Mary Anne Jackson

Children's Mercy Hospitals and Clinics, Kansas City, Missouri, United States

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Publications (121)369.18 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: Enterovirus 68 (EV-D68) causes acute respiratory tract illness in epidemic cycles, most recently in Fall 2014, but clinical characteristics of severe disease are not well reported. Children with EV-D68 severe respiratory disease requiring pediatric intensive care unit (PICU) management were compared with children with severe respiratory disease from other enteroviruses/rhinoviruses. A retrospective review was performed of all children admitted to Children's Mercy Hospital PICU from August 1-September 15, 2014 with positive PCR testing for enterovirus/rhinovirus. Specimens were subsequently tested for the presence of EV-D68. We evaluated baseline characteristics, symptomatology, lab values, therapeutics, and outcomes of children with EV-D68 viral infection compared with enterovirus/rhinovirus-positive, EV-D68-negative children. A total of 86 children with positive enterovirus/rhinovirus testing associated with respiratory symptoms were admitted to the PICU. Children with EV-D68 were older than their EV-D68-negative counterparts (7.1 vs. 3.5 years, P=0.01). They were more likely to have a history of asthma or recurrent wheeze (68% vs. 42%, P=0.03) and to present with cough (90% vs. 63%, P=0.009). EV-D68 children were significantly more likely to receive albuterol (95% vs. 79%, P=0.04), magnesium (75% vs. 42%, P=0.004), and aminophylline (25% vs. 4%, P=0.03). Other adjunctive medications used in EV-D68 children included corticosteroids, epinephrine, and heliox; 44% of EV-D68-positive children required non-invasive ventilatory support. EV-D68 causes severe disease in the pediatric population, particularly in children with asthma and recurrent wheeze; children may require multiple adjunctive respiratory therapies. Copyright © 2015 Elsevier B.V. All rights reserved.
    Journal of clinical virology: the official publication of the Pan American Society for Clinical Virology 09/2015; 70:77-82. DOI:10.1016/j.jcv.2015.07.298 · 3.47 Impact Factor
  • Jennifer L Goldman · Mary Anne Jackson
    PEDIATRICS 07/2015; 136(2). DOI:10.1542/peds.2015-1296 · 5.30 Impact Factor
  • Anik Patel · Angela Schmidt · Mary Anne Jackson
    Pediatrics in Review 07/2015; 36(7):e22-5. DOI:10.1542/pir.36-7-e22 · 0.82 Impact Factor
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    ABSTRACT: BACKGROUND The number of pediatric antimicrobial stewardship programs (ASPs) is increasing and program evaluation is a key component to improve efficiency and enhance stewardship strategies. OBJECTIVE To determine the antimicrobials and diagnoses most strongly associated with a recommendation provided by a well-established pediatric ASP. DESIGN AND SETTING Retrospective cohort study from March 3, 2008, to March 2, 2013, of all ASP reviews performed at a free-standing pediatric hospital. METHODS ASP recommendations were classified as follows: stop therapy, modify therapy, optimize therapy, or consult infectious diseases. A multinomial distribution model to determine the probability of each ASP recommendation category was performed on the basis of the specific antimicrobial agent or disease category. A logistic model was used to determine the odds of recommendation disagreement by the prescribing clinician. RESULTS The ASP made 2,317 recommendations: stop therapy (45%), modify therapy (26%), optimize therapy (19%), or consult infectious diseases (10%). Third-generation cephalosporins (0.20) were the antimicrobials with the highest predictive probability of an ASP recommendation whereas linezolid (0.05) had the lowest probability. Community-acquired pneumonia (0.26) was the diagnosis with the highest predictive probability of an ASP recommendation whereas fever/neutropenia (0.04) had the lowest probability. Disagreement with ASP recommendations by the prescribing clinician occurred 22% of the time, most commonly involving community-acquired pneumonia and ear/nose/throat infections. CONCLUSIONS Evaluation of our pediatric ASP identified specific clinical diagnoses and antimicrobials associated with an increased likelihood of an ASP recommendation. Focused interventions targeting these high-yield areas may result in increased program efficiency and efficacy. Infect Control Hosp Epidemiol 2015;00(0): 1-8.
