William J Barson

The Ohio State University, Columbus, Ohio, United States

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Publications (76)227.88 Total impact

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    ABSTRACT: Background. The impact of PCV13 on pneumococcal meningitis (PM) in U.S. children is unknown. We compared the serotype distribution, antibiotic susceptibility, hospital course and outcomes of children with PM 3 years before and 3 years after the introduction of PCV13. Methods. We identified patients ≤18 years of age with PM at 8 children's hospitals in the US. Pneumococcal isolates were collected prospectively. Serotyping and antibiotic susceptibility were performed in a central laboratory. Clinical data were abstracted from medical records. Patients were divided into 3 subgroups: pre-PCV13 (2007-2009), transitional year (2010) and post-PCV13 (2011-2013). IBM SPSS was used for statistical analysis. Results. During the study period, 173 of 1207 episodes (14%) of invasive pneumococcal disease (IPD) were identified as PM; 76 of 645 (12%) during 2007-2009 and 69 of 394 (18%) during 2011-2013 (+50%, p=0.03). The proportion of PCV13 serotype cases decreased from 54% in 2007-2009 to 27% in 2011-2013 (p=0.001). Non-PCV13 serotype cases represented 73% of the isolates in 2011-2013. Isolates with ceftriaxone MIC≥1µg/ml decreased (13% to 3%) from 2007-2009 to 2011-2013 (p=0.03). No significant differences were identified for hospital course or outcome, except a greater proportion of patients had subdural empyema and hemiparesis in 2011-2013. Conclusions. After the introduction of PCV13, the number of cases of PM in children remained unchanged compared to 2007-2009, though the proportion of PCV13 serotypes decreased significantly. Serotype 19A continued to be the most common serotype in 2011-2013. Antibiotic resistance decreased significantly. Morbidity and case-fatality rate due to PM remain substantial.
    Clinical Infectious Diseases 05/2015; DOI:10.1093/cid/civ368 · 9.42 Impact Factor
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    ABSTRACT: Background: Invasive pneumococcal infections (IPI) due to Streptococcus pneumoniae serotype (ST) 3 have not declined as dramatically in children as other vaccine STs since the introduction in 2010 of the 13-valent pneumococcal conjugate vaccine, PCV13. While persistence of ST 3 isolates is likely due to capsule characteristics, genotypes with greater fitness may also emerge. We analyzed molecular characteristics of S. pneumoniae ST 3 isolates that were obtained from children with IPI. Methods: IPI cases at 8 children’s hospitals in the United States were prospectively identified from 2008-2013. ST 3 isolates were selected from the associated database. Isolates were typed by multilocus sequence typing (MLST). Select patient information was analyzed and antibiotic susceptibility patterns were compared. Statistical analysis included Wilcoxon rank-sum and Fisher's exact tests. Results: Sixty-three patients with 62 isolates were identified from the database (Table); 36 were male. Median age was 3.7y (0.1-17.6y). Disease presentations were pneumonia (n=33), meningitis (n=9), bacteremia (n=7), mastoiditis (n=6), cellulitis/abscess (n=7), and peritonitis (n=1). Twelve (19%) patients had an underlying condition. The MLSTs were 180 (n=58), 260, 338, 433 and 1116. The MLST distribution did not change over time. All isolates were penicillin and ceftriaxone susceptible. Only 3 were resistant to erythromycin and 2 were resistant to clindamycin. Table. Characteristics of pediatric serotype 3 infections, 2008-2013 Year Total invasive SPN Serotype 3 (% of total) MLST 180 Pneumonia (% of total serotype 3) Mean Age (years) 2008 197 11 (6%) 11 8 (73%) 3.1 2009 219 22 (10%) 20 7 (32%) 5.6 2010 165 8 (5%) 7 5 (63%) 3.4 2011 128 5 (4%) 4 1 (20%) 6.2 2012 112 6 (5%) 5 4 (67%) 5.7 2013 104 11 (11%) 11 8 (73%) 6.2 Total 925 63 58 33 5.0 Conclusion: ST 3 isolates chiefly caused pneumonia in this patient population and were mainly MLST180. MLST distribution did not change following introduction of PCV13. No statistical differences in distribution, age, disease presentation, age or, antibiotic susceptibility were observed. A modified vaccine, potentially including non-capsular antigens, is likely required to optimally reduce IPI due to ST 3 in children.
