Is Antimicrobial Resistance Pattern of Enteric Fever Changing in Kathmandu Valley.

Introduction: Enteric fever is a public health problem in developing countries including Nepal. Antimicrobial sensitivity pattern of Salmonella sp causing enteric fever is changing over time and also differs according to geographical location. Periodic surveillance of antimicrobial resistance of Salmonella sp is mandatory for management of enteric fever rationally. The objective of this study was to analyze the resistance pattern of Salmonella sp to commonly used antimicrobials. Materials and Methods: This was a retrospective study undertaken reviewing the records of blood isolates of Salmonella sp over one year period at Kanti Children’s Hospital, Nepal. Antimicrobial sensitivity testing was done following Kirby Bauer’s disk diffusion technique using Muller Hinton agar. Results: Salmonella typhi was found to be 100% resistance to ampicillin and resistance to nalidixic acid and ciprofloxacin was also high. The resistance to chloramphenicol and ofloxacin was low. No resistance was found to amoxicillin, ceftriaxone, cefotaxime and amikacin. However, among the sensitive isolates of Salmonella typhi intermediate sensitivity to ceftriaxone and ceftazidime was reported to be high. Among the isolates of S paratyphi A, the resistance to nalidixic acid was 100% followed by 75% to ciprofloxacin. No resistance was found to chloramphenicol, ceftriaxone, cefixime, amikacin and low resistance to amoxicillin and ofloxacin. Among the sensitive isolates of S paratyphi A, majority of them were only moderately sensitive to cefotaxime and ceftazidime and about 1/3 of the organisms had only intermediate sensitivity to ceftriaxone. Conclusiion: Commonly used parenteral third generation cephalosporins, first line drugs like chloramphenicol and amoxicillin and ofloxacin among fluoroquinolones were found to be effective in vitro in treating enteric fever. However, Salmonella typhi was found to be highly resistant to the most frequently used drugs like ciprofloxacin and cefixime and Salmonella paratyphi A to ciprofloxacin. A comparative chart of antimicrobial sensitivity of enteric fever in children over 10 year period from different hospitals of Kathmandu valley is also presented in the study.

Clinical Analysis, Management and Outcome of Intussusception in Children.

Introduction: Intussusception is the commonest cause of bowel obstruction in infancy and childhood. Early diagnosis and management is essential to reduce morbidity and mortality. The objective was to To review the diagnostic criteria of intussusception in infants and children to increase awareness of attending personnel for effective management decrease the rate of operative treatment and complications. Materials and Methods: The data collected of all 38 patients admitted in Kanti Childrens Hospital between 2008 September to 2009 September were studied prospectively. Each patient was evaluated in regard to age at presentation, sex, signs and symptoms, diagnostic method, treatment (operative, non-operative). Results: During study period of one year there were a total of 20 (52%) males and 18 (48%) females of age 3 months to 6 years. Pain abdomen was seen in 25(66%), vomiting 16(42%), diarrhea 15(40%), blood mixed with stool 10(26%). These symptoms were seen in different combination. X-ray erect abdomen was done in 15 and ultrasound in all 38 cases. Ten out of 15 (66.6%) patients with early presentation and diagnosis had successful barium enema reduction.10 (66.6%) had successful reduction and admitted to our hospital. 28(74%) patients were undergone laparatomy. Among 28 (74%) patents that had lapartotomy, manual reduction was successful in 18 and 10 required bowel resection and anastomosis. Conclusion: The awareness of early features of intussusception is important for early referral to tertiary centers for successful non-operative barium reduction and reduce the need of laparotomies in children.

Metachromatic Leucodystrophy: A Case Report.

Metachromatic leukodystrophy (MLD) is an autosomal recessive neurodegenerative disorder characterized by deficient activity of the enzyme arylsulfatase-A. Deficiency of this enzyme results in intralysosomal storage of sphingolipid cerebroside 3-sulfates (sulfatides), which are abundant in myelin and neurons. A pathological hallmark of MLD is demyelination and neurodegeneration, causing various and ultimately lethal neurological symptoms. Its frequency is estimated to be 1/40,000 live births. The disease encompasses three clinical subtypes: late infantile (40% of the patients with MLD), juvenile (40%), and adult (20%).

Bacteriological Profile of Neonatal Sepsis: A Hospital Based Study.

Introduction: Neonatal sepsis is a major cause of mortality and morbidity in newborn. There are many factors that contribute to neonatal sepsis. The organisms responsible for early onset and late onset sepsis are different. Objective: This study was conducted to analyze the organisms responsible for early onset and late onset neonatal sepsis. Materials and Methods: A prospective hospital based study over the period of one year was conducted at neonatal intermediate care unit of Kanti Children’s Hospital, Maharajgunj, Kathmandu, Nepal. Results: Organisms were isolated in 6.1% of the collected blood samples. The male female ratio of culture proven sepsis was 1.9:1. Escherichia coli were found to be the most common organism in both early onset and late onset sepsis. Staphylococcus aureus was more common in late onset sepsis than early onset sepsis. Conclusion: Escherichia coli were the most common organism in both early onset and late onset sepsis. Staphylococcal aureus was significantly more common in late onset sepsis than early onset sepsis.

