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Dar A, Abram TB, Megged O. Impact of inadequate empirical antibiotic treatment on outcome of non-critically ill children with bacterial infections. BMC Pediatr 2024; 24:324. [PMID: 38734642 PMCID: PMC11088006 DOI: 10.1186/s12887-024-04793-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 04/26/2024] [Indexed: 05/13/2024] Open
Abstract
BACKGROUND The impact of inadequate empirical antibiotic treatment on patient outcomes and hospitalization duration for non-life-threatening infections in children remains poorly understood. We aimed to assess the effects of inadequate empirical antibiotic treatment on these factors in pediatric patients. METHODS The medical records of children admitted for infectious diseases with bacteria isolated from sterile sites between 2018 and 2020 were retrospectively reviewed. Patients who received adequate empirical treatment were compared with those who received inadequate treatment in terms of demographic, clinical, and laboratory variables. RESULTS Forty-eight patients who received inadequate empirical antimicrobial treatment were compared to 143 patients who received adequate empirical treatment. Inadequate empirical antimicrobial treatment did not significantly affect the length of hospital stay or the incidence of complications in non-critically ill children with bacterial infections. Younger age and underlying renal abnormalities were identified as risk factors for inadequate antimicrobial treatment, while associated bacteremia was more common in the adequate antimicrobial treatment group. CONCLUSIONS inadequate antibiotic treatment did not affect the outcomes of non-critically ill children with bacterial infectious diseases. Therefore, routine empirical broad-spectrum treatment may not be necessary for these cases, as it can lead to additional costs and contribute to antibiotic resistance. Larger prospective studies are needed to confirm these findings.
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Affiliation(s)
- Amit Dar
- Department of Internal Medicine, Hadassah-Hebrew University Medical Center, Ein Kerem, Jerusalem, Israel
| | - Tali Bdolah Abram
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Orli Megged
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.
- The Pediatric department and pediatric infectious diseases unit, Shaare Zedek Medical Center, P.O.B. 3235, Jerusalem, Israel.
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Tzvi-Behr S, Frishberg Y, Megged O, Weinbrand-Goichberg J, Becher-Cohen R, Terespolsky H, Rinat C, Choshen S, Ben-Shalom E. Acute glomerulonephritis with concurrent suspected bacterial pneumonia - is it the tip of the iceberg? Pediatr Nephrol 2024; 39:1143-1147. [PMID: 37943374 DOI: 10.1007/s00467-023-06217-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 10/18/2023] [Accepted: 10/25/2023] [Indexed: 11/10/2023]
Abstract
BACKGROUND Post infectious glomerulonephritis is the most common glomerulopathy in children, occurring several weeks after nephritogenic streptococcal throat or skin infection. Reports of acute glomerulonephritis (AGN) occurring during active bacterial pneumonia in children are rare. The aim of this study was to evaluate the incidence of AGN concurrent with bacterial pneumonia in children. METHODS We reviewed records of all children admitted with a diagnosis of pneumonia to the pediatric department in a single tertiary medical center between January 2015 and April 2023. Patients with bacterial pneumonia and concurrent glomerulonephritis were included. RESULTS Eleven (0.98%) of 1,123 patients with bacterial pneumonia had concurrent AGN. All were males with a median age of 2.7 years (range 1-13). Mean time from bacterial pneumonia onset to acute glomerulonephritis symptoms was 2.7 ± 1.5 days. Five (45%) patients had evidence of pneumococcal infection. Hypertension was found in 10 (91%) patients. Mean trough eGFR was 43.5 ± 21.4 ml/min/1.73 m2 (range 11-73). Ten patients (91%) had low C3 levels. Median urinary protein-to-creatinine ratio was 2.5 mg/mg (IQR 2.15-14.75). All patients fully recovered. Microscopic hematuria was the last finding to normalize after a median of 29.5 days (IQR 17.25-38). CONCLUSION AGN during bacterial pneumonia may be more frequent than previously recognized. Kidney prognosis was excellent in all patients. Prospective studies are needed to evaluate the impact of this condition.
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Affiliation(s)
- Shimrit Tzvi-Behr
- Shaare Zedek Medical Center, Shmuel Bait Street 12, 9103102, Jerusalem, Israel.
| | - Yaacov Frishberg
- Shaare Zedek Medical Center, Shmuel Bait Street 12, 9103102, Jerusalem, Israel
| | - Orli Megged
- Shaare Zedek Medical Center, Shmuel Bait Street 12, 9103102, Jerusalem, Israel
| | | | - Rachel Becher-Cohen
- Shaare Zedek Medical Center, Shmuel Bait Street 12, 9103102, Jerusalem, Israel
| | - Hadass Terespolsky
- Shaare Zedek Medical Center, Shmuel Bait Street 12, 9103102, Jerusalem, Israel
| | - Choni Rinat
- Shaare Zedek Medical Center, Shmuel Bait Street 12, 9103102, Jerusalem, Israel
| | - Sapir Choshen
- Shaare Zedek Medical Center, Shmuel Bait Street 12, 9103102, Jerusalem, Israel
| | - Efrat Ben-Shalom
- Shaare Zedek Medical Center, Shmuel Bait Street 12, 9103102, Jerusalem, Israel
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Sorotzky M, Raphael A, Breuer A, Odeh M, Gillis R, Gillis M, Shibli R, Fiszlinski J, Algur N, Magen S, Megged O, Schlesinger Y, Mendelovich J, Weiser G, Berliner E, Barak-Corren Y, Heiman E. Jerusalem's CoVID-19 Experience-The Effect of Ethnicity on Disease Prevalence and Adherence to Testing. J Racial Ethn Health Disparities 2024:10.1007/s40615-024-01965-7. [PMID: 38457104 DOI: 10.1007/s40615-024-01965-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Revised: 02/22/2024] [Accepted: 03/01/2024] [Indexed: 03/09/2024]
Abstract
BACKGROUND The management of the SARS-CoV-2 pandemic depends amongst other factors on disease prevalence in the general population. The gap between the true rate of infection and the detected rate of infection may vary, especially between sub-groups of the population. Identifying subpopulations with high rates of undetected infection can guide authorities to direct resource distribution in order to improve health equity. METHODS A cross-sectional epidemiological survey was conducted between April and July 2021 in the Pediatric Emergency Department of the Shaare Zedek Medical Center, Jerusalem, Israel. We compared three categories: unconfirmed disease (UD), positive serology test result with no history of positive PCR; confirmed disease (CD), history of a positive PCR test result, regardless of serology test result; and no disease (ND), negative serology and no history of PCR. These categories were applied to local prevailing subpopulations: ultra-orthodox Jews (UO), National Religious Jews (NRJ), secular Jews (SJ), and Muslim Arabs (MA). RESULTS Comparing the different subpopulations groups, MAs and UOs had the greatest rate of confirmed or unconfirmed disease. MA had the highest rate of UD and UO had the highest rate of CD. UD significantly correlated with ethnicity, with a low prevalence in NRJ and SJ. UD was also associated with larger family size and housing density defined as family size per number of rooms. CONCLUSION This study highlights the effect of ethnicity on disease burden. These findings should serve to heighten awareness to disease burden in weaker populations and direct a suitable prevention program to each subpopulation's needs. Early awareness and possible intervention may lower morbidity and mortality.
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Affiliation(s)
- Michael Sorotzky
- Department of Pediatrics, Shaare Zedek Medical Center, 12 Shmuel Bait St, PO Box 3235, 9103102, Jerusalem, Israel.
| | - Allon Raphael
- Department of Pediatrics, Shaare Zedek Medical Center, 12 Shmuel Bait St, PO Box 3235, 9103102, Jerusalem, Israel
| | - Adin Breuer
- Department of Pediatrics, Shaare Zedek Medical Center, 12 Shmuel Bait St, PO Box 3235, 9103102, Jerusalem, Israel
| | - Ma'aran Odeh
- Department of Pediatrics, Shaare Zedek Medical Center, 12 Shmuel Bait St, PO Box 3235, 9103102, Jerusalem, Israel
| | - Roni Gillis
- Department of Pediatrics, Shaare Zedek Medical Center, 12 Shmuel Bait St, PO Box 3235, 9103102, Jerusalem, Israel
| | - Michal Gillis
- Department of Pediatrics, Shaare Zedek Medical Center, 12 Shmuel Bait St, PO Box 3235, 9103102, Jerusalem, Israel
| | - Roaia Shibli
- Department of Pediatrics, Shaare Zedek Medical Center, 12 Shmuel Bait St, PO Box 3235, 9103102, Jerusalem, Israel
| | - Judith Fiszlinski
- Department of Pediatrics, Shaare Zedek Medical Center, 12 Shmuel Bait St, PO Box 3235, 9103102, Jerusalem, Israel
| | - Nurit Algur
- Clinical Endocrinology Laboratory, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Sophie Magen
- Clinical Endocrinology Laboratory, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Orli Megged
- Department of Pediatrics, Shaare Zedek Medical Center, 12 Shmuel Bait St, PO Box 3235, 9103102, Jerusalem, Israel
- Pediatric Infectious Diseases Unit, Shaare Zedek Medical Center, Jerusalem, Israel
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Yechiel Schlesinger
- Department of Pediatrics, Shaare Zedek Medical Center, 12 Shmuel Bait St, PO Box 3235, 9103102, Jerusalem, Israel
- Pediatric Infectious Diseases Unit, Shaare Zedek Medical Center, Jerusalem, Israel
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Joseph Mendelovich
- Department of Pediatrics, Shaare Zedek Medical Center, 12 Shmuel Bait St, PO Box 3235, 9103102, Jerusalem, Israel
- Pediatric Emergency Department, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Giora Weiser
- Department of Pediatrics, Shaare Zedek Medical Center, 12 Shmuel Bait St, PO Box 3235, 9103102, Jerusalem, Israel
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
- Pediatric Emergency Department, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Elihay Berliner
- Department of Pediatrics, Shaare Zedek Medical Center, 12 Shmuel Bait St, PO Box 3235, 9103102, Jerusalem, Israel
- Pediatric Emergency Department, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Yuval Barak-Corren
- Department of Pediatrics, Shaare Zedek Medical Center, 12 Shmuel Bait St, PO Box 3235, 9103102, Jerusalem, Israel
- Predictive Medicine Group, Boston Children's Hospital, Boston, USA
| | - Eyal Heiman
- Department of Pediatrics, Shaare Zedek Medical Center, 12 Shmuel Bait St, PO Box 3235, 9103102, Jerusalem, Israel
- Pediatric Emergency Department, Shaare Zedek Medical Center, Jerusalem, Israel
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Murik O, Zeevi DA, Mann T, Kashat L, Assous MV, Megged O, Yagupsky P. Whole-Genome Sequencing Reveals Differences among Kingella kingae Strains from Carriers and Patients with Invasive Infections. Microbiol Spectr 2023; 11:e0389522. [PMID: 37195188 PMCID: PMC10269580 DOI: 10.1128/spectrum.03895-22] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 04/26/2023] [Indexed: 05/18/2023] Open
Abstract
As a result of the increasing use of sensitive nucleic acid amplification tests, Kingella kingae is being recognized as a common pathogen of early childhood, causing medical conditions ranging from asymptomatic oropharyngeal colonization to bacteremia, osteoarthritis, and life-threatening endocarditis. However, the genomic determinants associated with the different clinical outcomes are unknown. Employing whole-genome sequencing, we studied 125 international K. kingae isolates derived from 23 healthy carriers and 102 patients with invasive infections, including bacteremia (n = 23), osteoarthritis (n = 61), and endocarditis (n = 18). We compared their genomic structures and contents to identify genomic determinants associated with the different clinical conditions. The mean genome size of the strains was 2,024,228 bp, and the pangenome comprised 4,026 predicted genes, of which 1,460 (36.3%) were core genes shared by >99% of the isolates. No single gene discriminated between carried and invasive strains; however, 43 genes were significantly more frequent in invasive isolates, compared to asymptomatically carried organisms, and a few showed a significant differential distribution among isolates from skeletal system infections, bacteremia, and endocarditis. The gene encoding the iron-regulated protein FrpC was uniformly absent in all 18 endocarditis-associated strains but was present in one-third of other invasive isolates. Similar to other members of the Neisseriaceae family, the K. kingae differences in invasiveness and tropism for specific body tissues appear to depend on combinations of multiple virulence-associated determinants that are widely distributed throughout the genome. The potential role of the absence of the FrpC protein in the pathogenesis of endocardial invasion deserves further investigation. IMPORTANCE The wide range of clinical severities exhibited by invasive Kingella kingae infections strongly suggests that isolates differ in their genomic contents, and strains associated with life-threatening endocarditis may harbor distinct genomic determinants that result in cardiac tropism and severe tissue damage. The results of the present study show that no single gene discriminated between asymptomatically carried isolates and invasive strains. However, 43 putative genes were significantly more frequent among invasive isolates than among pharyngeal colonizers. In addition, several genes displayed a significant differential distribution among isolates from bacteremia, skeletal system infections, and endocarditis, suggesting that the virulence and tissue tropism of K. kingae are multifactorial and polygenic, depending on changes in the allele content and genomic organization. Further analysis of these putative genes may identify genomic determinants of the invasiveness of K. kingae and its affinity for specific body tissues and potential targets for a future protective vaccine.
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Affiliation(s)
- Omer Murik
- Translational Genomics Laboratory, Medical Genetics Institute, Shaare Zedek Medical Center, Jerusalem, Israel
| | - David A. Zeevi
- Translational Genomics Laboratory, Medical Genetics Institute, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Tzvia Mann
- Translational Genomics Laboratory, Medical Genetics Institute, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Livnat Kashat
- Microbiology Laboratory, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Marc V. Assous
- Microbiology Laboratory, Shaare Zedek Medical Center, Jerusalem, Israel
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Orli Megged
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
- Pediatric Department and Infectious Diseases Unit, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Pablo Yagupsky
- Clinical Microbiology Laboratory, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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Ben-Shimol S, van der Beek BA, Mor M, Megged O, Dagan R. Dynamics of invasive pneumococcal disease in infants < 2 years old following PCV7/13 implementation using two infant and a booster dose schedule: evidence for indirect protection of young infants, Israel, 2004 to 2019. Euro Surveill 2023; 28:2200765. [PMID: 37347413 PMCID: PMC10288828 DOI: 10.2807/1560-7917.es.2023.28.25.2200765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 03/30/2023] [Indexed: 06/23/2023] Open
Abstract
BackgroundPneumococcal conjugated vaccine (PCV)7 and PCV13 programmes started in Israel from July 2009 and November 2010 respectively, with a 2+1 schedule (one dose at 2 months old, one at 4 months old, and a booster dose at 12 months old). Thereafter, invasive pneumococcal disease (IPD) rates substantially declined in children. Uptake of all three doses in < 2-year-olds since 2012 is > 90%. For still incompletely vaccinated infants (≤ 12 months old), how well the PCV 2+1 programme shields from IPD is not fully resolved.AimTo assess the adequacy of protection conferred by the 2+1 schedule PCV vaccination programme, particularly among incompletely-vaccinated infants.MethodsThis was a population-based, prospective, nationwide active IPD surveillance study in Israel, 2004-2019, in children < 24 months old. We estimated annual incidence rates (IR) of overall IPD, IPD caused by PCV13 serotypes (VT13), and non-PCV13 serotypes (NVT13). Annual IPD IRs were stratified by age: < 4 months (receiving ≤ 1 dose), 4-6 months (immediately post dose 2), 7-12 months (a few months post dose 2), and 13-23 months (post dose 3). Late-PCV (2004-2008) to pre-PCV13 (2016-2019) mean annual IR ratios (IRRs) were calculated.Results2,569 IPD episodes were recorded. VT13 decreased > 90% in all age groups, while NVT13 seemed to increase. All-IPD rates declined in all age groups by 56-70%. The 2+1 schedule impact on 7-12-month-old infants (pre-booster) was similar to that on 13-23-month-old children (post booster), with PCV13 IPD reductions of 97% and 98%, respectively.ConclusionsIndirect (herd) protection of infants, including < 4 month-olds with ≤ 1 PCV dose, was achieved by the 2+1 PCV schedule programme which thus seems adequate.
