Airway Infection In Children Research Articles

Carriage of oropharyngeal bacteria among children in a vulnerable rural population living in a tropical region in São Paulo, Brazil

This study aimed to detect the carriage of _Streptococcus pneumoniae_, _Haemophilus influenza_, and _Moraxella catarrhalis_ in the oropharynx and a possible association for airway infections in children of a vulnerable population living in a tropical rural settlement, São Paulo, Brazil. Demographic data were collected through standard questionnaires. Oropharyngeal samples were cultured and examined using the multiplex polymerase chain reaction. The molecular method had higher sensitivity and revealed a high rate of colonization by _S. pneumoniae _and _M. catarrhalis_. _H. influenza_ was not detected, highlighting the strength of Brazil's national immunization program. Low income was reported by 61.4% of participants. Carriage of _S. pneumoniae _was positively associated with being female (_P_=0.004) and being brown color (_P= _0.042). We identified risk factors for respiratory infections and vulnerabilities that may be widely applicable to other rural communities in Brazil and other settings of developing countries.

Measurement of the interbronchial angle in acute viral bronchiolitis.

Acute viral bronchiolitis (AVB) is the most common lower airway infection in children under 2 years. Attempts to determine disease severity based on clinical and radiological manifestations are a major challenge. Measurements of the anatomy of the trachea and main bronchi are not only limited to pure anthropometry, but are also useful for better care of critically ill patients. The purpose of the study is to verify the association between measurements of the interbronchial angle (ITB) and the severity of respiratory disease. A cross-sectional study, which included all patients admitted to the Santo Antônio Children's Hospital, over a period of 1 year, with diagnosis of AVB by respiratory syncytial virus (RSV) was designed. ITB angle was measured and clinical characteristics were analyzed. Quantitative variables were compared and correlation analysis was performed using Pearson's correlation coefficient. A receiving operator characteristic (ROC) curve was performed. P-value <0.05 was statistically significant. A total of 425 patients with AVB due to RSV were included. Most of these patients were male and the median age was 130 days, 91.11% of them required oxygen therapy through a nasal catheter, 3.3% used noninvasive ventilation and 4% used mechanical ventilation. Those who required MV or NIV and intensive care unit support were considered severe. The mean ITB was lower for these patients than for those of lesser severity (p < 0.05). The present study demonstrates that there is an association between ITB and AVB severity. The smaller the ITB, the greater the disease severity.

Increase in complicated upper respiratory tract infection in children during the 2022/2023 winter season—a post coronavirus disease 2019 effect?

BackgroundUpper respiratory tract infections usually peak during winter months.ObjectiveThe purpose of this study was to evaluate whether imaging of complicated upper airway infection in children increased during the winter season of 2022/2023.Materials and methodsIn a retrospective study setting, pediatric magnetic resonance imaging (MRI) and computed tomography (CT) scans for evaluation of upper respiratory tract infection performed between October 2022 and April 2023 were analyzed regarding presence of the following complications: mastoiditis, abscess, phlegmon, meningitis, reactive vasculitis, and sinus vein thrombosis. Pathogen detection, surgery, and infection parameters were obtained. Data were compared with MRI and CT scans performed in the same months of the preceding five years, distinguishing between pandemic and pre-pandemic years.ResultsDuring the 2022/2023 winter season, the number of MRI and CT scans in children with upper airway infections, the complication rate, the rate of detected streptococcal infections, and the rate of surgery increased significantly compared to expectations based on the five prior winter seasons (all P<0.05). During the first complete pandemic winter season in Europe (2020/2021), the number of MRI and CT scans in children with upper airway infection, the complication rate, and the rates of streptococcal detection and surgery decreased significantly compared to expectations based on the pre-pandemic, the second pandemic, and the post-pandemic winter seasons (all P<0.05).ConclusionAfter a decline during the first pandemic winter season, there was a marked rebound in complicated upper airway infection in children, with a significant increase in cases during the 2022/2023 winter season compared to the pre-pandemic and pandemic years.Graphical

Acute Upper Airway Disease in Children With the Omicron (B.1.1.529) Variant of SARS-CoV-2—A Report From the US National COVID Cohort Collaborative

This cohort study uses data from the US National COVID Cohort Collaborative to evaluate upper airway infections in children during the surge of the Omicron (B.1.1.529) variant of SARS-CoV-2 in the US.

