Blood culture contaminants in a paediatric population - retrospective study from a tertiary hospital in Oman

Objectives: Most children presenting with febrile illness require a blood culture to determine the causative organism as well as its sensitivity to antibiotics. However, false-positive results lead to unnecessary hospitalisations, prescriptions and tests. This study aimed to evaluate the impact of false-positive blood cultures among a paediatric population at a tertiary hospital in Oman

Methods: This retrospective study included all 225 children <13 years old with positive blood cultures who presented to the Sultan Qaboos University Hospital, Muscat, Oman, between July 2011 and December 2013. Blood cultures were reviewed to determine whether they were true-positive or contaminated

Results: A total of 344 positive blood cultures were recorded during the study period, of which 185 [53.8%] were true-positive and 159 [46.2%] were contaminated. Most true-positive isolates [26.5%] were coagulase-negative Staphylococcus spp. [CONS] followed by Escherichia coli [9.7%], while the majority of contaminated isolates were CONS [67.9%] followed by Streptococcus spp. [6.9%]. Children with contaminated cultures were significantly younger [P <0.001] while those with true-positive cultures required significantly more frequent hospital admissions, longer hospital stays and more frequent antibiotic prescriptions [P <0.001 each]. Chronic illness and mortality was significantly more frequent among those with true-positive cultures [P <0.001 and 0.04, respectively]. While white blood cell and absolute neutrophil counts were significantly higher in truepositive cultures [P <0.001 each], there was no significant difference in C-reactive protein [CRP] level [P = 0.791]

Conclusion: In this population, CRP level was not an adequate marker to differentiate between true- and falsepositive cultures. A dedicated well-trained phlebotomy team for paediatric patients is essential

Nocardia asteroides peritoneal dialysis-related peritonitis: first case in pediatrics, treated with protracted linezolid

Nocardia asteroides is a rare pathogen in peritoneal dialysis-related peritonitis. We report on a 13-year-old female with Nocardia asteroides peritonitis complicated by an intra-abdominal abscess. Linezolid was administered intravenously for 3 months and followed by oral therapy for an additional 5 months with close monitoring for adverse effects. The patient was discharged after 3 months of hospitalization on hemodialysis. The diagnosis and management of such cases can be problematic due to the slow growth and difficulty of identifying Nocardia species. The optimal duration of treatment for Nocardia peritonitis is not known. Linezolid can be used for prolonged periods in cases of trimethoprim/sulfamethoxazole-resistant cases with close monitoring for adverse effects

Incidence of antibiotics resistance among uropathogens in Omani children presenting with a single episode of urinary tract infection

Urinary tract infection [UTI] is one of the most common community-acquired infections. Different organisms can be the cause of UTI in children, with resistance to antibiotics becoming a significant problem in the choice of treatment. Worldwide studies have documented the prevalence of uropathogens in different countries. However, there is no previous study documenting the incidence of different uropathogens in Oman. We aim to report the most common uropathogens and their antibiotic sensitivity patterns in children presenting with documented, single episode UTI at a tertiary hospital in Oman. A retrospective analysis of all Omani children below 14 years who presented with a case of first documented UTI to SQUH between September 2008 and August 2012 was conducted. Data were obtained from the patients' electronic records in the hospital information system. Data were then analyzed using SSPS [Statistical Package for Social Sciences program, Version 20, IBM, Chicago, IL, USA]. In the retrospective review of all urine cultures, 438 positive urine cultures were identified. Out of those, 208 [47.5%] belonged to children with their first episode of UTI. Thirty-three patients were excluded and 75 patients were included in the final analysis. Escherichia coliwas the most frequently encountered uropathogen in our cohort [69%], followed by Klebsiella pneumoniae infection [17%]. Nearly half [46.6%] of these two common organism were resistant to Cotrimoxazole, while 31% of them were resistant to Augmentin. Twenty-four percent of the E. coli and K. pneumoniae strains were resistant to Cefuroxime, and only 10% were resistant to nitrofurantoin. Both Augmentin and Cotrimoxazole should not be the first line antibiotics to treat UTI