    IDWeek 2014 Meeting of the Infectious Diseases Society of America; 10/2014
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    ABSTRACT: Background: After the introduction of PCV7 the incidence of pediatric pneumococcal meningitis (PM) decreased significantly. The impact of PCV13 on PM in children is unknown. We compared the serotype (ST) distribution, antibiotic susceptibility and outcomes of children with PM 3 yrs before and 3 yrs after the introduction of PCV13. Methods: We identified patients ≤18 years with PM at 8 children's hospitals in the US (1/1/2007 - 12/31/2013). Pneumococcal isolates were collected prospectively. Serotyping and antibiotic susceptibility were performed in a central laboratory. Clinical and laboratory data were collected retrospectively. Patients were divided into 3 subgroups: pre-PCV13 (2007-2009), transitional year (2010) and post-PCV13 (2011-2013). Dichotomous variables were analyzed by Χ2 test and continuous variables with parametric/non-parametric tests. Results: During the study period, 173 of 1158 (15%) children with invasive pneumococcal disease (IPD) had PM; 76 of 644 (12%) during 2007-2009 and 69 of 344 (20%) during 2011-2013 (+8%, p<0.001) (Figure). We obtained clinical data from 125 patients (72%), of those 7 pneumococcal isolates were not viable for serotyping. In 2010, 22 cases were identified. 2007-2009 2011-2013 p N=103 56 47 Age, mo median (IQR) 16.8 (5-81) 16.3 (6-84) 0.9 Underlying condition (%) 16(29) 17(36) 0.4 CSF WBC (x103/mm3), median (IQR) 1.1 (0.1-2.9) 0.9 (0.1-2.8) 0.9 PCV13 ST 26/54 (48) 12/45 (27) 0.03 ST 19A 10/54 (19) 10/45 (22) 0.7 Penicillin MIC ≥0.12g/ml 13/54 (24) 14/45 (31) 0.4 Ceftriaxone MIC ≥0.5g/ml* 9/54 (17) 9/45 (20) 0.7 Death 1 (1.8) 5 (10.6) 0.08 Intensive care 33 (59) 38(81) 0.02 Fever after admission, days 3.22.4 4.73.7 0.02 *All ST 19A and 35B ST 7F decreased by 13% (p=0.02). The most common non-PCV13 STs during 2011-2013 were 33F (n=5; increased by 11%, p=0.02), 22F and 35B (n=4 each). Other measures of severity were similar during 2007-2009 and 2011-2013. Of all survivors, 46% had neurologic sequelae and 24% had sensorineural hearing loss. Rates of sequelae were similar among PCV13 and non-PCV13 ST cases; and during 2007-2009 and 2011-2013. Conclusion: After the introduction of PCV13, the number of cases of PM per year in children has remained unchanged, but with an increasing proportion of PM among children with IPD. ST 19A continues to be the most common ST in 2011-2013. Rates of morbidity and mortality remain substantial.
    IDWeek 2014 Meeting of the Infectious Diseases Society of America; 10/2014
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    ABSTRACT: Background: Following routine use of the 13-valent pneumococcal conjugate vaccine (PCV13, contains PCV7 serotypes [STs] + STs 1, 3, 5, 6A, 7F , 19A), invasive pneumococcal infections (IPI) declined over 40% in 2011 compared to the average number of cases in 2007 to 2009 at 8 children's hospitals in the United States. The most common STs causing IPI in 2011 were 19A, 7F and 33F (Pediatr Infect Dis J 2013;32:203-7). We now report findings for 2012 and 2013. Methods: IPI have been prospectively identified by investigators at 8 children's hospitals in the US since 1993. Demographic and clinical data are collected on case report forms and isolates are sent to a central laboratory where serotyping and antibiotic susceptibilities are performed. Dichotomous variables were analyzed by chi-square. Results: The total number of IPI, most common STs and % of children under 60 months old for each year is shown in the table. The total number of IPI has continued to decrease each year primarily related to declines in ST 19A (P=0.003) and 7F (P=0.02) isolates. However, ST 3 isolates remained at pre-PCV13 numbers. 9 children with ST 19A isolates and 4 children with ST 3 isolates had received 2 or more doses of PCV13 prior to IPI. In 2013, 3 of 12 children had received 4 PCV13 doses prior to ST19A IPI. Only 3 ST 1, 7 ST 19F, and 0 ST 5 isolates were encountered over these 3 years. STs 33F, 22F, 35B, 10, and 15C were the most common non-PCV13 STs. In 2012 and 2013, almost 75% of isolates were non-PCV13 STs. The % of children with underlying conditions was 45-46% each year. The most common conditions were malignancies (n=41), cardiovascular (n=15), genetic (n=14), renal (n=13) and central nervous system (n=10). Non-PCV13 STs accounted for 78% (32/144) of IPI isolates from children with underlying conditions. Isolates 2011 2012 2013 Total 128 112 104 19A 34 (2)* 16 (2) 12 (5) 3 5 (1) 6 (1) 11 (2) 7F 11 3 2 6C 5 3 5 33F 8 10 10 22F 5 9 8 35B 6 4 8 10 3 9 4 15C 3 8 3 23B 2 5 6 23A 4 6 2 12F 3 5 4 % non PCV13 54 73 74 % < 60 mon. 60 63 55 *() number of children who received ≥ 2 doses of PCV13 Conclusion: IPIs among 8 children's hospital continued to decline 2 and 3 years after full implementation of PCV13. STs 19A and 7F cases declined markedly whereas ST3 cases remained unchanged compared with pre-PCV13 findings. The number of non-PCV13 ST isolates has remained steady with STs 33F and 22F being the most common non-PCV13 STs in 2011 to 2013.