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Affiliation(s)
- Shalom Ben-Shimol
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
- Pediatric Infectious Disease Unit, Soroka University Medical Center, Beer Sheva, Israel
| | - Bart Adriaan van der Beek
- The Shraga Segal Dept. of Microbiology, Immunology, and Genetics, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Meirav Mor
- Infectious Diseases, Schneider Children's Medical Center of Israel, Petah Tikvah, Israel
| | - Orli Megged
- Pediatric Infectious Diseases, Shaare Zedek Medical Center, Jerusalem, Israel and Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | - Ron Dagan
- The Shraga Segal Dept. of Microbiology, Immunology, and Genetics, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel
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Raphael A, Shamriz O, Tvito A, Magen S, Goldberg S, Megged O, Lev A, Simon AJ, Tal Y, Somech R, Eisenberg R, Toker O. SARS-CoV-2 spike antibody concentration in gamma globulin products from high-prevalence COVID-19 countries are transmitted to X-linked agammaglobulinemia patients. Front Immunol 2023; 14:1156823. [PMID: 37063907 PMCID: PMC10090293 DOI: 10.3389/fimmu.2023.1156823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 03/20/2023] [Indexed: 03/31/2023] Open
Abstract
PurposePatients with X-linked agammaglobulinemia (XLA) are characterized by humoral impairment and are routinely treated with intravenous immunoglobulin (IVIG). In this study, we aimed to investigate the presence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antibodies in IVIG preparations harvested globally and evaluate the transfer of SARS-CoV-2 antibodies to the XLA patient.MethodsA single-center, prospective cohort study was conducted in the period of November 2020 to November 2022. Clinical and laboratory data, specifically, SARS-CoV-2 spike IgG levels from the serum of 115 IVIG preparations given to 5 XLA patient were collected. Concurrently, SARS-CoV-2 spike IgG levels from the serum of the 5 XLA was collected monthly.ResultsFive XLA patients were evaluated within the study period. All were treated monthly with commercial IVIG preparations. A total of 115 IVIG treatments were given over the study period. The origin country and the date of IVIG harvesting was obtained for 111 (96%) of the treatments. Fifty-four IVIG preparations (49%) were harvested during the COVID-19 pandemic of which 76% were positive (>50AU/mL) for SARS-CoV-2 spike antibodies which were subsequently transmitted to the XLA patients in an approximate 10-fold reduction. SARS-CoV2 spike IgG was first detected in IVIG batches that completed their harvest date by September 2021. Positive products were harvested from origin countries with a documented prevalence over 2,000 per 100,000 population.ConclusionAs the prevalence of COVID-19 infections rises, detection of SARS-CoV-2 spike IgG in commercial IVIG products increases and is then transmitted to the patient. Future studies are needed to investigate the neutralizing capabilities of SARS-CoV-2 IgG and whether titer levels in IVIG remain consistent as the incidence of infection and vaccination rates in the population changes.
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Affiliation(s)
- Allon Raphael
- Pediatric Department, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Oded Shamriz
- Allergy and Clinical Immunology Unit, Department of Medicine, Hadassah Medical Organization, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
- The Lautenberg Center for Immunology and Cancer Research, Institute of Medical Research Israel-Canada, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Ariella Tvito
- Department of Hematology, Shaare Zedek Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Sophie Magen
- Clinical Endocrinology Laboratory, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Shmuel Goldberg
- Department of Pediatrics, Pediatric Pulmonology Unit, Shaare Zedek Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Orli Megged
- Department of Pediatrics, Infectious Diseases Unit, Shaare Zedek Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Atar Lev
- Pediatric Department A and the Immunology Service, Jeffrey Modell Foundation Center, Edmond and Lily Safra Children’s Hospital, Tel-Hashomer Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- The Jeffrey Modell Foundation Israeli Network for Primary Immunodeficiency, New York, NY, United States
| | - Amos J. Simon
- Pediatric Department A and the Immunology Service, Jeffrey Modell Foundation Center, Edmond and Lily Safra Children’s Hospital, Tel-Hashomer Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yuval Tal
- Allergy and Clinical Immunology Unit, Department of Medicine, Hadassah Medical Organization, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Raz Somech
- Pediatric Department A and the Immunology Service, Jeffrey Modell Foundation Center, Edmond and Lily Safra Children’s Hospital, Tel-Hashomer Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- The Jeffrey Modell Foundation Israeli Network for Primary Immunodeficiency, New York, NY, United States
| | - Rachel Eisenberg
- Department of Pediatrics, Allergy and Clinical Immunology Unit, Shaare Zedek Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Ori Toker
- Department of Pediatrics, Allergy and Clinical Immunology Unit, Shaare Zedek Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
- *Correspondence: Ori Toker,
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Eldar-Yedidia Y, Ben-Shalom E, Hillel M, Belostotsky R, Megged O, Freier-Dror Y, Frishberg Y, Schlesinger Y. Association of post-transplantation anellovirus viral load with kidney transplant rejection in children. Pediatr Nephrol 2022; 37:1905-1914. [PMID: 34999988 DOI: 10.1007/s00467-021-05336-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 10/14/2021] [Accepted: 10/14/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND Post-transplantation immunosuppressive therapy reduces the risk of graft rejection but raises the risk of infection and malignancy. A biomarker of the level of immunosuppression can be helpful in monitoring immunosuppressive therapy. Inverse correlation between Torque teno virus (TTV) from the Anelloviridae (AV) family load and immune competence was described in previous studies. The aim of this study was to analyze the association between AV family viruses' kinetics and the risk for graft rejection in the first year after kidney transplantation in children. METHODS The titers of three genera (TTV, TTMDV, and TTMV) from the AV family were monitored by real-time PCR in consecutive samples from children before and after kidney transplantation. RESULTS Twenty-one children who underwent kidney transplantation were enrolled. Five out of 21 patients experienced acute graft rejection within a year from transplantation. We found that in patients who experienced graft rejection, the median titers of TTV and total AV titers at 5-6 months post-transplantation were lower than in those who did not. Using a threshold determined by ROC analysis, significant differences in TTV and total AV load were found between patients who had or did not have graft rejection (p = 0.002 and 0.004, respectively). No association was found between the dominance of any AV genus titer and the likelihood of rejection. CONCLUSION This pilot study suggests that children after kidney transplantation with low TTV and total AV titers 5-6 months post-transplantation are at increased risk for graft rejection within a year after transplantation. A higher resolution version of the Graphical abstract is available as Supplementary information.
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Affiliation(s)
- Yifat Eldar-Yedidia
- Research Laboratory of Infectious Diseases, Shaare Zedek Medical Center, affiliated to the Hadassah - Hebrew University Medical School, 12 Beit Shmuel Street, 91031, Jerusalem, Israel.
| | - Efrat Ben-Shalom
- Pediatric Nephrology Institute, Shaare Zedek Medical Center, affiliated to the Hadassah - Hebrew University Medical School Jerusalem, Jerusalem, Israel.,Department of Pediatrics, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Miriam Hillel
- Research Laboratory of Infectious Diseases, Shaare Zedek Medical Center, affiliated to the Hadassah - Hebrew University Medical School, 12 Beit Shmuel Street, 91031, Jerusalem, Israel
| | - Ruth Belostotsky
- Pediatric Nephrology Institute, Shaare Zedek Medical Center, affiliated to the Hadassah - Hebrew University Medical School Jerusalem, Jerusalem, Israel
| | - Orli Megged
- Department of Pediatrics, Shaare Zedek Medical Center, Jerusalem, Israel
| | | | - Yaacov Frishberg
- Pediatric Nephrology Institute, Shaare Zedek Medical Center, affiliated to the Hadassah - Hebrew University Medical School Jerusalem, Jerusalem, Israel.,Department of Pediatrics, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Yechiel Schlesinger
- Research Laboratory of Infectious Diseases, Shaare Zedek Medical Center, affiliated to the Hadassah - Hebrew University Medical School, 12 Beit Shmuel Street, 91031, Jerusalem, Israel.,Department of Pediatrics, Shaare Zedek Medical Center, Jerusalem, Israel
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Megged O, Assous MV. Non-typhoidal Salmonella bacteremia: comparison of adults and children in a single medical center. J Med Microbiol 2022; 71. [PMID: 35612897 DOI: 10.1099/jmm.0.001463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Introduction. Non-typhoidal Salmonella (NTS) bacteremia can cause significant morbidity and mortality. There is high incidence of Salmonellosis in the Middle East, including Israel, but there is a paucity of data on the clinical and epidemiological features of children in comparison to adults.Hypothesis/Gap Statement. Previous studies describing the differences between paediatric and adult populations with Salmonella bacteremia are sparse.Aim. This study's aim was to describe the differences between adults and children with NTS bacteremia.Methodology. All records of patients with NTS bacteremia between 1 January 1998 and 31 July 2020 were reviewed. Data regarding clinical manifestations and laboratory results were extracted from the medical records; records of children (aged <18 years) were compared with those of adults.Results. Records for 137 cases of Salmonella bacteremia (69 adults and 68 children, aged 2 days to 98 years) were reviewed. Seventy nine (58 %) patients had concomitant gastrointestinal symptoms. Fifty-eight (84 %) adults and 13 (19 %) children had underlying conditions (P<0.001). Eighteen patients died, none of whom was a child. Over the study period, most of the children (n=46, 67 %) but only five adults were discharged from the emergency department on their first visit to the ED.Conclusions. The main characteristics of NTS bacteremia in children compared to adults, are higher rates of prior discharge from emergency department, higher rate of gastrointestinal symptoms and better prognosis.
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Affiliation(s)
- Orli Megged
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
- Pediatric Department and Infectious Diseases Unit, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Marc V Assous
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
- Clinical Microbiology and Immunology Laboratory, Shaare Zedek Medical Center, Jerusalem, Israel
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Megged O, Dorembus S, Ben-Shalom E, Heiman E. Comparing blood culture contamination rates by different sampling methods in a paediatric emergency department. J Paediatr Child Health 2022; 58:669-673. [PMID: 34668594 DOI: 10.1111/jpc.15812] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 08/25/2021] [Accepted: 09/17/2021] [Indexed: 10/20/2022]
Abstract
AIM Blood culture contamination (BCC) can cause unnecessary hospitalisations and inappropriate use of antibiotics. The aim of this study was to find risk factors associated with BCCs in children and to compare contamination rates between open and closed blood culture collection systems. METHODS Data were prospectively collected regarding blood cultures obtained in the paediatric emergency department from February 26, 2020, to September 30, 2020, based on the method of drawing blood reported by the obtaining physician. A comparison between contaminated and non-contaminated blood cultures was performed. We also compared the composition of the contaminations in the study period to the same period in 2019. RESULTS A total of 512 blood cultures were included, 33 (6.4%) of which were contaminated. The only parameter that was associated with an increased rate of contamination by 2.34 fold (95% CI 1.1-4.99, P = 0.028) was obtaining blood through an 'open' system, using a syringe connected to a needle in order to draw blood from an open ended needle. The proportion of contaminations originating from oral flora decreased in the study period by 44.7% as compared to the same period in the previous year (13% vs. 23.5%, P = 0.056). CONCLUSIONS 'Open system' method, which is commonly used in paediatric emergency departments for blood culture obtainment, was associated with an increase in BCC. Adherence to blood cultures obtainment guidelines, even at the price of two different blood tests, is important in order to reduce BCC rates in children.
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Affiliation(s)
- Orli Megged
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.,The Pediatric Department, Shaare Zedek Medical Center, Jerusalem, Israel.,The Pediatric Infectious Disease Unit, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Sara Dorembus
- The Pediatric Department, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Efrat Ben-Shalom
- The Pediatric Department, Shaare Zedek Medical Center, Jerusalem, Israel.,The Pediatric Nephrology Unit, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Eyal Heiman
- The Pediatric Department, Shaare Zedek Medical Center, Jerusalem, Israel.,The Pediatric Emergency Department, Shaare Zedek Medical Center, Jerusalem, Israel
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10
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Eichler N, Joseph L, Megged O, Goldberg S, Picard E. The impact of pneumococcal conjugate vaccine on the prevalence and severity of hospitalizations for pneumonia in children. Eur J Clin Microbiol Infect Dis 2022; 41:439-444. [PMID: 34997390 DOI: 10.1007/s10096-021-04386-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 11/20/2021] [Indexed: 11/03/2022]
Abstract
Pneumococcal conjugate vaccines (PCV) were introduced into the Israeli national immunization plan starting with the heptavalent PCV7 in 2009 and then PCV13 in the late 2010. The objective of this study was to determine the vaccines' impact on hospitalization rates for community-acquired pneumonia on the severity of the pneumonia episodes and upon pneumococcal serotype distribution. We retrospectively reviewed all children hospitalized in our institution with pneumonia, aged between 1 and 16 years, between the years 2006 and 2015. Demographic, clinical, and laboratory data between three time periods: pre-PCV, PCV7, and PCV13, were compared. During the study period, 1375 children were hospitalized with pneumonia. A gradual decline in hospitalization rates due to pneumonia was observed starting in 2006 in the pre-PCV period and continued until after the introduction of PCV13. A similar trend was observed in pneumonias with a culture positive for S. pneumoniae. Pleural effusion was observed in 24% of all pneumonias, and this percentage was stable throughout the study period. The average age at hospitalization increased during the study period, as did the average duration of hospital stay. Pneumococcal serotypes included in the vaccine were isolated less frequently during the study and non-vaccine serotypes tended to appear more frequently. Pediatric pneumonia hospitalization rates continued to decline since the introduction of PCV without increasing the frequency of complications. Pneumococcal serotype distribution shifted in parallel. Our findings confirm the efficacy of PCV and support the evidence to include more serotypes in the next generation of PCV.
