Central nervous system infections in neonates caused by multiresistant Klebsiella pneumoniae

OBJECTIVE: To evaluate the incidence, clinical course and outcome of central nervous system (CNS) infections caused by multiresistant Klebsiella pneumoniae (MRKP) in critically ill neonates. METHODS: Retrospective study of neonates treated in Neonatal Department of Poznań University of Medical Science during a three years period from 1st January 1997 to 31st December 1999. Isolates were identified as Klebsiella pneumoniae with the ID32Gn test (bioMerieux), and antibiotic susceptibility was determined with ATBG test (bioMerieux) and with disc-diffusion technique. RESULTS: In this period there were 27 cases of CNS infections in our Department 17--65.4% of which (16 meningitis, one ventriculitis and one brain abscess), were caused by Klebsiella pneumoniae. 81.25% occurred in prematures (< 31 weeks of gestational age and < 1500 grams). In 10 (58.8%) cases CNSI developed in the course of sepsis. 9 children died. In all the isolates ESBL expression in vitro was detected. Only carbapenems and fluoroquinolones were active in all the cases. Ventriculitis was treated successfully with imipenem administered intraventrically and brain abscess surgically. CONCLUSIONS: CNS infections in neonates caused by MRKP are quite frequent, severe and possibly life threatening. Eradication of these strains from hospital environment by introducing adequate sanitary regime and reasonable antibiotic policies is the only method of conquering the infections.     

Hospital-acquired infections in the neonatal intensive care unit--Klebsiella pneumoniae

Klebsiella pneumoniae is medically the most important organism of the Klebsiella species. It is responsible for a significant proportion of hospital-acquired infections including septicemias, urinary tract infections, pneumonia, and soft tissue infections especially in the immunocompromised hosts such as the neonate. The hands of healthcare workers and the gastrointestinal tract of hospitalized infants serve as reservoirs for the transmission of the organism and are responsible for multiple hospital outbreaks. In recent years, there has been an increase in the incidence of outbreaks caused by multidrug resistance K. pneumoniae organisms or the extended spectrum beta-lactamase (ESBL)-producing K. pneumoniae. The problems associated with extended spectrum beta-lactamase-producing organisms include difficulties in accurate antimicrobial susceptibility testing, limited treatment options and increased morbidity and perhaps mortality. Hence, prevention through implementation of strict infection control guidelines, effective hand washing and judicious use of antimicrobials such as third generation cephalosporins is important to effectively reduce the morbidity associated with this infection.     

