[Early administration of antibiotic susceptible strain of Escherichia coli in the intestine of the premature infant]. / Administration précoce d'une souche de Escherichia coli antibiosensible dans l'intestin du nouveau-né prématuré.

An antibiotic-susceptible, innocuous Escherichia coli strain of human origin was administered to premature infants in order to protect them from nosocomial colonization by antibiotic-resistant enteric organisms. The strain was given to 16 untreated patients in the first six hours of life, and to 11 patients treated with antibiotics in the first six hours after cessation of treatment. The strain was able to colonize the intestinal tracts of all treated infants and 14/16 untreated infants. Colonization of these patients by antibiotic-resistant enteric organisms was compared with results obtained in a control group of 15 unadministered and untreated infants. A significant difference was recorded in the first ten days after administration. Our results show that previous antibiotic treatments did not impair intestinal colonization by an antibiotic-susceptible strain, and demonstrate the in vivo antagonistic abilities of the administered strain. Such antagonistic strains might thus be used for control of nosocomial infections of intestinal origin due to antibiotic-resistant enteric organisms.

Fecal short-chain fatty acids predict digestive disorders in premature infants.

BACKGROUND: Excretion of fecal short-chain volatile fatty acids (SCFAs) may indicate changes in colonic or colonocyte metabolism. The aim of this study was to detect the existence of an average fecal SCFA profile and to define which changes were associated with clinical events that occurred during the survey period. METHODS: SCFA profiles of 185 stool samples collected from 46 fed preterm neonates (mean birth weight, 1920 g; mean gestational age, 32.8 weeks) were evaluated and their association with digestive disorders or therapy was explored. RESULTS: Total SCFA concentration increased from 0 to 80 micromol/g feces wet weight over the first 20 days of life. A basic SCFA profile revealed the existence of a highly sensitive period between the second and the third week of life. In the absence of any digestive problem (n = 15), the butyric acid (C4) ratio increased from 7% to 24%. Phototherapy (n = 13) enhanced the SCFA concentration but decreased the ratios of C4 and minor acids. Digestive disorders reported included abdominal distention (n = 6) or bleeding (n = 8). Only in the case of bleeding was the SCFA profile changed by an enhancement of C4 by >50%. Antibiotic therapy (n = 3) suppressed SCFA production. CONCLUSIONS: This study supports a hypothesis that changes in the SCFA profile could offer a noninvasive method to anticipate functional modifications of the gastrointestinal tract before the first clinical signs of pathologic events, including necrotizing enterocolitis.

Diet, length of gestation, and fecal short chain fatty acids in healthy premature neonates.

BACKGROUND: Excretion of fecal short-chain fatty acids (SCFAs) may indicate changes in colonic or colonocyte metabolism. The aim of this study was to detect the influence of gestational age and feeding practices on SCFA concentrations and profiles in healthy preterm infants. METHODS: A total of 198 fecal samples (28 infants) were collected from 8 to 21 days of age from 3 groups of preterm infants born at 33 to 37 weeks of gestation and fed either breast milk (group I) or Nutramigen, a lactose-free formula (group II), and extremely preterm infants born before 33 weeks of gestation and fed breast milk (group III). Total SCFA concentrations and SCFA profiles were analyzed using a gas chromographic (GC) procedure. RESULTS: Total fecal SCFA excretion did not differ significantly between group I (mean, 24.0 micromol/g; range, 1.3 to 118.8 micromol/g) and group II (mean, 23.0 micromol/g; range, 3.0 to 73.3 micromol/g). Conversely, differences occurred between SCFA profiles and became significant after day 17. The main differences were a significant increase in the butyric acid concentration (12% versus 30%) with group II. Compared with group I, fecal SCFA concentrations were 3.2-fold lower (7.4 micromol/g; range, 0.3 to 37.4 micromol/g) in group III with no significant changes in the profiles. CONCLUSIONS: Fecal SCFA excretion may vary in absence of any digestive disease. During this study, in terms of gestational age, total SCFA concentrations were significantly lower in extremely premature infants compared with infants born less premature, despite their known higher deficiency in intestinal lactase activity. In terms of diet, the absence of lactose did not lead to a decrease in colonic fermentation and induced changes in SCFA patterns. These new baseline data may offer clues to further development of milk formulas.

