The spectrum and outcome of paediatric traumatic brain injury in KwaZulu-Natal Province, South Africa has not changed over the last two decades

Objectives. This retrospective review of a prospectively entered and maintained hybrid electronic trauma registry was intended to develop a comprehensive overview of traumatic brain injury (TBI) in children and adolescents and to compare it with previous audits from our local environment and from other developing world centres. All TBI patients admitted to hospital were included in this study. We reviewed the age, gender, outcomes, radiological findings and treatment of the patients.Methods. All patients aged ≤18 years old who were admitted by the Pietermaritzburg Metropolitan Trauma Service (PMTS) with TBI between December 2012 and December 2016 were included in this audit. Results. During the 4-year period under review, a total of 563 children and adolescents were treated for TBI by the PMTS. The median age was 6.4 years and 29% (n=165) were females. The mechanism of TBI was blunt trauma in 96% (n=544) of cases, with 4% (n=19) suffering penetrating trauma. The penetrating mechanisms included impalement by a cow horn and miscellaneous injuries due to saws, axes, barbed wire, spades, stones and knives. The blunt mechanisms included falls (n=102), assaults (n=108), collapse of a building (n=28), bicycle-related injury (n=14), falling off a moving vehicle (n=280), motor vehicle accident (MVA; n=59), pedestrian vehicle accident (PVA; n=183) and animal-related injuries (n=8). There were 454 (80%) mild, 67 (12%) moderate and 42 (7%) severe cases of TBI. A total of 48 patients were admitted to the intensive care unit and 23 were admitted to the high care unit. Nine patients died. All the deaths were in the MVA and PVA group. The spectrum of TBI as diagnosed on computed tomography scans was nonspecific cerebral contusion (n=92), depressed skull fracture (n=70), sub-arachnoid haemorrhage (n=60), extradural haemorrhage (n=41), intracerebral haemorrhage (n=19), free air (n=19), subdural haemorrhage (n=13), intraventricular haemorrhage (n=9). A total of 62 (11%) patients required surgery.Conclusion. There is a significant burden of paediatric TBI in Pietermaritzburg. The majority of TBI was related to blunt trauma and assaults were very common. Although the short-term outcomes are good, the long-term consequences are poorly understood. Injury prevention programmes are needed to help reduce this burden of disease and a nationwide trauma registry is long overdue

Fungal infection in Egyptian patients with diabetic foot ulcer [prevalence, spectrum, and antifungal susceptibility]

Foot ulcers are a very common complication of Type 1 and Type 2 diabetes. Patients having diabetic foot ulcer infection face serious problems including gangrene and amputations. The aim of this study was to determine the prevalence, spectrum of fungal infections in diabetic foot ulcer and to assess in vitro the antifungal susceptibility. This study was conducted on108 diabetic patients with foot ulcer attending the out-patient clinic of the National Institute of Diabetes and Endocrinology, from May to July 2014. Wound swabs were inoculated to slants of Sabouraud dextrose agar [SDA]. Yeast like growth on SDA was identified by Gram stain, germ tube formation, culture on Chrom agar Candida. The susceptibility of the isolated fungi was evaluated by disk diffusion method on Mueller- Hinton agar, using Amphotericin B, ketoconazole, fluconazole and itraconazole, posaconazole and caspofungin disks. Among the 108 patients 51% were females. Fungal foot infection were highest among the age group 51-60 years. 31.5% of patients were having fungal infection, Candida spp. was the most predominant isolated fungus [94.2%]; C. albicans [61.8%], C. glabrata [11.8%], other Candia spp. [8.8%], C. tropicalis and C. krusei each [5.9%]. In vitro susceptibility was highest to ketoconazole [78.1%], the highest resistance was for amphotericin B [87.5%]. Candida spp. is a predominant pathogen causing fungal infection in diabetic foot ulcer. High resistance to antifungal drugs is an emerging major problem

Coledocolitiasis y colangitis como complicación del uso de ceftriaxona en niños: reporte de caso / Choledocholithiasis and cholangitis as a complication of ceftriaxone in children: a case report

La ceftriaxona es ampliamente usada en pediatría debido a su espectro de acción, larga vida media y buena penetración en los sitios donde se asientan las infecciones más frecuentes. Es bien tolerada, aunque, con frecuencia, en niños que la reciben, se presenta barro biliar y pseudocolelitiasis. Esto se ve favorecido porque cerca del 40% del fármaco es eliminado por la bilis sin modificaciones, donde se comporta como un anión con alta afinidad por las sales de calcio. Resumen La mayoría de los casos cursan asintomáticos o mínimamente sintomáticos, y de resolución espontánea solo al suspender el uso del fármaco. Se presenta el caso de una niña de 4 años que recibe ceftriaxona durante 14 días por sinusitis, desarrollando al quinto día cálculos en la vesícula biliar que crecen hasta 11 mm y tardan 55 días en desaparecer; el día 34, presenta colecistitis, colangitis y coledocolitiasis que requieren manejo hospitalario.

