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1. Transition to Enteral Triazole Antifungal Therapy for Pediatric Invasive Candidiasis: Secondary Analysis of a Multicenter Cohort Study Conducted by the Pediatric Fungal Network

Author

Bucayu, Robert F T, Boge, Craig L K, Yildirim, Inci, Avilés-Robles, Martha, Vora, Surabhi B, Berman, David M, Sharma, Tanvi S, Sung, Lillian, Castagnola, Elio, Palazzi, Debra L, Danziger-Isakov, Lara, Yin, Dwight E, Roilides, Emmanuel, Maron, Gabriela, Tribble, Alison C, Soler-Palacin, Pere, López-Medina, Eduardo, Romero, José, Belani, Kiran, Arrieta, Antonio C, Carlesse, Fabianne, Nolt, Dawn, Halasa, Natasha, Dulek, Daniel, Rajan, Sujatha, Muller, William J, Ardura, Monica I, Pong, Alice, Gonzalez, Blanca E, Salvatore, Christine M, Huppler, Anna R, Aftandilian, Catherine, Abzug, Mark J, Chakrabarti, Arunaloke, Green, Michael, Lutsar, Irja, Knackstedt, Elizabeth D, Johnson, Sarah K, Steinbach, William J, Fisher, Brian T, and Wattier, Rachel L

Abstract

Of 319 children with invasive candidiasis, 67 (21%) transitioned from intravenous to enteral antifungal therapy. Eight (12%) transitioned back to intravenous antifungal therapy, one due to perceived treatment failure defined by clinical progression or worsening. Global treatment response at study completion was successful in 66 participants who transitioned to enteral therapy.

Published
2024
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3. Contributors

Author

Chang, Yeh-Chung, primary, Barbas, Andrew, additional, Dara, Jasmeen, additional, Dvorak, Christopher C., additional, Patel, Neil, additional, Green, Abby, additional, Madan, Rebecca Pellett, additional, Danziger-Isakov, Lara A., additional, Michaels, Marian G., additional, Green, Michael D., additional, Marón Alfaro, Gabriela M., additional, Gans, Hayley A., additional, Estabrook, Michele, additional, Ardura, Monica I., additional, Fisher, Brian T., additional, Sung, Lillian, additional, Posfay-Barbe, Klara M., additional, Halasa, Natasha, additional, Kelly, Matthew S., additional, Silverman, Michael A., additional, Wolf, Joshua, additional, Gerber, Jeffrey S., additional, Smith, Michael J., additional, Akinboyo, Ibukunoluwa C., additional, Nolt, Dawn, additional, Gonzalez, Blanca E., additional, Arshad, Mehreen, additional, Nowalk, Andrew, additional, Tamma, Pranita D., additional, Dulek, Daniel, additional, Statler, Victoria A., additional, Munoz, Flor M., additional, Lin, Philana Ling, additional, Sharma, Tanvi, additional, Gross, Thomas, additional, Allen, Upton D., additional, Muller, William J., additional, Herold, Betsy C., additional, Lugo, Debra J., additional, Zerr, Danielle M., additional, Waghmare, Alpana, additional, Englund, Janet A., additional, Florescu, Diana F., additional, Stohs, Erica J., additional, Laskin, Benjamin L., additional, Hirsch, Hans H., additional, Steinbach, William J., additional, Wattier, Rachel L., additional, Schuster, Jennifer E., additional, Lee, Philip, additional, Goldman, David L., additional, Christenson, John C., additional, Fox, Thomas G., additional, Chen, Sharon F., additional, Paulsen, Grant C., additional, Sue, Paul K., additional, Burton, Catherine, additional, Hanisch, Benjamin, additional, Gonzalez, Ivan A., additional, Stillwell, Terri, additional, Yildirim, Inci, additional, Doby Knackstedt, Elizabeth, additional, Mayer Arispe, Erick F., additional, and Shane, Andi L., additional

Published
2021
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5. Adjunctive Diagnostic Studies Completed Following Detection of Candidemia in Children: Secondary Analysis of Observed Practice From a Multicenter Cohort Study Conducted by the Pediatric Fungal Network