    IDWeek 2014 Meeting of the Infectious Diseases Society of America; 10/2014
  • William J Barson, J Robert Honegger, Karen Texter
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    ABSTRACT: Cat scratch disease is generally characterized by a self-limited chronic regional lymphadenopathy, but numerous other clinical manifestations involving a variety of organ systems have been reported. Cardiac involvement is unusual and when reported, it has been associated with culture negative endocarditis in adults. We present the case of an adolescent male with typical cat scratch disease and associated myopericarditis.
    The Pediatric Infectious Disease Journal 04/2014; 33(9). DOI:10.1097/INF.0000000000000352 · 3.14 Impact Factor
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    ABSTRACT: Background: Several virulence genes encoding proteins have been suggested as potential vaccine candidates for protection against either pneumococcal carriage or invasive disease. The distribution of these genes across serotypes and genotypes has not been analyzed, following the introduction of the pneumococcal conjugate vaccines (PCV7 and 13). Our study sought virulence genes commonly found in isolates recovered from children in the post-PCV era. Methods: Fifteen pneumococcal genes were selected. Sixty clinical S. pneumoniae isolates from 2001-2012 were selected from our collection; 92% of isolates were obtained post 2007. 49 non-PCV13 and 11 PCV13 serotypes were chosen to maximize the genetic variation among strains and included internationally recognized clones and sequence types (STs) observed among several serotypes. DNA was extracted. Multilocus sequence typing (MLST) was performed. Presence of genes was detected by polymerase chain reaction using primers designed from published sequences. Results: Forty-nine non-PCV13 isolates included serotypes 7C, 8, 10, 11, 12F, 13, 15A, 15B, 15C, 16, 17, 18A, 21, 22F, 23A, 23B, 24, 31, 33A, 33F, 34, 35B, 38, and 4 nontypeable (NT) strains. Eleven PCV13 isolates included serotypes 3, 6A, 18C, 19A, 19F, and 23F. Six genes were present across all strains including the NT S. pneumoniae, while cbpA, lytA, pspA and rrgC were present in less than 25% of the isolates (Table). Genomic diversity was evident by MLST, by which 47 STs were identified. Gene target(n=15) PCR-positive (n=60) pcsB, potD, pppA,sp2108, sp0148, stkP 60 (100%) nanA, pia, plyA, psaA 56-59 (93-98%) phtA 36 (60%) cbpA, lytA 9-13 (15-22%) pspA, rrgC 4-6 (7-10%) Conclusion: This study identified 6 genes encoding potential vaccine candidates that were present in both classic and NT S. pneumoniae representing a wide variety of genotypes. Expanded studies on the prevalence of specific genetic components across a larger number of isolates and genotypes will provide knowledge necessary to select candidates that maximize coverage against pneumococcal isolates.