Public Health Interventions for COVID-19 Reduce Kawasaki Disease in Taiwan.

Background: Kawasaki disease (KD) is a syndrome of unknown cause that results in high fever and coronary vasculitis in children. The incidence of KD increased in Taiwan over the past few decades. Taiwanese government executed domains of early screening, effective methods for isolation or quarantine, and digital technologies for identifying potential cases for the early elimination strategy for coronavirus disease 2019 (COVID-19) and public health interventions for the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) or COVID-19 pandemic, leading to an effective reduction of the risk of airway infections in children. The purpose of this study is to analyze whether those public health interventions reduce the incidence of KD in 2020. Methods: Patients with KD who visited Chang Gung Memorial Hospital (CGMH) between 1 January, 2018, and 31 December, 2020 were included for trend analysis. This is a retrospective case series study conducted at the CGMH, which consists of a network of seven hospital branches equipped with more than 10,000 beds in different areas of Taiwan. Results: Compared with the 2018 and 2019 databases, the incidence of KD decreased significantly by 30% and 31%, respectively (p < 0.05) in 2020, when public health interventions were comprehensively implemented in Taiwan. This result shows that the incidence of KD decreased during the COVID-19 pandemic in Taiwan without change of the presentation KD (typical or incomplete) and percentage of IVIG resistance in 2020. Conclusion: As public health interventions were carried out for the SARS-CoV-2 pandemic, the incidence of KD was significantly reduced in Taiwan. Is KD a preventable disease?

BACTERIAL BIOFILM IN CHILDREN WITH CHRONIC RHINOSINUSITIS AND CHRONIC ADENOIDITIS

Chronic rhinosinusitis with chronic adenoiditis in children represents a global public health issue, seriously affecting the quality of parents and children life, because of its irritating symptoms like intermittent snoring, mouth breathing, dry mouth, nasal obstruction, headaches increased irritability and focus disorders on children. Bacterial biofilms are highly associated with the chronic infectious processes in children. Correct therapeutical management of this diagnostic combination is mandatory to improve the quality of one’s life. Objectives. The aim of the study is: to observe the ratio of adenoid mucosa covered with bacterial biofilm extracted from the nasopharynx of 50 paediatric patients suffering of chronic rhinosinusitis (RSC) and chronic adenoiditis (CA); and to point the fact that the adenoids contaminated with bacterial biofilm are a generator for chronic upper airway infections in children. Material and methods. We have measured using an image analysis program the bacterial biofilm covering the entire surface of the extracted adenoids mases, from 28 girls and 22 boys aged between 5 and 12 years diagnosed with CRS and CA. Control visits were performed to verify symptom improvement at 1, 3 and 6 months. Outcomes. Adenoids extracted from paediatric patients diagnosed with CRS and CA presented bacterial biofilms coverage on almost the entire mucosa (86.75%). Conclusions. Adenoid mases removed from paediatric patients with CSR and CA have most of their mucosal covered with bacterial biofilm. In the nasopharynx of paediatric patients with CSR and CA, bacterial biofilm can play the role of a constant fountain of infection. Adenoid mass removal explains the symptomatic improvement observed post operatory in the CRS with CA paediatric patients that do not respond to antibiotic therapy.

Adenotonsillectomy Does not Alter the Risk of Upper Airway Infections in Children.

Given the conflicting evidence regarding adenotonsillectomy and the risk of upper airway infections (UAIs), including acute pharyngitis (APT), rhinosinusitis (ARS), and otitis media (AOM), we evaluated the risk of developing UAIs following adenotonsillectomy in a childhood population. In this population-based follow-up study, we used data from the National Health Insurance Service-National Sample Cohort. The adenotonsillectomy group (n=2,377) included patients aged <10 years who underwent an adenotonsillectomy. For every patient with APT (n=2,309), ARS (n=2,308), and AOM (n=2,207) who had an adenotonsillectomy, four participants were randomly selected for the control groups (n=9,204, n=9,196, and n=8,788, respectively) using propensity score matching. The number of postoperative hospital visits for UAIs was recorded for 1 to 9 years, and the equivalence test was used to compare the number of visits between the adenotonsillectomy and control groups. There were no significant differences in the incidence of APT, ARS, or AOM at the margin of equivalence of difference (-0.5 < 95% confidence interval of difference < 0.5) between the two groups from postoperative year 1 to year 9. The hospital visits for these diseases gradually decreased over time in both groups. There was a significant decrease in the number of visits for APT, ARS, and AOM in the 5-9 years age group when compared with those in the <4 years age group (P < .01). Our results suggest that adenotonsillectomy does not alter the frequency of UAIs in children. NA Laryngoscope, 131:2376-2383, 2021.

