The Changing Epidemiology of Serious Bacterial Infections in Young Infants

Greenhow, Tara L.; Hung, Yun‐Yi; Herz, Arnd M.; Losada, Elizabeth; Pantell, Robert H.

doi:10.1097/inf.0000000000000225

Cited by 191 publications

(163 citation statements)

References 29 publications

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“…Most previous epidemiologic descriptions of listeriosis in infants were statistically underpowered due to the rarity of the condition. 5,8,16,17,29,30 Our results failed to show a decline in the incidence of listeriosis in infants during 1997-2012, despite a decline in overall rates of foodborne listeriosis over the past decade.…”

Section: Discussioncontrasting

confidence: 37%

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Trends in US Hospital Stays for Listeriosis in Infants

Veesenmeyer

Edmonson

2016

Hospital Pediatrics

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A B S T R A C T BACKGROUND AND OBJECTIVES: Although listeriosis is rare in infants, it is commonfor young infants with suspected serious bacterial infection to be treated empirically with agents selected, in part, for their activity against Listeria monocytogenes. Our objectives were to describe the recent epidemiology of hospital discharges for listeriosis among infants in the United States and to precisely estimate the incidence of listeriosis according to infant age and meningitis status. METHODS:We generated national estimates for listeriosis discharges in each of the 6 years for which samples were available in the Kids' Inpatient Database during the period 1997-2012. We used random-effects models to pool descriptive information and population rates across study years. RESULTS:The cumulative number of US hospital discharges for listeriosis in infants was 344 (95% confidence interval [CI]: 290-397) over the 6 study years. The pooled annual incidence rate in infants (per 100 000 births) was 1.41 (95% CI: 1.01-1.80) after accounting for marked fluctuation in annual rates (range: 0.66-1.86; I 2 5 79.3%). Discharges for listeriosis without meningitis were particularly rare after the first week of life. Our models predicted only 2.7 (95% CI: 1.1-4.2) and 1.8 (95% CI: 0.0-3.6) such discharges per year in infants admitted at ages 7 to 28 days and 29 to 364 days, respectively. CONCLUSIONS:From the perspective of providing coverage against listeriosis, the routine practice of including ampicillin in the empirical treatment of febrile infants should be reevaluated for those older than 1 week without clinical evidence of meningitis.

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Section: Discussioncontrasting

confidence: 37%

“…11, [16][17][18] Most of these infants are older than 1 week and do not have clinical signs of bacterial meningitis or urinary tract infection (UTI).…”

mentioning

confidence: 99%

Trends in US Hospital Stays for Listeriosis in Infants

Veesenmeyer

Edmonson

2016

Hospital Pediatrics

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“…Improvement in the perinatal antibiotic prophylaxis has reduced the incidence of S. agalactiae early-onset sepsis, 35 -37 E coli is nowadays the leading cause of bacteremia in this population, 6,7,17,24 and Listeria is rarely involved. 6,7,17,24 On the other hand, new biomarkers that have been shown to be better predictors of IBI have been included in many management protocols. Curiously, the Lab-score, developed less than 10 years ago, revealed a lower performance compared with previously published studies.…”

Section: Discussionmentioning

confidence: 99%

“…Regardless of the protocol used, current adherence to any of them in clinical practice is low. 4,5 Changes in the epidemiology of bacterial pathogens in the last decades 6,7 and introduction of biomarkers such as C-reactive protein (CRP) and, more recently, procalcitonin (PCT) could justify this low adherence rate and make several authors advocate for a more individualized approach. The latter includes new biomarkers and a reduction in lumbar puncture rates, antibiotic treatments, or in-hospital admission for many well-appearing infants outside the neonatal period.…”

mentioning

confidence: 99%

Validation of the “Step-by-Step” Approach in the Management of Young Febrile Infants

et al. 2016

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on behalf of the European Group for Validation of the Step-by-Step Approach abstract BACKGROUND: A sequential approach to young febrile infants on the basis of clinical and laboratory parameters, including procalcitonin, was recently described as an accurate tool in identifying patients at risk for invasive bacterial infection (IBI). Our aim was to prospectively validate the Step-by-Step approach and compare it with the Rochester criteria and the Lab-score.

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“…Group B streptococcus and E. coli are common causes of meningitis in neonates (45,46), with group B streptococcus accounting for 86.1% of bacterial meningitis cases in patients of Ͻ2 months of age (14). Gram-negative aerobic bacteria, such as Klebsiella pneumoniae, Serratia marcescens, Salmonella spp., and Pseudomonas aeruginosa, can occasionally be responsible for meningitis in certain patient groups, including infants and patients with head injuries or those undergoing postneurosurgical procedures or immunosuppression (31,47,48).…”

Section: Meningitismentioning

confidence: 99%

Pathogens Penetrating the Central Nervous System: Infection Pathways and the Cellular and Molecular Mechanisms of Invasion

et al. 2014

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SUMMARY The brain is well protected against microbial invasion by cellular barriers, such as the blood-brain barrier (BBB) and the blood-cerebrospinal fluid barrier (BCSFB). In addition, cells within the central nervous system (CNS) are capable of producing an immune response against invading pathogens. Nonetheless, a range of pathogenic microbes make their way to the CNS, and the resulting infections can cause significant morbidity and mortality. Bacteria, amoebae, fungi, and viruses are capable of CNS invasion, with the latter using axonal transport as a common route of infection. In this review, we compare the mechanisms by which bacterial pathogens reach the CNS and infect the brain. In particular, we focus on recent data regarding mechanisms of bacterial translocation from the nasal mucosa to the brain, which represents a little explored pathway of bacterial invasion but has been proposed as being particularly important in explaining how infection with Burkholderia pseudomallei can result in melioidosis encephalomyelitis.

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The Changing Epidemiology of Serious Bacterial Infections in Young Infants

Abstract: Compared with earlier studies, UTIs now are found significantly more often than bacteremia and meningitis with 92% of occult infections associated with UTIs. These data emphasize the importance of an urinalysis in febrile infants.

Cited by 191 publications

References 29 publications

Trends in US Hospital Stays for Listeriosis in Infants

Trends in US Hospital Stays for Listeriosis in Infants

Validation of the “Step-by-Step” Approach in the Management of Young Febrile Infants

Pathogens Penetrating the Central Nervous System: Infection Pathways and the Cellular and Molecular Mechanisms of Invasion

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