Lower Tract Infections Research Articles

Evaluating the efficacy of corticosteroids and bronchodilators in the management of paediatric bronchiolitis

Background: Bronchiolitis, a standard lower tract infection in young children, poses significant challenges in terms of diagnosis and management. Corticosteroids and bronchodilators are often prescribed to manage this condition, despite limited evidence supporting their efficacy. This study aimed to judge the effectiveness of corticosteroids and bronchodilators within the management of paediatric bronchiolitis. Objective: to see the clinical efficacy of corticosteroids and bronchodilators in improving respiratory symptoms and reducing hospitalization rates among paediatric patients with bronchiolitis. Study Settings and Sample Size: This study was conducted at different centres including Department of Paediatrics, Social Security MNCH Hospital, Dera Ghazi Khan, Punjab and Sahara Medical College Narowal, Punjab in the period from October, 2022 to March, 2023 enrolling 300 children aged 1 month to 2 years with a clinical diagnosis of bronchiolitis. Methods: Participants were randomly assigned to at least one of three treatment groups: corticosteroids (n=100), bronchodilators (n=100), or placebo (n=100). the first outcome was improvement within the Respiratory Distress Assessment Instrument (RDAI) score. Secondary outcomes included hospitalization rates, length of hospital stay, and adverse events. Results: Children within the corticosteroid group experienced a significantly greater improvement in RDAI scores compared to the placebo group (p<0.001).

Etiology, clinical characteristics, and risk factors associated with severe influenza-like illnesses in Mexican adults

ObjectiveThe aim of this study was to determine the risk factors associated with severe influenza-like illness (ILI) in Mexican adults that could be useful to clinicians when assessing patients with ILI. MethodsData from adult patients enrolled from 2010 through 2014 in ILI002 – a prospective hospital-based observational cohort study – were analyzed. Etiology and clinical characteristics were compared between cases of severe ILI (defined as hospitalization and/or death) and cases of non-severe ILI. ResultsOverall, 1428 (39.0%) out of a total 3664 cases of ILI were classified as severe. Adjusted analyses showed a higher risk of severe ILI associated with signs and symptoms related to lower tract infection, i.e. cough with sputum (odds ratio (OR) 2.037, 95% confidence interval (CI) 1.206–3.477; P = 0.008), dyspnea (OR 5.044, 95% CI 2.99–8.631; and shortness of breath (OR 5.24, 95% CI 3.0839.124; P < 0.001), and with increases in lactate dehydrogenase (OR 4.426, 95% CI 2.321–8.881; P < 0.001) and C-reactive protein (OR 3.618, 95% CI 2.5955.196; P < 0.001). Further, there was an increased risk of severe ILI with a longer time between symptom onset and inclusion (OR 1.108, 95% CI 1.049–1.172; P < 0.001) and with chronic steroid use (OR 14.324, 95% CI 8.059-26.216; P < 0.001). ConclusionsRespiratory viruses can cause severe ILI. The results of this study highlight the importance of evaluating data compatible with lower tract involvement and previous use of immunosuppressants at baseline, because patients meeting these conditions may develop severe illness.

Bacteriological Profile and Antibiotics Sensitivity Pattern of Patients with Urinary Tract Infection in Tertiary Care Center, Pipariya, Vadodara, Gujarat

