Infant With Recurrent Omphalitis and Otitis

A baby boy, aged 14 days, presented with a temperature of 38.2°C (100.8°F), a generalized maculopapular rash, and purulent otorrhea. He was treated with oral amoxicillin for 10 days. At age 25 days, he again presented—this time with erythema and edema of the umbilicus, thrush, and fever of 24 hours' duration. The cord stump had dried and fallen off 2 days earlier. (The umbilical stump had been treated with triple dye in the newborn nursery, and there was no history of umbilical catheterization.) He was admitted to the local hospital for parenteral antibiotic treatment of the omphalitis. Purulent fluid draining from the umbilicus grew Pseudomonas aeruginosa, Enterobacter cloacae, and Enterococcus faecalis. An abdominal ultrasonogram revealed a fluid collection in the retro-umbilical area. After completion of 14 days of intravenous imipenem/cilastatin, which had been started empirically, both the omphalitis and the drainage of retro-umbilical fluid had resolved.