Community-acquired Stenotrophomonas maltophilia infections: A systematic review

Stenotrophomonas maltophilia is a pathogen that causes infections mainly in immunocompromised patients. However, community-acquired S. maltophilia infections have been occasionally reported. The objective of this paper was to collect and evaluate the available published data referring to community-acquired S. maltophilia infections. We searched PubMed, the Cochrane Library, and Scopus for articles providing data for patients with community-acquired S. maltophilia infections. Eight case series and 23 case reports (involving 77 and 26 patients with community-acquired S. maltophilia infections, respectively) were regarded as eligible for inclusion in our review. Regarding the 77 patients with community-acquired S. maltophilia infections included in the identified case series, 45 had bacteremia, six ocular infections, five respiratory tract infections, four wound/soft tissue infections, two urinary tract infections, one conjunctivitis, one otitis, and one cellulitis; data were not reported for the remaining 12 patients. Comorbidity (such as malignancy, HIV infection, prior hospitalization) was common. Data included in the eight case series regarding the outcome of infection were limited. From the 26 patients with community-acquired S. maltophilia infections reported in the case reports, 22 were cured from the infection, whereas 4 of 26 patients died; one death was attributed to septic shock due to S. maltophilia. Several publications report patients with community-acquired S. maltophilia infections; the majority of them refer to patients with some kind of comorbidity. Physicians should be aware that S. maltophilia infections are not restricted to hospitalized patients. © 2009 Springer-Verlag

Intravenous colistimethate (colistin) use in critically ill children without cystic fibrosis

Introduction: The increasing frequency of infections caused by multidrug-resistant (MDR) Gram-negative bacteria has led to the reappraisal of colistimethate use. Methods: We present a case series of critically ill pediatric patients without cystic fibrosis who received intravenous colistimethate treatment. All available relevant medical records were reviewed. Results: Seven children without cystic fibrosis (mean age 7.7 years; 2 female), admitted to the intensive care unit of a tertiary-care pediatric hospital in Athens, Greece, were identified to have received intravenous colistimethate during October 2004 to May 2008. MDR Acinetobacter baumannii, Pseudomonas aeruginosa, and/or Klebsiella pneumoniae were isolated from blood and/or bronchial secretions specimens in 6 of 7 reported patients. All isolates were susceptible to colistin. All 7 patients received intravenous colistimethate in a dosage of 5 mg/kg daily (divided in 3 equal doses, administered every 8 hours). Five children received colistimethate for 10 days and the remaining 2 for 2 and 23 days, respectively. The infections caused by MDR Gram-negative bacteria were improved in 6 children with microbiologically documented infections. Five of the 7 children were discharged from the ICU. The remaining 2 children died (1 of them had received colistimethate for 2 days); their death was not attributed to MDR Gram-negative infection. No nephrotoxicity or other type of toxicity of colistimethate was noted in this case-series. Conclusions: Although the small number of included cases precludes any firm conclusions, our study suggests that colistimethate may have a role for the treatment of infections caused by MDR Gram-negative bacteria in critically ill pediatric patients. © 2009 by Lippincott Williams & Wilkins

Hepatitis B vaccine alone or with hepatitis B immunoglobulin in neonates of HBsAg+/HBeAg- mothers: A systematic review and meta-analysis

Objectives: The cost-effectiveness of augmenting immunization against hepatitis B infection with hepatitis B immunoglobulin (HBIG) remains controversial, particularly for the subpopulation of babies of HBsAg+/HBeAg? mothers that are considered as low-infective. We aimed to evaluate the effectiveness of vaccine alone compared with vaccine plus HBIG for the immunization of babies of HBsAg+/HBeAg- mothers. Methods: We searched PubMed, Scopus and Cochrane Central Register of Controlled Trials databases to identify studies comparing the effectiveness of combined immunization (vaccine plus HBIG) with vaccine alone in neonates of HBsAg+/HBeAg- mothers. A systematic review and meta-analysis of eligible studies was performed. Results: A total of nine eligible studies were identified (four randomized controlled trials). No difference was found regarding the primary outcome of our meta-analysis, namely occurrence of hepatitis B infection, between neonates who received vaccine only, compared with those who received both vaccine and HBIG (four studies, 3426 patients, OR=0.82, 95% CI=0.41-1.64). This finding was consistent with regards to seroprotection rate (four studies, 1323 patients, OR=1.24, 95% CI=0.97-1.58). Safety data were not reported in the included studies. Conclusions: The available limited published evidence suggests that vaccine alone seems to be equally effective to the combination of HBIG and hepatitis B vaccine for neonates of HBsAg+/HBeAg- mothers in preventing infection. Further studies are needed in order to clarify the potential benefit of combined immunization to this specific subgroup of patients. © The Author 2014. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved

Bullying and Suicidality in Children and Adolescents Without Predisposing Factors: A Systematic Review and Meta-analysis

