Pediatric infectious diseases: 2009 update for the Rogers' Textbook of Pediatric Intensive Care.

OBJECTIVE

To review important articles in the field of infectious diseases that pertain to the care of children in pediatric critical care units, published subsequent to the fourth edition of the Rogers' Textbook of Pediatric Intensive Care.

DATA SOURCES

The U.S. National Library of Medicine was searched for the terms: critical care, nosocomial, antimicrobial resistance, opportunistic infection, sepsis, central nervous system infections, encephalitis, meningitis-bacterial, meningitis-tuberculous, brain abscess, measles, dengue, hemorrhagic fever, human immunodeficiency virus infection (HIV), opportunistic infections, fungal infections, tetanus, diphtheria, botulism, toxic shock syndrome, and pediatrics.

STUDY SELECTION AND DATA EXTRACTION

Promising articles were reviewed and the decision to include them or not in this review was made by the authors, based on clinical relevance.

DATA SYNTHESIS

Articles were included based on their relevance to specific chapters included in this section of the textbook.

CONCLUSIONS

Significant advances continue to be made in our understanding of specific diseases as well as the approach to treatment. There are significant variations in outcome from specific infectious diseases in developing countries compared with the developed world. The looming problem of antimicrobial resistance and relative lack of new anti-infective agents in development is an issue that will be faced by pediatric intensive care units throughout the world in the near future. Updated evidence-based guidelines have appeared for early treatment of septic shock in children, and on prevention and treatment of opportunistic infections in adults and adolescents with human immunodeficiency virus. In patients with measles, use of oral co-trimoxazole or amoxicillin reduces the risk of secondary bacterial infections of respiratory tract; however, the same may not be true for other systemic viral infections, such as influenza. In patients with acute bacterial meningitis, maintenance fluids-instead of restricted fluids-and use of glycerol may improve the outcomes; however, the role of dexamethasone in prevention of adverse outcome needs reevaluation. Intravenous use of botulism immune globulin decreases the length of hospital stay and mechanical ventilation. Pediatric patients with aspergillosis have radiologic findings distinct from those of adults and present more often with nodules, and only rarely with cavitation; early focal surgical resection may improve the survival of these patients.