    Infection Control and Hospital Epidemiology 03/2015; 36(06):1-8. DOI:10.1017/ice.2015.45 · 3.94 Impact Factor
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    ABSTRACT: Enterovirus D68 (EV-D68), a member of the Picornaviridae family, was first identified in 1962 and is part of a group of small, nonenveloped RNA viruses. As a family these viruses are among the most common causes of disease among humans. However, outbreaks of disease attributable to EV-D68 have been rarely reported in the previous four decades. Reports from a few localized outbreaks since 2008 describe severe lower respiratory tract infection (LRTI) in children. In the late summer of 2014, EV-D68 caused a geographically widespread outbreak of respiratory disease of unprecedented magnitude in the United States. The Centers for Disease Control (CDC) was first notified of increased respiratory viral activity by Children's Mercy Hospitals (CMH) in Kansas City, Missouri and EV-D68 was identified in 50% of nasopharyngeal specimens initially tested. Between mid-August and 18 December 2014, confirmed cases of LRTI caused by EV-D68 have been reported in 1,152 people in 49 states and The District of Columbia. A focused review of EV-D68 respiratory disease and clinical highlights from the 2014 United States outbreak are presented here.
    02/2015; 12(5). DOI:10.1513/AnnalsATS.201412-592FR
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    ABSTRACT: Screening of immunization status at each health care encounter is recommended to improve immunization coverage rates but is often limited to primary care practices. A pilot intervention study was performed to ascertain the immunization status of hospitalized children and determine if development of an immunization plan before discharge would improve the vaccination status for such children. On the basis of power calculations estimated to detect an increase in immunization status from 60% to 70% with 80% power, 356 randomly selected children were enrolled between March 6, 2012 and June 14, 2012. Immunization records were obtained, immunization status determined, and parent/guardian informed if catch-up dose(s) were needed. If parent requested vaccine dose(s), they were administered before discharge. Vaccination status was current per Advisory Committee on Immunization Practices guidelines in 73% of hospitalized children, and 27% children required catch-up dose(s) (200 doses for 95 children). Human papilloma virus vaccine (dose 1), varicella zoster vaccine (dose 2), and meningococcal conjugate vaccine were the most commonly identified dose(s) needed. Of those requiring catch-up dose(s), 25% were caught up, increasing vaccination status to 80% at 1-month post hospital discharge. This is the first study to determine the immunization status of hospitalized pediatric patients of all ages, including adolescents, providing new data on the immunization status of the inpatient pediatric population. A pilot intervention consisting of obtaining immunization records, determining immunization status, and discussing catch-up dose(s) before discharge resulted in improvement of immunization status, suggesting that the inpatient setting may be used along with many other national strategies to help address missed vaccination opportunities. Copyright © 2015 by the American Academy of Pediatrics.
    Hospital Pediatrics 01/2015; 5(1):35-41. DOI:10.1542/hpeds.2014-0027
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    ABSTRACT: This report details an increase in cases of enterovirus D68, a cause of severe respiratory illness most commonly found in children, and one that should be considered as potentially problematic in donors or recipients.
