[Croup in children--results of prospective, multicenter observation]

Croup syndrome is an urgent and frequent reason for hospitalization of children.

MATERIAL AND METHODS

632 children with croup syndrome (422 boys and 210 girls aged 2 months-17 years) admitted to 15 pediatric departments in Lower Silesia were prospectively observed for 12 months (from April 2001 to March 2002). We conducted prospective survey of clinical and laboratory data from all study centers.

RESULTS

Following diagnoses were accepted as the croup syndrome: subglottic laryngitis in 482 patients (75.4%), laryngotracheobronchitis in 75 (11.8%), laryngitis in 50 (7.8%) and epiglottitis in 20 children (3%). The most severe course was observed in children with epiglottitis. Four of them required airway intervention and had endotracheal intubation. H. influenzae b was cultured from blood of one patient. The most cases of epiglottitis occurred in the 3rd year of life (45%).

CONCLUSIONS

1. The most common reason of croup was subglottic laryngitis. 2. Epiglottitis was rare with serious course of disease; frequency was comparable with the frequency seen in European countries before the implementation of Hib vaccine. The routine use of Hib vaccine in Poland may prevent from children life threatening epiglottis cases.

[Treatment of croup syndrome in children in Poland: results of the prospective multi-center observation]

The aim of the study was to estimate treatment practice in hospital management of croup syndrome (laryngitis subglottica) in children in Poland.

MATERIAL AND METHODS

During the period of 12 months, we have prospectively observed 482 children with croup syndrome admitted to 15 pediatric departments in Lower Silesia (south-west region of Poland). Data concerning epidemiology, clinical course and treatment were collected from uniform observation cards. There were 326 boys and 156 girls aged between 2 and 174 months in our study.

RESULTS

Among 482 observed children, received glucocorticoids 424 (88%) mainly parenteral, L-epinephrine--211 (43.8%), mist therapy--241 (50%), antihistamines--308 (63.9%), antibiotics--280 (58.1%). Children treated with antibiotics were younger (p=0.0316), their temperature, amount of leukocytes and value of C-reactive protein was higher when compared with those not treated (p=0.0002; p=0.0081, p=0.0172 respectively).

CONCLUSIONS

Children in Lower Silesia with croup syndrome were treated in agreement with recent standards with glucocorticoids and/or epinephrine. There was an excessive usage of antihistamines which have no established treatment role. It seems that in many cases antibiotic treatment could have been avoided.

[Evaluation of sensitivity to antibiotics of microorganisms isolated from children with urinary tract infections]

The incidence of etiological factors of urinary tract infections in children and in vitro susceptibility of these strains to antibiotics were evaluated. 1082 strains isolated from 905 samples of urine of children hospitalized in the period of 01.01-31.12.2001 were tested. Among the isolated microorganisms, the most common group was the Enterobacteriaceae family (57.4%) and also very often Gram-positive cocci were isolated (34.2%). The most frequent causative agents of UTI (Escherichia coli and Enterococcus faecalis) were generally sensitive to all used antibiotics, but E. coli rods were resistant to ampicillin. In addition, 23.4% of E. coli were the ESBL-producing strains.

[Analysis of bacteriological tests of children with decreased serum immunoglobulin IgA levels]

Results of 142 children with decreased serum immunoglobulin IgA compared with the reference values for age, and 73 reached normal age levels for serum immunoglobulin (control group), up 6 months to 14 years of age with various clinical symptoms, admitted to hospital between 1999-2000, were analysed. The patients were divided into three groups: group I--children with decreased serum immunoglobulin IgA levels (86 patients), group II--children with hypogammaglobulinaemia IgA and IgG compared with the reference values for age (56 patients), group III--children reaching normal levels of serum immunoglobulin for age (73 patients)--control group. Staphylococcus aureus was found most frequently among pathogenic strains in groups I and II in comparison to the control group. In urine, Enterococcus faecalis strains were observed more often in the first and in the second group than in the control group. All patients in our three groups showed high per cent of Candida albicans in biological material from the pharynx and faeces. We associated this with treatment of recurrent infections in children, using many antibiotics. In conclusion, our results have demonstrated that low serum IgA and IgG concentrations in children are favourable for colonisation with pathogenic microorganisms.

[The sensitivity of the uropathogenic Escherichia coli strains to antibiotics, bacteriophages and bactericidal serum activity]

Escherichia coli strains isolated from children with urinary tract infections (UTI) were investigated for their sensitivity to antimicrobial drugs, bacteriophages and bactericidal activity of human serum. It has been proved, that the resistance to bactericidal effect of serum is not the dominant feature of uropathogenic Escherichia coli strains. Significant percentage of the strains appeared to be sensitive to the most popular drugs ordered during UTI treatment in children. No simple relationship between sensitivity of the strains to the drug and to the human serum has been found. Three of 44 bacteriophages specific to Escherichia coli have shown the lytic effect towards 50-60% strains under investigations.

[Etiological factors of urinary tract infections in children]

Etiological factors of urinary tract infection in children have been studied. The Escherichia coli, Klebsiella sp., Enterococcus sp. and Enterobacter sp. were the most often isolated bacteria from infant and baby urine. In this age group of patients uromycoses were also affirmed. From the urine of older children (1-18 years old) mainly Escherichia coli, Enterococcus sp., Proteus sp. and Morganella morganii have been raised. Uropathogens' occurrence was analysed by a statistical method in the relation to age and sex of the children. The girls in the age of 1 to 18 years were more open than boys to urinary tract infections caused by Escherichia coli and less open to infections caused by Morganella morganii and Enterococcus sp.

[Infectivity and resistance to antibiotics of uropathogenic gram-negative rods]

The nature of bacterial isolates from children with clinically suspected urinary tract infections (UTI) was studied. The susceptibility of urinary pathogens to selected antibiotics was determined. The results clearly show that E. coli was identified as the main causative agent of UTI children (67% of isolates). The second commonest pathogen was P. mirabilis (10%). Over half E. coli isolates were resistant to amino-penicilins but almost all isolates (over 80%) were sensitive to antimicrobial agents combined with beta-lactamase inhibitors. We found significantly high percentage (32.5%) of ESBL strains among K. pneumoniae isolates.