ISSN:0891-3668    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Background.The relationships among weight and height growth, viral load and survival in HIV-infected children remain unclear.Objectives.To determine whether weight or height growth velocity independently predicts survival and to investigate associations of weight, height and head circumference growth velocities with viral loads in symptomatic HIV-infected children.Methods.We analyzed data from a prospective antiretroviral study utilizing clinical endpoints (PACTG 152). Viral load [log(RNA PCR)] and anthropometric measures 12 weeks before and after viral load measures were available in 494 of 831 children. Interval changes during 24 weeks inz-scores for weight-for-age (&Dgr;WAZ), height-for-age (&Dgr;HAZ) and head circumference-for-age (&Dgr;HCZ) were used as growth velocity surrogates. Logistic regression determined whether &Dgr;WAZand/or &Dgr;HAZcorrelated with survival when age, viral load and CD4+cell count were controlled. Bivariate analysis assessed correlation among viral load and &Dgr;WAZ, &Dgr;HAZand/or &Dgr;HCZ.Results.Survival related significantly to height growth velocity (P= 0.03,n= 434) but not to weight growth velocity (P= 0.84,n= 446) or head circumference growth velocity (P= 0.67,n= 148). Viral load was not significantly associated with changes in weight-, height-, or head circumference-for-agezscores (P= 0.86,n= 235;P= 0.07,n= 226; andP= 0.09,n= 165, respectively) in children <30 months of age or with changes in weight- or height-for-agezscores (P= 0.27,n= 259;P= 0.11,n= 251) in older children.Conclusions.Height growth velocity predicted survival independently of age, viral load and CD4+cell count. Weight, height and head circumference growth velocities were not significantly associated with viral load in symptomatic HIV-infected children in this large prospective trial of nucleoside reverse transcriptase therapy.

ISSN:0891-3668    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Background.Aseptic meningitis associated with urinary tract infection (UTI) in young infants has not been described in detail in the literature. We performed a retrospective study to determine the incidence and clinical features of aseptic meningitis accompanying UTI.Methods.We retrospectively reviewed the medical records of all infants younger than 6 months of age hospitalized with a UTI at Miller Children’s Hospital from March 1995 through March 2000. UTI was defined as a urine culture growing ≥10 000 colony-forming units/ml of a single organism from a catheterized specimen or ≥100 000 colony-forming units/ml of a single organism from a bagged urine specimen. Meningitis was defined as a positive cerebrospinal fluid culture or cerebrospinal fluid with >35 white blood cells/mm3in infants ≤30 days of age or with >10 white blood cells/mm3in infants >30 days of age.Results.Of 386 infants with UTI, a lumbar puncture was performed in 260, and 31 (11.9%) had aseptic meningitis. One infant had bacterial meningitis. None of the 26 infants with UTI and bacteremia had aseptic meningitis. Two infants with meningitis had confirmed enteroviral infections, but aseptic meningitis did not occur more frequently in any particular month or during times of peak enteroviral activity.Conclusions.A cerebrospinal fluid pleocytosis is relatively common in hospitalized infants <6 months of age who have a UTI and usually does not reflect bacterial meningitis. Knowledge of this may prevent unnecessary courses of antibiotics for presumed bacterial meningitis and lead to evaluation for other possible causes of aseptic meningitis including viral or congenital infections.

ISSN:0891-3668    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Background.Because of rising resistance to antibiotics, appropriate use of antibiotics is an important measure of quality of care. The purpose of this study was to use an electronic medical record (EMR) to assess use of diagnostic testing and of antibiotics for pharyngitis in a pediatric outpatient setting and to target areas for improvement.Methods.Using data retrieved from the EMR, we analyzed visits from March 1, 2001 to February 28, 2002 for children 3 to 18 years old diagnosed with pharyngitis. We determined the proportion of episodes with a diagnostic test for group A streptococci, the proportion for which a prescription for an antibiotic was dispensed and factors that predicted prescribing and testing.Results.Of 391 episodes of pharyngitis, a test was ordered for 303 (78%). Antibiotics were prescribed for 90 (23%); for 76 of 90 (84%) a test was ordered. Clinicians were less likely to order tests late in the week [relative risk (RR), 0.76; 95% confidence interval (CI), 0.66, 0.87)], more likely to order tests for patients with an exudate (RR 1.2; 95% CI 1.1, 1.3) and more likely to prescribe an antibiotic for patients with an exudate (RR 1.5; 95% CI 1.1, 2.1). When prescribing an antibiotic clinicians were less likely to order tests late in the week (RR 0.1; 95% CI 0.02, 0.5) and for patients diagnosed with scarlet fever (RR 0.07; 95% CI 0.01, 0.4).Conclusion.Using data from the EMR, we could assess adherence to the guidelines for antibiotic use and identify areas to target for improving diagnostic testing and reducing overuse of antibiotics in our clinic.

