Bacteraemia in children

Objectives : (i)To know the etiology of bacteraemia in children, (ii) To learn the antibiotic sensitivity pattern of the isolates.Method : Over the period of thirteen months 4368 blood samples (for blood culture) were collected from children in the age group of 0 day-14 years, suspected of having fever and sepsis. Blood samples were collected for blood culture from each case. Organisms were isolated and identified by conventional methods. Antibiotic susceptibility for each isolate was determined by using modified Stokes method.Result : 1001 cases (22.9%) were culture positive. Incidence of bacteraemia in neonates was 521(33.94%). Gram negative organisms were the most predominant isolates (88.8%). Commonest wasKlebsiella 471 (47.1%) followed bySalmonella sp. 162 (16.2%) andPseudomonas 80 (8%) whereas in gram positive,Staphylococcus aureus 76 (7.6%) was the most common. Maximum sensitivity was seen by sulbactum/cefaperazone combination-969 (98.2%) by all isolates. Linezolid 97 (99.0%) was the most sensitive drug for gram positive isolates.Conclusion. Gram negative multidrug resistant organisms were the main cause of septicemia in all the age groups. Therefore great caution is required in selection of antibiotic therapy.     

Neonatal gram-negative bacteremia

A 22 months prospective study of neonatal gram-negative bacteremia was undertaken in a 15 bed NICU to find out the incidence and antibiotic resistance patterns. Clinically suspected 1326 cases of neonatal sepsis were studied during this period. More than 25% of the cases were microbiologically positive for sepsis. Among 230 (67.2%) cases of gram-negative bacteremia, the predominant isolates werePseudomonas aeruginosa (38.3%),Klebsiella pneumoniae (30.4%),Escherichia coli (15.6%) andAcinetobacter sp. (7.8%). Fifty-nine per cent of the neonates were born in hospital while 41% were from community and referral cases. Lower respiratory tract infection, umbilical sepsis, central intravenous line infection and infection following invasive procedures were the most commonly identified sources of.septicemia. Prematurity and low birth weight were the main underlying conditions in 60% of the neonates. Total mortality was 32%. Increased mortality was mainly associated with rmrhropenia, nosocomial infection and inappropriate antibiotic therapy. Resistance was increasingly noted agains’t many antibiotics. The isolates were predominantly resistant to extended spectrum cephalosporins (25%-75%), piperacillin (68%-78%), and gentamicin (23%-69%). The commonest microorganisms causing gram-negative bacteremia werePseudomonas aeruginosa followed byKlebsiella pneumoniae. The community-acquired bacteremia was mainly due to E.coli. The proportion of preterm and low birth weight babies was significantly high, and the major contributing factor in total mortality. Sensitivity to different antibiotics conclusively proved that a combination of ampicillin + sulbacfam with amikacin or ampicillin + sulbactam with ciprofloxacin is most effective.     

Neonatal community‐acquired pneumonia: Pathogens and treatment

Aim: To analyse the bacterial pathogens and drug sensitivities for neonatal community‐acquired pneumonia. Methods: Seven hundred sixty sputum samples from newborns with community‐acquired pneumonia were cultured to determine microbial organisms present and their drug sensitivities. Results: Of the 760 specimens, 425 grew pathogens for a 55.9% positive rate. Among the 425 positive cultures, 278 grew gram‐negative organisms (65.4%), 142 grew gram‐positive organisms (33.3%), while 5 grew fungus (1.3%). The most common gram‐negative organisms were Escherichia coli, Klebsiella pneumoniae and Hemophilus influenzae, while the most common gram‐positive organisms were Staphylococcus aureus, Staphylococcus epidermidis and Staphylococcus haemolyticus. To the gram‐negative organisms, the most sensitive drugs were meropenem, imipenem and amikacin, while to the gram‐positive ones were vancomycin, teicoplanin and quinupristin/dalfopristin. Conclusions: The most common causative bacteria were gram‐negative organisms, which were highly sensitive to Meropenem, Imipenem and Amikacin, yet often treatable with more focused antibiotic coverage, which depended on the bacterium identified.     

