Ciprofloxacin in typhoid fever

The study covers 78 children with typhoid fever who were hospitalized in April & May 1990. Serious complications were present in 32% (toxemia 22%, ileus 25% and myocarditis 8%). Blood cultures were positive in 30 of 49 tested. Others were diagnosed by positive Widal test.In vitro cultures ofS. typhi were resistant to chloramphenicol (90%), ampicillin (93%) and co-trimoxazole (97%). However all were highly sensitive to ciprofloxacin and moderately sensitive to cephalexin and gentamycin. Ciprofloxacin alone or in combination was given in 73 of the 78 children and found to be remarkably effective in controlling the disease and preventing relapse. No serious side effects were noted. The cohort is being followed up for possible long term adverse effects.     

In vitro antibiotic sensitivity pattern of common bacterial isolates from cases of acute bacterial meningitis with special reference to ceftriaxone

Ceftriaxone (RO 13-9904) has only recently been introduced in Benghazi and many parts of the word. We determined itsin vitro antibacterial activity against the primary aetiological agents of childhood meningitis in Benghazi, that included eighteen (23.3%) strains ofH. influenzas, 17 (22.1%) ofStr. pneumoniae and 1 (1.3%) ofN. meningitidis isolated from 77 cases of acute purulent meningitis above the age of neonatal period. All strains ofH. influenzae. Str. pneumoniae andN. meningitidis were sensitive to ceftriaxone and showed wide zones of inhibition by the disc diffusion technique of Kirby-Bauer. Ampicillin and chloramphenicol resistance was observed forH. influenzae (23% and 11% respectively), andStr. pneumoniae (12% and 0% respectively), in addition, 18% of strains ofStr. pneumoniae showed resistance to penicillin. The broad spectrum activity of ceftriaxone has been confirmed for our locality and this finding, together with its exceptionally long half-life, excellent penetration into the C.S.F. and ease of administration (single daily dose) warrants it as the drug of choice in empherical treatment of cases of acute bacterial meningitis in children in Benghazi and in cases where resistance to ampicillin and chloramphenicol are found on subsequent testing.     

Salmonella meningitis: report of five cases

Five cases of salmonella meningitis were encountered during a period of 5 years at Medical College Hospital, Rohtak. All were male children and four of them were below 5 years of age. Salmonella etiology had not been though of prior to laboratory confirmation in any of these cases. Early specific diagnosis followed by appropriate therapy produced good response in all except one infant who expired. Of the 5 salmonella isolates three were S. typhimurium and two S. typhi.     

Associated factors of protracted diarrhea

The associated factors in 80 children (less than 2 yrs) with protracted diarrhea (greater than 21 days duration) and weight loss were: secondary carbohydrate intolerance (36): enteric pathogens (non typhoidal salmonella (11), enteropathogenic E. coli 'EPEC' (6), giardia (4), and shigella (3); cow's milk protein intolerance (3), gluten intolerance (3); miscellaneous (5); and undiagnosed enteropathy (9). Three of the EPEC showed localised pattern of adherence in vitro with HEP-2 cells. Most patients with salmonella and EPEC had severe secretory diarrhea with large fecal sodium losses. All 6 patients who died had secretory diarrhea and very high fecal sodium. All but 4 patients could be effectively managed with a chicken puree-glucose-coconut oil based diet.     

An outbreak of multidrug resistant typhoid fever in Bangalore

Six hundred and eighty five blood cultures from children clinically diagnosed as enteric fever yielded 176 salmonella strains showing isolation success rate of 25.7%,S. typhi were 164 (93.2%),S. paratyphi A 5 (2.8%),S. choleraesuis 4 (2.3%) andS. typhimurium 3 (1.7%). Antibiogram of 164 isolates ofS. typhi showed triple drug resistance (TDR) in 156 strains (95.1%) to chloramphenicol, ampicillin and cotrimoxazole, and sensitivity of 90.2% and 95.1% to norfloxacin and ciprofloxacin respectively. Minimum inhibitory concentrations (MIC) of chloramphenicol were between 360 mcg and 640 mcg per ml. Phage types of 38 strains of TDRS. typhi were predominantly E1 and 0 with prevalences of 47.4% and 36.8% respectively in this region. All children with S.typhi isolates sensitive to quinolones inVitro responded well to these drugs with almost no relapse and hence, the newer generation of quinolones could be considered as the first choice in the primary treatment of enteric fever.     

