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BACKGROUND: Fever in infants younger than 90 days may reflect a serious bacterial infection, so blood cultures (BC) are taken routinely and the patient is hospitalized. The observation time to detect occult bacteremia is not well established. AIM: To describe type and positivity time of isolated bacteria in blood cultures in infants under 90 days admitted for fever. METHODS: Retrospective, descriptive study. Positive blood cultures taken between 2014-2016 in young infants admitted for fever were included. Identification and time of positivity of each bacteria, clinical, laboratory and demographic data were recorded. Demographic variables and the clinical outcome was obtained. RESULTS: There were 172 positive blood cultures, only 51 met inclusion criteria. Of these, 21 microorganisms were pathogenic (Escherichia coli: 10, Streptococcus agalactiae: 3, Streptococcus pyogenes: 3, others: 5) and 30 were considered contamination, mainly coagulase negative Staphylococcus. In relation to the total sample, the median time of positivity was 10 hrs. At 24 hours of culture, bacterial growth was detected in 94% of the sample. CONCLUSION: The pathogenic bacteria isolated in the blood cultures of patients younger than 90 days who were admitted with fever correspond mainly to Gram negative bacilli and streptococci. All isolated pathogens were detected before 24 h of incubation.

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INTRODUCCIÓN: En neonatos y lactantes bajo 90 días de vida la fiebre constituye un signo clínico relevante ya que puede corresponder a una infección bacteriana grave, por lo que se toman hemocultivos de forma rutinaria y el paciente es hospitalizado. Aún no existe una recomendación respecto al tiempo de observación necesario una vez internado el paciente. OBJETIVO: Describir las bacterias aisladas en hemocultivos de lactantes bajo 90 días de vida hospitalizados por fiebre y el tiempo de detección de crecimiento microbiano en los mismos. ¨MÉTODO: Estudio descriptivo, retrospectivo. Se revisaron hemocultivos positivos tomados entre 2014 y 2016 en neonatos y lactantes < 90 días de edad. Se obtuvieron las identificaciones, tiempo de positividad de las bacterias, así como datos clínicos, de laboratorio y demográficos. RESULTADOS: Se identificaron 172 hemocultivos positivos, 51 cumplían los criterios de inclusión. De éstos, 21 microorganismos fueron patógenos (Escherichia coli: 10, Streptococcus agalactiae: 3, Streptococcus pyogenes: 3, otros: 5) y 30 se consideraron contaminación, principalmente Staphylococcus coagulasa negativa. En relación al total de la muestra, la mediana del tiempo de positividad fue de 10 h. A las 24 h de cultivo se detectó crecimiento bacteriano en 94% de la muestra. CONCLUSIÓN: Las bacterias patógenas aisladas en los hemocultivos de pacientes < 90 días de edad, que ingresaron con fiebre, corresponden principalmente a bacilos gramnegativos y estreptococos. Todos los patógenos aislados fueron detectados antes de 24 h de incubación.

BACKGROUND: Fever in infants younger than 90 days may reflect a serious bacterial infection, so blood cultures (BC) are taken routinely and the patient is hospitalized. The observation time to detect occult bacteremia is not well established. AIM: To describe type and positivity time of isolated bacteria in blood cultures in infants under 90 days admitted for fever. METHODS: Retrospective, descriptive study. Positive blood cultures taken between 2014-2016 in young infants admitted for fever were included. Identification and time of positivity of each bacteria, clinical, laboratory and demographic data were recorded. Demographic variables and the clinical outcome was obtained. RESULTS: There were 172 positive blood cultures, only 51 met inclusion criteria. Of these, 21 microorganisms were pathogenic (Escherichia coli: 10, Streptococcus agalactiae: 3, Streptococcus pyogenes: 3, others: 5) and 30 were considered contamination, mainly coagulase negative Staphylococcus. In relation to the total sample, the median time of positivity was 10 hrs. At 24 hours of culture, bacterial growth was detected in 94% of the sample. CONCLUSION: The pathogenic bacteria isolated in the blood cultures of patients younger than 90 days who were admitted with fever correspond mainly to Gram negative bacilli and streptococci. All isolated pathogens were detected before 24 h of incubation.

