Septicemia In Children Research Articles

Comparison of the efficacy, safety and cost of cefixime, ceftriaxone and aztreonam in the treatment of multidrug-resistant Salmonella typhi septicemia in children

An increase in the incidence of Salmonella typhi strains resistant to chloramphenicol, ampicillin and trimethoprim-sulfamethoxazole causing enteric fever in Egyptian children stimulated the evaluation of alternative drugs. Children with positive blood cultures were treated with cefixime, ceftriaxone or aztreonam, and the efficacy, safety and cost of these regimens were evaluated and compared. Cefixime (7.5 mg/kg) was given orally twice daily to 50 children for 14 days, ceftriaxone (50 to 70 mg/kg) was given im once daily for 5 days to 43 children and aztreonam (50 to 70 mg/kg) was given im every 8 hours for 7 days to 31 children. Children in the 3 groups were comparable with regard to age, sex, duration and severity of illness before admission. All children were cured. A significant difference (P < 0.05) in duration of treatment before becoming afebrile seemed to favor ceftriaxone (3.9 days) over aztreonam (5.5 days) and cefixime (5.3 days). During the 4-week follow-up period relapses occurred in 3 (6%) children in the cefixime group, in 2 (5%) in the ceftriaxone group and in 2 (6%) in the aztreonam group. Safety and efficacy were comparable for all 3 drugs. Ceftriaxone was most cost-effective on an inpatient basis, because of a more rapid clinical cure, and cefixime was the most cost-effective on an outpatient basis, because of drug cost.

Moraxella septicemia in children with diarrheal disease

We report 10 cases of Moraxella septicemia associated with diarrheal disease. Their clinical presentations and outcomes are discussed. Recognition of the pathogenicity of these microorganisms in appropriate clinical setting should result in prompt and specific therapy.

Fatal pneumococcal septicemia in hemoglobin SC disease

We retrospectively examined the medical and autopsy records of seven previously unpublished cases of fatal pneumococcal septicemia in children with hemoglobin SC disease. The earliest death occurred in a 1-year-old child who had congenital heart disease with cyanosis; the other children were aged 3 1/2 to 15 years. Only one child had received pneumococcal vaccine or prophylactic penicillin therapy. All seven children had an acute febrile illness and rapid clinical deterioration despite parenterally administered antibiotic therapy and intensive medical support. Erythrocyte pit counts in two patients were 40.3% and 41.7%, respectively (normal, < or = 3.6%). Autopsy data from five cases showed marked splenic congestion without infarction in five, splenomegaly in four, and bilateral adrenal hemorrhage in three. These cases illustrate that functional asplenia predisposes some children with hemoglobin SC disease to the development of fatal septicemia after the age of 3 years. We conclude that pneumococcal vaccine should be administered to all children with hemoglobin SC disease and that acute febrile illnesses should be investigated promptly for the possibility of septicemia. The routine use of prophylactic penicillin therapy in infants and children with hemoglobin SC disease remains controversial.

The management of skin infarction after meningococcal septicaemia in children

The clinical course and management of 21 children (12 females, 9 males; mean age 2.4 years) with skin necrosis secondary to meningococcal septicaemia is described. Skin necrosis was most commonly sited in the lower limbs (20 patients). Sixteen patients had multiple areas of involvement and amputation of the digits was required in 5 patients. One required an above knee amputation. Small areas of skin necrosis were managed conservatively (4 patients) but larger areas required debridement and grafting. Skin grafting was delayed in 15 patients and graft loss occurred in 8. Multiple grafting procedures were required in 6 patients. Scar revision was required in 6 patients. Nutritional support is also an important component of management.

Outbreak of group a streptococcus septicemia in children: Wheeler MC, Roe MH, Kaplan EL, Schlievert PM, Todd JK. 1991;266:533–537

Outbreak of group a streptococcus septicemia in children: Wheeler MC, Roe MH, Kaplan EL, Schlievert PM, Todd JK. 1991;266:533–537

Group A Streptococcus Septicemia in Children

To the Editor. —Wheeler et al 1 reported a real increase in the incidence of of severe group A streptococcus sepsis in children in Denver based on an increase in cases per 10 000 patient discharges. A case was defined as a patient with one or more positive blood cultures. It is important to determine whether the incidence of discovery of septicemia in this defined medical care environment has changed over the 10-year period of this study and is therefore responsible for the observed increase in incidence rather than an actual increase in in Denver. Similar increases in the incidence of septicemia have been observed in our institution, but these disappear when intensity of discovery is controlled for. In order to control for changes in length of stay, it is necessary to calculate the incidence density for each period, which can be defined as follows: (number of