104例儿童肿瘤强烈化疗并发败血症的病原菌及其对药物敏感性的分析

目的探讨儿童恶性肿瘤化疗后并发败血症的诊断和治疗,指导经验性用药。方法对化疗后发热的病儿做血培养,建立病原菌谱和药敏数据库,分析近5年的监测资料。结果在104次败血症中分离到106株病原菌,包括64株(63.8%)革兰氏阴性(G-)杆菌,其中肺炎克雷伯氏菌17株、铜绿假单胞菌15株、大肠埃希氏菌14株;另外培养出革兰氏阳性(G+)细菌36株、真菌6株。发生感染性休克11例次,10次为G-杆菌引起,以肺炎克雷伯氏菌及大肠埃希氏菌发生率高。与G+细菌不同,G-杆菌败血症多数(68.8%)伴畏寒、寒战。G+细菌全部对万古霉素和替考拉宁敏感,利福平联合环丙沙星、庆大霉素的敏感率分别为92.3%和90.9%。9株凝固酶阴性葡萄球菌中耐甲氧西林5株(55.6%)。G-杆菌绝大多数对亚胺培南、美罗培南敏感(98.4%、97.7%),其次为头孢比肟(88.2%)、头孢哌酮/舒巴坦(88.1%)、哌拉西林/他唑巴坦(88.1%),头孢他定、阿米卡星与环丙沙星三者中任何两种联合对全部G杆菌的敏感率均在90%以上,后二者与哌拉西林/他唑巴坦联用则各达95%以上。产ESBLs的肺炎克雷伯氏菌、大肠埃希氏菌分别有7株(41.2%)和4株(28.6%);大肠埃希氏菌耐环丙沙星7株(50%)。结论本组病儿化疗后败血症病原菌以G-杆菌为主,最常见为肺炎克雷伯氏菌、大肠埃希氏菌及铜绿假单胞菌,前二者易引致感染性休克。G+球菌对万古霉素、替考拉宁敏感;G-杆菌以亚胺培南、美罗培南敏感率最高;一些常用、经济的抗菌药联用可明显提高菌谱覆盖范围。     

PICU细菌感染特点及耐药分析

目的 了解我院PICU细菌感染特点及其对常用抗菌药物的耐药性,为临床合理选用抗菌药物提供参考.方法 对我院PICU2009年10月至2012年9月所有住院患儿的基本临床资料、不同标本分离的病原菌及耐药情况进行回顾性分析.结果 近3年来我院PICU共送检培养标本4 020份,检出病原菌672株,阳性率16.7％,其中革兰阴性菌占75.1％,最常见细菌依次为铜绿假单胞菌、肺炎克雷白杆菌及大肠埃希菌.革兰阳性菌占24.9％,主要为葡萄球菌.常见阳性标本主要为痰（41.2％）及气管插管尖端（26.5％）,其次为血液（10.3％）及动静脉置管尖端（8.0％）.药敏结果显示大部分葡萄球菌对青霉素、苯唑西林耐药率高达90％,对红霉素、克林霉素、复方新诺明及庆大霉素耐药率较高,对喹诺酮类耐药率较低,对替考拉宁、利奈唑胺及万古霉素敏感.常见革兰阴性菌对氨苄西林、氨苄西林/舒巴坦、哌拉西林耐药率高达80％,对多种头孢菌素耐药率较高,而对含酶抑制剂哌拉西林/他唑巴坦、头孢哌酮/舒巴坦、喹诺酮类耐药率较低,对美罗培南、亚胺培南敏感.结论 PICU以革兰阴性菌感染为主（75.1％）,其中前3位细菌依次为铜绿假单胞菌、肺炎克雷白杆菌及大肠埃希菌,多数耐药性较高.细菌分析与耐药性监测对指导临床危重患儿的抗感染治疗及减少耐药菌株具有重要作用.     

