OBJECTIVE: This paper aimed to describe the clinical profile and short-term clinical outcomes of children with Acute Kidney Injury (AKI) requiring hemodialysis in a tertiary pediatric hospital. MATERIALS AND METHODS: A retrospective cohort on in-patients who received hemodialysis treatments at our institution was performed. Medical charts of patients admitted between July 2018 and July 2023 were retrieved. Demographic data, clinical profiles and subsequent outcomes in terms of mortality and recovery or non-recovery from AKI were recorded. RESULTS: After meeting the inclusion and exclusion criteria, 129 patients were included in the study‘s statistical analysis. There was an even distribution between males and females. The average age of treated patients was 10 years old (SD ± 4.3). The average weight of patients was 35kg (SD ± 16.9). The most common diagnosis of patients was severe dengue (21.7%), followed by severe sepsis (14.7%). More than half of patients (51.9%) had an existing co-morbidity, of which Systemic Lupus Erythematosus (22.4%) and solid tumors (22.4%) were most common. The most common indication for hemodialysis was uremia (52.7%). In terms of short-term outcome, majority of patients died during the same admission (56.5%), while 31 patients (24.0%) recovered. CONCLUSION The clinical profile of patients who underwent hemodialysis treatments for AKI were comparable to international data. The study did not differentiate deaths from AKI or underlying illness, but demonstrated a higher mortality rate compared to other existing studies. This study is the first known local paper to describe the profile and outcomes of children who received hemodialysis for AKI.
Hemodialysis ; Renal Dialysis ; Severe Sepsis ; Sepsis ; Severe Dengue

BACKGROUND: Previous antibiotic exposure may inhibit the growth of microorganisms in blood culture bottles. The authors investigated the frequency of previous antibiotic usage and analyzed the relationships among antibiotic usage, microbiological culture results and mortality of sepsis patients. METHODS: From April to May 2011, all blood cultures requested from inpatients were analyzed according to the admitted ward and antibiotic prescription records. The BacT/Alert 3D system (bioMerieux Inc.) was used with a standard bottle (SA, SN) for blood culture. RESULTS: Of 900 inpatients, 48% had been receiving antimicrobial agents when blood cultures were ordered. This group had a significantly higher mortality rate (36.2%) compared to the patients who had not received antibiotics (11.1%). Gram-negative rod bacteremia (37.1%) and candidemia (100%) resulted in a significantly higher mortality rate compared to Gram-positive cocci bacteremia (16.4%). In the analysis of 21 cases resulting in death, 15 (71.4%) patients died before or on the date when blood culture results were reported. CONCLUSION: Patients who receive antibiotics prior to blood collection may be at a higher risk for mortality. In the present study, Gram-negative rod bacteremia and candidemia cases showed a rapid progression of sepsis as indicated by Gram staining and thus should be regarded seriously.
Anti-Bacterial Agents ; Anti-Infective Agents ; Bacteremia ; Candidemia ; Gram-Positive Cocci ; Humans ; Inpatients ; Prescriptions ; Sepsis ; Sydnones

