bluuebunny/crossref_metadata_2025_split huggingface dataset:
Utilizing Pharmacy Records to Assess Antibiotic Prescribing Patterns on the Incidence of Community-Acquired Methicillin-Resistant Staphylococcus aureus Infections in Children
Authors: Johnson Peter N. , Rapp Robert P. , Nelson Christopher T. , Butler J.S. , Overman Sue , Kuhn Robert J. 
Published: October 2020

OBJECTIVE To assess the effect of prior antibiotic therapy on the incidence of community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) infections in children.METHODS This was a concurrent and retrospective review of antibiotic records for children &lt; 18 years of age with documented CA-MRSA infection identified between January 1, 2004, and December 31, 2005. Antibiotic records were compared against a control group. The primary outcome was the incidence of CA-MRSA using linear regression as a function of age and prior antibiotic therapy (i.e., 3 months prior to admission). Secondary objectives included a comparison of antibiotic courses and classes and a description of antibiotic susceptibilities in patients with CA-MRSARESULTS Data from 26 patients were included. Nine out of 51 patients (18%) with CA-MRSA were included. Another 17 children were enrolled in the control group. The median age was approximately 1.75 years (0.08–14 years) in the CA-MRSA group versus 2.75 years (0.005-15 years) in the control group. A statistical difference was noted in the number of patients with prior antibiotic exposure between the CA-MRSA and control group, 8 (88.9%) versus 6 (35.3%), respectively (P = .01). Antibiotic exposure was found to be a significant independent risk factor (P = .005; 95% CI, 0.167–0.846) for the development of CA-MRSA. The interaction between antibiotic exposure and age &lt; 3 was the most significant predictor of CA-MRSA (P = .019; 95% CI, 0.139–1.40).CONCLUSIONS Prior antibiotic therapy in patients &lt; 3 years of age was associated with a significant risk of developing CA-MRSA. A comprehensive assessment of CA-MRSA patients should include objective methods of measuring prior antibiotic exposure such as pharmacy records.
Physical Compatibility of Ibuprofen Lysine Injection with Selected Drugs During Simulated Y-site Injection
Authors: Holt Robert J. , Siegert Scott W.K. , Krishna Aravind 
Published: October 2020

PURPOSE To study the physical compatibility of ibuprofen lysine injection (NeoProfen, Ovation Pharmaceuticals Inc., Deerfield, IL) with medications commonly used in the premature neonatal population during simulated Y-site administration.
MATERIALS AND METHODS Commonly used intravenous medications in preterm infants were evaluated for physical compatibility with ibuprofen lysine injection. A 20-mL sample of ibuprofen lysine drug product solution was mixed with a 20-mL sample of each of the 34 medications at concentrations used clinically. The mixtures were stored at room temperature and each sample was evaluated for turbidity and physical appearance at time 0 (immediately after preparation) and at 4 hours after preparation.
RESULTS The following drugs were deemed compatible with ibuprofen lysine: ceftazidime, epinephrine, furosemide, heparin lock flush, diluted insulin, morphine sulfate, phenobarbital, potassium chloride, and sodium bicarbonate. Diluted dopamine was initially compatible at time 0 but showed a small precipitate at the 4-hour time point.
CONCLUSION Of the 37 drug solutions tested, 14 preparations (10 medications; several with more than one diluent) showed physical compatibility with ibuprofen lysine, 1 was compatible at time 0 and incompatible at 4 hours, and 1 could not be evaluated. The remaining preparations were considered to be incompatible.
Community-Associated Methicillin-Resistant Staphylococcus aureus in the Pediatric Population
Authors: Nemerovski Carrie W. , Klein Kristin C. 
Published: October 2020