Clostridium difficile in neonates: serogrouping and epidemiology

A typing scheme for clostridium difficile based on serogrouping, toxigenicity and sorbitol fermentation was applied to 270 strains isolated in one neonatal ward during a 6-month prospecitive study. Two hundred and twenty-three strains were isolated from 377 faecal samples of 114 neonates and 47 from 92 environmental specimens. The isolates were distributed among five different types; 87% of the faecal and 85% of the environmental isolates belonged to two of these types (toxigenic, sorbitol negative, serogroup F and nontoxigenic, sorbitol positive, serogroup A). Nosocomial spread was clearly demonstrated and the environment appeared to be the main source of contamination: most of the neonates were colonized after admission by strains found in their environment; clusters of colonization with unusual isolates were observed following referral of patients from the intensive care unit or from other hospitals. No relation was found between the acquisition or the carriage of C. difficile and any intestinal symptoms. All the strains belonged to types different from those usually found in cases of antibiotic associated colitis (AAC) suggesting differences of pathogenicity among the different types.Abbreviations PMC pseudomembranous colitis - AAC antibiotic associated colitis - AAD antibiotic associated diarrhoea - TCCFA taurocholate cycloserin cefotaxim fructose agar - ICU intensive care unit - SDS-PAGE sodium dodecyl sulphate-polyacrylamide gel electrophoresis     

Prospective germ surveillance in patients of a neonatal intensive care unit as a basis for the prevention of hospital infection and antibiotic strategy

During a period of 31 months ending February 1982 all bacterial pathogenes recovered from patients of our Newborn intensive care unit were registered. A total of 834 were isolated, 42% were cultured from the surface of the patient, 50% were cultured from secretions, tubes or catheters and 8% were isolations from blood, liquor or urine, thus proving septic infection. Staphylococcus albus, E. coli and Pseudomonas aeruginosa were most often found. The pattern of other pathogenes was very variable. High frequency of isolations of one specific germ was always followed by a remarkable infectious morbidity caused by this agent. Nosocomial infections were recognized easily by this program. Hospital hygiene could be altered appropriately according to the bacteria isolated. Antibiotic strategy was adapted to the antibiotic in vitro sensibility of the prevalent bacteria. Aminoglycosides and above all gentamycin were most effective.     

Bacteraemia in children

OBJECTIVES: (i)To know the etiology of bacteraemia in children, (ii) To learn the antibiotic sensitivity pattern of the isolates. METHOD: Over the period of thirteen months 4,368 blood samples (for blood culture) were collected from children in the age group of 0 day-14 years, suspected of having fever and sepsis. Blood samples were collected for blood culture from each case. Organisms were isolated and identified by conventional methods. Antibiotic susceptibility for each isolate was determined by using modified Stokes method. RESULT: 1,001 cases (22.9%) were culture positive. Incidence of bacteraemia in neonates was 521(33.94%). Gram negative organisms were the most predominant isolates (88.8%). Commonest was Klebsiella 471 (47.1%) followed by Salmonella sp. 162 (16.2%) and Pseudomonas 80 (8%) whereas in gram positive, Staphylococcus aureus 76 (7.6%) was the most common. Maximum sensitivity was seen by sulbactum/cefaperazone combination-969 (98.2%) by all isolates. Linezolid 97 (99.0%) was the most sensitive drug for gram positive isolates. CONCLUSION: Gram negative multidrug resistant organisms were the main cause of septicemia in all the age groups. Therefore great caution is required in selection of antibiotic therapy.     

Aetiology of neonatal sepsis in Blantyre, Malawi: 1996-2001

AIM: The aim of this retrospective study was to report causes, antibiotic resistance and outcome of neonatal sepsis (often fatal in developing countries) in Malawi. METHODS: All blood and cerebrospinal fluid isolates collected between January 1996 and December 2001 from inpatients aged 0-30 days with suspected sepsis at Queen Elizabeth Central Hospital, Blantyre, Malawi were reviewed. In vitro resistance to antibiotics commonly used in Malawi was assessed. Case fatality rate was analysed with respect to age, bacterial pathogen and infection site. RESULTS: A total of 801 bacteria were isolated from 784 neonates over 6 years-599 isolates from blood and 202 from cerebrospinal fluid. Overall, 54% of bacteria were gram-positive and 46% gram-negative. The commonest causes of neonatal sepsis were group B Streptococcus (17%) and non-typhoidal Salmonella (14%). In vitro antibiotic susceptibility to the first-line antibiotic combination of penicillin and gentamicin was 78% for all isolates, but in vitro sensitivities to gentamicin for Klebsiella spp and non-typhoidal Salmonella were only 33% and 53%, respectively. In-hospital case fatality rate was known for only 301 cases and was high at 48%. Group B Streptococcus was associated with the best outcome. Mortality was significantly higher if presentation was in the 1st week of life or if sepsis was caused by gram-negative bacteria. The causes of neonatal sepsis in this population show a different pattern from other studies in developing countries.     