    IDWeek 2013 Meeting of the Infectious Diseases Society of America; 10/2013
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    ABSTRACT: Background: Few studies describe age-specific reductions in the proportion of pediatric invasive pneumococcal disease (IPD) caused by serotype 19A and other 13-valent pneumococcal conjugate vaccine (PCV13) serotypes. Methods: Using ecological data, we determined age-specific proportions of IPD caused by serotype 19A and the other serotypes included in PCV13 before (2008-2009) and after (2010-2011) PCV13 introduction. IPD cases were identified from 8 children’s hospitals (US Pediatric Multicenter Pneumococcal Surveillance Group). We compared baseline rates (2008-2009) to the most recent data (2011) using Chi-square tests. Results: Among those aged 0-17 years, the proportion of IPD caused by serotype 19A in 2008-2009, 2010, and 2011 was 37%, 37%, and 28%. The proportion of IPD caused by the other 12 (non-19A) PCV13 serotypes for those same years was 66%, 62%, and 48%. However, reductions were not consistent across age group. Specifically, for those aged 0-1 year, there was a 44% (p<.01) relative reduction in the proportion of IPD caused by PCV13 serotypes, where as the percentage among those aged 2-17 was only 17% (p=.12) (p for interaction =.05). The difference in these two age groups was driven largely by the difference in reduction of the proportion of IPD caused by serotype 19A. While there was a 36% relative decrease (p<.01) in the proportion of IPD caused by serotype 19A among those aged 0-1, there was no change among those aged 2-17 (p=.87) (p for interaction =.04). For the other non-19A PCV13 serotypes, the relative percent reduction (32%, p=.04) did not depend on age group (p for interaction =.86). Only 2 children aged ≥11 had received PCV13. The proportion of children with IPD that had underlying comorbidities increased significantly with increasing age. For ages <1 year, 1-2, 3-5, and 6-17 years, respectively, 27%, 32%, 45%, and 60% of children with IPD had comorbid disease (p-trend<.001). Conclusion: Children aged 0-1 year had significant reductions in both 19A and in the other 12 (non-19A) PCV13 serotypes from 2008 through 2011. Children aged 2-17, however, had a reduction in non-19A PCV13 serotypes, but not 19A. Reasons for this could include lack of early indirect effect, virulence of 19A, and more comorbid disease and low PCV13 utilization in older children.
    IDWeek 2013 Meeting of the Infectious Diseases Society of America; 10/2013
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    ABSTRACT: BACKGROUND:: Invasive meningococcal infections can be devastating. Substantial endotoxemia releases mature and immature neutrophils. Endothelial margination of mature neutrophils may increase the immature to total neutrophil ratio. These changes have not been previously well-described in invasive meningococcal disease. METHODS:: Using 2001-2011 data from the US Multicenter Meningococcal Surveillance Study, the diagnostic sensitivity and clinical correlates of white blood cell count (WBC), absolute neutrophil count (ANC), immature neutrophil count (INC), and immature-to-total neutrophil ratio (ITR) were evaluated alone and in combination at the time of diagnosis of invasive meningococcal disease. RESULTS:: 216 patients were evaluated: meningococcemia (65), meningitis (145), and other foci (6). ANC ≤ 1000/mm or ≥ 10,000/mm was present in 137 (63%), INC ≥ 500/mm in 170 (79%), and ITR ≥0.20 in 139 (64%). One or more of these 3 criteria were met in 204/216 (94%). Results were similar for meningococcemia and meningitis subgroups. All 13 cases with mildest disease met one or more of the 3 criteria. Eight children presented with absolute neutrophil counts <1000/mm: three of them died and a fourth required partial amputation in all four limbs. CONCLUSIONS:: Invasive meningococcal disease is characterized by striking abnormalities in absolute neutrophil count, immature neutrophil count, and/or immature-to-total neutrophil ratio. Neutropenia was associated with a poor prognosis. Notably, without immature neutrophil counts, 37% of cases would have been missed. Automated methods not measuring immature WBCs should be avoided when assessing febrile children. Serious infection should be considered when counts meet any of the three criteria.