ISSN:0891-3668    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Background.Recent medical and surgical advances have increased the potential risk of endocarditis. Epidemiology, pathogens, morbidity and/or mortality may have evolved in the past decade in pediatric patients diagnosed with endocarditis.Methods.Retrospective reviews of medical records from Arkansas Children’s Hospital were done to identify patients with infective endocarditis from January 1990 through December 2002. Basic demographic and clinical data were gathered and reviewed.Results.Of 76 patients identified, 57 were included based on diagnostic criteria. Congenital heart disease with (56%) and without (25%) correction were the most common risk factors. Echocardiograms revealed vegetations in 67%. Echocardiograms remain relatively deficient in patients with complex cyanotic heart disease (50% positive) vs. those with normal anatomy (83% positive). Streptococci (30%) andStaphylococcus aureus(21%) were the most common organisms identified overall; however, we observed a predominance of enterococci in infants <2 years of age (41%). Our study revealed a reduced rate of complications, especially of the central nervous system (7% vs. 25 and 33% in prior studies); however, our rate ofS. aureuswas lower (21% vs. 32 and 39%), and this pathogen continues to be associated with a higher incidence of complications.Conclusions.Infective endocarditis continues to present a difficult challenge in pediatrics; its associated pathogens and outcomes have changed little in the past decade.

ISSN:0891-3668    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Objective.To identify the clinical utility of obtaining blood, urine and cerebrospinal fluid for bacterial culture among febrile infants <90 days of age with clinical bronchiolitis.Design.Retrospective chart review from 1995 to 2000.Setting.Urban emergency department of a tertiary children’s hospital.Participants.All infants <90 days of age presenting with fever and clinical bronchiolitis.Main outcome measures.Result of the cultures of blood, urine and cerebrospinal fluid.Results.Of 3051 (11%) febrile infants, 329 met criteria for clinical bronchiolitis. Blood for culture was obtained from 309 (94%), urine for culture was obtained from 273 (83%) and cerebrospinal fluid for culture was obtained from 200 (61%). One hundred eighty-seven (57%) infants had all 3 specimens sent for culture. No cases of bacteremia [0%; 95% confidence interval (CI), 0, 1.1%] or meningitis (0%; 95% CI 0, 1.8%) occurred among these infants. However, 6 infants (2%; 95% CI 0.8, 5.7%), all male, had a culture of urine consistent with infection (4Escherichia coli, 1Staphylococcus aureus, 1 viridans streptococci).Conclusion.The risk of bacteremia or meningitis among infants <90 days with fever and bronchiolitis is low in this age group. The risk of urinary tract infection in this age group is also low, but not negligible, at 2%.