PURPOSE To review the epidemiology and prevalence of community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA), define the differences between community-acquired and hospital-acquired strains, highlight the advantages and disadvantages of antibiotics commonly used to treat infections caused by this pathogen, and identify strategies to limit the spread of this organism and prevent future outbreaks.
DATA Literature was accessed through MEDLINE using the search terms community-acquired methicillin-resistant Staphylococcus aureus, community-associated methicillin-resistant Staphylococcus aureus, CA-MRSA, pediatrics, and children. Articles evaluated were published in the English language and limited to human studies. References of literature identified by initial search techniques were reviewed for additional relevant articles.
DATA SYNTHESIS Community-associated methicillin-resistant Staphylococcus aureus has become a prominent pathogen in pediatric patients in the last ten years. Its increasing prevalence has been reported throughout the United States, and it is the cause of over one half of all skin and soft tissue infections seen in many hospitals and emergency departments. The risk factors for infection with this pathogen differ from those associated with hospital-acquired strains. Mild to moderate infections can generally be treated with oral antibiotics, while more serious infections may require parenteral therapy. Sulfamethoxazole/trimethoprim and clindamycin are the preferred oral agents due to their efficacy, tolerability, well established side effect profiles, and cost. Vancomycin is the standard of care for parenteral therapy, although clindamycin is an acceptable parenteral alternative. More costly agents such as linezolid, daptomycin, and quinupristin/dalfopristin should be reserved for patients with severe infections, multiple allergies, or in strains with unusual resistance patterns. The best way to prevent and control outbreaks is to maintain standard infection control procedures including excellent hand hygiene.
CONCLUSIONS CA-MRSA is a serious and frequently seen pathogen. Proper antibiotic selection that takes into account patient factors, disease severity, ease of administration, and cost is necessary to maximize favorable patient outcomes.
Impact of a Prescription Review Program on the Accuracy and Safety of Discharge Prescriptions in a Pediatric Hospital Setting
Authors: Christiansen Shannon Ryan , Morgan Jill A. , Hilmas Elora , Shepardson Adrienne 
Published: October 2020

OBJECTIVE The purpose of this study was to determine if a prescription review service, at the time of discharge, enhances the accuracy and safety of prescriptions written at an academic pediatric hospital.
METHODS The study took place over a 30-day period and included prescriptions written for patients being discharged from the General Pediatric and Pediatric Intensive Care Services at the University of Maryland Hospital for Children, a 120-bed academic pediatric hospital. Discharge prescriptions were faxed to the Inpatient Pediatric Pharmacy where they were reviewed by a pediatric clinical pharmacist. Specific review criteria were aimed at detecting prescribing errors that included patient identification, medication selection, dosing, and therapy omission. A prescriber was notified via alpha page when errors were identified and advised on corrective measures. Interventions were compiled and analyzed to determine the overall impact of the discharge prescription review program.
RESULTS Over the 30-day period, 74 discharge prescriptions were reviewed by a pediatric clinical pharmacist. At least one prescribing error was detected in 81% of the prescriptions reviewed. Overall, 101 prescribing errors were documented and included patient identification, medication selection and dose calculation errors. The estimated cost-savings attributed to the interventions is approximately $7670.
CONCLUSION Through the discharge prescription review program, the pediatric clinical pharmacists were able to make interventions on the majority of prescriptions reviewed. The types of errors that required interventions have been identified as potential sources for major medication errors in the pediatric population. We concluded that the review of discharge prescriptions by a pediatric clinical pharmacist was an effective method of preventing prescribing errors in the pediatric environment.
Analysis of 72-Hour Sterility of Common Pediatric Continuous Intravenous Infusions
Authors: Piro Christina C. , Davis Jennifer , Frelix Arlesia , Grisso Alison G. , Sinclair-Pingel Julie , Willingham Harold , Wright Lorianne , Potts Amy L. 
Published: October 2020

