Bacterial Infections In Infants Research Articles

Presentation, Diagnostic Evaluation, Management, and Rates of Serious Bacterial Infection in Infants With Acute Dacryocystitis Presenting to the Emergency Department.

Dacryocystitis is considered benign, yet infants represent a population at risk of complications. The presentation, management, and rates of serious bacterial infection in infants with dacryocystitis have not been described. We conducted a retrospective study of infants (12 months or younger) presenting to a single urban tertiary care pediatric emergency department between January 1995 and March 2014 with concern for dacryocystitis. Exclusion criteria included immune compromise or craniofacial anomalies. Cases were identified using text search software, followed by manual chart review. We identified 333 subjects, and median age was 38 days (interquartile range, 12; 106). Fifty-three percent were female. Most were afebrile (81%, T < 38°C) at triage while 6% had fever of ≥39°C. Two of 135 blood cultures sent were positive (both Streptococcus pneumoniae). Lumbar punctures were performed on 40 patients (12%), and no cerebrospinal fluid (CSF) cultures were positive. Eye cultures were positive in 47% (N = 58) of infants cultured (N = 123); the most common pathogens were Haemophilus species (N = 17), Staphylococcus aureus (N = 13), Gram-negative rods (N = 7), and Moraxella species (N = 4). Imaging was obtained in 11 subjects (3.3%) with 3 demonstrating cellulitis and 1 a hemangioma. Ophthalmology was consulted for 21%, and an intervention/probe performed in 6%. Topical antibiotics were used in 147 subjects (44%), oral antibiotics in 100 (33%), and parenteral antibiotics in 87 (26%). Infants with dacryocystitis have a variable presentation and management ranges from observation to aggressive management. The rates of serious bacterial infection were low in this sample and not associated with any presenting risk factors.

Accuracy of Criteria to Identify Bacterial Infections in Infants

Accuracy of Criteria to Identify Bacterial Infections in Infants

Diagnostic Value of Urinary Heparin Binding Protein in Urinary Tract Infection in Children

Introduction Urinary tract infection is one of the most common bacterial infection in infants and children, diagnosis can be missed or delayed as urine cultures are time consuming. Aim of the Study Our aim is to assess the sensitivity and specificity of urinary heparin binding protein (U-HBP) in diagnosis of Urinary tract infection. Methods Acute febrile children with core temperature ≥ 38 for less than 1 week were enrolled, from 1 month to 3 years from January to May 2016. Urinary HBP levels were assessed by ELISA in the supernatant stored aliquots of centrifuged freshly voided urine. Data was analyzed using SPSS 21. Results We found that median levels of U-HBP, were significantly higher in positive focus group in comparison to negative with p value < 0.001, and that there's a significant relationship between the U-HBP and urine culture (gold standard) with good positive and negative predictive value. Conclusion Urinary heparin binding protein can be used as reliable biomarker for the detection of UTI at level 650 picogram/ml in infants and children with sensitivity (72.7%) and specificity (81.2%).

A positive nitrite test was an independent risk factor for invasive bacterial infections in infants under 90days of age with fever without source.

This study analysed the association between a positive nitrite dipstick test and an invasive bacterial infection (IBI) in infants younger than 90days of age with fever without source (FWS). We performed a secondary analysis of data from a prospective multicentre study of infants up to 90days of age with FWS undergoing care in 19 paediatric EDs between October 2011 and September 2013. Invasive bacterial infection was defined as a positive blood or cerebrospinal fluid culture. The dipstick urinalysis was positive for nitrite or leucocyte esterase in 766 (22.5%) of the 3401 infants we studied, and 270 (35.2%) had a dipstick test that was just positive for nitrite. Overall, 107 were diagnosed with an IBI (3.1%). The IBI prevalence was 2.2% among patients with a normal urine dipstick, 4.4% if they had positive leucocyte esterase test results, 8.3% where the nitrite test was positive and 10.6% when both tests were positive. After multivariate analysis, a positive nitrite test remained an independent risk factor for IBI (odds ratio 2.7, 95% confidence interval 1.4-4.9). In infants under 90days of age with FWS, a positive nitrite urine dipstick test was an independent risk factor for IBI.

Definite bacterial infection in recently vaccinated febrile infants.

