Development of resistance in Pseudomonas aeruginosa obtained from patients with cystic fibrosis at different times.

OBJECTIVE: Determination of the extent of changes in quantitative resistance in Pseudomonas aeruginosa isolates from patients with cystic fibrosis over a period of approximately 2 years. METHODS: Three hundred and ninety nine isolates of P. aeruginosa collected from 34 pediatric patients in the period between April 1994 and April 1996 were investigated. During the 2 years the children were treated with a combination of a betalactam and an aminoglycoside, approximately every 3 months. In between they received ciprofloxacin orally, when required. The minimal inhibitory concentrations (MICs) of 38 clones of P. aeruginosa defined by different patterns in macrorestriction analysis (pulse field gel electrophoresis, PFGE) were established for 12 antibiotics: gentamicin, amikacin, tobramycin, ciprofloxacin, levofloxacin, moxifloxacin, trovafloxacin, imipenem, meropenem, ceftazidime, cefepime, and piperacillin by means of broth microdilution tests according to DIN 58940. RESULTS: Twenty-four of the 38 clones developed increased MIC values during the time of observation especially for aminoglycosides and quinolones. Comparatively less affected were ceftazidime, imipenem and meropenem. An association between the number of the intravenous treatment courses and the increase of the MIC values could not be verified. CONCLUSIONS: A trend towards an increase of the MICs against antipseudomonal agents was observed over a limited period of time. It is necessary to prevent this development possibly by employing suitable combinations of antibiotics and the introduction of new substances.

Epidemiologic characterization of Pseudomonas aeruginosa in patients with cystic fibrosis.

OBJECTIVE: To determine persistence and variability of colonization with Pseudomonas aeruginosa in cystic fibrosis patients over long time periods, and to look for possible cross-colonization. METHODS: In total, 469 Pseudomonas aeruginosa isolates were obtained from 30 patients during the period from April 1994 to April 1996. The sources were mainly sputum and a few deep throat swabs. All grown strains dissimilar in macromorphology were processed separately. Typing with PFGE was carried out by contour-clamped homogeneous electric field electrophoresis. Genomic DNA was subjected to the rare-cutting restriction enzyme SpeI. For pyocin typing, the procedure described by Fyfe was applied. RESULTS: After typing with PFGE, we observed 40 restriction profiles. Eighteen different pyocin types were found. The most frequent pyocin type was type 3, followed by types 1 and 5. Twenty-two patients were persistently colonized by one clone specific and different for each patient, and four were co-colonized by a second clone also different for each of these patients. Cross-colonization had apparently been rare in the cystic fibrosis center of Leipzig. CONCLUSIONS: Typing with PFGE is well suited for detailed investigations of colonization with Pseudomonas aeruginosa in cystic fibrosis patients. Pyocin typing can provide additional information for epidemiologic purposes.

Soft tissue infection caused by Kingella kingae in a child.

During the last years an increasing number of reports concerning Kingella kingae infections in children has been published. Most cases were osteoarticular infections. The authors report the clinical and laboratory findings from a 3-year-old child with a presternal soft tissue infection due to K kingae. After surgical excochleation and antibiotic treatment there was an uneventful recovery. J Pediatr Surg 36:946-947.

[Rare case of an epidemiologically important tuberculosis in childhood]. / Seltener Fall einer epidemiologisch bedeutsamen Tuberkulose im Kindesalter.

BACKGROUND: Tuberculosis is an infectious disease which is nearly forgotten in Germany because of its low incidence. CASE REPORT: We report on a 14-year-old german girl who was disregarded when active case-finding of her uncle's active pulmonary tuberculosis was carried out three years before. As a result she herself developed a severe infectious pulmonary tuberculosis. The delay between onset of symptoms and diagnosis gives cause for concern and led to active tuberculosis in her brother and her girl friend as well. The lack of information about tuberculosis in population and delay of medical detection in this case led unnecessarily to the continuing chain of infection. CONCLUSIONS: This case report shows that there are severe infectious courses of tuberculosis even in childhood which might get epidemiologically important. For earlier diagnosis and successful interruption of chains of infection tuberculosis in the German population even today has to be taken into account. Case detection through contact investigation of adults is of great importance in childhood and adolescence.

[Urinary tract infection by Staphylococcus saprophyticus in a child]. / Harnwegsinfektion durch Staphylococcus saprophyticus bei einem Kind.

UNLABELLED: Staphylococcus (S.) saprophyticus belongs to the coagulase-negative staphylococci and is the cause of urinary tract infections, especially in young women, rarely in children and in elderly men. Probably the real incidence of urinary tract infections due to these organisms is higher than usually accepted. We report on a 11 3/12-year-old girl, who developed symptoms of a urinary tract infection (dysuria, flank pain), but without fever and elevated CRP. In the bladder aspirate we found leukocytes and S. saprophyticus (cotrimoxazole-resistant). Ultrasound detected intrarenal doubling, but no typical anomalies, disposing for urinary tract infections. The treatment with cefuroxim i.v. and clindamycin p.o. was successful. CONCLUSION: Coagulase-negative staphylococci cultivated in urine represent contamination (mostly S. epidermidis--except in patients, who have undergone manipulation or catheterization of the urinary tract) or they are the cause of an urinary tract infection (mostly S. saprophyticus).

