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Resumen Los objetivos de este estudio fueron determinar el desempeño del panel BCID de FilmArray® y establecer el impacto de estos resultados en el tratamiento antimicrobiano de pacientes con bacteriemia en 11 hospitales de Latinoamérica. Se incluyeron 397 episodios de bacteriemia y se documentaron 551 microorganismos aislados de hemocultivos. La identificación microbiana fue correcta en el 91,4% (504/551) de los aislados y en el 98,6% (504/511) si se consideran solo los microorganismos incluidos en el panel BCID. La sensibilidad en la detección de los genes mecA, vanA/B y blaKPC fue del 100% y la especificidad fue del 97%, 100% y 99,6% respectivamente. La notificación temprana del resultado permitió cambios terapéuticos en 242 episodios (60,9%). El panel BCID es un método confiable y rápido para la detección de mecanismos críticos de resistencia y de los microorganismos más frecuentemente aislados de bacteriemias y permite la optimización temprana del tratamiento antimicrobiano.

Abstract The objectives of this study were to determine the performance of the BCID panel and to establish the impact of these results on the antimicrobial treatment of patients with bacteremia in 11 hospitals in Latin America. Three hundred and ninety-seven episodes of bacteremia were included and 551 microorganisms isolated from blood cultures were documented. Microbial identification was correct in 91.4% (504/551) of the isolates and in 98.6% (504/511) if only the microorganisms included in the BCID panel are considered. The sensitivity in the detection of the genes mecA, vanA/B and blaKPC was 100% and the specificity was 97%, 100% and 99.6% respectively. Early notification of the outcome allowed therapeutic changes in 242 episodes (60.9%). The BCID panel is a reliable and rapid method for the detection of critical resistance mechanisms and of the microorganisms most frequently isolated from bacteremia and it enables early optimisation of antimicrobial treatment.

Resumo Os objetivos deste estudo foram determinar o desempenho do painel BCID do FilmArray® e estabelecer o impacto desses resultados no tratamento antimicrobiano de pacientes com bacteremia em 11 hospitais da América Latina. Trezentos e noventa e sete episódios de bacteremia foram incluídos e 551 microrganismos isolados de hemoculturas foram documentados. A identificação microbiana foi correta em 91,4% (504/551) dos isolados e em 98,6% (504/511) considerando apenas os microrganismos incluídos no painel BCID. A sensibilidade na detecção dos genes mecA, vanA/B e blaKPC foi de 100% e a especificidade foi de 97%, 100% e 99,6% respectivamente. A notificação precoce do desfecho permitiu mudanças terapêuticas em 242 episódios (60,9%). O painel BCID é um método confiável e rápido para a detecção de mecanismos críticos de resistência e dos microrganismos mais frequentemente isolados da bacteremia e permite a otimização precoce do tratamento antimicrobiano.

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Resumen: Introducción: neumonía necrotizante (NN) es una complicación frecuente en niños hospitalizados por neumonía adquirida en la comunidad (NAC), caracterizada por importante morbilidad. En 2009, se elaboró una definición de caso, que permitió unificar criterios y racionalizar recursos en la asistencia de estos niños. Objetivo: describir características clínicas y evolutivas de niños que desarrollaron NN en los últimos 10 años. Metodología: estudio descriptivo de niños hospitalizados por NN entre 1/1/2009 y 31/12/2018. Definición de caso: neumatoceles y uno o más de los siguientes criterios: mal estado general, fiebre persistente o recurrente, leucocitosis mayor a 30.000 o menor a 5.000/mm3, proteína C reactiva mayor a 120 mg/dl, láctico deshidrogenasa en líquido pleural mayor a 2.500 UI/L y/o fístula broncopleural (FBP). Se describieron características epidemiológicas, clínicas, etiológicas y evolutivas. Resultados: se diagnosticó NN en 197 niños (7,92% de las hospitalizaciones por NAC), con número anual de casos y tasas/10.000 egresos variables. La mediana de edad fue de 25 meses; 89,8% eran sanos. La fiebre previa al diagnóstico tuvo mediana de cinco días. Tenían neumonía multilobar 58%, insuficiencia respiratoria 62%, sepsis 19%, empiema 80% y fístula bronquio-pleural 51%. Persistieron con fiebre mediana por siete días. Requirieron cuidados intensivos 46% y asistencia ventilatoria mecánica 18%. Los reactantes de fase aguda al ingreso fueron elevados. Se identificó agente etiológico en 102 casos, S. pneumoniae en 92. Fallecieron dos niños. Conclusiones: NN fue una complicación frecuente en niños hospitalizados por NAC. La presentación clínica y la evolución fueron graves. La identificación etiológica fue elevada, la mayoría correspondió a S. pneumoniae. La mortalidad fue baja.

