RESUMEN
Shigella spp. is the most frequent micro-biological isolation in bacterial diarrhea in Argentina. It causes a watery diarrhea or dysenteric disease. It rarely causes extraintestinal problems. It has an incidence of bacteremia of 0,4-7,3%, and its appearance compels us to look for associated risk factors, as children under one year of age and immunodeficiency, among others. We describe two children with Shigella flexneri bacteremia. They presented with fever and diarrhea. One of them had primary immune deficiency.
Asunto(s)
Bacteriemia/microbiología , Disentería Bacilar/microbiología , Shigella flexneri/aislamiento & purificación , Bacteriemia/diagnóstico , Disentería Bacilar/diagnóstico , Humanos , Lactante , MasculinoRESUMEN
La aplasia medular es una enfermedad poco frecuente en pediatría, siendo el tratamiento de elección en las formas severas el trasplante de células progenitoras hematopoyéticas (TCPH). Gracias a los avances en TCPH, los nuevos tratamientos inmunosupresores y al adecuado tratamiento de sostén, se ha logrado en las últimas décadas una franca disminución de la mortalidad asociada a esta patología. Es por ello que uno de los principales desafíos consiste en prevenir la aparición de infecciones asociadas a la neutropenia severa y prolongada que padecen estos pacientes, siendo actualmente las infecciones bacterianas y fúngicas una de las principales causas de morbimortalidad. Por otra parte, la mayoría de las guías de manejo y tratamiento de sostén se basan en recomendaciones de expertos, siendo la evidencia escasa, más aún en pediatría. Gran parte de las recomendaciones de tratamiento empírico se basan en guías de neutropenia febril de pacientes hemato-oncológicos. A su vez, existe gran variabilidad, de acuerdo al centro de atención, en cuanto al uso de antimicrobianos para profilaxis primaria, debiéndose tener en cuenta la mayor propensión a presentar infecciones invasivas por hongos filamentosos y, en el caso de pacientes con linfopenia marcada, de enfermedad por P jirovecii a la hora de valorar la indicación de profilaxis de estos pacientes.Se detallarán a continuación las principales recomendaciones sobre manejo de prevención de infecciones y tratamiento precoz de pacientes pediátricos con aplasia medular severa.
Aplastic anemia (AA) is a rare condition in children. Hematopoietic stem cell transplantation (HSCT) is the treatment of choice for severe idiopatic AA. Survival in severe AA has markedly improved in the past decades due to advances in HSCT, immunosuppressive and biologic drugs, as well as supportive care. Since bacterial and fungal infections are one of the principal causes of morbidity and mortality in AA, one of the main challenges is to prevent the appearance of infections associated with severe and prolonged neutropenia. Most guidelines of treatment and prophylaxis are based on expert recommendations. Given the lack of controlled studies in children with AA, most recommendations of empiric treatment rely on guidelines for febrile-neutropenia management in hemato-oncologycal patients. A great variability exists in the use of antimicrobials for primary prophylaxis among different institutions. Due to the fact that patients with severe and prolonged AA present high incidence of filamentous fungal infections, an adecuate antifungal prophylaxis is recommended. In the case of severe lymphopenia, prophylaxis against P jirovecii should also be considered. Recommendations in prophylaxis and early treatment of infections in severe pediatric AA are detailed
Asunto(s)
Humanos , Recién Nacido , Lactante , Preescolar , Niño , Control de Infecciones , Trasplante de Células Madre Hematopoyéticas , Diagnóstico Precoz , Prevención de Enfermedades , Infecciones Fúngicas Invasoras/terapia , Anemia Aplásica/patología , Anemia Aplásica/prevención & controlRESUMEN
Resumen Shigella spp. es el aislamiento microbiológico más frecuente en las diarreas bacterianas en Argentina. Clínicamente puede causar desde una diarrea acuosa hasta disentería. En forma infrecuente causa complicaciones extraintestinales, con una incidencia de bacteriemia desde 0,4 a 7,3%; asociado a factores de riesgo como niños menores de un año de edad e inmunodeficiencias, entre otros. Presentamos los casos clínicos de dos lactantes con bacteriemia por Shigella flexneri, que consultaron por fiebre y diarrea, uno de ellos con diagnóstico de inmunodeficiencia primaria.
Shigella spp. is the most frequent micro-biological isolation in bacterial diarrhea in Argentina. It causes a watery diarrhea or dysenteric disease. It rarely causes extraintestinal problems. It has an incidence of bacteremia of 0,4-7,3%, and its appearance compels us to look for associated risk factors, as children under one year of age and immunodeficiency, among others. We describe two children with Shigella flexneri bacteremia. They presented with fever and diarrhea. One of them had primary immune deficiency.
Asunto(s)
Humanos , Masculino , Lactante , Shigella flexneri/aislamiento & purificación , Bacteriemia/microbiología , Disentería Bacilar/microbiología , Bacteriemia/diagnóstico , Disentería Bacilar/diagnósticoRESUMEN
Introducción. Las infecciones invasivas por Streptococcus pyogenes (IISP) presentan elevada morbimortalidad aún en la actualidad; no obstante, a nivel regional, existen escasas publicaciones en pediatría. Objetivo. Describir la prevalencia, los factores predisponentes y las características clínicas de niños internados por IISP, analizar los factores de riesgo asociados a bacteriemia y letalidad. Material y métodos. Estudio retrospectivo, descriptivo de IISP en niños ≤ 18 años, internados en Pediatría de 20 centros asistenciales del país, entre 2010 y 2012. Variables evaluadas: edad, sexo, focos clínicos iniciales y tardíos, patología crónica previa, factores predisponentes, tratamiento y evolución. Resultados. Se analizaron 143 pacientes. Incidencia de 4,97 casos/10 000 egresos. Mediana de edad 54 meses; tenían patología crónica previa 11,2%. Tuvieron factores predisponentes 67,1%. Las formas de presentación más frecuentes fueron la piel y las partes blandas en 77, sepsis en 30, osteoarticulares en 19, fascitis necrotizante en 13, síndrome de shock tóxico en 11. Se aisló Streptococcus pyogenes en 56,6% de los hemocultivos; la presencia de más de un foco clínico y la ausencia de cirugía se asociaron a bacteriemia (OR 4,8; p= 0,003 y OR 3,1; p= 0,0012, respectivamente). El promedio de internación fue 13,4 días. La tasa de letalidad fue 7,6% asociada a síndrome de shock tóxico (OR 10; p= 0,005), fascitis necrotizante (OR 104; p < 0,0001) e ingreso a la Unidad de Cuidados Intensivos Pediátricos (OR 26; p < 0,001). Conclusiones. La mayoría de las IISP se presentaron en pacientes sin patología crónica previa. Los focos de presentación, frecuentemente con bacteriemia, fueron la piel y las partes blandas. Hubo asociación estadísticamente significativa entre bacteriemia y ≥ 2 focos iniciales y ausencia de cirugía. La letalidad, asociada a SSTS y fascitis necrotizante, fue similar a otras publicaciones.
