ABSTRACT
OBJECTIVES: To determine risk factors for Serratia marcescens infection or colonization, and to identify the source of the pathogen and factors facilitating its persistence in a neonatal intensive-care unit (NICU) during an outbreak. DESIGN: Retrospective case-control study; review of NICU infection control policies, soap use, and handwashing practices among healthcare workers (HCWs); and selected environmental cultures. SETTING: A university-affiliated tertiary-care hospital NICU. PATIENTS: All NICU infants with at least one positive culture for S marcescens during August 1994 to October 1995. Infants who did not develop S marcescens infection or colonization were selected randomly as controls. RESULTS: Thirty-two patients met the case definition. On multivariate analysis, independent risk factors for S marcescens infection or colonization were having very low birth weight (< 1,500 g), a patent ductus arteriosus, a mother with chorioamnionitis, or exposure to a single HCW. During January to July 1995, NICU HCWs carried their own bottles of 1% chlorxylenol soap, which often were left standing inverted in the NICU sink and work areas. Cultures of 16 (31%) of 52 samples of soap and 1 (8%) of 13 sinks yielded S marcescens. The 16 samples of soap all came from opened 4-oz bottles carried by HCWs. DNA banding patterns of case infant, HCW soap bottle, and sink isolates were identical. CONCLUSIONS: Extrinsically contaminated soap contributed to an outbreak of S marcescens infection. Very-low-birth-weight infants with multiple invasive procedures and exposures to certain HCWs were at greatest risk of S marcescens infection or colonization.
Subject(s)
Anti-Infective Agents, Local , Cross Infection/transmission , Disease Outbreaks , Intensive Care Units, Neonatal , Serratia Infections/transmission , Serratia marcescens , Soaps , Xylenes , Case-Control Studies , Contact Tracing , Female , Housekeeping, Hospital , Humans , Infant, Newborn , Male , Retrospective Studies , Risk FactorsABSTRACT
Lyme disease is caused by the spirochete B. burgdorferi. Like its counterpart syphilis, it causes multisystem disease particularly affecting the skin, nervous system, heart and musculoskeletal system. It is endemic in several areas of the United States as well as in Europe. The prompt recognition of this disease and its diverse manifestations should lead to early treatment and resolution. Prevention is aimed at avoidance of the tick vector.
Subject(s)
Lyme Disease , Animals , Arachnid Vectors , Arthritis/etiology , Borrelia/isolation & purification , Diagnosis, Differential , Erythema/etiology , Humans , Lyme Disease/diagnosis , Lyme Disease/epidemiology , Lyme Disease/microbiology , Lyme Disease/therapy , Neuritis/etiology , Penicillins/therapeutic use , Rheumatic Fever/diagnosis , Tetracycline/therapeutic use , TicksABSTRACT
As part of a prospective study of acute bacterial meningitis in children, we studied for five years the hearing of 185 infants and children who had acute bacterial meningitis when they were more than one month of age. Nineteen (10.3 per cent) of the patients had persistent bilateral or unilateral sensorineural hearing loss. The incidence of hearing loss as determined by electric-response audiometry and conventional tests was 31 per cent with Streptococcus pneumoniae, 10.5 per cent with Neisseria meningitidis, and 6 per cent with Hemophilus influenzae infections. Transient conductive hearing impairment was found in 16 per cent of the sample, but in no case was there apparent improvement in a sensorineural deficit over time. The site of disease resulting in impaired hearing cannot be stated with certainty, but involvement of the inner ear or auditory nerve was suspected. The number of days of illness (symptoms) before hospitalization and institution of antibacterial treatment was not correlated with the development of sensorineural deafness.
Subject(s)
Bacterial Infections/complications , Hearing Loss, Conductive/etiology , Hearing Loss, Sensorineural/etiology , Hearing Loss/etiology , Meningitis/complications , Acute Disease , Adolescent , Anti-Bacterial Agents/therapeutic use , Audiometry , Bacterial Infections/diagnosis , Bacterial Infections/drug therapy , Child , Child, Preschool , Humans , Infant , Meningitis/diagnosis , Meningitis/drug therapy , Meningitis, Haemophilus/complications , Meningitis, Meningococcal/complications , Meningitis, Pneumococcal/complications , Prospective Studies , Time FactorsABSTRACT
Countercurrent immunoelectrophoresis was used for the detection of group- and type-specific antigens in the body fluids of 61 infants from St. Louis and Indiana with group B streptococcal infections. Urine concentrated using an Amicon filter yielded the highest percentage of positive results; 81% were positive in the St Louis group. When three body fluids (urine, CSF, and blood) were available, at least one was positive for group B streptococcus in 95% of the cases. This study demonstrates the applicability of this test in a tertiary care facility (St Louis) and in smaller hospitals (Indiana) with access to central laboratory.