Author

Wattier, Rachel L, primary, Bucayu, Robert F T, additional, Boge, Craig L K, additional, Ross, Rachael K, additional, Yildirim, Inci, additional, Zaoutis, Theoklis E, additional, Palazzi, Debra L, additional, Vora, Surabhi B, additional, Castagnola, Elio, additional, Avilés-Robles, Martha, additional, Danziger-Isakov, Lara, additional, Tribble, Alison C, additional, Sharma, Tanvi S, additional, Arrieta, Antonio C, additional, Maron, Gabriela, additional, Berman, David M, additional, Yin, Dwight E, additional, Sung, Lillian, additional, Green, Michael, additional, Roilides, Emmanuel, additional, Belani, Kiran, additional, Romero, José, additional, Soler-Palacin, Pere, additional, López-Medina, Eduardo, additional, Nolt, Dawn, additional, Bin Hussain, Ibrahim Zaid, additional, Muller, William J, additional, Hauger, Sarmistha B, additional, Halasa, Natasha, additional, Dulek, Daniel, additional, Pong, Alice, additional, Gonzalez, Blanca E, additional, Abzug, Mark J, additional, Carlesse, Fabianne, additional, Huppler, Anna R, additional, Rajan, Sujatha, additional, Aftandilian, Catherine, additional, Ardura, Monica I, additional, Chakrabarti, Arunaloke, additional, Hanisch, Benjamin, additional, Salvatore, Christine M, additional, Klingspor, Lena, additional, Knackstedt, Elizabeth D, additional, Lutsar, Irja, additional, Santolaya, Maria E, additional, Shuster, Sydney, additional, Johnson, Sarah K, additional, Steinbach, William J, additional, and Fisher, Brian T, additional

Published
2023
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11. Comparative Effectiveness of Echinocandins vs Triazoles or Amphotericin B Formulations as Initial Directed Therapy for Invasive Candidiasis in Children and Adolescents

Author

Fisher, Brian T, primary, Zaoutis, Theoklis E, additional, Xiao, Rui, additional, Wattier, Rachel L, additional, Castagnola, Elio, additional, Pana, Zoi Dorothea, additional, Fullenkamp, Allison, additional, Boge, Craig L K, additional, Ross, Rachael K, additional, Yildirim, Inci, additional, Palazzi, Debra L, additional, Danziger-Isakov, Lara, additional, Vora, Surabhi B, additional, Arrieta, Antonio, additional, Yin, Dwight E, additional, Avilés-Robles, Martha, additional, Sharma, Tanvi, additional, Tribble, Alison C, additional, Maron, Gabriela, additional, Berman, David, additional, Green, Michael, additional, Sung, Lillian, additional, Romero, José, additional, Hauger, Sarmistha B, additional, Roilides, Emmanuel, additional, Belani, Kiran, additional, Nolt, Dawn, additional, Soler-Palacin, Pere, additional, López-Medina, Eduardo, additional, Muller, William J, additional, Halasa, Natasha, additional, Dulek, Daniel, additional, Hussain, Ibrahim Zaid Bin, additional, Pong, Alice, additional, Hoffman, Jill, additional, Rajan, Sujatha, additional, Gonzalez, Blanca E, additional, Hanisch, Benjamin, additional, Aftandilian, Catherine, additional, Carlesse, Fabianne, additional, Abzug, Mark J, additional, Huppler, Anna R, additional, Salvatore, Christine M, additional, Ardura, Monica I, additional, Chakrabarti, Arunaloke, additional, Santolaya, Maria E, additional, Localio, A Russell, additional, and Steinbach, William J, additional

Published
2021
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13. Head Lice.

Author

Nolt, Dawn, Moore, Scot, Yan, Albert C., and Melnick, Laura

Subjects
*HOUSEHOLD supplies, *ANTIPARASITIC agents, *ESSENTIAL oils, *BIOLOGICAL products, *INSECTICIDES, *PEDICULOSIS, *PEDIATRICS, *MALATHION, *MEDICAL screening, *RE-entry students, *MACROLIDE antibiotics, *INFECTIOUS disease transmission
Abstract

Head lice infestation is associated with limited morbidity but causes a high level of anxiety among caregivers of school-aged children and adolescents. Since the 2015 clinical report on head lice was published by the American Academy of Pediatrics, new medications have been approved, and an algorithm for management of affected patients is included. This revised clinical report clarifies current diagnosis and treatment protocols. [ABSTRACT FROM AUTHOR]

