Assuntos
COVID-19/epidemiologia , Pandemias , Pediatria , Instituições Acadêmicas , Sociedades Médicas , Adolescente , Criança , França , HumanosRESUMO
OBJECTIVES: We hypothesized that antibiotic use in PICUs is based on criteria not always supported by evidence. We aimed to describe determinants of empiric antibiotic use in PICUs in eight different countries. DESIGN: Cross-sectional survey. SETTING: PICUs in Canada, the United States, France, Italy, Saudi Arabia, Japan, Thailand, and Brazil. SUBJECTS: Pediatric intensivists. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: We used literature review and focus groups to develop the survey and its clinical scenarios (pneumonia, septic shock, meningitis, and intra-abdominal infections) in which cultures were unreliable due to antibiotic pretreatment. Data analyses included descriptive statistics and linear regression with bootstrapped SEs. Overall response rate was 39% (482/1,251), with individual country response rates ranging from 25% to 76%. Respondents in all countries prolonged antibiotic duration based on patient characteristics, disease severity, pathogens, and radiologic findings (from a median increase of 1.8 d [95% CI, 0.5-4.0 d] to 9.5 d [95% CI, 8.5-10.5 d]). Younger age, severe disease, and ventilator-associated pneumonia prolonged antibiotic treatment duration despite a lack of evidence for such practices. No variables were reported to shorten treatment duration for all countries. Importantly, more than 39% of respondents would use greater than or equal to 7 days of antibiotics for patients with a positive viral polymerase chain reaction test in all scenarios, except in France for pneumonia (29%), septic shock (13%), and meningitis (6%). The use of elevated levels of inflammatory markers to prolong antibiotic treatment duration varied among different countries. CONCLUSIONS: Antibiotic-related decisions are complex and may be influenced by cultural and contextual factors. Evidence-based criteria are necessary to guide antibiotic duration and ensure the rational use of antibiotics in PICUs.
Assuntos
Antibacterianos , Estado Terminal , Antibacterianos/uso terapêutico , Brasil , Canadá , Criança , Estado Terminal/terapia , Estudos Transversais , França , Humanos , Itália , Japão , Inquéritos e Questionários , Estados UnidosRESUMO
OBJECTIVE: To assess the predictive value of procalcitonin, a serum inflammatory marker, in the identification of children with first urinary tract infection (UTI) who might have high-grade (≥3) vesicoureteral reflux (VUR). STUDY DESIGN: We conducted a meta-analysis of individual data, including all series of children aged 1 month to 4 years with a first UTI, a procalcitonin (PCT) level measurement, cystograms, and an early dimercaptosuccinic acid scan. RESULTS: Of the 152 relevant identified articles, 12 studies representing 526 patients (10% with VUR ≥3) were included. PCT level was associated with VUR ≥3 as a continuous (P = .001), and as a binary variable, with a 0.5 ng/mL preferred threshold (adjusted OR, 2.5; 95% CI, 1.1 to 5.4). The sensitivity of PCT ≥0.5 ng/mL was 83% (95% CI, 71 to 91) with 43% specificity rate (95% CI, 38 to 47). In the subgroup of children with a positive results on dimercaptosuccinic acid scan, PCT ≥0.5 ng/mL was also associated with high-grade VUR (adjusted OR, 4.8; 95% CI, 1.3 to 17.6). CONCLUSIONS: We confirmed that PCT is a sensitive and validated predictor strongly associated with VUR ≥3, regardless of the presence of early renal parenchymal involvement in children with a first UTI.