Public Health Interventions for COVID-19 Reduce Kawasaki Disease in Taiwan

Background: Kawasaki disease (KD) is a syndrome of unknown cause that results in high fever and coronary vasculitis on the affected children. The incidence of KD increased in Taiwan over the past few decades but seemed to have significantly decreased in 2020, when the Taiwanese government executed public health interventions for the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) or (coronavirus disease 2019, COVID-19) pandemic, leading to an effective reduction of the risk of airway infections in children. The purpose of this study is to analyze whether those public health interventions reduce the incidence of KD in 2020.Methods: Patients with KD who visited Chang Gung Memorial Hospital (CGMH) between January 1, 2018 and December 31, 2020 were included for trend analysis. This is a retrospective case series study conducted at the CGMH, which consists of a network of 7 hospital branches equipped with more than 10,000 beds in different area of Taiwan.Results: Compared with the 2018 and 2019 databases, the incidence of KD decreased significantly by 30% and 31%, respectively (p Conclusion: As public health interventions were carried out for the SARS-CoV-2 pandemic, the incidence of KD was significantly reduced. Is KD a preventable disease?Funding Statement: This study received funding from the following grants: MOST 108-2314-B-182 -037 -MY3 from the Ministry of Science and Technology of Taiwan and 8E0212, CMRPG8L0021 and CORPG8L0321 from Chang Gung Memorial Hospital, Taiwan. Although these institutes provided financial support, they had no influence on the way in which we collected, analyzed, or interpreted the data or wrote this manuscript.Declaration of Interests: All the authors hereby declare to have no financial interests todisclose with regard to this article.Ethics Approval Statement: This study was approved by the Institutional Review Board of the Chang Gung Medical Foundation (IRB number: 201801163B0 and 20210084B0).

Antimicrobial susceptibility and impact of macrolide antibiotics on Moraxella catarrhalis in the upper and lower airways of children with chronic endobronchial suppuration.

Moraxella catarrhalis is an important but insufficiently studied respiratory pathogen. To determine antibiotic susceptibility and impact of recent antibiotics on M. catarrhalis from children with chronic endobronchial suppuration. We cultured nasopharyngeal (NP) swabs and bronchoalveolar lavage (BAL) fluids collected from children who were prospectively enrolled in studies of chronic cough and had flexible bronchoscopy performed. Recent β-lactam or macrolide antibiotic use was recorded. M. catarrhalis isolates stored at -80 °C were re-cultured and susceptibility determined to a range of antibiotics including the macrolide antibiotic erythromycin. Data from concurrently collected NP and BAL specimens were available from 547 children (median age 2.4 years) enrolled from 2007 to 2016. M. catarrhalis NP carriage was detected in 149 (27 %) children and lower airway infection (≥104 c.f.u. ml-1 BAL) in 67 (12 %) children. In total, 91 % of 222 M. catarrhalis isolates were β-lactamase producers, and non-susceptibility was high to benzylpenicillin (98 %), cefaclor (39 %) and cotrimoxazole (38 %). Overall, >97 % isolates were susceptible to cefuroxime, chloramphenicol, erythromycin and tetracycline; three isolates were erythromycin-resistant (MIC >0.5 mg l-1). Recent macrolide antibiotics (n=152 children, 28 %) were associated with significantly reduced M. catarrhalis carriage and lower airway infection episodes compared to children who did not receive macrolides; odds ratios 0.19 (95 % CI 0.10-0.35) and 0.15 (0.04-0.41), respectively. Despite the frequent use of macrolides, few macrolide-resistant isolates were detected. This suggests a fitness cost associated with macrolide resistance in M. catarrhalis. Macrolide antibiotics remain an effective choice for treating M. catarrhalis lower airway infection in children with chronic endobronchial suppuration.

