Deepak Chitnis

SAN DIEGO– Instituting a standardized protocol for scoring and treating neonatal abstinence syndrome (NAS) patients can significantly decrease overall hospital costs, length of stay, and use of pharmacologic therapy on these young patients, according to a prospective study presented at the annual meeting of the Pediatric Academic Societies.

“Our project aims were to implement a standard care process for NAS at our institution, including consistent scoring, reduced transfers between units, decreased length of stay for treated babies, and decreased costs of NAS hospitalization for both opioid-exposed and NAS-affected newborns,” said Dr. Alison V. Holmes of Dartmouth College, Hanover, N.H., whose institution implemented the “coordinated [and] standardized program of care” in January 2013.

Bruce Jancin/Frontline Medical News

Under the new protocols, pharmacologic treatment of infants with NAS fell from 45% in 2012 to 25% in 2014, with a 37% rate of treatment over the last 3 years as a whole. Infants born at the hospital were treated pharmacologically at a rate of 36% in 2012, down to 15% in the second and third quarter of 2014, and adjunctive use of phenobarbital decreased from 11% to 5% over the same time period.

Mean length of stay decreased significantly, from 18.2 days to 13.6 days per patient, and the mean number of transfers between departments decreased from 2.1 to 1.5. Shorter hospital stays and fewer interdepartmental transfers decreased the overall hospitalization costs per patient from a mean of $20,225 to $11,318.

Despite all the changes, all-cause 30-day readmission rates and cumulative morphine doses did not change significantly over the course of the study. The total study population was 160 infants, 21% of whom were born in outside facilities before being brought to Dartmouth for NAS treatment; no adverse events were reported.

As explained by Dr. Holmes, the new protocols dictated that infants who did not require critical care were allowed to stay with their mothers in a mother/baby unit. Infants were transferred to the neonatal intensive care unit (NICU) only for treatment related to NAS; they stayed with their mothers or in the general pediatric ward for all other forms of treatment or observation.

This is vastly different from the previous model, which used infants’ Finnegan scores to determine if the baby should be moved to NICU for increased observation. When the infant’s condition improved, that infant was returned to rooming in with its mother. If increased symptoms returned, the baby would then go back to NICU for monitoring and treatment initiation, with the mother often discharged home in the interim. Once stable and on decreasing oral morphine doses, the baby would move back to the general pediatric ward to continue weaning, but if symptoms increased again and caused an increase in morphine dose, then the baby went back to NICU.

Under the new system, explained Dr. Holmes, the treatment team can safely interpret Finnegan scores in context of what is important to the newborn, assessments and scoring can be done on an infant schedule and can involve family, and costs for both treated and at-risk newborns can be halved.

“The implications are that centers with a length of stay of a month or more can significantly shorten their hospital course, and if this model is adopted widely, the potential cost savings and positive impact on families is tremendous,” Dr. Holmes concluded, adding that a limitation of this study is that it was a single-center study of a homogeneous patient population in a rural setting.

Dr. Holmes did not report any relevant financial disclosures.

[email protected]

This article was updated 5/15/2015.

SAN DIEGO– Instituting a standardized protocol for scoring and treating neonatal abstinence syndrome (NAS) patients can significantly decrease overall hospital costs, length of stay, and use of pharmacologic therapy on these young patients, according to a prospective study presented at the annual meeting of the Pediatric Academic Societies.

“Our project aims were to implement a standard care process for NAS at our institution, including consistent scoring, reduced transfers between units, decreased length of stay for treated babies, and decreased costs of NAS hospitalization for both opioid-exposed and NAS-affected newborns,” said Dr. Alison V. Holmes of Dartmouth College, Hanover, N.H., whose institution implemented the “coordinated [and] standardized program of care” in January 2013.

Bruce Jancin/Frontline Medical News

Under the new protocols, pharmacologic treatment of infants with NAS fell from 45% in 2012 to 25% in 2014, with a 37% rate of treatment over the last 3 years as a whole. Infants born at the hospital were treated pharmacologically at a rate of 36% in 2012, down to 15% in the second and third quarter of 2014, and adjunctive use of phenobarbital decreased from 11% to 5% over the same time period.

Mean length of stay decreased significantly, from 18.2 days to 13.6 days per patient, and the mean number of transfers between departments decreased from 2.1 to 1.5. Shorter hospital stays and fewer interdepartmental transfers decreased the overall hospitalization costs per patient from a mean of $20,225 to $11,318.

Despite all the changes, all-cause 30-day readmission rates and cumulative morphine doses did not change significantly over the course of the study. The total study population was 160 infants, 21% of whom were born in outside facilities before being brought to Dartmouth for NAS treatment; no adverse events were reported.

As explained by Dr. Holmes, the new protocols dictated that infants who did not require critical care were allowed to stay with their mothers in a mother/baby unit. Infants were transferred to the neonatal intensive care unit (NICU) only for treatment related to NAS; they stayed with their mothers or in the general pediatric ward for all other forms of treatment or observation.

This is vastly different from the previous model, which used infants’ Finnegan scores to determine if the baby should be moved to NICU for increased observation. When the infant’s condition improved, that infant was returned to rooming in with its mother. If increased symptoms returned, the baby would then go back to NICU for monitoring and treatment initiation, with the mother often discharged home in the interim. Once stable and on decreasing oral morphine doses, the baby would move back to the general pediatric ward to continue weaning, but if symptoms increased again and caused an increase in morphine dose, then the baby went back to NICU.

Under the new system, explained Dr. Holmes, the treatment team can safely interpret Finnegan scores in context of what is important to the newborn, assessments and scoring can be done on an infant schedule and can involve family, and costs for both treated and at-risk newborns can be halved.

“The implications are that centers with a length of stay of a month or more can significantly shorten their hospital course, and if this model is adopted widely, the potential cost savings and positive impact on families is tremendous,” Dr. Holmes concluded, adding that a limitation of this study is that it was a single-center study of a homogeneous patient population in a rural setting.

Dr. Holmes did not report any relevant financial disclosures.

[email protected]

This article was updated 5/15/2015.

SAN DIEGO– Instituting a standardized protocol for scoring and treating neonatal abstinence syndrome (NAS) patients can significantly decrease overall hospital costs, length of stay, and use of pharmacologic therapy on these young patients, according to a prospective study presented at the annual meeting of the Pediatric Academic Societies.

“Our project aims were to implement a standard care process for NAS at our institution, including consistent scoring, reduced transfers between units, decreased length of stay for treated babies, and decreased costs of NAS hospitalization for both opioid-exposed and NAS-affected newborns,” said Dr. Alison V. Holmes of Dartmouth College, Hanover, N.H., whose institution implemented the “coordinated [and] standardized program of care” in January 2013.

Bruce Jancin/Frontline Medical News

Under the new protocols, pharmacologic treatment of infants with NAS fell from 45% in 2012 to 25% in 2014, with a 37% rate of treatment over the last 3 years as a whole. Infants born at the hospital were treated pharmacologically at a rate of 36% in 2012, down to 15% in the second and third quarter of 2014, and adjunctive use of phenobarbital decreased from 11% to 5% over the same time period.

Mean length of stay decreased significantly, from 18.2 days to 13.6 days per patient, and the mean number of transfers between departments decreased from 2.1 to 1.5. Shorter hospital stays and fewer interdepartmental transfers decreased the overall hospitalization costs per patient from a mean of $20,225 to $11,318.

Despite all the changes, all-cause 30-day readmission rates and cumulative morphine doses did not change significantly over the course of the study. The total study population was 160 infants, 21% of whom were born in outside facilities before being brought to Dartmouth for NAS treatment; no adverse events were reported.

As explained by Dr. Holmes, the new protocols dictated that infants who did not require critical care were allowed to stay with their mothers in a mother/baby unit. Infants were transferred to the neonatal intensive care unit (NICU) only for treatment related to NAS; they stayed with their mothers or in the general pediatric ward for all other forms of treatment or observation.

This is vastly different from the previous model, which used infants’ Finnegan scores to determine if the baby should be moved to NICU for increased observation. When the infant’s condition improved, that infant was returned to rooming in with its mother. If increased symptoms returned, the baby would then go back to NICU for monitoring and treatment initiation, with the mother often discharged home in the interim. Once stable and on decreasing oral morphine doses, the baby would move back to the general pediatric ward to continue weaning, but if symptoms increased again and caused an increase in morphine dose, then the baby went back to NICU.

Under the new system, explained Dr. Holmes, the treatment team can safely interpret Finnegan scores in context of what is important to the newborn, assessments and scoring can be done on an infant schedule and can involve family, and costs for both treated and at-risk newborns can be halved.

“The implications are that centers with a length of stay of a month or more can significantly shorten their hospital course, and if this model is adopted widely, the potential cost savings and positive impact on families is tremendous,” Dr. Holmes concluded, adding that a limitation of this study is that it was a single-center study of a homogeneous patient population in a rural setting.

Dr. Holmes did not report any relevant financial disclosures.

[email protected]

This article was updated 5/15/2015.

Psoriasis patients with ultrasonographic enthesitis who undergo systemic treatments can experience significant reductions in morphologic abnormalities in as little as 6 months, according to the findings of a two-center prospective study published in Joint Bone Spine.

“Here, we showed that subclinical enthesitis of both [psoriasis] and PsA [psoriatic arthritis] population improve under systemic treatment,” wrote lead author Dr. Emilie Acquacalda of the University Hospital of Nice (France) and her associates. “Both patients under methotrexate and biologics had a reduction of the enthesitis at US [ultrasonographic] examination.”

The investigators enrolled 34 patients – 22 with psoriasis and 12 with symptomatic PsA – for whom US assessments were taken at baseline. Abnormalities, specifically hypoechogenicity and thickness, were noted in 86.4% (19) of psoriasis patients and 97.1% (33) of the total population. Enthesitis was found in 95 of the 340 entheses examined at baseline, 57 of which were in psoriasis patients (Joint Bone Spine 2015 April 13 [doi:10.1016/j.jbspin.2015.01.016]).

Psoriasis patients were given systemic treatment consisting of methotrexate and/or biologic therapies, which were infliximab, adalimumab, etanercept, and ustekinumab. At 6 months, 23 patients were assessed (11 refused ultrasonography), 13 of whom had psoriasis and 10 of whom had PsA. Of these subjects, 12 received methotrexate alone and 11 received it with a biologic.

