Citations 3
Pre-existing Immunocompromising Conditions and Outcomes of Acute COVID-19 Patients Admitted for Pediatric Intensive Care
Rowan, Courtney M. , Zambrano, Laura D. , Newhams, Margaret M. , Kücükak, Suden, McNamara, Elizabeth R, Mack, Elizabeth H. , Fitzgerald, Julie C. , Irby, Katherine , Schuster, Jennifer E. , Kong, Michele, Loftis, Laura L. , Kolmar, Amanda , Babbitt, Christopher , Nofziger, Ryan A. , Hall, Mark W. , Gertz, Shira J. , Zinter, Matt S. , Halasa, Natasha , Bradford, Tamara T. , McLaughlin, Gwenn E., Singh, Aalok R. , Staat, Mary Allen , Coates, Bria M. , Crandall, Hillary R, Maamari, Mia , Havlin, Kevin , Schwarz, Adam J. , Carroll, Christopher L. , Levy, Emily R. , Campbell, Angela P. , Randolph, Adrienne G. , Chou, Janet , Investigators, Overcoming COVID-19, Kong, Michele, Gaspers, Mary Glas , Sanders, Ronald C., Schwarz, Adam J, Harvey, Helen , Port, Emily, Shankman, Sara, Mansour, Rachel, Espinal, Paula S., Tarquinio, Keiko M. , Bhoojhawon, Guru , Sullivan, Janice E, Bradford, Tamara T, Newhams, Margaret M, Chen, Sabrina , Young, Cameron C, Carroll, Ryan W. , Yager, Phoebe H. , Flori, Heidi R. , Johnson, Brandi A., Drapeau, Noelle M., Malloch, Lacy , Martin, Lora, McGraw, Sarah , Schuster, Jennifer E, Cullimore, Melissa L. , Clouser, Katharine N. , Kleinman, Lawrence C. , Horwitz, Steven M. , Kuebler, Joseph D. , Soma, Vijaya L, Doymaz, Sule , Schwartz, Stephanie P, Walker, Tracie C. , Lansell, Amanda , Hall, Mark W. , Burnett, Ryan H., Bush, Jenny L., Carcillo, Joseph A. , Butler, Andrew , Reed, Nelson, Stewart, Laura S , Golchha, Meena, Samperio, Marian, Qurashi, Jacob , Bowens, Cindy , Crandall, Hillary , Smith, Lincoln , Kong, Michele , Martin, Lora , Randolph, Adrienne G , Levy, Emily R , Kong, Michele , Staat, Mary A , Gertz, Shira J , LaBere, Brenna , Young, Cameron C. , Maddux, Aline B. , Kong, Michele, Dapul, Heda , Schwartz, Stephanie P. , Bembea, Melania M. , Cvijanovich, Natalie Z , Hobbs, Charlotte V. , Wellnitz, Kari , Moffitt, Kristin , Investigators, Overcoming COVID-19, Kong, Michele, Typpo, Katri , Schwarz, Adam J, Pannaraj, Pia S. , Giuliano, John S. , Michelson, Kelly Nicole , Sullivan, Janice E, Montgomery, Vicki , Bradford, Tamara T, Graciano, Ana Lía , Newhams, Margaret M, Young, Cameron C, Son, Mary Beth F. , Fernandes, Neil D. , Hume, Janet R. , Behl, Supriya , McGraw, Sarah, Schuster, Jennifer E, Spinella, Philip C. , McCulloh, Russell J. , Li, Simon , Ratner, Adam J. , BIAGAS, KATHERINE V. , Schwartz, Stephanie P, Shein, Steven L. , Bush, Jenny, Thomas, Neal J. , Fink, Ericka L. , Reed, Nelson, Muñoz, Álvaro Coronado , McGuire, John K.
Clinical Infectious Diseases | March 11, 2024 | Volume: 79 | Issue: 2 | Pages: 395-404
Abstract Background We aimed to determine if pre-existing immunocompromising conditions (ICCs) were associated with the presentation or outcome of patients with acute coronavirus disease 2019 (COVID-19) admitted for pediatric intensive care. Methods Fifty-five hospitals in 30 US states reported cases through the Overcoming COVID-19 public health surveillance registry. Patients <21 years admitted 12 March 2020–30 December 2021 to the pediatric intensive care unit (PICU) or high-acuity unit for acute COVID-19 were included. Results Of 1274 patients, 105 (8.2%) had an ICC, including 33 (31.4%) hematologic malignancies, 24 (22.9%) primary immunodeficiencies and disorders of hematopoietic cells, 19 (18.1%) nonmalignant organ failure with solid-organ transplantation, 16 (15.2%) solid tumors, and 13 (12.4%) autoimmune disorders. Patients with ICCs were older, had more underlying renal conditions, and had lower white blood cell and platelet counts than those without ICCs, but had similar clinical disease severity upon admission. In-hospital mortality from COVID-19 was higher (11.4% vs 4.6%, P = .005) and hospitalization was longer (P = .01) in patients with ICCs. New major morbidities upon discharge were not different between those with and without ICC (10.5% vs 13.9%, P = .40). In patients with ICCs, bacterial coinfection was more common in those with life-threatening COVID-19. Conclusions In this national case series of patients <21 years of age with acute COVID-19 admitted for intensive care, existence of a prior ICCs were associated with worse clinical outcomes. Reassuringly, most patients with ICCs hospitalized in the PICU for severe acute COVID-19 survived and were discharged home without new severe morbidities.
