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Since 1982, a pediatric intensive care unit for neonates and pediatric patients up to 15 years of age has prospectively recorded every instance of use of antimicrobials, with the reasons for use, clinical and bacteriological parameters, and outcome. This approach encourages strict adherence to established protocols and provides a basis for discussing the rationale of each antimicrobial course. Effectiveness of protocols is evaluated annually and modifications or additions are introduced, as appropriate. Patterns in the proportion and nature of antimicrobials used to treat hospital-acquired infections can be monitored on the basis of the data collected. Changes in the nature of antimicrobials used, which may have repercussions on pathogen resistance to antimicrobials, are also monitored. Reasons for use of antimicrobials are categorized as follows: A = primary infection: B = secondary infection acquired in the ICU; C: secondary infection acquired in another unit or in another hospital; D = prophylaxis. In 1987, 46% of neonates and 59% of patients above one month of age were given antimicrobial agents; these figures are similar to those recorded during the previous years. Reasons for antimicrobial therapy were as follows in neonates: A = 48.5%; B = 40%; C = 1.2%; D = 10.3%; in patients above one month of age corresponding figures were: A = 23%; B = 44%; C = 0.9%; D = 31.9%. Among the neonates, the ampicillin-aminoglycoside combinations accounted for 41.5% of treatments (1/4th of these treatments were continued); in the older patients, penicillin G and ampicillin were the most commonly used antibiotics. In all age groups, hospital-acquired infections were mainly respiratory tract infections (approximately 50% in neonates and 80% in patients above one month of age). Staphylococcus aureus was the most prevalent organism; Pseudomonas was seen virtually only among the patients above one month of age with very prolonged endotracheal intubation. From 1983 through 1987, use of third-generation cephalosporins increased from 4.5% to 28.3% in neonates and from 5.5% to 9% for patients above one month of age. The changes identified over time should be interpreted in the light of changing patterns of disease; in particular, hospital-acquired infections among neonates increased twofold, probably as a result of the rising number of very-low-birth-weight infants.

Following a number of reports of purulent CSF specimens positive for Flavobacterium meningosepticum in pediatric patients in Yaoundé, a prospective study was carried out in the Department of Pediatrics of the Central Yaoundé Hospital from December 1988 through December 1989. The goals of this study were to determine the incidence of Flavobacterium meningosepticum among infants and children with purulent meningitis, to discover the origin of this pathogen, and to examine its susceptibility to antimicrobial agents. Flavobacterium meningosepticum (18.4% of cases) was second by order of incidence, after pneumococci (50%). Incidences were low for the other pathogens usually described in purulent meningitis (H. influenzae, meningococcus...). All the pneumococcus strains recovered were susceptible to ampicillin. In contrast, 21.43% of strains of Flavobacterium meningosepticum were resistant to both ampicillin and chloramphenicol (the combination currently used as first line therapy in the Department), and 14.25% of strains were resistant to cefotaxime. The origin of the Flavobacterium meningosepticum strains found remains to be discovered. The low incidence of H. influenzae deserves to be reevaluated over the next few years.

The new penicillins developed over the last few years have helped improve our therapeutic armamentarium against enterobacteriaceae, Pseudomonas, beta-lactamase-producing Haemophilus influenzae and Neisseria, Acinetobacter and anaerobes. However, they are of no benefit in the treatment of infections caused by staphylococci, streptococci and Listeria. These new molecules have little toxicity and represent a breakthrough in the development of drugs with improved pharmacokinetic properties and resistance to bacterial beta-lactamases. However, none has escaped the development of resistant bacteria that may cause clinical failures; this event is to be expected as resistant strains have been recovered from stools.