Characterization of third-generation cephalosporin-resistant Escherichia coli from slaughter calves and fattening pigs: A pilot study for monitoring antimicrobial resistance by whole genome sequencing in Switzerland.

INTRODUCTION: Whole genome sequencing (WGS) was introduced into Swiss antimicrobial resistance monitoring in 2022 as an additional method to phenotypic antimicrobial susceptibility testing by broth microdilution to characterize presumptive third-generation cephalosporin-resistant (3GC-R) Escherichia coli. Caecal samples from Swiss slaughter calves and fattening pigs, as well as beef and pork meat from Swiss retail taken in 2021, were analyzed for the presence of 3GC-R E. coli according to European harmonized protocols. In 2021, 3GC-R E. coli was detected in 23,8 % of slaughter calves, 5,9 % of fattening pigs, and 0 % of meat. Comparative analysis of the antimicrobial resistance results obtained by phenotypic measurement and those obtained by the detection of corresponding underlying molecular mechanisms by WGS showed very high agreement (99 %). Resistance to third-generation cephalosporins (3GCs) was mainly associated with the presence of blaCTX-M-15 in E. coli isolates from calves and blaCTX-M-1 in E. coli isolates from pigs and mutations in the ampC-promoter (g.-42 C>T) in E. coli isolates from both animal species. Moreover, WGS data were used for phylogenetic analysis based on multi locus sequence types (MLST) and core genome MLST(cgMLST) revealing that 3GC-R E. coli isolated from Swiss slaughter calves and fattening pigs were genetically diverse. In this study, it was shown that using WGS alone to monitor antimicrobial resistance could detect trends in known molecular antimicrobial resistance mechanisms while also providing other valuable information about the isolates, such as genetic relatedness. However, only by combining phenotypic susceptibility testing and WGS early detection of previously unknown resistance mechanisms will be possible.

INTRODUCTION: Le séquençage du génome entier (Whole Genome Sequencing, WGS) a été introduit dans la surveillance suisse de la résistance aux antibiotiques en 2022 en tant que méthode supplémentaire aux tests phénotypiques de sensibilité aux antibiotiques pour caractériser les Escherichia coli résistants aux céphalosporines de troisième génération (3GC-R). Des échantillons de cæcum pris en 2021 à l'abattoir de veaux et de porcs suisses, ainsi que de viande de bœuf et de porc provenant de détaillants suisses ont été analysés pour détecter la présence d'E. coli 3GC-R conformément aux protocoles européens harmonisés. En 2021, les E. coli 3GC-R ont été détectés dans 23,8 % des veaux d'abattage, 5,9 % des porcs d'engraissement et 0 % dans la viande. Les résultats de résistance aux antibiotiques obtenus par mesure phénotypique et ceux obtenus par la détection des mécanismes moléculaires sous-jacents concordaient à 99 %. La résistance aux céphalosporines de troisième génération était principalement associée à la pré-sence de blaCTX-M-15 dans les isolats d'E. coli provenant de veaux et de blaCTX-M-1 dans les isolats d'E. coli provenant de porcs et à des mutations dans le promoteur ampC (g.-42 C>T) dans les isolats d'E. coli provenant des deux espèces animales. Les données WGS ont également été utilisées pour une analyse phylogénétique basée sur les types de séquences multilocus (MLST) et MLST du génome de base (cgMLST) révélant que les E. coli 3GC-R isolés des veaux et des porcs suisses étaient génétiquement divers. Dans cette étude, il a été démontré que l'utilisation du WGS seul pour surveiller la résistance aux antibiotiques pouvait détecter des tendances dans les mécanismes moléculaires connus de la résistance aux antibiotiques tout en fournissant d'autres informations précieuses sur les isolats, comme la parenté génétique. Cependant, ce n'est qu'en combinant les tests de sensibilité phénotypique avec le WGS que la détection pré-coce de mécanismes de résistance inconnus sera possible.

Impaired antibody memory to varicella zoster virus in HIV-infected children: low antibody levels and avidity*.

