Anti infective

Highlights of the 2016 European Society for Paediatric Infectious Diseases meeting – a focus on respiratory tract infections

The 34th annual meeting of the European Society for Paediatric Infectious Diseases was held in Brighton, UK, from 10–14 May 2016. This year’s meeting brought together experts in the fields of paediatric infection, immunology, epidemiology and public health for an exciting programme of scientific discussion and educational workshops. 1

E-poster session upper and lower respiratory tract infections

Key presentations in this session included:

• A hospital-based study investigating household cooking practices in Nigeria as a risk factor for acute respiratory infections in children under 5 found that children from households that cook in the bedroom have a 3-fold greater risk of acute respiratory infections than those from households with separate kitchens. 2
  
• A study of the incidence of community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) pneumonia in a paediatric hospital in Argentina found that the incidence of CA-MRSA cases had markedly increased from 2008 to 2014. Compared with pneumococcal pneumonia, CA-MRSA increased the risk of presenting with sepsis or septic shock (15-fold), being admitted to paediatric intensive care (5-fold) and requiring assisted mechanical ventilation (11-fold). 3
  
• Researchers in India developed a novel scoring system to predict hospitalisation of children with bronchiolitis. A Glasgow Coma Scale score <15, peripheral capillary oxygen saturation <92% on room air, fever >37.8°C, tachypnea (respiratory rate >60) and age <6 months were significant risk factors for hospital admission with bronchiolitis. 4
  
• A Ukrainian study examined the duration of use of corticosteroid inhalers in asthmatic children and episodes of CAP. A strong positive correlation was observed between frequency of CAP episodes and duration of inhaled corticosteroid use for more than 2 years. 5
  
• An epidemiological study of the incidence, severity and management of acute otitis media (AOM) in children under 5 in Russia found a high AOM disease burden, underestimated by official statistics. 6
  
• A retrospective study in Belgian children with parapneumonic effusion as a complication of CAP showed that treatment of choice was a chest drain, with or without fibrinolytics, and conventional therapy with intravenous antibiotics. 7

ESPID symposium – Global impact better understanding respiratory infections

A study presented risk factors for hospital admission and death related to seasonal and pandemic influenza in paediatric intensive care units (PICU) in England and Wales. 8

Using logistic regression analysis, the authors investigated associations between demographic data, disease characteristics (including length of infection) and death in data from the Paediatric Intensive Care Audit Network relating to hospital admissions during influenza outbreaks:

• Pre-H1N1 pandemic (September 2003 – March 2009)
  
• H1N1 pandemic waves 1 and 2 (April 2009 – March 2010)
  
• H1N1 pandemic wave 3 (April 2010 – March 2011)
  
• Post-H1N1 pandemic (April 2011 – December 2014). 8

The highest influenza-related PICU admission rates were seen in infants. 8

After adjusting for age, girls were admitted less frequently than boys (incidence rate ratio 0.80; 95% confidence interval [CI] 0.70–0.92). However, once admitted to PICUs, girls had higher odds of death than boys after adjusting for ethnicity, influenza outbreak and chronic illness (adjusted odds ratio 1.57; 95% CI 1.04–2.38) adjusted for ethnicity, period and chronic illness. 8

An observational study investigating associations between nasopharyngeal bacterial colonisation and viral respiratory infections in nursery children in Bristol, UK found that a high percentage of children in the study were carriers of Streptococcus pneumoniae (78.8%), Moraxella catarrhalis (85.7%) and Haemophilus influenzae (85.0%). 9

In comparison to other bacterial species, these species were often found in high density (>1,000 gene copies/mL), and density increased 2-fold in children with evidence of respiratory viral infections and nasal discharge. 9

The total bacterial load of these six bacteria species (S. pneumoniae, S. pyogenes, N. meningitides, M. catarrhalis, H. influenzae and S. aureus) reduced with increasing age. 9

Respiratory viral infections and nasal discharge were independently associated with increased bacterial density. 9Transmission of common respiratory bacteria may be promoted by increased colonisation density and rhinitis. 9

Reference list

1. ESPID 2016 welcome letter. [Online] 2016.
   
2. ESPID 2016 e-poster viewing 05. S – Upper and lower respiratory tract infections. Fakunle A & Ogundare J. Household cooking practices as risk factor for acute respiratory infections among hospitalized under-5 children in Ibadan, Nigeria. [Online] 11 May 2016.
   
3. ESPID 2016 e-poster viewing 05. S – Upper and lower respiratory tract infections. Ensinck G, Lazarte G, Romagnoli A, Pinotti M, Cantador A, Ernst A, et al. Community-acquired methicillin resistant Staphylococcus aureus (CA-MRSA) pneumonia in a children´s hospital – our experience. [Online] 11 May 2016.
   
4. ESPID 2016 e-poster viewing 05. S – Upper and lower respiratory tract infections. Mahajan V, Bhatia R, Arya A, Tiwari A, Saini SS. Bronchiolitis clinical score to predict hospitalisation in children: a prospective cohort study. [Online] 11 May 2016.
   
5. ESPID 2016 e-poster viewing 05. S – Upper and lower respiratory tract infections. Nesterenko Z. Community-acquired pneumonia in children with asthma and different duration of inhaled corticosteroid therapy. [Online] 11 May 2016.
   
6. ESPID 2016 e-poster viewing 05. S – Upper and lower respiratory tract infections. Kozlov R, Muravyev A, Scherbakov M, Rodnikova V, Romanenko V, Safianov K. Incidence of acute otitis media (AOM) in Russia: an epidemiological study in children under 5 years of age. [Online] 11 May 2016.
   
7. ESPID 2016 e-poster viewing 05. S – Upper and lower respiratory tract infections. Bracke S, Schelstraete P, Willems J. The management of community-acquired pneumonia complicated by parapneumonic effusion in children: a single centre experience. [Online] 11 May 2016.
   
8. ESPID 2016 symposium 9 – Global impact: better understanding respiratory infections. Hardelid P, Kapetanstrataki M, Fleming SJ, Lister P, Gilbert R, Parslow R. Seasonal and pandemic influenza in paediatric intensive care units in England and Wales: risk factors for admission and mortality. [Online] 13 May 2016.
   
9. ESPID 2016 symposium 9 – Global impact: better understanding respiratory infections. Thors V, Morales-Aza B, Vipond I, Muir P, Finn A. Nasopharyngeal bacterial density is increased by viral respiratory infections which may facilitate transmission. [Online] 13 May 2016.