MIAMI BEACH — Your diagnosis and management of infectious diseases in children should have changed following the publication of 10 articles in 2006 and 2007, according to Dr. Russell W. Steele.
The reports range from antimicrobial therapy for methicillin-resistant Staphylococcus aureus infections to an update on cat scratch disease to the well-published alterations to antibacterial prophylaxis prior to dental and gastrointestinal procedures.
Dr. Steele explained why these reports are important for optimal pediatric practice at the annual Masters of Pediatrics conference sponsored by the University of Miami.
“These are all about infectious diseases, and [are] things that have a practical impact immediately—things that might change your practice,” Dr. Steele, division head of pediatric infectious diseases at Ochsner Children's Health Center and Tulane University in New Orleans, said in an interview. He was not an author of any of the articles and had no relevant financial disclosures.
Dr. Steele does a lot of journal reading and scanning. “When something is of obvious practical value—will change someone's practice—I make note of that.” Sometimes colleagues recommend a study to him or ask him questions about it. “Someone will call me when something comes out, and sometimes I haven't even seen it yet. For example, a cardiologist called me about the endocarditis article and it wasn't even out yet.”
Dr. Steele selected the following articles of import:
1. Community-onset methicillin-resistant Staphylococcus aureus skin and soft-tissue infections: impact of antimicrobial therapy on outcome (Clin. Infect. Dis. 2007;44:777–84). Dr. Jörg J. Ruhe of the University of Arkansas for Medical Sciences, Little Rock, and associates determined that use of an antimicrobial with activity against uncomplicated community-onset methicillin-resistant S. aureus (MRSA) skin and soft-tissue infections successfully treated 296 of 312 (95%) episodes. In contrast, treatment was successful for 190 of 219 (87%) cases in patients who did not receive an active antimicrobial. The researchers conducted the retrospective cohort study to address the conflicting data in the literature regarding the role of antimicrobials for these uncomplicated MRSA infections. Use of an inactive antimicrobial agent was an independent predictor of treatment failure, the authors noted. There were 45 treatment failures among the 531 infectious episodes experienced by the 492 adult patients.
2. Is Epstein-Barr virus transmitted sexually? (J. Infect. Dis. 2007;195:469–73). Dr. Joseph S. Pagano, in this editorial commentary, provides perspective on a report in the same issue by Craig D. Higgins of the Institute of Cancer Research, Surrey, England, and associates that demonstrates sexual transmission is possible for Epstein-Barr virus (J. Infect. Dis. 2007;195:474–82).
The retrospective study of 2,006 college students in Edinburgh is among the first to provide seroepidemiologic evidence of sexual transmission, wrote Dr. Pagano of the Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill. He pointed out that nonsexual contact, however, remains responsible for more cases of transmission of EBV and the other three well-established human herpesviruses transmitted sexually: herpes simplex virus type 2, cytomegalovirus, and Kaposi's sarcoma-associated herpesvirus.
Dr. Steele commented, “This article offers additional information as how [Epstein-Barr virus] might be transmitted. If you get an adolescent with Epstein-Barr virus, you might do a lot more history regarding sexual activity and more counseling.”
3. Specific real-time polymerase chain reaction places Kingella kingae as the most common cause of osteoarticular infections in young children (Pediatr. Infect. Dis. J. 2007;26:377–81). This prospective study identified Kingella kingae as the causative pathogen for 39 out of 87 (45%) children admitted to a pediatric unit for an osteoarticular infection. S. aureus was the second leading cause, identified in 25 (29%) children. Dr. Sylvia Chometon and the other French researchers implicated K. kingae as the leading pathogen at their institution using a real-time polymerase chain reaction assay they developed.
4. Practice parameter: treatment of nervous system Lyme disease (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology (Neurology 2007;69:91–102). There are sufficient data to conclude that, in both adults and children, nervous system Lyme disease infection responds well to penicillin, ceftriaxone, cefotaxime, and doxycycline, according to panel recommendations following a review of 37 articles in the literature. In addition, the subcommittee found no compelling evidence of a beneficial effect from prolonged antibiotic treatment in patients with post-Lyme syndrome. The number of children in the studies is limited, but available data indicate that findings are comparable to those in adults, they noted.
5. The clinical assessment, treatment and prevention of Lyme disease, human granulocytic anaplasmosis, and babesiosis: clinical practice guidelines by the Infectious Disease Society of America (Clin. Infect. Dis. 2006;43:1089–134). Updated evidence-based guidelines for the management of patients with Lyme disease, human granulocytic anaplasmosis (formerly known as human granulocytic ehrlichiosis), and babesiosis replace guidelines from 2000. An Infectious Diseases Society of America expert panel provided information about prevention, epidemiology, clinical manifestations, diagnosis, and treatment for each of these Ixodes tickborne infections. The guidelines recommended antimicrobial therapy regimens for Lyme disease prevention and treatment, and include a partial list of therapies to be avoided.