Viral aetiology and clinical outcomes in hospitalised infants presenting with respiratory distress.

AIM: To determine the prevalence of various types of viruses in infants hospitalised due to respiratory distress, compare molecular diagnostic tests and evaluate symptom severity. METHODS: All 136 nasopharyngeal aspirates from infants hospitalised for respiratory distress over a 9-month period were analysed for virus type by in-house respiratory syncytial virus (RSV) polymerase chain reaction (PCR) microarray-based and/or Luminex-based multiplex molecular tests. Medical records were reviewed retrospectively for clinical data. RESULTS: Viral aetiology was confirmed in 126 subjects (92.6%) with 26 infected by more than one virus. RSVA/B was the most common (50.9%), followed by entero/rhinovirus (21.6%), human metapneumovirus (10.5%), parainfluenza virus (5.9%) and influenza (3.3%). RSV-infected infants had significantly lower saturation levels (89% versus 92%, p < 0.001), higher demand for oxygen (42.7% versus 21.6%, p = 0.021) and fluids (28% versus 9.8%; p = 0.014) and longer hospital stays (4 versus 3 days, <0.001) than other viruses. Luminex assays gave repeatable, slightly less sensitive results than in-house RSV PCR. Microarray-based assays were more sensitive, however, producing some unrepeatable results. CONCLUSION: Respiratory syncytial virus dominates as the viral cause in hospitalised infants with respiratory distress in Sweden during the winter season, resulting in a clinical course that is significantly more severe. The multiplex assays produced reasonably concordant results.

Eradication of nasopharyngeal carriage of penicillin-non-susceptible Streptococcus pneumoniae--is it possible?

BACKGROUND: The South Swedish Pneumococcal Intervention Project (SSPIP) was started in 1995 with the aim of limiting the spread of penicillin-non-susceptible pneumococci (PNSP) in Skåne County, Sweden. As part of the SSPIP, eradication therapy with rifampicin in combination with 1 more antibiotic was considered on a social indication after prolonged carriage of 2-3 months. METHODS: In this retrospective study, 125 medical records were analyzed. Children aged 0-10 y referred for eradication therapy in Malmö and Lund, due to a prolonged nasopharyngeal carriage of PNSP with a penicillin G minimum inhibitory concentration of ≥ 0.5 mg/l, between the y 1997 and 2011 were included. Two consecutive negative cultures, with the second one no shorter than 7 days after treatment completion, were required for the carriage to be considered eradicated. RESULTS: Out of 125 children, 71 received treatment with rifampicin in combination with amoxicillin (n = 44), erythromycin (n = 22), or clindamycin (n = 5) for 7 days. Eradication treatment was successful in 91.5% of the children. Six children (8.5%) had treatment failure with amoxicillin and rifampicin; 3 were found by late follow-up. There was a trend towards a better outcome with erythromycin and clindamycin combinations in comparison to amoxicillin. CONCLUSIONS: Eradication therapy was successful, but a proper follow-up is essential.