Do combined upper airway cultures identify lower airway infections in children with chronic cough?

Obtaining lower airway specimens is important for guiding therapy in chronic lung infection but is difficult in young children unable to expectorate. While culture-based studies have assessed the diagnostic accuracy of nasopharyngeal or oropharyngeal specimens for identifying lower airway infection, none have used both together. We compared respiratory bacterial pathogens cultured from nasopharyngeal and oropharyngeal swabs with bronchoalveolar lavage (BAL) cultures as the "gold standard" to better inform the diagnosis of lower airway infection in children with chronic wet cough. Nasopharyngeal and oropharyngeal swabs and BAL fluid specimens were collected concurrently from consecutive children undergoing flexible bronchoscopy for chronic cough and cultured for bacterial pathogens. In cultures from 309 children (median age, 2.3 years) with chronic endobronchial suppuration, all main pathogens detected (Haemophilus influenzae, Streptococcus pneumoniae, and Moraxella catarrhalis) were more prevalent in nasopharyngeal than oropharyngeal swabs (37%, 34%, and 23% vs 21%, 6.2%, and 3.2%, respectively). Positive and negative predictive values for lower airway infection by any of these three pathogens were 63% (95% confidence interval [95% CI] 55, 70) and 85% (95% CI, 78, 91) for nasopharyngeal swabs, 65% (95% CI, 54, 75), and 66% (95% CI, 59, 72) for oropharyngeal swabs, and 61% (95% CI, 54,68), and 88% (95% CI, 81, 93) for both swabs, respectively. Neither nasopharyngeal nor oropharyngeal swabs, alone or in combination, reliably predicted lower airway infection in children with chronic wet cough. Although upper airway specimens may be useful for bacterial carriage studies and monitoring antimicrobial resistance, their clinical utility in pediatric chronic lung disorders of endobronchial suppuration is limited.

Is there any association between adenoid biofilm and upper airway infections in pediatric patients?

To evaluate the association of the presence and extent of adenoid biofilms and the frequency of upper airway infections in children with upper airway obstruction. This cross-sectional study was conducted from October 2014 to December 2015 on pediatric patients who were candidates for adenoidectomy due to obstructive sleep apnea. After removal of the adenoid tissue and fixation in 2.5% glutaraldehyde, the samples were sent to the electron microscopy unit. The extent of biofilm formation was examined using environmental scanning electron microscopy. These results were then confirmed using image analysis software. Fifty-seven children with a mean age of 7.31 (±2.65) years were included in the study. Forty-three (75.4%) were male and 14 (24.6%) were female. The average number of upper airway infections during the last 12 months before adenoidectomy was 10.01 (±5.38). Biofilm structures were detected in all (100%) samples. As the main outcome, the extent of biofilm grading exhibited a statistically significant correlation with the frequency of upper airway infections (p<0.001). There was no significant correlation between sex and adenoid size with the biofilm extent. The present study showed that the extent of adenoid biofilm had a significant relationship with the frequency of upper airway infection rate. It seems that the presence of a biofilm on the adenoid surface as a reservoir for microorganisms could cause chronic inflammation.

Reduced nontypeable Haemophilus influenzae lower airway infection in children with chronic endobronchial suppuration vaccinated with the 10-valent pneumococcal H. influenzae protein D conjugate vaccine

