ISSN:0891-3668    

出版商:OVID    

年代:2002

数据来源: OVID

ISSN:0891-3668    

出版商:OVID    

年代:2002

数据来源: OVID

ISSN:0891-3668    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Background.There are few data comparing the clinical features, management and outcome of penicillin-nonsusceptibleStreptococcus pneumoniae(PNSP) meningitis patients with penicillin-susceptibleS. pneumoniae(PSSP) meningitis patients.Methods.We performed a retrospective, nested case-control study comparing cases with PNSP meningitis with controls with PSSP meningitis obtained from the Immunization Monitoring Program, Active (IMPACT) cross-Canada surveillance study of invasiveS. pneumoniaeinfections.Results.There were 30 PNSP meningitis cases (10.1% of total) and 45 PSSP meningitis controls from 6 centers obtained from 297 meningitis cases in the IMPACT database from 1991 through 1999. Vancomycin was used for empiric therapy in no cases and controls in 1991 to 1993 and in all cases in 1999. A third generation cephalosporin was used in 93.3% of confirmed PNSP cases, and 70.0% also received vancomycin and/or rifampin. Penicillin was used in 66.7% of confirmed PSSP cases. PNSP cases were more likely than PSSP controls to have a second lumbar puncture (odds ratio, 4.1;P= 0.01). PNSP cases were treated with intravenous antibiotics for an average of 15.6 days compared with 12.3 days for controls (P= 0.04). Among PNSP cases, those patients who did not receive empiric vancomycin were treated with intravenous antibiotics for an average of 18.5 days compared with 12.0 days for those who did receive empiric vancomycin (P= 0.04). The overall mortality was 5.3%, and 36.6% of survivors had ≥1 neurologic sequelae, including 19.7% with hearing loss. In multivariate statistical models, PNSP was not a risk factor for intensive care unit admission or neurologic sequelae.Conclusions.Management of suspected bacterial meningitis and confirmedS. pneumoniaemeningitis in Canadian children changed in the past decade. Treatment of PNSP meningitis is significantly different from that for PSSP meningitis. These changes have occurred in response to the emergence of PNSP in Canada. Neurologic sequelae remain common afterS. pneumoniaemeningitis, but there are no differences between PNSP cases and PSSP cases.

ISSN:0891-3668    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Context.Community-acquired, methicillin-resistantStaphylococcus aureus(CA-MRSA) infections in children are increasing in frequency for unknown reasons.Objectives.To compare the presence of risk factors for methicillin resistance between patients with CA-MRSA and community-acquired methicillin-susceptibleS. aureus(CA-MSSA) infection and to compare the presence of risk factors among household contacts of the patients from both groups. To compare the demographic and clinical characteristics between children with CA-MRSA and CA-MSSA infection.Design.Prospective observational study conducted between February 2, 2000 and November 14, 2000, excluding the month of May and the period between September 2 and October 15.Setting and patients.Texas Children’s Hospital, Houston, TX; inpatients and outpatients with community-acquiredS. aureusinfection.Main outcome measures.Proportion of MRSA among all community-acquiredS. aureusinfections. The presence of risk factors associated with methicillin resistance among patients, and their household contacts, with CA-MRSA and CA-MSSA.Results.The monthly rates of methicillin resistance ofS. aureusvaried between 35 and 51%. CA-MSSA isolates were associated with deep-seated infections significantly more often (30%) than CA-MRSA isolates (11%;P= 0.01). CA-MRSA isolates were generally susceptible to clindamycin and trimethoprim-sulfamethoxazole and resistant to erythromycin. There were no significant differences in the exposure to risk factors between children with CA-MRSA and CA-MSSA infection. No significant risk factors for CA-MRSA were identified among household contacts.Conclusions.MRSA is an established, community-acquired pathogen in our area. This necessitates a change in empiric therapy of infections suspected to be caused byS. aureus.

ISSN:0891-3668    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Background.Reports from various geographic regions indicate that the prevalence of community-acquired methicillin-resistantStaphylococcus aureus(MRSA) infection is increasing. The primary reservoir is the anterior nares; nasal carriage is a risk factor for infection in a variety of populations. Little is known about MRSA nasal carriage rates among children in Nashville, TN and the associated likelihood of community MRSA transmission.Methods.Nasal swabs were collected from 500 children at well-child visits at either a university hospital pediatric clinic or a private pediatric office. Cultures were plated onto selective staphylococcal media, with or without oxacillin.S. aureusisolates were confirmed by coagulase tube testing. Antibiotic susceptibilities were determined for suspected methicillin-resistantS. aureusisolates by standard broth microdilution methods (National Committee for Clinical Laboratory Standards). Pulsed field gel electrophoresis was used to evaluate epidemiologic relatedness. PCR testing was done to assess for themecAgene. A parent questionnaire was administered regarding MRSA risk factors.Results.Four patients had oxacillin-resistantS. aureusisolates (MIC ≥ 4 &mgr;g/ml), and two had borderline resistant isolates (MICs = 1 and 2 &mgr;g/ml). One of the borderline-resistant isolates and one of the MRSA isolates had pulsed field gel electrophoresis typing results indicating close relatedness. ThemecAgene was present in all resistant isolates and one of the borderline-resistant isolates. Only having a household member employed in a hospital was associated with a greater risk of MRSA nasal carriage (odds ratio, 9.6;P= 0.008).Conclusions.MRSA nasal colonization is present within Nashville’s healthy pediatric population. Children with household contacts employed in a hospital are significantly more likely to be colonized.