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Affiliation(s)
- Noam Eichler
- Pediatric Pulmonology Institute, Shaare Zedek Medical Center, affiliated with The Hebrew University, School of Medicine, Jerusalem, Israel
| | - Leon Joseph
- Pediatric Pulmonology Institute, Shaare Zedek Medical Center, affiliated with The Hebrew University, School of Medicine, Jerusalem, Israel
| | - Orli Megged
- Pediatric Infectious Unit, Shaare Zedek Medical Center, affiliated with The Hebrew University, School of Medicine, Jerusalem, Israel
| | - Shmuel Goldberg
- Pediatric Pulmonology Institute, Shaare Zedek Medical Center, affiliated with The Hebrew University, School of Medicine, Jerusalem, Israel
| | - Elie Picard
- Pediatric Pulmonology Institute, Shaare Zedek Medical Center, affiliated with The Hebrew University, School of Medicine, Jerusalem, Israel.
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11
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Barak-Corren Y, Elizur Y, Yuval S, Burstyn A, Deri N, Schwartz S, Megged O, Toker O. The risk of serious bacterial infections among young ex-premature infants with fever. Front Pediatr 2022; 10:1021007. [PMID: 36313886 PMCID: PMC9597199 DOI: 10.3389/fped.2022.1021007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 09/22/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND AND OBJECTIVES To determine the rate of serious-bacterial-infections (SBI) in young ex-premature infants with fever, and to develop a risk-stratification algorithm for these patients. METHODS A retrospective cohort study including all infants who presented to the pediatric emergency department (ED) of a tertiary-care university-hospital between 2010 and 2020 with fever (≥38°C), were born prematurely (<37-weeks), had post-conception age of <52-weeks, and had available blood, urine, or CSF cultures. The rates of SBI by age-of-birth and age-at-visit were calculated and compared to a cohort of matched full-term controls. RESULTS The study included a total of 290 ex-premature cases and 290 full-term controls. There were 11 cases (3.8%) with an invasive bacterial infection (IBI) of either bacteremia, meningitis or both and only six controls (2.1%) with IBI (p = 0.32). Over 28-days chronologic-age, there were 10 (3.6%) IBIs among cases and no IBIs among the controls (p = 0.02). There were eight (3%) cases and three (1%) controls with IBI who were well-appearing on physical examination (p = 0.19). All eight well-appearing ex-premature infants were under 60-days adjusted-age, seven of whom (88%) were also under 28-days adjusted-age. There were 28 (10.6%) cases and 34 (12%) controls with urinary tract infection (UTI) (p = 0.5). Among cases under 60-days adjusted-age, urinalysis was not reliable to exclude UTI (50% negative). CONCLUSIONS Well-appearing ex-preterm infants have a significant risk for IBI until the adjusted age of 28-days and for UTI until the adjusted age of 60-days. Further studies are needed to evaluate the approach to fever in this unique population.
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Affiliation(s)
- Yuval Barak-Corren
- The Pediatrics Department, Shaare Zedek Medical Center, Jerusalem, Israel.,Predictive Medicine Group, Boston Children's Hospital, Boston, United States
| | - Yoav Elizur
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Shira Yuval
- The Pediatrics Department, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Amalia Burstyn
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Noy Deri
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Shepard Schwartz
- The Pediatric Emergency Department, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Orli Megged
- The Pediatrics Department, Shaare Zedek Medical Center, Jerusalem, Israel.,Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.,The Pediatric Infectious Disease Unit, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Ori Toker
- The Pediatrics Department, Shaare Zedek Medical Center, Jerusalem, Israel.,Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.,The Allergy and Clinical Immunology Unit, Shaare Zedek Medical Center, Jerusalem, Israel
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12
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Breuer A, Raphael A, Stern H, Odeh M, Fiszlinski J, Algur N, Magen S, Megged O, Schlesinger Y, Barak‐Corren Y, Heiman E. SARS-CoV-2 antibodies started to decline just four months after COVID-19 infection in a paediatric population. Acta Paediatr 2021; 110:3054-3062. [PMID: 34265136 PMCID: PMC8444680 DOI: 10.1111/apa.16031] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 07/13/2021] [Accepted: 07/14/2021] [Indexed: 12/13/2022]
Abstract
Aim We evaluated the prevalence of paediatric severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) infections using antibody testing and characterised antibody titres by time from exposure. Methods This was a single‐centre, prospective, cross‐sectional cohort study. Patients under 18 years old were eligible to participate if they attended the paediatric emergency department at the tertiary Shaare Zedek Medical Center, Jerusalem, Israel, from 18 October 2020 to 12 January 2021 and required blood tests or intravenous access. SARS‐CoV‐2 seropositivity and antibody levels were tested by a dual‐assay model. Results The study comprised 1138 patients (56% male) with a mean age of 4.4 years (interquartile range 1.3–11.3). Anti‐SARS‐CoV‐2 antibodies were found in 10% of the patients. Seropositivity increased with age and 41% of seropositive patients had no known exposure. Children under 6 years of age had higher initial antibody levels than older children, followed by a steeper decline. The seropositivity rate did not vary during the study, despite schools re‐opening. The findings suggest that children's immunity may start falling 4 months after the initial infection. Conclusion Immunity started falling after just 4 months, and re‐opening schools did not affect infection rates. These findings could aid decisions about vaccinating paediatric populations and school closures.
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Affiliation(s)
- Adin Breuer
- Department of Pediatrics Shaare Zedek Medical Center Jerusalem Israel
| | - Allon Raphael
- Department of Pediatrics Shaare Zedek Medical Center Jerusalem Israel
| | - Hagay Stern
- Department of Pediatrics Shaare Zedek Medical Center Jerusalem Israel
| | - Ma'aran Odeh
- Department of Pediatrics Shaare Zedek Medical Center Jerusalem Israel
| | - Judith Fiszlinski
- Department of Pediatrics Shaare Zedek Medical Center Jerusalem Israel
| | - Nurit Algur
- Clinical Endocrinology Laboratory Shaare Zedek Medical Center Jerusalem Israel
| | - Sophie Magen
- Clinical Endocrinology Laboratory Shaare Zedek Medical Center Jerusalem Israel
| | - Orli Megged
- Department of Pediatrics Shaare Zedek Medical Center Jerusalem Israel
- Pediatric Infectious Diseases Unit Shaare Zedek Medical Center Jerusalem Israel
- Faculty of Medicine Hebrew University of Jerusalem Jerusalem Israel
| | - Yechiel Schlesinger
- Department of Pediatrics Shaare Zedek Medical Center Jerusalem Israel
- Pediatric Infectious Diseases Unit Shaare Zedek Medical Center Jerusalem Israel
- Faculty of Medicine Hebrew University of Jerusalem Jerusalem Israel
| | - Yuval Barak‐Corren
- Department of Pediatrics Shaare Zedek Medical Center Jerusalem Israel
- Predictive Medicine Group Boston Children's Hospital Boston Massachusetts USA
| | - Eyal Heiman
- Department of Pediatrics Shaare Zedek Medical Center Jerusalem Israel
- Pediatric Emergency Department Shaare Zedek Medical Center Jerusalem Israel
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13
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Yarden Bilavski H, Balanson S, Damouni Shalabi R, Dabaja‐Younis H, Grisaru‐Soen G, Youngster I, Glikman D, Ben Shimol S, Somech E, Tasher D, Stein M, Gottesmanm G, Megged O, Livni G. Benign course and clinical features of COVID-19 in hospitalised febrile infants up to 60 days old. Acta Paediatr 2021; 110:2790-2795. [PMID: 34143508 PMCID: PMC8444866 DOI: 10.1111/apa.15993] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 06/15/2021] [Accepted: 06/17/2021] [Indexed: 01/26/2023]
Abstract
Aim Minimal data exist regarding the severity of COVID‐19 in febrile infants under 60 days old. This multicentre prospective study explored the clinical course and outcomes of this hospitalised patient population, as, to date, the best approach has not been specifically addressed. Methods This study focused on the clinical features, laboratory parameters and outcomes of febrile infants up to 60 days old who tested positive for the virus and were hospitalised in Israel from March 2020 to January 2021. The data were extracted from a real‐time prospective surveillance network for COVID‐19 that includes 20 of the country's 26 hospitals. Results We identified 75 febrile young infants (60% female) with COVID‐19 at a median age of 28 days (range 8–56 days). Of these, 84% had an unremarkable medical history, 29% had respiratory symptoms, and 96% had a mild illness. The Rochester criteria showed that 44% were considered at high‐risk for serious bacterial infections, and we found that eight infants actually had concomitant bacterial infections. Outcomes were excellent, and no complications or fatalities were reported. Conclusion The excellent outcomes of young febrile infants with COVID‐19 closely resembled other respiratory viral aetiologies of fever in this age group, and there were no fatalities.
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Affiliation(s)
- Havazelet Yarden Bilavski
- Department of Pediatrics A Schneider Children's Medical Center Sackler Faculty of Medicine Tel Aviv Israel
| | - Sarit Balanson
- Department of Pediatrics A Schneider Children's Medical Center Sackler Faculty of Medicine Tel Aviv Israel
| | - Ranaa Damouni Shalabi
- Pediatric Infectious Diseases Ruth Rappaport Children's Hospital Rambam Health Care Campus Haifa Israel
| | - Halima Dabaja‐Younis
- Pediatric Infectious Diseases Ruth Rappaport Children's Hospital Rambam Health Care Campus Haifa Israel
| | - Galia Grisaru‐Soen
- Pediatric Infectious Disease Unit Tel Aviv Sourasky Medical Center Dana‐Dwek Children's Hospital Sackler Faculty of Medicine Tel Aviv Israel
| | - Ilan Youngster
- Pediatric Infectious diseases unit Shamir Medical Center Sackler Faculty of Medicine Tel Aviv Israel
| | - Daniel Glikman
- Infectious Diseases Unit Padeh Poria Medical Center Poria Israel
- Azrieli Faculty of Medicine in the Galilee Bar‐Ilan University Safed Israel
| | - Shalom Ben Shimol
- Pediatric Infectious Disease Unit Soroka Medical Center Faculty of Health Sciences Ben‐Gurion University Beer Sheva Israel
| | - Eli Somech
- Department of Pediatrics Mayaney Hayeshuah Medical Center Bnei Brak and the Sackler School of Medicine Tel Aviv University Tel Aviv Israel
| | - Diana Tasher
- Pediatric Infectious Diseases Unit Wolfson Medical Center Holon and Sackler School of Medicine Tel Aviv University Tel Aviv Israel
| | - Michal Stein
- Infectious Disease & Infection Control Unit Hillel Yafe Medical Center Hadera Israel
- Rappaport Faculty of Medicine Technion–Israel Institute of Technology Haifa Israel
| | - Giora Gottesmanm
- Meir Medical Center Kfar Saba Israel
- The Sackler School of Medicine Tel Aviv University Tel Aviv Israel
| | - Orli Megged
- Department of Pediatrics A Schneider Children's Medical Center Sackler Faculty of Medicine Tel Aviv Israel
| | - Gilat Livni
- Department of Pediatrics A Schneider Children's Medical Center Sackler Faculty of Medicine Tel Aviv Israel
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14
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Ben-Shimol S, Regev-Yochay G, Givon-Lavi N, Van Der Beek BA, Brosh-Nissimov T, Peretz A, Megged O, Dagan R. Dynamics of Invasive Pneumococcal Disease in Israel in Children and Adults in the PCV13 Era: A Nationwide Prospective Surveillance. Clin Infect Dis 2021; 74:1639-1649. [PMID: 34293091 DOI: 10.1093/cid/ciab645] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Following 13-valent pneumococcal conjugate vaccine (PCV13) implementation in infants worldwide, overall and vaccine-type invasive pneumococcal disease (IPD) rates declined in children, with variable indirect impact on adults. METHODS A population-based, prospective, nationwide active surveillance of IPD in Israel, 2004-2019 (for adults ≥18 years, 2009-2019). The 7-valent PCV (PCV7)/PCV13 were implemented in Israel in July 2009/November 2010, respectively, with >90% uptake in children <2 years. The 23-valent pneumococcal polysaccharide vaccine (PPV-23) uptake among >65 years was ~75%. For pre-PCV episodes with missing serotype, extrapolations were applied. Overall, PCV13 serotypes (VT13) and non-VT13 (NVT) incidence rates ratios (IRRs) comparing pre-PCV (2004-2008), early-PCV (2009-2011) and late-PCV13 (2016-2019) periods were calculated for different age groups. RESULTS Overall, 8,614 IPD cases were recorded. IPD rates declined by 67% in children <5 and 5-17 years, comparing late-PCV13 vs. pre-PCV periods (IRR=0.33; CI: 0.27-0.40; and IRR=0.33; CI: 0.21-0.50, respectively). For adults, comparing late-PCV13 vs. early-PCV periods, rates significantly declined by 53% in 18-44 years, while rates did not decline significantly in other age groups.VT13 rates significantly declined in all ages, with decline rates ranging between 94% in children <5 years and 60% in adults ≥85 years. NVT rates significantly increased in <5, 50-64 and ≥65 years age groups. In late-PCV13 period, serotypes 3, 14 and 19A remained the predominant VT13, while serotypes 8 and 12F emerged as the predominant NVT. CONCLUSIONS Continuous monitoring of circulating serotypes in all ages demonstrated direct and indirect PCV effects, which are essential for the development of new vaccination strategies.
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Affiliation(s)
- Shalom Ben-Shimol
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel.,Pediatric Infectious Disease Unit, Soroka University Medical Center, Beer Sheva, Israel
| | - Gili Regev-Yochay
- Infection Prevention & Control Unit, Sheba Medical Center, Ramat-Gan, Israel, Affiliated to the Sackler School of Medicine, Tel-Aviv University, Israel
| | - Noga Givon-Lavi
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel.,Pediatric Infectious Disease Unit, Soroka University Medical Center, Beer Sheva, Israel
| | | | - Tal Brosh-Nissimov
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel.,Assuta Ashdod University Hospital, The Baruch Padeh Medical Center, Poriya, Tiberias, Israel
| | - Avi Peretz
- Clinical Microbiology Laboratory, The Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Orli Megged
- Faculty of Medicine, Hebrew University of Jerusalem, Israel, Pediatric Department and Pediatric Infectious Diseases Unit, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Ron Dagan
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
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15
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Abstract
To compare tickborne relapsing fever (TBRF) in children and adults in Jerusalem, Israel, we collected data from the medical records of all 92 patients with TBRF during 2004–2018. The 30 children with TBRF had more episodes of fever and lower inflammatory markers than adult patients.
