Antimicrobial resistance pattern in urinary tract infections in children on continuous ambulatory peritoneal dialysis

Growing antibiotic resistance demands the constant reassessment of antimicrobial efficacy, particularly in countries with wide antibiotic abuse. Knowledge of resistance trends is particularly important when prescribing antibiotics empirically, as is usually the case for urinary tract infections [UTIs] especially in children with terminal renal failure on continuous ambulatory peritoneal dialysis [CAPD] treatment. The aim of this study was to analyze the resistance of bacterial isolates to commonly used antibiotics in such patients. In this study, bacterial isolates were evaluated from urine samples collected from pediatric patients [6 months to 17 years] on CAPD with acute UTIs in Tehran from March 2006 through September 2006. Sensitivity was measured by disc diffusion method using NCCLS protocol. The most prevalent urinary pathogen was Escherichia coli from 27 cases [75%]. In general, the lowest resistance rate of microorganisms was against amikacin [3.7%] and the highest resistance rate was against amoxicillin [70.4%].A comparison of these data with those of other countries showed that there was considerable geographic variation in bacterial patterns of sensitivity and resistance properties. Therefore, the selection of antibiotics for empiric therapy especially in children with terminal renal failure on continuous ambulatory peritoneal dialysis [CAPD] treatment should be based on the knowledge of the local conditions

HIV-infected child with recurrent parotitis: a case report

Human immunodeficiency virus [HIV] infection in children causes a broad spectrum of diseases and varied clinical courses. Parotitis is one of the manifestations of paediatric HIV infection, occurs in 4-47% of children. We present a 4-year old boy with recurrent bilateral parotitis. He had been admitted twice with the diagnosis of iron deficiency anaemia and chronic hepatitis. During the last admission for recurrent parotitis, based on clinical and paraclinical findings, he was suspected to have HIV infection that was finally confirmed with laboratory tests. Despite low prevalence of HIV-infection among children, physicians should consider HIV infection in any pediatric patient who presents with unexplained signs and symptoms such as chronic or recurrent parotitis

Beta 2 microglubulin as a marker for vesicouretral reflux in children

Reflux nephropathy is one of the main causes of advanced renal failure in children the world over. Vesicoureteral reflux [VUR] is seen in 1.8% of the children; however; its prevalence is 34% in children suffering from urinary tract infections [UTI] and 40% in their siblings. The current study was carried out to evaluate the potential of replacing cystography [which requires exposure to radiation] by measuring urinary levels of beta[2]-microglubolin in screening reflux. The urine samples of 83 children undergoing cystography were assessed for beta[2]-microglubolin/creatinine [beta[2MG/Cr] ratio]. There were 47 children suffering from VUR and 36 healthy children [55 girls and 28 boys]. The urine samples were obtained during voiding cysto-urethrography [VCUG] and were evaluated for beta[2]-microglubolin and creatinine. VUR was classified based on WHO classification and beta[2]-micro-glubolin was reported in microgram to milligram of creatinine. Measurement of beta[2]-microglubolin was performed using 96-test beta[2]MG radioimmunoassay kit and creatinine by spectrophotometry using autoanalyzer. The mean beta[2MG/Cr] ratio was significantly higher in children with VUR [7.9 7 +/- 3.45] than the children without VUR [0.24 +/- 0.23] [P=0.01]. The mean beta[2MG/Cr] ratio in children with reflux grades 4 and 5 [12.01 +/- 8.93] was significantly higher than children with VUR of lower grades [3.04 +/- 0.81] [P=0.02]. The maximum beta[2MG/Cr] ratio [23.3] was seen in a patient with VUR of grade 4 while the minimum of it [0] was observed in patients without reflux. The difference between/32MG/Cr ratio in the patients without reflux and the patients with lower grades of VUR [1-3] was not significant. The maximum/32MG/Cr ratio was 0.85 in patients without reflux. The maximum beta[2MG/Cr] ratio was 0.85 in patients without reflux. This ratio can be assumed as the cutoff point for reflux screening. This study revealed that patients with grades 4 and 5 reflux have significantly higher beta[2MG/Cr] ratios than patients without reflux or with lower degrees of reflux. Renal failure was very soon observed in 2 children with the highest amounts of beta[2MG/Cr] suggesting that a simple urine test may demonstrate the prognosis. It is recommended to study the relationship between beta[2MG/Cr] and renal scars

Interleukins 1 and 6 in children with acute pyelonephritis

Renal infection and scarring are the leading causes of end stage renal disease [ESRD] in some parts of the world [e.g. Iran]. Urinary interleukins [IL] 1 and 6 have been reported to be high in acute pyelonephritis in previous studies. This study was performed to determine the relation between IL 1 and 6 levels in the presence of acute pyelonephritis and the relation between the amount of these cytokines and the severity of pyelonephritis by dimercaptosuccinic acid [DMSA] scan. Children ages 1 month to 12 years who were admitted to the nephrology ward of Mofid Children's Hospital for pyelonephritis from January to July 2004 were enrolled in the study. Interleukins 1 and 6 and creatinine were measured in 80 random urine samples of 37 patients [81%female] with acute pyelonephritis and 43 healthy children [81% female]. Urinary cytokines were measured by Enzyme Linked Immunosorbent Assay [ELISA] and creatinine by spectrophotometry methods and recorded in microgram per mg of creatinine. Pyelonephritis was confirmed by positive urine culture and/or DMSA scan in all patients using SPECT apparatus. Data were analyzed by paired student t test and differences considered significant if p<0.05. Mean interleukin 1/creatinine [IL 1/Cr] ratio in patients with pyelonephritis was 0.70 +/- 0.96 [range 0.02-5.08] and in healthy children was 0.04 +/- 0.12 [range 0-0.51]. Mean interleukin 6/creatinine [IL 6/Cr] ratio in patients with pyelonephritis was 4.80 +/- 10.06 [range 0.01-44.74] and in healthy children was 0.15 +/- 0.37 [range 0-2.32]. There were significantly higher levels of urinary IL-1 and IL-6 in children with pyelonephritis than healthy children, but we didn't find any significant relationship between urinary interleukin levels and other parameters such as pyuria, ESR, CRP and different grades of renal involvement in DMSA scans