Bacteriological Analysis and Antibiotic Sensitivity Pattern of Blood Culture Isolates in Kanti Children Hospital.

Introduction: As antibiotic sensitivity pattern to common pathogen has been changing day by day, so it has been necessary to study about bacteriological analysis and antibiotic sensitivity pattern. Therefore, the purpose of this study was to analyze on data on bacteremia in children, the pathogen involved and sensitivity pattern. Objectives: The aim of this study was to determine the bacteriological profile and antibiotic sensitivity pattern of blood culture isolates from Kanti Children Hospital. Method: All blood culture reports (n=9856) during one year period (April 2007 to March 2008) included in the study were analyzed and the sensitivity pattern were recorded. In this retrospective study, we reviewed records of patients from Kanti Children Hospital from April 2007 to March 2008. Results: The positivity of blood culture was 4.2% (414/9856). Out of them, 269 (65%) were positive for Staphylococcus aures, 121(29.3%) E coli, 13(3.1%) Klebsiella pneumonia, 6(1.4%) Streptococcus pneumonia and 5(1.2%) Streptococcus viridence. Staphylococcus aureus was found most sensitive to Chloramphenicol (88.8%) followed by Amikacin (87.5%), Ofloxacin (76.5%), Ciprofloxacin (72%) and least sensitive to Ampicillin, Cloxacillin and Penicillin. E.coli was found most sensitive to Amikacin (74.7%) followed by Ofloxacin (69.9%), Ciprofloxacin (56.4%) and least sensitive to Cephalexin, Gentamycin and Ampicillin. Klebsiella pneumoniae was found most sensitive to Amikacin (91.7%) followed by Ofloxacin (87.5%), Chloramphenical (81.8%) and least sensitive to Cotrimoxazole and Gentamycin. It is 100% resistance to Ampicillin and Erythromycin. Streptococcus pneumoniae was most sensitive to Penicillin, Chloramphenical (100%) followed by Ampicillin and Erythromycin (83.3%) and least sensitive to Cotrimoxazole. Streptococcus viridence was most sensitive to Chloramphenical (100%) followed by Erythromycin (80%), Penicillin (75%) and least sensitive to Cotrimoxazole. Conclusion: This highlights the variable nature of antibiotic susceptibility patterns both in time and location around different geographical locations and within the same country as well. Therefore, it is advisable to continuously evaluate the sensitivity-resistance pattern of isolates so as to make a rational use of antibiotics.

Wilm’s Tumor Ten Year Experience at Kanti Children’s Hospital.

Introduction: Wilm's tumor is the second most common abdominal tumor in children. It arises from the kidney. The survival of children with Wilm's tumor has improved over the past 25 years. Objectives: To study the clinical presentation of Wilm’s tumor and evaluate the ten year survival. Materials and Methods: A retrospective hospital based study was conducted at Kanti Children's Hospital from March 1998 to February 2008. A total of 60 histopathologically diagnosed children below 14 yr of age were included in the study. Results: About 2/3rd (66.5%) presented with abdominal swelling followed by abdominal pain (16.5%) and fever (13.5%). A few children manifested with red colored urine (3.5%). The age of children ranged from one month to 13 years with the mean age of 36 months. Males were affected more than the females (M:F=3:1). Most affected age group was 2 to 5 yrs (41.5%) followed by 1 to 2 yrs (25.0%). Most of the cases were in stage III (36.5%) followed by stage II (33.5%). SIOP protocol was used to treat these children and overall 10 year survival rate was 50.0%. One fifth (20%) of the cases died, 16.5% relapsed and 13.5% lost to follow up. Conclusion: Despite severe resource limitations, paediatric oncology unit at Kanti Children’s Hospital has been successfully treating Wilm's tumor with the success rate of 50.0%.

Causative agents of urinary tract infections in children and their antibiotic sensitivity pattern: a hospital based study.

A retrospective study was conducted to find out the causative agents of urinary tract infection (UTI) in children and their antibiotic sensitivity pattern among Nepalese children. This was done at Kanti Children's Hospital in Kathmandu (Nepal) by analyzing the records of urine samples collected for culture and sensitivity tests over a period of six months (April to November, 2007). Of the total 1878 mid-stream urine samples collected from suspected cases of UTI, 538 (28.6%) were positive for pathogenic organisms. There was no significant difference in growth positive rate in two genders (M: 51.7% and F: 48.3%). Of the various pathogenic organisms isolated, Escherichia coli constituted for 93.3% followed by Proteus sp, Klebsiella sp, Citrobacter sp, Staphylococcus aureus and others. E. coli was found to be most sensitive to amikacin, chloramphenicol, nitrofurantoin and ofloxacin and least sensitive to most commonly used drugs like cephalexin, nalidixic acid, cotrimoxazole and norfloxacin.