OBJECTIVE: HIV-infected children have impaired antibody responses after exposure to certain antigens. Our aim was to determine whether HIV-infected children had lower varicella zoster virus (VZV) antibody levels compared with HIV-infected adults or healthy children and, if so, whether this was attributable to an impaired primary response, accelerated antibody loss, or failure to reactivate the memory VZV response. METHODS: In a prospective, cross-sectional and retrospective longitudinal study, we compared antibody responses, measured by enzyme-linked immunosorbent assay (ELISA), elicited by VZV infection in 97 HIV-infected children and 78 HIV-infected adults treated with antiretroviral therapy, followed over 10 years, and 97 age-matched healthy children. We also tested antibody avidity in HIV-infected and healthy children. RESULTS: Median anti-VZV immunoglobulin G (IgG) levels were lower in HIV-infected children than in adults (264 vs. 1535 IU/L; P<0.001) and levels became more frequently unprotective over time in the children [odds ratio (OR) 17.74; 95% confidence interval (CI) 4.36-72.25; P<0.001]. High HIV viral load was predictive of VZV antibody waning in HIV-infected children. Anti-VZV antibodies did not decline more rapidly in HIV-infected children than in adults. Antibody levels increased with age in healthy (P=0.004) but not in HIV-infected children. Thus, antibody levels were lower in HIV-infected than in healthy children (median 1151 IU/L; P<0.001). Antibody avidity was lower in HIV-infected than healthy children (P<0.001). A direct correlation between anti-VZV IgG level and avidity was present in HIV-infected children (P=0.001), but not in healthy children. CONCLUSION: Failure to maintain anti-VZV IgG levels in HIV-infected children results from failure to reactivate memory responses. Further studies are required to investigate long-term protection and the potential benefits of immunization.

Acute transverse myelitis in Lyme neuroborreliosis.

INTRODUCTION: Acute transverse myelitis (ATM) is a rare disorder (1-8 new cases per million of population per year), with 20% of all cases occurring in patients younger than 18 years of age. Diagnosis requires clinical symptoms and evidence of inflammation within the spinal cord (cerebrospinal fluid and/or magnetic resonance imaging). ATM due to neuroborreliosis typically presents with impressive clinical manifestations. CASE PRESENTATION: Here we present a case of Lyme neuroborreliosis-associated ATM with severe MRI and CSF findings, but surprisingly few clinical manifestations and late conversion of the immunoglobulin G CSF/blood index of Borrelia burgdorferi sensu lato. CONCLUSION: Clinical symptoms and signs of neuroborrelial ATM may be minimal, even in cases with severe involvement of the spine, as shown by imaging studies. The CSF/blood index can be negative in the early stages and does not exclude Lyme neuroborreliosis; if there is strong clinical suspicion of Lyme neuroborreliosis, appropriate treatment should be started and the CSF/blood index repeated to confirm the diagnosis.

H-ficolin serum concentration and susceptibility to fever and neutropenia in paediatric cancer patients.

H-ficolin (Hakata antigen, ficolin-3) activates the lectin pathway of complement similar to mannose-binding lectin. However, its impact on susceptibility to infection is currently unknown. This study investigated whether the serum concentration of H-ficolin at diagnosis is associated with fever and neutropenia (FN) in paediatric cancer patients. H-ficolin was measured by time-resolved immunofluorometric assay in serum taken at cancer diagnosis from 94 children treated with chemotherapy. The association of FN episodes with H-ficolin serum concentration was analysed by multivariate Poisson regression. Median concentration of H-ficolin in serum was 26 mg/l (range 6-83). Seven (7%) children had low H-ficolin (< 14 mg/l). During a cumulative chemotherapy exposure time of 82 years, 177 FN episodes were recorded, 35 (20%) of them with bacteraemia. Children with low H-ficolin had a significantly increased risk to develop FN [relative risk (RR) 2.24; 95% confidence interval (CI) 1.38-3.65; P = 0.004], resulting in prolonged duration of hospitalization and of intravenous anti-microbial therapy. Bacteraemia occurred more frequently in children with low H-ficolin (RR 2.82; CI 1.02-7.76; P = 0.045). In conclusion, low concentration of H-ficolin was associated with an increased risk of FN, particularly FN with bacteraemia, in children treated with chemotherapy for cancer. Low H-ficolin thus represents a novel risk factor for chemotherapy-related infections.

