6. How reliable is a negative blood culture result? Volume of blood submitted for culture in routine practice in a children's hospital (Pediatrics 2007;119:891–6) “In routine clinical practice, a negative blood culture result is almost inevitable for a large proportion of blood cultures because of the submission of an inadequate volume of blood,” wrote Dr. Thomas G. Connell of the University of Melbourne, Parkville, Australia, and his associates. They assessed blood samples submitted for culture over 6 months at a children's hospital for adequate volume and use of proper culture bottles. Before an educational intervention to improve these parameters, they found 491 of 1,067 (46%) blood cultures had an adequate volume and 378 (35%) were submitted in the correct bottle type. After the intervention, there were significant improvements in the number of submission with adequate volume, 186 of 291 (64%) and use of the correct vial, 149 of 291 (51%) cultures.
7. Etiology of severe sensorineural hearing loss in children: independent impact of congenital cytomegalovirus infection and GJB2 mutations (J. Infect. Dis. 2007;195:782–8). In this study, Dr. Hiroshi Ogawa of Fukushima Medical University, Fukushima City, Japan, and associates demonstrated that congenital cytomegalovirus (CMV) infections are an important cause of severe sensorineural hearing loss. In addition, the incidence from this etiology is comparable to one of the major genetic causes of the condition, GJB2 gene mutations. These findings come from an assessment of DNA samples from 67 affected children born in Japan.
A total of 15% had congenital CMV infection and 24% had GJB2 mutations. All participants with CMV infection developed the severe hearing loss before age 2 years, and most had no clinically obvious abnormality at birth.
8. Surgical excision versus antibiotic treatment for nontuberculous mycobacterial cervicofacial lymphadenitis in children: a multicenter, randomized, controlled trial (Clin. Infect. Dis. 2007;44:1057–64.). Dr. Jerome A. Lindeboom of the University of Amsterdam and associates determined that surgery was more effective than antibiotics for children with nontuberculous mycobacterial cervicofacial lymphadenitis. Although surgery is considered standard treatment, increasing reports of successful antibiotic treatment spurred the study. The investigators randomized 100 children with the condition to surgical excision of the involved lymph nodes or to clarithromycin and rifabutin treatment for at least 12 weeks. Surgery was more effective with a cure rate of 96%, compared with the antibiotic therapy cure rate of 66%. Treatment failures were not associated with resistance to or noncompliance with the antibiotic regimens.
9. Lymph node biopsy specimens and diagnosis of cat-scratch disease (Emerg. Infect. Dis. 2006;12:1338–44). A diagnosis of cat scratch disease does not rule out a diagnosis of mycobacteriosis or neoplasm, according to this report. Dr. Jean-Marc Rolain, professor at the Unité des Rickettsies in Marseille, France, and associates performed microbiologic assessment of lymph node biopsies from 786 patients with suspected cat-scratch disease. The most common infectious agent was Bartonella henselae, found in 245 patients (31%). Mycobacteriosis was diagnosed in 54 patients (7%) by culture, and neoplasm was detected in 181 (26%) specimens suitable for histologic analysis from 47 patients. Of note, 13 patients with confirmed B. henselae infections had concurrent mycobacteriosis (10 cases) or neoplasm (3 cases). This suggests routine histologic testing of lymph node biopsy specimens is indicated because some patients might have a concurrent malignant disease or mycobacteriosis, the authors wrote.
10. Prevention of infective endocarditis: guidelines from the American Heart Association: a guideline from the American Heart Association Rheumatic Fever, Endocarditis, and Kawasaki Disease Committee, Council on Cardiovascular Disease in the Young, and the Council on Clinical Cardiology, Council on Cardiovascular Surgery and Anesthesia, and the Quality of Care and Outcomes Research Interdisciplinary Working Group (Circulation 2007;116:1736–54). This is an update to American Heart Association recommendations for prevention of infectious endocarditis, last released in 1997. The recommendations are based on literature reports of procedure-related bacteremia and infective endocarditis, in vitro susceptibility data for infective endocarditis microorganisms, prophylaxis findings from animal studies, and retrospective and prospective studies of prevention in humans.
Only an extremely small number of cases of infective endocarditis might be prevented by antibiotic prophylaxis for dental procedures, even if such prophylactic therapy were 100% effective, the writing committee found. In addition, prophylaxis for dental procedures is reasonable only for patients with underlying cardiac conditions associated with the highest risk of adverse outcome from infective endocarditis. The recommendations also state that administration of antibiotics solely to prevent endocarditis is not recommended for patients who undergo a genitourinary or gastrointestinal tract procedure.
These 10 articles have the potential to alter infectious disease practice, Dr. Steele said. “This article on endocarditis is the most dramatic example. We are using a lot less prophylaxis before dental procedures now.”