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Cadotte N, Moore H, Stone BL, Pershing NL, Ampofo K, Ou Z, Pavia AT, Blaschke AJ, Flaherty B, Crandall H. Prevalence of and Risks for Bacterial Infections in Hospitalized Children With Bronchiolitis. Hosp Pediatr 2024; 14:603-611. [PMID: 38973365 PMCID: PMC11287063 DOI: 10.1542/hpeds.2023-007549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 03/19/2024] [Accepted: 03/19/2024] [Indexed: 07/09/2024]
Abstract
BACKGROUND AND OBJECTIVES Viral bronchiolitis is a common pediatric illness. Treatment is supportive; however, some children have concurrent serious bacterial infections (cSBIs) requiring antibiotics. Identifying children with cSBI is challenging and may lead to unnecessary treatment. Improved understanding of the prevalence of and risk factors for cSBI are needed to guide treatment. We sought to determine the prevalence of cSBI and identify factors associated with cSBI in children hospitalized with bronchiolitis. METHODS We performed a retrospective cohort study of children <2 years old hospitalized with bronchiolitis at a free-standing children's hospital from 2012 to 2019 identified by International Classification of Diseases codes. cSBI was defined as bacteremia, urinary tract infection, meningitis, or pneumonia. Risk factors for cSBI were identified using logistic regression. RESULTS We identified 7871 admissions for bronchiolitis. At least 1 cSBI occurred in 4.2% of these admissions; with 3.5% meeting our bacterial pneumonia definition, 0.4% bacteremia, 0.3% urinary tract infection, and 0.02% meningitis. cSBI were more likely to occur in children with invasive mechanical ventilation (odds ratio [OR] 2.53, 95% confidence interval [CI] 1.78-3.63), a C-reactive protein ≥4 mg/dL (OR 2.20, 95% CI 1.47-3.32), a concurrent complex chronic condition (OR 1.67, 95% CI 1.22-2.25) or admission to the PICU (OR 1.46, 95% CI 1.02-2.07). CONCLUSIONS cSBI is uncommon among children hospitalized with bronchiolitis, with pneumonia being the most common cSBI. Invasive mechanical ventilation, elevated C-reactive protein, presence of complex chronic conditions, and PICU admission were associated with an increased risk of cSBI.
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Affiliation(s)
- Noelle Cadotte
- Divisions of Critical Care
- Department of Pediatrics, Navy Medicine Readiness and Training Command, San Diego, California
| | - Hannah Moore
- Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah
| | | | | | - Krow Ampofo
- Infectious Diseases, Department of Pediatrics
| | - Zhining Ou
- Epidemiology, Department of Internal Medicine
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Osborne CM, Chiotos K, Woods-Hill CZ. Diagnostic Challenges Associated With the Prevalence of Concurrent Serious Bacterial Infection in Children With Bronchiolitis. Hosp Pediatr 2024; 14:e355-e357. [PMID: 38973367 PMCID: PMC11287062 DOI: 10.1542/hpeds.2024-007856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2024] [Revised: 04/24/2024] [Accepted: 04/24/2024] [Indexed: 07/09/2024]
Affiliation(s)
- Christina M. Osborne
- Division of Critical Care Medicine, Department of Anesthesiology and Critical Care
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Kathleen Chiotos
- Division of Critical Care Medicine, Department of Anesthesiology and Critical Care
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- Department of Anesthesia and Critical Care
| | - Charlotte Z. Woods-Hill
- Division of Critical Care Medicine, Department of Anesthesiology and Critical Care
- Department of Anesthesia and Critical Care
- Leonard Davis Institute, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
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Garout W. Prevalence and risk factors of urinary tract infection among children with bronchiolitis. Pediatr Neonatol 2024; 65:348-353. [PMID: 38044234 DOI: 10.1016/j.pedneo.2023.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 07/24/2023] [Accepted: 08/24/2023] [Indexed: 12/05/2023] Open
Abstract
BACKGROUND The co-occurrence of bronchiolitis and urinary tract infections (UTI) in hospitalized children is associated with high morbidity and economic strain. However, due to a low prevalence (<3%) and inconsistent diagnostic criteria, there is ongoing debate regarding the necessity of systematic screening. This study estimated the prevalence of UTI among children admitted for bronchiolitis and analyzed the associated demographic and clinical factors. METHODS A 5-year (2016-2020) retrospective chart review was conducted among all children admitted for bronchiolitis at a referral pediatrics department in Jeddah, Saudi Arabia. UTI was diagnosed according to the American Association of Pediatrics criteria. Demographic, clinical, microbiological, and imaging data were extracted from the hospital electronic records. RESULTS Of the 491 cases of children with bronchiolitis, urine culture and analysis were available for 320 patients. Based on urine culture criteria alone, the prevalence of UTI was 13.1% (95% CI 9.6-17.3), and the most common pathogens included E. coli (33.3%), K. pneumoniae (23.8%), and Enterococcus faecalis (14.3%), and 13 (31.0%) of the isolates were EBSL. By considering urinalysis criteria, i.e., pyuria or nitrituria, the estimated prevalence of UTI decreased to 3.4% (1.7-6.1%), and the most common pathogens were K. pneumoniae (5/11) and E. coli (3/11), with 6/11 ESBL-producing isolates. Regurgitation associated with a higher risk of UTI compared to absence of regurgitation (5.3% versus 0.8%; p = 0.031). Urinary tract ultrasound showed high specificity (98.7-100%) and negative predictive value (97.4-97.7%) in UTI using either criterion. CONCLUSIONS There is a higher prevalence of UTI among children with bronchiolitis in the study center, which has several implications in screening, diagnosis, and management. Further multicenter studies are required to enhance the external validity of these findings and assess the cost-effectiveness of screening strategy at a national level.
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Iio K, Mikami N, Harada R, Hamada R, Hagiwara Y, Hataya H, Sandhu A, Goldman RD. Treatment Delay of Febrile Urinary Tract Infections Among Infants With Respiratory Symptoms. Pediatr Infect Dis J 2024; 43:e121-e124. [PMID: 38134370 DOI: 10.1097/inf.0000000000004226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2023]
Abstract
OBJECTIVE To evaluate whether antibiotic treatment of febrile urinary tract infection (UTI) is delayed in febrile infants with respiratory symptoms compared with those without. STUDY DESIGN Data of infants 2-24 months of age diagnosed with UTI from March 1, 2012 to May 31, 2023 were collected from our hospital's medical charts and triage records. Patients with known congenital anomalies of the kidney and urinary tract or a history of febrile UTI were excluded. Patients were classified as having respiratory symptoms if they had any of the following symptoms or clinical signs: cough, rhinorrhea, pharyngeal hyperemia and otitis media. Time to first antibiotic treatment from fever onset was compared between patients with and without respiratory symptoms. A Cox regression model was constructed to adjust for potential confounders. RESULTS A total of 214 patients were eligible for analysis. The median age of the eligible patients was 5.0 months (interquartile range: 3.0-8.8) and 118 (55%) were male. There were 104 and 110 patients in the respiratory symptom and no respiratory symptom groups, respectively. The time to first antibiotic treatment was significantly longer in the group with respiratory symptoms (51 hours vs. 21 hours). Respiratory symptoms were significantly associated with a longer time to first treatment after adjustment for age and sex in the Cox regression model (hazard ratio = 0.63, 95% confidence interval: 0.47-0.84). CONCLUSIONS Treatment of febrile UTI infants with respiratory symptoms tends to be delayed. Pediatricians should not exclude febrile UTI even in the presence of respiratory symptoms.
