1. Lancet. 2009 Jan 17;373(9659):270. Cunning and community-acquired pneumonia. Broadfield E, Doshi N, Alexander PD, Greaves M, Woodcock A.

Department of Intensive Care Medicine, University Hospital of South Manchester, Manchester, UK. PMID: 19150706 [PubMed - indexed for MEDLINE] 2. Pediatr Infect Dis J. 2009 Jan;28(1 Suppl):S10-8. Pathogens associated with sepsis in newborns and young infants in developing countries. Zaidi AK, Thaver D, Ali SA, Khan TA. Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan. anita.zaidi@aku.edu INTRODUCTION: Knowledge of pathogens causing infections in young infants (up to 90 days of life) is essential for devising community-based management strategies . Most etiological data from developing countries are hospital-based and may have little relevance to communities in which most babies are born at home. METHODS: We searched the literature for studies from developing countries reporting etiology of community-acquired infections (sepsis, pneumonia, meningitis) published since 1980. Hospital-based studies reporting early onset sepsis, sepsis among babies admitted from, or born at home were included. RESULTS: Of 63 studies, 13 focused on community-acquired infections, but limited data were available from home-born neonates. In the first week of life (3209 isolates), Klebsiella species (25%), Escherichia coli (15%), and Staphylococcus aureus (18%) were major pathogens. Group B streptococci (GBS) were relatively uncommon (7%), although regional differences existed. After the first week of life (835 isolates), S. aureus (14%), GBS (12%), Streptococcus pneumoniae (12%), and nontyphoidal Salmonella species (13%) were most frequent. S. pneumoniae (27% ) was most common in the postneonatal period (among 141 isolates). Gram-negatives predominated (77%) among home-delivered babies (among 170 isolates). CONCLUSIONS: Limited information is available on etiology of serious bacterial infections in community settings. Hospital-based studies suggest that most infections in the first week of life are due to Gram-negative pathogens, and man y may be environmentally rather than maternally-acquired, owing to unhygienic delivery practices. Such practices may also explain the predominance of Gram-negative infections among home-born infants, although data from home settings are limited. These findings have implications for developing prevention and management strategies in communities and hospitals. PMID: 19106757 [PubMed - indexed for MEDLINE] 3. Pediatr Infect Dis J. 2009 Jan;28(1 Suppl):S1-2.

Neonatal sepsis: a major global public health challenge. Qazi SA, Stoll BJ. Department of Child and Adolescent Health and Development, World Health Organization, Geneva, Switzerland. qazis@who.int PMID: 19106756 [PubMed - indexed for MEDLINE] 4. Pediatr Infect Dis J. 2009 Feb;28(2):108-13. Community-acquired bacteremia among children admitted to a rural hospital in Mozambique. Sigaque B, Roca A, Mandomando I, Morais L, Quint L, Sacarlal J, Macete E, Nhamposa T, Machevo S, Aide P, Bassat Q, Bardaj A, Nhalungo D, Soriano-Gabarr M, Flannery B, Menendez C, Levine MM, Alonso PL. Centro de Investigao em Sade da Manhia, Maputo, Mozambique. betuel.sigauque@manhica.net BACKGROUND: Although community-acquired bacteremia is an important cause of childhood mortality in Africa, recognition of disease burden and potential impac t of bacterial vaccines is limited. METHODS: Blood cultures for bacterial pathogens were conducted systematically among children <15 years of age admitted to Manhia District Hospital, from 2001 to 2006. RESULTS: Blood-stream infections were identified in 8% (1550/19,896) of pediatri c hospital admissions. Nontyphoidal Salmonella (NTS) and Pneumococcus were the mos t prevalent pathogens isolated (26% and 25% of 1550 cases, respectively). Until 28 days of life, Staphylococcus aureus (39%) and group B Streptococcus (20%) predominated. Incidence of community-acquired bacteremia per 100,000 child-years was 1730/10 in children <1 year old, 782/10 in 1-4 year oldd, and 49/10 in children 5 years and older. Case-fatality of bacteremia was 12%. Community-acquired bacteremia associated mortality accounted for 21% (162/788) o f hospital deaths. Resistance to antibiotics commonly used in Mozambique was high among invasive isolates of Haemophilus influenzae, Escherichia coli, and NTS. CONCLUSIONS: Community-acquired bacteremia is an important cause of pediatric hospital admission and death in rural African hospitals. The high burden of disease, mortality, and pattern of antibiotic resistance associated with bacteremia underscore the need for prevention in Sub-Saharan Africa. PMID: 19131902 [PubMed - indexed for MEDLINE] 5. Pediatr Infect Dis J. 2009 Jan;28(1 Suppl):S3-9. Burden of neonatal infections in developing countries: a review of evidence from community-based studies. Thaver D, Zaidi AK.

Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan. INTRODUCTION: Infections are a major contributor to newborn deaths in developing countries. Majority of these deaths occur at home without coming to medical attention. The Millennium Development Goal for child survival cannot be achieved without substantial reductions in infection-specific neonatal mortality. We describe the burden of neonatal infections in developing countries and discuss the need for community-based management approaches to improve survival from neonatal infections in these countries. METHODS: We reviewed community-based studies published since 1990 from developin g countries to estimate the rates of neonatal and young infant infections and infection-specific neonatal mortality. RESULTS: Thirty-two studies reviewed suggest that infections may be responsible for 8% to 80% of all neonatal deaths and as many as 42% of deaths in the first week of life. Eleven reports provided data on incidence of infections in neonate s and infants up to 60 days of life. Rates of neonatal sepsis were as high as 170/1000 live births (clinically diagnosed) and 5.5/1000 live births (blood culture-confirmed). CONCLUSIONS: Considerable heterogeneity exists among included studies, and more accurate data and standardized methodologies are required. However, data indicat e that a significant proportion of neonatal deaths in developing countries are due to infections. Current recommendations of hospitalization and parenteral therapy for managing neonatal infections are inadequately followed in developing countries. Approaches for detecting and managing serious infections within the community, at home or first-level health facilities, may be more effective options in settings where delays and reluctance to seek care, health system inefficiencies, socioeconomic and cultural, as well as logistic constraints exist. PMID: 19106760 [PubMed - indexed for MEDLINE] 6. Scand J Infect Dis. 2009;41(3):182-7. Complicated community acquired pneumonia in children prior to the introduction o f the pneumococcal conjugated vaccine. Goldbart AD, Leibovitz E, Porat N, Givon-Lavi N, Drukmann I, Tal A, Greenberg D. Department of Paediatrics, Soroka University Medical Centre, Beer-Sheva, Israel. avivgold@bgu.ac.il Increasing prevalence of pleural empyema (PE) complicating community acquired pneumonia (CAP) is reported worldwide. We compared hospitalized children with PE or non-purulent pleural effusion (NP-PEF) prior to the inclusion of the pneumococcal conjugated vaccine (PCV7) in the Israeli immunization schedule. We conducted a retrospective analysis of medical files of all children <18 y of age hospitalized with either PE or NP-PEF and CAP during 1990-2002. 75 children with

NP-PEF and 37 with PE were identified. PE annual incidence increased from 0.5 in 1990 to 4.2 per 100,000 children in 2002. Higher WBC and absolute neutrophils counts were found in sera and pleural fluid of PE. The leading pathogens include d Streptococcus pneumoniae (42%, all penicillin-susceptible) and Staphylococcus aureus (23%, all methicillin-susceptible). Blood cultures were positive only in children with PE (12/37, 32.4%). Patients with PE presented with higher respiratory rate and required longer hospitalization, more PICU admission, and more patients needed mechanical ventilation. PE prevalence increased in southern Israel during the study period. Streptococcus pneumoniae (62.5% serotype 1) was the most common pathogen causing PE before the introduction of PCV7. Future introduction of PCV7 or equivalents in the immunization schedule may impact clinical presentation and epidemic trends and will require future consideration. PMID: 19117244 [PubMed - indexed for MEDLINE] 7. Zhonghua Er Ke Za Zhi. 2008 Oct;46(10):728-31. [Bacterial etiology of pneumonia in hospitalized children: combined detection with culture and polymerase chain reaction]. [Article in Chinese] Zheng YJ, Deng JK, Zhao RZ. Division of Respiratory Diseases, Shenzhen Children's Hospital, Shenzhen 518026, China. OBJECTIVE: Bacterial cultures from respiratory aspirate or sputum have been the conventional diagnostic method for pneumonia, but the results of culture was often affected by early extensive use of antibiotics, sample collection and delivery. The objective of this study was to explore application of the combined detection of culture and polymerase chain reaction (PCR) assay in hospitalized children with pneumonia. METHODS: Totally 187 hospitalized children with pneumonia were enrolled. The age of the patients ranged from 1 month to 10 years, 124 were male, 63 female; 175 o f the patients received antibiotics treatment before admission. Deep respiratory aspirate sample from patients was cultured by Streptococcus pneumoniae selective plate, Hemophilus influenzae selective plate and conventional plate. The aspirat e samples were also amplified for DNA of 14 bacteria with target enriched multiple x polymerase chain reaction (Tem-PCR) and detected with Luminex xMAP technology platform. RESULTS: The total positive rate by bacterial culture was 40.1% (75/187), of which 17.1% (24/187) were Hemophilus influenzae b, 8.6% (16/187) were Escherichi a coli, 6.4% (12/187) were Klebsiella pneumoniae, 4.8% (9/187) were Staphylococcus aureus, 3.7% (7/187) were Streptococcus pneumoniae, 1.6% (3/187) were Pseudomona s

