One year study of bacterial and fungal nosocomial infections among patients in pediatric intensive care unit (PICU) in Alexandria.

UNLABELLED: A 1-year prospective and observational study included all admissions (n=216) until 48 h after discharge to Alexandria PICU between first of May 2003 and end of April 2004. Cultures for bacteria and fungi and antibiotic sensitivity tests (19 antibiotic using Bauer-Kirby disc diffusion method) were obtained (blood, stool, urine and cerebrospinal fluid, if needed) and repeated on suspicion of NIs. All cannulae, endotracheal tube (ET) aspirates and tips, nasogastric tubes and different catheters were cultured. All PICU health care workers (HCWs) were subjected to throat and under-finger nails cultures as well as inanimate objects, both on bimonthly basis. The referral place (ward or emergency), PRISM III score, length of stay (LOS) and fate were recorded. Amongst those patients whose age ranged from 1 to 23 months, 23 per cent had NIs with infection rates of 40/1000 days. Significantly high rates of mortality, LOS and PRISM III score were encountered among patients with NIs (52 per cent vs 30 per cent; 9.4+/-4.8 vs 5.4+/-2.2 days; 14.4+/-7 vs 11.8+/-6 respectively). The descending order of frequency of NIs was blood stream infection (BSI) (47 per cent), urinary tract infection (UTI) (28 per cent), ventilator-associated pneumonia (VAP) (16 per cent) and meningitis (9 per cent). Gr-ve bacilli accounted for 76.7 per cent; Gr+ve cocci 13.3 per cent (with satisfactory sensitivity to cefepime, imipenem and meropenem) and Candida albicans 10 per cent of all NIs. The rate of NIs/1000 device days were: 18.7 per cent for BSI, 10.9 per cent for VAP and 25.5 per cent for UTI. Vulnerable age groups were >6 m for VAP and <6 m for meningitis. Multiple logistic regression analysis identified LOS, PRISM III score and referral from wards a predictors of NI acquisition (odd ratio and 95 per cent confidence interval: 1.537, 1.423-1.659; 1.073, 1.041-1.105 and 0.269, 0.178-0.406 respectively). Bimonthly cultures for HCWs isolated coagulase-ve Staphylococci, while inanimate objects isolated diphtheroids and Candida albicans. CONCLUSION: NIs rate was high (23 per cent) mainly due to severity of condition on admission as shown by high PRISM III score value, the high PRISM III score, LOS and referral from wards were predictors of acquisition of NIs and there is a high incidence of Candida albicans infection (10 per cent of NIs).

The relation between HLA-DRB1 alleles and the outcome of therapy in children with idiopathic thrombocytopenic purpura.

Idiopathic thrombocytopenic purpura (ITP) is a common hematologic disease. The pathogenesis involves formation of autoantibodies against platelet glycoproteins. The mechanism of autoimmunity might involve binding of antigenic peptides to HLA antigens. In this study, we tried to find out if a specific HLA allele might be associated with the occurrence of ITP, and whether or not this specific allele, if present, is related to the response to treatment. We investigated the frequency of HLA-DRB1 alleles in 30 Egyptian children with documented diagnosis of ITP. All patients were followed up for at least 6 months. Ten healthy children of matched age and sex served as a control group. The alleles were identified using polymerase chain reaction (PCR) sequence specific primers. The median age of the study patients with good response was 3.94 +/- 2.31 years (range 2-10 years, female to male ratio was 2.6:1 and platelet count at presentation was 17.91 +/- 9.1 X 10(9)/L (range 10-36 X10(9)/L). For patients with poor response, female to male ratio was 3.8:1 the median age and platelet count at presentation were 4.85 +/- 2.57 years (range 2-10 years) and 29.36 +/- 24.02 X 109/L (range 10-81 X 109/1L) respectively. The median duration of disease for clinically responding patients was 10.29 +/- 2.75 months (range: 6-15 months) and for non responding patients was 29.84 +/- 16.30 months (range: 6-60 months). It was found that HLA-DRB1 *14 was significantly increased in ITP patients with good response (P<0.001) while HLA-DRB1 *13 was significantly decreased in patients with good response (P=0.002, OR=0.07, CI=0.01-0.69). In conclusion, HLA-DRB1 *07 allele seems to be protective marker against ITP, HLA-DRB1 *14 allele can be used as a predictive marker for therapy in ITP patients with good response and for favourable outcome after splenectomy. Moreover, HLA-DRB1 *13 allele has an important role in resistance to therapy. Our findings indicate that genetic factors might influence the clinical course of ITP.