Assuntos
Calcitonina/sangue , Precursores de Proteínas/sangue , Refluxo Vesicoureteral/diagnóstico , Peptídeo Relacionado com Gene de Calcitonina , Pré-Escolar , Dilatação Patológica , Humanos , Lactente , Recém-Nascido , Rim/diagnóstico por imagem , Valor Preditivo dos Testes , Radiografia , Cintilografia , Compostos Radiofarmacêuticos , Sensibilidade e Especificidade , Ácido Dimercaptossuccínico Tecnécio Tc 99m , Ultrassonografia , Bexiga Urinária/diagnóstico por imagem , Sistema Urinário/patologia , Infecções Urinárias/diagnósticoRESUMO
OBJECTIVE: To determine the incidence of Kawasaki disease (KD) in Northern France by using new American Heart Association (AHA) criteria. STUDY DESIGN: A 1-year prospective multicenter cohort study was performed in all pediatric departments. Patients <18 years old, who were admitted for prolonged but initially unexplained fever or suspected KD were included. All patients received the standard treatment considered appropriate by their physicians. A descriptive analysis and comparison of patients with complete and incomplete forms of KD were performed. The incidence of confirmed cases of KD (complete and incomplete forms) was calculated. RESULTS: Seventy-seven children were included (39 in whom KD was diagnosed). Of the patients with KD, 26 (67%) met the classic AHA case definition, and 7 (18%) had incomplete KD. Cardiac ultrasound scanning was helpful in the diagnosis of 6 of 7 patients with incomplete KD (86%). The final incidence of confirmed KD was 9 of 100,000 children <5 years of age. In 6 children (15%) the diagnosis of KD was uncertain, but they were successfully treated for it. Coronary disease was identified in 48% of patients with confirmed KD. CONCLUSION: The incidence of KD is higher than previously reported, in part because earlier reports did not include incomplete forms. New AHA criteria (laboratory tests and early echocardiography) were helpful for the diagnosis of incomplete forms of KD.
Assuntos
Algoritmos , Proteína C-Reativa/análise , Diagnóstico Precoce , Síndrome de Linfonodos Mucocutâneos/diagnóstico , Síndrome de Linfonodos Mucocutâneos/epidemiologia , Distribuição por Idade , Sedimentação Sanguínea , Criança , Pré-Escolar , Estudos de Coortes , Angiografia Coronária/métodos , Ecocardiografia Doppler/métodos , Feminino , Seguimentos , França/epidemiologia , Humanos , Incidência , Lactente , Masculino , Síndrome de Linfonodos Mucocutâneos/diagnóstico por imagem , Probabilidade , Estudos Prospectivos , Fatores de Risco , Índice de Gravidade de Doença , Distribuição por SexoRESUMO
OBJECTIVE: To validate sensitivity of the bacterial meningitis score (BMS) in a large population of children with bacterial meningitis (BM). STUDY DESIGN: Secondary analysis of prospective data for children presenting with BM to a hospital emergency department between January 2001 and February 2005. The BMS was applied to all children with acute BM using the same inclusion criteria proposed by the authors of the rule. The sensitivity of the rule was calculated. RESULTS: Of the 900 children aged 29 days to 18 years with acute BM who met all inclusion criteria, 889 had enough data for assigning the BMS. Use of the BMS correctly identified 884 children with BM, for 99.6% sensitivity (95% confidence interval: 98.9% to 99.8%). CONCLUSIONS: The sensitivity of the BMS to detect disease was very high, but a few cases of BM were missed. Further refinements of the BMS may be warranted to lower the false-negative rate.
Assuntos
Bacteriemia/diagnóstico , Proteínas do Líquido Cefalorraquidiano/análise , Meningites Bacterianas/diagnóstico , Meningites Bacterianas/mortalidade , Índice de Gravidade de Doença , Adolescente , Bacteriemia/epidemiologia , Líquido Cefalorraquidiano/microbiologia , Criança , Pré-Escolar , Estudos de Coortes , Intervalos de Confiança , Feminino , Bactérias Gram-Negativas/isolamento & purificação , Bactérias Gram-Positivas/isolamento & purificação , Humanos , Lactente , Recém-Nascido , Contagem de Linfócitos , Masculino , Meningites Bacterianas/líquido cefalorraquidiano , Probabilidade , Prognóstico , Estudos Prospectivos , Sistema de Registros , Medição de Risco , Sensibilidade e Especificidade , Análise de Sobrevida , Estudos de Validação como AssuntoRESUMO
OBJECTIVE: To validate high serum procalcitonin (PCT) as a predictor of vesicoureteral reflux (VUR) in children with a first febrile urinary tract infection (UTI). STUDY DESIGN: This secondary analysis of prospective hospital-based cohort studies included children ages 1 month to 4 years with a first febrile UTI. RESULTS: Of the 398 patients included in 8 centers in 7 European countries, 25% had VUR. The median PCT concentration was significantly higher in children with VUR than in those without: 1.6 versus 0.7 ng/mL (P = 10(-4)). High PCT (> or =0.5 ng/mL) was associated with VUR (OR: 2.3; 95% CI, 1.3 to 3.9; P = 10(-3)). After adjustment for all cofactors, the association remained significant (OR: 2.5; 95% CI, 1.4 to 4.4; P = 10(-3)). The strength of the relation increased with the grade of reflux (P = 10(-5)). The sensitivity of procalcitonin was 75% (95% CI, 66 to 83) for all-grade VUR and 100% (95% CI, 81 to 100) for grade > or =4 VUR, both with 43% specificity (95% CI, 37 to 48). CONCLUSIONS: High PCT is a strong, independent and now validated predictor of VUR that can be used to identify low-risk patients and thus avoid one third of the unnecessary cystourethrographies in children with a first febrile UTI.