Introduction. Invasive Streptococcus pyogenes infections (ISpIs) cause a high morbidity and mortality, even at present; however, at a regional level there are few publications on this subject in the field of pediatrics. Objective. To describe the prevalence, predisposing factors and clinical characteristics of children hospitalized for ISpI, and analyze risk factors associated with bacteremia and lethality. Material and methods. Retrospective, descriptive study on ISpIs in children <18 years old hospitalized in the Pediatric Ward of 20 healthcare facilities across Argentina between 2010 and 2012. Assessed outcome measures: age, gender, early and late clinical sources of infection, prior chronic condition, predisposing factors, treatment and evolution. Results. One hundred and forty-three patients were analyzed. The incidence of ISpI was 4.97 cases/10 000 hospital discharges. Patients' median age was 54 months old, and 11.2% had a prior chronic condition. Also, 67.1% had predisposing factors. The most common clinical manifestations were in the skin and soft tissue in 77 patients, sepsis in 30, bone and joint involvement in 19, necrotizing fasciitis in 13, and toxic shock syndrome in 11. Streptococcus pyogenes was isolated in the blood cultures of 56.6%. More than one clinical source of infection and no surgery were associated with bacteremia (odds ratio [OR]: 4.8, p= 0.003 and OR: 3.1, p= 0.0012, respectively). The average length of stay in the hospital was 13.4 days. Fatality rate was 7.6% in association with toxic shock syndrome (OR: 10, p= 0.005), necrotizing fasciitis (OR: 104, p < 0.0001) and admission to the Pediatric Intensive Care Unit (OR: 26, p < 0.001). Conclusions. Most ISpIs were observed in patients without a prior chronic condition. The most common manifestation was, frequently with bacteremia, in the skin and soft tissue. A statistically significant association was observed between bacteremia and ≥2 early sources of infection and no surgery. Fatality rate, in association with streptococcal toxic shock syndrome and necrotizing fasciitis, was similar to that observed in other publications.
Asunto(s)
Humanos , Lactante , Preescolar , Niño , Adolescente , Infecciones Estreptocócicas/complicaciones , Infecciones Estreptocócicas/diagnóstico , Infecciones Estreptocócicas/microbiología , Infecciones Estreptocócicas/epidemiología , Streptococcus pyogenes , Factores de Riesgo , Bacteriemia/etiología , Estudios Transversales , Estudios RetrospectivosRESUMEN
INTRODUCTION: Invasive Streptococcus pyogenes infections (ISpIs) cause a high morbidity and mortality, even at present; however, at a regional level there are few publications on this subject in the field of pediatrics. OBJECTIVE: To describe the prevalence, predisposing factors and clinical characteristics of children hospitalized for ISpI, and analyze risk factors associated with bacteremia and lethality. Material and methods. Retrospective, descriptive study on ISpIs in children <18 years old hospitalized in the Pediatric Ward of 20 healthcare facilities across Argentina between 2010 and 2012. Assessed outcome measures: age, gender, early and late clinical sources of infection, prior chronic condition, predisposing factors, treatment and evolution. RESULTS: To describe the prevalence, predisposing factors and clinical characteristics of children hospitalized for ISpI, and analyze risk factors associated with bacteremia and lethality. Material and methods. Retrospective, descriptive study on ISpIs in children <18 years old hospitalized in the Pediatric Ward of 20 healthcare facilities across Argentina between 2010 and 2012. Assessed outcome measures: age, gender, early and late clinical sources of infection, prior chronic condition, predisposing factors, treatment and evolution. CONCLUSIONS: Most ISpIs were observed in patients without a prior chronic condition. The most common manifestation was, frequently with bacteremia, in the skin and soft tissue. A statistically significant association was observed between bacteremia and ≥2 early sources of infection and no surgery. Fatality rate, in association with streptococcal toxic shock syndrome and necrotizing fasciitis, was similar to that observed in other publications.
INTRODUCCIÓN: Las infecciones invasivas por Streptococcus pyogenes (IISP) presentan elevada morbimortalidad aún en la actualidad; no obstante, a nivel regional, existen escasas publicaciones en pediatría. OBJECTIVO: Describir la prevalencia, los factores predisponentes y las características clínicas de niños internados por IISP, analizar los factores de riesgo asociados a bacteriemia y letalidad. Material y métodos. Estudio retrospectivo, descriptivo de IISP en niños ≤ 18 anos, internados en Pediatría de 20 centros asistenciales del país, entre 2010 y 2012. Variables evaluadas: edad, sexo, focos clínicos iniciales y tardíos, patología crónica previa, factores predisponentes, tratamiento y evolución. RESULTADOS: Se analizaron 143 pacientes. Incidencia de 4,97 casos/10 000 egresos. Mediana de edad 54 meses; tenían patología crónica previa 11,2%. Tuvieron factores predisponentes 67,1%. Las formas de presentación más frecuentes fueron la piel y las partes blandas en 77, sepsis en 30, osteoarticulares en 19, fascitis necrotizante en 13, síndrome de shock tóxico en 11. Se aisló Streptococcus pyogenes en 56,6% de los hemocultivos; la presencia de más de un foco clínico y la ausencia de cirugía se asociaron a bacteriemia (OR 4,8; p= 0,003 y OR 3,1; p= 0,0012, respectivamente). El promedio de internación fue 13,4 días. La tasa de letalidad fue 7,6% asociada a síndrome de shock tóxico (OR 10; p= 0,005), fascitis necrotizante (OR 104; p < 0,0001) e ingreso a la Unidad de Cuidados Intensivos Pediátricos (OR 26; p < 0,001). CONCLUSIONES: La mayoría de las IISP se presentaron en pacientes sin patología crónica previa. Los focos de presentación, frecuentemente con bacteriemia, fueron la piel y las partes blandas. Hubo asociación estadísticamente significativa entre bacteriemia y ≥ 2 focos iniciales y ausencia de cirugía. La letalidad, asociada a SSTS y fascitis necrotizante, fue similar a otras publicaciones.