Early cholestasis in premature infants receiving total parenteral nutrition: a possible consequence of shock and hypoxia.

We report 18 premature infants (gestational age: 31.1 weeks +/- 2.6 [mean +/- SD] (range: 28-36]) with necrotizing enterocolitis (NEC) who developed total parenteral nutrition (TPN) associated cholestasis. Liver function tests were performed at the start of TPN (D1) and repeated once a week. Considering the date of cholestasis onset (direct bilirubin > 30 mumol/l and/or serum bile salts > 10 mumol/l), the patients can be divided in two groups. The first group consisted of 9 patients who had cholestasis at D1. In these patients shock and/or hypoxia occurred prior to D1 and were the only risk factors of cholestasis identified before D1. The second group consisted of 9 patients who developed cholestasis after D1 and in whom the cause of cholestasis was multifactorial (sepsis, lack of enteral feeding, shock and/or hypoxia). These results suggest that shock and/or hypoxia can be responsible for early cholestasis in premature infants. We conclude that shock and hypoxia should be considered when discussing TPN-associated cholestasis.

[Frequency of the ocular carriage of Chlamydia trachomatis by newborns and infants. A multicenter French study]. / Fréquence du portage oculaire de Chlamydia trachomatis chez les nouveau-nés et les enfants. Une étude française multicentrique.

A multicenter study has been done in France in order to assess the presence of C. trachomatis in the newborn and the young infant. The results show that 4.3% of the infants less than 2 month old are positive. This put forward the question of the screening of pregnant women.

[Haemophilus influenzae: colonization and infection]. / Haemophilus influenzae: colonisation et infection.

Haemophilus influenzae can be demonstrated as a saprophyte in more than two-thirds of children, and almost as frequently in adults. Noncapsulated strains are more frequent than capsulated type b strains which are found in 5% of the samples. Other capsulated strains are rare. Transmission is made easier with close contact (daycare nurseries, home). Colonization is the result of adherence to nasopharyngeal epithelial cells, although characterized adhesion factors cannot be demonstrated for all strains (pili, adhesins, secretory IgA1 protease). Systemic infection is the result of the invasion of pharyngeal epithelium, made easier by upper respiratory tract infection. There is a risk of meningitis for high level bacteremia (> or = 10(5) CFU/ml). Risk factors are: age (child < 5 years), alteration of reticuloendothelial system, agammaglobulinemia. Anti-Haemophilus type b vaccine prevents nearly all infections, and suppresses or sharply reduces colonization.

["Serratia marcescens" in neonatology: epidemiology of a hazard (author's transl)]. / "Serratia marcescens" en médecine néo-natale. Epidémiologie d'un risque (à propos d'une méningite à 6 jours).

A case of meningitis, caused by Serratia marcescens in a 6-day old newborn triggered a search for Serratia in the Neonatology ward. Fifteen out of 38 newborns were found fecal carriers of S. marcescens. The source of S. marcescens was found in flasks containing almond oil with 1% cetyltrimethylammonium bromide used for skin care. All strain of S. marcescens belonged to pigmented biotype A6a and serotype 014 : H10. The spread of S. marcescens was controlled by heat sterilizing and renewing twice a week the almond oil flasks. Means of control of contamination sources are discussed.

[Bacterial infection of the newborn by maternal fetal contamination: one can depend on the anamnesis]. / Infection bactérienne du nouveau-né par contamination materno-foetale: on peut se fier à l'anamnèse.

