Prevalence and trends in the antimicrobial susceptibility pattern of Salmonella enterica serovars Typhi and Paratyphi A among children in a pediatric tertiary care hospital in South India over a period of ten years: a retrospective study.

The aim of this study was to determine the prevalence and trends in the antimicrobial resistance of typhoidal salmonellae in children and adolescents at a pediatric tertiary care hospital in South India. Typhoidal salmonellae were isolated from 483 of the 77,713 blood cultures received during the ten-year study period (2007-2016). Isolates were speciated by conventional biochemical reactions and serotyping. Antimicrobial susceptibility testing was performed and interpreted according to the British Society for Antimicrobial Chemotherapy (BSAC)/European Committee on Antimicrobial Susceptibility Testing (EUCAST) guidelines. The overall blood culture isolation rates of Salmonella enterica serovars Typhi and Paratyphi A in children were 0.5% (408 cases) and 0.1% (73 cases), respectively, with the highest isolation rates in school [299 (61.9%)] and preschool children [113 (23.4%)]. A decreasing prevalence of enteric fever was seen from 2012 to 2015, with a sudden surge in 2016. From 2011 onwards, a high fluoroquinolone resistance (90-100%) was observed. Multidrug resistance was observed in only four (0.9%) S. Typhi isolates. 100% susceptibility to third-generation cephalosporins and azithromycin was noted. Enteric fever as seen in a pediatric tertiary care hospital in India affects children and adolescents of all age groups, with greater isolation rates in school children, followed by those in preschool years, calling for targeted interventions against these age groups. The study findings support the use of third-generation cephalosporins and azithromycin as first-line therapy and ampicillin and co-trimoxazole as step-down therapy in pediatric enteric fever. However, continued local surveillance should be done to detect antimicrobial resistance trends to optimize treatment.

Clinical and Microbiology Profile and Outcome of Diarrhea by Coccidian Parasites in Immunocompetent Children.

BACKGROUND: Several studies have reported prevalence of pediatric coccidian parasitic diarrhea, but there is little information about their clinical profile, management and outcome. This study reviews the clinical profile and treatment outcome of coccidian parasitic diarrhea in immunocompetent children. METHODS: Five thousand one hundred and twenty-three immunocompetent children younger than 15 years of age presenting with acute diarrhea to a tertiary care pediatric hospital during a period of 4 years (2009-2012) were included in the study. Their demographic details and clinical course were recorded, and feces specimens received in the microbiology laboratory were subject to microbiology culture, wet mount microscopy, modified Ziehl-Neelsen staining to detect intestinal coccidian parasites and rotavirus sandwich enzyme-linked immunosorbent assay test (if age less than 2 years). RESULTS: The prevalence of coccidian parasitic diarrhea in immunocompetent children was 1.13% (58 cases) with Cryptosporidium spp. accounting for 1.09% (56 cases). Most Cryptosporidium infections were in children younger than 2 years [38 (67.85%)] and during the monsoon season [32 (57.14%)] with common clinical features being watery or liquid feces [44 (78.57%)], vomiting [40 (71.43%)] and fever [35 (62.5%)]. Thirteen (81.25%) of the 16 cases of cryptosporidiosis with dehydration were less than 2 years of age. Fifty-one (87.93%) of the 58 children were hospitalized. Thirty-eight (67.85%) children with cryptosporidiosis received empiric antimicrobial agents for suspected enteric bacterial and protozoan parasitic infection, which were discontinued after coccidian parasites were detected. Median duration of hospitalization was 2 days with no mortality reported. CONCLUSIONS: Coccidian parasitic diarrhea affects immunocompetent children of all age groups. Unnecessary administration of antimicrobial agents to these children can be avoided by routinely screening pediatric diarrheal fecal specimens for coccidian parasites by a cost-effective method such as modified Ziehl-Neelsen staining.

Umbilical arterial catheter insertion length: in quest of a universal formula.

OBJECTIVE: The study was aimed at comparing the accuracy in length of insertion of umbilical arterial catheter in all new born groups stratified according to weight, by using two different methods, that is, Wright et al./Case (Group I): (4 × Body wt (BW) (kg)) +7; Shukla et al./Control (Group II): (3 × BW (kg)) +9. STUDY DESIGN: It was a randomized open label case control study in a Level III tertiary level Neonatal Intensive Care Unit over 9 months. RESULT: The babies in both the groups were similar in relation to weight, gender, prematurity and weight subgroups. Under insertion was seen in 8% (4/50) of babies in group I and over insertion was seen in group II where it was 32.6% (16/49). There was a reduction of 82% abnormal insertions and repositioning by using the Wright's formula as compared with the Shukla's formula in preterm babies. Statistically significant reduction in repositioning was seen in all babies <1500 g in Group I and under insertion seen in 8% of babies in group I did not attain statistical significance (P=0.34). CONCLUSIONS: There is no universal formula, which gives the accurate length of placement of an umbilical arterial catheter, but Wright's formula comes closer in neonates with different weight sub groups.