新生儿肺炎克雷伯菌败血症与大肠埃希菌败血症临床特点及耐药性的比较

目的 对新生儿肺炎克雷伯菌败血症与大肠埃希菌败血症临床特点及耐药性进行对比分析,为临床早期诊断和合理治疗提供理论依据.方法 对2000年1月至2009年10月在我院新生儿重症监护病房住院治疗并确诊为肺炎克雷伯菌败血症(n=42)和大肠埃希菌败血症患儿(n=50)的病历资料进行回顾性分析,比较其临床特征、实验室检查、治疗转归情况.同时将不同发病日龄肺炎克雷伯菌败血症与大肠埃希菌败血症(发病日龄≤3 d为早发型败血症、发病日龄＞3 d为晚发型败血症)对抗生素的耐药情况进行比较分析.结果 (1)临床特点比较:肺炎克雷伯菌败血症比大肠埃希菌败血症新生儿气促、呼吸暂停的发生率高(61.9%和6.0%,x2=17.34,P＜0.05),在更短的时间内发展至多器官功能障碍综合征和弥漫性血管内凝血[(40±28)h和(89±26)h](t=-3.17,P＜0.05);但并发化脓性脑膜炎比例低(4.8%和30.0%,x2=9.65,P＜0.05).(2)非特异性实验室检查结果:肺炎克雷伯菌败血症与大肠埃希菌败血症相比较,白细胞＞25×109/L(42.9%和22.0%,x2=4.60,P＜0.05)、血小板＜100×109/L(52.4%和18.0%,x2=12.07,P＜0.05)、C反应蛋白＞8 mg/L(95.2%和76.0%,x2=6.55,P＜0.05)的比例较高.(3)抗生素耐药情况:对头孢菌素类抗生素肺炎克雷伯菌耐药率高于大肠埃希菌(81.8%～100.0%和17.2%～63.2%,x2=6.97～11.92,P＜0.05);晚发型肺炎克雷伯菌败血症对阿莫西林/棒酸、头孢哌酮/舒巴坦耐药率高于晚发型大肠埃希菌败血症(75.0%和0.0%,x2=26.67;83.3%和0.0%,x2=12.53,P均＜0.05);对亚胺培南均未发现耐药.晚发型大肠埃希菌败血症与肺炎克雷伯菌败血症产超广谱于内酰胺酶菌株检出率均较早发型高(65.0%和17.8%,x2=11.06;100.0%和30.0%,x2=20.22,P均＜0.05),其中晚发型肺炎克雷伯菌败血症产超广谱β-内酰胺酶菌株检出率高于晚发型大肠埃希菌败血症(100.0%和65.0%,x2=9.16,P＜0.05).(4)病死率:肺炎克雷伯菌败血症病死率高于大肠埃希菌败血症(21.4%和4.0%,x2=6.59,P＜0.05).结论 新生儿肺炎克雷伯菌败血症病情比大肠埃希菌败血症重,可迅速发展至多器官功能障碍综合征和弥漫性血管内凝血,病死率高.肺炎克雷伯菌和大肠埃希菌的产超广谱β-内酰胺酶菌株快速增长,临床应合理使用抗生素.

Abstract：

Objective To compare the clinical characteristics and antibiotics resistance of neonatal sepsis caused by Klebsiella pneumoniae and Escherichia coli in order to provide guidance for early diagnosis and appropriate treatment. Methods Forty-two newborns with Klebsiella pneumoniae sepsis and 50 newborns with Escherichia coli sepsis in the neonatal intensive care unit of Yuying Children's Hospital of Wenzhou Medical College from January 2000 to October 2009 were enrolled into this study. The clinical data, laboratory examinations and prognosis of these newborns were retrospectively analyzed and compared. The antibiotic resistance data of different onset age of the two diseases were compared. Early-onset sepsis was defined as the age at the onset ≤3 days, and late-onset sepsis was defined as the age at the onset ＞3 days. Results (1) Comparison of clinical characteristics: Klebsiella pneumoniae sepsis caused higher incidence of apnea or gasp compared with Escherichia coli sepsis (61.9% vs 6.0% ,x2= 17. 34, P＜0. 05); the time of developing to multiple organ dysfunction syndrome or disseminated intravascular coagulation of the newborns with Klebsiella pneumoniae sepsis [(40±28) h] was shorter than that of the newborns with Escherichia coli sepsis [(89±26) h] (t= -3.17, P＜0.05); while the incidence of purulent meningitis of Klebsiella pneumoniae sepsis was lower ( 4. 8% vs 30. 0 %, x2 = 9.65, P ＜ 0. 05 ). ( 2 ) Comparison of non-specific laboratory examinations: compared with Escherichia coli sepsis, Klebsiella pneumoniae sepsis caused higher incidence of the leucocyte count ＞ 25 × 109/L (42. 9% vs 22.0%, x2 = 4. 60,P＜0. 05), platelet count ＜ 100 × 109/L (52.4% vs 18.0%, x2 = 12.07, P＜0. 05) and C-reaction protein ＞8 mg/L (95.2% vs 76.0% ,x2 =6. 55, P＜0. 05). (3) Comparison of results of antibiotic resistance: the resistance rate of Klebsiella pneumoniae (81.8%00-100. 0%) to Cephalosporins was higher than that of Escherichia coli (17. 2%-63. 2%) (x2 =6.97-11.92, P＜0. 05); the resistance rates of late-onset sepsis of Klebsiella pneumoniae to Amoxicillin/clavulanic-acid and Cefoperazone/sulbactam were higher than those of Escherichia coli (75.0% vs 0.0%, x2 =26.67, P＜0. 05;83. 3%vs 0. 0%, x2 = 12.53, P＜0. 05 respectively); no resistance to Imipenem were found. The percentages of extended spectrum β-lactamases (ESBLs) positive Escherichia coli and Klebsiella pneumoniae were obviously higher in neonates with late-onset sepsis than those early-onset ones (65.0% vs 17. 8%,x2 = 11.06, P＜0. 05; 100. 0 % vs 30. 0 %, x2 = 20. 22, P＜0. 05 respectively); and positive ESBLs rate of the late-onset Klebsiella pneumoniae sepsis was higher than that of Escherichia coli sepsis (100. 0% vs 65.0%, x2 =9.16, P＜0. 05). (4) Comparison of mortality rate: the mortality rate of Klebsiella pneumoniae sepsis was higher than that of Escherichia coli sepsis (21.4% vs 4. 0%,x2=6.59, P ＜ 0. 05 ) . Conclusions Compared with Escherichia coli septicemia, Klebsiella pneumoniae septicemia has more severe symptoms, developed to multiple organ dysfunction syndrome or disseminated intravascular coagulation quicker, and has higher mortality rate. The percentage of ESBLs positive Escherichia coli and Klebsiella pneumoniae increased rapidly. The clinical use of antibiotics should be rationale.     

