RESUMO
BACKGROUND: Pyomyositis is the infection of skeletal muscle, a rare pathology in children. Aim To describe the characteristics of pyomyositis in pediatric patients. METHODS: Prospective analytical study of hospitalized children diagnosed with pyomyositis from May 2016 to April 2017 at the Ricardo Gutiérrez Children's Hospital, Buenos Aires, Argentina. RESULTS: Twenty-one patients with pyomyositis were identified. Annual rate: 21.5/10,000 admissions (95% CI 4.65-71.43). The median age was 5.4 years (range 1.25-11.6). The lower limbs were the most affected site. C-reactive protein (CRP) was elevated in all patients, with a mean of 124 mg/L (SD 96), being significantly higher in patients with bacteremia: 206 (DS 101) vs 98 (DS 81), p = 0.02. Bacterial cultures were positive in 17/21 (80.9%): 15 methicillin-resistant Staphylococcus aureus (MRSA), and 2 Streptococcus pyogenes. Blood cultures were positive in 5 (23.8%). CONCLUSION: MRSA-community acquired is the predominant pathogen in our setting. In the selection of the appropriate empirical treatment, the local resistance pattern and the CRP value should be taken into account.
Assuntos
Bacteriemia/diagnóstico , Piomiosite/diagnóstico , Infecções Estafilocócicas/diagnóstico , Antibacterianos/uso terapêutico , Argentina , Bacteriemia/tratamento farmacológico , Bacteriemia/microbiologia , Proteína C-Reativa/análise , Criança , Pré-Escolar , Clindamicina/uso terapêutico , Drenagem , Feminino , Hospitais Pediátricos , Humanos , Lactente , Extremidade Inferior , Masculino , Staphylococcus aureus Resistente à Meticilina/isolamento & purificação , Estudos Prospectivos , Piomiosite/tratamento farmacológico , Piomiosite/microbiologia , Infecções Estafilocócicas/tratamento farmacológico , Infecções Estafilocócicas/microbiologia , Ultrassonografia , Vancomicina/uso terapêuticoRESUMO
Resumen Introducción: La piomiositis es la infección del músculo esquelético, entidad poco frecuente en pediatría. Objetivo: Describir las características de 21 niños con piomiositis. Métodos: Estudio prospectivo-analítico de niños ingresados con diagnóstico de piomiositis entre mayo de 2016 y abril de 2017 en el Hospital de Niños Ricardo Gutiérrez, Buenos Aires, Argentina. Resultados: Tasa de hospitalización de 21,5/10.000 admisiones (IC 95% 4,65- 71,43). La mediana de edad fue de 5,4 años (rango 1,25-11,6). El 90,4% presentaba algún factor predisponente. La localización más frecuente fue en miembros inferiores. La proteína C reactiva (PCR) estuvo elevada en todos los pacientes, con una media de 124 mg/L (DS 96), siendo significativamente más elevada en los pacientes que tuvieron hemocultivos positivos 206 (DS 101) vs 98 (DS 81), (p = 0,02). Se obtuvo rescate microbiológico en 17 pacientes (80,9%): Staphylococcus aureus resistente a meticilina (SARM) (n: 15) y Streptococcus pyogenes (n: 2). Se presentó con bacteriemia 23,8% de los pacientes. El 81% requirió drenaje quirúrgico. Conclusión: Staphylococcus aureus RM adquirido en la comunidad (SARMAC) es el patógeno predominante. En la selección del tratamiento empírico adecuado debería tenerse en cuenta: el patrón de resistencia local y el valor de PCR.
