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ABSTRACTChildren who had acute otitis media and were treated with levofloxacin were assessed for the emergence of fluoroquinolone-resistant Streptococcus pneumoniae. Nasopharynx cultures were obtained from patients at the entry to and during levofloxacin therapy. All nasopharynx isolates (n= 59) from 12 children were levofloxacin susceptible without parC/Eor gyrA/Bmutations. Pneumococcal nasopharynx persistence was not associated with levofloxacin resistance.

We present the case of a hospitalized pediatric patient with short bowel syndrome who was dependent upon total parenteral nutrition for 17 months. Shortly after admission she became colonized with vancomycin-resistant Enterococcus faecium (VRE) and developed 12 distinct episodes of serious infection associated with it. The course of VRE colonization and infections in this patient was studied through analysis of 40 representative isolates obtained from different sites during distinct episodes of infection. Standard microbiological techniques, automated ribosomal DNA typing, polymerase chain reaction, and pulsed-field gel electrophoresis (PFGE) were used. All isolates except for the one associated with the initial episode of bacteremia were VRE, and were multidrug resistant. The last four episodes of infection were caused by isolates resistant to all tested antibiotics except for intermediate susceptibility to chloramphenicol. The vanA genotype was a source of vancomycin resistance in all VRE isolates. Both ribotyping and PFGE showed two distinct clones of VRE in clinical and stool surveillance isolates: one was associated with clinical illness and the other was not associated with infection. Recurrent VRE infections occur as a consequence of prolonged gastrointestinal colonization. Morbidity is associated with host factors, the presence of co-pathogens, and possibly intrinsically more virulent VRE strain.

Between 1990 to 1992 and 1993 to 1995 there was a >5-fold increase (16.7% to 89.8%) in vancomycin-resistant Enterococcus faeciumisolates as a percentage of all isolates of vancomycin-resistant enterococci on the pediatric units of The New York Hospital-Cornell Medical Center (NYH-CMC). A molecular epidemiologic investigation was undertaken to determine the extent to which this increase was associated with the spread of a vanA-containing clone of vancomycin-resistant E. faeciumthat had been previously defined in adults hospitalized at NYH-CMC or with the spread of another vanA clone that had been defined in children hospitalized on the pediatric service at Memorial Sloan-Kettering Cancer Center, which shares a common pediatric intensive care unit and pediatric house staff with NYH-CMC.

The development of health care in the Leogane region of Haiti has been a ten-year story of international cooperation among health professionals, of closely targeted assistance, and of policy coordination between assisting private agencies and the Haitian government. The broadly based health care program of l'Hopital Sainte Croix of Leogane is presented as a model of a cooperative effort that has resulted in rapid regional health care development and as an encouragement to the many differing types of groups responding to a world in medical need.(JAMA 1984;252:3149-3151)

Yersinia pseudotuberculosis is infrequently diagnosed as a cause of human disease. The most common clinical manifestation of human infection is mesenteric lymphadenitis, which may mimic appendicitis. Human infections have most frequently been reported from Europe and most frequently seen in young male patients in the first two decades of life.1 We recently isolated this organism from the feces of a female newborn who had severe abdominal colic.Report of a Case.—A 29-day-old female infant was hospitalized at Lallie Kemp Charity Hospital, Independence, La, for severe abdominal colic of three weeks' duration. She had been examined 13 days previously for irritability and vomiting. Blood, urine, and CSF cultures were sterile. A stool culture was not obtained. In the interim, she had stopped vomiting and was afebrile. However, she had borborygmi and intermittent episodes (one to ten per hour) of severe colic that lasted two to three minutes at a