Candidemia is a major cause of nosocomial morbidity and mortality in neonates. Prompt diagnosis and treatment is crucial. Risk factor analyses have been conducted worldwide, but limited local data are available. This study was conducted to help pediatricians practicing locally decide when to suspect if a neonate has candidemia; therefore, helping them in the judicious use of empirical antifungal therapy. Objective: To determine if there was a difference in the risk factors among neonates with candidemia and those without it, who were admitted at the Neonatal Intensive Care Unit of the Philippine General Hospital from October 2003 to August 2006. Methods: Neonates admitted within the mentioned period, surviving at least on the third day of life, and had at least one blood culture on or after day 3 of life were included in the study. A retrospective review of records was performed to identify the presence or absence of known risk factors for candidemia. The outcome of interest was the presence of candidemia. Each variable was analyzed initially using the bivariate analysis chi-square. Cut-off value for inclusion into multivariate analysis was p<0.25. Multivariate analysis, through backward elimination, was done to narrow down independent variables (p value for retention <0.25). Results: One hundred thirty-eight neonates (69 cases and 69 controls) were included. Based on bivariate analysis, patients exhibiting the following characteristics showed increased risk for candidemia: birth weights of 1250 to 1499g (OR: 3.24; 95% CI: 1.04-10.07) and 1500 to 2449g (OR: 3.84; 95% CI 1.31-11.27); pediatric aging < 28 weeks (OR: 1.42; 95% CI: 1.07-8.5) and 28 to 32 weeks (OR: 1.89; 95% CI: 0.74-4.84); central vascular access (OR: 0.52; 95% CI: 0.26-1.03); prolonged broad-spectrum antibiotic use (OR: 2.0; 95% CI: 0.95-4.2); and increased hospital stay (OR: 0.5; 95% CI: 0.24-1.05). Intralipid use was also associated with candidemia, but was excluded due to insufficient data available. In the multivariate analysis, only patients with birth weights of 1500 to 2449g (OR: 3.65; 95% CI: 1.24-10.77) and 1250 to 1499g (OR: 3.24; 95% CI: 1.04-10.07) qualified. A clinical predictive model in diagnosing candidemia was not possible due to insufficient variables available. Conclusion: Based on the study, infants with lower birth weights (<2500 g) were at most risk for developing subsequent candida infection.
Human ; CANDIDEMIA ; SEPSIS

To study the pathogens incidences in cord blood and the efficiency of different detective methods, 60 samples were drawn and reserved from collected and processed cord blood, respectively. The BACTEC 9050 system, improved Martin/thioglycollate broth (22 degrees C) and thioglycollate broth (35 degrees C) were employed to detected bacteria (including fungus) at the same time. Two hundred and six cord blood serum samples were used to detect the HBV DNA and HCV RNA by molecular biology technique, HBsAg, Anti-HBC, Anti-HCV, Anti-HCMV-IgM, HTLV-1, HTLV-2, HIV-1 and HIV-2 by ELISA and RBC agglutination test were used to detect the TPHA. Results showed that using BACTEC 9050 system, the incidence of bacteria and fungus was 3.33% and 0% respectively in collected cord blood; in processed cord blood, the rates increased to 6.67% and 1.67%, respectively. The sensitivity of BACTEC 9050 was higher than that of Martin/thioglycollate broth (22 degrees C/35 degrees C) culture. In 206 serum samples, the positive rate of HBV DNA was 5.8%, HCV RNA was 2.4%, HBsAg was 2.4%, HCMV-IgM was 1.89%, HCV was 2.4% and Anti-HBC was 29.4%. In those samples that Anti-HBC was positive, the positive rate of HBV DNA was 6.7%. It was concluded that the incidences of microbiological contamination in cord blood were high. The routine culture system would lead to false negative results of obligate anaerobes. It was necessary to replace the current culture system with improved system, such as BACTEC 9050 system. The molecular biology technique would make up for the default of ELISA.
Bacteremia ; epidemiology ; Blood Specimen Collection ; Fetal Blood ; microbiology ; virology ; Fungemia ; epidemiology ; Humans ; Polymerase Chain Reaction ; Probability ; Viremia ; epidemiology

BACKGROUND: Catheter-related sepsis (CRS) has become an important cause of nosocomial infections and the major complication with the intravenous central venous catheter (CVC) use. In this paper, we present the culture results of two years from Chonnam National University Hospital on the etiologic agents of CRS. METHODS: We reviewed the culture results for the most recent two years (July 1999 to June 2001) including semiquantitative CVC tip cultures (n=622) and differential quantitative blood cultures (n=149), as well as hospital records to determine clinical correlates of CRS. CRS was defined as a positive blood culture and catheter culture with the same organism in conjunction with a CVC tip >or=15 CFU or a central-to-peripheral blood culture colony count ratio of >or=5 :1. RESULTS: Forty-two (6.8%) of 622 CVC tip cultures and 13 (8.7%) of 149 differential quantitative blood cultures were associated with CRS. A total of 48 (32.0%) of 150 patients with bacteremia or candidemia were confirmed as having CRS, using semiquantitative tip cultures (30.9%, 42 of 136) and/or differential quantitative blood cultures (27.1%, 13 of 48). Twenty-one (48.8%) of 43 candidacies patients were associated with CRS and were more frequent than bacteremia due to Gram-positive cocci (27.3%, 18 of 66), and Gram-negative bacilli (23.1%, 9 of 39)(P<0.05). In 48 cases with proven CRS, Candida parapsilosis (29.2%) and Staphylococcus aureus (25.0%) were the most common etiologic agents, followed by coagulase negative Staphylococcus (10.4%), and Acinetobacter baumannii (8.3%). CONCLUSIONS: In culture proven cases of CRS, C. parapsilosis and S. aureus were the predominant causative organisms, and candidemia was more frequently associated with CRS than was bacteremia.
Acinetobacter baumannii ; Bacteremia ; Candida ; Candidemia ; Catheters ; Central Venous Catheters* ; Coagulase ; Cross Infection ; Gram-Positive Cocci ; Hospital Records ; Humans ; Jeollanam-do ; Prevalence* ; Sepsis* ; Staphylococcus ; Staphylococcus aureus