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16
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Ben-Shimol S, Livni G, Megged O, Greenberg D, Danino D, Youngster I, Shachor-Meyouhas Y, Dabaja-Younis H, Scheuerman O, Mor M, Somekh E, Yakub Hanna H, Givon-Lavi N, Guri A, Leibovitz E, Alkan Y, Grupel D, Rubinstein U, Steinberg Ben Zeev Z, Bamberger E, Asher Kuperman A, Grisaru-Soen G, Tasher D, Gottesman G, Glikman D, Stein M. COVID-19 in a Subset of Hospitalized Children in Israel. J Pediatric Infect Dis Soc 2021; 10:757-765. [PMID: 34129032 PMCID: PMC8344587 DOI: 10.1093/jpids/piab035] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 05/06/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Most pediatric coronavirus disease 2019 (COVID-19) is mild. We assessed nationally severe COVID-19, including pediatric inflammatory multisystem syndrome (PIMS), in hospitalized children. METHODS An ongoing, prospective, national surveillance was conducted from March 2020 through March 2021, at 20 hospitals treating children <18 years across Israel (~75% of Israeli hospitals). RESULTS Overall, 1007 cases (439 outpatients and 568 hospitalized) identified represent 0.35% of pediatric COVID-19 nationwide (n = 291 628). Of hospitalized cases, 464 (82%), 48 (8%), and 56 (10%) had mild, moderate/severe, and PIMS disease, respectively. The mean ± SD age was 5.6 ± 6.4 years. In mild, moderate/severe, and PIMS disease, 55%, 23%, and 4% of patients were <1 year old, respectively. Obesity was reported in 1%, 4%, and 13% of patients, respectively (P < .001). The most common symptom was fever in 67%, 60%, and 100%, respectively, whereas respiratory symptoms were documented in 33%, 41%, and 38% of patients, respectively. Lymphopenia was recorded in 25%, 60%, and 86% of cases, respectively. PIMS diagnosis was mainly serology-based (in 59%). Gastrointestinal symptoms, cardiovascular involvement, rash, and conjunctivitis were noted in 82%, 61%, 57%, and 34% of PIMS episodes, respectively. Elevated C-reactive protein (100%), ferritin, troponin, D-dimer, low albumin, and thrombocytopenia were common in PIMS. Echocardiography revealed pathological findings in 33% of patients. PIMS mainstay treatment included corticosteroids (77%) and intravenous immunoglobulin (53%). No mortality was recorded. CONCLUSIONS At a national level, pediatric COVID-19 is mild, even in hospitalized cases, with only a third presenting with respiratory involvement. PIMS is rare, but necessitates a high index of suspicion, and with suitable treatment prognosis is favorable.
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Affiliation(s)
- Shalom Ben-Shimol
- The Pediatric Infectious Disease Unit, Soroka University Medical Center, Beer-Sheva, Israel,Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel,Corresponding Author: Shalom Ben-Shimol, MD, Pediatric Infectious Disease Unit, Soroka University Medical Center, Beer-Sheva 84101, Israel. E-mail:
| | - Gilat Livni
- Department of Pediatrics A, Schneider Children’s Medical Center, Petah Tikva, Israel
| | - Orli Megged
- Pediatric Department and Pediatric Infectious Diseases Unit, Shaare Zedek Medical Center, Jerusalem, Israel
| | - David Greenberg
- The Pediatric Infectious Disease Unit, Soroka University Medical Center, Beer-Sheva, Israel,Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Dana Danino
- The Pediatric Infectious Disease Unit, Soroka University Medical Center, Beer-Sheva, Israel,Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Ilan Youngster
- Pediatric Infectious Diseases Unit, Shamir Medical Center, Zerifin, Israel,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yael Shachor-Meyouhas
- Pediatric Infectious Disease Unit, Ruth Rappaport Children’s Hospital, Rambam Health Care Campus, Haifa, Israel
| | - Halima Dabaja-Younis
- Pediatric Infectious Disease Unit, Ruth Rappaport Children’s Hospital, Rambam Health Care Campus, Haifa, Israel
| | - Oded Scheuerman
- Department of Pediatrics B, Schneider Children’s Medical Center, Petah Tikva, Israel
| | - Meirav Mor
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel,Infection Control Unit and Emergency Department, Schneider Children’s Medical Center, Petach Tikva, Israel
| | - Eli Somekh
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel,Department of Pediatrics, Mayanei Hayeshua Medical Center, Bnei Brak, Israel
| | - Husam Yakub Hanna
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel,Department of Pediatrics, Mayanei Hayeshua Medical Center, Bnei Brak, Israel
| | - Noga Givon-Lavi
- The Pediatric Infectious Disease Unit, Soroka University Medical Center, Beer-Sheva, Israel,Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Alex Guri
- Department of Pediatrics, Kaplan Medical Center, Rehovot, Israel,School of Medicine, Hadassah-Hebrew University, Jerusalem, Israel
| | - Eugene Leibovitz
- The Pediatric Infectious Disease Unit, Soroka University Medical Center, Beer-Sheva, Israel,Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Yoav Alkan
- Clalit Health Services, Sharon Shomron District, Israel
| | - Daniel Grupel
- Infectious Diseases Unit, Assuta Ashdod University Hospital, Ashdod, Israel
| | - Uri Rubinstein
- Department of Pediatrics, Laniado Medical Center, Netanya, Israel
| | | | - Ellen Bamberger
- Department of Pediatrics, Bnai Zion Medical Center, Haifa, Israel
| | - Amir Asher Kuperman
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel,Blood Coagulation Service and Pediatric Hematology Clinic, Galilee Medical Center, Nahariya, Israel
| | - Galia Grisaru-Soen
- Pediatric Infectious Disease Unit, Dana Children’s Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Diana Tasher
- Department of Pediatrics, Edith Wolfson Medical Center, Holon, Israel
| | - Giora Gottesman
- Pediatric Infectious Disease Unit, Meir Medical Center, Kfar Saba, Israel
| | - Daniel Glikman
- Infectious Diseases Unit, The Baruch Padeh Medical Center, Poriya, Israel,Azrieli Faculty of Medicine in the Galilee, Bar-Ilan University, Safed, Israel
| | - Michal Stein
- Infectious Disease and Infection Control Unit, Hillel Yaffe Medical Center, Hadera, Israel,Rappaport Faculty of Medicine, Technion Institute, Haifa, Israel
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17
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Hurvitz N, Cahan LOS, Gross I, Grupel D, Megged O, Pasternak Y, Temper V, Levy R, Weiser G, Hashavya S. The role of Staphylococcus lugdunensis as a pathogen in children: a multicentre retrospective study. J Med Microbiol 2021; 70. [PMID: 34038340 DOI: 10.1099/jmm.0.001357] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Introduction: Staphylococcus lugdunensis (SL), a tube coagulase negative Staphylococcus, is known to be pathogenic in adults, causing mainly skin infections.Gap Statement: Previous studies assessing SL's role in paediatric populations are sparse and are mainly limited to case reports.Aim: Present the clinical characteristics consistent with SL infections and its putative role as a pathogen in the paediatric population.Methodology: A retrospective multicentre study was conducted in four paediatric medical centres in Israel. Patients with isolates of SL presenting between 2009-2019 were included.Results: SL was isolated from 40 patients. Average (±SD) age at presentation was 5.9 (±6.2) years, with 22 (55 %) being female. Skin, soft tissue and musculoskeletal infections were the most common (n=20, 50%) followed by ear infections (n=13, 32.5%). Five cases of urine isolates and two isolates from blood culture samples were also reported. Skin abscess was the most common infection among skin and soft tissue isolates, reported in 17 children (85%) with SL being the only pathogen in 15 (75%). Otitis media was the most common ear infection accounting for 12 (92%) of all cases with SL as the only isolate reported in 6 (46%). Five cases of SL isolates from urine specimens were reported, all of which with poor growth of bacteria and normal urinalysis. Two cases of SL growth in blood culture were found in children presenting with signs and symptoms consistent with invasive blood stream infection.Conclusions: In the paediatric population, studied infections caused by SL are increasingly observed. The results of this study highlight its role as a pathogen in soft tissue infections and its putative role in otitis media and invasive blood stream infections. However, the role of SL as an uropathogen was not established.
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Affiliation(s)
- Noa Hurvitz
- Faculty of Medicine, Hadassah-Hebrew University Medical Centre, Jerusalem, Israel
| | | | - Itai Gross
- Department of Paediatric Emergency Medicine, Hadassah-Hebrew University Medical Centre, Jerusalem, Israel
| | - Daniel Grupel
- Department of Infectious Diseases, Samson Assuta Ashdod University Hospital, Ashdod, Israel
| | - Orli Megged
- Faculty of Medicine, Hadassah-Hebrew University Medical Centre, Jerusalem, Israel.,Department of Paediatrics and Paediatric Infectious Diseases Unit, Shaare Zedek Medical centre, Jerusalem, Israel
| | - Yehonatan Pasternak
- Schneider Children's Medical Centre in Israel, Ward A, Paediatrics, Sackler School of Medicine, Tel Aviv University, Petah Tikva, Israel
| | - Violeta Temper
- Department of Microbiology, Hadassah-Hebrew University Medical Centre, Jerusalem, Israel
| | - Rachel Levy
- Schneider Children's Medical Centre in Israel, Ward A, Paediatrics, Sackler School of Medicine, Tel Aviv University, Petah Tikva, Israel
| | - Giora Weiser
- Department of Paediatric Emergency Medicine, Shaare Zedek Medical centre, Jerusalem, Israel
| | - Saar Hashavya
- Department of Paediatric Emergency Medicine, Hadassah-Hebrew University Medical Centre, Jerusalem, Israel
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18
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Galper E, Bdolah‐Abram T, Megged O. Assessment of infections rate due to community-acquired Methicillin-resistant Staphylococcus aureus and evaluation of risk factors in the paediatric population. Acta Paediatr 2021; 110:1579-1584. [PMID: 33249634 DOI: 10.1111/apa.15698] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 11/20/2020] [Accepted: 11/26/2020] [Indexed: 11/30/2022]
Abstract
AIM We aimed at assessing the frequency of Community-acquired Methicillin-resistant Staphylococcus aureus (CA-MRSA) infections, identifying its risk factors and evaluating resistance patterns of Staphylococcus aureus to various antibiotics in order to recommend the optimal empirical treatment for suspected Staphylococcus aureus infections. METHODS We reviewed the medical records of children who were treated at Shaare Zedek medical centre, located in Jerusalem, Israel, over the years 2008-2019 and had a positive culture for Staphylococcus aureus. Patients with CA-MRSA infections were compared with Methicillin-susceptible Staphylococcus aureus (CA-MSSA) infections. RESULTS In this study, 620 paediatric patients were included. The number of children in the CA-MRSA study group was 124, while the MSSA control group consisted of 496 children. Risk factors for CA-MRSA infections included young age (1-5 years), female sex, Arab ethnicity and residence in East Jerusalem. The incidence of CA-MRSA increased over the past decade, with an average of 11.2%. An increase in MSSA resistance to clindamycin was noted while Trimethoprim-Sulphamethoxazole resistance remained low. CONCLUSION The incidence of CA-MRSA in Jerusalem was rising, along with changes in resistance patterns of both MSSA and MRSA to various antibiotic agents. In order to optimise empirical treatment for suspected staphylococcal infection, continued monitoring of CA-MRSA prevalence and resistance rates is essential.
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Affiliation(s)
- Ella Galper
- The Hebrew University Hadassah Medical School Jerusalem Israel
| | | | - Orli Megged
- The Hebrew University Hadassah Medical School Jerusalem Israel
- Pediatric department and Pediatric Infectious Diseases Unit Shaare Zedek Medical Center Jerusalem Israel
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19
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Breuer A, Megged O, Kashat L, Assous MV. Quantitative real-time PCR in Borrelia persica tick-borne relapsing fever demonstrates correlation with the Jarisch-Herxheimer reaction. Eur J Clin Microbiol Infect Dis 2021; 40:1113-1116. [PMID: 33394211 DOI: 10.1007/s10096-020-04148-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Accepted: 12/28/2020] [Indexed: 10/22/2022]
Abstract
The purpose of this study is to explore whether a correlation exists between the bacterial load of Borrelia persica in tick-borne relapsing fever (TBRF), established by quantitative real-time PCR, and the development of Jarisch-Herxheimer reaction (JHR) after the initiation of antibiotic treatment. Forty-two blood samples were included in our study. The mean bacterial load, as established by real-time PCR, in patients who developed JHR was significantly greater than in those patients who did not develop JHR (443,293 copies vs. 140,598, p = 0.035). Accordingly, real-time PCR may assist clinicians in identifying patients at higher risk of JHR.
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Affiliation(s)
- Adin Breuer
- Department of Pediatrics, Shaare Zedek Medical Center, 12 Shmuel Bait St., PO Box 3235, 9103102, Jerusalem, Israel.
| | - Orli Megged
- Department of Pediatrics, Shaare Zedek Medical Center, 12 Shmuel Bait St., PO Box 3235, 9103102, Jerusalem, Israel.,Pediatric Infectious Diseases Unit, Shaare Zedek Medical Center, Jerusalem, Israel.,Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Livnat Kashat
- Clinical Microbiology and Immunology Laboratory, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Marc Victor Assous
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.,Clinical Microbiology and Immunology Laboratory, Shaare Zedek Medical Center, Jerusalem, Israel
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20
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Orlanski-Meyer E, Yogev D, Auerbach A, Megged O, Glikman D, Hashkes PJ, Bar-Meir M. Multisystem Inflammatory Syndrome in Children Associated With Severe Acute Respiratory Syndrome Coronavirus-2 in an 8-Week-Old Infant. J Pediatric Infect Dis Soc 2020; 9:781-784. [PMID: 33175159 PMCID: PMC7717298 DOI: 10.1093/jpids/piaa137] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 10/31/2020] [Indexed: 12/25/2022]
Abstract
We describe an 8-week-old infant with severe gastrointestinal symptoms, significant hypoalbuminemia, and mild carditis following asymptomatic infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The infant's symptoms, including their temporal appearance, were consistent with multisystem inflammatory syndrome in children (MIS-C). A unique finding on colonic histology which may shed light on the pathogenesis of MIS-C was identified. The patient improved significantly following several anti-inflammatory treatments. The lag between the presentation of MIS-C and initial SARS-CoV-2 exposure, which may often be asymptomatic, together with the young age of our patient, makes this a challenging diagnosis. Clinicians should be aware of this entity, even in the neonatal and infantile age groups, to facilitate timely identification and treatment.