Morphologic abnormalities in the psoriasis population decreased significantly, from 30% (39 of 130) at baseline to 17.7% (23 of 130; P = .021). Psoriasis patients who took methotrexate had the most significant decreases, with methotrexate alone reducing the proportion of abnormalities from 28.8% (23 of 30) at baseline to 15% (12 of 80; P = .035), Dr. Acquacalda and her associates reported.

Treatment with biologics also showed promise, with abnormality rates dropping from 32% (16 of 80) to 22% (11 of 80), but the results were not statistically significant (P = .359). Overall, PsA patients saw enthesitis improvement from 33% (33 of 100) to 24% (24 of 100) over the 6-month study period, but the difference was not statistically significant (P = .164), they said.

The authors also noted that the relatively small number of subjects in their study prohibits them from making any definitive conclusions about the efficacy of systemic and biological treatments, but urged that “long-term follow-up studies of [psoriasis] patients with and without subclinical enthesitis are warranted to determine if they have a predictive value of future PsA, and to determine if rapid introduction of a systemic treatment could impact this evolution.”

The authors did not report any relevant conflicts of interest.

[email protected]

Psoriasis patients with ultrasonographic enthesitis who undergo systemic treatments can experience significant reductions in morphologic abnormalities in as little as 6 months, according to the findings of a two-center prospective study published in Joint Bone Spine.

“Here, we showed that subclinical enthesitis of both [psoriasis] and PsA [psoriatic arthritis] population improve under systemic treatment,” wrote lead author Dr. Emilie Acquacalda of the University Hospital of Nice (France) and her associates. “Both patients under methotrexate and biologics had a reduction of the enthesitis at US [ultrasonographic] examination.”

The investigators enrolled 34 patients – 22 with psoriasis and 12 with symptomatic PsA – for whom US assessments were taken at baseline. Abnormalities, specifically hypoechogenicity and thickness, were noted in 86.4% (19) of psoriasis patients and 97.1% (33) of the total population. Enthesitis was found in 95 of the 340 entheses examined at baseline, 57 of which were in psoriasis patients (Joint Bone Spine 2015 April 13 [doi:10.1016/j.jbspin.2015.01.016]).

Psoriasis patients were given systemic treatment consisting of methotrexate and/or biologic therapies, which were infliximab, adalimumab, etanercept, and ustekinumab. At 6 months, 23 patients were assessed (11 refused ultrasonography), 13 of whom had psoriasis and 10 of whom had PsA. Of these subjects, 12 received methotrexate alone and 11 received it with a biologic.

Morphologic abnormalities in the psoriasis population decreased significantly, from 30% (39 of 130) at baseline to 17.7% (23 of 130; P = .021). Psoriasis patients who took methotrexate had the most significant decreases, with methotrexate alone reducing the proportion of abnormalities from 28.8% (23 of 30) at baseline to 15% (12 of 80; P = .035), Dr. Acquacalda and her associates reported.

Treatment with biologics also showed promise, with abnormality rates dropping from 32% (16 of 80) to 22% (11 of 80), but the results were not statistically significant (P = .359). Overall, PsA patients saw enthesitis improvement from 33% (33 of 100) to 24% (24 of 100) over the 6-month study period, but the difference was not statistically significant (P = .164), they said.

The authors also noted that the relatively small number of subjects in their study prohibits them from making any definitive conclusions about the efficacy of systemic and biological treatments, but urged that “long-term follow-up studies of [psoriasis] patients with and without subclinical enthesitis are warranted to determine if they have a predictive value of future PsA, and to determine if rapid introduction of a systemic treatment could impact this evolution.”

The authors did not report any relevant conflicts of interest.

[email protected]

Psoriasis patients with ultrasonographic enthesitis who undergo systemic treatments can experience significant reductions in morphologic abnormalities in as little as 6 months, according to the findings of a two-center prospective study published in Joint Bone Spine.

“Here, we showed that subclinical enthesitis of both [psoriasis] and PsA [psoriatic arthritis] population improve under systemic treatment,” wrote lead author Dr. Emilie Acquacalda of the University Hospital of Nice (France) and her associates. “Both patients under methotrexate and biologics had a reduction of the enthesitis at US [ultrasonographic] examination.”

The investigators enrolled 34 patients – 22 with psoriasis and 12 with symptomatic PsA – for whom US assessments were taken at baseline. Abnormalities, specifically hypoechogenicity and thickness, were noted in 86.4% (19) of psoriasis patients and 97.1% (33) of the total population. Enthesitis was found in 95 of the 340 entheses examined at baseline, 57 of which were in psoriasis patients (Joint Bone Spine 2015 April 13 [doi:10.1016/j.jbspin.2015.01.016]).

Psoriasis patients were given systemic treatment consisting of methotrexate and/or biologic therapies, which were infliximab, adalimumab, etanercept, and ustekinumab. At 6 months, 23 patients were assessed (11 refused ultrasonography), 13 of whom had psoriasis and 10 of whom had PsA. Of these subjects, 12 received methotrexate alone and 11 received it with a biologic.

Morphologic abnormalities in the psoriasis population decreased significantly, from 30% (39 of 130) at baseline to 17.7% (23 of 130; P = .021). Psoriasis patients who took methotrexate had the most significant decreases, with methotrexate alone reducing the proportion of abnormalities from 28.8% (23 of 30) at baseline to 15% (12 of 80; P = .035), Dr. Acquacalda and her associates reported.

Treatment with biologics also showed promise, with abnormality rates dropping from 32% (16 of 80) to 22% (11 of 80), but the results were not statistically significant (P = .359). Overall, PsA patients saw enthesitis improvement from 33% (33 of 100) to 24% (24 of 100) over the 6-month study period, but the difference was not statistically significant (P = .164), they said.

The authors also noted that the relatively small number of subjects in their study prohibits them from making any definitive conclusions about the efficacy of systemic and biological treatments, but urged that “long-term follow-up studies of [psoriasis] patients with and without subclinical enthesitis are warranted to determine if they have a predictive value of future PsA, and to determine if rapid introduction of a systemic treatment could impact this evolution.”

The authors did not report any relevant conflicts of interest.

[email protected]

SAN DIEGO – Implementation of guidelines for the use of the high-flow nasal cannula in general pediatric wards for infants admitted with bronchiolitis can lead to significant decreases in length of stay, need for ICU level of care, and overall hospitalization costs, a retrospective chart study showed.

In the nonrandomized, pre- and postintervention chart analysis, the investigators reviewed the data for 2,446 infants under the age of 2 years who were admitted to Hasbro Children’s Hospital with a diagnosis for bronchiolitis in the 24 months before and after March 2012, when the hospital initiated high-flow nasal cannula (HFNC) protocols in its general pediatric wards.

“Admissions for bronchiolitis are extremely common for children under the age of 1 [year], and the costs associated with this are obviously quite high, but although centers around the country are now using [HFNC] for bronchiolitis, there’s little data at this point regarding the use of it on the general wards,” said Dr. Jamie Fierce of Hasbro Children’s Hospital in Providence, R.I., adding that the 2014 American Academy of Pediatrics guidelines on bronchiolitis called for more research on the efficacy of HFNC (Pediatrics 2014;134:e1474-502).

In total, 533 infants were selected for inclusion in the study, and were divided into groups based on whether they were admitted and discharged before or after the March 2012 implementation of HFNC protocols. The primary outcome measured for the study was the length of hospital stay; the median length before implementation was 4 days, while after implementation, the median length of stay decreased to 3 days (P < .001). In addition, the number of patients who required an ICU level of care decreased from the mandated 100% – because every subject who received HFNC would have to be admitted to the ICU before the new protocols were in place – to 70% of subjects after the new protocols were put in place (P < .001).

The cost of hospitalization also decreased significantly; prior to HFNC use on general wards, the median cost per patient was $12,865, but that amount decreased to $8,952 after March 2012, a difference of almost $4,000. Furthermore, there was no increase in intubation rates, nor in 30-day readmission rates from before to after March 2012. The average number of days spent on HFNC dropped from 2.5 days to 2 days, and the mean maximum HFNC rate also decreased from 9 L/min to 7 L/min, Dr. Fierce reported at the annual meeting of the Pediatric Academic Societies.

“One important limitation to this study is that it’s difficult to assess bronchiolitis severity in each of our groups, so there could have been seasonal variations that may have affected our outcomes,” he said. “Our after-implementation group is larger than our before-implementation group, and it’s hard to tell if that’s due to a seasonal increase in bronchiolitis cases, or if there was just higher use of HFNC on patients once it was allowed in the general wards.”

Demographic information was collected from the hospital billing database on subjects’ age, race, sex, and secondhand smoke exposure and whether they had public or private insurance. Although there was a statistically significant difference in age between the groups – 3 months before March 2012, 5 months after – the other demographic data were largely consistent from before implementation to after.

Dr. Fierce did not report any relevant financial disclosures.

[email protected]

SAN DIEGO – Implementation of guidelines for the use of the high-flow nasal cannula in general pediatric wards for infants admitted with bronchiolitis can lead to significant decreases in length of stay, need for ICU level of care, and overall hospitalization costs, a retrospective chart study showed.

In the nonrandomized, pre- and postintervention chart analysis, the investigators reviewed the data for 2,446 infants under the age of 2 years who were admitted to Hasbro Children’s Hospital with a diagnosis for bronchiolitis in the 24 months before and after March 2012, when the hospital initiated high-flow nasal cannula (HFNC) protocols in its general pediatric wards.

“Admissions for bronchiolitis are extremely common for children under the age of 1 [year], and the costs associated with this are obviously quite high, but although centers around the country are now using [HFNC] for bronchiolitis, there’s little data at this point regarding the use of it on the general wards,” said Dr. Jamie Fierce of Hasbro Children’s Hospital in Providence, R.I., adding that the 2014 American Academy of Pediatrics guidelines on bronchiolitis called for more research on the efficacy of HFNC (Pediatrics 2014;134:e1474-502).

In total, 533 infants were selected for inclusion in the study, and were divided into groups based on whether they were admitted and discharged before or after the March 2012 implementation of HFNC protocols. The primary outcome measured for the study was the length of hospital stay; the median length before implementation was 4 days, while after implementation, the median length of stay decreased to 3 days (P < .001). In addition, the number of patients who required an ICU level of care decreased from the mandated 100% – because every subject who received HFNC would have to be admitted to the ICU before the new protocols were in place – to 70% of subjects after the new protocols were put in place (P < .001).

