My Predictions for 2012

Nine trends and a wish for New Year blessings for your family and friends!

• Rethinking clindamycin. Many experts have recommended clindamycin as the go-to antibiotic for stable children hospitalized with skin, soft tissue, or musculoskeletal infections, and for complicated community-acquired pneumonia (in the latter, usually in combination with a third-generation cephalosporin). Over the last year, clindamycin resistance rates from our center have risen to 25%-30% for invasive isolates (higher for methicillin-sensitive Staphylococcus aureus than methicillin-resistant S. aureus). We are changing our recommendations for empiric treatment in cases where S. aureus is an etiologic consideration, and are depending on culture data to provide susceptibility information (using polymerase chain reaction in culture-negative cases) to guide our definitive therapy. Clinicians will need to carefully review their local clindamycin resistance rates for S aureus isolates, and to discuss the implications with their local pediatric infectious diseases specialists.

• Good news about MRSA. Thankfully, MRSA skin abscesses will be less commonly diagnosed. For several years now, a pediatric wound care clinic has been staffed by our emergency medicine faculty for the follow-up of children who had a skin abscess drained in the emergency department setting. At the peak of the MRSA epidemic in our community, this clinic cared for 350 children a month. The data for the last 6 months indicate that there has been a 60% decrease in the number of children seen, a welcome trend for both patient and doctor.

• New pneumococci. I suspect we will continue to see new serotypes of pneumococcus emerge, perhaps even after the 13-valent pneumococcal conjugate vaccine (PCV13) is fully implemented. In the last year, we confirmed an unexpected increase in infections from serotype 35, which is not a capsule serotype included in PCV13 vaccine, and almost one-quarter of these were penicillin nonsusceptible.

• Vaccinating adults, part 1. In 2012, pediatricians will be front and center in the process of building better systems for providing influenza immunization to children, but now will also be asked to address their parents. Look for American Academy of Pediatrics recommendations for providing parent vaccines at the pediatrician’s office; these will target the provision of tetanus-diphtheria-acellular pertussis (Tdap) and influenza vaccines.

• Vaccinating adults, part 2. New recommendations that followed the large 2010 California outbreak of pertussis emphasized the provision of a single dose of Tdap vaccine – not only for adolescents and adults, but also for the incompletely immunized child older than age 7 years and for adults older than 64 years. At least 5 years of pertussis protection is provided by the Tdap vaccine, but as additional data on the duration of protection are analyzed, we may be talking about a Tdap booster in the not-so-distant future.

• Measles won’t leave us. Measles outbreaks in 2012 will continue to be reported internationally and within the United States because of importation of cases and inadequate vaccination coverage in certain populations.

• Resisting resistances. Multidrug-resistant, gram-negative organisms will be an increasing problem for hospitalized children. This will fuel recommendations in 2012 that emphasize the judicious use of antibiotics both in hospitalized patients and for outpatient infections. Look for upcoming recommendations related to judicious use for antibiotic treatment of respiratory tract infections (that is, pharyngitis, otitis, and sinusitis) in children.

• Rising sulfa sensitivity. Long recognized but possibly forgotten, trimethoprim sulfamethoxazole (TMP-SMX) hypersensitivity reactions appear to be on the rise, and are correlated with the increase in the use of sulfa-based agents for treatment of MRSA skin infection. Parents should be instructed to contact you if their child develops a rash while taking TMP-SMX, because the hypersensitivity reactions related to this drug can be serious and potentially life threatening.

• Watching for flu. Pediatricians will be gearing up for the 2012 influenza season after the holidays, and are expecting the traditional potential mix of influenza A and influenza B viruses. Limited data from the Centers for Disease Control and Prevention confirm that all viruses circulating so far are included in this year’s seasonal influenza vaccine. There was a recent report describing infection caused by a reassortant swine-derived novel influenza virus in three children from separate counties in Iowa, prompting enhanced CDC surveillance for Iowa and the surrounding states. More swine flu for 2012? I think not, but keep an eye on trends at the CDC’s flu surveillance website.

This column, "ID Consult," regularly appears in Pediatric News, an Elsevier publication. Dr. Jackson is the chief of infectious diseases at Children’s Mercy Hospitals and Clinics in Kansas City, Mo. She has no disclosures to declare.