There is insufficient evidence regarding the best approach to evaluating recently vaccinated (RV) infants presenting to the paediatric emergency department with fever. The aim of the present study is to determine the prevalence of bacterial infections in infants presenting with fever within 72 h after vaccination. We retrospectively reviewed the electronic medical record of infants aged between 6 and 12 weeks who presented with a fever ≥38°C to the emergency department from January 2016 to December 2018. Febrile infants who were vaccinated within 72 h prior to their emergency department presentation were matched to those who had not received their vaccines in the previous 72 h. Definite serious bacterial infection was diagnosed based on culture results. A total of 198 infants (age: 9 ± 1.84 weeks, male: 119 (60.1%)) were enrolled in this study. Overall, 60 of 138 (30.3%) had received their vaccines within the previous 72 h. The prevalence of bacterial infection in RV infants was 5% compared to 15.2% in non-RV infants (P = 0.056). Interestingly, all vaccinated infants who had proven bacterial infection presented to the emergency department with fever within 24 h of vaccination, and all bacterial infections in that group were urinary tract infections. The prevalence of bacterial infection among non-RV febrile infants is relatively higher than those RV. However, fever should not be attributed only to the vaccinations, and all febrile RV infants should be carefully evaluated, and at least urine testing should be performed regardless of the time of vaccination.

Risk of serious bacterial infections in infants ≤60 days of age presenting to the emergency department with a history of fever only

Risk of serious bacterial infections in infants ≤60 days of age presenting to the emergency department with a history of fever only

Factors associated with serious bacterial infections in infants ≤60 days with hypothermia in the emergency department

BackgroundWe sought to investigate risk factors for serious bacterial infection (SBI: bacterial meningitis, bacteremia, and urinary tract infection [UTI]) among infants ≤60 days of age presenting to the emergency department (ED) with hypothermia (temperature < 36 °C). MethodsWe performed a single center study over a 12-year period including all patients ≤60 days old with hypothermia, excluding patients who did not receive a blood culture and patients who received antibiotics prior to culture acquisition. The primary outcome was SBI. Secondary outcomes were mortality and herpes simplex infection. We performed multivariable logistic regression to identify risk factors for primary outcomes reporting adjusted odds ratios with 95% confidence intervals (aOR, 95% CI). Results360 infants were identified. 10/360 (2.8%) had an SBI. All episodes of SBI occurred in infants ≤28 days of age. Two patients had meningitis, two had meningitis with bacteremia, one had isolated bacteremia, and five had UTI. Associated diagnoses included prematurity (46.9%), hyperbilirubinemia (28.3%) and dehydration (14.7%). In multivariable analysis, presentation at 15–28 days (7.60, 1.81–31.86; p = 0.005) compared to 0–14 days, higher absolute neutrophil count (1.25, 1.04–1.50; p = 0.015) and lower platelet count (0.99, 0.99–1.00; p = 0.046) were associated with SBI. Three patients without SBI died during or soon after their hospitalization. One patient had positive testing for herpes simplex. ConclusionIn this cohort of hypothermic infants, 2.8% had a SBI. Age of presentation, ANC, and lower platelet count were associated with serious infections. Hypothermic infants presenting to the ED carry significant morbidity and require prospective study to better risk-stratify this population.

2328. Community-Onset Invasive Bacterial Infections in Infants Under 3 Months–10 Years of Experience in Auckland, New Zealand

BackgroundSerious infections remain the leading cause of death in the first year of life. Sepsis in neonatal intensive care units is well described but infants with bacterial infections presenting from the community has not previously been described in New Zealand. Recent studies suggest an increasing incidence of Staphylococcus aureus and Streptococcus pyogenes in New Zealand pediatric populations. It is, therefore, important to understand the unique pattern of infections seen in the infant population in New Zealand as this may impact on empiric management.MethodsA retrospective study (2007–2017) including infants aged 8 to 90 days presenting with clinically significant infection and positive culture from a sterile site. Cases were identified from laboratory database and ICD discharge codes, enabling data collection and analysis.Results192 cases were identified from two major hospitals in Auckland. This represented an incidence of invasive bacterial infections of 129/100,000 live births. Escherichia coli (40%) and Streptococcus agalactiae (22%) were the commonest pathogens. Streptococcus pyogenes and Staphylococcus aureus caused 14% and 12% of bacteremias respectively. Pacific island infants had the highest rates of infection (255/100,000) as did those from deprived backgrounds.Conclusion Escherichia coli and Streptococcus agalactiae are the commonest causative organisms in community-onset infant sepsis in Auckland.Rates of invasive bacterial infections in this age group are higher than reported in other industrialized countries (including published data from the USA), with Staphylococcus aureus and Streptococcus pyogenes being the most disproportionate. Our study demonstrates the increased risk of invasive Staphylococcus aureus and Streptococcus pyogenes in New Zealand, even at this early age, and this impacts on empiric antibiotic prescribing and management of infant sepsis in New Zealand. The risk of invasive infection is highest in Pacific and Māori infants and those from deprived backgrounds.A small number of multi-resistant organisms were present in this age group, prior to antibiotic exposure, illustrating that rising rates of community antimicrobial resistance will need to be considered even when prescribing for infants.Disclosures All authors: No reported disclosures.