Subject(s)
Antigens, Bacterial/analysis , Counterimmunoelectrophoresis , Immunoelectrophoresis , Streptococcal Infections/immunology , Streptococcus agalactiae/immunology , Child, Preschool , Evaluation Studies as Topic , Female , Hospitals, Community , Humans , Infant , Infant, Newborn , Infant, Newborn, Diseases/immunology , MaleABSTRACT
A diagnosis of leptospirosis was confirmed in nine children who were admitted to St. Louis Children's Hospital during the past 54 months. Epidemiologic, clinical, cultural, and serologic data which were obtained emphasize (1) the high incidence of urban cases; (2) contact with dogs as the most likely source of infection; and (3) that serotypes other than Leptospira icterohaemorrhagiae may produce severe clinical disease. Unusual or previously unreported manifestations of leptospirosis including acalculous cholecystitis, pancreatitis, abdominal causalgia, desquamating skin rashes, and infarction of the extremities which were noted in these children are discussed.
Subject(s)
Leptospirosis , Weil Disease , Adolescent , Animals , Child , Child, Preschool , Disease Vectors , Dogs , Female , Humans , Leptospira/immunology , Leptospira/isolation & purification , Leptospira interrogans/immunology , Leptospira interrogans/isolation & purification , Leptospirosis/diagnosis , Leptospirosis/epidemiology , Male , Missouri , Weil Disease/diagnosis , Weil Disease/epidemiologySubject(s)
Antigens, Bacterial/analysis , Counterimmunoelectrophoresis/methods , Immunoelectrophoresis/methods , Meningitis/immunology , Antigens, Bacterial/cerebrospinal fluid , Antigens, Bacterial/urine , Child , Humans , Meningitis/blood , Meningitis, Haemophilus/diagnosis , Meningitis, Meningococcal/diagnosis , Meningitis, Pneumococcal/diagnosisABSTRACT
Cephalexin was compared to ampicillin for the treatment of otitis media in a randomized study. Bacteriologic diagnosis was sought by needle tympanocentesis in 179 children. No overall statistically significant differences were noted between the two groups; however, 20 patients who received cephalexin had a poor response to therapy whereas only five recipients of ampicillin responded poorly. A significant difference (P less than .05) between the two regimens was noted when Hemophilus influenzae was recovered. Fifty per cent of the children with H. influenzae otitis media who were treated with cephalexin responded poorly; no patients receiving ampicillin had a poor response. Our data suggest that the use of cephalexin monohydrate is not warranted for treatment of otitis media due to H. influenzae even when the isolate proves sensitive to this drug in vitro. In selected patients with otitis media caused by Staphylococcus aureus which is resistant to penicillin, cephalexin may provide effective treatment.
Subject(s)
Ampicillin/therapeutic use , Cephalexin/therapeutic use , Otitis Media/drug therapy , Ampicillin/administration & dosage , Ampicillin/adverse effects , Cephalexin/administration & dosage , Child , Child, Preschool , Clinical Trials as Topic , Female , Follow-Up Studies , Haemophilus influenzae/isolation & purification , Humans , Infant , Male , Otitis Media/microbiology , Staphylococcus aureus/isolation & purificationABSTRACT
Fifty children with Hemophilus influenzae meningitis have been enrolled in a prospective study. Patients were randomly assigned chloramphenicol or ampicillin treatment; there were no significant differences between groups in other respects. Countercurrent immunoelectrophoresis proved to be a valuable tool for rapid diagnosis of the causative agent even in pretreated patients. Increasing quantities of capsular polyribosephosphate antigen detected in the initial cerebrospinal fluid correlated significantly (r=0.62419; p less than 0.01) with early and late sequelae of meningitis. None of the patients died. Severe and persistent neurologic or intellectual deficits were noted in four (8%) of the children, and an additional 14 (28%) had IQ scores between 70 and 90. The presence of bactericidal antibody in serum was not protective. Anti-PRP antibody generally was not present in acute serum specimens and irrespective of the quantity of antigenic stimulus provided by the disease was nondetectable in 21 of 24 children less than 17 months of age following recovery.
