Bacterial Infections In Infants Research Articles

Severe and invasive bacterial infections in infants aged less than 90 days with and without SARS-CoV-2 infection

BackgroundFever in children represents one of the most common causes of medical evaluation. Infants younger than 90 days of age are at higher risk of severe and invasive bacterial infections (SBI and IBI). However, clinical signs and symptoms of viral and bacterial infections in young infants are frequently similar, and several studies have shown that the risk of SBIs remains non-negligible even in the presence of a positive point-of-care viral test. Our study aims to evaluate whether the proportion of SBIs and IBIs in febrile infants younger than 90 days during the COVID-19 pandemic was higher than that in the pre-pandemic period, and to describe the proportion of SBIs and IBIs in infants with and without SARS-CoV-2 infection.MethodsThis was a retrospective single-center cohort study conducted at the Children's Hospital of the University of Padua in Italy, involving febrile young infants evaluated in the Pediatric Emergency Department (PED) and admitted to Pediatric Acute Care Unit (PACU) between March 2017 to December 2022. Infants admitted before the COVID-19 pandemic were compared to infants admitted during the pandemic period and SARS-CoV-2 positive patients to the negative ones.Results442 febrile infants younger than 90 days were evaluated in Padua PED and admitted to the wards. The proportion of SBIs and IBIS did not significantly change over the study periods, ranging between 10.8% and 32.6% (p = 0.117) and between 0% and 7.6%, respectively (p = 0.367). The proportion of infants with a diagnosis of SBIs and IBIs was higher in the SARS-CoV-2 negative group (30.3% and 8.2%, respectively) compared to the positive group (8.5% and 2.8%, respectively) (p < 0.0001). The most common diagnosis in both groups was UTI, mainly caused by E. coli. A similar proportion of blood and urine cultures were performed, whereas lumbar puncture was more frequently performed in SARS-CoV-2 negative infants (40.2% vs 16.9%, p = 0.001).ConclusionsAlthough the risk of concomitant serious bacterial infection with SARS-CoV-2 is low, it remains non-negligible. Therefore, even in SARS-CoV-2-positive febrile infants, we suggest that the approach to screening for SBIs remains cautious.

Pediatric respiratory pathogen dynamics in Southern Sichuan, China: a retrospective analysis of gender, age, and seasonal trends.

To address the research gap in the epidemiology of pediatric respiratory tract infections (RTIs) in Luzhou, Southern Sichuan, China, by analyzing respiratory pathogens in a large pediatric cohort from 2018 to 2021, covering the pre- and during-COVID-19 periods. This study conducted a retrospective analysis of children with RTIs in Luzhou from July 2018 to January 2021. Strict exclusion criteria were applied to ensure an accurate representation of the pediatric population. Pathogen detection included viruses, bacteria, and atypical agents. Pathogens were identified in 52.8% of 12,546 cases. Viruses accounted for 32.2% of infections, bacteria for 29.8%, and atypical agents for 29.7%, with significant findings of Staphylococcus aureus, Moraxella catarrhalis, and Mycoplasma pneumoniae. Age-related analysis indicated a higher incidence of bacterial infections in infants and viral infections in preschool-aged children, with atypical pathogens being most prevalent in 3-5-year-olds. Gender-based analysis, adjusted for age, revealed similar overall pathogen presence; however, females were more susceptible to viral infections, while males were more prone to Streptococcus pneumoniae. Notably, there was an unusual increase in pathogen cases during spring, potentially influenced by behavioral changes and public health measures related to COVID-19. Co-infections were identified as a significant risk factor for the development of pneumonia. The study provides essential insights into the epidemiology of respiratory pathogens in pediatric populations, emphasizing the need for healthcare strategies tailored to age, gender, and seasonality. The findings highlight the impact of environmental and public health factors, including COVID-19 measures, on respiratory pathogen prevalence, underscoring the importance of targeted diagnostic and treatment protocols in pediatric respiratory infections.

Association Between Antibiotic Duration and Recurrence of Urinary Tract Infection in the Neonatal Critical Care Unit.