Risk of Serious Bacterial Infection in Infants Aged ≤60 Days Presenting to Emergency Departments with a History of Fever Only

To compare the risk of serious bacterial infection between infants aged ≤60 days who are febrile in the emergency department (ED) and those who have only a history of fever and are afebrile on arrival to the ED. In this secondary analysis of a multicenter prospective study using data collected between December 2008 and May 2013, we compared the rate of serious bacterial infection (urinary tract infection [UTI], bacteremia, and/or bacterial meningitis) between infants who have a history of fever but are afebrile on arrival to the ED and those with fever documented in the ED (rectal temperature ≥38.0 °C) using relative risk (RR) with 95% CI. Stratified analyses were performed for age (≤28 and 29-60 days) and serious bacterial infection type. Infants born prematurely and those with a clinical focal infection or serious illness were excluded. A total of 3825 infants (mean age, 35.2 days; 56.9% male) were included. Of the 1233 (32.2%) who were afebrile in the ED, 108 (8.8%) had a serious bacterial infection (UTI, n = 94 [7.6%]; bacteremia, n = 19 [1.5%]; bacterial meningitis, n = 8 [0.6%]). Of the 2592 infants (67.8%) who were febrile in the ED, 331 (12.8%) had a serious bacterial infection (UTI, n = 285 [11.0%]; bacteremia, n = 61 [2.4%]; bacterial meningitis, n = 17 [0.7%]). The RR for serious bacterial infection for afebrile vs febrile infants was 0.68 (95% CI, 0.56-0.84). A lower risk of serious bacterial infection was also seen among afebrile vs febrile infants aged ≤28 days (RR, 0.69; 95% CI, 0.52-0.93) and age 29-60 days (RR, 0.67; 95% CI, 0.50-0.89). The prevalence of serious bacterial infection is lower in infants aged ≤60 days with a history of fever compared with those who are febrile on arrival to the ED. The small risk reduction in this group is unlikely to alter decision making.

Modern compilation of etiology of invasive bacterial infection in infants

Woll et al present the compilation of bacteriologically confirmed bloodstream infection (BSI) and meningitis in infants <60 days of age who were evaluated in 11 children's hospital emergency departments over 5 years, 2011-2016. They also assessed infectious etiologies by weeks of age, and susceptibility of organisms to frequently used regimens for empiric therapy. Of 442 infants identified with confirmed invasive bacterial infection, approximately 80% had BSI, 14% had meningitis with BSI, and 6% had meningitis without BSI. Positive blood cultures represented 2% of those tested, and positive CSF cultures represented 0.7% of samples tested. Group B Streptococcus was the most common pathogen (37%), followed by E coli (31%) and Staphylococcus aureus (10%). More than 95% of pathogens would be expected to be susceptible to an empiric regimen of ampicillin plus gentamicin, or ampicillin plus a third-generation cephalosporin, but only 89% to a third-generation cephalosporin alone. Strengths of the study are its relatively large number of cases, and inclusion of infants evaluated across 11 children's hospitals. The reader should be cognizant that the primary focus of the study was only those infants with BSI or meningitis or both. The data are useful as a reliable summary of relative age-predictable prevalence of the most serious bacterial infections in very young infants, and of empiric antibiotic regimens to provide life-saving therapy empirically on the day of coming to medical attention. Article page 210 ▶ Epidemiology and Etiology of Invasive Bacterial Infection in Infants ≤60 Days Old Treated in Emergency DepartmentsThe Journal of PediatricsVol. 200PreviewTo help guide empiric treatment of infants ≤60 days old with suspected invasive bacterial infection by describing pathogens and their antimicrobial susceptibilities. Full-Text PDF

Invasive Bacterial Infections in Infants Younger Than 60 Days With Skin and Soft Tissue Infections.