aeruginosa, 1.1% (2/187) were Acinetobacter baumannii, and 1.1% (2/187) were Enterobacter cloacae. The total positive rate by combined detection of culture and Tem-PCR assay were 78.6% (147/187), of which 28.9% (54/187) were Hemophilus influenzae b, 19.3% (36/187) were Streptococcus pneumoniae, 8.6% (16/187) were Escherichia coli, 6.4% (12/187) were Klebsiella pneumoniae, 5.9% (11/187) were Staphylococcus aureus, 5.9% (11/187) were Acinetobacter baumannii, 2.7% (5/187) were Pseudomonas aeruginosa, and 1.1% (2/187) were Enterobacter cloacae. CONCLUSION: The Tem-PCR assay may increase the detection rate of Hemophilus influenzae b, Streptococcus pneumoniae, Staphylococcus aureus, Pseudomonas aeruginosa and Acinetobacter baumannii. The Combined detection may increase the positive rate of bacterial pathogens in hospitalized children with pneumonia, an d the results might reflect the real patterns of bacterial etiology. The Tem-PCR needs further improvement for diagnosis of Escherichia coli and Klebsiella pneumoniae. PMID: 19099875 [PubMed - indexed for MEDLINE] 8. Zhonghua Er Ke Za Zhi. 2008 Jun;46(6):468-9. [Clinical and etiological analyses of acute lower respiratory tract infections i n children in Kunming area]. [Article in Chinese] Wu Q, Ni LX, Li YF. PMID: 19099790 [PubMed - indexed for MEDLINE] 9. Zhonghua Er Ke Za Zhi. 2008 Feb;46(2):124-7. [Comparative analysis of the pathogens responsible for hospital acquired and community acquired late onset neonatal septicemia]. [Article in Chinese] Zhu ML, Zheng G, Chen JN, Lin ZL, Zhu JH, Lin J. Department of Neonatology, Yuying Children's Hospital of Wenzhou Medical College , Wenzhou 325000, China. OBJECTIVE: Late onset neonatal septicemia (systemic infection after 72 hours of life) remains a major cause of neonatal morbidity and mortality. Early treatment with appropriate antibiotics is critical since infected infants can deteriorate rapidly. The aim of this study was to review the pathogens responsible for late onset neonatal septicemia (LONS) and their antimicrobial susceptibilities in order to guide the initial selection of appropriate antibiotics for infants with suspected LONS. METHODS: A retrospective chart review of all cases with LONS seen in the neonata l intensive care unit (NICU) of Yuying Children's Hospital of Wenzhou Medical College from January 1, 2002 to December 31, 2005 was conducted. All cases were selected based on the clinical presentation and at least one positive result of blood culture. The basic clinical characteristics and the results of blood

culture and antimicrobial susceptibilities were analyzed. RESULTS: A total of 102 cases with LONS were identified. Among those 102 cases, 80 were community acquired (infants admitted from home and the blood culture was done on admission) and 22 were hospital acquired (infants became sick while in the NICU and the blood culture was done prior to use of antibiotics). The clinical presentations were non-specific. Compared to the infants with community acquired LONS, infants with hospital acquired LONS were usually born more prematurely (mean gestational age 33 +/- 3 vs 39 +/- 2 wks, t = 2.255, P < 0.01) , with lower weight (mean weight 1.79 +/- 0.70 vs 3.23 +/- 0.67 kg, t = 8.818, P < 0.01) and with younger age (mean age 12 +/- 6 vs 16 +/- 7 days, t = 7.581, P < 0.05). Of the 102 cases, a total of 103 strains of bacteria were isolated. Among the pathogenic bacteria isolated, the most common were coagulase-negative Staphylococcus (CoNS) (50/103, 48.5%), followed by Klebsiella pneumoniae (16/103 , 15.5%). The main pathogens for community acquired LONS were Staphylococcus species and Escherichia coli. The most important pathogen responsible for hospital acquired LONS was Klebsiella pneumoniae. Most (> 80%) of the Staphylococcus especially CoNS were resistant to common antibiotics such as penicillin, erythromycin and cefazolin. Significant numbers (6/9) of Staphylococcus aureus isolated were methicillin-resistant Staphylococcus aureus (MRSA). However, all of the Staphyloccus isolates were sensitive to vancomycin. Almost all (15/16) of the Klebsiella pneumoniae isolated were multi-drug resistant due to production of extended-spectrum beta-lactamases (ESBLs). They were sensitive only to a few antibiotics such as carbapenems, aminoglycosides an d quinolones. There was also one strain of vancomycin-resistant Enterococcus (VRE) . Furthermore, there was no a single case of late onset neonatal sepsis due to infection with group B Streptococcus (GBS). CONCLUSIONS: The clinical manifestations of late onset neonatal sepsis are usually non-specific. GBS is not a significant pathogen responsible for communit y acquired LONS in the Wenzhou area. There are increasing numbers of multi-drug resistant bacterial species isolated from the newborn infants with late onset neonatal septicemia, which is most likely due the non-restricted use of antibiotics in the hospitals as well as in the communities. A routine blood culture should be taken from any newborn infant who is suspected of LONS and empirical use of appropriate antibiotics should be initiated as soon as the bloo d specimen for culture has been drawn. To reduce the occurrence of multi-drug resistant bacteria, the use of antibiotics especially the third generation cephalosporins in neonates should be restricted as much as possible. PMID: 19099687 [PubMed - indexed for MEDLINE] 10. Zhongguo Dang Dai Er Ke Za Zhi. 2008 Dec;10(6):749-51. [Drug resistance of pathogens in infants with community acquired pneumonia from the south suburb of Xi'an]. [Article in Chinese] Wu JG, Zhang Y, Gong HJ.

