ISSN:0891-3668    

出版商:OVID    

年代:1996

数据来源: OVID

ISSN:0891-3668    

出版商:OVID    

年代:1996

数据来源: OVID

ISSN:0891-3668    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

BackgroundPenicillin resistance ofStreptococcus pneumoniae,one of the most common causes of acute otitis media, has recently increased and is now highly prevalent in many regions. However, its contribution to clinical failure still must be proved. Because the role of antibiotics in acute otitis media is to eradicate the pathogens present in the middle ear fluid, we conducted a randomized controlled study to determine bacterial eradication of pathogens in acute otitis media by two commonly used oral cephalosporins, cefuroxime axetil (30 mg/kg/day) and cefaclor (40 mg/kg/day).MethodsPatients 6 to 36 months old with pneumococcal otitis media seen in the Pediatrics Emergency Room were studied. An initial middle ear fluid culture was obtained at enrollment, and a second culture was obtained on Day 4 or 5 during treatment. Follow-up was done also on Days 10, 17 and 42 after initiation of treatment. In cases of clinical relapse a third culture was obtained.ResultsIn total 78 patients were enrolled, 41 in the cefuroxime axetil group and 37 in the cefaclor group. Of the 78S. pneumoniaeisolates 31 (40%) were intermediately penicillin-resistant (MIC 0.125 to 1.0μg/ml). Of the 47 patients with penicillin-susceptible organisms 3 (6%) had bacteriologic failurevs.4 of 19 (21%) and 7 of 11 (64%) of those with MIC of 0.125 to 0.25μg/ml and 0.38 to 1.0μg/ml, respectively (P< 0.001). For intermediately resistant pneumococci, in 7 of 12 (58%) of those receiving cefaclor the isolate was not eradicatedvs.only 4 of 19 (21%) of those receiving cefuroxime axetil (P= 0.084). MIC to the administered cephalosporin of >0.5μg/ml was associated with bacteriologic failure. Clinical failure was observed in 9 of 14 (64%) patients with bacteriologic failurevs.10 of 52 (19%) patients with bacteriologic eradication (P= 0.003).ConclusionIntermediately penicillin-resistantS. pneumoniaeis associated with an impaired bacteriologic and clinical response of acute otitis media to cefaclor and cefuroxime axetil. This effect was more pronounced with cefaclor than with cefuroxime axetil.

ISSN:0891-3668    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

BackgroundChildren <2 years old living in the Yukon-Kuskokwim Delta (YKD) region of Alaska have one of the highest pneumococcal bacteremia rates of in the world.MethodsTo determine the prevalence of and risk factors for infection with intermediate or resistantStreptococcus pneumoniaein the YKD, we cultured nasopharyngeal secretions of healthy children ≤5 years old, reviewed their hospital records and administered questionnaires to accompanying parents.ResultsOf 185 children evaluated we obtained 95 pneumococcal isolates; drug susceptibility patterns and serotyping results were available for 92. Of these, 33 (36%) were intermediate or resistant to at least one drug class tested; 27 isolates were intermediate (minimum inhibitory concentration 0.1 to 1.0 mg/l) and none were resistant to penicillin. Compared with other isolates, capsular serotype 6B isolates were more likely to be intermediate or resistant to at least one drug (relative risk, 5.3;P< 0.001) and to more than one drug (relative risk, 17.0;P< 0.001). The majority of 6B isolates had identical pneumococcal surface protein A patterns. Carriage of intermediate or resistant pneumococcus was associated with age <2 years (relative risk, 3.0;P< 0.001) but not with antibiotic use or other evaluated risk factors.ConclusionsYoung age but not antibiotic use was associated with carriage of intermediate or resistantS. pneumoniaein the YKD region of Alaska. Much of the intermediate or resistant pneumococcus in the YKD may have resulted from the proliferation of a single capsular serotype 6B clone.

ISSN:0891-3668    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Background.A vaccine for prevention of serogroup B meningococcal disease is not available in the United States, and indications for the use of mass chemoprophylaxis for control of meningococcal outbreaks are not well-defined. In response to an outbreak of six cases of enzyme type 5 serogroup B meningococcal disease among students at a middle school, we implemented a program of mass rifampin prophylaxis and evaluated the effectiveness of this preventive measure.Methods.Oropharyngeal cultures were obtained from 351 of the 900 students before prophylaxis; 196 participants were recultured 3 weeks later. Meningococcal isolates were subtyped and tested for rifampin susceptibility, and risk factors for disease or carriage among students were evaluated.Results.No cases occurred after prophylaxis. Before prophylaxis 10% (34 of 351) of students were meningococcal carriers and 3.4% (12 of 351) carried the epidemic strain. After prophylaxis 2.5% (5 of 196) were carriers and 1.0% (2 of 196) carried the epidemic strain. Rifampin was 85% effective in eradicating carriage, and the rate of acquisition of carriage during the 3-week period was low (0.5%). Carriage persisted after prophylaxis in 4 students; 3 of these postprophylaxis isolates were rifampin-resistant. Rifampin resistance thus developed in 12% (3 of 26) of preprophylaxis isolates. Disease/epidemic strain carriage was associated with enrollment in the school band and certain other classes.Conclusions.These findings suggests that mass chemoprophylaxis may be effective and should be considered for control of school serogroup B meningococcal outbreaks. This approach is less likely to be effective for control of outbreaks affecting larger, less well-defined populations and is associated with the rapid development of antibiotic resistance.

