Antibiotic Resistance Profile of Pathogen Escherichia Coli in Children with Urinary Tract Infection

Background: Urinary tract infection (UTI) in children is a serious condition that should be treated promptly and properly to prevent further complications. The most common causative agent of UTI is Escherichia coli (E.coli). This study aims to investigate the resistance profile of E.coli in pediatric cases of UTI. Method: In this cross-sectional study, the positive cultures for E.coli in patients admitted in Dr. Sheikh Children Hospital of Mashhad, Iran, in Feb 2020 to Feb 2021 were assessed. The demographic factors including age and sex were excluded. Urinalysis was conducted to assess the number of bacteria (categorized as mild, moderate, and many) and the WBC count (categorized as > 5/hpf, > 10/hpf, and > 15/hpf). Furthermore, the antibiogram was consulted to assess the sensitivity and resistance to different antibiotics. Data was analyzed using SPSS software. Results: In 160 children (20 males and 140 females) with the mean age of 24.00 ± 26.06 months, urinalysis showed that 22.5% were in the mild bacteriuria category, 21.3% in moderate bacteriuria, and 56.3% in the many bacteriuria category. For WBC count in urine, 12.5% had more than 5/hpf WBC, 11.9% had more than 10/hpf WBC, and 75.6% more than 15/hpf WBC. Regarding resistance, 4.5% of the patients were resistant to Amikacin, 6.5% to Nitrofurantoin, 20% to Ofloxacin, 35.1% to Ciprofloxacin, 50% to Gentamicin, 52.6% to Cefixime, 59.5% to Cefazolin, and 76.1% to Trimethoprim. The mean age and also the frequency of sex showed no significant difference between different severities of bacteriuria and WBC count in urine analysis (P > 0.05). Conclusion: The highest E.coli resistance was to Trimethoprim, Cefazolin, Cefixime, Gentamicin, and Ciprofloxacin. The lowest resistance was to aAmikacin and Nitrofurantoin

A Comparative Analysis of Clinical Characteristics and Laboratory Findings of COVID-19 between Intensive Care Unit and Non-Intensive Care Unit Pediatric Patients: A Multicenter, Retrospective, Observational Study from Iranian Network for Research in Viral

Introduction: To date, little is known about the clinical features of pediatric COVID-19 patients admitted to intensive care units (ICUs). Objective: Herein, we aimed to describe the differences in demographic characteristics, laboratory findings, clinical presentations, and outcomes of Iranian pediatric COVID-19 patients admitted to ICU versus those in non-ICU settings. Methods: This multicenter investigation involved 15 general and pediatrics hospitals and included cases with confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection based on positive real-time reverse transcription polymerase chain reaction (RT-PCR) admitted to these centers between March and May 2020, during the initial peak of the COVID-19 pandemic in Iran. Results: Overall, 166 patients were included, 61 (36.7%) of whom required ICU admission. The highest number of admitted cases to ICU were in the age group of 1–5 years old. Malignancy and heart diseases were the most frequent underlying conditions. Dyspnea was the major symptom for ICU-admitted patients. There were significant decreases in PH, HCO3 and base excess, as well as increases in creatinine, creatine phosphokinase (CPK), lactate dehydrogenase (LDH), and potassium levels between ICU-admitted and non-ICU patients. Acute respiratory distress syndrome (ARDS), shock, and acute cardiac injury were the most common features among ICU-admitted patients. The mortality rate in the ICU-admitted patients was substantially higher than non-ICU cases (45.9% vs. 1.9%, respectively; p<0.001). Conclusions: Underlying diseases were the major risk factors for the increased ICU admissions and mortality rates in pediatric COVID-19 patients. There were few paraclinical parameters that could differentiate between pediatrics in terms of prognosis and serious outcomes of COVID-19. Healthcare providers should consider children as a high-risk group, especially those with underlying medical conditions

Varicella Zoster Infection in Infancy (A Very Rare Case Report)

