Incidence of Escherichia coli and Its Susceptibility to Antimicrobials in Childhood Urinary Tract Infection

PURPOSE: Empirical antimicrobial treatment is indicated before bacteriological results are available for young children with febrile UTI to minimize renal scarring. To ensure appropriate therapy, knowledge of the prevalence of causative organisms and their susceptibility patterns to antimicrobials is mandatory. We performed a retrospective analysis investigating the local prevalence and resistance patterns of uropathogens, primarily E. coli, isolated from community-acquired UTIs. METHODS: A total of 103 positive urine cultures from children with febrile UTI collected at Bundang CHA General Hospital from February 2004 to February 2005 were analyzed. Inclusion criteria were fever higher than 37.5 degrees C, significant bacteriuria with single strain growth of at least 105 colony forming units/mL urine, and leukocyturia >5/HPF. RESULTS: E. coli(89.3%) was the leading uropathogen followed by Enterococcus spp.(3.9%) Klebsiella spp.(2.9%), Citrobacter spp.(1.9%) and Enterobacter spp.(1.9%). E. coli strains revealed a low proportion of antimicrobial susceptibility to ampicillin(AMP; 27.2%) ampicillin-sulbactam(AMS; 34.8%) and trimethoprim-sulfamethoxazole(SXT; 65.2%). Susceptibility patterns to cephalosporins were as follows; cefazolin(1st generation; 91.3%), cefoxitin(2nd; 100%), ceftriaxone(3rd; 97.8%) and cefepime(4th; 97.8%). Three E. coli isolates produced extended-spectrum beta-lactamase(ESBL). CONCLUSION: Empirical treatment with AMP, AMS and SXT, which are commonly used in pediatric clinics, is not recommended for childhood UTI due to high incidence of resistance. The high level of susceptibility to cephalosporins makes these drugs reasonable alternatives. However the emergence of ESBL-producers, even though they are quite few, may have an impact on cephalosporin treatment in the future.

Clinical Considerations of Panayiotopoulos Syndrome / 대한소아신경학회지

PURPOSE: Panayiotopoulos syndrome(PS) is a benign childhood focal seizure disorder characterized by seizures with emetic symptoms and other autonomic phenomena, and its EEG shows shifting and/or multiple foci, often with occipital predominance. More than 800 cases have been reported worldwide, but no case has been reported in Korea. This paper describes the characteristics of the patients that satisfy the diagnostic criteria of PS and gives its clinical considerations. METHODS: A total of 140 children with non-febrile seizures visited Bundang Cha General Hospital from June 2004 to June 2005. Among them seven patients satisfied the diagnostic criteria of PS. We analyzed their clinical findings and EEG results retrospectively. RESULTS: Boys predominated. The mean age at the first seizures was 6.21 years old. Nearly 57% of the cases had at least one seizure lasting more than 30 minutes. Seizures during sleep were more common than those in wakefulness. Seizures started with emesis while the children were usually fully conscious. Other conventional seizure manifestations such as loss of consciousness, eyeball deviation, and convulsions often ensued. The EEG records showed occipital spikes in four patients. Of the other three cases, two had extraoccipital spikes and one had a normal EEG. CONCLUSION: PS seems to be commonly observed in Korea, although it remains largely unknown in Korea. Since PS, in its early phases, is often indistinguishable from several serious diseases, a good knowledge of the condition can prevent unnecessary examinations and excessive treatment. Further studies are required to establish systematic practice parameter guidelines.

A Case of Thalamic Pain Syndrome after Meningoencephalitis / 대한소아신경학회지

Thalamic pain syndrome is a type of central pain caused by damage to both thalami and produces persistent and intractable pain; extreme burning or aching sensation by light touch, even without external stimuli. In adults, thalamic pain syndrome occurred in vascular diseases such as a stroke, but in children, it was reported that infectious diseases-upper respiratory infection or meningitis-were usually preceded by development of central pain syndrome. This paper reports on a 12 year old boy with meningoencephalitis followed by evolving to thalamic pain syndrome 10 days later, who suffered from hypersensitivity and severe generalized pain on his whole body. On the brain MRI, both medial temporal lobes showed increased signal intensity, worse on the right side. A combination therapy of intravenous ketamine, amitriptyline and gabapentine for intensive pain control markedly reduced the pain and hypersensitivity in about 1 month. On the following brain SPECT, a strong focal perfusion at the right temporo-parietal cortex area was nearly normalized compared to previous one.