Group A streptococcus septicemia in children

Group A streptococcus septicemia in children

Outbreak of group A streptococcus septicemia in children. Clinical, epidemiologic, and microbiological correlates

Outbreak of group A streptococcus septicemia in children. Clinical, epidemiologic, and microbiological correlates

Outbreak of Group A Streptococcus Septicemia in Children

To determine the epidemiologic, clinical, and microbiological features of group A streptococcus septicemia in children. A descriptive series of 34 cases over an 11-year period from 1980 through 1990. An academically affiliated tertiary-care pediatric hospital, the principal referral center for the state of Colorado and surrounding states. Thirty-four patients with positive blood cultures for group A streptococcus (33 medical records were available). Yearly incidence and clinical features of cases; microbiological features of isolated organisms. There was a significant increase (P = .01) in the incidence of group A streptococcus bacteremia over an 11-year period, with 14 (41%) of these cases occurring in 1989 and 1990. Patients had a rapidly progressing illness, usually without preceding pharyngitis. The prominent M and T types were 1 (4) and 12 (4). Eleven (73%) of the 15 strains produced pyrogenic exotoxin B that significantly correlated with production of proteinase. There appears to be an increase in group A streptococcus bacteremia in children that is associated with a strain phenotype that suggests a change in organism virulence.

Management of Bacterial Meningitis and Septicaemia in Children: Role of Antibiotics, Immunoglobulins and Corticosteroids

(1990). Management of Bacterial Meningitis and Septicaemia in Children: Role of Antibiotics, Immunoglobulins and Corticosteroids. Scandinavian Journal of Infectious Diseases: Vol. 22, No. sup73, pp. 1-56.

Increased Incidence of Gram-Positive Cocci Septicemia in Children with Leukemia and Lymphoma

Increased Incidence of Gram-Positive Cocci Septicemia in Children with Leukemia and Lymphoma

Staphylococcus epidermidis Septicemia in Children: An Emerging and Difficult Problem

Bacteria thought to be innocuous are a hazard to children whose immunologic capability is reduced by disease or by immunosuppressive therapy. Among bacteria responsible for severe infections is Staphylococcus epidermidis , a common surface inhabitant, ordinarily of no consequence to a healthy host. In the August issue of the American Journal of Diseases of Children (AJDC) , Louise Friedman and her colleagues at Memorial Sloan-Kettering and Cornell University Medical College in New York City detail the role of S epidermidis as a cause of septicemia among 92 children with leukemia. 1 They report that 12.7% of all septicemic episodes are caused by S epidermidis and explore the factors that have allowed this organism to become the fourth most frequent pathogen in their experience. The severity of S epidermidis septicemia is underscored by two deaths among the 19 patients affected. Primary care physicians are now responsible for the ongoing care of children who

Staphylococcus epidermidis septicemia in children: an emerging and difficult problem

Staphylococcus epidermidis septicemia in children: an emerging and difficult problem

Staphylococcus epidermidis septicemia in children with leukemia and lymphoma.

Staphylococcus epidermidis is emerging as a cause of morbidity and mortality in immunocompromised patients. From January 1980 through June 1982, there were 150 episodes of septicemia in 92 children with leukemia and lymphoma at Memorial Sloan-Kettering Cancer Center, New York. Staphylococcus epidermidis was the fourth most common organism isolated, responsible for 12.7% of all septicemic episodes. Only nine of 53 isolates were sensitive to methicillin; all were sensitive to vancomycin. Staphylococcus epidermidis septicemia was associated with immunosuppressive chemotherapy (94.7%); broad-spectrum antibiotics (79.0%); catheters and drains (73.7%); neutropenia (63.2%); skin or soft-tissue infections (42.1%); prior septicemia (42.1%); concurrent polymicrobial septicemia (21.1%); and prolonged hospitalization (mean, 39 days). Of 19 patients, two died. Increased awareness of the pathogenic potential of S epidermidis in children with hematologic malignancies and prompt alteration of therapy to an effective antimicrobial agent, in most cases vancomycin hydrochloride, is required when the organism is isolated in patients known to be at risk with clinical evidence of septicemia.

