Nitza Newman

Nasopharyngeal Carriage of Individual Streptococcus pneumoniae Serotypes During Pediatric Pneumonia as a Means to Estimate Serotype Disease Potential

Background: We aimed at estimating pneumococcal serotype-specific disease potential in pediatric community-acquired alveolar pneumonia (CAAP), by comparing nasopharyngeal pneumococcal carriage during disease to carriage in healthy children. Methods: Pneumococcal nasopharyngeal cultures were obtained from children <5 years old admitted to the emergency room or hospitalized with radiologically diagnosed CAAP and from healthy controls. Disease potential was estimated by calculating serotype-specific odds ratios (OR) of a given serotype to be carried during disease compared with healthy children (after adjustment for age, ethnicity, previous antibiotic therapy, and season). Results: A total of 603 and 1504 isolates were obtained from CAAP and healthy children, respectively. A significant OR >1.0 of a specific serotype being carried during disease (suggesting a higher disease potential) was observed with serotypes (by decreasing rank) 1, 5, 22F, 7F, 14, 9V, and 19A. A significant OR <1.0 of being carried during disease (suggesting a lower disease potential) was observed with serotypes 6A, 6B, 23A, and 35B. Carriage of PCV7 serotypes (grouped) during CAAP was highest in age group 6 to 17 months. PCV10 and PCV13 provided significantly higher coverage for both 6 to 17 and 18 to 35 month age groups. Conclusions: It is suggested that serotypes 1, 5, 7F, 9V, 14, 19A, and 22F have a higher disease potential for childhood pneumonia than do serotypes 6A, 6B, 23A, and 35B.

Current management of pediatric acute otitis media

Acute otitis media (AOM) is the most common childhood bacterial infection for which antibiotics are prescribed worldwide. The most common pathogens causing AOM in children are Streptococcus pneumoniae, nontypeable Haemophilus influenzae, Moraxella catarrhalis and Group A streptococcus. Antibiotic resistance is increasing among the bacterial pathogens causing AOM, with percentages of penicillin- and macrolide-resistant S. pneumoniae strains estimated to be between 30 and 70%, and of β-lactamase-producing H. influenzae ranging between 20 and 40%. The introduction of the seven-valent pneumococcal conjugated vaccine had a major role in decreasing the number of vaccine-related S. pneumoniae AOM episodes, recurrent AOM cases and cases requiring the insertion of ventilation tubes. In parallel, it caused a rapid shift in the microbiology of AOM, characterized by an increase in the number of nonvaccine S. pneumoniae serotypes and H. influenzae isolates. The management of AOM in childhood has evolved considerably during recent years as a result of the new insights provided by the publication of the American Academy of Pediatrics and American Academy of Family Physicians guidelines for the treatment of AOM. The new treatment guidelines establish a clear hierarchy among various antibacterials used in the treatment of AOM and also the use of an age-stratified approach to AOM by recommending an observation strategy (‘watchful waiting’) without the use of antibacterials for some groups of AOM patients. Adherence to such a policy in patients with uncertain/questionable AOM diagnosis and/or mild-to-moderate symptoms, in addition to its implementation in patients over 2 years of age, could substantially reduce the use of antibacterials for the treatment of AOM and play a major role in the strategy of decreasing antibacterial resistance.

Community-acquired complicated intra-abdominal infections in children hospitalized during 1995-2004 at a paediatric surgery department.

