High genotypic diversity of Rhinoviruses obtained from Tunisian children with severe acute respiratory infection.

INTRODUCTION: Rhinoviruses (HRV) are among the leading causes of Severe Acute Respiratory Infection (SARI). Their burden and genetic diversity vary from one region to another and little is known in Northern African regions. This study describes epidemiological patterns and genotypic diversity of HRV in SARI cases during a two and half year's study, in Northern Tunisia. METHODOLOGY: A total of 271 SARI cases, admitted into the Pediatric Intensive Care Unit of Bechir Hamza Children's Hospital in Tunis, were collected between September 2015 and December 2017. The investigation concerned 104 samples positive for HRV and/or HEV (Human Enterovirus) obtained among these cases. Specific HRV and HEV detections were assessed by real-time PCRs. The HRV molecular typing was based on the VP4-VP2 genomic region analyses. RESULTS: Among the viral SARI cases, 33.5% and 12.3% were positive for HRV and HEV respectively. Molecular investigations showed high prevalence of HRV-A (63.3%) followed by HRV-C (30.6%) and HRV-B (6.1%) and high genotypic diversity with 27 types. HRV cases were mostly detected in toddlers younger than 6 months. A total of 16 cases (28%) were found with bacterial and/or viral co-infection. HRV-C infection and HRV-A with bacterial co-infection were associated with complicated infection. Some of the detected types showed a continuous circulation or turnover during an extended period. HRV-A101 and HRV-C45 were the most frequently detected types. CONCLUSIONS: This study revealed, for the first time, the high HRV diversity in Tunisia, a North-African region. Specific phylogenetic investigations may help to evaluate their diversity and to trace their spread and epidemiological origin.

Epidemiology of hospital-acquired bloodstream infections in a Tunisian pediatric intensive care unit: a 2-year prospective study.

BACKGROUND: There are few data providing rates of nosocomial bloodstream infections (NBI) in pediatric intensive care patients from developing regions of the world. OBJECTIVES: To describe the epidemiology of NBI in a Tunisian pediatric intensive care unit (PICU). METHODS: A prospective surveillance study from January 2004 through December 2005 was performed in the PICU of the Children's Hospital of Tunis. All patients who remained in the PICU for more than 48 hours were included. Centers for Disease Control and Prevention criteria were applied for the diagnosis of NBI. RESULTS: Six hundred forty-seven patients aged 0 to 15 years were included. Forty-one NBIs occurred in 38 patients. The NBI rate was 7/1000 patient days (6.3/100 admissions). Twenty-seven NBIs (66%) occurred in patients with central venous catheter (CVC). CVC-associated infection rate was 14.8 per 1000 catheter days. Gram-negative rods were involved in 53.6% of NBIs. The most common organisms causing NBIs were Staphylococcus aureus (26.8%), Klebsiella pneumoniae (19.5%) and Coagulase-negative staphylococci (17%). Staphylococcus aureus was methicillin-resistant in 9.1% of cases. Eighty-seven percent of Klebsiella pneumoniae isolates had extended-spectrum beta-lactamases. The PICU crude mortality rate of infected patients was 42% (versus 5.9% in noninfected patients; P< .001). Multivariate logistic regression analyses demonstrated device utilization ratio greater than 1 (odds ratio [OR]=8.46; 95% confidence interval [CI] 3.11-23; P< .001) and previous colonization with multidrug resistant gram-negative rods (OR=2; 95% CI 1.39-2.89; P< .001) significantly related to NBI. CONCLUSIONS: Considering the high incidence of NBI resulted from multiple drug-resistant gram-negative rods in our center, implementation of improved infection control practices is required.

High-frequency oscillatory ventilation in term and near-term infants with acute respiratory failure: early rescue use.

This study describes a high-frequency oscillatory ventilation (HFOV) protocol for term and near-term infants with acute respiratory failure (ARF) and reports results of its prospective application. Neonates, with gestational age >or= 34 weeks, were managed with HFOV, if required, on conventional ventilation (CV), a fraction of inspired oxygen (F IO(2)) 0.5, and a mean airway pressure > 10 cm H (2)O to maintain adequate oxygenation or a peak inspiratory pressure > 24 cm H (2)O to maintain tidal volume between 5 and 7 mL/kg of body weight. Seventy-seven infants (gestational age, 37 +/- 2,3 weeks), received HFOV after a mean duration of CV of 7.5 +/- 9.7 hours. Arterial blood gases, oxygenation index (OI), and alveolar-arterial difference in partial pressure of oxygen (P AO(2) - Pa O(2)) were recorded prospectively before and during HFOV. There were a rapid and sustained decreases in mean airway pressure (MAP), F IO(2), OI, and P AO(2) - Pa O(2) during HFOV ( P

High-frequency oscillatory ventilation in pediatric patients with acute respiratory failure.

OBJECTIVE: To evaluate the effectiveness of high-frequency oscillatory ventilation (HFOV) in pediatric patients with acute respiratory failure, failing conventional ventilation. DESIGN: A prospective, clinical study. SETTING: Tertiary care pediatric intensive care unit. PATIENTS: Twenty pediatric patients (ages 12 days to 5 yrs) with acute respiratory failure (pneumonia, 14; sepsis with acute respiratory distress syndrome, 3; pulmonary edema as a complication of upper airway obstruction, 2; salicylate intoxication with acute respiratory distress syndrome, 1), failing conventional ventilation (median alveolar-arterial oxygen difference [P(A-a)O2] 578 [489-624] torr, median oxygenation index 26 [21-32]. INTERVENTIONS: HFOV was instituted after a median length of conventional ventilation of 15.5 (3.3-43.5) hrs. MEASUREMENTS AND MAIN RESULTS: Ventilator settings, arterial blood gases, oxygenation index, and P(A-a)O2 were recorded before HFOV (0 hrs) and at predetermined intervals during HFOV and compared using the one-way Friedman rank-sum procedure and a two-tailed Wilcoxon matched-pairs test. Initiation of HFOV caused a significant decrease in FiO2 at 1 hr that continued to 24 hrs (p

High-frequency oscillatory ventilation in paediatric patients with acute respiratory distress syndrome--early rescue use.

UNLABELLED: In order to determine the response to high-frequency oscillatory ventilation (HFOV), used as an "early rescue" therapy, in a cohort of paediatric patients with acute respiratory distress syndrome (ARDS), a prospective clinical study was performed in a tertiary care paediatric intensive care unit. Ten consecutive patients, aged 12 days to 5 years with ARDS and hypoxaemic respiratory failure on conventional ventilation (CV), using a lung protective strategy, were managed with HFOV early in the course of the disease process (median length of CV 4 h). Arterial blood gases, oxygenation index (OI), alveolar-arterial oxygen difference (P(A-a)O2) and PaO2/FIO2 ratio were prospectively recorded prior to HFOV (0 h) and at predetermined intervals throughout the course of the HFOV protocol. There was a significant improvement in PaCO2 4 h after institution of HFOV (P = 0.012). A significant and sustained increase (P < 0.001) in PaO2/FIO2 ratio and a significant and sustained decrease (P < 0.001) in OI and P(A-a)O2 were demonstrated during the HFOV trial. These improvements were achieved 4 h after initiating HFOV (P < 0.05). Eight patients survived. There were no deaths from respiratory failure. CONCLUSION: In paediatric patients with acute respiratory distress syndrome and hypoxaemic respiratory failure on conventional ventilation, using a lung protective strategy, high-frequency oscillatory ventilation used as an "early rescue" therapy, improves gas exchange in a rapid and sustained fashion and provides a good outcome. Use of this therapy should probably be considered early in the course of the disease process.