Microbiology of bacteria causing recurrent acute otitis media (AOM) and AOM treatment failure in young children in Spain: shifting pathogens in the post-pneumococcal conjugate vaccination era.

OBJECTIVE: To prospectively identify the bacterial aetiology and antimicrobial susceptibility of problematic (recurrent and treatment failure) acute otitis media in Spanish children several years after the introduction of 7-valent pneumococcal conjugate vaccine. METHODS: Tympanocentesis or careful sampling of spontaneous otorrhoea was performed on children aged 3 to <36 months with recurrent acute otitis media, acute otitis media treatment failure or unresolved acute otitis media. RESULTS: 105 acute otitis media episodes (77 sampled by tympanocentesis, 28 otorrhoea samples) were evaluated: 46 recurrent, 35 treatment failures, 24 unresolved acute otitis media. 74 episodes (70.4%) had at least one bacterium identified on culture: Streptococcus pneumoniae was identified in 21 episodes, Haemophilus influenzae (all non-typeable) in 44, Streptococcus pyogenes in 2, Moraxella catarrhalis in 2. No statistically significant difference in bacterial aetiology by episode type was detected. Non-typeable H. influenzae was the most commonly isolated pathogen in all acute otitis media types and in all age sub-groups. Forty percent of S. pneumoniae isolates were multi-drug resistant. Pneumococcal serotype 19A was the most frequently identified serotype (7/21 episodes). Multi-drug resistance was found in 56% of 19A isolates. Of non-typeable H. influenzae isolates, 15% were ampicillin resistant and 13% were amoxicillin/clavulanate resistant. S. pneumoniae and non-typeable H. influenzae DNA were each detected in 57% of samples culture negative for these pathogens, including 12 co-infections. CONCLUSION: Combining culture and polymerase chain reaction results, H. influenzae and S. pneumoniae may be implicated in 70% and 43% of clinically problematic bacterial acute otitis media episodes, respectively. The impact of new vaccines to prevent both S. pneumoniae and non-typeable H. influenzae acute otitis media may be substantial in this population and is worth investigating.

La lactancia en los libros para niños y niñas de 0 a 6 años / Breastfeeding in books for children of 0 to 6 years of age

Objetivo. Describir como se presenta la lactancia en las ilustraciones de los libros infantiles y relacionar el sexo de los autores e ilustradores, país de origen de la primera edición y grupo de edad destinatario del libro, con el tipo de lactancia representada. Método. Revisión de los libros para niños de 0 a 6 años de edad de tres bibliotecas infantiles y de una librería de Barcelona. Se seleccionaron todos los libros que contenían imágenes de lactancia y se registraron el tipo de lactancia y otras variables. Es un estudio descriptivo. Resultados. En el 42% de los 169 libros seleccionados hay imágenes de lactancia materna, 12% corresponden a lactancia materna en humanos y el resto en animales. En el 77.5% de los libros hay imágenes de lactancia artificial, el 23% de éstas son imágenes de lactancia artificial presentes en el entorno y el 18% son imágenes fuera del contexto de la lactancia. El género femenino es mayoriatariamente autor del texto y de las ilustraciones. El 90% de los libros proceden de la UE, el 18% del total de Catalunya. El 79% de los libros están destinados a niños de 3-6 años de edad. Conclusiones. Hay poca presencia de la lactancia materna en libros infantiles. Este trabajo nos lleva a los pediatras e infermeras de pediatría a animar a los editores de los libros infantiles a que transmitan la lactancia materna como el alimento óptimo para el recién nacido (AU)

Objective. To describe how breastfeeding is depicted in books addressed to young children, and to evaluate the relationship between the feeding practices mentioned in the books, and the sex of the authors and illustrators, the country where the book was edited, and the age group targeted. Methods. In this descriptive study, we reviewed books addressed to children younger than 6 years of age that were available in three childhood libraries and one general library. All the books that showed images of childfeeding were selected. The type of feeding and other variables were documented. Results. Forty-two percent of the 169 books selected showed images of breastfeeding; 12% of those referred to human breastfeeding, and the remaining referred to animal breastfeeding. Images showing formula feeding were present in 77.5% of the books. Most of the authors and illustrators were females. Ninety percent of the books were edited in the European Community, including 12% of he books that were edited in Catalonia. Seventy nine percent of the books were addressed to children aged 3 to 6 years. Conclusions. Breastfeeding is not very present in children’s books. Authors and editors of books addressed to young children should be encouraged to show breastfeeding as the best nutritional alternative (AU)