Antibiotic Resistance in Paediatric Febrile Urinary Tract Infections

: Febrile urinary tract infection (UTI) is currently considered the most frequent cause of serious bacterial illness in children in the first 2 years of life. UTI in paediatrics can irreversibly damage the renal parenchyma and lead to chronic renal insufficiency and related problems. To avoid this risk, an early effective antibiotic treatment is essential. Moreover, prompt treatment is mandatory to improve the clinical condition of the patient, prevent bacteraemia, and avoid the risk of bacterial localization in other body sites. However, antibiotic resistance for UTI-related bacterial pathogens continuously increases, making recommendations rapidly outdated and the definition of the best empiric antibiotic therapy more difficult. Variation in pathogen susceptibility to antibiotics is essential for the choice of an effective therapy. Moreover, proper identification of cases at increased risk of difficult-to-treat UTIs can reduce the risk of ineffective therapy. In this review, the problem of emerging antibiotic resistance among pathogens associated with the development of paediatric febrile UTIs and the best potential solutions to ensure the most effective therapy are discussed. Literature analysis showed that the emergence of antibiotic resistance is an unavoidable phenomenon closely correlated with the use of antibiotics themselves. To limit the emergence of resistance, every effort to reduce and rationalise antibiotic consumption must be made. An increased use of antibiotic stewardship can be greatly effective in this regard

Management of Pediatric Urinary Tract Infections: A Delphi Study

Urinary tract infection (UTI) is one of the most common infectious diseases in the pediatric population and represents a major cause of antibiotic consumption and hospitalization in children. Considering the ongoing controversies on the management of pediatric UTI and the challenges due to increasing antimicrobial resistance, the aim of the present study was to evaluate the level of agreement on UTI management in pediatric age in Emilia-Romagna Region, Italy, and to assess on the basis of recent studies whether there is the need to change current recommendations used by primary care pediatricians, hospital pediatricians, and pediatric surgeons in everyday clinical practice to possibly improve outcomes. This consensus provides clear and shared indications on UTI management in pediatric age, based on the most updated literature. This work represents, in our opinion, the most complete and up-to-date collection of statements on procedures to follow for pediatric UTI, in order to guide physicians in the management of the patient, standardize approaches, and avoid abuse and misuse of antibiotics. Undoubtedly, more randomized and controlled trials are needed in the pediatric population to better define the best therapeutic management in cases with antimicrobial resistance and real usefulness of long-term antibiotic prophylaxis

Mini Quadrotor UAV: Design and Experiment

The purpose of this work is to design a new-layout quadrotor UAS for experimental customized control systems validation. Geometrical and structural properties have been computed, whereas commercial-off-the-shelf equipments have been selected. The flight control system, both hardware and software has been custom developed; the same applies for the mathematical model describing the flight dynamics. Two Proportional- Derivative (PD) controllers have been designed and experimentally tested. A different control strategy with a state feedback controller has been implemented, assigning a robust eigenstructure and the desired dynamic specifications. An adaptive algorithm, which guarantees uniformly bounded response for both the inputs and the outputs, has been presented. A L1 adaptive controller has been studied and implemented, including the state predictor, the adaptive and the control laws. Tests with PD controller have shown slowly stable response even if numerical and vibrational noise carried on. In conclusion L1 adaptive controller permits to obtain optimal response characteristics and the low pass filter integrated in control law, combined with a Kalman filter, can reduce noise and correlate data between different sensor

Delayed Perihematomal Hypoperfusion is associated with Poor Outcome in Intracerebral Hemorrhage

Background: we aimed to characterize the temporal evolution and prognostic significance of perihematomal perfusion in acute intracerebral hemorrhage (ICH). Methods: single center prospective cohort of patients with primary spontaneous ICH receiving computed tomography perfusion (CTP) within 6 h from onset (T0) and at 7 days (T7). Cerebral blood flow (CBF), cerebral blood volume (CBV), mean transit time (MTT) were measured in the manually outlined perihematomal low-density area. Poor functional prognosis (modified Rankin Scale 3-6) at 90 days was the outcome of interest and predictors were explored with multivariable logistic regression. Results: a total of 150 patients were studied, of whom 52 (34.7%) had a mRS 3-6 at 90 days. Perihematomal perfusion decreased from T0 to T7 in all patients but the magnitude of CBF and CBV reduction was larger in patients with unfavorable outcome (median CBF change -7.8 vs. -6.0 mL/100g/min, p<0.001 and median CBV change -0.5 vs. -0.4 mL/100g, p=0.010 respectively). This finding remained significant after adjustment for confounders (odds ratio [OR] for 1mL/100g/min CBF reduction: 1.33, 95% confidence interval [CI] (1.15-1.55), p<0.001; OR for 0.1 mL/100g CBV reduction 1.67, 95% CI 1.18-2.35, p=0.004). The presence of CBF<20 mL/100g/min at T7 was then demonstrated as an independent predictor of poor functional outcome (adjusted OR: 2.45, 95% CI 1.08-5-54, p=0.032). Conclusion: perihemorrhagic hypoperfusion becomes more severe in the days following acute ICH and is independently associated with poorer outcome. Understanding the underlying biological mechanisms responsible for delayed decrease in perihematomal perfusion is a necessary step towards outcome improvement in patients with ICH

Non-contrast CT markers of intracerebral hemorrhage expansion: The influence of onset-to-CT time

Background: Hematoma expansion (HE) is an appealing therapeutic target in intracerebral hemorrhage (ICH) and non-contrast computed tomography (NCCT) features are promising predictors of HE. Aims: We investigated whether onset-to-CT time influences the diagnostic performance of NCCT markers for HE. Methods: Retrospective multicentre analysis of patients with primary ICH. The following NCCT markers were analyzed: hypodensities, heterogeneous density, blend sign, and irregular shape. HE was defined as growth > 6 mL and/or > 33%. We calculated the sensitivity, specificity, positive, and negative predictive values (PPVs and NPVs) of NCCT markers for HE, stratified by onset-to-CT time (<2 h, 2-4 h, 4-6 h, >6 h). Results: We included 1135 patients (median age 69, 53% males), of whom 307 (27%) experienced HE. Overall hypodensities had the highest sensitivity (0.68) and blend sign the highest specificity (0.87) for HE. Hypodensities were more common and had higher sensitivity (0.80) in patients with imaging within 2 h. The same result was observed for heterogeneous density, whereas irregular shape had a similar prevalence across time strata and higher sensitivity (0.79) beyond 6 h from onset. The frequency of blend sign increased with longer onset-to-CT time, whereas its specificity declined after 6 h from onset. Conclusion: The diagnostic performance of NCCT markers is influenced by imaging time. Hypodensities identified four out of five patients with HE within 2 h from onset, whereas irregular shape performed better in late presenters. Our findings may improve the use of NCCT markers in future studies and trials targeting HE