Common Infections In Children Research Articles

A clinical study of uropathogens causing urinary tract infection in children and adolescents in a tertiary care hospital

Background: Urinary Tract Infection (UTI) is one of the common infections in children. Incidence varies with age, race and gender. UTIs have become difficult to treat due to development of resistance among uropathogens. Regional data regarding the common uropathogens and their antimicrobial susceptibility pattern is required to guide the clinicians to start empirical therapy while treating UTIs.Aims: This study is aimed to study the profile of uropathogens causing UTI in children and adolescents, assess their antimicrobial susceptibility, the clinical course and outcome.Methods: All subjects with suspected UTI whose urine samples grew a positive culture of uropathogens were included in this prospective observational study. The study was done in the Department of Microbiology from July 2019 to December 2019. The urine samples were processed by standard methods (using 5% sheep blood agar and MacConkey agar) and antimicrobial susceptibility was performed using the Kirby-Bauer disk diffusion method. The details of the pathogens grown, and their antimicrobial sensitivity and resistance patterns were recorded, and the subjects were followed up during their course in the hospital.Results: A total of 109 urine samples from paediatric and adolescent subjects showed positive cultures (97.32%). UTI was common among toddlers (46.7%). E. coli contributed to 40.3% of the cases, followed by Enterococcus and Klebsiella pneumonaie. E. coli was resistant to amoxicillin + clavulanic acid, cephalosporins and ciprofloxacin. The organisms were sensitive to meropenem, amikacin and piperacillin + tazobactam.Conclusion: Incidence of UTI and the uropathogens causing UTI varies with age. Different uropathogens and their resistance to commonly used antimicrobials is a concern for future treatment options in UTI.

The potential negative impact of antibiotic pack on antibiotic stewardship in primary care in Switzerland: a modelling study

BackgroundIn Switzerland, oral antibiotics are dispensed in packs rather than by exact pill-count. We investigated whether available packs support compliance with recommended primary care treatment regimens for common infections in children and adults.MethodsHospital-based guidelines for oral community -based treatment of acute otitis media, sinusitis, tonsillopharyngitis, community-acquired pneumonia and afebrile urinary tract infection were identified in 2017 in an iterative process by contacting hospital pharmacists and infectious diseases specialists. Furthermore, newly available national guidelines published in 2019 were reviewed. Available pack sizes for recommended solid, dispersible and liquid antibiotic formulations were retrieved from the Swiss pharmaceutical register and compared with recommended regimens to determine optimal (no leftovers) and adequate (optimal +/− one dose) matches.ResultsA large variety of recommended regimens were identified. For adults, optimal and adequate packs were available for 25/70 (36%) and 8/70 (11%) regimens, respectively. Pack-regimen matching was better for WHO Watch (optimal: 15/24, 63%) than Access antibiotics (optimal: 7/39, 18%). For the four paediatric weight-examples and 42 regimens involving child-appropriate formulations, optimal and adequate packs were available for only 14/168 (8%) and 27/168 (16%), respectively. Matching was better for older children with higher body and for longer treatment courses > 7 days.ConclusionsFixed antibiotic packs often do not match recommended treatment regimens, especially for children, potentially resulting in longer than necessary treatments and leftover doses in the community. As part of national stewardship, a move to an exact pill-count system, including for child-appropriate solid formulations, should be considered.

Smell - Adding a New Dimension to Urinalysis.

