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:

Objectives.This report describes clinical signs of rotavirus infection (RVI) among neonates admitted to a neonatal intensive care unit (NICU), compares these signs between term and preterm neonates and assesses the seasonal distribution of RVI in the NICU with that of the community.Methods.After an initial prevalence study of 28 days, a prospective longitudinal study in the NICU was conducted. During the next 48 months from December 1, 1991 to November 30, 1995, term and preterm NICU patients were evaluated daily for pre-defined deviations in their baseline gastrointestinal status. Fecal specimens of neonates who fulfilled the entry criteria were tested for rotavirus by a monoclonal antibody-based enzyme immunoassay and by immunoelectron microscopy. Demographic and outcome data for these neonates were collected. In addition data assessing RVI in the community were collected during this period.Results.The prevalence of RVI among NICU patients was 18.4%. Of 194 neonates included in the longitudinal study, 95 had RVI. Neonates with RVI differed from those without RVI with respect to frequent stooling (P= 0.0005), higher percentage of bloody mucoid stools (P= 0.003) and higher percentage of watery stools (P= 0.023). The odds of these three clinical outcomes were ∼2.5 times higher in neonates with RVI than in neonates without RVI. Among neonates included in the study advanced necrotizing enterocolitis occurred at the same rate (15%) among those with and without RVI. Comparisons between term and preterm neonates with RVI showed that frequent stooling (P= 0.003) and watery stools (P= 0.0001) occurred more often among term neonates, whereas bloody mucoid stools (P= 0.001), abdominal distention (P= 0.03) and intestinal dilatation (P= 0.016) were more common in preterm neonates. The seasonal distribution of RVI in NICU paralleled its distribution in the community.Conclusion.RVI appears prevalent in the NICU setting. An absence of watery stools in a neonate should not preclude consideration of RVI when evaluating gastrointestinal signs among neonates. The clinical spectrum of RVI differs in term and preterm infants.

ISSN:0891-3668    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Background.Outbreaks of sepsis associated withAcinetobacter baumanniihave been rarely reported in neonatal intensive care units (NICUs). We describe such an outbreak in a NICU, and the results of molecular epidemiologic investigations are presented.Materials and Methods.Between August and September 2000, 6 premature infants hospitalized in a pediatric NICU developedA. baumanniisepsis. Three additional cases hadAcinetobacterinfections during November and December. For an environmental culture survey, 94 environmental specimens and hand washings of all 43 health care workers involved in this unit were examined for the presence of this organism. Two genotyping methods, pulsed field gel electrophoresis of genomic DNA digested withSmaI and infrequent restriction site polymerase chain reaction, were used to analyze the 9 bacteremic isolates and anyA. baumanniiisolates obtained from the environmental survey and the hand washings. Another 3 bacteremic isolates ofA. baumanniicollected in the same NICU in 1999 were incorporated as controls.Results.The 9 infants were premature and had birth weights of <1500 g. Before onset of sepsis 9 infants had received total parenteral nutrition, and 8 infants had had central venous catheters and received intrafat emulsion. Five (5.3%) environmental specimens and 10 (23.3%) hand washing specimens were positive for the organism. Except for the strain from Case 9, the results of both genotyping methods were concordant; 11 patterns were identified by infrequent restriction site polymerase chain reaction and 10 patterns by pulsed field gel electrophoresis. One major genotype was demonstrated in the first 6 bacteremic isolates as well as 3 hand washing isolates. The genotypes of the other 3 bacteremic isolates, the 3 control strains, the 5 environmental isolates and 7 other hand washing isolates were distinct from the genotype of outbreak strains.Conclusion.An outbreak ofA. baumanniibacteremia in a NICU was clearly demonstrated by the molecular epidemiologic investigation and was possibly transmitted via the hands of health care workers.