Information on the epidemiologic, clinical, microbiologic and therapeutic aspects of community-acquired complicated intra-abdominal infections in paediatrics is limited. The objectives of this study were to investigate the epidemiologic, clinical, microbiologic and therapeutic characteristics of community-acquired complicated intra-abdominal infections occurring in children aged 1 month–15 y. Medical charts and microbiology data of all children hospitalized with complicated intra-abdominal infections were retrospectively examined. Complicated intra-abdominal infections were defined as infections extending beyond the viscus of origin into the peritoneal space, with subsequent development of abscess or peritonitis. One hundred and twenty-three patients with complicated intra-abdominal infections (99/123, 80% >5 y of age) were included; 113 (92%) had complicated acute appendicitis. Twelve (10%) patients underwent computerized tomography-guided percutaneous drainage of periappendicular abscesses. The mean rate of complicated intra-abdominal infections among patients with complicated acute appendicitis was 10% without significant changes during the study years. Positive intra-abdominal cultures were recorded in 97/108 (90%) evaluable patients; 65/97 (67%) cases were characterized by mixed bacterial flora growth. One hundred and ninety pathogens (aerobes n=164, 86%; anaerobes n=26, 14%) were isolated. Escherichia coli was the most common pathogen (94 isolates, 57%). In vitro amoxicillin/clavulanate coverage of E. coli and Klebsiella spp was modest (81% and 86%, respectively). The ampicillin/gentamicin/metronidazole regimen was more appropriate in vitro than the amoxicillin/clavulanate regimen (3/80, 4% resistant pathogens compared with 8/43, 19%; p=0.02). Post-operative complications were recorded in 33/123 (27%) patients. Time until defervescence to < 37.5°C was shorter in children with periappendicular abscess than in children with generalized peritonitis (6±4 vs 4±3 days; p=0.009). In conclusion: (1) most community-acquired complicated intra-abdominal infections occurred as a result of acute appendicitis; (2) the rate of complicated intra-abdominal infections among patients with acute appendicitis was low and without significant changes during the study period; (3) E. coli was the most frequently isolated pathogen; (4) amoxicillin/clavulanate provided only partial coverage for complicated intra-abdominal infection pathogens and should be used with caution in the empiric treatment of complicated intra-abdominal infections.

Central venous catheter‐associated bloodstream infections

To investigate the epidemiologic and microbiological aspects of long‐term central vein catheter (CVC)‐associated bloodstream infections (CABSI) in children <18 years old treated at the hemato‐oncology unit during 1998–2008.

Intussusception in Children in Southern Israel: Disparity between 2 Populations

Background: Intussusception has been associated with 1 rotavirus vaccine. Our objective was to determine intussusception rates in children in southern Israel during a 15-year period before the introduction of new rotavirus vaccines. Methods: All children born at the Soroka Medical Center are hospitalized in that center, enabling population-based studies. Two populations reside in Southern Israel: the Jewish population (comparable to a Western population) and the Bedouin population (comparable to a developing population). Retrospectively, all children <5 years of age admitted with ICD-9 code for intussusception were recorded as well as their demographic and clinical data. Results: During 1990–2004, 316 patients with intussusception [241 (76%) Jewish children and 75 (24%) Bedouin children] were recorded. None died. The mean annual rates for children <5 years (per 100,000) were 49.3 ± 17.4 and 18.9 ± 9.6 for Jewish and Bedouin children, respectively (P < 0.001), with a significant increase in intussusception rates during the study period in Bedouin (P = 0.022), but not in Jewish children (P = 0.38). Mean annual intussusception rates per 100,000 for children <12 months were 199.6 ± 5.2 and 66.8 ± 44.1 for Jews and Bedouin infants, respectively (P < 0.001). In Bedouin children, a significantly higher number of cases were observed from March to May, whereas no seasonality pattern was noted in Jewish children. Negative correlation between intussusception and gastroenteritis was found in Bedouin infants during the summer months, whereas no such correlation was found in Jewish infants. Conclusions: Pre-rotavirus vaccination intussusception rate is high especially among Jewish infants in Southern Israel. Intussusception rates increased significantly during the study period in Bedouin infants.

Management of Blunt Pancreatic Injuries in Children

AbstractBackground: Most blunt abdominal injuries of solid organs in children can be managed nonoperatively. To date, however, there has been no general agreement regarding the application of nonoperative management to pancreatic injuries. Objective: We evaluated the course of patients who underwent blunt pancreatic trauma and were managed nonoperatively, in order to determine the efficacy and safety of this strategy. Patients and Methods: A retrospective study of 26 patients with blunt pancreatic injury admitted to the Department of Pediatric Surgery at the Soroka Medical Center between 1983 and 2002 was conducted. The data was collected from the Trauma Registry and the medical records. The results were analyzed using Fishers exact test for comparison of proportions and Students t-test for comparison of means. Level of confidence was defined at p < 0.05. Results: We identified 26 children with blunt panc reatic injuries. 19 patients sustained a minor injury, and seven had a major injury with transection of the main pancreatic duct. All 19 patients considered to have a minor injury, including three in whom pseudocysts were formed, responded well to nonoperative management. Five of the seven patients who sustained a major injury required an interventional procedure. Conclusion: Most pediatric patients with blunt pancreatic trauma, including those with pseudocyst formation, respond well to supportive nonoperative management. Symptomatic patients due to a large pseudocyst or a pancreatic abscess can be managed successfully by percutaneous computerized tomographic scan-guided drainage; however, some of these patients may require operative intervention.