Pulmonary Health Hub

SAN DIEGO – Oral antibiotic therapy should be the preferred postdischarge treatment for pediatric patients with complicated pneumonia, as peripherally inserted central catheter (PICC) treatment has higher rates of treatment failure, adverse drug reactions, and related revisits, according to Dr. Samir S. Shah.

“Pneumonia is important because it is costly; in terms of cumulative costs to children’s hospitals, it is the second-most costly condition,” explained Dr. Shah, director of the division of hospital medicine at the Cincinnati Children’s Hospital Medical Center, who presented the findings of this retrospective cohort study at the annual meeting of the Pediatric Academic Societies.

“It is also potentially serious,” Dr. Shah continued. “Up to 15% of children hospitalized with pneumonia may have their course complicated by empyema, [and] even more problematic is that the incidences of complicated pneumonia are increasing.”

Dr. Shah and his coinvestigators examined the records for all children hospitalized between Jan. 1, 2009, and Dec. 31, 2012, with complicated pneumonia at 36 centers from across the United States. The primary outcome was treatment failure. Secondary outcomes were revisits related to the index admission, such as PICC complications, adverse drug reactions, and overall revisits.

The rate of treatment failure was higher in patients receiving PICC: 3.2% vs. 2.6% for those receiving oral antibiotics after discharge. Adverse drug reactions occurred in 3.2% of subjects receiving PICC, compared with only 0.2% of subjects in the oral antibiotics cohorts. Both related and overall revisits were higher in the PICC cohort than in the oral antibiotics cohort, too: 6.1% vs. 3.0% for related revisits, and 17.8% vs. 5.8% for overall revisits (P < .05). Treatment failure occurred in 49 children across both cohorts (2.3%).

Of the 2,123 children deemed eligible and included in the study, 281 were prescribed PICC as postdischarge treatment (13.2%), and the use of PICC overall varied from hospital to hospital; some centers prescribed PICC treatment in as many as 71% of cases, while some never prescribed it. Serum sickness, drug-induced neutropenia, and PICC thrombosis, dislodgment, and fever were the most commonly reported adverse effects across both cohorts. Treatment failure was reported in 49 (2.3%) cases.

“There were some problems with matching,” explained Dr. Shah, who is also professor of pediatrics at the University of Cincinnati. “Because many centers had small numbers of kids discharged with PICC therapy, we could not account for differences across hospitals.”

A review of charts’ ICD-9 codes in the nationwide Pediatric Health Information System (PHIS) and the Pediatric Research in Inpatient Settings (PRIS) Network was used to collect the patient population, and providers at each of the 36 institutions included reviewed medical records to confirm patient eligibility, define treatment groups, determine which antibiotic each patient was discharged with, and verify outcomes.

“This was an observational study, [and] there are limitations that go with that,” said Dr. Shah. “We adjusted for confounding using propensity score matching, but there are unmeasured confounding factors; [however,] because we matched across hospitals, we could better account for confounding by indication at the patient level.”

Dr. Shah did not report any relevant financial disclosures.

[email protected]

SAN DIEGO – Oral antibiotic therapy should be the preferred postdischarge treatment for pediatric patients with complicated pneumonia, as peripherally inserted central catheter (PICC) treatment has higher rates of treatment failure, adverse drug reactions, and related revisits, according to Dr. Samir S. Shah.

“Pneumonia is important because it is costly; in terms of cumulative costs to children’s hospitals, it is the second-most costly condition,” explained Dr. Shah, director of the division of hospital medicine at the Cincinnati Children’s Hospital Medical Center, who presented the findings of this retrospective cohort study at the annual meeting of the Pediatric Academic Societies.

“It is also potentially serious,” Dr. Shah continued. “Up to 15% of children hospitalized with pneumonia may have their course complicated by empyema, [and] even more problematic is that the incidences of complicated pneumonia are increasing.”

Dr. Shah and his coinvestigators examined the records for all children hospitalized between Jan. 1, 2009, and Dec. 31, 2012, with complicated pneumonia at 36 centers from across the United States. The primary outcome was treatment failure. Secondary outcomes were revisits related to the index admission, such as PICC complications, adverse drug reactions, and overall revisits.

The rate of treatment failure was higher in patients receiving PICC: 3.2% vs. 2.6% for those receiving oral antibiotics after discharge. Adverse drug reactions occurred in 3.2% of subjects receiving PICC, compared with only 0.2% of subjects in the oral antibiotics cohorts. Both related and overall revisits were higher in the PICC cohort than in the oral antibiotics cohort, too: 6.1% vs. 3.0% for related revisits, and 17.8% vs. 5.8% for overall revisits (P < .05). Treatment failure occurred in 49 children across both cohorts (2.3%).

Of the 2,123 children deemed eligible and included in the study, 281 were prescribed PICC as postdischarge treatment (13.2%), and the use of PICC overall varied from hospital to hospital; some centers prescribed PICC treatment in as many as 71% of cases, while some never prescribed it. Serum sickness, drug-induced neutropenia, and PICC thrombosis, dislodgment, and fever were the most commonly reported adverse effects across both cohorts. Treatment failure was reported in 49 (2.3%) cases.

“There were some problems with matching,” explained Dr. Shah, who is also professor of pediatrics at the University of Cincinnati. “Because many centers had small numbers of kids discharged with PICC therapy, we could not account for differences across hospitals.”

A review of charts’ ICD-9 codes in the nationwide Pediatric Health Information System (PHIS) and the Pediatric Research in Inpatient Settings (PRIS) Network was used to collect the patient population, and providers at each of the 36 institutions included reviewed medical records to confirm patient eligibility, define treatment groups, determine which antibiotic each patient was discharged with, and verify outcomes.

“This was an observational study, [and] there are limitations that go with that,” said Dr. Shah. “We adjusted for confounding using propensity score matching, but there are unmeasured confounding factors; [however,] because we matched across hospitals, we could better account for confounding by indication at the patient level.”

Dr. Shah did not report any relevant financial disclosures.

[email protected]

SAN DIEGO – Oral antibiotic therapy should be the preferred postdischarge treatment for pediatric patients with complicated pneumonia, as peripherally inserted central catheter (PICC) treatment has higher rates of treatment failure, adverse drug reactions, and related revisits, according to Dr. Samir S. Shah.

“Pneumonia is important because it is costly; in terms of cumulative costs to children’s hospitals, it is the second-most costly condition,” explained Dr. Shah, director of the division of hospital medicine at the Cincinnati Children’s Hospital Medical Center, who presented the findings of this retrospective cohort study at the annual meeting of the Pediatric Academic Societies.

“It is also potentially serious,” Dr. Shah continued. “Up to 15% of children hospitalized with pneumonia may have their course complicated by empyema, [and] even more problematic is that the incidences of complicated pneumonia are increasing.”

Dr. Shah and his coinvestigators examined the records for all children hospitalized between Jan. 1, 2009, and Dec. 31, 2012, with complicated pneumonia at 36 centers from across the United States. The primary outcome was treatment failure. Secondary outcomes were revisits related to the index admission, such as PICC complications, adverse drug reactions, and overall revisits.

The rate of treatment failure was higher in patients receiving PICC: 3.2% vs. 2.6% for those receiving oral antibiotics after discharge. Adverse drug reactions occurred in 3.2% of subjects receiving PICC, compared with only 0.2% of subjects in the oral antibiotics cohorts. Both related and overall revisits were higher in the PICC cohort than in the oral antibiotics cohort, too: 6.1% vs. 3.0% for related revisits, and 17.8% vs. 5.8% for overall revisits (P < .05). Treatment failure occurred in 49 children across both cohorts (2.3%).

Of the 2,123 children deemed eligible and included in the study, 281 were prescribed PICC as postdischarge treatment (13.2%), and the use of PICC overall varied from hospital to hospital; some centers prescribed PICC treatment in as many as 71% of cases, while some never prescribed it. Serum sickness, drug-induced neutropenia, and PICC thrombosis, dislodgment, and fever were the most commonly reported adverse effects across both cohorts. Treatment failure was reported in 49 (2.3%) cases.

“There were some problems with matching,” explained Dr. Shah, who is also professor of pediatrics at the University of Cincinnati. “Because many centers had small numbers of kids discharged with PICC therapy, we could not account for differences across hospitals.”

A review of charts’ ICD-9 codes in the nationwide Pediatric Health Information System (PHIS) and the Pediatric Research in Inpatient Settings (PRIS) Network was used to collect the patient population, and providers at each of the 36 institutions included reviewed medical records to confirm patient eligibility, define treatment groups, determine which antibiotic each patient was discharged with, and verify outcomes.

“This was an observational study, [and] there are limitations that go with that,” said Dr. Shah. “We adjusted for confounding using propensity score matching, but there are unmeasured confounding factors; [however,] because we matched across hospitals, we could better account for confounding by indication at the patient level.”

Dr. Shah did not report any relevant financial disclosures.

[email protected]

SAN DIEGO – Cystic fibrosis–related diabetes is a unique disease, and it requires a different mindset on the part of the treating physician.

“The risk of cardiovascular death drives a lot of the recommendations for management of our patients with type 1 and type 2 diabetes, but this doesn’t apply in cystic fibrosis. Patients with cystic fibrosis–related diabetes do not appear to get macrovascular complications. These patients have other, more important concerns – namely, survival. They die from their CF lung disease. Diabetes is important, but we have to remember that in CF, lung function and nutrition come first. It’s our job to work around that,” Dr. Antoinette Moran asserted at the annual meeting of the Pediatric Academic Societies.

Bruce Jancin/Frontline Medical News

Diabetes is the most common comorbidity associated with CF. And it spells big trouble. It’s associated with pancreatic insufficiency, liver dysfunction, requirement for corticosteroids, and prognostically with undernutrition, worse pulmonary function, and early death, noted Dr. Moran, professor of pediatrics and chief of the division of pediatric endocrinology and diabetes at the University of Minnesota, Minneapolis.

The prevalence of cystic fibrosis–related diabetes (CFRD) is age related. It’s rare in children, but the prevalence climbs to about 15% in adolescents, 40% in 20- to 39-year-olds, and 55% after age 40.