ISSN:0891-3668    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Background.Widespread antimicrobial use is a risk factor for development of antimicrobial resistance. Antimicrobial treatment of acute otitis media (AOM) may not always be necessary. Little is known about the influence of parental expectations on physicians’ decision-making in relation to treatment of AOM. Evidence is insufficient as to whether tympanostomy tube placement reduces antibiotic consumption.Methods.We randomly selected 1030 children 1 to 6 years old living in 4 geographic areas in Iceland to be invited to participate in the study. Information about sociodemographic factors, antimicrobial prescriptions and their indications during the preceding 12 months, tympanostomy tube placements and parental views on antimicrobial use and bacterial resistance were obtained from a questionnaire completed by the parents and medical records.Results.The incidence of AOM episodes resulting in antimicrobial prescription for 804 children recruited into the study was 0.7 (95% confidence interval, 0.6 to 0.8) per child per year, highest among children age 1 year, i.e. 1.8 prescriptions (95% confidence interval, 1.4 to 2.2). The cumulative incidence of tympanostomy tube placements was ∼30%. Antimicrobial use during the preceding 8 weeks for children with and without tubes did not differ (P= 0.36). Fifteen percent of children with tubes had received antimicrobials during the preceding 8 weeks at last once for AOM compared with 14% of those without tubes (P= 0.97). Parents in the area where antimicrobial consumption was lowest were less likely to accept antimicrobial treatment than parents in the other areas (P= 0.005). Parents of children who had previously received antimicrobials for AOM were more likely to accept antimicrobials (P= 0.04).Conclusions.Parental expectations to antimicrobial treatment and awareness about resistance development appear to influence treatment strategies for AOM. The high rate of tympanostomy tube placement in preschool children does not result in reduced antimicrobial consumption.

ISSN:0891-3668    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Background.Nine- and 11-valent pneumococcal conjugate vaccines under development may control pediatric pneumococcal disease in nonindustrialized countries. Because these vaccines are expensive, population-based surveillance of pneumococcal disease in children <36 months of age was undertaken in Santiago, Chile to provide health authorities with reliable data on the burden of invasive pneumococcal disease and causative serotypes, including those in outpatients with high fever.Methods.Automated blood culture machines were introduced into 9 hospitals that admit 85% of all hospitalized children in Santiago. Acutely ill pediatric febrile ambulatory patients are attended at 8 emergency rooms (ERs) and 36 urgent primary care services. After a 12-month pilot study in 3 ERs, health authorities collected blood cultures from children <36 months of age with high fever seen in the ER as standard practice.Streptococcus pneumoniaeisolates were serotyped.Results.Blood cultures of 18 (1.2%) of 1503 outpatients 6 to 35 months of age with high fever in the pilot study yielded S.pneumoniae. In the ensuing 24 months 236 children <36 months old were hospitalized with invasive pneumococcal disease (incidence, 33.9 cases/105children), and 188 bacteremias were detected among ambulatory ER patients with high fever (incidence, 27.0 cases/105children). Although serotypes were similar among hospitalized and ambulatory cases (except 18C, which was more common in the latter), case fatality was 9.5% in hospitalized (21 of 236)vs.0% in ambulatory cases (0 of 188) (P= <0.0001). High level resistance to penicillin (25.8%vs.10.1%) and cefotaxime (19.5%vs.6.2%) was observed more often among pneumococcal isolates from hospitalized than among ambulatory cases (P< 0.001).Conclusions.ER surveillance detected approximately one case of pneumococcal bacteremia among febrile ambulatory patients for each hospitalized invasive case. Because 71% of cases were caused by vaccine serotypes (and 87% by vaccine serogroups), 9- and 11-valent pneumococcal conjugate vaccines could prevent most invasive pediatric pneumococcal disease in Chile.

ISSN:0891-3668    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Background.The recently described coryneform bacteriaTuricella otitidisandCorynebacterium auriswere first detected in the middle ear of patients with acute otitis media and chronic otitis media. Whether these bacteria play an essential role in the pathogenesis of otitis media with effusion (OME) is unclear.Methods.In a prospective study 60 children with OME and 205 controls were evaluated to determine the incidence ofT. otitidisandC. auris. Swabs from the external auditory canal (EAC) and the middle ear effusion (MEE) of OME children undergoing tympanotomy, ventilation tube insertion or both were cultured. Swabs from the EAC from healthy children served as controls.Results.In control childrenT. otitidiswas found in EAC swabs from 23 of 205 (11.2%) andC. aurisin 32 of 205 (15.6%).T. otitidiswas isolated from 14 of 60 (23.3%) OME patients from the EAC only and in 6 of 60 (10.0%) OME patients from both EAC and MEE.C. auriswas isolated in 2 of 60 (3.3%) from the EAC only and in 1 of 60 (1.7%) from both EAC and MEE. In no patient didT. otitidisorC. aurisgrow exclusively from MEE.Conclusion.T. otitidisandC. aurismay be part of the normal bacterial flora of the EAC in some children. Neither organism seems to cause OME in children.