Published
2022
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17. Association of Diagnostic Stewardship for Blood Cultures in Critically Ill Children With Culture Rates, Antibiotic Use, and Patient Outcomes: Results of the Bright STAR Collaborative

Author

Woods-Hill, Charlotte Z., Colantuoni, Elizabeth A., Koontz, Danielle W., Voskertchian, Annie, Xie, Anping, Thurm, Cary, Miller, Marlene R., Fackler, James C., Milstone, Aaron M., Agulnik, Asya, Albert, J. Elaine-Marie, Auth, Michael J., Bradley, Erin, Clayton, Jason A., Coffin, Susan E., Dallefeld, Samantha, Ezetendu, Chidiebere P., Fainberg, Nina A., Flaherty, Brian F., Foster, Charles B., Hauger, Sarmistha B., Hong, Sue J., Hysmith, Nicholas D., Kirby, Aileen L., Kociolek, Larry K., Larsen, Gitte Y., Lin, John C., Linam, William M., Newland, Jason G., Nolt, Dawn, Priebe, Gregory P., Sandora, Thomas J., Schwenk, Hayden T., Smith, Craig M., Steffen, Katherine M., Tadphale, Sachin D., Toltzis, Philip, Wolf, Joshua, and Zerr, Danielle M.

Abstract

IMPORTANCE: Blood culture overuse in the pediatric intensive care unit (PICU) can lead to unnecessary antibiotic use and contribute to antibiotic resistance. Optimizing blood culture practices through diagnostic stewardship may reduce unnecessary blood cultures and antibiotics. OBJECTIVE: To evaluate the association of a 14-site multidisciplinary PICU blood culture collaborative with culture rates, antibiotic use, and patient outcomes. DESIGN, SETTING, AND PARTICIPANTS: This prospective quality improvement (QI) collaborative involved 14 PICUs across the United States from 2017 to 2020 for the Bright STAR (Testing Stewardship for Antibiotic Reduction) collaborative. Data were collected from each participating PICU and from the Children’s Hospital Association Pediatric Health Information System for prespecified primary and secondary outcomes. EXPOSURES: A local QI program focusing on blood culture practices in the PICU (facilitated by a larger QI collaborative). MAIN OUTCOMES AND MEASURES: The primary outcome was blood culture rates (per 1000 patient-days/mo). Secondary outcomes included broad-spectrum antibiotic use (total days of therapy and new initiations of broad-spectrum antibiotics ≥3 days after PICU admission) and PICU rates of central line–associated bloodstream infection (CLABSI), Clostridioides difficile infection, mortality, readmission, length of stay, sepsis, and severe sepsis/septic shock. RESULTS: Across the 14 PICUs, the blood culture rate was 149.4 per 1000 patient-days/mo preimplementation and 100.5 per 1000 patient-days/mo postimplementation, for a 33% relative reduction (95% CI, 26%-39%). Comparing the periods before and after implementation, the rate of broad-spectrum antibiotic use decreased from 506 days to 440 days per 1000 patient-days/mo, respectively, a 13% relative reduction (95% CI, 7%-19%). The broad-spectrum antibiotic initiation rate decreased from 58.1 to 53.6 initiations/1000 patient-days/mo, an 8% relative reduction (95% CI, 4%-11%). Rates of CLABSI decreased from 1.8 to 1.1 per 1000 central venous line days/mo, a 36% relative reduction (95% CI, 20%-49%). Mortality, length of stay, readmission, sepsis, and severe sepsis/septic shock were similar before and after implementation. CONCLUSIONS AND RELEVANCE: Multidisciplinary diagnostic stewardship interventions can reduce blood culture and antibiotic use in the PICU. Future work will determine optimal strategies for wider-scale dissemination of diagnostic stewardship in this setting while monitoring patient safety and balancing measures.

Published
2022
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20. Spectrum of clinical manifestations of West Nile virus infection in children

Author

Yim, Robert, Posfay-Barbe, Klara M., Nolt, Dawn, Fatula, George, and Wald, Ellen R.

