A meta-analysis of mentalizing in anxiety disorders, obsessive-compulsive and related disorders, and trauma and stressor related disorders.

BACKGROUND: The number of studies that have researched the ability to mentalize in individuals with anxiety and related disorders is limited. Often, no distinction is made between different anxiety and related disorders in the examination of mentalization. OBJECTIVE: The goal of this study was to obtain insight into mentalization in anxiety and related disorders, and to compare this ability between these disorders. METHOD: A systematic literature search was performed to identify studies in which performance on a mentalization task was compared between a patient group diagnosed with an anxiety or a related disorder, and a control group. Meta-analyses were performed on the included articles. RESULTS: The initial search yielded 2844 articles, of which 26 studies on 1056 patients were included. Patients diagnosed with anxiety and related disorders showed a deficit in mentalization when compared to healthy controls (SMD = -0.60, p 0.001). A deficit was found in all patient groups: Patients with anxiety disorders (SMD = -0.39, p = 0.007), obsessive-compulsive and related disorders (SMD = -0.78, p = 0.01), and trauma and stressor related disorders showed significant deficits (SMD = -0.77, p = 0.02) as compared to healthy controls. CONCLUSION: The results indicated impaired mentalization in anxiety and related disorders, with specific deficiencies in posttraumatic stress disorder, social anxiety, and obsessive-compulsive disorders. Mentalization could provide a clinical target in treatment of these disorders.

Social cognitive performance in posttraumatic stress disorder: A meta-analysis.

BACKGROUND: Social support represents a key factor in the development of post-traumatic stress disorder (PTSD). Social cognition - the ability to perceive, interpret, and respond to other people - is considered fundamental in making use of social support. Gaining knowledge on the link between PTSD and social cognition is therefore essential. Whilst social cognitive difficulties in patients with PTSD are documented, an understanding of which particular social cognitive processes might be affected more than others, is lacking. The current meta-analysis was therefore aimed to examine social cognitive functioning in four underlying social cognitive domains (mentalization, emotion recognition, social perception, and attributional style) in PTSD diagnosed patients versus controls. METHODS: Meta-analyzes were conducted on studies examining performance on at least one social cognitive domain in PTSD diagnosed patients compared to controls. RESULTS: 19 studies were included, involving 565 patients and 641 controls. Relative to controls, the PTSD group scored lower on overall social cognitive functioning (SMD = -0.42), specifically on mentalization (SMD = -0.81) and social perception (SMD = -0.30), whilst the latter should be interpreted with caution as only one study was found pertaining to this domain. No emotion recognition and attributional style differences were found. LIMITATIONS: There was evidence of moderate heterogeneity in the results of the included studies for overall social cognition and attributional style. CONCLUSIONS: Findings indicate that social cognition represents a potential important clinical factor in PTSD and underscore the importance of differentiating between underlying social cognitive processes in research and treatment of PTSD.

Oxaliplatin infusion-related venous pain: prevention by simultaneous intravenous fluids.

OBJECTIVE: Oxaliplatin is a cytotoxic agent frequently used in the treatment of gastrointestinal cancer patients. A known side effect of oxaliplatin administration via a peripheral vein is infusion-related pain. In this retrospective cohort study we compared the incidence of infusion-related pain in patients treated with oxaliplatin with or without simultaneous fluid infusion (FI) (800 mL glucose 5% in 2 hours). METHODS: We retrospectively defined two cohorts: Patients treated with oxaliplatin and simultaneous intravenous FI and the same number of patients treated without FI.The incidence of infusion-related venous pain was the primary outcome measure. Secondary outcomes included: Incidence of hypersensitivity reactions, infusion time, dose density, number of patients switched to a central venous catheter and incidence of peripheral neuropathy. RESULTS: 100 patients were included, 50 patients in both groups. Baseline characteristics were comparable, except for age (median 66.8 vs 62.4 years in groups with and without FI; p=0.017), and body mass index (28.0 vs 25.7 kg/m2, respectively; p=0.012). Patients treated with simultaneous FI experienced significantly less vascular pain compared with those without FI (10% vs 78%, respectively; p<0.0001; OR 0.031 (95% CI: 0.01 to 0.098)). No difference was observed in dose density, treatment delay or the need of central venous catheter. Logistic regression analysis showed no confounders affecting the primary outcome. No adverse events of FI were observed. CONCLUSION: Concurrent infusion of 800 mL glucose 5% with peripheral venous administration of oxaliplatin significantly reduces the incidence of infusion-related pain in gastrointestinal cancer patients and is highly feasible and affordable in everyday clinical practice.

