[Incidence of pediatric nosocomial infection in Bizerte district: results of 3 months survey]

Children nosocomial infections are different than adult's according some criteria that makes necessary to conduct a special kind of surveillance program, which is specific to this category. In Tunisia, there are so few data available related to such hospital infections frequencies in paediatric services. In Bizerta region, the only survey on paediatric nosocomial infection was held in the beginning of the 90s. Recently a specific surveillance system for children was held there. The output of such system is able to provide a lot of information, according new cases [incidence], main criteria and risk factors. Because of practical matters, mainly feasibility, we've chosen to use repetitive periodic surveys as measurement method. This paper is reporting the first step of the study conducted in 2005 [called NOSOBIPED05] and concerning the two paediatric services of the region for three months [from 1[st] October to 31[st] December 2005]. A total of 860 sick children were concerned by the study, including 525 [61%] male and 335 female [39%]. Two hundred and eighty eight [288] of them were under one month age [33.5%] and 424 [49.3%] were more than one year. Perinatal pathologies were the first hospitalization diagnosis [267 cases], followed by respiratory illnesses [139 cases]. The average of the hospital stay was 4.9 days [with 0 and 46 days as extremes]. In our population study, there were so few intrinsic and extrinsic risk factors: diabetes [1.0%], malnutrition [0.6%], immune depression [0.5%], mechanic ventilation [0.2%]. But the use of peripheral vascular catheters was frequently found [52.8%]. Among the 860 sick children, only 705 were concerned by the academic definition of nosocomial infection [155 had stayed less than 48 hours]. The total number of nosocomial infection was 25, then 3.5 per 100 hospitalizations. That means 6.0 infections per 1000 patient-days density of incidence [reported to the number of days stay for the 705 concerned sick children]. No one case of infection was positive [14 negative bacterial researches were held]. Respiratory infections were the most commune location [68%] [17/25]. These results must be used by concerned services to improve prevention. More surveillance steps have to be continued in the next years, to better understand the epidemiology of those special paediatric infections in Bizerta region

[Primary spinal epidural abscess - a case report]

Spinal epidural abscess is a rare affection in child. Bacteria gain access to the epidural space through contiguous spread or hematogenous dissemination. It is more common in thoracolumbar than cervical areas. The organisms most frequently encountered are Staphylococcus aureus. Back pain, fever and neurologic deficit are the three most common symptoms. MRI is the imaging method of choice in diagnosing spinal epidural abscess. Surgical drainage with systemic antibiotics is the treatment of choice. We report the case of a 8 years old children, without any pathological antecedent, hospitalized in the service of Pediatrics for back pain, fever and lameness. The clinical examination found a lumbar rachis painful to the palpation with limited mobility, there was no neurologic deficit. Laboratory investigations showed that inflammatory markers were uniformly elevated. MRI showed a spinal epidural abscess in L3-L4. No micro-organism was isolated in blood cultures. A diagnosis of spinal epidural abscess was suspected and a medical treatment was indicated for 3 months. The outcome was favorable. On the light of this observation, the authors make a review of literature