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The distribution and time trend of organochlorine pesticide (OCP), polychlorinated biphenyl (PCB), and polychlorinated dibenzo-p-dioxin/polychlorinated dibenzofuran (PCDD/PCDF) concentrations in human milk samples from Croatia collected in 1981-2003 are presented. Between 1981/1982 and 1987/1989, the concentrations of HCB, beta-HCH, DDE, and total PCBs decreased about 50%, while for the last decade, the concentrations have been decreasing very slowly. In 2002/2003 the range of PCB congeners and OCPs was from below the limit of determination to 332 ng g(-1) milk fat. PCDD/PCDF concentrations in human milk samples collected in 1981-2000 ranged between 5.2 and 26.7 pg I-TEQ g(-1) milk fat and showed a decreasing trend.

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The incidence of human non-typhoidal Salmonella (NTS) infection has increased in many countries. Endovascular infection is one of the most serious forms of extraintestinal infection. Five patients with NTS endovascular infection treated at Middlemore Hospital, Auckland, New Zealand, are presented here. All persons with NTS bacteraemia who are older than 50 years and have a risk of atherosclerosis should be evaluated for possible endovascular infection.

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BACKGROUND: Staphylococcus aureus bacteremia is a common complication of S. aureus infection. There are few pediatric studies defining the incidence and associated morbidity and mortality of S. aureus bacteremia and no such New Zealand studies. We conducted a prospective study of S. aureus bacteremia in children in New Zealand. METHODS: From July 1, 1996 to December 31, 1998, we included all children < 16 years of age with S. aureus bacteremia in Auckland and Christchurch. Relevant information regarding patient demographics, clinical course and outcome and laboratory results was recorded. RESULTS: One hundred twenty-five cases of true S. aureus bacteremia were identified. There were 4 deaths within 30 days of the onset of bacteremia. Fourteen (11%) of the children were < 1 month of age. Maori children (relative risk, 2.0; 95% confidence interval, 1.3 to 3.2) were twice as likely and Pacific Island children (relative risk, 2.5; 95% confidence interval, 1.6 to 3.8) 2.5 times as likely as white children to acquire S. aureus bacteremia. The peak incidence of S. aureus bacteremia was observed in Pacific Island children < 1 year of age (105 cases/100,000 children/year). Twenty-seven percent of cases were related to intravenous catheters. Seventy percent of cases were community-acquired. Ninety-eight percent of non-catheter-related cases in children > 1 month of age were community-acquired. There was a low rate of methicillin resistance (6%). CONCLUSIONS: S. aureus bacteremia is largely community-acquired in children in New Zealand and is more common in Pacific Island and Maori populations. Although there is a low associated mortality, a significant number are potentially preventable cases secondary to intravenous catheters.

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AIMS: Despite availability of active antimicrobial agents for its treatment, the mortality from pneumococcal bacteraemia (PB) may reach 30% to 40% in high-risk groups. Greater vaccine use may reduce the incidence of PB. The aim of this study was to determine the proportion of patients with PB who had indications for, but had not received, pneumococcal vaccination. METHODS: From December 1998 to March 2000, all episodes of PB in adults in four Auckland hospitals were followed prospectively. Underlying disease, outcome, and pneumococcal vaccination history were recorded. RESULTS: 96 patients had PB: the median age was 63 years, range 16 to 93 years. 42 (44%) were > or = 65 years. The relative risk (RR) of acquiring PB for Maori and Pacific Island people was more than two times that of both European and other ethnic groups: RR 2.3 (95% CI 1.5 - 3.6) and 2.4 (1.6 - 3.8), respectively. The most common presentation was pneumonia; 84 (88%), of which 74 (88%) were community acquired. Five (5%) patients had meningitis. The overall mortality was 18%. Eleven (11%) pneumococcal isolates had intermediate susceptibility to penicillin and six (6%) were resistant. 69 (72%) patients had one or more condition for which pneumococcal vaccination is recommended but only two (2%) patients had received it. 82 (85%) patients were infected with serotypes included in the current pneumococcal vaccine. CONCLUSIONS: Most adult patients with PB have underlying medical conditions for which vaccination is recommended but only rare patients get vaccinated. Emerging antimicrobial resistance is a further incentive to increase the use of pneumococcal vaccination. Greater use of pneumococcal vaccine will probably require a change in its funding status, similar to the current policy for influenza vaccine. It may also be appropriate to consider targeted use of the vaccine in Maori and Pacific Island people given their higher rates of disease.

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BACKGROUND: Staphylococcus aureus bacteraemia (SAB) is a common complication of S. aureus infection and is associated with a high mortality. AIMS: To document prospectively the pattern of illness associated with SAB in New Zealand and, by recording patient demographic factors and clinical features, to identify risk factors associated with a poor outcome. METHODS: From 1 July 1996 to 31 December 1997, adults with SAB were prospectively studied in six tertiary care hospitals. All information obtained from patients' records was recorded on worksheets and transferred to a computerized spreadsheet for analysis. RESULTS: There were 424 patients with SAB. Maori (relative risk (RR)= 1.8, 95% confidence interval (CI) = 1.3-2.6) and Pacific Island people (RR = 4.0, 95% CI = 3.1-5.3) were significantly more likely than people of European descent to acquire SAB, but not to die from the infection. Fifty per cent of cases were community acquired. A source was identified for 85%: intravenous catheter (31%), primarily hospital acquired, and skin/soft tissue (22%), primarily community acquired, were the most common foci. The 30-day mortality was 19%, 83% of whom died within 2 weeks. Risk factors for a poor outcome were: increasing age above 60, female sex (RR = 1.4, 95% CI = 1.0-2.1), diabetes mellitus (RR = 1.5, 95% CI = 1.0-2.4), immunosuppression (RR = 1.5, 95% CI = 1.0-2.4), pre-existing renal impairment (RR = 1.8, 95% CI = 1.2-2.7), malignancy (RR= 2.2, 95% CI = 1.4-3.5), lung as a source (RR = 2.8, 95% CI = 1.9-4.2) and unknown source (RR = 2.3, 95% CI = 1.5-3.3). Mortality was also accurately predicted by two multifactor scoring systems. There was a low rate of methicillin resistance (5%). CONCLUSIONS: Staphylococcus aureus bacteraemia is more likely to occur in certain ethnic groups, while mortality is associated with other identifiable risk factors and continues to be high. Intravenous catheters remain the most common and most preventable cause of SAB.

