Showing papers by "Carrie L. Byington published in 2007"

Bottled, filtered, and tap water use in latino and non-latino children

Abstract: Objectives To describe bottled, filtered, and tap water consumption and fluoride use among pediatric patients; to analyze differences between ethnic and socioeconomic groups; and to describe the frequency of physician-parent discussions regarding water consumption. Design Convenience sample survey. Setting An urban public health clinic. Participants Parents attending a public health clinic. Outcome Measures The primary outcome measure was the prevalence of tap, filtered, and bottled water use. The secondary outcome measures were supplemental fluoride use and the percentage of patients reporting discussions of water consumption with their physician. Results A total of 216 parents (80.5% Latino and 19.5% non-Latino) completed the survey. Of the parents, 30.1% never drank tap water and 41.2% never gave it to their children. Latino parents were less likely than non-Latino parents to drink tap water (odds ratio, 0.26; 95% confidence interval, 0.10-0.67) and less likely to give tap water to their children (odds ratio, 0.32; 95% confidence interval, 0.15-0.70). More Latinos believed that tap water would make them sick (odds ratio, 5.63; 95% confidence interval, 2.17-14.54). Approximately 40% of children who never drank tap water were not receiving fluoride supplements. Of the lowest-income families (≤$14 999 per year), 64.9% always gave bottled (32.9%) or filtered (32.0%) water to their children. Of the parents surveyed, 82.5% reported that their child's physician had never discussed the type of water they should use. Conclusions Many Latino families avoid drinking tap water because they fear it causes illness. Unnecessary use of bottled and filtered water is costly and may result in adverse dental health outcomes. Physicians should provide guidance to families regarding the safety, low cost, and dental health benefits of drinking tap water.

Gordonia species: emerging pathogens in pediatric patients that are identified by 16S ribosomal RNA gene sequencing.

Abstract: Gordonia species are emerging pathogens that are often misidentified as Rhodococcus or Nocardia species but are reliably distinguished by 16S ribosomal RNA gene sequencing. We present a case series of 6 episodes of catheter-associated infection caused by Gordonia species in 5 patients seen at a tertiary care pediatric hospital and describe the management and outcomes of this infection in adults and children.

Clinical and economic outcomes for term infants associated with increasing administration of antibiotics to their mothers

Abstract: Summary Implementation of national guidelines for the prevention of group B streptococcal (GBS) infections has led to an increase in intrapartum antibiotic use and reduction in early-onset GBS infections in newborns. Other outcomes, including the clinical diagnosis of sepsis in term infants, treatment with antibiotics, length of stay, and cost have not been described. To examine these outcomes, we performed an analysis of maternal and newborn data collected between 1998 and 2002 of 130 447 in-hospital births of newborns ≥37 weeks gestation and their mothers from a large vertically integrated healthcare organisation in Utah. The main outcome measures included: (i) the number of women delivering at term who received intravenous antibiotics; (ii) the number of newborns treated for ‘clinical sepsis’, which was defined as receiving antibiotics for >72 h and the number of newborns who received antibiotics for ≤48 h, i.e. a ‘rule-out-sepsis’ course. We also compared the lengths of stay and variable costs of infants whose mothers received antibiotics with those whose mothers did not. We found that the proportion of mothers who received intravenous antibiotics rose from 26.8% in 1998 to 40.6% in 2002 (P < 0.0001). The proportion of newborns treated for clinical sepsis ranged from 1.2% to 1.4% over the 5-year period. (P for trend = 0.04). After controlling for maternal chorioamnionitis, delivery by caesarean section and maternal GBS status, newborns of mothers who received antibiotics were significantly more likely to be treated for clinical sepsis than were newborns of mothers who had not received them [adjusted OR = 3.3; 95% CI 2.9, 3.8]. The average length of stay for newborns whose mothers were treated with antibiotics was 55.8 h compared with 41.6 h for those not treated (P < 0.0001). The cost of caring for newborns whose mothers received antibiotics was $740 compared with $638 for those whose mothers had not received them (P < 0.001).

Management of parapneumonic empyema.