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Affiliation(s)
- Kazuki Iio
- From the Division of Pediatric Emergency Medicine
| | | | | | | | | | - Hiroshi Hataya
- Department of General Pediatrics, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
| | | | - Ran D Goldman
- Pediatric Research in Emergency Therapeutics (PRETx) Program, Division of Emergency Medicine, Department of Pediatrics, University of British Columbia, BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada
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Pérez-Porra S, Granda E, Benito H, Roland D, Gomez B, Velasco R. Prevalence of invasive bacterial infection in febrile infants ≤90 days with a COVID-19 positive test: a systematic review and meta-analysis. Emerg Med J 2024; 41:228-235. [PMID: 38071527 DOI: 10.1136/emermed-2023-213483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 11/15/2023] [Indexed: 01/24/2024]
Abstract
BACKGROUND Febrile infants with an infection by influenza or enterovirus are at low risk of invasive bacterial infection (IBI). OBJECTIVE To determine the prevalence of IBI among febrile infants ≤90 days old with a positive COVID-19 test. METHODS MEDLINE, Embase, Cochrane Central Register databases, Web of Science, ClinicalTrials.gov and grey literature were searched for articles published from February 2020 to May 2023. INCLUSION CRITERIA researches reporting on infants ≤90 days of age with fever and a positive test for SARS-CoV-2 (antigen test/PCR). Case reports with <3 patients, articles written in a language other than English, French or Spanish, editorials and other narrative studies were excluded. Preferred Reposting Items for Systematic Reviews and Meta-analysis guidelines were followed, and the National Institutes of Health Quality Assessment Tool was used to assess study quality. The main outcome was the prevalence of IBI (a pathogen bacterium identified in blood and/or cerebrospinal fluid (CSF)). Forest plots of prevalence estimates were constructed for each study. Heterogeneity was assessed and data were pooled by meta-analysis using a random effects model. A fixed continuity correction of 0.01 was added when a study had zero events. RESULTS From the 1023 studies and 3 databases provided by the literature search, 33 were included in the meta-analysis, reporting 3943 febrile infants with a COVID-19 positive test and blood or CSF culture obtained. The pooled prevalence of IBI was 0.14% (95% CI, 0.02% to 0.27%). By age, the prevalence of IBI was 0.56% (95% CI, 0.0% to 1.27%) in those 0-21 days old, 0.53% (95% CI, 0.0% to 1.22%) in those 22-28 days old and 0.11% (95% CI, 0.0% to 0.24%) in those 29-60 days old. CONCLUSION COVID-19-positive febrile infants ≤90 days old are at low risk of IBI, especially infants >28 days old, suggesting this subgroup of patients can be managed without blood tests. PROSPERO REGISTRATION NUMBER CRD42022356507.
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Affiliation(s)
- Silvia Pérez-Porra
- Pediatrics Department, Hospital Universitario Rio Hortega, Valladolid, Spain
| | - Elena Granda
- Pediatrics Department, Hospital Universitario Rio Hortega, Valladolid, Spain
- Pediatrics Department, Hospital Universitario de Burgos, Burgos, Spain
| | - Helvia Benito
- Gerencia de Atención Primaria de Segovia, Segovia, Spain
- CAP Concòrdia. Consorci Corporació Sanitària Parc Tauli, Sabadell, Barcelona, Spain
| | - Damian Roland
- SAPPHIRE Group, Health Sciences, University of Leicester, Leicester, UK
- Paediatric Emergency Medicine Leicester Academic (PEMLA) Group, Children's Emergency Department, Leicester Royal Infirmary, Leicester, UK
| | - Borja Gomez
- Pediatric Emergency Department, Biocruces Bizkaia Health Research Institute, Hospital Universitario de Cruces. University of the Basque Country, UPV/EHU, Barakaldo, Bilbao, Basque Country, Spain
| | - Roberto Velasco
- Pediatric Emergency Unit, Department of Pediatrics, Hospital Universitari Parc Tauli, Sabadell, Barcelona, Spain
- Department of Paediatrics & Child Health, University College Cork, Cork, Ireland
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Liang D, Wang ME, Dahlen A, Liao Y, Saunders AC, Coon ER, Schroeder AR. Incidence of Pediatric Urinary Tract Infections Before and During the COVID-19 Pandemic. JAMA Netw Open 2024; 7:e2350061. [PMID: 38170521 PMCID: PMC10765266 DOI: 10.1001/jamanetworkopen.2023.50061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 11/14/2023] [Indexed: 01/05/2024] Open
Abstract
IMPORTANCE Urinary tract infection (UTI) is common in children, but the population incidence is largely unknown. Controversy surrounds the optimal diagnostic criteria and how to balance the risks of undertreatment and overtreatment. Changes in health care use during the COVID-19 pandemic created a natural experiment to examine health care use and UTI diagnosis and outcomes. OBJECTIVES To examine the population incidence of UTI in children and assess the changes of the COVID-19 pandemic regarding UTI diagnoses and measures of UTI severity. DESIGN, SETTING, AND PARTICIPANTS This retrospective observational cohort study used US commercial claims data from privately insured patients aged 0 to 17 years from January 1, 2016, to December 31, 2021. EXPOSURE Time periods included prepandemic (January 1, 2016, to February 29, 2020), early pandemic (April 1 to June 30, 2020), and midpandemic (July 1, 2020, to December 31, 2021). MAIN OUTCOMES AND MEASURES The primary outcome was the incidence of UTI, defined as having a UTI diagnosis code with an accompanying antibiotic prescription. Balancing measures included measures of UTI severity, including hospitalizations and intensive care unit admissions. Trends were evaluated using an interrupted time-series analysis. RESULTS The cohort included 13 221 117 enrollees aged 0 to 17 years, with males representing 6 744 250 (51.0%) of the population. The mean incidence of UTI diagnoses was 1.300 (95% CI, 1.296-1.304) UTIs per 100 patient-years. The UTI incidence was 0.86 per 100 patient-years at age 0 to 1 year, 1.58 per 100 patient-years at 2 to 5 years, 1.24 per 100 patient-years at 6 to 11 years, and 1.37 per 100 patient-years at 12 to 17 years, and was higher in females vs males (2.48 [95% CI, 2.46-2.50] vs 0.180 [95% CI, 0.178-0.182] per 100 patient-years). Compared with prepandemic trends, UTIs decreased in the early pandemic: -33.1% (95% CI, -39.4% to -26.1%) for all children and -52.1% (95% CI, -62.1% to -39.5%) in a subgroup of infants aged 60 days or younger. However, all measures of UTI severity decreased or were not significantly different. The UTI incidence returned to near prepandemic rates (-4.3%; 95% CI, -32.0% to 34.6% for all children) after the first 3 months of the pandemic. CONCLUSIONS AND RELEVANCE In this cohort study, UTI diagnosis decreased during the early pandemic period without an increase in measures of disease severity, suggesting that reduced overdiagnosis and/or reduced misdiagnosis may be an explanatory factor.
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Affiliation(s)
- Danni Liang
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California
| | - Marie E. Wang
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California
| | - Alex Dahlen
- Quantitative Sciences Unit, Department of Medicine, Stanford University School of Medicine, Palo Alto, California
| | - Yungting Liao
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California
| | - Andrew C. Saunders
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California
| | - Eric R. Coon
- Department of Pediatrics, Primary Children’s Hospital and University of Utah School of Medicine, Salt Lake City
| | - Alan R. Schroeder
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California
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Greenhow TL, Nguyen THP, Young BR, Somers MJ, Huang J, Alabaster A, Vinson DR, Mark DG, Van Winkle PJ, Sharp AL, Reed ME, Shan J, Zhang JY, Rauchwerger AS, Ballard DW. CA FIRST (California Febrile Infant Risk Stratification Tool) Algorithm Development in a Learning Health System. Perm J 2023; 27:92-98. [PMID: 37559485 PMCID: PMC10502387 DOI: 10.7812/tpp/23.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/11/2023]
Abstract
Introduction There is considerable variation in the approach to infants presenting to the emergency department (ED) with fever. The authors' primary aim was to develop a robust set of algorithms using community ED data to inform modifications of broader clinical guidance. Methods The authors report the development of California Febrile Infant Risk Stratification Tool (CA FIRST) using key components of the Roseville Protocol (ROS) and American Academy of Pediatrics (AAP) Clinical Practice Guideline (CPG). Expanded guidance was derived using a retrospective analysis of a cohort of 3527 febrile infants aged 7-90 days presenting to any Kaiser Permanente Northern California ED between 2010 and 2019 who underwent a core febrile infant evaluation. Results Melding ROS and AAP CPG algorithms in infants 7-60 days old, CA FIRST Algorithms had comparable performance characteristics to ROS and AAP CPG. CA FIRST enhancements included guidance on febrile infants 61-90 days old, high-risk infants, infants with bronchiolitis, and infants who received immunizations within the prior 48 hours. This retrospective analysis revealed that of 235 febrile infants 22-90 days old with respiratory syncytial virus and 221 who had fever in the 48 hours following vaccination, there were no cases of invasive bacterial infection. Discussion CA FIRST is a set of 13 algorithms providing a thoughtful and flexible approach to the febrile infant while minimizing unnecessary interventions. Conclusions CA FIRST Algorithms empower clinicians to manage most febrile infants. Algorithms are being modified as new data become available, imparting useful and ever-current educational information within a learning health care system.