Periprocedural adverse events after endoscopic resection of T1 colorectal carcinomas.

BACKGROUND AND AIMS: In contrast to the adverse event (AE) risk of endoscopic resection (ER) of adenomas, the intra- and postprocedural AE risks of ER of T1 colorectal cancer (CRC) are scarcely reported in the literature. It is unclear whether ER of early CRCs, which grow into the submucosal layer and sometimes show incomplete lifting, is associated with an increased AE risk. We aimed to identify the AE rate after ER of T1 CRCs and to identify the risk factors associated with these AEs. METHODS: Medical records of patients with T1 CRCs diagnosed between 2000 and 2014 in 15 hospitals in the Netherlands were reviewed. Patients who underwent primary ER were selected. The primary outcome was the occurrence of endoscopy-related AEs. The secondary outcome was the identification of risk factors. Multivariate logistic regression was performed. RESULTS: Endoscopic AEs occurred in 59 of 1069 (5.5%) patients, among which 37.3% were classified as mild, 59.3% as moderate, and 3.4% as severe. AEs were postprocedural bleeding (n = 40, 3.7%), perforation (n = 13, 1.2%), and postpolypectomy electrocoagulation syndrome (n = 6, 0.6%). No fatal AEs were observed. Independent predictors for AEs were age >70 years (odds ratio, 2.11; 95% confidence interval, 1.12-3.96) and tumor size >20 mm (odds ratio, 2.22; 95% confidence interval, 1.05-4.69). CONCLUSIONS: In this large multicenter retrospective cohort study, AE rates of ER of T1 CRC (5.5%) are comparable with reported AE rates for adenomas. Larger tumor size and age >70 years are independent predictors for AEs. This study suggests that endoscopic treatment of T1 CRCs is not associated with an increased periprocedural AE risk.

Soluble mannose receptor levels in blood correlate to disease severity in patients with community-acquired pneumonia.

PURPOSE: Community-acquired pneumonia (CAP) is the most common form of pneumonia and is a leading infectious cause worldwide. Identification of patients that are at risk to develop severe disease has proven to be a major challenge. Soluble mannose receptor (sMR; sCD206) is a new serum marker for macrophage activation. Recent studies showed that sMR levels are increased in patients suffering from severe infections making it a potential biomarker for improved discrimination of disease severity. For measuring sMR, no standardized assay is available. Aim of this study is to develop an assay for standardized measurement of sMR. Next, this assay was used to assess sMR plasma levels for its ability to predict severe disease development in a patient cohort for community-acquired pneumonia. METHODS: We developed a well-validated sandwich ELISA that enables standardized measurement of sMR in plasma and serum samples. Repeatability was tested by calculating the percentage coefficient of variation (%CV) within and between runs and within and between operators. sMR levels were assessed in a cohort of 100 patients with community-acquired pneumonia. RESULTS: All %CV values were <10%, indicating low variation. Higher sMR levels were observed in patients with severe disease when compared to patients without severe disease development (p = 0.004). Patients with sMR levels between 100-430 ng/ml had 22.7% chance to develop severe disease whereas patients with levels between 430-1000 ng/ml had 33.3% chance to develop severe disease. CONCLUSIONS: We suggest that sMR has potential as a new biomarker for the prediction of disease severity in patients with community-acquired pneumonia.

Declining antibody levels after hepatitis B vaccination in Down syndrome: A need for booster vaccination?

We determined the anti-HBs titer in 227 children of all ages with Down syndrome (DS). Only 48.1% (95%CI: 35.1-61.3) of the DS children aged 7-10 years and 31.9% (95%CI: 22.1-43.6) of the DS children aged >10 years had a protective anti-HBs titer (≥10 IU/L). The geometric mean anti-HBs titer was significantly lower in the DS children; this suggests booster vaccination for HBV may be needed.

Effectiveness of a medication-adherence tool: study protocol for a randomized controlled trial.

