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Biomedical subjects

Robert S Baltimore

Publications and source records attributed to Robert S Baltimore.

18 recordsLinked to original sources
PubMed2006

Case-control analysis of endemic Serratia marcescens bacteremia in a neonatal intensive care unit.

BACKGROUND: Serratia marcescens is an opportunistic gram-negative rod which typically infects compromised hosts. OBJECTIVES: To identify risk factors, signs, and outcomes associated with non-epidemic S marcescens bacteremia in a neonatal intensive care unit (NICU). METHODS: The records of infants with S marcescens bacteremia while in the Yale-New Haven Hospital NICU from 1980-2004 were reviewed. A matched case-control study was performed by comparing each case of S marcescens to 2 uninfected controls and 2 cases of Escherichia coli bacteremia. RESULTS: Twenty-five sporadic cases of S marcescens bacteremia were identified. Eleven available isolates were determined to be different strains by pulse field gel electrophoresis. Infants with S marcescens bacteremia had median gestational age and birth weight of 28 weeks and 1235 grams, respectively. Compared to matched, uninfected controls, infants with S marcescens bacteremia were more likely to have had a central vascular catheter (OR = 4.33; 95% CI (1.41 to 13.36)) and surgery (OR = 5.67; 95% CI (1.81 to 17.37)), and had a higher overall mortality (44% vs 2%; OR = 38.50; 95% CI (4.57 to 324.47)). Compared to E coli matched controls, infants with S marcescens bacteremia had later onset of infection (median of 33 days of life vs 10; p<0.001), prolonged intubation (OR = 5.76; 95% CI (1.80 to 18.42)), and a higher rate of CVC (OR = 7.77; 95% CI (2.48 to 24.31)) use at the time of infection. A higher rate of meningitis (24% vs 7%; OR = 3.98; 95% CI (1.09 to 14.50)) was observed with S marcescens bacteremia compared to E coli. CONCLUSIONS: S marcescens bacteremia occurs sporadically in the NICU, primarily in premature infants requiring support apparatus late in their hospital course. Associated meningitis is common and mortality high.

Bacteremia↗
PubMed2006

Life-threatening sepsis caused by Burkholderia cepacia from contaminated intravenous flush solutions prepared by a compounding pharmacy in another state.

We report 2 life-threatening cases of Burkholderia cepacia sepsis caused by infusate contamination during compounding. Bacterial isolates from the patients' blood cultures and the infusate were indistinguishable by pulsed-field gel electrophoresis. Proper quality controls at a local and national level are important for ensuring safe delivery of compounded medications to patients in all settings, including those outside health care facilities.

Bacteremia↗
PubMed2006

Recent trends in meningococcal epidemiology and current vaccine recommendations.

PURPOSE OF REVIEW: In 2005, a new meningococcal vaccine, tetravalent meningococcal conjugate vaccine (MCV4) was approved for use. This review discusses the population for whom it is recommended and the logic underlying these recommendations. RECENT FINDINGS: The older meningococcal vaccine, composed of capsular polysaccharide, had limited use in civilian populations. The Centers for Disease Control and the American Academy of Pediatrics now recommend the routine vaccination of adolescents with MCV4. This recommendation is largely based on newer epidemiologic data showing a considerable risk of meningococcal disease in late adolescence, most of which is preventable with vaccine. CONCLUSION: The new MCV4 vaccine should be used in primary-care practices for the immunization of all adolescents and high-risk children and adults. In the future, further studies are likely to show it to be safe and effective for younger children too.

Adolescent↗
PubMed2005

Infective endocarditis: diagnosis, antimicrobial therapy, and management of complications: a statement for healthcare professionals from the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease, Council on Cardiovascular Disease in the Young, and the Councils on Clinical Cardiology, Stroke, and Cardiovascular Surgery and Anesthesia, American Heart Association: endorsed by the Infectious Diseases Society of America.

BACKGROUND: Despite advances in medical, surgical, and critical care interventions, infective endocarditis remains a disease that is associated with considerable morbidity and mortality. The continuing evolution of antimicrobial resistance among common pathogens that cause infective endocarditis creates additional therapeutic issues for physicians to manage in this potentially life-threatening illness. METHODS AND RESULTS: This work represents the third iteration of an infective endocarditis "treatment" document developed by the American Heart Association under the auspices of the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease, Council on Cardiovascular Disease of the Young. It updates recommendations for diagnosis, treatment, and management of complications of infective endocarditis. A multidisciplinary committee of experts drafted this document to assist physicians in the evolving care of patients with infective endocarditis in the new millennium. This extensive document is accompanied by an executive summary that covers the key points of the diagnosis, antimicrobial therapy, and management of infective endocarditis. For the first time, an evidence-based scoring system that is used by the American College of Cardiology and the American Heart Association was applied to treatment recommendations. Tables also have been included that provide input on the use of echocardiography during diagnosis and treatment of infective endocarditis, evaluation and treatment of culture-negative endocarditis, and short-term and long-term management of patients during and after completion of antimicrobial treatment. To assist physicians who care for children, pediatric dosing was added to each treatment regimen. CONCLUSIONS: The recommendations outlined in this update should assist physicians in all aspects of patient care in the diagnosis, medical and surgical treatment, and follow-up of infective endocarditis, as well as management of associated complications. Clinical variability and complexity in infective endocarditis, however, dictate that these guidelines be used to support and not supplant physician-directed decisions in individual patient management.

