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Kathryn M Edwards

Publications and source records attributed to Kathryn M Edwards.

63 records · Page 4Linked to original sources
PubMed2003

Fatal pulmonary hypertension associated with pertussis in infants: does extracorporeal membrane oxygenation have a role?

OBJECTIVE: The deaths of 4 infants who had confirmed pertussis infection at our hospital during the past year motivated us to review their cases as well as the use of extracorporeal membrane oxygenation (ECMO) in respiratory failure caused by pertussis. METHODS: Retrospective chart reviews of the 4 infants who had pertussis and died at Vanderbilt University Medical Center (VUMC) from May 2001 to May 2002 were conducted. The Extracorporeal Life Support Organization (ELSO) database is an international voluntary registry established in 1986 to compile passive reports of adult and pediatric patients placed on ECMO. We searched this database for pertussis cases and analyzed the clinical outcomes by age, ventilatory management, and measurements of cardiopulmonary status. RESULTS: All 4 infants who died from pertussis infection at VUMC were younger than 3 months and had severe pulmonary hypertension, and ECMO therapy was considered for respiratory failure. Review of the international ELSO database, focusing only on children from 1986 to July 2002, revealed a total of 23,970 patients placed on ECMO. Since the first pertussis case treated with ECMO in 1990, a total of 61 children with pertussis have been treated with ECMO, representing an increase from 0.09% to 1% of the total cases. Mean age of the pertussis patients placed on ECMO was 88 days (1 day-2.7 years). The overall mortality was 70.5% (43 of 61) but was significantly higher for infants who were younger than 6 weeks (84%) compared with infants who were older than 6 weeks (61%). When evaluating pre-ECMO management, survivors had received significantly higher mean positive end expiratory pressures than nonsurvivors (11.1 +/- 4.5 vs 7.3 +/- 3.1 cmH(2)O) and had significantly higher serum pH than nonsurvivors (7.31 +/- 0.14 vs 7.14 +/- 0.19). There was no effect of duration of ECMO, positive inspiratory pressure, mean arterial pressure, ECMO mode (venoarterial vs venovenous mode), or sex on mortality. CONCLUSIONS: Although the ECMO registry is not an active surveillance system, it suggests that the numbers of children who require ECMO for pertussis have significantly increased. The high fatality rates of pertussis patients who have placed on ECMO are alarming and should stimulate reevaluation of whether this high-risk intervention is beneficial to patients with pertussis. This review, coupled with the 4 infants who died of pertussis at VUMC, suggests that improved measures are needed to prevent pertussis in infants.

Extracorporeal Membrane Oxygenation↗
PubMed2002

Winter viruses: influenza- and respiratory syncytial virus-related morbidity in chronic lung disease.

BACKGROUND: Chronic lung disease predisposes to serious consequences of respiratory viruses. While increasing influenza immunization rates in older adults signals an awareness of the impact of influenza, children with asthma are infrequently immunized. While respiratory syncytial virus (RSV) is recognized as an important target of vaccine development for infants, its impact on adults is underappreciated. METHODS: We performed a retrospective cohort study to estimate rates of hospitalizations, deaths, outpatient visits, and antibiotic courses due to influenza and RSV in persons with chronic lung disease in the Tennessee Medicaid program from 1995 to 1999. Differences between study event rates when influenza was cocirculating with RSV and event rates when RSV was circulating alone were used to calculate influenza-attributable morbidity. Differences in rates when RSV was circulating alone and during summer months were calculated to assess the effect of RSV. RESULTS: Influenza- and RSV-associated hospitalizations were highest at the extremes of age. There were an estimated 8 and 23 hospitalizations per 1000 children younger than 5 years annually due to influenza and RSV, respectively. There were 23 and 18 hospitalizations, as well as 2 and 5 deaths per 1000 persons 65 years or older annually due to influenza and RSV, respectively. Both viruses were associated with an excess of outpatient visits in children, and antibiotic prescriptions in all age groups. CONCLUSION: Among persons with chronic lung disease, influenza virus and RSV accounted for 15% to 33% of acute respiratory hospitalizations in children, 7% to 9% of such hospitalizations in adults, and 9% of deaths in those 65 years or older.