“In fact, more than 80% of CF patients with the most severe mutations have diabetes by the time they’re 40,” according to Dr. Moran, who was lead author of CFRD management guidelines released last year by the International Society for Pediatric and Adolescent Diabetes (Pediatr. Diabetes 2014 Sep;15 Suppl 20:65-76).

CFRD is not an autoimmune disease. Ketones are rare. Glycosylated hemoglobin levels are spuriously low. And the definitive treatment for CFRD is insulin.

“Remember, you’re not just treating hyperglycemia, you’re treating insulin deficiency. Insulin deficiency is really the hallmark of this disease. It is progressive and eventually severe, but not complete – unlike in type 1 diabetes,” she observed. “Treatment of patients in their well state is similar to treating type 1 diabetes in the honeymoon phase. However, during acute illness patients become extremely insulin resistant. It’s a black hole that you can pour insulin into, and sometimes you can’t get them to budge. Then a couple of months later they’re insulin sensitive again.”

Multiple studies have demonstrated that diabetes has a negative impact upon survival in patients with CF. Both hyperglycemia and insulin insufficiency have negative impacts upon the CF lung disease.

Insulin is a potent anabolic hormone that’s necessary for maintenance of body weight and lean body mass, and insulin insufficiency leads to a catabolic state which accelerates pulmonary decline in CF. Studies show that nutritional status and pulmonary function start to decline in CF patients several years before they’re diagnosed with diabetes. Thus, by the time CFRD is diagnosed, patients have already experienced several years of insulin insufficiency, with adverse consequences.

Moreover, when blood glucose levels exceed 144 mg/dL, glucose appears in the airways of CF patients. That’s not good. It probably promotes pulmonary infection. Anecdotal evidence suggests hyperglycemia makes sputum thicker and more difficult to clear as well as boosting bacterial growth. And continuous glucose monitoring studies conducted in patients with CFRD indicate they spend roughly half of each day with a blood glucose in excess of 144 mg/dL.

Aggressive screening and early initiation of insulin therapy help reverse chronic weight loss and reduce mortality in patients with CFRD. The various guidelines recommend annual screening for diabetes in CF patients starting by age 10.

“I personally believe it should begin much earlier than that,” Dr. Moran said, citing a study led by her Minnesota colleague Dr. Katie L. Ode that showed that abnormal glucose tolerance was already present in 41% of children with CF at ages 6-9, and that those children had a high rate of early-onset CFRD (Pediatr. Diabetes 2010 Nov;11:487-92).

The oral glucose tolerance test, performed when the patient is clinically stable, is the screening tool of choice for CFRD.

“It’s not that it’s such a great test – we all know it has problems – but the other tests perform poorly in CF. And a diagnosis based upon an oral glucose tolerance test correlates with prognosis and future outcomes, so you get meaningful data when you do it,” she explained.

Evidence-based guidelines for CFRD put forth jointly by the American Diabetes Association, Cystic Fibrosis Foundation, and Lawson Wilkins Pediatric Endocrinology Society (Diabetes Care 2010;33:2697-2708) emphasize that, unlike in patients without CF, the diagnosis of CFRD can be made while a patient is hospitalized with an acute illness. The criterion is fasting or postprandial hyperglycemia persisting for more than 48 hours after hospitalization.

“Why are we calling this diabetes? These patients have repeated bouts of acute illness. The CF patient you’re seeing today in the hospital may very well be back in 5 months, and again 2 months after that. It’s a frequent event in these patients, and when their diabetes persists for longer than 48 hours it tends to persist for weeks before their need for insulin goes away until the next time they get sick. But most of these patients spend a substantial amount of time each year hyperglycemic. And most importantly, if you use as your date of diagnosis diabetes that’s present at the time of an acute illness, it correlates with microvascular complications and with mortality. So it establishes a meaningful start point for future risk,” Dr. Moran said.

She reported financial relationships with Novo Nordisk and Vertex.

[email protected]

SAN DIEGO – Cystic fibrosis–related diabetes is a unique disease, and it requires a different mindset on the part of the treating physician.

“The risk of cardiovascular death drives a lot of the recommendations for management of our patients with type 1 and type 2 diabetes, but this doesn’t apply in cystic fibrosis. Patients with cystic fibrosis–related diabetes do not appear to get macrovascular complications. These patients have other, more important concerns – namely, survival. They die from their CF lung disease. Diabetes is important, but we have to remember that in CF, lung function and nutrition come first. It’s our job to work around that,” Dr. Antoinette Moran asserted at the annual meeting of the Pediatric Academic Societies.

Bruce Jancin/Frontline Medical News

Diabetes is the most common comorbidity associated with CF. And it spells big trouble. It’s associated with pancreatic insufficiency, liver dysfunction, requirement for corticosteroids, and prognostically with undernutrition, worse pulmonary function, and early death, noted Dr. Moran, professor of pediatrics and chief of the division of pediatric endocrinology and diabetes at the University of Minnesota, Minneapolis.

The prevalence of cystic fibrosis–related diabetes (CFRD) is age related. It’s rare in children, but the prevalence climbs to about 15% in adolescents, 40% in 20- to 39-year-olds, and 55% after age 40.

“In fact, more than 80% of CF patients with the most severe mutations have diabetes by the time they’re 40,” according to Dr. Moran, who was lead author of CFRD management guidelines released last year by the International Society for Pediatric and Adolescent Diabetes (Pediatr. Diabetes 2014 Sep;15 Suppl 20:65-76).

CFRD is not an autoimmune disease. Ketones are rare. Glycosylated hemoglobin levels are spuriously low. And the definitive treatment for CFRD is insulin.

“Remember, you’re not just treating hyperglycemia, you’re treating insulin deficiency. Insulin deficiency is really the hallmark of this disease. It is progressive and eventually severe, but not complete – unlike in type 1 diabetes,” she observed. “Treatment of patients in their well state is similar to treating type 1 diabetes in the honeymoon phase. However, during acute illness patients become extremely insulin resistant. It’s a black hole that you can pour insulin into, and sometimes you can’t get them to budge. Then a couple of months later they’re insulin sensitive again.”

Multiple studies have demonstrated that diabetes has a negative impact upon survival in patients with CF. Both hyperglycemia and insulin insufficiency have negative impacts upon the CF lung disease.

Insulin is a potent anabolic hormone that’s necessary for maintenance of body weight and lean body mass, and insulin insufficiency leads to a catabolic state which accelerates pulmonary decline in CF. Studies show that nutritional status and pulmonary function start to decline in CF patients several years before they’re diagnosed with diabetes. Thus, by the time CFRD is diagnosed, patients have already experienced several years of insulin insufficiency, with adverse consequences.

Moreover, when blood glucose levels exceed 144 mg/dL, glucose appears in the airways of CF patients. That’s not good. It probably promotes pulmonary infection. Anecdotal evidence suggests hyperglycemia makes sputum thicker and more difficult to clear as well as boosting bacterial growth. And continuous glucose monitoring studies conducted in patients with CFRD indicate they spend roughly half of each day with a blood glucose in excess of 144 mg/dL.

Aggressive screening and early initiation of insulin therapy help reverse chronic weight loss and reduce mortality in patients with CFRD. The various guidelines recommend annual screening for diabetes in CF patients starting by age 10.

“I personally believe it should begin much earlier than that,” Dr. Moran said, citing a study led by her Minnesota colleague Dr. Katie L. Ode that showed that abnormal glucose tolerance was already present in 41% of children with CF at ages 6-9, and that those children had a high rate of early-onset CFRD (Pediatr. Diabetes 2010 Nov;11:487-92).

The oral glucose tolerance test, performed when the patient is clinically stable, is the screening tool of choice for CFRD.

“It’s not that it’s such a great test – we all know it has problems – but the other tests perform poorly in CF. And a diagnosis based upon an oral glucose tolerance test correlates with prognosis and future outcomes, so you get meaningful data when you do it,” she explained.

Evidence-based guidelines for CFRD put forth jointly by the American Diabetes Association, Cystic Fibrosis Foundation, and Lawson Wilkins Pediatric Endocrinology Society (Diabetes Care 2010;33:2697-2708) emphasize that, unlike in patients without CF, the diagnosis of CFRD can be made while a patient is hospitalized with an acute illness. The criterion is fasting or postprandial hyperglycemia persisting for more than 48 hours after hospitalization.

“Why are we calling this diabetes? These patients have repeated bouts of acute illness. The CF patient you’re seeing today in the hospital may very well be back in 5 months, and again 2 months after that. It’s a frequent event in these patients, and when their diabetes persists for longer than 48 hours it tends to persist for weeks before their need for insulin goes away until the next time they get sick. But most of these patients spend a substantial amount of time each year hyperglycemic. And most importantly, if you use as your date of diagnosis diabetes that’s present at the time of an acute illness, it correlates with microvascular complications and with mortality. So it establishes a meaningful start point for future risk,” Dr. Moran said.

She reported financial relationships with Novo Nordisk and Vertex.

[email protected]

SAN DIEGO – Cystic fibrosis–related diabetes is a unique disease, and it requires a different mindset on the part of the treating physician.

“The risk of cardiovascular death drives a lot of the recommendations for management of our patients with type 1 and type 2 diabetes, but this doesn’t apply in cystic fibrosis. Patients with cystic fibrosis–related diabetes do not appear to get macrovascular complications. These patients have other, more important concerns – namely, survival. They die from their CF lung disease. Diabetes is important, but we have to remember that in CF, lung function and nutrition come first. It’s our job to work around that,” Dr. Antoinette Moran asserted at the annual meeting of the Pediatric Academic Societies.

Bruce Jancin/Frontline Medical News

Diabetes is the most common comorbidity associated with CF. And it spells big trouble. It’s associated with pancreatic insufficiency, liver dysfunction, requirement for corticosteroids, and prognostically with undernutrition, worse pulmonary function, and early death, noted Dr. Moran, professor of pediatrics and chief of the division of pediatric endocrinology and diabetes at the University of Minnesota, Minneapolis.

The prevalence of cystic fibrosis–related diabetes (CFRD) is age related. It’s rare in children, but the prevalence climbs to about 15% in adolescents, 40% in 20- to 39-year-olds, and 55% after age 40.

