RESUMO
A risk prediction model for invasive bacterial infection (IBI) was prospectively evaluated among children presenting with cancer, fever, and neutropenia. The model incorporated assessment of 5 previously identified risk factors: serum level of C-reactive protein (CRP) >/=90 mg/L, hypotension, identification of relapse of leukemia as the cancer type, platelet count of
Assuntos
Infecções Bacterianas/etiologia , Febre/etiologia , Modelos Estatísticos , Neoplasias/complicações , Neutropenia/etiologia , Adolescente , Infecções Bacterianas/epidemiologia , Criança , Pré-Escolar , Humanos , Estudos Prospectivos , Reprodutibilidade dos Testes , Fatores de RiscoRESUMO
PURPOSE: To identify clinical and laboratory parameters present at the time of a first evaluation that could help predict which children with cancer, fever, and neutropenia were at high risk or low risk for an invasive bacterial infection. PATIENTS AND METHODS: Over a 17-month period, all children with cancer, fever, and neutropenia admitted to five hospitals in Santiago, Chile, were enrolled onto a prospective protocol. Associations between admission parameters and risk for invasive bacterial infection were assessed by univariate and logistic regression analyses. RESULTS: A total of 447 febrile neutropenic episodes occurred in 257 children. Five parameters were statistically independent risk factors for an invasive bacterial infection. Ranked by order of significance, they were as follows: C-reactive protein levels of 90 mg/L or higher (relative risk [RR], 4.2; 95% confidence interval [CI], 3.6 to 4.8); presence of hypotension (RR, 2.7; 95% CI, 2.3 to 3.2); relapse of leukemia as cancer type (RR, 1.8, 95% CI, 1.7 to 2.3); platelet count less than or equal to 50,000/mm(3) (RR, 1.7; 95% CI, 1.4 to 2.2); and recent (< or = 7 days) chemotherapy (RR, 1.3; 95% CI, 1.1 to 1.6). Other previously postulated risk factors (magnitude of fever, monocyte count) were not independent risk factors in this study population. CONCLUSION: In a large population of children, common clinical and laboratory admission parameters were identified that can help predict the risk for an invasive bacterial infection. These results encourage the possibility of a more selective management strategy for these children.
Assuntos
Infecções Bacterianas/etiologia , Infecções Bacterianas/prevenção & controle , Febre/complicações , Neoplasias/complicações , Neutropenia/complicações , Síndrome de Resposta Inflamatória Sistêmica/etiologia , Síndrome de Resposta Inflamatória Sistêmica/prevenção & controle , Adolescente , Antibacterianos/uso terapêutico , Antineoplásicos/uso terapêutico , Infecções Bacterianas/epidemiologia , Proteína C-Reativa/metabolismo , Criança , Pré-Escolar , Feminino , Febre/imunologia , Febre/terapia , Humanos , Hipotensão/complicações , Lactente , Modelos Logísticos , Masculino , Neoplasias/tratamento farmacológico , Neoplasias/imunologia , Neutropenia/imunologia , Neutropenia/terapia , Estudos Prospectivos , Fatores de Risco , Síndrome de Resposta Inflamatória Sistêmica/epidemiologiaRESUMO
BACKGROUND: Pediatric patients in treatment for cancer can have fatal bacterial infections. Thus, in the presence of fever or other signs infection, antimicrobials have to be prescribed empirically. AIM: To know the causative agents of bacteremia in children with cancer, their changes with time and between different hospitals and their patterns of susceptibility. MATERIAL AND METHODS: We reviewed the blood cultores of children with cancer in five hospitals of Santiago, from 1994 at 1998. RESULTS: During the study period, 707 agents were isolated. The most frequently isolated species or genus were coagulase negative Staphylococcus (43%), Staphylococcus aureus (16%), Escherichia coli (9%), Klebsiella spp. (8%), Pseudomonas spp. (5%) and Candida spp. (4%). Coagulase negative Staphylococcus was 55% resistant to meticilin and S. aureus was 44% resistant. Enterobacteriaceae had 15% resistance to gentamicin and amikacin, 2% to imipenem, 26% to ceftriaxone, 21% to cefotaxime and 20% to ceftazidime. Among non fermenting agents resistance was 6% for imipenem, 9% for amikacin 10% for ciprofloxacin, 19% for ceftazidime and 22% for cefoperazone. The resistance of Streptococcus spp. (non pneumoniae) to penicillin reached 50% and that of Enterococcus spp. was of 33%. CONCLUSIONS: Treatment for pediatric patients with cancer must be modified and new guidelines including more active medications for patients at risk for bacteremia, should be devised.
Assuntos
Bacteriemia/microbiologia , Infecção Hospitalar/microbiologia , Neoplasias/complicações , Adolescente , Criança , Pré-Escolar , Chile , Humanos , Lactente , Testes de Sensibilidade MicrobianaRESUMO
UNLABELLED: The incidence of Chlamydia pneumoniae in community-acquired pneumonia in children was studied prospectively in 112 children aged 1 mo to 14 y. Diagnosis of C. pneumoniae was performed by polymerase chain reaction (PCR) on nasopharyngeal aspirates and serology by the microimmunofluorescence test on a single serum specimen. Three (2.7%) cases of pneumonia due to this agent were diagnosed by both PCR and serology. C. pneumoniae was not found in any of 62 children below 5 y of age. In the age group 5-8 y, only 1/30 (3%) was found positive, and in the age group 9-14 y, C. pneumoniae was diagnosed in 2/20 (10%) children. CONCLUSION: Although the number of enrolled patients is small, and the diagnostic techniques used may have some limitations, the results of this study suggest that C. pneumoniae.plays a minor role in the aetiology of pneumonia in children less than 9 y of age in our country. However, it should be considered as a potential agent in pneumonia in older children.
Assuntos
Infecções por Chlamydia/diagnóstico , Chlamydophila pneumoniae , Pneumonia Bacteriana/diagnóstico , Adolescente , Anticorpos Antibacterianos/sangue , Criança , Pré-Escolar , Chile , Infecções por Chlamydia/microbiologia , Chlamydophila pneumoniae/imunologia , Infecções Comunitárias Adquiridas/diagnóstico , Humanos , Lactente , Recém-Nascido , Pneumonia Bacteriana/microbiologia , Reação em Cadeia da Polimerase , Estudos Prospectivos , Testes SorológicosRESUMO
The aim of this study was to compare in vitro activity, measuring minimal inhibitory concentration, of amoxicillin or its combination with clavulanic acid against 109 strains of Acinetobacter baumanii, 104 strains of Hemophilus influenzae and 94 strains of Staphylococcus aureus. All these were obtained from different hospitals of the Santiago Metropolitan Region. Amoxicillin-clavulanic acid association did not improve the activity of amoxicillin against Acinetobacter. The association was not active against methicillin resistant strains of S aureus; instead, it significantly increased the activity of amoxicillin against methicillin susceptible strains. All the H influenzae strains were susceptible to the combination.