Lack of Accuracy of Biomarkers and Physical Examination to Detect Bacterial Infection in Febrile Infants.

OBJECTIVES: The aim of this study was to analyze the usefulness of physical examination, C-reactive protein (CRP), procalcitonin (PCT), white blood cell (WBC) count, and absolute neutrophils counts (ANCs) for the diagnosis of invasive bacterial infections (IBIs) and potentially serious bacterial infections in infants younger than the age of 3 months presenting with fever without source (FWS) to the emergency department (ED). METHODS: A descriptive retrospective study that includes all infants aged younger than 3 months who presented with FWS to the ED between July 2008 and January 2012. We evaluated diagnostic performance for each test by receiver operating characteristic curve analysis. Sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio were also calculated. RESULTS: Three hundred eighteen patients met the inclusion criteria. Eleven bacteremia (3.5%) and 76 urinary tract infections (23.9%) were diagnosed. To detect IBI, the areas under the curve for the different tests were as follows: PCT, 0.77 (95% confidence interval [CI], 0.57-0.96); CRP, 0.54 (95% CI, 0.36-0.73); ANC, 0.53 (95% CI, 0.34-0.71); and WBC, 0.42 (0.24-0.61). To detect potentially serious bacterial infections, the areas under the curve were as follows: PCT, 0.66 (95% CI, 0.59-0.74); CRP, 0.68 (0.60-0.76); ANC, 0.64 (0.56-0.71); and WBC, 0.66 (0.58-0.72). CONCLUSIONS: Procalcitonin is better than CRP, WBC, and ANC to confirm or dismiss the presence of an IBI in infants aged younger than 3 months presenting with FWS to the ED. However, it could not identify almost 30% of infants with IBI. Most patients diagnosed with IBI (10 of 11) presented abnormal values in at least one of the analytical parameters and/or physical appearance. Four of 5 patients with IBI and well appearing presented abnormal results in at least one of the analytical parameters. Therefore, the development of tools combining different tests including the new biomarkers could increase the reliability of the tests for the diagnosis of IBI in these patients.

Rapid diagnosis of invasive pneumococcal disease in pediatric population.

The aim of this study was to evaluate the Binax NOW immunochromatographic pneumococcal antigen test for the identification of Streptococcus pneumoniae in pleural and cerebrospinal fluids from children with suspected invasive pneumococcal disease. The results were compared with those obtained by PCR. Binax NOW was applied to these samples as recommended by the manufacturer for urine and cerebrospinal samples. Detection of pneumococcal DNA was performed by real-time PCR assay targeting the autolysin gene (lytA). Of the 199 samples analyzed, 131 were positive by both Binax NOW and lytA PCR, and 36 samples were negative by both techniques. Using the real-time PCR as a comparative method to the Binax for the detection of S. pneumoniae, the sensitivity and specificity of Binax NOW was 88% and 72.5%, respectively. Of the 145 positive samples analyzed by Binax NOW, 119 showed intense coloring of the sample line and 26 showed weak intensity. Conventional culture is the most common method in clinical settings, but Binax NOW is an easier and faster test for identifying S. pneumoniae in pleural and cerebrospinal fluids from children with suspected invasive pneumococcal disease.

Advances in lower respiratory tract infections in critically ill patients / Avances en las infecciones del tracto respiratorio inferior en los pacientes en situación clínica crítica

The present article is an update of the literature on lower respiratory tract infections in critical patients. A multidisciplinary group of Spanish physicians with expertise in the field selected what they considered to be the most important papers published during 2004 and 2005. Each article was analyzed and discussed by one of the members of the panel. A critical review of all these contributions constitutes the body of this paper. After a review of the state of the art, papers selected in the field of new guidelines, risk factors, new diagnostic methods, antimicrobial therapy, and prevention are discussed

El artículo presente recoge una actualización de la bibliografía médica relativa a las infecciones del tracto respiratorio inferior en los pacientes en situación clínica crítica. Un grupo multidisciplinario de clínicos españoles con experiencia en este área seleccionó los que consideró los artículos más importantes sobre este campo publicados en 2004 y 2005. Cada artículo fue analizado y discutido por uno de los miembros del grupo. El artículo presente recoge una revisión crítica de todas estas contribuciones. Tras una revisión de la situación actual, se comentaron los artículos seleccionados relativos a las nuevas directrices, los factores de riesgo, los nuevos métodos diagnósticos, el tratamiento antimicrobiano y la prevención

Clinical presentation and characteristics of pharyngeal adenovirus infections.

We describe the clinical characteristics of 209 children younger than 15 years of age with positive pharyngeal cultures for adenovirus. The mean age of the children was 37 +/- 33 months, and the mean peak temperature was 39.2 +/- 0.76 degrees C. On physical examination, tonsillitis was found for 88% of children; 52% of them had exudative tonsillitis. Forty-eight percent of the patients who had a white blood cell count performed had >15,000 leukocytes per mm, and 25% had >20,000 leukocytes per mm. C-reactive protein concentrations were >7 mg/dL for 22.5% of the patients. Adenovirus pharyngeal infections in young children mimic severe bacterial infections.