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INTRODUCTION: Drug interactions are undesirable events observed in clinical practice. In patients with HIV infection on antiretroviral therapy (ART), it is particularly important to bear in mind that many drugs com monly used in pediatrics can cause such interactions. OBJECTIVE: to report a case of drug interaction between an antiretroviral drug (lopinavir/ritonavir) and inhaled corticosteroid in a child with HIV infection, and to review more frequent drug interactions in children on ART. CLINICAL CASE: 5-year- old male with history of stage N1 vertical transmitted HIV infection (1994 CDC classification), on ART from 8 months of age with zidovudine, lamivudine, and lopinavir/ritonavir, with successful virological and immunological outcome. Due to symptoms of allergic rhinitis (congestion, itchy nose, and nocturnal snoring) treatment with intranasal fluticasone was started. After 1 month of treatment, he developed cushingoid facies, weight gain, mixed dyslipidemia, insulin resistance, morning basal cortisol levels < 1 µg/dL, and Adrenocorticotropic hormone (ACTH) < 2 pg/ml, presenting ACTH stimulation test compatible with central adrenal insufficiency, attributed to a drug interaction with lopinavir/ritonavir due to known interaction. He started hydrocortisone replacement treatment, recovering hypothalamic-pituitary-adrenal axis function after 18 months. CONCLUSION: Knowledge of this and other drug interactions between ART and drugs commonly used in pediatrics is essential for the comprehensive management of patients with HIV infection, especially in the prevention of unwanted adverse effects.

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Resumen Introducción: Las infecciones osteoarticulares (IOA) son consideradas una urgencia infectológica en niños. Los principales microorganismos causales son Staphylococcus aureus y Streptococcus pyogenes. Objetivo: Describir las características bio-demográficas y clínicas de pacientes de 2 meses a 15 años hospitalizados entre 2012 y 2017 con diagnóstico de IOA. Pacientes y Métodos: Estudio retrospectivo en un hospital pediátrico. Se revisaron fichas clínicas de pacientes internados con diagnóstico de IOA. Resultados: Se incluyó a 146 pacientes. Un 60,3% fueron de sexo masculino, mediana de edad 3 años 11 meses. El síntoma más frecuente al ingreso fue dolor articular (90%) y la mediana de PCR fue de 43 mg/L. Se obtuvo identificación microbiológica en 48%; de ellos, 67,8 % S. aureus (10,2% resistentes a meticilina). El 94,5% de los pacientes recibió de forma empírica β-lactámico anti-estafilocócico. Un 70,5% de los niños requirió procedimiento quirúrgico. A las 72 h se observó respuesta clínica y a los 4,7 días descenso de parámetros inflamatorios de laboratorio. El 88% de los pacientes cursó sin complicaciones. Conclusiones: Las IOA son más frecuentes en varones, el agente infeccioso más frecuentemente identificado fue S. aureus, por lo cual se sugiere inicio del esquema antimicrobiano con un β-lactámico anti-estafilocócico, ampliando cobertura en pacientes bajo 5 años de edad. A los 5 días del tratamiento antimicrobiano ya hay respuesta clínica y descenso de parámetros inflamatorios.

Abstract Background: Osteoarticular infections (IOA) are considered infectious emergencies. The main microorganisms isolated are Staphylococcus aureus and Streptococcus pyogenes. Aim: To describe demographic and clinical characteristics of patients from 2 months to 15 years old, hospitalized between the years 2012 and 2017 with IOA diagnosis. Methods: Retrospective study in a pediatric hospital. Clinical records of hospitalized patients with IOA were reviewed. Results: 146 met inclusion criteria. 60.3% of the patients were male, median age 3 years 11 months. The main symptom at admission was joint pain (90%) and the median CRP was 43 mg/L. 48% of the patients had microbiological identification; 67.8% were positive for Staphylococcus aureus (10.2% SAMR). 94.5% of the sample received empirical antistaphylococcal beta-lactam treatment and 70,5% had a surgical intervention. Clinical response was observed 72 hours of beginning of treatment, and a decreased in inflammatory laboratory markers was observed at 4.7 days. 88% of patients attended without complications. Conclusions: IOA infections are more common in boys, S. aureus is the main isolated pathogen, so we suggest to initiate the antimicrobial scheme with an antistaphylococcal beta-lactam, adding broad spectrum antimicrobial in children under 5 years. After 5 days of treatment, clinical resolution and decreased inflammatory laboratory parameters were observed.