Non‐typhoidal Salmonella infections in children: Review of literature and recommendations for management

Non‐typhoidal Salmonellae are a major cause of infectious diarrhoea worldwide and can cause invasive diseases, including bacteraemia, meningitis and osteomyelitis. Young or immunocompromised children and those with underlying conditions such as sickle cell disease are particularly vulnerable to invasive disease. There has been an increase in the rate of resistant non‐typhoidal Salmonella, which is associated with invasive disease and hospitalisation. The intracellular nature of non‐typhoidal Salmonella protects against extracellular antibiotics and can facilitate disease relapse, particularly meningitis. Effective antimicrobial agents with good intracellular penetration include azithromycin, fluoroquinolones and third‐generation cephalosporins. Antibiotic treatment of non‐typhoidal Salmonella gastroenteritis is only indicated if there are risk factors for invasive disease as it can prolong excretion and does not shorten the duration of gastrointestinal symptoms. Optimal choice and length of therapy for gastroenteritis and invasive disease in children is not clear. Here, we provide a review of the literature and treatment recommendations.     

Drug resistance pattern of methicillin resistant Staphylococcus aureus.

A total of 404 methicillin resistant Staphylococcus aureus (MRSA) isolated from pus, CSF, blood and sputum of various hospitalized cases were analyzed. The resistance pattern of these strains were gentamicin (51.8%), erythromycin (80.1%) and co-trimoxazole (89.6%). All these strains were sensitive to vancomycin. The isolation rate was maximum from various surgical specialties (General surgery-28.5%; Neurosurgery-16.3% and Cardio-thoracic unit-10.5%) followed by Children Ward, Premature Nursery and Gynecology Ward, respectively. Use of cloxacillin needs to be restricted since vancomycin, the drug of choice is not available in our country.     

Evaluation of shigellosis in a Turkish children''s hospital

BACKGROUND: The aim of the present study was to evaluate cases of Shigella and determine the pattern of antimicrobial resistance of shigella species in central Turkey. METHODS AND RESULTS: One hundred and ninety-eight patients with shigella gastroenteritis presenting to Sami Ulus Children's Hospital from June 2002 to December 2002 were included in the study. The clinical and laboratory data of the patients with shigellosis were collected by chart review. Male/female ratio was 1.35 and mean age was 4.83 +/- 3.2 years (range: 1-16 years). Shigella sonnei (83.3%) was the most common serogroup. This was followed by S. flexneri (10.1%), then S. dysenteria (5.1%), and S. boydii (1.5%). The antibiotic susceptibility of the shigella strains was determined. Most strains of Shigella species were resistant to trimethoprim-sulfamethoxazole (90.4%). All strains were found to be sensitive to ciprofloxacin (100%). Ampicillin susceptibility was 86.4% and cefotaxim (and/or ceftriaxon) susceptibility was 98%. CONCLUSION: Ampicillin is the drug of choice in the treatment of shigella infection in this region of Turkey. Cefotaxim or ceftriaxon was the second choice of antibiotics. Thus, Shigella is an important etiologic agent of diarrhea in Turkey. To determine the antibiotic susceptibility of the Shigella strains and appropriate empiric antibiotic treatment in Turkey, further studies will be needed.     

Multidrug resistantSalmonella typhi in Delhi

In 1990, we isolated 158 strains ofSalmonella typhi from blood cultures of patients suffering from typhoid fever. Seventy nine (50%) of these isolates were found to be simultaneously resistant to chloramphenicol, ampicillin and cotrimoxazole. These strains were also resistant to streptomycin and tetracycline, but sensitive to gentamicin, amikacin and cephalexin. The minimum inhibitory concentrations of chloramphenicol and trimethoprim for a representative number of these strains were found to be >1024 ug/ ml and >128 ug/ml respectively. Majority of the multidrug resistant (MDR) strains tested against cefotaxime (23/23), ciprofloxacin (38/38) and amoxycillin plus clavulanic acid (23/24) were sensitive to these drugs.     

Samonella associated with diarrheal diseases in a pediatric hospital (1979–82)

A total of 241 Salmonella strains were isolated from diarrheal cases in a pediatric hospital during the year 1979–1982. The serotyped isolated were S. typhimurium (209), S. oranienburg (22), S. indiana (4), S. newport (4), S. stanley (1) and S.virchow (1). All except on strain of S.typhimurium were resistant to most of the antibiotics tested. The different Salmonella strains were also isolated from all the months with no seasonal variation. Enterotoxin production was detected in 6.6 percent of the diarrheal cases. Enterotoxigenic serotypes were S.typhimurium (11), S.oranienburg (3), and S. indiana (2) diseases.     