The urinary tract is divided into the upper urinary tract, composed of the kidneys, renal pelvis, and ureters, and the lower urinary tract, which consists of the urinary bladder and urethra. Upper urinary tract infections most commonly ascend in nature, originate in the urinary bladder, and ascend through the ureters to the kidneys. The cardinal clinical manifestations of upper urinary tract infections are flank pain and fever, which are often associated with chills, frequency, urgency, and dysuria, and are more suggestive of infection of the urinary bladder and urethra. However, symptoms consistent with lower tract infections develop first in some patients with pyelonephritis or other upper urinary tract infections, particularly ascending infections. Lower urinary tract infections typically involve the bladder and urethra. Urinary tract infections are one of the most common bacterial infections among community-acquired infections, and in-hospital setups, urinary tract infections are the most common hospital-acquired infections. At least half of women experience tracts infection once in their life. The majority of patients with UTIs are infected with Escherichia coli. Urine samples were collected by sampling the midstream flow using the clean-catch technique. A total of 135 urine samples were collected from suspected patients and sent to the microbiology laboratory for diagnosis using different methods, such as staining, bacteriological culture identification, and antibiotic sensitivity determined using the standard Kirby Bauer disc diffusion method, following the Clinical and Laboratory Standards Institute (CLSI) guidelines. Of the 135 patients, 43 (31.85%) showed positive growth on culture media, of which 29 (67.44%)were female, and 14 (32.55%) were male. E. coli was the most isolated organism, followed by Klebsiella pneumoniae and Pseudomonas spp., with a frequency rate of 20 (46.52%), 09 (20.93%), and 07(16.28%), respectively. Most organisms are sensitive to imipenem and piperacillin-tazobactam, and most organisms are resistant to cephalexin.

Heterozygous Variants in the DNA-binding Domain of c-Myb May Affect Normal B/T Cell Development.

Heterozygous Variants in the DNA-binding Domain of c-Myb May Affect Normal B/T Cell Development.

457. High Levels of Serum Troponin I Indicate Higher Mortality Risk in Patients with COVID-19

BackgroundUp until this day, over 3.5 million fatalities related to coronavirus disease 2019 (COVID-19) have been registered worldwide by the World Health Organization. Healthcare professionals require prognostic tools for COVID-19 patients in order to guide treatment strategies. Elevated troponin levels, a biomarker of cardiac injury, have been detected among patients with COVID-19, hence associating it with cardiac injury. Although several studies have mentioned it, the role of troponin as a prognosis biomarker is unclear. Elevation in troponin levels has been observed in patients with community-acquired pneumonia (CAP). However, its association with mortality is scarcely mentioned in literature. Thus, we sought to determine the utility of serum troponin I levels as a mortality predictor for patients with COVID-19 and CAP. MethodsA prospective observational study was carried out at Clinica Universidad de La Sabana, Colombia, with patients hospitalized due to CAP and COVID-19. Troponin biomarker was quantified in serum samples using the PATHFAST system within the first 24 hours of hospital admission. Serum concentrations of troponin were compared among study groups. To assess the biomarker′s capacity to predict mortality, ROC curves were used, quantifying their differences through the DeLong′s test. ResultsA total of 88 patients with CAP and 152 with COVID-19 were included in the study. In all cohort the median [IQR] serum concentration of troponin (ng/ml) was higher in those who died (34.2, [9.74-384] vs 5.89, [2.44-27.9] p< 0.001). Furthermore, troponin was higher in deceased patients with COVID-19 vs those who survived (77.35 [11.9-346.5] vs. 4.88 [2.10-13.02], p< 0.001). However, there was no significant difference between CAP deceased and not deceased patients (18.1 [8.52-398] vs 15.7 [3.75-62.8], p=0.16). Although sample size might be a limitation when analyzing these results, the AUC ROC of troponin I to predict mortality was 0.799 for COVID-19 and 0.615 for CAP, the DeLongs test for compared ROC curves was a p= 0.0351. A. Serum troponin I and mortality due to lower respiratory tract infections B. Serum troponin I to predict mortality in patients with lower tract infections C. ROC curve for serum troponin I to predict risk of mortalityConclusionOverall, troponin levels were higher among deceased patients. Our findings suggest that high troponin levels are a mortality predictor for patients with COVID-19.Disclosures All Authors: No reported disclosures

Featuring Characteristics of Chronic Obstructive Pulmonary Disease, Procalcitonin and Lower Tract Infections and Inert Gas Studies

Featuring Characteristics of Chronic Obstructive Pulmonary Disease, Procalcitonin and Lower Tract Infections and Inert Gas Studies

The Burden of Respiratory Syncytial Virus in Children Under 2 Years of Age in a Rural Community in Maharashtra, India.

