Stenotrophomonas maltophilia: Rare cause of meningitis

Stenotrophomonas maltophilia is a Gram‐negative bacillus, which is an extremely rare cause of meningitis. To our knowledge, there are only five previous pediatrics cases. Here, we describe the case of a 4‐year‐old boy who developed meningitis associated with this organism, after several neurosurgical procedures and previous treatment with a broad‐spectrum antibiotic. He was treated successfully with a combination of trimethoprim–sulfamethoxazole, ceftazidime and levofloxacin. Stenotrophomonas maltophilia should be considered as a potential cause of meningitis, especially among severely debilitated or immunosuppressed patients. Antimicrobial therapy is complicated by the high resistance of the organism to multiple antibiotics.     

Central venous catheter‐related blood stream infection with pyomyositis due to Stenotrophomonas maltophilia after allogeneic bone marrow transplantation in a patient with aplastic anemia

Stenotrophomonas maltophilia causes pneumonia and CVC‐CRBSI in HSCT. However, there are few reports of pyomyositis due to S. maltophilia. We report a patient with CRBSI and pyomyositis due to S. maltophilia after allogeneic HSCT who was successfully treated by removing the CVC and antibiotics without surgical drainage. Removing the CVC and the combined antibiotics without preventing the neutrophil engraftment could avoid surgical drainage in pyomyositis due to S. maltophilia when detected in an early stage.     

儿童隐性菌血症研究现状及进展

儿童隐匿性菌血症（occult bacteremia,OB）是指临床仅表现为发热（通常≥39℃）,没有中毒症状及局部感染的临床或实验室证据,而血培养阳性[1]。这些OB患儿大都可以自愈,且由于外观良好常被临床忽视,如果不及时诊断和治疗,有10%-25%会发生严重细菌感染[2, 3],其中3%-6%发展为脑膜炎[4],还会出现肺炎、化脓性关节炎、骨髓炎、败血症甚至死亡。我国仅有几篇关于OB的病例报道[5],缺乏关于OB流行病学研究及相关资料。本文就儿童隐性菌血症的研究现状和进展进行综     

Septicaemia due to glucose non-fermenting,gram-negative bacilli other than Pseudomonas aeruginosa in children

Bloodstream infections due to non-fermenting Gram-negative bacilli other than Pseudomonas aeruginosa (NF-GNB) are uncommon in children but their incidence is reported to be increasing. The aim of this study was to determine the characteristics of such infections in children in a London teaching hospital. All paediatric patients with positive NF-GNB blood cultures and clinical evidence of sepsis between July 1995 and June 2000 were included in the study. A total of 10278 blood cultures was performed, of which 356 (3.5%) represented clinically significant episodes of bacteraemia. Of these, 12 (0.1%) were due to NF-GNB. Nine of the 12 (75%) patients were receiving haemodialysis for end-stage renal failure (ESRF). Only one patient was receiving immunosuppressive therapy and none was neutropenic or had any malignancy. An intravascular catheter was identified as the focus of infection in all 12 cases. Stenotrophomonas maltophilia was the most common organism isolated (67%). Six patients were successfully treated with antibiotics alone. Four others received antibiotics, but also required line removal, and two patients responded to line removal without the need for antibiotics. CONCLUSION: An association was found between ESRF and NF-GNB infections, possibly related to the requirement for long-term catheters for dialysis. Antibiotic treatment alone was only successful in half the cases of catheter-related NF-GNB septicaemia, while removal of the infected catheter ensured complete cure in the cases where antibiotic treatment alone did not suffice.     

新生儿重症监护病房嗜麦芽窄食单胞菌感染临床分析

目的探讨新生儿重症监护病房（NICU）嗜麦芽窄食单胞菌（SMA）感染的临床特点、耐药情况及治疗。方法对2008年1月至2012年12月我院NICU收治的SMA感染患儿进行回顾性分析,对其临床特征、细菌耐药性及治疗情况进行总结。结果本院NICU近5年共收治新生儿20463例,其中SMA感染54例,发生率2.63‰,2008—2012年发生率分别为4.17‰、2.80‰、3.05‰、2.50‰、0.94‰。其中新生儿败血症36例,新生儿肺炎18例;早产儿与足月儿发生率差异无统计学意义（2.61‰比2.65‰,P〉0.05）。临床主要表现为气促（27例）、黄疸（22例）、青紫（17例）、消化道出血（7例）、腹胀（8例）、呕吐（7例）等,常见并发症有呼吸衰竭（18例）、心力衰竭（13例）、坏死性小肠结肠炎（6例）、弥散性血管内凝血（4例）、休克（3例）等;13例（24.1%）考虑为医院感染,早产儿及气管插管机械通气患儿医院感染发生率分别高于足月儿及鼻塞无创辅助通气患儿（1.63‰比0.2‰,7.21‰比0.75‰,P均〈0.01）。SMA对头孢哌酮/舒巴坦、替卡西林/克拉维酸钾敏感度较高,均〉70%,对哌拉西林/他唑巴坦、头孢他啶耐药率在30%~40%。结论SMA是新生儿医院感染的重要病原菌,新生儿SMA感染主要表现为新生儿败血症和新生儿肺炎,耐药率高,早产儿医院感染SMA发生率高于足月儿。     