Asunto(s)
Infecciones Estreptocócicas , Streptococcus pyogenes , Adolescente , Argentina , Bacteriemia/etiología , Niño , Preescolar , Estudios Transversales , Femenino , Humanos , Lactante , Masculino , Estudios Retrospectivos , Factores de Riesgo , Infecciones Estreptocócicas/complicaciones , Infecciones Estreptocócicas/diagnóstico , Infecciones Estreptocócicas/epidemiología , Infecciones Estreptocócicas/microbiologíaRESUMEN
Introducción. La Casa Garrahan (CG) aloja a niños con patologías complejas de todo el país, atendidos en los hospitales pediátricos de la Ciudad Autónoma de Buenos Aires. La varicela es una enfermedad muy contagiosa, cuya tasa de ataque alcanza el 90% en susceptibles. En comunidades cerradas, es fundamental implementar medidas de prevención ante brotes. Objetivos. Describir las características de los niños expuestos a casos de varicela en la CG, las medidas de profilaxis implementadas y su efectividad. Métodos. Estudio de cohorte prospectivo. Se evaluaron los niños expuestos a varicela en la CG entre 2008 y 2013, sus características demográficas, clínicas y vacunación y/o varicela previa, medidas de profilaxis y tasa de ataque secundaria. Resultados. N: 107. El 53% (n: 57) eran niñas. La mediana de edad fue 84 meses (RIC: 24144). El 95% (n: 102) teman enfermedad de base [oncohematológica: 39% (n: 42); neurológica: 18% (n: 19); cardiopatías congénitas: 9% (n: 10); y posoperatorios: 65 (n: 6)]. Tenían algún grado de inmunosupresión el 50% (n: 54). El 29% (n: 31) referían haber tenido varicela; el 27% (n: 29) referían no haber padecido la enfermedad; y el 41% (n: 44) no recordaban el antecedente. Solo 3% (n: 3) estaban vacunados. Sobre la base del estado inmunológico, edad y antecedentes de varicela previa, se indicó aciclovir como profilaxis en 61% (n: 65); vacuna, en 10% (n: 10); y gammaglobulina, en 1 paciente. No se observaron efectos adversos relacionados con las profilaxis. No se observó ningún caso secundario a los 30 días. Conclusiones. Las medidas implementadas resultaron efectivas en la prevención de casos secundarios. En niños sanos e inmunocomprometidos, la profilaxis con aciclovir fue efectiva y bien tolerada.(AU)
Introduction. Casa Garrahan (CG) accommodates children with complex conditions referred nationwide; these children are seen in childrens hospitals located in the Autonomous City of Buenos Aires. Varicella is a highly-contagious disease, with attack rates of up to 90% among susceptible individuals. In closed communities, the implementation of outbreak control measures is critical. Objectives. To describe the characteristics of children exposed to varicella at CG, the implemented prophylaxis measures and their effectiveness. Methods. Prospective, cohort study. Children exposed to varicella at CG between2008 and 2013, their demographic and clinical characteristics, immunization and/or history of varicella, prophylaxis measures, and secondary attack rate were assessed. Results. N: 107. Fifty-three percent (n: 57) were girls. Their median age was 84 months old [interquartile range (IQR): 24-144]. Ninety-five percent (n: 102) had an underlying disease [hemato-oncological disease: 39% (n: 42); neurological disease: 18% (n: 19); congenital heart disease: 9% (n: 10); and post-operative period: 65 (n: 6)]. Fifty percent had some degree of immunosuppression (n: 54). Twenty-nine percent (n: 31) referred to have had varicella; 27% (n: 29) indicated that they never had the infection; and 41% (n: 44) did not recall a history of varicella. Only 3% (n: 3) had been vaccinated. Based on their immune status, age and history of varicella, acyclovir was indicated as prophylaxis in 61% (n: 65); immunization in 10% (n: 10); and gamma globulin in 1 patient. No adverse effects were observed in relation to the different prophylaxis measures. No secondary cases were observed at 30 days. Conclusions. Implemented measures were effective to prevent secondary cases. Among healthy and immunocompromised children, prophylaxis with acyclovir was effective and well-tolerated.(AU)
RESUMEN
Introducción. La Casa Garrahan (CG) aloja a niños con patologías complejas de todo el país, atendidos en los hospitales pediátricos de la Ciudad Autónoma de Buenos Aires. La varicela es una enfermedad muy contagiosa, cuya tasa de ataque alcanza el 90% en susceptibles. En comunidades cerradas, es fundamental implementar medidas de prevención ante brotes. Objetivos. Describir las características de los niños expuestos a casos de varicela en la CG, las medidas de profilaxis implementadas y su efectividad. Métodos. Estudio de cohorte prospectivo. Se evaluaron los niños expuestos a varicela en la CG entre 2008 y 2013, sus características demográficas, clínicas y vacunación y/o varicela previa, medidas de profilaxis y tasa de ataque secundaria. Resultados. N: 107. El 53% (n: 57) eran niñas. La mediana de edad fue 84 meses (RIC: 24144). El 95% (n: 102) teman enfermedad de base [oncohematológica: 39% (n: 42); neurológica: 18% (n: 19); cardiopatías congénitas: 9% (n: 10); y posoperatorios: 65 (n: 6)]. Tenían algún grado de inmunosupresión el 50% (n: 54). El 29% (n: 31) referían haber tenido varicela; el 27% (n: 29) referían no haber padecido la enfermedad; y el 41% (n: 44) no recordaban el antecedente. Solo 3% (n: 3) estaban vacunados. Sobre la base del estado inmunológico, edad y antecedentes de varicela previa, se indicó aciclovir como profilaxis en 61% (n: 65); vacuna, en 10% (n: 10); y gammaglobulina, en 1 paciente. No se observaron efectos adversos relacionados con las profilaxis. No se observó ningún caso secundario a los 30 días. Conclusiones. Las medidas implementadas resultaron efectivas en la prevención de casos secundarios. En niños sanos e inmunocomprometidos, la profilaxis con aciclovir fue efectiva y bien tolerada.
Introduction. Casa Garrahan (CG) accommodates children with complex conditions referred nationwide; these children are seen in children's hospitals located in the Autonomous City of Buenos Aires. Varicella is a highly-contagious disease, with attack rates of up to 90% among susceptible individuals. In closed communities, the implementation of outbreak control measures is critical. Objectives. To describe the characteristics of children exposed to varicella at CG, the implemented prophylaxis measures and their effectiveness. Methods. Prospective, cohort study. Children exposed to varicella at CG between2008 and 2013, their demographic and clinical characteristics, immunization and/or history of varicella, prophylaxis measures, and secondary attack rate were assessed. Results. N: 107. Fifty-three percent (n: 57) were girls. Their median age was 84 months old [interquartile range (IQR): 24-144]. Ninety-five percent (n: 102) had an underlying disease [hemato-oncological disease: 39% (n: 42); neurological disease: 18% (n: 19); congenital heart disease: 9% (n: 10); and post-operative period: 65 (n: 6)]. Fifty percent had some degree of immunosuppression (n: 54). Twenty-nine percent (n: 31) referred to have had varicella; 27% (n: 29) indicated that they never had the infection; and 41% (n: 44) did not recall a history of varicella. Only 3% (n: 3) had been vaccinated. Based on their immune status, age and history of varicella, acyclovir was indicated as prophylaxis in 61% (n: 65); immunization in 10% (n: 10); and gamma globulin in 1 patient. No adverse effects were observed in relation to the different prophylaxis measures. No secondary cases were observed at 30 days. Conclusions. Implemented measures were effective to prevent secondary cases. Among healthy and immunocompromised children, prophylaxis with acyclovir was effective and well-tolerated.
