Preventing mosquito and tick bites: A Canadian update.

The present practice point provides updated guidance on personal protective measures to safely and effectively prevent mosquito and tick bites in Canada. Means of avoidance as well as physical and chemical barriers are described. Current information regarding insect and tick repellents and recommendations for their use are provided, along with instructions for removing ticks. Guidance on using insecticide for additional chemical protection is offered.

Le présent point de pratique contient des conseils à jour sur les mesures de protection individuelle pour prévenir les piqûres de moustiques et de tiques avec efficacité et en toute sécurité au Canada. On y décrit des moyens de prévention et des barrières physiques et chimiques, de même que de l'information à jour au sujet des répulsifs contre les insectes et les tiques, des recommandations au sujet de leur utilisation et des directives pour retirer les tiques. Des conseils sont également présentés sur l'utilisation d'insecticide pour assurer une protection chimique supplémentaire.

Lyme disease in Canada: Focus on children.

Lyme disease, the most common tick-borne infection in Canada and much of the United States, is caused by the bacteria Borrelia burgdorferi. Peak incidence for Lyme disease is among children five to nine years of age and older adults (55 to 59 years of age). The bacteria are transmitted through the bite of infected black-legged ticks of the Ixodes species. The primary hosts of black-legged ticks are mice and other rodents, small mammals, birds (which are reservoirs for B burgdorferi) and white-tailed deer. Geographical distribution of Ixodes ticks is expanding in Canada and an increasing number of cases of Lyme disease are being reported. The present practice point reviews the epidemiology, clinical presentation, diagnosis, management and prevention of Lyme disease, with a focus on children.

La maladie de Lyme, qui est l'infection à tiques la plus courante au Canada et dans une grande partie des États-Unis, est causée par la bactérie Borrelia burgdorferi. Elle touche surtout les enfants de cinq à neuf ans et les adultes d'âge mûr (de 55 à 59 ans). La bactérie est transmise par la piqûre de la tique occidentale à pattes noires de l'espèce Ixodes qui a été infectée, dont les hôtes primaires sont les souris et les autres rongeurs, les petits mammifères, les oiseaux (réservoirs du B burgdorferi) et les cerfs de Virginie. La répartition géographique des tiques Ixodes prend de l'expansion au Canada, et le nombre de cas de maladie de Lyme déclarés est en croissance. Le présent point de pratique porte sur l'épidémiologie, la présentation clinique, le diagnostic, la prise en charge et la prévention de la maladie de Lyme, particulièrement chez les enfants.

Community-acquired urinary tract pathogens and their resistance patterns in hospitalized children in southeastern Ontario between 2002 and 2006.

BACKGROUND: The purpose of the present study was to assess the epidemiology and resistance patterns of bacteria causing urinary tract infections in children who were admitted to Kingston General Hospital (Kingston, Ontario) - the regional tertiary care hospital of southeastern Ontario. METHODS: A retrospective chart review of patients one to 18 years of age who were admitted to Kingston General Hospital with a discharge diagnosis of urinary tract infection between 2002 and early 2006 was undertaken. RESULTS: One hundred forty-two patient charts were reviewed, of which 56.3% of patients were female. The mean age of the patients was 12.3 months. The most common bacteria identified on urine culture over a five-year period were Escherichia coli (71.6%), Enterococcus species (5.7%) and Klebsiella species (5.0%). Bacteria were frequently resistant to ampicillin (54.4%) and trimethoprim-sulfamethoxazole (TMP-SMX) (40.4%). During the three months before admission, bacteria resistant to ampicillin were cultured from the urine of 75.6% of patients who were receiving some antibiotic, compared with 44% of children with no documented use of antibiotics (P<0.0001). Resistance to TMP-SMX in those with pre-existing genitourinary disease was 72.2% versus 31.8% in those without (P<0.0001). Patients who had previous admissions for urinary tract infections also showed greater resistance to TMP-SMX (70.6% versus 32.7%; P<0.005), cefazolin (64.7% versus 20.0%; P<0.0001) and nitrofurantoin (58.8% versus 18.2%; P<0.0001). CONCLUSIONS: There was a high resistance to ampicillin. Risk factors for resistant bacteria included the use of antibiotics three months before admission, previous genitourinary disease and previous admissions for urinary tract infections. In the presence of these risk factors, a third-generation cephalosporin as first-line antimicrobial therapy is recommended. However, the combination of ampicillin plus gentamicin can be considered for empirical therapy in low-risk patients.

The Pediatric Investigators Collaborative Network on Infections in Canada study of predictors of hospitalization for respiratory syncytial virus infection for infants born at 33 through 35 completed weeks of gestation.

BACKGROUND: Infants born at 33 through 35 completed weeks of gestation (33-35GA) are at risk for severe respiratory syncytial virus (RSV) infection, and palivizumab prophylaxis lowers hospitalizations for RSV infection by as much as 80%. The 33-35GA cohort comprises 3-5% of annual births; thus expert panels recommend limiting prophylaxis to situations in which frequency or health care impact of RSV infection is high. This study sought to identify independent risk factors for hospitalization for RSV infection. METHODS: This was a multicenter, prospective, observational cohort study of 33-35GA infants followed through their first RSV season (2001/2002 or 2002/2003). Baseline data were collected by interview with parents and review of medical records. Respiratory tract illnesses were identified by monthly phone calls, and medical records were reviewed for emergency room visits or hospitalizations. Risk factors were determined by stepwise logistic regression. RESULTS: Of 1,860 enrolled subjects, 1,832 (98.5%) were followed for at least 1 month, and 1,760 (94.6%) completed all follow-ups. Of 140 (7.6%) subjects hospitalized for respiratory tract illnesses, 66 infants had proven RSV infection. Independent predictors for hospitalization for RSV infection were: day-care attendance (odds ratio, 12.32; 95% confidence interval, 2.56, 59.34); November through January birth (odds ratio, 4.89; 95% confidence interval, 2.57, 9.29); preschool age sibling(s) (odds ratio, 2.76; 95% confidence interval, 1.51, 5.03); birth weight <10th percentile (odds ratio, 2.19; 95% confidence interval, 1.14, 4.22); male gender (odds ratio, 1.91; 95% confidence interval, 1.10, 3.31); > or = 2 smokers in the home (odds ratio, 1.87; 95% confidence interval, 1.07, 3.26); and households with >5 people, counting the subject (odds ratio, 1.79; 95% confidence interval, 1.02, 3.16). Family history of eczema (odds ratio, 0.42; 95% confidence interval, 0.18, 0.996) was protective. CONCLUSIONS: Specific host/environmental factors can be used to identify which 33-35GA infants are at greatest risk of hospitalization for RSV infection and likely to benefit from palivizumab prophylaxis.