Sunday, November 11, 2012
Pneumonia number one killer of children
Pneumonia number one killer of children
Muhammad QasimSunday, November 11, 2012
From Print Edition
Muhammad QasimSunday, November 11, 2012
From Print Edition
Rawalpindi
Pneumonia being the leading cause of death in children kills an estimated 1.4 million children under the age of five every year worldwide. Every year, it accounts for 18 per cent of all deaths of children below five years of age, which is more than AIDS, malaria and tuberculosis combined. Out of these, 99 per cent of deaths occur in developing countries.
In Pakistan, more than 352,000 children die before their fifth birthday every year and almost one third of these deaths are due to pneumonia. If not all, at least 70 per cent of these deaths can be avoided with the help of in time management of the cases. There is a need to create awareness among public that pneumonia can easily be avoided through prevention and it is curable.
Professor and Head of Community Medicine at CMH Lahore Medical College Dr. Muhammad Ashraf Chaudhry expressed this while talking to ‘The News’ in connection with World Pneumonia Day, which is observed every year on November 12 around the globe. The theme of the day this year is: ‘Fight Pneumonia: Save a Child’.
He added that the day is observed with an aim to raise awareness of pneumonia as a public health issue and help prevent millions of avoidable deaths from pneumonia that occur each year. “World Pneumonia Day is an opportunity to remind our leaders that the lives of babies and children are too important to be discounted,” said Dr. Ashraf.
Pneumonia is a form of acute respiratory infection that affects the lungs. It is caused by viruses, bacteria or fungi (germs). The viruses and bacteria that are commonly found in a child’s nose or throat can infect the lungs if they are inhaled. They may also spread via air-borne drops from a cough or sneeze.
Studies reveal that children whose immune systems are compromised are at higher risk of developing pneumonia. A child’s immune system may be weakened by malnutrition or under nourishment, especially in infants who are not exclusively breastfed, said Dr. Ashraf.
He added that HIV infections and measles also increase child’s risk of contracting pneumonia. Environmental factors such as indoor air pollution caused by cooking fires and heating with biomass fuels (such as wood or dung), living in crowded homes and parental smoking also increase a child’s susceptibility to pneumonia, he said.
He believes that ignoring early signs of pneumonia can be death sentence. “The symptoms of pneumonia include rapid or fast breathing, cough, fever, chills, loss of appetite, wheezing, and lower chest wall in drawing while severely ill infants may be unable to feed or drink and may also experience convulsions.”
To a query, Dr. Ashraf said that the good news is that pneumonia is preventable and treatable with host of proven interventions including exclusive breastfeeding to infants in their six months of life, ensuring an environment free of indoor air pollution and promoting frequent hand washing (protection); immunizing against leading causes (prevention); and ensuring access to medical care and antibiotics when cases do emerge (treatment).
He added that limiting exposure to smoke from cigarettes or indoor cook stoves and fires can help limit the risk of pneumonia. Research has shown that hand washing with soap and water can reduce the number of pneumonia-related infections in children under the age of five by more than 50 per cent, he said.
He added that immunizing against Hib (Haemophilus influenzae type B vaccine), pneumococcus, measles and whooping cough is the most effective way to prevent pneumonia. “The government of Pakistan has recently included pneumococcal vaccine in Expanded Program on Immunization and all parents having infants below six weeks of age can now get their children immunized against pneumonia free of cost.”
Dr. Ashraf said that pneumonia can be treated with antibiotics but only 30 per cent of the children receive antibiotics when needed. “Pneumonia-related child deaths can be reduced by 70 per cent by managing cases of pneumonia in children with antibiotics at the community level.” He said that Lady Health Workers can be trained to assess signs of pneumonia, determine appropriate treatment and advice parents, administer antibiotics and provide home care. The LHWs can also refer sick children to a healthcare facility if complications arise.
He added that children suffering from pneumonia can be treated promptly and effectively with antibiotics, however, overuse of antibiotics should be avoided in order to curb microbial resistance and children with upper respiratory tract infections (mainly coughs and colds) should not be prescribed unnecessary antibiotics. Similarly indiscriminate use of cough medicines should also be reduced.