“In fact, more than 80% of CF patients with the most severe mutations have diabetes by the time they’re 40,” according to Dr. Moran, who was lead author of CFRD management guidelines released last year by the International Society for Pediatric and Adolescent Diabetes (Pediatr. Diabetes 2014 Sep;15 Suppl 20:65-76).

CFRD is not an autoimmune disease. Ketones are rare. Glycosylated hemoglobin levels are spuriously low. And the definitive treatment for CFRD is insulin.

“Remember, you’re not just treating hyperglycemia, you’re treating insulin deficiency. Insulin deficiency is really the hallmark of this disease. It is progressive and eventually severe, but not complete – unlike in type 1 diabetes,” she observed. “Treatment of patients in their well state is similar to treating type 1 diabetes in the honeymoon phase. However, during acute illness patients become extremely insulin resistant. It’s a black hole that you can pour insulin into, and sometimes you can’t get them to budge. Then a couple of months later they’re insulin sensitive again.”

Multiple studies have demonstrated that diabetes has a negative impact upon survival in patients with CF. Both hyperglycemia and insulin insufficiency have negative impacts upon the CF lung disease.

Insulin is a potent anabolic hormone that’s necessary for maintenance of body weight and lean body mass, and insulin insufficiency leads to a catabolic state which accelerates pulmonary decline in CF. Studies show that nutritional status and pulmonary function start to decline in CF patients several years before they’re diagnosed with diabetes. Thus, by the time CFRD is diagnosed, patients have already experienced several years of insulin insufficiency, with adverse consequences.

Moreover, when blood glucose levels exceed 144 mg/dL, glucose appears in the airways of CF patients. That’s not good. It probably promotes pulmonary infection. Anecdotal evidence suggests hyperglycemia makes sputum thicker and more difficult to clear as well as boosting bacterial growth. And continuous glucose monitoring studies conducted in patients with CFRD indicate they spend roughly half of each day with a blood glucose in excess of 144 mg/dL.

Aggressive screening and early initiation of insulin therapy help reverse chronic weight loss and reduce mortality in patients with CFRD. The various guidelines recommend annual screening for diabetes in CF patients starting by age 10.

“I personally believe it should begin much earlier than that,” Dr. Moran said, citing a study led by her Minnesota colleague Dr. Katie L. Ode that showed that abnormal glucose tolerance was already present in 41% of children with CF at ages 6-9, and that those children had a high rate of early-onset CFRD (Pediatr. Diabetes 2010 Nov;11:487-92).

The oral glucose tolerance test, performed when the patient is clinically stable, is the screening tool of choice for CFRD.

“It’s not that it’s such a great test – we all know it has problems – but the other tests perform poorly in CF. And a diagnosis based upon an oral glucose tolerance test correlates with prognosis and future outcomes, so you get meaningful data when you do it,” she explained.

Evidence-based guidelines for CFRD put forth jointly by the American Diabetes Association, Cystic Fibrosis Foundation, and Lawson Wilkins Pediatric Endocrinology Society (Diabetes Care 2010;33:2697-2708) emphasize that, unlike in patients without CF, the diagnosis of CFRD can be made while a patient is hospitalized with an acute illness. The criterion is fasting or postprandial hyperglycemia persisting for more than 48 hours after hospitalization.

“Why are we calling this diabetes? These patients have repeated bouts of acute illness. The CF patient you’re seeing today in the hospital may very well be back in 5 months, and again 2 months after that. It’s a frequent event in these patients, and when their diabetes persists for longer than 48 hours it tends to persist for weeks before their need for insulin goes away until the next time they get sick. But most of these patients spend a substantial amount of time each year hyperglycemic. And most importantly, if you use as your date of diagnosis diabetes that’s present at the time of an acute illness, it correlates with microvascular complications and with mortality. So it establishes a meaningful start point for future risk,” Dr. Moran said.

She reported financial relationships with Novo Nordisk and Vertex.

[email protected]

SAN DIEGO – A question that arises all the time for physicians who find themselves providing care for a patient with cystic fibrosis–related diabetes is, How do I code for it?

No specific code exists for cystic fibrosis–related diabetes (CFRD), even though it is a unique illness and the most common comorbid condition among patients with CF.

“People use a lot of different codes. I use the type 1 diabetes code, and my personal opinion is that there are good reasons for doing so,” Dr. Antoinette Moran said at the annual meeting of the Pediatric Academic Societies.

“For one thing, the patients perform similar tasks as those with type 1 diabetes. They’re taking the same amount of your time and your diabetes educator’s time. But here’s the most important reason: It seems like all around the country, insurance companies are getting more and more restrictive for people who don’t carry a diagnosis of type 1 diabetes. These CFRD patients need to test their blood sugars at least 4 times a day, sometimes 10 times a day. These are patients who do really, really well on insulin pump therapy. We don’t want to be the ones limiting their options just based on what is admittedly an arbitrary code,” explained Dr. Moran, professor of pediatrics and chief of the division of pediatric endocrinology and diabetes at the University of Minnesota – Minneapolis.

She reported financial relationships with Novo Nordisk and Vertex.

[email protected]

SAN DIEGO – A question that arises all the time for physicians who find themselves providing care for a patient with cystic fibrosis–related diabetes is, How do I code for it?

No specific code exists for cystic fibrosis–related diabetes (CFRD), even though it is a unique illness and the most common comorbid condition among patients with CF.

“People use a lot of different codes. I use the type 1 diabetes code, and my personal opinion is that there are good reasons for doing so,” Dr. Antoinette Moran said at the annual meeting of the Pediatric Academic Societies.

“For one thing, the patients perform similar tasks as those with type 1 diabetes. They’re taking the same amount of your time and your diabetes educator’s time. But here’s the most important reason: It seems like all around the country, insurance companies are getting more and more restrictive for people who don’t carry a diagnosis of type 1 diabetes. These CFRD patients need to test their blood sugars at least 4 times a day, sometimes 10 times a day. These are patients who do really, really well on insulin pump therapy. We don’t want to be the ones limiting their options just based on what is admittedly an arbitrary code,” explained Dr. Moran, professor of pediatrics and chief of the division of pediatric endocrinology and diabetes at the University of Minnesota – Minneapolis.

She reported financial relationships with Novo Nordisk and Vertex.

[email protected]

SAN DIEGO – A question that arises all the time for physicians who find themselves providing care for a patient with cystic fibrosis–related diabetes is, How do I code for it?

No specific code exists for cystic fibrosis–related diabetes (CFRD), even though it is a unique illness and the most common comorbid condition among patients with CF.

“People use a lot of different codes. I use the type 1 diabetes code, and my personal opinion is that there are good reasons for doing so,” Dr. Antoinette Moran said at the annual meeting of the Pediatric Academic Societies.

“For one thing, the patients perform similar tasks as those with type 1 diabetes. They’re taking the same amount of your time and your diabetes educator’s time. But here’s the most important reason: It seems like all around the country, insurance companies are getting more and more restrictive for people who don’t carry a diagnosis of type 1 diabetes. These CFRD patients need to test their blood sugars at least 4 times a day, sometimes 10 times a day. These are patients who do really, really well on insulin pump therapy. We don’t want to be the ones limiting their options just based on what is admittedly an arbitrary code,” explained Dr. Moran, professor of pediatrics and chief of the division of pediatric endocrinology and diabetes at the University of Minnesota – Minneapolis.

She reported financial relationships with Novo Nordisk and Vertex.

[email protected]

SAN DIEGO– Adoption of and strict adherence to a clinical pathway for diagnosis and treatment of bronchiolitis, especially in pediatric patients, can alleviate costs for both patients and hospitals in the ED and inpatient settings, and allow for shorter lengths of stay, according to a retrospective cohort study.

“This is an important topic because bronchiolitis is the leading cause of infant hospitalization in the U.S., and the cost of bronchiolitis hospitalization has been increasing,” Dr. Mersine A. Bryan of Seattle Children’s Hospital said at the annual meeting of the Pediatric Academic Societies.

“The care for bronchiolitis is supportive, meaning that testing and medical treatments are generally unnecessary, and can add to costs without improving outcomes. Because of that, bronchiolitis is a good candidate for clinical pathways and clinical practice guidelines,” Dr. Bryan said.

She and her coinvestigators looked at 282 children aged 0-24 months who presented at Seattle Children’s Hospital’s emergency department or inpatient setting with bronchiolitis between December 2009 and July 2012. A total of 18 process-of-care quality measures were instituted – 12 designed for inpatient care, 6 for emergency departments – with a primary objective of mitigating length-of-stay, costs, inpatient admission, and readmission. Pathways were meant to guide clinicians with “evidence-based recommendations and flows based on patient assessments and clinical findings.” Adherence to these pathways was scored by medical record review on a scale of 0-100 for each of the 18 categories. Low adherence was classified as a score below 86, midlevel adherence as a score between 86 and 93, and high adherence as anything above 94.

Mean adherence scores were: ED 78.2 (standard deviation [SD] 18.3, n = 279), inpatient 94.7 (SD 6.6, n = 231).No difference was noted in care of patients based on patient gender and medical complexity, but higher adherence was noted for younger patients.

Higher adherence led to shorter length of stay in both inpatient and emergency departments: 2.7 days vs. 3.7 days (P < .05), and 191 minutes vs. 264 minutes (P < .01), respectively. Mean patient costs saw greater reductions in departments with high adherence; a difference of $3,045 was noted in high-adherence inpatient departments, compared to a difference of $1,564 in inpatient departments with lower adherence to the pathway (P < .05). Similarly, emergency departments with high adherence saw average costs per patient drop by $183, compared to $95 for emergency departments with lower adherence scores (P < .05). Admittance odds and 7-day readmissions to emergency departments also were lower when adherence to pathways was higher.

Dr. Bryan cautioned that because this was a single-center study and the results may be difficult to generalize across institutions, adding that she and her coinvestigators were limited by the amount of information they could cull from available electronic medical records.

Dr. Bryan did not report any relevant financial disclosures.

[email protected]

SAN DIEGO– Adoption of and strict adherence to a clinical pathway for diagnosis and treatment of bronchiolitis, especially in pediatric patients, can alleviate costs for both patients and hospitals in the ED and inpatient settings, and allow for shorter lengths of stay, according to a retrospective cohort study.

