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

ISSN:0891-3668    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Background.The importance of human herpesvirus 6 (HHV-6) as a pathogen in febrile infants ≤90 days of age is unknown.Objective.To determine whether febrile infants 90 days of age and younger evaluated for sepsis have evidence of HHV-6 DNA in plasma or cerebrospinal fluid (CSF).Methods.Febrile infants ≤90 days of age were tested for HHV-6 DNA using a real time quantitative fluorescent probe polymerase chain reaction assay.Results.Eighty samples from 47 infants were tested for HHV-6 DNA; 5 of 47 infants (10.6%) had HHV-6 DNA in plasma. In 2 of the 5 infants with HHV-6 DNA in plasma, HHV-6 DNA was also detected in the CSF. Both infants with evidence of HHV-6 DNA in plasma and CSF had HHV-6 Variant A infection. The quantity of HHV-6 DNA detected ranged from 70 to 169 000 DNA copies/ml. One infant with HHV-6 variant B infection had concomitantEscherichia colibacteremia and urinary tract infection.Conclusions.Approximately 10% of febrile infants ≤90 days of age evaluated for sepsis had evidence of HHV-6 infection. HHV-6 Variant A and B infections were seen in these young infants. HHV-6 DNA was found in infants with and without another explanation for fever. Quantification of viral DNA may be important in determining the relevance of HHV-6 DNA in clinical specimens.

ISSN:0891-3668    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Background.Blood stream infections are a common and serious complication of central venous catheters (CVCs). To decrease catheter colonization, some authors advocate tunneling the catheter in the subcutaneous tissue during insertion. This technique has proved effective in adults, but there are no data on its safety and efficacy in critically ill children. Our objective was to evaluate the efficacy and safety of subcutaneous tunneling of short term, noncuffed CVCs for the prevention of CVC-related infections in critically ill children.Methods.A prospective randomized controlled trial was performed at a tertiary children’s medical center in Israel and included children ages 0 to 18 years admitted to the pediatric intensive care unit or the pediatric cardiac intensive care unit from September 2000 to April 2001 who required placement of a femoral central venous catheter for >48 h. The children were randomized for tunneled or nontunneled insertion. The main outcome measures were bacterial colonization of proximal and distal catheter segments tested by semiquantitative technique and infectious or noninfectious complications of the CVC.Results.Of 98 eligible children, 49 received tunneled catheters and 49 received nontunneled catheters. Patients’ age ranged from 1 month to 16.5 years (mean, 3.07 ± 2.48 years). There were no significant differences between the groups in age, sex, disease severity [Pediatric Risk of Mortality III (PRISM) score], duration of catheterization and underlying diseases. Bacterial colonization was found in 11 (22.4%) catheters in the nontunneled group compared with 3 (6.1%) in the tunneled group (P= 0.004). Proximal segment colonization occurred in 7 (14.2%) nontunneled catheters and 2 (4.8%) tunneled catheters (P= 0.07), and distal segment colonization occurred in 3 (6.1%) and 9(18.3%) tunneled and nontunneled catheters, respectively (P= 0.053). The main pathogens were coagulase-negative staphylococci,Pseudomonasspp. andKlebsiellaspp. There was no statistically significant difference between the groups in the rate of bloodstream infection (2 in the tunneled group, 3 in the nontunneled). Except for 1 case of subcutaneous hematoma, which resolved, there were no immediate or late complications of the tunneling procedure.Conclusion.Subcutaneous tunneling of CVCs in the femoral site is a safe procedure and decreases significantly the rate of CVC colonization in critically ill children.