Prevention and proper treatment of pneumonia could avert one million deaths in children every year while with proper treatment alone, over 600,000 deaths could be avoided, concluded Dr. Ashraf.
Labels: bacteria, children, fungi, germs, Haemophilus influenzae type B vaccine, HIV infections, killer, measles, pneumonia, viruses, World Pneumonia Day
# posted by Pat O'Connor @ 6:36 AM
Thursday, September 24, 2009
Guidelines Issued for Management of Opportunistic Infections Among HIV-Exposed Children
Guidelines Issued for Management of Opportunistic Infections Among HIV-Exposed Children
News Author: Laurie Barclay, MDCME Author: Charles P. Vega, MD, FAAFP
September 8, 2009 — Children who either have been exposed to HIV or who are infected with HIV are at increased risk for certain opportunistic diseases, according to new recommendations published online August 26 in the Morbidity and Mortality Weekly Report.
The new guidelines were issued jointly by the US Centers for Disease Control and Prevention, the National Institutes of Health (NIH), the HIV Medicine Association of the Infectious Diseases Society of America, the Pediatric Infectious Diseases Society, and the American Academy of Pediatrics.
These guidelines update previous recommendations for clinicians and other healthcare practitioners providing medical care for HIV-exposed or HIV-infected children. Earlier guidelines were last published in 2002 and 2004, respectively.
"In the pre-antiretroviral era and before development of potent combination highly active antiretroviral treatment (HAART) regimens, opportunistic infections (OIs) were the primary cause of death in [HIV]-infected children," write Lynne M. Mofenson, MD, from the NIH in Bethesda, Maryland, and colleagues.
"Current HAART regimens suppress viral replication, provide significant immune reconstitution, and have resulted in a substantial and dramatic decrease in [AIDS]-related OIs and deaths in both adults and children.... Despite this progress, prevention and management of OIs remain critical components of care for HIV-infected children."
Development of Updated Guidelines
The Pediatric Opportunistic Infections Working Group, a panel of experts from the US government and academic institutions specializing in pediatric HIV infection and other infectious diseases, developed recommendations for the most effective strategies for diagnosis, prevention, and treatment of OIs.
For each OI, a pediatric specialist expert in that OI reviewed the literature for new information published since the previous guidelines were issued. In June 2007, revised recommendations were proposed at an NIH meeting, and the draft guidelines were revised further, reviewed and approved by the working group, and approved by the issuing organizations.
In addition to covering the management of opportunistic diseases encountered in the United States (Pneumocystis pneumonia, Toxoplasma gondii, Mycobacterium avium complex, Coccidioides species, Cryptococcus neoformans, Histoplasma capsulatum, microsporidiosis, cytomegalovirus, invasive bacterial infections, bartonellosis, Candida [esophageal], and herpes simplex virus), the guidelines also discuss malaria — an OI that could be acquired during international travel.
For each OI, the report summarizes epidemiology, clinical presentation, and diagnosis in children. Main topics include preventing exposure to OIs, using chemoprophylaxis and/or vaccination to prevent infection, discontinuing primary prophylaxis after immune reconstitution, treating OIs, monitoring for adverse effects during treatment, managing treatment failure, preventing recurrence of OIs, and discontinuing secondary prophylaxis after immune reconstitution.
A working group of experts specializing in adult HIV and infectious disease prepared a separate report on the prevention and treatment of OIs in HIV-infected adults and postpubertal adolescents, titled "Guidelines for the Prevention and Treatment of Opportunistic Infections in HIV-Infected Adults and Adolescents."
Populations Affected by OIs
Because HIV-infected women coinfected with opportunistic pathogens may be more likely than women uninfected with HIV to transmit these OIs to their infants, an infected mother is an important pathway for OI transmission, as well as for HIV infection, among children. Furthermore, mothers and other family members coinfected with HIV and certain opportunistic pathogens may be more likely to transmit these infections horizontally to young children, increasing the probability that the child will primarily acquire these infections.
OIs may therefore affect not just HIV-infected infants but also HIV-exposed but uninfected infants who become infected by the pathogen via HIV-infected mothers or family members with coinfections. For these reasons, the updated guidelines for treating OIs in children consider treatment of infections among all children — both HIV-infected and uninfected — born to HIV-infected women.
