The overall proportion of S. pneumoniae isolates and vaccine serotypes in AOM were significantly reduced by community-wide use of PCV7 vaccine in our practice. The proportion of Gram-negative bacteria became 2-fold more frequent than S. pneumoniae in AOM in PCV7-vaccinated young children where PCV7 uptake was community-wide and supply was adequate.

We sought to determine the current level of resistance in Haemophilus influenzae and Streptococcus pneumoniae, the primary pathogens of pediatric conjunctivitis. Between January 1997 and March 1998, we prospectively cultured acute conjunctivitis in 250 ambulatory pediatric patients from rural Kentucky whose average age was 24.3 months. In those 250 cases, 106 H. influenzae (42% of the total) and 75 S. pneumoniae (30% of the total) pathogens were isolated, with no growth or no pathogen resulting in 79 cases (32% of the total). Beta-lactamase was detected in 60 (69%) of 87 tested strains of H. influenzae. Among 65 isolates of S. pneumoniae tested for penicillin susceptibility, 44 (68%) were susceptible, 17 (26%) were resistant, and 4 (6%) were intermediate. Conjunctivitis with acute otitis media was observed in 97 patients (39%), and H. influenzae was recovered in 57% of these 97 cases. As for in vitro activity, ciprofloxacin, ofloxacin, and tetracycline were the most active; and gentamicin, tobramycin, polymyxin B-trimethoprim, and polymyxin B-neomycin were intermediately active. Sulfamethoxazole possessed no activity against either pathogen. Beta-lactamase production was detected in 69% of H. influenzae strains, which still remains the primary causative pathogen of both conjunctivitis and conjunctivitis-otitis syndrome. Penicillin-nonsusceptible S. pneumoniae was observed in 32% of 65 patients with S. pneumoniae conjunctivitis, with most strains being penicillin resistant.Acute conjunctivitis is the most common ocular infection in childhood, usually affecting children younger than 6 years old with a peak incidence between 12 and 36 months (3). Pediatric acute conjunctivitis is diagnosed by clinical signs of ocular purulent discharge or hyperemia of bulbar conjunctiva. The etiology of this infection has been documented as bacterial in 54 to 73% of pediatric cases (3,20). The pathogens predominantly recovered include nontypeable Haemophilus influenzae (44 to 68% of cases) and Streptococcus pneumoniae (7 to 21% of cases). Concomitant infection with acute otitis media (AOM) has been coined the conjunctivitis-otitis syndrome by Bodor (4) and is associated with H. influenzae in 20 to 73% of cases and with S. pneumoniae in 12 to 20% of cases (4, 10). Other rare bacterial pathogens of conjunctivitis include Moraxella catarrhalis, Streptococcus mitis, and Streptococcus pyogenes (10,22).Clinicians nearly always empirically treat acute conjunctivitis with topical antimicrobial therapy. The disease is mild, cultures are rarely obtained because of expense, and culture results are reported days later (13). Compared with placebo, topical therapy with polymyxin-bacitracin ointment has been shown to reduce by half the duration of symptoms and to achieve a 2.5-fold increase in rate of bacteriologic eradication at days 8 to 10 (31 versus 79%, respectively) (6). Furthermore, selecting among the multitude of available topical antimicrobials to treat conjunctivitis has been based on either sparse in vitro data or on earlier limited c...

Death from choking is the fourth most common cause of unintentional-injury mortality, but little data are published on causes or locations of these episodes. These deaths typically are peaked at the extremes of age, with young children and the elderly having the greatest rate of fatal choking. Our objective was to characterize the causes of fatal airway obstruction in adults. The San Diego County Medical Examiner's database was searched for deaths attributed to choking in decedents 18 years and older during the 10-year period from 1994 to 2004. Data were abstracted regarding the underlying medical conditions, items choked on, location of the choking, and treatments involved in the individual cases. We found 133 victims who died from choking, with 14% having using alcohol or other sedatives and 55% having a documented neurological deficit or anatomic difficulty with swallowing. The most common specified food objects that victims choked on were meat products, and 45% occurred at home, followed by 26% at supervised facilities, and 14% at restaurants. Of the 19 choking episodes occurring in restaurants, only one employee was documented to attempt a resuscitative effort. Most victims who choked to death had an underlying neurological deficit, and occurred at home or supervised facilities appear to have an appropriate initial-response intervention.

Giving naloxone to patients with heroin overdoses in the field and then allowing them to sign out AMA resulted in no identifiable deaths within this study population.

This is the first study to report the isolation of C. pneumoniae in middle ear fluid of children with AOM.

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