    American Journal of Transplantation 11/2014; 14(11):2662-2663. DOI:10.1111/ajt.13035 · 6.19 Impact Factor
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    ABSTRACT: The purpose of this statement is to update recommendations for routine use of seasonal influenza vaccine and antiviral medications for the prevention and treatment of influenza in children. The American Academy of Pediatrics recommends annual seasonal influenza immunization for all people 6 months and older, including all children and adolescents. Highlights for the upcoming 2014-2015 season include the following: 1. The influenza vaccine composition for the 2014-2015 season is unchanged from the 2013-2014 season. 2. Both trivalent and quadrivalent influenza vaccines are available in the United States for the 2014-2015 season. 3. Annual universal influenza immunization is indicated with either a trivalent or quadrivalent vaccine (no preference). 4. Live attenuated influenza vaccine (LAIV) should be considered for healthy children 2 through 8 years of age who have no contraindications or precautions to the intranasal vaccine. If LAIV is not readily available, inactivated influenza vaccine (IIV) should be used; vaccination should not be delayed to obtain LAIV. 5. The dosing algorithm for administration of influenza vaccine to children 6 months through 8 years of age reflects that virus strains in the vaccine have not changed from last season. As always, pediatricians, nurses, and all other health care personnel should be immunized themselves and should promote influenza vaccine use and infection control measures. In addition, pediatricians should promptly identify clinical influenza infections to enable rapid antiviral treatment, when indicated, to reduce morbidity and mortality.
    Pediatrics 11/2014; 134(5):E1503-E1519. DOI:10.1542/peds.2014-2413 · 5.30 Impact Factor
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    ABSTRACT: Background: Pediatric ASPs have demonstrated the ability to decrease antibiotic (ab) use. No data exists on the clinical impact of pediatric ASPs. We evaluated the impact of an ASP on LOS and readmission rates at a children's hospital. Methods: Outcome data from patients enrolled between 3/3/08 – 3/3/13 in a prospective-antibiotic audit ASP were analyzed. ASP recommendations included to discontinue, modify or optimize the ab or to consult the infectious diseases service. Patients in whom a recommendation was made were propensity score matched to non-intervention patients based on the patient's age, ASP year of implementation, ab and indication for ab use, and further analyzed based on if the recommendation was implemented. Patients were stratified into 3 groups: surgical, medical and medical with complex chronic care (CCC). Patients with >1 ASP review or admitted to the pediatric or neonatal intensive care unit, or the hematology/oncology unit were excluded. Results: The ASP intervened on 17% (1191) of the 7051 reviewed patients. Interventions were most likely in patients receiving ceftriaxone/cefotaxime (62%), vancomycin (11%), and meropenem (5%); pneumonia (22%), urinary tract infections (19%), and rule out sepsis (9%) were the most common diagnoses. The most common intervention was stop followed by modify the ab. When ASP recommendations were followed, length of stay was shorter and there were no 30-day readmissions for surgery or patients with non CCC medical conditions.(Fig 1&2) Conclusion: An ASP at a freestanding childrens hospital decreased LOS and readmission rates among patients not requiring critical care. Future work is needed to better demonstrate the clinical impact of ASPs.
    IDWeek 2014 Meeting of the Infectious Diseases Society of America; 10/2014
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    ABSTRACT: Background: ASPs are growing in pediatrics. Many programs function by reviewing a large number of antimicrobial prescriptions on a daily basis to identify opportunities to improve or modify prescribing, thus leading to an intervention or recommendation. Little is known about the frequency with which reviewed prescriptions lead to an intervention and the patient and clinical factors most strongly associated with an intervention. A better understanding of these factors could lead to more targeted ASP reviews and more efficient use of resources. Objectives: Identify the antibiotics and clinical diagnoses most strongly associated with a pediatric ASP. Methods: We reviewed the frequency and types of interventions made by a pediatric ASP across 5 years, from 3/2008 to 3/2013. Our program uses a prospective audit and feedback structure where prescriptions for any of 18 selected antibiotics are reviewed daily for potential interventions. Interventions were grouped into four categories: stop therapy, modify therapy (i.e. change antibiotic), optimize therapy (i.e. alter dosing or route of administration) and consult infectious diseases. We used a multinomial distribution model to determine the probability of each ASP intervention group, based on the specific antimicrobial agent or disease category. Results: A total of 14,407 ASP reviews were included in our analysis. Among these, a total of 2,318 (16%) prompted an ASP intervention. The most common types of ASP recommendations were stop or modify therapy. The clinical diagnoses with the highest predicted probability of an intervention were community acquired pneumonia (CAP, 0.26), ear/nose/throat (ENT, 0.25), genitourinary (0.23), and respiratory infections (0.21) (Figure 1). The antibiotics with the highest predictive probability of an intervention were ceftriaxone (0.20), clindamycin (0.20), and gentamicin (0.19) (Figure 2). Conclusion: We identified several clinical diagnoses and antimicrobials that are associated with higher than average likelihood of triggering an ASP intervention. This analysis will assist in enhancing our ASP to focus not only on specific antibiotics but to also target specific conditions for review and development of clinical practice guidelines.