Incidence of HIV infection is rising both among adolescents with perinatal infection who have survived into their teenage years and among youth with behaviorally acquired HIV infection. The adult OI guidelines are applicable to postpubertal adolescents, but younger prepubertal or pubertal adolescents may have differing drug pharmacokinetics and response to treatment, with management best served by the pediatric guidelines.
Updated Recommendations
Since the previous versions of these guidelines, major changes in the new recommendations are as follows:
Increased emphasis on the importance of antiretroviral therapy to prevent and treat OIs, particularly those OIs for which no specific treatment is available.
New evidence regarding diagnosis and management of immune reconstitution inflammatory syndromes.
New information concerning management of antiretroviral therapy in children with OIs, including potential drug–drug interactions.
New strategies for diagnosis of HIV infection and for presumptively ruling out HIV infection in infants that affect the need to start prophylaxis for the prevention of Pneumocystis jirovecii pneumonia in neonates. Prophylaxis against Pneumocystis carinii should be considered in all infants exposed to HIV.
Updated recommendations for immunizing HIV-exposed and HIV-infected children against hepatitis A, human papillomavirus, meningococcus, and rotavirus. Children with HIV infection and good immune function should be routinely vaccinated against varicella, measles-mumps-rubella, and human papillomavirus. To weigh potential risks and benefits of vaccination against rotavirus in an infant exposed to HIV infection, expert consultation may be needed.
New sections on aspergillosis; bartonella; human herpes viruses 6, 7, and 8; malaria; and progressive multifocal leukodystrophy. Children infected with HIV do not require routine prophylaxis against aspergillosis, coccidiomycosis, or cryptococcal disease.
New guidelines for discontinuing OI prophylaxis after immune reconstitution in children.
In addition, there are 6 tables with information concerning prevention and treatment of OIs in children and 2 figures depicting immunization recommendations for children aged 0 to 6 years and 7 to 18 years. The guidelines authors acknowledge that treatment of OIs is an evolving science and that therapeutic options and preferences may change on the basis of the availability of new agents or clinical data on existing agents. The recommendations in these guidelines will therefore be updated periodically and posted on the NIH AIDSinfo Web site.
Morb Mortal Wkly Rep. Published online August 26, 2009.
Clinical Context
The main cause of HIV infection among children is vertical transmission from their mother, and the current guidelines highlight that the mother and nuclear family unit continue to be a strong potential reservoir for OIs as these children grow. These OIs may also infect infants without HIV infection. Therefore, the authors of the current guidelines focus their recommendations regarding OI prevention and treatment to all children born to women with HIV infection.
The guidelines regarding OIs among children were last updated in 2004. The current revised recommendations were initially proposed by an expert panel at a meeting of the NIH in 2007 and were then endorsed by multiple governmental and physician specialty groups.
Study Highlights
The use of HAART among children can be useful to both prevent and treat OIs for which specific treatments are less effective, including infections such as cryptosporidiosis and microsporidiosis.
Immune reconstitution inflammatory syndrome (IRIS) can occur in children after the initiation of treatment of HIV infection. However, among adults, up to 30% of cases of IRIS may be present at 3 months after initiation of HAART. HAART should be continued in cases of IRIS, and nonsteroidal anti-inflammatory drugs should be added, along with close supervision, for adequate treatment of most moderate cases. Antibiotics are unnecessary in the treatment of IRIS.
The best timing to initiate HAART after an OI remains unclear and needs to be individualized to the patient's needs.
Vaccination against varicella and measles-mumps-rubella may be considered among HIV-infected children with age-specific CD4 levels of at least 15%.
Although vaccine immune response may be less than among immunocompetent peers, the human papillomavirus vaccine may be administered to girls with HIV infection.
There are no safety data regarding the application of the rotavirus vaccine to infants who are potentially immunocompromised, and the diagnosis of HIV infection in the infant may not even be established at the time of the first vaccination. Whether to provide vaccination against rotavirus among infants exposed to HIV may require consultation with an expert in infectious disease or immunology.