Bacteriological profile of neonatal septicemia

Fortyfive cases of blood culture positive neonatal septicemia treated during 1985 and 1986 were studied. Klebsiella was the most common causative organism (68.8%). This remained the predominant organism in early as well as late onset septicemia, in preterm as well as full term babies and in low birth weight as well as normal weight babies. Even in neonates referred to our hospital from outside and blood cultured on hospital admission, commonest causative bacteria was Klebsiella. The organism had a high order of in-vitro sensitivity to a gentamicin, streptomycin and cephaloridine. A combination of cephaloridine and gentamicin covered all the Klebsiella isolates. Overall mortality was 53.3%.     

新生儿重症监护病房血培养252株病原菌分布及耐药性分析

目的　研究新生儿重症监护病房 (NICU)败血症和菌血症的病原菌分布及其耐药情况 ,为合理使用抗生素提供依据。方法　对 2 0 0 0年 1月至 2 0 0 3年 8月广州市儿童医院NICU中 10 90例新生儿的 10 90份血标本进行培养、分离、鉴定及药敏分析。结果　 10 90份血标本培养共分离病原菌 15种 2 5 2株 ,总阳性率为 2 3 1%。其中革兰阳性球菌 2 12株 ,以凝固酶阴性葡萄球菌占优势 ,其次为金黄色葡萄球菌 ;革兰阴性杆菌 38株 ,以大肠埃希菌居多 ,肺炎克雷伯杆菌次之。革兰阳性球菌对万古霉素、替考拉宁、头孢哌酮 /舒巴坦、克林霉素等的敏感性较高 ;革兰阴性杆菌对亚胺培南、头孢哌酮 /舒巴坦、羟氨苄 /克拉维酸具有很高的敏感性。结论　凝固酶阴性葡萄球菌、大肠埃希菌、肺炎克雷伯菌等是NICU中新生儿败血症 /菌血症最常见的几种病原菌 ,对常用的抗菌药物有程度不同的耐药性。     

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??Objective??To investigate the relevance of bacteria infection of the lower respiratory tract with persistent wheezing of infants and young children??and further evaluate the effect of antibiotic therapy on them. Methods??We collected the medical records of the infants and young children hospitalized for persistent wheezing in Children’s Hospital of Chongqing Medical University from January 1?? 2005 to January 1?? 2016?? and analyzed the pathogen in BALF culture??including bacteria culture?? the seven kinds of viral antigen of nasopharyngeal aspirate?? MP-PCR and CP-PCR. Further??we divided the cases with positive bacterial isolates into two groups based on whether they were administered with antibiotics. The population proportion of symptom improvement and the mean days of hospital stay were recorded. Results??Among the 136 children who underwent BALF??there were 67??49.3%?? children with positive bacterial isolates??and the most common bacteria were Pneumococcal pneumonia??Klebsiella pneumoniae pneumonia subspecies??and Haemophilus parainfluenzae. The population proportion of symptom improvement of antibiotic group was higher than control group??P??0.05????and the mean days of hospitalization was shorter in antibiotic group compared with control group ??P??0.05??. For Streptococcus pneumoniae??a high prevalence of resistant strains was found to Meropenem??81.82%????Macrolide erythrocin??63.64%?? and Cefoxitin resistence??54.55%??. Conclusion Bacterial infection of the lower respiratory tract maybe relevant in some infants and young children with persistent wheezing??and antibiotic treatment may improve the rate of symptom improvement in these children and shorten the mean days of hospitalization. Therefore??some of infants and young children with persistent wheezing can be improved after antibiotic treatment.     