Pneumocephalus secondary to septic thrombosis of the superior sagittal sinus: report of a case.

Pneumocephalus secondary to septic superior sagittal sinus thrombosis (SSSST) is extremely rare. We report computed tomography (CT) findings in a 63-year-old man with SSSST caused by the gas-forming organism Klebsiella pneumoniae. The patient presented with fever, chills, general weakness, and spontaneous progressive swelling of the right frontoparietal scalp. CT revealed a gas-containing abscess over the right frontoparietal subgaleal region and in the superior sagittal sinus. Surgical drainage of the subgaleal abscess was performed and blood and pus cultures grew Klebsiella pneumoniae. The patient died of sepsis on the 6th day of hospitalization.     

Neonatal septicemia caused by pneumococci.

Pneumococci (Streptococcus pneumoniae) infrequently cause neonatal septicemia. An increased number of cases have been reported in recent years, but no increase in the relative incidence among neonatal infections has been noted. On the basis of two cases of our own and a review of 40 recently published case reports, the clinical characteristics of pneumococcal septicemia are described and the pathogenesis is discussed. The presenting clinical picture in early-onset pneumococcal septicemia is dominated by respiratory distress, frequently accompanied by leukopenia, and is indistinguishable from that seen in septicemia caused by Group B Streptococci (GBS). The onset is preceded by prelabor rupture of the fetal membranes in almost half of the instances. The mortality is 50%, twice the figure given in recent GBS reports.     

Pneumonia caused by penicillin-nonsusceptible Streptococcus pneumoniae: clinical characteristics, prognostic factors, and outcomes.

BACKGROUND AND PURPOSE: Pneumococcal pneumonia caused by penicillin-nonsusceptible Streptococcus pneumoniae (PNSSP) is increasing worldwide. To better understand this infection, patients with pneumococcal pneumonia treated at National Taiwan University Hospital during a 5-year period were evaluated to determine the clinical characteristics, prognostic factors, and outcomes of the infection. METHODS: Eighty-one patients with 81 episodes of pneumococcal pneumonia diagnosed from January 1993 to December 1997 were analyzed retrospectively. Patients were categorized into two groups according to susceptibility results. Differences between groups were evaluated with Student's t-test and the chi-square test. Univariate analysis was used to identify factors associated with mortality. RESULTS: Infections were caused by penicillin-susceptible S. pneumoniae (PSSP) in 57 (70%) patients and by PNSSP in the remaining 24 (30%). Nosocomial acquisition was more common in PNSSP (25%) than in PSSP patients (10%) (p = 0.05), while the frequency of bacteremia (54% vs 60%) and the mortality rate (46% vs 32%) did not differ significantly between the PNSSP and PSSP groups. Among the 24 patients with pneumonia caused by PNSSP, those 65 years of age or older had a lower incidence of bacteremia (4/14, 29%) than those who were younger (9/10, 90%) (p = 0.03). In patients with pneumonia caused by PNSSP, the outcome was not significantly related to the treatment regimen (penicillin vs nonpenicillin beta-lactam antibiotics or vancomycin, 33% vs 47%; p = 0.4). The only factors associated with mortality from these infections were shock (p = 0.003) and multilobar consolidation (p = 0.01) at the time of admission. CONCLUSIONS: These data suggest that the clinical outcome of pneumococcal pneumonia is more closely related to the clinical condition at presentation than the susceptibility status of the pneumococcus.     

