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Nasopharyngeal carriage of non-typeable Haemophilus influenzae in children with non-severe pneumonia
S104
Posters / Paediatric Respiratory Reviews 11S1 (2010) S79–S115
P72J Nasopharyngeal carriage of non-typeable Haemophilus influenzae in children with non-severe pneumonia C.B. Kartasasmita1 , C. Murad1 , S. Sudigdo-Adi1 , M. Kuswandewi1 , E. Khrisna1 , E. Simoes2 . 1 Research Unit, School of Medicine, University Padjadjaran – Bandung, Indonesia; 2 The Children Hospital, University Colorado – Denver, USA Nasopharyngeal carriage is a major factor in the pathogenesis of pneumococcal and Haemophilus influenzae (Hi) diseases and its transmission. In the post Haemophilus influenzae type b (Hib) vaccine era, non-typable H influenza (NTHi) has emerged as an important microorganism for acute respiratory infections. This study was conducted to know the prevalence of NTHi in under five years old children with non-severe pneumonia and the antimicrobial resistance. One thousand and twelve children underfive years old were enrolled. Informed consent was obtained from their parents or guardians prior to inclusion of the subject in the study. Calcium-alginate nasopharyngeal swabs were obtained, and directly stored in amies transport before brought to the laboratory for further examination. Specimens were cultured on chocolate agar with Bacitracin, with identification using X and V factor. Serotype was performed by agglutination method using BD Difco Haemophylus influenza antisera. Antimicrobial succeptibility testing to amoxycilline, chloramphenicol and cotrimozaxole-trimetoprim were determined using E-test, and defined according to 2007 CLSI guidelines. Positive Hi isolates were found in 425 (41.99%) swabs, serotyping was done in 376 isolates. The serotype isolated were 132 (35%) NTHi, 199 (52.8%) Hi, and 46 (12.2%) typable Hi non-b. The age of children with NTHi positive ranged from 2 to 55 months; 43.5% age 2 to 12 months, 44.3% age 13 to 36 months, 8.4% age 37 to 48 months, and 3.8% age 49 to 60 months. There were 70 (53%) boys and 61 (47%) girls. Majority of the isolates (83.2%) were susceptible to amoxycillin, 80.9% to chloramphenicol, and only 51.9% to co-trimoxazole. Sixty three (47.7%) isolates were sensitive to all three antibiotics, and 6.8% were resistant to all antibiotics. In Indonesia Hib vaccination is not yet in the EPI programme, no one of the study children received Hib vaccination. The study showed that the prevalence of NTHi was rather high. However, more than 80% isolates were sensitive to amoxycillin and chloramphenicol, but only half susceptible to co-trimoxazole. P73J Paracetamol in pregnancy is not a risk factor for overall preschool wheezing disorder, but seems to be it for multiple-trigger wheeze H. Thengilsdottir1 , E. Goksor ¨ 1 , B. Alm1 , L. Erdes2 , P. Mollborg, ¨ 1 ˚ R. Pettersson4 , G. Norvenius1 , N. Aberg , G. Wennergren1 . 1 University of Gothenburg, Department of Pediatrics, Gothenburg, Sweden;; 2 Pediatric Outpatient Clinic, Skene, Sweden; 3 Fyrbodal Health Care Region, Central Infant Welfare Unit, Uddevalla, Sweden; 4 Pediatric Outpatient Clinic, Central Infant Welfare Unit, M¨ olndal, Sweden Background and Aim: A possible association between prenatal paracetamol exposure and asthma in childhood is debated. The aim of this analysis was to test the association between prenatal paracetamol exposure and overall preschool wheezing disorder, episodic viral wheeze and multiple-trigger wheeze. Multiple-trigger wheeze has been associated with future “true” asthma. Methods: Data were obtained from a prospective, longitudinal study of a cohort of children born in the region of Western Sweden in 2003. 8176 families (50% of the birth cohort) were randomly selected. The parents answered questionnaires at 6 and 12 months and at 4.5 years of age. The response rate at 4.5 years was 4496, i.e. 83% of the 5398 questionnaires distributed at 4.5 years. We here studied the association between maternal medication during pregnancy and wheezing at age 4.5 years. Overall wheezing disorder
was defined as recurrent wheeze (3 or more episodes during the last year) and/or wheeze treated with inhaled corticosteroids during the last year. Episodic viral wheeze was defined as wheezing only with viral infections and multiple-trigger wheeze as wheezing inbetween infections. Results: 28.4% of the mothers had used medicines during pregnancy. Paracetamol had been taken by 7.2%, allergy medicines, including asthma medication, by 4.4% and other medication by 15.6%. In the univariate analysis, we found an increased risk of overall wheezing disorder with both allergy/asthma medication (OR 3.0; 95% CI 2.0– 4.5) and paracetamol (OR 1.5; 1.03–2.2). In the multivariate analysis, only the association with maternal allergy/asthma medication remained statistically significant (OR 1.7; 1.002–2.9). However, the risk of multiple-trigger wheeze was increased by paracetamol, both in the univariate and multivariate analyses (OR 2.3; 1.3–4.2 and 2.4; 1.2–4.9, respectively). The risk of episodic viral wheeze was not increased by paracetamol, neither in the univariate, nor in the multivariate analysis, (OR 1.02; 0.6–1.8 and 0.8; 0.4–1.7). Conclusion: Prenatal paracetamol exposure was not an independent risk factor for overall wheezing disorder at preschool age. However, in the subgroup multiple-trigger wheeze an association with prenatal paracetamol exposure was found. As could be expected, maternal allergy/asthma medication during pregnancy was associated with wheezing disorder. P74J Belgian French-speaking pharmacists’ knowledge on childhood asthma E. Gueulette1 , E. Bodart2,1 . 