儿童侵袭性铜绿假单胞菌感染抗菌药物治疗现状及菌株药敏分析

目的分析侵袭性铜绿假单胞菌感染(IPAI)抗菌药物治疗现状及分离菌株药敏试验结果。方法回顾分析2014年1月至2019年3月住院的61例IPAI患儿的临床资料及61株侵袭性铜绿假单胞菌(IPA)菌株的药敏试验结果,比较48例经验性抗铜绿假单胞菌治疗与13例非抗铜绿假单胞菌治疗患儿以及27例经验性碳青霉烯类治疗与19例非碳青霉烯类治疗患儿的临床特征。结果 61例IPAI患儿中,男37例、女24例,中位年龄2.1(0.6～9.1)岁。院内死亡12例(19.67%),脓毒症休克15例(24.59%)。经验性非抗铜绿假单胞菌治疗患儿感染后住院时长较抗铜绿假单胞菌治疗患儿延长,差异有统计学意义(P=0.042),而重症病房入住率、院内死亡、脓毒症休克发生率的差异无统计学意义(P0.05)。经验性碳青霉烯与非碳青霉烯治疗患儿的重症病房入住率、院内死亡、脓毒症休克发生率、感染后住院时长的差异均无统计学意义(P0.05)。61株IPA菌株对哌拉西林/他唑巴坦、头孢他啶、头孢吡肟的敏感率为85%～90%,对亚胺培南、美罗培南的敏感率为90%～95%。结论重庆地区IPA菌株对常用抗铜绿假单胞菌抗菌药物有较高敏感性,青霉素类或头孢菌素类或其β-内酰胺酶抑制剂复合制剂可作为经验性治疗IPAI患儿的首选抗菌药物。     

Prevention of catheter-related bacteremia in pediatric intestinal transplantation/short gut syndrome children with long-term central venous catheters

Catheter-related bacteremia (CRB), along with liver failure is the leading cause of mortality and morbidity in parenteral nutrition dependent children. Immunosuppressant therapy following transplantation increases the risk of CRB. Previous reports in pediatric cancer patients have described the use of antibiotic lock solutions (ABL) for prophylaxis of CRB. In our institution, we evaluated five children (ages between one and four yr old), three with intestinal transplantation and two with short gut syndrome, who were high risk for recurrent CRB defined by their incidence of bacteremias in the observation period (>2 CRB/six months or life-threatening CRB). These children received the prophylactic ABL protocol with tobramycin-tissue plasminogen activator, four h per day, on alternating ports for six to eight months. Each patient was his/her own historical control. We observed decreased incidence of CRB's (p < 0.05), days of hospitalization due to CRB's (p < 0.0001), the days of intensive care admissions due to CRB (p < 0.0001), as well as the total days of systemic antibiotic exposure (p < 0.001). Catheter survival during the ABL era was longer but not reaching statistical significance. There was no advantage in removing and later replacing the catheter to wire-guided exchange while on systemic antibiotics. One patient presented with break-through bacteremia, septic shock and died. None of the catheters were lost to occlusion/malfunction. ABL did not induce an increased resistance to tobramycin. These preliminary findings suggest that ABL can be used safely and effectively in parenteral nutrition dependent children with long-term central venous catheters.     

