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 Blood was withdrawn from every Intensive Care Unit patient suspected infection 48 hours post admission.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 diabetic nephropathy in a pediatric patient

Diabetic nephropathy is the most common cause of end stage renal disease in adult. Around 25-45% of patients with type 1 diabetes will develop overt nephropathy, the natural history of which includes several stages occuring over 10 to 15 years following the diagnosis of diabetes. Hence it is considered to be very rare to encounter overt diabetic nephropathy in the pediatric age group. In this case report, we describe a 13-year-old girl, who was known to have type I diabetes mellitus, and who was poorly controlled because of non-compliance. After four years of diagnosis, our patient developed overt nephropathy manifested by odema and proteinnuria of 3.5g/ day. Despite the absence of other microvascular complications of diabetes in this particular patient, and the short duration between diabetes and the onset of proteinuria the diagnosis of diabetic nephropathy was confirmed by kidney biopsy and the patient was managed accordingly. Currently, it is generally recommended to start screening for macroalbuminuria after five years of diabetes. This case report raise the issue of whether screening should be done at an earlier stage than curently recommended, especially so in patients with identified risk factors including poor glycemic control and pubertal growth spurt