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Iron-deficiency anemia is the most common anemia in infants. In the routine pediatric care this problem is encountered every day. Numerous factors in infancy (low birth weight, rapid growth, insufficient nutrition) are involved in the development of iron-deficiency anemia, and they must be considered when establishing diagnosis, counselling parents, and prescribing oral iron preparations. Data on 119 patients aged up to two years treated in the Division of Gastroenterology and Nutrition, Pediatric Department, University Hospital Centre Zagreb Salata between 1994 and 1999, were analyzed. We were prompted to do so because of great frequency of iron-deficiency anemia as one of associated diagnoses, and unfortunately often the only diagnosis requiring hospitalization. Out of 119 patients with iron-deficiency anemia, nine (7.7%) patients (four premature newborns and three from twin pregnancy) had to receive transfusion of erythrocyte concentrate due to very bad general condition and low red blood count, accompanied by clinical signs of anemic hypoxia. We also analyzed prenatal and perinatal history, socioeconomic living conditions of these children, i.e. their nutrition, and if they had previously received oral iron preparations. Some of the results, such as inadequate alimentation with flour, as well as insufficient prophylaxis of iron deficiency, which were found in most cases of severe anemia, point to the need of paying greater attention to this problem, better parents education, and more adequate screening for iron deficiency anemia.

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AIM: In response to emerging vancomycin resistance among gram-positive cocci, it is recommended that hospitals develop guidelines for the appropriate use of glycopeptides and identify situations where glycopeptide use should be discouraged. The aim of this study was to audit the use of vancomycin in Auckland Healthcare hospitals. METHOD: Patients prescribed vancomycin were recorded by pharmacy staff at Auckland, Starship, Green Lane and National Women's Hospitals. Clinical and laboratory information was collected for each course of vancomycin treatment. Standard definitions were used to classify prophylactic, empirical or specific directed therapy as appropriate or inappropriate. Continuing vancomycin when cultures were negative for beta-lactam-resistant, gram-positive organisms and/or initial choice of vancomycin when it was not necessary for the presumed source of infection were reasons for inappropriate empirical use. Reasons for inappropriate specific directed therapy included vancomycin prescribed for methicillin susceptible S. aureus and coagulase-negative staphylococci, or penicillin susceptible viridans streptococci when there was no history of beta-lactam allergy. RESULTS: One hundred and sixty-eight courses of vancomycin were prescribed for 146 patients; 42 in children (<16 years) and 126 in adults. Thirty-two per cent of all vancomycin courses were in renal patients, 26% in surgical specialities, 17% in haematology/oncology patients, 14% in medical specialities and 10% in intensive care unit patients. Eighty-six (51%) courses of vancomycin were considered inappropriate. The majority, 54/86 (63%) of inappropriate use, was for empirical therapy. It was an inappropriate initial choice in 25 instances, the duration of treatment was inappropriate, given no beta-lactam-resistant organisms were isolated in nine instances and both its initial choice and duration were inappropriate in 20 instances. Switching to other antimicrobial agents sooner when culture results and susceptibilities became available would have shortened the duration of 58/86 (67%) of the inappropriate courses. Of the inappropriate courses, 44/86 (51%) were prescribed for renal patients, 22 for empirical use, e.g. for peritoneal dialysis-related peritonitis, wound infections and presumed line infections and 22 for specific therapy of beta-lactam susceptible isolates because of dosing convenience in patients with renal failure. CONCLUSION: Half of the vancomycin use in Auckland Healthcare hospitals could potentially be modified. The majority of inappropriate use (63%) was for empirical therapy. The microbiology laboratory's ability to promptly and accurately report culture and susceptibility results and convey these to the prescribing clinician is important in reducing unnecessary doses. This study identified areas where interventions will be focused to reduce vancomycin use.

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The specificities of arrangement and normal function of the intestinal immunological system are presented, and non-immunological and immunological gastrointestinal defense mechanisms are described. Of immunological defense mechanisms, cellular and humoral mechanisms are described separately, and their characteristics in childhood are highlighted. After a general survey of the intestinal immunological system disorders and their role in various diseases, three most frequent such diseases are described in detail: food intolerance, gluten enteropathy and chronic inflammatory bowel disease.

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Organochlorine compounds in milk were analyzed in samples collected over a nine-year period (1987-1995) from nursing mothers (N = 139) whose children were hospitalized for various disorders. All samples contained p,p'-DDE and PCBs; the median concentrations were 318 micrograms/kg milk fat and 220 micrograms/kg milk fat resp. Higher levels were found in mothers (N = 12) nursing neonates with impaired neurodevelopmental competencies or an inappropriate arousal reaction. No difference was observed between mothers nursing children with respiratory or gastrointestinal diseases, urinary tract infections or other infectious diseases, anemias, prolonged neonatal hyperbilirubinaemias or when children were with dermatological findings, congenital malformations or healthy.

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