Asunto(s)
Humanos , Niño , Aciclovir , Varicela , Profilaxis PosexposiciónRESUMEN
INTRODUCTION: Casa Garrahan (CG) accommodates children with complex conditions referred nationwide; these children are seen in children's hospitals located in the Autonomous City of Buenos Aires. Varicella is a highly-contagious disease, with attack rates of up to 90% among susceptible individuals. In closed communities, the implementation of outbreak control measures is critical. OBJECTIVES: To describe the characteristics of children exposed to varicella at CG, the implemented prophylaxis measures and their effectiveness. METHODS: Prospective, cohort study. Children exposed to varicella at CG between2008 and 2013, their demographic and clinical characteristics, immunization and/or history of varicella, prophylaxis measures, and secondary attack rate were assessed. RESULTS: N: 107. Fifty-three percent (n: 57) were girls. Their median age was 84 months old [interquartile range (IQR): 24-144]. Ninety-five percent (n: 102) had an underlying disease [hemato-oncological disease: 39% (n: 42); neurological disease: 18% (n: 19); congenital heart disease: 9% (n: 10); and post-operative period: 65 (n: 6)]. Fifty percent had some degree of immunosuppression (n: 54). Twenty-nine percent (n: 31) referred to have had varicella; 27% (n: 29) indicated that they never had the infection; and 41% (n: 44) did not recall a history of varicella. Only 3% (n: 3) had been vaccinated. Based on their immune status, age and history of varicella, acyclovir was indicated as prophylaxis in 61% (n: 65); immunization in 10% (n: 10); and gamma globulin in 1 patient. No adverse effects were observed in relation to the different prophylaxis measures. No secondary cases were observed at 30 days. CONCLUSIONS: Implemented measures were effective to prevent secondary cases. Among healthy and immunocompromised children, prophylaxis with acyclovir was effective and well-tolerated.
Asunto(s)
Aciclovir/uso terapéutico , Antivirales/uso terapéutico , Vacuna contra la Varicela , Varicela/prevención & control , Profilaxis Posexposición , Argentina , Niño , Preescolar , Estudios de Cohortes , Femenino , Hospitales Pediátricos , Humanos , Masculino , Estudios ProspectivosRESUMEN
Introducción. El uso inapropiado de antibióticos se relaciona con el incremento de los microorganismos resistentes, mayor morbimortalidad e impacto en la salud pública. Objetivo. Evaluar la efectividad de un programa para mejorar la adecuación del uso de los antimicrobianos en los pacientes internados en el Hospital Garrahan. Material y métodos. Estudio prospectivo, longitudinal, antes-después, sin grupo control. Período de estudio: del 1/7/2010 al30/6/2011. Se incluyeron pacientes con antibiótico parenteral. Se excluyeron los recién nacidos, quemados y aquellos con antibiótico como profilaxis. Se comparó el período previo y posterior a la implementación de talleres de discusión y monitoreo de indicaciones de antibióticos y la difusión de guías de tratamiento. Se realizó análisis univariado y estudio de regresión logística múltiple (STATA 8.0). Resultados. En el período preintervención, se incluyeron 376 pacientes; el 35,6% recibió tratamiento inadecuado. En el análisis de regresión múltiple, las variables finales de uso inadecuado fueron la infección respiratoria aguda baja (OR 3,80; IC 95% 1,35-3,26; p= 0,04), la fiebre sin foco en el paciente internado (OR 5,55; IC 95% 2,43-12,6; p < 0,01) y la neutropenia febril (OR 0,29; IC 95% 0,10-0,7; p < 0,01). Postintervención: se incluyeron 357 pacientes; 21,5% recibió tratamiento inapropiado. Se observó un descenso en la prescripción antibiótica inadecuada respecto al período preintervención (p < 0,01). En el análisis de regresión múltiple, las variables finales respecto al uso inadecuado fueron infección de piel y partes blandas (OR 0,33; IC 95% 0,13-0,93; p= 0,035) y neutropenia febril (OR 0,48; IC 95% 0,22-0,94; p= 0,04). Conclusión. El programa fue efectivo. Permitió mejorar las prácticas de prescripción de antibióticos en pacientes pediátricos hospitalizados.
Introduction. Inadequate antibiotic use is associated with an increased emergence of resistant microorganisms, higher morbidity and mortality rates, and an impact on public health. Objective. To assess the effectiveness of a program aimed at improving the use of antimicrobials in patients hospitalized at Hospital Garrahan. Material and Methods. Prospective, longitudinal, before and after study with no control group. Study period: From November 1st, 2010 to June 30th, 2011. Patients receiving parenteral antibiotics were included. Newborn infants, burned patients and those receiving prophylactic antibiotics were excluded. The periods before and after implementing discussion and monitoring workshops for antibiotic prescription and distributing treatment guidelines were compared. An univariate analysis and a multiple logistic regression study were performed (STATA 8.0). Results. In the pre-interventionperiod,376patients were included; of them, 35.6% had received inadequate treatment. The multiple regression analysis showed that the endpoints for inadequate antibiotic use were acute lower respiratory tract infection (OR: 3.80; 95% CI: 1.35-3.26; p=0.04), fever without a source in hospitalized patients (OR: 5.55; 95% CI: 2.43-12.6; p < 0.01), and febrile neutropenia (OR: 0.29; 95% CI: 0.10-0.7; p < 0.01). In the post-intervention period, 357 patients were included; 21.5% had received inadequate treatment. A reduction in inadequate antibiotic prescription was observed compared to the pre-intervention period (p < 0.01). The multiple regression analysis showed that endpoints for inadequate use were skin and soft tissue infections (OR: 0.33; 95% CI: 0.13-0.93; p = 0.035), and febrile neutropenia (OR: 0.48; 95% CI: 0.220.94; p= 0.04). Conclusion. The program was effective and allowed to improve antibiotic prescription practices in hospitalized children.
