Infectious causes associated with febrile seizure in children

To establish the infectious cause associated with the increase in temperature in patient with febrile convulsion admitted to the Prince Hashim Hospital and its association with the season, Retrospective study, including all children hospitalized with the diagnosis of febrile convulsion during period of two years from February 2007 to February 2009. We included 88 patients. Infectious diarrhea was the most important cause of fever [43%] followed by acute pharyngitis [36%] and bronchopneumonia [5%]. Less common causes such as cellulitis, urinary tract infection and post-vaccination reactions were associated in a small number of cases. In our study, winter time is more commonly associated with infectious disease outbreaks of gastrointestinal and respiratory infections [42%], followed by summer season [24%]. Gastrointestinal and upper respiratory tract infections were the most common causes of elevated temperature and subsequent febrile seizure. The epidemics of respiratory and diarrheal infections in winter season result in increasing the incidence of this disease

Spectrum of micro-organisms and anti-microbial resistance of gram negative micro-organisms in the intensive care unit at King Hussein Hospital

To determine the spectrum of micro-organisms and anti-microbial resistance of gram negative micro-organisms. A retrospective review was conducted at the Intensive Care Unit at King Hussein Medical Hospital between Jan 2007 and Jan 2008. Blood was withdrawn from every Intensive Care Unit patient suspected infection 48 hours post admission. Gram negative micro-organisms and antimicrobial resistance were determined by using the standard method at Prince Iman and Research Laboratory Center. A total of 610 blood culture specimens were obtained from 400 patients. Bacteria were isolated from 213 of these specimens. The different types of bacteria isolated were as follows: 47% were coagulase negative staphylococcus epidermidis, 35% were gram negative bacteria and 5% were Candida. Among the gram negative isolate the most common was Acinetobacter baumannii 31% while the least common was Citrobacter and Morganella 1.4% each. Rates of anti-microbial susceptibility for Acinetobacter were 45% for Ciprofloxacillin, 39% for Amikacin and 30% for Imipenem and Piperacillin while 48% of the Acinetobacter isolate were multi-resistant. This study provides information on spectrum of micro-organisms and antibiotic resistance of blood isolates. It may be a useful and baseline guide for physicians initiating empiric therapy and may help in providing antibiotic therapy policy in our hospital

Early detection of bacterial sepsis in newborns

Neonatal infections are the most common cause of morbidity and mortality in infancy. To determine the usefulness of interleukin-6 and blood culture in the diagnosis of suspected bacterial infections in neonatal intensive care unit. This retrospective case record analysis was conducted over two years 2009 -2010. Data was collected using patient's records from the pediatric and neonatal care unit of the hospital. The ages of the new born ranged from 28 to 42 weeks of gestation. Blood samples were collected at the time of admission, before the initiation of the first dose of antibiotic. Tests included; complete blood count, blood culture, and interleukin-6 [IL-6], C-reactive protein estimation. The results of blood culture and inflammatory markers, i.e. interleukin-6 [IL-6] and C-reactive protein were analysed. A total of 73 blood samples were taken from neonates who were clinically suspected to be having sepsis. Twenty two samples revealed positive blood cultures for bacteria. The level of interleukin in first hour was very high [>1000 pg/ml] in 17 samples while its median value was 100 pg/ml. Normal or minimal elevation of C-reactive protein was seen in these cases. Low level of [<350 pg/ml] was seen in 5 newborns and C-reactive protein in these cases was around 12 mg/l. High IL-6 levels show some correlation with positive bacterial blood culture and it can help in supplementing the diagnosis of neonatal sepsis

Reintubation increases ventilator-associated pneumonia in pediatric intensive care unit

To determine the incidence, risk factors, mortality, and causative organisms of Nosocomial Pneumonia [NP] in patients with endotracheal [ET] tube, with or without mechanical ventilation. Patients admitted to the Pediatric Intensive Care Unit [PICU], over a period of 1 year who had ET intubations, were enrolled consecutively into the study. Diagnosis of NP was based on CDC criteria [1988]. Semiquantiative assay of endotracheal aspirate [ETA] with a colony count of > 105 cfu/mL was taken as evidence of infection. Colonization was defined as isolation of organism with < 105 cfu/mL. Age, nutritional status, number and duration of intubations, duration of mechanical ventilation, sedation, nasogastric feeding were the risk factors studied for development of NP. Intubation attempts of more than one were defined as reintubation. Risk factors found significant on univariate analysis, were subjected to multiple regression analysis to determine the most important predictors of NP. The study group comprised of 72 children with a median age of 3.7 years and boys: girls' ratio of 1.9:1.Twenty two of 72 [30.5%] developed NP; the predominant isolates from ETA were Pseudomonas aeruginosa [12], Acinetobacter anitratus [5], Klebsiella sp [3] and Staphylococcus aureus and E.coli [1] each. Additionally, 18[39%] had evidence of ET colonization, with Pseudomonas aeruginosa being the commonest 9[50%]. Re-intubation, prolonged duration of intubation and mechanical ventilation were the significant risk factors on univariate analysis for development of NP. On multiple regression analysis, reintubation was the only independent risk factor for NP [OR 0.72, 95% CI 0.55-0.94]. Overall mortality was 21% [15/72];7[47%]of these deaths were secondary to NP. NP developed in nearly one third of the intubated patients; Gram negative organisms were the predominant etiological agents and associated with high mortality. Re-intubation, prolonged duration of intubation and mechanical ventilation were the significant risk factors on univariate analysis for development of NP. On multiple regression analysis, reintubation was the only independent risk factor for NP