Abstract: Parapneumonic empyema, or pus in the pleural space, was once a rare complication of bacterial pneumonia in children.1 It has become increasingly common in the United States (US) and Europe.2-6 At our institution alone (Primary Children’s Medical Center in Salt Lake City, UT) we have cared for over 500 children with parapneumonic empyema in the last decade. The rate of parapneumonic empyema in Utah increased dramatically from 1/100,000 children in 1993 to 14/100,000 children in 2003.2,7,8

Informing the front line about common respiratory viral epidemics.

Abstract: The nature of clinical medicine is to focus on individuals rather than the populations from which they originate. This orientation can be problematic in the context of acute healthcare delivery during routine winter outbreaks of viral respiratory disease where an individual’s likelihood of viral infection depends on knowledge of local disease incidence. The level of interest in and perceived utility of community and regional infection data for front line clinicians providing acute care is unclear. Based on input from clinicians, we developed an automated analysis and reporting system that delivers pathogen-specific epidemic curves derived from a viral panel that tests for influenza, RSV, adenovirus, parainfluenza and human metapneumovirus. Surveillance summaries were actively e-mailed to clinicians practicing in emergency, urgent and primary care settings and posted on a web site for passive consumption. We demonstrated the feasibility and sustainability of a system that provides both timely and clinically useful surveillance information.

Invasive Meningococcal Disease, Utah, 1995-2005

Abstract: Trends in invasive meningococcal disease in Utah during 1995–2005 have differed substantially from US trends in incidence rate and serogroup and age distributions. Regional surveillance is essential to identify high-risk populations that might benefit from targeted immunization efforts.

Human herpesvirus 6 in the newborn intensive care unit.

Abstract: Human herpesvirus 6 (HHV-6) is a ubiquitous DNA virus that causes roseola and may cause life-threatening illness in immune compromised hosts. Peak acquisition of the virus occurs between 6 and 9 months of age, but earlier acquisition has been reported [1]. Congenital infection has been postulated, but the clinical significance is unclear [2– 5]. Chromosomal integration and subsequent detection of HHV-6 DNA has recently been demonstrated, contributing to the confounding effect of detecting the virus in neonates and defining congenitally acquired infection [6]. We hypothesize that congenital HHV-6 may occur and cause “sepsis-like” episodes in infants cared for in the neonatal intensive care unit (NICU). A pilot cross-sectional study was performed to obtain an estimate of HHV-6 DNA prevalence in the NICU. All infants hospitalized in the Primary Children’s Medical Center (PCMC) NICU between December 2002 and November 2003 were eligible for inclusion. Investigators collected samples of surplus plasma from complete blood counts of NICU patients twice monthly. From this group, cases were defined as infants with a plasma sample positive for HHV-6 DNA by PCR. To test reproducibility, each sample with a positive result was tested two to four times, depending on the amount of plasma available. Only those patients with two or more positive results or all negative results were included in the analysis; the others were excluded and labeled as “indeterminate status.” DNA was extracted and tested with a real-time fluorescent probe quantitative PCR. The lower limit of detection was 234 copies/ml (six copies/reaction). The assay was performed on the HT7900 Sequence Detection System (Applied Biosystems, Foster City, CA, USA). Primers and probes amplified and detected a 115-bp region of the U67 gene [7]. Positive controls consisted of commercially available viral lysates (Advanced Biotechnologies, Columbia, MD, USA) of HHV-6A and HHV-6B. Negative controls of extracted water were included in each run. The investigators performing the PCR analysis (JS, WH and DH) were blinded as to the clinical findings of the infants and not involved in subsequent data collection or statistical analysis. Before the results of PCR analysis were complete, a retrospective review of each infant’s medical record was performed in order to record demographic and clinical information at the time the specimen was collected. The primary outcome variable was whether the complete blood count had been collected for symptoms of infection. Other variables were based on a conceptual model of potential sources of the virus or contributing risk factors and clinical signs based on the available literature (Table 1). For analysis, data were transformed into dichotomous variables Eur J Clin Microbiol Infect Dis (2007) 26:297–299 DOI 10.1007/s10096-007-0282-8