Bartenellosis may be prevented by the avoidance of body lice, cats, and cat fleas. Moderate cat-scratch disease among children with HIV infection typically does not respond to antibiotic therapy, and treatment is supportive.
Previous estimates have found that 1.1% of children with tuberculosis have a coinfection with HIV, a lower rate vs the adult population. Children with HIV infection should receive annual tuberculin skin tests. Treatment of active tuberculosis is similar among children with and without HIV, although the concurrent use of HAART can complicate tuberculosis treatment (particularly the use of rifamycins). The usual treatment period is 6 months.
Clarithromycin and azithromycin may be used to prevent M avium complex disease in children, but children with a sustained positive immune response to HAART for 3 months or longer may discontinue antibiotic prophylaxis against M avium complex.
Prophylaxis against aspergillosis and coccidiomycosis among children with HIV infection is not recommended. Voriconazole is the first-line therapy for active aspergillosis, and disseminated coccidiomycosis infection requires treatment with amphotericin B.
Children with HIV infection do not require routine testing for the cryptococcal antigen or prophylaxis against infection with cryptococcus.
Conversely, infants born to mothers with HIV infection should be considered for antibiotic prophylaxis against P carinii beginning at ages 4 to 6 weeks. Trimethoprim-sulfamethoxazole is the first-line agent for prophylaxis.
Children with HIV infection traveling to endemic areas of malaria infection should receive prophylactic antibiotics against malaria, and care must be taken to avoid significant interactions with HAART, if possible. Trimethoprim-sulfamethoxazole should not be used as prophylaxis against malaria.
Clinical Implications
The current study recommends routine vaccination against varicella, measles-mumps-rubella, and human papillomavirus among children with HIV infection and good immune function. However, vaccination against rotavirus may require consultation with an expert to weigh potential risks and benefits in an infant exposed to HIV infection.
Children with HIV infection do not require routine prophylaxis against aspergillosis, coccidiomycosis, or cryptococcus, but all infants exposed to HIV should be considered for prophylaxis against P carinii.
Medscape
News Author: Laurie Barclay, MDCME Author: Charles P. Vega, MD, FAAFP
September 8, 2009 — Children who either have been exposed to HIV or who are infected with HIV are at increased risk for certain opportunistic diseases, according to new recommendations published online August 26 in the Morbidity and Mortality Weekly Report.
The new guidelines were issued jointly by the US Centers for Disease Control and Prevention, the National Institutes of Health (NIH), the HIV Medicine Association of the Infectious Diseases Society of America, the Pediatric Infectious Diseases Society, and the American Academy of Pediatrics.
These guidelines update previous recommendations for clinicians and other healthcare practitioners providing medical care for HIV-exposed or HIV-infected children. Earlier guidelines were last published in 2002 and 2004, respectively.
"In the pre-antiretroviral era and before development of potent combination highly active antiretroviral treatment (HAART) regimens, opportunistic infections (OIs) were the primary cause of death in [HIV]-infected children," write Lynne M. Mofenson, MD, from the NIH in Bethesda, Maryland, and colleagues.
"Current HAART regimens suppress viral replication, provide significant immune reconstitution, and have resulted in a substantial and dramatic decrease in [AIDS]-related OIs and deaths in both adults and children.... Despite this progress, prevention and management of OIs remain critical components of care for HIV-infected children."
Development of Updated Guidelines
The Pediatric Opportunistic Infections Working Group, a panel of experts from the US government and academic institutions specializing in pediatric HIV infection and other infectious diseases, developed recommendations for the most effective strategies for diagnosis, prevention, and treatment of OIs.
For each OI, a pediatric specialist expert in that OI reviewed the literature for new information published since the previous guidelines were issued. In June 2007, revised recommendations were proposed at an NIH meeting, and the draft guidelines were revised further, reviewed and approved by the working group, and approved by the issuing organizations.
In addition to covering the management of opportunistic diseases encountered in the United States (Pneumocystis pneumonia, Toxoplasma gondii, Mycobacterium avium complex, Coccidioides species, Cryptococcus neoformans, Histoplasma capsulatum, microsporidiosis, cytomegalovirus, invasive bacterial infections, bartonellosis, Candida [esophageal], and herpes simplex virus), the guidelines also discuss malaria — an OI that could be acquired during international travel.