Prospective population-based study of RSV-related intermediate care and intensive care unit admissions in Switzerland over a 4-year period (2001-2005).

OBJECTIVES: Respiratory syncytial virus (RSV) infections are a leading cause of hospital admissions in small children. A substantial proportion of these patients require medical and nursing care, which can only be provided in intermediate (IMC) or intensive care units (ICU). This article reports on all children aged < 3 years who required admission to IMC and/or ICU between October 1, 2001 and September 30, 2005 in Switzerland. PATIENTS AND METHODS: We prospectively collected data on all children aged < 3 years who were admitted to an IMC or ICU for an RSV-related illness. Using a detailed questionnaire, we collected information on risk factors, therapy requirements, length of stay in the IMC/ICU and hospital, and outcome. RESULTS: Of the 577 cases reported during the study period, 90 were excluded because the patients did not fulfill the inclusion criteria; data were incomplete in another 25 cases (5%). Therefore, a total of 462 verified cases were eligible for analysis. At the time of hospital admission, only 31 patients (11%) were older than 12 months. Since RSV infection was not the main reason for IMC/ICU admission in 52% of these patients, we chose to exclude this subgroup from further analyses. Among the 431 infants aged < 12 months, the majority (77%) were former near term or full term (NT/FT) infants with a gestational age > or = 35 weeks without additional risk factors who were hospitalized at a median age of 1.5 months. Gestational age (GA) < 32 weeks, moderate to severe bronchopulmonary dysplasia (BPD), and congenital heart disease (CHD) were all associated with a significant risk increase for IMC/ICU admission (relative risk 14, 56, and 10, for GA < or = 32 weeks, BPD, and CHD, respectively). Compared with NT/FT infants, high-risk infants were hospitalized at an older age (except for infants with CHD), required more invasive and longer respiratory support, and had longer stays in the IMC/ICU and hospital. CONCLUSIONS: In Switzerland, RSV infections lead to the IMC/ICU admission of approximately 1%-2% of each annual birth cohort. Although prematurity, BPD, and CHD are significant risk factors, non-pharmacological preventive strategies should not be restricted to these high-risk patients but also target young NT/FT infants since they constitute 77% of infants requiring IMC/ICU admission.

Swiss recommendations for the management of varicella zoster virus infections.

Infections with varicella zoster virus (VZV) are common viral infections associated with significant morbidity. Diagnosis and management are complex, particularly in immunocompromised patients and during pregnancy. The present recommendations have been established by a multidisciplinary panel of specialists and endorsed by numerous Swiss medical societies involved in the medical care of such patients (Appendix). The aim was to improve the care of affected patients and to reduce complications.

The prevalence of penicillin-non-susceptible Streptococcus pneumoniae among children aged < 5 years correlates with the biannual epidemic activity of respiratory syncytial virus.

This study investigated whether the epidemiology of penicillin-non-susceptible pneumococci (PNSP) colonising small children correlated with the biannual epidemic activity of respiratory syncytial virus (RSV). Colonisation rates and the prevalence of PNSP among paediatric outpatients aged < 5 years was analysed between January 1998 and September 2003 using an established national surveillance network. Resistance trends were investigated using time-series analysis to assess the correlation with the biannual pattern of RSV infections and national sales of oral paediatric formulations of antibiotics and antibiotic prescriptions to children aged < 5 years for acute respiratory tract infections. PNSP rates exhibited a biannual cycle in phase with the biannual seasonal RSV epidemics (p < 0.05). Resistance rates were higher during the winter seasons of 1998-1999 (20.1%), 2000-2001 (16.0%) and 2002-2003 (19.1%), compared with the winter seasons of 1997-1998 (8.2%), 1999-2000 (11.6%) and 2001-2002 (9.5%). Antibiotic sales and prescriptions showed regular peaks during each winter, with no significant correlation with the biannual pattern of RSV activity and seasonal trends of PNSP. RSV is an important determinant of the spread of PNSP and must be considered in strategies aimed at antimicrobial resistance control.

