nutch_noindex
CANCELAR
/nutch_noindex

Hayden Schwenk, MD

  • Hayden Tyler Schwenk

Especialidades

Infectious Disease

Trabajo y Educación

Formación Profesional

University of Texas Southwestern Medical Center, Dallas, TX, 2006

Residencia

Lucile Packard Children's Hospital, Palo Alto, CA, 2009

Compañerismo

Boston Children's Hospital, Boston, MA, 2013

Certificaciones Médicas

Pediatric Infectious Disease, American Board of Pediatrics

Pediatrics, American Board of Pediatrics

Todo Publicaciones

Predictors of Antimicrobial Stewardship Program Recommendation Disagreement. Infection control and hospital epidemiology Bio, L. L., Kruger, J. F., Lee, B. P., Wood, M. S., Schwenk, H. T. 2018: 18

Abstract

OBJECTIVETo identify predictors of disagreement with antimicrobial stewardship prospective audit and feedback recommendations (PAFR) at a free-standing children's hospital.DESIGNRetrospective cohort study of audits performed during the antimicrobial stewardship program (ASP) from March 30, 2015, to April 17, 2017.METHODSThe ASP included audits of antimicrobial use and communicated PAFR to the care team, with follow-up on adherence to recommendations. The primary outcome was disagreement with PAFR. Potential predictors for disagreement, including patient-level, antimicrobial, programmatic, and provider-level factors, were assessed using bivariate and multivariate logistic regression models.RESULTSIn total, 4,727 antimicrobial audits were performed during the study period; 1,323 PAFR (28%) and 187 recommendations (15%) were not followed due to disagreement. Providers were more likely to disagree with PAFR when the patient had a gastrointestinal infection (odds ratio [OR], 5.50; 95% confidence interval [CI], 1.99-15.21), febrile neutropenia (OR, 6.14; 95% CI, 2.08-18.12), skin or soft-tissue infections (OR, 6.16; 95% CI, 1.92-19.77), or had been admitted for 31-90 days at the time of the audit (OR, 2.08; 95% CI, 1.36-3.18). The longer the duration since the attending provider had been trained (ie, the more years of experience), the more likely they were to disagree with PAFR recommendations (OR, 1.02; 95% CI, 1.01-1.04).CONCLUSIONSEvaluation of our program confirmed patient-level predictors of PAFR disagreement and identified additional programmatic and provider-level factors, including years of attending experience. Stewardship interventions focused on specific diagnoses and antimicrobials are unlikely to result in programmatic success unless these factors are also addressed.Infect Control Hosp Epidemiol 2018;1-8.

View details for DOI 10.1017/ice.2018.85

View details for PubMedID 29708081

An Observational Study of Severe Pertussis in 100 Infants 120 Days of Age PEDIATRIC INFECTIOUS DISEASE JOURNAL Cherry, J. D., Wendorf, K., Bregman, B., Lehman, D., Nieves, D., Bradley, J. S., Mason, W. H., Sande-Lopez, L., Lopez, M., Federman, M., Chen, T., Blumberg, D., Johnston, S., Schwenk, H. T., Weintrub, P., Quinn, K. K., Winter, K., Harriman, K. 2018; 37 (3): 2025

Abstract

Pertussis in young infants is a unique, severe, afebrile, cough illness that is frequently fatal.All pertussis cases 120 days of age admitted to a pediatric intensive care unit in California between October 1, 2013, and April 25, 2015, were evaluated.Of 100 pertussis patients 120 days of age admitted to pediatric intensive care unit, there were 5 deaths. The white blood cell counts in the fatal cases were significantly higher than in the nonfatal cases. Thirty-four percent of patients were intubated, 18% received inotropic and/or vasoactive support, 22% received steroid, 4% received extracorporal membrane oxygenation, and 3% underwent exchange blood transfusion. The median age at the time of illness onset in the patients who died was 23 days.These data, as well as data from previous California studies, suggest updated strategies for the management of severe pertussis. These include perform serial white blood cell counts, treat all presumptive cases with azithromycin, evaluate for pulmonary hypertension, intubate and administer oxygen for apneic episodes and administer inotropic/vasoactive agents for cardiogenic shock. Do not administer steroids or nitric oxide. Criteria for exchange blood transfusion therapy for leukocytosis with lymphocytosis are suggested.

