Multidrug-Resistant Pseudomonas aeruginosa Infection in a Child with Cystic Fibrosis

ABSTRACT We describe a pediatric cystic fibrosis patient who developed a pulmonary exacerbation due to two multidrug-resistant (MDR) Pseudomonas aeruginosa isolates. In addition to these MDR organisms, the case was further complicated by β-lactam allergy. Despite the MDR phenotype, both isolates were susceptible to an antimicrobial combination

Increased prevalence of methicillin-resistant Staphylococcus aureus nasal colonization in household contacts of children with community acquired disease

<p>Abstract</p> <p>Background</p> <p>To measure Methicillin-resistant <it>Staphylococcus aureus </it>(MRSA) nasal colonization prevalence in household contacts of children with current community associated (CA)-MRSA infections (study group) in comparison with a group of household contacts of children without suspected <it>Staphylococcus aureus </it>infection (a control group).</p> <p>Methods</p> <p>This is a cross sectional study. Cultures of the anterior nares were taken. Relatedness of isolated strains was tested using pulse field gel electrophoresis (PFGE).</p> <p>Results</p> <p>The prevalence of MRSA colonization in the study group was significantly higher than in the control group (18/77 (23%) vs 3/77 (3.9%); p ≤ 0.001). The prevalence of SA colonization was 28/77 (36%) in the study group and 16/77 (21%) in the control group (p = 0.032). The prevalence of SA nasal colonization among patients was 6/24 (25%); one with methicillin-susceptible <it>S. aureus </it>(MSSA) and 5 with MRSA. In the study (patient) group, 14/24 (58%) families had at least one household member who was colonized with MRSA compared to 2/29 (6.9%) in the control group (p = 0.001). Of 69 total isolates tested by PFGE, 40 (58%) were related to USA300. Panton-Valetine leukocidin (PVL) genes were detected in 30/52 (58%) tested isolates. Among the families with ≥1 contact colonized with MRSA, similar PFGE profiles were found between the index patient and a contact in 10/14 families.</p> <p>Conclusions</p> <p>Prevalence of asymptomatic nasal carriage of MRSA is higher among household contacts of patients with CA-MRSA disease than control group. Decolonizing such carriers may help prevent recurrent CA-MRSA infections.</p

Risk factors for community acquired urinary tract infections caused by extended spectrum β-lactamase (ESBL)

Extended-spectrum βlactamases (ESBLs)are β-lactamases that hydrolyze extended-spectrum cephalosporins with an oxyimino side chain. These cephalosporins include cefotaxime, ceftriaxone, and ceftazidime, as well as the oxyimino-monobactam aztreonam.Thus ESBLs confer resistance to these antibiotics and related oxyimino-βlactams. In recent years an increasing number of children with community acquired (CA)-UTI due to ESBL-producing organisms, especially E.coli,has been observed at our institution. The primary aim of this study was to determine the frequency of CA-UTIs caused by ESBL-producing bacterial pathogens in children seen at Children’s Hospital of Michigan during 2012-2016 and investigate the characteristics of childrento determine the risk factors associated with these infections. This study is a case control study Patients in the control group were matched by age, gender, and year of the CA-UTI due ESBL-producing E. coli group. Exclusion criteria included positive urine cultures >72 hours after hospitalization, patients with long term care facility stay within the preceding 3 months, postoperativeinfections within 10 days of surgery, and asymptomatic bacteriuria. Each urine culture was included once in the study.If more than one positiveESBL-producing E. coliurine culturewas present, the last clinical record with the least missing data was included. Positive urine culture was defined according to the method of collection of the urine sample. Bag specimens werenot included in the analysis. In midstreamspecimens of urine, UTI was defined as a positive urine culture ≥105CFU/mL or a positive urine culture (104-105CFU/mL) with pyuria of ≥10leukocytes per high power field. In specimens obtained through by bladder catheterization, growth of 104 -105CFU/mL was defined as UTI.Medical records ofpatients with UTI caused by ESBL-producing and non-ESBL producing E coliwere reviewed to obtain information on demographic characteristics, history of hospital visits, clinical findings, urine culturepathogen its antimicrobial susceptibilities, laboratory and imaging studies, comorbidities, treatment modalities,hospital course, complications,and outcome. Information was collected and analyzed for the following potential risk factorsfor ESBL infection: history of previous UTI, anatomic abnormalities of the urinary tract,antibiotic usage in the past 3months,previous hospitalizations,intensive care unit stay,surgeries,underlying neurologic abnormalitiessuch as spina bifidaor neurogenic bladder,previous infections,history of infection with ESBL-producing bacteria or other resistant bacteria,and intermittent urinary bladder catheterization. The results show a incrieasing risk of UTI with previouss use of antibiótics

Risk factors for community acquired urinary tract infections caused by extended spectrum β-lactamase (ESBL)