Frontotemporal dementia, semantic dementia, and Alzheimer's disease: the contribution of standard neuropsychological tests to differential diagnosis.

CERAD-NAB (Consortium to Establish a Registry for Alzheimer's Disease-Neuropsychological Assessment Battery) data were compared between 51 patients with frontotemporal dementia, 13 with semantic dementia, and 69 with Alzheimer's disease. There were statistically significant differences between the 3 groups. Compared with patients with Alzheimer's disease, patients with frontotemporal dementia were more impaired on Animal Fluency but not on any other CERAD-NAB subtest. Patients with semantic dementia performed worse in Animal Fluency and Boston Naming Test compared with frontotemporal dementia and Alzheimer's disease. Multiple logistic regression analysis revealed that in the differentiation between frontotemporal dementia and Alzheimer's disease, the combination of Animal Fluency and Boston Naming Test correctly classified 90.5% of patients. In segregating semantic dementia and Alzheimer's disease, the combination of Boston Naming Test and Mini Mental State Examination resulted in a correct classification of 96.3%. These findings demonstrate that the Mini Mental State Examination and the language subtests of the CERAD-NAB are valuable clinical instruments for the differential diagnosis between early frontotemporal dementia, semantic dementia, and Alzheimer's disease.

[Prevention of tick-borne encephalitis (TBE)]. / Prävention der Früh- sommer-Meningoenzephalitis (FSME).

Active immunization is the only reliable means of preventing TBE. Evidence suggests that effectiveness is greater than 95%. Breakthrough infections in fully immunized individuals, however, do occur. Recent data indicate that the duration of protection following basic immunization is substantially longer than previously appreciated. The vast majority of vaccinees are still seropositive > or = 8 years after the last dose. Thus, the current practice of administering booster doses every 3 years is a topic of intense debate. Until it is resolved, patients can be offered the determination of a serum anti-TBE IgG titre as an alternative to "blind" administration of a booster dose. It has recently been shown that seropositivity determined by some commonly used commercial ELISA tests correlates closely with the presence of protective antibody. In Switzerland, TBE vaccination is currently recommended for individuals older than 6 years of age who frequently dwell in endemic areas. Since 2005, health care insurances are required to cover for costs incurred by immunization according to these recommendations.

[Exanthema as a main symptom in the febrile child]. / Exanthem als Leit--symptom beim febrilen Kind.

Distinguishing in febrile children between harmless rashes and those, which require specific action, is a common problem in pediatric primary care. Major exanthematous diseases necessitating emergency hospitalization include invasive meningococcal disease and rarely gram-negative septicaemia caused by other pathogens, staphylococcal and streptococcal toxic shock syndrome, endocarditis, fever and rash in travellers returning from tropical countries and drug hypersensitivity syndrome. Therapeutic intervention is also necessary in patients with scarlet fever, rheumatic fever, varicella in postpuberal and immunocompromised individuals, in Kawasaki's disease, in Still's disease and in other non-infectious, inflammatory diseases (e.g., familial mediterranean fever). Finally, various specific measures need to be taken in reportable diseases, erythema infectiosum (parvovirus B19), primary HIV infection and in Henoch-Schölein purpura.

Autoantibodies directed against bactericidal/permeability-increasing protein in patients with cystic fibrosis: association with microbial respiratory tract colonization.