肺炎链球菌100株耐药性分析

目的　了解杭州地区小儿肺炎链球菌致病株的耐药特征。方法　用Kirby -Bauer法对浙江大学儿童医院 2 0 0 1年 7月至 2 0 0 2年 1月鉴定的 10 0株肺炎链球菌进行耐药性分析 ,同时用E -test法测定青霉素、氨苄西林、头孢噻肟和红霉素的最低抑菌浓度。结果　青霉素不敏感株 6 1株占 6 1% ,其中中介株占 46 % ,耐药株占15 % ,其最低抑菌浓度范围为 0 0 16～ 3 0 0 0mg/L ,平均 0 5 2 3mg/L。 92 %的菌株对红霉素耐药 ,对四环素、复方新诺明的耐药率也分别高达 85 %和 5 6 % ,氯霉素的耐药率为 16 %。多重耐药率为 6 3 % ,其中多数对红霉素、四环素和复方新诺明联合耐药。 99%的菌株对利福平敏感。未发现氨苄西林耐药株 ,但中介株达 43 %。所有的菌株都对头孢噻肟、万古霉素和氧氟沙星敏感。结论　杭州地区肺炎链球菌耐药现象比较严重 ,第三代头孢菌素是临床治疗耐青霉素肺炎链球菌感染的理想药物。     

Salmonella meningitis

Microbiological studies of cerebrospinal fluid samples during June, 1980 to October, 1983 encountered 25 strains of Salmonella. There were 4 strains of S.typhi, 18 of S.typhimurium and one each of S.enteritidis, S. oranienburg and salmonella group C. Eighty percent of the patients were neonates or infants with high mortality rate.     

2000~2004京沪穗渝5家儿童医院革兰阳性球菌耐药情况分析

[摘要]探讨我国不同地区儿科主要革兰阳性球菌耐药的情况。方法 对五家儿童专科医院从2000年1月1日至2004年12月31日内检验科送检标本分离出的四种革兰阳性球菌(共计8215株)进行Kirby-Bauer琼脂扩散法进行抗生素敏感试验，并按照每年NCCLS标准进行判读，并计算出所测细菌对抗菌药物的耐药率（R%＋I%）和敏感率（S%）。 结果 从感染患儿中分离出4004株金黄色葡萄球菌，甲氧西林耐药金黄色葡萄球菌（MRSA）的检出率为7.15%，红霉素总耐药率为61.96%,并且有逐年上升的趋势，4004株金葡菌中未发现对万古霉素耐药或中介的金葡菌；肺炎链球菌共2402株，青霉素不敏感肺炎链球菌（PNSP）的检出率为63.42%，红霉素耐药率为86.22%，两者耐药率均在上升；β溶血性链球菌共432株，对青霉素全部敏感，对红霉素的耐药率为68.47%，且耐药率在逐年增加；肠球菌共1377株，对万古霉素的中度敏感率为2.73%，对氨苄西林的耐药率为51.91%，对红霉素的耐药率高达88.10%。 结论 除了β溶血性链球菌之外，多数G＋细菌对广谱青霉素的耐药率都偏高；G＋细菌对万古霉素和环丙沙星的敏感率较高,但对红霉素的耐药率居高不下并有逐年上升的趋势。MRSA及仍在较低水平，在本研究中没有发现VRSA及VISA，但是仍然要加强各地对革兰阳性球菌耐药性和抗生素使用情况的监测,合理使用抗生素。     

Demonstration of mother-to-infant transmission ofStaphylococcus aureus by pulsed-field gel electrophoresis

We assessed mother-to-infant transmission ofStaphylococcus aureus. Anterior nares swabs of 466 pregnant women, vaginal swabs of 305 of these women and anterior nares swabs of 305 6-day-old infants were examined for the presence ofS. aureus. The results showed that 7.5% of the vaginal swabs from the pregnant women and 10.1% of the anterior nares swabs from the infants were positive forS. aureus. Six of the 466 pregnant women (1.3%) and 12 of the 305 infants (3.9%) carried methicillin-resistantS. aureus (MRSA) in the anterior nares site, but none of the vaginal specimens were positive for MRSA. Analysis ofSmaI digested chromosomal DNA analysis using pulsed-field gel electrophoresis (PFGE) showed that methicillin-sensitiveS. aureus (MSSA) strains obtained from four pairs of pregnant women and their infants were completely identical, which strongly suggesting mother-to-infant transmission ofS. aureus.Conclusion This study elucidated the prevalence ofS. aureus carriage among pregnant women and newborn infants. Mother-to-infant infection ofS. aureus was demonstrated phenotypically and genetically. PFGE is a useful tool to detect infection routes including mother-to-infant-infection.     