Efficacy of a vancomycin solution to prevent bacteremia associated with an indwelling central venous catheter in neutropenic and non-Neutropenic cancer patients

We evaluated the efficacy of a vancomycin solution in the prevention of bacteremia caused by vancomycin-sensitive organisms (VSO) in cancer patients with a tunneled central venous catheter (CVC). Eighty-three patients who had a single lumen CVC were randomized to use a heparin solution (25 U/ml) for daily catheter flush with (HepVan) or without (Hep) vancomycin, 25 mcg/ml. Febrile episodes were recorded, and central and peripheral blood cultures were drawn before beginning antibiotic therapy. Patients participated in follow-up for 16,677 catheter days (8,666 Hep and 8,011 HepVan), and 143 febrile episodes were recorded (82 Hep and 61 HepVan). Forty-four episodes of bacteremia occurred, 23 of them due to VSO (16 occurred in the Hep group and 7 in the HepVan group (P = 0.19). VSO bacteremia occurred in 14 neutropenic (absolute neutrophil count < 500 × 10⁴/l) episodes (7 Hep vs. 7 HepVan) and in 9 non-neutropenic episodes (9 Hep vs. 0 HepVan; P = 0.013). Vancomycin effectively prevented bacteremia by VSO in non-neutropenic patients, supporting the idea that intraluminal colonization of indwelling CVCs contributes to bacteremia only in these patients. Med. Pediatr. Oncol. 28:196–200 © 1997 Wiley-Liss, Inc.     

Tsukamurella inchonensis infection in a child with Hodgkin's lymphoma

Tsukamurella spp. infection is a rare but important cause of bacteremia in immunocompromised patients. The organism is an aerobic, Gram‐positive, weakly acid‐fast bacillus that is difficult to differentiate from other aerobic Actinomycetales by standard laboratory methods. Here, we report on the case of a 14‐year‐old patient with Hodgkin's lymphoma who, after intensive chemotherapy, developed Tsukamurella inchonensis bacteremia, which was identified on the peripherally inserted central venous catheter (PICC) using 16S rRNA sequencing analysis. The bacteremia was successfully controlled with antimicrobial therapy and subsequent removal of the PICC. This is the first report of bacteremia by Tsukamurella inchonensis in immunocompromised children. Careful observation and prompt analysis of opportunistic infection, including Tsukamurella spp., is very important in immunocompromised children.     

Silastic catheters for home antibiotic therapy in patients with cystic fibrosis

Repeated 14-day courses of intravenous antibiotic therapy for patients with cystic fibrosis (CF), who have been colonized with Pseudomonas aeruginosa (PA), is one currently accepted treatment. Conventional intravenous cannulas for antibiotic delivery often have a short line life leading to frequent venipunctures. Therefore we used silastic catheters as a peripheral venous access. Silastic catheters (15 cm, 0.6 mm diameter) were inserted 10 cm into a cubital vein in 15 patients with CF (age 5–32 years) for 20 antibiotic courses. After the antibiotic infusion the catheter was flushed with 200 U heparin (2 ml Vetren). In all patients the antibiotic therapy was delivered as a home therapy. In 15 antibiotic courses the silastic catheter could be continuously used for 14 days. One patient with methicillin resistant Staphylococcus aureus received antibiotic therapy for 54 consecutive days using the same silastic catheter. The catheter had to be removed in four courses: once because of thrombophlebitis with local inflammation, once because of burning pain during infusion and occlusion twice. In one case the patient removed his catheter because of technical problems. No other serious side effects occurred. Ten patients had previously received intravenous antibiotics at least once. The median line life of the last used conventional peripheral cannula of all patients was 4 days versus 14 days with the use of the silastic catheter (P < 0.005). All patients preferred the silastic catheter to other venous access. Conclusion Because of the long line life and easy handling, silastic catheters may be an alternative venous access to perform home antibiotic therapy in patients with CF. Received: 9 May 1996 / Accepted: 24 September 1996     

儿童铜绿假单胞菌脓毒症 14 例临床分析

目的了解儿童铜绿假单胞菌脓毒症的临床特点及药敏情况。方法回顾性分析2006-2016年诊断为铜绿假单胞菌脓毒症患儿的临床资料。结果符合铜绿假单胞菌脓毒症诊断患儿共14例,多于婴幼儿发病(78.6%),常见并发症为弥漫性血管内凝血(DIC)、肺出血。14例患儿中,7例治愈、4例死亡、3例因病情重家属放弃治疗。药敏结果提示所分离铜绿假单胞菌对氨基糖苷类和喹诺酮类抗生素具有良好的敏感性。结论铜绿假单胞菌脓毒症以婴幼儿多见,病死率高。对于疑诊患儿,早期抗感染治疗应使用覆盖铜绿假单胞菌的抗生素。     