OBJECTIVES Patient morbidity and mortality associated with contaminated and improperly prepared sterile products has captured national attention. In response, both the United States Pharmacopeia (USP) and Centers for Disease Control (CDC) have published recommendations in an effort to minimize the risk of infection. While the CDC recommends that administration sets are not changed more frequently than every 72 hours, the USP recommends a maximum beyond use date of 48 hours. Neither organization provides specific guidance on expiration dating once the intravenous drug is dispensed. Likewise, neither addresses the length of time that a bag containing medication for continuous infusion may hang once administration to the patient has begun. We evaluated the sterility of medications that are commonly administered by continuous infusion to pediatric patients. Because frequent manipulation of infusion and administration sets may predispose the patient to adverse events, we evaluated sterility for extended beyond use dating up to 72 hours.METHODS Thirty-five common intravenous (IV) continuous infusions using 94 standard concentrations and diluents were identified. IV solutions were mixed using sterile technique in the laminar flow hood in accordance with USP guidelines. Medications were excluded for short stability, short durations of use or high cost. A sample from each solution was tested for contamination or bacterial growth at 72 hours. Any visible discoloration suggesting physical instability was also evaluated.RESULTS None of the syringes or chambers resulted in contamination, bacterial growth or discoloration after 72 hours.CONCLUSIONS This study provides sufficient data that these compounded sterile products may be stored using a beyond use date up to 72 hours for a number of commonly used continuous IV infusions in pediatric patients. In our institution, this allows for a more convenient and consistent change of both administration sets and continuous infusions at 72 hours to potentially minimize adverse events, workload and cost.
Correlation of Vancomycin Dosing to Serum Concentrations in Pediatric Patients: A Retrospective Database Review
Authors: Benner Kim W. , Worthington Mary A. , Kimberlin David W. , Hill Kim , Buckley Kevin , Tofil Nancy M. 
Published: October 2020

OBJECTIVES Appropriate antimicrobial dosing maximizes therapeutic benefit while minimizing development of antimicrobial resistance. Common pediatric references recommend vancomycin dosing of 40 mg/kg/day divided every 6 to 8 hours for non-central nervous system infections, while some clinicians report utilizing higher initial doses to optimize efficacy. This study compares vancomycin serum concentrations following traditional dosing of 10 mg/kg/dose every 6 to 8 hours versus 15 to 20 mg/kg/dose every 6 to 8 hours.STUDY DESIGN Retrospective database review of vancomycin serum concentrations in pediatric patients.RESULTS Three hundred fifty-seven patients were analyzed. The mean peak concentration of the 10 mg/kg groups every 6 and every 8 hours were below 25 mg/L, whereas the mean peak concentrations of the 15 mg/ kg groups every 6 and 8 hours were within the 25–40 mg/L range (p &lt; 0.001). The mean trough concentration of the 10 mg/kg group every 6 hours was within the 5–15 mg/L range while the 10 mg/kg group dosed every 8 hours was below target. However, the mean trough concentrations of the 15 mg/kg group dosed every 6 and 8 hours were both within the 5–15 mg/L range (p &lt; 0.001).CONCLUSIONS Vancomycin doses of 15 mg/kg every 6 to 8 hours produce peak and trough serum concentrations within target range more often than 10 mg/kg every 6 to 8 hours.
Retrospective Analysis of the Initiation of Antibiotic Therapy In Severe Sepsis In Pediatric Patients
Authors: LaRochelle Joseph M. , Morgan Jill A. , Parbuoni Kristine A. 
Published: October 2020

BACKGROUND The 2008 Surviving Sepsis Campaign guidelines state that intravenous antibiotic therapy should be started within the first hour of recognition of septic shock. Currently, there are no published studies looking at antibiotic timing in pediatric sepsis patients.
OBJECTIVES The purpose of this study is to determine if sepsis patients admitted to a Pediatric Intensive Care Unit (PICU) are administered antibiotics in the appropriate time frame according to the Surviving Sepsis Guidelines.
METHODS A retrospective chart review was conducted during a six-month time frame. For the purpose of this pilot study the onset of severe sepsis was defined as the time of a physician order for a vasopressor. Antibiotic appropriateness was based on culture results, drug dosing, and route. Length of PICU stay, overall hospital days, and mortality data were collected. Descriptive statistics on patient demographics, and the prescribing and time of administration of both antibiotics and vasopressors are included.
RESULTS Fifty-four patients were identified, 4 of which were admitted twice during the study period. Fifty admissions did not meet criteria for analysis, with a final sample size of 8 patients identified. All patients were male with an average age of 7.6 years, average weight of 33.4 kg, and zero mortality rate. Eighty-eight percent of the patients were administered appropriate antibiotics. The average time from vasopressor order to the administration of antibiotics was 7 hours and 40 minutes.
CONCLUSIONS The time delay in administering antibiotics to our pediatric sepsis patients likely involved physicians, nurses, and pharmacists. System improvements are needed to decrease the time delay in providing antibiotics to this patient population. Although our sample size was small, the mortality rate found in this study is lower than what has been reported in adults with sepsis.
Evaluation of Adverse Events Noted in Children Receiving Continuous Infusions of Dexmedetomidine in the Intensive Care Unit
Authors: Honey Brooke L. , Harrison Donald L. , Gormley Andrew K. , Johnson Peter N. 
Published: October 2020

