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Byline: S. Krontal (1), E. Leibovitz (1), M. Greenwald-Maimon (1), D. Fraser (2), R. Dagan (1) Keywords: Key Words Klebsiella Bacteremia; Children; Epidemiology; Nosocomial Abstract: Background: Klebsiella spp. have emerged in recent years as a major cause of gram-negative bacteremia in infants and children. We therefore aimed to document the epidemiology, antibiotic susceptibility pattern and outcome of both community-acquired and nosocomial Klebsiella spp. bacteremias in children. Patients and Methods: From 1998--1997, 177 episodes of Klebsiella bacteremia, representing 15% of all gram-negative bacteremias, occurred at the Soroka Medical Center in 166 children aged 0--14 years. Results: The overall incidence of Klebsiella bacteremia in southern Israel during the study period was 0.13/1,000, with an increase from 0.1 to 0.2/1,000 children from 1988--1992 to 1993--1997 (p = 0.02). 113 and 64 episodes were recorded in Bedouin Arabs and Jewish children, respectively. The incidence of Klebsiella bacteremia was significantly higher in Bedouins compared to Jewish children (p &lt 0.001). The incidence of Klebsiella bacteremia increased significantly among Jewish children from 1993--1997 compared to 1988--1992. The incidence of Klebsiella bacteremia was 2/1,000 admissions, with an increase from 1.8 to 2.2/1,000 from 1993--1997 compared to 1988--1992. The incidence of Klebsiella bacteremia was significantly higher among hospitalized Bedouin children compared to Jewish children (3.1 vs. 1.4/1,000 admissions, p &lt 0.001). There were 48 (27%), 24 (14%) and 98 (55%) Klebsiella bacteremia episodes at the pediatric departments, pediatric intensive care unit (PICU) and neonatal intensive care unit (NICU), respectively. 76% of Klebsiella bacteremia episodes were nosocomial 66% occurred at NICU. 71% and 90% of Klebsiella bacteremia episodes occurring at NICU and PICU, respectively, were nosocomial. The overall incidence of nosocomial infections was 1.5/1,000 admissions, with an increase from 1.2 to 1.8/1,000 from 1993--1997 compared to 1988--1992 (p = 0.03). The resistance rates of Klebsiella spp. to piperacillin, ceftriaxone, ceftazidime and gentamicin were 34%, 17%, 17% and 14%, respectively. A significant increase in the resistance rates to ceftriaxone and ceftazidime was observed from 1993--1997 compared to 1988--92 (21.9% vs. 7.8%, p = 0.05 and 21.9% vs 5%, p = 0.03). A significant increase in resistance of ceftriaxone was recorded at PICU and NICU (from 12% and 0%, respectively, from 1988--1992, to 61% and 16%, respectively, from 1993--1997, p = 0.02). Overall mortality rate of Klebsiella bacteremia was 13% (21/167 cases, 12 and eight at PICU and NICU, respectively). Conclusion: An increase in Klebsiella bacteremia was recorded in southern Israel during the 10 years of the study. A marked increase in the rate of nosocomial Klebsiella bacteremia occurred at all departments. Resistance to third-generation cephalosporins emerged frequently at PICU and NICU during the last period of the survey. Author Affiliation: (1) Pediatric Infectious Disease Unit, Soroka University Medical Center, Beer-Sheva 84101, Israel Phone: (+97/27) 6-400547 Fax: -232334, e-mail: eugenel@bgumail.bgu.ac.il, IL (2) Epidemiology Unit, Soroka University Medical Center, Israel, IL Article note: Received: March 26, 2001 * Revision accepted: January 8, 2002

Byline: E. Somekh (1), N. Maharashak (1), Y. Shapira (1), D. Greenberg (2), R. Dagan (2) Keywords: Key Words Varicella; Hospitalization; Complications; Bedouins; Jews Abstract: Background: We conducted this study to determine the impact of chickenpox on two different ethnic populations in southern Israel: Jews and Bedouins. Methods: Hospital records of 113 patients discharged from the Soroka Medical Center with the diagnosis of varicella during a 4.5-year period were reviewed. Results: Mean age was 9.2 years and the average hospital stay was 5.4 days. Bacterial skin or soft tissue infections were the most common complications (30%), followed by pneumonia (17%) and central nervous system complications (11.5%). There were no fatal cases throughout the study period. The calculated hospitalization rate for varicella was one in every 319 cases. Major differences between Jews and Bedouins included an older mean age of Bedouin patients (13.9 years versus 4.5 years) higher hospitalization rate (relative risk [R.R.]: 2.8, 95% confidence interval: 1.9--4.2), and higher risk for complicated varicella (R.R.: 2.1, 95% confidence interval: 1.3--3.4). Conclusion: Hospitalization of patients with varicella in southern Israel is common and varicella infection in Bedouins is associated with greater morbidity compared with that in Jews in southern Israel. Author Affiliation: (1) Pediatric Infectious Disease Unit, Wolfson Medical Center, P.O. Box 5, Holon, Israel, IL (2) Pediatric Infectious Disease Unit, Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Soroka Medical Center, P.O. Box 151, Beer-Sheva 84101, Israel Phone: +972-7-6400547, Fax: +972-7-6232334, e-mail: rdagan@bgumail.bgu.ac.il, IL Article note: Received: April 4, 1999 * Revision accepted: February 23, 2000

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