Ceftriaxone is widely used in children because it has a great spectrum, long half-life and good penetration. Is generally well tolerated, although in children who receive the drug, it often presented pseudocolelitiasis and biliary sludge. This is favored because about 40% of the drug is eliminated unchanged in bile where it behaves as an anion with high affinity for calcium salts. Most cases present as asymptomatic or minimally symptomatic and spontaneous resolution, only when the drug is no longer taken. A case of a 4 year old girl who received ceftriaxone for 14 days for sinusitis and on day 5 develops gall bladder stones that grow to 11 mm and last 55 days to go away, the day 34 presents cholecystitis, cholangitis and choledocholithiasis requiring medical management to resolution.

Resistencia a los antibióticos en Escherichia coli con beta-lactamasas de espectro extendido en un hospital de la Orinoquia colombiana / Antimicrobial resistance of Escherichia coli with extended spectrum beta -lactamase in a hospital at the Colombian Orinoquia

Objetivo. Analizar la resistencia de Escherichia coli a los antibióticos de acuerdo con la presencia de beta-lactamasas de espectro extendido (BLEE). Materiales y métodos. Estudio descriptivo y de corte transversal, en el Hospital Departamental de Villavicencio, centro de atención de mediana y alta complejidad. La población de estudio fueron los pacientes con cultivos positivos para E. coli. La variable de estudio fue la resistencia a ceftazidima, cefotaxima y clavulanato. Se confirmó la presencia de BLEE y la resistencia a otros antibióticos. Resultados. Se tamizaron 29.451 estudios de microbiología, de los cuales 26,7 % fueron positivos. Se identificaron 77,6 % como Gram negativos y 2.551 (41,8 %) como E. coli. De los cultivos, 65,1 % se obtuvieron de orina; 9,5 % fueron resistentes a ceftazidima y 8,7 % a cefotaxime. En los aislamientos de orina, la resistencia de E. coli a ceftazidima fue de 6,5 %, mientras que, en aspirados traqueales, fue de 35,0 % (OR=7,98; p<0,05). Se hicieron 315 pruebas confirmatorias para BLEE con equipo Vitek® y 506 con AutoScan®. La mayor cantidad de muestras se obtuvieron de la consulta externa (34,0 %) y, aunque allí se encontró un número significativo de BLEE (6,9 %), hubo mayor resistencia en la unidad neonatal (16,9 %). La resistencia a ampicilina, cefalotina, ciprofloxacina, gentamicina y trimetoprim-sulfametoxazol, fue alta. El 7,1 % de las pruebas confirmatorias con clavulanato fueron positivas para BLEE. Conclusiones. El estudio demostró una frecuencia de 7,1 % de BLEE en esta institución. Hubo servicios con mayor riesgo, como el de neonatos, aunque el fenómeno no se limitaba al ambiente hospitalario. También, se encontró un pequeño porcentaje que fue resistente a carbapenem.

Objective: To analyze antimicrobial resistance of Escherichia coli according to the presence of extended spectrum beta-lactamase. Design: A cross sectional descriptive study. Setting: Hospital Departamental de Villavicencio, a State center of second and tertiary care. Study population: Positive cultures for E. coli were analyzed between September 2005 and November 2009. Interventions: None. Study variable: Ceftazidime and cefotaxime resistance with and without clavulanate. Outcomes: Confirmation of ESBL test and resistance to other antimicrobials. Results: From the 29,451 microbiological samples that were screened, 26.7% were positive. 77.6% were identified as Gram negative and 2,551 (41.8%) were typified as E. coli. 65.1% isolations were from urine samples and 9.5 and 8.7% of them were resistant to ceftazidime and cefotaxime, respectively. 6.5% of urine samples were resistant to ceftazidime, but it raised to 35% for tracheal aspirate (OR 7.98 p<0.05). Three hundred and fifteen confirmatory tests for ESBL were performed with Vitek® and 506 with AutoScan®. Most samples were ambulatory patients (34.0%) and a significant number of them were positive for ESBL (6.9%), but it was higher at the newborn ward (16.9%). Resistance was high for antimicrobials commonly used for infections by this microorganism such as ampicillin, cephalothin, ciprofloxacin, gentamycin and trimethoprim-sulfamethoxazole. Confirmatory ESBL test was 7.1%. Conclusions: The study demonstrates a 7.1% frequency of ESBL at this hospital but the samples from newborn ward showed a higher frequency of ESBL; nevertheless, the issue is not restricted to hospitalized patients. We also found a small number of isolations resistant to carbapenem.

