ISSN:0891-3668    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Considerable evidence indicates that both anticapsular antibody and immunologic memory play a role in immunity toHaemophilus influenzaetype b (Hib) disease. The efficacy of memory (or antibody) cannot be expected to be 100%; therefore some individuals may develop invasive disease despite their having been naturally primed. The proportion of cases ofH. influenzaetype b disease with evidence of immunologic memory is related to both the efficacy of memory in preventing disease and the age-related prevalence of memory in the population. The task is to discern the relative contributions of antibody and memory in conferring protection and to determine the extent to which natural exposure and vaccination establish these two effector mechanisms.

ISSN:0891-3668    

出版商:OVID    

年代:2001

数据来源: OVID

ISSN:0891-3668    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Objective.To undertake population pharmacokinetic modeling and to determine the safety and efficacy of once daily (OD) gentamicin dosing in children with severe urinary tract infections (UTI).Methods.An open, randomized, controlled trial comparing OD with three times daily (TD) gentamicin dosing in hospitalized children ages 1 month to 12 years with UTI. Daily doses (milligrams per kg per day) of gentamicin in both groups were 7.5 (<5 years old), 6.0 (5 to 10 years old) and 4.5 (>10 years old).Results.There were 179 children enrolled (90 OD, 89 TD). Baseline clinical characteristics and pathogens were similar, except that circulatory compromise and renal cortical scintigraphic defects were more common in the OD group. Median gentamicin treatment durations were 3.0 (OD) and 2.7 (TD) days. Mean peak gentamicin concentrations were 17.3 (OD)vs.6.4 (TD) mg/l; 99% of peak concentrations were >7 mg/l in the OD group whereas 16% of peak concentrations were <5 mg/l in the TD group. Mean trough concentrations were 0.35 (OD)vs.0.55 (TD) mg/l. In the OD group 4% of trough concentrations were ≥2 mg/l, whereas in the TD group only 0.7% were ≥2 mg/l. Age or prior elevated peak concentrations did not predict high trough concentrations. Population pharmacokinetic modeling of the data fitted a one-compartment model with first order elimination. There were no clinical or bacteriologic failures. The two disease-related complications were confined to the OD group. No nephro- or ototoxicity was identified.Conclusions.With age-appropriate dosing and measurement of serum trough concentrations before the second dose, OD gentamicin is safe and effective for the treatment of UTI requiring parenteral treatment in children aged 1 month to 12 years.

ISSN:0891-3668    

出版商:OVID    

年代:2001

数据来源: OVID

ISSN:0891-3668    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Background.Limited information exists on emerging bacterial resistance patterns in pediatric chronic sinusitis.Methods.A retrospective review (1995 to 1998) of the aerobic microbiology of chronic sinusitis in children at a tertiary care children’s hospital was conducted. One hundred nineteen children (mean age, 4.9 years) with maxillary sinusitis of >8 weeks duration and no known immunodeficiency or cystic fibrosis who underwent antral irrigation were included.Results.One hundred sixty-one of 240 (67%) aerobic cultures were positive, yielding 274 isolates. Eighty-eight positive cultures were polymicrobial. The most frequent isolates were nontypableHaemophilus influenzae(24%),Streptococcus pneumoniae(19%),Moraxella catarrhalis(17%), coagulase-negativeStaphylococcus(6%), alpha-streptococci (6%), diphtheroids (5%),Staphylococcus aureus(3%) andNeisseriaspp. (3%). Rates of nonsusceptibility ofStreptococcus pneumoniaewere 64% for penicillin (24% high grade resistance), 40% for cefotaxime, 18% for clindamycin and 0% for vancomycin. Rates of nonsusceptibility ofS. pneumoniaedid not change significantly during the study period. Thirty-nine percent ofH. influenzaeisolates were beta-lactamase-positive and 44% were nonsusceptible to ampicillin (41% high grade resistance). Beta-lactamase positivity ofH. influenzaedecreased during the study period (P= 0.06). AllM. catarrhalisisolates tested were beta-lactamase-positive.Conclusion.This study indicates that the aerobic pathogens in pediatric chronic sinusitis include bacteria typical of acute sinusitis as well as organisms more characteristic of chronic disease. Moreover it highlights the significant role of antibiotic-resistant aerobes, including multiply resistantS. pneumoniae, in pediatric chronic sinusitis.

ISSN:0891-3668    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Objectives.To establish the frequency of isolation ofBorrelia burgdorferisensu lato from blood of children with solitary erythema migrans (EM) in Europe, to determine the strains of the isolated borreliae and to compare the clinical course and the outcome of the disease according to positive and negative blood culture result.Methods.In the prospective study we included 134 consecutive patients younger than 15 years with solitary EM, referred to our institution in 1996 and 1997. One milliliter of blood was withdrawn before treatment and cultured in modified Kelly-Pettenkofer medium. Isolated borreliae were typed according to LRFP analysis. Patients were treated with either penicillin V or cefuroxime axetil for 14 days. The posttreatment course was surveyed by follow-up visits during 1 year.Results.B. burgdorferisensu lato was isolated in 12 of 134 (9%) patients. Eleven blood isolates were typed: 10 were found to beB. afzeliiand 1 wasBorrelia garinii. Comparison of blood culture-positive and -negative patients revealed no differences in pretreatment characteristics or in posttreatment clinical course. However, worsening of local and/or systemic signs and symptoms at the beginning of antibiotic therapy (Jarish-Herxheimer’s reaction) was identified more often in the blood culture-positive than in the blood culture-negative group (5 of 12vs.17 of 122, respectively;P= 0.0274).Conclusions.The isolation rate ofB. burgdorferisensu lato from the blood of children with solitary EM was 9%. The majority of the isolates wereB. afzelii. Blood culture-positive patients treated with oral antibiotics were not at greater risk for unfavorable course of the disease than patients with negative blood culture result.