Department of Pediatrics, Xi'an Aerospace General Hospital, Xi'an 710100, China. PMID: 19102847 [PubMed - indexed for MEDLINE] 11. J Infect Chemother. 2008 Dec;14(6):424-32. Epub 2008 Dec 17. Comprehensive detection of causative pathogens using real-time PCR to diagnose pediatric community-acquired pneumonia. Hamano-Hasegawa K, Morozumi M, Nakayama E, Chiba N, Murayama SY, Takayanagi R, Iwata S, Sunakawa K, Ubukata K; Acute Respiratory Diseases Study Group. Collaborators: Ishizawa S, Numata M, Kojima M, Nonoyama M, Kuroki H, Shimizu K, Kobayashi M, Saito K, Nitta M, Kawamura N, Sakai R, Ohnari S, Morinobu T, Tajima T, Oishi T. Kitasato Institute for Life Sciences, Laboratory of Molecular Epidemiology for Infectious Agents, 5-9-1 Shirokane, Minato-ku, Tokyo, 108-8641, Japan. We have developed a real-time reverse transcription-PCR (RT-PCR) method to detec t 13 respiratory viruses: influenza virus A and B; respiratory syncytial virus (RSV) subgroup A and B; parainfluenza virus (PIV) 1, 2, and 3; adenovirus; rhinovirus (RV); enterovirus; coronavirus (OC43); human metapneumovirus (hMPV); and human bocavirus (HBoV). The new method for detection of these viruses was applied simultaneously with real-time PCR for the detection of six bacterial pathogens in clinical samples from 1700 pediatric patients with community-acquired pneumonia (CAP). Of all the patients, 32.5% were suspected to have single bacterial infections; 1.9%, multiple bacterial infections; 15.2%, coinfections of bacteria and viruses; 25.8%, single viral infections; and 2.1%, multiple viral infections. In the remaining 22.6%, the etiology was unknown. The breakdown of suspected causative pathogens was as follows: 24.4% were Streptococcus pneumoniae, 14.8% were Mycoplasma pneumoniae, 11.3% were Haemophilus influenzae, and 1.4% were Chlamydophila pneumoniae. The breakdown of viruses was as follows: 14.5% were RV, 9.4% were RSV, 7.4% were hMPV, 7.2% were PIV, and 2.9% were HBoV. The new method will contribute to advances in the accuracy of diagnosis and should also result in the appropriate use of antimicrobials. PMID: 19089556 [PubMed - indexed for MEDLINE] 12. BMC Pregnancy Childbirth. 2008 Dec 8;8:52. The INIS Study. International Neonatal Immunotherapy Study: non-specific intravenous immunoglobulin therapy for suspected or proven neonatal sepsis: an international, placebo controlled, multicentre randomised trial. INIS Study Collaborative Group. Collaborators: Brocklehurst P, Brearley S, Haque K, Leslie A, Salt A, Stenson B, Stephenson J, Tarnow-Mordi W. BACKGROUND: Sepsis is an important cause of neonatal death and perinatal brain

damage, particularly in preterm infants. While effective antibiotic treatment is essential treatment for sepsis, resistance to antibiotics is increasing. Adjuvan t therapies, such as intravenous immunoglobulin, therefore offer an important additional strategy. Three Cochrane systematic reviews of randomised controlled trials in nearly 6,000 patients suggest that non-specific, polyclonal intravenou s immunoglobulin is safe and reduces sepsis by about 15% when used as prophylaxis but does not reduce mortality in this situation. When intravenous immunoglobulin is used in the acute treatment of neonatal sepsis, however, there is a suggestio n that it may reduce mortality by 45%. However, the existing trials of treatment were small and lacked long-term follow-up data.This study will assess reliably whether treatment of neonatal sepsis with intravenous immunoglobulin reduces mortality and adverse neuro-developmental outcome. METHODS AND DESIGN: A randomised, placebo controlled, double blind trial. Babies with suspected or proven neonatal sepsis will be randomised to receive intravenous immunoglobulin therapy or placebo. Eligibility criteria: Babies must be receiving antibiotics and have proven or suspected serious infection AND have at least one of the following: birthweight less than 1500 g OR evidence of infection in blood culture, cerebrospinal fluid or usually sterile body fluid OR be receiving respiratory support via an endotracheal tube AND there is substantial uncertaint y that intravenous immunoglobulin is indicated. Exclusion criteria: Babies are excluded if intravenous immunoglobulin