Factors predicting antibiotic prescription and referral to hospital for children with respiratory symptoms

Rebnord, I.K. et al. (2017) BMJ Open. 7:e012992.

Objectives: Acute respiratory infections and fever among children are highly prevalent in primary care. It is challenging to distinguish between viral and bacterial infections. Norway has a relatively low prescription rate of antibiotics, but it is still regarded as too high as the antimicrobial resistance is increasing. The aim of the study was to identify predictors for prescribing antibiotics or referral to hospital among children.

 

Conclusions: CRP values >20 mg/L, findings on ear examination, use of paracetamol and no vomiting in the past 24 hours were significantly associated with antibiotic prescription. Affected respiration was a predictor for referral to hospital. The parents’ assessment was also significantly associated with the outcomes.

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Bloodstream infections are the most common type of HCI in neonates, children, and adolescents

Zingg, W. et al. The Lancet Infectious Diseases. Published online: 12 January 2017

Background: In 2011–12, the European Centre for Disease Prevention and Control (ECDC) held the first Europe-wide point-prevalence survey of health-care-associated infections in acute care hospitals. We analysed paediatric data from this survey, aiming to calculate the prevalence and type of health-care-associated infections in children and adolescents in Europe and to determine risk factors for infection in this population.

Findings: We analysed data for 17 273 children and adolescents from 29 countries. 770 health-care-associated infections were reported in 726 children and adolescents, corresponding to a prevalence of 4·2% (95% CI 3·7–4·8). Bloodstream infections were the most common type of infection (343 [45%] infections), followed by lower respiratory tract infections (171 [22%]), gastrointestinal infections (64 [8%]), eye, ear, nose, and throat infections (55 [7%]), urinary tract infections (37 [5%]), and surgical-site infections (34 [4%]). The prevalence of infections was highest in paediatric intensive care units (15·5%, 95% CI 11·6–20·3) and neonatal intensive care units (10·7%, 9·0–12·7). Independent risk factors for infection were age younger than 12 months, fatal disease (via ultimately and rapidly fatal McCabe scores), prolonged length of stay, and the use of invasive medical devices. 392 microorganisms were reported for 342 health-care-associated infections, with Enterobacteriaceae being the most frequently found (113 [15%]).

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Etiology of Acute Respiratory Infections in Infants

Kumar, P. et al. (2017) Pediatric Infectious Disease Journal. 36(1) pp. 25–30

B0004785 Parainfluenza virus, TEM

Image source: David Gregory & Debbie Marshall – Wellcome Images // CC BY-NC-ND 4.0

Background: There is paucity of studies on etiology of acute respiratory infections (ARI) in infants. The objective of this study is to document incidence and etiology of ARI in infants, their seasonal variability and association of clinical profile with etiology.

 

Conclusion: In this cohort of infants, ARI incidence was 1.8 episodes per year per infant; 95% were upper respiratory tract infections. Viruses were identified in 63.3% episodes, and the most common viruses detected were rhinovirus, respiratory syncytial virus and parainfluenza virus.

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New Method for Predicting Congenital CMV Infection During the Prenatal Period

Tanimura, K. et al. (2016) Clinical Infectious Diseases. DOI:10.1093/cid/ciw707

cmv

Image source: Pete Jeffs – Wellcome Images // CC BY-NC-ND 4.0

Image shows illustration of a human cytomegalovirus (HCMV) virus particle

Background: The aim of this prospective study was to determine maternal clinical, laboratory, and ultrasound findings that effectively predict the occurrence of congenital cytomegalovirus (CMV) infection in high-risk pregnant women.

Conclusions: This is the first prospective cohort study to suggest that the presence of CMV-DNA in the maternal uterine cervical secretion and ultrasound fetal abnormalities was predictive of the occurrence of congenital CMV infection in high-risk pregnant women.

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Azithromycin Prophylaxis for Cesarean Delivery

Rothaus, C. The New England Journal of Medicine. Published online: September 29th 2016

Cesarean delivery is the most common major surgical procedure and is associated with a rate of surgical-site infection (including endometritis and wound infection) that is 5 to 10 times the rate for vaginal delivery. Tita et al. assessed whether the addition of azithromycin to standard antibiotic prophylaxis before skin incision would reduce the incidence of infection after cesarean section among women who were undergoing nonelective cesarean delivery during labor or after membrane rupture. In this new Original Article involving women who received standard antibiotic prophylaxis for nonelective cesarean section, the risk of infection after surgery was lower with the addition of azithromycin than with placebo.

Clinical Pearl

• How does pregnancy-associated infection rank as a cause of maternal death in the United States?

Globally, pregnancy-associated infection is a major cause of maternal death and is the fourth most common cause in the United States.

Clinical Pearl

• How often do postoperative infections occur after nonelective cesarean delivery?

Despite routine use of antibiotic prophylaxis (commonly, a cephalosporin given before skin incision), infection after cesarean section remains an important concern, particularly among women who undergo nonelective procedures (i.e., unscheduled cesarean section during labor, after membrane rupture, or for maternal or fetal emergencies). As many as 60 to 70% of all cesarean deliveries are nonelective; postoperative infections occur in up to 12% of women undergoing nonelective cesarean delivery with standard preincision prophylaxis.#

Read the full Now@NEJM Blog post here

Read the original research article here

Treatment of otitis media by transtympanic delivery of antibiotics

Yang, R. et al. (2016) Science Translational Medicine. 8(356) pp. 356ra120

Otitis media is the most common reason U.S. children receive antibiotics. The requisite 7- to 10-day course of oral antibiotics can be challenging to deliver in children, entails potential systemic toxicity, and encourages selection of antimicrobial-resistant bacteria.

We developed a drug delivery system that, when applied once to the tympanic membrane through the external auditory canal, delivers an entire course of antimicrobial therapy to the middle ear. A pentablock copolymer poloxamer 407–polybutylphosphoester (P407-PBP) was designed to flow easily during application and then to form a mechanically strong hydrogel on the tympanic membrane. U.S. Food and Drug Administration–approved chemical permeation enhancers within the hydrogel assisted flux of the antibiotic ciprofloxacin across the membrane.

This drug delivery system completely eradicated otitis media from nontypable Haemophilus influenzae(NTHi) in 10 of 10 chinchillas, whereas only 62.5% of animals receiving 1% ciprofloxacin alone had cleared the infection by day 7. The hydrogel system was biocompatible in the ear, and ciprofloxacin was undetectable systemically (in blood), confirming local drug delivery and activity. This fast-gelling hydrogel could improve compliance, minimize side effects, and prevent systemic distribution of antibiotics in one of the most common pediatric illnesses, possibly minimizing the development of antibiotic resistance.

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Skin antisepsis for reducing central venous catheter-related infections

Researchers supported by the National Institutes of Health have shown that it’s possible to diagnose a bacterial infection from a small sample of blood — based on the immune system’s response to the bacteria — in infants with fevers who are 2 months of age or younger.

With additional research, the new technique could be an improvement over the standard method, which requires isolating live bacteria from blood, urine or spinal fluid and growing them in a laboratory culture.

Full reference: Mahajan, P.  Association of RNA Biosignatures With Bacterial Infections in Febrile Infants Aged 60 Days or Younger  Journal of the American Medical Association. Aug. 23, 2016