No abstract

A one year, retrospective audit of intermittent vancomycin therapy within the Neonatal Unit at the Royal Hospital for Sick Children, Glasgow, found that only 33% of 984 vancomycin trough levels were within the British National Formulary for children (BNFc) target range of 10–15 mg/l and 25% were <10 mg/l. A detailed, prospective review of 20 courses (15 patients) over one month, while using the same dosing guidelines, highlighted that only 23 of 50 concentration measurements (46%) were within the target range and 20% were <10 mg/l, even though the initial doses used (table 1) were higher than those recommended by the BNFc. Dose adjustments were common and up to 80 mg/kg/day was often required for older infants. Appropriate interpretation of concentration results was compromised

Over an 18-month period we encountered 12 episodes of Serratia marcescens bacteraemia in 10 patients in a paediatric oncology unit. These were associated with long-term indwelling Hickman intravenous catheters (right atrial) and caused three deaths. Seven of the patients had only mild pyrexial illnesses and made a complete recovery. The source was traced to contaminated aqueous chlorhexidine in a bedside container in which plastic clamps were stored. When this was rectified the outbreak ceased. The identity of the causal Serratia strains was confirmed by plasmid analysis and they showed multiple antibiotic resistance, including the aminoglycosides. The study illustrates the emergence of S. marcescens as an opportunistic pathogen and emphasises the dangers of Hickman-associated bacteraemia.

1973 ;193 :493-8. 4 Kistner S, Norberg R. Urinary excretion of serum proteins in renal disease. Studies of electrophoretic fractions and IgA, IgG and IgM.