Epidemiología molecular de pseudomonas aeruginosa resistente a ß-lactámicos de amplio espectro en el Hospital San Jerónimo De Montería / Molecular epidemiolgy of broad-spectrum ß-lactams resistant Pseudomonasaeruginosa in Hospital San Jerónimo, Montería

Pseudomonas aeruginosa ha emergido como uno de los principales patógenos hospitalarios causantes de infecciones graves y productores de β -lactamasas de espectro extendido (BLEE) inusuales, como PER- 1, OXA y carbapenemasas. Objetivo. Caracterizar los aislamientos de P. aeruginosa resistentes a -β -lactámicos de amplio espectro por investigación de los genotipos por rep- PCR y su diseminación en este hospital. Métodos. Se obtuvieron 26 aislamientos clínicos de P. aeruginosaresistentes a β -lact´micos de amplio espectro del Hospital San Jerónimo de enero a agosto del 2002. La resistencia a los β -lact´micos de amplio espectro se estableció con el sistema MicroScan® ESBL plusTM. Se utilizó la técnica de rep- PCR para la tipificación molecular de los microorganismos. Resultados. Los aislamientos mostraron resistencia a la fluoroquinolona ciprofloxacina (15/26, 57,6%) y aminoglucósidos, como gentamicina (14/ 26, 53,8%) y amikacina (9/26, 34,6%). También se observó resistencia a meropenem e imipenem (3/ 26, 11,5%). La tipificación molecular por rep-PCR mostró dos clones A y B de 15 y 3 aislamientos, respectivamente y 8 aislamientos no relacionados. El clon A con 15 aislamientos incluía dos subclones idénticos de 8 y 2 aislamientos, y 5 aislamientos estrechamente relacionadas. El clon B incluyó 3 aislamientos estrechamente relacionados con similaridad mayor del 90% Conclusiones. La relación de los fenotipos de resistencia expresados por estos aislamientos, posiblemente, indique la existencia de plásmidos de resistencia causantes de la infección hospitalaria en este hospital y responsables de codificar la resistencia a β-lact´micos de amplio espectro. Asimismo, el análisis molecular por rep-PCR mostró la diseminación de dos clones de P. aeruginosa en el hospital, de los cuales el clon A presentó aislamientos idénticos diseminados en diferentes servicios de la institución, lo que sugiere una transmisión horizontal.

Pseudomonas aeruginosa has emergence as nosocomial pathogen mean causing several illness and producer of extended-spectrum β-lactamases (ESBL) unusual as PER-1, OXA and carbapenemases. Objetives Characterized isolates of broadspectrum β -lactams resistant P. aeruginosa by research of genotype rep-PCR and spread in this hospital. Methods: 26 clinical isolates of broadspectrum β-lactams resistant P. aeruginosa were obtained from Hospital San Jeronimo (HSJ), between January and August 2002. Broadspectrum β-lactams resistant was established with system MicroScan® ESBL plusTM (Dade Inc). Assays by rep-PCR were utilized for molecular typing of microorganisms. Results: Those isolates showed resistance to fluoroquinolone as ciprofloxacin (15/26, 57.6%) and aminoglicosides as gentamicin (14/26, 53.8%) and amikacin (9/26, 34.6%). Also showed resistance to meropenem and imipenem (3/26, 11.5%). Molecular typing by rep-PCR showed 2 clusters of 15 and 3 strains, and 8 strains unrelationed. Cluster of 15 strains included two clons of 8 and 2 strains, and 5 strains relationed. Cluster of 3 strains showed isolates relationed. Conclusions: Relation of resistance phenotypic expressed for this isolates indicating possibly the existance resistence plasmids causing of nosocomial infections in this hospital and responsible encoding broad-spectrum β-lactams resistant, moreover molecular assays by rep-PCR showed spread of 14 cluster of P. aeruginosa in HSJ, the clusters 1, 3 y 6 showed the biggest number of isolates, the remained clusters corresponded to single isolates that suggest an horizontal transmission.