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INTRODUCTION: In 20% of children with febrile syndrome, it appears as fever of unknown origin (FUO) syndrome. Management strategies in this group have high sensitivity but low specificity. OBJECTIVES: To cha racterize serious bacterial infections (SBI) in children younger than three months old hospitalized because of FUO syndrome and to evaluate the utility of clinical and laboratory parameters in the identification of patients that are at high risk of SBI. PATIENTS AND METHOD: Prospective study in patients aged < 3 months hospitalized due to FUO syndrome between January 2014 and November 2015 in two pediatric hospitals in the Metropolitan Region. INCLUSION CRITERIA: age 4 days - 3 months, fever > 38°C longer than 72 hours after onset without demonstrable cause. EXCLUSION CRITERIA: anti microbial use up to 7 days before admission, preterm infants < 34 weeks, birth weight < 2 kg, and im munocompromised. Demographic, clinical, and laboratory tests data were recorded as well as blood count and CRP, discharge diagnosis, and ruled out, probable or confirmed SBI. RESULTS: 32% of the patients were discharged with diagnosis of SBI, 28% with diagnosis of viral or probably viral infec tion, 34% with diagnosis of not specified FUO syndrome, and 6% due to other causes. There were no significant differences in the CRP value, altered WBCs count, toxic aspect, or hours of fever at the admission when comparing groups with and without SBI (p < 0.05). The combination of clinical and laboratory parameters showed 27% of sensitivity, 90% of specificity, 60% of PPV, and 71% of NPV. CONCLUSION: It was not possible to establish clinical and laboratory parameters that allow the identifi cation of children younger than 3 months old at high risk of SBI, however, they maintain their value as low risk indicators. It is necessary further investigation of other clinical and laboratory elements that allow discriminating SBI from viral infections.

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Resumen: Introducción: Un 20% de los niños con síndrome febril se presenta como síndrome febril sin foco (SFSF). Las es trategias de manejo en este grupo presentan alta sensibilidad, pero baja especificidad. Objetivos: Ca racterizar las infecciones bacterianas serias (IBS) en menores de 3 meses hospitalizados por SFSF, y evaluar utilidad de parámetros clínicos y de laboratorio en la identificación de pacientes con alto riesgo de IBS. Pacientes y Método: Estudio prospectivo en pacientes < 3 meses hospitalizados entre enero 2014 y noviembre 2015 por SFSF en dos hospitales pediátricos de la Región Metropolitana. Criterios de inclusión: edad 4 días - 3 meses, fiebre > 38°C de < 72 h de evolución sin causa demostra ble. Criterios de exclusión: uso de antimicrobianos hasta 7 días previo a su ingreso, prematuros < 34 semanas, peso de nacimiento < 2 kg e inmunocomprometidos. Se registraron datos demográficos, clínicos, y exámenes de laboratorio, hemograma y PCR, diagnóstico de egreso, IBS descartada, IBS probable o confirmada. Resultados: 32% de los pacientes egresó con diagnóstico de IBS, 28% con diagnóstico de infección viral o probablemente viral, 34% con diagnóstico de SFSF no especificado y 6% SFSF por otras causas. No se encontraron diferencias significativas en PCR, leucocitosis, aspecto tóxico ni horas de fiebre al ingreso al comparar los grupos con y sin IBS (p > 0,05). La combinación de parámetros clínicos y de laboratorio mostro sensibilidad de 27%, especificidad de 90%, VPP 60% y VPN 71%. Conclusión: No fue posible establecer que parámetros clínicos y de laboratorio permitan identificar menores de 3 meses con alto riesgo de IBS, manteniendo su utilidad como indicadores de bajo riesgo. Es necesario contar con otros elementos clínicos y de laboratorio que permitan discrimi nar IBS de infecciones virales.

