Browsing by Author "Kellner, James D"
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- ItemOpen AccessAntimicrobial Susceptibility of Invasive and Lower Respiratory Tract Isolates of Streptococcus pneumoniae, 1998 to 2007(2009-01-01) Vanderkooi, Otto G; McConnell, Athena; Church, Deirdre L; Kellner, James DPrevious surveys of antimicrobial resistance in Streptococcus pneumoniae have found differences depending on source of isolate (eg, higher resistance in lower respiratory tract [LRT] versus invasive isolate) and age (higher resistance in children versus adults). Susceptibility profiles in the Calgary Health Region (approximately 1.25 million population) over a 10-year period were studied. Prospective laboratory-based population surveillance for S pneumoniae disease has been conducted since 1998. Patient demographics and susceptibility testing were analyzed. In total, 2382 patient isolates were available for analysis from 1998 to 2007. Of these, 1170 isolates were invasive while 496 were LRT. Patient age distribution was: younger than five years, 14%; five to 17 years, 6%; 18 to 64 years, 56%; and 65 years or older, 24%. Mean patient age was 44.8 years and 60.0% were male. The overall incidence of nonsusceptibility was: penicillin, 8.2%; amoxicillin, 0.3%; cefuroxime, 6.2%; ceftriaxone, 1.7%; erythromycin, 8.8%; trimethoprim-sulfamethoxazole (TMP-SMX), 25.6%; clindamycin, 2.3%; and levofloxacin, 0.2%. Overall resistance rates were stable, except for increasing erythromycin resistance from 5.4% (1998) to a high of 14.2% (2004) (P=0.007). Isolates that were nonsusceptible to penicillin or TMP-SMX were more likely to be multidrug resistant (Pud_less_than0.001) compared with penicillin- or TMP-SMX-susceptible isolates. Compared with invasive isolates, LRT isolates showed more resistance to penicillin, TMP-SMX, cefuroxime and erythromycin, and were more likely to be multidrug resistant. Isolates from children younger than five years of age are more likely to be multidrug resistant and resistant to erythromycin and cefotaxime. Ongoing surveillance of S pneumoniae isolates is important because resistance rates vary by source and patient age among health care regions.
- ItemOpen AccessBeliefs and Behaviours of Parents Regarding Antibiotic Use by Children(2001-01-01) Bagshaw, Sean M; Kellner, James DOBJECTIVE: To determine parents' beliefs and behaviours about antibiotic use by their children in the ambulatory setting.DESIGN: Cross-sectional survey, where a self-administered questionnaire was completed by adult caregivers of children before the medical assessment of the child.SETTING: Three paediatric acute care settings (paediatric emergency department [PED], group paediatric practice and after hours walk-in medical clinic).POPULATION STUDIED: Adult caregivers (n=114; 76% mothers, 19% fathers and 4% other caregivers) of children brought for acute care were surveyed.MAIN RESULTS: Forty-one caregivers completed the survey in the PED, 37 in the paediatric office and 36 in the walk-in clinic. They believed that antibiotics were appropriate for ear infections (86%), pharyngitis (77%), bronchitis (49%), sinus colds (20%), cough (12%), colds (8%) and influenza (8%). Sixty-eight per cent of children had received antibiotics in the previous year. Thirteen per cent of caregivers reported previously requesting an antibiotic for their child, 18% believed a previous antibiotic prescription had been unnecessary and 19% had not complied with prescriptions in the past. Concerns about antibiotic use included antibiotic resistance (50%), harm to the immune system (40%), adverse effects (28%) and lack of efficacy (19%).CONCLUSIONS: In this population, parental knowledge and understanding of indications for antibiotics and their adverse effects were good; however, incorrect beliefs and disagreements with physicians did occur. To improve patterns of antibiotic use by children, it will be necessary to understand parents' beliefs, behaviours and information sources better so that misconceptions and disagreements with caregivers can be addressed appropriately.