Asunto(s)
Adolescente , Niño , Preescolar , Humanos , Lactante , Antibacterianos/uso terapéutico , Utilización de Medicamentos/normas , Argentina , Hospitalización , Estudios Longitudinales , Evaluación de Programas y Proyectos de Salud , Estudios Prospectivos , Atención Terciaria de SaludRESUMEN
Introducción. El uso inapropiado de antibióticos se relaciona con el incremento de los microorganismos resistentes, mayor morbimortalidad e impacto en la salud pública. Objetivo. Evaluar la efectividad de un programa para mejorar la adecuación del uso de los antimicrobianos en los pacientes internados en el Hospital Garrahan. Material y métodos. Estudio prospectivo, longitudinal, antes-después, sin grupo control. Período de estudio: del 1/7/2010 al30/6/2011. Se incluyeron pacientes con antibiótico parenteral. Se excluyeron los recién nacidos, quemados y aquellos con antibiótico como profilaxis. Se comparó el período previo y posterior a la implementación de talleres de discusión y monitoreo de indicaciones de antibióticos y la difusión de guías de tratamiento. Se realizó análisis univariado y estudio de regresión logística múltiple (STATA 8.0). Resultados. En el período preintervención, se incluyeron 376 pacientes; el 35,6% recibió tratamiento inadecuado. En el análisis de regresión múltiple, las variables finales de uso inadecuado fueron la infección respiratoria aguda baja (OR 3,80; IC 95% 1,35-3,26; p= 0,04), la fiebre sin foco en el paciente internado (OR 5,55; IC 95% 2,43-12,6; p < 0,01) y la neutropenia febril (OR 0,29; IC 95% 0,10-0,7; p < 0,01). Postintervención: se incluyeron 357 pacientes; 21,5% recibió tratamiento inapropiado. Se observó un descenso en la prescripción antibiótica inadecuada respecto al período preintervención (p < 0,01). En el análisis de regresión múltiple, las variables finales respecto al uso inadecuado fueron infección de piel y partes blandas (OR 0,33; IC 95% 0,13-0,93; p= 0,035) y neutropenia febril (OR 0,48; IC 95% 0,22-0,94; p= 0,04). Conclusión. El programa fue efectivo. Permitió mejorar las prácticas de prescripción de antibióticos en pacientes pediátricos hospitalizados.(AU)
Introduction. Inadequate antibiotic use is associated with an increased emergence of resistant microorganisms, higher morbidity and mortality rates, and an impact on public health. Objective. To assess the effectiveness of a program aimed at improving the use of antimicrobials in patients hospitalized at Hospital Garrahan. Material and Methods. Prospective, longitudinal, before and after study with no control group. Study period: From November 1st, 2010 to June 30th, 2011. Patients receiving parenteral antibiotics were included. Newborn infants, burned patients and those receiving prophylactic antibiotics were excluded. The periods before and after implementing discussion and monitoring workshops for antibiotic prescription and distributing treatment guidelines were compared. An univariate analysis and a multiple logistic regression study were performed (STATA 8.0). Results. In the pre-interventionperiod,376patients were included; of them, 35.6% had received inadequate treatment. The multiple regression analysis showed that the endpoints for inadequate antibiotic use were acute lower respiratory tract infection (OR: 3.80; 95% CI: 1.35-3.26; p=0.04), fever without a source in hospitalized patients (OR: 5.55; 95% CI: 2.43-12.6; p < 0.01), and febrile neutropenia (OR: 0.29; 95% CI: 0.10-0.7; p < 0.01). In the post-intervention period, 357 patients were included; 21.5% had received inadequate treatment. A reduction in inadequate antibiotic prescription was observed compared to the pre-intervention period (p < 0.01). The multiple regression analysis showed that endpoints for inadequate use were skin and soft tissue infections (OR: 0.33; 95% CI: 0.13-0.93; p = 0.035), and febrile neutropenia (OR: 0.48; 95% CI: 0.220.94; p= 0.04). Conclusion. The program was effective and allowed to improve antibiotic prescription practices in hospitalized children.(AU)
RESUMEN
INTRODUCTION: Inadequate antibiotic use is associated with an increased emergence of resistant microorganisms, higher morbidity and mortality rates, and an impact on public health. OBJECTIVE: To assess the effectiveness of a program aimed at improving the use of antimicrobials in patients hospitalized at Hospital Garrahan. MATERIAL AND METHODS: Prospective, longitudinal, before and after study with no control group. STUDY PERIOD: From November 1st, 2010 to June 30th, 2011. Patients receiving parenteral antibiotics were included. Newborn infants, burned patients and those receiving prophylactic antibiotics were excluded. The periods before and after implementing discussion and monitoring workshops for antibiotic prescription and distributing treatment guidelines were compared. An univariate analysis and a multiple logistic regression study were performed (STATA 8.0). RESULTS: In the pre-intervention period,376 patients were included; of them, 35.6% had received inadequate treatment. The multiple regression analysis showed that the endpoints for inadequate antibiotic use were acute lower respiratory tract infection (OR: 3.80; 95% CI: 1.35-3.26; p=0.04), fever without a source in hospitalized patients (OR: 5.55; 95% CI: 2.43-12.6; p < 0.01), and febrile neutropenia (OR: 0.29; 95% CI: 0.10-0.7; p < 0.01). In the post-intervention period, 357 patients were included; 21.5% had received inadequate treatment. A reduction in inadequate antibiotic prescription was observed compared to the pre-intervention period (p < 0.01). The multiple regression analysis showed that endpoints for inadequate use were skin and soft tissue infections (OR: 0.33; 95% CI: 0.13-0.93; p = 0.035), and febrile neutropenia (OR: 0.48; 95% CI: 0.220.94; p= 0.04). CONCLUSION: The program was effective and allowed to improve antibiotic prescription practices in hospitalized children.
Asunto(s)
Antibacterianos/uso terapéutico , Utilización de Medicamentos/normas , Adolescente , Argentina , Niño , Preescolar , Hospitalización , Humanos , Lactante , Estudios Longitudinales , Evaluación de Programas y Proyectos de Salud , Estudios Prospectivos , Atención Terciaria de SaludRESUMEN
This study reports the synthesis of porous nano alumina employing carboxylato-alumoxanes [Al(O) x (OH) y (O2CR) z ] n as precursors for controlling the pore size, pore size distribution and porosity of the alumina, using a new process ecofriendly. The carboxylato-alumoxanes was prepared by the reaction of boehmite with carboxylic acids. The boehmite was obtained by the hydrolysis of aluminum alkoxide in an aqueous solution. The colophony extract is employed as a source of carboxylic acids. The materials were characterized, using XRD, TGA, N2 physical adsorption, SEM, TEM, NMR and FTIR. A mechanism was proposed for the formation of the synthesized structures. TEM measurements confirmed particle size ranged from 5 to 8 nm.
