Search

L'apparition d'une tumefaction du cou chez l'enfant est toujours source d'inquietude pour les parents et parfois pour le medecin. La plupart du temps, le diagnostic est simple. Mais lorsqu'il parait plus difficile, il faut savoir retirer le maximum d'informations d'un examen clinique, fonde essentiellement sur la topographie, avant de recourir aux examens paracliniques qui ne donneront qu'un complement d'informations. Nous evoquerons le cou lui-meme, mais egalement ses parties superieures adjacentes que sont les regions sus- et sous-hyoidiennes et parotidiennes, car la clinique s'accommode mal de limites theoriques.

This study represents a 1-year surveillance period using our epidemiology-based principles published and successfully followed since 1979: weekly culture for yeasts of oral and anal swabs, treatment with oral nystatin of all colonized newborns, and good hygiene/handwashing. Colonization was demonstrated in 23 out of 791 newborns admitted from October 1998 to September 1999. Twenty-two strains of Candida were identified: 16 C. albicans, 2 C. parapsilosis, 3 C. glabrata, and 1 C. tropicalis. Symptoms were erythema of the buttocks in 6 colonized newborns. No other culture positive for Candida could be found. Previous contamination was the main source (previous stay in an intensive care unit, rarely maternal origin). Contamination in the unit was unlikely. Eradication of Candida could be observed within 1 week. These good results, controversial in the literature, were obtained following epidemiological conclusions and support our guidelines.

Last years, il became obvious that the colonization pattern described in 1976-1978 was no more valid: early colonization by Enterobacteriaceae at the 2-3 rd day of life in all newborns, with constant presence of antibioresistant strainseven in non treated newborns. To establish the new pattern of colonization, the same quantitative method of dilution and culture on selective media was used daily from day 1 to day 7 (5 days only for M). The number of Enterobacteriaceae, enterococci and staphylococci was determined in the stools of 10 newborns in the Maternity unit (= M) (term 40 weeks +/- 1, birth weight 3,356 g +/- 383), 10 in the Premature nursery (= P) (term 34.9 weeks +/- 1, birth weight 2,457 g +/- 676), and 14 in the Neonatal intensive care unit (= R) (term 35.2 weeks +/- 3.8, birth weight 2,457 g +/- 763). The results establish that colonization by Enterobacteriaceae is no more constant at D3. It could be demonstrated only in 8/10 M, 1/10 P, and 6/14 R (statistically different - p0.01 - between M and P). At D5, 9/10 M, 5/10 P, 10/14 R, and at D7, 6/10 P and 10/14 R were colonized. Resistant Enterobacteriaceae (Escherichia coli, Klebsiella pneumoniae, Enterobacter cloacae) could be found in only 3/10 M, 4/10 P and 6/14 R. Enterococci could be found in 1 newborn M, 2 P and 7 newborns R. Staphylococci appeared earlier: all newborns M, P and R were colonized at D2, 4 and 5 respectively. These bacteria were coagulase negative, associated with Staphylococcus aureus in 3 P. Our hypothesis is that late colonization with Enterobacteriaceae and enterococci is due to the improvement of hygiene procedures and due to the decontaminating effect of antibiotics in other treated newborns (Enterobacteriaceae by 3 rd generation cephalosporin and enterococci by pharyngeal vancomycin).

Production of beta-lactamase was detected using a microbiological assay (Guts test) in samples of tonsils, and by in Haemophilus growing from the same samples of both tonsils obtained from 30 children aged 2 to 13 years (18 aged6 years and 12 agedor = 6 years). Two pieces from each tonsil, core and superficial, were studied. The procedure included direct microscopic examination of smears, and culture to identify Haemophilus, beta-haemolytic streptococci and Streptococcus pneumoniae. Guts test was positive in tonsillar tissue obtained from 26 children (14 aged6 years and 2 agedor = 6 years) (p0.01). In 10 of them (9 aged6 years and 1 agedor = 6 years) (p0.05) grew beta-lactamase producer Haemophilus influenzae. One to three varieties of Haemophilus could be found in 28 children (11 with H. influenzae = 5 beta-lactamase +, 8 with Haemophilus parainfluenzae = 3 beta-lactamase +); Group A, C, or G streptococci in 5 children, but no strain of Streptococcus pneumoniae. No difference could be demonstrated between core and superficial samples: beta-lactamase activity was positive in superficial samples from 26 children and core samples from 24. Almost all bacteria described grew from superficial as well as (slightly but no significantly less) from core samples.