Background: Pyomyositis is the infection of skeletal muscle, a rare pathology in children. Aim To describe the characteristics of pyomyositis in pediatric patients. Methods: Prospective analytical study of hospitalized children diagnosed with pyomyositis from May 2016 to April 2017 at the Ricardo Gutiérrez Children's Hospital, Buenos Aires, Argentina. Results: Twenty-one patients with pyomyositis were identified. Annual rate: 21.5/10,000 admissions (95% CI 4.65-71.43). The median age was 5.4 years (range 1.25-11.6). The lower limbs were the most affected site. C-reactive protein (CRP) was elevated in all patients, with a mean of 124 mg/L (SD 96), being significantly higher in patients with bacteremia: 206 (DS 101) vs 98 (DS 81), p = 0.02. Bacterial cultures were positive in 17/21 (80.9%): 15 methicillin-resistant Staphylococcus aureus (MRSA), and 2 Streptococcus pyogenes. Blood cultures were positive in 5 (23.8%). Conclusion: MRSA-community acquired is the predominant pathogen in our setting. In the selection of the appropriate empirical treatment, the local resistance pattern and the CRP value should be taken into account.
Assuntos
Humanos , Masculino , Feminino , Lactente , Pré-Escolar , Criança , Infecções Estafilocócicas/diagnóstico , Bacteriemia/diagnóstico , Piomiosite/diagnóstico , Argentina , Infecções Estafilocócicas/microbiologia , Infecções Estafilocócicas/tratamento farmacológico , Proteína C-Reativa/análise , Clindamicina/uso terapêutico , Vancomicina/uso terapêutico , Drenagem , Estudos Prospectivos , Ultrassonografia , Bacteriemia/microbiologia , Bacteriemia/tratamento farmacológico , Extremidade Inferior , Piomiosite/microbiologia , Piomiosite/tratamento farmacológico , Staphylococcus aureus Resistente à Meticilina/isolamento & purificação , Hospitais Pediátricos , Antibacterianos/uso terapêuticoRESUMO
A multidrug resistant isolate, identified as Citrobacter amalonaticus using MALDI-TOF MS and confirmed by genomic analysis, was recovered from a pediatric patient in a hospital from Buenos Aires, Argentina. By whole-genome sequencing a total of 16 resistance genes were detected, including blaNDM-1 and mcr-1.5. To the best of our knowledge this is the first description of these two genes together in a clinical isolate of the Citrobacter genus.
Assuntos
Citrobacter/efeitos dos fármacos , Citrobacter/genética , Farmacorresistência Bacteriana Múltipla , Infecções por Enterobacteriaceae/microbiologia , beta-Lactamases/genética , Antibacterianos/farmacologia , Carbapenêmicos/farmacologia , Citrobacter/classificação , Citrobacter/isolamento & purificação , Colistina/farmacologia , Humanos , Testes de Sensibilidade Microbiana , FilogeniaRESUMO
Acinetobacter spp. are opportunistic pathogens being A. baumannii the most frequently identified in nosocomial settings. A. ursingii was mainly described as causing bacteremia and outbreaks in neonatal intensive care units. Ten A. ursingii isolates were recovered from rectal swab screening for carbapenemase-producing bacteria between June 2013 and December 2015 from a children hospital in Argentina. All ten isolates were metallo-ß-lactamase-producing, nine were positive for blaIMP-1 and one for blaNDM-1. IMP-positive isolates were also positive for blaOXA-58 gene. All isolates were susceptible to ciprofloxacin, colistin and minocycline, and nine were susceptible to ampicillin-sulbactam and gentamicin. Two A. ursingii displayed high level of resistance to aztreonam associated with blaCTX-M-15 in one isolate, and blaVEB-1 in the other. Eight SmaI-PFGE patterns were recognized. We evaluated the usefulness of Acinetobacter MLST-Pasteur scheme, to analyse A. ursingii isolates, however the rpoB gene was not amplified. A new set of primers were designed for specific amplification and sequencing, allowing the analysis of rpoB gene for this species. New alleles and the sequence types 748, 749, 750, 751, 993, 1186, 1187, and 1189 were included at the Acinetobacter MLST-Pasteur database. Those isolates showing related PFGE patterns were assigned to the same ST. To the best of our knowledge, this is the first report of MBL-producing A. ursingii in Argentina. The inclusion of A. ursingii species to the Acinetobacter MLST-Pasteur scheme allows deeper molecular characterization and a better understanding about the epidemiology of this germen.