Nine trends and a wish for New Year blessings for your family and friends!

• Rethinking clindamycin. Many experts have recommended clindamycin as the go-to antibiotic for stable children hospitalized with skin, soft tissue, or musculoskeletal infections, and for complicated community-acquired pneumonia (in the latter, usually in combination with a third-generation cephalosporin). Over the last year, clindamycin resistance rates from our center have risen to 25%-30% for invasive isolates (higher for methicillin-sensitive Staphylococcus aureus than methicillin-resistant S. aureus). We are changing our recommendations for empiric treatment in cases where S. aureus is an etiologic consideration, and are depending on culture data to provide susceptibility information (using polymerase chain reaction in culture-negative cases) to guide our definitive therapy. Clinicians will need to carefully review their local clindamycin resistance rates for S aureus isolates, and to discuss the implications with their local pediatric infectious diseases specialists.

• Good news about MRSA. Thankfully, MRSA skin abscesses will be less commonly diagnosed. For several years now, a pediatric wound care clinic has been staffed by our emergency medicine faculty for the follow-up of children who had a skin abscess drained in the emergency department setting. At the peak of the MRSA epidemic in our community, this clinic cared for 350 children a month. The data for the last 6 months indicate that there has been a 60% decrease in the number of children seen, a welcome trend for both patient and doctor.

• New pneumococci. I suspect we will continue to see new serotypes of pneumococcus emerge, perhaps even after the 13-valent pneumococcal conjugate vaccine (PCV13) is fully implemented. In the last year, we confirmed an unexpected increase in infections from serotype 35, which is not a capsule serotype included in PCV13 vaccine, and almost one-quarter of these were penicillin nonsusceptible.

• Vaccinating adults, part 1. In 2012, pediatricians will be front and center in the process of building better systems for providing influenza immunization to children, but now will also be asked to address their parents. Look for American Academy of Pediatrics recommendations for providing parent vaccines at the pediatrician’s office; these will target the provision of tetanus-diphtheria-acellular pertussis (Tdap) and influenza vaccines.

• Vaccinating adults, part 2. New recommendations that followed the large 2010 California outbreak of pertussis emphasized the provision of a single dose of Tdap vaccine – not only for adolescents and adults, but also for the incompletely immunized child older than age 7 years and for adults older than 64 years. At least 5 years of pertussis protection is provided by the Tdap vaccine, but as additional data on the duration of protection are analyzed, we may be talking about a Tdap booster in the not-so-distant future.

• Measles won’t leave us. Measles outbreaks in 2012 will continue to be reported internationally and within the United States because of importation of cases and inadequate vaccination coverage in certain populations.

• Resisting resistances. Multidrug-resistant, gram-negative organisms will be an increasing problem for hospitalized children. This will fuel recommendations in 2012 that emphasize the judicious use of antibiotics both in hospitalized patients and for outpatient infections. Look for upcoming recommendations related to judicious use for antibiotic treatment of respiratory tract infections (that is, pharyngitis, otitis, and sinusitis) in children.

• Rising sulfa sensitivity. Long recognized but possibly forgotten, trimethoprim sulfamethoxazole (TMP-SMX) hypersensitivity reactions appear to be on the rise, and are correlated with the increase in the use of sulfa-based agents for treatment of MRSA skin infection. Parents should be instructed to contact you if their child develops a rash while taking TMP-SMX, because the hypersensitivity reactions related to this drug can be serious and potentially life threatening.

• Watching for flu. Pediatricians will be gearing up for the 2012 influenza season after the holidays, and are expecting the traditional potential mix of influenza A and influenza B viruses. Limited data from the Centers for Disease Control and Prevention confirm that all viruses circulating so far are included in this year’s seasonal influenza vaccine. There was a recent report describing infection caused by a reassortant swine-derived novel influenza virus in three children from separate counties in Iowa, prompting enhanced CDC surveillance for Iowa and the surrounding states. More swine flu for 2012? I think not, but keep an eye on trends at the CDC’s flu surveillance website.

This column, "ID Consult," regularly appears in Pediatric News, an Elsevier publication. Dr. Jackson is the chief of infectious diseases at Children’s Mercy Hospitals and Clinics in Kansas City, Mo. She has no disclosures to declare.