Background: Urinary tract infections (UTI) are among the most common infections in children. The primary tool to detect UTI is dipstick urinalysis; however, this has limited sensitivity and specificity. Therefore, urine culture has to be performed to confirm a UTI. Urinary volatile organic compounds (VOC) may serve as potential biomarker for diagnosing UTI. Previous studies on urinary VOCs focused on detection of UTI in a general population; therefore, this proof-of-principle study was set up in a clinical high-risk pediatric population. Methods: This study was performed at a tertiary nephro-urological clinic. Patients included were 0–18 years, clinically suspected of a UTI, and had abnormal urinalysis. Urine samples were divided into four groups, i.e., urine without bacterial growth, contamination, colonization, and UTI. VOC analysis was performed using an electronic nose (eNose) (Cyranose 320®) and VOC profiles of subgroups were compared. Results: Urinary VOC analysis discriminated between UTI and non-UTI samples (AUC 0.70; p = 0.048; sensitivity 0.67, specificity 0.70). The diagnostic accuracy of VOCs improved when comparing urine without bacterial growth versus with UTI (AUC 0.80; p = 0.009, sensitivity 0.79, specificity 0.75). Conclusions: In an intention-to-diagnose high-risk pediatric population, UTI could be discriminated from non-UTI by VOC profiling, using an eNose. Since eNose can be used as bed-side test, these results suggest that urinary VOC analysis may serve as an adjuvant in the diagnostic work-up of UTI in children.

Defining Pneumonia Severity in Children: A Delphi Study.

Although community-acquired pneumonia (CAP) is one of the most common infections in children, no standardized risk classification exists to guide management. The objective of this study was to develop expert consensus for factors associated with various degrees of disease severity in pediatric CAP. Using a web-based classical Delphi process, a multidisciplinary panel of 10 childhood pneumonia experts rated the degree of severity (mild, moderate, or severe) of clinical, radiographic, and laboratory factors, as well as outcomes relevant to pediatric pneumonia. Round 1 was open-ended, with panelists freely stating all characteristics they felt determined pneumonia severity. In rounds 2 to 4, panelists used a 9-point Likert scale (1-3, mild; 4-6, moderate; 7-9, severe) to rate severity for each item. Consensus was defined as 70% or greater agreement in ranking mild, moderate, or severe. Panelists identified 318 factors or outcomes in round 1; the panel reached consensus for 286 (90%). The majority of items without consensus straddled levels of severity (eg, mild-moderate). Notable clinical factors with consensus included age, oxygen saturation, age-based respiratory rate, and gestational age. Severity classification consensus was also reached for specific imaging and laboratory findings. Need for and duration of hospitalization, supplemental oxygen/respiratory support, and intravenous fluids/medications were considered important outcomes in classifying severity. This study presents factors deemed important for risk stratification in pediatric CAP by consensus of a multidisciplinary expert panel. This initial step toward identifying and formalizing severity criteria for CAP informs critical knowledge gaps and can be leveraged in future development of clinically meaningful risk stratification scores.

Nursery rhyme can help curb spread of common infections in children

Using songs may help school children to remember proper hand washing steps says new study

1505. Shorter-Course Antibiotic Treatment for Pediatric Ventilator-Associated Tracheitis Is Safe and Effective

BackgroundVentilator-associated tracheitis (VAT) is a common infection in children cared for in pediatric intensive care units (PICU). Short-course antibiotic treatment (5 days) has been shown to be effective. In October 2016, we implemented a PICU VAT guideline for short-course therapy. We assessed the impact of this intervention.MethodsWe conducted a retrospective cohort study of PICU patients diagnosed with VAT from October 2016 to June 2018. The antimicrobial stewardship program (ASP) identified potential patients through daily chart review. Only those patients with a clinician diagnosis and who were receiving antibiotics for VAT, either enterally or parenterally, were included. Frequencies and proportions were calculated. Chi-square or Fisher exact tests were used to compare proportions.ResultsASP identified 251 potential patients, 105 (42%) of whom met inclusion criteria. The median age was 7 years (range: 0–21). Twenty-eight (27%) were tracheostomy dependent. The most commonly prescribed antibiotics were cefepime (43%), ceftriaxone (17%), and vancomycin (14%). Median antibiotic duration was 13 days (range: 1–29); 57 (52%) received > 5 days and 48 (44%) received 5 days. Only 3 (6%) patients who received 5 days of antibiotics required retreatment within 10 days of their initial course vs. 11 (19%) who received > 5 days (P = 0.09). A diagnosis of ventilator-associated pneumonia (VAP) within 10 days of completing VAT treatment was made in 2 (4%) patients who received 5 days vs. 3 (5%) of patients who received > 5 days (P = 1.0). C. difficile infection within 90 days occurred in 2 (4%) patients who received > 5 days vs. 1 (2%) who received 5 days (P = 1.0).ConclusionShort-course antibiotic therapy for VAT was not associated with retreatment for VAT or subsequent diagnosis of VAP. Development of C. difficile was similar between groups. Adherence to the guideline was approximately 50%, perhaps due to physician perception of disease severity. Additional work is needed to refine the diagnosis of VAT and assess the interaction between illness severity and treatment duration.Disclosures All authors: No reported disclosures.

