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RESUMEN Objetivo: analizar la prevalencia de sepsis por catéter central en pacientes hospitalizados en la unidad de cuidados intensivos del Hospital General Delfina Torres de Concha, de Esmeraldas. Materiales y métodos: estudio con enfoque cuantitativo, corte transversal y descriptivo; la población fue de 435 pacientes ingresados en el Servicio de Terapia Intensiva; la muestra se obtuvo por muestreo no probabilístico por conveniencia, obteniendo 22 pacientes que tuvieron catéter venoso central y cumplieron con los criterios de inclusión. Resultados: la prevalencia de sepsis por catéter venoso central, en los años 2018 y 2019, en el hospital Delfina Torres de Concha, fue de 5,06 %; el sexo femenino fue el de mayor incidencia, con un 57,14 %; en el rango de edad de entre 30 y 44 años se presentaron más casos de sepsis, representando el 6,74 %; los pacientes mayores de 60 años presentaron mayor mortalidad; el 60 % de los pacientes que pertenecían a este grupo y padecieron de sepsis por catéter venoso central fallecieron. La insuficiencia aguda de miocardio fue la patología en la que se presentó el mayor número de casos con sepsis por catéter venoso central; la mortalidad fue de 60 % en los pacientes con diagnóstico de trauma craneoencefálico; el agente etiológico con mayor incidencia fue la Klebsiella pneumoniae, con 54,54 %, seguido del Escherichia coli, con 36 %. Conclusiones: la prevalencia de sepsis por catéter es baja, y cuando se presenta en pacientes menores de 60 años hay mayores posibilidades de recuperación; el personal de salud que labora en la unidad de cuidados intensivos posee un nivel de conocimiento medio en cuanto a los cuidados del catéter venoso central.

ABSTRACT Objective: to analyze central catheter sepsis in inpatients admitted of the emergency care unit of General Hospital Delfina Torres de Concha, in Esmeraldas. Materials and methods: study with a quantitative, cross-sectional and descriptive approach; the population was 435 patients admitted to the Intensive Care Service; the sample was chosen by non-probabilistic sampling for convenience, obtaining 22 patients who had a central venous catheter and complied with the inclusion criteria. Results: the prevalence of sepsis due to central venous catheter was 5.06 % in 2018 and 2019 in the hospital Delfina Torres de Concha; female sex was the one with higher incidence, with 57.14 %: age range between 30 and 44 years presented more sepsis cases, representing 6.74 %. Patients over 60 years showed the higher mortality; 60 % of the patients who belonged to this age group and suffered central venous catheter sepsis, died. Acute myocardial failure was the condition which presented the higher number of cases in association with sepsis due to central venous catheter; mortality was 60 % in patients diagnosed of crania-encephalic trauma. The etiologic agent showing higher incidence was Klebsiella pneumoniae, 54,54 %, followed by Escherichia coli, 36 %. Conclusions: the prevalence of catheter sepsis is low, and when it occurs in patient under 60 years there are greater chances of recovery; the health care staff working at intensive care unit has an average level of knowledge regarding care to patient with central venous catheter.

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RESUMEN Introducción: la endocarditis infecciosa, es una enfermedad con una diversidad de presentación clínica, de elevada morbimortalidad, a pesar de los adelantos en el diagnóstico y en la eficacia de antibióticos. Objetivos: describir las características clínicas, bacteriológicas, demográficas y mortalidad asociada de los pacientes con endocarditis infecciosa, internados en el Hospital Nacional, Itauguá-Paraguay de 2016 a 2018. Metodología: estudio observacional descriptivo de corte transverso, de pacientes con endocarditis infecciosa, según los criterios de Duke modificados. Resultados: se incluyeron 50 pacientes; edad 43 ± 16 años, 70 % fueron varones, la procedencia (38 %) del Departamento Central, ingresaron por fiebre 42 (84 %); se encontró que 44 (88 %) de los casos sobre válvulas nativas, las más afectadas la mitral 20 (46 %) seguida de la aórtica 16 (36 %) siendo en este grupo Staphylococcus aureus (36 %) el germen prevalente, además 6 (12 %) de los casos sobre válvulas protésicas, siendo en este grupo Staphylococcus spp (46 %) el germen prevalente, se encontró que eran portadores de catéter para hemodiálisis 8 (16 %) de los pacientes, 17 (39 %) con hemocultivos negativos. Presentaron complicaciones (52 %) de estas fueron cardíacas (24 %), neurológicas (18 %), embolia pulmonar (6 %), renal (4 %) se constató desenlace fatal (44 %) de los casos, siendo las de peor pronóstico las complicaciones neurológicas. Conclusiones: la endocarditis infecciosa según los hallazgos, continúa siendo una enfermedad frecuente con complicaciones graves y de elevada mortalidad, un desafío; identificación de factores de riesgo abriendo un escenario en el que sería importante trabajar y promover las medidas de prevención, insistir en el uso de fístulas arterio venosas para hemodiálisis en pacientes ambulatorios. El germen más frecuente el Staphylococcus spp.

