Meirav Mor

Invasive fungal infections in pediatric oncology

Data on the epidemiology and outcome of invasive fungal infections in children with cancer are limited. The aim of the study was to delineate the epidemiologic, clinical features, risk factors, and outcome of invasive fungal infections in this population.

Validity of the quick-read C-reactive protein test in the prediction of bacterial pneumonia in the pediatric emergency department.

Background C-reactive protein (CRP) values are clinically useful in differentiating viral from bacterial illnesses in children, but the regular test is impractical in the emergency department (ED) setting. Objective To investigate the validity and feasibility of the 2-min bedside Quick Read (QR)-CRP test in the prediction of bacterial pneumonia in children in the ED. Methods Fifty randomly selected children aged 4 days to 17 years, who presented to a pediatric ED with symptoms and signs of pneumonia over a 6-month period, were prospectively studied. The diagnosis of bacterial/viral pneumonia was based on clinical and radiological findings. CRP was measured in leftover blood (0.2 ml) using the QR-CRP kit. Clinical and laboratory data were statistically analyzed against CRP values for ability to predict bacterial pneumonia. Results Thirty-six patients (72%) were diagnosed with bacterial pneumonia and 14 (28%) with viral pneumonia; mean CRP levels were 121.3±122 and 27.2±26 mg/l, respectively (P=0.007). Significantly higher CRP levels were associated with bacterial than with viral pneumonia in the patients who presented before 96 h of symptom onset (P=0.013–0.028), but not in those who presented later. On receiver operating characteristics analysis, CRP was a better indicator of a chest radiograph picture of bacterial pneumonia (area under the curve=0.79) than absolute neutrophil count (0.78) or white blood cell count (0.73). Combining all three parameters yielded an area of 0.865. Conclusion The QR-CRP test seems to be an useful predictor of bacterial pneumonia in children, especially those with a shorter illness duration, and is feasible for use in the ED.

The quick-read C-reactive protein test for the prediction of bacterial gastroenteritis in the pediatric emergency department.

Objective: To determine the clinical usefulness of the bedside Quick-Read (QR) C-reactive protein (CRP) test for predicting bacterial gastroenteritis in the pediatric emergency department. Study design: We tested for CRP in 44 children who presented to the emergency department with gastroenteritis and underwent blood tests and stool culture. C-reactive protein was measured in leftover blood or serum (0.2 mL) using the immunoturbidimetric QR-CRP test kit. Background and outcome data were collected from the files. Pearson correlation, analysis of variance, and logistic regression were used to determine the diagnostic ability of CRP. Results: Stool culture was positive for bacteria in 8 patients. High CRP levels correlated with a greater likelihood of a positive culture; the area under the receiver operating characteristics curve was 0.9427. The CRP values of 95 mg/L or higher had a sensitivity of 87% and a specificity of 91.7% for predicting culture-confirmed bacterial gastroenteritis. Conclusions: The QR-CRP test seems to be a useful predictor of bacterial gastroenteritis in children. It is amenable for use in the emergency department, making it a promising tool for infection control and for aiding physicians in decisions regarding antibiotic treatment. The CRP levels of 95 mg/L or higher during the first 48 hours are suggestive of bacterial disease.

Validity of the quick-read CRP test in the prediction of bacterial pneumonia and gastroenteritis in the pediatric emergency department

(96%), intubation equipment (100%), suction (92%) and a manual (97%) or (semi-) automatic defibrillator (AED). Twenty-three hospitals (37%) have an AED available on some, but not all, general wards, five (8%) consider the purchase of one or more AEDs and 34 (55%) do not. In 51 hospitals (82%), BLS training for general ward nurses is mandatory, and in seven (11%), training is optional. General ward nurses are found to respond adequately to medical emergencies in 32 hospitals (52%). Twenty-two hospitals (36%) mention the need for additional BLS training for ward nurses, seven centers (11%) find the input of general ward nurses redundant for an MET and do not perceive a need for additional training. Patient files are available and usable for the MET on general wards in 35 hospitals (57%). DNR codes are available and usable in 23 hospitals (38%). Conclusion METs are well spread in Flemish hospitals. In most cases, team composition and equipment are adequate, while organizational aspects and MET member training are usually considered sufficient to very good. On the other hand, collaboration with and training of general ward staff can be improved. Availability and usability of patient files and DNR codes are often inadequate. Despite literature evidence on the value of early intervention by METs, this concept is not implemented in many hospitals in Flanders.

Using the Rochester criteria to evaluate infantile fever is more effective in males than females.

The reliability of low‐risk and high‐risk criteria in evaluating febrile infants aged up to 60 days has been well documented. The aim of this study was to evaluate gender differences in the reliability of these criteria in order to exclude serious bacterial infection (SBI) in febrile infants.