BackgroundNontypeable Haemophilus influenzae (NTHi), the most common bacterial lower airway infection in children with protracted bacterial bronchitis, is associated with progression to bronchiectasis. We determined whether vaccination with 10-valent pneumococcal NTHi protein-D conjugate vaccine (PHiD-CV) reduced NTHi lower airway infection compared to children not PHiD-CV-vaccinated. Our unique childhood vaccination schedule and prospective 9-year bronchoalveolar lavage (BAL) collection provided an exclusive opportunity to examine this hypothesis. MethodsPaired BAL fluids and nasopharyngeal (NP) swabs were collected from 543 children (2007–2016) undergoing bronchoscopy for chronic cough. Children who received a primary course of ≥2 doses of one pneumococcal conjugate vaccine (PCV) and <2 doses of another PCV were included in each vaccine group. Logistic regression determined associations between NTHi lower airway infection (≥104 colony-forming units/mL BAL) and age, sex, Indigenous status, antibiotic exposure, and PHiD-CV vaccination. ResultsOf 262 PCV7-vaccinated, 53 PHiD-CV-vaccinated and 166 PCV13-vaccinated children (62 had mixed schedules, <2 PCV doses or missing vaccination data), NTHi lower airway infection was detected in 89 (34%), 9 (17%) and 47 (28%), respectively. On multivariate regression, significant independent factors associated with reduced NTHi lower airway infection were PHiD-CV vaccination (ORadjusted = 0.42, 95%CI 0.19–0.93), macrolide use (ORadjusted = 0.57, 95%CI 0.35–0.93) and increasing age (ORadjusted = 0.88, 95%CI 0.80–0.96). PHiD-CV vaccination had no impact on NTHi NP carriage. ConclusionsPHiD-CV-vaccinated children were significantly less likely to have NTHi lower airway infection than children not PHiD-CV-vaccinated. PHiD-CV is likely an effective intervention for reducing NTHi endobronchial infection in children at risk of chronic suppurative lung diseases.

Defining lower airway bacterial infection in children with chronic endobronchial disorders.

BackgroundDifferentiating lower airway bacterial infection from possible upper airway contamination in children with endobronchial disorders undergoing bronchoalveolar lavage (BAL) is important for guiding management. A diagnostic bacterial load threshold based on inflammatory markers has been determined to differentiate infection from upper airway contamination in infants with cystic fibrosis, but not for children with protracted bacterial bronchitis (PBB), chronic suppurative lung disease (CSLD), or bronchiectasis.MethodsBAL samples from children undergoing bronchoscopy underwent quantitative bacterial culture, cytologic examination, and respiratory virus testing; a subset also had interleukin‐8 examined. Geometric means (GMs) of total cell counts (TCCs) and neutrophil counts were plotted by respiratory pathogen bacterial load. Logistic regression determined associations between age, sex, Indigenous status, antibiotic exposure, virus detection and bacterial load, and elevated TCCs (>400 × 103 cells/mL) and airway neutrophilia (neutrophils >15% BAL leukocytes).ResultsFrom 2007 to 2016, 655 children with PBB, CSLD, or bronchiectasis were enrolled. In univariate analyses, Indigenous status and bacterial load ≥105 colony‐forming units (CFU)/mL were positively associated with high TCCs. Viruses and bacterial load ≥104 CFU/mL were positively associated with neutrophilia; negative associations were seen for Indigenous status and macrolides. In children who had not received macrolide antibiotics, bacterial load was positively associated in multivariable analyses with high TCCs at ≥104 CFU/mL and with neutrophilia at ≥105 CFU/mL; GMs of TCCs and neutrophil counts were significantly elevated at 104 and 105 CFU/mL compared to negative cultures.ConclusionsOur findings support a BAL threshold ≥104 CFU/mL to define lower airway infection in children with chronic endobronchial disorders.

Propensity of pneumococcal carriage serotypes to infect the lower airways of children with chronic endobronchial infections

BackgroundChronic endobronchial infections in children are responsible for a high disease burden. Streptococcus pneumoniae is frequently isolated; however, few publications have described serotypes associated with non-invasive lower airway infection. MethodsPaired nasopharyngeal (NP) swabs and bronchoalveolar lavage (BAL) fluids were collected from children undergoing bronchoscopy for chronic cough. NP swabs were also collected from asymptomatic children in otitis media surveillance studies (controls). Specimens were processed and lower airway infection defined (⩾104 colony forming units/mL BAL) as previously described. Serotype-specific odds ratios (ORs) were calculated (as described for invasive pneumococcal disease) to indicate propensity for infection. ResultsFrom 2007–2015, paired specimens were processed from 435 children with protracted bacterial bronchitis (PBB), chronic suppurative lung disease (CSLD) or bronchiectasis. S. pneumoniae lower airway infection was detected in 95 children: 27% with PBB and 20% with CSLD/bronchiectasis. Most (91%) children were vaccinated with ⩾2 doses of 7-valent, 10-valent or 13-valent pneumococcal conjugate vaccine. Paired NP and BAL serotype distributions were very similar; prevalent serotypes (>10 isolates) were 19A (9%), 19F, 6C, 35B, 15B, 16F, 15A, 15C, 23A, 23F and 11A. For 21 serotypes found in both NP and BAL specimens, ORs for infection were low; range 0.46 (serotype 23B) to 2.15 (serotype 6A). In the 2008–2013 surveillance studies, NP swabs were collected from 1565 asymptomatic children; 74% were pneumococcal carriers. For 21 of 22 serotypes found in both control NP swabs and BAL specimens, ORs for infection were similarly low; range 0.33 (serotype 23B) to 3.29 (serotype 22F); none was significantly different from 1. The exception was serotype 7B with OR 8.84 (95% CI 1.46, 38.1). ConclusionsMost NP carriage serotypes have a similar propensity to cause lower airway infection in children with suppurative lung diseases. Further development of pneumococcal vaccines is needed to prevent non-invasive disease caused by commonly carried serotypes.

