RESUMEN
Copeptin was found to be a stable biomarker of inflammation and stress response in cardiac, renal, metabolic, and respiratory conditions such as pneumonia. The aim of this study was to investigate the copeptin levels in biological fluids (serum and sputum supernatant) of cystic fibrosis pediatric patients during pulmonary exacerbation and remission and to investigate the possible influence of copeptin levels on disease severity and quality of life. Copeptin serum concentrations were measured in 28 pediatric cystic fibrosis (CF) patients: 13 in stable condition and 15 during pulmonary exacerbation. In 10 CF patients, copeptin was also measured in the sputum. In all the patients, we assessed complete blood count, BMI, sputum culture, lung function, and chest imaging (with Brasfield score). The severity of symptoms was assessed using the Shwachman-Kulczycki (SK) score, and the quality of life was assessed with the Cystic Fibrosis Quality of Life Questionnaire-Revised (CFQ-R). Copeptin concentrations in serum and sputum supernatant was measured using an ELISA kit. Statistical analysis was done in Statistica v.12. Serum and sputum copeptin levels were higher in CF patients during pulmonary exacerbation than in a stable period, but the differences were not significant (p = 0.58 and p = 0.13, respectively). Copeptin did not correlate significantly with any clinical, laboratory, or spirometry markers of exacerbation. There was, however, a significant inverse correlation between the serum copeptin level and symptoms severity (r = -0.77, p = 0.008) and radiological changes (r = -0.5626, p = 0.036) during pulmonary exacerbation in pediatric CF patients. Copeptin also inversely correlated with the quality of life domains in CF patients: vitality and eating habits, mostly loss of appetite (p = 0.031 and p = 0.016, respectively). Copeptin may be useful to identify patients with a higher risk of deterioration to improve their outcomes.
Asunto(s)
Fibrosis Quística/sangre , Fibrosis Quística/patología , Glicopéptidos/sangre , Análisis de Varianza , Fibrosis Quística/diagnóstico por imagen , Femenino , Volumen Espiratorio Forzado/fisiología , Humanos , Masculino , Estudios Prospectivos , Pruebas de Función Respiratoria , Encuestas y CuestionariosRESUMEN
AIM: The aim of the study was to describe the epidemiology and clinical characteristic of children hospitalized with pneumonia complicated by lung abscess, as well as to evaluate the long-term sequelae of the disease. METHODS: A retrospective review of medical records of all patients treated for pulmonary abscess in two tertiary centers was undertaken. Pulmonary function tests and lung ultrasound were performed at a follow-up. RESULTS: During the study period, 5151 children with pneumonia were admitted, and 49 (0.95%) cases were complicated with lung abscess. In 38 (77.5%) patients, lung abscess was treated solely with antibiotics, and in nine cases (16.3%) surgically. In 21 (51.21%) children complete radiological regression was documented. The mean time for radiological abnormalities regression was 84.14 ± 51.57 days, regardless of the treatment mode. Fifteen patients were followed up at 61.6 ± 28.3 months after discharge. Lung ultrasound revealed minor residual abnormalities: pleural thickening, subpleural consolidations and line B artefacts in 11 (73.3%) children. Pulmonary function tests results were abnormal in eight (53.3%) patients, the most frequent abnormality being hyperinflation. We did not find a restrictive disorder in any of the children. There were no deaths in our study. CONCLUSIONS: Lung abscess is a rare but severe complication of pneumonia in children. Most children recover uneventfully with no significant long-term pulmonary sequelae.
Asunto(s)
Infecciones Comunitarias Adquiridas/complicaciones , Infecciones Comunitarias Adquiridas/epidemiología , Absceso Pulmonar/epidemiología , Absceso Pulmonar/etiología , Neumonía/complicaciones , Neumonía/epidemiología , Antibacterianos/uso terapéutico , Preescolar , Infecciones Comunitarias Adquiridas/terapia , Femenino , Humanos , Incidencia , Cuidados a Largo Plazo , Absceso Pulmonar/terapia , Masculino , Neumonía/tratamiento farmacológico , Neumonía/cirugía , Radiografía , Pruebas de Función Respiratoria , Estudios Retrospectivos , Centros de Atención Terciaria , Factores de TiempoRESUMEN
OBJECTIVE: To evaluate the incidence, clinical course and outcome of central nervous system (CNS) infections caused by multiresistant Klebsiella pneumoniae (MRKP) in critically ill neonates. METHODS: Retrospective study of neonates treated in Neonatal Department of Poznan University of Medical Science during a three years period from 1st January 1997 to 31st December 1999. Isolates were identified as Klebsiella pneumoniae with the ID32Gn test (bioMerieux), and antibiotic susceptibility was determined with ATBG test (bioMerieux) and with disc-diffusion technique. RESULTS: In this period there were 27 cases of CNS infections in our Department 17--65.4% of which (16 meningitis, one ventriculitis and one brain abscess), were caused by Klebsiella pneumoniae. 81.25% occurred in prematures (< 31 weeks of gestational age and < 1500 grams). In 10 (58.8%) cases CNSI developed in the course of sepsis. 9 children died. In all the isolates ESBL expression in vitro was detected. Only carbapenems and fluoroquinolones were active in all the cases. Ventriculitis was treated successfully with imipenem administered intraventrically and brain abscess surgically. CONCLUSIONS: CNS infections in neonates caused by MRKP are quite frequent, severe and possibly life threatening. Eradication of these strains from hospital environment by introducing adequate sanitary regime and reasonable antibiotic policies is the only method of conquering the infections.