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Affiliation(s)
- Tara L Greenhow
- Division of Infectious Diseases, Department of Pediatrics, Kaiser Permanente Northern California, San Francisco, CA, USA
- The Permanente Medical Group, Oakland, CA, USA
| | - Tran HP Nguyen
- The Permanente Medical Group, Oakland, CA, USA
- Department of Hospital Pediatrics, Kaiser Permanente Northern California, Roseville, CA, USA
| | - Beverly R Young
- The Permanente Medical Group, Oakland, CA, USA
- Department of Hospital Pediatrics, Kaiser Permanente Northern California, Roseville, CA, USA
| | - Madeline J Somers
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Jie Huang
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Amy Alabaster
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - David R Vinson
- The Permanente Medical Group, Oakland, CA, USA
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Dustin G Mark
- The Permanente Medical Group, Oakland, CA, USA
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Patrick J Van Winkle
- Department of Pediatrics, Kaiser Permanente Southern California, Anaheim, CA, USA
- Kaiser Permanente Bernard J. Tyson School of Medicine, Health Systems Science Department, Pasadena, CA, USA
| | - Adam L Sharp
- Kaiser Permanente Bernard J. Tyson School of Medicine, Health Systems Science Department, Pasadena, CA, USA
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - Mary E Reed
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Judy Shan
- School of Medicine, University of California, San Francisco, CA, USA
| | - Jennifer Y Zhang
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Adina S Rauchwerger
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Dustin W Ballard
- The Permanente Medical Group, Oakland, CA, USA
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
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Sick-Samuels AC, Booth LD, Milstone AM, Schumacher C, Bergmann J, Stockwell DC. A Novel Comprehensive Algorithm for Evaluation of PICU Patients With New Fever or Instability. Pediatr Crit Care Med 2023; 24:670-680. [PMID: 37125808 PMCID: PMC10392890 DOI: 10.1097/pcc.0000000000003256] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
OBJECTIVES There is variation in microbiology testing among PICU patients with fever offering opportunities to reduce avoidable testing and treatment. Our objective is to describe the development and assess the impact of a novel comprehensive testing algorithm to support judicious testing practices and expanded diagnostic differentials for PICU patients with new fever or instability. DESIGN A mixed-methods quality improvement study. SETTING Single-center academic PICU and pediatric cardiac ICU. SUBJECTS Admitted PICU patients and physicians. INTERVENTIONS A multidisciplinary team developed a clinical decision-support algorithm. MEASUREMENTS AND MAIN RESULTS We evaluated blood, endotracheal, and urine cultures, urinalyses, and broad-spectrum antibiotic use per 1,000 ICU patient-days using statistical process control charts and incident rate ratios (IRRs) and assessed clinical outcomes 24 months pre- and 18 months postimplementation. We surveyed physicians weekly for 12 months postimplementation. Blood cultures declined by 17% (IRR, 0.83; 95% CI, 0.77-0.89), endotracheal cultures by 26% (IRR, 0.74; 95% CI, 0.63-0.86), and urine cultures by 36% (IRR, 0.64; 95% CI, 0.56-0.73). There was an anticipated rise in urinalysis testing by 23% (IRR, 1.23; 95% CI, 1.14-1.33). Despite higher acuity and fewer brief hospitalizations, mortality, hospital, and PICU readmissions were stable, and PICU length of stay declined. Of the 108 physician surveys, 46 replied (43%), and 39 (85%) recently used the algorithm; 0 reported patient safety concerns, two (4%) provided constructive feedback, and 28 (61%) reported the algorithm improved patient care. CONCLUSIONS A comprehensive fever algorithm was associated with reductions in blood, endotracheal, and urine cultures and anticipated increase in urinalyses. We detected no patient harm, and physicians reported improved patient care.
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Affiliation(s)
- Anna C Sick-Samuels
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD
- Department of Hospital Epidemiology and Infection Control, Johns Hopkins Hospital, Baltimore, MD
- Armstrong Institute of Patient Safety and Quality, Johns Hopkins University School of Medicine, Baltimore, MD
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Lauren D Booth
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Aaron M Milstone
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD
- Department of Hospital Epidemiology and Infection Control, Johns Hopkins Hospital, Baltimore, MD
- Armstrong Institute of Patient Safety and Quality, Johns Hopkins University School of Medicine, Baltimore, MD
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Christina Schumacher
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Jules Bergmann
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - David C Stockwell
- Armstrong Institute of Patient Safety and Quality, Johns Hopkins University School of Medicine, Baltimore, MD
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
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Dablool AS. An Antibiogram Study for Urine Culture Testing in Makkah Region Hospitals. Cureus 2023; 15:e36012. [PMID: 37041904 PMCID: PMC10084737 DOI: 10.7759/cureus.36012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/08/2023] [Indexed: 03/13/2023] Open
Abstract
BACKGROUND The antibiogram profile could be helpful in the selection of the most appropriate antimicrobial treatment for microbial infection and even useful to monitor antibiotic resistance. OBJECTIVE This study aims to identify the bacteria in the urine through urine culture and perform their antibiogram to determine the resistance profile between antibiotics and urine tract infection (UTI)-causing bacteria and to determine the effective and non-effective antibiotics. METHODS The study was based on urine culture data from five Makkah hospitals in the Kingdom of Saudi Arabia (KSA). RESULTS A total of 1000 pathogens were found in the urine culture; 899 were bacterial isolates, and 101 were Candida spp. Seven hundred and seventy-seven of the 899 bacteria isolates were gram-positive, while 122 were gram-negative bacteria. Escherichia coli (44%) was the most frequent UTI-causing bacteria, followed by Klebsiella spp. (20%), Pseudomonas aeruginosa (6%), S. aureus (5.5%), Enterococcus faecalis (4.5%), Enterobacter spp. (2%), and Proteus spp. (1%). There was clear evidence that ampicillin, cefepime, erythromycin, and moxifloxacin were not effective antibiotics for uropathogens in the Makkah area, KSA. The multiple drug resistance (MDR), extensively drug-resistant (XDR), extended spectrum beta lactamase (ESBL), CR, and quinolones resistance (QR) were higher in the gram-negative bacilli. The pandrug resistance (PDR) and AmpC seemed to have fewer ratios of UTIs caused by gram-negative bacteria. On the other hand, S. aureus of the gram-positive type was also involved in the UTI and had a higher ratio of MDR, QR, and methicillin-resistant Staphylococcus aureus (MRSA).
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Hon KL, Leung AKC, Wong AHC, Dudi A, Leung KKY. Respiratory Syncytial Virus is the Most Common Causative Agent of Viral Bronchiolitis in Young Children: An Updated Review. Curr Pediatr Rev 2023; 19:139-149. [PMID: 35950255 DOI: 10.2174/1573396318666220810161945] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 03/28/2022] [Accepted: 05/09/2022] [Indexed: 02/08/2023]
Abstract
BACKGROUND Viral bronchiolitis is a common condition and a leading cause of hospitalization in young children. OBJECTIVE This article provides readers with an update on the evaluation, diagnosis, and treatment of viral bronchiolitis, primarily due to RSV. METHODS A PubMed search was conducted in December 2021 in Clinical Queries using the key terms "acute bronchiolitis" OR "respiratory syncytial virus infection". The search included clinical trials, randomized controlled trials, case control studies, cohort studies, meta-analyses, observational studies, clinical guidelines, case reports, case series, and reviews. The search was restricted to children and English literature. The information retrieved from the above search was used in the compilation of this article. RESULTS Respiratory syncytial virus (RSV) is the most common viral bronchiolitis in young children. Other viruses such as human rhinovirus and coronavirus could be etiological agents. Diagnosis is based on clinical manifestation. Viral testing is useful only for cohort and quarantine purposes. Cochrane evidence-based reviews have been performed on most treatment modalities for RSV and viral bronchiolitis. Treatment for viral bronchiolitis is mainly symptomatic support. Beta-agonists are frequently used despite the lack of evidence that they reduce hospital admissions or length of stay. Nebulized racemic epinephrine, hypertonic saline and corticosteroids are generally not effective. Passive immunoprophylaxis with a monoclonal antibody against RSV, when given intramuscularly and monthly during winter, is effective in preventing severe RSV bronchiolitis in high-risk children who are born prematurely and in children under 2 years with chronic lung disease or hemodynamically significant congenital heart disease. Vaccines for RSV bronchiolitis are being developed. Children with viral bronchiolitis in early life are at increased risk of developing asthma later in childhood. CONCLUSION Viral bronchiolitis is common. No current pharmacologic treatment or novel therapy has been proven to improve outcomes compared to supportive treatment. Viral bronchiolitis in early life predisposes asthma development later in childhood.
