Update in infectious diseases: evidence published in 2012

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This Update summarizes studies published in 2012 that the authors consider highly relevant to the practice of infectious disease. Topics include sinusitis, azithromycin toxicity, infective endocarditis, asymptomatic bacteriuria and recurrent urinary tract infection, HIV prevention, a newly discovered pathogen, Lyme disease, and fungal meningitis.

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Lactobacillus GG in the Prevention of Nosocomial Gastrointestinal and Respiratory Tract Infections

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1. Published online April 19, 2010PEDIATRICS Vol. 125 No. 5 May 1, 2010 
   pp. e1171 -e1177 
   (doi: 10.1542/peds.2009-2568)

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1. Iva Hojsak, MD^a, 
2. Slaven Abdović, MD^a, 
3. Hania Szajewska, MD^b,
4. Milan Milošević, MD^c, 
5. Željko Krznarić, MD, PhD^d, 
6. Sanja Kolaček, MD, PhD^a

+Author Affiliations

1. ^aReferral Center for Pediatric Gastroenterology and Nutrition, Children's Hospital Zagreb, Klaićeva 16, Zagreb, Croatia;
2. ^b2nd Department of Pediatrics, Medical University of Warsaw, Warsaw, Poland;
3. ^cDepartment for Environmental and Occupational Health, “Andrija Štampar” School of Public Health, Rockefellerova 4, Zagreb, Croatia; and
4. ^dDivision of Gastroenterology and Hepatology, University Hospital Center Zagreb, Kispaticeva 12, Zagreb, Croatia

ABSTRACT

OBJECTIVE: The incidence of nosocomial infections, predominantly gastrointestinal and respiratory, in children in developed countries is high, ranging from 5% to 44%. There is no effective strategy for preventing these infections. The objective of our study was to investigate the role ofLactobacillusGG (LGG) in preventing nosocomial gastrointestinal and respiratory tract infections at a pediatric hospital.

METHODS: We conducted a randomized, double-blind, placebo-controlled trial of 742 hospitalized children. They were randomly allocated to receive for their hospitalization LGG at a dose of 10⁹ colony-forming units in 100 mL of a fermented milk product (LGG group, n = 376) or placebo that was the same postpasteurized fermented milk product without LGG (placebo group, n = 366).

RESULTS: In the LGG group, compared with the placebo group, we found a significantly reduced risk for gastrointestinal infections (relative risk [RR]: 0.40 [95% confidence interval (CI): 0.25–0.70]; number needed to treat: 15 [95% CI: 9–34)], respiratory tract infections (RR: 0.38 [95% CI: 0.18–0.85]; number needed to treat: 30 [95% CI: 16–159]), vomiting episodes (RR: 0.5 [95% CI: 0.3–0.9]), diarrheal episodes (RR: 0.24 [95% CI: 0.10–0.50]), episodes of gastrointestinal infections that lasted >2 days (RR: 0.40 [95% CI: 0.25–0.70]), and episodes of respiratory tract infections that lasted >3 days (RR: 0.4 [95% CI: 0.2–0.9]). Groups did not differ in hospitalization duration (P = .1).

CONCLUSIONS: LGG administration can be recommended as a valid measure for decreasing the risk for nosocomial gastrointestinal and respiratory tract infections in pediatric facilities.

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Does this child have a urinary tract infection?

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JAMA. 2007 Dec 26;298(24):2895-904.

Shaikh N, Morone NE, Lopez J, Chianese J, Sangvai S, D'Amico F, Hoberman A, Wald ER.

Source

Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA. nader.shaikh@chp.edu

Abstract  

CONTEXT:

Urinary tract infection (UTI) is a frequently occurring pediatric illness that, if left untreated, can lead to permanent renal injury. Accordingly, accurate diagnosis of UTI is important.

OBJECTIVE:

To review the diagnostic accuracy of symptoms and signs for the diagnosis of UTI in infants and children.

DATA SOURCES:

A search of MEDLINE and EMBASE databases was conducted for articles published between 1966 and October 2007, as well as a manual review of bibliographies of all articles meeting inclusion criteria, 1 previously published systematic review, 3 clinical skills textbooks, and 2 experts in the field, yielding 6988 potentially relevant articles.

STUDY SELECTION:

Studies were included if they contained data on signs or symptoms of UTI in children through age 18 years. Of 337 articles examined, 12 met all inclusion criteria.

DATA EXTRACTION:

Two evaluators independently reviewed, rated, and abstracted data from each article.

DATA SYNTHESIS:

In infants with fever, history of a previous UTI (likelihood ratio [LR] range, 2.3-2.9), temperature higher than 40 degrees C (LR range, 3.2-3.3), and suprapubic tenderness (LR, 4.4; 95% confidence interval [CI], 1.6-12.4) were the findings most useful for identifying those with a UTI. Among male infants, lack of circumcision increased the likelihood of a UTI (summary LR, 2.8; 95% CI, 1.9-4.3); and the presence of circumcision was the only finding with an LR of less than 0.5 (summary LR, 0.33; 95% CI, 0.18-0.63). Combinations of findings were more useful than individual findings in identifying infants with a UTI (for temperature >39 degrees C for >48 hours without another potential source for fever on examination, the LR for all findings present was 4.0; 95% CI, 1.2-13.0; and for temperature <39 degrees C with another source for fever, the LR was 0.37; 95% CI, 0.16-0.85). In verbal children, abdominal pain (LR, 6.3; 95% CI, 2.5-16.0), back pain (LR, 3.6; 95% CI, 2.1-6.1), dysuria, frequency, or both (LR range, 2.2-2.8), and new-onset urinary incontinence (LR, 4.6; 95% CI, 2.8-7.6) increased the likelihood of a UTI.

CONCLUSIONS:

Although individual signs and symptoms were helpful in the diagnosis of a UTI, they were not sufficiently accurate to definitively diagnose UTIs. Combination of findings can identify infants with a low likelihood of a UTI.

Comment in

• Ann Emerg Med. 2009 May;53(5):680-4.

PMID:

 

18159059

 

[PubMed - indexed for MEDLINE] 

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