ISSN:0891-3668    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

The spectrum of organisms responsible for lower respiratory tract infection in chronically ventilated neonates is poorly defined. During an 18-month period 63 infants with a respiratory deterioration defined as an increase in fractional inspired O2concentration ≥20% and/or mean airway pressure ≥3 cm H2O were evaluated for pulmonary infection. These infants were compared with 58 stable control ventilated infants. Tracheal aspirates for culture and Gram stain were taken from both groups and were cultured for bacteria, viruses,Chlamydia trachomatis, Ureaplasma urealyticumandMycoplasma hominis. In addition each infant had complete blood counts with differential and chest roentgenograms evaluated. Positive tracheal aspirates defined as a heavy growth of a single or two bacterial organisms, and/or any growth of virus,ChlamydiaandU. urealyticumwere found in 23 of 63 study patients and 20 of 58 controls (P> 0.05). The most frequent isolate in both groups wasU. urealyticum. Chest radiographs were positive (new changes, particularly atelectasis and infiltrates) more frequently in the study group than in controls, but complete blood count and tracheal aspirate Gram-stained smears were not helpful in discerning colonization from infection. We conclude that positive tracheal aspirates occur with equal frequency among infants with a clinical suspicion of lower respiratory tract infection and in “well” controls. Chest roentgenogram may be a useful adjunctive test to discriminate between colonization and lower respiratory tract infection.

ISSN:0891-3668    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

During January and August, 1990, 23 cases of early onset Group BStreptococcus(GBS) disease occurred in a Kansas City, MO, hospital with an attack rate of 14/1000 live births, compared with an annual rate of 1.2 cases/1000 live births for 1988 through 1989. Case infants were compared with controls matched by birth weight, race, maternal age and day of delivery and to a second group of infants of mothers colonized with GBS to identify risk factors and consider intervention strategies during the outbreak. The presence of multiple serotypes among the invasive strains suggested that the outbreak was not caused by a common source. Case mothers were more likely than control mothers to have chorioamnionitis, intrapartum fever or rupture of membranes > 12 hours, and premature case infants were more likely to have a history of rupture of membranes before onset of labor. Multiparous mothers of case infants were more likely to have a history of spontaneous abortion (odds ratio, 6.7; 95% confidence interval, 1.0 to 45.9). No single factor could explain the increase in GBS disease. If intrapartum antibiotic prophylaxis had been used for selected GBS carriers based on presence of either rupture of membranes >12 hours, intrapartum maternal fever or preterm labor, 7.4% of all deliveries would have received antibioties and 73% of cases could potentially have been prevented. We conclude that identification of colonized mothers with perinatal risk factors and use of intrapartum antibiotics could be expected to prevent substantial disease during an outbreak of early onset GBS disease.

ISSN:0891-3668    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

The role of genital mycoplasmas in the pathogenesis of neonatal infection is incompletely understood. We performed nasopharyngeal, blood and cerebrospinal fluid (CSF) cultures forMycoplasma hominisandUreaplasma urealyticumin 69 neonates who underwent a diagnostic workup for suspected sepsis. The mean gestational age was 35.9 weeks (range, 25 to 42 weeks) with a mean birth weight of 2386 g (range, 652 to 4420 g). Twenty-seven infants (39.1%) had positive nasopharyngeal cultures; 6 were positive forM. hominis, 10 forU. urealyticumand 11 for both organisms. Seven (26%) of these 27 patients developed chronic lung disease compared with 2 (4.7%) infants in the non-colonized group. Nine infants had positive CSF cultures forM. hominisand one infant had a positive CSF culture forU. urealyticum. All blood cultures were sterile. One of the infants with a positive CSF culture forM. hominishad clinical evidence of systemic infection. All of the infants were treated with antibiotic agents that were not active against mycoplasmas. These data indicate that genital mycoplasmas can be found commonly in the CSF and nasopharynx of infants with suspected sepsis. Their etiologic role in the causation of infection and chronic lung disease, however, remains unclear.

ISSN:0891-3668    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

Fungal peritonitis is uncommon is infants with severe necrotizing enterocolitis with intestinal perforation. In our institution we noted a significant (P≤ 0.01) increase in fungal peritonitis from 7% (3 of 45 cases of peritonitis) from January, 1980, to June, 1989, to 35% (8 of 23 cases of peritonitis) from July, 1989, to December, 1991. The mean birth weight of 11 infants with fungal peritonitis (946 ± 70 g) (mean ± SE) was significantly less (P= 0.008) than that of 57 infants with bacterial peritonitis (1282 ± 52 g). In a case-control study to identify risk factors associated with fungal peritonitis, 11 infants with bacterial peritonitis were matched to the 11 infants with fungal peritonitis by age at bowel perforation and birth weight. Infants with fungal compared with bacterial peritonitis had significantly longer (P< 0.05): median duration of umbilical vessel catheterization before bowel perforation, 10vs. 3 days, respectively; median duration of antibiotic therapy before bowel perforation, 23vs. 14 days, respectively; and median duration of intubation, 13vs. 5 days, respectively. Other potential risk factors that were not significant in this study included duration of central venous catheterization, total parenteral nutrition, intravenous lipid administration, aminoglycoside use, dexamethasone use or methyl xanthine therapy. In summary fungal peritonitis in neonates with necrotizing enteritis was significantly related to extremely low birth weight, prolonged umbilical vessel catheterization, prolonged exposure to antibiotics and prolonged intubation.