“This is an important topic because bronchiolitis is the leading cause of infant hospitalization in the U.S., and the cost of bronchiolitis hospitalization has been increasing,” Dr. Mersine A. Bryan of Seattle Children’s Hospital said at the annual meeting of the Pediatric Academic Societies.

“The care for bronchiolitis is supportive, meaning that testing and medical treatments are generally unnecessary, and can add to costs without improving outcomes. Because of that, bronchiolitis is a good candidate for clinical pathways and clinical practice guidelines,” Dr. Bryan said.

She and her coinvestigators looked at 282 children aged 0-24 months who presented at Seattle Children’s Hospital’s emergency department or inpatient setting with bronchiolitis between December 2009 and July 2012. A total of 18 process-of-care quality measures were instituted – 12 designed for inpatient care, 6 for emergency departments – with a primary objective of mitigating length-of-stay, costs, inpatient admission, and readmission. Pathways were meant to guide clinicians with “evidence-based recommendations and flows based on patient assessments and clinical findings.” Adherence to these pathways was scored by medical record review on a scale of 0-100 for each of the 18 categories. Low adherence was classified as a score below 86, midlevel adherence as a score between 86 and 93, and high adherence as anything above 94.

Mean adherence scores were: ED 78.2 (standard deviation [SD] 18.3, n = 279), inpatient 94.7 (SD 6.6, n = 231).No difference was noted in care of patients based on patient gender and medical complexity, but higher adherence was noted for younger patients.

Higher adherence led to shorter length of stay in both inpatient and emergency departments: 2.7 days vs. 3.7 days (P < .05), and 191 minutes vs. 264 minutes (P < .01), respectively. Mean patient costs saw greater reductions in departments with high adherence; a difference of $3,045 was noted in high-adherence inpatient departments, compared to a difference of $1,564 in inpatient departments with lower adherence to the pathway (P < .05). Similarly, emergency departments with high adherence saw average costs per patient drop by $183, compared to $95 for emergency departments with lower adherence scores (P < .05). Admittance odds and 7-day readmissions to emergency departments also were lower when adherence to pathways was higher.

Dr. Bryan cautioned that because this was a single-center study and the results may be difficult to generalize across institutions, adding that she and her coinvestigators were limited by the amount of information they could cull from available electronic medical records.

Dr. Bryan did not report any relevant financial disclosures.

[email protected]

SAN DIEGO– Adoption of and strict adherence to a clinical pathway for diagnosis and treatment of bronchiolitis, especially in pediatric patients, can alleviate costs for both patients and hospitals in the ED and inpatient settings, and allow for shorter lengths of stay, according to a retrospective cohort study.

“This is an important topic because bronchiolitis is the leading cause of infant hospitalization in the U.S., and the cost of bronchiolitis hospitalization has been increasing,” Dr. Mersine A. Bryan of Seattle Children’s Hospital said at the annual meeting of the Pediatric Academic Societies.

“The care for bronchiolitis is supportive, meaning that testing and medical treatments are generally unnecessary, and can add to costs without improving outcomes. Because of that, bronchiolitis is a good candidate for clinical pathways and clinical practice guidelines,” Dr. Bryan said.

She and her coinvestigators looked at 282 children aged 0-24 months who presented at Seattle Children’s Hospital’s emergency department or inpatient setting with bronchiolitis between December 2009 and July 2012. A total of 18 process-of-care quality measures were instituted – 12 designed for inpatient care, 6 for emergency departments – with a primary objective of mitigating length-of-stay, costs, inpatient admission, and readmission. Pathways were meant to guide clinicians with “evidence-based recommendations and flows based on patient assessments and clinical findings.” Adherence to these pathways was scored by medical record review on a scale of 0-100 for each of the 18 categories. Low adherence was classified as a score below 86, midlevel adherence as a score between 86 and 93, and high adherence as anything above 94.

Mean adherence scores were: ED 78.2 (standard deviation [SD] 18.3, n = 279), inpatient 94.7 (SD 6.6, n = 231).No difference was noted in care of patients based on patient gender and medical complexity, but higher adherence was noted for younger patients.

Higher adherence led to shorter length of stay in both inpatient and emergency departments: 2.7 days vs. 3.7 days (P < .05), and 191 minutes vs. 264 minutes (P < .01), respectively. Mean patient costs saw greater reductions in departments with high adherence; a difference of $3,045 was noted in high-adherence inpatient departments, compared to a difference of $1,564 in inpatient departments with lower adherence to the pathway (P < .05). Similarly, emergency departments with high adherence saw average costs per patient drop by $183, compared to $95 for emergency departments with lower adherence scores (P < .05). Admittance odds and 7-day readmissions to emergency departments also were lower when adherence to pathways was higher.

Dr. Bryan cautioned that because this was a single-center study and the results may be difficult to generalize across institutions, adding that she and her coinvestigators were limited by the amount of information they could cull from available electronic medical records.

Dr. Bryan did not report any relevant financial disclosures.

[email protected]

SAN DIEGO– There is no clear clinical benefit to diagnosing and treating infants with abnormal swallowing, according to the results of a video fluoroscopic swallow study (VFSS), and in certain cases, the study could be associated with an increased risk of developing acute respiratory infections (ARI) in these populations.

In a retrospective cohort study, Dr. Eric R. Coon of the University of Utah, Salt Lake City, and his colleagues examined data on all infants aged 12 months or younger who underwent VFSS from 2010 to 2012 at Primary Children’s Hospital in Salt Lake City.

“Providers implicitly believe that infant swallowing abnormalities lead to future respiratory illness,” Dr. Coon said at the annual meeting of the Pediatric Academic Societies. “However, data for that link is limited to descriptive case series, and studies relying on subjective definitions of aspiration that don’t include radiographic confirmation [and] interventions for swallowing abnormalities have not been shown to improve important clinical outcomes.”

The investigators looked at all inpatient, outpatient, and emergency department ARI cases in the Intermountain Healthcare system, a network of 22 hospital centers servicing five states, over the same time period in patients who experienced ARI between their first VFSS and age 3 years. ARI was defined as either bronchiolitis, asthma, pneumonia, or aspiration pneumonia, and was identified via IDC-9 codes.

Out of 576 infants, 199 (34%) exhibited oropharyngeal aspiration, 79 (14%) showed penetration, and 298 (52%)were classified as “normal.” Of the 199 with aspiration, 38 (19%) had thin aspiration and cough, 11 (6%) had thick aspiration and cough, 93 (47%) had thin aspiration and were silent, and 57 (28%) had thick aspiration and were silent.

Those deemed “thick aspiration, silent,” however, averaged 581 days to ARI, the shortest of any cohort, and a mean of 2.39 ARIs per subject. “Thin aspiration, cough” subjects had 638 mean days to ARI and a mean of 1.63 ARIs; “thick aspiration, cough” subjects had a mean of 750 days to ARI and 0.55 mean number of ARIs; and “thin aspiration, silent” had an average of 669 days to ARI and a mean of 1.69 ARIs (P < .05).

Those in the normal, or control, cohort averaged 715 days to ARI and 1.36 ARIs, while those with just penetration averaged 681 days to ARIs and 1.53 ARIs per subject (P < .05).

Cox regression models were used to calculate data time to first ARI, and Poisson regression was used for data on total number of ARIs experienced. Taking into account subject’s age at initial test, presence of complex chronic conditions in each subject, result of VFSS and type of aspiration intervention, silent aspiration with thickened feed yielded a Cox hazard ratio of 1.30 and a Poisson hazard ratio of 1.47, higher than all the others.

“The clinical importance of [VFSS]-detected abnormalities remains unclear, making them high-risk for overdiagnosis,” concluded Dr. Coon, adding that “patients may not experience net benefit, but may in fact be harmed.”

Dr. Coon did not report any relevant financial disclosures.

[email protected]

SAN DIEGO– There is no clear clinical benefit to diagnosing and treating infants with abnormal swallowing, according to the results of a video fluoroscopic swallow study (VFSS), and in certain cases, the study could be associated with an increased risk of developing acute respiratory infections (ARI) in these populations.

In a retrospective cohort study, Dr. Eric R. Coon of the University of Utah, Salt Lake City, and his colleagues examined data on all infants aged 12 months or younger who underwent VFSS from 2010 to 2012 at Primary Children’s Hospital in Salt Lake City.

“Providers implicitly believe that infant swallowing abnormalities lead to future respiratory illness,” Dr. Coon said at the annual meeting of the Pediatric Academic Societies. “However, data for that link is limited to descriptive case series, and studies relying on subjective definitions of aspiration that don’t include radiographic confirmation [and] interventions for swallowing abnormalities have not been shown to improve important clinical outcomes.”

The investigators looked at all inpatient, outpatient, and emergency department ARI cases in the Intermountain Healthcare system, a network of 22 hospital centers servicing five states, over the same time period in patients who experienced ARI between their first VFSS and age 3 years. ARI was defined as either bronchiolitis, asthma, pneumonia, or aspiration pneumonia, and was identified via IDC-9 codes.

Out of 576 infants, 199 (34%) exhibited oropharyngeal aspiration, 79 (14%) showed penetration, and 298 (52%)were classified as “normal.” Of the 199 with aspiration, 38 (19%) had thin aspiration and cough, 11 (6%) had thick aspiration and cough, 93 (47%) had thin aspiration and were silent, and 57 (28%) had thick aspiration and were silent.

Those deemed “thick aspiration, silent,” however, averaged 581 days to ARI, the shortest of any cohort, and a mean of 2.39 ARIs per subject. “Thin aspiration, cough” subjects had 638 mean days to ARI and a mean of 1.63 ARIs; “thick aspiration, cough” subjects had a mean of 750 days to ARI and 0.55 mean number of ARIs; and “thin aspiration, silent” had an average of 669 days to ARI and a mean of 1.69 ARIs (P < .05).

Those in the normal, or control, cohort averaged 715 days to ARI and 1.36 ARIs, while those with just penetration averaged 681 days to ARIs and 1.53 ARIs per subject (P < .05).

