RESUMO
Streptococcus lutetiensis has been known to cause sepsis in adults, but only one case regarding neonatal sepsis has been reported internationally, with no sequelae. We report the first case of neonatal bacteremia and meningitis with empyema caused by S. lutetiensis in the United States.
RESUMO
Evaluation of: Violari A, Paed FC, Cotton MF et al.: Early antiretroviral therapy and mortality among HIV-infected infants. N. Engl. J. Med. 359(21), 2233-2244 (2008). Violari and her colleagues report the first randomized, open-label trial showing that early diagnosis and treatment with antiretroviral therapy decreases mortality and HIV progression in HIV-infected infants. The reality of implementing this recommendation into clinical care is challenging in resource-poor countries. Support for earlier diagnosis and access to antiretrovirals is improving, but access to HAART for all HIV-infected infants and children is often lacking. A change in care systems advocating early institution of antiretroviral therapy for all infants in these developing countries is clearly needed.
RESUMO
Infections caused by vancomycin-resistant enterococci (VRE) may be difficult to treat because of the limited armamentarium of antimicrobial agents. The difficulty is compounded in pediatric patients in general and neonates in particular because many of the newer antimicrobials have not been studied or approved for children. We report a 3-week-old infant who developed enterococcal bacteremia on post-operative day 10 after a surgical palliation for complex congenital heart disease that was complicated by acute renal failure. Despite removal of vascular catheters and antimicrobial regimens that included linezolid, quinupristin/dalfopristin, ampicillin/sulbactam, rifampin, and gentamicin, bacteremia persisted. It was not cleared until daptomycin (in combination with doxycycline) was started. This is the first case of successful treatment of probable endocarditis due to VRE in a neonate using a daptomycin-containing regimen.