For each OI, the report summarizes epidemiology, clinical presentation, and diagnosis in children. Main topics include preventing exposure to OIs, using chemoprophylaxis and/or vaccination to prevent infection, discontinuing primary prophylaxis after immune reconstitution, treating OIs, monitoring for adverse effects during treatment, managing treatment failure, preventing recurrence of OIs, and discontinuing secondary prophylaxis after immune reconstitution.
A working group of experts specializing in adult HIV and infectious disease prepared a separate report on the prevention and treatment of OIs in HIV-infected adults and postpubertal adolescents, titled "Guidelines for the Prevention and Treatment of Opportunistic Infections in HIV-Infected Adults and Adolescents."
Populations Affected by OIs
Because HIV-infected women coinfected with opportunistic pathogens may be more likely than women uninfected with HIV to transmit these OIs to their infants, an infected mother is an important pathway for OI transmission, as well as for HIV infection, among children. Furthermore, mothers and other family members coinfected with HIV and certain opportunistic pathogens may be more likely to transmit these infections horizontally to young children, increasing the probability that the child will primarily acquire these infections.
OIs may therefore affect not just HIV-infected infants but also HIV-exposed but uninfected infants who become infected by the pathogen via HIV-infected mothers or family members with coinfections. For these reasons, the updated guidelines for treating OIs in children consider treatment of infections among all children — both HIV-infected and uninfected — born to HIV-infected women.
Incidence of HIV infection is rising both among adolescents with perinatal infection who have survived into their teenage years and among youth with behaviorally acquired HIV infection. The adult OI guidelines are applicable to postpubertal adolescents, but younger prepubertal or pubertal adolescents may have differing drug pharmacokinetics and response to treatment, with management best served by the pediatric guidelines.
Updated Recommendations
Since the previous versions of these guidelines, major changes in the new recommendations are as follows:
Increased emphasis on the importance of antiretroviral therapy to prevent and treat OIs, particularly those OIs for which no specific treatment is available.
New evidence regarding diagnosis and management of immune reconstitution inflammatory syndromes.
New information concerning management of antiretroviral therapy in children with OIs, including potential drug–drug interactions.
New strategies for diagnosis of HIV infection and for presumptively ruling out HIV infection in infants that affect the need to start prophylaxis for the prevention of Pneumocystis jirovecii pneumonia in neonates. Prophylaxis against Pneumocystis carinii should be considered in all infants exposed to HIV.
Updated recommendations for immunizing HIV-exposed and HIV-infected children against hepatitis A, human papillomavirus, meningococcus, and rotavirus. Children with HIV infection and good immune function should be routinely vaccinated against varicella, measles-mumps-rubella, and human papillomavirus. To weigh potential risks and benefits of vaccination against rotavirus in an infant exposed to HIV infection, expert consultation may be needed.
New sections on aspergillosis; bartonella; human herpes viruses 6, 7, and 8; malaria; and progressive multifocal leukodystrophy. Children infected with HIV do not require routine prophylaxis against aspergillosis, coccidiomycosis, or cryptococcal disease.
New guidelines for discontinuing OI prophylaxis after immune reconstitution in children.
In addition, there are 6 tables with information concerning prevention and treatment of OIs in children and 2 figures depicting immunization recommendations for children aged 0 to 6 years and 7 to 18 years. The guidelines authors acknowledge that treatment of OIs is an evolving science and that therapeutic options and preferences may change on the basis of the availability of new agents or clinical data on existing agents. The recommendations in these guidelines will therefore be updated periodically and posted on the NIH AIDSinfo Web site.
Morb Mortal Wkly Rep. Published online August 26, 2009.
Clinical Context
The main cause of HIV infection among children is vertical transmission from their mother, and the current guidelines highlight that the mother and nuclear family unit continue to be a strong potential reservoir for OIs as these children grow. These OIs may also infect infants without HIV infection. Therefore, the authors of the current guidelines focus their recommendations regarding OI prevention and treatment to all children born to women with HIV infection.
The guidelines regarding OIs among children were last updated in 2004. The current revised recommendations were initially proposed by an expert panel at a meeting of the NIH in 2007 and were then endorsed by multiple governmental and physician specialty groups.