Adolescent↗
PubMed2002

Lack of consistent relationship between quantity of aluminum in diphtheria-tetanus-acellular pertussis vaccines and rates of extensive swelling reactions.

The precise role that aluminum plays in local reactogenicity is not clear. We explored the relationship between rates of severe local reactions following the fourth and fifth booster doses of several diphtheria-tetanus-acellular pertussis vaccines (DTaP) and the quantity of aluminum contained in the different vaccines. Although there was a significant relationship between higher aluminum contents and swelling reactions >50 mm after dose 5, no relationship was seen with entire thigh swelling or with swelling >50 mm after dose 4. Because of the inconsistency of the data, a dose response between local reactogenicity and aluminum is questionable.

Adjuvants, Immunologic↗
PubMed2002

Influenza vaccines in children.

Influenza is a common disease of childhood. Young children and children with high-risk medical conditions are at increased risk of being hospitalized when infected with influenza virus. Children of all ages have excess physician visits and receive excess antibiotic prescriptions during influenza season. The safety, immunogenicity, and efficacy of influenza vaccines in children are described in this review. Clinical trials and postlicensure experience have demonstrated that trivalent inactivated influenza vaccine is well-tolerated in children. Efficacy of the inactivated vaccine also has been demonstrated in numerous clinical trials. In comparison to trivalent inactivated influenza vaccine, investigational cold-adapted, live-attenuated influenza vaccine (LAIV) has the advantage of an intranasal route of administration. A large clinical trial demonstrated the tolerability and efficacy of the trivalent live, attenuated product in children 15 to 71 months of age. Pending information on safety and coadministration of this vaccine with other childhood vaccines will determine if it is licensed and recommended for use in children, including possible expanded indications for routine yearly administration to young children.

Administration, Intranasal↗
PubMed2002

Prevalence of methicillin-resistant Staphylococcus aureus nasal carriage in the community pediatric population.

BACKGROUND: Reports from various geographic regions indicate that the prevalence of community-acquired methicillin-resistant (MRSA) infection is increasing. The primary reservoir is the anterior nares; nasal carriage is a risk factor for infection in a variety of populations. Little is known about MRSA nasal carriage rates among children in Nashville, TN and the associated likelihood of community MRSA transmission. METHODS: Nasal swabs were collected from 500 children at well-child visits at either a university hospital pediatric clinic or a private pediatric office. Cultures were plated onto selective staphylococcal media, with or without oxacillin. isolates were confirmed by coagulase tube testing. Antibiotic susceptibilities were determined for suspected methicillin-resistant isolates by standard broth microdilution methods (National Committee for Clinical Laboratory Standards). Pulsed field gel electrophoresis was used to evaluate epidemiologic relatedness. PCR testing was done to assess for the gene. A parent questionnaire was administered regarding MRSA risk factors. RESULTS: Four patients had oxacillin-resistant isolates (MIC >or= 4 microg/ml), and two had borderline resistant isolates (MICs = 1 and 2 microg/ml). One of the borderline-resistant isolates and one of the MRSA isolates had pulsed field gel electrophoresis typing results indicating close relatedness. The gene was present in all resistant isolates and one of the borderline-resistant isolates. Only having a household member employed in a hospital was associated with a greater risk of MRSA nasal carriage (odds ratio, 9.6; P= 0.008). CONCLUSIONS: MRSA nasal colonization is present within Nashville's healthy pediatric population. Children with household contacts employed in a hospital are significantly more likely to be colonized.

Anti-Bacterial Agents↗
PubMed2002

Decreased number of antibiotic prescriptions in office-based settings from 1993 to 1999 in children less than five years of age.