Urinary tract infection (UTI) is the most common bacterial infection in infants. Current practice guidelines suggest a treatment duration of 7 to 14 days. Suboptimal therapy may increase the risk for recurrent UTIs leading to renal scarring and possibly chronic kidney disease. The primary objective is to evaluate the duration of therapy for UTIs and its association with the incidence of recurrent UTIs in a neonatal intensive care unit (NICU). The secondary objectives are to identify the risk factors and the most common organisms for recurrent UTIs. Patients were identified via the diagnosis codes for UTIs and were included if admitted to the NICU and if they received antibiotics prior to hospital discharge. Patients were divided into 2 groups: antibiotic treatment for 7 days or fewer and antibiotic treatment for greater than 7 days. Eighty-six infants were included in the study. Twenty-six patients received antibiotics for 7 days or fewer, and 60 for more than 7 days. In the study, the median birth weight was 977 g and the median gestational age was 27.6 weeks. There was no significant difference in the rate of recurrent UTIs between the 2 groups (p = 0.66). However, in the subgroup analysis, the incidence was higher for patients receiving antibiotic therapy for fewer than 7 days versus 7 days (p = 0.03). There was no difference in recurrence of UTI between treatment groups (≤7 days versus >7 days), and recurrence was seen in a higher percentage of patients with a urinary tract anomaly.

Genetic determinants of renal scarring in children with febrile UTI

BackgroundFebrile urinary tract infections (UTIs) are among the most severe bacterial infections in infants, in which a subset of patients develops complications. Identifying infants at risk of recurrent infections or kidney damage based on clinical signs is challenging. Previous observations suggest that genetic factors influence UTI outcomes and could serve as predictors of disease severity. In this study, we conducted a nationwide survey of infant genotypes to develop a strategy for infection management based on individual genetic risk. Our aims were to identify genetic susceptibility variants for renal scarring (RS) and genetic host factors predisposing to dilating vesicoureteral reflux (VUR) and recurrent UTIs.MethodsTo assess genetic susceptibility, we collected and analyzed DNA from blood using exome genotyping. Disease-associated genetic variants were identified through bioinformatics analysis, including allelic frequency tests and odds ratio calculations. Kidney involvement was defined using dimercaptosuccinic acid (DMSA) scintigraphy.ResultsIn this investigation, a cohort comprising 1087 infants presenting with their first episode of febrile UTI was included. Among this cohort, a subset of 137 infants who underwent DMSA scanning was subjected to gene association analysis. Remarkable genetic distinctions were observed between patients with RS and those exhibiting resolved kidney involvement. Notably, the genetic signature indicative of renal scarring prominently featured mitochondrial genes.ConclusionsIn this nationwide study of genetic susceptibility to RS after febrile UTIs in infancy, we identified a profile dominated by mitochondrial polymorphisms. This profile can serve as a predictor of future complications, including RS and recurrent UTIs.Graphical abstractA higher resolution version of the Graphical abstract is available as Supplementary information

Incidence of infant Gram-negative invasive bacterial infections in England, 2011–2019: an observational study using population-wide surveillance data

ObjectiveInvasive bacterial infections account for an estimated 15% of infant deaths worldwide. We aimed to estimate the incidence and trends in invasive bacterial infections in infants caused by Gram-negative pathogens...

Utilizing Clinical Decision Support in the Treatment of Urinary Tract Infection across a Large Pediatric Primary Care Network.