Community-Onset Bacterial Coinfection in Children Critically Ill With Severe Acute Respiratory Syndrome Coronavirus 2 Infection
酒井, 忠雄, Nakamura, Mari M, Young, Cameron C, Newhams, Margaret M, Halasa, Natasha B, Reed, J Nelson, Fitzgerald, Julie C, Spinella, Philip C, Soma, Vijaya L, Walker, Tracie C, Loftis, Laura L, Maddux, Aline B, Kong, Michele, Rowan, Courtney M, Hobbs, Charlotte V, Schuster, Jennifer E, Riggs, Becky J, McLaughlin, Gwenn E, Michelson, Kelly N, Hall, Mark W, Babbitt, Christopher J, Cvijanovich, Natalie Z, Zinter, Matt S, Maamari, Mia, Schwarz, Adam J, Singh, Aalok R, Flori, Heidi R, Gertz, Shira J, Staat, Mary A, Giuliano, John S, Hymes, Saul R, Clouser, Katharine N, McGuire, John, Carroll, Christopher L, Thomas, Neal J, Levy, Emily R, Randolph, Adrienne G, Randolph, Adrienne G. , Spinella, Philip C. , Levy, Emily R. , Staat, Mary Allen , Young, Cameron C. , McGuire, John K. , Gertz, Shira J. , Kong, Michele , Zinter, Matt S. , Moffitt, Kristin , Malloch, Lacy , Moffitt, Kristin L , Young, Cameron C , Hobbs, Charlotte V , Randolph, Adrienne G , Levy, Emily R , Spinella, Philip C , Kong, Michele , Staat, Mary A , Gertz, Shira J , Nakamura, Mari M, Newhams, Margaret M, Halasa, Natasha B, Reed, J Nelson, Fitzgerald, Julie C, Spinella, Philip C, Soma, Vijaya L, Walker, Tracie C, Loftis, Laura L, Maddux, Aline B, Kong, Michele, Rowan, Courtney M, Schuster, Jennifer E, Riggs, Becky J, McLaughlin, Gwenn E, Michelson, Kelly N, Hall, Mark W, Babbitt, Christopher J, Cvijanovich, Natalie Z, Zinter, Matt S, Maamari, Mia, Schwarz, Adam J, Singh, Aalok R, Flori, Heidi R, Gertz, Shira J, Staat, Mary A, Giuliano, John S, Hymes, Saul R, Clouser, Katharine N, McGuire, John, Carroll, Christopher L, Thomas, Neal J, Levy, Emily R
Open Forum Infectious Diseases | March 7, 2023 | Volume: 10 | Issue: 3 | Pages: No page available
AbstractBackgroundCommunity-onset bacterial coinfection in adults hospitalized with coronavirus disease 2019 (COVID-19) is reportedly uncommon, though empiric antibiotic use has been high. However, data regarding empiric antibiotic use and bacterial coinfection in children with critical illness from COVID-19 are scarce.MethodsWe evaluated children and adolescents aged <19 years admitted to a pediatric intensive care or high-acuity unit for COVID-19 between March and December 2020. Based on qualifying microbiology results from the first 3 days of admission, we adjudicated whether patients had community-onset bacterial coinfection. We compared demographic and clinical characteristics of those who did and did not (1) receive antibiotics and (2) have bacterial coinfection early in admission. Using Poisson regression models, we assessed factors associated with these outcomes.ResultsOf the 532 patients, 63.3% received empiric antibiotics, but only 7.1% had bacterial coinfection, and only 3.0% had respiratory bacterial coinfection. In multivariable analyses, empiric antibiotics were more likely to be prescribed for immunocompromised patients (adjusted relative risk [aRR], 1.34 [95% confidence interval {CI}, 1.01–1.79]), those requiring any respiratory support except mechanical ventilation (aRR, 1.41 [95% CI, 1.05–1.90]), or those requiring invasive mechanical ventilation (aRR, 1.83 [95% CI, 1.36–2.47]) (compared with no respiratory support). The presence of a pulmonary comorbidity other than asthma (aRR, 2.31 [95% CI, 1.15–4.62]) was associated with bacterial coinfection.ConclusionsCommunity-onset bacterial coinfection in children with critical COVID-19 is infrequent, but empiric antibiotics are commonly prescribed. These findings inform antimicrobial use and support rapid de-escalation when evaluation shows coinfection is unlikely.