We investigated the combined effect of glutamine (GLN) and growth hormone (GH) on bacterial translocation (BT) in sepsis. After single intraperitoneal injection of lipopolysaccharide (10 mg/kg), 48 rats were divided randomly into four groups of 12 animals each: the control group received chow orally; the GLN group received chow plus 10% GLN; GH group received chow plus GH; and the GLN/GH group received chow, 10% GLN, and GH. Twenty-four and 96 hr later, rats were sacrificed. Portal blood culture, bacterial colony counts of cultured mesenteric lymph nodes, mucosal thickness, malondialdehyde (MDA), and glutathione (GSH) levels in the gut mucosa were measured. There was no significant change of the rate of portal blood culture between all treatment groups at 24 and 96 hr. At 24 hr, the rats receiving combined treatment of GLN and GH showed lower bacterial colony counts and mucosal MDA levels than the control rats, and higher mucosal GSH levels than the control and GLN-treated rats. At 96 hr, rats treated with both GLN and GH exhibited lower bacterial colony counts and mucosal MDA levels, and higher mucosal thickness and GSH levels than control, GLN, or GH-treated rats. This study suggests that the combination of GLN and GH may synergistically reduce BT over time in sepsis.
Animals ; Bacteremia/etiology ; Bacteremia/microbiology ; Bacteremia/prevention & control ; Bacterial Translocation/drug effects* ; Comparative Study ; Drug Evaluation, Preclinical ; Drug Synergism ; Endotoxemia/drug therapy* ; Endotoxemia/microbiology ; Escherichia coli/isolation & purification* ; Glutamine/pharmacology* ; Glutamine/therapeutic use ; Glutathione/analysis ; Human Growth Hormone/pharmacology* ; Human Growth Hormone/therapeutic use ; Ileum/microbiology ; Ileum/pathology ; Intestinal Mucosa/microbiology ; Intestinal Mucosa/pathology ; Lipid Peroxidation/drug effects ; Lymph Nodes/microbiology ; Male ; Rats ; Rats, Sprague-Dawley ; Recombinant Proteins/pharmacology ; Recombinant Proteins/therapeutic use ; Sepsis/microbiology ; Sepsis/prevention & control* ; Specific Pathogen-Free Organisms

Klebsiella pneumonia is an opportunistic pathogen that can lead to severe diseases such as septicemia, pneumonia, urinary and hepatobiliary track infection, in mainly hospitalized, immunocompromised patients. It has been reported to produce cellulitis, ecthyma gangrenosum in cutaneous manifestions, which are more commonly induced by bacteremia and spreading from other internal organs than primary inoculation. Herein, we present a case of a 75-year-old man with aplastic anemia, which progressed to septic shock and secondary cutaneous infection caused by Klebsiella pneumonia, but showed similar skin lesions to systemic fungal infection with dispersed erythematous macules and vesicular change on the center of his erythema.
Aged ; Anemia, Aplastic* ; Bacteremia ; Cellulitis ; Ecthyma ; Erythema ; Humans ; Immunocompromised Host ; Klebsiella* ; Pneumonia* ; Sepsis ; Shock, Septic ; Skin ; Track and Field

