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Indian Pediatr 2013;50: 620
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K Rajeshwari
Email: [email protected]
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Utility of blood culture in uncomplicated pneumonia in children (Clin
Med Insights Pediatr 2013; 7:1-5)
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It is believed to be the standard of care to obtain a blood culture in a
child who is hospitalized for pneumonia. In recent years, many studies
have questioned the utility of this practice in the presence of age
appropriate immunization. This study was conducted to determine the
current prevalence of bacteremia in children with uncomplicated
pneumonia and the utility of obtaining blood cultures in these
children.This was a retrospective review from July 2003 until July 2008.
The setting was the pediatric emergency department of an urban teaching
hospital. The study population included children less than 36 months of
age who had been fully immunized and had been hospitalized with
radiographic evidence of uncomplicated pneumonia. Excluded were children
who were currently using antibiotics or who had used antibiotics within
the previous 48 hours, as well as children with immunodeficiency status
such as sickle cell anemia, immunoglobulin deficiency, or children on
steroid therapy. The variables studied were age, gender, race, birth
history, pneumococcal vaccination status, appearance on arrival,
temperature on arrival, respiratory rate, oxygen saturation, white blood
cell (WBC) count, neutrophil count, band count, and urine culture. A
blood culture was obtained in 535 children hospitalized with
radiographic pneumonia. Bacteremia was present in 12 children (2.2%).
All organisms isolated from the blood cultures were considered
contaminants. Authors calculated that children hospitalized with
uncomplicated pneumonia have a low rate of positive blood cultures. The
absence of true-positive cultures among the organisms isolated suggests
little value in obtaining blood cultures in children hospitalized due to
uncomplicated pneumonia.
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Different guidelines for imaging after first UTI in febrile
infants (Pediatrics2013;131:e665-71).
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This study evaluated the yield, economic, and radiation costs of 5
diagnostic algorithms compared with a protocol where all tests are
performed (ultrasonography scan, cystography, and late technetium (99)dimercaptosuccinic
acid scan) in children after the first febrile urinary tract
infections.A total of 304 children, 2 to 36 months of age, who completed
the diagnostic follow-up (ultrasonography, cystourethrography, and acute
and late technetium(99)dimercaptosuccinic acid scans) of a randomized
controlled trial (Italian Renal Infection Study 1) were eligible. The
guidelines applied to this cohort in a retrospective simulation
included: Melbourne Royal Children’s Hospital, National Institute of
Clinical Excellence (NICE), top down approach, American Academy of
Pediatrics (AAP), and Italian Society of Pediatric Nephrology. Primary
outcomes were the yield of abnormal tests for each diagnostic protocol;
secondary outcomes were the economic and radiation costs.Vesicoureteral
reflux (VUR) was identified in 66 (22%) children and a parenchymal
scarring was identified in 45 (15%). For detection of VUR and scarring,
the top down approach showed the highest sensitivity (76% and 100%,
respectively) but also the highest economic and radiation costs.NICE
andAAP had the highest specificities for VUR (90%) and the Italian
Society of Pediatric Nephrology had the highest specificity for scars
(86%). NICE would have been the least costly and AAP would have resulted
in the least radiation exposure. It was concluded that there is no ideal
diagnostic protocol following a first febrile urinary tract infection.
An aggressive protocol has a high sensitivity for detecting VUR and
scarring but carries high financial and radiation costs with
questionable benefit.
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Daily chlorhexidine bathing to reduce bacteremia(Lancet
2013;381:1099-1106).
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Bacteremia is an important cause of morbidity and mortality in
critically ill children. The objective was to assess whether daily
bathing in chlorhexidinegluconate(CHG) compared with standard bathing
practices would reduce bacteremia in critically ill children.In an
unmasked, cluster-randomized, two-period crossover trial, ten pediatric
intensive-care units at five hospitals in the USA were randomly assigned
a daily bathing routine for admitted patients older than 2 months,
either standard bathing practices or using a cloth impregnated with 2%
CHG, for a 6-month period. Units switched to the alternative bathing
method for a second 6-month period. The primary outcome was an episode
of bacteremia. They did intention-to-treat (ITT) and per-protocol (PP)
analyses. In the ITT population, a non-significant reduction in
incidence of bacteremia was noted with CHG bathing compared with
standard practices. In the PP population, incidence of bacteremia was
lower in patients receiving CHG bathing compared with standard
practices. No serious study-related adverse events were recorded, and
the incidence of CHG-associated skin reactions was 1.2 per 1000 days.
The study concluded that critically ill children receiving daily CHG
bathing had a lower incidence of bacteremia compared with those
receiving a standard bathing routine.
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