Showing papers by "Carrie L. Byington published in 2003"

Serious Bacterial Infections in Febrile Infants Younger Than 90 Days of Age: The Importance of Ampicillin-Resistant Pathogens

Abstract: Background. Intrapartum antibiotic pro- phylaxis against group B Streptococcus (GBS) has re- duced the occurrence of serious bacterial infections (SBI) in young infants caused by GBS. Recommendations for initial antibiotic therapy for the febrile infant 1 to 90 days old were developed when infections with GBS were common and antibiotic resistance was rare. Objective. To document the pathogens responsible for SBI in recent years in febrile infants 1 to 90 days old and the antibiotic susceptibility of these organisms. Methods. The results of bacterial cultures from in- fants 1 to 90 days old evaluated for fever at Primary Children's Medical Center in Salt Lake City, Utah, be- tween July 1999 and April 2002 were analyzed. Antibiotic susceptibility profiles were collected and patient records were reviewed to determine if initial antibiotic therapy was changed following the identification of the organ- ism. Results. Of 1298 febrile infants enrolled from the Pri- mary Children's Medical Center emergency department, 105 (8%) had SBI. The mean age of the infants with SBI was 39 days (range 2- 82 days) and 2 (2%) were <7 days. SBI included urinary tract infection (UTI; 67%), bactere- mia (16%), bacteremia and UTI (6%), bacteremia and meningitis (5%), meningitis (2%), abscess (2%), meningi- tis and UTI (1%), and meningitis and gastroenteritis (1%). Eighty-three (79%) of 105 episodes of SBI were caused by Gram-negative bacteria, including 92% of UTI, 54% of bacteremia, and 44% of meningitis cases. The most com- mon pathogen was Escherichia coli (61%). Other Gram- negative pathogens were responsible for 19% of SBI. Staphylococcus aureus was the most common Gram-pos- itive pathogen, causing 8% of SBI. GBS accounted for 6% of SBI. Of the 105 pathogens, 56 (53%) were resistant to ampi- cillin. Of the pathogens causing meningitis, UTI, and bacteremia, 78%, 53%, and 50%, respectively, were resis- tant to ampicillin. Antibiotic therapy was changed in 54% of cases of SBI following identification of the organism. Conclusions. In Utah, ampicillin-resistant Gram-neg- ative bacteria are the most common cause of SBI in fe- brile infants <90 days old. This finding impacts antibi- otic selection, especially in cases of meningitis. Local surveillance of pathogens and antibiotic susceptibility patterns is critical to determine appropriate antibiotic

Aspergillosis in a 24-week newborn: a case report.

Abstract: Aspergillosis is an uncommon neonatal infection, diagnosed with an increasing frequency over the last two decades. We report a premature neonate who developed aspergillosis while receiving amphotericin B and fluconazole for candidiasis. Despite early recognition and diagnosis, the infant died. We review the clinical appearance of Aspergillus species, the distinctions between primary cutaneous aspergillosis and invasive aspergillosis, and advances in diagnosis and treatment.

A Pediatric Literacy Education Program for Low Socioeconomic, Culturally Diverse Families

Abstract: The objective of this research project is to describe parent-child activities and literacy experiences of low-income families attending an urban pediatric clinic. These data were used to educate clinic pediatricians about the needs of their patients and to facilitate the implementation of a literacy education program. Two hundred twenty-four primary caregivers of children between the ages of 1 and 5 years who spoke Spanish or English participated in clinic interviews. These low-income, diverse families engaged in many everyday activities that could facilitate the language and literacy development of their children. Barriers to greater literacy orientation among families included lack of access to children's books and limited use of libraries. Families most at risk for low child literacy orientation were recent immigrants (primarily from Mexico) who spoke English as a second language and had not completed high school. The knowledge of everyday parent-child activities, barriers to literacy, and the...

Method for creating and using a treatment protocol

Abstract: Systems, devices, methods, and software are provided that are suitable for use in the creation, implementation, use and/or refinement of treatment protocols. The software is configured for use in a client-server environment where the server [200] communicates with client devices such as PDAs [406], laptops [404], tablets [402], or desktop computers [408]. The software is directed to programming for basing an assessment of risk of bacterial infection in a subject on the presence, or lack, of viral illness in that subject. The diagnosis of viral illness is made through the use of results obtained from an enterovirus polymerase chain reaction test or a direct fluorescent assay test for respiratory viruses. Such test data, in conjunction with `time to positivity' data for urine, blood, cerebrospinal fluid, or other cultures, is then processed by the software to assess the individual risk of occurrence of various conditions, such as bacterial infection, in a particular subject.