Coccidioidal meningitis remains difficult to treat. The newer triazole, isavuconazole, has demonstrated efficacy in invasive fungal disease with less side effects than other azoles. We describe a case of refractory pediatric coccidioidal meningitis with disease stabilization and improvement on isavuconazole after failing treatment with other antifungal agents.

Infant coccidioidomycosis has a non-specific presentation and can mimic common infant respiratory illnesses. In endemic areas, coccidioidomycosis should be considered in the differential diagnosis of infants with pulmonary symptoms unresponsive to conventional treatment. Pediatr Pulmonol. 2016;51:858-862. © 2016 Wiley Periodicals, Inc.

BACKGROUND AND OBJECTIVES Bronchiolitis is a viral syndrome that occurs in children aged <2 years and is a common reason for admission to children’s hospitals. The American Academy of Pediatrics bronchiolitis guideline discourages routine antibiotic therapy for bronchiolitis. Despite this, there is high use of antibiotics in this patient population. METHODS We performed a retrospective chart review of all patients aged ≤2 years admitted to our tertiary care center with bronchiolitis during 2 subsequent respiratory seasons. Between the 2 seasons, we provided an intervention to our hospital medicine group, which included a didactic review of American Academy of Pediatrics bronchiolitis guideline followed by subsequent, ongoing reinforcement from antibiotic stewardship weekday rounds. RESULTS We were able to achieve a 40% decrease in overall antibiotic use between the 2 study periods (25% vs 15%, P < .001). CONCLUSIONS Provider education, along with focused antibiotic stewardship audits with real-time feedback, resulted in decreased use of antibiotics in patients admitted with bronchiolitis.

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BackgroundAntimicrobial stewardship programs (ASP) have been recognized nationally as one way to combat antimicrobial resistance. Using data from the Pediatric Health Information System (PHIS) database, we noticed high utilization of antimicrobials in our hospital particularly in the neonatal intensive care unit (NICU), which is a level IV tertiary unit. This prompted focused ASP efforts in the NICU consisting of development of sepsis management guidelines and prospective audit with intervention and feedback.MethodsUsing the PHIS database, we retrospectively measured days of therapy per 1000 patient days (DOT/1000 PD) in the NICU during the pre-implementation (calendar year 2014), implementation (2015) and post-implementation phase (2016) to determine the change in antimicrobial utilization. All antimicrobials administered between 01/01/14 to 12/31/16 were included in the review. Quarterly use by unit expressed in mean DOT/1000 PD was used for evaluation. Secondarily, we evaluated NICU mortality, necrotizing enterocolitis (NEC) rate in the very low birth weight neonates (VLBW) and hospital wide antimicrobial utilization. Comparison of means among groups was performed by analysis of variance (ANOVA).ResultsOverall, mean DOT/1,000 PD for the NICU decreased 30% from the pre-implementation, implementation and to the post-implementation phase (656.86 vs. 613.86 vs. 463.85 DOT/1,000 PD, P < 0.01). Mean DOT/1,000 PD for the entire hospital pre-implementation, implementation and post-implementation phase decreased 17% overall (892.79 vs. 821.38 vs. 738.84 DOT/1,000 PD, P < 0.01). NICU mortality rates remained stable (2.6, 4.2 and 3.5%) from 2014 to 2016, respectively. NEC rates decreased from 8.4%, 1.6% and 3.4% from 2014 to 2016, respectively.ConclusionImplementation of a NICU stewardship program helped reduce antimicrobial utilization in the NICU without increasing morbidity and mortality. In our experience, this was also associated with a decrease in NEC incidence rates in VLBW neonates. Hospitals with limited resources may consider targeted unit based stewardship to help reduce antimicrobial utilization.Disclosures All authors: No reported disclosures.