The cost of hospitalization also decreased significantly; prior to HFNC use on general wards, the median cost per patient was $12,865, but that amount decreased to $8,952 after March 2012, a difference of almost $4,000. Furthermore, there was no increase in intubation rates, nor in 30-day readmission rates from before to after March 2012. The average number of days spent on HFNC dropped from 2.5 days to 2 days, and the mean maximum HFNC rate also decreased from 9 L/min to 7 L/min, Dr. Fierce reported at the annual meeting of the Pediatric Academic Societies.

“One important limitation to this study is that it’s difficult to assess bronchiolitis severity in each of our groups, so there could have been seasonal variations that may have affected our outcomes,” he said. “Our after-implementation group is larger than our before-implementation group, and it’s hard to tell if that’s due to a seasonal increase in bronchiolitis cases, or if there was just higher use of HFNC on patients once it was allowed in the general wards.”

Demographic information was collected from the hospital billing database on subjects’ age, race, sex, and secondhand smoke exposure and whether they had public or private insurance. Although there was a statistically significant difference in age between the groups – 3 months before March 2012, 5 months after – the other demographic data were largely consistent from before implementation to after.

Dr. Fierce did not report any relevant financial disclosures.

[email protected]

SAN DIEGO – Implementation of guidelines for the use of the high-flow nasal cannula in general pediatric wards for infants admitted with bronchiolitis can lead to significant decreases in length of stay, need for ICU level of care, and overall hospitalization costs, a retrospective chart study showed.

In the nonrandomized, pre- and postintervention chart analysis, the investigators reviewed the data for 2,446 infants under the age of 2 years who were admitted to Hasbro Children’s Hospital with a diagnosis for bronchiolitis in the 24 months before and after March 2012, when the hospital initiated high-flow nasal cannula (HFNC) protocols in its general pediatric wards.

“Admissions for bronchiolitis are extremely common for children under the age of 1 [year], and the costs associated with this are obviously quite high, but although centers around the country are now using [HFNC] for bronchiolitis, there’s little data at this point regarding the use of it on the general wards,” said Dr. Jamie Fierce of Hasbro Children’s Hospital in Providence, R.I., adding that the 2014 American Academy of Pediatrics guidelines on bronchiolitis called for more research on the efficacy of HFNC (Pediatrics 2014;134:e1474-502).

In total, 533 infants were selected for inclusion in the study, and were divided into groups based on whether they were admitted and discharged before or after the March 2012 implementation of HFNC protocols. The primary outcome measured for the study was the length of hospital stay; the median length before implementation was 4 days, while after implementation, the median length of stay decreased to 3 days (P < .001). In addition, the number of patients who required an ICU level of care decreased from the mandated 100% – because every subject who received HFNC would have to be admitted to the ICU before the new protocols were in place – to 70% of subjects after the new protocols were put in place (P < .001).

The cost of hospitalization also decreased significantly; prior to HFNC use on general wards, the median cost per patient was $12,865, but that amount decreased to $8,952 after March 2012, a difference of almost $4,000. Furthermore, there was no increase in intubation rates, nor in 30-day readmission rates from before to after March 2012. The average number of days spent on HFNC dropped from 2.5 days to 2 days, and the mean maximum HFNC rate also decreased from 9 L/min to 7 L/min, Dr. Fierce reported at the annual meeting of the Pediatric Academic Societies.

“One important limitation to this study is that it’s difficult to assess bronchiolitis severity in each of our groups, so there could have been seasonal variations that may have affected our outcomes,” he said. “Our after-implementation group is larger than our before-implementation group, and it’s hard to tell if that’s due to a seasonal increase in bronchiolitis cases, or if there was just higher use of HFNC on patients once it was allowed in the general wards.”

Demographic information was collected from the hospital billing database on subjects’ age, race, sex, and secondhand smoke exposure and whether they had public or private insurance. Although there was a statistically significant difference in age between the groups – 3 months before March 2012, 5 months after – the other demographic data were largely consistent from before implementation to after.

Dr. Fierce did not report any relevant financial disclosures.

[email protected]

SAN DIEGO – Narrow-spectrum antibiotics yield outcomes that are at least comparable, if not better, than broad-spectrum antibiotics when prescribed to children with appendicitis, according to a retrospective cohort study presented at the annual meeting of the Pediatric Academic Societies.

The study found that in cases of both complicated and uncomplicated appendicitis, rates of hospital readmission were consistently lower for children prescribed narrow-spectrum antibiotics versus broad-spectrum ones.

“Current guidelines recommend what we ended up defining as narrow-spectrum antibiotics, such as cefoxitin, for uncomplicated cases of appendicitis,” said Dr. Matthew P. Kronman of Seattle Children’s Hospital and the study’s lead author. “For the complicated appendicitis cases, the guidelines state that you can either use one of the narrow-spectrum antibiotics, or you can use other agents – such as piperacillin, ticarcillin, ceftazidime, cefepime, or a carbapenem, for example – that we defined as “broad spectrum” because they provide a wider range of protection and have so much activity that patients often don’t need.”

Dr. Kronman and his coinvestigators analyzed the records of 27,306 children aged 3-18 years, admitted to 1 of 23 hospitals for at least 1 day between 2011 and 2013 with appendicitis. The primary outcome was readmission within 30 days for any subsequent abdominal infection or procedure.

Uncomplicated cases accounted for 18.939 of subjects (69.9%), and complicated appendicitis was recorded in the remaining 8.367 (30.1%) of children. Subjects were given broad-spectrum antibiotics in 28.1% of uncomplicated cases and 64.7% of complicated cases.

Overall, 1.0% of patients with uncomplicated appendicitis (189) and 6.0% (498) of complicated cases were readmitted within 30 days. Of the uncomplicated cases, the readmission rate for patients who got broad-spectrum antibiotics was 1.4%, compared with 0.9% for patients who received narrow-spectrum ones; in cases of complicated appendicitis, 6.8% of subjects given broad-spectrum antibiotics were readmitted within 30 days, compared with 4.4% for patients on narrow-spectrum antibiotics.

Multivariate logistic regression was performed on the study population, with adjustments for demographic factors, as well as illness severity and length of stay. Investigators found that age, sex, and insurance type were not factors in the association between broad-spectrum antibiotic intake and readmission within 30 days. However, increased length of stay, illness severity, and placement of a peripherally inserted central catheter line, which was used exclusively for patients with complicated appendicitis, were associated with the primary outcome.

The association between broad-spectrum agents and higher readmission rates could be a result of confounding by indication, wherein patients are given broad-spectrum drugs by physicians because the patients present as very sick, Dr. Kronman said. However, that alone means that they’re at a higher risk for developing complications and being readmitted shortly after receiving treatment, he added.

“But I think it’s reasonable to conclude that those treated with narrow-spectrum antibiotics didn’t do worse, and if they didn’t do worse, there’s no reason that every kid with appendicitis shouldn’t be treated with narrow-spectrum antibiotics because we know that those treated with broader-spectrum antibiotics are more likely to develop colonization with resistant organisms, and can have other complications due to the spectrum of activity brought on by the antibiotics they were given,” Dr. Kronman said. “So if narrow-spectrum antibiotics are just as good, we should try to get every hospital to use them.”

Dr. Kronman did not report any financial disclosures. The study was supported by the Clinical Research Scholars Program at Seattle Children’s Hospital and by the National Center of Advancing Translational Sciences at the National Institutes of Health.

[email protected]

SAN DIEGO – Narrow-spectrum antibiotics yield outcomes that are at least comparable, if not better, than broad-spectrum antibiotics when prescribed to children with appendicitis, according to a retrospective cohort study presented at the annual meeting of the Pediatric Academic Societies.

The study found that in cases of both complicated and uncomplicated appendicitis, rates of hospital readmission were consistently lower for children prescribed narrow-spectrum antibiotics versus broad-spectrum ones.

“Current guidelines recommend what we ended up defining as narrow-spectrum antibiotics, such as cefoxitin, for uncomplicated cases of appendicitis,” said Dr. Matthew P. Kronman of Seattle Children’s Hospital and the study’s lead author. “For the complicated appendicitis cases, the guidelines state that you can either use one of the narrow-spectrum antibiotics, or you can use other agents – such as piperacillin, ticarcillin, ceftazidime, cefepime, or a carbapenem, for example – that we defined as “broad spectrum” because they provide a wider range of protection and have so much activity that patients often don’t need.”

Dr. Kronman and his coinvestigators analyzed the records of 27,306 children aged 3-18 years, admitted to 1 of 23 hospitals for at least 1 day between 2011 and 2013 with appendicitis. The primary outcome was readmission within 30 days for any subsequent abdominal infection or procedure.

Uncomplicated cases accounted for 18.939 of subjects (69.9%), and complicated appendicitis was recorded in the remaining 8.367 (30.1%) of children. Subjects were given broad-spectrum antibiotics in 28.1% of uncomplicated cases and 64.7% of complicated cases.

Overall, 1.0% of patients with uncomplicated appendicitis (189) and 6.0% (498) of complicated cases were readmitted within 30 days. Of the uncomplicated cases, the readmission rate for patients who got broad-spectrum antibiotics was 1.4%, compared with 0.9% for patients who received narrow-spectrum ones; in cases of complicated appendicitis, 6.8% of subjects given broad-spectrum antibiotics were readmitted within 30 days, compared with 4.4% for patients on narrow-spectrum antibiotics.

Multivariate logistic regression was performed on the study population, with adjustments for demographic factors, as well as illness severity and length of stay. Investigators found that age, sex, and insurance type were not factors in the association between broad-spectrum antibiotic intake and readmission within 30 days. However, increased length of stay, illness severity, and placement of a peripherally inserted central catheter line, which was used exclusively for patients with complicated appendicitis, were associated with the primary outcome.

The association between broad-spectrum agents and higher readmission rates could be a result of confounding by indication, wherein patients are given broad-spectrum drugs by physicians because the patients present as very sick, Dr. Kronman said. However, that alone means that they’re at a higher risk for developing complications and being readmitted shortly after receiving treatment, he added.

“But I think it’s reasonable to conclude that those treated with narrow-spectrum antibiotics didn’t do worse, and if they didn’t do worse, there’s no reason that every kid with appendicitis shouldn’t be treated with narrow-spectrum antibiotics because we know that those treated with broader-spectrum antibiotics are more likely to develop colonization with resistant organisms, and can have other complications due to the spectrum of activity brought on by the antibiotics they were given,” Dr. Kronman said. “So if narrow-spectrum antibiotics are just as good, we should try to get every hospital to use them.”