Abstract: Introduction: In 20% of children with febrile syndrome, it appears as fever of unknown origin (FUO) syndrome. Management strategies in this group have high sensitivity but low specificity. Objectives: To cha racterize serious bacterial infections (SBI) in children younger than three months old hospitalized because of FUO syndrome and to evaluate the utility of clinical and laboratory parameters in the identification of patients that are at high risk of SBI. Patients and Method: Prospective study in patients aged < 3 months hospitalized due to FUO syndrome between January 2014 and November 2015 in two pediatric hospitals in the Metropolitan Region. Inclusion criteria: age 4 days - 3 months, fever > 38°C longer than 72 hours after onset without demonstrable cause. Exclusion criteria: anti microbial use up to 7 days before admission, preterm infants < 34 weeks, birth weight < 2 kg, and im munocompromised. Demographic, clinical, and laboratory tests data were recorded as well as blood count and CRP, discharge diagnosis, and ruled out, probable or confirmed SBI. Results: 32% of the patients were discharged with diagnosis of SBI, 28% with diagnosis of viral or probably viral infec tion, 34% with diagnosis of not specified FUO syndrome, and 6% due to other causes. There were no significant differences in the CRP value, altered WBCs count, toxic aspect, or hours of fever at the admission when comparing groups with and without SBI (p < 0.05). The combination of clinical and laboratory parameters showed 27% of sensitivity, 90% of specificity, 60% of PPV, and 71% of NPV. Conclusion: It was not possible to establish clinical and laboratory parameters that allow the identifi cation of children younger than 3 months old at high risk of SBI, however, they maintain their value as low risk indicators. It is necessary further investigation of other clinical and laboratory elements that allow discriminating SBI from viral infections.

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BACKGROUND: Osteoarticular infections (IOA) are considered infectious emergencies. The main microorganisms isolated are Staphylococcus aureus and Streptococcus pyogenes. AIM: To describe demographic and clinical characteristics of patients from 2 months to 15 years old, hospitalized between the years 2012 and 2017 with IOA diagnosis. METHODS: Retrospective study in a pediatric hospital. Clinical records of hospitalized patients with IOA were reviewed. RESULTS: 146 met inclusion criteria. 60.3% of the patients were male, median age 3 years 11 months. The main symptom at admission was joint pain (90%) and the median CRP was 43 mg/L. 48% of the patients had microbiological identification; 67.8% were positive for Staphylococcus aureus (10.2% SAMR). 94.5% of the sample received empirical antistaphylococcal beta-lactam treatment and 70,5% had a surgical intervention. Clinical response was observed 72 hours of beginning of treatment, and a decreased in inflammatory laboratory markers was observed at 4.7 days. 88% of patients attended without complications. CONCLUSIONS: IOA infections are more common in boys, S. aureus is the main isolated pathogen, so we suggest to initiate the antimicrobial scheme with an antistaphylococcal beta-lactam, adding broad spectrum antimicrobial in children under 5 years. After 5 days of treatment, clinical resolution and decreased inflammatory laboratory parameters were observed.

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UNLABELLED: Outpatient parenteral antimicrobial therapy (OPAT) was first introduced in 1973 as an alternative treatment. Since then, there have been numerous international case based studies including both children and adults with significant bacterial infections using this strategy. The protocol requires a careful screening and evaluation process of the patient. There must be no other motive for hospitalization other than the need for parenteral antibiotics. OBJECTIVE: To describe the results of OPAT during a period of 26 months in emergency department of a Chilean pediatric public hospital. RESULTS: During the study period 228,144 patients received medical care in the Emergency Department (ED) and 380 patients were admitted to the OPAT program after clinical evaluation and based on the socioeconomic and cultural conditions of their parents. The major indications of OPAT were skin and soft tissues infections (50%) and pneumonia (28%) respectively. (beta-lactamic antibiotics the were most commonly prescribed. Thirty eight patients (10%) required hospitalization, mostly because of clinical deterioration. There were no deaths. CONCLUSION: In our public hospital OPAT for treatment of significant bacterial infections constitutes an efficient and safe alternative to hospitalization allowing the child to remain in his home.

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Outpatient parenteral antimicrobial therapy (OPAT) was first introduced in 1973 as an alternative treatment. Since then, there have been numerous international case based studies including both children and adults with significant bacterial infections using this strategy. The protocol requires a careful screening and evaluation process of the patient. There must be no other motive for hospitalization other than the need for parenteral antibiotics. Objective: To describe the results of OPAT during a period of 26 months in emergency department of a Chilean pediatric public hospital. Results: During the study period 228,144 patients received medical care in the Emergency Department (ED) and 380 patients were admitted to the OPAT program after clinical evaluation and based on the socioeconomic and cultural conditions of their parents. The major indications of OPAT were skin and soft tissues infections (50 percent) and pneumonia (28 percent) respectively. (ß-lactamic antibiotics the were most commonly prescribed. Thirty eight patients (10 percent) required hospitalization, mostly because of clinical deterioration. There were no deaths. Conclusión: In our public hospital OPAT for treatment of significant bacterial infections constitutes an efficient and safe alternative to hospitalization allowing the child to remain in his home.