Twenty-five infants with suspected or confirmed coagulase negative staphylococcal infection were studied. Continuous administration of vancomycin was used because it is usual with infusions prepared daily for catheterized patients, and because continuous infusions are well tolerated and achieve better penetration in tissues and CSF. Vancomycin acts as a time-dependent antibiotic. The aim was to obtain a level of 20-25 mg/l. in serum. Fifteen newborns term 27-35 weeks (m = 30.3) aged 7-30 days (m = 16.1) received 10 to 45 mg/kg/day of vancomycin and were monitored for 2 to 12 days. The sample for assay was taken in a peripheral vein, and the results were the same during the infusion or 15 minutes after its end. The daily dose of vancomycin necessary varied from 25 to 40 mg/kg for newborns with serum creatinine70 mmol/l and 10 to 30 mg/kg with serum creatinineor = 90 mmol/l. Except for a newborn with multiorgan failure, serum creatinine rapidly decreased. Four newborns term 38-40 weeks (m = 39.5) aged 2-12 days (m = 8.3) received 20 to 45 mg/kg/day of vancomycin and were monitored for 2 to 12 days. The daily dose necessary varied from 30 to 40 mg/kg/day with important individual variations, and 20 mg/kg/day in a newborn with a high level of creatinine. In 6 infants aged 2-22 months receiving 22-45 mg/kg/day of vancomycin, a mean daily dosage of 40-45 mg/kg was adequate, with important individual variations.(ABSTRACT TRUNCATED AT 250 WORDS)

The ecological effect of cefixime on aerobic fecal flora was evaluated in 6 children aged 2 to 5 years given oral cefixime (8 mg/kg/day in two divided doses) for five days. Serial dilutions of stools recovered at baseline (D0), 2 and 5 days after initiation of therapy (D2 and D5) and two days after completion of therapy (DC + 2) were cultured on selective media. Colonies of Enterobacteriaceae, group D streptococci, staphylococci, and Candida were counted. A moderate but significant (p less than 0.01) decrease in the Enterobacteriaceae count was seen, with a fall from 8 log 10 (4.8 to 9.4) on D0 to 6.4 (3.6-9) on D2, 6 (4.6-7.2) on D5 and 4.7 (2-8.2) on DC + 2. No cefixime-resistant Entrobacteriaceae or Pseudomonas strains were evidenced. A slight, non significant decrease in group D streptococci counts was found, with values of 7.1, 7.1, 5.8, and 8.3 log 10 at the successive time points. All children exhibited fecal staphylococcal strains which were all coagulase-negative and which did not undergo noticeable quantitative changes (mean successive values were 2.5, 1.8, 3.5, and 3.8 log 10). Candida were found in four children and also changed little over time (mean successive values: 2, 1.7, 2, and 2.6 log 10). In sum, oral administration of cefixime was associated with a modest decrease in the number of Enterobacteriaceae, with no development of resistance to cefixime.

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.

All babies born in a University maternity unit over a period of four months had bacteriological swabs taken in the labour ward. This was to see whether a list of criteria in the history for bacterial infection of the newborn could be relied on. The criteria were: premature rupture of the membranes (before labour had started at all), rupture of the membranes for more than 12 hours, stained liquor, prematurity, fetal tachycardia of more than 160 per minute or abnormal rhythm of the heartbeat, an Apgar score of less than 7 after 1 minute, maternal genital or urinary tract infection (not cured) in month before delivery, maternal temperature above 38 degrees C in labour. During the study there were: 570 live births of which 222 (39%) were at risk of infection according to the above list of criteria, 35 had bacterial colonies present and 4 were definitely infected. More cultures from the placenta, the gastric fluid and the skin came back positive when there was a recognised risk of infection. Both the clinical and bacteriological results show that the risk was 5.24 of colonisation when the risk of infection had been recognised. These prospective results when checked against the retrospective results already obtained in the same department, suggest that this kind of screening for infection is worthwhile without being too expensive, and one can rely on the history to screen for neonatal bacterial infection.