Cystitis and pyelonephritis are common bacterial infections in infants and children, and initial treatment is usually empirical. Antimicrobial stewardship advocates using narrow-spectrum antibiotics with consideration for local resistance patterns. Narrow-spectrum antibiotic use is critical in addressing the global issue of bacterial antimicrobial resistance, associated with approximately 5 million annual deaths. The antimicrobial stewardship committee developed a guideline for diagnosing and managing urinary tract infections and distributed it to all primary care providers. A standardized order set provided clinical decision support regarding appropriate first-line antibiotic therapy. A chief complaint of dysuria prompted the use of the order set. Prescription rates for the most common antimicrobials were tracked on a control chart. From March 2018 through March 2020, there were 4,506 antibiotic prescriptions for urinary tract infections. Utilization of the recommended first-line therapy, cephalexin, increased from 27.5% to 74.8%. Over the same period, trimethoprim-sulfamethoxazole, no longer recommended due to high local resistance, decreased from 31.8% to 8.1%. Providers have maintained these prescribing patterns since the conclusion of the project. Using clinical decision support as a standardized order set can sustainably improve the use of first-line antimicrobials for treating pediatric urinary tract infections.

Comparation on the ability of the step-by-step approach and the lab-score method in early identification of non-bacterial infection in febrile infants with less than 90 days old

To compare the ability of the step-by-step approach and the lab-score method in early identification of non-bacterial infection in febrile infants with less than 90 days old. A prospective study was conducted. The febrile infants with less than 90 days old hospitalized in the department of pediatrics of Xuzhou Central Hospital from August 2019 to November 2021 were enrolled. The basic data of the infants were recorded. The infants with high risk or low risk of bacterial infection was evaluated by the step-by-step approach and the lab-score method, respectively. The step-by-step approach was based on clinical manifestations, age, blood neutrophil absolute value or C-reactive protein (CRP), urine white blood cells, blood venous blood procalcitonin (PCT) or interleukin-6 (IL-6) to gradually assess the high risk or low risk of bacterial infection in infants with fever. The lab-score method was based on the levels of laboratory indicators such as blood PCT, CRP and urine white blood cells, which were assigned different scores to evaluate the high risk or low risk of bacterial infection in febrile infants according to the total score. Using clinical bacterial culture results as the "gold standard", the negative predictive value (NPV), positive predictive value (PPV), negative likelihood ratio, positive likelihood ratio, sensitivity, specificity, and accuracy of the two methods were calculated. The consistency of the two evaluation methods was tested by Kappa. A total of 246 patients were enrolled in the analysis, and ultimately confirmed by bacterial culture as non-bacterial infections in 173 cases (70.3%), bacterial infection in 72 cases (29.3%), and unclear in 1 case (0.4%). There were 105 cases with low risk evaluated by the step-by-step approach, and 98 cases (93.3%) were ultimately confirmed as non-bacterial infection; 181 cases with low risk evaluated by the lab-score method, and 140 cases (77.4%) were ultimately confirmed as non-bacterial infection. The consistency of the two evaluation methods was poor (Kappa value = 0.253, P < 0.001). The ability of the step-by-step approach in early identification of non-bacterial infection in febrile infants with less than 90 days old was superior to the lab-score method (NPV: 0.933 vs. 0.773, negative likelihood ratio: 5.835 vs. 1.421), but the sensitivity of the former was lower than that of the latter (0.566 vs. 0.809). The ability of the step-by-step approach in early identification of bacterial infection in febrile infants with less than 90 days old was similar to the lab-score method (PPV: 0.464 vs. 0.484, positive likelihood ratio: 0.481 vs. 0.443), but the specificity of the former was higher than that of the latter (0.903 vs. 0.431). The overall accuracy of the step-by-step approach and the lab-score method was similar (66.5% vs. 69.8%). The ability of the step-by-step approach in early identification of non-bacterial infections in febrile infants with less than 90 days old is superior to the lab-score method.

Usefulness of C-Reactive Protein and Clinical Characteristics in Identifying Severe Bacterial Infection in Children with Fever without Source.

