Comparison of Antimicrobial Sensitivity to Older and Newer Quinolones versus Piperacillin-Tazobactam, Cefepime and Meropenem in Febrile Patients with Cancer in two Referral Pediatric Centers in Tehran, Iran.

BACKGROUND: Infection in pediatric cancer patients has become a concerning problem due to increasing antimicrobial resistance. The goal of this study was to determine the antimicrobial resistance patterns of blood isolates from pediatric oncology patients in Iran to determine if there was significant resistance to quinolones. METHODS: Children with cancer who were admitted with or developed fever during admission to Aliasghar Children's Hospital or Mahak Hospitals July 2009 through June 2011 were eligible for enrollment. Two blood cultures were obtained. Antimicrobial sensitivity test was performed for ciprofloxacin, moxifloxacin, gatifloxacin, meropenem, cefepime, and piperacillin-tazobactam on isolates from children who were bacteremic. RESULTS: Blood cultures were positive for 38 episodes in 169 enrolled children but 9 episodes were excluded as blood cultures were thought to be contaminated, yielding a bacteremia rate of 29/160 (18%). The mean age of children and the stage of malignancy did not differ between those with and without bacteremia. Meropenem was the most likely antibiotic to cover isolates (97%) with cefepime having the lowest coverage rate (21%). Quinolone coverage ranged from 63% to 76%. CONCLUSION: Quinolones may not be suitable for use as empiric therapy in febrile pediatric oncology patients in Iran.

Preventing respiratory syncytial virus infections.

Respiratory syncytial virus infection is the leading cause of lower respiratory tract infections in young children. Palivizumab, a respiratory syncytial virus-specific monoclonal antibody, reduces the hospitalization rate of high-risk children but it is very costly. This statement replaces three previous position statements from the Canadian Paediatric Society about this topic, and was updated primarily to discuss recent changes in the American Academy of Pediatrics guidelines in the Canadian context. It reviews the published literature and provides recommendations regarding palivizumab use in high-risk children.

Pneumonia in healthy Canadian children and youth: Practice points for management.

Although immunization has decreased the incidence of bacterial pneumonia in vaccinated children, pneumonia remains common in healthy children. Unless it is totally impractical, a chest radiograph should be performed to confirm the diagnosis of pneumonia. Factors such as age, vital signs and other measures of illness severity are critical in the decision regarding whether to admit a patient to hospital. Because Streptococcus pneumoniae continues to be the most common cause of bacterial pneumonia in children, prescribing amoxicillin or ampicillin for seven to 10 days remains the mainstay of empirical therapy for non-severe pneumonia. If improvement does not occur, consideration should be given to searching for complications (empyema or lung abscess). Routine chest radiographs at the end of therapy are not recommended unless clinically indicated.

Paediatric complicated pneumonia: Diagnosis and management of empyema.

Pneumonia can be complicated by an empyema, progressing from an exudative effusion, to a fibrinopurulent stage with loculations, and then organized with a thick fibrinous peel. The predominant causative organisms are Streptococcus pneumoniae, Staphyloccocus aureus (including methicillin-resistant S aureus) and Streptococcus pyogenes. Recently, an increased incidence of paediatric complicated pneumonia has been reported. For diagnostic imaging, a chest radiograph followed by a chest ultrasound is preferred. Computed tomography chest scans, with associated radiation, should not be routinely used. Antibiotic coverage should treat the most common causative organisms. Additional invasive or surgical management is recommended to reduce the duration of illness in cases not promptly responding to antibiotics or with significant respiratory compromise. Choice of management should be guided by best evidence and local expertise. Video-assisted thorascopic surgery or insertion of a small-bore percutaneous chest tube with instillation of fibrinolytics are the best current options.

Water Quality Functions of Riparian Forest Buffers in Chesapeake Bay Watersheds

/ Maryland, Virginia, and Pennsylvania, USA, have agreed to reduce nutrient loadings to Chesapeake Bay by 40% by the year 2000. This requires control of nonpoint sources of nutrients, much of which comes from agriculture. Riparian forest buffer systems (RFBS) provide effective control of nonpoint source (NPS) pollution in some types of agricultural watersheds. Control of NPS pollution is dependent on the type of pollutant and the hydrologic connection between pollution sources, the RFBS, and the stream. Water quality improvements are most likely in areas of where most of the excess precipitation moves across, in, or near the root zone of the RFBS. In areas such as the Inner Coastal Plain and Piedmont watersheds with thin soils, RFBS should retain 50%-90% of the total loading of nitrate in shallow groundwater, sediment in surface runoff, and total N in both surface runoff and groundwater. Retention of phosphorus is generally much less. In regions with deeper soils and/or greater regional groundwater recharge (such as parts of the Piedmont and the Valley and Ridge), RFBS water quality improvements are probably much less. The expected levels of pollutant control by RFBS are identified for each of nine physiographic provinces of the Chesapeake Bay Watershed. Issues related to of establishment, sustainability, and management are also discussed.KEY WORDS: Riparian forest buffers; Chesapeake Bay; Nonpoint source pollution; Nitrogen; Phosphorus; Sediment