescribing patterns pre- and post-CPG implementation. Prior to CPG-implementation, an anonymous case-based survey was distributed to evaluate knowledge of the current PIDS/IDSA guideline. A retrospective chart review of patients treated in the ED for CAP from January 2015 to February 2017 was performed to assess prescribing patterns for intravenous (IV) antibiotics in the ED at Children's National Health System pre- and post-CPG implementation. ED providers were aware of the PIDS/IDSA guideline recommendations, with 86.4% of survey responders selecting ampicillin as the initial antibiotic of choice. However, only 41.2% of patients admitted to the hospital with uncomplicated CAP pre-CPG received ampicillin (P<0.01). There was no statistically significant increase in ampicillin prescribing post-CPG (P=0.40). Providers in the ED are aware of the PIDS/IDSA guideline regarding the first-line therapy for uncomplicated CAP; however, this knowledge does not translate into clinical practice. Implementation of a CPG in isolation did not significantly change prescribing patterns for uncomplicated CAP.

Skin and Soft Tissue Infection Treatment and Prevention Practices by Pediatric Infectious Diseases Providers.

We surveyed 323 members of the Pediatric Infectious Diseases Society about their clinical practices for skin abscess management based on the 2011 Infectious Diseases Society of America guidelines and contemporary evidence. Despite this guideline and recent randomized trials, variability exists among pediatric infectious diseases clinicians in current skin and soft tissue infection management practices.

Inhibition of Complement C1s with Sutimlimab in Patients with Cold Agglutinin Disease (CAD): Results from the Phase 3 Cardinal Study

Inhibition of Complement C1s with Sutimlimab in Patients with Cold Agglutinin Disease (CAD): Results from the Phase 3 Cardinal Study

Inhibition of the Classical Pathway of Complement with Sutimlimab in Chronic Immune Thrombocytopenic Purpura Patients without Adequate Response to Two or More Prior Therapies

Inhibition of the Classical Pathway of Complement with Sutimlimab in Chronic Immune Thrombocytopenic Purpura Patients without Adequate Response to Two or More Prior Therapies

766. Telehealth Practices, Barriers, and Future Interest among Pediatric Infectious Disease Clinicians in the United States: Results from the 2019 Pediatric Infectious Diseases Society (PIDS) Telehealth Working Group Survey

BackgroundThere is a paucity of access to pediatric infectious diseases (PID) physicians in the United States. To improve access, PID clinicians spend significant time providing nonreimbursed curbside consultations (CCs) to community providers. While there is increasing utilization of telehealth technologies to increase access to PID physicians, there is limited knowledge regarding adoption of these technologies and how they may be used to improve care and reimbursement.MethodsThe PIDS Telehealth Working Group developed a 33-question online survey to collect individual- and practice-level data on the burden of CCs, current telehealth practices and barriers, and interest in providing future telehealth services. It was emailed to the PIDS Listserv (n = 1,213) in April 2019.ResultsA total of 161 (13%) providers completed the survey (100% MD/DO), representing 37 states; most are university- (n = 100, 62%) and/or hospital- (n = 74, 46%) employed. Respondents’ practices provide a mean of 1–10 CCs/week to outside institutions (median 3–5 hours/week), with a median of 6–10% resulting in referrals. Outside nonreimbursed CCs are performed by phone/paging systems (n = 156, 98%), secure email (n = 66, 42%), text messaging (n = 46, 29%), and EMR-messaging (n = 38, 24%); they include a variety of services (Figure 1). Only 46 (29%) of individual respondents provide any type of reimbursed telehealth at their practices (Figure 2). Reimbursement mechanisms include fee-for-service (31%), Medicaid/Medicare (25%), private insurance (24%), and internal institutional (i.e., internal RVU) payments (16%). The majority of respondents were unaware of credentialing (n = 90, 64%) and liability coverage needs for telehealth (n = 68, 47%). Though most respondents (n = 81, 57%) were not satisfied with their current telehealth program and barriers were significant (Figure 3), the majority (n = 144, 95%) were interested in implementing a variety of reimbursable telehealth services and modalities (Figure 4).ConclusionPID survey respondents indicated a lack of knowledge on key aspects of telehealth and perceive significant barriers to implementing telehealth at their institutions. Nonetheless, there is a strong interest in participating in a variety of telehealth services to increase access to care, with appropriate institutional support. Disclosures All authors: No reported disclosures.