Fever continues to be the most frequent cause of care in the pediatric population. The uses of invasive and unnecessary tests result in discomfort to the patients. Local epidemiological data could help to refine screening strategies, especially in low resources settings. The present study aims to describe the prevalence of serious bacterial infections in infants with fever without source and to evaluate the usefulness of clinical and laboratory parameters in the identification of serious bacterial infections. We included all children aged 0-36 months presenting with fever without source between January 2015 and December 2017. Demographic and clinical characteristics, investigations, and management procedures were recorded at the time of inclusion. Potential predictors of serious bacterial infections were compared between patients with and without serious bacterial infections. In total, 137 patients were included. Serious bacterial infections were diagnosed in 41 patients (29.9%; 95% CI, 22%-38%). The most frequent diagnosis in serious bacterial infection patients was urinary tract infection (78%). Serum C-reactive protein levels greater than 80 mg/L (odds ratio, 2.79 [1.14,6.86]) and total days with fever (odds ratio, 2.56 [1.81,3.62]) showed a significant association to predict serious bacterial infections. Most infants with fever without source presented self-limited febrile syndromes without evidence of severe bacterial infection. C-reactive protein levels greater than 80 mg/L and the number of previous days with fever were variables associated with the presence of serious bacterial infections. Our results need to be validated in other tropical countries.

High-Throughput 16 S rRNA Gene Sequencing Reveals Bacterial Diversity of Infant Formula Production Line Samples in Spring and Summer

The trend of low breastfeeding rates increases the demand for infant milk formula (IMF) worldwide, but the use of IMF may be one of the causes of bacterial infections in infants. Complete sterility in the whole production line of IMF cannot be guaranteed; therefore, it is necessary to closely monitor the microbial content in the process. In the present study, an IMF powder production line based on the wet mixing process was sampled at 27 suspicious points in spring and summer to analyze the bacterial diversity by high-throughput sequencing. We found that 70 and 69 different bacterial phyla were present in spring and summer samples, respectively, with Proteobacteria and Firmicutes being the dominant phyla (&gt;80% relative abundance). Moreover, 13 dominant genera each were present in spring (e. g., Pseudomonas and Lactococcus) and summer (e. g., Pseudomonas, Bacillus, and Streptococcus). Samples associated with workers showed higher bacterial species diversity (Shannon index) and richness (Chao1 index) in summer than in spring. The bacterial community composition showed high similarity between liquid milk after pasteurization and concentrated milk after evaporation. The potential bacterial pathogens were identified as Pseudomonas aeruginosa in spring and Acinetobacter baumannii in summer. Through retrospective analysis of the two opportunistic pathogens identified, it was found that the workshop environment was the potential contamination point in spring, whereas the auxiliary ingredients were the potential source of contamination in summer. The results highlight the effect of season on bacterial diversity associated with the production process of IMF and are useful in controlling the microbial quality and safety of infant dairy products.

The prevalence of serious bacterial infections in infants 90 days and younger with viral respiratory tract infections.

To determine the prevalence and risk factors of serious bacterial infections (SBIs) in infants 90 days and younger with a confirmed respiratory tract infection (RTI). A retrospective cross-sectional study was carried out of infants 90 days and younger who were admitted to King Abdullah Specialized Children's Hospital, Riyadh, Saudi Arabia, from January 2019 to December 2020, with polymerase chain reaction (PCR)-proven RTI. Cultures from the urine, blood, and cerebrospinal fluid were reviewed with the patients' demographic information and clinical presentation. Of 322 patients with a viral RTI, 21 (6.5%) had a concurrent urinary tract infection (UTI), and no patients had bacteremia or bacterial meningitis. The risk of a concurrent SBI was 4 times higher in neonates (odds ratio [OR]=4.66, 95% confidence interval [CI]: [1.32-16.47]). Previously healthy infants were at lower risk to have a SBI in comparison to those with chronic diseases or renal abnormalities (OR=0.23, 95% CI: [0.09-0.61]). In addition, male gender (OR=3.49, 95% CI: [1.07-11.38]) and abnormal urinalysis (OR=4.12, 95% CI: [1.48-11.42]) were predictors of SBIs. There was no statistically significant association between the number or type of detected viruses and SBIs. No cases of invasive bacterial infections were found in infants with PCR-proven viral RTIs. There is a risk of having a concurrent UTI in this cohort of patients. Neonates had a higher risk of UTIs as compared to older infants.

