Respiratory viruses associated with severe mechanically ventilated pneumonia in children.

The burden of pneumonia, especially that caused by respiratory viruses, is markedly high in the pediatric age group. This study aimed to assess viral agents causing severe pneumonia among mechanically ventilated patients. Nonbronchoscopic bronchoalveolar lavage was performed for pediatric patients having severe pneumonia indicated for mechanical ventilation to be tested with a multiplex PCR immediate diagnosis of their etiologic pathogen. Among the 75 patients recruited, viral agents were detected in 73.4% of cases. Rhinovirus and respiratory syncytial virus (RSV) were the most common viruses detected in 32.1% and 29.5%, respectively. The rate of viral infection showed a clear increased incidence in the winter season. The mortality rate among viral-associated severe pneumonia reached 56.36%. Odds of mortality increased threefolds in presence of comorbid conditions and 10-folds with congenital heart disease. The study demonstrated the neglected importance of rhinovirus besides RSV in causing severe critical pneumonia in the pediatric age.

A Pilot Study to Assess Transfusion Transmission of Hepatitis C Virus.

Alexandria University blood bank adopted double screening tests: a fully automated chemiluminescence immunoassay followed by nucleic acid testing. The aim of the study was to assess the efficiency of dual check of HCV in preventing transfusion related infection among patients admitted to PICU. A prospective cohort study was carried on patients admitted to PICU during 6 months. The included patients performed HCV RNA detection on admission by conventional reverse transcriptase polymerase chain reaction (RT-PCR) technique. Only negative cases were recruited, then patients receiving blood or its product were checked after 4 weeks from discharge by RT-PCR for HCV RNA. A total of 33 patients received 108 transfusions: 9 patients of them deceased during PICU stay and the remaining 24 patients were all found to be negative for HCV. The dual screening of HCV should be implemented in all blood banks of Egypt especially for critically ill pediatric patients.

Bacteriologic profile and susceptibility pattern of mechanically ventilated paediatric patients with pneumonia.

AIM: Due to the current widespread bacterial resistance to many antibiotics - especially extended-spectrum ß-lactams, carbapenems, and anti-pseudomonal drugs - therapy for severe pneumonia is very challenging. This study aimed to assess antimicrobial sensitivity patterns and optimisation of the antibiotic stewardship program applied at a university-affiliated paediatric intensive care unit (PICU). SUBJECTS AND METHODS: This prospective cohort study included all patients aged 1 month to 12 years, admitted to the PICU with severe pneumonia episodes indicated for mechanical ventilation, and were followed up and investigated. Non-bronchoscopic bronchoalveolar lavage specimens were tested for positive microbiological yields and examined for their susceptibility pattern. RESULTS: Of 85 patients with 96 episodes, 69 of them yielded positive growth: 43 were community-acquired pneumonia episodes, 62.79% of which were of unidentified cause. The isolated bacteria were predominantly due to Chlamydia pneumonia (18.6%) followed by Staphylococcus aureus and its resistant form (9.3%). Hospital and ventilator-associated pneumonia were mainly related to Gram-negative bacteria (91.67% and 87.8%, respectively), especially Klebsiella acinetobacter and Pseudomonas. There was a significant increase in multi-drug resistance among Gram-negative bacteria, which was considered an independent risk factor of mortality (P=0.003). CONCLUSION: Severe community-acquired pneumonia was treated with macrolides in combination with vancomycin or linezolid if methicillin-resistant S. aureus was suspected. This was appropriate, in view of its causative agents and their susceptibility pattern. Hospital and ventilator-associated pneumonia caused by resistant Gram-negative organisms might have better outcomes by adding tigecycline or colistin in combination with fluoroquinolones. Owing to the widespread resistance of many Gram-negative bacteria, it is recommended that the antibiotic stewardship program be frequently updated.

Association of lactate/albumin ratio level to organ failure and mortality in severe sepsis in a pediatric intensive care unit in Egypt.

Moustafa AA, Antonios MAM, Abdellatif EM, Hussain AH. Association of lactate/albumin ratio level to organ failure and mortality in severe sepsis in a pediatric intensive care unit in Egypt. Turk J Pediatr 2018; 60: 691-701. This study aimed at investigating the lactate to albumin ratio, as a newly introduced biomarker of multiple organ dysfunction syndrome (MODS) and mortality compared to the classic lactate clearance in pediatric patients. We designed a prospective cohort study and 155 patients with severe sepsis or septic shock admitted to a Pediatric Intensive Care Unit were included, starting from January 2016 to March 2017. The data of 119 patients who completed the study, were analyzed. Results revealed that lactate clearance (6h, 24h) was significantly lower and lactate/albumin ratio (0h, 6h, 24h) was significantly higher in patients who developed MODS and in those who passed away. The univariate logistic regression showed that both lactate clearance and lactate/albumin ratio were significant prognostic factors of MODS and mortality. According to the AUC, lactate/albumin ratio (0h, 6h, 24h) showed better discrimination of MODS development (with AUC of 0.729, 0.814, and 0.819, respectively) compared to lactate clearance (6h, 24h; AUC of 0.738, and 0.672, respectively). Again the lactate/albumin ratio (0h, 6h, 24h) showed better discriminatory power of mortality (0.681, 0.741, and 0.856, respectively) compared to the lactate clearance (6h, 24h; 0.638 and 0.77, respectively). The Youden Index specified a lactate/albumin ratio (0h, 6h, 24h) of 1.17, 1.07, and 1.1 to be the cut-off discriminating values, respectively. The Kaplan-Meier curves revealed that the cumulative of survival is significantly better for the group of patients with a lactate/albumin ratio less than the cut-off values. It was concluded that lactate/albumin ratio is a better discriminator of MODS development and mortality than lactate clearance in pediatric patients with severe sepsis or septic shock.