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C15.1 Varicella in immunocompromised filipino children: A six-year experience
Free Papers llnternational Journal of Antimicrobial Agents 26S (2005) $65 Sl12
C14.11 Comparison of the Serum Sensitivity and Antibiotic Susceptibility of Uropathogenie EschericMa coli Strains Isolated from Different Diagnostic G r o u p s Jasmina VRANES, Branka BEDENIC. Zagreb U~ziversiiy Medical School, Zagreb Institute of Public Health, Zagreb, Croatia
Objectives: To determine and compare the serum sensitivity, anti genic structure, expression of adhesins and antibiotic susceptibility of uropathogenic Escherichia coli strains isolated from patients with urinary tract ilffection and asymptomatic bacteriuria Significance: The bactericidal activity of serum caused by complement system is an important defense mechanism protecting the host organism against infection. The capacity to resist bactericidal activity of normal human serum contributes to the virulence of many Gram negative pathogens. Study Design: Ex vivo study Setting: University hospital for infectious diseases Population: Patients with urinary tract infection or asymptomatic baeteriuria Methodology: The capacity of Escheriehia coli to resist the baeterici dal action of serum was examined in 85 clinical isolates obtained from patients with acute pyelonepliritis (n~3), acute cystitis (n~2), chi'onic pyelonephiitis (n 22) and asymptomatic bacteriuria (in 18). Serum sensitivity was also examined in relation to the serogroup specificity and expression of the different adhesins of the strains. Bacterial susceptibility to serum killing was measured by assessing regrowth after incubation in serum according to Schiller and Hatch method, and susceptibility to antimicrobial agents was determined by Kifw-Bauer disc diffusion method. The adhesins of E coli were detemfined by hemagglutination and inhibition of hemagglutination, and serotyping was peffm'med on glass slides and confirmed using a mechanized mieroteehnique. Results: The significant correlation between serum resistance of uropathogenic strains of E. coli and expression of P fimbriae and 06 serogroup was observed. P fimbriated strains were more frequently re sistant to tetracycline and cafoenicillin than strains in which P- fimbriae were not detected, and they all were resistant to amoxicillin, in contrast with non-P-fimbriated strains (p<0.01). The incidence of serum-resiatmlt E. eoli strains was significantly higher in strains isolated from urine of patients with acute pyelonephritis, as compared to strains isolated in other diagnostic groups (p<0.01), which is in accordance with higher virulence and invasive potential of these strains. Conclusion: The observed relationship between P-fimbriae and amoxicillin resistance among strains in which different serogroups were detected suggests the possibility of horizontal gene transfer of these properties.
C14.12 Risk Factors for Urinary Tract Infections due to Extendedspectrum [3-Lactamase Producing Escherichia coil in Children Eun Hwa CHOI 1,2, Jun-Ho LEE 1, Eun-Kyoung SONG l, Nam Hee KIM1, Jin-A. LEE 1, Kyung-Chang OH 1, Hoan-Jong LEE 1. ISeou l National Universi~ College of Medicine; 2Medical Seience Researeh Institute, Seoul National Universiiy Bundang Hospital, Seoul, Korea
Objective: To evaluate risk factors for urinary tract infection (UT1) by extended spectrum ~ lactamase (ESBL) producing Escheriehia eoli in children. Significance: By validating the risk factm's for infection by ESBLproducers in pediatric UTI, we can appropriately control the wide spread of this emerging foml of resistance. Study Design: Prospective cohort study Setting: A 250 bed, tertiary care university hospital and referral center Population: Hospitalized children Methodology: We analyzed 125 episodes of UTI which developed in
S101
112 c[fildren at the Seoul National University Children's Hospital from July to December 2002. Medical records of 74 episodes of UTI caused by k~ eoli were reviewed in search for possible risk factors for infection by ESBL producers. The presence of ESBL in k~ eoli was screened and confirmed by the National Committee for Clinical Laboratmy Standards guidelines, double disc syne1~gytest, or both. Results: The most common pathogens of UTI were K coli (174 isolates), followed by Enterobacter spF. (9 isolates) and Klebsiella spp. (8 isolates). Fifteen isolates were Gram positive microorganisms. Overall, 18% (:13 of 74:) episodes of k~ eoli UTI were due to ESBL producing organisms. After adjustment for potentially confounding variables, previous hospitalization within 6 months (p 0.001; odds ratio [OR], 8.72, 95% confidence interval [CI], 1.87 to 40.61) and prior use of extended-spectrum cephalosporins within a month (p=0.009; OR10.94, 95% CI, 1.59 to 75.4:) were associated with the increased risk of UTI by ESBL producing E. coll. However, age, sex, and the underlying urogenital anomalies did not contribute to the development of UTI by ESBL-producing E. coli. Conclusion: ESBL-producing stlains of E. coli have been increasingly recognized in pediatric UTI. Previous use of antibiotics was related to the risk of infection by ESBL producers. Therefore, prudent use of antibiotics should be recommended for the antimierobial therapy in children.
