OBJECTIVE:To compare polymerase chain reaction (PCR) with blood culture for the detection of fungemia in neonatal and pediatric intensive care unit patients.
STUDY DESIGN:A total of 0.2 to 0.5 ml of blood was collected simultaneously with blood culture in patients with suspected sepsis. Following DNA extraction, the gene for fungal 18S rRNA was amplified and PCR products analyzed by agarose gel electrophoresis.
RESULTS:Of 70 patient samples, nine of nine with a positive blood culture for Candida were PCR positive, and one of four with a positive blood culture for Malassezia was PCR positive. In total, 13 of 57 samples with negative blood culture for fungus were PCR positive. Seven of these 13 patients had other evidence of invasive fungal disease. In contrast, none of the 44 blood culture-negative/PCR-negative patients had other evidence of fungal infection.
CONCLUSIONS:PCR may be a useful adjunct to blood culture for the rapid detection of fungemia in high-risk patients.
Objective: Enteral nutrition (EN) has well-established benefits in critically ill children. Optimally, full nutritional support should be achieved expeditiously. The authors hypothesized that a protocolized continuous gastric EN (GEN) approach would decrease time to goal feeding rate and calories (TTG). Design: 96 patients were enrolled, divided equally into control (pre) and treatment (post) groups. Patients were monitored every 4 hours for 5 signs of feeding intolerance. Significance was defined as P < .05. Setting: 23-bed multidisciplinary pediatric intensive care unit (PICU). Subjects: PICU patients <18 years of age in whom GEN was to be started were eligible. Exclusion criteria included patients receiving total parental nutrition, <24 hours postoperative, had transpyloric feeding, had previous fundoplication, had preexisting gastrointestinal disease or chronic regimen. Interventions: The authors instituted a protocolized, weight-based approach to GEN and collected outcomes and tolerance data on both the control and treatment groups. Measurements and Main Results: There was no difference in TTG between the control and treatment groups. However, for patients less than 10 kg (74/96 patients), TTG was 15 hours faster in the treatment group compared with the control (56.85 ± 22.71, 70.44 ± 32.45 hours, respectively). Conclusions: The authors investigated the value of a GEN protocol in improving efficiency to goal nutrition in critically ill children. While no difference was found overall, in the subgroup analysis (77%) a significant improvement in TTG was found in infants <10 kg. Further investigation is needed to define impact on patient outcomes, such as length of stay, weight gain, and ICU morbidities.
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