ISSN:0891-3668    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Routine surveillance for bacterial colonization has been used for the past three decades as a tool for the prediction of nosocomial infection in low birth weight infants; however, its usefulness has never been proven. A prospective cohort study was conducted to examine the utility of surveillance for pharyngeal colonization in detection and control of serious bacterial illness in low birth weight infants. One hundred fifty-four infants who weighed less than 1750 g and who were admitted to the Neonatal Intensive Care Unit were enrolled and followed for a total of 5620 infant-days. Pharyngeal cultures were collected at the time of enrollment and then weekly. All infants had bacterial pharyngeal colonization by the third day of life. Coagulase-negative staphylococci were the most common organisms cultured from the pharynx, followed by viridans streptococci andStaphylococcus aureus.More than 90% of the pharyngeal cultures grew multiple isolates. Gram-positive organisms, particularly coagulase-negative staphylococci, were the most prevalent organisms recovered from blood and cerebrospinal fluid cultures. Fifty-two episodes of bacteremia and 6 episodes of cerebrospinal fluid infection occurred in 42 infants. Among infants with viridans streptococci in pharyngeal cultures, the subsequent risk of serious bacterial illness was significantly reduced (odds ratio = 0.16). However, pharyngeal cultures were poor predictors of the causative organism in an episode of serious bacterial illness. Pharyngeal and blood/cerebrospinal fluid cultures were concordant in only 11% of invasive infections. We conclude that pharyngeal surveillance cultures provide little clinically meaningful information and have no apparent utility in the Neonatal Intensive Care Unit setting.

ISSN:0891-3668    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

We developed a decision rule to define a group of newborns eligible for discontinuation of antibiotic treatment 24 hours after initiation. The decision rule is based on two clinical assessments, three demographic variables, four maternal risk factors and six laboratory studies. The rule was created by retrospective analysis of all admissions to rule out sepsis at 10 Kaiser Permanente Northern California Region nurseries during a 2-month period in 1990. Of the 214 study subjects, 11 (5%) had a positive bacterial or viral culture result. No deaths occurred, but three babies who had negative culture results experienced late deterioration (after 24 hours in the special care nursery). After 24 hours of antibiotic treatment, 133 (67%) of the 199 babies who had negative culture results were asymptomatic, 36 (18%) had clear signs of illness and 30 (15%) had questionable signs of illness. The rule correctly identified all babies with positive culture results as well as persistently symptomatic babies with negative culture results. The rule also identified 57 low-risk babies eligible for only 24 hours of antibiotic treatment. We tested the rule on a second data set. The rule identified 19 of 20 newborns with positive culture results in this independent group. The 20th baby was not identified because a required test (complete blood count at 12 to 24 hours of age) was not done. Under controlled clinical conditions, this baby could have returned to the nursery to complete antibiotic treatment. We concluded that early discontinuation of antibiotic treatment in selected newborns is safe and could lead to a 1 to 2% decrease in special care nursery days in our 10 hospitals.

ISSN:0891-3668    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

In order to gather data regarding the utility of heparin therapy in limiting digit and extremity necrosis resulting from meningococcal purpura fulminans in children, we reviewed the charts of 24 pediatric patients with PF associated with meningococcal disease. Our study population was comprised of the 13 patients who survived more than 2 days. Clinical and outcome data were compared between the group of patients who received therapeutic heparin treatment in the initial 72 hours (≥50 units/kg bolus followed by an infusion, three patients) and the group who did not (10 patients). Demographic and initial clinical and laboratory findings were similar between groups (P> 0.15). When the two groups were compared for dermatologic and orthopedic sequelae, the mean number of digits (6.3vs.11.1;P= 0.35) and extremities (1.7vs.3.0;P= 0.17) with necrosis was less in those patients who received therapeutic doses of heparin, although the differences were not statistically significant. When only those patients on whom diffuse purpura were noted on admission were compared, these differences were greater. This small, retrospective series suggests that heparin therapy may limit digit and extremity necrosis when used early and in therapeutic doses in meningococcal purpura fulminans. Therefore, a larger, prospective controlled trial is warranted.