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Affiliation(s)
- Kam L Hon
- Department of Paediatrics and Adolescent Medicine, The Hong Kong Children's Hospital, Kowloon Bay, Hong Kong
| | - Alexander K C Leung
- Department of Pediatrics, The University of Calgary, and The Alberta Children's Hospital, Calgary, Alberta, Canada
| | - Alex H C Wong
- Department of Family Medicine, The University of Calgary, Calgary, Alberta, Canada
| | - Amrita Dudi
- Department of Paediatrics and Adolescent Medicine, The Hong Kong Children's Hospital, Kowloon Bay, Hong Kong
| | - Karen K Y Leung
- Department of Paediatrics and Adolescent Medicine, The Hong Kong Children's Hospital, Kowloon Bay, Hong Kong
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Lirette MP, Kuppermann N, Finkelstein Y, Zemek R, Plint AC, Florin TA, Babl FE, Dalziel S, Freedman S, Roland D, Lyttle MD, Schnadower D, Steele D, Fernandes RM, Stephens D, Kharbanda A, Johnson DW, Macias C, Benito J, Schuh S. International variation in evidence-based emergency department management of bronchiolitis: a retrospective cohort study. BMJ Open 2022; 12:e059784. [PMID: 36600373 PMCID: PMC9730363 DOI: 10.1136/bmjopen-2021-059784] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES We aimed to evaluate the international variation in the use of evidence-based management (EBM) in bronchiolitis. We hypothesised that management consistent with full-EBM practices is associated with the research network of care, adjusted for patient-level characteristics. Secondary objectives were to determine the association between full-EBM and (1) hospitalisation and (2) emergency department (ED) revisits resulting in hospitalisation within 21 days. DESIGN A secondary analysis of a retrospective cohort study. SETTING 38 paediatric EDs belonging to the Paediatric Emergency Research Network in Canada, USA, Australia/New Zealand UK/Ireland and Spain/Portugal. PATIENTS Otherwise healthy infants 2-11 months old diagnosed with bronchiolitis between 1 January 2013 and 31 December, 2013. OUTCOME MEASURES Primary outcome was management consistent with full-EBM, that is, no bronchodilators/corticosteroids/antibiotics, no chest radiography or laboratory testing. Secondary outcomes included hospitalisations during the index and subsequent ED visits. RESULTS 1137/2356 (48.3%) infants received full-EBM (ranging from 13.2% in Spain/Portugal to 72.3% in UK/Ireland). Compared with the UK/Ireland, the adjusted ORs (aOR) of full-EBM receipt were lower in Spain/Portugal (aOR 0.08, 95% CI 0.02 to 0.29), Canada (aOR 0.13 (95% CI 0.06 to 0.31) and USA (aOR 0.16 (95% CI 0.07 to 0.35). EBM was less likely in infants with dehydration (aOR 0.49 (95% CI 0.33 to 0.71)), chest retractions (aOR 0.69 (95% CI 0.52 to 0.91)) and nasal flaring (aOR 0.69 (95% CI 0.52 to 0.92)). EBM was associated with reduced odds of hospitalisation at the index visit (aOR 0.77 (95% CI 0.60 to 0.98)) but not at revisits (aOR 1.17 (95% CI 0.74 to 1.85)). CONCLUSIONS Infants with bronchiolitis frequently do not receive full-EBM ED management, particularly those outside of the UK/Ireland. Furthermore, there is marked variation in full-EBM between paediatric emergency networks, and full-EBM delivery is associated with lower likelihood of hospitalisation. Given the global bronchiolitis burden, international ED-focused deimplementation of non-indicated interventions to enhance EBM is needed.
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Affiliation(s)
- Marie-Pier Lirette
- Division of Pediatric Emergency Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Nathan Kuppermann
- The Departments of Emergency Medicine and Pediatrics, University of California Davis School of Medicine, Sacramento, California, USA
- University of California Davis Health System, Sacramento, California, USA
| | - Yaron Finkelstein
- Division of Pediatric Emergency Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
- Hospital for Sick Children Research Institute, University of Toronto, Toronto, Ontario, Canada
| | - Roger Zemek
- Division of Pediatric Emergency Medicine, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
- Division of Pediatric Emergency Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Amy C Plint
- Division of Pediatric Emergency Medicine, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
- Division of Pediatric Emergency Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Todd Adam Florin
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Department of Pediatrics, Ann and Robert H Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Franz E Babl
- Emergency Department, Murdoch Childrens Research Institute, Melbourne, Victoria, Australia
- The University of Melbourne/The Royal Children's Hospital CICH, Parkville, Victoria, Australia
| | - Stuart Dalziel
- Emergency Department, Starship Children's Health, Auckland, Auckland, New Zealand
- Departments of Surgery and Paediatrics: Child and Youth Health, The University of Auckland, Auckland, New Zealand
| | - Stephen Freedman
- Department of Pediatrics, Sections of Pediatric Emergency Medicine and Gastroenterology, Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada
- University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - Damian Roland
- Paediatric Emergency Medicine Leicester Academic (PEMLA) Group, Leicester Royal Infirmary, Leicester, UK
- SAPPHIRE Group, Health Sciences, University of Leicester, Leicester, Leicestershire, UK
| | - Mark David Lyttle
- Emergency Department, Bristol Royal Hospital for Children, Bristol, UK
- Faculty of Health and Applied Life Sciences, University of the West of England, Bristol, UK
| | - David Schnadower
- Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Dale Steele
- Pediatric Emergency Medicine, Hasbro Children's Hospital, Providence, Rhode Island, USA
- Departments of Emergency Medicine, Pediatrics and Health Services, Policy & Practice, Brown University, Providence, Rhode Island, USA
| | - Ricardo M Fernandes
- Department of Pediatrics, Hospital de Santa Maria, Lisboa, Portugal
- Laboratory of Clinical Pharmacology and Therapeutics, Faculty of Medicine, Universidade de Lisboa Instituto de Medicina Molecular, Lisboa, Portugal
| | - Derek Stephens
- Hospital for Sick Children Research Institute, University of Toronto, Toronto, Ontario, Canada
| | - Anupam Kharbanda
- Department of Pediatric Emergency Medicine, Children's Minnesota, Minneapolis, Minnesota, USA
| | - David W Johnson
- University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
- Departments of Pediatrics, Emergency Medicine, and Physiology and Pharmacology, Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada
| | - Charles Macias
- Division of Pediatric Emergency Medicine, UH Rainbow Babies and Children's Hospital, Cleveland, Ohio, USA
- Case Western Reserve University, Cleveland, Ohio, USA
| | - Javier Benito
- Pediatric Emergency Department, Cruces University Hospital, Barakaldo, Spain
| | - Suzanne Schuh
- Hospital for Sick Children Research Institute, University of Toronto, Toronto, Ontario, Canada
- Division of Pediatric Emergency Medicine, The Hospital for Sick Children, Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
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12
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Almojali AI, Alshareef MS, Aljadoa OF, Alotaibi FF, Masuadi EM, Hameed TK. The prevalence of serious bacterial infections in infants 90 days and younger with viral respiratory tract infections. Saudi Med J 2022; 43:1007-1012. [PMID: 36104056 PMCID: PMC9987656 DOI: 10.15537/smj.2022.43.9.20220400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 07/21/2022] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES 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). METHODS 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. RESULTS 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. CONCLUSION 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.