A prospective etiologic study of community-acquired pneumonia in Taiwan.

BACKGROUND AND PURPOSE: The treatment of community-acquired pneumonia (CAP) is complicated by the growing threat of antimicrobial resistance and the tendency to rely on empirical therapy. This study investigated the etiologic agents of adult CAP in Taiwan and the susceptibility of Streptococcus pneumoniae isolates from these patients. METHODS: A collaborative group was established in the emergency department to conduct a prospective study of the etiology of adult CAP. The etiologic agent was determined by a combination of microscopic, culture, serologic and antigen detection methods. Pneumococcal susceptibility testing was performed to determine the extent of penicillin resistance. RESULTS: A total of 100 consecutive cases of mild to moderate adult CAP prior to the severe acute respiratory syndrome epidemic were enrolled. The etiologic agent was determined in 72% of cases. The 5 most common causative pathogens were S. pneumoniae (26%), Mycoplasma pneumoniae (20%), Chlamydia pneumoniae (13%), Haemophilus influenzae (9%), and Klebsiella pneumoniae (5%). Atypical pathogens accounted for 40% of CAP. Bacteremic pneumonia was diagnosed in 6.2% of cases. Co-infections with 2 or more pathogens were found in 16% of the cases. Among the 20 isolates of S. pneumoniae, 85% (17/20) were susceptible to penicillin, 3 (15%) were intermediate, and none were resistant to penicillin. CONCLUSION: S. pneumoniae, M. pneumoniae and C. pneumoniae were the 3 leading causes of mild to moderate CAP in Taiwan. This study indicates that penicillin-resistant S. pneumoniae play a very limited role in this condition in adults.     

肺炎支原体肺炎诊治的若干问题

肺炎支原体(MPP)是儿童社区获得性肺炎的重要病原之一,MPP感染多发生在人口密集的地方。多数MP感染引起的临床症状较轻,具有自限性,但也有导致重症肺炎或肺外并发症的可能。近几年MP耐药率上升,难治性、重症MPP肺炎病例增多,给儿童健康构成较大威胁。本文就MPP感染诊治进展及应需加强探讨的问题做一总结,以期对儿科医生有所帮助。     

Pyogenic liver abscess caused by Burkholderia pseudomallei in Taiwan.

Pyogenic liver abscess in Taiwan is a well-known disease entity, commonly associated with a single pathogen, Klebsiella pneumoniae. Melioidosis is an endemic disease in Taiwan that can manifest as multiple abscesses in sites including the liver. We report three cases of liver abscesses caused by Burkholderia pseudomallei. The first patient was a 54-year-old diabetic woman, who presented with liver abscess and a left subphrenic abscess resulting from a ruptured splenic abscess, co-infected with K. pneumoniae and B. pseudomallei. The second patient, a 58-year-old diabetic man, developed bacteremic pneumonia over the left lower lung due to B. pseudomallei with acute respiratory distress syndrome, and relapsed 5 months later with bacteremic abscesses of the liver, spleen, prostate and osteomyelitis, due to lack of compliance with prescribed antibiotic therapy. The third patient was a 61-year-old diabetic man with a history of travel to Thailand, who presented with jaundice and fever of unknown origin. Liver and splenic abscesses due to B. pseudomallei were diagnosed. A high clinical alertness to patients' travel history, underlying diseases, and the presence of concomitant splenic abscess is essential to early detection of the great mimicker, melioidosis. The treatment of choice is intravenous ceftazidime for at least 14 days or more. An adequate duration of maintenance oral therapy, with amoxicillin-clavulanate or trimethoprim-sulfamethoxazole for 12-20 weeks, is necessary to prevent relapse. Liver abscess in Taiwan is most commonly due to K. pneumoniae, but clinicians should keep in mind that this may be a presenting feature of melioidosis.     

