Sarmistha B. Hauger

Primary group A streptococcal peritonitis in a previously healthy child.

Primary peritonitis in a child without underlying medical conditions is rare outside the neonatal period. A girl with no past medical history presented with acute abdominal pain. Laparotomy revealed primary peritonitis due to group A Streptococcus (serotype emm89). She was treated with antibiotics and immune globulin, and recovered fully.

Mother-to-child transmission of the human immunodeficiency virus in Texas

Background. The Pediatric Spectrum of HIV Diseases (PSD) project has been collecting data on HIV-exposed children in Texas since 1989. These data have now been analyzed to describe mother-to-child transmission in Texas and to provide much needed information on the magnitude of the pediatric HIV epidemic in the state. Methods. We examined trends in the numbers of perinatally exposed children and perinatally acquired cases of HIV in the Texas PSD cohort. We calculated transmission rates and relative risks for 656 children born from January, 1995, to July, 1998, that received all or part of the ACTG 076 regimen. Results. Only a small proportion (38%) of pairs of an HIV-infected mother and her HIV-exposed child received the full AIDS Clinical Trial Group 076 (ACTG 076) regimen; only 73% of the mothers received at least some prenatal care. In recent years, however, the numbers of perinatally exposed children and perinatally acquired cases of HIV have decreased in Texas. Univariate analyses showed that a reduction in the vertical transmission of HIV was associated with receipt of a full ACTG 076 regimen, receipt of a partial ACTG 076 regimen and residence in Dallas County. Conclusions. Findings identify a gap in meeting the health care needs of pregnant HIV-infected women and suggest missed opportunities to prevent mother-to-child transmission of HIV. At the same time this study confirms progress in prevention efforts to reduce mother-to-child transmission of HIV in Texas.

Invasive Kingella kingae Resulting in a Brodie Abscess

Timothy K. Ruttan, Eric Higginbotham, Nicole Higginbotham, Coburn H. Allen, and Sarmistha Hauger Department of Pediatric Emergency Medicine, Dell Children’s Medical Center of Central Texas, Austin, United States; Department of Neurosurgery, Dell Children’s Medical Center of Central Texas, Austin, United States; Departments of Pediatric Emergency Medicine and Pediatric Infectious Diseases, Dell Children’s Medical Center of Central Texas, Austin, United States; and Department of Pediatric Infectious Diseases, Dell Children’s Medical Center of Central Texas, Austin, United States

Disseminated Pulmonary Aspergillosis in a Previously Healthy Adolescent

on oral bronchodilator therapy. He returned one day prior to admission with continued complaints of abdominal pain; a chest roentgenogram revealed an infiltrate in the right lung. The patient was sent home on oral erythromycin therapy for a presumptive diagnosis of Mycoplasma pneumoniae pneumonia. He returned on the following day with continued complaints and diminished oral intake. On physical exam, he was found to be afe-

Carbapenem-Sparing Antibiotic Treatment Options in Children with Extended-Spectrum β-Lactamase (ESBL) Producing Bacteria

RESEARCH ARTICLE Carbapenem-Sparing Antibiotic Treatment Options in Children with Extended-Spectrum β-Lactamase (ESBL) Producing Bacteria Marisol Fernandez, Rachel D. Quick, Kathryn G. Merkel, Sarah Casey, Patrick Boswell, Ann Bailey and Sarmistha B. Hauger Pediatric Infectious Diseases, University of Texas at Austin Dell Medical School, Dell Children’s Medical Center of Central Texas, Austin, TX, USA Pediatric Infectious Diseases, Dell Children’s Medical Center of Central Texas, Austin, TX, USA Department of Pharmacy, Dell Children’s Medical Center of Central Texas, Austin, TX, USA Clinical Quality and Operational Effectiveness, Dell Children’s Medical Center of Central Texas, Austin, TX, USA Infection Control Preventionist, Dell Children’s Medical Center of Central Texas, Austin, TX, USA

Increasing Kingella Identification in Bone and Joint Infections in Young Children

Abstract Background Kingella kingae is an increasingly recognized pathogen among young children with bone and joint infections. Antibiotics given to cover methicillin-resistant Staphylococcus aureus are not effective against Kingella, and necessitate additional empiric antibiotics in this age group. Improving Kingella identification can narrow antibiotic choices and improve efficacy for long-term oral therapy. Methods We implemented a bone and joint infection guideline at a free standing children’s hospital that called for early imaging, focal sampling, and polymerase chain reaction (PCR) testing for culture-negative specimens. The goal was to increase identification of Kingella and other pathogens to improve targeted antimicrobial therapy. Children 6 to ≤ 60 months of age with uncomplicated acute hematogenous osteomyelitis or septic arthritis between January 1, 2009–December 31, 2016, were included in this study. Outcomes of bacterial identification were measured. Results Charts for 49 cases that met criteria were reviewed. Prior to the algorithm, we identified Kingella in 4% (1/25) of cases. Following routine use of updated sampling and testing techniques, including PCR testing, Kingella kingae identification increased to 29% of cases (7/24; P = 0.02) and, in fact, was the predominant pathogen identified in this age group. Conclusion Identification of Kingella was enhanced as a result of changes to sampling and testing, including PCR testing (Figure 1). Post-implementation, Kingella was more commonly identified than Staphylococcus aureus. Widespread availability of PCR testing in the future may allow for the use of narrowed antibiotic therapy and targeted transition to oral antibiotics in young children with bone or joint infection.Figure 1. Bacterial identification pre and post guideline among children aged 6–60 months. Disclosures All authors: No reported disclosures.

Management of Rabies Prophylaxis for Potential Bat Exposures in a Level III Neonatal Intensive Care Unit.

This report describes the unique challenges of managing potential exposure to bats in a neonatal intensive care unit. The outcome demonstrates that rabies post-exposure prophylaxis can be safely administered to preterm infants with evidence that preterm infants are able to develop adequate titers post vaccination. Infect Control Hosp Epidemiol 2017;38:483-485.

Decreasing Exposure to Radiation, Surgical Risk, and Costs for Pediatric Complicated Pneumonia: A Guideline Evaluation

OBJECTIVES This report describes the creation and successful implementation of a complicated pneumonia care algorithm at our institution. Outcomes are measured for specific goals of the algorithm: to decrease radiation exposure, surgical risk, and patient charges without adversely affecting clinical outcomes. METHODS We describe steps involved in algorithm creation and implementation at our institution. To depict outcomes of the algorithm, we completed a retrospective cohort study of hospitalized pediatric patients with a diagnosis of complicated pneumonia at a single institution between January 2010 and April 2016 who met criteria for the algorithm. Charts were manually reviewed and data were analyzed via Wilcoxon rank sum, χ2, and Fishers exact tests. RESULTS Throughout the algorithm creation process, our institution began to see a change in practice. We saw a statistically significant decrease in the number of patients who underwent a chest computed tomography scan and an increase in patients who underwent a chest ultrasound (P < .001). We also saw an increase in the use of chest tube placement with fibrinolytics and a decrease in the use of video-assisted thoracoscopic surgery as the initial chest procedure (P ≤ .001) after algorithm implementation. These interventions reduced related charges without significantly affecting length of stay, readmission rate, or other variables studied. CONCLUSIONS The collaborative creation and introduction of an algorithm for the management of complicated pneumonia at our institution, combined with an effort among physicians to incorporate evidence-based clinical care into practice, led to reduced radiation exposure, surgical risk, and cost to patient.