Impact of infection by verotoxigenic Escherichia coli O157:H7 on the use of surgical services in a children's hospital

OBJECTIVES

To determine the impact of Escherichia coli O157:H7 infection in children on the need for surgical assessment in a pediatric surgical practice and whether clinical and bacteriologic variables might contribute to that need.

DESIGN

Examination of a case series.

SETTING

A tertiary-care pediatric hospital.

PATIENTS

Between 1990 and 1994, E. coli O157:H7 gastrointestinal infections were documented among 85 children, 29 of whom suffered from hemolytic-uremic syndrome.

INTERVENTION

Surgical consultation for presumed or proven complications of the infection.

MAIN OUTCOME MEASURES

The frequency of and reasons for surgical consultation, clinical and bacteriologic variables between patients who did or did not require surgical assessment.

RESULTS

Of the 85 children, 17 (20%) were assessed by the surgical service. The majority of these children were inpatients. Two required abdominal surgery. Female gender, older age and progression to hemolytic-uremic syndrome were factors associated in univariate analyses with a likelihood of need for surgical assessment; variation in bacterial genotype was not.

CONCLUSION

There is the potential for verotoxigenic E. coli O157:H7 infection to have a considerable impact on the utilization of pediatric surgical services.

Endemic giardiasis and municipal water supply

To test the hypothesis that endemic giardiasis may be transmitted by unfiltered municipal water supplies, the incidence of laboratory-confirmed giardiasis was studied in a natural experiment due to the arrangement of the public water supply of Dunedin, New Zealand. The incidence rate ratio was 3.3 (90% CI = 1.1, 10.1) for the population receiving unfiltered (microstrained) water relative to that using sand filtered water. In a parallel case-control study of incident cases, the odds ratio for giardiasis and unfiltered (microstrained) water supply was 1.8 (90% CI = 0.5, 6.9).

Adolescent and adult lymphoblastic leukaemia: prognostic factors and response to treatment

Thirty consecutive patients with acute lymphoblastic leukaemia (ALL) who received treatment at Christchurch Hospital between 1972 and 1982 were reviewed. Complete remission (CR) was achieved in 80 per cent with a median survival of 65 weeks. Eleven of 30 patients had one or more of the following features--B cell ALL, a mediastinal mass, the Philadelphia chromosome (Ph1) and age 60 years or older at diagnosis. Although CR was obtained in 8 of these patients none survived three years. The remaining 19 patients were regarded as 'good risk' and treated by moderate intensity chemotherapy schedules. CR was obtained in 16 of these patients (84 per cent) and the estimated 5 year survival was 62 per cent with 6 patients remaining in remission from 5 to 9 years from diagnosis. These results demonstrate the value of objective and reproducible clinical and laboratory findings in defining a subset of ALL patients which may not require high intensity chemotherapy schedules.