Card Set Information
Peds Serious Infection
What is the pathophysiology of osteomyelitis?
1. hematogenous spread most common in children
2. primarily develops in metaphysis of long bones
3. slowed blood flow predisposes area to bacterial invasion
4. acute infection and inflammation ensue
5. infection can spread and enter joint space
What is the clinical presentation of osteomyelitis in neonates?
may exhibit pseudoparalysis or pain with movement
half of neonates do not have fever and may not appear ill
What is the clinical presentation of osteomyelitis in older infants and children?
more likely to have fever and localize pain
: edema, erythema and warmth
limp or refusal to walk with involvement of lower extremities
How is osteomyelitis diagnosed?
white blood cell count (WBC)
erythrocyte sedimentation rate (ESR)
c-reactive protein (CRP)
computed tomography (CT)
magneticc resonance imaging (MRI)
What are the causes of osteomyelitis?
bacteria = most common pathogens
Group A streptococcus
Group B streptococcus and enteric gram-negative bacilli
What are the treatment options for osteomyelitis?
What is the duration of therapy for osteomyelitis treatment?
minimum of 21 days
--> patient shows prompt resolution (within 5-7 days)
-->ESR and CRP normalized
4-6 weeks may be required
What is the osteomyelitis empiric antibiotic treatment for neonates?
antistaphylococcal penicillin + broad spectrum cephalosporin
aminoglycoside may be used instead of a cephalosporin
modify antibiotics based on culture results when possible
What is the osteomyelitis empiric antibiotic treatment for infants and children?
vancomycin 60 mg/kg/day divided q 6-8h
modify antibiotics based on culture results when possible
What are the requirements for surgical treatment of osteomyelitis?
frank pus from subperiosteal or metaphyseal aspiration
retained foreign body is possible
infection of hip and/or pelvis
What monitoring is required with osteomyelitis?
WBC, ESR, CRP
children may need long term follow-up
What is the pathophysiology of meningitis in newborns?
acquired during birth from contact with maternal genital and GI flora
What is the pathophysiology of meningitis in older infants and children?
infxn of upper respiratory tract --> invasion of blood --> invasion of CNS --> immunologic cascade --> local tissue damage, edema, increased ICP
What are the classic signs and symptoms (early) of meningitis?
nuchal rigidity (neck stiffness)
altered mental status
kernig sign (+)
brudzinski sign (+)
petechial rash (
What are the late signs and symptoms of meningitis?
How can meningitis be diagnosed?
history and physical examination
CSF gram stain and culture
polymerase chain reaction (PCR)
How does opening pressure present for normal, bacterial and viral meningitis?
: 75 - 175 mm H
How do WBCs present for normal, bacterial and viral meningitis?
: < 5 (cells/mm
: 1000-5000 (cells/mm3)
: 100-1000 (cells/mm3)
How does the differential lab present for normal, bacterial and viral meningitis?
: > 90% monos
: > 80% PMNs
: 50% lymphs
How does protein present for normal, bacterial and viral meningitis?
: < 50 mg/dL
: 100-500 mg/dL
: 30-100 mg/dL
How does glucose present for normal, bacterial and viral meningitis?
: 50-66% simultaneous serum value/ 0.6 CSF:serum glucose
: < 40 (<60% simultaneous serum value);
0.4 CSF:serum glucose (> 2 months);
0.6 CSF:serum glucose (neonates)
What are the common pathogens for meningitis in < 1 month of age?
What is the antibiotic therapy for meningitis in < 1 month of age?
Ampicillin + Cefotaxime or Gentamicin
What are the common pathogens of meningitis in 1-23 months?
What is the antibiotic therapy for meningitis in 1-23 months of age?
Vancomycin + Ceftiaxone OR Cefotaxime
What are the common pathogens of meningitis in children > 2 years?
What is the antibiotic therapy for meningitis in children > 2 years?
Vancomycin + Ceftriaxone OR Cefotaxime
What are the doses of antibiotics for the treatment of meningitis in infants and children?
: 100 mg/kg/dose IV q 6 h
: 225-300 mg/kg/day IV divided q 6-8 h
: 100 mg/kg/day IV divided q 12 h
: 15 mg/kg/dose IV q 6 h
What is the duration of treatment for meningitis?
