Active surveillance for carbapenem resistant enterobacteriaceae (CRE) using stool cultures as a method to decrease CRE infections in the pediatric intensive care unit (PICU).

BACKGROUND: The incidence of Carbapenem Resistant Enterobacteriaceae (CRE) infections is increasing worldwide. Due to dearth of alternative antibiotics, prevention of infection transmission is a part of CRE infection management strategy. Early detection of CRE by active surveillance coupled with contact isolation is much more appropriate compared to contact isolation upon receipt of routine cultures dictated by the patient's clinical condition. OBJECTIVES: To determine whether active CRE surveillance will decrease CRE infection rates in the Pediatric Intensive Care Unit (PICU). METHODS: Retrospective observational study done in the 10-bed PICU of a tertiary care teaching children's hospital from July 2013 to June 2015. Rectal swabs for CRE were sent from all PICU patients except stable post-operative patients. Contact isolation precautions were followed for rectal swab positive patients. CRE colonization and infection rates were calculated and compared. RESULTS: Total of 1262 rectal swabs were sent from 1022 patients. CRE colonization rate was 19.5%. Post intervention, ICU acquired CRE colonization decreased by 36% and ICU acquired CRE infection rates decreased by 100%, both showed significant decrease (p â€‹< â€‹0.0001). CONCLUSION: Active CRE surveillance and institution of contact isolation in appropriate situations is helpful in decreasing CRE colonization and infection rates in the PICU.

Neuromelioidosis Masquerading as Acute Demyelinating Encephalomyelitis.

BACKGROUND: Neuromelioidosis is a rare conduction, which is difficult to diagnose and treat. CASE CHARACTERISTICS: Preadolescent girl presenting with prolonged fever, acute ascending paralysis and encephalopathy. OUTCOME: Neuromelioidiosis was confirmed on brain biopsy culture. Patient improved with an intensive antibiotic regimen. MESSAGE: Neuromelioidosis can mimic acute demyelinating encephalomyelitis clinically and radiologically.