Outcome of Antimicrobial Therapy of Pediatric Urinary Tract Infections Caused by Extended-Spectrum beta-Lactamase-Producing Enterobacteriaceae / 감염과화학요법

BACKGROUND: The purpose of this study was to compare the outcome of carbapenem versus non-carbapenem antimicrobial therapy for pediatric urinary tract infections (UTIs) caused by extended-spectrum beta-lactamase (ESBL) producing Enterobacteriaceae. MATERIALS AND METHODS: From 2006 to 2011, 42 episodes of UTI caused by ESBL-producing Enterobacteriaceae were diagnosed at Seoul National University Children's Hospital. Patients were grouped according to the antimicrobials they received into a carbapenem group and a non-carbapenem group. Medical records were retrospectively reviewed to assess treatment outcome, time to defervescence after initiation of treatment, and relapse rate. RESULTS: There were 36 children with 42 episodes of UTI caused by ESBL-producing Enterobacteriaceae. Twenty-seven cases (64%) had an underlying urologic disease, 28 (67%) cases were caused by Escherichia coli, and 14 (33%) cases were caused by Klebsiella pneumoniae. Four (10%) cases were treated with carbapenem, 23 cases (55%) were treated with non-carbapenem, and 15 (36%) cases were treated by switching from a carbapenem to a non-carbapenem and vice versa. There was no treatment failure at the time of antimicrobial discontinuation. Between the carbapenem and the non-carbapenem treatment groups, there were no significant differences in bacterial etiology (P = 0.59), time to defervescence after the initiation of antimicrobials (P = 0.28), and relapse rate (P = 0.50). In vitro susceptibility to non-carbapenem antimicrobials did not affect the time to defervescence after the initiation of antimicrobial treatment, and the relapse rate in the non-carbapenem group. CONCLUSIONS: This study found no significant difference in the treatment outcome between pediatric patients treated with carbapenem and those treated with non-carbapenem antimicrobials for UTI caused by ESBL-producing Enterobacteriaceae. Therefore, the initially administered non-carbapenem can be maintained in UTI patients showing clinical improvement.

Current Complementary Feeding and Maternal Nutritional Knowledge in Multicultural Family: Compared to the Korean Survey / 대한소아소화기영양학회지

PURPOSE: To evaluate current complementary feeding and maternal nutritional knowledge of a multicultural family in Korea. METHODS: Foreign mothers of babies aged 9~24 months, who visited pediatric clinics or attended a meeting on a multicultural family party between December 2010 and April 2011, were asked to fill out questionnaires. Data from 146 questionnaires were analyzed. RESULTS: Complementary food was introduced at 4~7 months in 78% of babies. The following were the sources of information on complementary feeding: friends (34%), relatives (27%), books/magazines (19%), multicultural family educational support center (8%), mass media (4%), and hospitals (3%). The cases of complementary food introduction after 8 months (21% vs. 10%, p<0.001), initial use of commercial food (26% vs. 6%, P<0.001) and initial use of bottle feeding (15% vs. 3%, p<0.001) were more frequent compared to the 2009 Korean survey. Mothers agreeing with the following suggestions were relatively fewer: feeding minced meat from 6~7 months (61%), No mixed cereal powder as complementary food (61%), feeding egg white after 12 months (63%), no adding salt or sugar to the complementary food (64%), bottle weaning before 15~18 months (66%) and considering formula better than soy milk (68%). CONCLUSION: Complementary feeding practices of multicultural families showed many points of improvement compared with the 2009 Korean survey. Pediatricians should make more of an effort to consult with families of multicultural infants about nutrition and complementary feeding. Also, the government and the pediatrics academy need to institute policies to support the nutrition of multicultural infants.

Associated Symptoms of Kawasaki Disease

BACKGROUND AND OBJECTIVES: In addition to diagnostic criteria, a broad range of nonspecific clinical features can be found in patients with Kawasaki disease. This lack of specificity may cause confusion with other febrile illnesses and delay the diagnosis of Kawasaki disease. The purpose of this study is to describe common associated symptoms and their clinical significances in children affected with Kawasaki disease. SUBJECTS AND METHODS: As a retrospective study, we reviewed the medical records of 121 children who were treated for Kawasaki disease at Presbyterian medical center from January 2005 to June 2010. All clinical symptoms, laboratory data and echocardiographic findings in patients with KD were collected and analyzed. RESULTS: We found that there are 9 associated symptoms, namely cough, rhinorrhea, sputum, abdominal pain, vomiting, diarrhea, arthralgia, headache and seizure, which occur in patients with Kawasaki disease. Among the study group, there were only 32 children with no associated symptoms (26.4%). Patients with abdominal pain and headache had an older mean age than those without such symptoms. The incidence of seizure was significantly higher in incomplete Kawasaki disease patients compared with those with complete Kawasaki disease. Vomiting was highly associated with IVIG non-responder group. CONCLUSION: To decrease the incidence of serious coronary complications due to delayed diagnosis, physicians need to be aware of the manifestations of Kawasaki disease and the possibility of associated symptoms, which, being unspecific, may otherwise not raise any red flags.