Utility of the systemic immune-inflammation index to predict serious bacterial infections in infants with fever without a source

ABSTRACT Introduction This study analyzed the utility of the systemic immune-inflammation index (SII) in predicting serious bacterial infections (SBIs) in infants with fever without a source (FWS). Methods Infants (aged 1–4 months) evaluated in the pediatric emergency department for FWS were divided into two groups: with SBI and without SBI. The efficacy of inflammatory markers in predicting SBI was compared. Results The study included 223 infants with a mean age of 76.65 ± 25.42 days; 62 (27.8%) of them were included in the SBI group, and all of them were diagnosed with a urinary tract infection (UTI). The hospitalization rate and length of hospital stay were significantly higher in UTI patients (p < 0.001 for each). The mean SII was 795.76 ± 475.85 in the SBI group and 318.24 ± 300.70 in the non-SBI group, and there was a significant difference between the groups (p < 0.001). In diagnosis of SBI, the area under the curve values were found to be 0.89 [95% confidence interval (CI): 0.85–0.94] for C-reactive protein (CRP), 0.86 (95% CI: 0.81–0.91) for absolute neutrophil count (ANC), 0.84 (95% CI: 0.78–0.89) for the SII, and 0.81 (95% CI: 0.74–0.87) for WBC. In the multivariate logistic regression analysis, high CRP and SII values were found to be predictive factors for UTI without bacteremia (p < 0.001 and p = 0.008, respectively). Conclusion We found that high CRP and SII values could be predictive for UTI without bacteremia in infants with FWS. The SII may be preferred because it can be easily calculated using the hemogram results, is not accompanied by extra costs, and does not require further blood collection.

Risk factors for multidrug resistant bacterial infection in infants with bronchopulmonary dysplasia re-hospitalized due to lower respiratory tract infection: a case-control study

To evaluate the epidemiological characteristics and risk factors for multidrug-resistant bacterial infection (MDRI) in infants with bronchopulmonary dysplasia (BPD) readmitted to the hospital due to lower respiratory tract infection (LRTI), providing a basis for the clinical prevention and treatment of MDRI.A retrospective analysis of readmission due to LRTI in infants with BPD within 1 year corrected age from October 2012 to December 2020 was performed. Twenty-nine children with MDRI were selected as the case group, and 80 children without MDRI during the same period served as the control group. We reviewed and collected relevant infants’ neonatal hospitalization experience, broad-spectrum antibiotic (BSA) selection, and microbiological data. BSA included carbapenem antibiotics, third-generation cephalosporins and cephalosporin/β-lactamase inhibitor combinations, and penicillin/β-lactamase inhibitor (P/BLI) combinations.The length of stay in hospitalized patients with MDRI was significantly prolonged (p &lt; 0.05), and the BSA use rate was high (&gt;94.1%). Single-level factor analyses showed that nosocomial infection and the P/BLI usage rate in the Neonatal Intensive Care Unit (NICU) were related to MDRIs (all p &lt; 0.05). NICU-MDRI, BSA, dual antibiotics, and mechanical ventilation were not significantly associated with MDRIs on readmission (all p &gt; 0.05). Binary logistic regression analysis indicated nosocomial infection as an independent risk factor related to MDRIs (Odds ratio (OR) 5.3, 95% confidence interval (CI) 1.7–16.4).Nosocomial infection remains the most important risk factor for MDRI in BPD infants. For infants with BPD, more cautions should be taken on whether to choose BSA directly based on the bacterial species infected during the NICU or the long-term hospitalization history.