[Dentogenic infection due to Streptococcus constellatus in a child]. / Dentogene Infektion durch Streptococcus constellatus bei einem Kind.

An 8-year-old boy was admitted with a pain-full swelling at the right mandible and symptoms of septicemia. The illness was caused by a dental infection due to Streptococcus constellatus proved by isolation from blood culture, the origin was a decayed tooth. Treatment comprised suitable antibiotics, extraction of the tooth and local irrigations with chlorhexidine solution. General condition improved rapidly, the local situation rather slowly, however.

[Pyogenic sacroiliitis in children]. / Beitrag zur bakteriellen Sakroiliitis im Kindesalter.

Pyogenic sacroiliitis is a rarely occurring disease. In recent years more reports have been published about this topic. We report on a case of infectious sacroiliitis in a young female patient. The multivarious clinical symptoms, the problems of diagnosis, differential diagnosis, treatment and prognosis of this disease will be described.

Leukocytopenia, thrombocytopenia and fever related to piperacillin/tazobactam treatment--a retrospective analysis in 38 children with cystic fibrosis.

Bone marrow suppression is an important adverse reaction to most betalactam antibiotics. Recently it was suggested that piperacillin/tazobactam (PT) also may cause bone marrow toxicity. We retrospectively analyzed 100 i.v. antibiotic treatment courses (mean duration 12.5 days) in 38 patients (median age 14 years) with cystic fibrosis (CF) who were treated in our hospital. Of the patients receiving PT (84%), 6 patients (18.75% of PT-treated patients, 10.3% of PT treatment courses) developed fever, malaise and headache during treatment without signs of acute infection. In one patient definite thrombocytopenia and neutropenia, in two others a milder decrease in leukocyte and thrombocyte counts was observed after the onset of fever. The events were time- and dose-dependent occurring between day 11 and 15 of treatment. Treatment courses lasted longer (14.2 vs 11.3 days; p < 0.05) and patients had received a higher cumulative dose of PT (4919 +/- 1975 mg/kg b.w. vs 3161 +/- 1635 mg/kg; p < 0.02, Student's t-test) in the affected group than in the unaffected group. After discontinuation of PT, fever subsided within 24 h and blood cell counts normalized. We hypothesize that these fever episodes and changes of blood parameters are related to PT therapy.

[Congenital syphilis]. / Beitrag zur Problematik der Lues connata.

Four infants with Lues connata, three with the early stage of the disease (patients 1-3), are reported. Diagnosis was made after exclusion of other diseases. Initially an infectious disease was expected, since anemia, leucocytosis, thrombocytopenia, hepatomegaly and/or splenomegaly and a bad condition were found. In two patients bone structure was abnormal. Elevated serum concentrations of liver enzymes (ALAT, ASAT) were the indication for liver biopsy in one patient, in whom an accompanying hepatitis was diagnosed. Treatment was performed with penicillin, no JARISCH-HERXHEIMER reaction was observed. The Lues tests were negative during pregnancy but a displacental transfer of pathogenic agents could be assumed. Patient 4 was diagnosed at 9 months of age. Infection of the mother probably occurred in the last 6 weeks of pregnancy. It can not be decided if the baby has a connatal or acquired Lues. The titer decrease of the CMT-test after the end of the penicillin therapy is a marker for a successful treatment. If treatment was started at 2 years of age a total clinical recovery can be expected. The case reports demonstrate that negative Lues test during pregnancy do not exclude Lues connata in newborns. The Lues diagnosis should be considered if an infectious disease in a newborn can not be diagnosed. A general Lues serodiagnostic test is recommended in all newborns before they leave the obstetrics department.

[Gonarthritis due to Salmonella enteritidis in a patient with systemic lupus erythematosus]. / Gonarthritis durch Salmonella enteritidis bei einer Patientin mit floridem systemischen Lupus erythematodes.

Extraintestinal manifestations of Salmonella infection occur more frequently in immunocompromised patients than in healthy persons. About 25 % present as septic arthritis. Particularly patients with SLE are predisposed. We report a case of a 16-year old girl with systemic lupus erythematosus who developed septic arthritis of the left knee. Delayed diagnosis because of similar symptoms of arthritis due to lupus and purulent arthritis led to a destruction of the joint despite systemic antibiotic treatment. Seven months later an endoprosthesis was implanted with good outcome. Early diagnosis, adequate antibiotic therapy and, if necessary, surgical intervention are essential for successful treatment. In patients with SLE suffering from fever or arthritis it is necessary to think of infections particularly due to salmonella.

Chronic recurrent multifocal osteomyelitis--report of eight patients.

The authors undertook a retrospective review of the clinical records and radiologic findings of eight children with chronic, recurrent multifocal osteomyelitis (CRMO). This disease is a recognized clinicopathologic entity with typical radiographic findings, mostly in the metaphyses of the long bones. The diagnosis is one of exclusion without pathognomonic findings. The patients were treated with non-steroidal anti-inflammatory drugs. There was no evidence of altered bone growth or abnormal joint development. It is concluded that CRMO is a distinct clinical entity that is different from acute or subacute bacterial osteomyelitis. Recognition of this condition is important to avoid treatment with antibiotics and repeated operations.