Common Childhood Bacterial Infections

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Children with infectious diseases are commonly encountered in primary care settings. Identification of the subset of patients with bacterial infections is key in guiding the best possible management. Clinicians frequently care for children with infections of the upper respiratory tract, including acute otitis media, otitis externa, sinusitis, and pharyngitis. Conjunctivitis is not an uncommon reason for office visits. Bacterial pneumonia, urinary tract infections, and gastroenteritis are regularly seen. Over the last decade, a growing number of children have had infections of the skin and soft tissue, driven by the increased prevalence of infections caused by methicillin-resistant Staphylococcus aureus. The following review addresses the epidemiology and risk factors for specific infections and examines the clinical presentation and selection of appropriate diagnostic methods in such conditions. Methods to prevent these bacterial infections and recommendations for follow-up are suggested. Management of these infections requires that antimicrobial agents be used in a judicious manner in the outpatient setting. Such antibiotic therapy is recommended using both available clinical evidence and review of disease-specific treatment guidelines.

Section snippets

Acute Otitis Media

Acute otitis media (AOM) is the most common childhood infectious disease treated with antibiotics in the United States.1 AOM refers to an infection of the middle ear space associated with rapid onset of symptoms and concurrent findings of middle ear fluid. AOM must be differentiated from otitis media with effusion (OME), defined as fluid in the middle ear without signs and symptoms of an ear infection. In the majority of young children, the clinical presentation of AOM is nonspecific and

Acute Otitis Externa

Acute otitis externa (AOE) is a generalized, inflammation of the external auditory canal, resulting in cellulitis of the canal skin. In some cases, the pinna or TM may be involved. Up to 10% of all individuals may experience an episode of AOE during their lifetime.21 The median age of diagnosis is 9 years. AOE is uncommon before 2 years.22 The infection is unilateral in the great majority of patients. Most cases (98%) are caused by bacterial infection. P aeruginosa (20% to 60% prevalence) and S

Streptococcal Pharyngitis

Tonsillopharyngitis is diagnosed in approximately 11 million patients in US ambulatory settings each year.26 Most episodes are caused by viruses. Group A β-hemolytic streptococci (GAS) is primarily a disease of children 5-15 years of age. A recent study found that 37% of children of all ages who present with a sore throat will have a GAS infection.27 GAS causing pharyngitis is relatively uncommon in preschool children. In temperate climates, infections tend to occur in winter and early spring.28

Acute Bacterial Sinusitis

An acute viral infection associated with the common cold accounts for greater than 95% of all cases of sinusitis (viral rhinosinusitis).35, 36 Acute bacterial sinusitis (ABS) is a bacterial infection of the paranasal sinuses. ABS is almost always preceded by a viral upper respiratory infection (URI), with an estimated 6% to 13% of viral URIs in children complicated by a secondary bacterial infection of the sinuses. Approximately 20 million cases of ABS occur annually in the US and account for a

Bacterial Conjunctivitis

Inflammation of the conjunctiva is common, accounting for 1% to 4% of primary care encounters46 and more than 5 million ambulatory visits in the United States annually.47 Etiologies of conjunctivitis include bacteria, viruses, traumatic, allergic, and following chemical exposures. Bacterial infection accounts for 50% to 80% of all pediatric cases of conjunctivitis. Pathogens are age-related and include S aureus, H influenzae, S pneumoniae, and M catarrhalis48, 49, 50 (Table 4).

The “red eye” is

Pneumonia

Pneumonia is one of the most common infections in children worldwide. Community acquired pneumonia (CAP) refers to lung infection in a previously healthy child who acquired the infection outside of a health care facility. Viral pathogens cause 95% of cases in infancy and are the most common cause of pneumonia in all age groups. In North America, the annual incidence of pneumonia is 34-45 cases per 1000 in children younger than 5 years old and drops to about 20 cases per 1000 in children older

Urinary Tract Infection

Urinary tract infection (UTI) is one of the most common infections encountered in the pediatric age group. Although most UTIs in children are managed on an outpatient basis, it remains one of the most common indications for hospital admission.84 Prevalence rates vary according to age, gender, race, and circumcision status, with uncircumcized male infants less than 3 months of age and females less than 12 months having highest prevalence in the childhood. 85, 86