BackgroundGlobally, respiratory syncytial virus (RSV) is a common cause of acute lower tract infection (LRTI) in children younger than 2 years of age, but there are scant population-based studies on the burden of RSV illness in rural communities and no community studies in preterm infants.MethodsActive surveillance of LRTI was performed in the community and hospital setting for the population of 93 tribal villages in Melghat, Central India, over 4 respiratory seasons. A nasopharyngeal swab was obtained from cases presenting as a severe LRTI for molecular analysis of respiratory pathogens including RSVA and B.ResultsHigh rates of RSV-associated LRTI were found in preterm and term infants beyond 6 months of age, extending into the second year of life. Community severe RSV LRTI rates for 0–11 months of age was 22.4 (18.6–27.0)/1000 child-years (CY) and the hospital-associated rate was 14.1 (11.1–17.8)/1000 CY. For preterm infants, these rates were 26.2 (17.8–38.5)/1000 CY and 12.6 (7.2–22.0)/1000 CY. Comparable rates in the first 6 months were 15.9 (11.8–21.4)/1000 CY and 12.9 (9.3–18.0)/1000 CY in term infants and 26.3 (15.4–45.0)/1000 CY and 10.1 (4.2–24.2)/1000 CY for preterms. The single RSV B season had higher incidences of RSV LRTI in every age group than the 2 RSV A seasons in both preterm and term infants. There were 11 deaths, all term infants.ConclusionsStudies restricted to the healthcare settings significantly underestimate the burden of RSV LRTI and preterm and term infants have comparable burdens of disease in this rural community.

Akut Alt Solunum Yolu Enfeksiyonu Nedeni ile Yatırılarak İzlenen Yenidoğanların Klinik ve Virolojik Özellikleri

Aim: Viruses including respiratory syncytial virus, parainfluenza virus, rhinovirus are the primary etiologic agents in acute lower tract infections in neonates. We aimed to evaluate the clinical and demographic characteristics of newborns with acute lower tract infections. Material and Method: Data was recorded from patients' medical records admitted between January 2013 and April 2016. Results: The study population consisted of 43 neonates (19 girls, 24 boys). Mean gestational age and birthweight were 32 ± 4.4 weeks and 1735 ± 820 g, respectively. On admission, mean postnatal day and postmenstrual ages were 61 ± 48 days and 41 ± 4.3 weeks. Respiratory syncytial virus (n:8), rhinovirus (n:3), parainfluenza-3 virus (n:3) and adenovirus (n:3), respiratory syncytial virus and parechovirus (n:1), respiratory syncytial virus and adenovirus (n:1), rhinovirus and human bocavirus (n:1) were detected by polymerase chain reaction 20 patients in total. Siblings in the house (n:31), viral infection in the family (n:23), insufficient breastfeeding (n:15), bronchopulmonary dysplasia (n:13), siblings attending school (n:10) and being twin or triplet (n:7) were leading risk factors. Median hospital stay was 9 (1-60) days. Prematurity, fever, rales, respiratory support and feeding difficulty were statistically more common in polymerase chain reaction positive patients. Patients with the respiratory syncytial virus had higher gestational age, birth weight, less respiratory distress syndrome, surfactant use and patent ductus arteriosus, and lower postnatal day on admission than patients with other viruses (p&amp;lt;0.05). Conclusion: Respiratory syncytial virus is the commonest cause of acute lower tract infections in newborns, but the clinical importance of co-infection and rare agents such as human bocavirus and parechovirus should be kept in mind. Supportive management is the mainstay of the therapy.

Recurrent FAN1 p.W707X Pathogenic Variant Originating Before ad 1800 Underlies High Frequency of Karyomegalic Interstitial Nephritis in South Pacific Islands

Recurrent FAN1 p.W707X Pathogenic Variant Originating Before ad 1800 Underlies High Frequency of Karyomegalic Interstitial Nephritis in South Pacific Islands

Urınary tract ınfectıons in obese children and adolescents with their outcomes and clinical aspects