OBJECTIVES
Dexmedetomidine is an α2-adrenergic receptor agonist with sedative and analgesic effects in mechanically ventilated adults and children. Safety and efficacy data are limited in children. The purpose of this study is to retrospectively identify the incidence and types of adverse events noted in children receiving continuous infusions of dexmedetomidine and evaluate potential risk factors for adverse events.

METHODS
Between July 1, 2006, and July 31, 2007, data were collected on all children (&lt; 18 years) who received continuous infusions of dexmedetomidine. Data collection included demographics, dexmedetomidine regimen, and type/number of adverse events. The primary endpoint was the total number of adverse events noted, including: transient hypertension, hypotension, neurological manifestations, apnea, and bradycardia. Secondary endpoints included categorization of each type of adverse event and an assessment of risk factors. A logistic regression model was used to assess the relationship of adverse events with independent variables including length of ICU stay, cumulative dose, peak infusion rate, duration of therapy, PRISM III score, and bolus dose.

RESULTS
Thirty-six patients received dexmedetomidine representing 41 infusions. The median age was 16 months (range, 0.1–204 months) and median PRISM III score was 2 (range, 0–18). Eighteen (43.9%) patients received a bolus dose of dexmedetomidine. The median cumulative dose (mcg/kg) and peak dose (mcg/kg/hr) were 8.5 (range, 2.2–193.7) and 0.5 (range, 0.2–0.7), respectively. Dexmedetomidine was continued for a median of 20 (range, 3–263) hours. Six (14.6%) patients were slowly tapered off the continuous infusions. Twenty-one adverse events were noted in 17 patients, including 4 neurologic manifestations. Fourteen patients required interventions for adverse events. ICU length of stay was the only independent risk factor (p=0.036) for development of adverse events.

CONCLUSIONS
Several potential adverse events were noted with dexmedetomidine continuous infusions including possible neurological manifestations. Further studies are needed looking at adverse events associated with dexmedetomidine use in the pediatric population.
The Controversy over Generic Antiepileptic Drugs
Authors: Shaw Susan J. , Hartman Adam L. 
Published: October 2020

ABSTRACTAs patent protection ends for the next generation of antiepileptic drugs (AEDs), a complex debate continues over generic substitution of AEDs. On one hand, generic drug formulations provide cost savings for patients and society. On the other hand, patients with epilepsy and physicians are wary about the adequacy and efficacy of the Food and Drug Administration's (FDA) standards for generics. This article reviews current and proposed bioequivalence test procedures, summarizes new generic AED formulations and their costs, and discusses potential pitfalls in the current standards. These shortcomings include certain pharmacokinetic factors and clinical pharmacologic factors that may affect bioequivalence of generic AEDs, and statistical limitations of the standards. While the drug concentration differences between the brand name drug and each generic formulation are unlikely to be substantial, the differences with generic-to-generic switches will be greater and potentially clinically significant. Conversely, owing to their more favorable pharmacokinetic profile, newer AEDs may be less prone to problems with generic substitution than older ones. Unfortunately, very few data are available to guide decisions regarding what is best for an individual patient. Based on new prediction methods, generic substitution should be safe for many patients but identifying them ultimately requires more rigorous study.
Penicillin Prophylaxis in Children with Sickle Cell Disease
Authors: Cober Mary Petrea , Phelps Stephanie J. 
Published: October 2020