    The Pediatric Infectious Disease Journal 06/2013; 32(10). DOI:10.1097/INF.0b013e31829e31f1 · 3.14 Impact Factor
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    ABSTRACT: BACKGROUND:: The 13-valent pneumococcal conjugate vaccine (PCV13) was introduced for routine administration to infants and children in 2010 in the United States. We have monitored clinical and microbiologic features of invasive pneumococcal infections among children before and after PCV13 use. METHODS:: Infants and children cared for at 8 children hospitals in the United States with culture-proven invasive infections caused by S. pneumoniae were identified in an ongoing prospective surveillance study. Demographic and clinical data were recorded on a standard case report form. Serotype and antimicrobial susceptibilities of isolates were determined. RESULTS:: Since routine PCV13 immunization in 2010, invasive pneumococcal infections decreased 42% overall and 53% for children <24 months of age in 2011 compared with the average number of cases for 2007 to 2009. PCV13 serotype isolates decreased 57% during these same time periods; 19A, 7F and 3 decreased by 58%, 54% and 68%, respectively. The number of infections caused by serotypes 1 and 6C also decreased in 2011. The most common non-PCV13 serotypes encountered in 2010 and 2011 combined were 33F, 22F, 12, 15B, 15C, 23A and 11. Bacteremia, pneumonia and mastoiditis cases decreased more than meningitis cases. CONCLUSIONS:: After the introduction of PCV13, invasive pneumococcal infections decreased among 8 children hospitals compared with the 3 years before PCV13 use. Slight increases in some non-PCV13 serotype isolates were noted in 2011. Continued surveillance is necessary to determine the effectiveness of PCV13 including herd protection as well as any emerging invasive serotypes.
    The Pediatric Infectious Disease Journal 03/2013; 32(3):203-207. DOI:10.1097/INF.0b013e318275614b · 3.14 Impact Factor
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    ABSTRACT: Among 594 Streptococcus pneumoniae serotype 19A invasive pneumococcal disease (IPD) isolates from 1993-2011, we identified 85 sequence types (ST) by multilocus sequence typing (MLST). CC320 was associated with multidrug resistance and reduced susceptibility to penicillin and ceftriaxone and still predominated among declining serotype 19A IPD isolates following PCV13 introduction.
    Journal of clinical microbiology 02/2013; 51(4). DOI:10.1128/JCM.00058-13 · 4.23 Impact Factor
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    ABSTRACT: Background: Streptococcus pneumoniaeis a major cause of invasive disease in pediatric populations. With serotype 23F incorporated into PCV 7 & 13, a limited number of serogroup 23 isolates have been collected from invasive cases in recent years at our institutions. With the possible emergence of non-vaccine serotypes as causes of disease we characterized serogroup 23 isolates causing invasive pneumococcal disease (IPD) by multilocus sequence typing (MLST) and pulsed field gel electrophoresis (PFGE). Methods: Serogroup 23 isolates causing IPD from 2007-2011, were selected from the United States pediatric multicenter pneumococcal surveillance study. MLST was performed according to the MLST website (www.mlst.net). PFGE was performed using standard methods. Antibiotic susceptibilities were obtained (CLSI methods and guidelines). Results: Thirty-eight serogroup 23 invasive isolates were obtained: 17 serotype 23A, 20 serotype 23B, and 1 serotype 23F. There was no increase in numbers per year (2007-7, 2008-11, 2009-7, 2010-7, 2011-6). Disease presentations included bacteremia (n=25), meningitis (n=5), pneumonia (n=4) and other (n=4). Serotype 23A isolates were mainly ST338 (n=12), plus singletons of ST42, ST172, ST435, ST1336 and a new ST (SLV of ST215). Serotype 23B isolates were predominately ST1373 (n=8) or ST439 (n=7), but ST1448, ST1847 and 2 new STs were also identified. The serotype 23F isolate was ST81 (previously associated with multidrug resistant clone PMEN1). The PFGE results identified similar clusters as did MLST. Comparisons in the MLST database indicated that several of the observed STs had been previously associated with other serotypes (e.g. serogroups 6, 15 and 19). All isolates were susceptible to penicillin and ceftriaxone (MIC range 0.008-2 and 0.008-1 ug/ml, respectively), 79% to erythromycin, 89% to clindamycin and 63% to trimethoprim-sulfamethoxazole. Conclusion: As of yet, we have found no changes in the number of invasive infections that were associated with this serogroup 23 post PCV13. Capsular switching and emergence of infections caused by non-vaccine serotypes is likely in the post PCV13 era. Further analysis of non-vaccine serogroups and continuing surveillance will detect these developments as they occur.
