fosfomycin and Infant--Premature--Diseases

Forty-two infants, some premature, with enteropathogenic Esch. coli (EPEC) gastroenteritis were treated with an oral suspension of fosfomycin in a dose of 100 and 200 mg/kg per day. After the treatment there were 11 secondary clinical infections (6 reinfections and 5 relapses) which received a second treatment with fosfomycin. In total, 53 treatments were made with fosfomycin and in 92% of the cases there was both clinical and bacteriological cure. 93% of the EPEC strains were sensitive to fosfomycin in vitro, their minimum inhibitory concentrations being less than 64 mug/ml. The concentration of fosfomycin in blood and faeces was assayed by a diffusion plate microbiological method in a group of these children, showing that this antibiotic is partly absorbed and the rest eliminated in the faeces, where its concentration was found to be very high. Tolerance of the product was good, and there were neither toxic nor side effects.

Topics: Anti-Bacterial Agents; Clinical Trials as Topic; Escherichia coli Infections; Feces; Female; Fosfomycin; Gastroenteritis; Humans; Infant; Infant, Newborn; Infant, Premature, Diseases; Intestinal Absorption; Male; Microbial Sensitivity Tests

We have collected cases of iatrogenic meningitis managed in the Children's Hospital of Tunis, between January 1998 and December 2006. Clinical information about each patient were collected, all bacterial samples were investigated in the microbiology laboratory of the hospital. Bacterial isolates were identified according to conventional criteria. In the interval under study, we recorded three cases of iatrogenic meningitis after lumbar puncture. Two cases occurred in newborn admitted for suspicion of neonatal infection and one in a 2-month-old infant admitted for exploration of hyperpyretic convulsion. In all patients, the initial cerebrospinal fluid was normal. All patients developed symptoms of acute meningitis within 72 hours after lumbar puncture; the second cerebrospinal fluid was, then, typical for purulent meningitis. The causal agents isolated in the three cases were Klebsiella pneumoniae, Enterobacter cloacae, and Serratia marcescens, all resistant to beta-lactams by extended spectrum beta-lactamase production. The use of quinolones was required in all cases. Different complications were recorded: hydrocephalus and brain abscess in one case, respiratory and hemodynamic failure managed in the intensive care unit in the second, and brain hygroma in the third case. This study shows high morbidity of iatrogenic meningitis. Simple aseptic precautions undertaken before the procedure of lumbar puncture can prevent such cases. The urgent need for increasing the awareness among medical personnel in hospitals of developing countries cannot be overemphasized.

Topics: beta-Lactam Resistance; Brain Abscess; Brain Damage, Chronic; Ciprofloxacin; Drug Therapy, Combination; Enterobacter cloacae; Enterobacteriaceae Infections; Female; Fosfomycin; Humans; Hydrocephalus; Iatrogenic Disease; Imipenem; Infant; Infant, Newborn; Infant, Premature; Infant, Premature, Diseases; Klebsiella Infections; Klebsiella pneumoniae; Male; Meningitis, Bacterial; Muscle Hypotonia; Seizures; Serratia Infections; Serratia marcescens; Spinal Puncture; Subdural Effusion; Tunisia