Microbiologic features of adult community-acquired bacterial meningitis in Taiwan.

BACKGROUND AND PURPOSE: Community-acquired bacterial meningitis (CABM) is a life-threatening disease that requires prompt initiation of appropriate antibiotic therapy. The purpose of this study was to determine the causative microorganisms of CABM and their antimicrobial susceptibility patterns at a major teaching hospital in Taipei from 1993 to 1998. METHODS: A review of medical records and microbiologic data was used to identify cases of CABM and causative pathogens. Antimicrobial susceptibility testing for bacterial isolates was performed by the disk diffusion method. RESULTS: Among the 48 adult patients with a diagnosis of CABM during the study period, the causative pathogens were identified in 36 cases. Unlike reports from other countries, Klebsiella pneumoniae was the leading causative pathogen (33%), followed by Streptococcus pneumoniae (28%), Listeria monocytogenes (11%), Neisseria meningitidis (6%), Staphylococcus aureus (6%), streptococci (6%), and Pseudomonas aeruginosa (6%). The incidence of CABM due to K. pneumoniae increased during the study period (p = 0.012, Poisson regression), while the incidence of CABM due to other pathogens remained stable. All of the CABM-associated K. pneumoniae isolates were susceptible to cefotaxime but 25% of the CABM-associated S. pneumoniae strains were not susceptible to penicillin G. CONCLUSIONS: Penicillin G alone was not an appropriate empiric therapy for adult CABM because a high percentage of cases were due to K. pneumoniae or penicillin nonsusceptible S. pneumoniae. While the recommendations for the initial empiric regimen for CABM due to S. pneumoniae in Taiwan remain to be developed, third-generation cephalosporins appear to be an appropriate initial empiric regimen for the treatment of CABM due to K. pneumoniae.     

Pneumonia in pregnancy

Pneumonia complicating pregnancy requires a prompt diagnosis and the institution of adequate supportive and antimicrobial therapy. In a patient with a classic presentation of pneumonia, the most likely pathogens are Streptococcus pneumoniae and Haemophilus influenzae. In a patient with an atypical presentation of pneumonia, Mycoplasma pneumoniae and Chlamydia pneumoniae are frequently encountered. In a patient suffering from acquired immunodeficiency syndrome (AIDS), Pneumocystis carinii is the most frequent pathogen. The antimicrobial therapy, therefore, has to be tailored to the sensitivity patterns of these pathogens in the community. Hospitalization is recommended for the pregnant patient diagnosed with pneumonia to ensure effective supportive care and minimize the risk of preterm labor and delivery.     

Perimenopausal pneumococcal tubo-ovarian abscess--a case report and review

BACKGROUND: Genital tract infections in females secondary to Streptococcus pneumoniae (pneumococcus) are unusual. Tubo-ovarian abscess resulting from such an infection is a rare occurrence and diagnosis is not always easy. This report demonstrates the problems of recognizing this condition and summarizes the pathomechanism, investigations leading to a diagnosis and the subsequent management. CASE: A rare case of a tubo-ovarian abscess caused by pneumococcus, occurring in a previously healthy 48-year-old woman, is presented. The tubo-ovarian abscess may have developed insidiously and probably had an acute exacerbation prior to presentation. CONCLUSION: This case is unusual in that there were no identifiable initiating events for the source of the pneumococcal infection. Early recognition of a tubo-ovarian abscess is important in order to prevent the associated morbidity and mortality. This condition has the propensity to mimic a neoplasm.     