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Affiliation(s)
- Abdullah I. Almojali
- From the Department of Pediatrics (Almojali, Alshareef, Aljadoa, Alotaibi, Hameed), King Abdullah Specialized Children’s Hospital, King Abdulaziz Medical City; from King Abdullah International Medical Research Center (Almojali, Alshareef, Aljadoa, Alotaibi, Masuadi, Hameed), Ministry of National Guard - Health Affairs; and from the College of Medicine (Almojali, Alshareef, Aljadoa, Alotaibi, Masuadi, Hameed), King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia.
| | - Musab S. Alshareef
- From the Department of Pediatrics (Almojali, Alshareef, Aljadoa, Alotaibi, Hameed), King Abdullah Specialized Children’s Hospital, King Abdulaziz Medical City; from King Abdullah International Medical Research Center (Almojali, Alshareef, Aljadoa, Alotaibi, Masuadi, Hameed), Ministry of National Guard - Health Affairs; and from the College of Medicine (Almojali, Alshareef, Aljadoa, Alotaibi, Masuadi, Hameed), King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia.
| | - Othman F. Aljadoa
- From the Department of Pediatrics (Almojali, Alshareef, Aljadoa, Alotaibi, Hameed), King Abdullah Specialized Children’s Hospital, King Abdulaziz Medical City; from King Abdullah International Medical Research Center (Almojali, Alshareef, Aljadoa, Alotaibi, Masuadi, Hameed), Ministry of National Guard - Health Affairs; and from the College of Medicine (Almojali, Alshareef, Aljadoa, Alotaibi, Masuadi, Hameed), King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia.
| | - Fahad F. Alotaibi
- From the Department of Pediatrics (Almojali, Alshareef, Aljadoa, Alotaibi, Hameed), King Abdullah Specialized Children’s Hospital, King Abdulaziz Medical City; from King Abdullah International Medical Research Center (Almojali, Alshareef, Aljadoa, Alotaibi, Masuadi, Hameed), Ministry of National Guard - Health Affairs; and from the College of Medicine (Almojali, Alshareef, Aljadoa, Alotaibi, Masuadi, Hameed), King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia.
| | - Emad M. Masuadi
- From the Department of Pediatrics (Almojali, Alshareef, Aljadoa, Alotaibi, Hameed), King Abdullah Specialized Children’s Hospital, King Abdulaziz Medical City; from King Abdullah International Medical Research Center (Almojali, Alshareef, Aljadoa, Alotaibi, Masuadi, Hameed), Ministry of National Guard - Health Affairs; and from the College of Medicine (Almojali, Alshareef, Aljadoa, Alotaibi, Masuadi, Hameed), King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia.
| | - Tahir K. Hameed
- From the Department of Pediatrics (Almojali, Alshareef, Aljadoa, Alotaibi, Hameed), King Abdullah Specialized Children’s Hospital, King Abdulaziz Medical City; from King Abdullah International Medical Research Center (Almojali, Alshareef, Aljadoa, Alotaibi, Masuadi, Hameed), Ministry of National Guard - Health Affairs; and from the College of Medicine (Almojali, Alshareef, Aljadoa, Alotaibi, Masuadi, Hameed), King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia.
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13
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Mellick LB, Murray C, Kalra S. "Parenteral" Diarrhea Associated With Pediatric Urinary Tract Infections: A Retrospective Chart Review. Pediatr Emerg Care 2022; 38:e1489-e1492. [PMID: 35413044 DOI: 10.1097/pec.0000000000002717] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The association of noninfectious diarrhea with extraintestinal infections such as otitis media, pneumonia, or febrile urinary tract infections (UTIs) is commonly known as parenteral diarrhea. Although this association has been described for over a century and parenteral diarrhea is mentioned in current reference literature, available evidence for this association seems to be limited. The primary research question was to determine if there is an association between UTIs and reports of diarrhea. METHODS A retrospective chart review was performed using the medical records from October 1, 2017, to March 29, 2019 at our tertiary pediatric medical center. We searched for all cases of afebrile and febrile UTIs evaluated in the pediatric emergency department or admitted directly to the hospital for treatment. All children younger than 5 years were eligible for inclusion. Exclusion criteria included children with recent urological procedures, known urinary tract disease, immune suppression, sepsis, or known gastrointestinal diseases. The medical records of each of the pediatric patients with culture-positive UTIs were reviewed for reports of concurrent diarrhea or diarrhea-like illness. In addition, using a comparative quantitative design, we performed a retrospective chart review of all children younger than 5 years with 1 of 2 noninfectious chief complaints, head trauma, and extremity fractures, presenting during the same period to assess the background rate of reported diarrhea.This research project received the approval of the University of South Alabama's Institutional Review Board. RESULTS A total of 236 children with a culture-positive UTI presented to our pediatric medical center from October 1, 2017 to March 29, 2019. Reports of diarrhea were documented in the medical record for 44 of the 236 UTIs (18.6%). Escherichia coli was the predominant infectious agent in 32 of the 44 children (72.7%) with culture-positive UTIs and diarrhea. Of the 368 comparison group patients who visited the pediatric emergency department for a noninfectious complaint, diarrhea was reported in 2 patients (0.01%). CONCLUSIONS Our retrospective review of pediatric patients younger than 5 years with culture-proven UTIs found an association of reported diarrhea. It is our opinion based on our single-center retrospective chart review that the current available evidence suggests an association between UTIs and extraintestinal diarrhea. Future prospective studies are recommended to confirm this association.
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Affiliation(s)
| | - Caleb Murray
- Pediatrics, University of South Alabama, Mobile, AL
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14
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Dalziel SR, Haskell L, O'Brien S, Borland ML, Plint AC, Babl FE, Oakley E. Bronchiolitis. Lancet 2022; 400:392-406. [PMID: 35785792 DOI: 10.1016/s0140-6736(22)01016-9] [Citation(s) in RCA: 55] [Impact Index Per Article: 27.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 03/27/2022] [Accepted: 05/26/2022] [Indexed: 02/06/2023]
Abstract
Viral bronchiolitis is the most common cause of admission to hospital for infants in high-income countries. Respiratory syncytial virus accounts for 60-80% of bronchiolitis presentations. Bronchiolitis is diagnosed clinically without the need for viral testing. Management recommendations, based predominantly on high-quality evidence, advise clinicians to support hydration and oxygenation only. Evidence suggests no benefit with use of glucocorticoids or bronchodilators, with further evidence required to support use of hypertonic saline in bronchiolitis. Evidence is scarce in the intensive care unit. Evidence suggests use of high-flow therapy in bronchiolitis is limited to rescue therapy after failure of standard subnasal oxygen only in infants who are hypoxic and does not decrease rates of intensive care unit admission or intubation. Despite systematic reviews and international clinical practice guidelines promoting supportive rather than interventional therapy, universal de-implementation of interventional care in bronchiolitis has not occurred and remains a major challenge.
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Affiliation(s)
- Stuart R Dalziel
- Department of Surgery, The University of Auckland, Auckland, New Zealand; Department of Paediatrics: Child and Youth Health, The University of Auckland, Auckland, New Zealand; Children's Emergency Department, Starship Children's Hospital, Auckland, New Zealand.
| | - Libby Haskell
- Department of Paediatrics: Child and Youth Health, The University of Auckland, Auckland, New Zealand; Children's Emergency Department, Starship Children's Hospital, Auckland, New Zealand
| | - Sharon O'Brien
- Emergency Department, Perth Children's Hospital, Perth, WA, Australia; School of Nursing, Curtin University, Perth, WA, Australia
| | - Meredith L Borland
- Emergency Department, Perth Children's Hospital, Perth, WA, Australia; Division of Paediatrics, School of Medicine, University of Western Australia, Perth, WA, Australia; Division of Emergency Medicine, School of Medicine, University of Western Australia, Perth, WA, Australia
| | - Amy C Plint
- Department of Pediatrics, University of Ottawa, Ottawa, ON, Canada; Department of Emergency Medicine, University of Ottawa, Ottawa, ON, Canada; Emergency Department, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
| | - Franz E Babl
- Department of Emergency Medicine, Royal Children's Hospital, Melbourne, VIC, Australia; Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia; Murdoch Children's Research Institute, Melbourne, VIC, Australia
| | - Ed Oakley
- Department of Emergency Medicine, Royal Children's Hospital, Melbourne, VIC, Australia; Department of Critical Care, University of Melbourne, Melbourne, VIC, Australia; Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia; Murdoch Children's Research Institute, Melbourne, VIC, Australia
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15
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Chang PW, Schroeder AR, Lucas BP, McDaniel CE. Impact of Diagnostic Criteria on UTI Prevalence in Young Infants With Jaundice: A Meta-analysis. Hosp Pediatr 2022; 12:425-440. [PMID: 35322269 DOI: 10.1542/hpeds.2021-006382] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND AND OBJECTIVE Previously reported prevalence of urinary tract infections (UTIs) in infants with jaundice range from <1% to 25%. However, UTI criteria are variable and, as demonstrated in a meta-analysis on UTI prevalence in bronchiolitis, disease prevalence is greatly impacted by disease definition. The objective of this study was to conduct a systemic review and meta-analysis examining the impact of including positive urinalysis (UA) results as a diagnostic criterion on the estimated UTI prevalence in young infants with jaundice. METHODS The data sources used were Medline (1946-2020) and Ovid Embase (1976-2020) through January 2020 and bibliographies of retrieved articles. We selected studies reporting UTI prevalence in young infants with jaundice. Data were extracted in accordance with meta-analysis of observational studies in epidemiology guidelines. Random-effects models produced a weighted pooled event rate with 95% confidence intervals (CI). RESULTS We screened 526 unique articles by abstract and reviewed 53 full-text articles. We included 32 studies and 16 contained UA data. The overall UTI prevalence in young infants with jaundice from all 32 studies was 6.2% (95% CI, 3.9-8.9). From the 16 studies with UA data, the overall UTI prevalence was 8.7% (95% CI, 5.1-13.2), which decreased to 3.6% (95% CI, 2.0-5.8) with positive UA results included as a diagnostic criterion. CONCLUSIONS The estimated UTI prevalence in young infants with jaundice decreases substantially when UA results are incorporated into the UTI definition. Due to the heterogeneity of study subjects' ages and definitions of jaundice, positive UA results, and UTI, there is uncertainty about the exact prevalence and about which infants with hyperbilirubinemia warrant urine testing.