    IDWeek 2014 Meeting of the Infectious Diseases Society of America; 10/2014
  • Mary Anne Jackson
    IDWeek 2014 Meeting of the Infectious Diseases Society of America; 10/2014
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    ABSTRACT: On August 19, 2014, CDC was notified by Children's Mercy Hospital in Kansas City, Missouri, of an increase (relative to the same period in previous years) in patients examined and hospitalized with severe respiratory illness, including some admitted to the pediatric intensive care unit. An increase also was noted in detections of rhinovirus/enterovirus by a multiplex polymerase chain reaction assay in nasopharyngeal specimens obtained during August 5-19. On August 23, CDC was notified by the University of Chicago Medicine Comer Children's Hospital in Illinois of an increase in patients similar to those seen in Kansas City. To further characterize these two geographically distinct observations, nasopharyngeal specimens from most of the patients with recent onset of severe symptoms from both facilities were sequenced by the CDC Picornavirus Laboratory. Enterovirus D68 (EV-D68) was identified in 19 of 22 specimens from Kansas City and in 11 of 14 specimens from Chicago. Since these initial reports, admissions for severe respiratory illness have continued at both facilities at rates higher than expected for this time of year. Investigations into suspected clusters in other jurisdictions are ongoing.
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    ABSTRACT: Guidance from the American Academy of Pediatrics (AAP) for the use of palivizumab prophylaxis against respiratory syncytial virus (RSV) was first published in a policy statement in 1998. Guidance initially was based on the result from a single randomized, placebo-controlled clinical trial conducted in 1996-1997 describing an overall reduction in RSV hospitalization rate from 10.6% among placebo recipients to 4.8% among children who received prophylaxis. The results of a second randomized, placebo-controlled trial of children with hemodynamically significant heart disease were published in 2003 and revealed a reduction in RSV hospitalization rate from 9.7% in control subjects to 5.3% among prophylaxis recipients. Because no additional controlled trials regarding efficacy were published, AAP guidance has been updated periodically to reflect the most recent literature regarding children at greatest risk of severe disease. Since the last update in 2012, new data have become available regarding the seasonality of RSV circulation, palivizumab pharmacokinetics, the changing incidence of bronchiolitis hospitalizations, the effects of gestational age and other risk factors on RSV hospitalization rates, the mortality of children hospitalized with RSV infection, and the effect of prophylaxis on wheezing and palivizumab-resistant RSV isolates. These data enable further refinement of AAP guidance to most clearly focus on those children at greatest risk.
    Pediatrics 08/2014; 134(2):E620-E638. DOI:10.1542/peds.2014-1666 · 5.30 Impact Factor
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    ABSTRACT: Objective: To assess the performance of the QuantiFERON-TB Gold in-tube (QFT-GIT) assay for tuberculosis (TB) screening using a convenience sample from among a population of healthcare provider (HCP) employees of a hospital. Methods: For the individuals in our cohort, we reviewed occupational health records, including TB risk factors, and the results of OFT-GIT testing. We considered a QFT-GIT result of greater than 0.35 IU/mL to be positive; when we obtained a positive result from a specimen from a particular individual, we repeated testing on a fresh specimen from that individual. Results: Of the 758 HCP employees whose specimens we screened, 439 had negative OFT-GIT results with negative TB risk factors and 268 had a negative QFT-GIT result but had positive TB risk factors. OFT-GIT results were positive in 47 subjects. Of the positive participants, 12 had a mean TB antigen value (antigen minus nil stimulated concentrations [Ag-Nil]) of 0.61 on initial testing and had a negative result on repeat testing, 22 had a TB Ag-Nil of 1.19 on initial testing and had a positive result on repeat testing (P = .01). Conclusions: The OFT-GIT assay is useful for screening HCPs. However, false-positive results occur, particularly in a borderline zone of less than 11U/ml. Re-evaluation by repeat testing of fresh specimens from the same individual should be considered in subjects whose specimens test within the low-level positive cutoff.
