Review of Staphylococcus aureus infections requiring admission to a paediatric intensive care unit

Aims: To review clinical features and outcome of children with severe Staphylococcus aureus sepsis (SAS) presenting to a paediatric intensive care unit (PICU) with particular focus on ethnicity, clinical presentation, cardiac involvement, and outcome. Methods: Retrospective chart review of patients coded for SAS over 10 years (October 1993 to April 2004). Results: There were 58 patients identified with SAS over the 10 year study period; 55 were community acquired. This accounted for 4% of hospital admissions for SAS over this time; children with staphylococcal illness comprised 1% of all admissions to the PICU. Maori and Pacific children with SAS were overly represented in the PICU (81%) from a paediatric population where they contribute 21.6%. Musculoskeletal symptoms (79%) dominated presentation rather than isolated pneumonia (10%). An aggressive search for foci and surgical drainage of infective foci was required in 50% of children. Most children had multifocal disease (67%) and normal cardiac valves (95%); the few children (12%) presenting with methicillin resistant S aureus (MRSA) had community acquired infection. The median length of stay in the PICU was 3 (mean 5.8, SD 7.6, range 1–44) days. The median length of stay in hospital was 15 (mean 21, SD 22.7, range 2–149) days. Mortality due to SAS was 8.6% (95% CI 1.4–15.8%) compared with the overall mortality for the PICU of 6% (95% CI 5.3–6.7%). Ten children had significant morbidity after discharge. Conclusions: Community acquired SAS affects healthy children, is multifocal, and has high morbidity and mortality, in keeping with the high severity of illness scores on admission. It is imperative to look for sites of dissemination and to drain and debride foci. Routine echocardiography had low yield in the absence of pre-existing cardiac lesions, persisting fever, or persisting bacteraemia

Increasing incidence of life-threatening pertussis: A retrospective cohort study in New Zealand.

Background Infectious disease (ID) hospitalisation rates are increasing in New Zealand (NZ), especially in preschool children, and Māori and Pacific people. We aimed to identify risk factors for ID hospitalisation in infancy within a birth cohort of NZ children, and to identify differences in risk factors between ethnic groups. Methods We investigated an established cohort of 6846 NZ children, born in 2009-10, with linkage to a national dataset of hospitalisations. We used multivariable logistic regression to obtain odds ratios (OR) for factors associated with ID hospitalisation in the first year of life, firstly for all children, and then separately for Māori or Pacific children. Results In the whole cohort, factors associated with ID hospitalisation were Māori (OR=1.49, 95%CI 1.17-1.89) or Pacific (2.51, 2.00-3.15) vs. European maternal ethnicity, male gender (1.32, 1.13-1.55), low birthweight (1.94, 1.39-2.66), exclusive breastfeeding for &lt;4 months (1.22, 1.04-1.43), maternal experience of healthcare racism (1.60, 1.19-2.12), household deprivation (most vs. least deprived quintile of households [1.50, 1.12-2.02]), day-care attendance (1.43, 1.12-1.81), and maternal smoking (1.55, 1.26-1.91). Factors associated with ID hospitalisation for Māori infants were: high household deprivation (2.16, 1.06-5.02) and maternal smoking (1.48, 1.02-2.14); and for Pacific infants: delayed immunization (1.72, 1.23-2.38), maternal experience of healthcare racism (2.20, 1.29-3.70), and maternal smoking (1.59, 1.10-2.29). Conclusions: Māori and Pacific children in NZ experience a high burden of ID hospitalisation. Some risk factors, for example maternal smoking, are shared while others are ethnic-specific. Interventions aimed at preventing ID hospitalisations should address both shared and ethnic-specific factors.</p

Increasing incidence of life-threatening pertussis: A retrospective cohort study in New Zealand.

Background Infectious disease (ID) hospitalisation rates are increasing in New Zealand (NZ), especially in preschool children, and Māori and Pacific people. We aimed to identify risk factors for ID hospitalisation in infancy within a birth cohort of NZ children, and to identify differences in risk factors between ethnic groups. Methods We investigated an established cohort of 6846 NZ children, born in 2009-10, with linkage to a national dataset of hospitalisations. We used multivariable logistic regression to obtain odds ratios (OR) for factors associated with ID hospitalisation in the first year of life, firstly for all children, and then separately for Māori or Pacific children. Results In the whole cohort, factors associated with ID hospitalisation were Māori (OR=1.49, 95%CI 1.17-1.89) or Pacific (2.51, 2.00-3.15) vs. European maternal ethnicity, male gender (1.32, 1.13-1.55), low birthweight (1.94, 1.39-2.66), exclusive breastfeeding for Factors associated with ID hospitalisation for Māori infants were: high household deprivation (2.16, 1.06-5.02) and maternal smoking (1.48, 1.02-2.14); and for Pacific infants: delayed immunization (1.72, 1.23-2.38), maternal experience of healthcare racism (2.20, 1.29-3.70), and maternal smoking (1.59, 1.10-2.29). Conclusions: Māori and Pacific children in NZ experience a high burden of ID hospitalisation. Some risk factors, for example maternal smoking, are shared while others are ethnic-specific. Interventions aimed at preventing ID hospitalisations should address both shared and ethnic-specific factors.</p

Dose-effect relationship and risk factors for vaginal stenosis after definitive radio(chemo)therapy with image-guided brachytherapy for locally advanced cervical cancer in the EMBRACE study

Biological, physical and clinical aspects of cancer treatment with ionising radiatio

Clinical and imaging findings in cervical cancer and their impact on FIGO and TNM staging – An analysis from the EMBRACE study

Objective: To investigate differences in local tumour staging between clinical examination and MRI and differences between FIGO 2009, FIGO 2018 and TNM in patients with primary cervical cancer undergoing definitive radio-chemotherapy. Methods: Patients from the prospective observational multi-centre study “EMBRACE” were considered for analysis. All patients had gynaecological examination and pelvic MRI before treatment. Nodal status was assessed by MRI, CT, PET-CT or lymphadenectomy. For this analysis, patients were restaged according to the FIGO 2009, FIGO 2018 and TNM staging system. The local tumour stage was evaluated for MRI and clinical examination separately. Descriptive statistics were used to compare local tumour stages and different staging systems. Results: Data was available from 1338 patients. For local tumour staging, differences between MRI and clinical examination were found in 364 patients (27.2%). Affected lymph nodes were detected in 52%. The two most frequent stages with FIGO 2009 are IIB (54%) and IIIB (16%), with FIGO 2018 IIIC1 (43%) and IIB (27%) and with TNM T2b N0 M0 (27%) and T2b N1 M0 (23%) in this cohort. Conclusions: MRI and clinical examination resulted in a different local tumour staging in approximately one quarter of patients. Comprehensive knowledge of the differential value of clinical examination and MRI is necessary to define one final local stage, especially when a decision about treatment options is to be taken. The use of FIGO 2009, FIGO 2018 and TNM staging system leads to differences in stage distributions complicating comparability of treatment results. TNM provides the most differentiated stage allocation