Perioperative Antibiotic Prophylaxis in Pediatric Cardiac Surgery—Simple Is Better

Pediatric cardiac surgery requires perioperative antibiotic prophylaxis (PAP) to reduce the risk of surgical site infections. However, the complexity of these procedures and the metabolic immaturity of children impede the establishment of PAP regimens that are both efficacious and in line with antimicrobial stewardship (AMS). In this study, we compared two PAP regimens: cefazolin with gentamicin (in a retrospective group) and cefazolin only (prospectively) in children undergoing elective cardiac surgery. In the prospective group, additional elements of AMS were introduced, i.e., restricted access to cefazolin and more diligent use of empirical antibiotics proceeded by consultation with an AMS team. The rate of surgical site infections (SSI), the scope of PAP deviations, and the postoperative use of antibiotics other than PAP within 30 days after surgery were analyzed. There were no significant differences in the rate of SSIs between the groups (3.9% vs. 1.2% in the prospective and retrospective groups, respectively (p = 0.35)). However, in the prospective group, the PAP violation was significantly reduced compared with the retrospective group (full compliance with the PAP regimen was 45.5% vs. 4.8%, p < 0.001, respectively). In addition, a reduction of postoperative antibiotic use was observed in the prospective group (0.991 vs. 1.932 defined daily doses, respectively)

Assessment of interleukin-17A, C5a and RANTES for early diagnosis of neonatal sepsis – a preliminary study

The aim of the present study was to investigate serum levels of novel markers: interleukin 17A (IL-17A), anaphylatoxin C5a and chemokine regulated upon activation normal T-cell expressed and secreted (RANTES) in neonates with clinically suspected early-onset neonatal sepsis (EONS), and to compare their values with those of non-infected neonates. Eighteen neonates with clinical signs and symptoms of EONS were enrolled in this study. Fifty healthy, non-infected neonates served as the control group. In all neonates serum levels of IL-17A, C5a and RANTES were measured by solid-phase sandwich enzyme-linked immunosorbent assay (ELISA). At the time of investigation serum levels of anaphylatoxin C5a were significantly higher in neonates with clinical symptoms of EONS than in non-infected neonates (median 65.35 vs. 50.4 ng/ml, p = 0.034), whereas levels of RANTES were similar and levels of IL-17A were under detection limit of the method. Based on these preliminary results, serum levels of C5a may be a useful marker of inflammation in early onset neonatal sepsis. Because traditional methods of microbiological diagnostics in EONS are frequently unsuccessful, the search for an alternative laboratory biomarkers is of great clinical importance. Thus, there is a strong need for further studies evaluating usefulness of this anaphylatoxin in EONS diagnosis on a larger group of patients

Lyme Neuroborrelioza (LNB) – trudności kliniczne i diagnostyczne

Aim: Assessment of clinical utility of Borrelia burgdorferi DNA detection in cerebrospinal fluid (CSF) and urine using RT-PCR method in pediatric patients with different neurological signs and symptoms and suspicion of Lyme disease. Material and methods: Prospective study was carried out in 107 children aged 1–18 (mean 12.2 ) years. Serological tests in blood were performed in two-step approach – ELISA followed by Western blot. ELISA test was performed on CSF samples as well as RT- -PCR method for confirmation or exclusion of Lyme neuroborreliosis (LNB) diagnosis. All patients underwent neurological, ophtalmological and neuroimaging examinations. Results: In 60 (56.1%) children IgG and/or IgM Borrelia antibodies were positive in serum and/or CSF. Only in 2/60 (3.3%) Borrelia burgdorferi DNA was found in CSF with specific antibodies detected in serum and CSF – (LNB – aseptic meningitis with TIA and nerve II and VI neuritis cases). LNB was diagnosed in 33 patients and in 22/107(20.5%) demyelinating diseases. IgG in CSF, Western blot test results were significantly higher in children with LNB – IgG p (chi2 &gt;9.333) =0.0023, WB- p (chi2&gt;12.941)=0.0003. Conclusions: Detection of DNA Borrelia burgdorferi in CSF using RT-PCR method might be helpful for confirmation of early LNB diagnosis. Negative results for DNA Borrelia burgdorferi in CSF are especially important for exclusion of LNB and useful for establishment of demyelinating diseases diagnosis. Four-week intravenous Ceftriaxone course is sufficient for LNB neuroinfection treatment, elimination of DNA Borrelia burgdorferi from CSF and clinical improvement of patients.Cel: Zastosowanie metody RT-PCR dla wykrywania DNA Borrelia burgdorferi w płynie mózgowo-rdzeniowym u pacjentów pediatrycznych z różnymi objawami neurologicznymi i podejrzeniem choroby z Lyme. Materiał i metody: Badanie prospektywne przeprowadzono u 107 dzieci w wieku od 1–18 lat (średnio 12.2 lat). Badania serologiczne we krwi przeprowadzano dwuetapowo – test ELISA, a następnie test Western blot. W próbkach płynu mózgowo-rdzeniowego wykonywano test ELISA oraz badanie metodą RT-PCR celem potwierdzenia lub wykluczenia rozpoznania neuroboreliozy (LNB). U wszystkich pacjentów wykonywano badania neurologiczne, okulistyczne i neuroobrazowe. Wyniki: U 60 (56.1%) dzieci stwierdzono dodatnie wyniki przeciwciał IgG i/lub IgM w surowicy i/lub w płynie mózgowo-rdzeniowym. Tylko u 2/60 (3.3%) wykryto DNA Borrelia burgdorferi PMRDz oraz specyficzne przeciwciała w surowicy i w płynie mózgowo-rdzeniowym (przypadki LNB – aseptyczne zapalenie opon mózgowo-rdzeniowych z TIA oraz zapalenie nerwu II I nerwu VI). LNB zdiagnozowano u 33 pacjentów a u 22/107 (20.5%) rozpoznano choroby demielinizacyjne. U dzieci z LNB stwierdzono statystycznie znamiennie wyższe miana IgG w PMRDz i wyniki testu Western blot – IgG p (chi2 >9.333)=0.0023, WB- p (chi2>12.941)=0.0003. Wnioski: Wykrycie DNA Borrelia burgdorferi w PMRDz przy użyciu metody RT-PCR może być pomocne dla potwierdzenia diagnozy wczesnej LNB. Negatywne wyniki DNA Borrelia burgdorferi w PMRDz są szczególnie ważne dla wykluczenia LNB i przydatne dla ustalenia rozpoznania chorób demielinizacyjnych. Kuracja Ceftraksonem podawanym dożylnie przez 4 tygodnie jest skuteczna w leczeniu neuroinfekcji, eliminacji DNA Borrelia burgdorferi z płynu mózgowo-rdzeniowego i poprawy klinicznej pacjentów