ISSN:0891-3668    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

Cimetidine, an H2 histamine receptor antagonist, was used in subacute selerosing panencephalitis patients for its immunomodulatory effect. Patients were randomly assigned to cimetidine (n= 7) and placebo (n= 7) groups. Neurologic disability index, lymphocyte functions, cerebrospinal fluid measles antibodies and IgG index were evaluated before and after 2 months of treatment. The neurologic disability index of the cimetidine group remained stable during the study period whereas the placebo group worsened. There were no differences in the immunologic test results, cerebrospinal fluid measles antibody titers and IgG index of the two groups. This study suggests that cimetidine may have a favorable effect on the clinical progression of subacute sclerosing panencephalitis. Further studies are required to investigate its mechanism of action and the associated changes in immune status.

ISSN:0891-3668    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

The activity of a number of detergents and disinfectants against respiratory syncytial virus (RSV) was evaluated in anin vitroassay system. Equal volumes of RSV and serial 10-fold dilutions of the test agents were mixed at 4°C for 5 minutes. The RSV titer in each mixture was compared with that of untreated RSV alone. In 14 experiments with input RSV titers ranging from 2.6 x 103to 2 x 107plaque-forming units/ml, a 10-fold dilution of 5.25% sodium hypochlorite (generic bleach) inactivated (>3-log reduction in titer) the virus. With lower RSV titers inactivation was also observed at a 100-fold dilution of bleach. Fetal calf serum concentrations up to 50% as an organic load did not diminish the bleach effect. The degree of RSV inactivation was also defined for Lysol®, povidone-iodine, Amphyl®, Hibiclens®, Osyl®, ethanol and Listermint®. The short contact time, the reproducible nature of the findings and the continued effectiveness with increasing organic loads all suggest that detergents and disinfectants can potentially play an important role in decreasing the spread of RSV infection.

ISSN:0891-3668    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

Urinary albumin excretion (AE) was determined by a sensitive method (below dipstick positive values, 15 to 300 μg/minute) in 68 children with meningitis during 48 hours after hospital admission; 51 children had bacterial meningitis (BM) and 17 had aseptic meningitis. AE (results as mean ± SD) during 0 to 24 hours was higher (P≤ 0.001) in patients with BM (36 ± 40 μg/minute) than with aseptic meningitis (7 ± 5 μg/minute), albeit no cutoff value distinguished the two conditions accurately. In BM the clinical course (uneventful, intermediate, complicated, fatal) correlated with AE of 0 to 24 hours (r= 0.34,P≤ 0.05) and AE of 25 to

ISSN:0891-3668    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

Rates of invasiveHaemophilus influenzaetype b (Hib) disease in children decreased very rapidly after licensure of Hib conjugate vaccines. A role for a vaccine-related reduction in nasopharyngeal carriage of Hib has been suggested. We studied oropharyngeal carriage of Hib and vaccination rates in a population of 2− to 5-year-old children in metropolitan Atlanta. Among 584 children 75% were vaccinated with an Hib conjugate vaccine, 17% had not been vaccinated and 8% had no vaccination records available. Forty-one percent of the children were colonized withH. influenzae. One child was colonized with Hib. Hib carriage (0.17%; upper 95% confidence interval boundary, 0.97%) was substantially lower than the estimates of Hib carriage from prior studies of children who had not received Hib conjugate vaccines. Our data are consistent with a decline in Hib carriage induced by widespread use of conjugate Hib vaccines, which may have contributed to the decline of Hib disease in United States children.

ISSN:0891-3668    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

The effect ofHaemophilus influenzaetype b (Hib) meningococcal protein conjugale vaccine (Hib-OMPC; Merck, Sharp & Dohme) on oropharyngeal (OP) carriage of Hib was evaluated in Navajo and Apache Indian children, who are known to be at high risk for invasive Hib disease. We obtained 1423 OP swabs at well child visits from 1321 children 3 months to 4 years of age: 293 of the swabs were obtained from children before the administration of any Hib-OMPC; 1119 were taken after the primary vaccination series; and 11 after the booster dose. Swabs were tested for the presence of Hib capsular polysaccharide antigen by enzyme-linked immunosorbent assay. Forty of 1423 swabs were positive for Hib. Among the 40 positive swabs 5 (13%) were obtained from children who

ISSN:0891-3668    

出版商:OVID    

年代:1993

数据来源: OVID