Published evidence has suggested that engaging in school or cyber bullying may potentially be associated with a suicidal ideation and suicide attempts. The aim of our review/meta-analysis was to evaluate the potential association between school and cyber bullying and suicidality (including suicidal ideation, planning and/or committing a suicide attempt) in children and adolescents (< 19 years old) who are considered as a “healthy” population, without predispositions for suicidality factors (not subpopulations with characteristics that may constitute proneness to bullying and its consequences, including sexual minorities, drug users and youth with psychiatric comorbidity). Regarding school bullying, victims and bullies independently, and victims and bullies together, were significantly more likely to present suicidal ideation and commit a suicide attempt, compared to non-involved participants. Victims of school bullying were found to be significantly more likely to commit a suicide attempt that required medical treatment. Victims of cyber bullying were significantly more likely to present suicidal ideation and commit a suicide attempt. A positive relationship between involvement in both school bullying and cyber-bullying with suicidal ideation and suicidal behavior was observed. This review/meta-analysis contributes to further understanding bullying and suicidality as it includes results of participants without any predisposing factors for suicidality, thus providing more clear results with regard to the magnitude of the effects of both school and cyber bullying on suicidality. © 2018, Springer International Publishing AG, part of Springer Nature

Ciprofloxacin in critically ill children

Data regarding the use of fluoroquinolones in critically ill children are scarce. We present our experience regarding the use of ciprofloxacin in this specific patient population. We prospectively identified all paediatric patients who received ciprofloxacin treatment in the intensive care unit of the tertiary care P. & A. Kyriakou Children's Hospital during a three year period (2005 to 2008). Eighteen paediatric patients (mean age 23 months, 12 females) who received intravenous ciprofloxacin were identified. Various underlying diseases, including malignancy and immunodeficiency, were observed. None of the evaluated patients had cystic fibrosis. Fourteen patients had bacteraemia (mainly caused from Gram-negative pathogens), one had Stenotrophomonas maltophilia pneumonia, while no pathogen was identified in three patients. The latter patients received ciprofloxacin due to the severity of their clinical manifestations. All patients with microbiologically documented infections recovered. Three deaths attributed to the underlying diseases were noted. Within a 10-day follow-up, two cases of diarrhoea, one case of vomiting and one case of reversible supraventricular tachycardia were noted. No case of QT prolongation was noted. The short-term follow-up hampered any assessment of joint and cartilage toxicity, potentially associated with ciprofloxacin treatment. Our study suggests that ciprofloxacin may be a useful option for critically ill children without cystic fibrosis. Even though firm conclusions regarding the safety profile of ciprofloxacin in critically ill children could not be drawn, our study provides useful information regarding short-term adverse events associated with ciprofloxacin

Inhaled colistin for the treatment of tracheobronchitis and pneumonia in critically ill children without cystic fibrosis

Data regarding the role of inhaled colistin in critically ill pediatric patients without cystic fibrosis are scarce. Three children (one female), admitted to the intensive care unit (ICU) of a tertiary-care pediatric hospital in Athens, Greece, during 2004-2009 received inhaled colistin as monotherapy for tracheobronchitis (two children), and as adjunctive therapy for necrotizing pneumonia (one child). Colistin susceptible Acinetobacter baumannii and Pseudomonas aeruginosa were isolated from the cases' bronchial secretions specimens. All three children received inhaled colistin at a dosage of 75?mg diluted in 3?ml of normal saline twice daily (1,875,000?IU of colistin daily), for a duration of 25, 32, and 15 days, respectively. All three children recovered from the infections. Also, a gradual reduction, and finally total elimination of the microbial load in bronchial secretions was observed during inhaled colistin treatment in the reported cases. All three cases were discharged from the ICU. No bronchoconstriction or any other type of toxicity of colistin was observed. In conclusion, inhaled colistin was effective and safe for the treatment of two children with tracheobronchitis, and one child with necrotizing pneumonia. Further studies are needed to clarify further the role of inhaled colistin in pediatric critically ill patients without cystic fibrosis. Pediatr Pulmonol. 2010;45:1135-1140. ©2010 Wiley-Liss, Inc

Liposomal amphotericin B in critically ill paediatric patients

What is known and Objective: Literature provides much evidence regarding liposomal amphotericin B treatment for fungal infections in neonates and infants. Relevant data regarding critically ill paediatric patients of older age are scarce. We aimed to present our experience regarding liposomal amphotericin B use in critically ill paediatric patients from a tertiary-care paediatric hospital in Athens, Greece. Methods: We prospectively identified all paediatric patients who received treatment with liposomal amphotericin B in the intensive care unit of a tertiary-care paediatric hospital during a 3-year period (2005-2008). Data were retrieved from the evaluation of the available medical records. Results and Discussion: Twenty-three (nine females, mean age: 26.4 months, range: 5-39 months) critically ill paediatric patients were included; 12 had malignancy. In 16 of the 23 included children, liposomal amphotericin B was administered for the treatment of confirmed fungal infections (all but one were invasive), whereas in seven patients, it was used as pre-emptive treatment. One patient received voriconazole concomitantly. Eleven of the 16 children with documented infections were cured; five improved. Six of the seven children who received pre-emptive treatment also showed clinical improvement. Nine deaths were noted, all attributed to underlying diseases. Two cases of hepatotoxicity and one case of nephrotoxicity (all leading to drug-discontinuation) occurred. Seven and five cases of mild reversible hypokalaemia and hyponatraemia, respectively, were also noted. What is new and Conclusion: According to the findings of our small case series, liposomal amphotericin B may provide a useful treatment option for fungal infections of vulnerable critically ill paediatric patients with considerable comorbidity. © 2011 Blackwell Publishing Ltd