BACKGROUND: Cystic fibrosis (CF) is associated with the appearance of serum autoantibodies directed against bactericidal/permeability-increasing protein (BPI). OBJECTIVES: To determine the age-specific seroprevalence rates of anti-BPI-IgG and IgA in a population of patients with CF and to correlate anti-BPI antibody concentrations with microbial respiratory tract colonization and pulmonary function variables at the time of serum sampling and 6 years thereafter. METHODS: Determination of BPI antibodies of the IgG and IgA isotypes using a commercial enzyme-linked immunosorbent assay in sera of a CF serum bank of 1992; correlation of anti-BPI antibody concentrations with age, clinical score, pulmonary function variables in 1992 and 1998, total serum immunoglobulin isotype concentrations and respiratory tract colonization with Pseudomonas aeruginosa and Aspergillus spp. RESULTS: Seventy-one patients (age in 1992, 14.1 +/- 7.5 years) were studied. Reactivities for anti-BPI-IgG and IgA were found in 28 (39%) and 26 (37%) patients, respectively. The seroprevalence of anti-BPI-IgA, but not IgG, increased significantly with age. P. aeruginosa colonization was associated with elevated concentrations of anti-BPI-IgG (P = 0.003) and IgA (P = 0.037). There were significant negative correlations between pulmonary function variables (vital capacity, forced expiratory volume in 1 s) in 1992 and 1998, respectively, and concentrations of anti-BPI-IgG or IgA in a multiple regression analysis. Anti-BPI-IgG, but not IgA, remained significantly associated with P. aeruginosa colonization (P = 0.006) and with reduced vital capacity (P = 0.01) in 1998 after correction for total serum isotype concentration. CONCLUSIONS: Anti-BPI-IgG are strongly associated with concurrent P. aeruginosa colonization and with long term restrictive pulmonary function abnormalities.

Respiratory response to salbutamol (albuterol) in ventilator-dependent infants with chronic lung disease: pressurized aerosol delivery versus intravenous injection.

OBJECTIVE: To compare the effects of intravenously injected with inhaled salbutamol in ventilator dependent infants with chronic lung disease (CLD). DESIGN: Prospective randomized study which each patient served as his/her own control. SETTING: Multidisciplinary neonatal and pediatric ICU. PATIENTS: 8 ventilator dependent premature infants with CLD. INTERVENTIONS: Salbutamol, 10 micrograms/kg was given intravenously, and 10-19 h later, twice 100 micrograms as pressurized aerosol, or vice versa, sequence randomized. The pressurized aerosol was delivered by a metered dose inhaler into a newly developed aerosol holding chamber, integrated into the inspiratory limb of the patient circuit. Respiratory system mechanics were assessed by the single breath occlusion method before and 10 and 60 min after drug administration. MEASUREMENTS AND RESULTS: Compliance improved significantly after intravenous injection (0.48 +/- 0.18 to 0.67 +/- 0.16, p < 0.01 and 0.59 +/- 0.23 ml/cmH2O/kg, NS, (mean +/- 1 SD) and after inhalation (0.46 +/- 0.19 to 0.64 +/- 0.32, p < 0.01 and 0.56 +/- 0.31 ml/cmH2O/kg, NS). Resistance decreased after iv. use (0.38 +/- 0.17 to 0.25 +/- 0.11, p < 0.001 and 0.25 +/- 0.10 cmH2O/ml/s, NS) and after inhalation (0.35 +/- 0.12 to 0.27 +/- 0.09, p < 0.01 and 0.28 +/- 0.12 cmH2O/ml/s, NS). Heart rate increased significantly after both routes of application, whereas mean arterial pressure, respirator settings, FIO2, transcutaneous SO2 and capillary PCO2 did not change. CONCLUSIONS: Inhaled and intravenous salbutamol improves pulmonary mechanics to the same extent with comparable side effects, and may therefore be used to facilitate weaning from respirators.

Characterisation of an outer membrane protein of Moraxella catarrhalis.

