Nosocomial urinary tract infections at a pediatric hospital.

Although the epidemiology of nosocomial urinary tract infections (NUTIs) is well-described in the adult population, there is little information on children. We therefore reviewed all our patients with NUTIs, to determine their age, underlying diagnoses, microorganisms involved, use of catheters and secondary bacteremias. During a 2-year period at our institution, NUTIs accounted for 10% of all nosocomial infections (0.8 infections/100 admissions). Of 44,948 patients admitted during this period 0.7% (n = 318) acquired 351 episodes of NUTI. The patient ages ranged from 5 days to 21 years. The highest rates of NUTIs per ward (NUTI/100 admissions or transfers to the ward) were seen in the neonatal surgery (4.8), hematology/oncology (2.7), infant neurosurgery (2.1) and neonatal intensive care units (1.9). The most common organisms isolated were Escherichia coli (26%), Enterococcus sp. (15%), Pseudomonas sp. (13%), Klebsiella sp. (10%) and coagulase-negative Staphylococcus (9%). Catheterrelated infections accounted for 48% of all the NUTIs. Secondary bacteremia occurred rarely, with an incidence of 2.9% (n = 7). We conclude that NUTIs represent an important proportion (10%) of nosocomial infections in our population of hospitalized children, but secondary bacteremia is uncommon.

[Clinical analysis of 36 cases with amebic liver abscess].

OBJECTIVE: To investigate the clinical features of amebic liver abscess, the causes of misdignosis and the effect of medical and surgical therapy on patient's prognosis. METHODS: The clinical features of 36 patients with amebic liver abscess admitted from 1982 to 1997 in our hospital were retrospectively reviewed. RESULTS: The major clinical manifestations were: abdominal pain (86.1%), fever (86.1%), hepatomegaly with tenderness (83.3%) and right intercostal tenderness (58.3%). Leukocytosis was observed in 61.1%, and increased of ESR in 88.5% (23/28). Serologies against Entamoeba histolytica were noted in 92.6%. Ultrasonography showed single lesions in 75% and right-lobe involvement in 75%. All patients were treated with metronidazole and 27 patients received treatment with needle aspiration or draining at the same time. After treatment, 10 patients were cured, 25 patients were improved significantly and effective rate was 97.2%. One patient died of hepatic failure. CONCLUSION: Medical therapy alone was excellent for small abscesses, while percutaneous needle aspiration or draining was a successful approach in patients with large abscesses.