RESUMO

BACKGROUND: Nosocomial Infections (NI) are a frequent and relevant problem. The purpose of this study was to determine the epidemiology of the three most common NI in a Pediatric Intensive Care Unit from a developing country. METHODS: We performed a prospective study in a single Pediatric Intensive Care Unit during 12 months. Children were assessed for 3 NI: bloodstream infections (BSI), ventilator-associated pneumonia (VAP) and urinary tract infections (UTI), according to Center for Disease Control criteria. Use of devices (endotracheal tube [ETT], central venous catheter [CVC] and urinary catheter [UC]) was recorded. RESULTS: Four hundred fourteen patients were admitted; 81 patients (19.5%) developed 85 NIs. Density of incidence of BSI, VAP and UTI was 18.1, 7.9 and 5.1/1000 days of use of CVC, ETT and UC respectively. BSI was more common in children with CVCs than in those without CVCs (20% vs. 4.7%, p < 0.05). Candida spp. was the commonest microorganism in BSI (41%), followed by Coagulase-negative Staphylococcus (17%). Pseudomonas (52%) was the most common germ for VAP and Candida (71%) for UTI. The presence of NI was associated with increased mortality (38.2% vs. 20.4% in children without NI; p < 0.001) and the median length of ICU stay (23 vs. 6 days in children without NI; p < 0.001). Children with NI had longer average hospital stay previous to diagnosis of this condition (12.3 vs. 6 days; p < 0.001). CONCLUSIONS: One of every 5 children acquires an NI in the PICU. Its presence was associated with increased mortality and length of stay. At the same time a longer stay was associated with an increased risk of developing NI.

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RESUMO

Con el objetivo de evaluar la utilidad de los antígenos nativos de cepas autóctonas de Aspergillus fumigatus para el inmunodiagnóstico de aspergiloma, se desarrolló un estudio empleando dos cepas de ese hongo, aisladas de pacientes con diagnóstico de aspergiloma (533 y 554), los cuales fueron confrontados con sueros controles comerciales de A. fumigatus, A. flavus, A. niger, Candida, Coccidioides, Histoplasma y Paracoccidioides mediante la prueba de inmunodifusión, asimismo, se evaluaron frente a 28 sueros de pacientes con sospecha de aspergiloma. Además, se realizó la caracterización de los componentes proteicos de los antígenos nativos con la técnica de SDS-PAGE y se confrontaron con diez sueros de pacientes con aspergiloma, paracoccidioidomicosis, histoplasmosis, proteína C reactiva e hidatidosis y suero de persona sana por inmunoblot. Se encontró una buena concordancia (kappa 0,92) entre los antígenos 533 y 554, y algo menor de éstos con el antígeno comercial para A. fumigatus (kappa 0,73 y 0,81 para el 553 y 554; respectivamente). La banda de 97 kDa reaccionó sólo con sueros de pacientes con aspergiloma siendo inmunodominante.

In order to evaluate the usefulness of native antigens of autochthonous strains of Aspergillus fumigatus for immunodiagnosis of aspergilloma, We was conducted a study using two strains of this fungus, isolated from patients with aspergilloma (533 and 554), which were confronted with commercial control serum of A. fumigatus, A. flavus, A. niger, Candida, Coccidioides, Histoplasma and Paracoccidioides by immunodiffusion test, moreover, we evaluated 28 serum samplesfrom patients with suspected aspergilloma. We also performed the characterization of the protein components of native antigens using the technique of SDS-PAGE and were confronted with ten serum samples from patients with aspergilloma,paracoccidioidomycosis, histoplasmosis, C-reactive protein and hydatidosis, also healthy person serum by immunoblot.Good agreement (kappa 0.92) was found between antigens 533 and 554 and somewhat less than those with commercial antigen A. fumigatus (kappa 0.73 and 0.81 for the 533 and 554, respectively). The band of 97 kDa reacted only with sera from patients with aspergilloma being immunodominant.

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