Nine trends and a wish for New Year blessings for your family and friends!

• Rethinking clindamycin. Many experts have recommended clindamycin as the go-to antibiotic for stable children hospitalized with skin, soft tissue, or musculoskeletal infections, and for complicated community-acquired pneumonia (in the latter, usually in combination with a third-generation cephalosporin). Over the last year, clindamycin resistance rates from our center have risen to 25%-30% for invasive isolates (higher for methicillin-sensitive Staphylococcus aureus than methicillin-resistant S. aureus). We are changing our recommendations for empiric treatment in cases where S. aureus is an etiologic consideration, and are depending on culture data to provide susceptibility information (using polymerase chain reaction in culture-negative cases) to guide our definitive therapy. Clinicians will need to carefully review their local clindamycin resistance rates for S aureus isolates, and to discuss the implications with their local pediatric infectious diseases specialists.

• Good news about MRSA. Thankfully, MRSA skin abscesses will be less commonly diagnosed. For several years now, a pediatric wound care clinic has been staffed by our emergency medicine faculty for the follow-up of children who had a skin abscess drained in the emergency department setting. At the peak of the MRSA epidemic in our community, this clinic cared for 350 children a month. The data for the last 6 months indicate that there has been a 60% decrease in the number of children seen, a welcome trend for both patient and doctor.

• New pneumococci. I suspect we will continue to see new serotypes of pneumococcus emerge, perhaps even after the 13-valent pneumococcal conjugate vaccine (PCV13) is fully implemented. In the last year, we confirmed an unexpected increase in infections from serotype 35, which is not a capsule serotype included in PCV13 vaccine, and almost one-quarter of these were penicillin nonsusceptible.

• Vaccinating adults, part 1. In 2012, pediatricians will be front and center in the process of building better systems for providing influenza immunization to children, but now will also be asked to address their parents. Look for American Academy of Pediatrics recommendations for providing parent vaccines at the pediatrician’s office; these will target the provision of tetanus-diphtheria-acellular pertussis (Tdap) and influenza vaccines.

• Vaccinating adults, part 2. New recommendations that followed the large 2010 California outbreak of pertussis emphasized the provision of a single dose of Tdap vaccine – not only for adolescents and adults, but also for the incompletely immunized child older than age 7 years and for adults older than 64 years. At least 5 years of pertussis protection is provided by the Tdap vaccine, but as additional data on the duration of protection are analyzed, we may be talking about a Tdap booster in the not-so-distant future.

• Measles won’t leave us. Measles outbreaks in 2012 will continue to be reported internationally and within the United States because of importation of cases and inadequate vaccination coverage in certain populations.

• Resisting resistances. Multidrug-resistant, gram-negative organisms will be an increasing problem for hospitalized children. This will fuel recommendations in 2012 that emphasize the judicious use of antibiotics both in hospitalized patients and for outpatient infections. Look for upcoming recommendations related to judicious use for antibiotic treatment of respiratory tract infections (that is, pharyngitis, otitis, and sinusitis) in children.

• Rising sulfa sensitivity. Long recognized but possibly forgotten, trimethoprim sulfamethoxazole (TMP-SMX) hypersensitivity reactions appear to be on the rise, and are correlated with the increase in the use of sulfa-based agents for treatment of MRSA skin infection. Parents should be instructed to contact you if their child develops a rash while taking TMP-SMX, because the hypersensitivity reactions related to this drug can be serious and potentially life threatening.

• Watching for flu. Pediatricians will be gearing up for the 2012 influenza season after the holidays, and are expecting the traditional potential mix of influenza A and influenza B viruses. Limited data from the Centers for Disease Control and Prevention confirm that all viruses circulating so far are included in this year’s seasonal influenza vaccine. There was a recent report describing infection caused by a reassortant swine-derived novel influenza virus in three children from separate counties in Iowa, prompting enhanced CDC surveillance for Iowa and the surrounding states. More swine flu for 2012? I think not, but keep an eye on trends at the CDC’s flu surveillance website.

This column, "ID Consult," regularly appears in Pediatric News, an Elsevier publication. Dr. Jackson is the chief of infectious diseases at Children’s Mercy Hospitals and Clinics in Kansas City, Mo. She has no disclosures to declare.