ISSN:0891-3668    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Background.There is evidence of an immunosuppressive effect of cytomegalovirus (CMV), and CMV has been claimed to be a copathogen in respiratory tract infections (RTI). We therefore studied the significance of CMV viral load in infants with RTI, compared the frequency of infection with respiratory viruses and followed the course of RTI in CMV-excretingvs.nonexcreting infants.Methods.We examined 201 infants consecutively admitted to the Department of Pediatrics for RTI. At admission nasopharyngeal aspirates, throat swabs and urine were examined for CMV, and nasopharyngeal aspirates were examined for respiratory viruses.Results.In these patients 23.3% had CMV in the urine, 15.3% had CMV in the throat and 10.9% had CMV in the nasopharynx; 26.2% excreted CMV in at least one site. No relationship was found between CMV viral load and clinical symptoms. Infection with respiratory viruses was as common in infants excreting CMV as in nonexcreting infants. Symptoms and the course of infection were not different in the two groups except that CMV-excreting infants had a significantly higher frequency of rhonchi at admission (P= 0.007) and a tendency for longer duration of cough (P= 0.06).Conclusion.CMV viral load was not related to clinical symptoms. The frequency of infection with common respiratory viruses in infants was independent of CMV excretion. The course of infection was not more complicated in infants excreting CMV; however, a higher frequency of rhonchi was demonstrated in patients with CMV.

ISSN:0891-3668    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Background.Trimethoprim-sulfamethoxazole (T/S) has often been used as first and second line of treatment for acute otitis media (AOM). Because of the increasing resistance ofStreptococcus pneumoniaeandHaemophilus influenzaeto T/S, we undertook the present study to investigate the bacteriologic and clinical efficacy of this drug in AOM.Methods.Fifty-four culture-positive evaluable patients ages 3 to 32 months with AOM were treated with T/S 4/20 mg/kg in two divided daily doses for 10 days. Middle ear fluid (MEF) was cultured at enrollment (Day 1) and on Days 4 and 5 after initiation of treatment. Additional MEF cultures were obtained if clinical relapse occurred. Clinical failure was determined when the symptoms and signs of AOM did not improve or recurred during therapy. Bacteriologic failure was defined by positive culture on Days 4 and 5, or negative on Days 4 and 5 but positive again before the end of treatment. Patients were followed until Day 28 ± 2.Results.A total of 67 organisms were isolated from MEF specimens of the 54 study patients:S. pneumoniae,24;H. influenzae,40; andStreptococcus pyogenes,3. Fifteen (63%) of 24S. pneumoniaewere nonsusceptible to T/S (trimethoprim MIC, >0.5 &mgr;g/ml), of which 10 (67%) were highly resistant to T/S (trimethoprim MIC, ≥4.0 &mgr;g/ml). Twelve (30%) of 40H. influenzaeand all 3S. pyogenesisolates were nonsusceptible to T/S (MIC ≥ 4.0 &mgr;g/ml). Bacteriologic eradication occurred in 9 of 9 (100%) and 27 of 27 (100%) T/S-susceptibleS. pneumoniaeandH. influenzae, respectively,vs.4 of 15 (27%) and 6 of 12 (50%) T/S-nonsusceptibleS. pneumoniaeandH. influenzae, respectively (P< 0.001). The 3 patients withS. pyogenesfailed bacteriologically. Nine new organisms, not initially isolated, emerged during treatment, 7 of which (77%) were resistant to T/S. Altogether bacteriologic failure (organisms not eradicated plus newly emerged) occurred in 29 (53%) of 54 patients. Clinical failures occurred in 8 (15%) of 54 patients, and in 7 of these 8 cases the clinical failures occurred in those with bacteriologic failures. Ten patients relapsed clinically after completion of treatment and in 8 of them tympanocentesis for MEF culture was performed. Six of these 8 cultures were positive, and the initial pathogen was isolated in 4 of 6 (67%).Conclusions.A high bacteriologic failure rate as well as a considerable clinical failure rate occurred among patients with AOM treated with T/S. We believe that T/S is no longer an appropriate empiric choice for the treatment of AOM in regions where high T/S resistance among respiratory pathogens is reported.

ISSN:0891-3668    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Objectives.To facilitate the study of the prevalence of herpes simplex virus (HSV) infection and its determinants in children, we developed a noninvasive saliva test.Methods.A capture enzyme-linked immunosorbent assay (ELISA) for the detection of IgG to HSV in saliva was developed, validated against a commercial serum ELISA in 110 children and 187 adults and used in a cross-sectional population-based study including 2048 children ages 1 to 17 years, recruited in day-care centers and schools of Geneva, Switzerland. Demographic and socioeconomic determinants of HSV prevalence were studied.Results.The sensitivity and specificity of the saliva assay were 94.1 and 95.5%, respectively, compared with the commercial serum ELISA. Participation in the cross-sectional study was 86.6%. The overall prevalence of anti-HSV IgG was 23.9%. It increased with age up to 7 years, reaching a plateau at 35% without evidence for day-care or school transmission. The main determinants of prevalence were region of national origin and parents’ professional category.Conclusions.This new saliva-based assay proved its feasibility in the first population-based study of HSV prevalence in children that uses saliva, confirmed its validity by identifying determinants of prevalence consistent with previous reports and yielded new information, such as the lack of influence of day-care attendance, in the population studied.

ISSN:0891-3668    

出版商:OVID    

年代:2001

数据来源: OVID