Evaluation of clinical Spectrum, antibiotic Sensitivity, and clinical Outcome in pediatric Age Group (0–18 Years) with Extended-spectrum Beta-lactamase-producing <i>Escherichia coli-</i>associated Urinary Tract Infection in Tertiary Care Hospital in India

Background: There is an increasing prevalence of extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli-associated urinary tract infections (UTIs) in the pediatric population. These multidrug infections are challenging to treat. Objectives: Our aim is to study the clinical profile in children having urine culture positive with ESBL E. coli, antibiotic sensitivity pattern for ESBL E. coli in urine cultures, and evaluate clinical outcomes in patients with ESBL E. coli-associated UTI in our hospital. Methods: We collected reports of all urine cultures for age group 0–18 years with colony counts >105 CFU/mL during the study period from January 2017 to December 2021 done in our hospital pathology lab. All urine culture positive reports were separated according to causative organism. From this, the subgroup of patients with ESBL E. coli was our study's focus. The prevalence of ESBL E. coli as a causative organism was calculated. These patients were further analyzed for clinical spectrum, antibiotic sensitivity pattern, and clinical outcome. Results: Out of 450 urine culture positive reports during the study period, E. coli was the most common organism with 259 (57%) cases. The maximum incidence of ESBL E. coli-associated urinary infection was in patients between 0 and 5 years (56%). The prevalence of infection in females (59%) was slightly higher than in males (41%). Extended-spectrum beta-lactamase E. coli are highly sensitive to the carbapenem group of antibiotics, amikacin, and fosfomycin. Resistance was 100% for ampicillin, aztreonam, ceftriaxone, and cefixime. Other antibiotics with high resistance were trimethoprim/sulfamethoxazole and the fluoroquinolone group of antibiotics. About 25% of children had h/o previous episodes of UTI. About 43% of patients had some significant underlying medical problem. About 51% of indoor patient department (IPD) patients had normal ultrasonogram (USG) or no findings related to the renal system. Each IPD patient was treated with antibiotics (IV plus oral) for 11 days on average. There were differences between in vitro antibiotic sensitivity and clinical experience for a few cephalosporin antibiotics. Overall mortality among IPD patients was 4%. Conclusions: Girls have more chances of getting UTIs due to ESBL E. coli than boys. Incidence of UTI due to ESBL E. coli is more during 0–5 years of life than in older children. Urinary tract infection due to ESBL E. coli is associated with high mortality. Carbapenems, amikacin, and fosfomycin are good choices of antibiotics to treat such infections. Antibiotic sensitivity patterns for cephalosporins derived by currently available methods do not always match clinical experience

Optimizing Treatment Strategies in a Pediatric Infectious Case: A Multidisciplinary Perspective

This case study presents the comprehensive evaluation and management of a 4-year-old male patient with phimosis who presented with fever, anorexia, weakness, and burning micturition. Upon admission, bilateral multiple renal abscesses and cystitis were diagnosed through ultrasound examination, prompting initiation of intravenous (IV) piperacillin–tazobactam combination and IV vancomycin. Due to concerns of red man syndrome, vancomycin was closely monitored, and a multidisciplinary approach involving specialists in pediatric infectious diseases and surgery was adopted. Sensitivity testing revealed Escherichia coli infection resistant to multiple antibiotics, leading to a switch to IV meropenem. Additional investigations for suspected mumps yielded negative results, emphasizing the importance of thorough evaluation. The patient’s condition improved with appropriate antibiotic therapy, as evidenced by decreasing abscess size and resolution of symptoms. This case underscores the significance of tailored antibiotic therapy, close monitoring, and multidisciplinary collaboration in managing complex pediatric infectious cases, ensuring optimal patient outcomes. Additionally, the patient’s complete vaccination highlights the potential for atypical mumps presentations. Resurgence factors include secondary vaccine failure, reduced vaccine effectiveness (85–90%), and lack of natural boosting from wild-type virus

Data-Driven and Machine-Learning-Based Real-Time Viscosity Measurement Using a Compliant Mechanism

In this work, a novel method of viscosity measurement is proposed using a device comprising a compliant mechanism, a vibration source, and a piezoelectric sensor. The vibration source creates linear harmonic vibrations in the compliant mechanism suspended in the liquid, and the acceleration response of the mechanism is measured using the piezoelectric sensor. The vibration source is located in the central mass of the compliant mechanism, which is designed to have the necessary directional stiffness. As the mechanism vibrates, the links in the mechanism undergo damping due to the shearing action of the fluid because of its viscosity. A series of viscosity measurements are carried out with the use of water&ndash;glycerol solutions such that the acceleration of the mass is influenced by the fluid&rsquo;s viscosity. During the working of the device, the mechanism is immersed in the liquid whose viscosity is to be measured. The acceleration response of the mass is recorded as time domain data using NI Lab View hardware and software, which are used to train a machine learning model. Later, a regression-based machine learning model is used for the estimation of dynamic viscosity for the given acceleration input. Experiments are performed with the prototype device using the water&ndash;glycerol solution within a viscosity ranging from 10 cP to 60 cP. The proposed sensor can be used for in-line measurements or used as a handheld instrument for quick measurements. The machine learning model achieved a high level of accuracy, evidenced by an R-squared value of 0.99, indicating that it explains 99% of the variance in the data

International Nosocomial Infection Control Consortiu (INICC) report, data summary of 43 countries for 2007-2012. Device-associated module

We report the results of an International Nosocomial Infection Control Consortium (INICC) surveillance study from January 2007-December 2012 in 503 intensive care units (ICUs) in Latin America, Asia, Africa, and Europe. During the 6-year study using the Centers for Disease Control and Prevention's (CDC) U.S. National Healthcare Safety Network (NHSN) definitions for device-associated health care–associated infection (DA-HAI), we collected prospective data from 605,310 patients hospitalized in the INICC's ICUs for an aggregate of 3,338,396 days. Although device utilization in the INICC's ICUs was similar to that reported from ICUs in the U.S. in the CDC's NHSN, rates of device-associated nosocomial infection were higher in the ICUs of the INICC hospitals: the pooled rate of central line–associated bloodstream infection in the INICC's ICUs, 4.9 per 1,000 central line days, is nearly 5-fold higher than the 0.9 per 1,000 central line days reported from comparable U.S. ICUs. The overall rate of ventilator-associated pneumonia was also higher (16.8 vs 1.1 per 1,000 ventilator days) as was the rate of catheter-associated urinary tract infection (5.5 vs 1.3 per 1,000 catheter days). Frequencies of resistance of Pseudomonas isolates to amikacin (42.8% vs 10%) and imipenem (42.4% vs 26.1%) and Klebsiella pneumoniae isolates to ceftazidime (71.2% vs 28.8%) and imipenem (19.6% vs 12.8%) were also higher in the INICC's ICUs compared with the ICUs of the CDC's NHSN