Summary: Introduction: necrotizing pneumonia (NP) is a complication of community-acquired pneumonia (CAP) in hospitalized children, with significantly high morbidity. A case definition was devised in 2009, which enabled physicians to unify criteria and rationalize resources for the assistance of children with NP. Objective: describe clinical characteristics and evolution of children who developed NP. Methodology: descriptive study, NP hospitalized children between 1/1/2009 and 12/31/2018. Case definition: pneumatoceles and one or more of the following criteria: malaise, persistent/recurrent fever, white blood cell count over 30,000 or less than 5.000/mm3, C-reactive protein over 120 mg/dL, lactic dehydrogenase in pleural fluid over 2,500UI/L and/or bronchopleural fistula (BPF). Clinical, epidemiological, etiological and evolutionary characteristics were described. Results: NP was diagnosed in 197 children (7.92% of CAP hospitalizations), with variable annual cases and annual rate/10,000 discharges. Children had a median age of 25 months; 89.8% were previously healthy. They presented fever prior to diagnosis, median 5 days, multilobar pneumonia 58%, respiratory failure 62%, sepsis 19%, empyema 80% and BPF 51%, persistent fever median 7 days. 46% required intensive care and 18% required assisted mechanical ventilation. Acute phase reactants on admission were high. An etiological agent was identified in 102 cases, S.pneumoniae in 92. Two children died. Conclusions: NP was a frequent complication in CAP hospitalized children. Clinical presentation and evolution were severe. The etiological identification was high, most of them corresponded to S. pnuemoniae. Mortality was low.

Resumo: Introdução: a pneumonia necrosante (PN) é uma complicação da pneumonia adquirida na comunidade (PAC) em crianças hospitalizadas, com morbidade significativamente elevada. Em 2009, elaborou-se uma definição de caso, que possibilitou aos médicos unificar critérios e racionalizar recursos para o atendimento à criança com PN. Objetivo: descrever as características clínicas e evolutivas de crianças que desenvolveram PN nos últimos 10 anos. Metodologia: estudo descritivo de crianças internadas por PN entre 01/01/2009 e 31/12/2018. Definição de caso: pneumatoceles e um ou mais dos seguintes critérios: mau estado geral, febre persistente ou recorrente, leucocitose superior a 30.000 ou inferior a 5.000 / mm3, proteína C reativa superior a 120 mg / dl, desidrogenase láctica no líquido pleural superior 2.500 UI / L e / ou fístula broncopleural (BPF). Descreveram-se características epidemiológicas, clínicas, etiológicas e evolutivas. Resultados: a PN foi diagnosticada em 197 crianças (7,92% das internações por PAC), com número de casos e taxas anuais variáveis/10.000 altas. A idade média foi de 25 meses; 89,8% eram saudáveis. A febre antes do diagnóstico teve uma mediana de 5 dias. Eles tinham 58% de pneumonia multilobar, 62% de insuficiência respiratória, 19% de sepse, 80% de empiema e 51% de FBP. Eles persistiram com febre mediana por 7 dias. 46% necessitaram de cuidados intensivos e 18% de assistência ventilatória mecânica. Os reagentes de fase aguda na admissão foram elevados. Em 102 casos foi identificado um agente etiológico, S. pneumoniae em 92. 2 crianças morreram. Conclusões: NP é uma complicação frequente em crianças hospitalizadas por PAC. O quadro clínico e a evolução foram graves. A identificação etiológica foi alta, a maioria correspondeu a S. pneumoniae. A mortalidade foi baixa.