Cytokine Profiles in Human Metapneumovirus Infected Children: Identification of Genes Involved in the Antiviral Response and Pathogenesis.

Human metapneumovirus (hMPV) causes severe airway infection in children that may be caused by an unfavorable immune response. The nature of the innate immune response to hMPV in naturally occurring infections in children is largely undescribed, and it is unknown if inflammasome activation is implicated in disease pathogenesis. We examined nasopharynx aspirates and blood samples from hMPV-infected children without detectable co-infections. The expression of inflammatory and antiviral genes were measured in nasal airway secretions by relative mRNA quantification while blood plasma proteins were determined by a multiplex immunoassay. Several genes were significantly up-regulated at mRNA and protein level in the hMPV infected children. Most apparent was the expression of the chemokine IP-10, the pro-inflammatory cytokine IL-18 in addition to the interferon inducible gene ISG54. Interestingly, children experiencing more severe disease, as indicated by a severity index, had significantly more often up-regulation of the inflammasome-associated genes IL-1β and NLRP3. Overall, our data point to cytokines, particularly inflammasome-associated, that might be important in hMPV mediated lung disease and the antiviral response in children with severe infection. Our study is the first to demonstrate that inflammasome components are associated with increased illness severity in hMPV-infected children.

Bacterial Tracheitis in a 9-Month-Old Child

The most common cause of stridor in children presenting to emergency departments during the fall and winter is viral laryngotracheobronchitis, or croup. 1 Miranda A Valdez T Pereira K Bacterial tracheitis: a varied entity. Pediatr Emerg Care. 2011; 27: 950-953 Crossref PubMed Scopus (10) Google Scholar However, bacterial tracheitis, a rare upper airway infectious disease, has recently emerged as the most common life-threatening upper airway infection in children. 2 Hopkins A Lahiri T Salerno R Heath B Changing epidemiology of life-threatening upper airway infections: the reemergence of bacterial tracheitis. Pediatrics. 2006; 118: 1418-1421 Crossref PubMed Scopus (68) Google Scholar In their article on the re-emergence of bacterial tracheitis, Hopkins et al 2 Hopkins A Lahiri T Salerno R Heath B Changing epidemiology of life-threatening upper airway infections: the reemergence of bacterial tracheitis. Pediatrics. 2006; 118: 1418-1421 Crossref PubMed Scopus (68) Google Scholar announced that “the epidemiology of potentially life-threatening upper airway infections is changing.” This change is partially due to the introduction of the Haemophilus influenzae type b (Hib) vaccine, which has contributed to a decreased incidence of epiglottitis. 3 Zoorob R Sidani M Murray J Croup: an overview. Am Fam Physician. 2011; 83: 1067-1073 PubMed Google Scholar The results of a 9-year retrospective study of pediatric patients (n = 107) with potentially life-threatening upper airway infections by Hopkins et al 2 Hopkins A Lahiri T Salerno R Heath B Changing epidemiology of life-threatening upper airway infections: the reemergence of bacterial tracheitis. Pediatrics. 2006; 118: 1418-1421 Crossref PubMed Scopus (68) Google Scholar demonstrated that bacterial tracheitis was 3 times more likely to have caused respiratory failure than both viral croup and epiglottitis combined. Elizabeth Stone Griffin is Staff Nurse IV, Children’s Emergency Department, WakeMed Health & Hospitals, Raleigh, NC, and Clinical Faculty, School of Nursing, University of North Carolina–Chapel Hill, Chapel Hill, NC. Tiffany Young is Staff Nurse IV, WakeMed Health & Hospitals, Raleigh, NC, and Pediatric Nurse Practitioner, Nash General Hospital, Rocky Mount, NC.