    IDWeek 2012 Meeting of the Infectious Diseases Society of America; 10/2012
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    ABSTRACT: Background: Isolation of pneumococcal serotype 19A from invasive pneumococcal disease (IPD) in children dramatically increased after the 7-valent pneumococcal conjugate vaccine (PCV7) was introduced in 2000. With the inclusion of serotype 19A in the 13-valent PCV, licensed in 2010, a decline in serotype 19A isolates is expected. We analyzed serotype 19A invasive isolates from 1993-2011 by multilocus sequence type (MLST) and antimicrobial susceptibility (AS). Methods: Invasive isolates prospectively collected from 1993-2011 and corresponding patient data were retrieved from a study database. Penicillin (PEN) and ceftriaxone (CEF) MICs by microbroth, and AS by Kirby-Bauer test for erythromycin (E), clindamycin (C) and trimethoprim-sulfamethoxazole (TS) were obtained (CLSI guidelines). MLST was performed as advised (www.mlst.net). Statistical analysis was performed using the Fisher’s exact test. Results: We identified 84 sequence types (ST) among 586 isolates. Serotype 19A isolates were isolated at a rate of <20 per year until 2005. In 2007, a peak was reached with 87 isolates after which the yearly numbers declined. Two main clusters were identified by eBURST analysis: ST199+22 single locus variants (SLV) and 320+7 SLV. ST199+ SLV encompassed 224 isolates and predominated until 2006, when ST320+SLV became predominant. Overall, ST320+ SLV included 231 (39.4%) isolates. In 2011, a total of 26 serotype 19A isolates were collected: 2 (8%) 199+SLV, 19 (73%) 320+SLV and 5 of other STs. Disease presentations included meningitis (n=56), bacteremia (n=196), pneumonia (n=212), bone and joint (n=24), mastoiditis (n=73), cellulitis/abscess (n=17), other (n=8). Compared to all other STs, ST320+SLV were associated with Caucasian ethnicity (58% vs 34%, p<0.001), mastoiditis (21% vs 7%, p<0.001), non-susceptibility to E (99% vs 29%, p<0.001), C (95% vs 51%, p<0.001) and TS (99% vs 58%, p<0.001). ST320+SLV median MIC was 2 ug/ml (range 0.25-8 ug/ml) for PEN and 1 ug/ml (range 0.125-8 ug/ml) for CEF. Conclusion: Serotype 19A IPD has declined among our 8 children’s hospitals post PCV13.ST320+SLV, associated with multidrug resistance and reduced susceptibility to PEN and CEF, predominates while ST199 has been almost completely eliminated.
    IDWeek 2012 Meeting of the Infectious Diseases Society of America; 10/2012
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    ABSTRACT: Background: Studies have described an association between influenza virus and bacteria in the pathogenesis of lower respiratory tract (LRT) infections. However, the clinical impact of other respiratory viruses in children with complicated pneumonia has not been well characterized. Our objectives were to determine the frequency of viral detection in children with complicated pneumonia and to describe and compare the clinical characteristics and outcomes of those with and without respiratory viruses detected. Methods: Retrospective review of patients < 21 years of age hospitalized at NCH from January 1, 2006, to April 30, 2011, with complicated pneumonia (defined as parapneumonic effusion or empyema requiring a drainage procedure) who had one or more laboratory tests performed for respiratory viruses. Cases were defined as patients in whom a viral pathogen was identified, and controls were patients who tested negative for viruses. Each case was matched with two controls for age, sex, race, and bacterial pathogen (S.pneumoniae, S. pyogenes, S. aureus, or none). Demographic, clinical, laboratory, and outcome data were compared between the groups. Results: Of 222 patients hospitalized with complicated pneumonia during the study period, respiratory virus testing was performed in 95 (43%). A viral pathogen was identified in 26 patients: 12% of all patients and 27% of those with viral testing. Viruses detected included 10 influenza virus, 8 respiratory syncytial virus, 4 parainfluenza virus, 3 human metapneumovirus, and 1 adenovirus. Compared with controls, cases had significantly longer length of stay (13 vs 8.5 days; p<0.01) and days of fever (8 vs 5 days; p<0.01). They were also more likely to have necrotizing pneumonia (OR 4.7; 95% CI: 1.5-14; p<0.01) and require ICU admission (OR 3.4; 95% CI: 1.1-10; p<0.05) or surgical decortication (OR 6.4; 95% CI: 1.5-28; p=0.01). Conclusion: Viral detection was common in children hospitalized with complicated pneumonia and such patients showed increased disease severity. These findings lend further evidence to the hypothesis of viral-bacterial synergism in LRT disease. Routine implementation of viral testing in this clinical setting may improve patient outcomes when specific antiviral therapies are available.