PICU呼吸机相关性肺炎深部痰液病原菌分布与耐药性分析

目的 分析本院PICU呼吸机相关性肺炎（ventilator associated pneumonia,VAP）深部痰液病原菌分布及耐药性变迁,指导VAP的早期经验性抗生素应用.方法 2009年1月至2013年12月浙江大学附属儿童医院符合VAP诊断标准的121例在PICU呼吸机治疗的患儿,通过封闭式吸痰收集其深部痰液,采用W1TEK60微生物全自动细菌鉴定仪进行细菌鉴定,采用Kirby-Bauer法进行药物敏感试验,并对特殊耐药菌进行鉴定.结果 PICU符合条件的痰标本共分离出病原菌127株,革兰阴性菌64.57％ （82/127）,其中以鲍曼不动杆菌、大肠埃希菌、嗜麦芽窄食单胞菌、肺炎克雷白杆菌、铜绿假单胞菌最常见,所占比例分别为25.61％ （21/127）、20.27％（17/127）、20.27％ （17/127）、16.22％（12/127）、9.46％（11/127）,其对β内酰胺类抗生素的耐药性达77.62％.革兰阳性菌29.92％（38/127）,其中表皮葡萄球菌10株、金黄色葡萄球菌6株,除对万古霉素和利奈唑胺仍敏感外,对头孢菌素以及氨基糖苷类抗生素的耐药率很高.真菌占5.51％ （7/127）.结论 PICU患儿VAP深部痰培养仍以革兰阴性菌为主,其耐药性较强,特别是产超广谱β内酰胺酶的菌株对β内酰胺类抗生素的耐药性;革兰阳性菌以葡萄球菌为主.加强VAP的综合防治和抗生素的合理使用是降低感染和细菌耐药的重要保证.     

Neonatal escherichia coli infections: concerns regarding resistance to current therapy

Currently recommended antibiotic treatment of suspected neonatal sepsis is ampicillin and an aminoglycoside. Recently, we observed increasing ampicillin and gentamicin resistance in strains of Escherichia coli isolated from neonates at our institution. We therefore reviewed clinical and laboratory records of all neonates with systemic infection, hospitalized from 1994 through 1998, from whom E. coli was isolated from blood and/or cerebrospinal fluid. The influence of perinatal variables (e.g. rupture of foetal membranes > 24h, group B Streptococcus (GBS) colonization, urinary tract infection during pregnancy and the use of antepartum and/or intrapartum antibiotics), and neonatal variables (e.g. gestational age, age at onset of sepsis (early: < or = 72 h, late: >72 h), number of E. coli septic recurrences, and associated underlying medical and/or surgical conditions) on antimicrobial susceptibilities of invasive E. coli isolates was studied. Twenty-three neonates with invasive E. coli infection were identified; most [19 (83%)] presented as late-onset sepsis (LOS). Ampicillin-resistant E. coli were isolated in 75% and 53% of neonates in the early- and late-onset groups, respectively. Gentamicin resistance was found in 50% of early-onset sepsis (EOS) isolates compared with 16% in the late-onset group. Isolates from two neonates with EOS were resistant to both ampicillin and gentamicin. One neonate with EOS and three with LOS had recurrent E. coli sepsis; all isolates were ampicillin-resistant and one was gentamicin-resistant. All these neonates were initially treated with ampicillin and gentamicin. Both groups had associated underlying medical and/or surgical conditions (50% early-onset, 47% late-onset). Maternal GBS colonization occurred in 2 (50%) versus 3 (16%) of EOS and LOS cases, respectively. All GBS colonized women received intrapartum ampicillin prior to delivery. CONCLUSIONS: Ampicillin and gentamicin resistance is emerging in neonatal E. coli isolates from invasive infection. Current- empiric management of neonatal sepsis requires re-evaluation given changing antimicrobial susceptibilities.     