All babies born in a University maternity unit over a period of four months had bacteriological swabs taken in the labour ward. This was to see whether a list of criteria in the history for bacterial infection of the newborn could be relied on. The criteria were: premature rupture of the membranes (before labour had started at all), rupture of the membranes for more than 12 hours, stained liquor, prematurity, fetal tachycardia of more than 160 per minute or abnormal rhythm of the heartbeat, an Apgar score of less than 7 after 1 minute, maternal genital or urinary tract infection (not cured) in month before delivery, maternal temperature above 38 degrees C in labour. During the study there were: 570 live births of which 222 (39%) were at risk of infection according to the above list of criteria, 35 had bacterial colonies present and 4 were definitely infected. More cultures from the placenta, the gastric fluid and the skin came back positive when there was a recognised risk of infection. Both the clinical and bacteriological results show that the risk was 5.24 of colonisation when the risk of infection had been recognised. These prospective results when checked against the retrospective results already obtained in the same department, suggest that this kind of screening for infection is worthwhile without being too expensive, and one can rely on the history to screen for neonatal bacterial infection.

[Role of azlocillin in the treatment of Pseudomonas aeruginosa otitis in children]. / Place de l'azlocilline dans le traitement des otites à pyocyanique de l'enfant.

From May, 1978 to October, 1983, 88 children with otitis due to Pseudomonas aeruginosa were seen at Paediatric Unit E.N.T. consultation of the University Hospital of Tours. Epidemiologically, it is worth mentioning that the majority of these infections was not of nosocomial origin: 56 children were infected outside the hospital and 26 during their stay in hospital; 3 neonates were referred directly from the Maternity Unit. Most strains of Ps. aeruginosa, with various serotypes, were sensitive to azlocillin. Twenty-four children received a systemic treatment required by their local or general condition. Azlocillin was used in 24 cases on the basis of positive sensitivity tests and was occasionally combined with topical treatment using antiseptics or the antibiotic itself. Or the 3 failures observed, 2 were due to acquired resistance to azlocillin and 1 to chronic otitis. An incomplete result was obtained in a case of otitis externa caused by a strain of intermediate sensitivity. The remaining 19 cases were cured, including 3 neonates with otitis externa or media, 1 child with otitis externa, 1 with combined otitis externa and media, 10 with otitis media, usually protracted, 2 with mastoiditis medically cured and 1 with superinfection following mastoidectomy for cholesteatoma. Secretions dried up within 3 to 4 days and treatment was discontinued after clinical cure was obtained in 9 to 19 days. Fever, which was present in 7 cases, abated within 2 to 8 days. The only relapse that occurred, one month after treatment of an otitis media, responded to a second course of azlocillin.

[Prevention of contamination of microhemocultures. Value of a new instrument, the hemopipette]. / Prévention des souillures des microhémocultures. Intérêt d'un nouvel instrument, l'hémopipette.

We have experimented with a new instrument, "hemopipette", known to reduce the incidence of contamination in small samples of capillary blood for haemoculture. Without altering our usual skin asepsis procedure, we carried out 270 microhaemocultures in 240 neonates. Two haemocultures (0.74%) were contaminated, a significantly lower percentage than the 3.6% observed in a first series of 411 microsamples obtained prior to the introduction of "hemopipette". This fall in contamination rate appears to be associated with the use of this instrument which combines a pipette and a lancet and facilitates capillary blood withdrawal.

[Monotherapy of Pseudomonas aeruginosa septicemia with azlocillin]. / Monothérapie des septicémies à Pseudomonas aeruginosa par azlocilline.

Azlocillin was administered alone to seven patients without malignant or blood disease presenting with septicaemia caused by Pseudomonas aeruginosa. In 6 cases the infection developed after surgery and in 3 of these it was responsible for a state of shock, twice associated with acute anuric renal failure. The minimum inhibitory concentrations of azlocillin varied from 2 to 32 micrograms/ml; 5 strains were resistant to carbenicillin. The minimum inhibitory to minimum bactericidal concentrations ratio, measured on five occasions, was equal to 2. Bacterial eradication was obtained in 6 patients. One patient with multivisceral failure died during treatment and in this case the responsible organism had become resistant to azlocillin.