Assuntos
Infecções por Acinetobacter/epidemiologia , Infecções por Acinetobacter/microbiologia , Acinetobacter/genética , Infecção Hospitalar , beta-Lactamases/genética , Acinetobacter/classificação , Acinetobacter/efeitos dos fármacos , Infecções por Acinetobacter/tratamento farmacológico , Antibacterianos/farmacologia , Argentina/epidemiologia , Criança , Eletroforese em Gel de Campo Pulsado , Hospitais Pediátricos , Humanos , Testes de Sensibilidade Microbiana , Tipagem de Sequências Multilocus , Filogenia , Resistência beta-LactâmicaRESUMO
La espondilodiscitis infecciosa es una infección poco frecuente en niños, con mayor incidencia en menores de 6 años. Se presenta el caso de una paciente de 8 años, que se internó por dolor lumbar de 2 meses de evolución, afebril. La radiografía, tomografía e imagen por resonancia magnética nuclear fueron compatibles con espondilodiscitis a nivel de L4-L5. Luego de 10 días de antibioticoterapia empírica con clindamicina, con regular respuesta, se realizó punción ósea y se aisló Kingella kingae. Existe un aumento en la incidencia de infecciones osteoarticulares por Kingella kingae en lactantes y niños pequeños. La reemergencia en los últimos años se justifica por la optimización en las técnicas de cultivo, el uso de sistemas automatizados y de técnicas moleculares de diagnóstico. Kingella kingae es un patógeno que ha adquirido importancia en los últimos años en las infecciones osteoarticulares.
Infectious Spondylodiscitis is a rare infection in children. It is more frequent in patients under 6 years of age. We report the case of an 8-year-old patient with lumbar pain for 2 months, without fever. Xrays, computed tomography and magnetic resonance imaging all three showed spondylodiscitis L4-L5. After a 10-day antibiotic treatment with clindamycin with regular response, a bone puncture was performed isolating Kingella kingae (Kk). Ostearticular infections caused by Kk have increased among infants and children. Due to improvement in culture techniques, the usage of automatic systems and assessment molecular techniques, these infections re-emerged in the past few years. Kk is a pathogen that has lately become significant in osteoarticular infections.
Assuntos
Humanos , Feminino , Criança , Discite/diagnóstico , Infecções por Neisseriaceae/diagnóstico , Kingella kingae/isolamento & purificação , Antibacterianos/administração & dosagem , Imageamento por Ressonância Magnética/métodos , Clindamicina/administração & dosagem , Discite/microbiologia , Discite/tratamento farmacológico , Tomografia Computadorizada por Raios X/métodos , Infecções por Neisseriaceae/microbiologia , Infecções por Neisseriaceae/tratamento farmacológicoRESUMO
Infectious Spondylodiscitis is a rare infection in children. It is more frequent in patients under 6 years of age. We report the case of an 8-year-old patient with lumbar pain for 2 months, without fever. Xrays, computed tomography and magnetic resonance imaging all three showed spondylodiscitis L4-L5. After a 10-day antibiotic treatment with clindamycin with regular response, a bone puncture was performed isolating Kingella kingae (Kk). Ostearticular infections caused by Kk have increased among infants and children. Due to improvement in culture techniques, the usage of automatic systems and assessment molecular techniques, these infections re-emerged in the past few years. Kk is a pathogen that has lately become significant in osteoarticular infections.
La espondilodiscitis infecciosa es una infección poco frecuente en niños, con mayor incidencia en menores de 6 años. Se presenta el caso de una paciente de 8 años, que se internó por dolor lumbar de 2 meses de evolución, afebril. La radiografía, tomografía e imagen por resonancia magnética nuclear fueron compatibles con espondilodiscitis a nivel de L4-L5. Luego de 10 días de antibioticoterapia empírica con clindamicina, con regular respuesta, se realizó punción ósea y se aisló Kingella kingae. Existe un aumento en la incidencia de infecciones osteoarticulares por Kingella kingae en lactantes y niños pequeños. La reemergencia en los últimos años se justifica por la optimización en las técnicas de cultivo, el uso de sistemas automatizados y de técnicas moleculares de diagnóstico. Kingella kingae es un patógeno que ha adquirido importancia en los últimos años en las infecciones osteoarticulares.