The vascular complications of peritonsillar phlegmons have become exceptional. On the basis of a recent case, the authors sum up the criteria of severity, including: white puncture sample, paralysis of the 9th, 10th, 11th, 12th cranial nerves and of the cervical sympathetic nerve. Computed tomography allows not only refining the topographic diagnosis, but even sometimes diagnosing a pseudoaneurysm before it is fissured. At this stage, intraoperative radiology may probably prevent the unavoidable secondary rupture. If it cannot be used, preventive ligation must be proposed. In the absence of cataclysmic hemorrhage, this easier procedure usually does not cause any irreversible neurological deficit. If performed in emergency, it may entail a major risk, not only a neurological risk, but a vital risk as well.

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.

A multicenter study has been done in France in order to assess the presence of C. trachomatis in the newborn and the young infant. The results show that 4.3% of the infants less than 2 month old are positive. This put forward the question of the screening of pregnant women.

Counts of aerobic faecal flora were done using serial dilutions of stools cultured on selective media in order to estimate the ecological effects of ceftriaxone. Twenty children were studied (24 courses of treatment), 17 of them with post-chemotherapy agranulocytosis. Enterobacteriaceae disappeared in all cases. After treatment, they rose again, unless another antibiotic was administered. No Pseudomonas could be found, due to the protective isolation. Streptococci D disappeared in 6 children. Staphylococcus aureus was present transiently at a low level in one case. Candida persisted in two cases at the same level in spite of antifungal therapy.

Two antibiotic-susceptible and non-pathogenic Escherichia coli strains were administered to hospitalized premature infants in order to protect them from intestinal colonization by hospital-acquired antibiotic-resistant enteric organisms (EOs). Three groups of 16 premature newborns received respectively strain ECA, strain EMO and both strains simultaneously. A fourth group was used as a control. Resistant EOs became spontaneously established in the digestive tract of a majority of the unadministered children. Both ECA and EMO were able to colonize the digestive tract of a majority of the subjects, and reached high population numbers (greater than 10(7)/g) in the faeces. Both strains appeared as able to reduce significantly the establishment of antibiotic-resistant EOs. This effect was more prominent with EMO, which also impaired the implantation of ECA when both strains had been administered simultaneously. The use of such innocuous microorganisms could thus constitute an additional means of preventing nosocomial infections of intestinal origin.

An antibiotic-susceptible, innocuous Escherichia coli strain of human origin was administered to premature infants in order to protect them from nosocomial colonization by antibiotic-resistant enteric organisms. The strain was given to 16 untreated patients in the first six hours of life, and to 11 patients treated with antibiotics in the first six hours after cessation of treatment. The strain was able to colonize the intestinal tracts of all treated infants and 14 16 untreated infants. Colonization of these patients by antibiotic-resistant enteric organisms was compared with results obtained in a control group of 15 unadministered and untreated infants. A significant difference was recorded in the first ten days after administration. Our results show that previous antibiotic treatments did not impair intestinal colonization by an antibiotic-susceptible strain, and demonstrate the in vivo antagonistic abilities of the administered strain. Such antagonistic strains might thus be used for control of nosocomial infections of intestinal origin due to antibiotic-resistant enteric organisms.

Resume Les cellulites faciales peuvent etre post-traumatiques, hematogenes ou de voisinage. Ces dernieres sont les plus frequentes. Les cellulites orbitaires comportent les cellulites preseptales ou periorbitaires dues a la dacryocystite, aux traumatismes cutanes, aux infections des voies aeriennes superieures, aux infections dentaires. Les cellulites retroseptales sont beaucoup plus rares et surtout dues a S. aureus , streptocoque A et les anaerobies. Leur gravite necessite au moindre doute le recours au scanner. La cellulite premaxillaire s'observe chez le nouveau-ne ( S. aureus ) et chez le grand enfant (origine dentaire). Les cellulites du plancher de la bouche ont un envahissement rapide et peuvent entrainer une asphyxie. Les autres cellulites s'observent dans l'actinomycose, la maladie des griffes du chat, les adenites bacteriennes.