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Affiliation(s)
- Pearl W Chang
- Department of Pediatrics, University of Washington, Seattle Children's Hospital, Seattle, Washington
| | - Alan R Schroeder
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | - Brian P Lucas
- Department of Medicine, The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, New Hampshire
| | - Corrie E McDaniel
- Department of Pediatrics, University of Washington, Seattle Children's Hospital, Seattle, Washington
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16
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Okada M, Kijima E, Yamamura H, Nakatani H, Yokoyama H, Imai M, Suzuki N, Oshiba A, Nagasawa M. Obesity and febrile urinary tract infection in young children. Pediatr Int 2022; 64:e14686. [PMID: 33682248 DOI: 10.1111/ped.14686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 02/14/2021] [Accepted: 03/01/2021] [Indexed: 01/06/2023]
Abstract
BACKGROUND Obesity is a risk factor for infectious diseases. However, the relationship between obesity and febrile urinary tract infection (fUTI) is controversial. This study aimed to determine the relationship between obesity and fUTI in young children. METHODS We analyzed the medical records of children aged <2 years who were admitted to our hospital because of fever between April 2013 to March 2018. The children were categorized into three groups of non-obese, overweight, and obese according to the World Health Organization weight-for-length curves for children aged <2 years. RESULTS A total of 600 patients were enrolled in this study, of whom 118 were diagnosed with first fUTI. Patients in the fUTI group were younger than those in the control group (patients who were diagnosed with other febrile diseases) (5 ± 5.11 vs 11 ± 6.53 months; P < 0.001). There were no significant differences in the populations of overweight and obese children between the fUTI and control groups. In the fUTI group, the duration of fever, types of pathogen, recurrent rate, the grades of vesicoureteral reflux, and renal scarring were not associated with obesity. The white blood cell count and C-reactive protein levels were not significantly different among the three weight-for-length categories. The same results were obtained when the fUTI group was compared with an age-matched control group (n = 192, 4 ± 2.55 months old; P = 0.261). CONCLUSIONS Obesity is not a significant risk factor for fUTI in febrile hospitalized young children. Our study suggests that conducting urinalysis for febrile young children without obvious sources, irrespective of obesity, should be considered.
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Affiliation(s)
- Mari Okada
- Department of Pediatrics, Musashino Red Cross Hospital, Musashino, Tokyo, Japan
| | - Emi Kijima
- Department of Pediatrics, Musashino Red Cross Hospital, Musashino, Tokyo, Japan
| | - Haruka Yamamura
- Department of Pediatrics, Musashino Red Cross Hospital, Musashino, Tokyo, Japan
| | - Hisae Nakatani
- Department of Pediatrics, Musashino Red Cross Hospital, Musashino, Tokyo, Japan
| | - Haruna Yokoyama
- Department of Pediatrics, Musashino Red Cross Hospital, Musashino, Tokyo, Japan
| | - Masako Imai
- Department of Pediatrics, Musashino Red Cross Hospital, Musashino, Tokyo, Japan
| | - Natsuko Suzuki
- Department of Pediatrics, Musashino Red Cross Hospital, Musashino, Tokyo, Japan
| | - Akihiro Oshiba
- Department of Pediatrics, Musashino Red Cross Hospital, Musashino, Tokyo, Japan
| | - Masayuki Nagasawa
- Department of Pediatrics, Musashino Red Cross Hospital, Musashino, Tokyo, Japan
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Elkhunovich MA, Wang VJ, Pham P, Arpilleda JC, Clingenpeel JM, Mansour K, Riech T, Yen K, Liu DR. Assessing the Utility of Urine Testing in Febrile Infants 2 to 12 Months of Age With Bronchiolitis. Pediatr Emerg Care 2021; 37:e1104-e1109. [PMID: 31804430 DOI: 10.1097/pec.0000000000001912] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The utility of testing for urinary tract infection (UTI) in febrile infants with bronchiolitis is indeterminate. OBJECTIVE The objective of this study was to investigate if the incidence of UTIs in febrile infants 2 to 12 months of age with bronchiolitis is higher than the presumed incidence of asymptomatic bacteriuria and determine risk factors associated with UTIs in this population. METHODS This prospective multicenter cross-sectional study was conducted in the emergency departments of 6 children's hospitals between November 2011 and June 2015. We obtained a convenience sample of febrile infants with bronchiolitis 2 to 12 months of age who were tested for UTI. Patient characteristics analyzed included age, maximum temperature, duration of fever, ethnicity, sex, and circumcision status. RESULTS A total of 442 patients (including 86 from a previously published pilot study) were enrolled. Mean age was 5.5 months, 65.2% were Latino, 50.9% were male, and 27.6% of male infants were circumcised. Urinary tract infections were found in 33 patients (7.69%, binomial; 95% confidence interval [CI], 5.19%-10.33%). Urinary tract infections were not related to age, height of temperature, duration of fever, or ethnicity. Uncircumcised males were significantly more likely to have UTIs than circumcised males (7.64% vs 0%, P = 0.03). Odds ratios (ORs) were lower for circumcised males but not uncircumcised males when compared with females (OR, 0.12; CI, 0.0-0.71; P = 0.01 vs OR, 0.77; CI, 0.33-1.74; P = 0.64). CONCLUSIONS Febrile infants 2 to 12 months of age with bronchiolitis have a clinically significant incidence of UTI, suggesting that UTI evaluation should be considered in these patients.
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Affiliation(s)
- Marsha A Elkhunovich
- From the Division of Emergency Medicine, Children's Hospital Los Angeles, Los Angeles, CA
| | - Vincent J Wang
- Division of Pediatric Emergency Medicine, UT Southwestern Medical Center, Dallas, TX
| | - Phung Pham
- From the Division of Emergency Medicine, Children's Hospital Los Angeles, Los Angeles, CA
| | - Joyce C Arpilleda
- Department of Emergency Medicine, Napa-Solano Permanente Medical Group, Napa, CA
| | - Joel M Clingenpeel
- Division of Emergency Medicine, Children's Hospital of the King's Daughters, Norfolk, VA
| | - Karim Mansour
- Division of Emergency Medicine, UCSF Benioff Children's Hospital Oakland, Oakland, CA
| | - Teresa Riech
- Division of Emergency Medicine, OSF Children's Hospital of Illinois, Peoria, IL
| | - Ken Yen
- Division of Pediatric Emergency Medicine, UT Southwestern Medical Center, Dallas, TX
| | - Deborah R Liu
- From the Division of Emergency Medicine, Children's Hospital Los Angeles, Los Angeles, CA
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18
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Edun TR, Aldibasi O, Jamil SF. Urinary Tract Infection in Children With Bronchiolitis: Is It Worth Testing Everyone? Cureus 2021; 13:e15485. [PMID: 34262821 PMCID: PMC8260889 DOI: 10.7759/cureus.15485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/06/2021] [Indexed: 01/09/2023] Open
Abstract
Objective The current study aims to determine the prevalence of urinary tract infection (UTI) and the need to perform urine analysis and cultures in children admitted with bronchiolitis in a large tertiary children's hospital in Riyadh, Saudi Arabia. Methods We conducted a retrospective chart review of pediatric patients 0-2 years of age who were admitted with bronchiolitis from November 2016 till April 2017. All charts were analyzed to identify the children investigated for UTI, and their results were then reviewed. Results There were 407 children admitted with bronchiolitis during the study period. Two-thirds of them were investigated for UTI. Only 2.6% of the patients tested positive for urine culture, and only 0.96% were found to have a true UTI. Conclusion The prevalence of UTI in children with bronchiolitis is too low to justify routine screening. Therefore, only children with a high risk of having UTI should be investigated.
