Havatzelet Yarden-Bilavsky

C-reactive protein as a marker of serious bacterial infections in hospitalized febrile infants

Objective:  To determine the potential predictive power of C‐reactive protein (CRP) as a marker of serious bacterial infection (SBI) in hospitalized febrile infants aged ≤3 months.

Clinical, laboratory, and microbiological differences between children with simple or complicated mastoiditis.

OBJECTIVE To assess clinical, laboratory, and microbiological differences between children with simple and complicated mastoiditis. PATIENTS AND METHODS Data on all children who were hospitalized at a tertiary center for acute mastoiditis over a 5-year period were collected from the computerized files. Findings were compared between those with simple mastoiditis vs. cases with intra- or extra-cranial complications. RESULTS Of the 308 children with acute mastoiditis, 55 (17.9%) had complicated disease. This group was characterized by a significantly higher maximal fever at presentation and higher absolute neutrophil count and C-reactive protein level than the children with simple disease. There was no statistically significant between-group difference in age, history of otitis media, prior antibiotic treatment, days of illness before presentation, absolute leukocyte count, and platelet count. No difference was detected between the groups in the penicillin and ceftriaxone susceptibility of the Streptococcus pneumoniae isolates. CONCLUSION High-grade fever, high absolute neutrophil count, and high C-reactive protein level may serve as clinical and laboratory markers of complicated mastoiditis. Children with these findings warrant close follow-up and perhaps, earlier surgical intervention.

Fusobacterium necrophorum mastoiditis in children – Emerging pathogen in an old disease

BACKGROUND Anaerobic bacteria are uncommon etiologic agents of acute mastoiditis in children. However, recent studies suggest an increase in the incidence of Fusobacterium necrophorum mastoid infections in the last two decades. METHODS A surveillance study performed over 3.5 years in a tertiary pediatric medical center identified 7 children with acute F. necrophorum mastoiditis. Clinical, laboratory, and treatment data were collected by file review. RESULTS Five of the 7 children presented in the last year of the study. All 7 children were less than 26 months old on admission, and none had a history of otogenic infections. All cases were characterized by significantly elevated levels of inflammatory markers. All were diagnosed as complicated mastoiditis with abscess formation. Four children had an epidural abscess, three children had evidence of osteomyelitis beyond the mastoid bone, and four children had imaging evidence of sinus vein thrombosis. All seven children required cortical mastoidectomy with ventilatory tubes insertion and two children required more than one surgical intervention. During follow-up, two children had recurrent episodes of mastoiditis due to other pathogens. CONCLUSION Our data support the literature suggesting that the occurrence of F. necrophorum mastoiditis among children is rising. Acute coalescent mastoiditis due to F. necrophorum is associated with a complicated course and warrants particular attention by pediatricians, infectious disease experts, and ear, nose and throat specialists.

Should complete blood count be part of the evaluation of febrile infants aged ≤2 months?

Objective:  To determine the utility and importance of total white blood cell count (WBC) and absolute neutrophil count (ANC) as markers of serious bacterial infection (SBI) in hospitalized febrile infants aged ≤2 months.

Primary meningococcal arthritis in a child: Case report and literature review

We present a case of primary meningococcal arthritis in an 8-month-old immunocompetent female. We also review 18 additional paediatric cases and characterize this unique form of meningococcal disease.

Fever survey highlights significant variations in how infants aged ≤60 days are evaluated and underline the need for guidelines.

To assess the common practices for evaluating and treating febrile infants aged ≤60 days in a nationwide survey.

Month-by-Month Age Analysis of the Risk for Serious Bacterial Infections in Febrile Infants With Bronchiolitis

Objective. This study’s aim was to assess the risk of serious bacterial infections (SBI) in each of the first 3 months in hospitalizes febrile infants with bronchiolitis. Patients and methods. The risk of SBI was compared between hospitalized infant with or without bronchiolitis by age in months. Results. A total of 1125 febrile infants aged ≤3 months were admitted during the study period, 948 without and 177 with bronchiolitis. The incidence of SBI was significantly lower among infants with bronchiolitis compared with those without (4% vs 12.2%, P < .001). However, within the subgroup of neonates with bronchiolitis aged ≤28 days, the incidence of SBI was 9.7% and was not significantly lower than in neonates without bronchiolitis. Conclusion. The risk of SBI among febrile infants with bronchiolitis is significantly lower compared with febrile infants without bronchiolitis, but only after the neonatal period in which the risk for urinary tract infection was relatively high (9.7%).