has already been given OR intravenous immunoglobulin is thought to be needed OR contra-indicated. Trial treatment: Babies will be given either 10 ml/kg of intravenous immunoglobulin or identical placebo solution over 4-6 hours, repeated 48 hours later. Primary outcome: Mortality or major disability at two years, corrected for gestational age. Data collection: Data will be collected at discharge from hospital and at 2 years of age (corrected for gestation) using a parental questionnaire and a health status questionnaire completed during a face-to-face follow-up appointment with the child's paediatrician. TRIAL REGISTRATION: Current Controlled Trials ISCRTN94984750. PMCID: PMC2626572 PMID: 19063731 [PubMed - indexed for MEDLINE] 13. Expert Rev Anti Infect Ther. 2008 Dec;6(6):929-38. Management of neonatal sepsis by Gram-negative pathogens. Venkatesh MP, Garcia-Prats JA. Baylor College of Medicine & Texas Children's Hospital, 6621 Fannin Street, MC, WT 6-104, Houston, TX 77030, USA. mohanv@bcm.edu For the pediatrician and neonatologist who care for term and preterm infants, th e challenge remains to keep these infants free of infection after delivery in special-care nurseries and neonatal intensive care units. Studies of complications associated with term infants at risk due to maternal factors, as well as preterm infants after early delivery, have demonstrated that sepsis is a major cause of neonatal mortality and morbidity. Infections due to Gram-negative

organisms are increasingly being reported from neonatal units. Moreover, Gram-negative organisms that are multidrug resistant are on the increase and pos e a formidable clinical challenge. In this article, we review current epidemiology , risk factors, clinical features, diagnosis, therapy and preventive measures related to Gram-negative infections in neonates. PMID: 19053905 [PubMed - indexed for MEDLINE] 14. Int J Infect Dis. 2009 Jul;13(4):499-505. Epub 2008 Dec 5. Etiology of neonatal blood stream infections in Tbilisi, Republic of Georgia. Macharashvili N, Kourbatova E, Butsashvili M, Tsertsvadze T, McNutt LA, Leonard MK. Infectious Diseases, AIDS, and Clinical Immunology Research Center, Tbilisi, Georgia. BACKGROUND: Neonatal blood stream infections (BSI) are a major cause of morbidit y and mortality in developing countries. It is crucial to continuously monitor the local epidemiology of neonatal BSI to detect any changes in patterns of infectio n and susceptibility to various antibiotics. OBJECTIVES: To examine the etiology of BSI in two neonatal intensive care units (NICUs) in the Republic of Georgia, a resource-poor country, and to determine antibiotic susceptibility of the isolated organisms. METHODS: A cross-sectional study of all septic infants was conducted in the NICU s of two pediatric hospitals in Tbilisi between September 2003 and September 2004. RESULTS: A total of 200 infants with clinical signs of sepsis were admitted to two NICUs. Of these, 126 (63%) had confirmed bacteremia. The mortality rate was 34%. A total of 98 (78%) of 126 recovered isolates were Gram-negative organisms and 28 (22%) were Gram-positive. Klebsiella pneumoniae was the most common pathogen, accounting for 36 (29%) of 126 isolates, followed by Enterobacter cloacae accounting for 19 (15%) and Staphylococcus aureus accounting for 15 (12%). The Gram-negative organisms showed a high degree of resistance to commonl y used antibiotics such as ampicillin and amoxicillin/clavulanate, and comparatively low resistance to amikacin, ciprofloxacin, carbapenems, and gentamicin; 40% of S. aureus isolates were methicillin-resistant (MRSA). In multivariate analysis only umbilical discharge was a significant risk factor for having a positive blood culture at admission to NICU (prevalence ratio = 2.25, 95% confidence interval 1.82-2.77). CONCLUSIONS: Neonatal BSI was mainly caused by Gram-negative organisms, which ar e developing resistance to commonly used antibiotics. Understanding the local epidemiology of neonatal BSI can lead to the development of better medical practices, especially more appropriate choices for empiric antibiotic therapy, and may contribute to improvement of infection control practices. PMCID: PMC2695829 PMID: 19058989 [PubMed - indexed for MEDLINE]