View details for DOI 10.1097/INF.0000000000001710

View details for Web of Science ID 000426088200010

View details for PubMedID 28737623

IMPLEMENTATION OF A VANCOMYCIN MODEL-BASED DOSING TOOL INTEGRATED WITHIN THE ELECTRONIC HEALTH RECORD. Goswami, S., Keizer, R., Ghaskari, S., Schneider, L., Faulkenberry, J. H., Chasmawala, B., Schwenk, H. T., Frymoyer, A. WILEY. 2018: S68
A quality improvement initiative to optimize dosing of surgical antimicrobial prophylaxis. Paediatric anaesthesia Caruso, T. J., Wang, E., Schwenk, H. T., Scheinker, D., Yeverino, C., Tweedy, M., Maheru, M., Sharek, P. J. 2017; 27 (7): 702-710

Abstract

The risk of surgical site infections is reduced with appropriate timing and dosing of preoperative antimicrobials. Based on evolving national guidelines, we increased the preoperative dose of cefazolin from 25 to 30 mgkg(-1) . This quality improvement project describes an improvement initiative to develop standard work processes to ensure appropriate dosing.The primary aim was to deliver cefazolin 30 mgkg(-1) to at least 90% of indicated patients. The secondary aim was to determine differences between accuracy of cefazolin doses when given as an electronic order compared to a verbal order.Data were collected from January 1, 2012 to May 31, 2016. A quality improvement team of perioperative physicians, nurses, and pharmacists implemented a series of interventions including new electronic medical record order sets, personal provider antibiotic dose badges, and utilization of pharmacists to prepare antibiotics to increase compliance with the recommended dose. Process compliance was measured using a statistical process control chart, and dose compliance was measured through electronic analysis of the electronic medical record. Secondary aim data were displayed as percentage of dose compliance. An unpaired t-test was used to determine differences between groups.Between January 1, 2012 and May 31, 2016, cefazolin was administered to 9086 patients. The mean compliance of cefazolin at 30 mgkg(-1) from May 2013 to March 2014 was 40%, which prompted initiation of this project. From April 2014 to May 2016, a series of interventions were deployed. The mean compliance from September 2015 to May 2016 was 93% with significantly reduced variation and no special cause variation, indicating that the process was in control at the target primary aim. There were 649 cefazolin administrations given verbally and 1929 given with an electronic order between October 1, 2014 and May 31, 2016. During this time period, the rate of compliance of administering cefazolin at 30 mgkg(-1) was significantly higher when given after an electronic order than when given verbally, 94% vs 76%.This comprehensive quality improvement project improved practitioner compliance with evidence-based preoperative antimicrobial dosing recommendations to reduce the risk of surgical site infections.

View details for DOI 10.1111/pan.13137

View details for PubMedID 28321988

Subacute Sclerosing Panencephalitis: The Foothold in Undervaccination JOURNAL OF PEDIATRICS Holt, R. L., Kann, D., Rassbach, C. E., Schwenk, H. T., Ritter, J. M., Rota, P. A., Elbers, J. 2016; 179: 259-262

Abstract

Subacute sclerosing panencephalitis (SSPE) is a fatal complication of measles infection. We present a case of a fully vaccinated 3-year-old boy who was diagnosed with and treated for autoimmune encephalitis before arriving at a diagnosis of SSPE. We discuss the challenges of diagnosing SSPE in developed countries.

View details for DOI 10.1016/j.jpeds.2016.08.051

View details for Web of Science ID 000390027100051

View details for PubMedID 27634625

Anchoring Bias as a Limiting Factor in High-Value Care: A Case of Fever of Unknown Origin in a Hospitalized Child. Hospital pediatrics Festa, N., Park, K. T., Schwenk, H. 2016; 6 (11): 699-701

View details for PubMedID 27789539

Fever and Renal Failure in a Child With DiGeorge Syndrome and Tetralogy of Fallot. Journal of the Pediatric Infectious Diseases Society Itoh, M., Kann, D. C., Schwenk, H. T., Gans, H. A. 2015; 4 (4): 373-375

View details for DOI 10.1093/jpids/piv029

View details for PubMedID 26407263

Bordetella petrii Sinusitis in an Immunocompromised Adolescent. Pediatric infectious disease journal Nagata, J. M., Charville, G. W., Klotz, J. M., Wickremasinghe, W. R., Kann, D. C., Schwenk, H. T., Longhurst, C. A. 2015; 34 (4): 458-?

View details for DOI 10.1097/INF.0000000000000564

View details for PubMedID 25760569

Coping with college and inflammatory bowel disease: implications for clinical guidance and support. Inflammatory bowel diseases Schwenk, H. T., Lightdale, J. R., Arnold, J. H., Goldmann, D. A., Weitzman, E. R. 2014; 20 (9): 1618-1627

Abstract

Studies have shown that young adults with chronic diseases, including inflammatory bowel disease (IBD), experience greater difficulty during the transition to college, reaching lower levels of educational attainment and reporting greater levels of perceived stress than their otherwise-healthy peers. We performed a qualitative study to better understand how underlying illness shapes the college experience for patients with IBD and how the college experience, in turn, impacts disease management.Fifteen college students with IBD were recruited from the Boston Children's Hospital Center for IBD. We conducted an approximately 1 hour semistructured qualitative interview with each participant, and the interviews were thematically analyzed after an iterative and inductive process.Four primary themes were identified: (1) The transition experience of college students with IBD is shaped by their health status, perceived readiness, and preparedness, (2) Elements of the college environment pose specific challenges to young adults with IBD that require adaptive strategies, (3) College students with IBD integrate their underlying illness with their individual and social identity, and (4) College students navigate health management by conceptualizing themselves, their families, and providers as serving particular roles.For young adults with IBD, college is a proving ground for demonstrating self-care and disease management practices. Future initiatives aimed at this population should recognize the evolving roles of patients, parents, and providers in disease management. Increased attention should also be paid to the promotion of patient's self-management and the unique challenges of the structural and psychosocial college environment.