Dr. Kronman did not report any financial disclosures. The study was supported by the Clinical Research Scholars Program at Seattle Children’s Hospital and by the National Center of Advancing Translational Sciences at the National Institutes of Health.

[email protected]

SAN DIEGO – Narrow-spectrum antibiotics yield outcomes that are at least comparable, if not better, than broad-spectrum antibiotics when prescribed to children with appendicitis, according to a retrospective cohort study presented at the annual meeting of the Pediatric Academic Societies.

The study found that in cases of both complicated and uncomplicated appendicitis, rates of hospital readmission were consistently lower for children prescribed narrow-spectrum antibiotics versus broad-spectrum ones.

“Current guidelines recommend what we ended up defining as narrow-spectrum antibiotics, such as cefoxitin, for uncomplicated cases of appendicitis,” said Dr. Matthew P. Kronman of Seattle Children’s Hospital and the study’s lead author. “For the complicated appendicitis cases, the guidelines state that you can either use one of the narrow-spectrum antibiotics, or you can use other agents – such as piperacillin, ticarcillin, ceftazidime, cefepime, or a carbapenem, for example – that we defined as “broad spectrum” because they provide a wider range of protection and have so much activity that patients often don’t need.”

Dr. Kronman and his coinvestigators analyzed the records of 27,306 children aged 3-18 years, admitted to 1 of 23 hospitals for at least 1 day between 2011 and 2013 with appendicitis. The primary outcome was readmission within 30 days for any subsequent abdominal infection or procedure.

Uncomplicated cases accounted for 18.939 of subjects (69.9%), and complicated appendicitis was recorded in the remaining 8.367 (30.1%) of children. Subjects were given broad-spectrum antibiotics in 28.1% of uncomplicated cases and 64.7% of complicated cases.

Overall, 1.0% of patients with uncomplicated appendicitis (189) and 6.0% (498) of complicated cases were readmitted within 30 days. Of the uncomplicated cases, the readmission rate for patients who got broad-spectrum antibiotics was 1.4%, compared with 0.9% for patients who received narrow-spectrum ones; in cases of complicated appendicitis, 6.8% of subjects given broad-spectrum antibiotics were readmitted within 30 days, compared with 4.4% for patients on narrow-spectrum antibiotics.

Multivariate logistic regression was performed on the study population, with adjustments for demographic factors, as well as illness severity and length of stay. Investigators found that age, sex, and insurance type were not factors in the association between broad-spectrum antibiotic intake and readmission within 30 days. However, increased length of stay, illness severity, and placement of a peripherally inserted central catheter line, which was used exclusively for patients with complicated appendicitis, were associated with the primary outcome.

The association between broad-spectrum agents and higher readmission rates could be a result of confounding by indication, wherein patients are given broad-spectrum drugs by physicians because the patients present as very sick, Dr. Kronman said. However, that alone means that they’re at a higher risk for developing complications and being readmitted shortly after receiving treatment, he added.

“But I think it’s reasonable to conclude that those treated with narrow-spectrum antibiotics didn’t do worse, and if they didn’t do worse, there’s no reason that every kid with appendicitis shouldn’t be treated with narrow-spectrum antibiotics because we know that those treated with broader-spectrum antibiotics are more likely to develop colonization with resistant organisms, and can have other complications due to the spectrum of activity brought on by the antibiotics they were given,” Dr. Kronman said. “So if narrow-spectrum antibiotics are just as good, we should try to get every hospital to use them.”

Dr. Kronman did not report any financial disclosures. The study was supported by the Clinical Research Scholars Program at Seattle Children’s Hospital and by the National Center of Advancing Translational Sciences at the National Institutes of Health.

[email protected]

Surveillance of cardiac surgical site infections (SSIs) improved significantly when registry and infection control surveillance data were linked with electronic health records, a retrospective analysis showed.

Over the course of a 47-month period starting in 2011, Vaidehi Nayar of the Children’s Hospital of Philadelphia and her coinvestigators launched a quality improvement initiative at their institution that linked administrative databases with their clinical registry, allowing caregivers to more accurately monitor and assess SSIs and provide more effective adjudication and treatments thereafter. The investigators chose to link their hospital’s electronic health record (EHR) billing information and reporting from the infection surveillance database for the National Healthcare Safety Network with data from the Society of Thoracic Surgeons Congenital Heart Surgery Database (STS-CHSD).

To further facilitate the flow and interpretation of data, the investigators used a visualization tool to analyze the STS-CHSD for case ascertainment; to resolve discrepancies among STS-CHSD, infection surveillance, and billing SSI cases; and to assess the impact of the hospital’s quality improvement protocols. These protocols consisted of wound alert reports from the EHR, bedside reviews for SSI adjudication, inpatient and outpatient SSI prevention bundles, prophylactic antibiotic dosing changes, removal of steroids from the bypass circuit, and biller education on SSIs.

Control charts in the data visualization tool allowed for statistical monitoring of SSI rate changes, and SSI case discrepancies across the databases were reviewed to ensure that differences were the result of variations in SSI reporting criteria for each database, not inaccurate surveillance population ascertainment or inaccurate SSI identification, according to Ms. Nayar and her colleagues,

“Workflow changes, including the wound alert report and bedside reviews, facilitated communication among providers and improved adjudication of suspected SSIs,” she said in presenting the J. Maxwell Chamberlain Memorial Paper for Congenital Heart Surgery at the annual meeting of the Society of Thoracic Surgeons in San Diego earlier this year.

In total, 156 SSIs were identified via the STS-CHSD, 79 via the infection surveillance database, and 433 via billing. There was a significant decrease in the rolling 12-month SSI rate from 2.48% (21/848 in January 2013) to 0.76% (11/1,442 in January 2014), based on the STS-CHSD data, although Ms. Nayar pointed out that this decline could not definitely be attributed to reporting improvements or to the specific quality improvement initiatives that were implemented. Ms. Nayar also explained that there was a “general improvement in reporting, as shown by the stark drop in billing” and “a general alignment of all three data sources.”

“Accurate assessment of morbidity data, including [SSIs], has implications for public reporting, benchmarking, assessment of [quality improvement] impact, and possible denial of payments,” said Ms. Nayar. “In summary, we achieved our two simultaneous goals of improving SSI reporting – or decreasing the data errors – and decreasing SSI incidents by improving overall patient care.”

During discussion, Ms. Nayar elaborated on the study’s generalizability and potential application to other facets of congenital heart disease treatments, saying that such application is, in fact, possible.

“Yes, this is very generalizable, but one key important fact is relevant: As long as there is a source of truth for case ascertainment, this methodology can be used in several different areas,” she explained. “For example, we are currently working at our institution to integrate and link the [Pediatric Cardiac Critical Care Consortium] database to be able to better monitor any critical care–related morbidity information and ultimately use similar methodology to assess the impact of outcomes in the critical care field.”

Ms. Nayar said that she did not have any relevant financial conflicts of interest to disclose.

[email protected]

Surveillance of cardiac surgical site infections (SSIs) improved significantly when registry and infection control surveillance data were linked with electronic health records, a retrospective analysis showed.

Over the course of a 47-month period starting in 2011, Vaidehi Nayar of the Children’s Hospital of Philadelphia and her coinvestigators launched a quality improvement initiative at their institution that linked administrative databases with their clinical registry, allowing caregivers to more accurately monitor and assess SSIs and provide more effective adjudication and treatments thereafter. The investigators chose to link their hospital’s electronic health record (EHR) billing information and reporting from the infection surveillance database for the National Healthcare Safety Network with data from the Society of Thoracic Surgeons Congenital Heart Surgery Database (STS-CHSD).

To further facilitate the flow and interpretation of data, the investigators used a visualization tool to analyze the STS-CHSD for case ascertainment; to resolve discrepancies among STS-CHSD, infection surveillance, and billing SSI cases; and to assess the impact of the hospital’s quality improvement protocols. These protocols consisted of wound alert reports from the EHR, bedside reviews for SSI adjudication, inpatient and outpatient SSI prevention bundles, prophylactic antibiotic dosing changes, removal of steroids from the bypass circuit, and biller education on SSIs.

Control charts in the data visualization tool allowed for statistical monitoring of SSI rate changes, and SSI case discrepancies across the databases were reviewed to ensure that differences were the result of variations in SSI reporting criteria for each database, not inaccurate surveillance population ascertainment or inaccurate SSI identification, according to Ms. Nayar and her colleagues,

“Workflow changes, including the wound alert report and bedside reviews, facilitated communication among providers and improved adjudication of suspected SSIs,” she said in presenting the J. Maxwell Chamberlain Memorial Paper for Congenital Heart Surgery at the annual meeting of the Society of Thoracic Surgeons in San Diego earlier this year.

In total, 156 SSIs were identified via the STS-CHSD, 79 via the infection surveillance database, and 433 via billing. There was a significant decrease in the rolling 12-month SSI rate from 2.48% (21/848 in January 2013) to 0.76% (11/1,442 in January 2014), based on the STS-CHSD data, although Ms. Nayar pointed out that this decline could not definitely be attributed to reporting improvements or to the specific quality improvement initiatives that were implemented. Ms. Nayar also explained that there was a “general improvement in reporting, as shown by the stark drop in billing” and “a general alignment of all three data sources.”

“Accurate assessment of morbidity data, including [SSIs], has implications for public reporting, benchmarking, assessment of [quality improvement] impact, and possible denial of payments,” said Ms. Nayar. “In summary, we achieved our two simultaneous goals of improving SSI reporting – or decreasing the data errors – and decreasing SSI incidents by improving overall patient care.”

During discussion, Ms. Nayar elaborated on the study’s generalizability and potential application to other facets of congenital heart disease treatments, saying that such application is, in fact, possible.

“Yes, this is very generalizable, but one key important fact is relevant: As long as there is a source of truth for case ascertainment, this methodology can be used in several different areas,” she explained. “For example, we are currently working at our institution to integrate and link the [Pediatric Cardiac Critical Care Consortium] database to be able to better monitor any critical care–related morbidity information and ultimately use similar methodology to assess the impact of outcomes in the critical care field.”

Ms. Nayar said that she did not have any relevant financial conflicts of interest to disclose.