1 Clinique et Maternit´e Sainte-Elisabeth – Namur, Belgium; 2 Cliniques Universitaires U.C.L de Mont-Godinne – Yvoir, Belgium Introduction: All the consensuses underline the importance of education in the global management of asthma in children. As doctor’s co-actors, pharmacists play a crucial role in this education. Study: We have conducted an e-mail survey amongst pharmacists registered to the Scientific Society for French speaking pharmacists. The survey aimed at measuring their knowledge of the disease and how they behave around it. The questionnaire addressed items related to the following areas: demographics, general knowledge of the illness, diagnosis and management, medications and inhalation systems. Results: Out of 1000 e-mails sent, 236 were read by the surveyed audience. 78 completed the survey which represents 33%. At least once a week, 79.2% of pharmacists provide medication prescribed by a doctor or answer customer’s question about the disease. In the general knowledge area, 41.9% do not know how prevalent the illness in Belgium is. 86.1% believe that allergological skin tests cannot be conducted before the age of 2. 45.9% explain that eggs are the most commonly spread dietary allergen in Belgium. The item about diagnosis and medical care showed 61.6% of responders estimating that the level of asthma control is mainly based on the child’s quality of life. On the contrary, a majority (80.8%) knows that child asthma diagnosis is essentially based on symptoms and 92.1% know that the treatment is adapted according to the level of the illness control. Concerning medication, 60.8% ignore that a higher dose of medicine administered to infants have to be provided upon a doctor’s prescription unlike to older patients. Respectively 72% and 41% are not aware of the dose or optimal frequency of a short acting beta-2 agonist. Also, 88.5% believe that a long acting beta-2 agonist cannot be proposed as a preventive mean in case of exercice induced asthma. In terms of inhaling systems, 33.8% of pharmacists never explain their customer how to maintain a inhalation chamber and 23% admit they never inform them how to use appropriate inhalers prescribed by the doctor.
Posters / Paediatric Respiratory Reviews 11S1 (2010) S79–S115
P72J Nasopharyngeal carriage of non-typeable Haemophilus influenzae in children with non-severe pneumonia C.B. Kartasasmita1 , C. Murad1 , S. Sudigdo-Adi1 , M. Kuswandewi1 , E. Khrisna1 , E. Simoes2 . 1 Research Unit, School of Medicine, University Padjadjaran – Bandung, Indonesia; 2 The Children Hospital, University Colorado – Denver, USA Nasopharyngeal carriage is a major factor in the pathogenesis of pneumococcal and Haemophilus influenzae (Hi) diseases and its transmission. In the post Haemophilus influenzae type b (Hib) vaccine era, non-typable H influenza (NTHi) has emerged as an important microorganism for acute respiratory infections. This study was conducted to know the prevalence of NTHi in under five years old children with non-severe pneumonia and the antimicrobial resistance. One thousand and twelve children underfive years old were enrolled. Informed consent was obtained from their parents or guardians prior to inclusion of the subject in the study. Calcium-alginate nasopharyngeal swabs were obtained, and directly stored in amies transport before brought to the laboratory for further examination. Specimens were cultured on chocolate agar with Bacitracin, with identification using X and V factor. Serotype was performed by agglutination method using BD Difco Haemophylus influenza antisera. Antimicrobial succeptibility testing to amoxycilline, chloramphenicol and cotrimozaxole-trimetoprim were determined using E-test, and defined according to 2007 CLSI guidelines. Positive Hi isolates were found in 425 (41.99%) swabs, serotyping was done in 376 isolates. The serotype isolated were 132 (35%) NTHi, 199 (52.8%) Hi, and 46 (12.2%) typable Hi non-b. The age of children with NTHi positive ranged from 2 to 55 months; 43.5% age 2 to 12 months, 44.3% age 13 to 36 months, 8.4% age 37 to 48 months, and 3.8% age 49 to 60 months. There were 70 (53%) boys and 61 (47%) girls. Majority of the isolates (83.2%) were susceptible to amoxycillin, 80.9% to chloramphenicol, and only 51.9% to co-trimoxazole. Sixty three (47.7%) isolates were sensitive to all three antibiotics, and 6.8% were resistant to all antibiotics. In Indonesia Hib vaccination is not yet in the EPI programme, no one of the study children received Hib vaccination. The study showed that the prevalence of NTHi was rather high. However, more than 80% isolates were sensitive to amoxycillin and chloramphenicol, but only half susceptible to co-trimoxazole. P73J Paracetamol in pregnancy is not a risk factor for overall preschool wheezing disorder, but seems to be it for multiple-trigger wheeze H. Thengilsdottir1 , E. Goksor ¨ 1 , B. Alm1 , L. Erdes2 , P. Mollborg, ¨ 1 ˚ R. Pettersson4 , G. Norvenius1 , N. Aberg , G. Wennergren1 . 