BACKGROUND: Research shows that more than half of the people taking medication for a chronic condition are non-adherent. Nonadherence hinders disease control with a burden on patient quality of life and healthcare systems. We developed a tool that provides insight into nonadherence risks and barriers for medication-adherence including an intervention strategy to overcome those barriers. This study aims to assess the effectiveness of using this adherence tool in starters with cardiovascular or oral blood glucose-lowering medication to improve medication-adherence. METHODS/DESIGN: In a cluster-randomized controlled trial 25 pharmacies in the Netherlands will be randomized to the intervention or control arm. Patients registered in a general practice participating in a collaborative can be included when they start cardiovascular or oral blood glucose-lowering medication prescribed by their general practitioner. Participants complete an assessment consisting of measuring nonadherence risk and potential barriers to adherence. For patients with an increased nonadherence risk, a graphic barrier profile is created, showing to what extent eight cognitive, emotional, or practical barriers are present. All patients will fill in the medication-adherence assessment twice: between 1 and 2 weeks after the start of the medication and after 8 months. The intervention strategy consists of discussing this barrier profile to overcome barriers. Pharmacists and assistants of the intervention pharmacies are trained in discussing the profile and to offer a tailored intervention to overcome barriers. In the control arm, patients receive care as usual. The primary outcome is medication-adherence of patients with a high risk of nonadherence at 8 months follow-up. Secondary outcomes include the difference in the percentage of patients with an increased nonadherence risk between intervention and control group after 8 months, the predictive values of the baseline questionnaire in the control group in relation to medication-adherence after 8 months, medication-adherence after 1 year follow-up, and barriers and facilitators in the implementation of the tool. DISCUSSION: This manuscript presents the protocol for a cluster-randomized clinical trial on the use of an adherence tool to improve medication-adherence. This study will provide insight into the effectiveness of the tool in starters with cardiovascular or oral blood glucose-lowering medication in improvement of medication-adherence. TRIAL REGISTRATION: The Netherlands National Trial Register, NTR5186 . Registered on 18 May 2015.

Sputum Induction in Children Is Feasible and Useful in a Bustling General Hospital Practice.

We prospectively studied the feasibility and effectiveness of sputum induction in obtaining good quality sputum and its subsequent bacterial yield in children with clinically suspected acute lower-respiratory-tract infection (aLRTI). Good quality sputum was collected in 89/98 (91%) patients. Sputum cultures revealed ≥1 bacterial pathogens in 22 cases (25%). Adverse events were infrequent and mild (6%). Sputum induction is feasible in young children and leads to an increased number of etiological diagnoses of aLRTI.

Yoga Therapy for Abdominal Pain-Related Functional Gastrointestinal Disorders in Children: A Randomized Controlled Trial.

OBJECTIVES: The aim of the present study was to compare effects of 10 weeks of yoga therapy (YT) and standard medical care (SMC) on abdominal pain and quality of life (QoL) in children with abdominal pain-related functional gastrointestinal disorders (AP-FGIDs). METHODS: Sixty-nine patients, ages 8 to 18 years, with AP-FGIDs, were randomized to SMC complemented with YT or SMC alone. YT is a mixture of yoga poses, meditation, and relaxation exercises and was given once a week in group sessions. SMC consisted of education, reassurance, dietary advice, and fibers/mebeverine, if necessary. Pain intensity (pain intensity score [PIS] 0-5) and frequency (pain frequency score [PFS] 0-4) were scored in a pain diary, and QoL was measured with KIDSCREEN-27. Follow-up was 12 months. Treatment response was defined as ≥50% reduction of weekly pain scores. RESULTS: At 1-year follow-up, treatment response was accomplished in 58% of the YT group and in 29% of the control group (P = 0.01); no significant differences for other time points were found. YT, and not SMC, resulted in a significant reduction of PIS (P < 0.01) and PFS (P < 0.01) after 12 months. During the study, however, YT was not significantly superior compared with SMC. Subanalyses for time points demonstrated a significant greater reduction of PIS at 12 months in favor of YT. No differences were found for QoL. YT was more effective in the reduction of reported monthly school absence (P = 0.03). CONCLUSION: At 1-year follow-up, YT in addition to standard care was superior compared with SMC according to treatment success, PIS, and reduction of school absence. YT, however, was not significantly more effective in improving PFS or QoL, compared with SMC.

Allelic imbalance at the HER2/TOP2A locus in breast cancer.

