Insurance Status and the Risk of Severe Respiratory Syncytial Virus Disease in United States Preterm Infants Born at 32-35 Weeks Gestational Age.

Background. Database studies have identified that public health insurance status is associated with an increased risk of severe respiratory syncytial virus (RSV) disease in US infants. However, these studies did not adjust for the presence of other risk factors and did not evaluate the risk in preterm infants. Methods. In this study, we evaluate the independent association between public insurance and severe RSV disease outcomes adjusting for other risk factors. The prospective, observational RSV Respiratory Events among Preterm Infants Outcomes and Risk Tracking (REPORT) study was conducted over 2 consecutive RSV seasons at 188 US clinical sites that enrolled preterm infants born at 32-35 wGA who had not received RSV immunoprophylaxis with palivizumab. Adjusted incidence rates per 100 infant-seasons of the RSV-associated endpoints of outpatient lower respiratory tract infection (LRI), emergency department (ED) visits, RSV hospitalizations (RSVHs), and intensive care unit admissions during peak RSV season (November-March) were compared for infants with private and public insurance. Results. Of 1642 evaluable infants enrolled in the REPORT study, 50.1% had private insurance and 49.9% had public health insurance. Adjusted rates of RSV outpatient LRIs were similar; however, rates of ED visits (hazard ratio [HR], 2.04; 95% confidence interval [CI], 1.20-3.45) were higher for subjects with public insurance, with a similar but nonsignificant trend observed for hospitalization (HR, 1.61; 95% CI, .93-2.78). Conclusions. Socioeconomic status, as evaluated by public versus private healthcare insurance, is a significant independent risk factor for ED use in US preterm infants and may contribute to increased RSVHs in this population.

Acute necrotizing ulcerative gingivitis and bacteremia caused by Stenotrophomonas maltophilia in an immunocompromised host.

An 8-year-old girl with leukemia developed acute necrotizing ulcerative gingivitis with Stenotrophomonas maltophilia and herpes simplex virus. Progression to bacteremia with pathologic evidence of osteomyelitis occurred despite appropriate antimicrobial therapy. This case highlights the importance of prompt recognition, debridement and appropriate therapy in immunocompromised patients with acute necrotizing ulcerative gingivitis.

In situ diagnosis of central venous catheter-related bloodstream infection without peripheral blood culture.

BACKGROUND: Catheter-related bloodstream infections (CRBIs) are frequent complications of the use of long term central venous catheters (CVCs). Comparative quantitative culture of blood obtained via the CVC and a peripheral vein (PV) is a well-accepted method of diagnosing CRBI; however, an alternative definition for use when a PV culture is not available is desirable. METHODS: A computerized search of patient records identified all positive blood culture results from the St. Jude Children's Research Hospital Microbiology Laboratory between January 1996 and May 2001. Demographic data, catheter information and culture results were abstracted. Sensitivity, specificity, positive predictive value (PPV), and likelihood ratio were calculated for 2 alternative definitions of CRBI. RESULTS: Review of the medical records revealed 136 episodes of bacteremia that were evaluable for alternative definition 1 and 241 episodes that were evaluable for alternative definition 2. In patients with a double lumen CVC, CRBI can be diagnosed by a > or = 5-fold difference in colony-forming units/mL between the 2 lumens (alternative definition 1) with sensitivity, specificity, PPV and likelihood ratio of 61.8, 93.3, 92.2 and 9.22, respectively. In patients with a single or double lumen CVC, CRBI can be diagnosed when the CVC culture yields > or = 100 colony-forming units/mL (alternative definition 2) with sensitivity, specificity, PPV and likelihood ratio of 75.5, 69.1, 79.3, and 2.44, respectively. CONCLUSIONS: Our study suggests that comparison of colony counts from 2 lumens of a double lumen catheter is acceptable for diagnosis of CRBI when a PV culture is not available. Further validation is needed before discontinuing the recommendation to obtain a PV culture.