ABSTRACT
INTRODUCTION: distal renal tubular acidosis (dRTA) presents itself with variable clinical manifestations and often with late expressions that impact on prognosis. CASE REPORT: A 45-day-old male infant was admitted with stopping growth, difficult feeding and vomiting after meals. Clinical tests and labs revealed a type 1 renal tubular acidosis, even if the first blood tests showed ammonium and lactate increase. We had to exclude metabolic diseases before having a certain diagnosis. CONCLUSIONS: blood and urine investigations and genetic tests are fundamental to formulate dRTA diagnosis and to plan follow-up, according to possible phenotypic expressions of recessive and dominant autosomal forms in patients with dRTA.
Subject(s)
Acidosis, Renal Tubular/diagnosis , Hyperammonemia/etiology , Lactates/blood , Acidosis, Renal Tubular/blood , Acidosis, Renal Tubular/complications , Acidosis, Renal Tubular/genetics , Acidosis, Renal Tubular/therapy , Growth Disorders/etiology , Humans , Hyperammonemia/blood , Hyperammonemia/diagnosis , Hyperammonemia/genetics , Infant , Male , Mutation , Phenotype , Potassium Citrate/administration & dosage , Sodium Bicarbonate/administration & dosage , Treatment Outcome , Vomiting/etiologyABSTRACT
Blood culture results obtained between January 2000 and July 2003 were reviewed for 1360 patients in a paediatric intensive care unit (PICU). The BacT/Alert FA aerobic medium was used with a blood volume of 1.5 mL for the first 23 months, and the BacT/Alert PF paediatric medium was used with a 0.5-mL volume for the remaining 18 months. The isolation rates were similar during both periods (13.4% vs. 13.1%), and staphylococci were the most common isolates (72.8%). There was a shorter time to detection of staphylococci with the smaller-volume (PF) procedure, which thus seems suitable for use in the diagnosis of staphylococcal bacteraemia in the PICU.
Subject(s)
Bacteremia/diagnosis , Bacteriological Techniques , Intensive Care Units, Pediatric , Staphylococcal Infections/diagnosis , Staphylococcus/isolation & purification , Adolescent , Child , Child, Preschool , Culture Media , Culture Techniques , Humans , InfantABSTRACT
Treatment of Burkholderia cepacia-complex infections in cystic fibrosis patients is problematic, since the microorganism is often resistant to most antimicrobial agents. In this study, the Epsilometer test, or E test, was used to assess the activity of antimicrobial combinations against Burkholderia cepacia-complex. In a preliminary evaluation, the E test was compared to the checkerboard method using 10 test organisms. Synergy testing by the E test was then performed on 131 clinical isolates of Burkholderia cepacia-complex using various combinations of antimicrobial agents. Agreement between the E test and the checkerboard method was 90%. The rate of resistance to individual agents ranged from 48% for meropenem to 100% for tobramycin, chloramphenicol, and rifampin. In 71.6%, 15.6%, and 12.6% of the test evaluations performed, the combinations tested resulted in additivity/indifference, synergism, and antagonism, respectively. The highest rates of synergy were observed with combinations of ciprofloxacin-piperacillin (44%), rifampin-ceftazidime (33%), chloramphenicol-ceftazidime (22%), cotrimoxazole-piperacillin/tazobactam (22%), and ciprofloxacin-ceftazidime (21%). Rates of antagonism for cotrimoxazole and chloramphenicol in combination with beta-lactam agents were higher than those observed for ciprofloxacin plus beta-lactam agents. These results suggest that the E test is a valuable and practical method to be considered for improving the identification of possible therapeutic options in cystic fibrosis patients infected with organisms belonging to the Burkholderia cepacia-complex.
Subject(s)
Bacteriological Techniques , Burkholderia Infections/drug therapy , Burkholderia cepacia/drug effects , Cystic Fibrosis/complications , Drug Therapy, Combination/pharmacology , Microbial Sensitivity Tests/methods , Burkholderia Infections/etiology , Burkholderia cepacia/isolation & purification , Ceftazidime/pharmacology , Chi-Square Distribution , Child , Child, Preschool , Ciprofloxacin/pharmacology , Cystic Fibrosis/drug therapy , Drug Resistance, Microbial , Drug Synergism , Female , Humans , Lactams/pharmacology , Male , Piperacillin/pharmacology , Rifampin/pharmacology , Sensitivity and SpecificityABSTRACT
H. influenzae, S. pneumoniae and M. catarrhalis are the most common bacterial pathogens causing respiratory infections in children. Resistance to antibiotics may vary according to the geographical area. It is therefore important that the resistance pattern of such pathogens is determined by surveillance studies carried out both on a national scale and by individual laboratories. In this study, we determined retrospectively the prevalence of H. influenzae, S. pneumoniae and M. catarrhalis in upper respiratory tract infections involving subjects of paediatric age, with reference to the type of clinical sample (pharingeal swab and nasal swab), symptomatology and age group. Moreover, for the above micro-organisms the pattern of sensitivity to antibiotics was assessed. In the observation period (January 1996-December 1999), at the day hospital of the Paediatric Pneumology Division of the Gaslini Institute in Genova, in 476 patients between 0 and 15 years of age a total of 460 respiratory pathogens were isolated: 164 S. pneumoniae strains, 163 of H. influenzae (96 belonging to type B and 67 non-attributable to any type) and 133 of M. catarrhalis. As regards sensitivity to antibiotics, ceftriaxone and amoxycillin/clavulanic acid proved to be the most active molecules in all the studied strains.