BACKGROUND: Breast cancer is a heterogeneous disease with various histological features and molecular markers. These are utilized for the prediction of clinical outcome and therapeutic decision making. In addition to well established markers such as HER2 overexpression and estrogen and progesterone receptor (ER and PR) status, chromosomal instability is evolving as an important hallmark of cancers. The HER2/TOP2A locus is of great importance in breast cancer. The copy number variability at this locus has been proposed to be a marker for the degree of chromosomal instability. We therefore developed a Single Nucleotide Polymorphism (SNP) assay to evaluate allelic imbalance at the HER2/TOP2A locus in three different entities of primary breast tumors. METHODS: Eleven SNPs were carefully selected and detected by real time PCR using DNA extracted from paired (histologically normal and tumor) paraffin-embedded tissues. Primary breast tumors of 44 patients were included, 15 tumors with HER2 overexpression, 16 triple negative tumors, defined by the absence of HER2 overexpression and a negative ER and PR status and 13 ER and PR positive tumors without HER2 overexpression. As controls, histologically normal breast tissues from 10 patients with no breast tumor were included. RESULTS: Allelic imbalance was observed in 13/15 (87 %) HER2 positive tumors, the remaining 2 being inconclusive. Of the 16 triple negative tumors, 12 (75 %) displayed instability, 3 (19 %) displayed no instability, and 1 was inconclusive. Of the 13 hormone receptor positive tumors, 5 (38 %) displayed allelic imbalance, while 8 did not. CONCLUSIONS: We conclude that the SNP assay is suitable for rapid testing of allelic (im)balance at the HER2/TOP2A locus using paraffin-embedded tissues. Based on allelic imbalance at this locus, both triple negative and ER and PR positive breast tumors can be subcategorized. The clinical relevance of the allelic (im)balance status at the HER2/TOP2A locus in breast cancer is subject of future study. VIRTUAL SLIDES: The virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/2086062232155220.

Selection of key recommendations for quality indicators describing good quality outbreak response.

BACKGROUND: The performance of recommended control measures is necessary for quick and uniform infectious disease outbreak control. To assess whether these procedures are performed, a valid set of quality indicators (QIs) is required. The goal of this study was to select a set of key recommendations that can be systematically translated into QIs to measure the quality of infectious disease outbreak response from the perspective of disaster emergency responders and infectious disease control professionals. METHODS: Applying the Rand modified Delphi procedure, the following steps were taken to systematically select a set of key recommendations: extraction of recommendations from relevant literature; appraisal of the recommendations in terms of relevance through questionnaires to experts; expert meeting to discuss recommendations; prioritization of recommendations through a second questionnaire; and final expert meeting to approve the selected set. Infectious disease physicians and nurses, policymakers and communication experts participated in the expert group (n=48). RESULTS: In total, 54 national and international publications were systematically searched for recommendations, yielding over 200 recommendations. The Rand modified Delphi procedure resulted in a set of 65 key recommendations. The key recommendations were categorized into 10 domains describing the whole response pathway from outbreak recognition to aftercare. CONCLUSION: This study provides a set of key recommendations that represents 'good quality of response to an infectious disease outbreak'. These key recommendations can be systematically translated into QIs. Organizations and professionals involved in outbreak control can use these QIs to monitor the quality of response to infectious disease outbreaks and to assess in which domains improvement is needed.

Dientamoeba fragilis and chronic abdominal pain in children: a case-control study.

BACKGROUND: The association between Dientamoeba (D.) fragilis and the aetiology of functional gastrointestinal disorders (FGID) in children is unclear. AIM: The aim of this retrospective case-control study is to clarify the clinical relevance of D. fragilis in children with chronic abdominal pain. METHODS: From April 2011 until April 2013, a total of 132 patients with chronic abdominal pain (AP), aged 8-18 years, referred to a non-academic hospital, and 77 control patients, aged 8-18 years without gastrointestinal symptoms referred to a psychiatric hospital, were included in the study. D. fragilis was diagnosed by real-time PCR in faecal samples. Symptomatic children without a D. fragilis infection fulfilled the ROME III criteria for AP-related FGID (AP-FGID). Clinical data were retrospectively analysed by examining patients' hospital records from the Jeroen Bosch Hospital and Herlaarhof in The Netherlands. RESULTS: D. fragilis was detected in 57 patients with chronic AP (43.2%) and in 39 controls (50.6%) (p=0.255). No significant differences in symptomatology were found between D. fragilis-infected children and children fulfilling the criteria for AP-FGID. Parasitological eradication was achieved in 61.7% of patients after treatment with metronidazole or clioquinol, while clinical improvement occurred in only 40.4% of patients (p=0.435). CONCLUSIONS: There were no differences in symptoms comparing children with and without D fragilis infection. Furthermore, no relation was found between clinical and microbiological response after treatment for D. fragilis. This retrospective study suggests that there is no association between chronic AP and D. fragilis infection.