Subjects
West Nile virus -- Health aspects, Arbovirus diseases -- Case studies
Abstract

Reports of clinical manifestations of West Nile virus (WNV) infections in children have been relatively rare. Four cases of WNV infection in children are described: the first report of prolonged encephalitis and fulminant hepatitis caused by WNV, and 3 other presentations of WNV, including the first report of ocular involvement in a child. Pediatrics 2004;114:1673-1675; West Nile virus, hepatitis, vitritis, encephalitis, meningitis, child. ABBREVIATIONS. WNV, West Nile virus; CNS, central nervous system; CBC, complete blood count; WBC, white blood cell; CSF, cerebrospinal fluid; CPK, creatine phosphokinase; HSV, herpes simplex virus; CT, computed tomography; Ig, immunoglobulin; ELISA, enzyme-linked immunosorbent assay., West Nile virus (WNV) has become a significant cause of arboviral infection of the central nervous system (CNS) in the United States since it was first identified in 1999. (1) [...]

Published
2004

26. .

Author

Ondusko, Devlynne S and Nolt, Dawn

Published
2018
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34. Intrathoracic disease from nontuberculous mycobacteria in children: two cases and a review of the literature

Author

Nolt, Dawn, Michaels, Marian G., and Wald, Ellen R.

Abstract

Pulmonary disease caused by nontuberculous mycobacteria (NTM) is a relatively rare occurrence in immunocompetent children. Two cases of endobronchial NTM infection in immunocompetent children are described. In addition, 41 other children with NTM pulmonary disease reported in the English literature between 1930 and 2003 are reviewed. Clinical manifestations are either purely respiratory or respiratory with more widespread systemic symptoms. Compared with children with only respiratory complaints, children with constitutional symptoms from NTM pulmonary disease 1) had symptoms for a shorter period before presentation (10 vs 28 days), 2) had more radiographic evidence of pulmonary disease, and 3) were treated longer with antimycobacterial agents (11.5 months vs 6 months). The most common causative organism was Mycobacterium avium complex. Pediatricians should be increasingly aware of NTM in the differential diagnosis of persistent pulmonary disease in previously healthy children. Pediatrics 2003;112:e434-e439. URL: http://www.pediatrics.org/cgi/content/full/112/5/e434; atypical mycobacteria, Mycobacterium, lung disease, respiratory tract infections.

Published
2003

35. Survival with hypopituitarism from congenital syphilis

Author

Nolt, Dawn, Saad, Rola, Kouatli, Amjad, Moritz, Michael L., Menon, Ram K., and Michaels, Marian G.

Subjects
Syphilis, Congenital, hereditary, and infantile -- Case studies
Abstract

Congenital syphilis continues to occur despite the advances in testing of pregnant women in many countries and the availability of penicillin since 1943. This is a report of a child with multiple systemic manifestations of congenital syphilis. This is one of the few cases of survival with pituitary involvement from congenital syphilis and the first noted case in which diabetes insipidus developed. Institution of routine testing in all countries might have prevented the severe manifestations of syphilis seen in this child. Pediatrics 2002;109(4). URL: http://www.pediatrics.org/cgi/content/full/109/4/e63; congenital syphilis, diabetes insipidus, hypopituitarism.

Published
2002

39. Granulomas and Guidelines: The Search for Tuberculosis During Tumor Necrosis Factor–α Inhibition.

Author

Nolt, Dawn

Subjects
*TUBERCULOSIS risk factors, *ANTI-inflammatory agents, *BIOLOGICAL models, *GRANULOMA, *HOST-bacteria relationships, *IMMUNOSUPPRESSION, *MEDICAL protocols, *MEDICAL research, *RISK assessment, *TREATMENT effectiveness
Abstract

The article discusses that 4000 persons die of tuberculosis (TB) disease. It mentions the impact of tumor necrosis factor-alpha (TNF)-α inhibitors in increasing the risk and susceptibility of TB infection is well-documented in adults. It also mentions that TNF-α appears essential for the control of primary TB infection and as a defense against reactivation.

Published
2020
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41. Interleukin-12 therapy reduces the number of immune cells and pathology in lungs of mice infected with Mycobacterium tuberculosis.