Cefotaxime has a good meningeal diffusion and is effective at low concentrations on many bacteria, especially ampicillin resistant Enterobacteriaceae and Hemophilus influenzae. We have therefore used cefotaxime (150 mg/kg/24 h, continuous infusions lasting 30 minutes q. 6 h.) in meningitis due to gram negative bacilli. Twenty eight infants and children have been treated within 4 years. The 13 Hemophilus influenzae meningitis (including 2 beta-lactamase producers) have been cured without immediate sequelae. The duration of treatment could be reduced from 3 weeks to 2 weeks. The 7 infants with Enterobacteria meningitis (6 E. coli and 1 Serratia) have been cured of their infection with a 21 to 28 days treatment. The C.S.F. was sterile 2-3 days after treatment except a case of E. coli persisting during 7 days in C.S.F. contrasting with a normal ventricular fluid. A case of relapse with E. coli remaining sensitive was cured with a new course of the same treatment. Five meningitis complicated with hydrocephalus needed external drainage: the fluid was sterile 1 day after treatment in 4 of them. Two superinfections of ventriculo-peritoneal shunt due to Enterobacteriaceae have been cured. To obtain a good result, the need for a careful drug monitoring must be emphasized.

Aztreonam, a new monobactam, has a spectrum limited to Gram negative aerobic bacilli. To evaluate its effect after parenteral administration on aerobic stool flora (Gram negative bacilli, Streptococci D, Staphylococci, Candida), quantitative cultures used serial dilution of stools twice a week on selective media. For Gram negative bacilli, agar dishes containing aztreonam or not were used. Colonies of different morphologies were counted. Representatives of each morphological type were then picked for identification and susceptibility tests. Among the 16 patients treated, 12 were decontaminated for aerobic gram negative bacilli by the 3rd day. Sensitive bacteria persisted in 4 cases, although at a low level. Resistant bacteria (Enterobacter cloacae and Acinetobacter) appeared at a "normal" level in 2 patients initially decontaminated. No dramatic change could be detected for Streptococci D, Staphylococci and Candida. In twelve additional infants neither hospitalized nor treated, no aztreonam resistant Gram negative bacilli could be found.

The authors report 27 cases of external ventricular drainage employed in children. The usage of this technique caused neither infection nor surinfection in any of the cases. It is difficult to interpret the analysis of the cerebrospinal fluid thus obtained. Decisive criteria for recovery or non infection can be derived by studying the isozymatic profile of the L.D.H. (lactic dehydrogenase).

We have experimented with a new instrument, "hemopipette", known to reduce the incidence of contamination in small samples of capillary blood for haemoculture. Without altering our usual skin asepsis procedure, we carried out 270 microhaemocultures in 240 neonates. Two haemocultures (0.74%) were contaminated, a significantly lower percentage than the 3.6% observed in a first series of 411 microsamples obtained prior to the introduction of "hemopipette". This fall in contamination rate appears to be associated with the use of this instrument which combines a pipette and a lancet and facilitates capillary blood withdrawal.

The colonisation by enterobacteria of neonates, born normally, has been studied by quantitative and qualitative techniques (by the determination of the differing patterns of antibiotic resistance). The resistant enterobacteria were less common than the sensitive strains but resistant ones were widespread in the first week of life and 6 out of 10 babies became carriers of Klebsiella. The results enabled epidemiological observations to be made (the role of the mother, who only seems to be important during delivery, and the importance of the bacteria carried on the hands of the staff), and to assess the effect of antibiotics in hospital even if they are not given to the baby.

Five meningitis due to Haemophilus influenzae and 6 meningitis due to Enterobacteria were treated with cefotaxime. The antibiotic was administered at a dose of 150 to 200 mg/kg/day in four 1 hour infusions. The pathogens were eradicated in all patients. Cefotaxime activity was efficient either against resistant pathogens (Haemophilus, Enterobacter) or against organism susceptible to ampicillin. Because cefotaxime is active at low concentration and has a good diffusion in the CSF, it provides a particularly effective treatment in Gram-negative meningitis in children. The initial use of cefotaxime should result in rapid eradication of the pathogen, with consequent improvement in the prognosis.

An 11 year old boy with medullary aplasia developed extensive mycosis of the face. This mucormycosis is a rare affection that appears in patients with predisposing disease (diabetes, blood disorders) and is easily diagnosed, if considered, from clinical features. Diagnosis is confirmed by histopathology, culture sometimes identifying the causative fungus. Despite the intrinsic serious course of this affection (facial necrosis, death) prognosis appears to be related essentially to the rapid control of the subjacent disease.