The objective of this study was to describe the frequency of invasive bacterial infections (IBIs) in young infants with skin and soft tissue infections (SSTIs) and the impact of IBI evaluation on disposition, length of stay (LOS), and cost. This retrospective (2009-2014) cohort study used data from 35 children's hospitals in the Pediatric Health Information System. We included infants younger than 60 days who presented to an emergency department (ED) with SSTI. Invasive bacterial infection was defined as bacteremia/sepsis, bone/joint infection, or bacterial meningitis. Readmission and return ED visits within 30 days were evaluated to identify missed IBIs for infants. A total of 2734 infants were included (median age, 33 days; interquartile range [IQR], 21-44); 62% were hospitalized. Invasive bacterial infection was identified in 2%: bacteremia (1.8%), osteomyelitis (0.1%), and bacterial meningitis (0.1%). Hospitalization occurred in 78% of infants with blood cultures, 95% with cerebrospinal fluid cultures, and 23% without cultures. Median hospitalization LOS was 2 days (IQR, 1-3). Median cost was US $4943 for infants with cerebrospinal fluid cultures (IQR, US $3475-6780) compared with US $419 (IQR, US $215-1149) for infants without IBI evaluations (P < 0.001). Five infants (0.2%) returned to the ED within 30 days with new IBI diagnoses (4 bacteremia, 1 meningitis). Invasive bacterial infection occurs infrequently in infants younger than 60 days who present to children's hospital EDs with SSTI. Bacteremia is the most common IBI. More extensive evaluation for IBI is associated with increased rate of admission, LOS, and cost. Further studies are needed to evaluate the safety of a limited IBI evaluation in young infants with SSTI.

Plasma Neutrophil Gelatinase-Associated Lipocalin as a Predictor of Renal Parenchymal Involvement in Infants With Febrile Urinary Tract Infection: A Preliminary Study.

BackgroundUrinary tract infection (UTI) is the most common bacterial infection in infants. Renal parenchymal involvement is an important prognostic factor; however, early detection of parenchymal involvement in UTI may be difficult during infancy. This study aimed to assess whether a recently established biomarker of UTI, neutrophil gelatinase-associated lipocalin (NGAL), can serve as a useful marker for the detection of cortical defects (CD) and to determine the appropriate diagnostic cut-off value of NGAL in infants with febrile UTI.MethodsInfants hospitalized for febrile UTI were divided into two groups according to the presence of cortical defects on dimercaptosuccinic acid (DMSA) scintigraphy. Among 64 enrolled infants, 43 (67%) had CD (UTI-CD) and 21 (33%) had no CD (UTI-ND). The white blood cell count, C-reactive protein, and plasma NGAL (pNGAL) levels were determined before antibiotic therapy and compared between the two groups.ResultspNGAL level was significantly higher in the UTI-CD group than in the UTI-ND group (340 µg/L vs 214 µg/L, P=0.002). Multivariate analysis showed that pNGAL level was the only independent predictor of CD (odds ratio 2.759, P=0.039). In the ROC curve analysis, pNGAL showed the highest area under the curve (0.745; 95% confidence interval, 0.561–0.821; P=0.014). The appropriate cut-off value of pNGAL was 267 µg/L (sensitivity, 72.1%; specificity, 71.4%).ConclusionspNGAL was found to be a useful marker for early prediction of renal parenchymal involvement in infants with febrile UTI.

Epidemiology and Etiology of Invasive Bacterial Infection in Infants ≤60 Days Old Treated in Emergency Departments

To help guide empiric treatment of infants ≤60 days old with suspected invasive bacterial infection by describing pathogens and their antimicrobial susceptibilities. Cross-sectional study of infants ≤60 days old with invasive bacterial infection (bacteremia and/or bacterial meningitis) evaluated in the emergency departments of 11 children's hospitals between July 1, 2011 and June 30, 2016. Each site's microbiology laboratory database or electronic medical record system was queried to identify infants from whom a bacterial pathogen was isolated from either blood or cerebrospinal fluid. Medical records of these infants were reviewed to confirm the presence of a pathogen and to obtain demographic, clinical, and laboratory data. Of the 442 infants with invasive bacterial infection, 353 (79.9%) had bacteremia without meningitis, 64 (14.5%) had bacterial meningitis with bacteremia, and 25 (5.7%) had bacterial meningitis without bacteremia. The peak number of cases of invasive bacterial infection occurred in the second week of life; 364 (82.4%) infants were febrile. Group B streptococcus was the most common pathogen identified (36.7%), followed by Escherichia coli (30.8%), Staphylococcus aureus (9.7%), and Enterococcus spp (6.6%). Overall, 96.8% of pathogens were susceptible to ampicillin plus a third-generation cephalosporin, 96.0% to ampicillin plus gentamicin, and 89.2% to third-generation cephalosporins alone. For most infants ≤60 days old evaluated in a pediatric emergency department for suspected invasive bacterial infection, the combination of ampicillin plus either gentamicin or a third-generation cephalosporin is an appropriate empiric antimicrobial treatment regimen. Of the pathogens isolated from infants with invasive bacterial infection, 11% were resistant to third-generation cephalosporins alone.