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Affiliation(s)
- Esther Orlanski-Meyer
- Institute of Pediatric Gastroenterology and Nutrition, The Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel,Shaare Zedek Medical Center, Jerusalem, Israel,Corresponding Author: Esther Orlanski-Meyer, MD, Tel: 972-52-802-0855,
| | - Dotan Yogev
- Institute of Pediatric Gastroenterology and Nutrition, The Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel,Shaare Zedek Medical Center, Jerusalem, Israel,Hadassah Hebrew University Medical School
| | - Adi Auerbach
- Pediatric Endocrinology unit, The Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel,Shaare Zedek Medical Center, Jerusalem, Israel
| | - Orli Megged
- Pediatric Infectious Diseases unit, The Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel,Shaare Zedek Medical Center, Jerusalem, Israel,Hadassah Hebrew University Medical School
| | - Daniel Glikman
- Padeh-Poriya Medical Center and The Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Philip J Hashkes
- Pediatric Rheumatology Unit, The Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel,Hadassah Hebrew University Medical School
| | - Maskit Bar-Meir
- Pediatric Infectious Diseases unit, The Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel,Shaare Zedek Medical Center, Jerusalem, Israel,Hadassah Hebrew University Medical School
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21
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Maor Y, Cohen D, Paran N, Israely T, Ezra V, Axelrod O, Shinar E, Izak M, Rahav G, Rahimi-Levene N, Bazofin BM, Gelman R, Dicker D, Brosh-Nissimov T, Megged O, Dahan D, Benov A, Paz A, Edward K, Moran A, Rogowski O, Sorkine P, Mayo A, Zimhony O, Chen J. Compassionate use of convalescent plasma for treatment of moderate and severe pneumonia in COVID-19 patients and association with IgG antibody levels in donated plasma. EClinicalMedicine 2020; 26:100525. [PMID: 32923991 PMCID: PMC7480446 DOI: 10.1016/j.eclinm.2020.100525] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 08/10/2020] [Accepted: 08/12/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND We assessed outcome of patients with moderate and severe COVID-19 following treatment with convalescent plasma (CP) and the association with IgG levels in transfused CP. METHODS A prospective cohort study. Primary outcome was improvement at day 14 defined as alive, not on mechanical ventilation, and moderate, mild, or recovered from COVID-19. Antibody levels in CP units were unknown at the time of treatment. IgG against the spike protein S1 was subsequently measured by ELISA. Neutralizing antibodies titers were determined in a subset. Outcome was assessed in relation to the mean antibody level transfused to the patients (≤4.0 versus >4.0). FINDINGS Of 49 patients, 11 (22.4%) had moderate, 38 (77.6%) had severe disease, 28 were ventilated. At day 14, 24 (49.0%) patients improved, 9 (18.4%) died, and 13 (26.5%) were ventilated. In 14/98 (14.3%) CP units IgG was < 1.1 (cutoff calibration) and in 60 (61.2%) ≤4.0. IgG level and neutralizing antibody titer were correlated (0.85 p < 0.001). In patients receiving ≤4.0 antibody levels, 11/30 improved (36.7%) versus 13/19 (68.4%) in patients receiving >4.0 odds ratio (OR) 0.267 [95% confidence interval (CI) 0.079-0.905], P = 0.030. In patients diagnosed >10 days prior to treatment, 4/14 (22.4%) improved in the ≤4.0 antibody group, versus 6/7 (85.7%) in the >4.0 antibody group, OR 0.048 (95% CI, 0.004-0.520), P = 0.007. No serious adverse events were reported. INTERPRETATION Treatment with CP with higher levels of IgG against S1 may benefit patients with moderate and severe COVID-19. IgG against S1 level in CP predicts neutralization antibodies titers.
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Affiliation(s)
- Yasmin Maor
- Infectious Disease Unit, Wolfson Medical Center, Holon, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Daniel Cohen
- School of Public Health, Tel Aviv University, Tel Aviv, Israel
| | - Nir Paran
- Department of Infectious Diseases, Israel Institute for Biological Research, Ness Ziona, Israel
| | - Tomer Israely
- Department of Infectious Diseases, Israel Institute for Biological Research, Ness Ziona, Israel
| | - Vered Ezra
- Medical directorate, Ministry of Health, Jerusalem, Israel
| | | | - Eilat Shinar
- Magen David Adom, National Blood Services, Ramat Gan, Israel
| | - Marina Izak
- Magen David Adom, National Blood Services, Ramat Gan, Israel
| | - Galia Rahav
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Infectious Diseases Unit, Sheba Medical Center, Ramat Gan, Israel
| | - Naomi Rahimi-Levene
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Shamir (Assaf Harofeh) Medical Center, Medical Director of the Blood Bank, Zerifin 703301, Israel
| | - Baruch M Bazofin
- Department of Anesthesiology and Critical Care Medicine, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Ram Gelman
- Department of Medicine, Hebrew University-Hadassah Medical Center, Jerusalem, Israel
- Israel Defense Forces, Medical Corps, Tel Hasomer, Ramat Gan, Israel
| | - Dror Dicker
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Internal Medicine D and Obesity Clinic Hasharon Hospital-Rabin Medical center, Petah Tiqva, Israel
| | - Tal Brosh-Nissimov
- Infectious Diseases Unit, Assuta Ashdod University Hospital, Ashdod, Israel
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er-Sheva, Israel
| | - Orli Megged
- Pediatric Infectious diseases Unit, Shaare Zedek Medical Center, Jerusalem, Israel
| | - David Dahan
- Respiratory ICU, Meir Medical Center, Kfar Saba, Israel
| | - Avi Benov
- Israel Defense Forces, Medical Corps, Tel Hasomer, Ramat Gan, Israel
- The Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Alona Paz
- Infectious Unit, Bnei Zion Medical Center, Haifa, Israel
| | - Kaykov Edward
- Department of Geriatric Medicine, Galilee Medical Center, Naharia, Israel
| | - Amit Moran
- Department of head and neck surgery, the University of Texas, MD Anderson Cancer Center, Houston, Texas USA
| | - Ori Rogowski
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Internal Medicine "C" Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Patrick Sorkine
- General Intensive Care Unit, Mayanei Hayeshua Medical Center, Bnei Brak, Israel
| | - Ami Mayo
- Department of Critical Care Medicine, Assuta Ashdod University Hospital, Ashdod, Israel
| | - Oren Zimhony
- Infectious Diseases Unit, Kaplan Medical Center, Rehovot, Israel, affiliated to the School of Medicine, Hebrew University and Hadassah, Jerusalem, Israel
| | - Jacob Chen
- Medical directorate, Ministry of Health, Jerusalem, Israel
- Israel Defense Forces, Medical Corps, Tel Hasomer, Ramat Gan, Israel
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22
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Gross I, Ben Nachum N, Molho-Pessach V, Weiser G, Oster Y, Engelhard D, Megged O, Hashavya S. The molluscum contagiosum BOTE sign-Infected or inflamed? Pediatr Dermatol 2020; 37:476-479. [PMID: 32115769 DOI: 10.1111/pde.14124] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 01/13/2020] [Accepted: 01/28/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Molluscum contagiosum (MC) is a common skin infection in the pediatric age group. The infection is self-limited and manifests as discrete, umbilicated skin-colored papules on any skin surface of the body. At times, complications such as local dermatitis and swelling, erythema, and pus formation may appear. These signs of inflammation are commonly presumed to represent bacterial infection. METHODS This multicenter study was a retrospective analysis of data collected on all patients diagnosed with inflamed lesions secondary to MC and treated at the Hadassah Medical Centers and Shaare Zedek Medical Center in Jerusalem, Israel, from 1/1/2008 to 1/07/2018. Characteristics of children with positive cultures were compared to those with negative cultures and those with contaminants. RESULTS A total of 56 cases were reviewed; the mean age at presentation was 4.6 years. Fever was reported in 12.5%, and 62.5% received systemic antibiotics because of their inflamed MC prior to admission. Fifty-five percent had sterile cultures or cultures growing only contaminants. Only seven had positive cultures with the common cutaneous pathogens. No statistical difference was observed between the patients with pathogenic isolates and patients with sterile or non-pathogenic cultures in terms of demographics, lesion characteristics, inflammatory markers, or length of hospitalization. CONCLUSION The findings suggest that most cases of suspected MC-related secondary infection can be attributed to inflammation rather than to bacterial infection. However, in some cases, true bacterial infection should be suspected and treated accordingly.
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Affiliation(s)
- Itai Gross
- Department of Pediatric Emergency Medicine, Hadassah Medical Center, Jerusalem, Israel.,Department of Pediatric Emergency Medicine, Queensland Children's Hospital, Brisbane, Australia
| | - Noa Ben Nachum
- Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | - Vered Molho-Pessach
- Pediatric Dermatology Service, Department of Dermatology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Giora Weiser
- Department of Pediatric Emergency Medicine, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Yonatan Oster
- Department of clinical microbiology and infectious diseases, Hadassah Medical Center, Jerusalem, Israel
| | - Dan Engelhard
- Pediatric Department and Pediatric Infectious Diseases Unit, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Orli Megged
- Pediatric Department and Pediatric Infectious Diseases Unit, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Saar Hashavya
- Department of Pediatric Emergency Medicine, Hadassah Medical Center, Jerusalem, Israel
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23
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Shamriz O, Simon AJ, Lev A, Megged O, Ledder O, Picard E, Joseph L, Molho-Pessach V, Tal Y, Millman P, Slae M, Somech R, Toker O, Berger M. Exogenous interleukin-2 can rescue in-vitro T cell activation and proliferation in patients with a novel capping protein regulator and myosin 1 linker 2 mutation. Clin Exp Immunol 2020; 200:215-227. [PMID: 32201938 DOI: 10.1111/cei.13432] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Revised: 03/04/2020] [Accepted: 03/16/2020] [Indexed: 12/27/2022] Open
Abstract
Capping protein regulator and myosin 1 linker 2 (CARMIL2) deficiency is characterized by impaired T cell activation, which is attributed to defective CD28-mediated co-signaling. Herein, we aimed to analyze the effect of exogenous interleukin (IL)-2 on in-vitro T cell activation and proliferation in a family with CARMIL2 deficiency. This study included four children (one male and three females; aged 2·5-10 years at presentation). The patients presented with inflammatory bowel disease and recurrent viral infections. Genetic analysis revealed a novel homozygous 25-base pairs deletion in CARMIL2. Immunoblotting demonstrated the absence of CARMIL2 protein in all four patients and confirmed the diagnosis of CARMIL2 deficiency. T cells were activated in-vitro with the addition of IL-2 in different concentrations. CD25 and interferon (IFN)-γ levels were measured after 48 h and 5 days of activation. CD25 surface expression on activated CD8+ and CD4+ T cells was significantly diminished in all patients compared to healthy controls. Additionally, CD8+ T cells from all patients demonstrated significantly reduced IFN-γ production. When cells derived from CARMIL2-deficient patients were treated with IL-2, CD25 and IFN-γ production increased in a dose-dependent manner. T cell proliferation, as measured by Cell Trace Violet, was impaired in one patient and it was also rescued with IL-2. In conclusion, we found that IL-2 rescued T cell activation and proliferation in CARMIL2-deficient patients. Thus, IL-2 should be further studied as a potential therapeutic modality for these patients.
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Affiliation(s)
- O Shamriz
- The Lautenberg Center for Immunology and Cancer Research, Institute of Medical Research Israel-Canada, Hebrew University-Hadassah Medical School, Jerusalem, Israel.,Allergy and Clinical Immunology Unit, Department of Medicine, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - A J Simon
- Sheba Cancer Research Center and Institute of Hematology, Sheba Medical Center, Tel HaShomer, Ramat-Gan, Israel
| | - A Lev
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Pediatric Department A and Immunology Service, Jeffrey Modell Foundation Center, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Affiliated with Tel Aviv University, Tel Aviv, Israel
| | - O Megged
- Pediatric Infectious diseases Unit, Shaare Zedek Medical Center, Jerusalem, Israel
| | - O Ledder
- Juliet Keidan Institute of Pediatric Gastroenterology and Nutrition, Shaare Zedek Medical Center, Jerusalem, Israel
| | - E Picard
- Pediatric pulmonology Unit, Shaare Zedek Medical Center, Jerusalem, Israel
| | - L Joseph
- Pediatric pulmonology Unit, Shaare Zedek Medical Center, Jerusalem, Israel
| | - V Molho-Pessach
- Department of Dermatology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Y Tal
- Allergy and Clinical Immunology Unit, Department of Medicine, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - P Millman
- Pediatric Gastroenterology Unit, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - M Slae
- Pediatric Gastroenterology Unit, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - R Somech
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Pediatric Department A and Immunology Service, Jeffrey Modell Foundation Center, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Affiliated with Tel Aviv University, Tel Aviv, Israel
| | - O Toker
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.,Allergy and Clinical Immunology Unit, Shaare Zedek Medical Center, Jerusalem, Israel
| | - M Berger
- The Lautenberg Center for Immunology and Cancer Research, Institute of Medical Research Israel-Canada, Hebrew University-Hadassah Medical School, Jerusalem, Israel
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24
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Doyev R, Ben-Shalom E, Megged O. The predictive utility of prior positive urine culture in children with recurrent urinary tract infections. Eur J Pediatr 2020; 179:415-421. [PMID: 31768637 DOI: 10.1007/s00431-019-03522-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 10/31/2019] [Accepted: 11/03/2019] [Indexed: 11/25/2022]
Abstract
Urinary tract infections can cause renal damage if not treated promptly. The aim of this study was to examine if prior urine cultures can predict antibiotic susceptibility profile in a subsequent culture, in children with recurrent urinary tract infections. The medical records of all children with at least two episodes of urinary tract infection between 1999-2015 that occurred 2 weeks to 1 year apart were reviewed. Pathogen identity and antibiogram were compared between the two cultures for every patient. One hundred sixty-one cases of recurrent urinary tract infections were identified. Seventy-seven (48%) pairs of cultures grew the same pathogen. However, of these, 31 had an altered biogram. In 53% of the culture pairs, the pathogen in the second culture had a similar or better antibiotic susceptibility profile. We found no statistically significant correlation between the elapsed time between the two cultures and the probability of similar susceptibility profile between them. There was no correlation between antibiogram change and any of the demographic characteristics, including a history of renal transplantation and taking antibiotic prophylactic treatment.Conclusions: Antibiotic susceptibility profile of the pathogen in a prior urinary tract infection did not predict antibiotic susceptibility profile in a subsequent urinary tract infection in our study.What is Known:• Children with urinary tract infections often have recurrent infections.• Clinicians often use prior urine cultures to choose empirical antibiotic treatment in subsequent infections.What is New:• In only 50% of the cases, a subsequent urinary tract infection grows the same pathogen as the 1st urinary tract infection.• Even in cultures with the same pathogen growth, antibiogram is often different.
