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.
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.
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.
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