Study Highlights
The use of HAART among children can be useful to both prevent and treat OIs for which specific treatments are less effective, including infections such as cryptosporidiosis and microsporidiosis.
Immune reconstitution inflammatory syndrome (IRIS) can occur in children after the initiation of treatment of HIV infection. However, among adults, up to 30% of cases of IRIS may be present at 3 months after initiation of HAART. HAART should be continued in cases of IRIS, and nonsteroidal anti-inflammatory drugs should be added, along with close supervision, for adequate treatment of most moderate cases. Antibiotics are unnecessary in the treatment of IRIS.
The best timing to initiate HAART after an OI remains unclear and needs to be individualized to the patient's needs.
Vaccination against varicella and measles-mumps-rubella may be considered among HIV-infected children with age-specific CD4 levels of at least 15%.
Although vaccine immune response may be less than among immunocompetent peers, the human papillomavirus vaccine may be administered to girls with HIV infection.
There are no safety data regarding the application of the rotavirus vaccine to infants who are potentially immunocompromised, and the diagnosis of HIV infection in the infant may not even be established at the time of the first vaccination. Whether to provide vaccination against rotavirus among infants exposed to HIV may require consultation with an expert in infectious disease or immunology.
Bartenellosis may be prevented by the avoidance of body lice, cats, and cat fleas. Moderate cat-scratch disease among children with HIV infection typically does not respond to antibiotic therapy, and treatment is supportive.
Previous estimates have found that 1.1% of children with tuberculosis have a coinfection with HIV, a lower rate vs the adult population. Children with HIV infection should receive annual tuberculin skin tests. Treatment of active tuberculosis is similar among children with and without HIV, although the concurrent use of HAART can complicate tuberculosis treatment (particularly the use of rifamycins). The usual treatment period is 6 months.
Clarithromycin and azithromycin may be used to prevent M avium complex disease in children, but children with a sustained positive immune response to HAART for 3 months or longer may discontinue antibiotic prophylaxis against M avium complex.
Prophylaxis against aspergillosis and coccidiomycosis among children with HIV infection is not recommended. Voriconazole is the first-line therapy for active aspergillosis, and disseminated coccidiomycosis infection requires treatment with amphotericin B.
Children with HIV infection do not require routine testing for the cryptococcal antigen or prophylaxis against infection with cryptococcus.
Conversely, infants born to mothers with HIV infection should be considered for antibiotic prophylaxis against P carinii beginning at ages 4 to 6 weeks. Trimethoprim-sulfamethoxazole is the first-line agent for prophylaxis.
Children with HIV infection traveling to endemic areas of malaria infection should receive prophylactic antibiotics against malaria, and care must be taken to avoid significant interactions with HAART, if possible. Trimethoprim-sulfamethoxazole should not be used as prophylaxis against malaria.
Clinical Implications
The current study recommends routine vaccination against varicella, measles-mumps-rubella, and human papillomavirus among children with HIV infection and good immune function. However, vaccination against rotavirus may require consultation with an expert to weigh potential risks and benefits in an infant exposed to HIV infection.
Children with HIV infection do not require routine prophylaxis against aspergillosis, coccidiomycosis, or cryptococcus, but all infants exposed to HIV should be considered for prophylaxis against P carinii.
Medscape
Labels: children, guidlines, HAART, HIV, human papillomavirus, Immune reconstitution inflammatory syndrome, Infection, measles, meningococcus, mumps, rotavirus, rubella, trteatment, varicella
# posted by Pat O'Connor @ 3:03 AM
Friday, November 30, 2007
Nosocomial Gram-positive bacterial infections in children: Results of a 7 year study.
Nosocomial Gram-positive bacterial infections in children: Results of a 7 year study.
Celebi S, Hacimustafaoglu M, Ozdemir O, Ozakin C.
Department of Pediatrics, Division of Pediatric Infectious Diseases, Uludag University Medical Faculty, Gorukle, Bursa, Turkey.
Background: The aim of the present paper was to determine the rate of culture-proven nosocomial infections and evaluate the episodes of nosocomial Gram-positive (GP) bacterial infections in pediatric patients.