    Laboratory Medicine 06/2014; 45(3):207-210. DOI:10.1309/LMLSJ4BVXS66WJHS · 0.49 Impact Factor
  • Pediatrics 02/2014; 133(2):357-U401. DOI:10.1542/peds.2013-3965 · 5.30 Impact Factor
  • J Michael Klatte · Jason G Newland · Mary Anne Jackson
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    ABSTRACT: Objective. To identify risk factors for pediatric Candida central line-associated bloodstream infections (CLABSIs). Design. Retrospective case-control study. Setting. Freestanding tertiary care children's hospital. Patients. Patients with Candida CLABSI from January 31, 2000, through December 31, 2010, compared with age- and year-matched controls. Methods. Demographics, comorbidities, presence of indwelling foreign bodies, exposure to antibiotics or corticosteroids, total parenteral nutrition (TPN) or blood transfusions, complications, and outcome were evaluated. Bivariate and then logistic regression were used to compare temporal trends and risk factors. Results. A total of 160 Candida CLABSI patients (median age, 1.96 years) were compared with 457 controls. Those with Candida CLABSIs were more likely to have intestinal failure (adjusted odds ratio [aOR], 6.777 [95% confidence interval (CI), 2.315-19.839]; [Formula: see text]), to have a gastrostomy tube in place (aOR, 4.156 [95% CI, 2.317-7.456]; [Formula: see text]), and to receive TPN (aOR, 3.897 [95% CI, 2.403-6.319]; [Formula: see text]) or blood transfusions (aOR, 2.990 [95% CI, 1.841-4.856]; [Formula: see text]), and they had a 3-fold increase in mortality (aOR, 3.543 [95% CI, 1.501-8.364]; [Formula: see text]). Candida albicans was most common, but non-albicans strains resistant to amphotericin (C. lusitaniae) and fluconazole (C. glabrata and C. krusei) were also found. Conclusions. Those patients with intestinal failure, gastrostomy tube presence, and/or receipt of TPN and blood transfusions are at increased risk for development of Candida CLABSI.
    Infection Control and Hospital Epidemiology 12/2013; 34(12):1266-71. DOI:10.1086/673988 · 3.94 Impact Factor
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    ABSTRACT: Intravenous immunoglobulin (IVIG) is commonly used for a wide range of diagnoses, by multiple pediatric subspecialists. We report two cases of hepatitis B screening results post IVIG infusion, where positive anti-Hepatitis B core antigen serology tests indicated possible occult hepatitis infection, leading to a delay in care. However, serial antibody testing showed results consistent with the passive transfer of antibodies.
    F1000 Research 11/2013; 2:249. DOI:10.12688/f1000research.2-249.v1
  • Adam L Hersh · Mary Anne Jackson · Lauri A Hicks
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    ABSTRACT: Most upper respiratory tract infections are caused by viruses and require no antibiotics. This clinical report focuses on antibiotic prescribing strategies for bacterial upper respiratory tract infections, including acute otitis media, acute bacterial sinusitis, and streptococcal pharyngitis. The principles for judicious antibiotic prescribing that are outlined focus on applying stringent diagnostic criteria, weighing the benefits and harms of antibiotic therapy, and understanding situations when antibiotics may not be indicated. The principles can be used to amplify messages from recent clinical guidelines for local guideline development and for patient communication; they are broadly applicable to antibiotic prescribing in general.