Ambulatory Care↗
PubMed2005

Seventy-five years of neonatal sepsis at Yale: 1928-2003.

OBJECTIVE: Yale-New Haven Hospital (Y-NHH) has maintained the longest running, single-center longitudinal database of neonatal sepsis, started in 1928. The objective of this study was to update this database with review of neonatal sepsis cases at Y-NHH to identify longitudinal trends in demographics, pathogens, and outcome. METHODS: Records of infants with positive blood cultures obtained while they were inpatients in the NICU at Y-NHH from 1989 to 2003 were reviewed retrospectively. Records of infants who were < or =30 days of age, had positive blood cultures, and were hospitalized at Y-NHH outside the NICU from the same period were also reviewed, and all findings were compared with 60 years of preexisting data. RESULTS: A total of 862 organisms were identified in 755 episodes of sepsis from 647 infants. The percentage of cases of early-onset sepsis decreased and late-onset sepsis increased compared with the previous 10-year study period. A marked increase in cases as a result of commensal species was observed, particularly in preterm infants who had indwelling central vascular catheters, were receiving parenteral nutrition, and required prolonged mechanical ventilation. The overall percentage of sepsis caused by group B streptococcus and Escherichia coli decreased. No episodes of sepsis from Streptococcus pneumoniae or S pyogenes, common in the early years of the survey, were observed. The sepsis-related mortality rate steadily decreased, from 87% in 1928 to 3% in 2003. CONCLUSIONS: The demographics, pathogens, and outcome associated with neonatal sepsis continue to change. The increase in late-onset sepsis in preterm infants who required prolonged intensive care indicates that strategies to prevent infection are urgently needed for this population of infants.

Bacteremia↗
PubMed2004

Diagnosis, treatment, and long-term management of Kawasaki disease: a statement for health professionals from the Committee on Rheumatic Fever, Endocarditis and Kawasaki Disease, Council on Cardiovascular Disease in the Young, American Heart Association.

BACKGROUND: Kawasaki disease is an acute self-limited vasculitis of childhood that is characterized by fever, bilateral nonexudative conjunctivitis, erythema of the lips and oral mucosa, changes in the extremities, rash, and cervical lymphadenopathy. Coronary artery aneurysms or ectasia develop in approximately 15% to 25% of untreated children and may lead to ischemic heart disease or sudden death. METHODS AND RESULTS: A multidisciplinary committee of experts was convened to revise the American Heart Association recommendations for diagnosis, treatment, and long-term management of Kawasaki disease. The writing group proposes a new algorithm to aid clinicians in deciding which children with fever for > or =5 days and < or =4 classic criteria should undergo echocardiography, receive intravenous gamma globulin (IVIG) treatment, or both for Kawasaki disease. The writing group reviews the available data regarding the initial treatment for children with acute Kawasaki disease, as well for those who have persistent or recrudescent fever despite initial therapy with IVIG, including IVIG retreatment and treatment with corticosteroids, tumor necrosis factor-alpha antagonists, and abciximab. Long-term management of patients with Kawasaki disease is tailored to the degree of coronary involvement; recommendations regarding antiplatelet and anticoagulant therapy, physical activity, follow-up assessment, and the appropriate diagnostic procedures to evaluate cardiac disease are classified according to risk strata. CONCLUSIONS: Recommendations for the initial evaluation, treatment in the acute phase, and long-term management of patients with Kawasaki disease are intended to assist physicians in understanding the range of acceptable approaches for caring for patients with Kawasaki disease. The ultimate decisions for case management must be made by physicians in light of the particular conditions presented by individual patients.

Algorithms↗
PubMed2004

Impact of pneumococcal and influenza vaccines on otitis media.

PURPOSE OF REVIEW: The pneumococcal conjugate vaccine and influenza virus vaccines have the potential to reduce the risk of acute otitis media. Several recent studies have evaluated the impact of each of these vaccines on the incidence of acute otitis media. RECENT FINDINGS: In controlled studies, pneumococcal conjugate vaccine has resulted in a reduction in the incidence of acute otitis media of approximately 6%. Inactivated influenza vaccine does not appear to reduce the incidence of acute otitis media in children 6-24 months of age, but a few studies, each with design or methodological limitations, suggest that it may reduce the incidence among older children. One study reported that the live-attenuated, cold-adapted trivalent influenza vaccine reduced the incidence of febrile otitis media by 30%. Additional studies are needed to clarify the value of influenza vaccines to prevent acute otitis media. SUMMARY: The pneumococcal conjugate vaccine and the influenza vaccines may have a limited beneficial impact on the incidence of acute otitis media. Nevertheless, at this time, these vaccines should be promoted because of their primary benefits, which are reduced serious pulmonary and invasive infections, and not because they may reduce the incidence of acute otitis media.