[Bacteriologic monitoring of external ventricular drainage in children]. / Surveillance bactériologique des dérivations ventriculaires externes chez l'enfant.

The authors report 27 cases of external ventricular drainage employed in children. The usage of this technique caused neither infection nor surinfection in any of the cases. It is difficult to interpret the analysis of the cerebrospinal fluid thus obtained. Decisive criteria for recovery or non infection can be derived by studying the isozymatic profile of the L.D.H. (lactic dehydrogenase).

[Cervicofacial manifestations of tularemia. Apropos of a familial case]. / Manifestations cervico-faciales de la tularémie. A propos d'un cas familial.

Tularemia is a rare infectious disease, due to Francisella tularensis, a virulent bacterium transmitted by a carrier insect (essentially ticks) or by the meat of an infected animal (generally hares). We report 3 cases that occurred in the same family, showing the various symptoms of this disease. Revealing head and neck manifestations may mislead diagnosis.

[Septic erosion of the internal carotid artery and retrostylian phlegmon. Apropos of a case]. / Erosion septique de l'artère carotide interne et phlégmon rétro-stylien. A propos d'un cas.

The vascular complications of peritonsillar phlegmons have become exceptional. On the basis of a recent case, the authors sum up the criteria of severity, including: white puncture sample, paralysis of the 9th, 10th, 11th, 12th cranial nerves and of the cervical sympathetic nerve. Computed tomography allows not only refining the topographic diagnosis, but even sometimes diagnosing a pseudoaneurysm before it is fissured. At this stage, intraoperative radiology may probably prevent the unavoidable secondary rupture. If it cannot be used, preventive ligation must be proposed. In the absence of cataclysmic hemorrhage, this easier procedure usually does not cause any irreversible neurological deficit. If performed in emergency, it may entail a major risk, not only a neurological risk, but a vital risk as well.

[Extensive mycoses of the face. Apropos of a case]. / Mycose extensive de la face. A propos d'un cas.

An 11 year old boy with medullary aplasia developed extensive mycosis of the face. This mucormycosis is a rare affection that appears in patients with predisposing disease (diabetes, blood disorders) and is easily diagnosed, if considered, from clinical features. Diagnosis is confirmed by histopathology, culture sometimes identifying the causative fungus. Despite the intrinsic serious course of this affection (facial necrosis, death) prognosis appears to be related essentially to the rapid control of the subjacent disease.

[Deep Candida and related yeast infections]. / Infections profondes à Candida et levures voisines.

Yeast-like fungi that are commonly found on the skin and in the digestive tract of healthy people may be responsible for deep infections as well as for cutaneous and mucosal diseases. Such deep infections have long been known in the case of Candida spp.; they are facilitated by immunosuppression or by factors that enable this opportunistic organism to proliferate in the gut, skin or mucosae and to penetrate into deep tissues. In addition to such well-known clinical manifestations as septicaemia and endocarditis and to pulmonary, neuromeningeal, osteo-articular and ophthalmic lesions (to be systematically searched for), and apart from the special case of chronic granulomatosis, new syndromes have been described in heroin-addicts, including syndromes with deep cranial nodules and folliculitis. The difficult diagnosis often justifies and empirical treatment in neutropenic patients. In patients with AIDS, buccal and oesophageal candidiasis is common and sometimes reveals the syndrome, but other localizations are rarely encountered. Deep manifestations in the newborn are very seldom due to contamination by the mother; they are usually iatrogenic, so that their transmission can be prevented. More recently, deep mycoses caused by other fungi beside cryptococci have been described in fragile patients. Torulopsis glabrata, Trichosporon cutaneum or even Rhodotorula spp. may penetrate through catheters or drains and cause fungaemia and septicaemia. Malassezia furfur has been found in contaminated catheters and drains and causes pulmonary infections almost exclusively in premature infants under prolonged parenteral lipid diet.