To elucidate potential vaccine antigens, Moraxella catarrhalis outer membrane proteins (OMPs) were studied. We have previously shown an OMP to be a target for human IgG and have now further characterised this OMP which appears to have a molecular mass of 84 kDa and to be distinct from the 81-kDa OMP, CopB. Human transferrin was shown to bind the 84-kDa OMP alone. N-terminal sequencing of this OMP and purified M. catarrhalis transferrin binding protein B (TbpB) revealed homology both with each other and with the TbpB of Haemophilus influenzae and Neisseria meningitidis. Adsorption of human anti-serum with purified TbpB from two M. catarrhalis strains abolished or reduced binding of IgG to the 84-kDa OMP from three M. catarrhalis isolates. IgG binding to CopB was unaffected. It is clear that the 84-kDa OMP is distinct from CopB and is a likely homologue of TbpB.

Lung mechanics and gas exchange in ventilated preterm infants during treatment of hyaline membrane disease with multiple doses of artificial surfactant (Exosurf)

Eight premature infants ventilated for hyaline membrane disease and enrolled in the OSIRIS surfactant trial were studied. Lung mechanics, gas exchange [PaCO2, arterial/alveolar PO2 ratio (a/A ratio)], and ventilator settings were determined 20 minutes before and 20 minutes after the end of Exosurf instillation, and subsequently at 12-24 hour intervals. Respiratory system compliance (Crs) and resistance (Rrs) were measured by means of the single breath occlusion method. After surfactant instillation there were no significant immediate changes in PaCO2 (36 vs. 37 mmHg), a/A ratio (0.23 vs. 0.20), Crs (0.32 vs. 0.31 mL/cm H2O/kg), and Rrs (0.11 vs. 0.16 cmH2O/mL/s) (pooled data of 18 measurement pairs). During the clinical course, mean a/A ratio improved significantly each time from 0.17 (time 0) to 0.29 (time 12-13 hours), to 0.39 (time 24-36 hours) and to 0.60 (time 48-61 hours), although mean airway pressure was reduced substantially. Mean Crs increased significantly from 0.28 mL/cmH2O/kg (time 0) to 0.38 (time 12-13 hours), to 0.37 (time 24-38 hours), and to 0.52 (time 48-61 hours), whereas mean Rrs increased from 0.10 cm H2O/mL/s (time 0) to 0.11 (time 12-13 hours), to 0.13 (time 24-36 hours) and to (time 48-61 hours) with no overall significance. A highly significant correlation was found between Crs and a/A ratio (r = 0.698, P less than 0.001). We conclude that Exosurf does not induce immediate changes in oxygenation as does the instillation of (modified) natural surfactant preparations. However, after 12 and 24 hours of treatment oxygenation and Crs improve significantly.(ABSTRACT TRUNCATED AT 250 WORDS)

Febrile seizures and parental anxiety: does information help?

AIM OF THE STUDY: To investigate the effect of febrile seizures on the behaviour and emotional situation of parents in order to improve our attitude towards these children and parents in future. METHODS: We analysed 135 questionnaires on parents' behaviour and emotional situation during and after a febrile seizure in their children. RESULTS: Febrile seizures were unknown to 44% of the parents. 121 parents (91%) reported severe anxiety on witnessing the first febrile seizure. In 69% the anxiety was so strong, that the parents believed their child would die. Severe anxiety was significantly associated with lack of knowledge about febrile seizures: 79% (no knowledge of febrile seizures) versus 59% (with knowledge). The level of anxiety appeared to be associated with low educational level, but not with ethnic background or income. CONCLUSIONS: Our study shows that knowledge of febrile seizures among concerned parents in our region remains insufficient. The results are ambiguous. On the one hand we found an association between severe anxiety and lack of knowledge on febrile seizures, suggesting that information prior to the first febrile seizure might reduce the anxiety level and thus lead to appropriate reactions in case of recurrence. On the other hand although parents knew about febrile seizures, they still had very high anxiety levels and would react inappropriately in case of recurrence. Therefore if information is provided to parents, it must be specific, especially about which measures are to be taken or avoided respectively. A prospective study to observe positive and negative effects of preventive information is needed.

