Pediatric Infections

Question 1

What is different about the definition of SIRS in kids?

Answer 1

• Core temp > 38.5 or 2 SD above normal for age
• Respiratory rate >2 SD above normal for age
• High or low WBC

Question 2

When are babies most at risk of serious bacterial infection?

Answer 2

First 3 months of life

Question 3

What are 3 examples of Serious bacterial infection (SBI) types in children?

Answer 3

1-Meningitis
2-Bacteremia
3-UTI (most common in infants

Question 4

What are 8 laboratory evaluations you might consider?

Answer 4

1-BCB with differential
2-Blood gas
3-Coagulation tests
4-Comprehensive metabolic panel
5-CRP
6-Urinalysis
7-blood and urine cultures
8-CSF for gram stain and culture

Question 5

What images might you consider for SIRS?

Answer 5

1-CXR
2-KUB
3-Brain imaging
4-Others

Question 6

What are the 3 most common causes of neonatal SBI?

Answer 6

1-Group B strep (S. agalactiae)
2-Listeria monocytogenes
3-E. Coli

Question 7

What are 6 viral causes of neonatal sepsis?

Answer 7

1-HSV 1 and 2
2-VZV
3-Enteroviruses
4-Influenza
5-Adenovirus
6-RSV

Question 8

Which pathogen is a gram positive cocci, beta hemolytic?

Answer 8

Group B streptococcus

Question 9

Which drug is used for GBS IAP and only reduces early-onset GBS infection?

Answer 9

Penicillin (or ampicillin)

*clindamycin if you know the isolate is susceptible

Question 10

Which pathogen is a gram positive rod, facultative anaerobe, nonsporulating incomplete beta-hemolytic with polar flagellae and grows well at refrigerator temps?

Answer 10

Listeria monocytogenes

*can appear like diphtheroids, cocci or diplococci

Question 11

Listeria is a risk especially in unpasteurized cheeses, deli meats and ready to eat foods and is treated with what drug?

Answer 11

Ampicillin (plus gentamicin for synergy)

*cephalosporins don’t have activity

Question 12

Which pathogen is a gram negative, motile rod, facultative anaerobe, lactose-fermenting and is the predominant facultative anaerobe of the human GI tract?

Answer 12

E. Coli

Question 13

What is the best way to treat E. Coli?

Answer 13

• Textbook says ampicillin but there is resistance
• Extended spectrum cephalosporin such as CEFOTAXIME is best

*think galactosemia with E. Coli sepsis

Question 14

Which drug is used for gram-positive infections (GBS and Listeria) and is the only active agent for listeria?

Answer 14

Ampicillin

Question 15

Which drug is synergistic for listeria and GBS and gives additional gram negative coverage?

Answer 15

Gentamicin

Question 16

Which drug gives gram negative coverage and is especially important if suspecting meningitis (good CSF penetration)?

Answer 16

Cefotaxime

*Ceftriaxone if > 1 month

Question 17

Which drug is used to treat HSV?

Answer 17

Acyclovir

Question 18

What are the main causes of neonatal conjunctivitis and how is it prevented?

Answer 18

1-Chemical irritation from silver nitrate
2-Chlamydia trachomatis
3-Neisseria gonorrhoeae
4-Other bacteria
5-HSV

*Prevent with Erythromycin

Question 19

Which pathogen is and obligate intracellular bacterium and causes the #1 reportable STD in the US?

Answer 19

Chlamydia trachomatis

*Incubation period for neonates (5-14 days)