Information on the causative agents of acute otitis media (AOM) in infants <2 months of age is limited.
To analyze the etiology, pathogen susceptibility patterns, clinical presentation and frequency ...of serious bacterial infections in infants <2 months of age with AOM and to determine the relationship between the organisms isolated systemically and those isolated from the middle ear fluid in the patients with serious bacterial infections in the presence of AOM.
The medical records of 137 infants <2 months of age with AOM who underwent tympanocentesis in the emergency room of Soroka University Medical Center between January 1, 1995, and May 30, 1999, were reviewed. The main variables analyzed included demography, frequency of serious bacterial infections, bacteriologic results, susceptibility patterns of the pathogens and clinical presentation.
Median age was 38.7 +/- 13 days; 112 of 137 (82%) infants were hospitalized. Six (4%), 27 (20%), 46 (34%) and 58 (42%) episodes were recorded at age 0 to 2, 3 to 4, 5 to 6 and 7 to 8 weeks, respectively. Fever (temperature >38 degrees C) was present in 96 (70%) of the cases. Culture-negative (bacterial) meningitis was diagnosed in 3 cases. Blood and urine cultures were positive in 1 and 6 infants, respectively. None of the afebrile infants developed serious bacterial infection. One hundred twenty-two bacterial pathogens were isolated from the middle ear fluid of 109 of 137 (80%) patients: Streptococcus pneumoniae in 56 (46%), Haemophilus influenzae in 41 (34%), group A Streptococcus in 12 (10%), enteric gram-negative bacilli in 9 (7%), Moraxella catarrhalis in 3 (2%) and Streptococcus faecalis in 1 (1%). Eleven (20%) of the 56 S. pneumoniae isolates were nonsusceptible to penicillin. Serious bacterial infections were diagnosed in 6 of 137 (4%) patients. Whereas blood and urine grew pathogens typical for blood and urinary tract infections, the middle ear fluid isolates represented different pathogens usually isolated in AOM without any correlation between these 2 groups of pathogens.
(1) Most cases of AOM in infants <2 months of age are caused by pathogens similar to those causing AOM in older children; (2) antibiotic resistance may already be present at early age and should be considered in the empiric treatment of AOM in infants <2 months of age; (3) the presence of AOM does not predict a higher risk for serious bacterial infections in afebrile and febrile infants <2 months of age.
Objectives: To determine clinical characteristics of AOM at presentation and during therapy according to specific etiologies.
Patients and Methods: 1003 patients studied during 1996–2001 in ...antibiotic efficacy studies underwent tympanocentesis and middle ear fluid culture at enrollment and on Day 4–6 (in initially culture‐positive patients only). We used a clinical/otologic (CO) score for evaluating severity of fever, irritability and tympanic membrane redness and bulging (0–3 each parameter, maximal score = 12).
Results: Seven hundred sixty‐three patients had positive cultures with 392 (39%) Haemophilus influenzae, 198 (20%) Streptococcus pneumoniae and 173 (17%) mixed H. influenzae and S. pneumoniae infection. Mean CO score was higher in culture‐positive versus culture‐negative patients (8.21 ± 2.17 vs. 7.73 ± 2.32, p = 0.003) regardless of isolated organism. A marked improvement in CO score was observed on Day 4–6 in all patients: 1.83 ± 2.18 in children initially culture‐positive and 0.9 ± 1.67 in those initially culture‐negative (p < 0.001). The improvement was greater in patients with eradication versus those with bacteriological failure (CO score 1.52 ± 1.82 vs. 2.77 ± 2.85, p < 0.001).
Conclusions: CO score before treatment, after bacterial eradication or in bacteriologic failures are similar in bacterial AOM and are not predictive of the etiology of the disease.
Trimethoprim-sulfamethoxazole (T/S) has often been used as first and second line of treatment for acute otitis media (AOM). Because of the increasing resistance of Streptococcus pneumoniae and ...Haemophilus influenzae to T/S, we undertook the present study to investigate the bacteriologic and clinical efficacy of this drug in AOM.
Fifty-four culture-positive evaluable patients ages 3 to 32 months with AOM were treated with T/S 4/20 mg/kg in two divided daily doses for 10 days. Middle ear fluid (MEF) was cultured at enrollment (Day 1) and on Days 4 and 5 after initiation of treatment. Additional MEF cultures were obtained if clinical relapse occurred. Clinical failure was determined when the symptoms and signs of AOM did not improve or recurred during therapy. Bacteriologic failure was defined by positive culture on Days 4 and 5, or negative on Days 4 and 5 but positive again before the end of treatment. Patients were followed until Day 28 +/- 2.