Molecular epidemiology of human respiratory syncytial virus and human metapneumovirus in hospitalized children with acute respiratory infections in Croatia, 2014–2017

Acute respiratory infection (ARI) is the most common infection in children under 5 years of age and it is frequently caused by two pneumoviruses, human respiratory syncytial virus (HRSV) and human metapneumovirus (HMPV). Epidemic seasons of these viruses overlap and disease manifestations are highly similar, including severe lower ARI such as bronchiolitis or pneumonia. Reinfections with pneumoviruses are frequent and limited prevention treatment is available. Genetic diversity of HRSV and HMPV strains circulating in Croatia was monitored during four consecutive years (2014–2017). Co-circulation of multiple lineages was observed for both viruses. Within HRSV group A, ON1 strains gained strong predominance during the 4-year period, while previously dominant genotype NA1 was detected only sporadically. Similarly, newly occurring HMPV genotype A2c gained predominance over genotype A2b during this period, resulting in all infection in 2017 being caused by A2c. Along with phylogenetic analysis based on the commonly used fragments for detection and genotyping of these viruses, full length G and SH genes were also analysed. Evolutionary dynamics showed that inferred substitution rates of HRSV and HMPV are between 2.51 × 10−3 and 3.61 × 10−3 substitutions/site/year. This study established presence of recently described HMPV strains containing large duplications in the G gene in Croatia. Viruses with either of the two duplications belong to a subcluster A2c, which has completely replaced all other group A subclusters in 2017.

Antibiotic prescriptions in acute otitis media and pharyngitis in Italian pediatric outpatients

BackgroundAcute otitis media (AOM) and pharyngitis are very common infections in children and adolescents. Italy is one of the European countries with the highest rate of antibiotic prescriptions. The aim of this study is to describe first-line treatment approaches for AOM and pharyngitis in primary care settings in Italy over six years, including the prevalence of ‘wait and see’ for AOM, where prescription of antibiotics is delayed 48 h from presentation, and differences in prescribing for pharyngitis when diagnostic tests are used.MethodsThe study is a secondary data analysis using Pedianet, a database including data at outpatient level from children aged 0–14 in Italy. Prescriptions per antibiotic group, per age group and per calendar year were described as percentages. “Wait and see” approach rate was described for AOM and pharyngitis prescriptions were further grouped according to the diagnostic test performed and test results.ResultsWe identified 120,338 children followed by 125 family pediatricians between January 2010 and December 2015 for a total of 923,780 person-years of follow-up. Among them 30,394 (mean age 44 months) had at least one AOM diagnosis (n = 54,943) and 52,341 (mean age 5 years) had at least one pharyngitis diagnosis (n = 126,098). 82.5% of AOM diagnoses were treated with an antibiotic within 48 h (mainly amoxicillin and amoxicillin/clavulanate) and the “wait and see” approach was adopted only in 17.5% of cases. The trend over time shows an increase in broad spectrum antibiotic prescriptions in the last year (2015). 79,620 (63%) cases of pharyngitis were treated and among GABHS pharyngitis confirmed by rapid test 56% were treated with amoxicillin. The ones not test confirmed were treated mainly with broad spectrum antibiotics.ConclusionsDespite guidance to use the ‘wait and see’ approach in the age group analyzed, this strategy is not often used for AOM, as previously noted in other studies in hospital settings. Broad-spectrum antibiotic prescription was more frequent when pharyngitis was not confirmed by rapid test, in keeping with evidence from other studies that diagnostic uncertainty leads to overuse of antibiotics.