Background: Herpes zoster occurs due to reactivation of varicella zoster-virus (VZV) that is latent in dorsal root ganglion cells after primary varicella infection. It can occur in any age but is very rare during infancy. Acquisition of this virus in utero or early after birth may result in infantile herpes zoster. Case report: Here, it is aimed to report an infant with herpes zoster whom his mother had developed varicella two years before pregnancy. Conclusion: Despite the rarity of shingles in infants after birth, any infant who has a vesicular lesion in a particular neurological dermatome should be aware of the disease

A Comparative Study of Blood Culture Sampling from Umbilical Catheter Line versus Peripheral Site

Neonatal sepsis is an important cause of death and morbidity in newborns and is diagnosed by isolation of organism in blood culture. In several reports,reliablity of blood cultures were done from umbi lical catheters,have been demonstrated. The objective of the present study was to determine,wether an inde welling umbilical catheter, could be an alternative site for blood culture. In a prospective study over 6 months during 2006,141 paired blood cultures from 134 infant,were done simultaneously from peripheral site and umbilical catheter (mostly U. V. C),during the first four days of life. Majority of these infants were preterm and admitted to NICU for special care. these infants had indwelling umbilical line and had indication of sepsis workup. A total of 141 pairs of blood cultures were obtained from 134 infants. In 16 infants blood culture pairs were positive for one organism in both peripheral vein and umbilical site. 71. 6% of total cultures (n=11)pairs were negative in boths site. A total of 22 pairs were positive in one site only,with 5 positive from peripheral vein only and the other 17 from umblical site. Two pairs were positve in boths site with two different organism. In over all 16 infant (11%)of blood were considered to be contaminated. Contamination rate were 2. 4% and 9. 2% for peripheral and umbilical catheter site. Contamination rate increased after 48 hours of age in umbilical catheter. The result showed that after 2 days contamination rate for blood culture taken from catheter line increased and specifity decreased. We recommended that blood culture via umblical catheter in first 2 days in sick neonates with indwelling catheter can be a alternate site of blood culture sampelling

Nosocomial Infections and Antibiotic Administration in Pediatric Department, Imam Reza Hospital, Mashhad-Iran

Introduction: Nosocomial Infections (NI) are a frequent and relevant problem, in other hands; those are responsible of mortality especially in pediatric ICU( Intensive Care Unit) and NICUs (Neonatal Intensive Care Unit). Healthcare-associated infections are important in wide-ranging concern in the medical field. The most cause of Nosocomial infection include: bloodstream infection, urinary tract infection, pneumonia, and wound infection. The purpose of this study was to determine the epidemiology of the three most common NI in the Pediatric department.        Materials and Methods: We performed a prospective study in a single Pediatric department during 12 months. Children were assessed for 3 NI: wound infections, pneumonia and urinary tract infections (UTI), as the same method as Center of Disease Control criteria. All patients were followed up and individuals who had have NI and their treatment was entered in this study.          Results: In this study 811 patients were hospitalized that 60% of them were male and were older than 60 months. The main causes of hospitalization include: toxicity, seizure, respiratory infection and fever. Among them 15 cases had NI (1.87%). The most NI occurred in pediatric intensive care unit (PICU) and it was followed in aspect of intubation. The most cultured organism was pseudomonas that they suspected to ceftazidime and isolate from blood and endotracheal tube.           Conclusion:  NI presence was associated with increased mortality and length of stay in hospital. This study highlights the importance of NIs in children admitted to a pediatric department especially PICU in a developing country. Clinical monitoring of NIs and bacterial resistance profiles are required in all pediatric units

Comparison of Group B Streptococcal Colonization in the Pregnant Diabetic and Non-Diabetic Women