A total of 67 organisms were isolated from MEF specimens of the 54 study patients: S. pneumoniae, 24; H. influenzae, 40; and Streptococcus pyogenes, 3. Fifteen (63%) of 24 S. pneumoniae were nonsusceptible to T/S (trimethoprim MIC, >0.5 microg/ml), of which 10 (67%) were highly resistant to T/S (trimethoprim MIC, > or = 4.0 microg/ml). Twelve (30%) of 40 H. influenzae and all 3 S. pyogenes isolates were nonsusceptible to T/S (MIC > or = 4.0 microg/ml). Bacteriologic eradication occurred in 9 of 9 (100%) and 27 of 27 (100%) T/S-susceptible S. pneumoniae and H. influenzae, respectively, vs. 4 of 15 (27%) and 6 of 12 (50%) T/S-nonsusceptible S. pneumoniae and H. influenzae, respectively (P < 0.001). The 3 patients with S. pyogenes failed bacteriologically. Nine new organisms, not initially isolated, emerged during treatment, 7 of which (77%) were resistant to T/S. Altogether bacteriologic failure (organisms not eradicated plus newly emerged) occurred in 29 (53%) of 54 patients. Clinical failures occurred in 8 (15%) of 54 patients, and in 7 of these 8 cases the clinical failures occurred in those with bacteriologic failures. Ten patients relapsed clinically after completion of treatment and in 8 of them tympanocentesis for MEF culture was performed. Six of these 8 cultures were positive, and the initial pathogen was isolated in 4 of 6 (67%).
A high bacteriologic failure rate as well as a considerable clinical failure rate occurred among patients with AOM treated with T/S. We believe that T/S is no longer an appropriate empiric choice for the treatment of AOM in regions where high T/S resistance among respiratory pathogens is reported.
Gatifloxacin is an 8-methoxyfluoroquinolone with good activity against respiratory pathogens.
To document the bacteriologic and clinical efficacy of gatifloxacin in recurrent/nonresponsive acute ...otitis media (AOM).
One hundred sixty patients 6 to 48 months of age with recurrent/nonresponsive AOM received gatifloxacin suspension (10 mg/kg once daily for 10 days). Recurrent AOM was defined as > or =3 AOM episodes during the previous 6 months or > or =4 AOM episodes during the previous 12 months. Nonresponsive AOM was defined as AOM occurring < or =14 days after completing antibiotic treatment or not improving after > or =48 h of therapy. Middle ear fluid (MEF) obtained by tympanocentesis pretreatment (Day 1) and 3 to 5 days after initiation of treatment (Days 4 to 6) was cultured. Additional MEF cultures were obtained if clinical failure or recurrence of AOM occurred. Bacteriologic failure was defined by culture-positive MEF during treatment. Patients were followed until Days 22 to 28. Susceptibility was determined by broth microdilution.
One hundred twenty-eight (80%) patients completed treatment, and 32 discontinued the study prematurely (adverse events, 17; lost to follow-up, 10; consent withdrawal, 3; and laboratory abnormalities, 2). From 89 patients (median age, 1 year; median number of prior AOM episodes, 4; range, 0 to 12), 121 pathogens were recovered: Haemophilus influenzae, 74 (61%); Streptococcus pneumoniae, 36 (30%); Moraxella catarrhalis, 9 (7%); and Streptococcus pyogenes, 2 (2%). The 36 S. pneumoniae isolates were susceptible to gatifloxacin (MIC50 0.25 microg/ml); 26 of 36 (72%) were penicillin-nonsusceptible (15 fully resistant). All 74 H. influenzae isolates were susceptible to gatifloxacin (MIC < or = 0.03 mg/ml). Fourteen of 74 (19%) and 9 of 9 (100%) H. influenzae and M. catarrhalis isolates, respectively, produced beta-lactamase. Bacteriologic eradication was achieved for 118 of 121 (98%) pathogens: 74 of 74 H. influenzae; 34 of 36 (94%) S. pneumoniae; 9 of 9 M. catarrhalis; and 1 of 2 S. pyogenes. Clinical improvement/cure at end of treatment was seen in 103 of 114 (90%) clinically evaluable patients. Clinical recurrence of AOM after completion of therapy occurred in 31 patients. Of the 27 recurrent AOM cases in which tympanocentesis was performed, there were 16 (59%) new infections, 4 (15%) culture-negative results and only 7 (26%) true bacteriologic relapses. Adverse events were recorded in 21 of 160 (13%) patients: vomiting, 16; diarrhea, 3; maculopapular rash, 2. No articular adverse events were recorded.
Gatifloxacin is efficacious and safe for the treatment of recurrent/nonresponsive AOM.
