BackgroundAn estimated 32,000 children develop multidrug-resistant tuberculosis (MDR-TB; Mycobacterium tuberculosis resistant to isoniazid and rifampin) each year. Little is known about the optimal treatment for these children.Methods and findingsTo inform the pediatric aspects of the revised World Health Organization (WHO) MDR-TB treatment guidelines, we performed a systematic review and individual patient data (IPD) meta-analysis, describing treatment outcomes in children treated for MDR-TB. To identify eligible reports we searched PubMed, LILACS, Embase, The Cochrane Library, PsychINFO, and BioMedCentral databases through 1 October 2014. To identify unpublished data, we reviewed conference abstracts, contacted experts in the field, and requested data through other routes, including at national and international conferences and through organizations working in pediatric MDR-TB. A cohort was eligible for inclusion if it included a minimum of three children (aged <15 years) who were treated for bacteriologically confirmed or clinically diagnosed MDR-TB, and if treatment outcomes were reported. The search yielded 2,772 reports; after review, 33 studies were eligible for inclusion, with IPD provided for 28 of these. All data were from published or unpublished observational cohorts. We analyzed demographic, clinical, and treatment factors as predictors of treatment outcome. In order to obtain adjusted estimates, we used a random-effects multivariable logistic regression (random intercept and random slope, unless specified otherwise) adjusted for the following covariates: age, sex, HIV infection, malnutrition, severe extrapulmonary disease, or the presence of severe disease on chest radiograph. We analyzed data from 975 children from 18 countries; 731 (75%) had bacteriologically confirmed and 244 (25%) had clinically diagnosed MDR-TB. The median age was 7.1 years. Of 910 (93%) children with documented HIV status, 359 (39%) were infected with HIV. When compared to clinically diagnosed patients, children with confirmed MDR-TB were more likely to be older, to be infected with HIV, to be malnourished, and to have severe tuberculosis (TB) on chest radiograph (p < 0.001 for all characteristics). Overall, 764 of 975 (78%) had a successful treatment outcome at the conclusion of therapy: 548/731 (75%) of confirmed and 216/244 (89%) of clinically diagnosed children (absolute difference 14%, 95% confidence interval [CI] 8%–19%, p < 0.001). Treatment was successful in only 56% of children with bacteriologically confirmed TB who were infected with HIV who did not receive any antiretroviral treatment (ART) during MDR-TB therapy, compared to 82% in children infected with HIV who received ART during MDR-TB therapy (absolute difference 26%, 95% CI 5%–48%, p = 0.006). In children with confirmed MDR-TB, the use of second-line injectable agents and high-dose isoniazid (15–20 mg/kg/day) were associated with treatment success (adjusted odds ratio [aOR] 2.9, 95% CI 1.0–8.3, p = 0.041 and aOR 5.9, 95% CI 1.7–20.5, p = 0.007, respectively). ...

Recently, Acinetobacter emerged as an important pathogen and the rate of isolation has increased since the last two decades worldwide. Objectives of the present study were to see the incidence of Acinetobacter infection at a tertiary care hospital at Kashmir, India, demographic features of the infections, species identification and antibiotic sensitivity and resistance pattern of the isolates. The clinical samples submitted to Microbiology laboratory at SKIMS over a period of 2 years (June, 2001 to June, 2003) were investigated. Identification, speciation and antibiotyping were performed for the isolates of Acinetobacter recovered from clinical samples including urine, pus, sputum, blood, CSF and other body fluids. Clinical and demographic characteristics were studied retrospectively. Out of a total of 5352 infected samples, 258 (4.8%) were found to be due to Acinetobacter. The organism was responsible for 76 (39.64%) cases of urinary tract infection and 38 (29.45%) cases of wound infection and was most prevalent in the intensive care unit (29.84%). A. baumannii was the most predominant species. Prolong hospital stay, Mechanical ventilation and Intensive Care Units were found to be potential risk factors. High level of resistance was recorded for Ampicillin (86.3%), Cefazolin (93.2%) Gentamicin (61.5%), Cefotaxime (65.8%), Ceftriaxone (61.5%) and Ciprofloxacin (69.2%). Although no specific pattern during antibiotyping was observed, but most of them were multi-drug resistant. Nosocomial infections by multi-drug-resistant Acinetobacter have emerged as an increasing problem especially in the intensive care units of the hospital. The analysis of risk factors and susceptibility pattern will be useful in understanding epidemiology of this organism in a hospital setup. Key words: Acinetobacter, Nosocomial infection, Antibiotyping, Multi-drug resistant   doi: 10.3329/bjmm.v3i1.2969 Bangladesh J Med Microbiol 2009; 03 (01): 34-38

Chronic suppurative otitis media (CSOM) is one of the most common chronic childhood infections worldwide. CSOM most often occurs in the first 5 years of life, and is common in developing countries, in special populations such as children with craniofacial anomalies and in certain racial groups 1,2 The WHO defines CSOM as "otorrhea through a perforated tympanic membrane present for at least two weeks" ,. 3 CSOM can occur when acute otitis media (AOM) causes acute perforation of the tympanic membrane or when AOM occurs in conjunction with chronic perforation or tympanostomy tubes. 4 The most common sequelae of CSOM is conductive or sensorineural hearing loss. 5 Since CSOM can cause significant morbidity, knowledge of the pathogens responsible for CSOM can assist in the selection of the most appropriate treatment regimen. The aim of this study was to determine the aerobic organisms ABSTRACT Background: Chronic suppurative otitis media (CSOM) remains one of the most common childhood chronic infectious diseases worldwide, affecting diverse racial and cultural groups both in developing and industrialized countries. It involves considerable morbidity and can cause extra-and intra-cranial complications. The aim of this study was to determine the microbial diversity and the antibiogram of aerobic bacterial isolates among patients suffering from CSOM who attended the ENT Department of SMHS hospital, a tertiary care centre located in the heart of the Kashmir valley. Methods: A total of 154 patients clinically diagnosed with CSOM were enrolled in the study and the samples were obtained from each patient using sterile cotton swabs and cultured for microbial flora. Drug susceptibility testing for aerobic isolates was conducted using Kirby-Bauer disc diffusion method. Results: Out of total 154 ear swabs processed, microbial growth was seen in 138 (89.61%) while 16 (10.38%) samples showed no growth. In 102 (66.23%) samples mono-microbial growth was seen whereas 26 (16.88%) samples showed poly-microbial growth. The most frequent organism isolated was Pseudomonas aeroginsa followed by Staphylococcus aureus and Proteus sp. The most effective antibiotic against Pseudomonas aeroginsa was amikacin followed by imipenem and piperacillin plus tazobactam, while as Staphylococcus aureus showed maximum sensitivity to vancomycin. Conclusion: Otitis media linked with high levels of multiple antibiotic resistant bacteria is a major health concern in all age groups of the study population. An appropriate knowledge of the etiology and antibacterial susceptibility of microorganisms would contribute to a rational antibiotic use and the success of treatment for chronic supportive otitis media.

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