Microbiological spectrum of septicemia and peritonitis in nephrotic children

From April 1993 to December 1997, 452 admissions of 231 children with nephr otic syndrome to Chang Gung Children's Hospital were retrospectively review ed. There were 10 episodes of sepsis and 8 episodes of peritonitis in 18 ch ildren, and 14 microorganisms were cultured. Two children died due to Strep tococcus pneumoniae sepsis. Gram-positive microorganisms (n=7) and Gram-neg ative microorganisms (n=7) were found in equal numbers. Enterococcus (1), S treptococcus pneumoniae (4), group D streptococcus (1), and Streptococcus v iridans (1) were the Gram-positive microorganisms cultured. Two of 4 cases of Streptococcus pneumoniae sepsis were penicillin resistant. Gram-negative microorganisms included Enterobacter cloacae (1), Klebsiella pneumoniae (1 ), Escherichia coli (2), Acinetobacter baumannii (1), Neisseria meningitidi s (1), and group B salmonella (1). The last three microorganisms have not b een previously associated with nephrotic children. Vancomycin therapy to co ver penicillin-resistant Streptococcus pneumoniae and a third-generation ce phalosporin therapy to cover rare Gram-negative microorganisms should be co nsidered in serious infections of nephrotic children.