Adverse effects of vancomycin in children: a review of 22 cases.

Vancomycin has been frequently recommended for the treatment of multi-resistant infections. Twenty-two children undergoing vancomycin treatment were observed. Nine adverse effects were registered in 6 children: eosinophilia in 5 cases, skin rash in 2 cases, and an increase in plasma creatinine in 2 cases. All adverse effects remitted with withdrawal of the drug.

Primary community-acquired pneumonia by Escherichia coli. Case report and review of the literature.

A two year old girl with chronic neurologic convulsive disease was admitted with a six day history of pneumonia and, despite treatment, died on hospital day 3. The X-ray revealed right upper lobar pneumonia. The results of pleural effusion and blood cultures drawn on admission yielded a non-typable Escherichia coli. No other source of infection was identified. The authors discuss the clinical and pathophysiological aspects of Escherichia coli pneumonia.

[Necrotizing tracheobronchitis in an infant]. / Traqueobronquite necrotisante: relato de um caso em lactente.

OBJECTIVE: To alert the pediatric emergency physician about an unusual cause of airways obstruction in children undergoing mechanical ventilation. METHODS: We report a case of necrotizing tracheobronchitis (NTB) in an 8-month-old boy and discuss the pathophysiology, diagnosis and treatment of this disease. RESULTS: This child presented a good outcome that was related to prompt diagnosis and treatment with bronchoscopic removal of necrotic tissue. CONCLUSIONS: The pediatric emergency physician must consider NTB in every children undergoing mechanical ventilation who presents acute episodes of airways obstruction, hypercarbia, lack of chest movement and pulmonary hyperinflation, even out of the perinatal period. This characteristic clinical presentation, when recognized, is an indication for emergency tracheobronchoscopy.

[Monitorization of blood levels of vancomycin in children with multi-resistant bacterial infections]. / Monitorização das concentrações séricas da vancomicina em crianças com infecções por bactérias multiresistentes.

Pharmacokinetics of vancomycin depends on many factors and one of them is the age of the patient. It is better known in adults and there are few studies in children. Therefore, we studied the serum concentrations in 22 children with multi-resistant bacteria infections that received vancomycin. The doses administered followed the recommended rules for its utilization. This study was made at the equilibrium phase and immunofluorescence was the method utilized. The peak serum concentrations varied from 23 to 99 mcg/ml and only in 8 children (36%) they varied from 30 to 40 mcg/ml. In 10 cases (45%) we found valley serum concentration between 5 to 10 mcg/ml. These observations confirm the imprevisibility of serum concentrations obtained from one single recommended dose. Therefore, due to the complexity of vancomycin pharmacokinetics, the monitoring of blood levels is recommended in order to obtain therapeutic success.

[Septicaemia caused by Klebsiella pneumoniae--a review of 28 cases]. / Sepse por Klebsiella pneumoniae--revisão de 28 casos.

Twenty-eight children with septicaemia and positive blood cultures for Klebsiella pneumoniae were retrospectively studied and compared with 190 children with sepsis caused by other organisms, identified or not in blood cultures. Septicaemia due to Klebsiella pneumoniae occurred more frequently in children older than 2 years of age, especially those who had an underlying disease and, therefore, were malnourished or had an impaired immune defense system that had required invasive procedures and previous hospitalization. Although the case fatality rate was high in both groups, Klebsiella pneumoniae did not contribute to elevate the relative risk of death. In this study, Klebsiella pneumoniae isolates were highly sensitive to colistin (92.9%) and cefoxitin (82.1%), but poorly sensitive to third generation cephalosporin and imipenen.

[Psoas muscular abscess in children]. / Abscesso de músculo psoas em crianças.

Symptoms of psoas muscular abscess in children are nonspecific and differential diagnosis is made among diseases included in childrens acute hip pain syndrome, imaging tests being necessary for diagnostic confirmation. During the first semester of 1995, 48,550 children were examined in Pronto Socorro do Instituto da Criança do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, four of them diagnosed as having psoas muscular abscess (2 females and 2 males, ages varying from 1 to 12 years). All of them had nonspecific clinical features and diagnosis was confirmed by abdominal ultrasound and/or computerized tomography. Staphylococcus aureus was isolated as the etiologic agent in 3 children, findings similar to the ones in literature.

Septicemia por Staphylococcus aureus em crianças: tolerância bacteriana à vancomicina e poder bactericida do soro / Staphylococcus aureus septicemia in children: bacterial tolerance to vancomycin and serum bactericidal test

OBJETIVO. Analisar a sensibilidade e tolerância das cepas de Staphylococcus aureus isoladas de crianças com septicemia e avaliar o poder bactericida sérico na monitorizaçäo terapêutica desses casos. MÉTODOS. Foram estudados 17 casos de crianças com septicemia por Staphylococcus aureus internadas na Enfermaria de cuidados semi-Intensivos do Instituto da Criança do Hospital das Clínicas da Faculdade de Medicina da Universidade de Säo Paulo. Foram realizados testes de sensibilidade antimicrobiana pelo método de difusäo em disco e diluiçäo em tubo. Foram realizados 29 testes no pico e 23 no vale dos antibióticos utilizados, determinando o poder bactericida do soro. RESULTADOS. As cepas de Staphylococcus aureus de origem hospitalar mostraram resistência a quase todos os antibióticos, exceto vancomicina e pefloxacina. Observou-se fenômeno de tolerância em cinco (50 por cento) das cepas testadas para vancomicina, sendo que quatro apresentaram má evoluçäo clínica. Os testes para determinaçäo do poder bactericida sérico revelaram títulos no pico ò1/8 em 55,5 por cento das observaç 8es; neste grupo a evoluçäo clínica foi melhor. CONCLUSäO. As cepas de Staphylococcus aureus de origem hospitalar estudadas säo multirresistentes. O fenômeno de tolerância antimicrobiana, assim como o poder bactericida do soro em níveis baixos, pode estar associado a má resposta terapêutica. A valorizaçäo do PBS como critério de avaliaçäo terapêutica em infecçöes graves e o papel da tolerância do Staphylococcus aureus à vancomicina merecem maiores estudos

[Staphylococcus aureus septicemia in children: bacterial tolerance to vancomycin and serum bactericidal activity]. / Septicemia por Staphylococcus aureus em criança: tolerância bacteriana à vancomicina e poder bactericida do soro.