A search for the ‘Holy Grail’ in the evaluation of febrile neonates aged 28 days or less: A prospective study

Abstract Objective: To determine the reliability of low-risk criteria to exclude serious bacterial infection (SBI) in febrile neonates aged ≤28 days. Methods: All febrile neonates who were hospitalized for fever evaluation were prospectively divided into 2 groups by risk status for SBI. The following criteria were used to define low risk: (1) unremarkable medical history; (2) well-appearing; (3) no focal signs of infection; (4) white blood cell count between 5000 and 15,000/mm3; (5) normal urinalysis; (6) no mucoid or bloody diarrhoea. Results: Of the 465 enrolled neonates, 177 (38.1%) were considered high risk for SBI and 288 (61.9%) low risk. SBIs were found in 55 (31.1%) neonates in the high-risk group compared to 10 (3.5%) in the low-risk group (p < 0.001). The sensitivity, specificity, positive predictive value and negative predictive value of the criteria for all types of SBI were 84.6% (95% confidence interval (CI) 73.9–91.4%), 69.5% (95% CI 64.8–73.8%), 31% (95% CI 27.3–35.1%) and 96.5% (95% CI 94.3–98%), respectively. Conclusions: The defined criteria are not sufficiently reliable to exclude an SBI or an invasive SBI. We therefore suggest that all febrile neonates in this age group should be hospitalized for complete evaluation and consideration of empirical intravenous antibiotic treatment.

Serious bacterial infections in neonates with fever by history only versus documented fever

Abstract The objective of the study was to assess the risk of serious bacterial infection (SBI) in hospitalized neonates aged ≤28 days with fever by history only compared to neonates with documented fever. Data regarding the presence of fever at presentation and during hospitalization, laboratory results and the diagnosis of an SBI were collected prospectively. Of the 399 neonates who met the inclusion criteria, 143 (35.8%) had fever by history only and 256 (64.2%) had documented fever at presentation. SBI was detected in 12 neonates in the history-only group (8.4%; urinary tract infection (UTI) in all cases) compared with 46 neonates with documented fever (18%; UTI in 33, UTI with bacteraemia in 4, isolated bacteraemia in 5 and pneumonia in 4). This difference was statistically significant (p = 0.008). Documented fever on admission was associated with an adjusted odds ratio of 3.23 (95% confidence interval 1.50–6.93, p = 0.003) of having an SBI. In hospitalized neonates aged ≤28 days, fever by history only is associated with a significantly lower rate of SBI, and particularly less invasive infections, than in neonates with documented fever. Since the risk is significantly lower, a more conservative approach to neonates without documentation of fever may be appropriate.

Effect of benzathine penicillin treatment on antibiotic susceptibility of viridans streptococci in oral flora of patients receiving secondary prophylaxis after rheumatic fever

OBJECTIVE To assess the level of antibiotic resistance of viridans streptococci in the oral flora of children with a history of rheumatic fever, receiving long-term monthly intramuscular benzathine penicillin G prophylaxis. PATIENTS AND METHODS Oral swabs from patients receiving monthly penicillin G prophylaxis for rheumatic fever were cultured and tested for viridans streptococci. The E-test was used to test susceptibility to penicillin G, clindamycin, clarithromycin and rifampin. Findings were compared with samples from healthy children who had not been exposed to antibiotic treatment for at least 2 months. RESULTS Twenty-six patients and 20 control children were included in the study. Duration of intramuscular antibiotic treatment ranged from 5 months to 13.5 years. Sixty isolates of viridans streptococci species were obtained, with a similar distribution in the two groups. Intermediate resistance to penicillin (MIC 0.25-2 mg/L) was documented in 10 of the 32 isolates (31.2%) in the study group, and high resistance in none, compared to seven of 28 isolates (25%) with intermediate or high resistance in the control group (p=NS). All isolates in the study group and all but one in the control group were susceptible to clindamycin, and all isolates from both groups were susceptible to rifampin. One isolate (3.1%) in the study group and two (7.1%) in the control group were resistant to clarithromycin. CONCLUSION Monthly Intramuscular penicillin prophylaxis has no effect on the antibiotic susceptibility of viridans streptococci in oral flora in children with a history of rheumatic fever, receiving secondary prophylaxis after rheumatic fever, regardless of the duration of treatment.