BACKGROUND: Bacteremia is now an uncommon presentation to the children's emergency department (ED) but is associated with significant morbidity and mortality. Its evolving etiology may affect the ability of clinicians to initiate timely, appropriate antimicrobial therapy.
BackgroundAccording to the World Health Organisation, influenza A (2009 pdmH1N1) has moved into the post-pandemic phase, but there were still high numbers of infections occurring in the United Kingdom in 2010-11. It is therefore important to examine the burden of acute respiratory infections at a large children’s hospital to determine pathogen prevalence, occurrence of co-infection, prevalence of co-morbidities and diagnostic yield of sampling methods.MethodsThis was a retrospective study of respiratory virus aetiology in acute admissions to a paediatric teaching hospital in the North West of England between 1st April 2010 and 31st March 2011. Respiratory samples were analysed either with a rapid RSV test if the patient had symptoms suggestive of bronchiolitis, followed by multiplex PCR testing for ten respiratory viruses, or with multiplex PCR testing alone if the patient had suspected other ARI. Patient demographics and data regarding severity of illness, presence of co-morbidities and respiratory virus sampling method were retrieved from case notes.Results645 patients were admitted during the study period. 82/645 (12.7%) patients were positive for 2009 pdmH1N1, of whom 24 (29.2%) required PICU admission, with 7.3% mortality rate. Viral co-infection occurred in 48/645 (7.4%) patients and was not associated with more severe disease. Co-morbidities were present more frequently in older children, but there was no significant difference in prevalence of co-morbidity between 2009 pdmH1N1 patients and those with other ARI. NPA samples had the highest diagnostic yield with 192/210 (91.4%) samples yielding an organism.ConclusionsInfluenza A (2009 pdmH1N1) is an ongoing cause of occasionally severe disease affecting both healthy children and those with co-morbidities. Surveillance of viral pathogens provides valuable information on patterns of disease.
Hypospadias surgery with foreskin reconstruction is an increasingly preferred option for the management of this common condition. The objective of this study was to identify the bacterial flora present before and after cleansing of the prepuce as well as 7 d after surgery. Sixty-three boys aged between 12-14 months, with primary distal hypospadias undergoing tubularized incised plate repair, were recruited between October 2013 and April 2014. Microbiological swabs were taken pre-and post-operatively to identify organisms present under their foreskin at the time of surgery and compared with organisms present 7 d post-operatively at the time of dressing removal. A parent reported wound infection tool was used to explore parents' perception and management of their son's wound 4 weeks following surgery. Bacterial colonization of the penis was common. Routine cleansing with an alcoholic chlorhexidine solution reduced bacterial flora in 82% of boys with a positive preoperative swab result. Post-operative colonization of the penis was found in 93% of patients, wound dressing colonization was common. Two parents' reported concerns regarding their son's wound healing. Topical cleansing at the time of surgery is effective in reducing the number of organisms present under the foreskin. Despite recolonization 7 d after surgery, clinical infection remains uncommon. Complication rate 12 months after surgery was very low <2%.
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