Aim: The relationship between obesity and urinary tract infections (UTI) was reported in adult studies, but pediatric data is lacking. Methods: This prospective study included children, who were admitted to the outpatient clinic only with the complaint of obesity. UTI screening with symptomatic questioning and clinical feature was performed. Symptomatic participants were examined(urinalysis, culture, or/and blood work, imaging tests). Characteristics of those with UTI, and we determined an obese/overweight, but non-UTI control group matched with age and gender and conducted a case-control study. Results: In this study, 1001 participants were screened, UTI frequency was 3,39%, with 91,2% female predominance. The mean age of all participants was 11.44±3.21 years. All of the UTIs were lower tract infections. Escherichia coli(82,4%) was the most frequently isolated microorganism. History of UTI and hypertension was more frequent in the UTI group(n=34) compared with non UTI group (n=136)(p=0,001; p=0,001). Conclusion: In the UTI group, hypertension and previous UTI history were shown to be more common, so it may be important to question obese/overweight children for UTI at their clinical application.

Serum Interleukin-6 and Interleukin-8 are Sensitive Markers for Early Detection of Pyelonephritis and Its Prevention to Progression to Chronic Kidney Disease.

Background:Pyelonephritis is the most common bacterial infection in children that can cause renal failure if not diagnosed or treated early. We used serum biomarker interleukins (IL-6 and IL-8) and then confirmed the results by the findings dimercaptosuccinic acid (DMSA) scan to distinguish upper-tract infection from lower-tract infection.Methods:Serum IL-6 and IL-8 were measured in 57 children with newly diagnosed untreated urinary tract infection (UTI) documented by a positive urine culture. All children had a DMSA to determine whether serum IL6, IL-8 can be used as a marker to predict upper-tract from lower-tract infection. IL-6 and IL8 were determined by the enzyme link immunosorbent assay (ELISA) technique.Results:Of the 57 patients, 24 (42%) had renal parenchymal lesions on the DMSA scan. Patients with abnormal DMSA had significantly higher serum IL-6 and IL-8 compared with those with normal DMSA scan (187.1 ± 113.1 ng/mL vs. 396.1 ± 246.0 ng/mL, P = 0.005; and 165 ± 76.1 ng/mLvs. 190.8 ± 60.8 ng/mL, P = 0.026, respectively). Pyelonephritis was more frequent in children younger than 20 months old (n = 36, 63%, P < 0.005) and more prevalent in girls (n = 36, 63%, P = 0.005). Serum IL-6 had a sensitivity of 67.3% and a specificity of 63.0% and serum IL8 had a sensitivity of 80.1% and a specificity of 73.5% in the differential diagnosis of pyelonephritis and cystitis (P = 0.03).Conclusions:Serum levels of IL-6 and IL-8 are both sensitive biomarkers of UTI and can discriminate the upper from lower tract urinary infections. Determination of these biomarkers may help to identify patients with acute pyelonephritis and need for DMSA study.

Worsening disability status in multiple sclerosis predicts urologic complications.

Multiple sclerosis (MS) causes voiding dysfunction and might predispose to urologic complications. However, long-term complications and risk factors for complications are unknown. We aim to assess long-term changes in voiding function and to determine risk factors for urologic complications during MS follow-up. We analyzed the records of MS patients and recorded baseline and follow-up voiding symptoms, urodynamic (UDS) findings, Expanded Disability Status Scale (EDSS), serum blood studies, imaging, and complications. T test and Chi-square test were used to determine statistical significance using a two-tailed p value < 0.05. We assessed complication-free survival using Kaplan-Meier curves and performed multiple variable Cox proportional hazard models to estimate hazard ratios predicting complications for various independent variables. 126 women and 35 men with MS were followed for a median of 9.7years (IQR 4.3-13). Mean age at MS diagnosis was 36.7 with a mean EDSS of 3.2. During follow-up, EDSS progressed to a mean of 5.5. In addition, at least one complication occurred in 60.2% and major complications were present in 16.7%. After multivariable analysis, EDSS progression ≥ 2.0 (p = 0.003), follow-up EDSS ≥ 6.0 (p = 0.01), use of intermittent catheterization (p < 0.001) and urinary reconstruction with continent catheterizable stoma (p = 0.009) were significantly related to an increased hazard for any complications. Upper tract changes and other major complications were uncommon. Complications were related to MS progression, resultant increase in total disability, and the need for intervention to maintain functional continence. Lower tract infections occurred more frequently in patients with the need for catheterization.