Invasive Bacterial Infections in Infants With Skin and Soft-Tissue Infections

Research Article| September 01 2021 Invasive Bacterial Infections in Infants With Skin and Soft-Tissue Infections AAP Grand Rounds (2021) 46 (3): 27. https://doi.org/10.1542/gr.46-3-27 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Twitter LinkedIn Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation Invasive Bacterial Infections in Infants With Skin and Soft-Tissue Infections. AAP Grand Rounds September 2021; 46 (3): 27. https://doi.org/10.1542/gr.46-3-27 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search nav search search input Search input auto suggest search filter All PublicationsAll JournalsAAP Grand RoundsPediatricsHospital PediatricsPediatrics In ReviewNeoReviewsAAP NewsAll AAP Sites Search Advanced Search Topics: bacterial infections, skin, skin and soft tissue infections, soft tissue infections, urinary tract infections, bacteremia Source: Lopez MA, Hall M, et al. Invasive bacterial infections in infants younger than 60 days with skin and soft tissue infections. Pediatr Emerg Care. 2021;37(6):e301-e306; doi: https://doi.org/10.1097/PEC.0000000000001584Google Scholar Investigators from multiple institutions conducted a retrospective cohort study to determine the frequency of invasive bacterial infection (IBI) in infants with skin and soft-tissue infections (SSTI). Infants were eligible if they were: (a) <60 days of age; (b) visited 1 of 35 EDs that contribute data to the Pediatric Health Information System (PHIS) between 2009–2014; and (c) were assigned a primary ICD-9 code for SSTI (eg, cellulitis, abscess, mastitis) or a secondary diagnosis of SSTI and a primary diagnosis of fever, IBI, urinary tract infection (UTI), or anal fistula. Infants with complex chronic conditions were excluded. Demographics as well as... You do not currently have access to this content.

Treatment of UTIs in Infants

Urinary tract infections (UTIs) are the most common bacterial infections in infants <2 months of age. However, there are no clear guidelines on the appropriate duration of antibiotics in this age group. In this living systematic review, we compared different durations of parenteral antibiotics (≤3 vs >3 days) in neonates and young infants (<2 months) with UTIs. The secondary objective was to compare different durations of total antibiotic courses (≤10 vs >10 days). MEDLINE, Embase, Cochrane Central Register of Controlled Trials, Web of Science, Literatura Latino-Americana e do Caribe em Ciências da Saúde, Google Scholar, and gray literature, up to March 2, 2021. Citations were screened in triplicate by using a crowdsourcing methodology, to identify randomized controlled trials and observational studies. Data were extracted by 2 crowd members and verified by an expert investigator. Outcomes were pooled via random-effects models. A total of 10 334 citations were screened, and 12 eligible studies were identified. A total of 59 of 3480 (1.7% [95% confidence interval (CI): 1.3% to 2.2%]) infants had a UTI recurrence within 30 days after short parenteral treatment (≤3 days), and 47 of 1971 (2.4% [95% CI: 1.8% to 3.2%]) after longer courses. The pooled adjusted odds ratio for UTI recurrence with a short versus long duration of parenteral antibiotics was 1.02 (95% CI: 0.64 to 1.61; P = .95; n = 5451). A total of 5 studies assessed the risk of recurrence on the basis of the total duration of antibiotics (≤10 vs >10 days) with no significant differences (pooled odds ratio: 1.29 [95% CI: 0.45 to 3.66; P = .63; n = 491). On the basis of retrospective studies and Grading of Recommendations, Assessment, Development, and Evaluation level low evidence, short and long duration of parenteral antibiotics were associated with a similar risk of UTI recurrence in infants <2 months.

Prevalence and Atopy Association of Mycoplasma Pneumoniae and Chlamydia Pneumoniae Infections in Infants with Recurrent Wheezing

The most common cause in the etiology of wheezing is respiratory tract infections. Viruses (in especially RSV), Chlamydia Pneumoniae and Mycoplasma Pneumoniae bacteria can cause transient airway hypersensitivity and wheezing by causing tissue damage and inflammation when they reach the lower respiratory tract. The association has been demonstrated and discussed between these two atypical bacteria and asthma. By setting major and minor parameters for predicting asthma risk, the asthma predictive index (API) was developed in children with excessive wheezing. This study was planned to examine the relationship of atopy and atypical bacterial infections in infants with persistent wheezing. Thirty-two females and fifty-eight males children under 2 years of age were included in the study. Fifty-six cases (62.2%) were positive for API and thirty-four cases (37.8%) were negative. The presence of infection was investigated by enzyme-linked immunosorbent assay (ELISA) and polymerase chain reaction (PCR) method. It was found that both infections were substantially more serious in the second year than in the first year of life. However no statistically meaningful outcome was obtained, when comparing the presence of both pathogens and API positivity. Regardless of the API, the existence of bacterial agents was found to be statistically meaningful, especially in the range of 1-2 years, when subgroup analysis was performed in children with wheezing under the age of 2 years. It is appropriate to keep in mind the existence of these two bacteria in wheezy children. In the second year of life, both infection agents also showed a statistically significant increase and found that these patients could develop persistent wheezing.

