ABSTRACT
OBJECTIVES: This study aimed to compare the change in pulmonary function in children and adolescents with cystic fibrosis (CF) who were infected with methicillin-resistant Staphylococcus aureus (MRSA) treated with either vancomycin (VAN) alone or vancomycin plus rifampin (VAN-RIF). METHODS: Included patients were ages 6 to 20 years; hospitalized for an acute pulmonary exacerbation (APE) of CF from May 1, 2012, to April 30, 2014; had a respiratory tract culture positive for MRSA within 1 month of index hospital admission; received at least 48 consecutive hours of VAN or VAN-RIF; and had admission and discharge pulmonary function tests. The primary end point was change in percent predicted forced expiratory volume in 1 second (FEV1). RESULTS: A total of 39 encounters met inclusion criteria: 24 in the VAN group (mean age 15.1 years) and 15 in the VAN-RIF group (mean age 13.7 years). There were no between-group differences in mean percent change in FEV1 (32.6% ± 28.8% vs. 21.1% ± 12.1%; p = 0.091), mean percent change in forced vital capacity (22.6% ± 25.8% vs. 14% ± 9.4%; p = 0.127), or return to baseline FEV1 (20 [83.3%] vs. 14 [93.3%] patients; p = 0.631). Median (IQR) length of stay (13 days [11-14 days] vs. 13 days [9-14 days]; p = 0.6) and median (IQR) time to readmission (82 days [43-129 days] vs. 147 days [78-219 days]; p = 0.2) were similar between the VAN and VAN-RIF groups, respectively. CONCLUSIONS: Vancomycin monotherapy appears to be adequate when treating APEs of CF in children and adolescents with moderate lung disease and high MRSA VAN minimum inhibitory concentrations. Therefore, the addition of RIF may be unnecessary; however, larger studies are needed to confirm these findings.
ABSTRACT
PURPOSE: To determine whether the incidence of complications varies between among types of distal phalangeal fractures in a pediatric population. METHODS: We retrospectively reviewed the medical records and radiographs of patients seen in the pediatric hand surgery clinic from 2011 to 2012 with a diagnosis of distal phalanx fracture. Patients were identified by International Classification of Diseases-Ninth Revision code (816.02 or 816.12). We reviewed 206 charts and included them in the study. Demographic data, location of the fracture, specific diagnosis, mechanism of injury, outcomes, and complications were recorded. The treating physicians clinically identified the outcomes and complications. RESULTS: Average age of patients was 7.5 years. Fracture distribution was tuft (37%), mallet (18%), Salter-Harris I/II (13%), shaft (11%), base (11%), Seymour (6%), Salter-Harris III/IV (2%), and tip amputation (1%). Complications occurred in 31% of patients. The highest rates were for Salter-Harris IV (100%), Seymour (62%), and mallet fractures (49%). There was a statistically significant difference in complication rate by diagnosis. The most common complications were infection (22%), stiffness (15%), and nail deformity (13%). CONCLUSIONS: Complications of distal phalanx fractures in children are frequent. The incidence varies by fracture type, the highest of which are for Salter-Harris IV, Seymour, and mallet fractures. Special care needs to be taken to reduce the complication rates of these common fractures. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.