[email protected]

Surveillance of cardiac surgical site infections (SSIs) improved significantly when registry and infection control surveillance data were linked with electronic health records, a retrospective analysis showed.

Over the course of a 47-month period starting in 2011, Vaidehi Nayar of the Children’s Hospital of Philadelphia and her coinvestigators launched a quality improvement initiative at their institution that linked administrative databases with their clinical registry, allowing caregivers to more accurately monitor and assess SSIs and provide more effective adjudication and treatments thereafter. The investigators chose to link their hospital’s electronic health record (EHR) billing information and reporting from the infection surveillance database for the National Healthcare Safety Network with data from the Society of Thoracic Surgeons Congenital Heart Surgery Database (STS-CHSD).

To further facilitate the flow and interpretation of data, the investigators used a visualization tool to analyze the STS-CHSD for case ascertainment; to resolve discrepancies among STS-CHSD, infection surveillance, and billing SSI cases; and to assess the impact of the hospital’s quality improvement protocols. These protocols consisted of wound alert reports from the EHR, bedside reviews for SSI adjudication, inpatient and outpatient SSI prevention bundles, prophylactic antibiotic dosing changes, removal of steroids from the bypass circuit, and biller education on SSIs.

Control charts in the data visualization tool allowed for statistical monitoring of SSI rate changes, and SSI case discrepancies across the databases were reviewed to ensure that differences were the result of variations in SSI reporting criteria for each database, not inaccurate surveillance population ascertainment or inaccurate SSI identification, according to Ms. Nayar and her colleagues,

“Workflow changes, including the wound alert report and bedside reviews, facilitated communication among providers and improved adjudication of suspected SSIs,” she said in presenting the J. Maxwell Chamberlain Memorial Paper for Congenital Heart Surgery at the annual meeting of the Society of Thoracic Surgeons in San Diego earlier this year.

In total, 156 SSIs were identified via the STS-CHSD, 79 via the infection surveillance database, and 433 via billing. There was a significant decrease in the rolling 12-month SSI rate from 2.48% (21/848 in January 2013) to 0.76% (11/1,442 in January 2014), based on the STS-CHSD data, although Ms. Nayar pointed out that this decline could not definitely be attributed to reporting improvements or to the specific quality improvement initiatives that were implemented. Ms. Nayar also explained that there was a “general improvement in reporting, as shown by the stark drop in billing” and “a general alignment of all three data sources.”

“Accurate assessment of morbidity data, including [SSIs], has implications for public reporting, benchmarking, assessment of [quality improvement] impact, and possible denial of payments,” said Ms. Nayar. “In summary, we achieved our two simultaneous goals of improving SSI reporting – or decreasing the data errors – and decreasing SSI incidents by improving overall patient care.”

During discussion, Ms. Nayar elaborated on the study’s generalizability and potential application to other facets of congenital heart disease treatments, saying that such application is, in fact, possible.

“Yes, this is very generalizable, but one key important fact is relevant: As long as there is a source of truth for case ascertainment, this methodology can be used in several different areas,” she explained. “For example, we are currently working at our institution to integrate and link the [Pediatric Cardiac Critical Care Consortium] database to be able to better monitor any critical care–related morbidity information and ultimately use similar methodology to assess the impact of outcomes in the critical care field.”

Ms. Nayar said that she did not have any relevant financial conflicts of interest to disclose.

[email protected]

HOUSTON – For rituximab patients undergoing desensitization, mast cell degranulation is a more effective predictor of hypersensitive reactions (HSR) than are the traditionally employed skin tests, according to a study presented at the annual meeting of the American Academy of Allergy, Asthma, and Immunology.

“In this particular study, we were interested in investigating the roles of immunoglobulin E (IgE) in the mast cells in rituximab hypersensitivity,” said Dr. Johnson T. Wong of Massachusetts General Hospital, Boston, who presented the findings during a session dedicated to “Novel Insights in Drug Allergy.”

The study comprised 25 patients with persistent or severe rituximab sensitivity (RITS) who were treated at Massachusetts General between 2008 and 2013. Dr. Wong and his coinvestigators performed skin testing on 18 subjects, of which 7 (39%) reacted positively at least once during the course of testing.

HSR reactions occurred at similar rates in subjects who reacted positively and negatively to skin testing. Tryptase levels were taken in 18 subjects (72%), during 67% of the HSR desensitizations and 21% of the asymptomatic desensitizations.

Overall, elevated levels were noted in 21% of the HSR desensitizations.

The elevated tryptase levels in patients experiencing HSR indicates that mast cell degranulation is likely a major contributing factor in causing HSR, with cytokine release and tumor lysis also playing an important role, Dr. Wong said. Mast cell degranulations also points to an association with IgE mechanisms as a reliable indicator of HSR likelihood.

Dr. Wong and his coauthors concluded via tryptase level testing that asymptomatic mast cell degranulation happened very rarely, as only 1 out of 27 assessments (3%) indicated that result. One patient was excluded from the HSR desensitization cohort’s results because of probable mast cell activation syndrome, which caused abnormally elevated tryptase levels throughout the study period.

“In both positive and negative skin test patients, our desensitization protocol was able to reduce the reaction rate to less than 30%, so around 70% of patients had no reaction at all during desensitization,” said Dr. Wong, adding that nearly all desensitizations were completed successfully.

Dr. Wong had no disclosures.

[email protected]

HOUSTON – For rituximab patients undergoing desensitization, mast cell degranulation is a more effective predictor of hypersensitive reactions (HSR) than are the traditionally employed skin tests, according to a study presented at the annual meeting of the American Academy of Allergy, Asthma, and Immunology.

“In this particular study, we were interested in investigating the roles of immunoglobulin E (IgE) in the mast cells in rituximab hypersensitivity,” said Dr. Johnson T. Wong of Massachusetts General Hospital, Boston, who presented the findings during a session dedicated to “Novel Insights in Drug Allergy.”

The study comprised 25 patients with persistent or severe rituximab sensitivity (RITS) who were treated at Massachusetts General between 2008 and 2013. Dr. Wong and his coinvestigators performed skin testing on 18 subjects, of which 7 (39%) reacted positively at least once during the course of testing.

HSR reactions occurred at similar rates in subjects who reacted positively and negatively to skin testing. Tryptase levels were taken in 18 subjects (72%), during 67% of the HSR desensitizations and 21% of the asymptomatic desensitizations.

Overall, elevated levels were noted in 21% of the HSR desensitizations.

The elevated tryptase levels in patients experiencing HSR indicates that mast cell degranulation is likely a major contributing factor in causing HSR, with cytokine release and tumor lysis also playing an important role, Dr. Wong said. Mast cell degranulations also points to an association with IgE mechanisms as a reliable indicator of HSR likelihood.

Dr. Wong and his coauthors concluded via tryptase level testing that asymptomatic mast cell degranulation happened very rarely, as only 1 out of 27 assessments (3%) indicated that result. One patient was excluded from the HSR desensitization cohort’s results because of probable mast cell activation syndrome, which caused abnormally elevated tryptase levels throughout the study period.

“In both positive and negative skin test patients, our desensitization protocol was able to reduce the reaction rate to less than 30%, so around 70% of patients had no reaction at all during desensitization,” said Dr. Wong, adding that nearly all desensitizations were completed successfully.

Dr. Wong had no disclosures.

[email protected]

HOUSTON – For rituximab patients undergoing desensitization, mast cell degranulation is a more effective predictor of hypersensitive reactions (HSR) than are the traditionally employed skin tests, according to a study presented at the annual meeting of the American Academy of Allergy, Asthma, and Immunology.

“In this particular study, we were interested in investigating the roles of immunoglobulin E (IgE) in the mast cells in rituximab hypersensitivity,” said Dr. Johnson T. Wong of Massachusetts General Hospital, Boston, who presented the findings during a session dedicated to “Novel Insights in Drug Allergy.”

The study comprised 25 patients with persistent or severe rituximab sensitivity (RITS) who were treated at Massachusetts General between 2008 and 2013. Dr. Wong and his coinvestigators performed skin testing on 18 subjects, of which 7 (39%) reacted positively at least once during the course of testing.

HSR reactions occurred at similar rates in subjects who reacted positively and negatively to skin testing. Tryptase levels were taken in 18 subjects (72%), during 67% of the HSR desensitizations and 21% of the asymptomatic desensitizations.

Overall, elevated levels were noted in 21% of the HSR desensitizations.

The elevated tryptase levels in patients experiencing HSR indicates that mast cell degranulation is likely a major contributing factor in causing HSR, with cytokine release and tumor lysis also playing an important role, Dr. Wong said. Mast cell degranulations also points to an association with IgE mechanisms as a reliable indicator of HSR likelihood.

Dr. Wong and his coauthors concluded via tryptase level testing that asymptomatic mast cell degranulation happened very rarely, as only 1 out of 27 assessments (3%) indicated that result. One patient was excluded from the HSR desensitization cohort’s results because of probable mast cell activation syndrome, which caused abnormally elevated tryptase levels throughout the study period.

“In both positive and negative skin test patients, our desensitization protocol was able to reduce the reaction rate to less than 30%, so around 70% of patients had no reaction at all during desensitization,” said Dr. Wong, adding that nearly all desensitizations were completed successfully.

Dr. Wong had no disclosures.

[email protected]

Despite birth rates among American teenagers continuing to decrease in recent years, not enough sexually active teens know of and use LARC, which the Centers for Disease Control and Prevention calls the most effective type of reversible birth control currently available and is highlighting in their latest Vital Signs report.

Long-acting reversible contraception (LARC) is a contraceptive method that involves using either an intrauterine device (IUD) or an implant to prevent pregnancy. The IUD comes in hormonal and copper variants; the former releases progestin in the uterus and can be effective for up to 5 years, while the latter is effective for up to 10 years. The LARC implant is a device placed into a patient’s arm, secreting progestin to stop ovulation; it lasts 3 years.

“Nearly 90% of teens used birth control the last time they had sex, [but] most teens used condoms and birth control pills, which are not always used consistently or correctly,” CDC Principal Deputy Director Ileana Arias, Ph.D., said during a media telebriefing, stressing that LARC is entirely reversible and that studies have shown that fewer than 1% of women become pregnant in their first year of using LARC.