红霉素耐药肺炎链球菌基因分布及耐药性分析

目的了解广州地区对红霉素耐药的肺炎链球菌中ermB及mefE基因的分布，比较ermB基因与mefE基因对红霉素耐药的肺炎链球菌的耐药性。 方法2001—2004于广州市儿童医院用克林霉素纸片法检测239株对红霉素耐药的肺炎链球菌，并用浓度梯度法检测其耐药性。 结果239株对红霉素耐药的肺炎链球菌中，ermB、mefE基因介导的耐药率分别为70.3%(168/239)和29.7%(71/239)。168株ermB基因介导对红霉素耐药的肺炎链球菌，对青霉素(MIC50 0.19μg/mL、MIC90 1.5μg/mL)、阿莫西林/克拉维酸(MIC50 0.19μg/mL、MIC90 1.0μg/mL)、头孢曲松(MIC50 0.19μg/mL、MIC90 0.75μg/mL)、头孢呋辛(MIC50 0.38μg/mL、MIC90 2.0μg/mL)、头孢克洛(MIC50 2.0μg/mL、MIC90 32.0μg/mL)的不敏感率分别为58.4%、1.2%、20.8%、46.5%和51.7%。71株mefE基因介导对红霉素耐药的肺炎链球菌，对青霉素(MIC50 0.5μg/mL、MIC90 1.5μg/mL)、阿莫西林/克拉维酸(MIC50 0.38μg/mL、MIC90 1.0μg/mL)、头孢曲松(MIC50 0.38μg/mL、MIC90 0.75μg/mL)、头孢呋辛(MIC501.0μg/mL、MIC90 3.0μg/mL)、头孢克洛(MIC50 6.0μg/mL、MIC90 48.0μg/mL)的不敏感率分别为67.6%、0、19.7%、59.2%和61.9%。 结论广州地区对红霉素耐药的肺炎链球菌其耐药机制以ermB基因介导为主；ermB基因介导的红霉素耐药性高于mefE基因介导的耐药性；ermB和mefE基因介导对红霉素耐药的肺炎链球菌对β 内酰胺类药物存在不同程度的耐药。     

Successful treatment of late-onset infection due to resistant Klebsiella pneumoniae in an extremely low birth weight infant using ciprofloxacin.

OBJECTIVE: This paper presents a case in which an extremely low birth weight infant with multidrug-resistant Klebsiella pneumoniae infection was successfully treated with ciprofloxacin and gentamicin. STUDY DESIGN: A clinical case report of a neonate who received broad spectrum antibiotics for possible infection despite negative cultures. The infant developed sepsis and meningitis resulting from multidrug-resistant K. pneumoniae, which was treated with ciprofloxacin and gentamicin. The literature for the use of ciprofloxacin in pediatric patients was reviewed. RESULTS: The infant responded to the antibiotic regimen with sterilization of blood and cerebrospinal fluid; no adverse effects were attributable to the ciprofloxacin. Although ciprofloxacin has been found to cause irreversible injury to cartilage in juvenile laboratory animals, a review of the literature found that this complication occurs rarely if at all in pediatric patients. Ciprofloxacin has been found to be effective in the treatment of multidrug-resistant Gram-negative infections in pediatric patients, including premature infants. CONCLUSION: Ciprofloxacin should be considered in the treatment of neonatal infection caused by multidrug-resistant Gram-negative organisms. Although the published experience with this drug suggests that it is effective and that significant toxicity is not common, its use should be restricted to the treatment of serious infections for which an alternative antibiotics is not available.     

