Microbiological spectrum of septicemia and peritonitis in nephrotic children

From April 1993 to December 1997, 452 admissions of 231 children with nephrotic syndrome to Chang Gung Children's Hospital were retrospectively reviewed. There were 10 episodes of sepsis and 8 episodes of peritonitis in 18 children, and 14 microorganisms were cultured. Two children died due to Streptococcus pneumoniae sepsis. Gram-positive microorganisms (n=7) and Gram-negative microorganisms (n=7) were found in equal numbers. Enterococcus (1), Streptococcus pneumoniae (4), group D streptococcus (1), and Streptococcus viridans (1) were the Gram-positive microorganisms cultured. Two of 4 cases of Streptococcus pneumoniae sepsis were penicillin resistant. Gram-negative microorganisms included Enterobacter cloacae (1), Klebsiella pneumoniae (1), Escherichia coli (2), Acinetobacter baumannii (1), Neisseria meningitidis (1), and group B salmonella (1). The last three microorganisms have not been previously associated with nephrotic children. Vancomycin therapy to cover penicillin-resistant Streptococcus pneumoniae and a third-generation cephalosporin therapy to cover rare Gram-negative microorganisms should be considered in serious infections of nephrotic children.