ABSTRACT
OBJECTIVES: To evaluate whether the implementation of a multiplex gastrointestinal pathogen panel (GIP) was associated with changes in Clostridioides difficile (C difficile) testing and detection rates. STUDY DESIGN: We conducted an observational study using interrupted time series analysis and included pediatric patients with testing capable of detecting C difficile. From 2013 to 2015 ("conventional diagnostic era"), stool testing included C difficile-selective polymerase chain reaction and other pathogen-specific tests. From 2015 to 2017 ("GIP era"), C difficile polymerase chain reaction was available along with the GIP, which detected 22 pathogens including C difficile, and replaced the need for additional tests. Outcomes included C difficile testing and detection rates in ambulatory, emergency department, and inpatient settings. RESULTS: There were 6841 tests performed and 1214 C difficile positive results. Across the 3 settings, GIP era had significantly higher C difficile testing (1.7-2.3 times higher) and C difficile detection rates (1.9-3.4 times higher) compared with conventional diagnostic era. After adjusting for the number of tests performed, detection rates were no longer significantly different. Of C difficile positive GIPs, 31% were coinfected with another organism. With GIP testing, patients 1 year of age had a significantly higher C difficile percent positivity than 2-year-old (P = .02) and 3- to 18-year-old children (P < .01). Younger children with C difficile were more likely to be coinfected (P < .01). CONCLUSIONS: Introducing a multiplex panel led to increased C difficile testing, which resulted in increased C difficile detection rates and potential identification and treatment of colonized patients. This highlights an important target for diagnostic stewardship and the challenges associated with multiplex testing.
Subject(s)
Clostridioides difficile/isolation & purification , Diarrhea/microbiology , Feces/microbiology , Gastrointestinal Diseases/diagnosis , Gastrointestinal Diseases/microbiology , Adolescent , Child , Child, Preschool , Clostridioides difficile/classification , Diarrhea/diagnosis , Female , Humans , Incidence , Male , Multiplex Polymerase Chain Reaction , Polymerase Chain Reaction , PrevalenceSubject(s)
Hospitals, Pediatric/standards , Hospitals, Teaching/organization & administration , Internship and Residency/organization & administration , Pediatrics/education , Quality Improvement/organization & administration , Clinical Competence , Colorado , Humans , Pediatrics/organization & administration , Program Development , Program EvaluationABSTRACT
BACKGROUND: Acute bacterial meningitis (ABM) remains a significant cause of pediatric illness and death in low and middle income countries. Identifying severity risk factors and predictive scores may guide interventions to reduce poor outcomes. METHODS: Data from a prospective surveillance study for ABM in children aged 0-59 months admitted to 3 referral hospitals in Guatemala City from 2000 to 2007 were analyzed. ABM was defined as positive cerebrospinal fluid (CSF) culture, positive latex agglutination or CSF white blood cell greater than 100 cells/mL. Univariate and multivariate analyses of risk factors at hospital admission that predicted major morbidity or death during hospitalization were performed, along with validation of the predictive Herson-Todd score (HTS). RESULTS: Of 809 children with ABM episodes, 221 (27.3%) survived with major morbidity and 192 (23.7%) died. Among 383 children with nonmissing data, the most significant multivariate predictors for death or major morbidity were seizure [odds ratio (OR), 101.5; P < 0.001], CSF glucose less than 20 mg/dL (OR, 5.3; P = 0.0004), symptom duration more than 3 days (OR, 3.7; P = 0.003) and coma (OR, 6.3; P = 0.004). Of 221 children with a HTS greater than 5, 204 (92%) died or suffered major morbidity (OR, 10.3; P < 0.0001). CONCLUSION: ABM is a cause of considerable morbidity and mortality in Guatemala. Several clinical risk factors and the composite HTS predicted death or major morbidity. These predictors could help clinicians in low and middle income country guide medical care for ABM and could contribute to the public health impact assessment in preventing meningitis with vaccines.
Subject(s)
Meningitis, Bacterial/epidemiology , Meningitis, Bacterial/mortality , Child, Preschool , Cities , Female , Guatemala/epidemiology , Hospitals , Humans , Infant , Infant, Newborn , Male , Prospective Studies , Risk Factors , Survival AnalysisABSTRACT
OBJECTIVE: To investigate whether children in Michigan with private insurance have better hospitalization-related outcomes than those with public or no insurance. STUDY DESIGN: Population-based hospitalization rates were calculated for newborns and children aged <18 years in Michigan for the years 2001-2006 and stratified by age, disease grouping, and health insurance status using inpatient records from the Michigan Inpatient Database and population estimates from the US Census Current Population Survey. RESULTS: Michigan children with public/no insurance had significantly higher overall hospital admission rates and admission rates for ambulatory-sensitive conditions, and were more likely to be admitted through the emergency room, compared with those with private health insurance. Similarly, newborns with public/no insurance had significantly higher rates of hospitalization-related outcomes. Hospital charges per child were higher in the public/no insurance population, translating to potential excess charges of between $309.8 and $401.8 million in 2006. CONCLUSIONS: There are disparities in health outcomes and charges between Michigan children and newborns with public/no insurance and those with private health insurance, presenting a significant opportunity to improve the efficiency and efficacy of care.