OBJECTIVES: Study aimed to assess the nurse's knowledge, attitude and practice regarding Hepatitis-B infection in Tertiary care public Hospital in Quetta Pakistan. METHODS: A cross-sectional ...descriptive study was conducted from February to October, 2016 in the Public and Private hospitals of Quetta city by using a self-administered questionnaire to investigate KAP among registered nurses, of which 384 were agreed to participate. Descriptive and inferential statistics was performed by using SPSS vs 20, Person correlation (p < 0.01) was used to assess the relationship among knowledge, attitude and Practice. RESULTS: The mean age was 27.66±9.13 year. Majority (n=191, 55.4%) were belong to age group 17-26 years with Job Experience of 1-3 years (n=198, 57.4%) working as Nurse (n=162, 47.0) in a Government Hospital (n=275, 79.7%). Overall the study participants had mean knowledge, attitude and practice score were (16.53 ± 2.08), (4.91 ± 1.14) and (6.83 ± 1.61) respectively. There were significant positive linear correlations between knowledge-attitude (r=0.361, p<0.01) knowledge-practice (r=0.246, p<0.01) and attitude-practice (r-0.213, p<0.01) were observed. CONCLUSIONS: The Study conclude that the Nurses had Adequate knowledge, positive attitude but poor practices special with regards to needle prick injuries, it is important to know that this carelessness of the needle prink injury may lead to higher incidence and transmission of Hepatitis-B.
OBJECTIVES: This study aimed to assess the knowledge and awareness regarding cervical cancer and its prevention among nurses working in different hospitals of Quetta, Pakistan METHODS: The cross ...sectional, descriptive study was conducted by using structured questionnaire in different hospitals of Quetta from January to September 2016. Convenient sampling technique was applied by targeting all the nurses working in different hospitals of Quetta city. Study questionnaire was developed and tested for validity and reliability. Descriptive and inferential statistics (Mann Whitney U test and Kruskal Wallis tests, p < 0.05) were used to assess the significance among study variables and were performed by using IBM SPSS v.20. RESULTS: Out of 415 distributed questionnaires 324 were returned (response rate of 78%). The mean Age of respondents were 28.18±9.5 years. Majority (n=127, 43.3%) of participants were interns and had no or less than one year of experience (n=128, 43.7%) with negative family history of any cancer (n=275,93.9%). Mean knowledge score was 18.52±4.84 with majority (n=258, 88.1%) had adequate knowledge regarding cervical cancer. Respondents age, current area of practice, qualification, Institute of degree and past family history were contributing factors (p > 0.05) in adequate knowledge in this study. The results also reviled that not only 68.3% (n=200) and 65.5% (n=192) respondents knew that cervical cancer is vaccine preventable and availability of the vaccine for it. CONCLUSIONS: Nurses working in different hospitals of Quetta city had better understanding of the disease cervical cancer and its prevention. Yet many of the respondent are not aware of it vaccine and its availability.
OBJECTIVES: This study was conducted to determine the health related quality of life in Coronary heart disease (CHD) patients attending different hospitals in Quetta, Pakistan. METHODS: This cross ...sectional study was undertaken in different hospitals of Quetta, Pakistan from January to October 2016 and recruiting patients with coronary heart disease attending the hospital for follow ups the data was obtained by using EQ-5D-3L questionnaire to evaluate health related quality of life (HRQOL) descriptive statistics were used to present result and united kingdom general population survey were used to evaluate EQ-5D scoring and analysis were perfumed using IBM SPSS v.20. RESULTS: Three hundred and fifty-three CHD patients were enrolled in study, majority were belonging to age group 56 - 65 years (n=126, 35.5%) with male dominancy (n=269, 75.8%), The mean EQ-5D descriptive score and EQ-VAS score were 0.54536±0.304 and 67.15±15.99. Demographic characteristics; number of medicines, gender, ethnicity, occupation, education and income were associated with the mean EQ5D and VAS and lower health related quality of life scores in patients with CHD. CONCLUSIONS: The present study showed that quality of life was low in those suffering from CHD. CHD had an adverse impact on all aspects of life such as physical and psychological functioning and general wellbeing.
OBJECTIVES: This study aimed to assess the level of adherence of hypertensive patients in Quetta, by using MMAS-8 and Hill Bone Compliance Scale. METHODS: A Cross-sectional descriptive study was ...conducted in Sandeman Provincial Hospital and Bolan Medical Complex to assess the adherence among hypertensive patients of Quetta, Pakistan. Study has been conducted from March to October 2016. Convenience sampling technique was used to collect data. Those patients who were willing to participate and were suffering with hypertension and receiving medication treatment are included in study. MMAS-8 Urdu version and Hill bone compliance scale was used to assess the level of medication adherence. SPSS V 20 used for descriptive and inferential statistics. RESULTS: Respondents mean age was 45.1 years. Majority 223 (55.6%) were. Marital status showed that maximum respondents 361 (90.0%) were married. Majority of respondents 108 (26.9%) were uneducated. Majority 178 (44.4%) were housewives. And Ethnic group showed that maximum respondents 132 (32.9 %) were Pashtun. The MMAS-8 mean score of adherence in hypertensive patients was 3.55. Among 401 majority of patients 306 (76.6%) were poorly adhered to medications. Ninety-four (23.4%) had moderate adherence. While only (0.2%) had good adherence. The mean score of hill bone compliance Scale in hypertensive patients was 24.16, 83.4% (n=336) had imperfect adherence and 16.2% (n=65) have perfect adherence CONCLUSIONS: It is concluded, patients with hypertension were non-adherence to treatment regimen by using both the questionnaire and both MMAS-8 and Hill Bone Compliance Scale give similar results.
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