15. Pediatr Infect Dis J. 2009 Jan;28(1):53-5. Culture versus polymerase chain reaction for the etiologic diagnosis of community-acquired pneumonia in antibiotic-pretreated pediatric patients. Deng J, Zheng Y, Zhao R, Wright PF, Stratton CW, Tang YW. Shenzhen Children's Hospital, China Medical University, Shenzhen, China. Tracheal aspirates were collected from 176 hospitalized antibiotic-pretreated children with community-acquired pneumonia. Haemophilus influenzae and Streptococcus pneumoniae were detected by both culture and target-enriched multiplex (TEM)-PCR whereas Mycoplasma pneumoniae and Chlamydia pneumoniae were detected by TEM-PCR only. TEM-PCR detected more S. pneumoniae (32 vs. 7) and H. influenzae (29 vs. 23) than did culture. TEM-PCR detected an additional 26 M. pneumoniae and 1 C. pneumoniae. TEM-PCR significantly enhances the pathogen-specific diagnosis of CAP in children. PMID: 19034066 [PubMed - indexed for MEDLINE] 16. Ann Trop Paediatr. 2008 Dec;28(4):253-60. Bacterial aetiology and outcome in children with severe pneumonia in Uganda. Nantanda R, Hildenwall H, Peterson S, Kaddu-Mulindwa D, Kalyesubula I, Tumwine JK. Department of Paediatrics & Child Health, Makerere University Medical School, Kampala, Uganda. rnantanda@yahoo.com BACKGROUND: Pneumonia is a major cause of morbidity and mortality in the 'under-5s' and in Uganda accounts for 10-30% of childhood deaths. Antibiotic resistance is increasing. OBJECTIVE: To describe the bacterial aetiology, antimicrobial sensitivity and outcome of severe pneumonia among children aged 2-59 months admitted to the Acut e Care Unit, Mulago Hospital, Uganda. METHODS: A total of 157 children aged 2-59 months with symptoms of severe pneumonia according to WHO guidelines were recruited over a 4-month period in 2005/2006. Blood and induced sputum were obtained for culture, and chest radiographs were undertaken. Children were clinically classified as having sever e or very severe pneumonia and were followed up for a maximum of 7 days. RESULTS: Bacteraemia was detected in 15.9% of patients with Staphylococcus aureu s (36%) and Streptococcus pneumoniae (28%) were the organisms most commonly isolated. Bacteria were isolated from sputum in half of the children, the commonest organisms being Streptococcus pneumoniae (45.9%), Haemophilus influenzae (23.5%) and Klebsiella species (22.4%). Staphylococcus aureus had onl y 33.3% sensitivity to chloramphenicol and H. influenzae isolates were completely resistant. S. pneumoniae was sensitive to chloramphenicol in 87.4% of cases. The case fatality rate was 15.5%. Independent predictors of death were very severe pneumonia (OR 12.9, CI 2.5-65.8), hypoxaemia (SaO(2) <92%, OR 4.9, CI 1.2-19.5) and severe malnutrition (OR 16.5, CI 4.2-65.5). CONCLUSION: S. aureus, S. pneumoniae and H. influenzae are common bacterial causes of severe pneumonia. Chloramphenicol, the current first-line antibiotic for treating severe pneumonia in Ugandan children, is useful in pneumonia caused

by S. pneumoniae but other common bacteria show resistance. The presence of severe malnutrition, hypoxaemia and very severe pneumonia increase the risk of death and should be considered in case management protocols. PMID: 19021940 [PubMed - indexed for MEDLINE] 17. Acta Paediatr. 2009 Feb;98(2):332-6. Epub 2008 Oct 29. Community-acquired pneumonia (CAP) in children in Oslo, Norway. Senstad AC, Surn P, Brauteset L, Eriksson JR, Hiby EA, Wathne KO. Department of Paediatrics, Ullevl University Hospital, Oslo, Norway. asenstad@gmail.com AIM: To investigate the epidemiology and clinical characteristics of community acquired pneumonia (CAP) in children before the introduction of the 7-valent pneumococcal vaccine in the national vaccination programme. METHODS: For the period 21 May 2003 to 20 May 2005 hospitalization rates for pneumonia in children were obtained from retrospective studies of medical journals. Pneumonia was also studied prospectively in children less than sixteen years old referred to Ullevl University Hospital (Oslo) in the same time period. RESULTS: The overall observed hospitalization rate of pneumonia was 14.7/10 000 (95% CI: 12.2-17.1), for children under five it was 32.8/10 000 (95% CI: 