AbstractChildren who have sickle cell disease and are under the age of five years are at increased risk of life-threatening pneumococcal infection due to absent or non-functional spleens and a decreased immune response. To prevent pneumococcal infection, the American Academy of Pediatrics recommends the use of penicillin prophylaxis in children with sickle cell disease under the age of five and in older children who have had a previous severe pneumococcal infection or have functional/surgical asplenia. These recommendations are based on two landmark studies, the first evaluating the effectiveness of penicillin prophylaxis and the second evaluating the duration of prophylaxis. Although the mortality rate from infection has been reduced following penicillin prophylaxis, altered immunologic response and penicillin-resistant S. pneumoniae remain a concern. This paper will review the literature that supports the use of penicillin prophylaxis, potential problems associated with prolonged therapy and recommendations for prophylaxis.
Thimerosal-Containing Vaccines and Autism: A Review of Recent Epidemiologic Studies
Authors: Hurley Anne M. , Tadrous Mina , Miller Elizabeth S. 
Published: October 2020

AbstractAlthough epidemiologic evidence has not supported the hypothesis of a causal relationship between thimerosal-containing vaccines and autism, concerns continue about pediatric exposure to mercury through vaccine administration. A statement issued by the American Academy of Pediatrics and the US Public Health Service in 1999 prompted the removal of thimerosal from many vaccines. In 2004, the Immunization Safety Review Committee of the Institute of Medicine rejected the hypothesis of a causal relationship between thimerosal-containing vaccines and autism.In a search of MEDLINE and EMBASE, we identified articles that address the potential association between thimerosal and neurodevelopmental disorders, specifically autism. In this article, we review recent pharmacokinetic and epidemiologic studies published between 2003 and 2008 regarding the proposed link between thimerosal and autism.
Computerized Pharmaceutical Algorithm Reduces Medication Administration Errors During Simulated Resuscitations
Authors: Deshpande Girish G. , Torres Adalberto , Buchanan David L. , Shane Gray Susan C. , Brown Suzanne C. , Hoadley Theresa , Ruppel Patricia L. , Tobias Joseph D. 
Published: October 2020

ABSTRACTOBJECTIVEMedication errors involving intravenous medications continue to be a significant problem, particularly in the pediatric population due to the high rate of point-of-care and weight-adjusted dosing. The pharmaceutical algorithm computerized calculator (pac2) assists in converting physician medication orders to correct volumes and rates of administration for intravenous medications. This study was designed to assess the efficacy of the pac2 in simulated clinical scenarios of point-of-care dosing.MethodsThe study design was a within-subject controlled study in which 33 nurses from pediatrics, pediatric critical care, or critical care (mean nursing experience of 10.9 years) carried out various point-of-care medication-dosing scenarios with and without the aid of the pac2.RESULTSUse of the pac2 resulted in a significantly higher percentage (mean [95% CI]) of medication volumes calculated and drawn accurately (91% [87–95%] versus 61% [52–70%], p&lt;0.0001), a higher percentage of correct recall of essential medication information (97% [95–99%] versus 45% [36–53%], p&lt;0.0001), and better recognition of unsafe doses (93% [87–99%] versus 19% [12–27%], p&lt;0.0001) as compared to usual practice. The pac2 also significantly reduced average medication calculation times (1.5 minutes [1.3–1.7 minutes] versus 1.9 minutes [1.6–2.2 minutes], p=0.0028) as compared to usual practice.CONCLUSIONSThe pac2 significantly improved the performance of drug calculations by pediatric and critical care nurses during simulated clinical scenarios designed to mimic point-of-care dosing. These results suggest that the pac2 addresses an area of safety vulnerability for point-of-care dosing practices and could be a useful addition to a hospital's overall program to minimize medication errors.
Angiotensin Converting Enzyme Inhibitor (ACEI)-Induced Acute Renal Failure in Premature Newborns with Congenital Heart Disease
Authors: Lee Grace J. , Cohen Risa , Chang Anthony C. , Cleary John P. 
Published: October 2020

ABSTRACTWe report three cases of angiotensin converting enzyme inhibitor (ACEI) induced nephrotoxicity in preterm infants with congenital heart disease. Patients developed acute renal failure after starting captopril or enalapril at doses commonly prescribed for term neonates. There was no underlying renal disease found in these infants and the acute renal failure was reversible upon discontinuation of the ACEI. Conservative starting doses of ACEI should be used in patients with multiple risk factors for nephrotoxicity. A summary of previously reported ACEI induced renal failure in premature infants and congenital heart disease is included.