The Role of Quantitative C-Reactive Protein, White Blood Cell Count and Pyuria in Predicting Urinary Tract Infection among Febrile Infants and Children

Introduction: Urinary tract infection (UTI) is among the commonest bacterial infections in infants and children that warrants early detection and management to prevent long term consequences in kidney causing significant morbidity. The prevalence of UTI varies according to age, gender, race, circumcision status of children but it occurs in 1% of boys and 1 to 3% of girls. There have been studies that have highlighted the importance of C-reactive as an inflammatory marker involved during urinary tract infection in children.Objectives: To find out how Quantitative C-reactive protein level, white blood cell count and pus cells in urine are associated in febrile infants and children with UTI. To find out the antibiotic sensitivity pattern of UTI.Methodology: A prospective cross sectional study was conducted to evaluate febrile infants and children of 2 months to 13 years of age with suspected UTI for a period of six months. Venous blood samples were sent for Quantitative estimation of CRP, White blood cell count and urine samples were sent for urine microscopy and culture sensitivity. Statistical analysis of data was done using SPSS software version 16.Results: Among 210 infants and children enrolled in the study, 62 (29.55%) had positive urine culture, representing 31.2% and 28.6% of female and male populations respectively. The sensitivity, specificity, positive predictive value(PPV) and negative predictive(NPV) value of CRP (with cut off of 1mg/dl) was 77%,81%, 63% &amp; 90% respectively and that of WBC Count (with cut off of &gt; 12000/ml ) were 56%, 88%, 66% &amp; 83% respectively. Similarly for pyuria (with cut off of &gt;10/HPF) using urine culture as gold standard were 63%, 91%,74% and 85% respectively. The most common organism found in urine culture was E. coli 49(79%). Highest number of isolates were sensitive to Nitrofurantoin(96%) and Amikacin(94%) whereas Amoxycillin was resistant to all the organism tested that was the resistance of 100%.The next common antibiotics found to be resistant was cotrimoxazole (70%).Conclusion: Quantitative C- reactive protein and White blood cell count in blood are very useful markers to predict UTI in febrile infants and children. E coli is the commonest pathogen to cause UTI and Pyuria(pus cells &gt; 10/HPF) has high predictive value for UTI. Birat Journal of Health SciencesVol.2/No.3/Issue 4/Sep- Dec 2017, Page: 296 - 299

Prevalence of Invasive Bacterial Infections in Infants &amp;lt;60 Days with Skin and Soft Tissue Infections

Prevalence of Invasive Bacterial Infections in Infants &amp;lt;60 Days with Skin and Soft Tissue Infections

Serotype distribution and antibiotic resistance of Streptococcus pneumoniae isolates from 17 Chinese cities from 2011 to 2016

BackgroundStreptococcus pneumoniae, the leading pathogen of bacterial infections in infants and the elderly, is responsible for pneumococcal diseases with severe morbidity and mortality. Emergence of drug-resistant strains presented new challenges for treatment and prevention. Vaccination has proven to be an effective means of preventing pneumococcal infection worldwide. Detailed epidemiological information of antibiotic susceptibilities and serotype distribution will be of great help to the management of pneumococcal infections.MethodsA total of 881 S. pneumoniae isolates were collected from patients at 23 teaching hospitals in 17 different cities from 2011 to 2016. The main specimen types included sputum, blood, broncho-alveolar lavage fluid, pharyngeal swabs, and cerebrospinal fluid. Minimum inhibitory concentrations (MICs) were determined using the agar dilution method. Capsular serotypes were identified using latex agglutination and quellung reaction test. Molecular epidemiology was investigated using multilocus sequence typing.ResultsS. pneumoniae isolates were highly resistant to macrolides, tetracycline, and trimethoprim/sulfamethoxazole. The rate of resistance to penicillin was 51.6% (oral breakpoint). However, levofloxacin and moxifloxacin maintained excellent antimicrobial activity and all of the isolated strains were susceptible to vancomycin.Twenty-two serotypes were identified among the 881 isolates. Prevalent serotypes were 19F (25.7%), 19A (14.0%), 15 (6.8%), 6B (3.6%), 6A (3.0%), and 17 (2.8%). The overall vaccine coverage rates for 7- and 13-valent pneumococcal conjugate vaccines were 37.5% and 58.3%, respectively. Vaccine coverage rates in young children and economically underdeveloped regions were higher than those in older adults and developed regions. Vaccine-covered serotypes demonstrated higher resistance compared with uncovered serotypes.Molecular epidemiological typing demonstrated that S. pneumoniae showed significant clonal dissemination and that ST271 (120, 28.3%), ST320 (73, 17.2%) and ST81 (27, 6.6%) were the major STs.ConclusionsHigh resistance to clinical routine antibiotics was observed for all 881 S. pneumoniae strains. Drug resistance varied among different serotypes and age groups. Prevalent serotypes among the isolates were 19F, 19A, 15, 6B, 6A, and 17. Community-acquired strains should also be included in future studies to gain a better understanding of the prevalence and resistance of S. pneumoniae in China.