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Affiliation(s)
- Reut Doyev
- The Hebrew University Hadassah Medical School, Jerusalem, Israel
| | - Efrat Ben-Shalom
- Pediatric Department, Shaare Zedek Medical Center, P.O.B. 3235, Jerusalem, Israel.,Pediatric Nephrology Unit, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Orli Megged
- The Hebrew University Hadassah Medical School, Jerusalem, Israel. .,Pediatric Department, Shaare Zedek Medical Center, P.O.B. 3235, Jerusalem, Israel. .,Infectious Diseases Unit, Shaare Zedek Medical Center, Jerusalem, Israel.
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25
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Glikman D, Curiel N, Glatman‐Freedman A, Megged O, Youngster I, Marom R, Lavie K, Smolkin T, Troitzky M, Stein M, Stein M, Glikman D, Curiel N, Glatman‐Freedman A, Megged O, Eventov‐Fiedman S, Keller N, Kriger O, Somekh E, Tasher D, Gottesman G, Guri A, Ashkenazi‐Hoffnung L, Ben‐Zvi H, Youngster I, Herzlich J, Schindler Y, Marom R, Rubinstein U, Midlij E, Miron D, Damouni R, Kassis I, Nimri‐Atrash N, Freiman S, Lavie K, Smolkin T, Melamed R, Troitzky M, Sayag A. Nationwide epidemiology of early-onset sepsis in Israel 2010-2015, time to re-evaluate empiric treatment. Acta Paediatr 2019; 108:2192-2198. [PMID: 31168848 DOI: 10.1111/apa.14889] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 05/27/2019] [Accepted: 06/04/2019] [Indexed: 01/25/2023]
Abstract
AIM Early-onset neonatal sepsis (EOS) may lead to significant morbidity and mortality, yet the recommended antimicrobials have not changed for many years. We aimed to optimise EOS treatment by examining EOS pathogens, resistance rates and resistance risk factors. METHODS A retrospective, nationwide cohort study analysing 2010-2015 EOS data in Israel. RESULTS The 21 participating centres constitute 92% of the total birth cohort (around 180 000 live births/year). Of 549 EOS neonates (0.57/1000 live births), 306 (56%) and 243 (44%) were full-term and preterm, respectively (0.35 vs. 2.94 per/1000 live births). Gram-negative pathogens predominated, especially in preterms. Escherichia coli and Streptococcus agalactiae were most common pathogens (0.2 and 0.19 per 1000 live births, respectively). In 277 Gram-negatives, 16%, 14%, 8% and 3% were gentamicin-resistant, extended-spectrum beta-lactamase (ESBL)-positive, gentamicin-resistant and ESBL-positive, and amikacin-resistant, respectively; preterms had higher resistance rates. No risk factors for antimicrobial resistance were identified. Mortality was reported in 21% of Gram-negative EOS versus 7% of Gram-positive EOS [OR 3.4 (95% CI 1.8-6.2), p < 0.01]. CONCLUSION In this nationwide study, EOS was caused predominantly by Gram-negatives, with high gentamicin resistance and ESBL phenotype rates, without identifiable resistance risk factors. As EOS is life-threatening, modification of empiric therapy for amikacin-based regimens should be considered, mainly in preterms.
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Affiliation(s)
- Daniel Glikman
- The Azrieli Faculty of Medicine in the Galilee Bar‐Ilan University Safed Israel
| | - Nitzan Curiel
- The Azrieli Faculty of Medicine in the Galilee Bar‐Ilan University Safed Israel
| | - Aharona Glatman‐Freedman
- Israel Centre for Disease Control Tel Hashomer Ramat Gan Israel
- Sackler School of Medicine Tel Aviv University Tel‐Aviv Israel
| | - Orli Megged
- Paediatrics Shaare Zedek Medical Center Jerusalem Israel
- The School of Medicine The Hebrew University and Hadassah Medical Centre Jerusalem Israel
| | - Ilan Youngster
- Sackler School of Medicine Tel Aviv University Tel‐Aviv Israel
- Paediatrics, Centre for Microbiome Research Assaf Harofeh Medical Centre Zerifin Israel
| | - Ronella Marom
- Sackler School of Medicine Tel Aviv University Tel‐Aviv Israel
- Neonatology Tel Aviv Medical Centre Tel Aviv Israel
| | - Karen Lavie
- Neonatology Carmel Medical Centre Haifa Israel
- Rappaport Faculty of Medicine Technion – Israel Institute of Technology Haifa Israel
| | - Tatiana Smolkin
- The Azrieli Faculty of Medicine in the Galilee Bar‐Ilan University Safed Israel
- Neonatology Baruch Padeh Medical Centre Poria Israel
| | - Mara Troitzky
- Neonatology Barzilai Medical Centre Ashkelon Israel
- Ben‐Gurion University of the Negev Be'er Sheva Israel
| | - Michal Stein
- Rappaport Faculty of Medicine Technion – Israel Institute of Technology Haifa Israel
- Infectious disease and infection control unit Hillel Yaffe Medical Centre Hadera Israel
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26
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Megged O, Koriat Y. The prevalence of vesicoureteral reflux in infants with first urinary tract infection following circumcision is similar to infants with UTI not following circumcision. Int Urol Nephrol 2019; 52:417-422. [PMID: 31784897 DOI: 10.1007/s11255-019-02352-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2019] [Accepted: 11/25/2019] [Indexed: 11/30/2022]
Abstract
PURPOSE Urinary tract infections (UTIs) are common serious bacterial infections in early infancy. Ritual circumcision in neonates may increase the risk of UTI within 2 weeks of the procedure. The aims of this study were to assess the prevalence and risk factors for vesicoureteral reflux (VUR) among young infants with first UTI following circumcision, and compare it with the prevalence of VUR among young infants with first UTI not related to circumcision. METHODS In this retrospective cohort study, the medical records of all children aged 0-100 days who were diagnosed with UTI at Shaare Zedek Medical Center between 2005 and 2012 were reviewed for demographic, clinical and laboratory data and for the presence of VUR in voiding cystourethrography (VCUG). RESULTS Four hundred and sixty eight cases of UTI were included. Infants with post-circumcision UTI in our study were more likely to have associated bacteremia and abnormal renal function tests. VCUG was done for 166 infants (35%). There was no statistically significant difference in the prevalence of abnormal VCUG between infants with UTI following circumcision, in comparison to infants with UTI not following circumcision (30% vs. 36%, p = NS). CONCLUSIONS The decision regarding the need for radiographic evaluation and prophylactic antibiotic treatment following UTI should be made regardless if infection was related to circumcision.
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Affiliation(s)
- Orli Megged
- Pediatric Department and Infectious Diseases Unit, Shaare Zedek Medical Center Affiliated with Hebrew University-Hadassah School of Medicine, P.O.B. 3235, Jerusalem, Israel.
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Ben-Shimol S, Givon-Lavi N, Greenberg D, Stein M, Megged O, Bar-Yochai A, Negari S, Dagan R, On Behalf Of The Israel Bacteremia And Meningitis Active Surveillance Group. Impact of pneumococcal conjugate vaccines introduction on antibiotic resistance of Streptococcus pneumoniae meningitis in children aged 5 years or younger, Israel, 2004 to 2016. ACTA ACUST UNITED AC 2019; 23. [PMID: 30482264 PMCID: PMC6341944 DOI: 10.2807/1560-7917.es.2018.23.47.1800081] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Background Empiric treatment of pneumococcal meningitis includes ceftriaxone with vancomycin to overcome ceftriaxone resistant disease. The addition of vancomycin bears a risk of adverse events, including increased antibiotic resistance. We assessed antibiotic resistance rates in pneumococcal meningitis before and after pneumococcal conjugate vaccine (PCV) implementation. Methods All pneumococcal meningitis episodes in children aged 5 years and younger, from 2004 to 2016, were extracted from the nationwide bacteremia and meningitis surveillance database. For comparison purposes, we defined pre-PCV period as 2004–2008 and PCV13 period as 2014–2016. Minimal inhibitory concentration (MIC) > 0.06 and > 0.5 μg/mL were defined as penicillin and ceftriaxone resistance, respectively. Results Overall, 325 episodes were identified. Pneumococcal meningitis incidence rates declined non-significantly by 17%, comparing PCV13 and pre-PCV periods. Throughout the study, 90% of isolates were tested for antibiotic susceptibility, with 26.6%, 2.1% and 0% of isolates resistant to penicillin, ceftriaxone and vancomycin, respectively. Mean proportions (± SD) of meningitis caused by penicillin-resistant pneumococci were 40.5% ± 8.0% and 9.6% ± 7.4% in the pre-PCV and the PCV13 periods, respectively, resulting in an overall 83.9% reduction (odd ratio:0.161; 95% confidence interval: 0.059–0.441) in penicillin resistance rates. The proportions of meningitis caused by ceftriaxone resistant pneumococci were 5.0% ± 0.8% in the pre-PCV period, but no ceftriaxone resistant isolates were identified since 2010. Conclusions PCV7/PCV13 sequential introduction resulted in > 80% reduction of penicillin- resistant pneumococcal meningitis and complete disappearance of ceftriaxone resistant disease. These trends should be considered by the treating physician when choosing an empiric treatment for pneumococcal meningitis.
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Affiliation(s)
- Shalom Ben-Shimol
- The Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.,The Pediatric Infectious Disease Unit, Soroka University Medical Center, Beer-Sheva, Israel
| | - Noga Givon-Lavi
- The Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.,The Pediatric Infectious Disease Unit, Soroka University Medical Center, Beer-Sheva, Israel
| | - David Greenberg
- The Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.,The Pediatric Infectious Disease Unit, Soroka University Medical Center, Beer-Sheva, Israel
| | - Michal Stein
- Infectious Diseases and Infection Control Unit, Hillel Yaffe Medical Center, Hadera, Israel and Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
| | - Orli Megged
- Pediatric Infectious Diseases Unit, Shaare Zedek Medical Center, affiliated with Hebrew University-Hadassah School of Medicine, Jerusalem, Israel
| | - Avihu Bar-Yochai
- Infectious Disease Unit, Assaf Harofe Medical Center, Zerifin, Israel
| | - Shahar Negari
- The Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.,The Pediatric Infectious Disease Unit, Soroka University Medical Center, Beer-Sheva, Israel
| | - Ron Dagan
- The Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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Arkush L, Megged O, Nitzan I, Yaakobi-Simhayoff N, Feinstein S, Tzvi-Behr S. Glomerulonephritis and nephrotic syndrome in a child with DiGeorge syndrome: Questions. Pediatr Nephrol 2019; 34:1733-1734. [PMID: 30963281 DOI: 10.1007/s00467-019-04242-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Accepted: 03/18/2019] [Indexed: 10/27/2022]
Affiliation(s)
- Leo Arkush
- Wilf Children's Hospital, Pediatric Department, Shaare Zedek Medical Center, Shmuel Bait Street 12, 9103102, Jerusalem, Israel.
| | - Orli Megged
- Wilf Children's Hospital, Pediatric Department, Shaare Zedek Medical Center, Shmuel Bait Street 12, 9103102, Jerusalem, Israel.,Pediatric Infectious Diseases Unit, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Itamar Nitzan
- Wilf Children's Hospital, Pediatric Department, Shaare Zedek Medical Center, Shmuel Bait Street 12, 9103102, Jerusalem, Israel
| | - Nurit Yaakobi-Simhayoff
- Wilf Children's Hospital, Pediatric Department, Shaare Zedek Medical Center, Shmuel Bait Street 12, 9103102, Jerusalem, Israel.,Pediatric Cardiology Unit, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Sofia Feinstein
- Wilf Children's Hospital, Pediatric Department, Shaare Zedek Medical Center, Shmuel Bait Street 12, 9103102, Jerusalem, Israel.,Division of Pediatric Nephrology, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Shimrit Tzvi-Behr
- Wilf Children's Hospital, Pediatric Department, Shaare Zedek Medical Center, Shmuel Bait Street 12, 9103102, Jerusalem, Israel.,Division of Pediatric Nephrology, Shaare Zedek Medical Center, Jerusalem, Israel
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Megged O, Cytter-Kuint R. Intrathoracic Kidney. J Pediatr 2019; 211:224. [PMID: 31128884 DOI: 10.1016/j.jpeds.2019.04.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Accepted: 04/16/2019] [Indexed: 10/26/2022]
Affiliation(s)
- Orli Megged
- Pediatric Department and Infectious Diseases Unit
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Affiliation(s)
- Orli Megged
- Pediatric Department and Infectious Diseases Unit
| | - Eytan Baskin
- Pediatrics Department Shaare Zedek Medical Center Jerusalem, Israel
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Abstract
Acute otitis media (AOM) is a common childhood illness. The aim of this study was to assess whether AOM in the first month of life predicts recurrent AOM (rAOM) in early childhood. The medical records of all neonates with AOM and isolation of bacterial pathogen from middle-ear fluid during 2005-2010 were reviewed. Neonates without AOM admitted during the same period for neonatal fever workup were included as controls. Information regarding rAOM and possible risk factors were collected through a phone interview with the parents. A total of 84 neonates with AOM were enrolled; 25 (30%) had rAOM compared with 8/79 (10%) in the control group. Neonatal AOM increases 4-fold the odds of rAOM later in childhood (odds ratio = 4; 95% CI = 1.44-11.42; P = .008), independent of smoke exposure, numbers of siblings, AOM in siblings, breastfeeding, day care attendance, or use of pacifier. Neonatal AOM is a significant risk factor for rAOM during infancy.