View details for DOI 10.1097/MIB.0000000000000124

View details for PubMedID 25105948

Progressive multifocal leukoencephalopathy in pediatric patients: case report and literature review. Pediatric infectious disease journal Schwenk, H., Ramirez-Avila, L., Sheu, S., Wuthrich, C., Waugh, J., Was, A., DeGirolami, U., Burchett, S., Koralnik, I. J., Ahmed, A. 2014; 33 (4): e99-105

Abstract

Progressive multifocal leukoencephalopathy is a rare, demyelinating disease of the central nervous system caused by JC virus. Fewer than 30 cases have been reported in HIV- and non-infected children. We report the case of a 15-year-old girl with progressive multifocal leukoencephalopathy and AIDS who presented with nystagmus, dysarthria and ataxia. Following combined antiretroviral therapy, she developed immune reconstitution inflammatory syndrome, which proved fatal.

View details for DOI 10.1097/INF.0000000000000237

View details for PubMedID 24632669

Progressive multifocal leukoencephalopathy in pediatric patients: case report and literature review. Pediatric infectious disease journal Schwenk, H., Ramirez-Avila, L., Sheu, S., Wuthrich, C., Waugh, J., Was, A., DeGirolami, U., Burchett, S., Koralnik, I. J., Ahmed, A. 2014; 33 (4): e99-e105

Abstract

Progressive multifocal leukoencephalopathy is a rare, demyelinating disease of the central nervous system caused by JC virus. Fewer than 30 cases have been reported in HIV- and non-infected children. We report the case of a 15-year-old girl with progressive multifocal leukoencephalopathy and AIDS who presented with nystagmus, dysarthria and ataxia. Following combined antiretroviral therapy, she developed immune reconstitution inflammatory syndrome, which proved fatal.

View details for DOI 10.1097/INF.0000000000000237

View details for PubMedID 24632669

Vancomycin Use for Pediatric Clostridium difficile Infection Is Increasing and Associated with Specific Patient Characteristics ANTIMICROBIAL AGENTS AND CHEMOTHERAPY Schwenk, H. T., Graham, D. A., Sharma, T. S., Sandora, T. J. 2013; 57 (9): 4307-4313

Abstract

In adults with Clostridium difficile infection (CDI), enteral vancomycin is considered the preferred initial regimen for severe disease; however, patterns of antimicrobial use for children with CDI are unknown. We sought to describe trends in and predictors of vancomycin use for the treatment of children with CDI admitted to tertiary-care children's hospitals in the United States. We used a database of freestanding children's hospitals to identify patients 1 to 18 years old with CDI between January 2006 and June 2011. The first hospitalization with a diagnosis of CDI for each patient was identified, and CDI-directed therapy was assessed. Generalized estimating equations were used to identify predictors of vancomycin receipt, controlling for clustering within hospitals. Vancomycin use has increased significantly (P = 0.005), with substantial variability between hospitals (0 to 16%). In multivariate analyses, vancomycin use was more common in children age 7 to 13 years old (versus children 1 to 2 years old: adjusted odds ratio [AOR] = 1.57; 95% confidence interval [CI] = 1.13 to 2.18), 14 to 18 years old (AOR = 1.40; 95% CI = 1.11 to 1.76), in an ICU (AOR = 1.37; 95% CI = 1.05 to 1.80), or with chronic gastrointestinal conditions (AOR = 2.01; 95% CI = 1.44 to 2.81). Vancomycin use was less common in black (AOR = 0.53; 95% CI = 0.39 to 0.73) and Hispanic (AOR = 0.63; 95% CI = 0.47 to 0.84) patients and in children with malignancies (AOR = 0.57; 95% CI = 0.36 to 0.89). Despite a lack of empirical evidence to suggest superiority, vancomycin use for pediatric CDI is increasing. Furthermore, there is substantial variability in vancomycin use between hospitals. Further studies are needed to explore potential racial and ethnic differences in CDI management and to investigate clinicians' rationale for using vancomycin for initial therapy in selected populations.

View details for DOI 10.1128/AAC.00661-13

View details for Web of Science ID 000323285500027

View details for PubMedCentralID PMC3754290