Few patients with community-acquired pneumonia (CAP) require admission to the intensive care unit (ICU-CAP). However, they represent the most severe form of the disease. An understanding of the etiologic agents of ICU-CAP may lead to better treatment decisions and patient outcomes. The objective of this study was to determine the incidence of respiratory viruses in patients with ICU-CAP. This was an observational study conducted in six Kentucky hospitals from December 2008 through October 2011. A case of ICU-CAP was defined as a patient admitted to an ICU with the diagnosis of CAP. The Luminex xTAG multiplex polymerase chain reaction (PCR) assay was used for viral identification. A total of 468 adult and pediatric patients with ICU-CAP were enrolled in the study. A total of 92 adult patients (23 %) and 14 pediatric patients (19 %) had a respiratory virus identified. Influenza was the most common virus identified in adults and the second most common in pediatric patients. This study suggests that respiratory viruses may be common etiologic agents of pneumonia in patients with ICU-CAP. The Centers for Disease Control and Prevention (CDC) recommend empiric anti-influenza therapy during the winter for hospitalized patients with CAP. This study supports this recommendation in patients with ICU-CAP.
Serial renal ultrasounds are required to reliably detect late appearing renal fungus balls in neonates with candiduria. Complications requiring surgical intervention, like urinary tract obstruction, were uncommon.
Streptococcus pneumoniae is a rarely recognized cause of neonatal sepsis. We present a recent case of S. pneumoniae bacteremia acquired on the first day of life in a neonate born at 30 weeks of gestation to a mother without prenatal care who had prolonged rupture of the membranes and received intravenous ampicillin prior to delivery. The isolate was resistant to penicillin, with a MIC of the drug of 4 g/ml. The child responded to a 7-day course of intravenous vancomycin. S. pneumoniae was recovered from the vagina of the mother on a swab culture collected prior to delivery, and isolates from mother and child were confirmed to be identical on the basis of pulsed-field gel electrophoresis. Although neonatal sepsis due to the peripartum transmission of S. pneumoniae is rare, this case highlights the concern that increasing efforts to prevent group B streptococcus neonatal disease may lead to an increase in neonatal infections due to resistant organisms.
CASE REPORTThe mother was a 20-year-old employee of a fast-food restaurant who presented in premature labor with rupture of her membranes that occurred during sexual intercourse on the day of admission. This was her fourth pregnancy; she had undergone normal vaginal delivery of a healthy, full-term male infant 2 years earlier and had had two voluntary abortions. She presented at her 30th week of pregnancy after having had only one prenatal visit approximately 1 month prior to her presentation. Her only medications were prenatal vitamins and metronidazole that she had been taking for an episode of bacterial vaginosis diagnosed 1 to 2 weeks earlier. She denied history of fever, cough, headache, neck stiffness, dysuria, abdominal pain, or diarrhea.On examination, she was alert and awake, with painful uterine contractions every 3 to 4 min. Her vital signs were normal and she was afebrile. The results of heart and lung examinations were normal, and her abdomen was gravid and nontender. She had pooling of clear amniotic fluid in her vaginal vault, and her cervix was dilated between 8 and 9 cm. Fetal heart sounds were present at a rate of approximately 160 beats per min, with variable decelerations during contractions. Routine laboratory testing that was performed at the time of admission included a normal white blood cell count as well as a negative rapid plasma reagin test, hepatitis B surface antigen test, human immunodeficiency virus serology, cervical swabbing for Neisseria gonorrhoeae and Chlamydia trachomatis for a nucleic acid amplification test, urine toxicology screening, and vaginal culture testing for group B streptococcus. Except for the white blood cell count, none of these test results were available until at least 1 day following admission of the patient.The mother was admitted with anticipated vaginal delivery, and at 24 h after the rupture of her membranes, she was given 2 g of intravenous ampicillin with plans to continue this at a dose of 1 g every 4 h for the prevention of group B streptococcus early onset disease. Approximately 2 h after her initial d...
The incidence of invasive candidiasis in infants with birth weights > 2500 g requiring admission to a NICU was much less than has been reported for very low birth weight infants. This review points out that in infants with birth weights > 2500 g who develop invasive candidiasis, major congenital malformations are the most frequent underlying conditions responsible for prolonged NICU hospitalization.
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