RESUMO
We describe a case of cerebral trichomoniasis in a neonate in whom seizures and multiorgan failure developed during treatment for staphylococcal sepsis. Brain abscesses were identified with cranial sonography, and Trichomonas vaginalis was isolated from cerebrospinal fluid samples. The patient died despite metronidazole therapy.
Assuntos
Abscesso Encefálico/parasitologia , Tricomoníase/diagnóstico , Trichomonas vaginalis/isolamento & purificação , Antiprotozoários/uso terapêutico , Abscesso Encefálico/diagnóstico por imagem , Evolução Fatal , Feminino , Humanos , Recém-Nascido , Louisiana , Staphylococcus aureus Resistente à Meticilina/efeitos dos fármacos , Metronidazol/uso terapêutico , Sepse/tratamento farmacológico , Sepse/microbiologia , Tricomoníase/líquido cefalorraquidiano , UltrassonografiaRESUMO
INTRODUCTION: The recent increase in multidrug-resistant (MDR) Escherichia coli infections is not well described in children. We determined the risk factors and outcomes of extraintestinal E. coli infections in children in our region. METHODS: We conducted a retrospective cohort study of children ≤18 years in Olmsted County, MN, USA, between January 1, 2012 and December 31, 2012. MDR isolates were defined as resistant to ≥3 antibiotic classes. RESULTS: A total of 368 children each contributed 1 isolate. Isolates were predominantly community-associated (82%) and from urine (90%), and outpatients (86%); 46 (13%) isolates were MDR. In multivariable analysis, genitourinary (GU) tract anomaly (OR 2.42, 95% CI 1.03-5.68), invasive devices (OR 3.48, 95% CI 1.37-8.83) and antibiotic use at presentation (OR 2.62, 95% CI 1.06-6.47) were associated with MDR E. coli. Children with MDR infections were more likely to have a complex infection (35% vs. 17%, P = 0.026), less likely to receive effective empiric antibiotics (47% vs. 74%, P < 0.001), had longer time to receipt of effective antibiotics (median 19.2 vs. 0.6 h, P < 0.001), and longer hospitalization (median 10 vs. 4 days, P = 0.029) than children with non-MDR infections. CONCLUSION: Pediatric MDR E. coli infection was associated with GU tract anomaly, invasive devices, antibiotic use, delays in effective therapy and longer hospitalization.
Assuntos
Antibacterianos/uso terapêutico , Farmacorresistência Bacteriana/efeitos dos fármacos , Infecções por Escherichia coli/epidemiologia , Adolescente , Criança , Pré-Escolar , Escherichia coli/efeitos dos fármacos , Escherichia coli/isolamento & purificação , Infecções por Escherichia coli/tratamento farmacológico , Feminino , Humanos , Incidência , Lactente , Masculino , Minnesota/epidemiologia , Estudos RetrospectivosRESUMO
We report a case of bacteremia secondary to Cupriavidus pauculus in a 15-month-old boy on extracorporeal membrane oxygenation (ECMO). The source of the organism was water in the thermoregulator reservoir. The child responded well to cefepime and ciprofloxacin, a delayed oxygenator change out and replacement of the thermoregulator reservoir with a unit that was cleaned and decontaminated with sodium hypochlorite. Isolation of Cupriavidus pauculus from a patient on ECMO support should raise suspicion of the reservoir as a source.