According to findings made by the Title X Family Planning program in a study undertaken jointly by the CDC and the Department of Health and Human Services’ Office of Population Affairs (OPA), there were more than 273,000 infants born to parents aged 15-19 years in 2013. However, more teens are abstaining from sex, and higher numbers of teens who are sexually active are using contraceptives. LARC is proving popular in certain states, particularly Colorado, where 26% of teens used it in 2013, while rates in other states ranged from less than 1% to 20%.

Nationwide, LARC usage increased from 0.4% to 7.1% between 2005 and 2013, with implants being favored more than IUDs: Of 616,148 female teens seeking contraception in 2013, 4.3% used implants and 2.8% used IUDs. LARC was more popular in older teens (aged 18-19 years) than younger teens (aged 15-17 years), with 7.6% of older teens using LARC, compared with only 6.5% of younger teens (P < .001).

Dr. Arias highlighted the need for more outreach and awareness of LARC, putting the onus on domestic health care professionals to ensure that teenagers across the nation have all the resources they need to make informed decisions about birth control. To do this, she explained, requires dispelling misconceptions and eliminating barriers that stand in the way of teens having access to LARC.

In a press release, the CDC noted that clinics have reported high upfront costs for LARC supplies, lack of training, and “misplaced concerns about the safety and appropriateness of LARC for teens” as the main obstacles standing in the way of more pervasive LARC adoption. Furthermore, teenagers themselves often know very little, if anything, about LARC, and often think they can’t use it because of their age.

“Health care professionals [can] encourage teens not to have sex and discuss the use of IUDs and implants as contraceptive options available to teens who choose to be sexually active,” Dr. Arias said in a statement. “[LARC] is safe for teens, easy to use, and very effective [and] we need to remove barriers and increase awareness, access, and availability of long-acting reversible contraception such as IUDs and implants.”

Dr. Arias’s sentiments were echoed by the American College of Obstetricians and Gynecologists, which lauded the CDC’s ongoing efforts to promote LARCs efficacy and safety to American teenagers.

“Obstetrician-gynecologists play an integral role in reducing teen pregnancy rates through increased education and access to birth control [and] we firmly believe that increased adoption of [LARC] methods can play a role in reducing unintended pregnancy,” Dr. Hal C. Lawrence, ACOG CEO and executive vice president, said in a statement. He added that, “data have demonstrated that LARC methods of birth control are just as safe and as effective when used by adolescents as adults. That’s why ACOG recommends use of LARC in its committee opinion #539 entitled, ‘Adolescents and Long-Acting Reversible Contraception: Implants and Intrauterine Devices’ (Obstet. Gynecol. 2012;120:983-8).”

Despite birth rates among American teenagers continuing to decrease in recent years, not enough sexually active teens know of and use LARC, which the Centers for Disease Control and Prevention calls the most effective type of reversible birth control currently available and is highlighting in their latest Vital Signs report.

Long-acting reversible contraception (LARC) is a contraceptive method that involves using either an intrauterine device (IUD) or an implant to prevent pregnancy. The IUD comes in hormonal and copper variants; the former releases progestin in the uterus and can be effective for up to 5 years, while the latter is effective for up to 10 years. The LARC implant is a device placed into a patient’s arm, secreting progestin to stop ovulation; it lasts 3 years.

“Nearly 90% of teens used birth control the last time they had sex, [but] most teens used condoms and birth control pills, which are not always used consistently or correctly,” CDC Principal Deputy Director Ileana Arias, Ph.D., said during a media telebriefing, stressing that LARC is entirely reversible and that studies have shown that fewer than 1% of women become pregnant in their first year of using LARC.

According to findings made by the Title X Family Planning program in a study undertaken jointly by the CDC and the Department of Health and Human Services’ Office of Population Affairs (OPA), there were more than 273,000 infants born to parents aged 15-19 years in 2013. However, more teens are abstaining from sex, and higher numbers of teens who are sexually active are using contraceptives. LARC is proving popular in certain states, particularly Colorado, where 26% of teens used it in 2013, while rates in other states ranged from less than 1% to 20%.

Nationwide, LARC usage increased from 0.4% to 7.1% between 2005 and 2013, with implants being favored more than IUDs: Of 616,148 female teens seeking contraception in 2013, 4.3% used implants and 2.8% used IUDs. LARC was more popular in older teens (aged 18-19 years) than younger teens (aged 15-17 years), with 7.6% of older teens using LARC, compared with only 6.5% of younger teens (P < .001).

Dr. Arias highlighted the need for more outreach and awareness of LARC, putting the onus on domestic health care professionals to ensure that teenagers across the nation have all the resources they need to make informed decisions about birth control. To do this, she explained, requires dispelling misconceptions and eliminating barriers that stand in the way of teens having access to LARC.

In a press release, the CDC noted that clinics have reported high upfront costs for LARC supplies, lack of training, and “misplaced concerns about the safety and appropriateness of LARC for teens” as the main obstacles standing in the way of more pervasive LARC adoption. Furthermore, teenagers themselves often know very little, if anything, about LARC, and often think they can’t use it because of their age.

“Health care professionals [can] encourage teens not to have sex and discuss the use of IUDs and implants as contraceptive options available to teens who choose to be sexually active,” Dr. Arias said in a statement. “[LARC] is safe for teens, easy to use, and very effective [and] we need to remove barriers and increase awareness, access, and availability of long-acting reversible contraception such as IUDs and implants.”

Dr. Arias’s sentiments were echoed by the American College of Obstetricians and Gynecologists, which lauded the CDC’s ongoing efforts to promote LARCs efficacy and safety to American teenagers.

“Obstetrician-gynecologists play an integral role in reducing teen pregnancy rates through increased education and access to birth control [and] we firmly believe that increased adoption of [LARC] methods can play a role in reducing unintended pregnancy,” Dr. Hal C. Lawrence, ACOG CEO and executive vice president, said in a statement. He added that, “data have demonstrated that LARC methods of birth control are just as safe and as effective when used by adolescents as adults. That’s why ACOG recommends use of LARC in its committee opinion #539 entitled, ‘Adolescents and Long-Acting Reversible Contraception: Implants and Intrauterine Devices’ (Obstet. Gynecol. 2012;120:983-8).”

Despite birth rates among American teenagers continuing to decrease in recent years, not enough sexually active teens know of and use LARC, which the Centers for Disease Control and Prevention calls the most effective type of reversible birth control currently available and is highlighting in their latest Vital Signs report.

Long-acting reversible contraception (LARC) is a contraceptive method that involves using either an intrauterine device (IUD) or an implant to prevent pregnancy. The IUD comes in hormonal and copper variants; the former releases progestin in the uterus and can be effective for up to 5 years, while the latter is effective for up to 10 years. The LARC implant is a device placed into a patient’s arm, secreting progestin to stop ovulation; it lasts 3 years.

“Nearly 90% of teens used birth control the last time they had sex, [but] most teens used condoms and birth control pills, which are not always used consistently or correctly,” CDC Principal Deputy Director Ileana Arias, Ph.D., said during a media telebriefing, stressing that LARC is entirely reversible and that studies have shown that fewer than 1% of women become pregnant in their first year of using LARC.

According to findings made by the Title X Family Planning program in a study undertaken jointly by the CDC and the Department of Health and Human Services’ Office of Population Affairs (OPA), there were more than 273,000 infants born to parents aged 15-19 years in 2013. However, more teens are abstaining from sex, and higher numbers of teens who are sexually active are using contraceptives. LARC is proving popular in certain states, particularly Colorado, where 26% of teens used it in 2013, while rates in other states ranged from less than 1% to 20%.

Nationwide, LARC usage increased from 0.4% to 7.1% between 2005 and 2013, with implants being favored more than IUDs: Of 616,148 female teens seeking contraception in 2013, 4.3% used implants and 2.8% used IUDs. LARC was more popular in older teens (aged 18-19 years) than younger teens (aged 15-17 years), with 7.6% of older teens using LARC, compared with only 6.5% of younger teens (P < .001).

Dr. Arias highlighted the need for more outreach and awareness of LARC, putting the onus on domestic health care professionals to ensure that teenagers across the nation have all the resources they need to make informed decisions about birth control. To do this, she explained, requires dispelling misconceptions and eliminating barriers that stand in the way of teens having access to LARC.

In a press release, the CDC noted that clinics have reported high upfront costs for LARC supplies, lack of training, and “misplaced concerns about the safety and appropriateness of LARC for teens” as the main obstacles standing in the way of more pervasive LARC adoption. Furthermore, teenagers themselves often know very little, if anything, about LARC, and often think they can’t use it because of their age.

“Health care professionals [can] encourage teens not to have sex and discuss the use of IUDs and implants as contraceptive options available to teens who choose to be sexually active,” Dr. Arias said in a statement. “[LARC] is safe for teens, easy to use, and very effective [and] we need to remove barriers and increase awareness, access, and availability of long-acting reversible contraception such as IUDs and implants.”

Dr. Arias’s sentiments were echoed by the American College of Obstetricians and Gynecologists, which lauded the CDC’s ongoing efforts to promote LARCs efficacy and safety to American teenagers.

“Obstetrician-gynecologists play an integral role in reducing teen pregnancy rates through increased education and access to birth control [and] we firmly believe that increased adoption of [LARC] methods can play a role in reducing unintended pregnancy,” Dr. Hal C. Lawrence, ACOG CEO and executive vice president, said in a statement. He added that, “data have demonstrated that LARC methods of birth control are just as safe and as effective when used by adolescents as adults. That’s why ACOG recommends use of LARC in its committee opinion #539 entitled, ‘Adolescents and Long-Acting Reversible Contraception: Implants and Intrauterine Devices’ (Obstet. Gynecol. 2012;120:983-8).”

Despite birth rates among American teenagers continuing to decrease in recent years, not enough sexually active teens know of and use LARC, which the Centers for Disease Control and Prevention calls the most effective type of reversible birth control currently available and is highlighting in their latest Vital Signs report.

Long-acting reversible contraception (LARC) is a contraceptive method that involves using either an intrauterine device (IUD) or an implant to prevent pregnancy. The IUD comes in hormonal and copper variants; the former releases progestin in the uterus and can be effective for up to 5 years, while the latter is effective for up to 10 years. The LARC implant is a device placed into a patient’s arm, secreting progestin to stop ovulation; it lasts 3 years.

“Nearly 90% of teens used birth control the last time they had sex, [but] most teens used condoms and birth control pills, which are not always used consistently or correctly,” CDC Principal Deputy Director Ileana Arias, Ph.D., said during a media telebriefing, stressing that LARC is entirely reversible and that studies have shown that fewer than 1% of women become pregnant in their first year of using LARC.