Etiology of acute viral respiratory infections common in Pakistan: A review.

SummaryRespiratory infections, especially those of the lower respiratory tract, remain a foremost cause of mortality and morbidity of children greater than 5 years in developing countries including Pakistan. Ignoring these acute‐level infections may lead to complications. Particularly in Pakistan, respiratory infections account for 20% to 30% of all deaths of children. Even though these infections are common, insufficiency of accessible data hinders development of a comprehensive summary of the problem. The purpose of this study was to determine the prevalence rate in various regions of Pakistan and also to recognize the existing viral strains responsible for viral respiratory infections through published data. Respiratory viruses are detected more frequently among rural dwellers in Pakistan. Lower tract infections are found to be more lethal. The associated pathogens comprise respiratory syncytial virus (RSV), human metapneumovirus (HMPV), coronavirus, enterovirus/rhinovirus, influenza virus, parainfluenza virus, adenovirus, and human bocavirus. RSV is more dominant and can be subtyped as RSV‐A and RSV‐B (BA‐9, BA‐10, and BA‐13). Influenza A (H1N1, H5N1, H3N2, and H1N1pdm09) and Influenza B are common among the Pakistani population. Generally, these strains are detected in a seasonal pattern with a high incidence during spring and winter time. The data presented include pneumonia, bronchiolitis, and influenza. This paper aims to emphasise the need for standard methods to record the incidence and etiology of associated pathogens in order to provide effective treatment against viral infections of the respiratory tract and to reduce death rates.

206. Respiratory Viral Testing Is Associated with Lower Frequency of Antibiotic Prescribing for Acute Upper Respiratory Infections at a Large Ambulatory Cancer Center

BackgroundInappropriate outpatient antibiotic prescribing for acute upper respiratory infections (URIs) is a high priority target for antimicrobial stewardship and has not been described for cancer patients. The goal of this study was to characterize patterns of and factors associated with antibiotic prescribing among ambulatory oncology patients with URIs.MethodsWe selected outpatients >18 years old seen at an ambulatory cancer center with ICD-10 diagnosis code consistent with URI from October 1, 2015 to September 30, 2016 for chart review. Patients without documented active URI symptoms or with lower tract infection at the first clinical encounter for the URI (day 0) were excluded. We obtained demographic, clinical, antimicrobial prescribing and viral testing data for days 0–14. We used generalized estimating equations to test for associations of baseline factors with a ≥1 antibiotic prescription for URI while accounting for correlation among patients seen by the same provider.ResultsOf the 341 charts reviewed, 251 (74%) patients, seen by 99 providers were eligible for analysis. A total of 162/251 (65%) had an underlying hematologic malignancy or disorder; of those, 51% had a prior hematopoietic cell transplant. Eighty-four (33%) received ≥1 antibiotic prescription for URI with 63% ordered on day 0. Azithromycin (47%) and fluoroquinolones (25%) were most often prescribed. One hundred thirteen (45%) patients had respiratory viral testing performed; 85 (75%) tested positive (Figure 1). Both antibiotic prescribing (P = 0.005) and viral testing (P < 0.001) varied by clinical service (Figure 2). Viral testing on day 0 was associated with lower risk of antibiotic prescribing while sputum production or chest congestion was associated with higher risk of antibiotic prescribing (Figure 3).ConclusionAntibiotics were prescribed in one in three oncology outpatients with URI, although viral etiologies were identified in most who were tested. Respiratory viral testing was associated with reduced antibiotic prescribing though collinearity between clinical service and viral testing limited our ability to separate these effects on antibiotic prescribing. It is important to further explore the role of viral testing in antibiotic prescribing for URI in outpatient oncology settings. Disclosures All authors: No reported disclosures.

