2025 – PAGE 323 – INFECTIOUS DISEASES

NEONATAL BACTEREMIA

Note that neonatal bacteremia is NOT the same thing as the syndrome of neonatal sepsis.

• CHILD < 30 DAYS OLD: Differential includes Group B Streptococcus (GBS), E. coli, Streptococcus pneu­mo­niae, and Staphylococcus aureus. Strep is the most common overall.
• CHILD < 12 MONTHS OLD: Same as above + Salmonella.
• IMMUNOCOMPROMISED CHILD: Cancer and HIV patients tend to get very bad gram-negative infections. Think E. coli, Klebsiella, and Pseudomonas.

SINUSITIS

Sinusitis usually starts as a viral infection but may turn into an acute bacterial rhinosinusitis (ABRS). It may be associated with nasal congestion, rhinorrhea, fever, worsening cough, headache or purulent drainage. Suspect ABRS with a history of a child worsening after initially improving. Because of potential complications, antibiotics are initiated promptly when ABRS is suspected. Start antibiotics if you note severe or worsening symptoms, persistent symptoms for > 10 days, antibiotic use in the previous 4 weeks, a history of respiratory disease, concurrent bacterial infection (otitis media, pharyngitis, pneumonia), temperature > 39 °C, or several days of purulent nasal discharge. Start amoxicillin-clavulanate to cover for the usual “HMS” bugs (Haemophilus influenza, Moraxella catarrhalis, and Streptococcus pneumoniae) for uncomplicated disease. Cefpodoxime, cefdinir or levofloxacin (if there’s a penicillin allergy) may also be used. Use ampicillin-sulbactam, ceftriaxone or levofloxacin if the patient is admitted. Add vancomycin if there are no cultures to guide you and the patient is not improving or worsening. Vancomycin can help to treat resistant Strep species and also Staph aureus, which is implicated in more complicated cases. Potential complications include an ethmoid sinusitis leading to an orbital cellulitis and a frontal sinusitis leading to a brain abscess.

PEARL: Children with sinusitis often do not have a headache. If given the history of UNILATERAL foul-smelling nasal discharge, always consider foreign body as the diagnosis, even if the patient has cystic fibrosis!