Urinary Tract Infection in Children.

Background: Urinary Tract Infection (UTI) is a common infection in children. Prompt diag-nosis and appropriate treatment are very important to reduce the morbidity associated with this condition.Objective: To provide an update on the evaluation, diagnosis, and treatment of urinary tract infection in children.Methods: A PubMed search was completed in clinical queries using the key terms “urinary tract infec-tion”, “pyelonephritis” OR “cystitis”. The search strategy included meta-analyses, randomized controlled trials, clinical trials, observational studies, and reviews. The search was restricted to English literature and the pediatric age group. Patents were searched using the key terms “urinary tract infection” “pyelonephri-tis” OR “cystitis” from www.google.com/patents, http://espacenet.com, and www.freepatentsonline.com.Results: Escherichia coli accounts for 80 to 90% of UTI in children. The symptoms and signs are non-specific throughout infancy. Unexplained fever is the most common symptom of UTI during the first two years of life. After the second year of life, symptoms and signs of pyelonephritis include fever, chills, rigor, flank pain, and costovertebral angle tenderness. Lower tract symptoms and signs include suprapu-bic pain, dysuria, urinary frequency, urgency, cloudy urine, malodorous urine, and suprapubic tenderness. A urinalysis and urine culture should be performed when UTI is suspected. In the work-up of children with UTI, physicians must judiciously utilize imaging studies to minimize exposure of children to radia-tion. While waiting for the culture results, prompt antibiotic therapy is indicated for symptomatic UTI based on clinical findings and positive urinalysis to eradicate the infection and improve clinical outcome. The choice of antibiotics should take into consideration local data on antibiotic resistance patterns. Recent patents related to the management of UTI are discussed.Conclusion: Currently, a second or third generation cephalosporin and amoxicillin-clavulanate are drugs of choice in the treatment of acute uncomplicated UTI. Parenteral antibiotic therapy is recommended for infants ≤ 2 months and any child who is toxic-looking, hemodynamically unstable, immunocompromised, unable to tolerate oral medication, or not responding to oral medication. A combination of intravenous ampicillin and intravenous/intramuscular gentamycin or a third-generation cephalosporin can be used in those situations. Routine antimicrobial prophylaxis is rarely justified, but continuous antimicrobial prophylaxis should be considered for children with frequent febrile UTI.

Efficacy of vitamin C for the prevention and treatment of upper respiratory tract infection. A meta-analysis in children.

Upper respiratory tract infection (URTI) is a common infection in children, generally caused by viral respiratory infection. Vitamin C is currently proposed as prophylaxis for URTI. The purpose of this study was to assess the effectiveness of vitamin C administration in children for the prevention and reduced duration of URTI through a systematic literature review. Review of the literature conducted between October 2017 and January 2018 in the main medical databases (CENTRAL, Medline and Embase) and by a gray literature approach. The selection criteria were: double-blind randomized controlled trials (RCTs) comparing vitamin C use to placebo in children aged 3months to 18years without chronic infection. Efficacy was assessed in terms of incidence, duration and severity of symptoms of URTI. A meta-analysis was conducted where possible. Eight RCTs, including 3135 children aged 3months to 18years, were selected. Quantitative analysis showed no difference between vitamin C administration and placebo (odds ratio = 0.75, 95% CI [0.54-1.03], p = 0.07, I2 = 74%). Vitamin C administration was found to decrease the duration of URTI by 1.6days (standardized mean differences = -0.30 [-0.53; -0.08], p = 0.009, I2 = 70%). Children under 6years of age benefit from more effective vitamin C supplementation associated with echinacea. No serious adverse events were reported. Although no preventive effects were found, vitamin C intake reduced the duration of URTI. Considering the frequency of URTI, the inappropriate prescription of antibiotics, and the safe nature of vitamin C, its supplementation is justified, especially in children under 6years of age and those who present a high frequency of URTI. There is a sound rationale for further trials with greater statistical power among children of this age.