Prevalence of multidrug drug resistant organisms and hand hygiene compliance in surgical NICU in Cairo University Specialized Pediatric Hospital

Background

The incidence of neonatal sepsis increased during the recent years, it may be due to frequent use of invasive procedures and the development of resistant organisms. Bacterial resistance to commonly used antibiotics has emerged and complicated the management of NS.

下呼吸道细菌感染与婴幼儿持续喘息关系及抗生素疗效分析

目的　分析下呼吸道细菌感染与婴幼儿持续喘息的关系及抗生素的疗效。方法 收集重庆医科大学附属儿童医院2005年1月1日到2016年1月1日因持续喘息住院的598例婴幼儿的临床资料, 分析其支气管肺泡灌洗液（BALF）中细菌培养、鼻咽部抽吸物呼吸道7种病毒、 肺炎支原体及衣原体检测结果。进一步根据支气管肺泡灌洗液细菌培养阳性的婴幼儿院内使用抗生素情况分为抗生素组41例, 未使用抗生素组26例, 对两组患儿症状、 体征改善总有效率及平均住院天数进行评分。结果　（1）136例行纤维支气管镜灌洗的婴幼儿中, 有67例（49.3%）患儿支气管肺泡灌洗液细菌培养阳性, 其中, 检出率最高的3种细菌分别为肺炎链球菌、 肺炎克雷伯菌肺炎亚种和副流感嗜血杆菌; （2）出院时抗生素组较对照组患儿症状改善总有效率有明显增加（P＜0.05）, 且平均住院天数较对照组缩短（P＜0.05）; （3）肺炎链球菌耐药率最高的3种抗生素分别为： 美洛配能（81.82%）、红霉素（63.64%）及头孢西丁（54.55%）。结论 细菌感染与部分婴幼儿持续性喘息有关, 在运用抗生素治疗后症状、 体征改善总有效率有明显增加, 平均住院天数较未用抗生素组缩短（P＜0.05）。因此, 抗生素治疗对部分持续喘息的婴幼儿可能有效。     

Etiology of septicemia in children with acute leukemia: 9-year experience from a children's hospital in China

Bloodstream infection is an important cause of death among leukemia patients, and the etiologic agent surveillance is important for the prophylaxis and treatment. This study aims to identify the common bloodstream isolates in hospitalized leukemia patients with septicemia in our hospital, to choose the ideal combination of antimicrobial agents for infection prophylaxis and to clarify the appropriate time for antibiotic prophylaxis. To know this information, a retrospective analysis was conducted over a 9-year period from July 2001 to July 2010 by reviewing medical records of leukemia children admitted to our hospital. The overall frequencies of isolation were 45% in Gram-positive bacteria, 53.8% in Gram-negative bacteria, and 1.2% in fungi, respectively. Coagulase-negative Staphylococci were the most common organisms isolated, accounting for 32.7% of the total blood culture isolates, followed by Escherichia coli (15.7%) and Klebsiella pneumoniae (7.1%). The incidence of septicemia caused by extended-spectrum β-lactamase-producing E. coli and K. pneumoniae was high (69.2% and 58.8% of total isolates, respectively). The coverage rate of antimicrobial combinations of "vancomycin+cefoperazone-sulbactam" and "vancomycin+piperacillin-tazobactam" to blood culture isolates of leukemia patients in our hospital were 91.88% and 90.27%, respectively. More than 90% of septicemia occurred when the absolute neutrophil count was lower than 1.6×10?/L and 83.05% when absolute neutrophil count was lower than 1.0×10?/L. These results suggest that ongoing surveillance for antimicrobial susceptibility in leukemia children remains essential. Vancomycin+cefoperazone-sulbactam and vancomycin+piperacillin-tazobactam are the good choice for leukemia children to prevent bacterial infections in our hospital. In an effort to reduce total consumption of antibiotics and to elevate the therapeutic efficacy, antibiotics prophylaxis should be started with the appearance of neutropenia in leukemia children.     