The approach to community-acquired pneumonia: A survey study

INTRODUCTION AND AIM: Community-acquired pneumonia (CAP), which is often seen in daily practice, is a lower respiratory tract and pulmonary parenchyma infection which develops in society and daily life with community-acquired pathogens in individuals with no known immune failure. Delay in the treatment of pneumonia is known to increase morbidity and mortality. Various scoring systems are currently used in the identification of treatment groups in pneumonia. With the aim of evaluating the approach to CAP cases, the infection. MATERIALS AND METHODS: Working Group of the Turkish Respiratory Research Association (TUSAD) prepared a 22-item questionnaire. RESULTS: The survey was published on the TUSAD official website between July 2013 and June 2016. A total of 78 individuals responded to the questionnaire on the website. CONCLUSION: The responses to the questionnaire could indicate the way forward for new guidelines for physicians in respect of the approach to CAP.

555 - Oral Ribavirin for the Treatment of Respiratory Syncytial Virus (RSV) and Human Metapneumovirus (hMPV) Infections in Hematology Patients and Stem Cell Transplant (SCT) Recipients at a Nci-Designated Cancer Center

Background: Respiratory infections cause morbidity and increased mortality in immunosuppressed populations. These patients are at an increased risk of an upper respiratory tract infection (URTI) progressing to a lower respiratory tract infection (LRTI) leading to fatal pneumonia. Ribavirin is a purine analog that is active against RNA and DNA viruses. Aerosolized ribavirin is approved for use in children with RSV pneumonia, and has been used for treatment of RSV and hMPV infections in immunosuppressed adults. Ribavirin is available in oral formulation for the treatment of hepatitis C but there is an increasing trend to utilize it for RSV and hMPV infections. At our center, a standardized protocol was developed and implemented for treatment of these infections with oral ribavirin. Methods: Retrospective chart review of patients treated with oral ribavirin for RSV or hMPV during a 5-year period. Results: Over the 5-year period, 62 patients were treated with oral ribavirin for RSV or hMPV respiratory infections. Majority of patients were male, and the majority of infections were RSV (68%). The patient population was evenly split between hematology and SCT. The most common hematologic malignancy was acute myelogenous leukemia and of the SCT recipients, most were allogeneic (24 of 31). Majority of the cases presented with findings of upper and lower tract infection (42%), with 13 and 23 patients having symptoms consistent only with URTI and LRTI, respectively. Seasonal correlation was noted, with almost 90% of infections occurring between October and May and infections were hospital acquired in one third of the cases (21 of 62). In addition to ribavirin, intravenous immunoglobulin (IVIG) was administered in 15 of the 62 patients, 13 with document IgG levels of <400 mg/dL at diagnosis. The median treatment duration was 10 days (range 2-29), with only 6 patients discontinuing the drug due to side effects. Three patients required intubation with an overall 8% (5 of 62 patients) infection related mortality while on oral ribavirin treatment. All patients that expired had RSV. Conclusion: This retrospective review suggests that oral ribavirin, with or without IVIG, is a well-tolerated option for treating RSV and hMPV infection in patients with hematologic malignancies or after SCT.

Application of three-grade prevention and nursing in caring hematological malignancies patients with oral mucositis during perichemotherapy

Objective To explore the effects of three-grade prevention and nursing when used in caring hematological malignancies (HM) patients with oral mucositis (OM) . Methods Totally 128 HM patients who received chemotherapy in the Third Affiliated Hospital of Wenzhou Medical University from January 2015 to June 2016 were divided randomly into an observation group (64) and a control group (64). Patients in both groups received conventional chemotherapy nursing, and on this basis, patients in the observation group were treated with three-grade prevention and nursing, which was followed by a comparison in incidence of oral mucositis (OM) , Fungous infection of lower respiratory tract (FILRT) and oral cavity fungus infection (OCFI) between patients in the two groups. Results As for OM incidence, patients in the observation group were better than those in the control group (P<0. 05). The FILRT incidence of patients in the observation was lower than that of patients in the control group (P<0.05) ; and the OCFI incidence of patients in the observation group were higher than that of patients in the control group (P<0. 05) . Conclusions Three-grade prevention and nursing effectively reduces the incidence of OM and FILRT among HM patients during perichemotherapy, and is worthy of clinical expansion and application. Key words: Hematologic neoplasms; Nursing care; Oral mucositis

Management of culture positive urinary tract infections in children aged 0-16 years: An audit conducted in a District General Hospital in the United Kingdom