ISSN:0891-3668    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Streptococcus pneumoniaeis one of the major invasive pathogens in childhood. The increasing worldwide prevalence of penicillin-resistant strains makes management of invasive infections difficult and underscores the need for effective vaccines. Currently avaialable vaccines are of limited value in the pediatric age group. Trials are taking place to evaluate conjugated pneumococcal vaccines and in view of this it is important to establish local epidemiology of pneumococcal disease. The aims of this population-based study were to review all of the cases of invasive pneumococcal disease occurring during a 9-year period (1984 to 1992) in Auckland, New Zealand. Through the use of laboratory records and hospital discharge codes, 413 isolates from 407 patients were found. Age-specific incidence for all invasive disease was 22.0/100 000 for children less than 15 years old but 56.0/100 000 for children less than 5 years old (X2Yates corrected 18.20;P= 0.001). Two-thirds were less than 2 years old. The rates were higher in Maori and Pacific Island children than in Caucasian children. A total of 70 isolates from 68 patients with meningitis occurred. The majority were less than 5 years old (incidence of meningitis was 10.0/100 000) and 84% were less than 2 years old. The overall mortality from meningitis was 4.3%. Of the 129 isolates serogrouped or serotyped, 14, 6 and 19 accounted for 23%, 16% and 16%, respectively, of cases. Although 98% of serotypes identified would be covered by the currently available 23-valent vaccine, two-thirds of the children affected by these isolates would be unprotected because of poor immunogenicity of polysaccharide vaccines in children less than 2 years old.

ISSN:0891-3668    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

This study was designed to determine the middle ear bacterial pathogens, the frequency of serum immunoglobulin deficiency and the efficacy of medical management in patients with chronic suppurative otitis media without cholesteatoma. This was an open noncomparative clinical trial performed at the National Children's Hospital, San Jose, Costa Rica, and included 186 patients older than 2 months of age with a confirmed diagnosis of chronic suppurative otitis media without cholesteatoma. Middle ear cultures and serum for immunoglobulin determinations were obtained on admission. The first 40 patients were treated only with ceftazidime and from patient 41 and up, if a Grampositive organism was cultured, oxacillin was added to (for combined infection) or replaced ceftazidime. Parenteral antibiotics and suction twice daily were continued until three days after the middle ear became dry. Trimethropimsulfamethoxazole prophylaxis was administered during the follow-up period. Middle ear bacterial cultures were positive in 166 patients.Pseudomonassp. (35.6%), enteric Gram-negative organisms (28.7%) and Gram-positive cocci (26%) were the most common organisms. Immunoglobulin determinations were below normal in 3 of 69 (4.3%) evaluable patients. Dryness of the ear was achieved in 174 patients (93.5%) including 130 of 139 patients treated with ceftazidime, 28 of 28 patients treated with oxacillin and 14 of 14 patients treated with ceftazidime and oxacillin. Recurrent otorrhea developed in 39 (23.4%) patients. Twice-daily canal aspiration and parenteral ceftazidime for Gram-negative organisms and/or oxacillin for Gram-positive bacteria for 3 days after dryness of the middle ear followed by prophylactic oral antimicrobials are effective for treatment of most chronic suppurative otitis media without cholesteatoma patients.

ISSN:0891-3668    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

At St. Göran's Children's Hospital (a tertiary center), we perform electron microscopy of feces in most cases of nosocomial gastroenteritis. From September 1987 through April 1992 we identified 32 episodes of calicivirus infection, 25 of which were nosocomial and, except for one outbreak, sporadic. Systematic study of the nosocomial outbreak of calcivirus gastroenteritis from November 1991 to January 1992, revealed calcivirus in the stools of 8 of 23 children with diarrhea and 0 of 10 without diarrhea. In 3 of 7 sampled after cessation of diarrhea, calicivirus excretion continued for 3 to 6 days. We found no calicivirus in 42 staff members or 9 members of infected patients' families. Nosocomial transmission of calicivirus can occur among infants.

