Purulent pericarditis with cardiac tamponade caused by community-acquired methicillin-resistant Staphylococcus aureus is rare and fatal. There are limited data in children in the current antibiotic era, and available reports usually involve patients with immune dysfunction and prior thoracic instrumentation or has a thoracic focus of infection. Rapid recognition and treatment are paramount in the survival of patients. We report a case of purulent pericarditis with cardiac tamponade secondary to community-acquired MRSA in a previously healthy 10-month-old male infant who presented with fever, pallor, shock, and cardio-respiratory distress. CBC showed leukocytosis with neutrophilia, markedly elevated inflammatory markers, and cardiomegaly on chest radiography. The ECG showed diffuse concave ST-segment elevation, low QRS voltages on precordial leads, and electrical alternans consistent with pericarditis with probable significant pericardial effusion confirmed by 2D echocardiography with note of cardiac tamponade. He was managed effectively with pericardiostomy in combination with a 4-week course of vancomycin. Blood and pericardial fluid culture grew MRSA. This case underscores the organism’s lethality and its potential to infect immunocompetent children without predisposing factors. The value of early recognition, prompt initiation of treatment and management is of utmost importance.
Pericardial Window Techniques

Background: Influenza is a commonly encountered respiratory tract infection and diagnosis remains to be a challenge. Use of a rapid antigen test may influence decisions on treatment in the emergency room (ER). Objectives: This research aims to determine the effects of rapid influenza antigen test (RIAT) on antimicrobial management of influenza-like illness (ILI) in the ER, determine the clinical profile of pediatric patients with ILI and look into the relationship between RIAT result, symptomatology, and immunization status. Methods: This is a cross-sectional study which involved review of charts of 195 pediatric patients with ILI who underwent RIAT (KlintecTM) through a nasopharyngeal swab in the ER of a tertiary hospital from September 2019 to February 2020. Chi-square, Fischer exact test and likelihood ratio were used for data analysis. Results: Most pediatric patients were 7–12 years old males. Majority presented with fever, cough, and colds and underwent RIAT at 2–4 days from onset of illness. About 73.33% of study participants did not receive their yearly influenza vaccine and 70.7% of patients with positive RIAT had no influenza vaccine. There is a lower percentage of vaccinated children who developed cough (86.5% vs. 89.5%) and colds (80.8% vs. 83.2%) when compared with unvaccinated children. RIAT result significantly affected management in terms of antimicrobial prescribing to patients with ILI. Conclusion Influenza presents with non-specific symptoms and vaccination remains a major preventive measure against the disease. The result of RIAT facilitates targeted treatment for influenza and decreases unnecessary antibacterial use, but this should be done with careful thought and interpretation.
Influenza, Human

The most frequent cause of mortality in neonates is infections which include sepsis, meningitis, pneumonia, diarrhea and tetanus. Approximately 1.6 million deaths due to neonatal infections occur annually in developing countries. The causes of sepsis vary from one geographic area to another. Thus, it is important to create a database for the Philippines regarding the etiologies of neonatal sepsis. Objectives: The study was undertaken to determine the most common bacterial pathogens of neonatal sepsis in the Philippines and the antibiotic sensitivity patterns of these pathogens. Methods: A multicenter surveillance and chart review was conducted in five hospital sites for a period of six months- from July to December 2006. All neonates less than or equal to 28 days who had positive cultures from a sterile site and or had fulfilled the SIRS criteria as defined by the International Pediatric Sepsis Consensus Conference in the presence of suspected or proven infection were included in the study. Results: A total of 289 neonates fulfilled the criteria of sepsis. More than 61% of the patients had early onset neonatal sepsis. The most common site of infection was the lungs, (57%), followed by sepsis without an obvious site of infection (35%). In 50% of patients, an organism was identified; gram-negative bacteria were the dominant bacteria found (Pseudomonas, Burkholderia, Klebsiella) which comprised 94% of the bacteria isolated. Resistance patterns varied among the different urban study centers. The Pseudomonas and Burkholderia isolates from the Philippine General Hospital (PGH) were sensitive to ceftazidime. All Klebsiella isolates from St. Louis University (SLU) were resistant to third generation cephalosporins. In contrast, Klebsiella isolates from PGH and Davao were sensitive to third generation cephalosporins but resistant to piperacillin-tazobactam. The overall mortality rate was 11%. Ampicillin and an aminoglycoside were the most common regimens used but were only successful in less than 50% of cases. Conclusion: Gram-negative organisms comprised the majority of the neonatal infections, with Pseudomonas and Burkholderia being the most prevalent. Resistance patterns differed among the different centers. Continuing surveillance of infections is still needed in order choose the most appropriate empiric therapy for each center.
Human ; Male ; Female ; Infant Newborn ; SEPSIS ; INFECTION