According to findings made by the Title X Family Planning program in a study undertaken jointly by the CDC and the Department of Health and Human Services’ Office of Population Affairs (OPA), there were more than 273,000 infants born to parents aged 15-19 years in 2013. However, more teens are abstaining from sex, and higher numbers of teens who are sexually active are using contraceptives. LARC is proving popular in certain states, particularly Colorado, where 26% of teens used it in 2013, while rates in other states ranged from less than 1% to 20%.

Nationwide, LARC usage increased from 0.4% to 7.1% between 2005 and 2013, with implants being favored more than IUDs: Of 616,148 female teens seeking contraception in 2013, 4.3% used implants and 2.8% used IUDs. LARC was more popular in older teens (aged 18-19 years) than younger teens (aged 15-17 years), with 7.6% of older teens using LARC, compared with only 6.5% of younger teens (P < .001).

Dr. Arias highlighted the need for more outreach and awareness of LARC, putting the onus on domestic health care professionals to ensure that teenagers across the nation have all the resources they need to make informed decisions about birth control. To do this, she explained, requires dispelling misconceptions and eliminating barriers that stand in the way of teens having access to LARC.

In a press release, the CDC noted that clinics have reported high upfront costs for LARC supplies, lack of training, and “misplaced concerns about the safety and appropriateness of LARC for teens” as the main obstacles standing in the way of more pervasive LARC adoption. Furthermore, teenagers themselves often know very little, if anything, about LARC, and often think they can’t use it because of their age.

“Health care professionals [can] encourage teens not to have sex and discuss the use of IUDs and implants as contraceptive options available to teens who choose to be sexually active,” Dr. Arias said in a statement. “[LARC] is safe for teens, easy to use, and very effective [and] we need to remove barriers and increase awareness, access, and availability of long-acting reversible contraception such as IUDs and implants.”

Dr. Arias’s sentiments were echoed by the American College of Obstetricians and Gynecologists, which lauded the CDC’s ongoing efforts to promote LARCs efficacy and safety to American teenagers.

“Obstetrician-gynecologists play an integral role in reducing teen pregnancy rates through increased education and access to birth control [and] we firmly believe that increased adoption of [LARC] methods can play a role in reducing unintended pregnancy,” Dr. Hal C. Lawrence, ACOG CEO and executive vice president, said in a statement. He added that, “data have demonstrated that LARC methods of birth control are just as safe and as effective when used by adolescents as adults. That’s why ACOG recommends use of LARC in its committee opinion #539 entitled, ‘Adolescents and Long-Acting Reversible Contraception: Implants and Intrauterine Devices’ (Obstet. Gynecol. 2012;120:983-8).”

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Despite birth rates among American teenagers continuing to decrease in recent years, not enough sexually active teens know of and use LARC, which the Centers for Disease Control and Prevention calls the most effective type of reversible birth control currently available and is highlighting in their latest Vital Signs report.

Long-acting reversible contraception (LARC) is a contraceptive method that involves using either an intrauterine device (IUD) or an implant to prevent pregnancy. The IUD comes in hormonal and copper variants; the former releases progestin in the uterus and can be effective for up to 5 years, while the latter is effective for up to 10 years. The LARC implant is a device placed into a patient’s arm, secreting progestin to stop ovulation; it lasts 3 years.

“Nearly 90% of teens used birth control the last time they had sex, [but] most teens used condoms and birth control pills, which are not always used consistently or correctly,” CDC Principal Deputy Director Ileana Arias, Ph.D., said during a media telebriefing, stressing that LARC is entirely reversible and that studies have shown that fewer than 1% of women become pregnant in their first year of using LARC.

According to findings made by the Title X Family Planning program in a study undertaken jointly by the CDC and the Department of Health and Human Services’ Office of Population Affairs (OPA), there were more than 273,000 infants born to parents aged 15-19 years in 2013. However, more teens are abstaining from sex, and higher numbers of teens who are sexually active are using contraceptives. LARC is proving popular in certain states, particularly Colorado, where 26% of teens used it in 2013, while rates in other states ranged from less than 1% to 20%.

Nationwide, LARC usage increased from 0.4% to 7.1% between 2005 and 2013, with implants being favored more than IUDs: Of 616,148 female teens seeking contraception in 2013, 4.3% used implants and 2.8% used IUDs. LARC was more popular in older teens (aged 18-19 years) than younger teens (aged 15-17 years), with 7.6% of older teens using LARC, compared with only 6.5% of younger teens (P < .001).

Dr. Arias highlighted the need for more outreach and awareness of LARC, putting the onus on domestic health care professionals to ensure that teenagers across the nation have all the resources they need to make informed decisions about birth control. To do this, she explained, requires dispelling misconceptions and eliminating barriers that stand in the way of teens having access to LARC.

In a press release, the CDC noted that clinics have reported high upfront costs for LARC supplies, lack of training, and “misplaced concerns about the safety and appropriateness of LARC for teens” as the main obstacles standing in the way of more pervasive LARC adoption. Furthermore, teenagers themselves often know very little, if anything, about LARC, and often think they can’t use it because of their age.

“Health care professionals [can] encourage teens not to have sex and discuss the use of IUDs and implants as contraceptive options available to teens who choose to be sexually active,” Dr. Arias said in a statement. “[LARC] is safe for teens, easy to use, and very effective [and] we need to remove barriers and increase awareness, access, and availability of long-acting reversible contraception such as IUDs and implants.”

Dr. Arias’s sentiments were echoed by the American College of Obstetricians and Gynecologists, which lauded the CDC’s ongoing efforts to promote LARCs efficacy and safety to American teenagers.

“Obstetrician-gynecologists play an integral role in reducing teen pregnancy rates through increased education and access to birth control [and] we firmly believe that increased adoption of [LARC] methods can play a role in reducing unintended pregnancy,” Dr. Hal C. Lawrence, ACOG CEO and executive vice president, said in a statement. He added that, “data have demonstrated that LARC methods of birth control are just as safe and as effective when used by adolescents as adults. That’s why ACOG recommends use of LARC in its committee opinion #539 entitled, ‘Adolescents and Long-Acting Reversible Contraception: Implants and Intrauterine Devices’ (Obstet. Gynecol. 2012;120:983-8).”

[email protected]

Despite birth rates among American teenagers continuing to decrease in recent years, not enough sexually active teens know of and use LARC, which the Centers for Disease Control and Prevention calls the most effective type of reversible birth control currently available and is highlighting in their latest Vital Signs report.

Long-acting reversible contraception (LARC) is a contraceptive method that involves using either an intrauterine device (IUD) or an implant to prevent pregnancy. The IUD comes in hormonal and copper variants; the former releases progestin in the uterus and can be effective for up to 5 years, while the latter is effective for up to 10 years. The LARC implant is a device placed into a patient’s arm, secreting progestin to stop ovulation; it lasts 3 years.

“Nearly 90% of teens used birth control the last time they had sex, [but] most teens used condoms and birth control pills, which are not always used consistently or correctly,” CDC Principal Deputy Director Ileana Arias, Ph.D., said during a media telebriefing, stressing that LARC is entirely reversible and that studies have shown that fewer than 1% of women become pregnant in their first year of using LARC.

According to findings made by the Title X Family Planning program in a study undertaken jointly by the CDC and the Department of Health and Human Services’ Office of Population Affairs (OPA), there were more than 273,000 infants born to parents aged 15-19 years in 2013. However, more teens are abstaining from sex, and higher numbers of teens who are sexually active are using contraceptives. LARC is proving popular in certain states, particularly Colorado, where 26% of teens used it in 2013, while rates in other states ranged from less than 1% to 20%.

Nationwide, LARC usage increased from 0.4% to 7.1% between 2005 and 2013, with implants being favored more than IUDs: Of 616,148 female teens seeking contraception in 2013, 4.3% used implants and 2.8% used IUDs. LARC was more popular in older teens (aged 18-19 years) than younger teens (aged 15-17 years), with 7.6% of older teens using LARC, compared with only 6.5% of younger teens (P < .001).

Dr. Arias highlighted the need for more outreach and awareness of LARC, putting the onus on domestic health care professionals to ensure that teenagers across the nation have all the resources they need to make informed decisions about birth control. To do this, she explained, requires dispelling misconceptions and eliminating barriers that stand in the way of teens having access to LARC.

In a press release, the CDC noted that clinics have reported high upfront costs for LARC supplies, lack of training, and “misplaced concerns about the safety and appropriateness of LARC for teens” as the main obstacles standing in the way of more pervasive LARC adoption. Furthermore, teenagers themselves often know very little, if anything, about LARC, and often think they can’t use it because of their age.

“Health care professionals [can] encourage teens not to have sex and discuss the use of IUDs and implants as contraceptive options available to teens who choose to be sexually active,” Dr. Arias said in a statement. “[LARC] is safe for teens, easy to use, and very effective [and] we need to remove barriers and increase awareness, access, and availability of long-acting reversible contraception such as IUDs and implants.”

Dr. Arias’s sentiments were echoed by the American College of Obstetricians and Gynecologists, which lauded the CDC’s ongoing efforts to promote LARCs efficacy and safety to American teenagers.

“Obstetrician-gynecologists play an integral role in reducing teen pregnancy rates through increased education and access to birth control [and] we firmly believe that increased adoption of [LARC] methods can play a role in reducing unintended pregnancy,” Dr. Hal C. Lawrence, ACOG CEO and executive vice president, said in a statement. He added that, “data have demonstrated that LARC methods of birth control are just as safe and as effective when used by adolescents as adults. That’s why ACOG recommends use of LARC in its committee opinion #539 entitled, ‘Adolescents and Long-Acting Reversible Contraception: Implants and Intrauterine Devices’ (Obstet. Gynecol. 2012;120:983-8).”

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The United States is currently experiencing an outbreak of shigellosis caused by a strain of the Shigella sonnei bacteria that is resistant to ciprofloxacin, the most commonly prescribed antimicrobial treatment for shigellosis.

In its Morbidity and Mortality Weekly Report, the CDC revealed that 243 individuals in 32 states and the territory of Puerto Rico have come down with shigellosis between May 2014 and February 2015. Of those 243 cases, 126 isolates were tested and 109 (87%) of those were found to be nonsusceptible to ciprofloxacin. The largest clusters of the disease were found in Massachusetts (45 cases), California (25 cases), and Pennsylvania (18 cases).