76 Aerosolized antibiotic therapy in cystic fibrosis with Pseudomonas aeruginosa airway infection in children

76 Aerosolized antibiotic therapy in cystic fibrosis with Pseudomonas aeruginosa airway infection in children

Perfil de prescritores e prescrição de antimicrobianos nas infecções das vias aéreas superiores em Pediatria

OBJETIVO: Traçar um perfil dos médicos que atendem crianças nos sistemas público (Sistema Único de Saúde) e privado de saúde e verificar como são prescritos antimicrobianos nas infecções das vias aéreas superiores. MÉTODOS: Médicos de algumas cidades do interior do Estado de São Paulo receberam via correio ou nas Unidades Básicas de Saúde uma carta explicativa sobre a pesquisa e o questionário, com perguntas sobre: tempo de graduação, residência médica, carga horária e local de trabalho, forma de atualização, fatores que consideram ao prescrever antimicrobianos e casos clínicos sobre as infecções das vias aéreas superiores. Os dados pessoais dos médicos foram relacionados com as respostas aos casos clínicos. Para análise estatística, foram aplicados os testes Z e de Tukey-Kramer, sendo p&lt;0,05 significante. RESULTADOS: A amostra foi composta por 170 prescritores: 86,5% possuíam residência em Pediatria, 75% trabalhavam no Sistema Único de Saúde e 71% tinham carga horária superior a 40 horas semanais. Os formados há menos de dez anos valorizaram mais os laboratórios farmacêuticos como forma de atualização do que os graduados há mais de 30 anos; 33% dos médicos do Sistema Único de Saúde atendem mais de cinco pacientes por hora. A média de acerto nos casos clínicos foi de 87%. O uso das entidades médicas como forma de atualização foi associado a respostas corretas, enquanto o uso de materiais de laboratório estava ligado a respostas incorretas (p&lt;0,05). Houve clara tendência de diminuição dos acertos conforme o número de pacientes atendidos por hora aumentava. CONCLUSÕES: Educação adequada sobre o tema e melhora nas condições de trabalho podem ser eficientes para reduzir a prescrição de antibióticos para infecções das vias aéreas superiores em crianças.

Viral co-detection in infants hospitalized with respiratory disease: is it important to detect?

Until relatively recently, our view of acute viral respiratory illnesses in early childhood was somewhat limited. We “understood” the following: children were exposed to respiratory viruses by exposure to other children; all children would be exposed to common respiratory viruses during the first year or two of life, with many infections remaining subclinical and the minority becoming severe enough to warrant medical attention or hospitalization; human rhinovirus (HRV) did not cause lower airway infections in children; and normal children did not “carry” viruses in their upper airway. We also “knew” that lungs were normally sterile and, unlike the upper airway, the gastrointestinal tract, and the skin, did not have a resident microbiome. With data collected from community-based birth cohort studies and advances in diagnostic techniques, we now understand that many of our earlier concepts were flawed. Systematic studies of respiratory infections in communitybased birth cohort studies, the Childhood Asthma Study from Perth, Australia1 and the Childhood Origins of Asthma study from Wisconsin, USA2 have changed a number of these previously held beliefs. Both studies collected nasal samples from children at times of acute respiratory infections as well as control samples collected when the children were well. These studies firmly established that HRV was responsible for a considerable number of acute lower respiratory illnesses in early life, including those associated with wheeze, and that HRV could be identified in nasal samples collected from approximately 20% of children when they were completely well.1 In addition, definitive proof has been provided that

Bronchoalveolar lavage in children with cystic fibrosis: how many lobes should be sampled?

BackgroundThe European Respiratory Society guidance on bronchoalveolar lavage (BAL) in children was published in 2000. It recommended taking one BAL specimen from the most affected lobe or from the right...