C15. Viral Infections C15.1
Varicella in Immunocompromised Filipino Children: A Six-Year Experience Elizabeth GALLARDO. Philippine General Hospital, Manila, Philippines Objective: To describe the profile, clinical course, treatment and outcome of varicella in immunocompromiscd children at the Philippine General Hospital from January 1999 to December 2004 Significance: Immunocompromised patients with impaired ceUmediated immunity are prone to develop severe vadceUa and its complications. Locally, there has been no study done on the management and outcome of varicella in such children. Study Design: Retrospective descriptive study Setting: Pediatric wards of a tertiary government university hospital Population: Immunocompromised children with varicella Methodology: All (consecutive) immunocompromised patients aged 0 to less than 19 years old with a clinical diagnosis of variceUa adnlitted at the Pliilippine GenerM Hospital during the six-year study period were included. We reviewed medical records and monthly census reports of the Pediatric Infectious Disease and Hematology Oncology Services. Results: Out of 26 immunocompromiscd patients who developed variceUa during the study period, only 22 charts were available for review (185%). Of these patients, 50% were males and 41% were females. The higheat incidence occmred from 0 to 5 years (141%1). Twenty (201) patients had an underlying malignancy in the form of leukemia (n=14) and solid organ tumors (n=6) and were mostly on maintenance phase of anti cancer treatment. Two patients were on chronic high dose steroid therapy (prednisone) for mine than a month due to neptu'otic syndrome and myelodysplastic syndrome with Stevens-Johnson Syndrome. The moat common presenting symptom was a rash (68%1) with an associated fever seen in 54% of cases. Majority were treated with acyclovir (96%), initially given intravenously then shifted to oral or purely oral for an average of 7 days with good response. Nine patients developed complications (41%), mailfly pneumonia and sepsis. Recovery rate was 82% with a case fatality rate of 13.6%. Conclusion: V,uiceUa in immunocompromised cliildren is associated with increased morbidity and mortality. Our patients responded well to both sequential intravenous and oral acyclovir as well as to oral acyclovir alone.
C14.11 Comparison of the Serum Sensitivity and Antibiotic Susceptibility of Uropathogenie EschericMa coli Strains Isolated from Different Diagnostic G r o u p s Jasmina VRANES, Branka BEDENIC. Zagreb U~ziversiiy Medical School, Zagreb Institute of Public Health, Zagreb, Croatia
Objectives: To determine and compare the serum sensitivity, anti genic structure, expression of adhesins and antibiotic susceptibility of uropathogenic Escherichia coli strains isolated from patients with urinary tract ilffection and asymptomatic bacteriuria Significance: The bactericidal activity of serum caused by complement system is an important defense mechanism protecting the host organism against infection. The capacity to resist bactericidal activity of normal human serum contributes to the virulence of many Gram negative pathogens. Study Design: Ex vivo study Setting: University hospital for infectious diseases Population: Patients with urinary tract infection or asymptomatic baeteriuria Methodology: The capacity of Escheriehia coli to resist the baeterici dal action of serum was examined in 85 clinical isolates obtained from patients with acute pyelonepliritis (n~3), acute cystitis (n~2), chi'onic pyelonephiitis (n 22) and asymptomatic bacteriuria (in 18). Serum sensitivity was also examined in relation to the serogroup specificity and expression of the different adhesins of the strains. Bacterial susceptibility to serum killing was measured by assessing regrowth after incubation in serum according to Schiller and Hatch method, and susceptibility to antimicrobial agents was determined by Kifw-Bauer disc diffusion method. The adhesins of E coli were detemfined by hemagglutination and inhibition of hemagglutination, and serotyping was peffm'med on glass slides and confirmed using a mechanized mieroteehnique. Results: The significant correlation between serum resistance of uropathogenic strains of E. coli and expression of P fimbriae and 06 serogroup was observed. P fimbriated strains were more frequently re sistant to tetracycline and cafoenicillin than strains in which P- fimbriae were not detected, and they all were resistant to amoxicillin, in contrast with non-P-fimbriated strains (p<0.01). The incidence of serum-resiatmlt E. eoli strains was significantly higher in strains isolated from urine of patients with acute pyelonephritis, as compared to strains isolated in other diagnostic groups (p<0.01), which is in accordance with higher virulence and invasive potential of these strains. Conclusion: The observed relationship between P-fimbriae and amoxicillin resistance among strains in which different serogroups were detected suggests the possibility of horizontal gene transfer of these properties.