1 University of Gothenburg, Department of Pediatrics, Gothenburg, Sweden;; 2 Pediatric Outpatient Clinic, Skene, Sweden; 3 Fyrbodal Health Care Region, Central Infant Welfare Unit, Uddevalla, Sweden; 4 Pediatric Outpatient Clinic, Central Infant Welfare Unit, M¨ olndal, Sweden Background and Aim: A possible association between prenatal paracetamol exposure and asthma in childhood is debated. The aim of this analysis was to test the association between prenatal paracetamol exposure and overall preschool wheezing disorder, episodic viral wheeze and multiple-trigger wheeze. Multiple-trigger wheeze has been associated with future “true” asthma. Methods: Data were obtained from a prospective, longitudinal study of a cohort of children born in the region of Western Sweden in 2003. 8176 families (50% of the birth cohort) were randomly selected. The parents answered questionnaires at 6 and 12 months and at 4.5 years of age. The response rate at 4.5 years was 4496, i.e. 83% of the 5398 questionnaires distributed at 4.5 years. We here studied the association between maternal medication during pregnancy and wheezing at age 4.5 years. Overall wheezing disorder
was defined as recurrent wheeze (3 or more episodes during the last year) and/or wheeze treated with inhaled corticosteroids during the last year. Episodic viral wheeze was defined as wheezing only with viral infections and multiple-trigger wheeze as wheezing inbetween infections. Results: 28.4% of the mothers had used medicines during pregnancy. Paracetamol had been taken by 7.2%, allergy medicines, including asthma medication, by 4.4% and other medication by 15.6%. In the univariate analysis, we found an increased risk of overall wheezing disorder with both allergy/asthma medication (OR 3.0; 95% CI 2.0– 4.5) and paracetamol (OR 1.5; 1.03–2.2). In the multivariate analysis, only the association with maternal allergy/asthma medication remained statistically significant (OR 1.7; 1.002–2.9). However, the risk of multiple-trigger wheeze was increased by paracetamol, both in the univariate and multivariate analyses (OR 2.3; 1.3–4.2 and 2.4; 1.2–4.9, respectively). The risk of episodic viral wheeze was not increased by paracetamol, neither in the univariate, nor in the multivariate analysis, (OR 1.02; 0.6–1.8 and 0.8; 0.4–1.7). Conclusion: Prenatal paracetamol exposure was not an independent risk factor for overall wheezing disorder at preschool age. However, in the subgroup multiple-trigger wheeze an association with prenatal paracetamol exposure was found. As could be expected, maternal allergy/asthma medication during pregnancy was associated with wheezing disorder. P74J Belgian French-speaking pharmacists’ knowledge on childhood asthma E. Gueulette1 , E. Bodart2,1 . 1 Clinique et Maternit´e Sainte-Elisabeth – Namur, Belgium; 2 Cliniques Universitaires U.C.L de Mont-Godinne – Yvoir, Belgium Introduction: All the consensuses underline the importance of education in the global management of asthma in children. As doctor’s co-actors, pharmacists play a crucial role in this education. Study: We have conducted an e-mail survey amongst pharmacists registered to the Scientific Society for French speaking pharmacists. The survey aimed at measuring their knowledge of the disease and how they behave around it. The questionnaire addressed items related to the following areas: demographics, general knowledge of the illness, diagnosis and management, medications and inhalation systems. Results: Out of 1000 e-mails sent, 236 were read by the surveyed audience. 78 completed the survey which represents 33%. At least once a week, 79.2% of pharmacists provide medication prescribed by a doctor or answer customer’s question about the disease. In the general knowledge area, 41.9% do not know how prevalent the illness in Belgium is. 86.1% believe that allergological skin tests cannot be conducted before the age of 2. 45.9% explain that eggs are the most commonly spread dietary allergen in Belgium. The item about diagnosis and medical care showed 61.6% of responders estimating that the level of asthma control is mainly based on the child’s quality of life. On the contrary, a majority (80.8%) knows that child asthma diagnosis is essentially based on symptoms and 92.1% know that the treatment is adapted according to the level of the illness control. Concerning medication, 60.8% ignore that a higher dose of medicine administered to infants have to be provided upon a doctor’s prescription unlike to older patients. Respectively 72% and 41% are not aware of the dose or optimal frequency of a short acting beta-2 agonist. Also, 88.5% believe that a long acting beta-2 agonist cannot be proposed as a preventive mean in case of exercice induced asthma. In terms of inhaling systems, 33.8% of pharmacists never explain their customer how to maintain a inhalation chamber and 23% admit they never inform them how to use appropriate inhalers prescribed by the doctor.