ISSN:0891-3668    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

BackgroundCandida parapsilosisis a common cause of sporadic and epidemic infections in neonatal intensive care units (NICUs). When a cluster ofC. parapsilosisbloodstream infections occurred in NICU patients in a hospital in Louisiana, it provided us with the opportunity to conduct an epidemiologic investigation and to apply newly developed molecular typing techniques.MethodsA case-patient was defined as any NICU patient at Louisiana State University Medical Center, University Hospital, with a blood culture positive forC. parapsilosisduring July 20 to 27, 1991. To identify risk factors forC. parapsilosisbloodstream infection, a cohort study of all NICU infants admitted during July 17 to 27, 1991, was performed. Electrophoretic karyotyping was used to assess the relatedness ofC. parapsilosisisolates.ResultsThe receipt of liquid glycerin given as a suppository was indentified as a risk factor (relative risk, 31.2; 95% confidence intervals, 4.3 to 226.8). Glycerin was supplied to the NICU in a 16-oz multidose bottle. Bottles used at the time of the outbreak were not available for culture. All six available isolates from four case-patients had identical chromosomal banding patterns; six University Hospital non-outbreak isolates had different banding patterns.ConclusionsThis study demonstrates the utility of combined epidemiologic and laboratory techniques in identifying a novel common source for aC. parapsilosisbloodstream infection outbreak and illustrates that extreme caution should be exercised when using multidose medications in more than one patient.

ISSN:0891-3668    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

ObjectivesTo describe the clinical character istics and laboratory diagnosis of seven children with disseminated histoplasmosis and evaluate the effectiveness of itraconazole therapy in this severe form of the mycosis as well as to determine the long term results of such treatment.MethodsThe diagnosis of histoplasmosis was based on the direct observation ofHistoplasma capsulatumvar.capsulatumand/or on the isolation of the fungus from pathologic materials; the results of the serologic tests were taken into consideration. Chest roentgenograms also contributed to the diagnosis.PatientsThe patients were seven rural children, five girls and two boys, ages 1 to 14 years (mean, 4.6), with a confirmed diagnosis of disseminated histoplasmosis and who had no underlying disease other than malnourishment.ResultsThe seven children experienced a subacute febrile syndrome for 4 months accompanied by anorexia, weight loss and signs of reticuloendothelial involvement such as lymph node hypertrophy, hepatomegaly and/or splenomegaly. The lung revealed roentgenographic alterations consisting mainly of nodular infiltrates. All patients received itraconazole orally in a mean dosage of 7.2 mg/kg/day, for variable periods (3 to 12 months), depending on the individual response and the toxic effects of the medication. One of the patients who was improving after 1 month of treatment was taken from the hospital by his guardian against medical advice and died shortly afterward. The remaining six patients responded to the treatment with marked clinical improvement and showed negative cultures and decreases in anti-H. capsulatumantibody titers after 3 months of treatment. Only one patient, the youngest and most severely affected child, exhibited hepatotoxicity, which subsided when itraconazole was discontinued. Extended follow-up studies revealed no relapses.ConclusionThe results of this study indicate that itraconazole is effective for treatment of disseminated childhood histoplasmosis. More studies should be performed to determine the most appropriate dosage and the optimal duration of itraconazole treatment in children.

ISSN:0891-3668    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

ObjectiveTo describe a family cluster of Shiga toxin-producingEscherichia coliO111:NM infection.Study designThe index case was identified as part of a United States prospective study of hemolytic-uremic syndrome. Epidemiologic investigation was conducted through interviews.E. coliO111:NM infection was characterized through culture and serology. Shiga toxin 1 and 2 gene sequences were determined with oligonucleotide DNA probes.ResultsAll three children and both parents had nonbloody diarrhea, vomiting and abdominal cramps, and one child developed hemolyticuremic syndrome. Shiga toxin 1- and 2-producingE. coliO111ac:NM was isolated from two children. IgG antibodies toE. coliO111 were detected in all three children.ConclusionsTo our knowledge this is the first reported cluster of O111 infection and only the second caused by non-O157 Shiga toxin-producingE. coliin North America.

ISSN:0891-3668    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

ObjectiveTo compare the safety and immunogenicity of two dosages of tetravalent rhesus rotavirus vaccine (RRV-TV) and the effect of age at dosing.MethodsA total of 195 infants were stratified by age into 2 groups, 6 to 12 weeks and 16 to 24 weeks, and randomly assigned to receive a single dose of placebo or RRV-TV containing either 4 × 105or 4 × 106plaque-forming units (pfu). Symptoms were recorded for 5 days after vaccination. Anti-rotavirus IgA and neutralizing antibody to human rotavirus serotypes G1 to G4 and RRV were measured in serum obtained pre- and post-vaccination.ResultsRates of fever >38°C (9%), diarrhea (6%) and vomiting (8%) were similar in all groups. IgA (69%vs. 49%,P= 0.02) and RRV (85%vs. 66%,P= 0.004) seroconversion rates were significantly higher in the 4 × 106pfu vaccine group as were antibody titers to RRV (440.2vs. 263.7,P= 0.04). Older infants demonstrated significantly higher seroconversion rates and antibody titers for IgA (71%vs. 52%,P= 0.03; and 110.6vs. 54.8,P= 0.004) and RRV (92%vs. 66%,P= 0.05 and 498.3vs. 205.6,P= 0.01) at either dose level than did the younger infants. There were no significant differences in seroconversion rates or antibody titers to human rotavirus types G1 to G4 between the two vaccination groups.ConclusionsRRV-TV at a dose of 4 × 106pfu can be safely administered to infants 6 to 24 weeks of age. A single dose of 4 × 106pfu of RRV-TV was significantly more immunogenic than a single dose of 4 × 105pfu but did not improve responses to the human serotypes. Older vaccine recipients demonstrated significantly higher IgA and neutralizing antibody seroconversion rates and antibody titers than younger infants independent of dosage.

ISSN:0891-3668    

出版商:OVID    

年代:1996

数据来源: OVID