ISSN:0891-3668    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Intrafamilial transmission of hepatitis C virus (HCV) was studied in family members of 44 children with chronic hepatitis C infection (index cases). There were 22 males and the mean age of all patients was 9.5 years (range, 1.5 to 16 years). Eleven index patients were multitransfused because of thalassemia major. Aminotransferase serum concentrations and anti-HCV antibodies were evaluated in 77 parents (38 fathers) and 56 siblings (28 males; mean age, 11.2 years; range, 2.5 to 18 years). No sibling showed evidence of liver disease or HCV infection. Eight parents (14%) were found to be anti-HCV positive, but only one of them acquired HCV infection from an index case through an accidental needle stick injury. A nonsexual person-to-person transmission of HCV was conceivable only in a girl (index case) who had no risk factor other than the contact with anti-HCV-positive father. Vertical transmission played a role in five children (index cases) (three males) from five different mothers. Among the eight children belonging to these mothers, three did not show evidence of HCV infection although born after their HCV-infected siblings. Furthermore, we have not identified factors related to activity of disease or to duration of contact with index cases or to peculiar features of family members capable of favoring the spreading of HCV infection. Different from hepatitis B, pediatric age does not seem to represent a reservoir for HCV infection since the majority of children acquired HCV infection through parenteral routes and no HCV-infected child transmitted HCV infection horizontally.

ISSN:0891-3668    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

The acquisition of serum antirotavirus antibodies among children in day care centers was monitored through two rotavirus seasons. Twenty-six children were monitored daily for diarrhea and weekly for stool rotavirus excretion through a rotavirus season of infections with serotype G1 and a successive season of infections with both G1 and G3. Sera were collected before and after each rotavirus season and tested for antirotavirus IgA and IgG and for G type-specific blocking antibody. The prevalence of protective serum IgA and IgG titers increased from 36% and 45% before Season 1 to 77% and 96% after Season 2, respectively (P< 0.02 and 0.001). G type-specific antibodies also increased (G1,P< 0.001; G2,P= 0.005; G3,P= 0.003; G4,P= 0.006), including for noncirculating types. Homotypic and heterotypic antibodies increased as the number of rotavirus infections experienced by a child increased. The group of children with two proven infections developed protective isotype-specific and G type-specific antibodies. These results indicate that in first exposures to rotavirus G types, children develop predominantly homotypic antibody. However, as number of rotavirus infections increase, children develop heterotypic antibody to G types at levels that correlate with broad protection against rotavirus infection and illness, despite exposure to a restricted number of G types.

ISSN:0891-3668    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

The purpose of this study was to determine whether soluble CD8 (sCD8) in serum of perinatally human immunodeficiency virus 1 (HIV-1)-infected children during the first year of life differs from that of HIV-1-uninfected control children. Soluble CD8 concentrations in stored plasma and serum samples of children of HIV-1-infected and uninfected mothers were determined using a sandwich immune assay. In the first month of life significantly greater concentrations of sCD8 occurred in 12 HIV-1-infected infants than in 9 uninfected infants born to infected mothers (mean = 1054, SD 540vs.589, SD 370 units/ml,P< 0.05), although the CD8+ T cell proportions were not different (21.7vs.21.1,P> 0.5). The differences in sCD8 concentrations was most pronounced in 8 infants who were HIV-1 culture positive on initial testing in the first week of life compared with the remaining 4 patients when virus was first detected on subsequent analysis (mean = 1315, SD 446vs.529, SD 231 units/ml,P< 0.01). The concentration of sCD8 was also greater in 26 HIV-1-infected children than in either 26 uninfected children born to infected mothers or 25 seronegative children during the first year of life (mean = 1268, SD 529vs.630, SD 290vs.553, SD 315 units/ml,P< 0.05). Early and persistent elevation in sCD8 probably reflects immune activation resulting from HIV-1 infection. The occurrence of this increase in the neonatal period may reflect prenatal viral transmission, a higher viral inoculum or coinfection with other agents stimulating immune activation.

ISSN:0891-3668    

出版商:OVID    

年代:1994

数据来源: OVID