La terapia antimicrobiana endovenosa ambulatoria (TAEA) surgió como una alternativa de tratamiento en 1973, publicándose numerosas experiencias internacionales en niños y adultos para diversas infecciones bacterianas de importancia mayor. Requiere seleccionar a cada paciente considerando que no hay otro motivo de hospitalización, salvo la administración del fármaco. Objetivo: Sistematizar la experiencia de TAEA efectuada durante 26 meses en el servicio de urgencia (SU) de un hospital pediátrico público de Chile. Resultados: De un total de 228.144 pacientes consultantes al SU en el período elegido, un total de 380 pacientes ingresaron al programa de TAEA luego de una evaluación clínica y de las condiciones socioeconómicas y culturales de sus apoderados. La principal indicación de TAEA fueron las infecciones de piel y tejidos blandos (50 por ciento), seguida de neumonía (28 por ciento), utilizándose en su mayoría ß-lactámicos solos o asociados. Diez por ciento de los pacientes requirió hospitalización, en su mayoría por deterioro de su condición clínica. Ninguno falleció. Conclusión: En nuestro medio, la TAEA es una alternativa eficiente y segura a la hospitalización, que permite tratar pacientes pediátricos con infecciones bacterianas mayores en su entorno familiar.

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Background: Nearly 10% of emergency consultations are due to acute abdominal pain. In people over 65 years old, it can have atypical presentations, that retard the correct diagnosis and worsens prognosis. Aim: To study the causes, evolution and prognosis of acute abdomen in the elderly. Material and methods: Prospective study of 45 patients aged more than 65 years old (mean age ± SD, 75.7±7.7, 51% men) and 221 patients of less than 65 years old (mean age ± SD, 36.7±14.0, 48% men), consulting for acute abdomen in the emergency room. Results: Sixty six percent of elderly patients had concomitant diseases, that were multiple in 63%. In this age group, the causes accounting for 71% of acute abdominal pain were bilio-pancreatic diseases (31.1%), intestinal adhesive obstruction (17.7%), complicated abdominal wall hernia (13.7%), and complications of peptic ulcer disease (8.9%). Sixty four percent required surgical treatment and, in almost 50% the surgical risk was classified in ASA III or IV, according to the American Society of Anesthesiology. Thirty one percent had postoperative complications. Compared with their younger counterparts, elderly patients required significantly (p<0.05) more admissions to intensive care units (2.7 and 24.2% respectively), more connections to mechanical ventilation (1.4 and 8.9% respectively) and longer hospital stays (5.4±7.4 and 12.4±10.9 days, respectively). In this series overall mortality was 6.7%, being 0.6% for young patients and 11.1% for the surgical group over 65 years old. Conclusions: Acute abdomen in the elderly has a high rate of complications and mortality. According to the causes of acute abdomen in this group, evaluation in the emergency setting with an ultrasonography may be very useful. In the elderly, elective correction of potential causes of acute abdomen should be done.

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La disquinesia ciliar primaria (DCP) es una enfermedad subdiagnosticada que suele tener manifestaciones importantes en Otorrinolaringología. Se analizan 14 pacientes en quienes el diagnóstico de DCP se basó en la persistencia de infecciones crónicas, ya sea a nivel nasosinusal u ótico. Las patologías más frecuentemente involucradas fueron la rinosinusitis crónica y la otitis media con efusión. El diagnóstico se hizo con microscopía electrónica de transmisión de mucosa bronquial. La alteración ciliar encontrada más reiteradamente fue la ausencia del brazo interno de dineína. En 6 pacientes se debió realizar cirugía endoscópica funcional de cavidades perinasales debido a una rinosinusitis crónica y, en 8, se debió colocar tubos de ventilación, por la otitis media con efusión persistente.

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