<Emphasis Type="Italic">Salmonella typhimurium</Emphasis> outbreak in a neonatal unit in Turkey

Objective  To analyze an outbreak caused by a multipl resistant strain of S. typhimurium in a newborn unit in Turkey. Methods  The outbreak occured during the period 15 to 29 March,2005. A newborn infected with S. typhimurium was defined as a case. Newborns who were hospitalized during the outbreak period with no diagnosis of S. typhimurium infections (n=50) constituted the control group I (CG I). The matched patients of the control group II (CG II) (n=20) were selected from neonates without S. typhimurium infections during the period. Results  Of 22 infants who were affected two died. Cases developed diarrhea (n=20), septicemia (n=5) and meningtis (n=1). The strain was resistant to ampicillin, ceftriaxone, ceftazidime, amikacin, trimethoprim-sulfamethoxasole and chloromphenicol, susceptible to meropenem. All of the infected neonates were treated with meropenem. The surveillance cultures were negative. The outbreak was controlled by approprite therapy and institution of effective control measures. The cases were more exposed to mechanical ventilation than CG I (p<0.05). The mean additional length of stay in cases was significantly different from CG II (14.9 days vs. 5.1 days, p<0.05). The mean charges was $1588.78 for a case and $506.94 for a control (P<0.05). Accommodation accounted for 44.5% of these extra charges. Conclusion  This study increases the understanding of the burden of multidrug-resistant S. typhimurium infection. Nosocomial outbreaks have a major effect on healthcare delivery, costs and outcomes.     

Bacteraemia in children in Iceland 1994–2005

Aim: To investigate the aetiology of bacteraemia in children in Iceland, the antibiotic resistance and possible preventive measures. Methods: All positive bacterial blood cultures from children 0–18 years old isolated at Landspítali University Hospital Iceland from 1994 to 2005 were included in the study. Epidemiological and microbiological data were registered. The blood cultures were categorized according to likelihood of infection or contamination. Results: During the study period 1253 positive blood cultures were obtained from 974 children; 647 from boys and 606 from girls. Positive blood cultures were most common during the first year of life (594; 47.4%) with 252 of them from neonates. Coagulase negative staphylococci were most common (37%). Of probable or definite infections Streptococcus pneumoniae was the most common (19.3%) followed by Staphylococcus aureus (17.6%) and Neisseria meningitidis (13.5%). The most common pneumococcal serogroups were 23, 6, 7, 19 and 14. Commercially available vaccines contain up to 88% of all pneumococcal strains and 67% of all multi‐resistant strains. N. meningitidis group C was not isolated after vaccinations were started in 2002. Conclusion: Our study provides important epidemiological data on bacterial bloodstream infections in children in Iceland. The results demonstrate the excellent efficacy of meningococcal group C vaccination.     

Antimicrobial susceptibility of Staphylococcus aureus in children with atopic dermatitis

Background: Skin infection and/or nasal carriage of Staphylococcus aureus in children with atopic dermatitis (AD) is a risk factor for exacerbating disease or subsequent recurrent S. aureus infection. The purpose of the study is to evaluate the antibiotic susceptibilities of S. aureus strains from AD children and determine the most appropriate choice of antibiotics. Methods: Nasal swabs from 168 healthy children with AD and 20 AD children with concurrent skin and soft‐tissue infections (SSTI) were collected in 2005–2008. S. aureus strains were further analyzed for and compared with antibiotic susceptibilities. Results: There were 78 (46.4%) healthy children with AD colonized with S. aureus, and 24 (30.8%) were methicillin‐resistant S. aureus (MRSA). Among the 20 SSTI‐infecting strains, 12 (60%) were MRSA. Antimicrobial susceptibility testing showed that, after penicillin, colonizing and SSTI‐infecting strains had the highest rates of resistance to erythromycin (50% and 70%, respectively). All isolated strains were susceptible to vancomycin, rifampin, and mupirocin. Multi‐drug resistance was found in 70% of the colonizing and 50% of the SSTI‐infecting strains. D‐test assay revealed inducible clindamycin resistance in 75% of the colonizing strains. The most prevalent resistance gene was ermB which was present in 94.9% and 92.9% of colonizing and SSTI‐infecting strains, respectively. Conclusions: This study found that colonizing and SSTI‐infecting strains of S. aureus from AD children had a high prevalence of MRSA and multi‐drug resistance. Trimethoprim‐sulfamethoxazole, rifampin, fusidic acid and mupirocin appear to be more suitable for treatment and decolonization of S. aureus in AD children.     