Based on pathogen:
N. meningitides, H. influenza
: 7 days
: 10-14 days
Aerobic gram-negative bacilli: 21 days
Discuss adjunctive dexamethasone therapy for meningitis.
routine use controversial
evidence of decreased hearing loss in infants & children w/
type b meningitis
no significant difference in time to bacterial eradication
before (up to 1 hr) or at the same time
as 1st dose of abx
dexamethasone 0.15 mg/kg/dose q 6 h for 2-4 days
: dec. amount of drug that penetrates CNS
What prevention techniques are available for
1. chemoprophylaxis (close contacts or rifampin)
Discuss chemoprophylaxis of
1. close contacts
: persons w/ prolonged contact to infected person or their secretions w/in 1 wk before sx begin until 24h after abx are initiated
What are the rifampin dosages for prevention of
< 1 month
: 10 mg/kg/day divided q 12 h x 4 doses
infants & children
: 20 mg/kg/day divided q 12 h x 4 doses
: 600mg q 12 h x 4 doses
What are the 2 types of vaccinations for meningitis and who are vaccines recommended for?
1. conjugated vaccine
9 months; Menveo
recommendation: all persons aged 11-18 yrs; persons 9-23 mos at inc risk, 2-10 yrs & 19-55 yrs at inc risk
What vaccines are available for meningitis due to
1. pneumococcal polysaccharide vaccine (23-valent)
65 yo and 2-64 yo w/ increased risk factors
2. pneumococcal conjugate vaccine (13-valent)
- all children < 23 mos and children 24-59 mos w/ chronic illnesses
What are the s/sx of community acquired pneumonia?
: poor feeding, lethrgy, irritability, poor color, +/- fever, cough, grunting, nasal flaring, use of accessory muscles
: fever, cough, malaise, wheezing, chest pain
What are the clinical s/sx of CAP?
: tachypnea, cough, nasal flaring, decreased breath sounds, rales
What are the diagnostic tests used for CAP?
CBC w/ differential
What is the etiology of CAP?
: RSV, influenza A or B, adenovirus, rhinovirus, parainfluenza viruses
S. pneumonia, H. influenza
type b & Non-typeable
Mycoplasma pneumoniae & Chlamydia pneumoniae
Which patients are eligible for hospitalization associated with CAP?
: younger than 3-6 months
: family cannot provide adequate care
: oxygen saturation less than 90%
4. Moderate to severe respiratory distress
: RR >70 breaths/min for infants < 12 mos of age and > 50 breaths/min for older children
5. Toxic appearance
7. Suspicious of MRSA or other particularly virulent pathogen
Failed outpatient tx
: 48-72 hrs w/o improvement
Age 0 - 20 days: which pathogens, outpatient and inpatient treatment
: Group B streptococci, Listeria monocytogenes, gram neg enteric bacteria
: none - admit pt
: ampicillin + gentamicin or cefotaxime
Age 3 weeks to 3 months: which pathogens, outpatient and inpatient treatment?
: Chlamydia trachomatis, respiratorysyncytial virus (RSV), parainfluenza virus, Streptococcus pneumoniae
: azithromycin 10mg/kg x 1, 5mg/kg x 4 doses; clarithromycin or erythromycin
: azithromycin or erythromycin IV;
: IV macrolide + cefotaxime or ceftriaxone
4 months to 4 years: which pathogens, outpatient and inpatient treatment
: RSV, S. pneumoniae, H. influenzae, Mycoplasma pneumoniae
: amoxicillin PO 90 mg/kg/day divided BID
: ceftriaxone or cefuroxime IV
5 years to 15 years: pathogens, outpatient and inpatient therapy
: mycoplasma pneumoniae, chlamydia pneumoniae, streptococcus pneumoniae
: azithromycin 10 mg/kg x 1, 5 mg/kg x 4 doses; clarithromycin or erythromycin
: macrolide IV + ceftriaxone or cefuroxime IV
What is the treatment for viral CAP?
No abx initially
: deterioration in clinical status should signal possibility of superimposed bacterial infx & abx therapy should be initiated
: oxygen supplementation, fluids, antipyretics