Clinical presentation of UTI

Bacterial Gastroenteritis

Acute gastroenteritis (AGE) is an acute diarrheal illness that may or may not be associated with nausea, emesis, fever, or abdominal pain. Although acute diarrheal illness is less prevalent in the USA than in developing countries, an estimated 4% of hospitalizations and 2% of outpatient visits among children are due to diarrhea.103 Viruses, the most common pathogens causing AGE in children, are responsible for 70% to 80% of infectious diarrhea in the developed world. The impact of bacterial

Bacterial Skin and Soft Tissue Infections

Bacterial skin and soft tissue infections (SSTIs) are frequent causes for primary care and emergency visits. While most physicians correctly recognize these infections clinically, the emergence of antimicrobial resistance and evolving virulence factors in strains of S aureus and GAS call for a fresh look at routine management of these diseases.

S aureus is agile in both evading host immune responses and resisting antibiotics. Shortly following introduction of penicillin, some S aureus isolates

Conclusions

Effective management of bacterial infections regularly seen in infants and children mandates that the clinician be aware of some important issues. One must be alert to the clinical presentations of these common maladies and aware of the organisms that may cause the infections. In instances where isolation of the organism is difficult, as in otitis media and sinusitis, antibiotics should be directed against the expected pathogens. Knowledge of the local antibiotic susceptibility patterns among

References (134)

  • D.G. Hwang

    Fluoroquinolone resistance in ophthalmology and the potential role for newer ophthalmic fluoroquinolones

    Surv Ophthalmol

    (2004)
  • F. Mah

    Bacterial conjunctivitis in pediatrics and primary care

    Pediatr Clin North Am

    (2006)
  • N.A. Chaudhry et al.

    Emerging ciprofloxacin-resistant Pseudomonas aeruginosa

    Am J Ophthalmol

    (1999)
  • D.G. Wolf et al.

    Association of human metapneumovirus with radiologically diagnosed community-acquired alveolar pneumonia in young children

    J Pediatr

    (2010)
  • T.J. Sandora et al.

    Pneumonia in hospitalized children

    Pediatr Clin North Am

    (2005)
  • L.E. Nicolle

    Asymptomatic bacteriuria: when to screen and when to treat

    Infect Dis Clin North Am

    (2003)
  • M.D. Lee et al.

    Screening young children with a first febrile urinary tract infection for high-grade vesicoureteral reflux with renal ultrasound scanning and technetium-99m-labeled dimercaptosuccinic acid scanning

    J Pediatr

    (2009)
  • L.F. McCaig et al.

    Trends in antimicrobial prescribing rates for children and adolescents

    JAMA

    (2002)
  • D.W. Teele et al.

    Epidemiology of otitis media during the first seven years of life in children in greater Boston: a prospective, cohort study

    J Infect Dis

    (1989)
  • J.M. Gould et al.

    Otitis media

    Pediatr Rev

    (2010)
  • M. Uhari et al.

    A meta-analytic review of the risk factors for acute otitis media

    Clin Infect Dis

    (1996)
  • C.D. Bluestone et al.

    Otitis Media in Infants and Children

  • T. Chonmaitree et al.

    Viral upper respiratory tract infection and otitis media complication in young children

    Clin Infect Dis

    (2008)
  • M.R. Jacobs et al.

    Prevalence of antimicrobial-resistant pathogens in middle ear fluid: Multinational study of 917 children with acute otitis media

    Antimicrob Agents Chemother

    (1998)
  • S. Black et al.

    Postlicensure surveillance for pneumococcal invasive disease after use of heptavalent pneumococcal conjugate vaccine in Northern California Kaiser Permanente

    Pediatr Infect Dis J

    (2004)
  • Y. Berkun et al.

    Acute otitis media in the first two months of life: Characteristics and diagnostic difficulties

    Arch Dis Child

    (2008)
  • J.R. Casey et al.

