Antibiotic Sensitivity Pattern of Pathogens from Children with UTI

PURPOSE: We studied the degree of changes in antibiotic sensitivity toward causative organisms, prevalence and clinical manifestations of extended-spectrum beta-lactamase(ESBL)- producers of urinary tract infection(UTI) for a period of three years. This serves to provide useful information in selecting adequate drugs for the treatment of UTI. METHODS: We recruited 137 patients who grew more than 105 CFU/mL in their urine culture among 250 patients who visited and were admitted to Handong University's Sunlin Hospital for UTI treatment from January 2003 to December 2005. We retrospectively analyzed the data from the medical records. RESULTS: The common pathogenic organisms were Escherichia coli(65.0%), Klepsiella pneumoniae(14.0%), Enterococcus faecalis(5.8%) and Proteus vulgaris(2.9%) in consecutive order. The prevalence of ESBL-producers among isolated E. coli and K. pneumoniae was 4.5%(4 cases) and 14.3%(2 cases), respectively. The antibiotic sensitivity rates of E. coli were relatively high to amikacin(100%), imipenem(100%), ceftriaxone(95.5%) and tobramycin(91.4%) while relatively low to TMP/SMZ(55.4%), ampicillin/sulbactam(29.4%) and ampicillin (24.2%). CONCLUSION: The use of ampicillin, ampicillin/sulbactam and TMP/SMZ, which have been the first choices in the treatment of UTI, should be reconsidered due to the low sensitivity rates towards these antibiotics. Due to the high incidence and antibiotic tolerance of ESBL that might have risen from the development of new antibiotics and increased antibiotic use, it is necessary to consider changing the standard antibiotics that have been used in the treatment of UTI.

Outcome of Continuous Renal Replacement Therapy in Children / 소아과

PURPOSE: There is growing use of continuous renal replacement therapy(CRRT) for pediatric patients, but reports about the use and outcome of CRRT in children is rare in Korea. We report our experiences of CRRT in critically ill pediatric patients. METHODS: We reviewed the medical records of 23 pediatric patients who underwent CRRT at Asan Medical Center between May 2001 and May 2004. We evaluated underlying diseases, clinical features, treatment courses, CRRT modalities and outcomes. RESULTS: Ages ranged from three days to 16 years with a median of five years. Patients weighed 2.4 to 63.9 kg(median 23.0 kg; 10 patients < or =20 kg). The underlying diseases were malignancy(nine cases), multiple organ dysfunction syndrome(five cases), hyperammonemia(four cases), acute renal failure associated with liver failure(three cases), dilated cardiomyopathy(one case) and congenital nephrotic syndrome(one case). Pediatric Risk of Mortality(PRISM) III score was 17.6+/-7.6 and the mean number of failing organs was 3.0+/-1.7. Duration of CRRT was one to 27 days(median:nine days). Eleven patients(47.8%) survived. Chronic renal failure developed in two cases, intracranial hemorrhage in one case, and chylothorax in one case among the survivors. PRISM III score and the number of vasopressor before the start of CRRT was significantly lower in the survivors(12.7+/-4.2 and 0.9+/-1.1) compared with nonsurvivors(22.1+/-7.8 and 2.4+/-1.4)(P<0.05). CONCLUSION: CRRT driven in venovenous mode is an effective and safe method of renal support for critically-ill infants and children to control fluid balance and metabolic derangement. Survival is affected by PRISM III score and the number of vasopressors at the initiation of CRRT.

Infectious Mononucleosis in Children

We reviewed the clinical findings of infectious mononucleosis and performed Epstein-Barr virus (EBV) serologic antibody tests in infectious mononucleosis and healthy group. One groupwas 18 cases of children, diagnosed as infectious mononucleosis who had been admitted to the department of Pediatrics, Asan Medical Center for two years and eight months, from November, 1989 to June, 1992. Another group was 20 cases of healthy 5-year old children. @ES The results wereas follows: 1) The age distributions of 18 patients with infectious mononucleosis were as follows: nine patients were less than 5 year old and nine patients (50%)were older than 5 year old. 2) The hematologic findings revealed increased atypicallymphocytes in sixteen patients (88%), leukopenia in one patient (6%), thrombocytopenia in one patient (6%). In addition, we observed transient hepatitis in eight patients (44%) and jaundice in one patient (6%). 3) Hemophagocytic sydrome wasdeveloped in one patient who expired due to meningitis. 4) The heterophil antibody tests werepositive in two cases (11%) out of eighteen infectious mononucleosis patients. 5) EBV serologic antibody tests for IgM antibody to EBV-viral capsid antigen (VCA) in 18 patients were all positive, which implies primary infection. 6) EBV serologic antibody tests for IgG antibody to EBV-VCA and antibody to Epstein-Barr nuclear antigen (EBNA) in helathy 5-year old children were negative in 3 cases (15%) out of 20 cases each other, which suggests primary infection might occur afer five years of age. 7) Recently, more cases of clinically typical infectious mononucleosis are detected and the onset of EBV primary infection is becoming late in Korea, which is thought to be due to economic developments and improvements of environmental hygine. And we recommend EBV serologic antibody test for the confirmative diagnostic test of infectious mononucleosis.

Prevalence of Epstein-Barr Virus(EBV) Antibody in Korean Children

Recently, cases with typical clinical manifestations of infectious mononucleosis are increasing in Korea. So, to evaluate the recent epidemiology of EBV infection in Korea, we performed EBV serologic antibody tests for IgG antibody to EBV-viral capsid antigen (VCA) and antibody to EBV-associated nuclear antigen (EBNA) among the 108 healthy Korean infants and children whose ages were from newborn to 15 years old. And the results were as follows; 1) The positive rates of anti-VCA IgG 100% in newborn, 90% in 2 to 6 months, 20% in 7 to 12 months, 60% in 1 to 2 years, 77.3% in 3 to 4 years, 88.5% in 5 to 6 years, 90% in 7 to 9 years, and 100% in 10 to 15 years of age, respectively. 2) The anti-VCA IgG titers ranged from 1:20 to 1:1280. 3) The positive rates of anti-EBNA were 100% in newborn, 60% in 2 6 months, 10% in 7 to 12 months, 60% in 1 to 2 years, 68.2% in 3 to 4 years, 84.5% in 5 to 6 years, 70% in 7 to 9 years, and 100% in 10 to 15 years of age, respectively. 4) The anti-EBNA titers ranged from 1:2 to 1:128. According to these data, the age of primary infection of EBV has increased compared to the previous data in Korean children.

Hand, foot and mouth disease associated with the aseptic meningitis in Seoul, 1990

We performed clinical and virological studies on 79 children with hand, foot and mouth disease (HFMD) who had been admitted or visited to the department of Pediatrics, Asan Medical Center from February to August, 1990. The results were as follows; 1) There were total of 79 cases with hand, foot and mouth disease during this period. The aseptic meningitis was combined in 18 cases (22.8%). 2) The male-to-female ratio of HFMD was 2.03 to 1, but that of aseptic meningitis was 8 to 1. 3) Hand, foot and mouth disease occurred more frequently in under the age of 5 years, and the aseptic meningitis in under the age of 1 year. 4) Hand, foot and mouth disease and the aseptic meningitis occurred mostly in May and June. 5) In addition to the skin manifestations characteristic in hand, foot and mouth disease, some of the patients with aseptic meningitis had the following symptoms: change of consiousness, seizure, monoparesis in the upper extremity, paraparesis in the lower extremity. 6) The causative agent of hand, foot and mouth disease associated with the aseptic meningitis in Seoul in 1990 seemed to be enterovirus 71 according to the serologic study.