Urinary tract infection in children presenting with diarrhea

Background: Urinary tract infection (UTI) are the 3rd most common bacterial infection in infants and young children in developing countries after those of respiratory and gastrointestinal tract infection. Because of nonspecific signs and vague symptoms in very young children, they may remain unrecognized. Rapid evaluation and treatment of UTI is important to prevent renal parenchymal damage and renal scarring that can cause hypertension and progressive renal damage. Since gastroenteritis is rampant in developing countries demonstration of an association between UTI and diarrhea will be of clinical significance. The objective of this study was to estimate the prevalence of UTI in children presenting with diarrhea and to identify the clinical co-relates which may guide to identify children with UTI.Methods: This was a descriptive observational study done in 120 children meeting the inclusion and exclusion criteria, who were admitted in the paediatric ward in father Muller medical college hospital for a period of 1 and a half years. After obtaining an informed consent, a detailed clinical examination was performed on children meeting the inclusion criteria and the data was entered to the preformatted sheet. Urine samples were obtained from all the patients by clean catch mid-stream urine sample, following which urine culture was done for all the children.Results: In the present study, out of 120 children presenting with Diarrhea 17% had UTI. E. coli (15 cases) was the most common organism isolated in urine culture followed by Enterococcus. Out of 20 UTI cases, 15 were in the age group of 6 months to 1 year followed by 4 cases among 1-3-year age group.18 out of 20 UTI cases were females. Male:female ratio of UTI patients was 1:9.Conclusions: UTI in young children can present with diarrhea and other nonspecific symptoms. Children presenting with diarrhea need to have a urine analysis and urine culture for the confirmation of UTI, so that long term complications like renal parenchymal damage and hypertension can be prevented.

Risk factors for death in suspected severe bacterial infection in infants aged

BackgroundYearly, about two million infants die during the first 28 days of life. Most of these deaths occur in sub-Saharan Africa and a third of those are caused by severe infections. The early identification of infants at risk of death is important when trying to prevent poor outcomes. ObjectiveThe aim of this study was to identify risk factors for death among young infants with possible serious bacterial infection (pSBI) at hospital admission. MethodsThis prospective, observational, single-site, descriptive study forms part of a larger study on bacterial meningitis in infants <90 days of age admitted to the Pediatric Hospital of Luanda, the capital of Angola, from February 1, 2016 to October 23, 2017. Infants with pSBI, a known outcome, and a final diagnosis were included. ResultsOf 574 young infants with pSBI, 115 (20%) died in hospital. An altered level of consciousness, absence of spontaneous movements, dyspnea, CSF that is not clear, low CSF glucose, high CSF protein, heart rate over the median, and seizures were identified as risk factors for death in the univariate analysis. In the multivariate analysis, only heart rate over the median and seizures were independent predictors of death. ConclusionsEasily recognizable clinical signs – tachycardia and seizures – may guide clinicians to identify infants at high risk of death due to severe bacterial infections in sub-Saharan Africa.

Urinary imaging findings in young infants with bacteremic urinary tractinfection.

