Randomized comparison of cefepime versus ceftazidime monotherapy for fever and neutropenia in children with solid tumors

Background. With the availability of new broad-spectrum antibiotics, initial therapy with a single agent has become an alternative to classic combinations, especially beta -lactam antibiotics plus aminoglycosides, in the management of febrile neutropenic cancer patients

Risk factors for acquisition of extended-spectrum beta-lactamase producing Klebsiella infections

We set out to determine risk factors contributing to the development of resistance in Klebsiella infections caused by extended spectrum beta-lactamase (ESBL) producing strains. We reviewed the medical records of 33 patients from whom ESBL producing Klebsiella pneumoniae was isolated in any culture. The mean age was 12 months (1 day-8 years) and 20 of the 33 were boys. Of the 37 isolates of ESBL-producing K. pneumoniae, the site of isolation was urine in 17, cerebrospinal fluid in eight and blood in two cases. 28 of the patients were hospitalized and 22 had been admitted to the hospital in the past. All except one were being treated with antibiotics, third generation cephalosporins in 26 cases. The risk of acquisition of a resistant strain was high if the period of hospitalization exceeded 10 days. We conclude that isolation of multiresistant organisms should be expected in children with a history of previous admission to hospital or with a prolonged stay in hospital. The widespread use of extended spectrum antibiotics contributes to the emergence of resistance. Med Sci Res 27:407-408 (C) 1999 Lippincott Williams & Wilkins

Prevalence of antimicrobial resistance in Haemophilus influenzae, Streptococcus pneumoniae, Moraxella catarrhalis and Streptococcus pyogenes: results of a multicentre study in Turkey

The in vitro activities of several antimicrobial agents against clinical isolates of Streptococcus pneumoniae (283), Haemophilus influenzae (272), Moraxella catarrhalis (179) and Streptococcus pyogenes (256) were determined in a multicentre study with the participation of five hospitals from four cities in Turkey. Penicillin resistance in S. pneumoniae was evaluated using the E-test and the remaining agents by disk diffusion. For S. pneumoniae overall 25.8% of the isolates were intermediately and 3.9% were highly resistant to penicillin and resistance to chloramphenicol, azithromycin and trimethoprim/sulphamethoxazole (TMP/SMX) was 3.8, 2.1 and 55.4%,, respectively. Seven percent of H. influenzae produced P-lactamase and all were susceptible to cefotaxime and azithromycin; the highest rate of resistance, 23.5%, was for TMP/SMX. Eighty-one percent of M. catarrhalis isolates produced beta-lactamase, 18.4% were resistant to TMP/SMX and all were susceptible to sulbactam/ampicillin combination. Resistance to chloramphenicol and azithromycin of S. pyogenes was 2.2 and 1.9%, respectively. (C) 2002 Elsevier Science B.V. and International Society of Chemotherapy. All rights reserved

Nasal carriage of methicillin-resistant Staphylococcus aureus in the children of hospital staff attending a day-care centre

Methicillin-resistant Staphylococcus aureus (MRSA) is an important nosocomial pathogen. Hospital staff with nasal carriage might transmit it to family members. We conducted this study to determine whether MRSA, acquired in the hospital environment, was a threat to the children of hospital staff. We obtained anterior nares cultures from 135 children, either one of whose parents was working in the hospital, who were attending the associated day-care centre. Three children with no history of previous hospital admission showed nasal carriage of MRSA. They were treated with topical mupirocin for 7 days. Cultures obtained after a drug-free 7 days revealed no growth. The mother and sister of a child were determined to be nasal carriers and they were treated with topical mupirocin. Our findings imply that children of hospital staff may be at risk for MRSA carriage. Med Sci Res 27:161-162 (C) 1999 Lippincott Williams & Wilkins

Streptococcus pneumoniae penicillin resistance in Turkey

Resistance of Streptococcus pneumoniae (750) to penicillin, erythromycin, chloramphenicol and trimethoprim/sulfamethoxazole isolated in 4 Turkish hospitals between 1996 and 1999 was evaluated according to year of isolation, patients' age groups and specimen. Penicillin susceptibility was determined by E-test strips and the other antibiotics were tested by disk diffusion test following the NCCLS guidelines in each center. Overall high and intermediate resistance to penicillin was 3% and 29%, respectively. There was a significant difference (p <0.001) between the centers with regard to penicillin resistance. However, there was no significant increase in resistance by year. Penicillin resistance varied significantly among children and adults (36% versus 25%) and according to the specimen. Highest rate of penicillin resistance was observed in respiratory specimens (36%) followed by ear exudates (33.5%). In blood isolates, resistance to penicillin was 28.6%. Overall resistance to erythromycin was 8%, to chloramphenicol 5% and to trimethoprim-sulfamethoxazole 47%. Although overall penicillin resistance in these Turkish S. pneumoniae isolates is high, resistance rates vary in each center and have not increased from 1996 to 1999