A SIX-YEAR-OLD MALE WITH DOWN SYNDROME AND ACUTE LUNG ABSCESS

Introduction Children with Down syndrome (DS) are at risk for recurrent and severe respiratory tract infections, however lung abscesses are not commonly reported. Case Description The patient is a six-year-old male with DS, asthma, obstructive sleep apnea, atrioventricular canal defect status post repair, admitted with two days of fever and cough. Examination revealed hypoxia and tachypnea. Chest x-ray showed right upper lobe (RUL) opacity concerning for pneumonia, thought to be due to rhinovirus/enterovirus. Fever persisted despite corticosteroids and respiratory medications. Chest CT scan revealed large RUL abscess with mediastinal shift and compression of the trachea and right atrium (Figure 1). Antibiotics were initiated with gradual improvement. There was no prior history of bacterial pneumonia or serious bacterial infection. Flow cytometry revealed T (CD3+ 779 cells/µL) and B cell (CD19+ 130 cells/µL) lymphopenia. Quantitative immunoglobulins, neutrophil oxidative burst, and CD18 expression were normal. Tetanus titer was protective. Pneumococcal titers showed 3/23 (0/11 non-pneumococcal conjugate vaccine) serotypes protective. Discussion Lung abscess is not a common infection in children with DS. Additionally, the acute presentation of RUL abscess in this patient is unusual; lung abscesses often present with indolent symptoms and are associated with aspiration pneumonia. Patients with DS can develop immune deficiency of varying degrees. Further immune work-up including T lymphocyte functional testing and convalescent titers post-pneumococcal polysaccharide vaccine is pending. Treatment for immune deficiency may be indicated based on results. Lung abscess should be considered in the differential diagnosis for patients with DS presenting with acute respiratory illness and protracted fever.

Urinary Tract Infections in Children: Never Ending Story

The aim of this paper is to provide information from the most important literature on the diagnosis, treatment and further management of urinary tract infections (UTI) in childhood. Following acute viral respiratory tract infections, UTIs are the second, most common infections in children. After febrile UTI, up to 40% of children have permanent renal scarring that may lead to poor renal growth, arterial hypertension, preeclampsia and chronic renal failure. Diagnosis and management of UTI is still one of the most controversial topics of pediatrics. The recent recommendations for the diagnosis, treatment, prophylaxis, and imaging of UTI in childhood based on evidence, or on a consensus of experts are discussed in this review article. Conclusion – Prompt diagnosis and treatment of UTI remain of utmost importance. Most existing guidelines recommend renal ultrasound after the first febrile UTI, but cystography only in the presence of risk factors or anomalies on ultrasound. There is still no consensus regarding antibiotic prophylaxis after the first episode of febrile UTI.

A study of pattern of some common infections in children one month to five years of age

Background: Understanding the causes of child mortality provides important public health insights. Globally 6.9 million deaths in children under-5 occurred in 2011. The objective of the present study was to study the pattern of some common infections in children one month to five years of ageMethods: Observational descriptive study was conducted at Department of Paediatric from July 2012 to June 2013 among 368 randomly selected children. Standard diagnostic criteria for Respiratory tract infection, Diarrhea, Tuberculosis, Urinary tract infection, Malaria, Enteric fever, Measles, Pyoderma, Parasitic infections was followed for all children.Results: Respiratory tract infection and Diarrhea occurred most frequently in 7 to 24 month of child that was 82 (51.9%) and 53 (58.2%), respectively. Stool examination in Parasitic infestation showed that Amoeba 1 (7.1%), Giardia 1 (7.1%), Ascariasis 6 (42%), and Hookworms were 6 (42%) in total of 14 cases. Anemia was present in URI, Tuberculosis, Malaria, and Parasitic infestation with mean hemoglobin (Hb) ranges from 8.6 to 9.2. Mantoux showed that 20 (87%) cases had mantoux > 10 mm. Malarial species found were Vivax (16, 66.7%). Respiratory tract infection occurred mostly in winter season.Conclusions: Most common infections in children 1 month to 5 years of age was Respiratory tract infection followed by diarrhea, enteric fever, malaria, tuberculosis, urinary tract infection, parasitic infection, measles and pyoderma.