Methods: The data of children with positive culture, who were diagnosed as having nosocomial infection on the Centers for Disease Control and Prevention criteria, were examined and only the patients with nosocomial GP bacterial infections were included in the study.
Results: Between January 1997 and January 2004 a total of 836 episodes of nosocomial GP bacterial infections were observed. The most frequently seen nosocomial GP bacterial infections were primary bloodstream infections (BSI; 43%), ventriculoperitoneal shunt infections (18%), and nosocomial pneumonias (11%). Coagulase-negative staphylococci (CONS; 46%) were the most common nosocomial GP bacteria isolated, followed by Staphylococcus aureus (33%). Methicillin resistance rates for CONS and S. aureus were 85% and 25.2%; respectively. The mortality rate was 4% of all children with nosocomial GP bacterial infections in the present study.
Conclusion: In the present patients primary BSI were the most common nosocomial GP bacterial infections and CONS were the most frequent GP pathogen isolated. Antimicrobial resistance in GP isolates is an increasing problem.
PMID: 18045289 [PubMed - in process]
Celebi S, Hacimustafaoglu M, Ozdemir O, Ozakin C.
Department of Pediatrics, Division of Pediatric Infectious Diseases, Uludag University Medical Faculty, Gorukle, Bursa, Turkey.
Background: The aim of the present paper was to determine the rate of culture-proven nosocomial infections and evaluate the episodes of nosocomial Gram-positive (GP) bacterial infections in pediatric patients.
Methods: The data of children with positive culture, who were diagnosed as having nosocomial infection on the Centers for Disease Control and Prevention criteria, were examined and only the patients with nosocomial GP bacterial infections were included in the study.
Results: Between January 1997 and January 2004 a total of 836 episodes of nosocomial GP bacterial infections were observed. The most frequently seen nosocomial GP bacterial infections were primary bloodstream infections (BSI; 43%), ventriculoperitoneal shunt infections (18%), and nosocomial pneumonias (11%). Coagulase-negative staphylococci (CONS; 46%) were the most common nosocomial GP bacteria isolated, followed by Staphylococcus aureus (33%). Methicillin resistance rates for CONS and S. aureus were 85% and 25.2%; respectively. The mortality rate was 4% of all children with nosocomial GP bacterial infections in the present study.
Conclusion: In the present patients primary BSI were the most common nosocomial GP bacterial infections and CONS were the most frequent GP pathogen isolated. Antimicrobial resistance in GP isolates is an increasing problem.
PMID: 18045289 [PubMed - in process]
Labels: bloodstream infections, children, Nosocomial Gram-positive bacterial infections, pediatric patients, pneumonias, staphylococci, ventriculoperitoneal shunt infections
# posted by Pat O'Connor @ 3:08 AM
Friday, November 02, 2007
Household contacts were key factor for children's colonization with resistant Escherichia coli in community setting.
Household contacts were key factor for children's colonization with resistant Escherichia coli in community setting.
Lietzau S, Raum E, von Baum H, Marre R, Brenner H.
Department of Epidemiology, German Centre for Research on Ageing, Heidelberg, Germany.
Keywords: Antibiotic resistance, Bacterial, E. coli, Children, Household, Transmission
OBJECTIVE: In young children infections with resistant Escherichia coli (E. coli) can lead to life-threatening situations. Epidemiological data on the prevalence and major determinants of carriage of antibiotic resistant E. coli among children in the community setting are sparse.
STUDY DESIGN AND SETTING: In a population-based study from Germany, stool samples were obtained from children aged 6 months to 4 years attending a pediatrician for a regular health screening (N=568) or an acute infection (N=316), as well as from their parents (N=1,594) and siblings (N=624). E. coli was cultured, and minimal inhibitory concentrations to various antibiotics were tested. We determined prevalences of E. coli resistance to commonly prescribed antibiotics and their association with potential risk factors.
RESULTS: Prevalence of E. coli resistance was 16.6%, 8.7%, and 11.6% for ampicillin, cotrimoxazole, and doxycycline, respectively. Strong associations were found with antibiotic resistance among siblings (odds ratios [95% confidence intervals] for ampicillin, doxycycline, and cotrimoxazole resistance: 4.4 [1.8-10.8], 8.0 [3.0-21.2], and 10.8 [3.5-32.7], respectively).