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Affiliation(s)
- Orli Megged
- 1 Shaare-Zedek Medical Center (affiliated with Hebrew University-Hadassah School of Medicine), Jerusalem, Israel
| | - Suzan Abdulgany
- 1 Shaare-Zedek Medical Center (affiliated with Hebrew University-Hadassah School of Medicine), Jerusalem, Israel
| | - Maskit Bar-Meir
- 1 Shaare-Zedek Medical Center (affiliated with Hebrew University-Hadassah School of Medicine), Jerusalem, Israel
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Ben-Shimol S, Givon-Lavi N, Grisaru-Soen G, Megged O, Greenberg D, Dagan R. Comparative incidence dynamics and serotypes of meningitis, bacteremic pneumonia and other-IPD in young children in the PCV era: Insights from Israeli surveillance studies. Vaccine 2017; 36:5477-5484. [PMID: 28579230 DOI: 10.1016/j.vaccine.2017.05.059] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Revised: 05/08/2017] [Accepted: 05/22/2017] [Indexed: 01/12/2023]
Abstract
INTRODUCTION Widespread introduction of pneumococcal conjugated vaccines (PCVs) impacted on invasive pneumococcal disease (IPD). However, IPD reduction may not be similar in all outcomes within IPD. We assessed PCV7/PCV13 impact on pneumococcal meningitis, bacteremic pneumonia (BP) and other (non-meningitis, non-pneumonia) IPD episodes in children <5years in Israel. METHODS A prospective, population-based, active nationwide surveillance. All pneumococcal invasive episodes with positive blood/CSF cultures, July 2000 through June 2016, were included. Three sub-periods were defined: pre-PCV (2000-2008), PCV7 (2009-2011) and PCV13 (2014-2016). Incidence rate ratios (IRRs) were calculated. RESULTS Overall, 4321 episodes were recorded; 456 (10.6%) meningitis, 1478 (34.2%) pneumonia and 2387 (55.2%) other-IPD. In the pre-PCV period, proportion of serotypes in PCV13, but not in PCV7 (mainly serotypes 1, 5 and 19A) was higher in BP (43.3%) compared with other-IPD episodes (32.8%, p<0.001) and similar to that of meningitis (37.6%, p=0.1). The proportion of episodes in children <12months was higher in meningitis (52.1%) compared with pneumonia (23.2%) and other-IPD episodes (39.5%; p<0.001 for both). The declines of the 3 entities were not similar; Meningitis rate non-significantly declined by 24% (IRR=0.76; 95% CI 0.57-1.01), while BP and other-IPD rates significantly declined by 57% and 70%, respectively. In contrast to other entities, BP did not decline significantly after PCV7 introduction but started to decline only after PCV13 introduction. Rates of meningitis, pneumonia and other-IPD caused by PCV13-serotypes (VT13) substantially declined by 88%, 95% and 97%, respectively, comparing PCV13 and the pre-PCV periods. However, diseases caused by non-VT13 increased by 256%, 302% in meningitis and pneumonia, respectively, but only 116% in other-IPD. CONCLUSIONS Following PCV7/PCV13 introduction, rates of episodes caused by VT13 were substantially reduced in all 3 groups. However, differences in age distribution, serotype replacement and specific serotype decrease suggest different pathogenesis and host susceptibility between the 3 entities.
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Affiliation(s)
- Shalom Ben-Shimol
- The 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
- The Pediatric Infectious Disease Unit, Soroka University Medical Center, Beer-Sheva, Israel; Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Galia Grisaru-Soen
- Pediatric Infectious Disease Unit, Dana Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Orli Megged
- Pediatric Department and Infectious Diseases Unit, Shaare Zedek Medical Center Affiliated with Hebrew University-Hadassah School of Medicine, Jerusalem, Israel
| | - David Greenberg
- The Pediatric Infectious Disease Unit, Soroka University Medical Center, Beer-Sheva, Israel; Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Ron Dagan
- The Pediatric Infectious Disease Unit, Soroka University Medical Center, Beer-Sheva, Israel.
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Affiliation(s)
- Shimrit Tzvi-Behr
- Shaare Zedek Medical Center (affiliated with
Hebrew University, Hadassah School of Medicine), Jerusalem, Israel
| | - Yechiel Schlesinger
- Shaare Zedek Medical Center (affiliated with
Hebrew University, Hadassah School of Medicine), Jerusalem, Israel
| | - Maskit Bar-Meir MD
- Shaare Zedek Medical Center (affiliated with
Hebrew University, Hadassah School of Medicine), Jerusalem, Israel
| | - Orli Megged
- Shaare Zedek Medical Center (affiliated with Hebrew University, Hadassah School of Medicine), Jerusalem, Israel
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Baram N, Megged O, Weiser G. Occult Bacteremia: Should We Look for the Needle in the Haystack? Isr Med Assoc J 2016; 18:649-651. [PMID: 28466611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
BACKGROUND Once a well-recognized entity, occult bacteremia (OB) is no longer a significant or serious bacterial infection. First following the introduction of the Haemophilus influenzae type B vaccine and now with the implementation of the conjugate pneumococcal vaccine (PCV), the number of cases has declined significantly. This has led to a change in many published guidelines to avoid taking blood cultures in fully vaccinated children presenting with fever. In Israel, the introduction of the PCV13 is now widespread. OBJECTIVES To assess the incidence and outcome of OB, specifically by Streptococcus pneumoniae, in a single large pediatric medical center. METHODS We conducted a retrospective review of all cases of pneumococcal bacteremias in the years 2008-2013 and specifically those considered occult. RESULTS Of 355 cases of bacteremia diagnosed during the study period, 164 were caused by S. pneumoniae and 20 (12.8%) were considered occult. None of the OB cases had any complications. OB was not found in children over the age of 36 months. There was a change in the serotypes involving pneumococcal OB. CONCLUSIONS OB is uncommon in the PCV-vaccinated population and the serotypes involved have changed.
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Affiliation(s)
- Neta Baram
- Department of Pediatrics, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Orli Megged
- Department of Pediatrics, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Giora Weiser
- Department of Pediatric Emergency Medicine, Shaare Zedek Medical Center, Jerusalem, Israel
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Megged O, Chazan B, Ganem A, Ayoub A, Yanovskay A, Sakran W, Miron D, Dror-Cohen A, Kennes Y, Berdenstein S, Glikman D. Brucellosis Outbreak in Children and Adults in Two Areas in Israel. Am J Trop Med Hyg 2016; 95:31-4. [PMID: 27114301 DOI: 10.4269/ajtmh.16-0116] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Accepted: 03/02/2016] [Indexed: 11/07/2022] Open
Abstract
Two parallel outbreaks of Brucella melitensis infection occurred in 2014 in two geographical areas in Israel. In two medical centers in northern Israel and one medical center in Jerusalem, 102 patients (58 children, 47 adults) were diagnosed with brucellosis. Most patients (N = 76, 72%) were Muslim Arabs, 28 (27%) were Druze, and one was Jewish. The source of infection was often traced to cheese from the Palestinian Authority. Biovar-1 was evident in 98% in northern Israel but only in 42% in Jerusalem. Most common manifestations were fever (82%) and osteoarticular symptoms (49%). The major differences between the geographic areas were ethnicity and duration until diagnosis. Compared with adults, children had higher rates of hospitalization (93% versus 64%, P = 0.001), osteoarticular symptoms (60% versus 36%, P = 0.05), elevated alanine aminotransferase (12% versus 0%, P = 0.01), and lower C-reactive protein (2.28 ± 2.08 versus 5.57 ± 6.3l mg/dL, P = 0.001). Two unrelated brucellosis outbreaks occurred in 2014 in two different geographic areas of Israel and were limited to sections of the Arab and Druze populations. Most of the demographic and clinical aspects of patients were not affected by geographic variability. Clinical and laboratory differences were found between children and adults emphasizing the nonuniformity of the disease in different age groups. Effective control of unpasteurized dairy foods, health education programs, and improved regional cooperation are required to control brucellosis in Israel.
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Affiliation(s)
- Orli Megged
- Pediatric Infectious Diseases Unit, Pediatric Department, Shaare Zedek Medical Center, Jerusalem, Israel.
| | - Bibiana Chazan
- Infectious Diseases Unit, Emek Medical Center, Afula, Israel
| | - Atef Ganem
- Clinical Microbiology Laboratory, Galilee Medical Center, Nahariya, Israel
| | - Abeer Ayoub
- Pediatric Department, Galilee Medical Center, Nahariya, Israel
| | - Anna Yanovskay
- Infectious Diseases Unit, Emek Medical Center, Afula, Israel
| | - Waheeb Sakran
- Pediatric Department B', Emek Medical Center, Afula, Israel. The Pediatric Infectious Diseases Service, Emek Medical Center, Afula, Israel
| | - Dan Miron
- The Pediatric Infectious Diseases Service, Emek Medical Center, Afula, Israel. Pediatric Department A', Emek Medical Center, Afula, Israel
| | - Ahuva Dror-Cohen
- Immunology and Serology Laboratory, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Yoram Kennes
- Microbiology Laboratory, Emek Medical Center, Afula, Israel
| | - Svetlana Berdenstein
- Brucellosis Lab, OIE, FAO Reference Laboratory, Kimron Veterinary Institute, Bet Dagan, Israel
| | - Daniel Glikman
- The Pediatric Infectious Diseases Service, Galilee Medical Center, Nahariya, Israel. The Faculty of Medicine in the Galilee, Bar-Ilan University, Safed, Israel
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Abu Omar R, Algur N, Megged O, Hammerman C, Kaplan M. Glucose-6-Phosphate Dehydrogenase Screening in Israel-Arab and Palestinian-Arab Neonates. J Pediatr 2015; 167:169-72. [PMID: 25979319 DOI: 10.1016/j.jpeds.2015.04.039] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Revised: 03/11/2015] [Accepted: 04/14/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To evaluate the frequency of glucose-6-phosphate dehydrogenase (G-6-PD) deficiency, the incidence of clinically significant jaundice (any serum total bilirubin value >75th percentile on the hour-specific bilirubin nomogram), and the need for phototherapy in the pooled male Israeli-Arab and Palestinian-Arab population born at the Shaare Zedek Medical Center in Jerusalem, Israel. STUDY DESIGN Quantitative G-6-PD enzyme testing of umbilical cord blood was performed during birth hospitalization. G-6-PD deficiency was defined as any G-6-PD value <7.0 U/gHb. Transcutaneous bilirubin was performed daily during birth hospitalization, with serum total bilirubin testing in those with a transcutaneous bilirubin value >75th percentile. RESULTS Ten of 286 (3.5%) consecutively delivered male Arab newborns had G-6-PD deficiency. Clinically significant jaundice was higher in the population with G-6-PD deficiency compared with normal controls (relative risk, 3.45; 95% CI, 1.24-9.58). Thirty percent of the newborns with G-6-PD deficiency met American Academy of Pediatrics indications for phototherapy according to the high-risk (middle) curve on the phototherapy graph. CONCLUSION The frequency of G-6-PD deficiency in the Arab neonatal population delivering at this medical center meets World Health Organization criteria for neonatal G-6-PD screening (3%-5%). As in other ethnic groups, clinically significant jaundice is more frequent in newborns of this ethnic group with G-6-PD deficiency compared with G-6-PD-normal controls. Neonatal G-6-PD screening for both males and females of this population subgroup, in conjunction with parental education regarding the dangers of the condition and its prophylaxis, has now been incorporated into our institution's routine G-6-PD screening program.
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Affiliation(s)
- Rawan Abu Omar
- Department of Neonatology, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Nurit Algur
- Clinical Biochemistry Laboratory, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Orli Megged
- Department of Pediatrics, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Cathy Hammerman
- Department of Neonatology, Shaare Zedek Medical Center, Jerusalem, Israel; Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | - Michael Kaplan
- Department of Neonatology, Shaare Zedek Medical Center, Jerusalem, Israel; Faculty of Medicine, Hebrew University, Jerusalem, Israel.
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Megged O. Extended-spectrum β-lactamase-producing bacteria causing community-acquired urinary tract infections in children. Pediatr Nephrol 2014; 29:1583-7. [PMID: 24705795 DOI: 10.1007/s00467-014-2810-y] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2014] [Revised: 03/07/2014] [Accepted: 03/12/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND Extended-spectrum β-lactamase (ESBL)-producing bacteria are infrequent pathogens of community-acquired (CA) urinary tract infections (UTIs) in children. The aim of this study was to assess the frequency of and identify risk factors for CA-UTIs due to ESBL-producing microorganisms (CA-ESBL-UTI). METHODS The medical records of all children diagnosed with CA-ESBL-UTI at our medical center between 2003 and 2013 were reviewed. Patients with non-ESBL-UTIs during the same period were included as controls. RESULTS Eighty cases of CA-ESBL-UTI were identified. The incidence of ESBL-UTI increased from 2 to 3.8% during the study period. Compared to children with non-ESBL-UTI, those with ESBL were more likely to be of Arab descent, to have underlying medical conditions, to have received antibiotics in the month prior to the UTI and to have been previously hospitalized. The mean duration of hospitalization for patients with an ESBL-UTI was significantly longer than that for patients with a non-ESBL UTI (3.6 vs. 2 days; P = 0.01). In multivariate analysis, Arab ethnicity [odds ratio (OR) 6.1; 95 % confidence interval (CI) 2.7-13.6] and recent antibiotic treatment (OR 4.0; 95 % CI 1.6-10.4) were risk factors for CA-ESBL-UTI. CONCLUSIONS The incidence of CA-ESBL-UTI is rising. The empiric treatment for suspected UTI in children who had been previously hospitalized and who had received antibiotics in the last month should cover ESBL-producing bacteria.
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Affiliation(s)
- Orli Megged
- Pediatric Department and Infectious Diseases Unit, Shaare Zedek Medical Center affiliated with Hebrew University-Hadassah School of Medicine, P.O.B. 3235, Jerusalem, Israel,
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Martínez-Barricarte R, Megged O, Stepensky P, Casimir P, Moncada-Velez M, Averbuch D, Assous MV, Abuzaitoun O, Kong XF, Pedergnana V, Deswarte C, Migaud M, Rose-John S, Itan Y, Boisson B, Belkadi A, Conti F, Abel L, Vogt G, Boisson-Dupuis S, Casanova JL, Bustamante J. Mycobacterium simiae infection in two unrelated patients with different forms of inherited IFN-γR2 deficiency. J Clin Immunol 2014; 34:904-9. [PMID: 25135595 DOI: 10.1007/s10875-014-0085-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2014] [Accepted: 07/30/2014] [Indexed: 01/04/2023]
Abstract
Interferon-γ receptor 2 (IFN-γR2) deficiency is a rare primary immunodeficiency characterized by predisposition to infections with weakly virulent mycobacteria, such as environmental mycobacteria and BCG vaccines. We describe here two children with IFN-γR2 deficiency, from unrelated, consanguineous kindreds of Arab and Israeli descent. The first patient was a boy who died at the age of 4.5 years, from recurrent, disseminated disease caused by Mycobacterium simiae. His IFN-γR2 defect was autosomal recessive and complete. The second patient was a girl with multiple disseminated mycobacterial infections, including infection with M. simiae. She died at the age of 5 years, a short time after the transplantation of umbilical cord blood cells from an unrelated donor. Her IFN-γR2 defect was autosomal recessive and partial. Autosomal recessive IFN-γR2 deficiency is life-threatening, even in its partial form, and genetic diagnosis and familial counseling are therefore particularly important for this condition. These two cases are the first of IFN-γR2 deficiency associated with M. simiae infection to be described.