Life-Threatening Complications of Influenza vs Coronavirus Disease 2019 (COVID-19) in US Children
Halasa, Natasha , Young, Cameron C. , Newhams, Margaret M. , Nakamura, Mari , Levy, Emily R. , Soma, Vijaya L, Talj, Rana, Fitzgerald, Julie C. , Mack, Elizabeth H. , Schuster, Jennifer E. , Coates, Bria M. , Hall, Mark W. , Schwarz, Adam J. , Kong, Michele, Spinella, Philip C. , Loftis, Laura L. , McLaughlin, Gwenn E., Rowan, Courtney M. , Nofziger, Ryan A. , Babbitt, Christopher , Bowens, Cindy , Flori, Heidi R. , Gertz, Shira J. , Zinter, Matt S. , Hume, Janet R. , Singh, Aalok R. , Crandall, Hillary A, Cullimore, Melissa L. , Patel, Manish M. , Randolph, Adrienne G. , Influenza, for the Pediatric Intensive Care, Investigators, Overcoming COVID-19, Kong, Michele, Gaspers, Mary Glas , Sanders, Ronald C., Irby, Katherine , Peter, Mourani, Harvey, Helen , Osborne, Christina , Sara, Shankman, Mourani, Peter M. , Port, Emily, Van, Kevin A, Carroll, Christopher L. , Tarquinio, Keiko M. , Coates, Bria M, Wellnitz, Kari , Bhoojhawon, Guru , Sullivan, Janice E, Bradford, Tamara T. , Riggs, Becky J. , Randolph, Adrienne G, Chen, Sabrina R., Carroll, Ryan W. , Yager, Phoebe H. , Heidemann, Sabrina M. , Hume, Janet R, Martin, Lora , Malloch, Lacy , Inagaki, Kengo , Schuster, Jennifer E, Kietzman, Abigail , Clouser, Katharine N. , Kleinman, Lawrence C. , Horwitz, Steven M. , Keenaghan, Michael , Doymaz, Sule , Walker, Tracie C. , Hall, Mark W, Lansell, Amanda , Staat, Mary Allen , Carcillo, Joseph A. , Smallcomb, Laura , Halasa, Natasha B, Stewart, Laura S , Romero, Yesenia, Hayek, Haya , Bowens, Cindy, Maamari, Mia , Crandall, Hillary , Smith, Lincoln , Kong, Michele , Young, Cameron C , Randolph, Adrienne G , Levy, Emily R , Spinella, Philip C , Kong, Michele , Hume, Janet R , Staat, Mary A , Gertz, Shira J , Spieker, Andrew J. , Olson, Samantha M. , Amarin, Justin Z. , Moffitt, Kristin , Weiss, Scott L. , Maddux, Aline B. , Schwartz, Stephanie P. , Kong, Michele, Hobbs, Charlotte V. , Bembea, Melania M. , Giuliano, John S. , Cvijanovich, Natalie Z , Thomas, Neal J. , Influenza, for the Pediatric Intensive Care, Investigators, Overcoming COVID-19, Kong, Michele, Typpo, Katri , Michelson, Kelly Nicole , Coates, Bria M, Sullivan, Janice E, Montgomery, Vicki , Havlin, Kevin , Randolph, Adrienne G, Fernandes, Neil D. , Hume, Janet R, Dhanrajani, Anita D. , Schuster, Jennifer E, Hill, Shannon, McCulloh, Russell J. , Li, Simon , Ratner, Adam J. , Dapul, Heda , Harwayne‐Gidansky, Ilana , Hymes, Saul , Hall, Mark W, Shein, Steven L. , Fink, Ericka L. , Halasa, Natasha B, Muñoz, Álvaro Coronado , Bowens, Cindy, McGuire, John K.
Clinical Infectious Diseases | June 19, 2022 | Volume: 76 | Issue: 3 | Pages: e280-e290
Abstract Background Clinical differences between critical illness from influenza infection vs coronavirus disease 2019 (COVID-19) have not been well characterized in pediatric patients. Methods We compared demographics, clinical characteristics, and outcomes of US children (aged 8 months to 17 years) admitted to the intensive care or high-acuity unit with influenza or COVID-19. Using mixed-effects models, we assessed the odds of death or requiring life support for influenza vs COVID-19 after adjustment for age, sex, race and Hispanic origin, and underlying conditions including obesity. Results Children with influenza (n = 179) were younger than those with COVID-19 (n = 381; median, 5.2 years vs 13.8 years), less likely to be non-Hispanic Black (14.5% vs 27.6%) or Hispanic (24.0% vs 36.2%), and less likely to have ≥1 underlying condition (66.4% vs 78.5%) or be obese (21.4% vs 42.2%), and a shorter hospital stay (median, 5 days vs 7 days). They were similarly likely to require invasive mechanical ventilation (both 30.2%), vasopressor support (19.6% and 19.9%), or extracorporeal membrane oxygenation (2.2% and 2.9%). Four children with influenza (2.2%) and 11 children with COVID-19 (2.9%) died. The odds of death or requiring life support in children with influenza vs COVID-19 were similar (adjusted odds ratio, 1.30; 95% confidence interval, .78–2.15; P = .32). Conclusions Despite differences in demographics and clinical characteristics of children with influenza or COVID-19, the frequency of life-threatening complications was similar. Our findings highlight the importance of implementing prevention measures to reduce transmission and disease severity of influenza and COVID-19.