PURPOSE: To evaluate the susceptibility and of strains of Staphylococcus aureus isolated from children with septicemia, and to evaluate the importance of the serum bactericidal test. METHODS: Seventeen children with Staphylococcus aureus septicemia admitted to the Semi Intensive Care Unit of the Instituto da Criança do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo were studied. Twenty nine tests in the pico and 23 in the nadir of the antibiotics were made. RESULTS: Strains of Staphylococcus aureus from hospital origin were resistant to all the antibiotics but vancomycin and pefloxacin. The phenomenon of tolerance was seen in 5 (50%) of the strains that were tested for vancomycin, and 4 of the children had a bad evolution. The serum bactericidal tests showed titles in the pico > or = 1/8 in 55.5% of the observations; in this group the evolution was better. CONCLUSION: Strain of Staphylococcus aureus from hospital origin are multiresistant. The phenomenon of antimicrobial tolerance, as well as the serum bactericidal test may be related to a bad therapeutic evolution. The increasing value of the serum bactericidal test as a way to evaluate the therapeutic evolution in severe infections, and the role of the tolerance of the Staphylococcus aureus to vancomycin more studies.

[Rotavirus, adenovirus, astrovirus, calicivirus and small round virus particles in feces of children with and without acute diarrhea, from 1987 to 1988, in the greater São Paulo]. / Rotavírus, adenovírus, astrovírus, calicivírus e "small round virus particles" em fezes de crianças, com e sem diarréia aguda, no período de 1987 a 1988, na grande São Paulo.

Between 1987 and 1988, 193 faecal specimens from children, with or without diarrhea, were submitted to enzyme immunoassay, polyacrylamide-gel electrophoresis and electronmicroscopy tests for virus detection. The positivity for Rotavirus, Adenovirus, Astrovirus, Calicivirus and Small Round Virus Particles (SRVP) was 11.3%, 3.1%, 2.1%, 1.0% and 4.1%, respectively, for the 97 children with acute diarrhea. Of the 96 children without diarrhea, 4.2% were positive for Rotavirus, 1.0% for Calicivirus and 7.3% for SRVP. Of 15 positive specimens for Rotavirus, 14 showed electrophoretic patterns proper to group A and 1 specimen of group C Rotavirus. The analysis of electrophorotypes demonstrated great heterogeneity of electrophoretic patterns and predominance of subgroup 2, "long". The association of virus, bacteria and parasites was present both in children with or without acute diarrhea.

[Cryptosporidium parasitism in children with acute diarrhea]. / Parasitismo por Cryptosporidium sp. em crianças com diarréia aguda.

During the period from August 1987 to July 1990, 241 fecal samples collected from 1 to 48 months old children with acute diarrhea and examined in the Child's Institute of Hospital das Clínicas of Faculdade de Medicina da Universidade de São Paulo, were submitted to parasitological tests in the Enteroparasitosis Section of the Instituto Adolfo Lutz. Fourty two (17.43%) fecal samples showed Cryptosporidium sp. oocysts by carbol-fucsin stain. Parasitism by Cryptosporidium sp. was more frequent during the period comprised from March to May, in the studied three years. The authors discussed the Cryptosporidium sp. in association with other agents.

[Oral rehydration--some current aspects]. / Hidratacão oral--alguns aspectos atuais.

Some findings in a recent study (1982), with metabolic balances, in five severely dehydrated infants (with weight above the 10th percentile) are commented. An oral solution, for maintenance was administered, after an initial intravenous infusion of half isotonic saline (100 cc/kg). The composition of the fluid was: Na 45 mEq/l, K 33 mEq/l, CL 78 mEq/l and glucose 2,8%. Metabolic balance were performed for the first six days of recovery. A similar group of infants, treated only with intravenous fluid was used for comparison. Results have shown that: 1) the sodium concentration was enough to achieve positive sodium balances, but only due to an intense reduction of renal sodium excretion; 2) the amount of potassium was well tolerated and hyperkalemia was not observed; 3) improvement of acid base status was satisfactory even without the use of bicarbonate in the oral solution.

Hidratacao oral - alguns aspectos atuais. / Oral rehydration - some current aspects

Sao comentados alguns achados de estudo recente (1982) sobre balanco metabolico em cinco lactentes com desidratacao grave (com peso acima do percentil 10). Apos uma fase inicial de hidratacao venosa com soro fisiologico ao meio (100 cc/kg) foi administrada uma solucao oral para manutencao.A composicao da solucao oral era: Na 45 mEq/l. K 33 mEq/l, C1 78 mEq/l e glicose 2,8%. O balanco metabolico foi avaliado nos primeiros 6 dias de recuperacao. Um grupo de lactentes de mesmas caracteristicas, tratado apenas com hidratacao venosa, foi usado como controle. Os resultados mostraram que: 1) a concentracao de sodio foi suficiente para atingir balancos positivos de sodio, mas somente devido a uma intensa reducao da sua excrecao renal; 2) a quantidade de potassio foi bem tolerada e nao se observou hipercalemia; 3) a melhora do equilibrio acido-basico foi satisfatoria mesmo sem uso de bicarbonato na solucao oral