Healthcare delivery in the early management of bacterial meningitis

The aim of this study was to define early presenting features of bacterial meningitis in young infants in England and to review the adequacy of individual case management as compared with relevant national guidelines and an expert panel review | BMJ Open

W0043115 Tuberculous meningitis

Image source: Wellcome Images // CC0

Results: Of the 97 cases recruited across England and Wales, 66 (68%) were admitted from home and 31 (32%) were in hospital prior to disease onset. Almost all symptoms reported by parents appeared at the onset of the illness, with very few new symptoms appearing subsequently. Overall, 20/66 (30%) infants were assessed to have received inappropriate prehospital management. The median time from onset of first symptoms to first help was 5 hours (IQR: 2–12) and from triage to receipt of first antibiotic dose was 2.0 hours (IQR: 1.0–3.3), significantly shorter in infants with fever or seizures at presentation compared with those without (1.7 (IQR: 1.0–3.0) vs 4.2 (IQR: 1.8–6.3) hours, p=0.02). Overall, 26 (39%) infants had a poor outcome in terms of death or neurological complication; seizures at presentation was the only significant independent risk factor (OR, 7.9; 95% CI 2.3 to 207.0). For cases in hospital already, the median time from onset to first dose of antibiotics was 2.6 (IQR: 1.3–9.8) hours, and 12/31 (39%) of infants had serious neurological sequelae at hospital discharge. Hearing test was not performed in 23% and when performed delayed by ≥4 weeks in 41%.

Conclusions: In young infants, the non-specific features associated with bacterial meningitis appear to show no progression from onset to admission, whereas there were small but significant differences in the proportion of infants with more specific symptoms at hospital admission compared with at the onset of the illness, highlighting the difficulties in early recognition by parents and healthcare professionals alike. A substantial proportion of infants received inappropriate prehospital and posthospital management. We propose a targeted campaign for education and harmonisation of practice with evidence-based management algorithms.

Full reference: Okike, I.O. et al. (2017) Assessment of healthcare delivery in the early management of bacterial meningitis in UK young infants: an observational study. BMJ Open. 7:e015700.

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Risk Factors for Community-Associated Clostridium difficile Infection in Children

Adams, D.J. et al. The Journal of Pediatrics | Published online: 7 April 2017

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Objective: To characterize the medication and other exposures associated with pediatric community-associated Clostridium difficile infections (CA-CDIs).

Conclusions: CA-CDI is associated with medications regularly prescribed in pediatric practice, along with exposure to outpatient healthcare clinics and family members with CDI. Our findings provide additional support for the judicious use of these medications and for efforts to limit spread of CDI in ambulatory healthcare settings and households.

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Acute Otitis Media During Infancy: Parent-reported Incidence and Modifiable Risk Factors

Prins-van Ginkel, A.C. et al. (2017) Pediatric Infectious Disease Journal. 36(3) pp. 245–249

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Acute otitis media (AOM) is a common infection during infancy. By the age of 1 year, 25%–36% of children have experienced at least 1 episode of AOM and approximately 20% of children develop recurrent AOM.AOM is one of the main reasons for primary care visits, specialist referral, antibiotic consumption and surgical ear, nose and throat procedures among young children.But besides the high burden on health care, AOM also poses a high burden on parents and families; during an episode of AOM, which lasts on average 6–9 days, most parents are absent from work for 2–3 days and experience reduced quality of life because of lack of sleep and concerns about their child’s health. For these reasons, prevention of AOM is of major public health and economic importance.

With this study, we aim to determine the impact of day care attendance, breastfeeding and tobacco smoke and the effect of timing of these risk factors in the first year of life on the occurrence of AOM symptom episodes. To capture both medically and nonmedically attended AOM symptom episodes, we investigated the association between these risk factors and parent-reported AOM symptom episode occurrence in the community in a cohort of Dutch infants.

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What You Should Know About Mumps: A Disease From the Past Makes a Resurgence

Mumps may seem like a contagion relegated to history books, but like many other diseases of the past now preventable with a vaccine, mumps has been making a resurgence | Infection Control Today

B0006271 Mumps virus protein in cultured cells

Image source: Paul Duprex – Wellcome Images // CC BY-NC-ND 4.0 

Cases are at 10-year high and are especially common on college campuses across the country. Now the Dallas area is seeing the largest outbreak in Texas in years. Cristie Columbus, MD, vice dean of the Texas A&M College of Medicine’s Dallas campus and an infectious disease specialist, explains what people need to know about the mumps.