Extended-spectrum βlactamases (ESBLs)are β-lactamases that hydrolyze extended-spectrum cephalosporins with an oxyimino side chain. These cephalosporins include cefotaxime, ceftriaxone, and ceftazidime, as well as the oxyimino-monobactam aztreonam.Thus ESBLs confer resistance to these antibiotics and related oxyimino-βlactams. In recent years an increasing number of children with community acquired (CA)-UTI due to ESBL-producing organisms, especially E.coli,has been observed at our institution. The primary aim of this study was to determine the frequency of CA-UTIs caused by ESBL-producing bacterial pathogens in children seen at Children’s Hospital of Michigan during 2012-2016 and investigate the characteristics of childrento determine the risk factors associated with these infections. This study is a case control study Patients in the control group were matched by age, gender, and year of the CA-UTI due ESBL-producing E. coli group. Exclusion criteria included positive urine cultures >72 hours after hospitalization, patients with long term care facility stay within the preceding 3 months, postoperativeinfections within 10 days of surgery, and asymptomatic bacteriuria. Each urine culture was included once in the study.If more than one positiveESBL-producing E. coliurine culturewas present, the last clinical record with the least missing data was included. Positive urine culture was defined according to the method of collection of the urine sample. Bag specimens werenot included in the analysis. In midstreamspecimens of urine, UTI was defined as a positive urine culture ≥105CFU/mL or a positive urine culture (104-105CFU/mL) with pyuria of ≥10leukocytes per high power field. In specimens obtained through by bladder catheterization, growth of 104 -105CFU/mL was defined as UTI.Medical records ofpatients with UTI caused by ESBL-producing and non-ESBL producing E coliwere reviewed to obtain information on demographic characteristics, history of hospital visits, clinical findings, urine culturepathogen its antimicrobial susceptibilities, laboratory and imaging studies, comorbidities, treatment modalities,hospital course, complications,and outcome. Information was collected and analyzed for the following potential risk factorsfor ESBL infection: history of previous UTI, anatomic abnormalities of the urinary tract,antibiotic usage in the past 3months,previous hospitalizations,intensive care unit stay,surgeries,underlying neurologic abnormalitiessuch as spina bifidaor neurogenic bladder,previous infections,history of infection with ESBL-producing bacteria or other resistant bacteria,and intermittent urinary bladder catheterization. The results show a incrieasing risk of UTI with previouss use of antibiótics.2019-08-17 01:01:01: Script de automatizacion de embargos. info:eu-repo/date/embargoEnd/2019-08-1

Infectious and Noninfectious Acute Pericarditis in Children: An 11-Year Experience

Objective. The study was undertaken to determine the etiology, review management, and outcome in children diagnosed with acute pericarditis during 11 years at tertiary pediatric institution. Methods. Retrospective chart review of children diagnosed between 2004 and 2014. Patients with postsurgical pericardial effusions were excluded. Results. Thirty-two children were identified (median age 10yr/11mo). Pericardiocentesis was performed in 24/32 (75%) patients. The most common cause of pericarditis was infection in 11/32 (34%), followed by inflammatory disorders in 9 (28%). Purulent pericarditis occurred in 5 children including 4 due to Staphylococcus aureus: 2 were methicillin resistant (MRSA). All patients with purulent pericarditis had concomitant infection including soft tissue, bone, or lung infection; all had pericardial drain placement and 2 required pericardiotomy and mediastinal exploration. Other infections were due to Histoplasma capsulatum (2), Mycoplasma pneumoniae (2), Influenza A (1), and Enterovirus (1). Pericarditis/pericardial effusion was the initial presentation in 4 children with systemic lupus erythematosus including one who presented with tamponade and in 2 children who were diagnosed with systemic onset juvenile inflammatory arthritis. Tumors were diagnosed in 2 patients. Five children had recurrent pericarditis. Systemic antibiotics were used in 21/32 (66%) and prednisone was used in 11/32 (34%) patients. Conclusion. Infections remain an important cause of pericarditis in children. Purulent pericarditis is most commonly caused by Staphylococcus aureus and is associated with significant morbidity, need of surgical intervention, and prolonged antibiotic therapy. Echocardiography-guided thoracocentesis remains the preferred diagnostic and therapeutic approach. However, pericardiotomy and drainage are needed when appropriate clinical response is not achieved with percutaneous drainage

Increased Prevalence of G1P[4] Genotype among Children with Rotavirus-Associated Gastroenteritis in Metropolitan Detroit

The G and P genotypes of rotavirus stool isolates from 100 children were determined by reverse transcription-PCR and nucleotide sequencing. G1P[4] was the most prevalent genotype(41%), followed by G1P[8] (16%) and G4P[4] (14%). The G genoypes detected were G1 (73%), G4 (17.4%), G9 (6.3%), and G2 (2.8%). The P genotypes were P[4] (71%) and P[8] (29%). Coinfection with more than one G genotype occurred in 12 patients, and coinfection with more than one P genotype occurred in 11 patients