A note on antibiotic resistance in Escherichia coli isolated from children with diarrhoea in the Sudan

This study investigates antibiotic resistance in gut commensals obtained from children presenting with diarrhoea in Khartoum and Juba, Sudan. Fifty-one isolates of Escherichia coli were obtained from the faeces of 34 children. Sensitivity to six antibiotics generally available in Sudan were determined for all isolates using a disc diffusion method. Twenty-five (74%) of the children had isolates resistant to at least four of the antibiotics, and seven (20%) had isolates resistant to all six antibiotics. A greater number of resistant isolates was obtained from inpatients than outpatients but were significantly different for only two antibiotics. There was no significant difference in the prevalence of resistant isolates obtained from children below 1 year of age. The results suggest that multiply resistant Escherichia coli may be acquired from the environment, and may play a role in the epidemiology of multiply resistant enteric pathogens.     

Cephalosporin resistant urinary tract infections in young children

OBJECTIVE: To describe the antibiotic resistance pattern of bacteria causing urinary tract infection (UTI) in a cohort of Australian children under 6 years of age. METHODS: Data were collected over a 12-month period from children under 6 years of age with a provisional diagnosis of UTI made in the Emergency Department of Sunshine Hospital, Victoria. RESULTS: During the study period 100 culture-proven UTI were identified in 97 children. Three children had two episodes. Out of the 100 episodes, 39% were male, 56% were under 12 months of age at presentation and 61% were managed as outpatients. Clinical features were non-specific in the majority of cases. Hydronephrosis and vesicoureteric reflux was detected in 5.5% and 28.6%, respectively, of children with their first investigated UTI. A single bacterial isolate was cultured from 97 urines and two from three samples. Escherichia coli (n = 90) and Proteus mirabilis (n = 5) were the most common isolates. In vitro resistance to ampicillin/amoxycillin was found in 52% of isolates, to trimethoprim in 14% and to cephalothin/cephalexin in 24%. This resistance rate to first generation cephalosporins is the highest reported to date in adult or paediatric UTI in Australia. CONCLUSIONS: Ampicillin/amoxycillin or cephalothin/cephalexin may not be the optimal choice of antibiotic for the empiric treatment of UTI in this and possibly other paediatric populations.     

INFECTIONS IN CHILDHOOD ACUTE LYMPHOBLASTIC LEUKEMIA: An Analysis of 222 Febrile Neutropenic Episodes

A retrospective analysis was performed on febrile neutropenic episodes in patients with acute lymphoblastic leukemia (ALL) from 1992 to 2002. There were 222 febrile neutropenic episodes in 266 ALL patients with documented ANC < 500/mm³. Of the 222 episodes, 98 (44%) had documented focus of infection; the rest were fever without focus. There were 274 different sites of infection in the 98 episodes of documented focus of infection; pulmonary infections were the commonest site of infection (27.3%) followed by HEENT (22.9%). Of 69 bacterial isolates, gram-negative bacteria (n = 46, 67%) were twice as common as gram-positive bacteria (n = 23, 33%). Most common site of isolation for gram-negative bacteria was blood (50%) followed by urine (32.6%). Blood (78.3%) was predominant site of isolation of gram-positive bacteria followed by HEENT (8.7%). Escherichia coli (45.7%) was the commonest gram-negative isolate, while Staphylococcus aureus (39%) was the commonest gram-positive bacterial isolate. There were a total of 22 fungal isolates, the majority from urine (n = 12) and HEENT (n = 9). Of the 22 fungal isolates, 19 were detected in induction phase of chemotherapy. A total of 95/222 (42.8%) febrile neutropenic episodes improved with first-line antibiotic therapy, while modification was required in 127 episodes (57.2%). Antifungal therapy was used in 86 episodes (38.7%). There were a total of 13 deaths, 6 each during induction and intensification/consolidation phases, while 1 died during maintenance phase. Of the 13 deaths, 10 had pneumonia, 8 had bacteremia, and 7 had fungal infection. The current study stresses the importance of frequent reviewing of type, frequency, severity, and outcome of infection complications over the years to detect changing epidemiological patterns. The majority of fungal infections were detected during induction chemotherapy, which highlights the need to consider this type of infection in the evaluation of patients.