ISSN:0891-3668    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Background.Children <6 months of age are at increased risk of pneumococcal disease. The early immunogenicity of conjugate vaccines therefore may be important to prevent disease in young children.Objectives.To determine the immunogenicity of a nonavalent pneumococcal conjugate vaccine after one dose, two doses and three doses and its impact on the antibody response to coadministered antigens.Methods.A total of 500 infants from Soweto were immunized at 6, 10 and 14 weeks of age with either placebo (n= 250) or 9-valent pneumococcal conjugate vaccine (n= 250) containing serotypes 1, 4, 5, 6B, 9V, 14, 18C, 19F and 23F conjugated to CRM197mutant diphtheria protein. Blood was taken for determination of serotype-specific IgG before the first dose and 1 month after each dose.Results.Before the first dose at 6 weeks of age >80% of infants had >0.15 &mgr;g/ml antibody to six of the nine antigens, >70% to serotypes 18C and 23F and >50% to serotype 4. Geometric mean concentrations (GMCs) after one dose ranged from 0.27 &mgr;g/ml for serotype 23F to 2.98 &mgr;g/ml for serotype 1; >90% of infants had serotype-specific antibody >0.15 &mgr;g/ml except for serotypes 23F (70%) and 6B (80%). After two doses GMCs ranged from 1.14 &mgr;g/ml for serotype 23F to 5.68 &mgr;g/ml for serotype 1; >95% of infants had serotype-specific antibody >0.15 &mgr;g/ml and >75% had >0.5 &mgr;g/ml for all nine serotypes. GMCs after three doses ranged from 2.73 &mgr;g/ml for serotype 23F to 6.18 &mgr;g/ml for serotype 5; >98% of infants had serotype-specific antibody >0.15 &mgr;g/ml and >92% had >0.5 &mgr;g/ml for all nine serotypes. Antibody concentrations after three doses were significantly higher toHaemophilus influenzaetype b-polyribosylribitol phosphate vaccine in children who received pneumococcal conjugate vaccine, but they had lower antibodies to pertussis toxin than controls.Conclusions.A single dose of this pneumococcal conjugate vaccine produces a potentially protective antibody response to most serotypes in the majority of children in this population.

ISSN:0891-3668    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Background.Streptococcus pneumoniaeis a major cause of acute otitis media (AOM) in young children. More than 90 immunologically distinct pneumococcal serotypes have been identified, but limited information is available regarding their relative importance in AOM.Methods.We analyzed nine existing datasets comprising pneumococcal isolates from middle ear fluid samples collected from 1994 through 2000 from 3232 children with AOM from Finland, France, Greece, Israel, several East European countries, the US and Argentina. We examined the distribution of pneumococcal serotypes in relation to several demographic and epidemiologic variables, including gender, age, antibiotic resistance and source of culture material.Results.The major serotypes identified included 19F and 23F, each comprising 13 to 25% of pneumococcal middle ear fluid isolates in most datasets; 14 and 6B, comprising 6 to 18%; whereas 6A, 19A and 9V each comprised 5 to 10%. Despite differences in location, study design and antibiotic susceptibility, each major serotype was prominent in most age groups of each dataset. Serotypes represented in the 7-valent pneumococcal conjugate vaccine (PCV-7, 4, 6B, 9V, 14, 18C, 19F, 23F) accounted for 60 to 70% of all pneumococcal isolates in the 6- to 59-month age range, but only 40 to 50% of isolates in children <6 or ≥60 months old. Serotype 3 and, in certain datasets, serotypes 1 and 5, were more important in the <6- and ≥60-month age groups. In each age group vaccine-related serotypes (mainly 6A and 19A) comprised an additional 10 to 15% of all pneumococcal isolates. Four serotypes (23F, 19F, 14 and 6B) accounted for 83% of all penicillin-resistant observations.Conclusions.This analysis of several geographically diverse datasets indicates that a limited number of serotypes, largely represented in PCV-7, accounted for the majority of episodes of pneumococcal AOM in children between 6 and 59 months of age. Certain serotypes appeared to be relatively more significant in children <6 months or >59 months of age.