Cox regression models were used to calculate data time to first ARI, and Poisson regression was used for data on total number of ARIs experienced. Taking into account subject’s age at initial test, presence of complex chronic conditions in each subject, result of VFSS and type of aspiration intervention, silent aspiration with thickened feed yielded a Cox hazard ratio of 1.30 and a Poisson hazard ratio of 1.47, higher than all the others.

“The clinical importance of [VFSS]-detected abnormalities remains unclear, making them high-risk for overdiagnosis,” concluded Dr. Coon, adding that “patients may not experience net benefit, but may in fact be harmed.”

Dr. Coon did not report any relevant financial disclosures.

[email protected]

SAN DIEGO– There is no clear clinical benefit to diagnosing and treating infants with abnormal swallowing, according to the results of a video fluoroscopic swallow study (VFSS), and in certain cases, the study could be associated with an increased risk of developing acute respiratory infections (ARI) in these populations.

In a retrospective cohort study, Dr. Eric R. Coon of the University of Utah, Salt Lake City, and his colleagues examined data on all infants aged 12 months or younger who underwent VFSS from 2010 to 2012 at Primary Children’s Hospital in Salt Lake City.

“Providers implicitly believe that infant swallowing abnormalities lead to future respiratory illness,” Dr. Coon said at the annual meeting of the Pediatric Academic Societies. “However, data for that link is limited to descriptive case series, and studies relying on subjective definitions of aspiration that don’t include radiographic confirmation [and] interventions for swallowing abnormalities have not been shown to improve important clinical outcomes.”

The investigators looked at all inpatient, outpatient, and emergency department ARI cases in the Intermountain Healthcare system, a network of 22 hospital centers servicing five states, over the same time period in patients who experienced ARI between their first VFSS and age 3 years. ARI was defined as either bronchiolitis, asthma, pneumonia, or aspiration pneumonia, and was identified via IDC-9 codes.

Out of 576 infants, 199 (34%) exhibited oropharyngeal aspiration, 79 (14%) showed penetration, and 298 (52%)were classified as “normal.” Of the 199 with aspiration, 38 (19%) had thin aspiration and cough, 11 (6%) had thick aspiration and cough, 93 (47%) had thin aspiration and were silent, and 57 (28%) had thick aspiration and were silent.

Those deemed “thick aspiration, silent,” however, averaged 581 days to ARI, the shortest of any cohort, and a mean of 2.39 ARIs per subject. “Thin aspiration, cough” subjects had 638 mean days to ARI and a mean of 1.63 ARIs; “thick aspiration, cough” subjects had a mean of 750 days to ARI and 0.55 mean number of ARIs; and “thin aspiration, silent” had an average of 669 days to ARI and a mean of 1.69 ARIs (P < .05).

Those in the normal, or control, cohort averaged 715 days to ARI and 1.36 ARIs, while those with just penetration averaged 681 days to ARIs and 1.53 ARIs per subject (P < .05).

Cox regression models were used to calculate data time to first ARI, and Poisson regression was used for data on total number of ARIs experienced. Taking into account subject’s age at initial test, presence of complex chronic conditions in each subject, result of VFSS and type of aspiration intervention, silent aspiration with thickened feed yielded a Cox hazard ratio of 1.30 and a Poisson hazard ratio of 1.47, higher than all the others.

“The clinical importance of [VFSS]-detected abnormalities remains unclear, making them high-risk for overdiagnosis,” concluded Dr. Coon, adding that “patients may not experience net benefit, but may in fact be harmed.”

Dr. Coon did not report any relevant financial disclosures.

[email protected]

SAN DIEGO – Neonatal intensive care units are famously spendthrift when it comes to antibiotic utilization, but a well-executed antibiotic stewardship strategy can safely reduce unnecessary prescribing – as demonstrated at the 90-bed, level-IIIC neonatal intensive care unit (NICU) at Parkland Memorial Hospital, Dallas.

Results of the Surveillance and Correction of Unnecessary Antibiotic Therapy (SCOUT) study showed that total antibiotic days of therapy (DOT) in the Parkland NICU dropped by 27% following implementation of an antibiotic stewardship program featuring hard stops built into the electronic medical record, Dr. Joseph B. Cantey reported at the annual meeting of the Pediatric Academic Societies.

This overall reduction in antibiotic utilization was accomplished through improvements in the three specific categories of NICU antibiotic use targeted for intervention in the SCOUT study: treatment courses of more than 48 hours for “rule-out sepsis” and treatment lasting longer than 5 days for pneumonia or “culture-negative sepsis.”

The proportion of antibiotic treatment courses for rule-out sepsis that were discontinued by 48 hours when cultures were sterile tripled from 32% to 95% between a 9-month baseline period and a second 9-month period after implementation of the antibiotic stewardship program. The proportion of courses of antibiotics for pneumonia that were limited to 5 days doubled from 36% to 72%. Similarly, there was a doubling in the proportion of treatment courses for “culture-negative sepsis” limited to 5 days, with the rate going from 31% to 62%, said Dr. Cantey, a pediatrics fellow in training at the University of Texas Southwestern Medical Center, Dallas.

During the 9-month baseline surveillance period, in which there were 1,607 patients in the NICU, the total antibiotic use was 343 DOT per 1,000 patient-days. During period two with the intervention in place, there were 895 NICU patients, and 251 DOT per 1,000 patient-days. The DOT, a commonly used measure in the field of infectious diseases, is determined by multiplying the number of doses by the dosing interval. DOTs in patients on multiple antibiotics are additive, he explained.

During the baseline observation period, 94% of all antibiotic use in the NICU was empiric therapy for suspected infection. More specifically, 63% of all antibiotic use was for rule-out sepsis. And while many of the courses of antibiotics given for this reason that exceeded the 48-hour limit during the baseline period did so by only one or two doses, those extra doses added up to 41 DOT per 1,000 patient-years, making this a worthy target for intervention. Together with treatment of pneumonia or “culture-negative sepsis” for longer than 5 days, these three high-yield targets accounted for 87% of all antibiotic use in the NICU during the baseline period, Dr. Cantey said.

The infants occupying the NICU during the two 9-month study periods were virtually identical in terms of their characteristics and reasons for admission.

Antibiotics are the most commonly prescribed medications in NICUs. Their use has been associated with adverse NICU outcomes, including increased risks of necrotizing enterocolitis, late-onset sepsis, and death in infants with birth weights below 1,500 g, as well as an increase in multidrug-resistant organisms, he noted.

In SCOUT, the composite outcome of necrotizing enterocolitis, late-onset sepsis, or death didn’t differ between the two study periods: 17.1% at baseline and 15.8% during the intervention period. Similarly, the incidence of colonization with multidrug-resistant organisms was 1.4% during the baseline period and not significantly different at 1% after implementation of the antibiotic stewardship program. Larger multicenter studies with pooled data will be required to determine whether antibiotic stewardship in NICUs affects neonatal outcomes, Dr. Cantey said.

He added that he and his coinvestigators are now trying to identify additional NICU scenarios in which antibiotics can safely be withheld. One likely candidate: asymptomatic preterm infants exposed to premature rupture of membranes. The investigators also hope to utilize the ongoing prospective surveillance element of Parkland’s NICU antibiotic stewardship program to identify the safe minimum treatment duration for common conditions such as urinary tract infections, sepsis, and necrotizing enterocolitis.

Audience members were effusive in their praise of the SCOUT study and the Parkland program. They wanted to hear more details about how the physician behavior change was accomplished. Dr. Cantey said that the three intervention targets were approved by the NICU medical director and the plan was disseminated to all the neonatologists, nurse practitioners, fellows, and residents. It was important to be able to assure everyone that outcomes would be prospectively monitored closely to ensure safety. The toughest task, he added, was to create the hard stops in the electronic medical record so that, for example, treatment for rule-out sepsis would automatically stop at 48 hours: skilled information technologists were essential.

The SCOUT study was supported by a Gerber Novice Researcher Award from the Gerber Foundation. Dr. Cantey reported having no financial conflicts.

[email protected]

SAN DIEGO – Neonatal intensive care units are famously spendthrift when it comes to antibiotic utilization, but a well-executed antibiotic stewardship strategy can safely reduce unnecessary prescribing – as demonstrated at the 90-bed, level-IIIC neonatal intensive care unit (NICU) at Parkland Memorial Hospital, Dallas.

Results of the Surveillance and Correction of Unnecessary Antibiotic Therapy (SCOUT) study showed that total antibiotic days of therapy (DOT) in the Parkland NICU dropped by 27% following implementation of an antibiotic stewardship program featuring hard stops built into the electronic medical record, Dr. Joseph B. Cantey reported at the annual meeting of the Pediatric Academic Societies.

This overall reduction in antibiotic utilization was accomplished through improvements in the three specific categories of NICU antibiotic use targeted for intervention in the SCOUT study: treatment courses of more than 48 hours for “rule-out sepsis” and treatment lasting longer than 5 days for pneumonia or “culture-negative sepsis.”

The proportion of antibiotic treatment courses for rule-out sepsis that were discontinued by 48 hours when cultures were sterile tripled from 32% to 95% between a 9-month baseline period and a second 9-month period after implementation of the antibiotic stewardship program. The proportion of courses of antibiotics for pneumonia that were limited to 5 days doubled from 36% to 72%. Similarly, there was a doubling in the proportion of treatment courses for “culture-negative sepsis” limited to 5 days, with the rate going from 31% to 62%, said Dr. Cantey, a pediatrics fellow in training at the University of Texas Southwestern Medical Center, Dallas.

During the 9-month baseline surveillance period, in which there were 1,607 patients in the NICU, the total antibiotic use was 343 DOT per 1,000 patient-days. During period two with the intervention in place, there were 895 NICU patients, and 251 DOT per 1,000 patient-days. The DOT, a commonly used measure in the field of infectious diseases, is determined by multiplying the number of doses by the dosing interval. DOTs in patients on multiple antibiotics are additive, he explained.

During the baseline observation period, 94% of all antibiotic use in the NICU was empiric therapy for suspected infection. More specifically, 63% of all antibiotic use was for rule-out sepsis. And while many of the courses of antibiotics given for this reason that exceeded the 48-hour limit during the baseline period did so by only one or two doses, those extra doses added up to 41 DOT per 1,000 patient-years, making this a worthy target for intervention. Together with treatment of pneumonia or “culture-negative sepsis” for longer than 5 days, these three high-yield targets accounted for 87% of all antibiotic use in the NICU during the baseline period, Dr. Cantey said.