©CDC

Ninety-five of the cases associated with the current outbreak were traced back to the homeless population of San Francisco; about half of the remaining cases were attributed to international travelers – specifically, those visiting the Dominican Republic and India – who contracted the bacteria while abroad and unknowingly brought it to the United States. The disease is known to spread quickly in populations of children who attend child care facilities, homeless individuals, and men who have sex with men.

“These outbreaks show a troubling trend in Shigella infections in the United States,” Dr. Thomas Frieden, CDC director, said in a statement. “Drug-resistant infections are harder to treat and because Shigella spreads so easily between people, the potential for more – and larger – outbreaks is a real concern. We’re moving quickly to implement a national strategy to curb antibiotic resistance because we can’t take for granted that we’ll always have the drugs we need to fight common infections.”

Shigellosis causes an estimated 500,000 cases of diarrhea in the United States each year. To help curb the growing number of shigellosis cases, the CDC recommends that international travelers wash their hands meticulously while abroad, and follow strict dietary precautions, such as eating hot foods and drinking beverages only from sealed containers, especially when consuming water.

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The United States is currently experiencing an outbreak of shigellosis caused by a strain of the Shigella sonnei bacteria that is resistant to ciprofloxacin, the most commonly prescribed antimicrobial treatment for shigellosis.

In its Morbidity and Mortality Weekly Report, the CDC revealed that 243 individuals in 32 states and the territory of Puerto Rico have come down with shigellosis between May 2014 and February 2015. Of those 243 cases, 126 isolates were tested and 109 (87%) of those were found to be nonsusceptible to ciprofloxacin. The largest clusters of the disease were found in Massachusetts (45 cases), California (25 cases), and Pennsylvania (18 cases).

©CDC

Ninety-five of the cases associated with the current outbreak were traced back to the homeless population of San Francisco; about half of the remaining cases were attributed to international travelers – specifically, those visiting the Dominican Republic and India – who contracted the bacteria while abroad and unknowingly brought it to the United States. The disease is known to spread quickly in populations of children who attend child care facilities, homeless individuals, and men who have sex with men.

“These outbreaks show a troubling trend in Shigella infections in the United States,” Dr. Thomas Frieden, CDC director, said in a statement. “Drug-resistant infections are harder to treat and because Shigella spreads so easily between people, the potential for more – and larger – outbreaks is a real concern. We’re moving quickly to implement a national strategy to curb antibiotic resistance because we can’t take for granted that we’ll always have the drugs we need to fight common infections.”

Shigellosis causes an estimated 500,000 cases of diarrhea in the United States each year. To help curb the growing number of shigellosis cases, the CDC recommends that international travelers wash their hands meticulously while abroad, and follow strict dietary precautions, such as eating hot foods and drinking beverages only from sealed containers, especially when consuming water.

[email protected]

The United States is currently experiencing an outbreak of shigellosis caused by a strain of the Shigella sonnei bacteria that is resistant to ciprofloxacin, the most commonly prescribed antimicrobial treatment for shigellosis.

In its Morbidity and Mortality Weekly Report, the CDC revealed that 243 individuals in 32 states and the territory of Puerto Rico have come down with shigellosis between May 2014 and February 2015. Of those 243 cases, 126 isolates were tested and 109 (87%) of those were found to be nonsusceptible to ciprofloxacin. The largest clusters of the disease were found in Massachusetts (45 cases), California (25 cases), and Pennsylvania (18 cases).

©CDC

Ninety-five of the cases associated with the current outbreak were traced back to the homeless population of San Francisco; about half of the remaining cases were attributed to international travelers – specifically, those visiting the Dominican Republic and India – who contracted the bacteria while abroad and unknowingly brought it to the United States. The disease is known to spread quickly in populations of children who attend child care facilities, homeless individuals, and men who have sex with men.

“These outbreaks show a troubling trend in Shigella infections in the United States,” Dr. Thomas Frieden, CDC director, said in a statement. “Drug-resistant infections are harder to treat and because Shigella spreads so easily between people, the potential for more – and larger – outbreaks is a real concern. We’re moving quickly to implement a national strategy to curb antibiotic resistance because we can’t take for granted that we’ll always have the drugs we need to fight common infections.”

Shigellosis causes an estimated 500,000 cases of diarrhea in the United States each year. To help curb the growing number of shigellosis cases, the CDC recommends that international travelers wash their hands meticulously while abroad, and follow strict dietary precautions, such as eating hot foods and drinking beverages only from sealed containers, especially when consuming water.

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HOUSTON– Given the low incidence of adverse drug reactions to cephalosporin antibiotics among nearly a million California health plan patients, patients with a history of penicillin allergy can safely be given cephalosporins, according to Dr. Eric M. Macy.

The recommendation is based on the findings of a retrospective, population-based analysis of the records of 949,323 Kaiser Permanente Southern California health plan members, which was presented by Dr. Macy, of the Kaiser Permanente Medical Center in San Diego, at the annual meeting of the American Academy of Allergy, Asthma, and Immunology.

Dr. Macy and his colleagues examined the records of 622,456 health plan members who were given 901,908 regimens of oral cephalosporins and 326,867 members given 487,630 parenteral cephalosporin regimens between Jan. 1, 2010, and Dec. 31, 2012.

Clostridium difficile infection within 90 days, nephropathy within 30 days, and all-cause death within 1 day were the most common cephalosporin-associated adverse drug reactions (ADRs) reported by physicians, with rates of 0.91%, 0.15%, and 0.10%, respectively. Cephalosporin-associated anaphylaxis was documented by physicians a total of five times in oral patients and eight times in parenteral patients (P = .0761), while only three serious cutaneous adverse reactions (SCARs) were recorded. All of those SCARS were attributable to other antibiotics taken at the same time as the cephalosporins, according to Dr. Macy.

Patients who reported developing new cephalosporin allergies over the course of the study period were significantly more likely to be female than male: 0.56% vs. 0.43% (P < .0001). And patients with a history of penicillin allergy were more likely to report a new cephalosporin allergy within 30 days than patients with no drug allergy, another cephalosporin allergy, or a non–beta-lactam allergy.

The numbers are smaller than those reported recently in the American Journal of Medicine (2009;122: 778.e1–7), Dr. Macy noted, “because there it was new allergy reports in the year after any cephalosporin exposure, as opposed to our new report, which looks at reactions within 30 days of exposure.”

Dr. Macy disclosed that he has received research support from ALK and BioMarin.

[email protected]

HOUSTON– Given the low incidence of adverse drug reactions to cephalosporin antibiotics among nearly a million California health plan patients, patients with a history of penicillin allergy can safely be given cephalosporins, according to Dr. Eric M. Macy.

The recommendation is based on the findings of a retrospective, population-based analysis of the records of 949,323 Kaiser Permanente Southern California health plan members, which was presented by Dr. Macy, of the Kaiser Permanente Medical Center in San Diego, at the annual meeting of the American Academy of Allergy, Asthma, and Immunology.

Dr. Macy and his colleagues examined the records of 622,456 health plan members who were given 901,908 regimens of oral cephalosporins and 326,867 members given 487,630 parenteral cephalosporin regimens between Jan. 1, 2010, and Dec. 31, 2012.

Clostridium difficile infection within 90 days, nephropathy within 30 days, and all-cause death within 1 day were the most common cephalosporin-associated adverse drug reactions (ADRs) reported by physicians, with rates of 0.91%, 0.15%, and 0.10%, respectively. Cephalosporin-associated anaphylaxis was documented by physicians a total of five times in oral patients and eight times in parenteral patients (P = .0761), while only three serious cutaneous adverse reactions (SCARs) were recorded. All of those SCARS were attributable to other antibiotics taken at the same time as the cephalosporins, according to Dr. Macy.

Patients who reported developing new cephalosporin allergies over the course of the study period were significantly more likely to be female than male: 0.56% vs. 0.43% (P < .0001). And patients with a history of penicillin allergy were more likely to report a new cephalosporin allergy within 30 days than patients with no drug allergy, another cephalosporin allergy, or a non–beta-lactam allergy.

The numbers are smaller than those reported recently in the American Journal of Medicine (2009;122: 778.e1–7), Dr. Macy noted, “because there it was new allergy reports in the year after any cephalosporin exposure, as opposed to our new report, which looks at reactions within 30 days of exposure.”

Dr. Macy disclosed that he has received research support from ALK and BioMarin.

[email protected]

HOUSTON– Given the low incidence of adverse drug reactions to cephalosporin antibiotics among nearly a million California health plan patients, patients with a history of penicillin allergy can safely be given cephalosporins, according to Dr. Eric M. Macy.

The recommendation is based on the findings of a retrospective, population-based analysis of the records of 949,323 Kaiser Permanente Southern California health plan members, which was presented by Dr. Macy, of the Kaiser Permanente Medical Center in San Diego, at the annual meeting of the American Academy of Allergy, Asthma, and Immunology.

Dr. Macy and his colleagues examined the records of 622,456 health plan members who were given 901,908 regimens of oral cephalosporins and 326,867 members given 487,630 parenteral cephalosporin regimens between Jan. 1, 2010, and Dec. 31, 2012.

Clostridium difficile infection within 90 days, nephropathy within 30 days, and all-cause death within 1 day were the most common cephalosporin-associated adverse drug reactions (ADRs) reported by physicians, with rates of 0.91%, 0.15%, and 0.10%, respectively. Cephalosporin-associated anaphylaxis was documented by physicians a total of five times in oral patients and eight times in parenteral patients (P = .0761), while only three serious cutaneous adverse reactions (SCARs) were recorded. All of those SCARS were attributable to other antibiotics taken at the same time as the cephalosporins, according to Dr. Macy.

Patients who reported developing new cephalosporin allergies over the course of the study period were significantly more likely to be female than male: 0.56% vs. 0.43% (P < .0001). And patients with a history of penicillin allergy were more likely to report a new cephalosporin allergy within 30 days than patients with no drug allergy, another cephalosporin allergy, or a non–beta-lactam allergy.

The numbers are smaller than those reported recently in the American Journal of Medicine (2009;122: 778.e1–7), Dr. Macy noted, “because there it was new allergy reports in the year after any cephalosporin exposure, as opposed to our new report, which looks at reactions within 30 days of exposure.”

Dr. Macy disclosed that he has received research support from ALK and BioMarin.

[email protected]