Endotoxemia ; diagnosis ; Endotoxins ; analysis ; Humans ; Sepsis ; diagnosis

BACKGROUND: Characterization of clinical features of bacteremic severe sepsis acquired from the community has been inadequate; therefore, our goal in this study was to identify prognostic factors associated with outcome in patients with community-acquired bacteremic severe sepsis. MATERIALS AND METHODS: Adult patients (> or =18 years) with community-acquired severe sepsis in whom pathogens were identified from blood cultures were included in the study. Data were collected prospectively from 12 teaching hospitals between May, 2005, and February, 2009. Data included demographic characteristics, co-morbid medical conditions, primary infection sites, sepsis severity, mortality, causative microorganisms, and the appropriateness of initial empirical antibiotic therapy. RESULTS: During the study period, 1,152 patients were diagnosed with community-acquired severe sepsis and 422 patients were found to harbor pathogens in their blood. Among the 422 patients analyzed, 253 (60.0%) patients went into shock and 121 patients (28.7%) died during hospitalization. Risk factors, including respiratory tract infection (odds ratio [OR], 2.60; 95% confidence interval [CI], 1.11-6.09), number of organ dysfunctions (OR, 1.39; 95% CI, 1.13-1.71), and higher APACHE II scores (OR, 1.08; 95% CI, 1.03-1.13) showed an association with poor survival, whereas Escherichia coli as a pathogen (OR, 0.31; 95% CI, 0.16-0.64) showed an association with lower mortality. CONCLUSIONS: In addition to severity of illness, the primary site of infection and causative microorganisms were also identified as important prognostic factors in patients with community-acquired bacteremic severe sepsis.
Adult ; APACHE ; Bacteremia ; Community-Acquired Infections ; Escherichia coli ; Hospitalization ; Hospitals, Teaching ; Humans ; Prospective Studies ; Respiratory Tract Infections ; Risk Factors ; Sepsis ; Shock ; Shock, Septic

BACKGROUND: Viridans streptococci, a diverse group of streptococcal species is present in the oral flora of all humans, and clinical isolation of these organisms could be misinterpreted as contamination. The purposes of this study were to ascertain the clinical significance of viridans streptococcal bacteremia and to determine the epidemiological, clinical, and microbiological features. METHODS: All cases of viridans streptococcal bacteremia in the period from January 1998 to December 2002 were reviewed. Bacterial identification was done with the Vitek system, and antimicrobial susceptibility tests for penicillin, cefotaxime, chloramphenicol, clindamycin, and erythromycin by the disk diffusion method or E-test were carried out. RESULTS: Of 154 cases of viridans streptococcal bacteremia, 56 cases were identified to the species level such as S. salivarius (19), S. mitis (16), S. intermedius (7), S. sanguis (7), S. uberis (3), S. oralis (2), S. bovis (1), and S. mutans (1). The most frequent diagnostic category was infectious diseases (54), followed by solid organ tumors (45), hematologic malignancies (29), and liver diseases (8). Seven patients (4.5%) had subacute endocarditis and all of them had underlying heart disease. Seventy six (49.3%) patients showed positive blood culture from two or more blood samples. Thirty three (21.4%) patients had an absolute neutrophil count of less than 500 cells/ L. Thirty four cases of bacteremia were polymicrobial (22%). When the diagnosis of viridans streptococcal bacteremia was established by the presence of two or more positive blood cultures or presence of neutropenia or signs of sepsis, 29.9% was interpreted as contamination. Two patients died of septic shock caused by viridans streptococcal infection alone. Sixty-eight percent of isolates were susceptible to penicillin. CONCLUSIONS: About 70% of viridans streptococcal bacteremia was clinically significant. Most viridans streptococcal bacteremia was found in patients with cancer or neutropenia and these infections were associated with limited morbidity.
Bacteremia* ; Cefotaxime ; Chloramphenicol ; Clindamycin ; Communicable Diseases ; Diagnosis ; Diffusion ; Endocarditis ; Erythromycin ; Heart Diseases ; Hematologic Neoplasms ; Humans ; Liver Diseases ; Neutropenia ; Neutrophils ; Penicillins ; Sepsis ; Shock, Septic ; Streptococcal Infections ; Viridans Streptococci