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BACKGROUND: Salmonella can cause asymptomatic infections, diarrhea, bacteremia and focal infections such as meningitis and osteomyelitis. AIM: To describe clinical and microbiological aspects of infections by Salmonella spp. in children in a pediatric referral hospital: Centro Hospitalario Pereira Rossell, in Montevideo, Uruguay. MATERIALS AND METHODS: Descriptive and retrospective study of 46 patients, from which Salmonella spp was isolated between January 1, 2005 and December 31, 2010. RESULTS: Salmonella spp was isolated in 46 children younger than 15 years old. 18 were below 2 years old and 5 children below three months. 24% of the children had risk factors, such as HIV infection, oncological diseases and malnutrition; low birth weight and pneumonia were associated conditions. No deaths were reported. The serotypes more frequently found were: Typhimurium and Enteritidis. Most of the strains were susceptible to ampicillin and third generation of cephalosporins. DISCUSSION: Diarrhea with blood was the predominant clinical presentation, and there were no outbreaks. Typhimurium and Enteritidis were the most common serotypes. Based on the profiles of susceptibility antimicrobial, we could maintain the same recommendations until the moment suggested. CONCLUSIONS: we must consider the Salmonella infection in febrile children under risk of an invasive bacterial disease, with or without focal infection.

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Resumen Introducción: Salmonella sp puede causar infecciones asintomáticas, gastroenteritis, bacteriemia e infecciones focales como meningitis y osteomielitis. Objetivo: Describir aspectos microbiológicos y clínicos de las infecciones por Salmonella spp en niños en un hospital de referencia pediátrico Centro Hospitalario Pereira Rossell. Montevideo Uruguay. Material y Métodos: Estudio descriptivo y retrospectivo de pacientes en quienes se aislara Salmonella spp en el período 1 de enero de 2005 al 31 de diciembre de 2010. Resultados: Se aisló Salmonella spp en 46 niños menores de 15 años. Dieciocho eran menores de 2 años y 5 niños menores de tres meses. 24% de los pacientes presentaba factores de riesgo (infección por VIH; enfermedad hemato-oncológica, desnutrición) y co-morbilidades (bajo peso al nacer y neumonía). No hubo fallecidos. Los serotipos más frecuentes fueron: Typhimurium y Enteritidis. La mayoría de las cepas eran sensibles a ampicilina y cefalosporinas de tercera generación. Discusión: La presentación clínica predominante fue diarrea con sangre, no se presentaron brotes. Basados en los perfiles de susceptibilidad antimicrobiana, se pueden mantener las recomendaciones hasta el momento sugeridas. Conclusiones: Se debe tener en cuenta la infección por Salmonella sp en niños febriles con riesgo de enfermedad bacteriana invasora, con o sin focalidad.

Background: Salmonella can cause asymptomatic infections, diarrhea, bacteremia and focal infections such as meningitis and osteomyelitis. Aim: To describe clinical and microbiological aspects of infections by Salmonella spp. in children in a pediatric referral hospital: Centro Hospitalario Pereira Rossell, in Montevideo, Uruguay. Materials and Methods: Descriptive and retrospective study of 46 patients, from which Salmonella spp was isolated between January 1, 2005 and December 31, 2010. Results: Salmonella spp was isolated in 46 children younger than 15 years old. 18 were below 2 years old and 5 children below three months. 24% of the children had risk factors, such as HIV infection, oncological diseases and malnutrition; low birth weight and pneumonia were associated conditions. No deaths were reported. The serotypes more frequently found were: Typhimurium and Enteritidis. Most of the strains were susceptible to ampicillin and third generation of cephalosporins. Discussion: Diarrhea with blood was the predominant clinical presentation, and there were no outbreaks. Typhimurium and Enteritidis were the most common serotypes. Based on the profiles of susceptibility antimicrobial, we could maintain the same recommendations until the moment suggested. Conclusions: we must consider the Salmonella infection in febrile children under risk of an invasive bacterial disease, with or without focal infection.