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Affiliation(s)
- Tasnim R Edun
- Pediatrics, King Abdullah Specialized Children's Hospital, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, SAU
| | - Omar Aldibasi
- Biostatistics, King Abdullah International Medical Research Center, Riyadh, SAU
| | - Syed F Jamil
- Pediatrics, College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, SAU
- Pediatrics, King Abdullah Specialized Children's Hospital, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, SAU
- Biostatistics, King Abdullah International Medical Research Center, Riyadh, SAU
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Abstract
Sepsis, in particular severe sepsis, is a major cause of morbidity and mortality in pediatrics. It is most likely to affect very young children and children with significant medical comorbidities. The definition of sepsis in pediatrics is currently rapidly evolving but the best treatment for children with severe sepsis remains early goal directed therapy with intravenous fluids and antibiotics. It is therefore important for any pediatric urgent care providers to be able to recognize and treat patients with severe sepsis. It is also important for pediatric urgent care providers to be aware of certain groups of patients who have an increased risk of mortality when they develop sepsis. This article summarizes the current understanding of pediatric sepsis and then focuses on the management of these patients in the pediatric urgent care setting, with special attention paid to groups at higher risks of negative outcomes.
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Affiliation(s)
- Benjamin Klick
- USADirector of Resident Education, Children's Hospital of the King's Daughters Urgent Care Division, Assistant Professor of Pediatrics, Eastern Virginia Medical School.
| | - Theresa Guins
- Director, CSG Division of Urgent Care, Medical Director, CHKD Urgent Care Services, Director, EVMS/CSG PA Urgent Care Fellowship, Associate Professor of Pediatrics, Eastern Virginia Medical School USA.
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Kim JM, Koo JW, Kim HB. Is it necessary to evaluate urinary tract infection in children with lower respiratory tract infection? J Paediatr Child Health 2020; 56:1924-1928. [PMID: 32770814 DOI: 10.1111/jpc.15080] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Revised: 06/17/2020] [Accepted: 06/21/2020] [Indexed: 11/30/2022]
Abstract
AIM Although the incidence of urinary tract infection (UTI) in children with lower respiratory tract infection (LRTI) has been reported as 3.1-10.0%, the exact concomitant prevalence is questionable. Here, we evaluated the prevalence and related risk factors of UTI associated with LRTI in children under 36 months of age. METHODS We retrospectively reviewed the medical charts of 1574 patients under 36 months of age who were hospitalised with LRTI from January 2017 to December 2019 in a single centre, Seoul, South Korea. Among them, we analysed 278 patients who showed fever and performed urine evaluation. Urine was collected by catheterisation in children under 24 months of age and by voided urine between 24 and 36 months of age. RESULTS The prevalence of concomitant UTI and LRTI was 13.6% in children under 24 months of age. Mean age was significantly younger in the UTI versus non-UTI group (6.93 ± 7.26 months vs. 12.61 ± 11.70 months; P < 0.001). When the participants were stratified by age, the prevalence of UTI was significantly higher in children younger than 24 months of age compared to older ones (P = 0.006). UTIs were more prevalent in boys than in girls (14.6% vs. 5.8%, P = 0.018). Peak body temperature, fever duration, premature birth and detected respiratory virus type did not differ between groups. CONCLUSIONS It is not uncommon for children with LRTI with fever to be accompanied by UTI. When evaluating for UTI in children with febrile LRTI, age and sex must be considered.
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Affiliation(s)
- Jeong Min Kim
- Department of Pediatrics, Inje University Sanggye Paik Hospital, Seoul, South Korea
| | - Ja Wook Koo
- Department of Pediatrics, Inje University Sanggye Paik Hospital, Seoul, South Korea
| | - Hyo-Bin Kim
- Department of Pediatrics, Inje University Sanggye Paik Hospital, Seoul, South Korea
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21
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Schorlemer C, Eber E. [Acute viral bronchiolitis and wheezy bronchitis in children]. Monatsschr Kinderheilkd 2020; 168:1147-1157. [PMID: 32836401 PMCID: PMC7429454 DOI: 10.1007/s00112-020-00993-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Akute Bronchiolitis und obstruktive Bronchitis sind im Säuglings- und Kleinkindalter sehr häufige Krankheitsbilder. Sie werden durch Viren, v. a. respiratorisches Synzytialvirus und Rhinoviren, verursacht. Risikofaktoren für schwere Verläufe sind u. a. Frühgeburtlichkeit, Tabakrauchexposition und Immundysfunktionen. Die Diagnose kann durch Anamnese und klinische Untersuchung gestellt werden; Thorax-Röntgen und Laboruntersuchungen sind in der Regel nicht notwendig. Für die akute Bronchiolitis wurden viele therapeutische Ansätze propagiert, generell empfohlen sind aber nur supportive Maßnahmen (minimales Handling, Sicherstellung ausreichender Oxygenierung und Hydratation). Routinemäßig nicht empfohlen werden u. a. Antibiotika, Bronchodilatatoren, Kortikosteroide und Leukotrienrezeptorantagonisten. Kurz wirksame β2-Agonisten sind Therapie der 1. Wahl bei akuter obstruktiver Bronchitis. Bei häufigen und/oder schweren obstruktiven Bronchitiden kann zur Symptomkontrolle eine Therapie mit inhalativen Kortikosteroiden versucht werden. Die Entstehung von Asthma bronchiale ist jedoch durch keine medikamentöse Therapie zu verhindern.
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Affiliation(s)
- Christina Schorlemer
- Klinische Abteilung für Pädiatrische Pulmonologie und Allergologie, Univ.-Klinik für Kinder- und Jugendheilkunde, Medizinische Universität Graz, Auenbruggerplatz 34/2, 8036 Graz, Österreich
| | - Ernst Eber
- Klinische Abteilung für Pädiatrische Pulmonologie und Allergologie, Univ.-Klinik für Kinder- und Jugendheilkunde, Medizinische Universität Graz, Auenbruggerplatz 34/2, 8036 Graz, Österreich
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22
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Zipursky A, Kuppermann N, Finkelstein Y, Zemek R, Plint AC, Babl FE, Dalziel SR, Freedman SB, Steele DW, Fernandes RM, Florin TA, Stephens D, Kharbanda A, Roland D, Lyttle MD, Johnson DW, Schnadower D, Macias CG, Benito J, Schuh S. International Practice Patterns of Antibiotic Therapy and Laboratory Testing in Bronchiolitis. Pediatrics 2020; 146:peds.2019-3684. [PMID: 32661190 DOI: 10.1542/peds.2019-3684] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/06/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES International patterns of antibiotic use and laboratory testing in bronchiolitis in emergency departments are unknown. Our objective is to evaluate variation in the use of antibiotics and nonindicated tests in infants with bronchiolitis in 38 emergency departments in Pediatric Emergency Research Networks in Canada, the United States, Australia and New Zealand, the United Kingdom and Ireland, and Spain and Portugal. We hypothesized there would be significant variation, adjusted for patient characteristics. METHODS We analyzed a retrospective cohort study of previously healthy infants aged 2 to 12 months with bronchiolitis. Variables examined included network, poor feeding, dehydration, nasal flaring, chest retractions, apnea, saturation, respiratory rate, fever, and suspected bacterial infection. Outcomes included systemic antibiotic administration and urine, blood, or viral testing or chest radiography (CXR). RESULTS In total, 180 of 2359 (7.6%) infants received antibiotics, ranging from 3.5% in the United Kingdom and Ireland to 11.1% in the United States. CXR (adjusted odds ratio [aOR] 2.3; 95% confidence interval 1.6-3.2), apnea (aOR 2.2; 1.1-3.5), and fever (aOR 2.4; 1.7-3.4) were associated with antibiotic use, which did not vary across networks (P = .15). In total, 768 of 2359 infants (32.6%) had ≥1 nonindicated test, ranging from 12.7% in the United Kingdom and Ireland to 50% in Spain and Portugal. Compared to the United Kingdom and Ireland, the aOR (confidence interval) results for testing were Canada 5.75 (2.24-14.76), United States 4.14 (1.70-10.10), Australia and New Zealand 2.25 (0.86-5.74), and Spain and Portugal 3.96 (0.96-16.36). Testing varied across networks (P < .0001) and was associated with suspected bacterial infections (aOR 2.12; 1.30-2.39) and most respiratory distress parameters. Viral testing (591 of 768 [77%]) and CXR (507 of 768 [66%]) were obtained most frequently. CONCLUSIONS The rate of antibiotic use in bronchiolitis was low across networks and was associated with CXR, fever, and apnea. Nonindicated testing was common outside of the United Kingdom and Ireland and varied across networks irrespective of patient characteristics.
