Epidemiologic study of nosocomial bacterial infection of pediatric patients at BMA Medical College and Vajira Hospital.

BACKGROUND: Nosocomial infection is a global public health problem, particularly by multi-drug resistant bacteria, increasing morbidity, mortality, and health care costs. The distribution of pathogens and antimicrobial sensitivity patterns change with time and vary among hospitals. OBJECTIVE: To determine and compare the bacterial pathogens causing nosocomial infections in pediatric patients and their susceptibility patterns between January 2000-December 2002 and January 2003-December 2005. MATERIAL AND METHOD: The bacterial pathogens and antimicrobial susceptibilities of children diagnosed as nosocomial infections at BMA Medical College and Vajira Hospital between January 2000-December 2002 and January 2003-December 2005 were comparatively analyzed. RESULTS: 1,863 and 1,884 isolates were identified in 2000-2002 and 2003-2005, respectively. The common sites of infections were bloodstream (28.6%), lower respiratory tract (15.3%), skin and soft tissue (14.9%), and urinary tract (12.5%). The major isolated gram positive pathogens were S. aureus, coagulase negative Staphylococcus and Enterococus. The major gram negative pathogens were E. coli, P. aeruginosa, K. pneumoniae, Enterobacter spp. and Acinetobacter spp. Compared between 2000-2002 and 2003-2005, methicillin resistant S. aureus (MRSA) was decreased from 4.3% to 1.5% P. aeruginosa from 13.3% to 7.5%, Enterobacter spp. from 4.2% to 2.4%, Serratia spp. from 1.3% to 0.3%, but methicillin resistant coagulase negative Staphylococcus was increased from 5.6% to 10.5% and K. pneumoniae from 5.5% to 7.7%, (p < 0.05). All gram positive cocci remained sensitive to vancomycin and linezolid. In 2003-2005, gram negative rods were less sensitive to 3rd and 4th generation cephalosporins and aminoglycosides than in 2000-2002. Sensitivity of gram negative rods to 3rd and 4th generation cephalosporins were not significantly different except Enterobacter spp. and Serratia spp., which were more sensitive to 4th generation cephalosporin (p < 0.05). Most gram negative pathogens (80-100%) were sensitive to ciprofloxacin except Acinetobacter spp. (61%). Carbapenems sensitivity were 100% except 92-100% for Enterobacter and 67-86% for P. aeruginosa, Acinetobacter spp. and Serratia spp. CONCLUSION: The bacterial pathogens causing nosocomial infections and their susceptibility patterns change with time, so periodic surveillance are essential as a guide for more proper empirical therapy especially in serious or life threatening infections that need urgent appropriate antibiotics.

Risk factors of dengue shock syndrome in children.

BACKGROUND: Dengue shock syndrome (DSS) is a major public health problem with high morbidity and mortality, especially in a case of prolonged shock with subsequently massive bleeding. The morbidity and mortality from DSS can be decreased by early diagnosis of shock and adequate replacement of plasma loss. Therefore, determination of risk factors of DSS is crucial for early detection and proper management of shock. OBJECTIVE: To determine the risk factors of dengue shock syndrome in children. MATERIAL AND METHOD: Medical records of 110 patients with dengue hemorrhagic fever (DHF) and 55 with DSS admitted at BMA Medical College and Vajira Hospital between January 2003 and December 2005 were collected by simple random sampling. Clinical data including age, sex, signs and symptoms, and laboratory data (before defervescence) of patients with DHF and DSS were comparatively analyzed. Risk factors of DSS were determined by Mantel-Haenzel test, simple and multiple logistic regression analysis. RESULTS: Of the 165 children, 110 were in the DHF group (grade I, 72 children; grade II, 38 children) and 55 were in the DSS group (grade III, 53 children; grade IV, 2 children). The age, sex, nutritional status, and duration of fever between both groups were not statistically different. Risk factors of DSS were bleeding, secondary dengue infection, and hemoconcentration of more than 22%from baseline hematocrit (adjusted OR (95% CI): 5.1 (1.5-17.1), 21.8 (5.3-90.8), 15.5 (4.4-54.6), respectively). CONCLUSION: Risk factors of DSS are bleeding, secondary dengue infection, and hemoconcentration of more than 22%. Patients with DHF who have one of these risk factors should be closely observed for early signs of shock, as prompt and adequate fluid replacement can prevent the progression of shock.

Nocardia pneumonia with empyema thoracis in a healthy neonate: a case report.

A 40-day-old male infant presented with fever and non-productive cough for 3 weeks, tachypnea and dyspnea 5 days before admission. The chest radiograph and computed tomographic (CT) scan revealed right lung consolidation with pleural effusion. Pleural tapping showed frank pus that grew Nocardia asteroides. The CT scan of the brain and abdomen were normal. The patient was treated with 15 mg/kg/day of trimethoprim and 75 mg/kg/day of sulfamethoxazole intravenously for 3 weeks and then orally for 6 months with complete recovery. T cell quantitative studies were normal and anti-HIV was non-reactive. A flow cytometric assay with Staphylococcal aureus and phorbol myristate acetate (PMA) as the stimulants showed normal oxidative burst which represented normal intracellular killing. One year after completion of treatment, he was healthy and the chest radiograph was normal.