Joseph M. Campos

Comparison of Urine Dipstick, Microscopy, and Culture for the Detection of Bacteriuria in Children

The authors compared dipstick tests for leukocyte esterase and nitrite and microscopic examination of urinary sediment with urine culture to assess whether the former tests could reliably rule out bacteriuria in specimens from children. The authors studied urine specimens from 1010 infants and children younger than age 18. Compared with culture at ≥105 colony forming units (cfu)/ml, the sensitivities of leukocyte esterase, nitrite, and microscopic examination of white blood cells (≥5 wbc/hpf) or bacteria (in at least moderate numbers) were 76 percent, 29 percent, 82 percent, and 80 percent, respectively. The specificities of the same tests were 81 percent, 99 percent, 81 percent, and 83 percent, respectively. Compared with culture at ≥104 cfu/ml, the sensitivities of the tests were 64 percent, 21 percent, 64 percent, and 59 percent; the specificities were 82 percent, 99 percent, 81 percent, and 83 percent, respectively. The negative predictive values of leukocyte esterase and microscopic examinations of urinary sediment for white blood cells and bacteria were all 95 percent (≥104 cfu/ml) or 98 percent (≥105 cfu/ml). The authors conclude that the leukocyte esterase test is as accurate as sediment microscopy in identifying urine specimens from infants and children harboring <10 4 or <105 cfu/ml.

A stepwise approach to control an outbreak and ongoing transmission of methicillin-resistant Staphylococcus aureus in a neonatal intensive care unit

BACKGROUND Preventing methicillin-resistant Staphylococcus aureus (MRSA) transmission in health care facilities where MRSA is endemic is challenging yet critical. OBJECTIVE We sought to determine the effectiveness of 2 bundles of interventions for preventing MRSA transmission in a neonatal intensive care unit (NICU). METHODS This retrospective cohort study included infants admitted to our NICU between September 1, 2004, and March 31, 2009. Following a MRSA outbreak between September 2004 and September 2005, preventing ongoing MRSA transmission remained a challenge. In July 2006, bundle-I, including culture-based active surveillance, preemptive contact precaution for up to 72 hours for new admissions, and cohorting assignment of direct caregivers was introduced for eradicating MRSA transmission. Bundle-II began in April 2007 and included bundle-1 measures except that the real-time polymerase chain reaction test replaced culture for the detection of MRSA. RESULTS This study identified 218 infants who developed MRSA infection or colonization and 151 instances of MRSA transmission during the study period. After instituting bundle-II, the transmission rate declined from 2.9 to 2.1 per 1000 patient-days-at-risk (incidence rate ratio, 1.4; 95% confidence interval: 0.9-2.2), and hospital-acquired MRSA infections declined from 1.3 to 0.5 per 1000 patient-days-at-risk (incidence rate ratio, 2.5; 95% confidence interval: 1.1-5.8). CONCLUSION Despite an increasing incidence of MRSA in community settings, preventing MRSA transmission within a NICU is achievable through implementation of optimal intervention strategies.

Teaching pediatric laboratory medicine to pathology residents

CONTEXT Laboratory data are essential to the medical care of fetuses, infants, children, and adolescents. However, the performance and interpretation of laboratory tests on specimens from these patients, which may constitute a significant component of the workload in general hospitals and integrated health care systems as well as specialized perinatal or pediatric centers, present unique challenges to the clinical pathologist and the laboratory. Therefore, pathology residents should receive training in pediatric laboratory medicine. OBJECTIVE Childrens Health Improvement through Laboratory Diagnostics, a group of pathologists and laboratory scientists with interest and expertise in pediatric laboratory medicine, convened a task force to develop a list of curriculum topics, key resources, and training experiences in pediatric laboratory medicine for trainees in anatomic and clinical pathology or straight clinical pathology residency programs and in pediatric pathology fellowship programs. DATA SOURCES Based on the experiences of 11 training programs, we have compiled a comprehensive list of pediatric topics in the areas of clinical chemistry, endocrinology, hematology, urinalysis, coagulation medicine, transfusion medicine, immunology, microbiology and virology, biochemical genetics, cytogenetics and molecular diagnostics, point of care testing, and laboratory management. This report also includes recommendations for training experiences and a list of key texts and other resources in pediatric laboratory medicine. CONCLUSIONS Clinical pathologists should be trained to meet the laboratory medicine needs of pediatric patients and to assist the clinicians caring for these patients with the selection and interpretation of laboratory studies. This review helps program directors tailor their curricula to more effectively provide this training.

365Molecular Detection of Multi-Drug Resistant Organism (MDRO) Colonization in a High Risk Patient Population

365. Molecular Detection of Multi-Drug Resistant Organism (MDRO) Colonization in a High Risk Patient Population Xiaoyan Song, PhD, MBBS; Doug Toal, PhD; Terry Walker; Evelio Perez, MD, PhD; Joseph Campos, PhD; Roberta Debiasi, MD; George Washington University School of Medicine, Washington, DC; Infectious Disease, Children’s National Medical Center, Washington, DC; Clinical Services, OpGen, Inc., Gaithersburg, MD; R&D, OpGen Inc., Gaithersburg, MD; Pediatrics, George Washington University School of Medicine, Washington, DC; Laboratory Medicine, Children’s National Medical Center, Washington, DC; Of Pediatrics, Pathology, and Microbiology/Immunology/Tropical Medicine, George Washington University School of Medicine, Washington, MD; Children’s National Medical Center, Washington, DC