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Affiliation(s)
| | - Nathan Kuppermann
- Departments of Emergency Medicine and Pediatrics, School of Medicine, University of California Davis and University of California Davis Health, Sacramento, California
| | - Yaron Finkelstein
- Division of Pediatric Emergency Medicine and.,Research Institute, The Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
| | - Roger Zemek
- Division of Pediatric Emergency Medicine, Faculty of Medicine, University of Ottawa and Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Amy C Plint
- Division of Pediatric Emergency Medicine, Faculty of Medicine, University of Ottawa and Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Franz E Babl
- Emergency Department, Murdoch Children's Research Institute, The Royal Children's Hospital and The University of Melbourne, Melbourne, Australia
| | - Stuart R Dalziel
- Emergency Department, Starship Children's Hospital and the Departments of Surgery and Paediatrics: Child and Youth Health, School of Medicine, The University of Auckland, Auckland, New Zealand
| | - Stephen B Freedman
- Sections of Pediatric Emergency Medicine and Gastroenterology, Department of Pediatrics, Alberta Children's Hospital and
| | - Dale W Steele
- Department of Pediatric Emergency Medicine, Hasbro Children's Hospital and Departments of Emergency Medicine and Pediatrics, Warren Alpert Medical School and Department of Health Services, Policy, and Practice, School of Public Health, Brown University, Providence, Rhode Island
| | - Ricardo M Fernandes
- Department of Pediatrics, Hospital de Santa Maria and Laboratory of Clinical Pharmacology and Therapeutics, Faculty of Medicine, Instituto de Medicina Molecular, University of Lisbon, Lisbon, Portugal
| | - Todd A Florin
- Department of Pediatrics, Feinberg School of Medicine, Northwestern University and Division of Emergency Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Derek Stephens
- Research Institute, The Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
| | - Anupam Kharbanda
- Department of Pediatric Emergency Medicine, Children's Hospital of Minnesota, Minneapolis, Minnesota
| | - Damian Roland
- Paediatric Emergency Medicine Leicester Academic Group, Children's Emergency Department, Leicester Royal Infirmary, Leicester, United Kingdom.,Social Science Applied to Healthcare Improvement Research Group, Department of Health Sciences, University of Leicester, Leicester, United Kingdom
| | - Mark D Lyttle
- Paediatric Emergency Department, Bristol Royal Hospital for Children, Bristol, United Kingdom.,Faculty of Health and Applied Life Sciences, University of the West of England, Bristol, United Kingdom
| | - David W Johnson
- Departments of Pediatrics, Emergency Medicine, and Physiology and Pharmacology, Alberta Children's Hospital Research Institute, Cumming School of Medicine, Calgary, Alberta, Canada
| | - David Schnadower
- Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Charles G Macias
- Division of Pediatric Emergency Medicine, University Hospitals Rainbow Babies and Children's Hospital and Case Western Reserve University, Cleveland, Ohio; and
| | - Javier Benito
- Pediatric Emergency Department, Cruces University Hospital, Barakaldo, Bizkaia, Spain
| | - Suzanne Schuh
- Division of Pediatric Emergency Medicine and .,Research Institute, The Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
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23
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Jain S, Schroeder AR. Asymptomatic bacteriuria prevalence. J Pediatr 2020; 222:253-257. [PMID: 32586532 DOI: 10.1016/j.jpeds.2020.04.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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24
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Klouda TM, Wang H, Yaeger JP. Association of Cough Status With Bacterial Infections in Febrile Infants. Hosp Pediatr 2020; 10:185-189. [PMID: 31915133 DOI: 10.1542/hpeds.2019-0227] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVES To examine the association between cough status and bacterial infections (BIs) to more accurately stratify risk and predict BIs in febrile infants. METHODS A retrospective cohort study was performed by identifying all infants ≤60 days old with temperature ≥38°C at an urban pediatric emergency department from 2014 to 2016. The Rochester Risk model was used to stratify risk. Cough status (with or without) was the main covariate of interest. The primary outcome was a BI, including urinary tract infection, bacteremia, or meningitis. Analyses consisted of descriptive statistics, simple and multiple regression to compare the odds of BI on the basis of cough status, as well as χ2 statistics to compare the BI rates among high-risk infants with and without cough. RESULTS Of 508 febrile infants ≤60 days old, 46 (9.1%) had a BI, 13 of which were either bacteremia or meningitis. There were no BIs among low-risk infants with a cough. The odds of BI increased progressively, peaking at 14.6 (95% confidence interval: 4.3-49.7) for high-risk infants without a cough. The adjusted odds of BI among infants with cough was 0.47 (95% confidence interval: 0.22-0.99). CONCLUSIONS In our findings, an inverse relationship is demonstrated between presence of cough and odds of BI, suggesting that cough status may be a useful marker of viral infections in febrile infants. Considering that detecting cough status is noninvasive, inexpensive, and immediately available, it represents an attractive value-based risk factor to enhance current BI prediction models.
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Affiliation(s)
- Timothy M Klouda
- Department of Pediatrics, St. Christopher's Hospital for Children, Philadelphia, Pennsylvania; and
| | | | - Jeffrey P Yaeger
- Departments of Pediatrics and Public Health Sciences, School of Medicine and Dentistry, University of Rochester, Rochester, New York
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25
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Hendaus MA. Why Are Children With Bronchiolitis At Risk Of Urinary Tract Infections? Risk Manag Healthc Policy 2019; 12:251-254. [PMID: 31819685 PMCID: PMC6881700 DOI: 10.2147/rmhp.s222470] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Accepted: 10/30/2019] [Indexed: 01/12/2023] Open
Abstract
Viral respiratory infections are frequently eliminated from human bodies without any sequelae. Secondary serious bacterial infection (SBI) in children with acute bronchiolitis has been an apprehension expressed by health care providers. Several published studies have shown an association between acute bronchiolitis and secondary bacterial infection, including urinary tract infections (UTI). However, the proposed mechanism by which a virus can induce UTIs is not yet known. The aim of this commentary is to update the current evidence of risk of UTI in children with bronchiolitis. We present several clinical studies related to the topic as well as a brief review of the potential pathophysiology of secondary infections that could present with viral respiratory illness.
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Affiliation(s)
- Mohamed A Hendaus
- Department of Pediatrics, Section of Academic General Pediatrics, Sidra Medicine, Doha, Qatar.,Department of Clinical Pediatrics, Weill- Cornell Medicine, Doha, Qatar
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26
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Lendner I, Justman N, Givon-Lavi N, Maimon MS, Kestenbaum I, Ben-Shimol S. Urine dipstick low sensitivity for UTI diagnosis in febrile infants*. Infect Dis (Lond) 2019; 51:764-771. [DOI: 10.1080/23744235.2019.1652339] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Affiliation(s)
- Idan Lendner
- Pediatric Infectious Disease Unit, Soroka University Medical Center, Beer-Sheva, Israel
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Naphtali Justman
- Pediatric Infectious Disease Unit, Soroka University Medical Center, Beer-Sheva, Israel
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Noga Givon-Lavi
- Pediatric Infectious Disease Unit, Soroka University Medical Center, Beer-Sheva, Israel
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Michal S. Maimon
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
- Department of Pediatric Emergency Medicine, Soroka University Medical Center, Beer-Sheva, Israel
| | - Inbal Kestenbaum
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
- Department of Pediatric Emergency Medicine, Soroka University Medical Center, Beer-Sheva, Israel
| | - Shalom Ben-Shimol
- Pediatric Infectious Disease Unit, Soroka University Medical Center, Beer-Sheva, Israel
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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