Ceftizoxime was evaluated in the treatment of 49 children and 15 neonates. The average dosage was 150 mg/kg/d for newborns and 115 mg/kg/d for children, administered IV, 3 or 4 times daily. Clinical and bacteriological cure was achieved in 93% children and 92% neonates. The clinical and biological tolerance was very good. Pharmacokinetic parameters were studied in 17 patients, including 2 neonates. In children the mean serum peak was 40 mug/ml and the mean half life was 2.2 +/- 0.6 H, after a dose of 30 mg/kg. In both neonates the half life was 3.1 H and 3.6 H. In urine, mean concentration of 4 g/l has been obtained in the first 2 hours after IV.

Cefotaxime concentrations obtained in the C.S.F. of twelve children suffering from bacterial meningitis and undergoing monotherapy with this antibiotic are reported. Among these 12 patients, 4 infants (aged 3 to 28 days) had neonatal meningitis (due to Serratia marcescens, Proteus mirabilis, Enterobacter cloacae, Escherichia coli); one infant (2 months old) had meningitis due to Salmonella panama; 5 children (aged 5 to 11 months) had meningitis due to Haemophilus; and 2 children had belated superinfection caused by a ventriculo-peritoneal shunt due to Klebsiella pneumoniae and Pseudomonas aeruginosa. Cefotaxime concentration reached a high level as early as one hour after the injection (3 to 19 mcg/ml), remained at this level until the fifth hour (1,8 to 14,3 mcg/ml) and decreased without significant proportionality with the disappearance of the inflammatory symptoms. Compared to the M.I.C. of the bacteria which caused the twelve cases of meningitis, these results show that the concentrations in the C.S.F. are much higher than the M.I.C.'s. These results are comparable to those of previous studies. Cefotaxime diffuses in the C.S.F. and gives concentrations which ensures an antibacterial activity that ampicillin could not reach: in particular against Haemophilus influenzae and enterobacteriaceae.

An attempt was made to define the value of the bacteriological examination of tracheal aspirations in patients on artificial ventilation. Quantitative cultures of lung biopsies, taken immediately after death, were made on 21 patients in an intensive care unit. The results were compared with the clinical signs, antibiotic therapy and quantitative cultures of tracheal secretions taken before and very soon after death. A comparison of the results shows that microbial species present in tracheal secretions at a level equal to or greater than 10(7)/ml were found in 53 percent of lung biopsies. However, the predominant bacteria found in the lung biopsies were not necessarily similar to those in the tracheal secretions. Also, bacteria minimally present or completely absent in tracheal secretions could be found in lung biopsies. Therapeutic decisions can only be made on clinical and radiological signs; bacteriological examination may be a help in the choice of drugs once such treatment has been decided upon.

From May, 1978 to October, 1983, 88 children with otitis due to Pseudomonas aeruginosa were seen at Paediatric Unit E.N.T. consultation of the University Hospital of Tours. Epidemiologically, it is worth mentioning that the majority of these infections was not of nosocomial origin: 56 children were infected outside the hospital and 26 during their stay in hospital; 3 neonates were referred directly from the Maternity Unit. Most strains of Ps. aeruginosa, with various serotypes, were sensitive to azlocillin. Twenty-four children received a systemic treatment required by their local or general condition. Azlocillin was used in 24 cases on the basis of positive sensitivity tests and was occasionally combined with topical treatment using antiseptics or the antibiotic itself. Or the 3 failures observed, 2 were due to acquired resistance to azlocillin and 1 to chronic otitis. An incomplete result was obtained in a case of otitis externa caused by a strain of intermediate sensitivity. The remaining 19 cases were cured, including 3 neonates with otitis externa or media, 1 child with otitis externa, 1 with combined otitis externa and media, 10 with otitis media, usually protracted, 2 with mastoiditis medically cured and 1 with superinfection following mastoidectomy for cholesteatoma. Secretions dried up within 3 to 4 days and treatment was discontinued after clinical cure was obtained in 9 to 19 days. Fever, which was present in 7 cases, abated within 2 to 8 days. The only relapse that occurred, one month after treatment of an otitis media, responded to a second course of azlocillin.

Two different studies assessed that materno-fetal contamination at time of delivery is not the usual way of colonization of newborns with Candida albicans. In a first study, occurence of Candida albicans in neonate units disappeared owing to prophylactic measures, such as strict care in hospital hygiene. In a second study, detailed herein and performed in an obstetric ward, it was found that despite a rate of vaginal Candida carrier of 19 %, candidiasis in newborns was exceptional.

