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Ampicillin-resistant Hemophilus influenzae type B septic arthritis in children
Abstract:
Three cases of ampicillin-resistant Hemophilus influenzae type B septic arthritis are described. These patients presented over a four-month period (November 1978 to February 1979). All were less than 18 months of age, all had positive blood and joint aspirate cultures, and counter-current immunoelectrophoresis (CIE) on serum positive for Hemophilus influenzae type B. The ampicillin minimum inhibitory concentration (MIC) for all three isolates was 6.25 microgram/ml or greater. All patients recovered uneventfully with intravenous chloramphenicol therapy. We suggest that chloramphenicol be considered in the initial therapy of children under 18 months of age who present with septic arthritis, at least in geographic areas where the incidence of ampicillin resistance is high.
Insights
Ampicillin-resistant Hemophilus influenzae type B caused septic arthritis in three young children. Intravenous chloramphenicol effectively treated all cases, suggesting its consideration for initial therapy in at-risk populations.
Area of Science:
- Pediatric Infectious Diseases
- Bacterial Pathogenesis
- Antimicrobial Resistance
Background:
- Septic arthritis in infants and young children poses significant clinical challenges.
- Increasing antimicrobial resistance necessitates updated treatment guidelines.
- Hemophilus influenzae type B was a common cause of invasive bacterial infections before widespread vaccination.
Observation:
- Three pediatric cases of septic arthritis caused by ampicillin-resistant Hemophilus influenzae type B were observed between November 1978 and February 1979.
- All patients were under 18 months of age and presented with positive blood and joint fluid cultures.
- Serum testing confirmed Hemophilus influenzae type B, with minimum inhibitory concentrations for ampicillin at 6.25 µg/ml or higher.
Findings:
- All three patients achieved uneventful recovery following treatment with intravenous chloramphenicol.
- The study highlights the emergence of ampicillin resistance in Hemophilus influenzae type B isolates causing septic arthritis.
- Chloramphenicol demonstrated efficacy against these resistant strains.
Implications:
- Chloramphenicol should be considered in the initial management of septic arthritis in children under 18 months, particularly in regions with high ampicillin resistance rates.
- This finding underscores the importance of monitoring antimicrobial resistance patterns for guiding pediatric infectious disease treatment.
- Early and effective antimicrobial therapy is crucial for favorable outcomes in pediatric septic arthritis.