- To Compare colonization of group B streptococcus (GBS) in diabetic and non-diabetic pregnant women. In this prospective study 50 pregnant women with diabetes mellitus (both pregestational and gestational) and 43 pregnant women without diabetes between 33 and 37 weeks' gestation were evaluated. Three samples for Group B streptococcal culture detection were obtained from each subject in the following order: perinea sample, vaginal sample, and an anorectic sample. All had singleton gestations, negative tests for human immunodeficiency virus, and intact membranes at enrollment. Pearson chi-square and fisher, Exact test were used when appropriate. Most common site of GBS colonization in all women was vagina (11.8%). Colonization of group B streptococcus in control group included vagina (7%) perineum (0.3%) and rectum 0.3%) and in diabetic group included vagina (16%) perineum (16%) and rectum (16%). Although comparison was shown higher vaginal colonization rate in diabetic group (16% versus 7%) but difference was not significant (P=0.154).The prevalence of group B streptococcus colonization in gestational diabetes was 20% and higher than pregestational diabetic women. Among women with pregestational diabetes, the prevalence of group B streptococcus colonization was 15% in non-insulin dependent diabetic women and 10% in insulin dependent diabetic women (P> 0.05). Comparison between two groups showed high rectal colonization in diabetic group and difference was significant (P= 0.027). Pregnant diabetic patients have higher carriage rates of group B streptococcus (GBS) in rectum than non-diabetic pregnant women and diabetes is a risk factor for group B streptococcus colonization during pregnancy

Incidence of Rotavirus Diarrhea in Children Under 6 years Referred to the Pediatric Emergency and Clinic of Ghaem Hospital, Mashhad, Iran

"nRotavirus is the most important pathogen responsible for acute diarrhea in infants and young children. The incidence of rotavirus infection was studied in 156 children less than six years of age who were suffering from acute gastroenteritis, between February 22, 2006 and February 21, 2007 in Mashhad. Rotavirus antigen was detected by latex agglutination test (Rotascreen) in 28.8% of the stool samples examined. The frequency of rotavirus infection was significantly higher among patients under 24 months of age (69%) than among children two years old or more (31%). The peak of incidence was in the winter. This study revealed that rotavirus is an important etiological agent of acute gastroenteritis among children in Mashhad

Evaluation of Group B Streptococci Colonization Rate in Pregnant Women and Their Newborn

Group B Streptococcus (GBS) is one of the most important bacteria in the majority of maternal and neonatal infections, such as chorioamnionitis, endometritis, bacteremia, sepsis and meningitis. During pregnancy, GBS screening is one of the recommended strategies that are recommended by center of disease control (CDC). This study was aimed to determine the rectovaginal colonization prevalence among pregnant women, and also the rate of transmission to their offspring. Between June 2008 and April 2009, two hundred pregnant women admitted in department of Obstetrics and Gynecology (Ghaem Hospital, Mashhad, Iran) were enrolled in present study. Samples from maternal rectum and vagina as well as neonate ear and umbilical cord were taken for culture. The colonization rate for GBS in pregnant women and their neonates was around 6% and 5% respectively. All the carrier mothers were cases with premature rupture of membranes (at least 18 hours before delivery). In terms of colonization, there was a significant correlation between mothers and newborns, and more than 80% of neonates from GBS carrier mothers were colonized by GB

Moyamoya Disease Mimicking Encephalitis

Moyamoya disease is a rare vaso-occlusive illness with an unknown etiology characterized by stenosis of the internal carotid arteries with spontaneous development of a collateral vascular network. A 15-month-old girl was referred to the emergency ward of Imam Reza Hospital due to decreased level of consciousness, focal seizures and fever during the previous 24 hours with an impression of encephalitis. Physical examination revealed left side hemiparesis; however brain CT-Scan did not show any significant lesions. Initial therapy with vancomycin, ceftriaxone and acyclovir was administered. CSF analysis did not show any abnormality and the blood as well as CSF cultures results were negative. Brain MRI showed hyperintensity at right frontal and parietal regions, suggesting vascular lesion. Magnetic resonance angiography (MRA) showed bilaterally multiple torsions in vessels at the basal ganglia consistent with moyamoya vessels. In all children exhibiting encephalitis, vascular events such as moyamoya disease should be considered. Brain MRI is a critical tool for this purpose. Common causes of encephalitis such as herpes simplex should also be ruled out