ISSN:0891-3668    

出版商:OVID    

年代:2003

数据来源: OVID

ISSN:0891-3668    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Background.Malaria and HIV are important pediatric problems in sub-Saharan Africa. It is uncertain how HIV-related immunosuppression and malaria interact in children. We aimed to describe associations among HIV status, presentation and outcome from malaria in children from Hlabisa district, KwaZulu-Natal, South Africa, a region of high HIV prevalence and unstablePlasmodium falciparumtransmission.Methods.Consecutive febrile children were screened for malaria with a rapid antigen test. After consent was given, clinical data were recorded, and blood spots were obtained for HIV antibody testing. Cases were managed according to national guidelines.Results.Malaria was diagnosed in 663 children, of whom 10.1% were HIV antibody-positive. Semiquantitative asexual and sexual stage parasitemia densities were unrelated to HIV status. Overall 161 children were hospitalized; 19 (12%) were <1 year old; and 41 (25%) had severe/complicated malaria. Severe disease presented more frequently in HIV antibody-positive than in HIV-uninfected children (P= 0.05), particularly in those >1 year old with coma (P= 0.02) and hypoglycemia (P= 0.05). Receiving parenteral antibiotics was associated with severe disease (odds ratio, 3.0; 95% confidence interval, 1.3 to 6.7) whereas a low white blood cell count (<4 × 106/l) was associated with nonsevere disease (odds ratio, 0.4; 95% confidence interval, 0.2 to 0.8). Seven children (4.3%) died. Coma, age <1 year and low white blood cell count were the clearest predictors of poor outcome.Conclusion.HIV infection was associated with severe/complicated malaria, although the magnitude of the effect may be relatively small. Given that both malaria and HIV are widespread in Africa, even small effects may generate significant morbidity and mortality and major public health consequences.

ISSN:0891-3668    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Background.Because of the increasing number of resistant middle ear pathogens and the impact of the new conjugateStreptococcus pneumoniaevaccine, an active surveillance of the microbiology and susceptibility pattern of middle ear pathogens is required.Objective.To study the microbiology and susceptibility pattern of middle ear pathogens obtained from Costa Rican children with acute otitis media (AOM), recurrent otitis media (ROM) and therapeutic failure otitis media (FOM).Methods.Between 1999 and 2001 middle ear fluid (MEF) was collected from 276 Costa Rican patients.S. pneumoniaeserotyping and pulsed field gel electrophoresis analysis was done on available strains.Results.Among the total study population, 102 were AOM patients, 98 were ROM patients and 76 were FOM patients. OverallS. pneumoniae(88 strains) was the most common pathogen isolated followed byHaemophilus influenzae(41 strains) andStreptococcus pyogenes(10 strains).H. influenzaewas the most common agent in FOM patients (P= 0.015). Beta-lactamase production was observed in 3 of 41 (7%)H. influenzaestrains and 3 of 3 (100%)Moraxella catarrhalisstrains. Penicillin-nonsusceptibleS. pneumoniaestrains were more common in FOM (64%) and ROM (63%) patients than in AOM (42%) patients (P= 0.05).S. pneumoniaeserotype 19F was the most prevalent serotype, mainly within one distinct clone.Conclusions.OverallS. pneumoniaeserotype 19F was the most common isolate from the middle ear fluid of Costa Rican children. Beta-lactamase-negativeH. influenzaewas the most prevalent in the subpopulation of patients with FOM.S. pyogeneswas the third most common isolate andM. catarrhaliswas uncommon.

ISSN:0891-3668    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Background.Streptococcus pneumoniaeis a leading cause of invasive bacterial disease in children worldwide. Although morbidity and mortality associated with invasive pneumococcal disease (IPD) are known to be high in Latin American infants, the current situation for Central American children is unclear.Methods.A 7-year retrospective review of IPD cases (January 1995 to December 2001) treated at the National Children’s Hospital in San José, Costa Rica.Results.We analyzed 135 episodes that occurred in 132 patients. The mean age of presentation was 35.7 months (range, 0 to 11.4 ys), with 73.3% of all episodes occurring in patients <5 years of age and 56% occurring in patients <24 months of age. Underlying medical conditions were present in 47% of children. The most common clinical presentations were meningitis in 56 (41.5%) patients, pneumonia in 36 (26.7%), bacteremia alone in 30 (22.2%), peritonitis in 10 (7.4%), septic arthritis in 2 (1.5%) and osteomyelitis in 1 (0.7%). The case fatality rate was 14.4%, and children <2 years of age had the highest rates of complications, sequelae and death. Penicillin or cefotaxime nonsusceptibility was observed in 14.3% (10.7% intermediate, 3.6% resistant) and 4.5% (1.5% intermediate, 3% resistant) of tested isolates, respectively.Conclusions.IPD in Costa Rica is associated with high morbidity and mortality, particularly among young infants. Most prevalent IPD are the ones observed in developed countries before the introduction of current conjugated vaccine. Penicillin and third generation cephalosporin resistance in invasive cases is present at low rates.

ISSN:0891-3668    

出版商:OVID    

年代:2003

数据来源: OVID