ISSN:0891-3668    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Objective.We assessed epidemiologic, clinical and laboratory features of aseptic meningitis during one season of multiserotype enteroviral meningitis in East Germany in 70 consecutive patients with aseptic meningitis admitted to the Children’s University Hospital Leipzig.Results.Patients, age 1 to 16 years, typically presented with headache, emesis and fever, whereas signs of meningeal irritation were only moderately expressed in one-half of the patients. The median number of leukocytes in the CSF was 151 cells/mm3(range, 2 to 1820) with a high percentage of polymorphonuclear cells (PMNs). Initial blood counts showed mild leukocytosis and pronounced PMN predominance (78.9 ± 1.3%). The percentage of PMNs in the peripheral blood decreased in favor of mononuclear cells after 3 days to a pattern more compatible with viral infection as opposed to that suggestive for bacteria in the beginning. Mean cerebrospinal fluid values of protein, glucose and lactate and the C-reactive protein were mildly elevated or normal. Nonpolio enteroviruses were detected in 30 of 70 patients. Subsequent serotyping revealed echovirus type 13 (13 patients), type 6 (2), type 30 (1) and coxsackie B virus type 5 (2). There were no differences in demographic or clinical data between enterovirus positive and negative patients.Conclusions.Even though individual laboratory values do not solely allow discrimination between viral and bacterial meningitis, the combined epidemiologic, clinical and laboratory data facilitate the diagnosis of aseptic meningitis in most cases. Viral diagnostics, identifying echovirus type 13 that thus far has not been associated with epidemics of meningitis, adds important epidemiologic information.

ISSN:0891-3668    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Objective.To clarify the relation between the time of parvovirus B19 (B19) infection in pregnancy and fetal outcome, including the viral persistence in the fetus.Methods.Among 57 pairs showing serologic and/or virologic evidence of maternal and fetal B19 infection between 1986 and 1999 in Japan, 13 maternal-fetal pairs with the time of maternal B19 infection documented were retrospectively evaluated for fetal outcome and viral persistence.Results.Nonimmune hydrops occurred at 23, 21 and 26 gestational weeks (gw) in three fetuses as a result of their mothers’ symptomatic infection (erythema infectiosum) at 3, 16 and 19 gw, respectively. Spontaneous abortion without hydrops and intrauterine growth retardation resulting in small-for-gestational age (SGA) classification occurred in two fetuses whose mothers had developed erythema infectiosum at 5 and 16 gw, respectively. Eight fetuses were asymptomatic as a result of their mothers’ infection at 6, 9, 12, 15, 18, 23, 23 and 33 gw, respectively. B19 DNA was detected in neonatal serum in all nine cases tested.Conclusion.Maternal B19 infection throughout gestation including the early stage after fertilization caused fetal infection that persisted until intrauterine fetal death with or without nonimmune hydrops or until the neonatal period after birth.

ISSN:0891-3668    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Background.Shigella dysenteriaetype 1 (Sd1) dysentery is associated with serious morbidity and mortality. Treatment is either costly or complicated by the emergence of bacterial resistance. This study compared the efficacy and safety of short course (3 days) and standard course (5 days) oral ciprofloxacin in children with Sd1 dysentery.Methods.A multicenter, randomized, double blind, controlled clinical trial. Children between 1 and 12 years of age with Sd1 dysentery were randomized to receive oral ciprofloxacin suspension 15 mg/kg every 12 h for 3 days followed by placebo for 2 days or ciprofloxacin suspension for 5 days. Treatment success was defined as either resolution of illness or marked improvement on Day 6 of study. Bacteriologic cure was defined as failure to grow Sd1 on a stool sample collected on Day 6. Clinical assessments and joint examinations were performed at baseline, at discharge and 2 weeks later.Results.Of 253 patients enrolled 128 were assigned to short course ciprofloxacin and 125 to standard course ciprofloxacin. The success rates were 65 and 69% for short and standard course ciprofloxacin, respectively. All patients had bacteriologic cure, and all Sd1 isolates were susceptiblein vitroto ciprofloxacin. No bacteriologic relapses occurred during the study period. Eight patients reported arthralgia. All patients had normal joint function including at follow-up.Conclusion.In this study twice daily ciprofloxacin for 3 days achieved clinical cure rates similar to those for the same dosage given for 5 days in children with Sd1 dysentery.

ISSN:0891-3668    

出版商:OVID    

年代:2002

数据来源: OVID