    PEDIATRICS 11/2013; 132(6). DOI:10.1542/peds.2013-3260 · 5.30 Impact Factor
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    ABSTRACT: Background: Human Parechoviruses (HPeVs) are recognized causes of infant sepsis-like illness and CNS infection. No studies have examined testing utility of non-CSF specimens for HPeV. Our aim was to evaluate non-CSF specimens in predicting HPeV or EV CNS infection in infants with sepsis-like illness. Methods: Hospitalized infants < 90 days old with CSF WBC counts <1000 and negative CSF gram stain were enrolled between 1/3/2011–12/31/2012. Stool, throat and nasal specimens were prospectively obtained. Scavenged CSF, blood and urine were collected when available. EasyMag® or Qiacube® was used to extract total nucleic acids, which were then tested by two-step real-time EV/HPeV RT-PCR. Diagnostic utility of non-CSF specimens to predict HPeV-CNS infection was determined by analyzing EV/HPeV results from paired CSF and non-CSF specimens in the same infants. Results: From 461 infants, 2001 specimens were obtained (432 CSF, 341 blood, 224 urine, 407 throat, 229 nasal, 368 stool). HPeV was detected in 164 specimens (46 subjects) and EV in 115 specimens (47 subjects). HPeV and EV were detected in 40 and 35 CSF samples, respectively. HPeV detection sensitivity in non-CSF specimens compared to CSF detection: blood (96%), stool (82%), throat (71%), nasal (63%) and urine (43%). HPeV detection specificity in all non-CSF specimens was 100%. EV detection sensitivity in non-CSF specimens: stool (94%), blood (64%), throat (41%), urine (6%) and nasal (5%). EV detection specificity for all non-CSF specimens was >95%. HPeV vs. EV blood and respiratory specimen testing showed HPeV blood testing outperformed EV blood testing in correctly predicting CNS disease presence/absence (p = 0.037), as did HPeV respiratory testing vs. EV respiratory testing (p = 0.015). Conclusion: HPeV can be detected from multiple anatomic sites outside CSF in HPeV-infected infants. Excluding stool, HPeV is detected at a higher frequency in non-CSF specimens than EV. Blood appears a useful non-CSF specimen for HPeV (96%) and EV (64%) detection in infants with sepsis-like illness. Stool appears suitable for both HPeV and EV detection, while respiratory specimens (nasal/ throat) are more reliable for infant HPeV detection. PCR testing of non-CSF specimens can be useful adjuncts in diagnosis of HPeV CNS disease in infants presenting with sepsis-like illness.
    IDWeek 2013 Meeting of the Infectious Diseases Society of America; 10/2013
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    ABSTRACT: We evaluated vancomycin minimum inhibitory concentration (MIC) trends by three methods (broth microdilution, Etest, Vitek 2®) in 208 S. aureus blood isolates from 2006-2009 and assessed for heteroresistance. Vancomycin MICs did not increase nor was heteroresistance identified. Etest yielded higher MIC results than the other two methods. No MIC was > 2 µg/ml by any testing method.
    The Pediatric Infectious Disease Journal 09/2013; 33(2). DOI:10.1097/01.inf.0000434354.84352.ca · 3.14 Impact Factor

Publication Stats

1k Citations
369.18 Total Impact Points

Institutions

  • 2008–2015
    • Children's Mercy Hospitals and Clinics
      Kansas City, Missouri, United States
    • University of Kansas
      • Division of Infectious Diseases
      Lawrence, Kansas, United States
  • 1989–2015
    • Children's Mercy Hospitals and Clinics
      Kansas City, Missouri, United States
  • 1987–2015
    • University of Missouri - Kansas City
      • • Department of Pediatrics
      • • School of Medicine
      Kansas City, Missouri, United States
  • 1989–2014
    • Children's Mercy Hospital
      Kansas City, Missouri, United States
  • 1993
    • University of Missouri
      Columbia, Missouri, United States
  • 1982
    • University of Cincinnati
      • Department of Pediatrics
      Cincinnati, Ohio, United States