26.8-38.8), and for children under two 42.1/10 000 (95% CI: 32.0-52.3). In the clinical study 123 children, of whom 59% (73) were boys, met the inclusion criteria and were enrolled. Only 2.4% (3) had pneumonia complicated with pleural effusion and in general few complications were observed. No patients required assisted ventilation, and none were transferred to the intensive care unit. Penicillin was effective as treatment for pneumonia. CONCLUSION: Pneumonia, seen in a paediatric department in Oslo, is a common but benign disease. Penicillin is effective as treatment for pneumonia in Norwegian children. PMID: 19006533 [PubMed - indexed for MEDLINE] 18. Indian J Med Microbiol. 2008 Oct-Dec;26(4):356-60. Increased prevalence of extended spectrum beta lactamase producers in neonatal septicaemic cases at a tertiary referral hospital. Bhattacharjee A, Sen MR, Prakash P, Gaur A, Anupurba S. Department of Microbiology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, UP, India. mr_senbhu@yahoo.com Emergence of extended spectrum beta lactamases (ESBLs) producing strains of gram negative bacteria, as one of the leading cause of septicaemia often complicates the clinical and therapeutic outcome. The present study was undertaken to investigate the prevalence of ESBLs in bacteria isolated from neonatal septicaemic cases along with their antimicrobial sensitivity pattern. Blood samples were collected from 243 suspected cases of neonatal septicaemia. Apart from susceptibility testing, all the gram negative isolates were subjected to phenotypic tests for ESBL production. Amongst the positive test samples (n =

115), 84 were gram negative rods. ESBL was detected in 26 (32%) isolates. Result s indicate that routine ESBL detection should be made imperative and empirical use of third generation cephalosporins must be discouraged. PMID: 18974490 [PubMed - indexed for MEDLINE] 19. Afr J Med Med Sci. 2008 Jun;37(2):185-91. Childhood bacterial meningitis in Ibadan, Nigeria--antibiotic sensitivity patter n of pathogens, prognostic indices and outcome. Lagunju IA, Falade AG, Akinbami FO, Adegbola R, Bakare RA. Department of Paediatrics, University College Hospital/College of Medicine, University of Ibadan, Ibadan, Nigeria. ilagunju@yahoo.co.uk Bacterial meningitis remains a major cause of morbidity, mortality and neurodisability in childhood, particularly in the developing world where effective vaccines against the usual pathogens responsible for the disease are not in routine use. To describe the patterns and outcome of bacterial meningitis among children admitted into the University College Hospital (UCH), Ibadan, Nigeria. All children who satisfied the case definition for meningitis, admitted into the paediatric wards of the University College Hospital, UCH, Ibadan over a period of 30 months were prospectively enrolled and blood and CSF samples were taken for bacteriological analyses. A total of 97 children, 62 males and 35 females were studied. Their ages ranged between 2 months and 12 years, mean age 33.0 (SD=41.7) months, with 80.4% of the cases below the age of 5 years. Haemophilus influenzae type b (Hib) was the leading pathogen, found in 16 (55.1% ) of the 29 cases of definite meningitis. Other isolates include Streptococcus pneumoniae (24.1%), Klebsiella spp (7.0%), Staphylococcus aureus (7.0%), Escherichia coli (3.4%) and Pseudomonas spp. (3.4%). Hib and pneumococcus showed varying degrees of resistance to chloramphenicol, penicillin and cotrimoxazole. Twenty six (26.8%) of the cases died and 67.6% of the survivors developed significant neurological sequele. Bacterial meningitis remains a major cause of childhood mortality and neurodisability. Hib and pneumococcus remain the major pathogens responsible for this dreadful disease in Ibadan, Nigeria. The increasing emergence of antibiotic resistance calls for institution of adequate control measures, particularly routine childhood immunisation against the disease. PMID: 18939404 [PubMed - indexed for MEDLINE] 20. Eur J Intern Med. 2008 Oct;19(6):421-6. Epub 2008 Feb 19. Community acquired acute bacterial meningitis in children and adults: an 11-year survey in a community hospital in Israel. Mishal J, Embon A, Darawshe A, Kidon M, Magen E.