    Changes in frequency and pathogens causing acute otitis media in 1995-2003

    Pediatr Infect Dis J

    (2004)
  • S.L. Block et al.

    Community-wide vaccination with the heptavalent pneumococcal conjugate significantly alters the microbiology of acute otitis media

    Pediatr Infect Dis J

    (2004)
  • M.E. Pichichero et al.

    Emergence of a multiresistant serotype 19A pneumococcal strain not included in the 7-valent conjugate vaccine as an otopathogen in children

    JAMA

    (2007)
  • J.R. Casey et al.

    New patterns in the otopathogens causing acute otitis media six to eight years after introduction of pneumococcal conjugate vaccine

    Pediatr Infect Dis J

    (2010)

  • Subcommittee on management of acute otitis mediaDiagnosis and management of acute otitis media

    Pediatrics

    (2004)
  • S. Sanders et al.

    Antibiotics for acute otitis media in children

    Cochrane Database Sys Rev

    (2010)
  • A. Hoberman et al.

    Treatment of acute otitis media in children under 2 years of age

    N Engl J Med

    (2011)
  • P.A. Tähtinen et al.

    A placebo-controlled trial of antimicrobial treatment for acute otitis media

    N Engl J Med

    (2011)
  • S.I. McCoy et al.

    Antimicrobial prescribing for otitis externa in children

    Pediatr Infect Dis J

    (2004)
  • R. Lang et al.

    Successful treatment of malignant external otitis with oral ciprofloxacin: report of experience with 23 patients

    J Infect Dis

    (1990)
  • S.L. Block

    Otitis externa: providing relief while avoiding complications

    J Fam Pract

    (2005)
  • E. Hing et al.

    National Ambulatory Medical Care Survey: 2003 summary

    Adv Data

    (2005)
  • N. Shaikh et al.

    Prevalence of streptococcal pharyngitis and streptococcal carriage in children: a meta-analysis

    Pediatrics

    (2010)
  • M.A. Gerber et al.

    Prevention of rheumatic fever and diagnosis and treatment of acute Streptococcal pharyngitis: a scientific statement from the American Heart Association Rheumatic Fever, Endocarditis, and Kawasaki Disease Committee of the Council on Cardiovascular Disease in the Young, the Interdisciplinary Council on Functional Genomics and Translational Biology, and the Interdisciplinary Council on Quality of Care and Outcomes Research: Endorsed by the American Academy of Pediatrics

    Circulation

    (2009)
  • A.L. Bisno et al.

    Practice guidelines for the diagnosis and management of group A streptococcal pharyngitis

    Clin Infect Dis

    (2002)
  • D.R. Lennon et al.

    Once-daily amoxicillin versus twice-daily penicillin V in group A beta-haemolytic streptococcal pharyngitis

    Arch Dis Child

    (2008)
  • J.R. Casey et al.

    Meta-analysis of cephalosporin versus penicillin treatment of group A streptococcal tonsillopharyngitis in children

    Pediatrics

    (2004)
  • R.R. Tanz et al.

    Community-based surveillance in the united states of macrolide-resistant pediatric pharyngeal group A streptococci during 3 respiratory disease seasons

    Clin Infect Dis

    (2004)
  • H.J. Sharp et al.

    Treatment of acute and chronic rhinosinusitis in the United States, 1999-2002

    Arch Otolaryngol Head Neck Surg

    (2007)
  • G. Wolf et al.

    Development of the paranasal sinuses in children: Implications for paranasal sinus surgery

    Ann Otol Rhinol Laryngol

    (1993)

  • Clinical practice guideline: management of sinusitis [published corrections appear in Pediatrics 2002; 109(5):40 and Pediatrics 2001; 108(5):A24]

    Pediatrics

    (2001)
  • I. Brook

    Microbiology and antimicrobial management of sinusitis

    L Laryngol Otol

    (2005)
  • G.P. DeMuri et al.

    Acute sinusitis: clinical manifestations and treatment approaches

    Pediatr Ann

    (2010)
  • N.M. Rankhethoa et al.

    Significance of Streptococcus milleri in acute rhinosinusitis with complications

    L laryngol Otol

    (2008)

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