What is mumps?: Mumps is caused by a virus, specifically a type of Rubulavirus in the Paramyxovirus family. Before the vaccine was widely introduced in the United States in 1967, nearly every child would become infected. Although cases have declined more than 99 percent since then, outbreaks do still occasionally occur.

What are the symptoms of mumps?: The classic symptom of mumps is swollen salivary glands, which causes puffy cheeks and a swollen jaw that can make it difficult to eat. Other symptoms, which last seven to 10 days, may include a fever, fatigue and head and muscle aches. Some people—possibly as many as 40 percent of those infected—may have only very mild symptoms (if they have any at all), and therefore might not realize they have the disease. Still, they may be able to spread the virus to others.

How long after being infected do symptoms usually appear?: Symptoms can appear between 12 and 25 days after the initial infection, but usually people begin experiencing them 16 to 18 days after they are infected.

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Burden of Recurrent Respiratory Tract Infections in Children

Toivonen, L. et al. (2016) Pediatric Infectious Disease Journal35(12) pp. e362–e369

 

B0004413 Reovirus particles

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

Image shows colour-enhanced image of reovirus particles

Background: The burden of recurrent respiratory infections is unclear. We identified young children with recurrent respiratory infections in order to characterize the clinical manifestations, risk factors and short-term consequences.

Conclusions: Children with recurrent respiratory infections frequently use health care services and antibiotics, undergo surgical procedures and are at risk for asthma in early life. Having older siblings increases the risk of recurrent infections.

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Compliance with the current recommendations for prescribing antibiotics for paediatric community-acquired pneumonia is improving

Launay, E. at al. BMC Pediatrics | Published online: 12 August 2016

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Image shows electron micrograph of klebsiella pneumoniae bacteria 

Background: Lower respiratory tract infection is a common cause of consultation and antibiotic prescription in paediatric practice. The misuse of antibiotics is a major cause of the emergence of multidrug-resistant bacteria. The aim of this study was to evaluate the frequency, changes over time, and determinants of non-compliance with antibiotic prescription recommendations for children admitted in paediatric emergency department (PED) with community-acquired pneumonia (CAP).

Methods: We conducted a prospective two-period study using data from the French pneumonia network that included all children with CAP, aged one month to 15 years old, admitted to one of the ten participating paediatric emergency departments. In the first period, data from children included in all ten centres were analysed. In the second period, we analysed children in three centers for which we collected additional data. Two experts assessed compliance with the current French recommendations. Independent determinants of non-compliance were evaluated using a logistic regression model. The frequency of non-compliance was compared between the two periods for the same centres in univariate analysis, after adjustment for confounding factors.

Results: A total of 3034 children were included during the first period (from May 2009 to May 2011) and 293 in the second period (from January to July 2012). Median ages were 3.0 years [1.4–5] in the first period and 3.6 years in the second period. The main reasons for non-compliance were the improper use of broad-spectrum antibiotics or combinations of antibiotics. Factors that were independently associated with non-compliance with recommendations were younger age, presence of risk factors for pneumococcal infection, and hospitalization. We also observed significant differences in compliance between the treatment centres during the first period. The frequency of non-compliance significantly decreased from 48 to 18.8 % between 2009 and 2012. The association between period and non-compliance remained statistically significant after adjustment for confounding factors. Amoxicillin was prescribed as the sole therapy significantly more frequently in the second period (71 % vs. 54.2 %, p < 0.001).

Conclusions: We observed a significant increase in the compliance with recommendations, with a reduction in the prescription of broad-spectrum antibiotics, efforts to improve antibiotic prescriptions must continue.

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Treatment of Meningococcal Disease

Nadel, S. Journal of Adolescent Health. Volume 59(2). pp. S21-S28

Abstract

Image shows a positive test result for meningitis using the ultrasound enhanced diagnostic test

Meningococcal disease is a life-threatening infection that may progress rapidly, even after appropriate treatment has commenced. Early suspicion of the diagnosis is vital so that parenteral antibiotic treatment can be administered as soon as possible to reduce the complications of infection. The outcome of meningococcal disease is critically dependent on prompt recognition of two important complications: shock and raised intracranial pressure. Rapid recognition of disease and of these complications, together with appropriate management is crucial to the outcome of affected patients. This article summarizes the clinical features of invasive meningococcal disease, diagnostic tools, treatment modalities, and common post-infection sequelae.

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