Background: The Urinary Tract Infection (UTIs) is one of the most widely acquired bacterialinfections in infants. UTI sometimes accompanied by bacteremia. Bacteremia is characterising as thedevelopment of a pathogen within the blood culture. Imaging tests, such as a Renal Ultrasound (RUS)and Avoiding Cystourethrogram (VCUG) use to diagnose UTIs. Aim: We aimed to describe RUS and VCUG findings in young infants with bacteremic urinary tractinfection and to determine the association between imaging findings and other variables at a tertiaryhospital in Jeddah, Saudi Arabia. Methods: We retrospectively studied the medical records of 30 infants from both genders who haddiagnosed with bacteremic UTIs at a tertiary hospital in Jeddah, Saudi Arabia. Infants were excludedif they had known urologic abnormalities at the time of presentation, required intensive unite care andinfants with immunocompromised diseases. Data was analyzed by SPSS program. Results: Of the 30 infants, 70% were boys, 50% aged from 0-3 months while the other 50% aged >3months, 14 (46.7%) were Saudis while 16 (53.3%) were non-Saudis, 61.1% were non-febrile, 58.62%had standard creatinine value. All infants 100% underwent RUS, 96.2% of them had RUSabnormalities (18 males and seven females) while only 3.8% (1 male) had typical RUS result. 37.9% ofinfants underwent VCUG, 18.2% (2 miles) of them had normal VCUG, while the majority 81.8% (7males and two females) had abnormal findings. 17.9% presented with VUR. There was no significantassociation between RUS results with sex, age group, creatinine value and urine cultures. On anotherhand, there was a significant association between RUS abnormal result and blood culture. Also, nosignificant association found between VCUG results with sex, age group, creatinine, blood and urinecultures. Conclusion: In conclusion, the prevalence of RUS and VCUG abnormality in our cohort found to behigher than other studies. There was a significant association between RUS finding and blood cultureresults; on another hand, there was no significant association between RUS and VCUG findings withother variables that could suggest bacteremic risk in UTI infants.

Use of procalcitonin and C-reactive protein in the diagnosis of bacterial infection in infants with severe bronchiolitis.

The objective was to evaluate the use of procalcitonin (PCT) and C-reactive protein (CRP) for the diagnosis of bacterial infection in bronchiolitis patients. A prospective, single-centre, descriptive, and comparative observational study was carried out on patients with severe bronchiolitis admitted to the paediatric intensive care unit (PICU), from January 2011 to July 2017. Two cohorts were compared: patients with invasive bacterial infection (IBI) and patients with no bacterial infection (NBI). We included 675 patients, 399 of whom were males (59.1%), with median age of 47 days (IQR 25-100.3). Of them, 181 patients were diagnosed with IBI (26.8%). Seventy-two had sepsis (10.7%), 106 had pneumonia (15.7%), and 41 had a urinary tract infection (6.1%). PCT and CRP values were significantly higher in patients with IBI. ROC curves compared the ability of PCT and CRP to diagnose IBI at admission, 24 h, and 48 h. PCT showed a better AUC for diagnosing IBI, with statistically significant differences at all time points (p < 0.001). The best PCT cut-off for IBI diagnosis at admission was 1.4 ng/mL, with a sensitivity of 69% (95% CI 58.4-74.9) and a specificity of 91% (95% CI 88.1-92.5). Procalcitonin showed a better AUC for diagnosing both sepsis and pneumonia, which makes it an excellent predictor.Conclusion: We present PCT as a novel test in comparison with the traditional CRP screening test to discern which bronchiolitis patients have IBI. We highlight the importance of PCT for the diagnosis of pneumonia and sepsis, as it proved to be more sensitive and specific than CRP, with statistically significant differences. What is Known: • Bronchiolitis should be treated with antibiotics only when a bacterial infection is present. • The rate of antibiotic prescription in severe bronchiolitis is extremely high, so diagnostic tools are needed. What is New: • PCT is a good biomarker to discern which bronchiolitis patients have IBI, specially for pneumonia and sepsis diagnoses. It is more sensitive and specific than CRP, with statistically significant differences. • Implementation of PCT cut-off values may prevent unnecessary antibiotic use.

Accuracy of PECARN rule for predicting serious bacterial infection in infants with fever without a source

ObjectiveTo validate the Febrile Infant Working Group of the Pediatric Emergency Care Applied Research Network (PECARN) clinical prediction rule on an independent cohort of infants with fever without a source...