Author

Nolt, Dawn and Flynn, JoAnne L

Abstract

Alternate modalities for the treatment of Mycobacterium tuberculosis are needed due to the rise in numbers of immunosuppressed individuals at risk for serious disease and the increasing prevalence of multidrug-resistant isolates. Interleukin-12 (IL-12) has been shown to improve immune responses against M. tuberculosis infection in both humans and mice. Previous studies using high-dose IL-12 in various disease models reported a paradoxical immunosuppression. We demonstrate here that exogenous administration of IL-12 for 8 weeks after an aerosolized low dose of M. tuberculosis results in increased survival and decreased pulmonary bacterial loads for CD4-T-cell-deficient mice, most likely due to an early increase in gamma interferon. IL-12 treatment did not impair or enhance the ability of the wild-type mice to control infection, as measured by bacterial numbers. Two novel findings are reported here regarding exogenous IL-12 therapy for M. tuberculosis infections: (i). IL-12 treatment resulted in decreased numbers of immune cells and reduced frequencies of lymphocytes (CD8(+), CD4(+), and NK cells) in the lungs of infected mice and (ii). IL-12 therapy reduced the pathology of M. tuberculosis-infected lungs, as granulomas were smaller and less numerous. These studies support an immunoregulatory role for IL-12 in tuberculosis.

Published
2004

44. Implementing standardized criteria for multi-drug-resistant organisms: a retrospective cost-avoidance analysis for discontinuing contact precautions for ESBL.

Author

Crossley B, Cortes-Ramos CT, and Nolt D

Abstract

Objective: This manuscript calculates the estimated cost-savings associated with implementing criteria for multi-drug-resistant organisms (MDRO)., Design: The study evaluated extended-spectrum beta-lactamase (ESBL) producing Enterobacterales isolates utilizing the MDRO criteria established by Infection Prevention and Control. Isolates were categorized as either meeting or not meeting criteria. The number of inpatient days for patients with isolates not meeting criteria was calculated. The average daily cost of personal protective equipment (PPE) for patients in contact isolation was determined via literature review. Annual cost savings were determined by multiplying the total number of inpatient days by the average cost of PPE per day. Because our institution only isolates patients who meet the MDRO criteria, this approach was considered a cost-saving measure., Setting: 560 licensed bed, tertiary care facility in the United States., Patients: Adult inpatients between the years of 2019-2022 with an ESBL-producing Enterobacterales isolated from any specimen source., Results: 229 patients met inclusion criteria. 73% of isolates did not meet MDRO criteria. The patients with ESBL isolates not meeting criteria represented 2942 isolation days over four years. The average cost of PPE for contact isolation per day was $40.18. Cost-savings were estimated at $118,209 over four years., Conclusions: Our findings provide support for other healthcare systems to define organisms that warrant transmission-based contact precautions., Competing Interests: All authors report no conflicts of interest relevant to this article., (© The Author(s) 2024.)

Published
2024
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45. Long-term control of Mycobacterium tuberculosis infection is mediated by dynamic immune responses.

Author

Lazarevic V, Nolt D, and Flynn JL

Subjects
Acute Disease, Animals, Antigens, Bacterial immunology, Antigens, Bacterial metabolism, Apoptosis immunology, CD4-Positive T-Lymphocytes immunology, CD4-Positive T-Lymphocytes pathology, CD8-Positive T-Lymphocytes immunology, CD8-Positive T-Lymphocytes pathology, Cell Proliferation, Cells, Cultured, Chronic Disease, Cytotoxicity Tests, Immunologic, Epitopes, T-Lymphocyte metabolism, Interferon-gamma biosynthesis, Lymphocyte Activation immunology, Lymphocyte Count, Mice, Mice, Inbred C57BL, Mycobacterium tuberculosis growth & development, Time Factors, Tuberculosis, Pulmonary pathology, Mycobacterium tuberculosis immunology, Tuberculosis, Pulmonary immunology, Tuberculosis, Pulmonary prevention & control
Abstract

The primary goal of this study was to determine how chronic exposure to Ag influences the functionality of Mycobacterium tuberculosis-specific T cell responses. The frequency of IFN-gamma-producing effector CD4(+) and CD8(+) T cells dynamically changed during persistent M. tuberculosis infection. CD8(+) T cells used differential effector functions during acute and chronic phases of the immune response, where CD8(+) T cells produced negligible amounts of IFN-gamma early in infection, but switched to cytokine production during the chronic stage of infection. Using limiting dilution analysis, CD8(+) T cells isolated during the initial phase of infection demonstrated lytic potential, but this waned in the chronic stage. The apparent loss of cytotoxic activity was not associated with the lack of perforin. Ag dose could potentially govern the functional program of CD8(+) T cells. Collectively, these results depict a host immune response mounted against M. tuberculosis of a significantly more dynamic nature than previously recognized.

Published
2005
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