The infants occupying the NICU during the two 9-month study periods were virtually identical in terms of their characteristics and reasons for admission.

Antibiotics are the most commonly prescribed medications in NICUs. Their use has been associated with adverse NICU outcomes, including increased risks of necrotizing enterocolitis, late-onset sepsis, and death in infants with birth weights below 1,500 g, as well as an increase in multidrug-resistant organisms, he noted.

In SCOUT, the composite outcome of necrotizing enterocolitis, late-onset sepsis, or death didn’t differ between the two study periods: 17.1% at baseline and 15.8% during the intervention period. Similarly, the incidence of colonization with multidrug-resistant organisms was 1.4% during the baseline period and not significantly different at 1% after implementation of the antibiotic stewardship program. Larger multicenter studies with pooled data will be required to determine whether antibiotic stewardship in NICUs affects neonatal outcomes, Dr. Cantey said.

He added that he and his coinvestigators are now trying to identify additional NICU scenarios in which antibiotics can safely be withheld. One likely candidate: asymptomatic preterm infants exposed to premature rupture of membranes. The investigators also hope to utilize the ongoing prospective surveillance element of Parkland’s NICU antibiotic stewardship program to identify the safe minimum treatment duration for common conditions such as urinary tract infections, sepsis, and necrotizing enterocolitis.

Audience members were effusive in their praise of the SCOUT study and the Parkland program. They wanted to hear more details about how the physician behavior change was accomplished. Dr. Cantey said that the three intervention targets were approved by the NICU medical director and the plan was disseminated to all the neonatologists, nurse practitioners, fellows, and residents. It was important to be able to assure everyone that outcomes would be prospectively monitored closely to ensure safety. The toughest task, he added, was to create the hard stops in the electronic medical record so that, for example, treatment for rule-out sepsis would automatically stop at 48 hours: skilled information technologists were essential.

The SCOUT study was supported by a Gerber Novice Researcher Award from the Gerber Foundation. Dr. Cantey reported having no financial conflicts.

[email protected]

SAN DIEGO – Neonatal intensive care units are famously spendthrift when it comes to antibiotic utilization, but a well-executed antibiotic stewardship strategy can safely reduce unnecessary prescribing – as demonstrated at the 90-bed, level-IIIC neonatal intensive care unit (NICU) at Parkland Memorial Hospital, Dallas.

Results of the Surveillance and Correction of Unnecessary Antibiotic Therapy (SCOUT) study showed that total antibiotic days of therapy (DOT) in the Parkland NICU dropped by 27% following implementation of an antibiotic stewardship program featuring hard stops built into the electronic medical record, Dr. Joseph B. Cantey reported at the annual meeting of the Pediatric Academic Societies.

This overall reduction in antibiotic utilization was accomplished through improvements in the three specific categories of NICU antibiotic use targeted for intervention in the SCOUT study: treatment courses of more than 48 hours for “rule-out sepsis” and treatment lasting longer than 5 days for pneumonia or “culture-negative sepsis.”

The proportion of antibiotic treatment courses for rule-out sepsis that were discontinued by 48 hours when cultures were sterile tripled from 32% to 95% between a 9-month baseline period and a second 9-month period after implementation of the antibiotic stewardship program. The proportion of courses of antibiotics for pneumonia that were limited to 5 days doubled from 36% to 72%. Similarly, there was a doubling in the proportion of treatment courses for “culture-negative sepsis” limited to 5 days, with the rate going from 31% to 62%, said Dr. Cantey, a pediatrics fellow in training at the University of Texas Southwestern Medical Center, Dallas.

During the 9-month baseline surveillance period, in which there were 1,607 patients in the NICU, the total antibiotic use was 343 DOT per 1,000 patient-days. During period two with the intervention in place, there were 895 NICU patients, and 251 DOT per 1,000 patient-days. The DOT, a commonly used measure in the field of infectious diseases, is determined by multiplying the number of doses by the dosing interval. DOTs in patients on multiple antibiotics are additive, he explained.

During the baseline observation period, 94% of all antibiotic use in the NICU was empiric therapy for suspected infection. More specifically, 63% of all antibiotic use was for rule-out sepsis. And while many of the courses of antibiotics given for this reason that exceeded the 48-hour limit during the baseline period did so by only one or two doses, those extra doses added up to 41 DOT per 1,000 patient-years, making this a worthy target for intervention. Together with treatment of pneumonia or “culture-negative sepsis” for longer than 5 days, these three high-yield targets accounted for 87% of all antibiotic use in the NICU during the baseline period, Dr. Cantey said.

The infants occupying the NICU during the two 9-month study periods were virtually identical in terms of their characteristics and reasons for admission.

Antibiotics are the most commonly prescribed medications in NICUs. Their use has been associated with adverse NICU outcomes, including increased risks of necrotizing enterocolitis, late-onset sepsis, and death in infants with birth weights below 1,500 g, as well as an increase in multidrug-resistant organisms, he noted.

In SCOUT, the composite outcome of necrotizing enterocolitis, late-onset sepsis, or death didn’t differ between the two study periods: 17.1% at baseline and 15.8% during the intervention period. Similarly, the incidence of colonization with multidrug-resistant organisms was 1.4% during the baseline period and not significantly different at 1% after implementation of the antibiotic stewardship program. Larger multicenter studies with pooled data will be required to determine whether antibiotic stewardship in NICUs affects neonatal outcomes, Dr. Cantey said.

He added that he and his coinvestigators are now trying to identify additional NICU scenarios in which antibiotics can safely be withheld. One likely candidate: asymptomatic preterm infants exposed to premature rupture of membranes. The investigators also hope to utilize the ongoing prospective surveillance element of Parkland’s NICU antibiotic stewardship program to identify the safe minimum treatment duration for common conditions such as urinary tract infections, sepsis, and necrotizing enterocolitis.

Audience members were effusive in their praise of the SCOUT study and the Parkland program. They wanted to hear more details about how the physician behavior change was accomplished. Dr. Cantey said that the three intervention targets were approved by the NICU medical director and the plan was disseminated to all the neonatologists, nurse practitioners, fellows, and residents. It was important to be able to assure everyone that outcomes would be prospectively monitored closely to ensure safety. The toughest task, he added, was to create the hard stops in the electronic medical record so that, for example, treatment for rule-out sepsis would automatically stop at 48 hours: skilled information technologists were essential.

The SCOUT study was supported by a Gerber Novice Researcher Award from the Gerber Foundation. Dr. Cantey reported having no financial conflicts.

[email protected]

SAN DIEGO– Children exposed to antibiotics are at a significantly heightened risk to develop extended-spectrum cephalosporin-resistant (ESC-R) and carbapenem-resistant (CR) Enterobacteriaceae infections within 30 days of said exposure, according to a prospective, case-controlled study.

Dr. Matthew P. Kronman, a pediatric infectious disease specialist at Seattle Children’s Hospital, and several coinvestigators examined data on 1,263 children from four hospital centers in the United States – Seattle Children’s Hospital; Washington University, St. Louis; Children’s Mercy Hospital, Kansas City, Mo.; and Children’s Hospital of Philadelphia – from Oct. 1, 2009, through Sept. 30, 2013.

“The CDC [Centers for Disease Control and Prevention] estimates that 2 million Americans get multidrug resistant organism [MDRO] infections each year, and 23,000 die,” said Dr. Kronman, adding that while it’s known that prior exposure to antibiotics is a key risk factor for colonization and development of an infection in adults, similar data among children with respect to ampC and extended-spectrum beta-lactamase (ESBL) are conflicting.

The study population included 95 subjects with ampC infections, 213 with ESBL infections, and 955 controls, for a total of 1,263 children. Prior exposure to antibiotics within the previous month or 3 months before infection was associated with infection of either ESC-R or CR Enterobacteriaceae (P < .01). A cumulative effect was noted, with increased exposure to antibiotics increasing the likelihood of developing an MDRO infection within 3 months (odds ratio 1.28 per month, P < .01), Dr. Kronman reported at the annual meeting of the Pediatric Academic Societies.

Those with ESBL infections were more likely to have any antibiotic exposure in the 30 days prior to their infection than were their control counterparts (OR > 2), but a similar, statistically significant relationship among those with ampC infections was not observed. When the researchers looked at broad-spectrum antibiotic exposures – defined as “carbapenems, beta-lactams, beta-lactase inhibitors, tetracyclines, and so on” – those with ESBL infections were more likely to have broad-spectrum antibiotic exposures in the month prior to their infection, which was not the case for those with ampC infections.

Both ESBL and ampC subjects were more likely to have been exposed to extended-spectrum cephalosporin use in the month prior to infection than controls. “When we looked just the use of antibiotics with anaerobic activity only, neither ESBL nor ampC infections were more likely than their control counterparts to have had exposure to anaerobic antibiotics in the month prior to infection,” Dr. Kronman said.

Patients had Escherichia coli and Klebsiella pneumoniae isolates collected from normally sterile sites; 91% were isolated from urine, and 46% were found to be associated with “community onset infection.” Samples were phenotypically resistant to extended spectrum cephalosporins, but were genotyped at Seattle Children’s Hospital to determine if the resistant strain was ampC or an ESBL. E. coli cases dominated the study population (85%), compared with cases of K. pneumoniae (15%). Results were adjusted for age, gender, prior hospitalization, underlying medical conditions, immunosuppression, and presence of indwelling devices. Median age of subjects was 5 years.

Those with resistant infections were more likely to have a “significant past medical history” of urologic conditions or malignancies; to have had hospitalization within the previous year; to be on immunosuppression at the time of the infection; or to have an indwelling device at the time of the infection. Resistant infections were less likely to originate in the community and were more commonly health care associated.

Dr. Kronman did not report any relevant financial disclosures.

[email protected]

SAN DIEGO– Children exposed to antibiotics are at a significantly heightened risk to develop extended-spectrum cephalosporin-resistant (ESC-R) and carbapenem-resistant (CR) Enterobacteriaceae infections within 30 days of said exposure, according to a prospective, case-controlled study.

