Evaluation of urine collection methods for the diagnosis of urinary tract infection in children

To evaluate the accuracy of urine sample collection methods among children suspected of having urinary tract infections. Four methods for urine sample collection were evaluated in 1,067 children aged 0-16 years with suspected urinary tract infections over 2 months at Dr. Sami Ulus Children's Hospital. Within 30 min of collection, all specimens were sent to the laboratory, refrigerated and processed according to standard hospital microbiological procedures. Urine samples were analyzed using routine culture techniques. At initial sending of the urine culture, 617 [57.8%] had negative culture results, 145 [13.6%] had positive culture results, and 305 [28.6%] had evidence of bacterial contamination. Clean catch specimens showed a contamination rate of 14.3% and urethral catheterization specimens showed a similar contamination rate [14.3%]. However, urethral catheterization was preferred in only a small number of cases [n = 7]. Suprapubic aspiration was also used in a small number of cases [n: 11] and the contamination rate for suprapubic aspiration was 9.1% [n: 1/11]. The contamination rate for sterile urine bag was 43.9%, significantly higher than the other methods [p< 0.001]. Suprapubic aspiration showed the lowest contamination rate and sterile urine bag showed the highest contamination rate among 4 methods of urine sample collection. Contaminated specimens, needed to be repeated and this procedure increased the cost of urine culture. In conclusion, measures should be taken to reduce the contamination rate in our center. This is an area where further investigation is required

single-center experience of antimicrobial resistance patterns in pediatric urinary tract infection

To assess the prevalence of urinary tract pathogens and their resistance patterns against antimicrobial agents in a single center. In children <16 years of age admitted for urinary tract infection [UTI] to the Dr. Sami Ulus Teaching and Training Hospital from January 2004 to December 2008, positive urine cultures were reviewed. A total of 3, 485 positive urine cultures were identified, of which 2, 379 [68%] were from females and 106 [32%] from males. Their mean age was 63.5 +/- 40.7 months. Escherichia coli was the most common causative agent both in total and among different age groups. Ampicillin had the highest resistance rate from all the pathogens isolated [63.8%], followed by piperacillin [51.8%] and trimethoprim-sulfamethoxazole [TMP-SMX; 48.6%]. Cephalotin also had a high resistance rate [32.7%]. The least resistance was for imipenem, amikacin, netilmicin and ciprofloxacin [0.13, 1.7, 2.4 and 7.5%, respectively]. None of the Klebsiella and Pseudomonas isolates were resistant to imipenem. None of the Staphylococcus aureus isolates were resistant to teicoplanin and vancomycin. Vancomycin-resistant Enterococcus spp. were isolated from two cultures. E. coli was the most common causative agent of UTI in children. Ampicillin, TMP-SMX or cephalothin and piperacillin had the highest resistance rates against urinary tract pathogens in our center

Visual hallucinations possibly associated with clarithromycin administration at therapeutic dosage in two children

Our aim was to present 2 children with visual hallucinations possibly associated with clarithromycin administration at therapeutic dosage. Two children were admitted to our hospital with sudden onset of visual hallucinations after taking clarithromycin at therapeutic dosage by mouth. Physical examination, laboratory investigations and imaging studies were normal. The symptoms gradually disappeared once the clarithromycin therapy had been discontinued, making us suspect clarithromycin as the agent responsible for the visual hallucinations. They were observed monthly for a year without any symptoms or further treatment. This report highlights hallucinations due to therapeutic doses of clarithromycin therapy as a possible new side effect in children