RESUMEN
INTRODUCTION: Inadequate antibiotic use is associated with an increased emergence of resistant microorganisms, higher morbidity and mortality rates, and an impact on public health. OBJECTIVE: To assess the effectiveness of a program aimed at improving the use of antimicrobials in patients hospitalized at Hospital Garrahan. MATERIAL AND METHODS: Prospective, longitudinal, before and after study with no control group. STUDY PERIOD: From November 1st, 2010 to June 30th, 2011. Patients receiving parenteral antibiotics were included. Newborn infants, burned patients and those receiving prophylactic antibiotics were excluded. The periods before and after implementing discussion and monitoring workshops for antibiotic prescription and distributing treatment guidelines were compared. An univariate analysis and a multiple logistic regression study were performed (STATA 8.0). RESULTS: In the pre-intervention period,376 patients were included; of them, 35.6
had received inadequate treatment. The multiple regression analysis showed that the endpoints for inadequate antibiotic use were acute lower respiratory tract infection (OR: 3.80; 95
CI: 1.35-3.26; p=0.04), fever without a source in hospitalized patients (OR: 5.55; 95
CI: 2.43-12.6; p < 0.01), and febrile neutropenia (OR: 0.29; 95
CI: 0.10-0.7; p < 0.01). In the post-intervention period, 357 patients were included; 21.5
had received inadequate treatment. A reduction in inadequate antibiotic prescription was observed compared to the pre-intervention period (p < 0.01). The multiple regression analysis showed that endpoints for inadequate use were skin and soft tissue infections (OR: 0.33; 95
CI: 0.13-0.93; p = 0.035), and febrile neutropenia (OR: 0.48; 95
CI: 0.220.94; p= 0.04). CONCLUSION: The program was effective and allowed to improve antibiotic prescription practices in hospitalized children.
RESUMEN
Objetivo. Describir el estado de la aplicación de la norma relacionada con la prohibición de la venta de antibióticos sin prescripción médica en farmacias de Bogotá, Colombia. Métodos. Estudio descriptivo transversal, en el cual se utilizó la técnica de simulación de compra en farmacias (droguerías) de Bogotá. La muestra de 263 farmacias se calculó con una precisión de 5% y un factor de corrección de 2% mediante estratificación (farmacias de cadena e independientes) y asignación aleatoria simple en cada estrato. Resultados. Del total de farmacias estudiadas, 80,3% no cumplen la norma que establece la venta de antibióticos con receta. En 20,1% de los casos, el expendedor indagó la edad del paciente o sus síntomas o ambos, con el fin de ofrecer otros medicamentos o para cambiar el antibiótico. En ninguna oportunidad se preguntó por antecedentes personales de alergia a los antibióticos. En los casos en los cuales hubo intención de venta del antibiótico, la presentación genérica fue la más comúnmente ofrecida (81,2%). Algunos expendedores de medicamentos hicieron recomendaciones inapropiadas. Las localidades con mayor incumplimiento de la norma coinciden con aquellas que tienen altas tasas de necesidades básicas insatisfechas. Conclusiones. A cinco años de adopción de la norma orientada a contrarrestar la venta libre de antibióticos, su cumplimiento es mínimo y la entrega no se realiza de acuerdo a los parámetros establecidos. El personal de farmacia no suministra la información requerida de acuerdo con sus competencias.
Objective. Describe the implementation status of a regulation prohibiting antibiotic sales without a medical prescription in pharmacies of Bogotá, Colombia. Methods. A cross-sectional descriptive study was conducted using the simulated purchase technique in Bogotá pharmacies (drugstores). The sample of 263 pharmacies was calculated by stratification (chain pharmacies and independent pharmacies) with 5% accuracy and a 2% correction factor. Simple randomization was assigned in each stratum. Results. Out of the total pharmacies studied, 80.3% did not comply with the regulation established for prescription sales of antibiotics. In 20.1% of the cases, the dispenser asked about the patients age, symptoms, or both age and symptoms in order to offer other drugs or change the antibiotic. There were no inquiries about a medical history of allergy to antibiotics. In cases in which there was the intention to sell antibiotics, the generic format was most commonly offered (81.2%). Some drug dispensers made inappropriate recommendations. The locations with the highest levels of noncompliance with the regulation were also those with high rates of unmet basic needs. Conclusions. Five years after passage of a regulation to halt the unrestricted sales of antibiotics, there is minimal compliance, and dispensing does not conform to the established parameters. Pharmacy personnel do not provide the required information according to their responsibilities.
Asunto(s)
Niño , Preescolar , Femenino , Humanos , Masculino , Antibacterianos/uso terapéutico , Hospitales Pediátricos , Prescripción Inadecuada/psicología , Motivación , Médicos/psicología , Antibacterianos/administración & dosificación , Argentina , Actitud del Personal de Salud , Infecciones Bacterianas/tratamiento farmacológico , Infecciones Bacterianas/prevención & control , Anomalías Congénitas , Infección Hospitalaria/complicaciones , Infección Hospitalaria/tratamiento farmacológico , Prescripciones de Medicamentos/estadística & datos numéricos , Utilización de Medicamentos/estadística & datos numéricos , Fiebre/etiología , Hospitales Pediátricos/estadística & datos numéricos , Unidades de Cuidado Intensivo Pediátrico/estadística & datos numéricos , Instituciones de Cuidados Intermedios/estadística & datos numéricos , Neoplasias/complicaciones , Enfermedades del Sistema Nervioso/complicaciones , Neutropenia/complicaciones , Complicaciones Posoperatorias/tratamiento farmacológico , Guías de Práctica Clínica como AsuntoRESUMEN
OBJECTIVE: Retrospective description of fungal infections in a specialized intensive care burn unit. RESULTS: A total of 41 (21%) of 195 patients admitted from January 2002 to March 2006 developed fungal infections at any site. The median age of patients was 48 months (interquartile range: 18-84), and the affected burn surface was 40% (interquartile range 30 and 65% The median time lapse between admission and fungal infections was 13 days (interquartile range 8-20 d) The most frequent site of isolation was burnt wound in 38 patients (93%) and in blood cultures in 3 patients (7%). In 93% of patients bacterial infections were also found. The predominant fungus recovered was Candida spp in 20 patients (49%); followed by Aspergillus sp in 6 patients (15%), Anphotericin B was the drug of choice. The median time of complete treatment was 23 days (interquartile range: 15-30). One patient died (2%) from causes related to fungal infection. CONCLUSION: A total of 41 (21%) of 195 patients admitted from January 2002 to March 2006 developed fungal infections. Candida sp was the most frequently found. Mortality was low.
