The findings from this investigation indicate that this outbreak of Fusarium keratitis was associated with use of ReNu with MoistureLoc contact lens solution. Contact lens users should not use ReNu with MoistureLoc.

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BACKGROUND AND OBJECTIVE: Nephrotoxic medication exposure represents a common cause of acute kidney injury (nephrotoxin-AKI) in hospitalized children. Systematic serum creatinine (SCr) screening has not been routinely performed in children receiving nephrotoxins, potentially leading to underestimating nephrotoxin-AKI rates. We aimed to accurately determine nephrotoxin exposure and nephrotoxin-AKI rates to drive appropriate interventions in non-critically ill hospitalized children. METHODS:We conducted a prospective quality improvement project implementing a systematic electronic health record (EHR) screening and decision support process (trigger) at a single quaternary pediatric hospital. Patients were all noncritically ill hospitalized children receiving an intravenous aminoglycoside for $3 days or $3 nephrotoxins simultaneously (exposure). Pharmacists recommended daily SCr monitoring in exposed patients. AKI was defined by the modified pediatric Risk, Injury, Failure, Loss and End-stage Renal Disease criteria ($25% decrease in estimated creatinine clearance). We developed 4 novel metrics: exposure rate per 1000 patient-days, AKI rate per 1000 patient-days, AKI rate (%) per high nephrotoxin admission, and AKI days per 100 exposure days (AKI intensity).RESULTS: This study included 21 807 patients accounting for 27 711 admissions. A total of 726 (3.3%) unique exposed patients accounted for 945 hospital admissions (6713 patient-days). AKI occurred in 25% of unique exposed patients and 31% of exposure admissions (1974 patient-days). Our EHR-driven SCr nephrotoxin-AKI surveillance process was associated with a 42% reduction in AKI intensity.CONCLUSIONS: Nephrotoxin-AKI rates are high in noncritically ill children; systematic screening for nephrotoxic medication exposure and AKI detection was accomplished reliably through an EHR based trigger tool. Pediatrics 2013;132:e756-e767 The changing disease distribution in tertiary and quaternary medical centers has led to therapies required to promote survival but that increasingly put patients at risk for iatrogenic injuries including kidney damage. [1][2][3][4] Nephrotoxic medication exposure and associated acute kidney injury (nephrotoxin-AKI) occur commonly in hospitalized children. Eighty-six percent of noncritically ill children at a large children' s hospital received at least 1 nephrotoxin. 5 Nephrotoxin-AKI was cited as the primary cause of 16% of pediatric AKI cases 3 and is associated with significant morbidity and increased length of stay and costs. 5,6 Noncritically ill children with AKI are 1.7 times more likely to have received a nephrotoxin, 5 and AKI rates increase from 16% to 45% with exposure to $3 nephrotoxins. 5 Intravenous aminoglycoside (IV AG) exposure for .5 days is associated with nephrotoxin-AKI rates of 19% to 31%. 6 Thus, nephrotoxin-AKI represents a significant health care burden for hospitalized children.Nephrotoxin-AKI is usually diagnosed by a serum creatinine (SCr) level increase, because nephrotoxin-AKI is generally nonoliguric in...

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An MLP identified and improved home environmental conditions for children living in a cluster of substandard housing.