    Infectious Diseases Society of America 2011 Annual Meeting; 10/2011
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    ABSTRACT: Streptococcus pneumoniae serotype 6C, which was described in 2007, causes invasive disease in adults and children. We investigated the prevalence of 6C among pediatric isolates obtained from eight children's hospitals in the United States. S. pneumoniae isolates were identified from a prospective multicenter study (1993 to 2009). Fifty-seven serotype 6C isolates were identified by multiplex PCR and/or Quellung reaction. Five were isolated before 2000, and the prevalence increased over time (P < 0.000001). The median patient age was 2.1 years (range, 0.2 to 22.5 years). Clinical presentations included bacteremia (n = 24), meningitis (n = 7), pneumonia (n = 4), abscess/wound (n = 3), mastoiditis (n = 2), cellulitis (n = 2), peritonitis (n = 1), septic arthritis (n = 1), otitis media (n = 10), and sinusitis (n = 3). By broth microdilution, 43/44 invasive serotype 6C isolates were susceptible to penicillin (median MIC, 0.015 μg/ml; range, 0.008 to 2 μg/ml); all were susceptible to ceftriaxone (median MIC, 0.015 μg/ml; range, 0.008 to 1 μg/ml). By disk diffusion, 16/44 invasive isolates (36%) were nonsusceptible to erythromycin, 19 isolates (43%) were nonsusceptible to trimethoprim-sulfamethoxazole (TMP-SMX), and all isolates were clindamycin susceptible. Multilocus sequence typing (MLST) revealed 24 sequence types (STs); 9 were new to the MLST database. The two main clonal clusters (CCs) were ST473 and single-locus variants (SLVs) (n = 13) and ST1292 and SLVs (n = 23). ST1292 and SLVs had decreased antibiotic susceptibility. Serotype 6C causes disease in children in the United States. Emerging CC1292 expressed TMP-SMX resistance and decreased susceptibility to penicillin and ceftriaxone. Continued surveillance is needed to monitor changes in serotype prevalence and possible emergence of antibiotic resistance in pediatric pneumococcal disease.
    Journal of clinical microbiology 03/2011; 49(6):2097-101. DOI:10.1128/JCM.02207-10 · 4.23 Impact Factor
  • The Pediatric Infectious Disease Journal 10/2010; 29(10):984, 988-9. DOI:10.1097/INF.0b013e3181e29886 · 3.14 Impact Factor
  • Michael Bolton, William Barson
    Pediatric Annals 08/2010; 39(8):497-503. DOI:10.3928/00904481-20100726-08 · 0.29 Impact Factor
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    ABSTRACT: The purpose of this study was to monitor the clinical and microbiologic features of invasive infections caused by Streptococcus pneumoniae among children before and after the introduction of the 7-valent pneumococcal conjugate vaccine (PCV7). We conducted a 15-year prospective surveillance study of all invasive pneumococcal infections in children. The sample included infants and children at 8 children's hospitals in the United States with culture-proven invasive S pneumoniae infections. Since the implementation of routine PCV7 immunization in 2000, invasive infections have decreased yearly from 2001 through 2004, to a nadir of 151 infections; the rate then increased from 2005 through 2008. Compared with the pre-PCV7 era, a greater proportion of children with invasive pneumococcal infection had an underlying condition in the post-PCV7 period. Compared with the total number of annual admissions, the number of 19A isolates increased significantly from 2001 to 2008 (P < .00001). In 2007 and 2008, only 16 isolates (4%) were vaccine serotypes; 19A accounted for 46% (168 of 369) of the non-PCV7 serotypes. Thirty percent of the 19A isolates were multidrug resistant. Serotypes 1, 3, and 7F accounted for 22% of the non-PCV7 serotypes. Among children with invasive pneumococcal infections, the likelihood of a 19A serotype increased with the number of preceding PCV7 doses. Since 2005, the number of invasive pneumococcal infections in children has increased at 8 children's hospitals, primarily as a result of serotype 19A isolates, one third of which were resistant to multiple antibiotics in 2007 and 2008. Continued surveillance is necessary to detect emerging serotypes after the planned introduction of 13-valent or other pneumococcal vaccines.