Febrile infant update.

The approach to febrile young infants remains challenging. This review serves as an update on the care of febrile infants less than 90 days of age with a focus on the changing epidemiology of serious bacterial infection (SBI), refinement of management strategies based on biomarkers, and the development of novel diagnostics. There is high variability in the emergency department management of febrile young infants without significant differences in outcomes. C-reactive protein (CRP) and procalcitonin have emerged as valuable risk-stratification tests to identify high-risk infants. When interpreting automated urinalyses for suspected urinary tract infection (UTI), urine concentration influences the diagnostic value of pyuria. Novel diagnostics including RNA biosignatures and protein signatures show promise in better identifying young febrile infants at risk of serious infection. The majority of febrile infants with an SBI will have a UTI but the diagnosis of invasive bacterial infection in infants continues to be challenging. The use of procalcitonin and CRP as biomarkers in prediction algorithms facilitates identification of low-risk infants.

Avoidance of voiding cystourethrography in infants younger than 3 months with Escherichia coli urinary tract infection and normal renal ultrasound

Background and objectiveUrinary tract infection (UTI) represents the most common bacterial infection in infants, and its prevalence increases with the presence of high-grade vesicoureteral reflux (VUR). However, voiding cystourethrography (VCUG)...

Renal scarring in children under 36 months hospitalised for acute pyelonephritis

Abstract Introduction Acute pyelonephritis (APN) is one of the most common causes of serious bacterial infection in infants. Renal scarring is the most prevalent long-term complication. Objectives To review the incidence of renal scarring within 6 months after an episode of APN in children under 36 months and its relationship with imaging studies, clinical settings, and bacteriology. Method A retrospective study of previously healthy patients aged one to 36 months, admitted for a first episode of APN, with a minimum follow-up of 6 months. Demographic and clinical variables were collected along with bacteriology, renal and bladder ultrasound scan, voiding cystourethrography, DMSA-scintigraphy, and re-infection events. Results A total of 125 patients were included in the study, of which 60% were male, the large majority (92%) febrile, and due to Escherichia coli (74.6%). There was a history of prenatal ultrasound scan changes in 15.4%. Ultrasound scan found dilation of the urinary tract in 22.1%. Voiding cystourethrography was performed on 70 patients: 54.3% no abnormalities, 12.8% vesicoureteral reflux (VUR) grade i - iii , and 32.9% iv - v grade VUR. Six patients had iv - v grade VUR with a normal ultrasound scan. Adherence to DMSA-scintigraphy at 6 months was only 61% of that indicated. Renal scarring was found in 44.3% of those in which it was performed (60 cases). Conclusions Almost half (44%) DMSA-scintigraphy in children aged one to 36 months hospitalised for APN show renal scarring at 6 months, which was found to be associated with the re-infection events and the iv - v grade VUR. There was no relationship between scarring and the bacteriology or the elevations of inflammatory biochemical markers.

Early-Onset Neonatal Sepsis in the Era of GBS Prophylaxis

The incidence of early-onset neonatal sepsis due to group B Streptococcus (GBS) has declined significantly following the implementation of intrapartum prophylaxis. Initial surveillance reports raised concerns that screening and prophylaxis for GBS would result in an increased burden of antibiotic-resistant Escherichia coli neonatal sepsis. In the current study, investigators reviewed 10 years of population-based surveillance data on invasive bacterial infections in infants …