Association of raised titres of antibodies to Chlamydia pneumoniae with a history of pre-eclampsia

OBJECTIVE: To establish the prevalence of Chlamydia pneumoniae (C. pneumoniae) infection in a pregnant UK population and to investigate whether C. pneumoniae infection is more common in women with a previous history of pre-eclampsia. DESIGN: Prospective study. SETTING: Academic Hospital. POPULATION: Ninety-one pregnant women (54 parous and 37 nulliparous) at 16-22 weeks of gestation were studied. Of the parous women, 32 had a previous history of pre-eclampsia. METHODS: Peripheral blood was drawn for C. pneumoniae antibodies between 16-22 and 28-40 weeks of gestation. C. pneumoniae antibodies were measured using a solid-phase enzyme immunoassay. According to pregnancy outcome, women were categorised into normal, gestational hypertension and pre-eclampsia groups. MAIN OUTCOME MEASURES: Serum levels of IgG, IgA and IgM C. pneumoniae antibodies. RESULTS: Prevalence of seropositivity to C. pneumoniae was 77%. Parous women had significantly higher levels of IgA and IgM C. pneumoniae antibodies than nulliparous women (P < 0.04). Parous women with previous pre-eclampsia were found to have higher levels of antibodies than parous women with a normal obstetric history (P< or = 0.003). There was no difference in the antibody levels in women with different pregnancy outcomes. CONCLUSIONS: The longitudinal data do not indicate an association between C. pneumoniae infection and pre-eclampsia. However, the subgroup analysis of parous women demonstrated raised C. pneumoniae antibodies in the women with previous pre-eclampsia, and therefore suggests that there may be an association between C. pneumoniae and the disease in this group.     

Comparison of the clinical manifestations of severe acute respiratory syndrome and Mycoplasma pneumoniae pneumonia.

BACKGROUND AND PURPOSE: The clinical manifestations of severe acute respiratory syndrome (SARS) and mycoplasma pneumonia are similar. However, administration of corticosteroid to Mycoplasma pneumoniae patients suspected of having SARS may unnecessarily increase the risk of opportunistic infection. We compared the clinical course of 13 SARS patients and 6 patients with mycoplasma pneumonia treated during the outbreak of SARS in Taiwan. METHODS: Patients admitted due to suspicion of SARS with a subsequent diagnosis of SARS or Mycoplasma pneumoniae pneumonia were included. RESULTS: The initial clinical manifestations were similar in patients with SARS and those with M. pneumoniae infection. However, SARS patients had more severe lymphopenia (p = 0.013) and anemia (p = 0.007), and more persistent pulmonary infiltrates (p = 0.023). Respiratory failure developed in 15.4% of the SARS patients and in none of the M. pneumoniae patients. Recovery from thrombocytopenia was associated with defervescence in 12 SARS patients and radiographic improvement in 6 in the following 5 days. In those with unsatisfactory resolution of the pulmonary infiltrates, corticosteroid therapy was associated with rapid radiographic improvement. CONCLUSIONS: Because of similar initial presentations, differentiating SARS from M. pneumoniae pneumonia is very difficult based on symptomatology. In this series, lymphopenia and anemia were more severe in SARS than in M. pneumoniae infection, and SARS patients had more persistent and more new pulmonary infiltrates after hospitalization.     