Background : Urinary tract infection (UTI) is common among children. Management of UTI requires prompt diagnosis, treatment and most often, a regular follow up. Objectives : To evaluate compliance with the NICE guidelines 2007 when managing children aged 0 to16 years with bacteriologically proven UTI in a District General Hospital. Method: A descriptive retrospective study was carried out at Bronglais General Hospital, Aberystwyth, United Kingdom (UK) on children aged 0 to16 years with culture positive UTI from 1 st January 2012 to 31 st December 2014. Infants and children with urinary catheters in situ, pre-existing renal disorders and immune-suppression were excluded from the study. Patients were grouped into age categories to facilitate comparison of treatment and radiological investigations. Further categorisation was done according to NICE guidelines for urinary tract infection in children. Approval for the conduct of the audit was given by the Clinical Audit Department, Bronglais Hospital, UK. Ethical clearance for the study was obtained from the Ethical Review Committee of the Sri Lanka College of Paediatricians. Results : There were 104 children aged 0 to 16 years with culture proven UTI during the study period of whom 8 were excluded. Only 25% of infants 3 months old or less received intravenous (IV) antibiotics in compliance with the guidelines; 25% had only oral antibiotics and 50% had IV followed by oral antibiotics. For treatment of lower tract infection, duration of antibiotics prescription was longer than recommended. Overall adherence to investigations such as ultrasonography, dimercaptosuccinic acid scan and micturating cystourethrogram was 81%, 91% and 93% respectively. All children with recurrent UTIs were prescribed antibiotic prophylaxis adhering to NICE guidelines. Conclusions : Duration of antibiotic therapy in UTI was in compliance with NICE guidelines in 16-86% children. Radiological investigations were requested in UTI in compliance with NICE guidelines in 71-97% children. Prophylactic antibiotics were prescribed in UTI in compliance with NICE guidelines in 34-100% children.

Salmonella typhi vaccination response study reveals defective antibody production selective IgA deficiency patient

Selective IgA deficiency (SIgAD) is the most prevalent immunodeficiency worldwide, progressing to common variable immunodeficiency only in few reported cases. We report the case of a Spanish female aged 22 and diagnosed of selective IgA deficiency, a long history of bronchitis, several episodes of pneumonia, bilateral bronchiectasis, normal IgG, IgM, IgG subclasses, and detectable pre-vaccination IgG antibodies against tetanus toxoid and Streptococcus pneumoniae. She was evaluated in our clinic in order to rule out common variable immunodeficiency. We observed good antibody response to tetanus toxoid, absence of circulating switched memory B cells, decreased response to pneumococcal polysaccharide antigens and a lack of response to Salmonella typhi vaccine. Most SIgAD patients presents with upper respiratory tract infections or mild diarrhea. Those with lower tract infections, pneumonia or untreatable diarrhea should follow B-cell subpopulations' study and antibody response to vaccines. Absence of response to Salmonella typhi vaccine allowed us to expose the defective antibody production.

Management of Urinary Tract infections in Children: Compliance with the National Institute for Health and Care Excellence (NICE) guidelines?

Background Urinary tract infections (UTI) are common among children. Management of UTI requires prompt diagnosis, treatment and most often, a regular follow up. Objective of the study was to evaluate compliance with the NICE guidelines 2007 when managing children with UTI at Bronglais General Hospital, Aberystwyth, United Kingdom. Method Study design was descriptive, retrospective and single centered study. Study population was 96 children aged 0 to16 year managed at above hospital during 2012 to 2014 period with confirmed UTI. Results Only 25% of infants less than 3 months old received intravenous antibiotics, deviating from the guidelines. Majority had oral only (25%) or intravenous followed by oral antibiotics (50%). For treatment of lower tract infection, duration of antibiotics prescription was longer than recommended. Overall adherence to investigations such as ultrasonography (USS), DMSA and Micturating Cysto-urethrogram (MCUG) was 81%, 91% and 93% respectively. All children with recurrent UTIs were prescribed antibiotic prophylaxis adhering to NICE guidelines. Conclusions This study highlights the disparity in the management of UTI in children despite established guidelines.