既往健康儿童社区获得性铜绿假单胞菌败血症临床分析

目的探讨既往健康儿童社区获得性铜绿假单胞菌败血症的临床特点。方法对北京儿童医院1993~2004年出院诊断铜绿假单胞菌败血症患儿进行回顾性分析。结果在符合既往健康儿童社区获得性铜绿假单胞菌败血症诊断标准的8例患儿中,4例小于1岁5例死于感染性休克(2例合并肺出血),2例存活患儿有严重后遗症,1例自动出院。本病常见症状有发热、精神反应减弱、纳差、腹胀、腹泻、皮疹、呼吸急促。常见并发症为感染性休克、多器官功能障碍、DIC。入院时一半患儿外周血白细胞降低。5例患儿进行CRP检查,4例显著增高,其中2例>100 mg/L。细菌培养阳性标本21份,全部对丁胺卡那、环丙沙星敏感,对头孢他啶、亚胺培南耐药各2份标本(各1例)。8例患儿入院时均未选用敏感抗生素治疗。结论社区获得性铜绿假单胞菌败血症小婴幼儿多见,起病急,病死率高、并发症多、后遗症严重。对于发热、精神反应减弱、有腹泻病史、病情进展迅速、早期出现感染性休克、外周血白细胞降低,特别是CRP显著增高的患儿均应考虑到本病的可能,并早期经验性使用有效抗生素治疗。     

A 1-year survey of catheter-related infections in a pediatric university hospital: A prospective study

BackgroundCentral venous catheters (CVCs) provide a great comfort for hospitalized children. However, CVCs increase the risk of severe infection. As there are few data regarding pediatric epidemiology of catheter-related infections (CRIs), the main objective of this study was to measure the incidence rate of CRIs in our pediatric university hospital. We also sought to characterize the CRIs and to identify risk factors.Materials and methodsWe conducted an epidemiological prospective monocentric study including all CVCs, except Port-a-Caths and arterial catheters, inserted in children from birth to 18 years of age between April 2015 and March 2016 in the pediatric University Hospital of Nantes. Our main focus was the incidence rate of CRIs, defined according to French guidelines, while distinguishing between bloodstream infections (CRBIs) and non-bloodstream infections (CRIWBs). The incidence rate was also described for each pediatric ward. We analyzed the association between infection and potential risk factors using univariate and multivariate analysis by Cox regression.ResultsWe included 793 CVCs with 60 CRBIs and four CRIWBs. The incidence rate was 4.6/1000 catheter-days, with the highest incidence rate occurring in the neonatal intensive care unit (13.7/1000 catheter-days). Coagulase-negative staphylococci were responsible for 77.5% of the CRIs. Factors independently associated with a higher risk of infection in neonates were invasive ventilation and low gestational age.ConclusionsThe incidence of CRIs in children hospitalized in our institution appears to be higher than the typical rate of CRIs reported in the literature. This was particularly true for neonates. These results should lead us to reinforce preventive measures and antibiotic stewardship but they also raise the difficulty of diagnosing with certainty CRIs in neonates.     

Qualitative versus quantitative blood cultures in the diagnosis of catheter-related bloodstream infections in children with malignancy

BACKGROUND: Paired quantitative and qualitative blood cultures have been introduced for the diagnosis of catheter-related bloodstream infections (CRBI) with the catheter in situ. The aim of the study was to compare the diagnostic performance and the prognostic value of the two methods in the evaluation of febrile episodes without an apparent source in children with cancer. PROCEDURE: During a 4-year period, in every febrile episode without an apparent focus, blood was drawn simultaneously from the catheter lumen and a peripheral vein in order to perform paired quantitative (Isolator) as well as qualitative (BacT/Alert) blood cultures. The diagnosis of a CRBI was defined as either a case of greater (at least 10 fold) or earlier (differential time to positivity >2 h) bacterial growth from the catheter compared to the peripheral blood sample, respectively. RESULTS: Nineteen febrile episodes manifested in 16 children (total period of observation 11,150 catheter-days) were evaluated with both methods. A concordant diagnosis of CRBI was stated with both methods in six episodes; one episode was diagnosed as CRBI only with qualitative culture criteria. Treatment failure resulted in catheter removal in five out of the seven episodes defined as CRBI with either method. Episodes where a CRBI was ruled out with both methods had a favorable outcome. CONCLUSIONS: In this study the two methods showed comparable results in the diagnosis of CRBI and both were of prognostic significance, regarding the outcome of the treatment. However, large scale studies are required in order to evaluate the clinical relevance and the cost effectiveness of performing routinely paired blood cultures with either method.