Assuntos
Calcitonina/sangue , Precursores de Proteínas/sangue , Infecções Urinárias/sangue , Infecções Urinárias/diagnóstico por imagem , Urografia/estatística & dados numéricos , Peptídeo Relacionado com Gene de Calcitonina , Intervalos de Confiança , Europa (Continente) , Feminino , Seguimentos , Glicoproteínas , Humanos , Lactente , Recém-Nascido , Masculino , Valor Preditivo dos Testes , Estudos ProspectivosRESUMO
OBJECTIVE: To identify the biologic tests that best distinguish between bacterial and aseptic meningitis in an emergency department (ED). STUDY DESIGN: All children hospitalized for bacterial meningitis between 1995 and 2004 or for aseptic meningitis between 2000 and 2004 were included in a retrospective cohort study. Predictive values of blood (C-reactive protein, procalcitonin [PCT], white blood cell [WBC] count, neutrophil count) and cerebrospinal fluid (CSF) findings (protein, glucose, WBC count, neutrophil count) available in the ED were determined. Tests with the best predictive value were identified by using univariate and multivariate analyses and ROC curves comparison. RESULTS: Among the 167 patients included, 21 had bacterial meningitis. The CSF gram-stain and bacterial antigen test had 86% and 60% sensitivity rates, respectively. PCT (>/=0.5 ng/mL) and CSF protein (>/=0.5 g/L) were the best biologic tests, with 89% and 86% sensitivity rates, 89% and 78% specificity rates, adjusted odds ratios of 108 (95% CI, 15-772) and 34 (95% CI, 5-217), and areas under the ROC curves of 0.95 and 0.93, respectively. CONCLUSION: PCT and CSF protein had the best predictive value to distinguish between bacterial and aseptic meningitis in children.
Assuntos
Calcitonina/sangue , Meningite Asséptica/diagnóstico , Meningites Bacterianas/diagnóstico , Precursores de Proteínas/sangue , Adolescente , Biomarcadores/sangue , Biomarcadores/líquido cefalorraquidiano , Proteína C-Reativa/análise , Peptídeo Relacionado com Gene de Calcitonina , Proteínas do Líquido Cefalorraquidiano/análise , Criança , Pré-Escolar , Estudos de Coortes , Diagnóstico Diferencial , Feminino , Glucose/líquido cefalorraquidiano , Humanos , Lactente , Contagem de Leucócitos , Masculino , Meningite Asséptica/sangue , Meningite Asséptica/líquido cefalorraquidiano , Meningites Bacterianas/sangue , Meningites Bacterianas/líquido cefalorraquidiano , Neutrófilos/metabolismo , Curva ROC , Estudos Retrospectivos , Sensibilidade e EspecificidadeRESUMO
We evaluated retrospectively the safety of mefloquine (25 mg/kg) for the curative treatment of uncomplicated Plasmodium falciparum malaria in 26 infants weighing <15 kg and managed during a 5-year period. Side effects were recorded in 30.8% of patients and consisted chiefly of mild and transient gastrointestinal symptoms. Mefloquine was safe in infants weighing <15 kg in our experience.