A Self-Assembling Whole-Cell Vaccine Antigen Presentation Platform.

Diarrhea is the most common infection in children under the age of 5 years worldwide. In spite of this, only a few vaccines to treat infectious diarrhea exist, and many of the available vaccines are sparingly and sporadically administered. Major obstacles to the development and widespread implementation of vaccination include the ease and cost of production, distribution, and delivery. Here we present a novel, customizable, and self-assembling vaccine platform that exploits the Vibrio cholerae bacterial biofilm matrix for antigen presentation. We use this technology to create a proof-of-concept, live-attenuated whole-cell vaccine that is boosted by spontaneous association of a secreted protein antigen with the cell surface. Sublingual administration of this live-attenuated vaccine to mice confers protection against V. cholerae challenge and elicits the production of antigen-specific IgA in stool. The platform presented here enables the development of antigen-boosted vaccines that are simple to produce and deliver, addressing many of the obstacles to vaccination against diarrheal diseases. This may also serve as a paradigm for the development of broadly protective biofilm-based vaccines against other mucosal infections.IMPORTANCE Diarrheal disease is the most common infection afflicting children worldwide. In resource-poor settings, these infections are correlated with cognitive delay, stunted growth, and premature death. With the development of efficacious, affordable, and easily administered vaccines, such infections could be prevented. While a major focus of research on biofilms has been their elimination, here we harness the bacterial biofilm to create a customizable platform for cost-effective, whole-cell mucosal vaccines that self-incorporate secreted protein antigens. We use this platform to develop a sublingually administered live-attenuated prototype vaccine based on Vibrio cholerae This serves not only as a proof of concept for a multivalent vaccine against common bacterial enteric pathogens but also as a paradigm for vaccines utilizing other bacterial biofilms to target mucosal infections.

2092 A multicenter study of fecal microbiota transplantation for Clostridium difficile infection in children

OBJECTIVES/SPECIFIC AIMS: Clostridium difficile infection (CDI) is the most common cause of antibiotic-associated diarrhea and an increasingly common infection in children in both hospital and community settings. Between 20% and 30% of pediatric patients will have a recurrence of symptoms in the days to weeks following an initial infection. Multiple recurrences have been successfully treated with fecal microbiota transplantation (FMT), though the body of evidence in pediatric patients is limited primarily to case reports and case series. The goal of our study was to better understand practices, success, and safety of FMT in children as well as identify risk factors associated with a failed FMT in our pediatric patients. METHODS/STUDY POPULATION: This multicenter retrospective analysis included 373 patients who underwent FMT for CDI between January 1, 2006 and January 1, 2017 from 18 pediatric centers. Demographics, baseline characteristics, FMT practices, C. difficile outcomes, and post-FMT complications were collected through chart abstraction. Successful FMT was defined as no recurrence of CDI within 60 days after FMT. Of the 373 patients in the cohort, 342 had known outcome data at two months post-FMT and were included in the primary analysis evaluating risk factors for recurrence post-FMT. An additional six patients who underwent FMT for refractory CDI were excluded from the primary analysis. Unadjusted analysis was performed using Wilcoxon rank-sum test, Pearson χ2 test, or Fisher exact test where appropriate. Stepwise logistic regression was utilized to determine independent predictors of success. RESULTS/ANTICIPATED RESULTS: The median age of included patients was 10 years (IQR; 3.0, 15.0) and 50% of patients were female. The majority of the cohort was White (89.0%). Comorbidities included 120 patients with inflammatory bowel disease (IBD) and 14 patients who had undergone a solid organ or stem cell transplantation. Of the 336 patients with known outcomes at two months, 272 (81%) had a successful outcome. In the 64 (19%) patients that did have a recurrence, 35 underwent repeat FMT which was successful in 20 of the 35 (57%). The overall success rate of FMT in preventing further episodes of CDI in the cohort with known outcome data was 87%. Unadjusted predictors of a primary FMT response are summarized. Based on stepwise logistic regression modeling, the use of fresh stool, FMT delivery via colonoscopy, the lack of a feeding tube, and a lower number of CDI episodes before undergoing FMT were independently associated with a successful outcome. There were 20 adverse events in the cohort assessed to be related to FMT, 6 of which were felt to be severe. There were no deaths assessed to be related to FMT in the cohort. DISCUSSION/SIGNIFICANCE OF IMPACT: The overall success of FMT in pediatric patients with recurrent or severe CDI is 81% after a single FMT. Children without a feeding tube, who receive an early FMT, FMT with fresh stool, or FMT via colonoscopy are less likely to have a recurrence of CDI in the 2 months following FMT. This is the first large study of FMT for CDI in a pediatric cohort. These findings, if confirmed by additional prospective studies, will support alterations in the practice of FMT in children.