Asunto(s)
Quemaduras/complicaciones , Micosis/etiología , Niño , Preescolar , Femenino , Humanos , Lactante , Unidades de Cuidados Intensivos , Masculino , Micosis/epidemiología , Estudios RetrospectivosRESUMEN
OBJECTIVE: Determine the reasons for inappropriate prescription of antibiotics and identify opportunities to improve prescription of these drugs in pediatric patients hospitalized in intermediate and intensive care units. METHODS: A prospective, descriptive longitudinal study was conducted of pediatric patients in intermediate and intensive care units who received parenteral administration of antibiotics, with the exception of newborns, burn unit patients, and surgical prophylaxis patients. A univariate analysis and multiple logistic regression were performed. RESULTS: A total of 376 patients with a median of age of 50 months were studied (interquartile range [IQR] 14.5-127 months). Out of the total patients studied, 75% had one or more underlying conditions. A total of 40.6% of these patients had an oncologic pathology and 33.5% had neurological conditions. The remaining 25.9% had other underlying conditions. Antibiotic treatment was inappropriate in 35.6% of the patients studied (N = 134). In 73 (54.4%) of the 134 cases, inappropriate use was due to the type of antibiotic prescribed, the dose administered, or the treatment period. The 61 (45.5%) remaining cases did not require antibiotic treatment. In the multivariate analysis, the risk factors for inappropriate use of antibiotics were: administration of ceftriaxone OR 2 (95% CI, 1.3-3.7; P = 0.02); acute lower respiratory tract infection OR 1.8 (95% CI, 1.1-3.3; P < 0.04); onset of fever of unknown origin in hospital inpatients OR 5.55 (95% CI, 2.5-12; P < 0.0001); and febrile neutropenia OR 0.3 (95% CI, 0.1-0.7; P = 0.009). CONCLUSIONS: Inappropriate use of antibiotics was less common in the clinical conditions that were well-characterized. Prescribing practices that could be improved were identified through the preparation and circulation of guidelines for antibiotic use in hospital inpatients.
Asunto(s)
Antibacterianos/uso terapéutico , Hospitales Pediátricos , Prescripción Inadecuada/psicología , Motivación , Médicos/psicología , Antibacterianos/administración & dosificación , Argentina , Actitud del Personal de Salud , Infecciones Bacterianas/tratamiento farmacológico , Infecciones Bacterianas/prevención & control , Niño , Preescolar , Anomalías Congénitas , Infección Hospitalaria/complicaciones , Infección Hospitalaria/tratamiento farmacológico , Prescripciones de Medicamentos/estadística & datos numéricos , Utilización de Medicamentos/estadística & datos numéricos , Femenino , Fiebre/etiología , Hospitales Pediátricos/estadística & datos numéricos , Humanos , Unidades de Cuidado Intensivo Pediátrico/estadística & datos numéricos , Instituciones de Cuidados Intermedios/estadística & datos numéricos , Masculino , Neoplasias/complicaciones , Enfermedades del Sistema Nervioso/complicaciones , Neutropenia/complicaciones , Complicaciones Posoperatorias/tratamiento farmacológico , Guías de Práctica Clínica como AsuntoAsunto(s)
Control de Medicamentos y Narcóticos , Antibacterianos , Farmacorresistencia Bacteriana , Legislación de Medicamentos , Colombia , Antibacterianos , Farmacorresistencia Bacteriana , Legislación de Medicamentos , Antibacterianos , Hospitales Pediátricos , Médicos , Argentina , Anomalías Congénitas , Utilización de Medicamentos , Fiebre , Unidades de Cuidado Intensivo Pediátrico , Neoplasias , Neutropenia , Guías de Práctica Clínica como Asunto , Control de Medicamentos y Narcóticos , Prescripción Inadecuada , Motivación , Actitud del Personal de Salud , Infecciones Bacterianas , Infección Hospitalaria , Prescripciones de Medicamentos , Instituciones de Cuidados Intermedios , Enfermedades del Sistema Nervioso , Complicaciones PosoperatoriasRESUMEN
Introducción. Escasos estudios han evaluado el impacto de S. aureus meticilino-resistente proveniente de la comunidad en bacteriemias. Objetivos. Analizar las características epidemiológicas, microbiológicas, clínicas y de evolución de los niños con bacteriemias por S. aureus (SA) provenientes de la comunidad. Material y métodos. Estudio retrospectivo, observacional y comparativo (Período I: 1993-2004 y Período II: 2004-2007). Se incluyeron niños mayores de 1 mes con bacteriemias por S. aureus provenientes de la comunidad. Resultados. Se registraron 647 bacteriemias por SA (Período I: 499 y Período II: 148), 140 (28%) y 49 (33%) fueron de la comunidad en cada período. La edad (media) fue 5,9 y 4,8 años, respectivamente (p= NS). La presencia de foco clínico de infección y shock séptico fue semejante en ambos períodos (78 contra 67%; p= NS). La celulitis prevaleció durante el segundo período (56 contra 40%) (p= NS). En el primer período se detectaron 4 niños con bacteriemias por SA de la comunidad resistentes a meticilina (3%) mientras que en el segundo período ocurrieron 23 casos (47%) (p <0,05). La resistencia a clindamicina y gentamicina fue mayor en el segundo período (10% contra 2% y 20% contra 3%, respectivamente) (p <0,05). En el período II hubo mayor duración del tratamiento antibiótico (media: 16,6 contra 10,1; p < 0,05) y mayor porcentual de tratamiento discordante (53 por ciento contra por ciento)(p <0,05). Durante el primer período fue mayor el tiempo de internación (19,2 contra 12,2 días) (p <0,05). La mortalidad fue más alta durante el primer período (14% contra 5%) (p= NS). Conclusión. Se registró un aumento significativo de niños con bacteriemias por SA de la comunidad resistentes a meticilina a partir de 2004. Estomotivó la revaloración del tratamiento empírico de estos niños con infección grave.(AU)
Background. Community-acquired methicillinresistant Staphylococcus aureus (CAMRSa) emerged in recent years. Few studies analyzed the impact of these infections in bacteremias (B). Objectives. To analyze clinical, epidemiological, microbiological and outcome of CASa B between two periods (Period I: 1993-2004, and Period II: 2004-2007).Material and methods. Retrospective, observational and comparative study. All children older than 1 month of age and CASa B were included. Results. During the study period 647 SaB werediagnosed (Period I: 499 and Period II: 148). Of them, 140 (28%) and 49 (33%) were CSa B, respectively. The median age of patients was 5.9 and4.8 years, respectively (p= NS). Clinical foci of infection and septic shock were more frequent in the period I (78% vs. 47%) and (5% vs. 16%) (p <0.05), respectively. Skin infection and septicshock were similar in both periods (78% vs. 67% and 5% vs. 8%; p=NS). Four CAMRSa B (3%) were diagnosed during the first period. One predisposing factor was identified in all cases. Inversely, 23 cases (47%) were diagnosed during the Period II (p<0.05). Resistance rates to clindamycin and gentamicin were more highduring the second period (10% vs. 2% and 20% vs. 3%, respectively) (p <0.05). Patients in the second period had longer antibiotic treatment (X16.6 vs. 10.1 days) and more frequent inappropriate treatment at admission (53% vs. 5%) (p <0.05). Hospital stay time was longer during de first period (19.2 vs. 12.2 days) (p <0.05). Themortality rate was higher in the first period (13% vs. 4%) (p=NS). Conclusion. A significant increase of CAMRSa B were detected in recent years. It is necessary to evaluate the empirical treatment of severe community infections in children in our country.(AU)