Effect of the pneumococcal conjugate vaccine on pneumococcal carriage in Turkish children

Background: The aim of our study was to evaluate the effect of the seven‐valent pneumococcal conjugate vaccine which has recently been included in the national immunization schedule on the nasopharyngeal carriage of Streptococcus pneumoniae in a group of healthy Turkish children. This is the first study determining the efficacy of this vaccine in Turkey. Methods: One hundred and thirty‐eight children who had completed their pneumococcal vaccination series and 109 unvaccinated control subjects aged 12–59 months were included in the study between October 2007 and April 2008. A single nasopharyngeal swab sample was obtained from each subject. Results: S. pneumoniae was isolated in 32 (12.9%) of 247 subjects. No significant differences were detected in pneumococcal carriage rate between the vaccinees and controls (10.1% vs 16.5%). Prevalence of vaccine type (VT) carriage was statistically lower in the vaccinated group than the controls while non‐vaccine type carriage (NVT) was similar. Most frequently isolated vaccine serotype was 23F in the vaccinated group and 19F in the non‐vaccinated group. Of the isolated S. pneumoniae, 13.3% were penicillin susceptible and 86.7% were non‐susceptible. Vaccinees and controls did not differ statistically with respect to carriage rate of penicillin‐resistant S. pneumoniae. All the pneumococcal isolates were susceptible to ceftriaxone, vancomycin, rifampicin and quinolones. Conclusion: Seven‐valent conjugate vaccine induces long‐term protection against carriage of VT S. pneumoniae in Turkish children. The ability of the conjugate vaccine to reduce transmission of antibiotic resistant S. pneumoniae may be possible if its introduction is coupled with a reduction in inappropriate use of antibiotics.     

Efficacy and safety of linezolid in immunocompromised children with cancer

Background: The aim of this study was to determine the safety, tolerance and efficacy of linezolid for the treatment of infections from Gram‐positive bacteria in immunocompromised children with cancer. Methods: This was a prospective non‐comparative unblinded study in the Hematology/Oncology Unit over a two‐year period, administering linezolid as monotherapy in children with cancer. Results: Seventeen children received linezolid (30 mg/kgr: 3 i.v. per day). Mean duration of linezolid administration was 12.2 days (range, 6–38 days), while the median age of the evaluable patients was 2.2 years (range, 6 months–11.2 years). Primary diagnosis was acute lymphoblastic leukemia (nine patients), brain tumor (three patients), multi‐organ Langerhans cell histiocytosis (two patients), rhabdomyosarcoma, Burkitt's lymphoma and ovarian tumor (one patient each). All patients were in the midst of chemotherapy cycles. Ten out of 17 children had positive blood cultures (methicillin‐resistant Staphylococcus aureus, four patients; vancomycin‐resistant Enterococcus, three patients; penicillin‐resistant Streptococcus pneumoniae, three patients), while seven of the 17 had fever and vancomycin‐resistant Enterococcus in stool cultures. All patients were considered clinically cured after the end of the linezolid regimen (100% efficacy). The main adverse events were thrombocytopenia grade 1–3 and anemia grade 2–3 (four and two patients, respectively). Chemotherapy‐induced myelotoxicity (six patients) was not worsened during linezolid therapy. No bleeding episodes were presented. Self‐limited diarrhea grade 1–2 was presented in four patients (mean duration 2 days). The total adverse event rate was 23.5%; however, there was no premature cessation of linezolid in any patient. Conclusions: Linezolid may be another effective and safe therapy to treat infections from resistant Gram‐positive bacteria in immunocompromised children, even in young ages.     

Usefulness of the Widal test in diagnosing childhood typhoid fever in endemic areas

Data are presented for 2382 children investigated for fever in a Malaysian hospital between 1984 and 1987 when Widal tests and blood cultures were a routine part of every fever screen. There were 145 children who were culture positive (TYP-CP) for Salmonella typhi, while 166 were culture negative but were diagnosed as having typhoid (TYP-CN). Analyses of the sensitivity and specificity of combinations of initial Widal titres in predicting a positive S. typhi culture in a febrile child (culture positive vs the rest) showed the best model to be an O- and/or H-titre of ≥ 1 in 40 (sensitivity 89%; specificity 89%). While the negative predictive value of the model was high (99.2%) the positive predictive value remained below 50% even for very high titres of O and H (> 1 in 640), at which point the specificity was 98.5%, supporting the clinical view that a high proportion of the TYP-CN patients really were typhoid but were missed by culture. The TYP-CN patients showed a very similar clinical and age profile to TYP-CP patients. The length of history of fever did not affect the initial Widal titre in culture positive cases. The Widal test in children remains a sensitive and specific ‘fever screen’ for typhoid although it will not identify all cases. In children, lower cut-off points for O- and H-titres should be used than are generally recommended.