温州育英儿童医院小儿下呼吸道感染的病原菌及耐药性调查

目的调查温州育英儿童医院小儿下呼吸道感染的病原菌及其耐药性。 方法对2003 01—2004 12温州医学院附属育英儿童医院呼吸病区1763例下呼吸道感染患儿的痰液标本经分离培养，做菌株鉴定和药敏试验。 结果共分离培养出病原菌715株，总阳性率为40.6%。其中革兰阴性菌448株，占62.7%；革兰阳性菌148株，占20.7%；真菌119株，占16.6%。革兰阴性菌以肺炎克雷伯菌、大肠埃希菌、铜绿假单胞菌和鲍曼不动杆菌为主。肺炎克雷伯菌和大肠埃希菌产超广谱β 内酰胺酶(ESBLs)的百分率分别为49.3%和46.5%，较敏感的抗生素为亚胺培南、丁胺卡那霉素、环丙沙星、哌拉西林/他唑巴坦和头孢哌酮/舒巴坦；除铜绿假单胞菌对复方新诺明的耐药率为100%外，铜绿假单胞菌和鲍曼不动杆菌对各种抗生素的耐药性均较低。革兰阳性菌中以肺炎链球菌和金黄色葡萄球菌为主。肺炎链球菌对青霉素的耐药率达到71.1%，对环丙沙星和万古霉素敏感，耐药率为0。金黄色葡萄球菌中耐甲氧西林金葡菌(MRSA)占18.0%(9/50)，对环丙沙星、左旋氧氟沙星和万古霉素敏感。 结论温州地区小儿下呼吸道感染的病原菌以革兰阴性菌为主，肺炎克雷伯菌、大肠埃希菌、铜绿假单胞菌、鲍曼不动杆菌、肺炎链球菌、金黄色葡萄球菌为主要病原菌。对抗生素的耐药性较强，临床上应注意对这些菌株的检测，积极防治。     

Intrarenal abscess caused by Klebsiella pneumoniae in a neonate: modern management and diagnosis

We recently cared for a 12-day-old infant who was hospitalized for renal abscess caused by Klebsiella pneumoniae, an organism not identified as etiologic in the three newborns described to date with this disorder. The advent of cross-sectional diagnostic imaging techniques, specifically ultrasonography and computed tomography (CT), has changed the management of renal abscess in children and neonates. Ultrasonography is the diagnostic procedure of choice, but CT is another reliable imaging modality, particularly if there is spread of the abscess outside the kidney. Whether surgery is necessary for a resolution of renal abscess remains controversial. However, percutaneous aspiration under diet ultrasonographic or CT guidance has replaced routine exploration and deroofing of the abscess and therefore made the management of renal abscess achievable by simpler, less invasive techniques.     

Seroprevalence of antibodies to Chlamydia pneumoniae in women with preeclampsia

OBJECTIVE: Preeclampsia shares many risk factors and pathophysiologic features with coronary heart disease. We studied whether, like atherosclerosis, preeclampsia is related to seroprevalence of immunoglobulin (Ig) G antibodies to Chlamydia pneumoniae. METHODS: Cross-sectional comparisons were made for 37 women with preeclampsia and 37 women with normal pregnancies at term. In these two groups, antibody titers for IgG, IgM, and IgA seroprevalence to C pneumoniae and IgG to Chlamydia trachomatis and Chlamydia psittaci were compared. RESULTS: Immunoglobulin G antibodies to C pneumoniae at a titer of at least 1:16 were more common in women with preeclampsia (25 of 37) than in women without (15 of 37) (odds ratio 3.1; 95% confidence interval 1.2, 7.9). There were no significant differences in the seroprevalence of IgA or IgM antibodies to C pneumoniae. Women with preeclampsia were also no more likely to have IgG antibodies to C trachomatis or C psittaci. CONCLUSION: Women with preeclampsia had an increased IgG seroprevalence to C pneumoniae but not to C trachomatis or C psittaci. These preliminary data suggest a specific association between infection with C pneumoniae and preeclampsia.     

Emphysematous prostatitis caused by Klebsiella pneumoniae.

Emphysematous prostatitis is a rare condition that is characterized by gas and abscess accumulation in the prostate. We report a 60-year-old man with emphysematous prostatitis caused by Klebsiella pneumoniae. He had a history of recently diagnosed diabetes mellitus and a 16-year history of alcoholic liver cirrhosis. He was admitted due to fever, dysuria and difficult urination. Physical examination revealed lower abdominal tenderness and prostatic fluctuance on digital examination. Leukocytosis, pyuria and elevated C-reactive protein were found. Abdominal radiography disclosed a collection of abnormal air pockets in the lower pelvic cavity and computed tomography scans corroborated the existence of extensive air collection in the prostate. Under the impression of emphysematous prostatitis, the patient was successfully treated with transurethral incision of the prostate and antibiotics for 6 weeks; there were no urinary sequelae during 6 months of follow-up.