Child, Preschool↗
PubMed2004

Diagnosis, treatment, and long-term management of Kawasaki disease: a statement for health professionals from the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease, Council on Cardiovascular Disease in the Young, American Heart Association.

BACKGROUND: Kawasaki disease is an acute self-limited vasculitis of childhood that is characterized by fever, bilateral nonexudative conjunctivitis, erythema of the lips and oral mucosa, changes in the extremities, rash, and cervical lymphadenopathy. Coronary artery aneurysms or ectasia develop in approximately 15% to 25% of untreated children and may lead to ischemic heart disease or sudden death. METHODS AND RESULTS: A multidisciplinary committee of experts was convened to revise the American Heart Association recommendations for diagnosis, treatment, and long-term management of Kawasaki disease. The writing group proposes a new algorithm to aid clinicians in deciding which children with fever for > or =5 days and < or =4 classic criteria should undergo echocardiography [correction], receive intravenous gamma globulin (IVIG) treatment, or both for Kawasaki disease. The writing group reviews the available data regarding the initial treatment for children with acute Kawasaki disease, as well for those who have persistent or recrudescent fever despite initial therapy with IVIG, including IVIG retreatment and treatment with corticosteroids, tumor necrosis factor-alpha antagonists, and abciximab. Long-term management of patients with Kawasaki disease is tailored to the degree of coronary involvement; recommendations regarding antiplatelet and anticoagulant therapy, physical activity, follow-up assessment, and the appropriate diagnostic procedures to evaluate cardiac disease are classified according to risk strata. CONCLUSIONS: Recommendations for the initial evaluation, treatment in the acute phase, and long-term management of patients with Kawasaki disease are intended to assist physicians in understanding the range of acceptable approaches for caring for patients with Kawasaki disease. The ultimate decisions for case management must be made by physicians in light of the particular conditions presented by individual patients.

Algorithms↗
PubMed2003

Should smallpox vaccine be tested in children?

Following the terrorist attacks on 11 September 2001 there has been increased concern about bioterrorism, much of it focused on smallpox. Routine smallpox vaccination in the USA was discontinued in 1972 and most US citizens are susceptible to smallpox. The last natural case of smallpox occurred in 1978 but the virus has been stocked in freezers. If a terrorist had access to stored smallpox virus a release could produce a chaotic situation. In response the USA has developed a program for vaccinating adults but children have been left out. The only available vaccine has recently been tested in adults but a proposal for testing children was not approved. We need to know if available vaccines are safe for children so children can be safely and effectively vaccinated in an emergency situation.

Adolescent↗
PubMed2003

New recommendations for influenza vaccination for children and pregnant women.

This year the Advisory Committee on Immunization Practices of the United States Centers for Disease Control and Prevention has updated recommendations for use of influenza vaccine. Previously, use of influenza vaccine focused primarily on the elderly as well as younger persons with underlying conditions that place them at high risk for severe disease and complications from influenza infection. The new recommendations also emphasize the benefits of influenza vaccination for young, healthy children who are at high risk for hospitalization with influenza infection. These changes are the result of recent reports demonstrating that otherwise healthy young children aged 6 to 24 months are hospitalized for influenza and its complications at rates comparable to those for whom influenza vaccination is already recommended, including the elderly.

Adult↗
PubMed2003

Neonatal sepsis: epidemiology and management.

Neonatal sepsis is uncommon (2-4 per 1000 live births in developed countries), but the rate increases dramatically in premature newborns and those born to mothers with infections or prolonged rupture of the fetal membranes. While infections caused by organisms contracted from the mother at birth have decreased in the past two decades, there has been an increase in nosocomial infections. Today, most infants with sepsis have been hospitalized in neonatal intensive care units for weeks or months because of extreme prematurity, or because of a congenital malformation or surgical condition. Antimicrobial therapy is usually begun prior to the isolation of a pathogen and is based upon knowledge of the likely microbes in the particular clinical situation. The number of antimicrobial agents that can be safely used in neonates is relatively small, and dose administration usually needs to be adjusted based upon birthweight and post-gestational age. The decision whether to treat with antimicrobials should be made with consideration of the history, physical examination, and laboratory data. One should also consider the effects of the use of antimicrobials on the flora of the care unit. Bacterial resistance in the resident flora of the unit has become a major problem where there has been indiscriminate use of broad-spectrum agents.

Anti-Bacterial Agents↗