C14.12 Risk Factors for Urinary Tract Infections due to Extendedspectrum [3-Lactamase Producing Escherichia coil in Children Eun Hwa CHOI 1,2, Jun-Ho LEE 1, Eun-Kyoung SONG l, Nam Hee KIM1, Jin-A. LEE 1, Kyung-Chang OH 1, Hoan-Jong LEE 1. ISeou l National Universi~ College of Medicine; 2Medical Seience Researeh Institute, Seoul National Universiiy Bundang Hospital, Seoul, Korea
Objective: To evaluate risk factors for urinary tract infection (UT1) by extended spectrum ~ lactamase (ESBL) producing Escheriehia eoli in children. Significance: By validating the risk factm's for infection by ESBLproducers in pediatric UTI, we can appropriately control the wide spread of this emerging foml of resistance. Study Design: Prospective cohort study Setting: A 250 bed, tertiary care university hospital and referral center Population: Hospitalized children Methodology: We analyzed 125 episodes of UTI which developed in
S101
112 c[fildren at the Seoul National University Children's Hospital from July to December 2002. Medical records of 74 episodes of UTI caused by k~ eoli were reviewed in search for possible risk factors for infection by ESBL producers. The presence of ESBL in k~ eoli was screened and confirmed by the National Committee for Clinical Laboratmy Standards guidelines, double disc syne1~gytest, or both. Results: The most common pathogens of UTI were K coli (174 isolates), followed by Enterobacter spF. (9 isolates) and Klebsiella spp. (8 isolates). Fifteen isolates were Gram positive microorganisms. Overall, 18% (:13 of 74:) episodes of k~ eoli UTI were due to ESBL producing organisms. After adjustment for potentially confounding variables, previous hospitalization within 6 months (p 0.001; odds ratio [OR], 8.72, 95% confidence interval [CI], 1.87 to 40.61) and prior use of extended-spectrum cephalosporins within a month (p=0.009; OR10.94, 95% CI, 1.59 to 75.4:) were associated with the increased risk of UTI by ESBL producing E. coll. However, age, sex, and the underlying urogenital anomalies did not contribute to the development of UTI by ESBL-producing E. coli. Conclusion: ESBL-producing stlains of E. coli have been increasingly recognized in pediatric UTI. Previous use of antibiotics was related to the risk of infection by ESBL producers. Therefore, prudent use of antibiotics should be recommended for the antimierobial therapy in children.
C15. Viral Infections C15.1
Varicella in Immunocompromised Filipino Children: A Six-Year Experience Elizabeth GALLARDO. Philippine General Hospital, Manila, Philippines Objective: To describe the profile, clinical course, treatment and outcome of varicella in immunocompromiscd children at the Philippine General Hospital from January 1999 to December 2004 Significance: Immunocompromised patients with impaired ceUmediated immunity are prone to develop severe vadceUa and its complications. Locally, there has been no study done on the management and outcome of varicella in such children. Study Design: Retrospective descriptive study Setting: Pediatric wards of a tertiary government university hospital Population: Immunocompromised children with varicella Methodology: All (consecutive) immunocompromised patients aged 0 to less than 19 years old with a clinical diagnosis of variceUa adnlitted at the Pliilippine GenerM Hospital during the six-year study period were included. We reviewed medical records and monthly census reports of the Pediatric Infectious Disease and Hematology Oncology Services. Results: Out of 26 immunocompromiscd patients who developed variceUa during the study period, only 22 charts were available for review (185%). Of these patients, 50% were males and 41% were females. The higheat incidence occmred from 0 to 5 years (141%1). Twenty (201) patients had an underlying malignancy in the form of leukemia (n=14) and solid organ tumors (n=6) and were mostly on maintenance phase of anti cancer treatment. Two patients were on chronic high dose steroid therapy (prednisone) for mine than a month due to neptu'otic syndrome and myelodysplastic syndrome with Stevens-Johnson Syndrome. The moat common presenting symptom was a rash (68%1) with an associated fever seen in 54% of cases. Majority were treated with acyclovir (96%), initially given intravenously then shifted to oral or purely oral for an average of 7 days with good response. Nine patients developed complications (41%), mailfly pneumonia and sepsis. Recovery rate was 82% with a case fatality rate of 13.6%. Conclusion: V,uiceUa in immunocompromised cliildren is associated with increased morbidity and mortality. Our patients responded well to both sequential intravenous and oral acyclovir as well as to oral acyclovir alone.