Background: Febrile neutropenia is defined as a fever with a temperature more than or equal to 38.3°C in two measurements within 24 hours and accompanied by severe neutropenia (≤500/μL). Gram-positive bacteria have been the most common cause of febrile neutropenia in children for the previous two decades. However, the contradiction in some studies reported that gram-negative bacteria were the main pathogens causing infection. Because there are differences and shifts in the bacterial spectrum, information on the bacterial pattern and antibiotic susceptibility is critical to reaching the optimal management of febrile neutropenia patients. Methods: This observational, descriptive study was conducted in Sanglah Hospital, Bali, Indonesia, involving pediatric patients (<18 years old) with febrile neutropenia. Data on antibiotic susceptibility and microbial patterns were collected retrospectively from the blood culture registry taken from febrile neutropenia patients from October 2017 to August 2020. Collected data were analyzed using the SPSS program for Windows, version 21.0. Univariate analysis was conducted, and data with a categorical scale were reported in frequency distribution and percentage, then displayed in a table and graph. Result: A total of 180 episodes of febrile neutropenia were collected from 89 patients. Among 180 blood cultures, there were found 44 (24.44%) blood cultures with positive results. A higher proportion of gram-negative organisms (33; 75%) is found compared to gram-positive organisms (11; 25%). The susceptibility rates were 100% for Azithromycin, Amoxicillin Clavulanate, Cefoperazone Sulbactam, Meropenem, Linezolid, and Doxycycline, while Cefepime, the previous empirical antibiotic, was susceptible at 79.31% isolates. Conclusion: Gram-negative bacteria were the most frequent cause of infection among febrile neutropenic patients. Although the research evidence is still weak due to the small sample size, Cefoperazone Sulbactam could be a better option to replace Cefepime as an empirical antibiotic due to its significantly higher susceptibility.
Teratomas are the most common germ cell tumor, and further classified into mature or immature. Immature teratoma comprise less than one percent of all teratomas and with the peak incidence at birth until four years. They were diagnosed by history taking, physical examination, laboratory, imaging, and pathological anatomy as a gold standard. This report presents our experience of diagnosed, giving treatment with or without surgery and chemotherapy in three patients with teratoma. We report three cases of teratoma, at age six months, eight months and four years old with site of cases are retroperitoneal immature teratoma, cervical teratoma and ovarian immature teratoma. History taking of these patients, they have same symptom such as enlargement of the mass. Two cases were noticed after birth and progressively getting bigger until six and eight months old. One case was noticed when the patient had abdominal pain and was suspected with appendicitis at first. The computed tomography (CT) scan of these cases showed a mass as a part of teratoma and confirmed with pathological anatomy. Two cases were immature, and one case was mature teratoma. Two patients undergone surgery resection and continue with chemotherapy (cisplatin, etoposide, and bleomycin) for 10-14 weeks showed a good result until now and showed no residual mass anymore form CT scan, but one patient did not undergo surgery and chemotherapy yet. Early diagnosis of teratomas is leading us to a definitive therapy and showed a good result.
This paper reports the first case of Rh-incom-patibility in newborns found at our hospital.
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