    PEDIATRICS 02/2010; 125(3):429-36. DOI:10.1542/peds.2008-1702 · 5.30 Impact Factor
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    ABSTRACT: Introduction of the heptavalent conjugate vaccine for Streptococcus pneumoniae (PCV7) has led to a dramatic decline in meningitis by PCV7 serotypes, raising the possibility of similar trends by PCV7-related serogroups through cross-protection. A present concern, however, is of serotype replacement by pneumococci not related to PCV7 serogroups. If this occurs, there are currently few data to predict whether clinical outcomes will change substantially. To address these questions, we analyzed medical records of 86 cases of pneumococcal meningitis treated at Nationwide Children's Hospital (1993-2004). Adverse neurologic sequelae and death were compared between cases with cerebrospinal fluid isolates characterized as vaccine-related serogroups-serotypes belonging to PCV7 or related to PCV7 serogroups, and those designated nonvaccine serogroups-serotypes neither belonging to PCV7 nor related to PCV7 serogroups. Serotype 19A, because of recent reports of increased incidence, was subanalyzed separately. Thirty-six of 86 (42%) subjects had serious complications, including 6 who died. All 6 deaths occurred in patients with vaccine-related serogroups. Deafness was the most common complication, occurring in 26 (32.5%) survivors. There was no difference in the frequency of total complications between PCV7-related and non-PCV7 groups: 5 of 12 (42%) for non-PCV7 serogroups versus 31 of 74 (42%) for PCV-related serogroups (OR: 1.0; 95% CI: 0.2-4.0). Serious outcomes occurred in 3 of 4 cases due to serogroup 19A. Non-PCV7 serogroups increased slightly at the end of the study period. In children with pneumococcal meningitis, infections with non-PCV7 serogroups seem less likely to result in death. Among survivors, there is preliminary evidence of parity in neurologic sequelae between PCV7 and non-PCV7 serogroups.
    The Pediatric Infectious Disease Journal 10/2008; 27(9):771-5. DOI:10.1097/INF.0b013e3181710976 · 3.14 Impact Factor
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    ABSTRACT: Recurrent systemic pneumococcal infection usually occurs in immunocompromised patients and patients with underlying conditions. Between 1993 and 2006, investigators at 8 pediatric hospitals prospectively identified cases of invasive pneumococcal disease (IPD) and retrospectively documented demographics and clinical information. Antibiotic susceptibility was determined for penicillin and ceftriaxone by microbroth dilution. Isolates were serotyped and molecular relatedness determined using pulse field gel electrophoresis (PFGE). Four thousand sixty-seven children were diagnosed with IPD over 12.3 years. One hundred and 8 episodes of recurrent disease were seen in 90 children (2.6%); 75 experienced 2 infections, 12 experienced 3 infections and 3 experienced 4 infections. Fourteen of the 15 children with >2 episodes of infection had underlying conditions. The mean duration between 1st and 2nd infection was 22.9 weeks for children with no known underlying condition and 43.0 weeks for children with an underlying condition (P = 0.001). Seventy episodes of IPD among the 90 patients were caused by a different serotype or a different genotype as demonstrated by the PFGE. Sixteen children had intervals <30 days between infections; 7 were caused by different strains. Approximately 80% of the children with recurrent invasive pneumococcal disease had underlying conditions. Seven of 16 children with recurrent infection <30 days apart were caused by acquisition of a new strain. Relapse of infection requires documentation that the pneumococcal isolates are not only the same serotype but also have the same PFGE patterns.
    The Pediatric Infectious Disease Journal 06/2007; 26(6):480-4. DOI:10.1097/INF.0b013e31805ce277 · 3.14 Impact Factor

Publication Stats

2k Citations
227.88 Total Impact Points

Institutions

  • 1981–2015
    • The Ohio State University
      • • Department of Pediatrics
      • • Division of Infectious Diseases
      • • College of Pharmacy
      • • College of Medicine
      Columbus, Ohio, United States
  • 2008–2014
    • Nationwide Children's Hospital
      • Department of Infectious Diseases
      Columbus, Ohio, United States
  • 2011
    • Columbus Community Hospital, Inc.
      Колумбус, Nebraska, United States
  • 2007
    • Baylor University
      Waco, Texas, United States
  • 1998–2003
    • Baylor College of Medicine
      • Department of Pediatrics
      Houston, TX, United States
  • 2002
    • Children's Memorial Hospital
      Chicago, Illinois, United States
  • 2001
    • Childrens Hospital of Pittsburgh
      • Department of Pediatrics
      Pittsburgh, Pennsylvania, United States
  • 2000
    • Wake Forest School of Medicine
      • Department of Pediatrics
      Winston-Salem, NC, United States
  • 1999
    • Arkansas Children's Hospital
      Little Rock, Arkansas, United States