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Introducción: la urticaria es motivo frecuente de consulta en la urgencia pediátrica. Debe considerarse como un signo clínico y no una enfermedad en sí misma. Puede ser provocada por alimentos, agentes físicos, fármacos, toxinas, y picaduras de insectos. Las enfermedades infecciosas, en general virales, también son causa frecuente de urticaria. En ocasiones, puede corresponder a una enfermedad de origen bacteriano, de diferentes grados de severidad. Objetivo: presentar dos casos clínicos asistidos en el Departamento de Emergencia Pediátrica del Centro Hospitalario Pereira Rossell con urticarias febriles, expresión de una enfermedad infecciosa bacteriana. Discusión: uno de los objetivos más importantes en la asistencia inicial es determinar el grado de urgencia de la atención, aplicando un sistema de categorización sistematizado “triage” lo que permite establecer si existe riesgo vital y necesidad de tratamiento inmediato, independiente de la causa que lo provoca. Ambos casos clínicos presentaban una infección bacteriana que se manifestó inicialmente como una urticaria febril. En el primer caso se confirmó al diagnóstico de infección urinaria en un paciente sin riesgo vital inmediato. En el segundo niño la urticaria se presentó en un paciente grave con afectación sistémica que posteriormente se focaliza como una osteoartritis de cadera. Conclusión: la urticaria en la infancia suele ser considerada una enfermedad benigna. En ocasiones puede ser la manifestación inicial de una enfermedad infecciosa grave. Las infecciones severas deben ser consideradas en la evaluación de un niño que se presenta con urticaria, fundamentalmente si se acompaña de fiebre.

Introduction: hives are frequent cause of consultation in pediatric emergency. It should be considered a clinical sign and not a disease in itself. It can be caused by food, physical agents, drugs, toxins, and insect bites. Infectious diseases in general are also common viral cause of urticaria. Occasionally, it may correspond to a bacterial disease, with different degrees of severity. Objective: to present two cases of febrile hives seen in the Pediatric Emergency Department at the Pereira Rossel Hospital Center, resulting from a bacterial infectious disease. Discussion: one of the most important objectives in the initial assistance is to determine the degree of urgency of care, by applying a systematic categorization system of “triage”, which allows to establish whether it is life-threatening and needs immediate treatment, regardless of the cause it causes. Both clinical cases had a bacterial infection that initially manifested itself as a febrile urticaria. In the first case, the diagnosis of urinary tract infection in a patient not immediately life-threatening was confirmed. In the second case, hives occurred in patients with severe systemic disease which later focused as a hip osteoarthritis. Conclusion: hives in children is usually considered a benign disease. Sometimes it may be the initial manifestation of a serious infectious disease. Severe infections should be considered when evaluating a child who presents hives, mainly if accompanied by fever.

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This study evaluated the seroprevalence of poliovirus types 1, 2 and 3 antibodies and vaccination coverage in 780 subjects aged between 7 months and 39 years in Montevideo, Uruguay, where oral polio vaccine (OPV) is used. Antibody titers were measured and seroprotection rates and geometric mean titers (GMTs) were compared among four age groups. Vaccination histories were recorded from documents and interviews. Seroprotection rates ranged from 72% to 95% in children aged 7-23 months, 31-77% in 2-9-year olds, 14-45% in 10-19-year olds and 20-59.5% in 20-39-year olds. Seroprotection decreased significantly with increasing age (p<0.05). Polio vaccination coverage was >90% for the two youngest age groups. These results could help guide public policy decisions regarding polio vaccination, and support the use of inactivated polio vaccine following cessation of OPV.

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