- ItemOpen AccessClinical Features and Outcomes of Serotype 19A Invasive Pneumococcal Disease in Calgary, Alberta(2014-01-01) Ricketson, Leah J; Vanderkooi, Otto G; Wood, Melissa L; Leal, Jenine; Kellner, James DBACKGROUND: Streptoccocus pneumoniae serotype 19A (ST19A) became an important cause of invasive pneumococcal disease (IPD) after the introduction of the conjugate vaccine.OBJECTIVE: To examine the severity and outcome of ST19A IPD compared with non-ST19A IPD.METHODS: The Calgary Area Streptococcus pneumoniae Epidemiology Research (CASPER) study collects clinical and laboratory data on all IPD cases in Calgary, Alberta. Analysis was performed on data from 2000 to 2010 comparing ST19A and non-ST19A IPD cases. Adjusted linear and logistic regression models were used to examine outcomes of duration of appropriate intravenous antibiotic therapy and intensive care unit admission, respectively.RESULTS: ST19A tended to cause disease in younger patients. ST19A isolates were more often multidrug resistant (19% versus 0.3%; Pud_less_than0.001). Adjusted logistic regression showed no difference in intensive care unit admission between ST19A and non-ST19A IPD cases (OR 1.4 [95% CI 0.8 to 2.7]). An adjusted linear regression model showed patients ud_less_than18 years of age with a diagnosis of bacteremia and no risk factors infected with ST19A were, on average, treated with antibiotics 1.4 times (95% CI 1.1 to 1.9) as long as patients with non-19A IPD and the same baseline characteristics.DISCUSSION: ST19A IPD was associated with an increase in average time on antibiotics. Although many of the infecting strains of ST19A were within the threshold for susceptibility, they may be sufficiently resilient to require a longer duration of antibiotic therapy or higher dose to clear the infection.CONCLUSIONS: ST19A is more common in younger individuals, is more antibiotic resistant and may require longer average treatment duration.
- ItemOpen AccessCommunity-Acquired Pneumonia in Children: A Multidisciplinary Consensus Review(2003-01-01) Low, Donald E; Kellner, James D; Allen, Upton; Boucher, Francois D; Kovesi, Thomas; Riesman, John; Davidson, Ross; Langley, Joanne MCommunity-acquired pneumonia (CAP) is common among children and may have viral, bacterial or, occasionally, other causes. The etiology is complex, with age-related trends, and differs from that in adult CAP, necessitating different management guidelines. There is an absence of current guidelines for the management of pediatric CAP (PCAP) that take into account changing etiologies, antimicrobial-resistance issues and the use of newly licensed antimicrobials. The present review does not provide specific guidelines, but it reviews the literature and presents currrent approaches to the treatment of PCAP. To compile the review, an expert panel was convened to provide a consensus. The review discusses the etiology, diagnosis and antimicrobial treatment of PCAP as well as indications for referral to a hospital emergency department. The goal of the review is to provide those involved with treatment of PCAP in the community setting with information that can be used to make effective treatment choices.
- ItemOpen AccessInvasive Pneumococcal Disease in Calgary During the Sars-CoV-2 Pandemic 2020(2021-05-13) Kellner, James D; Ricketson, Leah JDuring the Sars-CoV-2 pandemic in 2020, many countries shut down schools and businesses in an effort to slow transmission of the virus. As some businesses reopened, increased public health protocols, mask wearing, hand sanitizer, and personal protective equipment use remained. The shut down and public health restrictions for person-to-person interaction, resulted in a decline of other transmissible diseases as well as Sars-CoV-2. In Calgary, the incidence of invasive disease due to Streptococcus pneumoniae declined to much lower levels than would be expected in early spring and remained low until December 2020. This decline occurred despite no changes in vaccine use and uptake.
- ItemOpen AccessInvasive Streptococcus pneumoniae Infection Causing Hemolytic Uremic Syndrome in Children: Two Recent Cases(2003-01-01) Vanderkooi, Otto G; Kellner, James D; Wade, Andrew W; Jadavji, Tajdin; Midgley, Julian P; Louie, Thomas; Tyrrell, Gregory JINTRODUCTION: Streptococcus pneumoniae is an uncommon cause of hemolytic uremic syndrome (HUS) with a unique pathophysiology that differs from Shiga toxin-related HUS.METHODS: Case descriptions for each patient are provided. Each strain of S pneumoniae was subjected to a pulsed-field gel electrophoresis (PFGE) analysis, Shiga toxin assay and polymerase chain reaction to detect Shiga toxin genes. A review of the current literature was conducted.CASE PRESENTATIONS: Two patients with S pneumoniae-related HUS that presented to the Alberta Children's Hospital, Calgary, Alberta, within four weeks of each other in 2001 are described. Both presented with pneumonia and empyema with associated HUS. Both patients required dialysis, one patient for 10 days and the other for 18 days. Neither patient demonstrated evidence of Shiga toxin-related disease. S pneumoniae isolated from blood or pleural fluid was penicillin susceptible. One isolate was serotype 3 and the other was serotype 14. The two strains had different PFGE patterns. Both patients recovered well with no persistent renal dysfunction.CONCLUSIONS: S pneumoniae continues to be an uncommon but important cause of HUS. Most cases can be confirmed or at least considered probable without performing a renal biopsy.