A patient-centered network approach to multidisciplinary-guideline development: a process evaluation.

BACKGROUND: Guideline development and uptake are still suboptimal; they focus on clinical aspects of diseases rather than on improving the integration of care. We used a patient-centered network approach to develop five harmonized guidelines (one multidisciplinary and four monodisciplinary) around clinical pathways in fertility care. We assessed the feasibility of this approach with a detailed process evaluation of the guideline development, professionals' experiences, and time invested. METHODS: The network structure comprised the centrally located patients and the steering committee; a multidisciplinary guideline development group (gynecologists, physicians, urologists, clinical embryologists, clinical chemists, a medical psychologist, an occupational physician, and two patient representatives); and four monodisciplinary guideline development groups. The guideline development addressed patient-centered, organizational, and medical-technical key questions derived from interviews with patients and professionals. These questions were elaborated and distributed among the groups. We evaluated the project performance, participants' perceptions of the approach, and the time needed, including time for analysis of secondary sources, interviews with eight key figures, and a written questionnaire survey among 35 participants. RESULTS: Within 20 months, this approach helped us develop a multidisciplinary guideline for treating infertility and four related monodisciplinary guidelines for general infertility, unexplained infertility, male infertility, and semen analysis. The multidisciplinary guideline included recommendations for the main medical-technical matters and for organizational and patient-centered issues in clinical care pathways. The project was carried out as planned except for minor modifications and three extra consensus meetings. The participants were enthusiastic about the approach, the respect for autonomy, the project coordinator's role, and patient involvement. Suggestions for improvement included timely communication about guideline formats, the timeline, participants' responsibilities, and employing a librarian and more support staff. The 35 participants spent 4497 hours in total on this project. CONCLUSIONS: The novel patient-centered network approach is feasible for simultaneously and collaboratively developing a harmonized set of multidisciplinary and monodisciplinary guidelines around clinical care pathways for patients with fertility problems. Further research is needed to compare the efficacy of this approach with more traditional approaches.

A new impetus for guideline development and implementation: construction and evaluation of a toolbox.

BACKGROUND: In the last decade, guideline organizations faced a number of problems, including a lack of standardization in guideline development methods and suboptimal guideline implementation. To contribute to the solution of these problems, we produced a toolbox for guideline development, implementation, revision, and evaluation. METHODS: All relevant guideline organizations in the Netherlands were approached to prioritize the topics. We sent out a questionnaire and discussed the results at an invitational conference. Based on consensus, twelve topics were selected for the development of new tools. Subsequently, working groups were composed for the development of the tools. After development of the tools, their draft versions were pilot tested in 40 guideline projects. Based on the results of the pilot tests, the tools were refined and their final versions were presented. RESULTS: The vast majority of organizations involved in pilot testing of the tools reported satisfaction with using the tools. Guideline experts involved in pilot testing of the tools proposed a variety of suggestions for the implementation of the tools. The tools are available in Dutch and in English at a web-based platform on guideline development and implementation (http://www.ha-ring.nl). CONCLUSIONS: A collaborative approach was used for the development and evaluation of a toolbox for development, implementation, revision, and evaluation of guidelines. This approach yielded a potentially powerful toolbox for improving the quality and implementation of Dutch clinical guidelines. Collaboration between guideline organizations within this project led to stronger linkages, which is useful for enhancing coordination of guideline development and implementation and preventing duplication of efforts. Use of the toolbox could improve quality standards in the Netherlands, and might facilitate the development of high-quality guidelines in other countries as well.

Biomarkers and molecular analysis to improve bloodstream infection diagnostics in an emergency care unit.