CONCLUSION: Resistance prevalences in this community-based study were much lower than those reported from the clinical sector. Household contacts seem to be the key factor for children;s colonization with resistant E. coli in the community setting.
J Clin Epidemiol. 2007 Nov
Lietzau S, Raum E, von Baum H, Marre R, Brenner H.
Department of Epidemiology, German Centre for Research on Ageing, Heidelberg, Germany.
Keywords: Antibiotic resistance, Bacterial, E. coli, Children, Household, Transmission
OBJECTIVE: In young children infections with resistant Escherichia coli (E. coli) can lead to life-threatening situations. Epidemiological data on the prevalence and major determinants of carriage of antibiotic resistant E. coli among children in the community setting are sparse.
STUDY DESIGN AND SETTING: In a population-based study from Germany, stool samples were obtained from children aged 6 months to 4 years attending a pediatrician for a regular health screening (N=568) or an acute infection (N=316), as well as from their parents (N=1,594) and siblings (N=624). E. coli was cultured, and minimal inhibitory concentrations to various antibiotics were tested. We determined prevalences of E. coli resistance to commonly prescribed antibiotics and their association with potential risk factors.
RESULTS: Prevalence of E. coli resistance was 16.6%, 8.7%, and 11.6% for ampicillin, cotrimoxazole, and doxycycline, respectively. Strong associations were found with antibiotic resistance among siblings (odds ratios [95% confidence intervals] for ampicillin, doxycycline, and cotrimoxazole resistance: 4.4 [1.8-10.8], 8.0 [3.0-21.2], and 10.8 [3.5-32.7], respectively).
CONCLUSION: Resistance prevalences in this community-based study were much lower than those reported from the clinical sector. Household contacts seem to be the key factor for children;s colonization with resistant E. coli in the community setting.
J Clin Epidemiol. 2007 Nov
Labels: Antibiotic resistance, Bacterial, children, childrens infection, community acquired, E. coli, Household, resistant Escherichia coli, Transmission
# posted by Pat O'Connor @ 10:21 PM
Friday, May 11, 2007
Predictors of long term neurological outcome in bacterial meningitis.
Predictors of long term neurological outcome in bacterial meningitis.
Indian J Pediatr. 2007 Apr
Singhi P,
Bansal A,
Geeta P,
Singhi S.
Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Indian J Pediatr. 2007 Apr
Singhi P,
Bansal A,
Geeta P,
Singhi S.
Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
OBJECTIVE: To study the long-term neurological and developmental outcome and the clinical and laboratory predictors of sequelae in children with acute bacterial meningitis (ABM).
METHODS: Detailed clinical and demographic data was retrieved from the medical records of study children. Subsequently they were followed up for a minimum of 12 months after discharge for development, neurological and hearing assessment. All sequelae were identified and divided into minor or major. For analysis data was divided into 2 groups those with sequelae and without sequelae at follow-up. Statistical analysis was done using SPSS version 10.00 and Epi Info version 2000.
RESULTS: 61 boys and 19 girls, a mean age of 31.4 +/= 41.9 months at the time of ABM, were included in the study. Of these 62.5% children were infants. Mean age at follow-up was 58.6 +/= 47.2 months. Sequelae were observed in 32 (40%) children (8 (10%) minor and 24 (30%) major). Mean social quotient at follow-up was 92.8 +/= 32.6. Developmentally 22 (37.9%) children were normal and 20 (34.5%) had global delay. Seizures (P=0.015), cranial nerve palsy (P=0.0065), abnormal deep tendon reflexes (P=0.002), Glasgow coma scale score (GCS) < p =" 0.044)" p="0.001)" p="0.001)">
CONCLUSION: Neurological and audiological sequelae and global developmental delay may be seen in about one third of survivors of bacterial meningitis. GCS score <8,>
Indian Journal of PediatricsLabels: bacterial menningitis, children, neurological damage, Neurological sequelae; Developmental delay; Outcome
# posted by Pat O'Connor @ 8:12 PM