Fulminating Clostridial Septicemia in Children treated for Lymphoproliferative Disorders

Fulminating Clostridial Septicemia in Children treated for Lymphoproliferative Disorders

Quantitative blood cultures in the evaluation of septicemia in children with Broviac catheters

We applied quantitative methods of analysis to all blood cultures drawn during the course of treatment in 28 children with Broviac catheters in a central vein. Thirty febrile episodes in 14 of these patients were evaluated. Samples of blood obtained from a peripheral vein and through the central catheter were cultured quantitatively on agar plates and nonquantitatively in standard broth media. Catheters were judged to be a source of septicemia nine times in seven children. In all nine positive catheter samples, the concentration of pathogens was 10 times as great as that observed in the peripheral venous sample. The blood drawn through the Broviac catheter contained greater than or equal to 2000 colony-forming units per milliliter in six cases. Quantitative cultures in two patients with septicemia not attributable to the catheter yielded low colony counts in the catheter sample. Cultures of blood samples drawn through the catheter when a child was well were not helpful in predicting subsequent septicemia. The technique of inoculating blood directly onto agar plates is easily performed and superior to standard broth cultures, because it detected pathogens within 16 hours and identified infections with multiple organisms.

Use of buffy-coat smears in the diagnosis of septicaemia in children.

Gram-stained buffy-coat smears from venous and capillary blood samples in 105 children suspected of septicaemia were examined for the presence of bacteria and the results compared with blood culture isolates. Gram-positive and Gram-negative bacteria were identified in 18 venous (44%) and 19 capillary (46%) buffy-coat preparations in 41 instances where bacterial organisms were isolated from the blood cultures. It is concluded that the examination of buffy-coat smears for bacteria in children suspected of septicaemia is a useful adjunct to blood cultures and, in areas where no facilities exist for culture of blood, may be a simple and rapid method of establishing the diagnosis of bacteraemia in suspected patients.

C-reactive protein in rapid diagnosis and follow-up of bacterial septicemia in children with leukemia.

C-reactive protein (CRP) was evaluated as an indicator of septic bacterial infections in children with acute lymphoblastic leukemia (ALL). Thirty-five children with newly diagnosed ALL and 10 children receiving antileukemic chemotherapy developed 13 episodes of verified septicemia. Newly diagnosed ALL alone influenced the CRP level moderately; half of the children with no concomitant bacterial infection had measurable CRP values. However, the CRP values in this group were significantly lower than those in children with proved septicemia in whom the CRP level ranged from 15 to 340 mg/liter (median, 125 mg/liter). We conclude that CRP levels exceeding 100 mg/liter indicate bacterial septicemia with a high specificity regardless of the stage of ALL. Moreover, a negative CRP value virtually excludes septicemia. Patients ith moderately elevated CRP values, i.e. under 100 mg/liter, should be closely observed. Sequential CRP determinations are useful in children with invasive bacterial infections.

Is There an Increased Risk of Haemophilus influenzae Septicemia in Children with Sickle Cell Anemia?

The risk of Haemophilus influenzae septicemia/meningitis to children who have sickle cell anemia (SS) has been determined to be greater than that seen among normal infants. Of ten bacteriologically proven cases, eight episodes of infection were observed among 234 children with sickle cell anemia (645 person-years), who were less than 5 years of age. There was one case per 69 infants with sickle cell anemia who were less than 18 months old and one case per 36 children with sickle cell anemia between 19 and 59 months of age. Unexpectedly, two infections occurred among 224 children (824 person-years), aged 5 to 9 years; both died. Contrary to the rapid clinical course of pneumococcal infections in children with sickle cell anemia H influenzae septicemia was regularly heralded by a greater than 24-hour prodrome of upper respiratory tract infection, low-grade fever, and otitis media. Three (30%) preventable deaths occurred. Antibiotic therapy for the febrile child with sickle cell anemia must be predicated on the known 400-fold increased risk of pneumococcal septicemia in those less than 5 years old and the fourfold risk of H influenzae septicemia in those less than 9 years of age.

Selection of antimicrobial agents for initial treatment of suspected septicemia in infants and children.

Septicemia is relatively common in infants and children, and empiric antimicrobial therapy is frequently necessary. In immunocompetent children the most likely causative agents are Streptococcus pneumoniae, Haemophilus influenzae, Neisseria meningitidis, and Salmonella species. Effective empiric therapy is often the combination of ampicillin and chloramphenicol. In immunocompromised children the etiologic possibilities in septicemia include a large number of opportunistic pathogens, the most common of which are Escherichia coli and other enteric bacilli, Pseudomonas species and other hospital-related bacilli, and Staphylococcus aureus. Empiric therapy often consists of an aminoglycoside, a penicillinase-resistant penicillin or cephalosporin, and carbenicillin or ticarcillin. The third-generation cephalosporins offer considerable promise in the empiric treatment of septicemia in children.