Asunto(s)
Humanos , Masculino , Adolescente , Femenino , Lactante , Preescolar , Niño , Bacteriemia/epidemiología , Bacteriemia/etiología , Bacteriemia/microbiología , Staphylococcus aureus , Resistencia a la Meticilina , Infecciones Comunitarias Adquiridas , Estudios Retrospectivos , Estudios Observacionales como AsuntoRESUMEN
Introducción. Escasos estudios han evaluado el impacto de S. aureus meticilino-resistente proveniente de la comunidad en bacteriemias. Objetivos. Analizar las características epidemiológicas, microbiológicas, clínicas y de evolución de los niños con bacteriemias por S. aureus (SA) provenientes de la comunidad. Material y métodos. Estudio retrospectivo, observacional y comparativo (Período I: 1993-2004 y Período II: 2004-2007). Se incluyeron niños mayores de 1 mes con bacteriemias por S. aureus provenientes de la comunidad. Resultados. Se registraron 647 bacteriemias por SA (Período I: 499 y Período II: 148), 140 (28%) y 49 (33%) fueron de la comunidad en cada período. La edad (media) fue 5,9 y 4,8 años, respectivamente (p= NS). La presencia de foco clínico de infección y shock séptico fue semejante en ambos períodos (78 contra 67%; p= NS). La celulitis prevaleció durante el segundo período (56 contra 40%) (p= NS). En el primer período se detectaron 4 niños con bacteriemias por SA de la comunidad resistentes a meticilina (3%) mientras que en el segundo período ocurrieron 23 casos (47%) (p <0,05). La resistencia a clindamicina y gentamicina fue mayor en el segundo período (10% contra 2% y 20% contra 3%, respectivamente) (p <0,05). En el período II hubo mayor duración del tratamiento antibiótico (media: 16,6 contra 10,1; p < 0,05) y mayor porcentual de tratamiento discordante (53 por ciento contra por ciento)(p <0,05). Durante el primer período fue mayor el tiempo de internación (19,2 contra 12,2 días) (p <0,05). La mortalidad fue más alta durante el primer período (14% contra 5%) (p= NS). Conclusión. Se registró un aumento significativo de niños con bacteriemias por SA de la comunidad resistentes a meticilina a partir de 2004. Estomotivó la revaloración del tratamiento empírico de estos niños con infección grave.
Background. Community-acquired methicillinresistant Staphylococcus aureus (CAMRSa) emerged in recent years. Few studies analyzed the impact of these infections in bacteremias (B). Objectives. To analyze clinical, epidemiological, microbiological and outcome of CASa B between two periods (Period I: 1993-2004, and Period II: 2004-2007).Material and methods. Retrospective, observational and comparative study. All children older than 1 month of age and CASa B were included. Results. During the study period 647 SaB werediagnosed (Period I: 499 and Period II: 148). Of them, 140 (28%) and 49 (33%) were CSa B, respectively. The median age of patients was 5.9 and4.8 years, respectively (p= NS). Clinical foci of infection and septic shock were more frequent in the period I (78% vs. 47%) and (5% vs. 16%) (p <0.05), respectively. Skin infection and septicshock were similar in both periods (78% vs. 67% and 5% vs. 8%; p=NS). Four CAMRSa B (3%) were diagnosed during the first period. One predisposing factor was identified in all cases. Inversely, 23 cases (47%) were diagnosed during the Period II (p<0.05). Resistance rates to clindamycin and gentamicin were more highduring the second period (10% vs. 2% and 20% vs. 3%, respectively) (p <0.05). Patients in the second period had longer antibiotic treatment (X16.6 vs. 10.1 days) and more frequent inappropriate treatment at admission (53% vs. 5%) (p <0.05). Hospital stay time was longer during de first period (19.2 vs. 12.2 days) (p <0.05). Themortality rate was higher in the first period (13% vs. 4%) (p=NS). Conclusion. A significant increase of CAMRSa B were detected in recent years. It is necessary to evaluate the empirical treatment of severe community infections in children in our country.
Asunto(s)
Humanos , Masculino , Adolescente , Femenino , Lactante , Preescolar , Niño , Bacteriemia/epidemiología , Bacteriemia/etiología , Bacteriemia/microbiología , Infecciones Comunitarias Adquiridas , Resistencia a la Meticilina , Staphylococcus aureus , Estudios Observacionales como Asunto , Estudios RetrospectivosRESUMEN
BACKGROUND: Community-acquired methicillin-resistant Staphylococcus aureus (CAMRSa) emerged in recent years. Few studies analyzed the impact of these infections in bacteremias (B). OBJECTIVES: To analyze clinical, epidemiological, microbiological and outcome of CASa B between two periods (Period I: 1993-2004, and Period II: 2004-2007). MATERIAL AND METHODS: Retrospective, observational and comparative study. All children older than 1 month of age and CASaB were included. RESULTS: During the study period 647 SaB were diagnosed (Period I: 499 and Period II: 148). Of them, 140 (28%) and 49 (33%) were CSaB, respectively. The median age of patients was 5.9 and 4.8 years, respectively (p= NS). Clinical foci of infection and septic shock were more frequent in the period I (78% vs. 47%) and (5% vs. 16%) (p <0.05), respectively. Skin infection and septic shock were similar in both periods (78% vs. 67% and 5% vs. 8%; p= NS). Four CAMRSa B (3%) were diagnosed during the first period. One predisposing factor was identified in all cases. Inversely, 23 cases (47%) were diagnosed during the Period II (p <0.05). Resistance rates to clindamycin and gentamicin were more high during the second period (10% vs. 2% and 20% vs. 3%, respectively) (p <0.05). Patients in the second period had longer antibiotic treatment (X 16.6 vs. 10.1 days) and more frequent inappropriate treatment at admission (53% vs. 5%) (p <0.05). Hospital stay time was longer during de first period (19.2 vs. 12.2 days) (p <0.05). The mortality rate was higher in the first period (13% vs. 4%) (p= NS). CONCLUSION: A significant increase of CAMRSa B were detected in recent years. It is necessary to evaluate the empirical treatment of severe community infections in children in our country.