OBJECTIVE: Increasing rates of antibiotic resistance have stimulated efforts to decrease antibiotic use. To assess the success of these efforts, we analyzed antibiotic prescribing trends in children younger than 5 years old, the group with the highest use, from 1993 to 1999. METHODS: Data from the National Ambulatory Medical Care Survey were analyzed to determine antibiotic prescribing patterns for office-based visits from 1993 to 1999 for children <5 years old. Data were stratified by US regions, patient's race and gender. Antibiotic prescription rates per 1,000 population were calculated with population data from the US Census Bureau as the denominator. Specific prescribing of penicillins, cephalosporins, macrolides and sulfas was also assessed. RESULTS: Overall antibiotic prescribing in the office-based setting peaked in 1995 at 1,191 antibiotic courses per 1,000 children, then declined to 698 per 1,000 in 1999, a decrease of 41%. Antibiotic prescribing was consistently higher in whites than blacks; however, declines in prescribing over time were observed in both groups. Although there was wide regional variation in antibiotic prescribing in the early 1990's, by the late 1990's prescribing rates were similar in all regions. Prescriptions for penicillins and cephalosporins combined comprised 77 and 70% of total prescriptions during 1993 to 1997 and 1998 to 1999, respectively. Macrolide prescriptions reached a nadir during 1993 to 1997, accounting for 9% of the total, but increased to 16% during 1998 to 1999. CONCLUSION: Since 1995 the rates of antibiotic prescriptions in children <5 years of age have declined substantially. At the same time changes have occurred in the types of antibiotics prescribed. It appears that efforts to reduce antibiotic use have been successful. Whether this decrease in use will be accompanied by lower rates of antibiotic resistance will need to be determined.

Anti-Bacterial Agents↗
PubMed2002

Bedside diagnosis of influenzavirus infections in hospitalized children.

OBJECTIVE: For preventing nosocomial influenza infections and to facilitate prompt antiviral therapy, an accessible, rapid diagnostic method for influenzavirus is needed. We evaluated the performance of a lateral-flow immunoassay (QuickVue Influenza Test) completed at the bedside of hospitalized children during the influenza season. METHODS: All children who were evaluated at a large teaching hospital during the 1999 to 2000 influenza season were eligible if they were 1) younger than 19 years and hospitalized with respiratory symptoms or 2) younger than 3 years and hospitalized with fever. Each study child had 2 nasal swabs obtained--1 for influenzavirus culture and polymerase chain reaction (PCR) and the other for the QuickVue Influenza Test. The performance of the rapid diagnostic test was compared with the results of culture or PCR for influenza A or B. RESULTS: Of 303 eligible children, 233 (77%) were enrolled. In this population, 19 children had culture- and/or PCR-confirmed influenza A infection, prevalence of 8%. The QuickVue Influenza Test had a sensitivity of 74%, specificity of 98%, positive predictive value of 74%, and negative predictive value of 98%. CONCLUSIONS: Among children hospitalized with fever/respiratory symptoms during the influenza season, negative bedside QuickVue Influenza Tests indicated very low likelihood of influenza infection, whereas positive tests greatly increased the probability of influenza-associated illness.

Adolescent↗
PubMed2001

Burden of interpandemic influenza in children younger than 5 years: a 25-year prospective study.

Many respiratory viruses cause morbidity in young children, but a licensed vaccine and effective oral therapy are available only for influenzavirus. To determine the incidence of laboratory-confirmed influenza illness, we prospectively followed up 1665 healthy children aged <5 years who were enrolled in the Vanderbilt Vaccine Clinic at some point from 1974 through 1999. Viral cultures were obtained when the children presented with clinical illness. The isolation of influenzavirus was associated with an estimated 95 health care visits for children with symptoms of influenza, 46 episodes of acute otitis media, and 8 episodes of lower respiratory tract disease per 1000 children yearly. Rates of acute otitis media and lower respiratory tract disease were highest among children aged <2 years. Hospitalizations associated with culture-positive influenza occurred at an annual rate of 3-4 per 1000 children aged <2 years. Influenza is associated with substantial morbidity in otherwise healthy children aged <5 years.

Child, Preschool↗