- ItemOpen AccessMaternal perceptions of childhood vaccination: explanations of reasons for and against vaccination(2019-01-10) McNeil, Deborah A; Mueller, Melissa; MacDonald, Shannon; McDonald, Sheila; Saini, Vineet; Kellner, James D; Tough, SuzanneAbstract Background Understanding reasons for and against vaccination from the parental perspective is critical for designing vaccination campaigns and informing other interventions to increase vaccination uptake in Canada. The objective of this study was to understand maternal vaccination decision making for children. Methods Mothers participating in a longitudinal community-based pregnancy cohort, the All Our Babies study in Calgary, Alberta, completed open-ended survey questions providing explanations for the vaccination status of their child by 24 months postpartum. Qualitative responses were linked to administrative vaccination records to examine survey responses and recorded child vaccination status. Results There were 1560 open-ended responses available; 89% (n = 1391) provided explanations for vaccinating their children, 5% (n = 79) provided explanations for not vaccinating/delaying, and 6% (n = 90) provided explanations for both. Themes were similar for those vaccinating and not vaccinating/delaying; however, interpretations were different. Two broad themes were identified: Sources of influence and Deliberative Processes. Sources of influence on decision making included personal, family, and external experiences. Deliberative Processes included risk, research, effectiveness, and balancing risks/benefits. Under Deliberative Processes, responsibility was a category for those vaccinating; while choice, instrumental/practical, and health issues were categories for those not vaccinating/delaying. Mothers’ levels of conviction and motivation provided a Context for understanding their decision making perspectives. Conclusions Vaccination decision making is complex and impacted by many factors that are similar but contribute to different decisions depending on mothers’ perspectives. The results of this study indicate the need to examine new intervention approaches to increase uptake that recognize and address feelings of pressure and parental commitment to choice.
- ItemOpen AccessPneumococcal Disease Trends in the Post-Vaccine Era in Calgary, Canada: An Interrupted Time Series Analysis(2022-06-20) Ricketson, Leah; Kellner, James D; CASPER InvestigatorsBackground: In 2002 the 4-dose 7-valent pneumococcal conjugate vaccine (PCV7) was introduced in Calgary for vaccination of children, followed by the 3-dose 13-valent vaccine (PCV13) in 2010. Methods: We conducted an interrupted time series analysis on incidence of IPD per quarter allowing for change in trends in 2002 and 2010. We included models for IPD overall and age and serotype restricted models. Results: The incidence of PCV7 IPD (all ages) decreased after PCV7 introduction in 2002 (P<0.001) and was sustained after PCV13 introduction in 2010. In children, the incidence of PCV13 (less PCV7 ST) IPD increased in children after PCV7 introduction (P<0.001) and decreased after PCV13 introduction (P=0.002). After PCV7 introduction, overall IPD incidence was lower in children, but not significant, (P=0.054) and was unchanged in adults (P=0.4721). After PCV13 introduction, overall IPD incidence was unchanged in children (P=0.88) and increased in adults (P<0.001). Conclusions: PCV7 IPD has declined in the post-PCV period, but overall IPD had not declined significantly and was increasing in adults prior to the precipitous decline observed in 2021, during the COVID-19 pandemic. PCV13 serotypes, as well as non-vaccine serotypes, continue to cause disease, including outbreaks of serotype 4, 5, and 8. It is unclear whether the change from 4 doses to 3 doses of PCV has reduced overall vaccine effectiveness.
- ItemOpen AccessPneumococcal Peritonitis: Still with Us and Likely to Increase in Importance(2010-01-01) Waisman, Darcy C; Tyrrell, Gregory J; Kellner, James D; Garg, Sipi; Marrie, Thomas JBACKGROUND: Pneumococcal peritonitis is uncommon and poorly understood.METHODS: As part of a five-year study (2000 to 2004) of invasive pneumococcal disease (IPD) in Alberta, all cases of peritonitis due to Streptococcus pneumoniae were reviewed and compared with all other cases of IPD.RESULTS: Twenty-three of 1768 (1.3%) IPD patients were found to have peritonitis. Patients with peritonitis were more likely to have cirrhosis, hepatitis C, alcoholism and HIV/AIDS, than the remainder of the patients with IPD. The all-cause mortality did not differ between the two groups. Peritonitis was classified as primary in nine (39%) patients, secondary in 12 (52%) patients, and genitourinary in females, specifically, in two (9%) patients. Pneumococcal serotypes causing peritonitis were under-represented in current vaccines – 17% among peritonitis patients versus 53% for the remainder of IPD patients for the 7-valent pneumococcal conjugate vaccine, and 56% versus 86% for the 23-valent pneumococcal polysaccharide vaccine.CONCLUSIONS: Peritonitis represents a small subset of patients with IPD, but one that is likely to grow in importance given the increase in the number of patients with hepatitis C and HIV, and the reduced coverage of peritonitis serotypes in currently available vaccines.