Molecular pathogen detection from blood is still expensive and the exact clinical value remains to be determined. The use of biomarkers may assist in preselecting patients for immediate molecular testing besides blood culture. In this study, 140 patients with ≥ 2 SIRS criteria and clinical signs of infection presenting at the emergency department of our hospital were included. C-reactive protein (CRP), neutrophil-lymphocyte count ratio (NLCR), procalcitonin (PCT) and soluble urokinase plasminogen activator receptor (suPAR) levels were determined. One ml EDTA blood was obtained and selective pathogen DNA isolation was performed with MolYsis (Molzym). DNA samples were analysed for the presence of pathogens, using both the MagicPlex Sepsis Test (Seegene) and SepsiTest (Molzym), and results were compared to blood cultures. Fifteen patients had to be excluded from the study, leaving 125 patients for further analysis. Of the 125 patient samples analysed, 27 presented with positive blood cultures of which 7 were considered to be contaminants. suPAR, PCT, and NLCR values were significantly higher in patients with positive blood cultures compared to patients without (p < 0.001). Receiver operating characteristic curves of the 4 biomarkers for differentiating bacteremia from non-bacteremia showed the highest area under the curve (AUC) for PCT (0.806 (95% confidence interval 0.699-0.913)). NLCR, suPAR and CRP resulted in an AUC of 0.770, 0.793, and 0.485, respectively. When compared to blood cultures, the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for SepsiTest and MagicPlex Sepsis Test were 11%, 96%, 43%, 80%, and 37%, 77%, 30%, 82%, respectively. In conclusion, both molecular assays perform poorly when one ml whole blood is used from emergency care unit patients. NLCR is a cheap, fast, easy to determine, and rapidly available biomarker, and therefore seems most promising in differentiating BSI from non-BSI patients for subsequent pathogen identification using molecular diagnostics.

Emergence of methicillin resistance and Panton-Valentine leukocidin positivity in hospital- and community-acquired Staphylococcus aureus infections in Beira, Mozambique.

OBJECTIVES: The objective of this study was to investigate the antibiotic resistance patterns, including methicillin resistance, inducible macrolide-lincosamide-streptogramin B (MLSB ) resistance and Panton-Valentine leukocidin (PVL) toxin gene carriage among hospital-acquired Staphylococcus aureus (HA-SA) and community-acquired S. aureus (CA-SA), in Beira, Mozambique. METHODS: In 2010-2011, two prospective surveillance studies were conducted on post-operative and burn wound infections at the Central Hospital of Beira and on skin and soft tissue abscesses at the São Lucas Health Centre. We cultured pus samples, identified suspected S. aureus isolates and performed antimicrobial susceptibility testing, including detection of MLSB resistance. Real-time polymerase chain reaction was used to detect mecA, Martineau and PVL genes. RESULTS: The prevalence of hospital-acquired methicillin-resistant S. aureus (HA-MRSA) infection among 53 inpatients was 15.1%; the prevalence of community-acquired methicillin-resistant S. aureus (CA-MRSA) infection among 100 outpatients was 1.0%. Inducible MLSB resistance was present in 41.7% and 10.7% of HA-SA and CA-SA isolates, respectively. PVL toxin gene was detected in 81.1% of methicillin-susceptible S. aureus (MSSA) compared with 11.1% of methicillin-resistant S. aureus. CONCLUSIONS: Our study shows, for the first time in Mozambique, the emergence of HA-MRSA. The prevalence of CA-MRSA was low, whereas the rate of PVL toxin gene carriage in MSSA was high. The high rate of inducible MLSB resistance indicates the importance of performing routine D-tests. Overall, our results show the need of strengthening laboratory facilities to provide microbiological data for both directed therapy and surveillance.

Probiotics for childhood functional gastrointestinal disorders: a systematic review and meta-analysis.

UNLABELLED: A systematic review and meta-analysis were performed to investigate the quantity and quality of the current evidence regarding the effect of different probiotic strains in the treatment of functional gastrointestinal disorders (FGID) in children and adolescents. CONCLUSION: Probiotics are more effective than placebo in the treatment of patients with abdominal pain-related FGID, especially with respect to patients with irritable bowel syndrome. To date, however, probiotics have not proved effective for children with functional constipation.

Extremely high prevalence of multi-resistance among uropathogens from hospitalised children in Beira, Mozambique.

OBJECTIVES: A prospective surveillance study was conducted to investigate the epidemiology and patterns of antibiotic resistance among uropathogens from hospitalised children in Beira, Mozambique. Additionally, information regarding determinants of a urinary tract infection (UTI) was obtained. METHODS: Bacterial species identification, antimicrobial susceptibility testing and extended-spectrum beta-lactamase testing were performed for relevant bacterial isolates. RESULTS: Analysis of 170 urine samples from 148 children yielded 34 bacterial isolates, predominantly Escherichia coli and Klebsiella spp., causative of a urinary tract infection in 29 children; 30/34 isolates (88.2%) from 26/29 children (89.7%) were considered highly resistant micro-organisms (HRMOs). No significant determinants of urinary tract infection with HRMOs were detected when analysing gender, antibiotic use during hospital admission and HIV status. CONCLUSION: This study shows, for the first time in Mozambique, an extremely high prevalence of HRMOs among uropathogens from hospitalised children with a urinary tract infection.