Dr. Matthew P. Kronman, a pediatric infectious disease specialist at Seattle Children’s Hospital, and several coinvestigators examined data on 1,263 children from four hospital centers in the United States – Seattle Children’s Hospital; Washington University, St. Louis; Children’s Mercy Hospital, Kansas City, Mo.; and Children’s Hospital of Philadelphia – from Oct. 1, 2009, through Sept. 30, 2013.

“The CDC [Centers for Disease Control and Prevention] estimates that 2 million Americans get multidrug resistant organism [MDRO] infections each year, and 23,000 die,” said Dr. Kronman, adding that while it’s known that prior exposure to antibiotics is a key risk factor for colonization and development of an infection in adults, similar data among children with respect to ampC and extended-spectrum beta-lactamase (ESBL) are conflicting.

The study population included 95 subjects with ampC infections, 213 with ESBL infections, and 955 controls, for a total of 1,263 children. Prior exposure to antibiotics within the previous month or 3 months before infection was associated with infection of either ESC-R or CR Enterobacteriaceae (P < .01). A cumulative effect was noted, with increased exposure to antibiotics increasing the likelihood of developing an MDRO infection within 3 months (odds ratio 1.28 per month, P < .01), Dr. Kronman reported at the annual meeting of the Pediatric Academic Societies.

Those with ESBL infections were more likely to have any antibiotic exposure in the 30 days prior to their infection than were their control counterparts (OR > 2), but a similar, statistically significant relationship among those with ampC infections was not observed. When the researchers looked at broad-spectrum antibiotic exposures – defined as “carbapenems, beta-lactams, beta-lactase inhibitors, tetracyclines, and so on” – those with ESBL infections were more likely to have broad-spectrum antibiotic exposures in the month prior to their infection, which was not the case for those with ampC infections.

Both ESBL and ampC subjects were more likely to have been exposed to extended-spectrum cephalosporin use in the month prior to infection than controls. “When we looked just the use of antibiotics with anaerobic activity only, neither ESBL nor ampC infections were more likely than their control counterparts to have had exposure to anaerobic antibiotics in the month prior to infection,” Dr. Kronman said.

Patients had Escherichia coli and Klebsiella pneumoniae isolates collected from normally sterile sites; 91% were isolated from urine, and 46% were found to be associated with “community onset infection.” Samples were phenotypically resistant to extended spectrum cephalosporins, but were genotyped at Seattle Children’s Hospital to determine if the resistant strain was ampC or an ESBL. E. coli cases dominated the study population (85%), compared with cases of K. pneumoniae (15%). Results were adjusted for age, gender, prior hospitalization, underlying medical conditions, immunosuppression, and presence of indwelling devices. Median age of subjects was 5 years.

Those with resistant infections were more likely to have a “significant past medical history” of urologic conditions or malignancies; to have had hospitalization within the previous year; to be on immunosuppression at the time of the infection; or to have an indwelling device at the time of the infection. Resistant infections were less likely to originate in the community and were more commonly health care associated.

Dr. Kronman did not report any relevant financial disclosures.

[email protected]

SAN DIEGO– Children exposed to antibiotics are at a significantly heightened risk to develop extended-spectrum cephalosporin-resistant (ESC-R) and carbapenem-resistant (CR) Enterobacteriaceae infections within 30 days of said exposure, according to a prospective, case-controlled study.

Dr. Matthew P. Kronman, a pediatric infectious disease specialist at Seattle Children’s Hospital, and several coinvestigators examined data on 1,263 children from four hospital centers in the United States – Seattle Children’s Hospital; Washington University, St. Louis; Children’s Mercy Hospital, Kansas City, Mo.; and Children’s Hospital of Philadelphia – from Oct. 1, 2009, through Sept. 30, 2013.

“The CDC [Centers for Disease Control and Prevention] estimates that 2 million Americans get multidrug resistant organism [MDRO] infections each year, and 23,000 die,” said Dr. Kronman, adding that while it’s known that prior exposure to antibiotics is a key risk factor for colonization and development of an infection in adults, similar data among children with respect to ampC and extended-spectrum beta-lactamase (ESBL) are conflicting.

The study population included 95 subjects with ampC infections, 213 with ESBL infections, and 955 controls, for a total of 1,263 children. Prior exposure to antibiotics within the previous month or 3 months before infection was associated with infection of either ESC-R or CR Enterobacteriaceae (P < .01). A cumulative effect was noted, with increased exposure to antibiotics increasing the likelihood of developing an MDRO infection within 3 months (odds ratio 1.28 per month, P < .01), Dr. Kronman reported at the annual meeting of the Pediatric Academic Societies.

Those with ESBL infections were more likely to have any antibiotic exposure in the 30 days prior to their infection than were their control counterparts (OR > 2), but a similar, statistically significant relationship among those with ampC infections was not observed. When the researchers looked at broad-spectrum antibiotic exposures – defined as “carbapenems, beta-lactams, beta-lactase inhibitors, tetracyclines, and so on” – those with ESBL infections were more likely to have broad-spectrum antibiotic exposures in the month prior to their infection, which was not the case for those with ampC infections.

Both ESBL and ampC subjects were more likely to have been exposed to extended-spectrum cephalosporin use in the month prior to infection than controls. “When we looked just the use of antibiotics with anaerobic activity only, neither ESBL nor ampC infections were more likely than their control counterparts to have had exposure to anaerobic antibiotics in the month prior to infection,” Dr. Kronman said.

Patients had Escherichia coli and Klebsiella pneumoniae isolates collected from normally sterile sites; 91% were isolated from urine, and 46% were found to be associated with “community onset infection.” Samples were phenotypically resistant to extended spectrum cephalosporins, but were genotyped at Seattle Children’s Hospital to determine if the resistant strain was ampC or an ESBL. E. coli cases dominated the study population (85%), compared with cases of K. pneumoniae (15%). Results were adjusted for age, gender, prior hospitalization, underlying medical conditions, immunosuppression, and presence of indwelling devices. Median age of subjects was 5 years.

Those with resistant infections were more likely to have a “significant past medical history” of urologic conditions or malignancies; to have had hospitalization within the previous year; to be on immunosuppression at the time of the infection; or to have an indwelling device at the time of the infection. Resistant infections were less likely to originate in the community and were more commonly health care associated.

Dr. Kronman did not report any relevant financial disclosures.

[email protected]

ASHEVILLE, N.C. – “Children really do develop contact dermatitis, and they are frequently mislabeled as cases of eczema,” Dr. Bruce Brod said at the annual meeting of the Noah Worcester Dermatological Society.

When taking a history in a child with potential contact dermatitis, keep the most likely allergens in mind, especially nickel, said Dr. Brod of the University of Pennsylvania, Philadelphia. Nickel remains the most common allergen in adults and young children, and more than a quarter of patients are positive on patch testing.

Consider all possible sources of nickel. In addition to the old standbys of jewelry and buckles, ask patients and families about the use of flip-style cell phones, as well as first generation iPads (the cases contained nickel). “Old cell phones do not make great toys,” Dr. Brod emphasized.

Patch testing children with potential contact dermatitis makes sense in several situations, including cases of new-onset dermatitis; progressing or deteriorating dermatitis; involvement of specific body sites, such as the face, eyelids, or neck folds; an increase in the total body surface area affected; clinical presentation of dyshidrosis; and dermatitis that resists standard therapies and only improves with oral or extremely potent topical steroids, he said.

Children with atopic dermatitis are more prone to irritation from patch testing, so shorten the exposure time and use a lower concentration of allergens such as nickel, formaldehyde, and rubber additives, advised Dr. Brod. Shorten the exposure time for children younger than 5 years of age, whether or not they have atopy, he added. Videos or video games can work well as a distraction.

When taking a history, consider the most the common allergens in children, defined in a recent study of patch testing results (Dermatitis 2014;25:345-55), said Dr. Brod. He offered the mnemonic MAFLPP (More Allergies for Lovable Pediatric Patients) to characterize the top categories: metals (nickel and cobalt), antibiotics (neomycin and bacitracin), fragrance (fragrances and balsam of Peru), lanolin, phenylenediamine, and preservatives (including quatemium-15 and methylisothiazolinone).

After patch testing, describe the allergen to patients and their families, and explain where it is found, Dr. Brod said. The site mypatchlink.com has helpful information. Also remind patients to read product labels, and to check pharmacy websites such as drugstore.com or cvs.com.

Members of the American Contact Dermatitis Society can access the Contact Allergen Management Program (CAMP) database to help patients identify allergen-free products based on their patch test results, he said.

Dr. Brod had no relevant financial conflicts to disclose.

[email protected]

ASHEVILLE, N.C. – “Children really do develop contact dermatitis, and they are frequently mislabeled as cases of eczema,” Dr. Bruce Brod said at the annual meeting of the Noah Worcester Dermatological Society.

When taking a history in a child with potential contact dermatitis, keep the most likely allergens in mind, especially nickel, said Dr. Brod of the University of Pennsylvania, Philadelphia. Nickel remains the most common allergen in adults and young children, and more than a quarter of patients are positive on patch testing.

Consider all possible sources of nickel. In addition to the old standbys of jewelry and buckles, ask patients and families about the use of flip-style cell phones, as well as first generation iPads (the cases contained nickel). “Old cell phones do not make great toys,” Dr. Brod emphasized.

Patch testing children with potential contact dermatitis makes sense in several situations, including cases of new-onset dermatitis; progressing or deteriorating dermatitis; involvement of specific body sites, such as the face, eyelids, or neck folds; an increase in the total body surface area affected; clinical presentation of dyshidrosis; and dermatitis that resists standard therapies and only improves with oral or extremely potent topical steroids, he said.

Children with atopic dermatitis are more prone to irritation from patch testing, so shorten the exposure time and use a lower concentration of allergens such as nickel, formaldehyde, and rubber additives, advised Dr. Brod. Shorten the exposure time for children younger than 5 years of age, whether or not they have atopy, he added. Videos or video games can work well as a distraction.