ISSN:0891-3668    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Background.In the US a pneumococcal conjugate vaccination program with a 7-valent conjugate vaccine was successfully implemented in 2000. How much invasive pneumococcal disease can potentially be prevented by the 7-valent (or 11-valent) vaccine in Europe?Methods.Prospective, active surveillance of invasive pneumococcal disease in German children age <16 years was performed between 1997 and 2000. Age- and disease-specific coverage and incidence rates were assessed in children old enough to benefit from complete vaccination to estimate the annual number of cases potentially preventable.Results.A total of 1,743 cases were reported; 667 isolates were serotyped. Coverage of 7-valent (11-valent) conjugate vaccines in children age 6 months and older was age- and diagnosis-dependent, ranging from 10.5% (15.8%) to 78.3% (82.6%) for meningitis and from 13.6% (68.2%) to 75.0% (89.3%) for nonmeningitis invasive pneumococcal disease cases. Of an estimated annual number of 176 children with pneumococcal meningitis age 6 months or older, 112 (122) cases had serotypes included in the 7-valent (11-valent) conjugate vaccine compared with 181 (254) of 324 nonmeningitis invasive pneumococcal disease cases, with 37 of the 73 cases covered by the 11-valent vaccine only in children older than 5 years. Regarding meningitis in this age group the potential benefit was equally poor for both the 7-valent (12 of 37 cases) and the 11-valent vaccine (15 of 37 cases).Conclusion.Coverage of the 7- and 11-valent conjugate vaccines depends markedly on age and disease. The additional potential benefit of the 11-valent compared with the 7-valent vaccine for pneumococcal meningitis was marginal.

ISSN:0891-3668    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Objective.Increasing rates of antibiotic resistance have stimulated efforts to decrease antibiotic use. To assess the success of these efforts, we analyzed antibiotic prescribing trends in children younger than 5 years old, the group with the highest use, from 1993 to 1999.Methods.Data from the National Ambulatory Medical Care Survey were analyzed to determine antibiotic prescribing patterns for office-based visits from 1993 to 1999 for children <5 years old. Data were stratified by US regions, patient’s race and gender. Antibiotic prescription rates per 1000 population were calculated with population data from the US Census Bureau as the denominator. Specific prescribing of penicillins, cephalosporins, macrolides and sulfas was also assessed.Results.Overall antibiotic prescribing in the office-based setting peaked in 1995 at 1191 antibiotic courses per 1000 children, then declined to 698 per 1000 in 1999, a decrease of 41%. Antibiotic prescribing was consistently higher in whites than blacks; however, declines in prescribing over time were observed in both groups. Although there was wide regional variation in antibiotic prescribing in the early 1990s, by the late 1990s prescribing rates were similar in all regions. Prescriptions for penicillins and cephalosporins combined comprised 77 and 70% of total prescriptions during 1993 to 1997 and 1998 to 1999, respectively. Macrolide prescriptions reached a nadir during 1993 to 1997, accounting for 9% of the total, but increased to 16% during 1998 to 1999.Conclusion.Since 1995 the rates of antibiotic prescriptions in children <5 years of age have declined substantially. At the same time changes have occurred in the types of antibiotics prescribed. It appears that efforts to reduce antibiotic use have been successful. Whether this decrease in use will be accompanied by lower rates of antibiotic resistance will need to be determined.

ISSN:0891-3668    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Objective.To determine the risk factors associated with progression from colonization to infection with health care-associated antimicrobial-nonsusceptible Enterobacteriaceae (ANE) in critically ill neonates.Study design.During a 3-year period (1998 to 2000), surveillance rectal cultures were performed on neonates admitted to our Level III neonatal intensive care unit after a cluster of four cases of ANE infection were identified in 1998. ANE were defined as members of the Enterobacteriaceae family that exhibited nonsusceptibility to ceftazidime or laboratory evidence of extended spectrum beta-lactamase (ESBL) production.Results.A total of 1710 patients were admitted to the neonatal intensive care unit during the study period. Of the 1710 patients 300 (18%) were excluded from the risk factor analysis. Of the 1410 remaining neonates the incidence of health care-associated ANE colonization was 17% (240 of 1410 patients), and 14% of the colonized patients (34 of 240 patients) developed ANE infections. Of the 206 ANE-colonized patients who did not develop disease, 60 (29%) harbored ESBL-producing isolates. Of the 34 ANE-infected patients, 14 (41%) yielded growth of ESBL-producing isolates. Multiple logistic regression analysis revealed that colonized neonates with very low birth weights (<1000 g) and those who had received prolonged exposures to antimicrobial agents were at increased risk of ANE infections.Conclusions.Colonization with ANE places hospitalized neonates at risk for development of systemic infections. Very low birth weight (<1000 g) and prolonged exposure to antimicrobial agents were the only two independent risk factors associated with ANE infection.

ISSN:0891-3668    

出版商:OVID    

年代:2002

数据来源: OVID