Regional impact of prophylaxis with the monoclonal antibody palivizumab on hospitalisations for respiratory syncytial virus in infants.

QUESTIONS: Palivizumab is approved in Switzerland for prevention of hospitalisation for RSV infection in children with one of the following risk factors: (1) history of prematurity < or = 35 weeks and age < or = 6 months or (2) chronic lung disease and age < or = 1 year. Regional data on the expected effectiveness of this monoclonal antibody are not available. METHODS: (1) Retrospective, descriptive, single-site study on the characteristics of RSV hospitalisations during two consecutive seasons. (2) Extrapolation of data to generate population-based estimates on the impact of palivizumb if used according to the approved indications. RESULTS: Of 242 RSV hospitalisations, 216 (89.3%) and 26 (10.7%) occurred in children without and with risk factors, respectively. Patients without and with risk factors had similar clinical courses with respect to ICU admission rate (11.6 vs. 11.5%) and rate of mechanical ventilation (3.2 vs. 3.8%). Of a total of 28 ICU admissions, 13 (46%) occurred among infants aged < or = 1 month without risk factors. Former premature infants were significantly older than patients with longer gestation (median age 7.5 vs. 3.7 months, p = 0.026). Applying the approved age criteria would have excluded 10 of 26 patients (38.5%) from eligibility for palivizumab. During the 1999/2000 RSV season, 36% of hospitalisations occurred after April 1, 2000. None of them may have been preventable had prophylaxis been started before November 1, 1999 and carried out for 5 months as recommended. In an annual birth cohort of 10,000, palivizumab as indicated would be expected to prevent between 5 and 7 RSV hospitalisations. CONCLUSIONS: The impact of palivizumab on the prevention of RSV hospitalisations in the Canton of Bern, Switerland, is expected to be small, and the approved indications may not target infants at greatest risk for severe disease.

[Antimicrobial resistance--consequences for ambulatory treatment of infections in children]. / Antimikrobielle Resistenzen--Konsequenzen für die ambulante Behandlung von Infektionskrankheiten bei Kindern.

Increasing antimicrobial resistance among clinical isolates of Streptococcus pneumoniae calls for a revision of treatment strategies for pediatric infections, particularly for acute otitis media. Restrictive use of antimicrobials is the key strategy for slowing the spread of resistances. Before initiation of antimicrobial therapy, suspected bacterial infections should be confirmed clinically (e.g. by observation of the natural evolution) or microbiologically. For acute otitis media, oral amoxicillin remains the drug of choice because of superior middle ear pharmacokinetics and pharmacodynamics. Treatment failure caused by resistance of the infecting pneumococcus can be overcome be increasing the dose, and not by switching to another class of antibiotics (e.g., cephalosporin, macrolide, cotrimoxazole), which is less likely to achieve middle ear eradication a priori. Widespread macrolide resistance among isolates of S. pneumoniae precludes the use of this class of antimicrobials for empiric therapy of community-acquired pneumonia in children. Aminopenicillins are preferred because of their rapidly bactericidal activity against the most common organisms causing potentially progressive pneumonia in children.

[Infections in pregnancy]. / Infektionen in der Schwangerschaft.

Infections in pregnancy may complicate its course and harm the fetus or newborn after vertical transmission. Treatment of asymptomatic bacteriuria is mandatory in pregnant women given the high risk of secondary pyelonephritis. Intraamniotic infection usually arises by the ascending route and is associated with premature rupture of membranes. Vaginal infections promote preterm labour or premature rupture of membranes and may be transmitted to the child during labour. They must therefore be treated although they often cause little discomfort to the pregnant woman. Systemic infections due to viral, protozoal and bacterial pathogens may be transmitted transplacentally and cause embryopathies, fetopathies or neonatal infections. Depending on the responsible agent the negative impact on the course of pregnancy and on the fetus' or neonate's health can be prevented or reduced by prophylactic or therapeutic interventions.