When taking a history, consider the most the common allergens in children, defined in a recent study of patch testing results (Dermatitis 2014;25:345-55), said Dr. Brod. He offered the mnemonic MAFLPP (More Allergies for Lovable Pediatric Patients) to characterize the top categories: metals (nickel and cobalt), antibiotics (neomycin and bacitracin), fragrance (fragrances and balsam of Peru), lanolin, phenylenediamine, and preservatives (including quatemium-15 and methylisothiazolinone).

After patch testing, describe the allergen to patients and their families, and explain where it is found, Dr. Brod said. The site mypatchlink.com has helpful information. Also remind patients to read product labels, and to check pharmacy websites such as drugstore.com or cvs.com.

Members of the American Contact Dermatitis Society can access the Contact Allergen Management Program (CAMP) database to help patients identify allergen-free products based on their patch test results, he said.

Dr. Brod had no relevant financial conflicts to disclose.

[email protected]

ASHEVILLE, N.C. – “Children really do develop contact dermatitis, and they are frequently mislabeled as cases of eczema,” Dr. Bruce Brod said at the annual meeting of the Noah Worcester Dermatological Society.

When taking a history in a child with potential contact dermatitis, keep the most likely allergens in mind, especially nickel, said Dr. Brod of the University of Pennsylvania, Philadelphia. Nickel remains the most common allergen in adults and young children, and more than a quarter of patients are positive on patch testing.

Consider all possible sources of nickel. In addition to the old standbys of jewelry and buckles, ask patients and families about the use of flip-style cell phones, as well as first generation iPads (the cases contained nickel). “Old cell phones do not make great toys,” Dr. Brod emphasized.

Patch testing children with potential contact dermatitis makes sense in several situations, including cases of new-onset dermatitis; progressing or deteriorating dermatitis; involvement of specific body sites, such as the face, eyelids, or neck folds; an increase in the total body surface area affected; clinical presentation of dyshidrosis; and dermatitis that resists standard therapies and only improves with oral or extremely potent topical steroids, he said.

Children with atopic dermatitis are more prone to irritation from patch testing, so shorten the exposure time and use a lower concentration of allergens such as nickel, formaldehyde, and rubber additives, advised Dr. Brod. Shorten the exposure time for children younger than 5 years of age, whether or not they have atopy, he added. Videos or video games can work well as a distraction.

When taking a history, consider the most the common allergens in children, defined in a recent study of patch testing results (Dermatitis 2014;25:345-55), said Dr. Brod. He offered the mnemonic MAFLPP (More Allergies for Lovable Pediatric Patients) to characterize the top categories: metals (nickel and cobalt), antibiotics (neomycin and bacitracin), fragrance (fragrances and balsam of Peru), lanolin, phenylenediamine, and preservatives (including quatemium-15 and methylisothiazolinone).

After patch testing, describe the allergen to patients and their families, and explain where it is found, Dr. Brod said. The site mypatchlink.com has helpful information. Also remind patients to read product labels, and to check pharmacy websites such as drugstore.com or cvs.com.

Members of the American Contact Dermatitis Society can access the Contact Allergen Management Program (CAMP) database to help patients identify allergen-free products based on their patch test results, he said.

Dr. Brod had no relevant financial conflicts to disclose.

[email protected]

SAN DIEGO – The proportion of children with asthma receiving the influenza vaccine has continued to increase in the past decade or so, though not as quickly as for children without asthma, results from national survey data found.

While the influenza vaccine is recommended for all children aged 6 months and older, trends in influenza vaccination for early (August-October) versus late (November-May) vaccination in children with asthma have not been examined, lead study author Dr. Alan E. Simon said during a poster session at the annual meeting of the Pediatric Academic Societies.

Doug Brunk/Frontline Medical News

Dr. Simon, a medical officer with the office of analysis and epidemiology at the National Center for Health Statistics, Hyattsville, Md., and his associates evaluated National Health Interview Survey (NHIS) sample child files for 2005-2013. They limited the analysis to children aged 2-17 years and defined current asthma as a “yes” response to two questions: “Has your doctor ever told you that your child has asthma?” and “Does your child still have asthma?” A total of 31,668 NHIS interviews conducted between April and July 2005-2013 were assessed for vaccine receipt between August and May of the previous flu season. The researchers conducted logistic regression with predictive margins with receipt of flu shot as the dependent variable, and year, current asthma, and the interaction between year and asthma as dependent variables.

Dr. Simon reported that the percentage of children with asthma who received a flu shot increased an average of 3.2 percentage points per year during the time period, reaching 55% in 2012-2013. At the same time, the percentage of children without asthma who received a flu shot increased an average of 4.2 percentage points per year, reaching 45% in 2012-2013. Meanwhile, the percentage of children in both groups who received early vaccination increased about 1.5% per year, reaching 32% in children with asthma and 27% among children without asthma in 2012-2013.

The researchers also found that over the last three flu seasons, the following characteristics were predictive of children with asthma having a longer time to vaccination or a lower probability of vaccination: being aged 12-17 years vs. 2-5 years (adjusted hazard ratio of 0.75; P less than .01); being uninsured vs. privately insured (aHR 0.52; P less than .01), and living in the South or the West vs. the Northeast (aHR 0.79; P less than .05).

Dr. Simon said that similar overall results were observed when he and his associates conducted a separate analysis that assessed 85,087 NHIS interviews from 2005 to 2013 and used Kaplan-Meier survival statistics to estimate yearly vaccination estimates and early vaccination estimates.

The study was funded by the Centers for Disease Control and Prevention. Dr. Simon reported having no relevant financial conflicts.

[email protected]

On Twitter @dougbrunk

SAN DIEGO – The proportion of children with asthma receiving the influenza vaccine has continued to increase in the past decade or so, though not as quickly as for children without asthma, results from national survey data found.

While the influenza vaccine is recommended for all children aged 6 months and older, trends in influenza vaccination for early (August-October) versus late (November-May) vaccination in children with asthma have not been examined, lead study author Dr. Alan E. Simon said during a poster session at the annual meeting of the Pediatric Academic Societies.

Doug Brunk/Frontline Medical News

Dr. Simon, a medical officer with the office of analysis and epidemiology at the National Center for Health Statistics, Hyattsville, Md., and his associates evaluated National Health Interview Survey (NHIS) sample child files for 2005-2013. They limited the analysis to children aged 2-17 years and defined current asthma as a “yes” response to two questions: “Has your doctor ever told you that your child has asthma?” and “Does your child still have asthma?” A total of 31,668 NHIS interviews conducted between April and July 2005-2013 were assessed for vaccine receipt between August and May of the previous flu season. The researchers conducted logistic regression with predictive margins with receipt of flu shot as the dependent variable, and year, current asthma, and the interaction between year and asthma as dependent variables.

Dr. Simon reported that the percentage of children with asthma who received a flu shot increased an average of 3.2 percentage points per year during the time period, reaching 55% in 2012-2013. At the same time, the percentage of children without asthma who received a flu shot increased an average of 4.2 percentage points per year, reaching 45% in 2012-2013. Meanwhile, the percentage of children in both groups who received early vaccination increased about 1.5% per year, reaching 32% in children with asthma and 27% among children without asthma in 2012-2013.

The researchers also found that over the last three flu seasons, the following characteristics were predictive of children with asthma having a longer time to vaccination or a lower probability of vaccination: being aged 12-17 years vs. 2-5 years (adjusted hazard ratio of 0.75; P less than .01); being uninsured vs. privately insured (aHR 0.52; P less than .01), and living in the South or the West vs. the Northeast (aHR 0.79; P less than .05).

Dr. Simon said that similar overall results were observed when he and his associates conducted a separate analysis that assessed 85,087 NHIS interviews from 2005 to 2013 and used Kaplan-Meier survival statistics to estimate yearly vaccination estimates and early vaccination estimates.

The study was funded by the Centers for Disease Control and Prevention. Dr. Simon reported having no relevant financial conflicts.

[email protected]

On Twitter @dougbrunk

SAN DIEGO – The proportion of children with asthma receiving the influenza vaccine has continued to increase in the past decade or so, though not as quickly as for children without asthma, results from national survey data found.

While the influenza vaccine is recommended for all children aged 6 months and older, trends in influenza vaccination for early (August-October) versus late (November-May) vaccination in children with asthma have not been examined, lead study author Dr. Alan E. Simon said during a poster session at the annual meeting of the Pediatric Academic Societies.

Doug Brunk/Frontline Medical News

Dr. Simon, a medical officer with the office of analysis and epidemiology at the National Center for Health Statistics, Hyattsville, Md., and his associates evaluated National Health Interview Survey (NHIS) sample child files for 2005-2013. They limited the analysis to children aged 2-17 years and defined current asthma as a “yes” response to two questions: “Has your doctor ever told you that your child has asthma?” and “Does your child still have asthma?” A total of 31,668 NHIS interviews conducted between April and July 2005-2013 were assessed for vaccine receipt between August and May of the previous flu season. The researchers conducted logistic regression with predictive margins with receipt of flu shot as the dependent variable, and year, current asthma, and the interaction between year and asthma as dependent variables.

Dr. Simon reported that the percentage of children with asthma who received a flu shot increased an average of 3.2 percentage points per year during the time period, reaching 55% in 2012-2013. At the same time, the percentage of children without asthma who received a flu shot increased an average of 4.2 percentage points per year, reaching 45% in 2012-2013. Meanwhile, the percentage of children in both groups who received early vaccination increased about 1.5% per year, reaching 32% in children with asthma and 27% among children without asthma in 2012-2013.

The researchers also found that over the last three flu seasons, the following characteristics were predictive of children with asthma having a longer time to vaccination or a lower probability of vaccination: being aged 12-17 years vs. 2-5 years (adjusted hazard ratio of 0.75; P less than .01); being uninsured vs. privately insured (aHR 0.52; P less than .01), and living in the South or the West vs. the Northeast (aHR 0.79; P less than .05).

Dr. Simon said that similar overall results were observed when he and his associates conducted a separate analysis that assessed 85,087 NHIS interviews from 2005 to 2013 and used Kaplan-Meier survival statistics to estimate yearly vaccination estimates and early vaccination estimates.

The study was funded by the Centers for Disease Control and Prevention. Dr. Simon reported having no relevant financial conflicts.

[email protected]

On Twitter @dougbrunk