1139. Multidisciplinary Initiative to Increase Guideline-Concordant Antibiotic Prescriptions at Discharge for Hospitalized Children with Uncomplicated Community-Acquired Pneumonia

BackgroundCommunity-acquired pneumonia (CAP) is the most common diagnosis in hospitalized children. The Pediatric Infectious Diseases Society and the Infectious Diseases Society of America published evidenced-based clinical practice guidelines for the management of CAP in children 3 months of age or older in 2011. These guidelines are not consistently followed. Our objective was to evaluate if quality improvement (QI) methods could improve guideline-concordant antibiotic prescribing, specifically addressing the use of oral third-generation cephalosporins, at hospital discharge for children with uncomplicated CAP.MethodsQI interventions, implemented at a single tertiary care children’s hospital in Washington, D.C., focused on key drivers targeting hospital medicine resident teams. Multiple plan-do-study-act (PDSA) cycles were performed. Initial interventions included educational sessions (in small group and lecture formats) aimed at pediatric resident physicians, as well as visual job aids (Figure 1) and guideline summaries posted in resident physician work areas. Interventions were implemented in series to allow for statistical analysis via run chart. Medical records of eligible patients were reviewed monthly after each intervention to determine the impact on appropriate discharge antibiotic prescribing.ResultsAt baseline, the median percentage of children with a diagnosis of uncomplicated CAP discharged with guideline-concordant antibiotics was 50%. Median rates of guideline-concordant antibiotic prescribing improved to 87.5% after initial interventions (Figure 2).ConclusionA fellow-led multidisciplinary QI initiative was successful in decreasing rates of non-guideline-concordant antibiotic prescribing at discharge. These interventions can be tailored for use at other institutions and for other infectious processes with established treatment guidelines. To ensure sustained improvement in guideline-concordant prescribing, future planned interventions include additional educational sessions with residents, faculty, and pharmacists, EMR order set modification and physician benchmarking. These tactics are intended to address the anticipated challenge of resident/faculty turnover and automate antibiotic choice for uncomplicated CAP. Disclosures All authors: No reported disclosures.

Update From the Advisory Committee on Immunization Practices.

The Advisory Committee on Immunization Practices (ACIP), a group of medical and public health experts, meets 3 times per year to develop recommendations for vaccine use in the United States. There usually are 15 voting members, but at the June 2019 meeting, only 14 were present; each member's term is 4 years. ACIP members and Centers for Disease Control and Prevention (CDC) staff discuss the epidemiology of vaccine-preventable diseases and vaccine research, effectiveness, safety data, and clinical trial results. Representatives from the American Academy of Pediatrics (AAP) (Y. A. M. and D. W. K.) and the Pediatric Infectious Diseases Society (S. T. O.) are present as liaisons to the ACIP. The ACIP met on June 26 to 27, 2019, to discuss the use of human papillomavirus (HPV) vaccine in adults, pneumococcal vaccines in adults, measles updates, zoster vaccine, influenza vaccines, hepatitis A virus (HAV) vaccines, meningococcal vaccines, and dengue vaccine.

Update From the Advisory Committee on Immunization Practices

The Advisory Committee on Immunization Practices (ACIP), a group of medical and public health experts, meets 3 times per year to develop recommendations for vaccine use in the United States. The group usually has 15 voting members, each of whom is appointed to a 4-year term. ACIP members and Centers for Disease Control and Prevention staff discuss the epidemiology of vaccine-preventable diseases and vaccine research, effectiveness, safety data, and clinical trial results. Representatives from the American Academy of Pediatrics (Y. A. M. and D. W. K.) and the Pediatric Infectious Diseases Society (S. T. O.) are present as liaisons to the ACIP. The ACIP met February 27 to 28, 2019, to discuss hepatitis A (HepA) vaccination of human immunodeficiency virus-infected persons, pneumococcal vaccination among adults aged 65 years or older, influenza vaccine effectiveness and safety, anthrax vaccination in the setting of a mass exposure, human papillomavirus vaccine, zoster vaccines, and Japanese encephalitis vaccine.