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Affiliation(s)
- Rubén Martínez-Barricarte
- St. Giles Laboratory of Human Genetics of Infectious Diseases, Rockefeller Branch, The Rockefeller University, New York, NY, USA
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Affiliation(s)
- Orli Megged
- Pediatric Department and Infectious Diseases Unit
| | | | | | - Meital Elimelech
- Clinical Microbiology Laboratory, Shaare Zedek Medical Center, Hebrew University-Hadassah School of Medicine, Jerusalem, Israel
| | - Marc Victor Assous
- Clinical Microbiology Laboratory, Shaare Zedek Medical Center, Hebrew University-Hadassah School of Medicine, Jerusalem, Israel
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Ben-Ami R, Rahav G, Elinav H, Kassis I, Shalit I, Gottesman T, Megged O, Weinberger M, Ciobotaro P, Shitrit P, Weber G, Paz A, Miron D, Oren I, Bishara J, Block C, Keller N, Kontoyiannis D, Giladi M. Distribution of fluconazole-resistant Candida bloodstream isolates among hospitals and inpatient services in Israel. Clin Microbiol Infect 2013; 19:752-6. [DOI: 10.1111/1469-0691.12004] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Affiliation(s)
- Shimrit Tzvi-Behr
- Pediatrics Department, Shaare Zedek Medical Center, Jerusalem, Israel
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Abu Omar R, Fink D, Megged O. Cardiac arrhythmias in meningococcal meningitis - case report and review of the literature. Acta Paediatr 2013; 102:e279-80. [PMID: 23414146 DOI: 10.1111/apa.12205] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2013] [Accepted: 02/14/2013] [Indexed: 11/27/2022]
Affiliation(s)
- Rawan Abu Omar
- Pediatric Department; Shaare Zedek Medical Center; affiliated with the Hadassah-Hebrew University Medical School; Jerusalem Israel
| | - Daniel Fink
- Pediatric Department; Shaare Zedek Medical Center; affiliated with the Hadassah-Hebrew University Medical School; Jerusalem Israel
- Cardiology Unit; Shaare Zedek Medical Center; affiliated with the Hadassah-Hebrew University Medical School; Jerusalem Israel
| | - Orli Megged
- Pediatric Department; Shaare Zedek Medical Center; affiliated with the Hadassah-Hebrew University Medical School; Jerusalem Israel
- Infectious Diseases Unit; Shaare Zedek Medical Center; affiliated with the Hadassah-Hebrew University Medical School; Jerusalem Israel
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Megged O, Assous MV, Miskin H, Peleg U, Schlesinger Y. Neurologic manifestations of Fusobacterium infections in children. Eur J Pediatr 2013; 172:77-83. [PMID: 23015047 DOI: 10.1007/s00431-012-1847-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2012] [Revised: 09/10/2012] [Accepted: 09/17/2012] [Indexed: 10/27/2022]
Abstract
UNLABELLED Fusobacterium necrophorum causes various clinical syndromes, ranging from otitis media to life-threatening Lemierre's syndrome. The purpose of this study was to review our experience with pediatric Fusobacterium infections. The medical records of all children aged 0 to 18 years who were diagnosed between 1999 and 2011 with Fusobacterium infection were reviewed. Fusobacterium was isolated from clinical samples of 27 children: blood cultures (n = 16), abscesses (n = 8), joint fluids (n = 2), and cerebrospinal fluid (n = 1). The median age at admission was 3.5 years (range, 7 months to 17 years). Eight children (30 %) had seizures at presentation. Ten children (37 %) underwent lumbar puncture. Fifteen children (56 %) underwent brain imaging, and in seven of these children, a thrombus was identified either in a sinus vein or in an internal jugular vein. The most common source of infection was otogenic in 19 (70 %) of the children. Six of the children presented in 2011. All patients recovered. CONCLUSIONS Neurologic manifestations are common at presentation of children with Fusobacterium infections. In young children, the most common source of infection is otogenic. Thrombotic complications are common, and imaging should be considered in all children with Fusobacterium infections arising from the head or neck region. There was a recent increase in the isolation of this bacterium, either because of better culturing techniques and increased awareness to this entity or a true increase in infections due to this organism.
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Affiliation(s)
- Orli Megged
- Pediatric Department and Pediatric Infectious Diseases Unit, Shaare Zedek Medical Center, Hadassah-Hebrew University Medical School, P.O.B. 3235, Jerusalem, Israel.
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Megged O, Assous M, Weinberg G, Schlesinger Y. Inducible clindamycin resistance in β-hemolytic streptococci and Streptococcus pneumoniae. Isr Med Assoc J 2013; 15:27-30. [PMID: 23484235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
BACKGROUND Resistance to macrolides in beta-hemolytic streptococci and Streptococcus pneumoniae arises primarily due to Erm(B) or Mef(A). Erm(B) typically confers high level resistance to macrolides, lincosamides and streptogramin B (MLSB phenotype), whereas Mef(A) confers low level resistance to macrolides only (M phenotype). OBJECTIVES To investigate the incidence of macrolide resistance mechanisms in isolates of beta-hemolytic streptococci and pneumococci in Israel, with particular emphasis on inducible MLSB phenotype. METHODS We collected 316 clinical isolates of streptococci during May-August 2010. Erythromycin resistance mechanism was determined by the erythromycin-clindamycin double disk diffusion method. RESULTS Erythromycin and clindamycin resistance rates were 19.4% and 13.4% for S. pneumoniae, 4.7% and 1.6% for group A Streptococcus (GAS), 17% and 17% for group B Streptococcus (GBS), and 38.8% and 27.8% for group G Streptococcus (GGS) respectively. The most common resistance mechanism for all streptococci was constitutive MLSB (cMLSB). Inducible MLSs (iMLSB) mechanism was found in 3% of all strains and represented 25% of resistance mechanisms. CONCLUSIONS The prevalence of macrolide resistance and the distribution of resistance mechanisms differ among beta-hemolytic streptococci and S. pneumoniae, with GBS, GGS and S. pneumoniae showing the highest resistance rate. Macrolide or lincosamide cannot be empirically used for severe streptococcal infections before strains are proved to be susceptible. Continuous surveillance of erythromycin and clindamycin resistance patterns among streptococci is needed.
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Affiliation(s)
- Orli Megged
- Pediatric Infectious Diseases Unit, Shaare Zedek Medical Center, affiliated with Hadassah-Hebrew University Medical School, Jerusalem, Israel.
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Berliner E, Bar Meir M, Megged O. [Congenital skull base defect causing recurrent bacterial meningitis]. Harefuah 2012; 151:472-497. [PMID: 23350293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Bacterial meningitis is a life threatening disease. Most patients will experience only one episode throughout life. Children who experience bacterial meningitis more than once, require further immunologic or anatomic evaluation. We report a 9 year old child with five episodes of bacterial meningitis due to a congenital defect of the skull base. A two and a half year old boy first presented to our medical center with pneumococcal meningitis. He was treated with antibiotics and fully recovered. Two months later he presented again with a similar clinical picture. Streptococcus pneumoniae grew in cerebrospinal fluid (CSF) culture. CT scan and later MRI of the brain revealed a defect in the anterior middle fossa floor, with protrusion of brain tissue into the sphenoidal sinus. Corrective surgery was recommended but the parents refused. Three months later, a third episode of pneumococcal meningitis occurred. The child again recovered with antibiotics and this time corrective surgery was performed. Five years later, the boy presented once again with clinical signs and symptoms consistent with bacterial meningitis. CSF culture was positive, but the final identification of the bacteria was conducted by broad spectrum 16S ribosomal RNA PCR (16S rRNA PCR) which revealed a sequence of Neisseria lactamica. CT and MRI showed recurrence of the skull base defect with encephalocele in the sphenoid sinus. The parents again refused neurosurgical intervention. A year later the patient presented with bacterial meningitis. CSF culture obtained after initiation of antibiotics was negative, but actinobacillus was identified in the CSF by 16S rRNA PCR. The patient is scheduled for neurosurgical intervention. In patients with recurrent bacterial meningitis caused by organisms colonizing the oropharynx or nasopharynx, an anatomical defect should be carefully sought and surgically repaired.
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Affiliation(s)
- Elihay Berliner
- Department of Pediatrics and Infectious Diseases Unit, Shaare Zedek Medical Center, Jerusalem.
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Megged O, Bar-Meir M, Schlesinger Y. Haemophilus influenzae activity in a single medical center in Israel in the post-vaccine era. Isr Med Assoc J 2012; 14:410-414. [PMID: 22953615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
BACKGROUND The incidence of invasive disease due to Haemophilus influenzae has decreased since the implementation of vaccination against serotype B. OBJECTIVES To describe the epidemiological, clinical and microbiological characteristics of patients with H. influenzae meningitis or bacteremia in the vaccine era in Israel. METHODS We reviewed the medical records of all patients admitted to Shaare Zedek Medical Center between 1997 and 2010 who had blood or cerebrospinal fluid culture positive for H. influenzae. RESULTS The study group comprised 104 patients - 57 children and 47 adults. Overall, 21 (20%) of the infections were due to serotype b. The children had shorter hospitalizations (6vs. 12 days, P = 0.005) and lower mortality rate (5% vs. 28%, P = 0.003) as compared to the adults. Bacteremic pneumonia was the most common diagnosis in adults (45% vs. 28% in children, P = 0.08) while meningitis was more common in children (17% vs. 3.5%, P = 0.09). There was a seasonal pattern, with infections being more common during the winter and spring. CONCLUSIONS Invasive H. influenzae disease is uncommon but still exists in both children and adults. The disease course tends to be more severe in adults. Even in the global vaccination era, serotype b constitutes a significant portion of invasive disease.
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Affiliation(s)
- Orli Megged
- Pediatric Infectious Diseases Unit, Shaare Zedek Medical Center, affiliated with Hadassah-Hebrew University Medical School, Jerusalem, Israel.
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Abstract
OBJECTIVE To review the epidemiology and clinical course of invasive pneumococcal diseases of infants younger than 60 days. STUDY DESIGN All Streptococcus pneumoniae strains isolated from blood and cerebrospinal fluid cultures of infants below the age of 60 days during the years 1999-2009 were included in this study. Demographic, clinical, and laboratory data were collected from medical records. RESULTS In all, 24 cases of pneumococcal invasive infections were identified. The primary diagnoses were bacteremia without a focus (n = 13), meningitis (n = 6), bacteremia with otitis media (n = 3), and joint infection with bacteremia (n = 2). Only one of the serotypes found is included in the heptavalent pneumococcal conjugated vaccine (PCV7). CONCLUSIONS Streptococcus pneumoniae should be considered and treated empirically in infants with suspected invasive bacterial disease during the first 60 days of life. Routine vaccination with PCV7 in not expected to substantially reduce the incidence of invasive pneumococcal disease in Israeli infants of this age as a result of herd immunity.
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Affiliation(s)
- Limor Ashkenazi
- Pediatrics and Infectious Diseases Unit, Shaare Zedek Medical Center, PO Box 3235, Jerusalem 91031, Israel.
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Stein M, Tasher D, Glikman D, Shachor-Meyouhas Y, Barkai G, Yochai AB, Leibovitz E, Hausman-Kedem M, Hess A, Megged O, Kassis I, Gresario G, Somekh E. Hospitalization of children with influenza A(H1N1) virus in Israel during the 2009 outbreak in Israel: a multicenter survey. ACTA ACUST UNITED AC 2010; 164:1015-22. [PMID: 21041594 DOI: 10.1001/archpediatrics.2010.195] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVES To describe the clinical characteristics of children hospitalized with 2009 influenza A(H1N1) infection in Israel and the risk factors associated with this infection. DESIGN Prospective collection of data on children hospitalized with 2009 influenza A(H1N1) infection. SETTING Seven medical centers around Israel. Patients From July 12, 2009, to December 24, 2009, all patients 18 years or younger hospitalized with acute respiratory or acute unspecified febrile illness were screened for 2009 influenza A(H1N1) virus by reverse transcription-polymerase chain reaction. INTERVENTION Prospective data collection for patients with confirmed infection. MAIN OUTCOME MEASURES Clinical characteristics of patients and hospitalization rates. RESULTS The mean age of 478 patients studied was 6.1 years. Forty-two patients (8.8%) were admitted to the pediatric intensive care unit; 3 patients (0.6%) died. The most frequent clinical presentations were pneumonia, influenza-like illness, wheezing exacerbation, and convulsions. Predisposing underlying illnesses were detected in 48.7% of patients. Patients with metabolic and neurologic disorders were at highest risk for severe complications (relative risk, 6.5 and 2.9, respectively). In addition, patients with cyanotic heart lesions and infants 3 months or younger who were born at 33 weeks' gestation or earlier tended to require higher rates of mechanical ventilation. The hospitalization rate for 2009 influenza A(H1N1) was 0.7 per 1000 children. The mortality rate was 3.6 per 1 000 000 children. CONCLUSIONS The severity variables for 2009 influenza A(H1N1) were similar to the figures reported for seasonal influenza. Patients with underlying metabolic and neurologic metabolic disorders and presumably patients with cyanotic heart lesions and infants born prematurely are at highest risk for severe complications following 2009 influenza A(H1N1) infection.
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Affiliation(s)
- Michal Stein
- Pediatric Infectious Disease Unit, Department of Pediatrics, Edith Wolfson Medical Center, Holon, Israel
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Megged O, Schlesinger Y, Attias D, Rudensky B. [Gastrointestinal carriage of Pseudomonas aeruginosa in children residing in chronic care institutes in Jerusalem: high prevalence and high rates of antibiotic resistance]. Harefuah 2009; 148:766-793. [PMID: 20027979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
BACKGROUND Pseudomonas aeruginosa carriage in the gastrointestinal tract is uncommon in healthy children. Children living in chronic care institutions are often carriers of P. aeruginosa in the respiratory tract, but data is lacking regarding gastrointestinal carriage in these children. AIMS To examine the carriage rate of P. aeruginosa in children living in chronic care institutions in Jerusalem and to assess resistance rates of the bacteria to different classes of antibiotics. METHODS Rectal swabs were taken from all children residing in two chronic care institutions in Jerusalem: "St. Vincent" and "Aleh". The swabs were examined for presence of Pseudomonas aeruginosa. The authors used disk diffusion technique and E Test to assess resistance for different antibiotics. RESULTS Gastrointestinal carriage of P. aeruginosa was detected in 37 out of 125 of the children (30%); 16% of the P. aeruginosa isolates were resistant to carbapenems; 16% were resistant to aminoglycosides, 14% to ureidopenicillins and 11% to quinolones. All isolates were sensitive to ceftazidime and colistin. In 84% of the isolates, the minimal inhibitory concentration (MIC) for meropenem was significantly lower than the MIC for imipenem. SUMMARY P. aeruginosa is a common colonizer of the gastrointestinal tract of children living in chronic care institutions. Empiric antibiotic treatment against P. aeruginosa should be considered when treating children with acute gastrointestinal pathologies. Antibiotic resistance, and particularly carbapenem resistance, is common in this population. There is a significant difference between the MICs for imipenem and meropenem. Future studies are needed to understand the clinical significance of this finding.
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Affiliation(s)
- Orli Megged
- Pediatric Department and Infectious Diseases Unit, Shaare Zedek Medical Center, Jerusalem.
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