A case of meningitis, caused by Serratia marcescens in a 6-day old newborn triggered a search for Serratia in the Neonatology ward. Fifteen out of 38 newborns were found fecal carriers of S. marcescens. The source of S. marcescens was found in flasks containing almond oil with 1% cetyltrimethylammonium bromide used for skin care. All strain of S. marcescens belonged to pigmented biotype A6a and serotype 014 : H10. The spread of S. marcescens was controlled by heat sterilizing and renewing twice a week the almond oil flasks. Means of control of contamination sources are discussed.

To eradicate Candida from a neonatal unit the authors used increasingly strigent protocols of prophylaxis and treatment. Finally all carriers were identified and treated with nystatin. A strict routine for washing hands was introduced. As a result of these measures the cross infection rate within the hospital was very low (3%). The eradication was maintained by constant surveillance (weekly oral and rectal swabs) because of regular reintroduction of Candida by babies who had been infected before transfer to the unit. The other conclusions were that post natal infection is usually due to cross infection and rarely from mother. The gut and perianal skin are important reservoirs of infection. Erythema of the buttocks almost disappeared after the eradication of Candida. Guteal erythema commonly preceded of manifestations of Leiner's disease.

The administration of the Escherichia coli (az) strain has already been used successfully to protect premature infants against intestinal colonization by nosocomial strains of antibiotic resistant enteric organisms. The purpose of the present study was to assess the protective value of this strain in older full term babies after cessation of an antibiotics treatment. Two groups of children treated with antibiotics of respectively 8-90 days and 3-12 months of age were studied and compared to two control groups of untreated children. In both groups of children, the implantation of E. coli az was higher in treated than in untreated subjects. The group of younger children was significantly less colonized by antibiotic resistant hospital acquired enteric organisms, whereas in 3-12 months old children non protective effect of E. coli az was recorded. Therefore, the antagonistic effect of the strain studied appeared as age dependent.

An antibiotic-susceptible, innocuous Escherichia coli strain of human origin was administered to premature infants in order to protect them from nosocomial colonization by antibiotic-resistant enteric organisms. The strain was given to 16 untreated patients in the first six hours of life, and to 11 patients treated with antibiotics in the first six hours after cessation of treatment. The strain was able to colonize the intestinal tracts of all treated infants and 14/16 untreated infants. Colonization of these patients by antibiotic-resistant enteric organisms was compared with results obtained in a control group of 15 unadministered and untreated infants. A significant difference was recorded in the first ten days after administration. Our results show that previous antibiotic treatments did not impair intestinal colonization by an antibiotic-susceptible strain, and demonstrate the in vivo antagonistic abilities of the administered strain. Such antagonistic strains might thus be used for control of nosocomial infections of intestinal origin due to antibiotic-resistant enteric organisms.

Two studies were undertaken to determine the effect of antibiotic therapy in the mother on the enterobacteriaceae of the newborn's fecal flora. In the first, mothers were given tetracycline after delivery. Although the effect on the maternal flora was important there was no noticeable effect on the enterobacteriaceae of the newborn although the organisms were predominantly susceptible. In the second, mothers were given ampicillin before delivery and resistant enterobacteriaceae were predominant in all the newborns. In the controls born to untreated mothers susceptible organism still predominate. Antibiotic treatment of the mother has an important effect on the newborn's flora if the treatment is given before delivery.

In an intensive care unit, 14 newborns, without antibiotic intake, received orally 1 ml of culture broth from an antibiotic-sensitive strain of Escherichia coli marked with resistance to sodium azide. The purpose was to study the fate of the E. coli administered and to determine whether an interaction was obtained between that strain and antibiotic-resistant enterobacteria in the gut flora. In 3 infants the strain administered developed and was the only enterobacterium excreted during the first week; in 4 others the strain was recovered during one week or more, in quantities greater than 10(6)/g of stools. In 6 others, the strain appeared for less than one week, and/or in quantity less than 10(6)/g of stools. In 1 child the strain could not be recovered at all. These data show what is obtained in "holoxenic" newborns in spite of challenge with many other bacteria. They have been obtained with an ubiquitus E. coli and can be used as a control for further studies.

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.