ISSN:0891-3668    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Background.Comparisons of rapid antigen tests for the diagnosis ofStreptococcus pyogenespharyngitis are often made between published studies but may not be reliable given differences in study design, sampling and reference standard definitions. Tests are rarely compared against each other in a single study.Methods.The sensitivity and specificity of twoS. pyogenesrapid diagnostic tests were compared against a multiplate culture standard defined as the identification ofS. pyogeneson any of four culture plates. Paired swabs were tested forS. pyogenesantigen using Genzyme’s OSOM Ultra Strep A Test and compared with Biostar’s Strep A OIA Max Test.Results.Ninety-four (31.1%) of 302 matched samples were identified withS. pyogenes.The sensitivity of Genzyme’s OSOM Ultra Strep A Test against the multiplate culture standard was 92.6%, significantly higher (P= 0.001) than that (75.5%) of Biostar’s Strep A OIA Max Test. Specificities were 92.8 and 97.1%, respectively. Data analysis of culture results and statistical modeling showed that cultures of two or more samples are necessary for a sensitivity of 95% or greater for a comparison standard compared with true disease status.Conclusions.When comparing the performance of rapid antigen tests forS. pyogenespharyngitis, a rigorous culture standard should be used consisting of at least two separate samples (swabs and/or pledgets), ultimately plated on selective agar. Genzyme’s OSOM Ultra Strep A Test was significantly more sensitive than Biostar’s Strep A OIA Max Test in comparison with a multiplate culture standard and a same swab, single plate culture standard.

ISSN:0891-3668    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Background and aim.Varicella is normally a self-limited disease of childhood that does not require hospitalization. In the prevaccine era varicella caused >9000 hospitalizations per year. To determine whether the varicella vaccine, licensed in 1995, has decreased hospitalizations because of varicella, we examined national rates of varicella-related hospital discharges (VRHD) covering a 12-year period that included pre- and postvaccine data.Methods.Data from the 1988 to 1999 National Hospital Discharge Survey and population estimates from the National Center for Health Statistics were used to calculate biennial rates of VRHD. To control for coding consistency, rates of invasive disease caused byHaemophilus influenzaewere calculated for the same time period.Results.The rate of VRHD for 1998 to 1999 (4.42 hospitalizations per 100 000 person-years) was the lowest of any of the periods measured, but this difference was not statistically significant. The same was true of VRHD limited to cases with varicella coded as the primary diagnosis. A trend toward a decrease in VRHD was observed in all age groups examined, although none was statistically significant. Calculated rates from this national data set were in agreement with prior studies using active surveillance, and the previously documented fall in hospitalizations caused by invasiveH. influenzaedisease was demonstrated using these methods.Conclusions.Although it is uncommon for children with varicella to require hospitalization, these cases are an important contributor to cost and morbidity of varicella. In contrast to predictions of prelicensure mathematical models, there has not been a significant decrease in total or first diagnosis VRHD since the vaccine became available. Current coverage levels are below those used in prelicensure models. Increased acceptance of the varicella vaccine by parents and practitioners may aid in the further decrease of varicella-related hospitalizations.

ISSN:0891-3668    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Background.Varicella epidemiology is changing with increasing use of the varicella vaccine.Methods.To describe the epidemiology of severe varicella disease before and after vaccine introduction, data from the National Hospital Discharge Survey (NHDS) for 1988 to 1999 were analyzed. Incidental cases of varicella in persons hospitalized for a different indication were excluded.Results.In the prevaccination era (1988 to 1995), there were 10 632 varicella hospitalizations annually. The most common complications were viral pneumonitis (20.9%), fluid/electrolyte disturbances (19.3%) and soft tissue infections (17.8%). Most (89.1%) persons had no severe underlying immunocompromising conditions. The mean length of hospitalization was 5.4 days, corresponding to ∼57 000 days of hospitalization annually. In the first years after vaccine licensure (1996 to 1999), vaccine coverage reached 59%. Although not statistically significant, there was a trend toward decreased hospitalizations and a decline in mean length of hospitalization.Conclusions.Varicella morbidity was higher in the prevaccination era than previously reported. Although no significant decline is evident, a trend toward decreased hospitalizations is emerging in the first years after vaccine introduction.

ISSN:0891-3668    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Background.Organisms of theEnterobacterspp.,Serratia marcescens,Citrobacter freundii, indole-positiveProteusspp.,Providenciaspp. andMorganella morganii(ESCaPPM) group are a common cause of hospital-acquired bacteremia and share the potential to develop beta-lactam resistance during therapy. The emergence of such resistance may have adverse consequences, but the frequency with which this occurs has not been studied in children. It has been suggested that such organisms should be treated with combination antimicrobials or carbapenems, but the optimal regimen is uncertain.Aim.To determine the frequency with which beta-lactam resistance develops during ESCaPPM sepsis in children and the optimal treatment of such sepsis.Methods.A review of the case notes and microbiologic records of all cases of ESCaPPM bacteremia and meningitis managed at a tertiary children’s hospital during a 6-year period.Results.Fifty-eight cases were identified, and in three (5%) cases beta-lactam resistance emerged during treatment, with adverse clinical consequences in two cases. Clinical and microbiologic outcome was similar in those treated with carbapenems and in those treated with a beta-lactam and aminoglycoside combination. Cefotaxime resistance was found in 57, 30, 24 and 7% of children who had received carbapenems, cephalosporins, penicillins or no/other antimicrobials in the month before ESCaPPM sepsis, respectively.Conclusions.The emergence of beta-lactam resistance during treatment of ESCaPPM sepsis is uncommon in our hospital but can have adverse consequences. Where isolates are reported as susceptible to both classes of drugs, an extended spectrum penicillin in combination with an aminoglycoside may be preferable first line treatment of ESCaPPM sepsis to a carbapenem or quinolone.

ISSN:0891-3668    

出版商:OVID    

年代:2002

数据来源: OVID