Platelet indices in children with urinary tract infection

Background: Urinary tract infection is one of the most common infection in children and may lead to serious morbidity like chronic pyelonephritis and renal scarring. Our hypothesis is that alteration of the platelet morphology can be a reliable index for early diagnosis and management of UTI without waiting for urine culture results. We try to demonstrate a link between the platelet indices and the type of organism, whether gram positive or gram negative to allow proper selection of the antibiotic regimen.Methods: It is a retrospective case control study where 35 urine culture proven cases and 35 cases of non UTI cases was taken as control. Children with haematological diseases affecting platelet were excluded. Platelet indices were taken including for MPV, PDW and platelet count and statistically analysed.Results: MPV and PDW were higher in patient with culture proven especially with gram positive organism.Conclusions: Although urine culture is considered as golden standard for diagnosis of urinary culture, it is time consuming. But early diagnosis can prevent renal parenchymal complications. Hence, we tried to find out other early, easy and sensitive method for detection of urinary tract infections in children. Platelet parameters (thrombocytosis, mean platelet volume, platelet distribution width) is available in analyser report of any complete blood count with no added value. It was also found that gram positive organism has higher mean platelet volume and platelet distribution width as compared to gram negative organism.

The burden of common infections in children and adolescents with diabetes mellitus: A Pediatric Health Information System study.

People with diabetes mellitus (DM) have increased infection risk. The healthcare utilization of pediatric and adolescent diabetic patients with infection is not well defined. This study evaluates the number of pediatric and adolescent patients with DM that seek medical treatment for infection management and assesses its socioeconomic impact. A retrospective analysis was performed using the Pediatric Health Information System (PHIS) database on children and adolescents with DM who presented to the Emergency Department (ED) or were hospitalized for infection management from 2008 to 2014. The PHIS database collects admission, demographic, and economic data from 44 freestanding children's hospitals across the United States. In total, 123 599 diabetic patient encounters were identified (77% type 1 DM, 23% type 2 DM). ED visits and hospitalizations for type 1 DM and type 2 DM increased throughout the study period. Total charges for these encounters were greater than $250 million dollars per year and increased each year. Infection encounters make up more than 30% of that cost while accounting for only 14% of the visits. Respiratory infections were the most common type of infection followed by skin and soft tissue infections for both ED care and inpatient hospitalizations. Patients with infections had longer hospital length of stay and higher cost per day than those without infections. Children and adolescents with type 1 and type 2 DM commonly present to the ED and require hospitalization for infection evaluation and management. Encounters with infection make up a large proportion of a growing economic burden on the United States' healthcare system. As the prevalence of DM grows, this burden can be expected to become even more significant. Cost-effective strategies for the prevention of infection in pediatric patients with DM are needed.