Infectious Diseases Unit, Barzilai Medical Center, Ashkelon, Ben Gurion University of Negev, Israel. OBJECTIVES: We aimed to investigate the association between the presenting clinical manifestations of bacterial meningitis and the duration of time elapsed before lumbar puncture and start of antibiotic treatment. DESIGN: Retrospective epidemiologic study using the clinical records in Barzilai Medical Center Emergency Department between 1988 and 1999. RESULTS: 97 patients, 72 children and 25 adults with ABM were identified. 30 of 97 (31%) were diagnosed by the primary physicians at primary care units. Acute meningitis was suspected by emergency department (ED) physicians in 51% of the referred patients. Patients with a scarce clinical picture at hospital arrival (those without fever, headache or nuchal rigidity) showed a trend toward a longe r median delay until a diagnostic lumbar puncture was performed and antibiotic therapy was started (median of 14.7 h compared with 2.1 h for those with severe clinical picture) (p<0.02). Nevertheless, the clinical outcome for the total cohort did not yield a significant difference when analyzed regarding the duration of time between arrival to emergency department and antibiotic treatmen t initiation (p>0.3). CONCLUSIONS: The interval before diagnosis of community acquired ABM in both children and adults is longer for those patients who present to the emergency department with an atypical clinical picture, mostly, without fever and without nuchal rigidity. Until bacterial meningitis can be effectively prevented, we can expect this life-threatening infection to continue to cause diagnostic and medical difficulties. PMID: 18848175 [PubMed - indexed for MEDLINE] 21. BMC Infect Dis. 2008 Sep 25;8:129. Empyema associated with community-acquired pneumonia: a Pediatric Investigator's Collaborative Network on Infections in Canada (PICNIC) study. Langley JM, Kellner JD, Solomon N, Robinson JL, Le Saux N, McDonald J, Ulloa-Gutierrez R, Tan B, Allen U, Dobson S, Joudrey H. Department of Pediatrics, Dalhousie University, Halifax, Canada. jmlangle@dal.ca BACKGROUND: Although the incidence of serious morbidity with childhood pneumonia has decreased over time, empyema as a complication of community-acquired pneumonia continues to be an important clinical problem. We reviewed the epidemiology and clinical management of empyema at 8 pediatric hospitals in a period before the widespread implementation of universal infant heptavalent pneumococcal vaccine programs in Canada. METHODS: Health records for children<18 years admitted from 1/1/00-31/12/03 were searched for ICD-9 code 510 or ICD-10 code J869 (Empyema). Empyema was defined a s at least one of: thoracentesis with microbial growth from pleural fluid, or no pleural fluid growth but compatible chemistry or cell count, or radiologist diagnosis, or diagnosis at surgery. Patients with empyemas secondary to chest trauma, thoracic surgery or esophageal rupture were excluded. Data was retrieved

using a standard form with a data dictionary. RESULTS: 251 children met inclusion criteria; 51.4% were male. Most children wer e previously healthy and those<or=5 years of age comprised 57% of the cases. The median length of hospitalization was 9 days. Admissions occurred in all months but peaked in winter. Oxygen supplementation was required in 77% of children, 75 % had chest tube placement and 33% were admitted to an intensive care unit. While similarity in use of pain medication, antipyretics and antimicrobial use was observed, a wide variation in number of chest radiographs and invasive procedure s (thoracentesis, placement of chest tubes) was observed between centers. The most common organism found in normally sterile samples (blood, pleural fluid, lung biopsy) was Streptococcus pneumoniae. CONCLUSION: Empyema occurs most commonly in children under five years and is associated with considerable morbidity. Variation in management by center was observed. Enhanced surveillance using molecular methods could improve diagnosis and public health planning, particularly with regard to the relationship between immunization programs and the epidemiology of empyema associated with community-acquired pneumonia in children. PMCID: PMC2571094 PMID: 18816409 [PubMed - indexed for MEDLINE] 22. Scand J Infect Dis. 2008;40(11-12):881-7. Surveillance of bacterial meningitis in children under 2 y of age in Denmark, 1997-2006. Howitz M, Hartvig Christiansen A, Harboe ZB, Mlbak K. Department of Epidemiology, Statens Serum Institute, Copenhagen, Denmark. how@ssi.dk Worldwide the 3 most common pathogens for bacterial meningitis among infants and young children are Haemophilus influenzae, Streptococcus pneumoniae and Neisseri a meningitidis. Denmark included in the National Childhood Vaccination Programme vaccination against H. influenzae type B (Hib) in 1993 and invasive pneumococcal disease as of October 2007. Introduction of the conjugated heptavalent pneumococcal vaccine is, as in the post-Hib vaccination era, expected to change the epidemiology of bacterial meningitis in infants and young children. In 1980 it became mandatory to report suspected cases of bacterial meningitis and the surveillance system was further enhanced for laboratory diagnosed cases of N. meningitis in 1992 and S. pneumoniae in 1996 when a reminder procedure to the physician was issued. In this article we review the epidemiology of 418 notified cases of bacterial meningitis in children <2 y of age in Denmark in the pre-pneumococcal vaccination era 1997-2006 and discuss points of awareness for the future surveillance system. PMID: 18720256 [PubMed - indexed for MEDLINE]