Changing Epidemiology of Outpatient Bacteremia in 3- to 36-Month-Old Children After the Introduction of the Heptavalent-Conjugated Pneumococcal Vaccine

Herz, Arnd M.; Greenhow, Tara L.; Alcantara, Jay; Hansen, John; Baxter, Roger; Black, Steve; Shinefield, Henry R.

doi:10.1097/01.inf.0000207485.39112.bf

Cited by 174 publications

(139 citation statements)

References 25 publications

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“…Although we have no concrete explanation for this fi nding, it may refl ect decreasing concern about bacteremia in general because rou tine vaccination against pneumococcus began in 2000 in the United States. 11,18,19 This hypothesis is supported by our demonstration that the decrease was more pronounced in infants aged ≥4 months. The reported prevalence from previous studies of bacteremic UTIs in children is variable.…”

Section: Discussionsupporting

confidence: 77%

Diagnosis and Management of Bacteremic Urinary Tract Infection in Infants

Román

Chang

Schroeder

2015

Hospital Pediatrics

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Objectives: To report the prevalence of bacteremia by age in a sample of infants <1 year of age with urinary tract infections (UTIs), to compare characteristics of infants with UTIs with and without bacteremia, and to describe treatment courses and 30-day outcomes in infants with UTIs with and without bacteremia. Methods: We used a retrospective cross-sectional design to determine the prevalence of bacteremia in infants with UTIs at our institution. A double cohort design matching for age and gender was used to compare clinical characteristics and outcomes between infants with bacteremic versus nonbacteremic UTIs. Results: We identified 1379 UTIs, with blood cultures obtained in 52% of cases. The prevalence of bacteremia was 4.1% (95% confidence interval 3.1%–5.3%) for all UTIs and 8% (95% confidence interval 6.1%–10.2%) for UTIs in which blood culture was obtained. Fifty-five infants with bacteremic UTIs were compared with 110 infants with nonbacteremic UTIs. Except for minor differences in the urinalysis and serum band count, there were no significant differences in clinical presentation between the 2 groups. Bacteremic infants received longer parenteral treatment courses than nonbacteremic infants (mean 6.7 vs 2.4 days, P < .001). Treatment courses in the bacteremic group were variable and predicted by age but not severity of illness. No bacteremic infant had recurrent UTI or bacteremia with the same organism within 30 days of discharge. Conclusions: Treatment was variable but outcomes were excellent in infants with bacteremic UTIs.

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Section: Discussionsupporting

confidence: 77%

Diagnosis and Management of Bacteremic Urinary Tract Infection in Infants

Román

Chang

Schroeder

2015

Hospital Pediatrics

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“…This trend was observed for the proportion of bacteraemia caused by Staph. aureus in young children after vaccination (Herz et al, 2006). Considering our results, these previous results support the suggestion that nasopharynx flora modification such as the elimination of Strep.…”

Section: Association Between Colonization Of the Four Bacteriasupporting

confidence: 80%

Nasal colonization by four potential respiratory bacteria in healthy children attending kindergarten or elementary school in Seoul, Korea

Bae

Lee

et al. 2012

Journal of Medical Microbiology

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A longitudinal analysis was carried out of the colonization by four potential respiratory pathogens -Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis and Staphylococcus aureus -in 165 healthy children (aged 3-7 years) attending three kindergartens and 417 healthy children (aged 7-10 years) attending an elementary school in Seoul, Korea, by four consecutive examinations over 1 year. The prevalence of nasal carriers of one or more of four bacteria was found to be higher in younger children (¡7 years) (mean 68.6 %) than that in older children (mean 46.8 %). The mean rates of nasal carriage of Strep. pneumoniae, H. influenzae, M. catarrhalis and Staph. aureus were 16.8, 18.9, 20.2 and 18.2 %, respectively. Colonization by Strep. pneumoniae, H. influenzae and M. catarrhalis was higher in pre-school children (28.6, 32.4 and 35.0 %, respectively) than in school children (12.2, 13.6 and 14.3 %, respectively). Carriage trends differed with age, with Strep. pneumoniae, H. influenzae and M. catarrhalis colonization decreasing with age but Staph. aureus colonization increasing. Positive associations of co-occurrence between Strep. pneumoniae, H. influenzae and M. catarrhalis were evident, with a significant negative association evident between Staph. aureus and the other three bacteria. A better understanding of the colonization and interaction of potential respiratory pathogens may be important for predicting changes in bacterial ecology and for designing control strategies that target bacterial colonization in upper respiratory tract infections.

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“…Previous studies indicated that white blood cell count is an imperfect tool for distinguishing between viral and bacterial infection, a distinction often used to determine whether to treat the patient with antibiotics (21,22). We compared classification based on transcriptional profiles with classification based on white blood cell count using a cutoff of 15,000/mm 3 as recommended by the American Academy of Pediatrics in their guideline for the management of febrile young children 0-36 mo of age (23).…”

Section: Transcriptional Profile Was Superior To Traditional White Blmentioning

confidence: 99%

Gene expression profiles in febrile children with defined viral and bacterial infection

Hu¹,

Crosby

et al. 2013

Proc. Natl. Acad. Sci. U.S.A.

116

119

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Viral infections are common causes of fever without an apparent source in young children. Despite absence of bacterial infection, many febrile children are treated with antibiotics. Virus and bacteria interact with different pattern recognition receptors in circulating blood leukocytes, triggering specific host transcriptional programs mediating immune response. Therefore, unique transcriptional signatures may be defined that discriminate viral from bacterial causes of fever without an apparent source. Gene expression microarray analyses were conducted on blood samples from 30 febrile children positive for adenovirus, human herpesvirus 6, or enterovirus infection or with acute bacterial infection and 22 afebrile controls. Blood leukocyte transcriptional profiles clearly distinguished virus-positive febrile children from both virus-negative afebrile controls and afebrile children with the same viruses present in the febrile children. Virus-specific gene expression profiles could be defined. The IFN signaling pathway was uniquely activated in febrile children with viral infection, whereas the integrin signaling pathway was uniquely activated in children with bacterial infection. Transcriptional profiles classified febrile children with viral or bacterial infection with better accuracy than white blood cell count in the blood. Similarly accurate classification was shown with data from an independent study using different microarray platforms. Our results support the paradigm of using host response to define the etiology of childhood infections. This approach could be an important supplement to highly sensitive tests that detect the presence of a possible pathogen but do not address its pathogenic role in the patient being evaluated.

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Changing Epidemiology of Outpatient Bacteremia in 3- to 36-Month-Old Children After the Introduction of the Heptavalent-Conjugated Pneumococcal Vaccine

Cited by 174 publications

References 25 publications

Diagnosis and Management of Bacteremic Urinary Tract Infection in Infants

Diagnosis and Management of Bacteremic Urinary Tract Infection in Infants

Nasal colonization by four potential respiratory bacteria in healthy children attending kindergarten or elementary school in Seoul, Korea

Gene expression profiles in febrile children with defined viral and bacterial infection

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