The microorganism and underlying urological anomalies causing the urinary tract infection in the children attended the pediatric surgery clinic at the maternity and children teaching hospital al-qadisiya\ iraq

Urinary tract infections (UTI) are among the most common infections in children. UTI related morbidity remains high despite the use of numerous effective antibacterial agents . The sample of this study was conducted in the pediatric surgery unit at the Maternity and Children Teaching Hospital , Al-Diwaniya ( Iraq) and from the 1st of August 2005 to the end of July 2008. All the patients presenting with UTI to the outpatient clinic or to the surgical ward were investigated prospectively . The aim of this study was to determine how many patients had underlying urological abnormalities, the specific type of abnormality, and the microorganism causing the UTI in the patients with or without urological anomalies.There were 78 (70.9%) girls and 32 (29%) boys , 19 (17.2%) were between 0-1 year, 68 (61.8%) were at an age between 1-5 years, and 23 (20.9%) were more than 5 years of age. Forty seven (42.7%) of these patients had abnormal urological findings. Of 78 girls, 31 (39.7%) had urological abnormalities. Sixteen children had VUR as an only abnormality. The distribution of abnormalities showed some changes by age and sex. Bacteriuria (>105 bacteria per milliliter of urine) was found in 44 (40%) of patients. The most common bacterial agent of urinary infections was E. coli (61.3%) of total isolates in both sexes , it was the most common pathogen among all patients (those with urological abnormalities and those without). There was no difference in the distribution of microorganisms in patients with and without urological anomalies. The diagnosis of UTI in young children is important as it is a marker for urinary tract abnormalities. A child with a suspected UTI should have a urine culture and colony count performed in order to identify organisms for confirmation of diagnosis and recommend prompt treatment to reduce UTI related morbidity and mortality in children.

Impact of Personalized Audit and Feedback on Management of Pediatric Outpatient Community-Acquired Pneumonia

BackgroundCommunity-acquired pneumonia (CAP) is a common infection in children. Guidelines recommend amoxicillin as first line therapy for CAP, while macrolides are recommended for school-aged children with atypical pneumonia. Despite guidelines, antibiotic choice for CAP varies widely among providers. We aimed to determine the impact of outpatient audit and feedback to individual providers on adherence with published guidelines.MethodsWe conducted a randomized controlled trial of primary care clinicians in a multi-state primary care network from 8/2016–2/2017. Providers received baseline education. The intervention included personalized feedback from investigators at 1-month intervals on the provider’s management of a case of CAP identified by ICD-10-CM codes. Prescription counts of guideline-recommended antibiotic therapy were compared between groups by Pearson’s chi-squared. Performance scores incorporating diagnostic and treatment decisions such as physical examination elements, antibiotics and medication dosing appropriate for a CAP encounter as defined by clinical practice guidelines were calculated for each encounter during study intervals.ResultsAmong the 43 providers, the majority were physicians (76% control, 86% intervention). There were no significant differences in work hours, years since board certification, sex or race between groups. 316 distinct cases of CAP were diagnosed (214 control; 102 intervention). In patients <5 years, there was no significant difference in prescription of amoxicillin between groups (61/103 (59.2%) control; 23/48 (47.9%) intervention, P = 0.19). In patients ≥5 years, there was a significant difference in prescription of guideline recommended antibiotics of amoxicillin or azithromycin (81/103 (78.6%) control; 48/51 (94.1%) intervention, P < 0.05). There was a small, but apparent upward trend in mean performance scores in the intervention group (Figure 1).ConclusionPersonalized, scheduled audit and feedback in the outpatient setting had a small but measurable impact on improving physician adherence with guidelines. Audit and feedback alone is insufficient to substantially improve guideline adherence in the management of CAP and should be combined with other antimicrobial stewardship interventions.Disclosures All authors: No reported disclosures.

Common infections in children

Common infections in children