ABSTRACT Introduction: infective endocarditisis a disease with a diversity of clinical presentation, high morbidity and mortality, a weight of advances in diagnosis and in the efficacy of antibiotics. Objectives: to describe the clinical, bacteriological, demographic and associated mortality characteristics of patients with infective endocarditis, admitted to the Hospital Nacional, Itauguá-Paraguay from 2016 to 2018. Methodology: observational, descriptive, cross-sectional study of patients with infective endocarditisis, according to modified Duke criteria Results: 50 patients were included; age 43 ± 16 years, 70 % were men, the origin (38 %) of the Departamento Central, 42 entered for fever (84 %); It was found that 44 (88 %) of the cases on native valves, the most affected were the mitral 20 (46 %) followed by the aortic 16 (36 %), with Staphylococcus aureus (36 %) being the prevalent germ in this group, in addition 6 (12 %) of the cases on prosthetic valves, being in this group Staphylococcus spp (46 %) the prevalent germ, it was found that they were catheter carriers for hemodialysis 8 (16 %) of the patients, 17 (39 %) with blood cultures negatives. They presented complications (52 %) of these were cardiac (24 %), neurological (18 %), pulmonary embolism (6 %), renal (4 %) and a fatal outcome (44 %) of the cases was found, being those with the worst prognosis neurological complications. Conclusions: infective endocarditisis, according to the findings, continues to be a frequent disease with serious complications and high deaths, a challenge; Identification of risk factors to open a scenario in which it would be important to work and promote preventive measures, insist on the use of arteriovenous fistulas for hemodialysis in outpatients. The most frequent germ Staphylococcus spp.

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Fish diseases represent a significant limiting factor in aquaculture systems. Among the many pathogens, bacteria are probably the most significant group of etiological agents. Thus, the objective of this work was to isolate and to report the incidence of streptococcosis and other possible pathogens in fish polyculture systems in the region of Lavras, state of Minas Gerais, Brazil. Fish samples were randomly collected from seven fish polyculture systems in the region, including the following municipalities: Lavras, Itutinga, Itumirim, Nepomuceno, Carrancas, São Sebastião da Vitória, and Ingaí. The specimens analyzed were: Tilapia (Oreochromis niloticus), Dourado (Salminus brasiliensis), Cará (Geophagus brasiliensis), Curimba (Prochilodus lineatus), Surubim (Pseudoplatystoma corruscans), and Piracanjuba (Brycon orbignyanus). Samples of kidney, brain, liver, spleen, and intestinal tract, and skin scraping was collected and sown in a culture medium. After the incubation period, the microorganisms were identified according to the culture, morphology, dyeing, and biochemical characteristics of the bacteria. Colonies of Streptococci, Aeromonas, and Edwardsiella were identified in Tilapia, Cara, Curimba, and Surubim fish species. The results showed the identification of the bacteria in fish polyculture systems in the region of Lavras, southern Minas Gerais. Therefore, greater sanitary control and the development of other studies to treat diseases related to these pathogens are necessary.

As doenças em peixes representam um fator limitante nos sistemas de aquicultura, e as bactérias, dentre vários patógenos, provavelmente constituam o grupo de agente etiológicos economicamente mais significante. Desta forma, o objetivou-se com este trabalho, isolar e relatar a ocorrência da estreptococose e outros prováveis patógenos em pisciculturas de policultivo da região de Lavras – MG. Foram coletadas amostras aleatórias de peixes em sete criatórios de policultivo de peixes da região, que englobam os seguintes munícipios: Lavras, Itutinga, Itumirim, Nepomuceno, Carrancas, São Sebastião da Vitória e Ingaí. Exemplares de tilápia, dourado, cará, curimba, surubim e piracanjuba foram analisados. Amostras de órgãos dos peixes foram coletadas e semeadas em meio de cultura. Após o período de incubação, a identificação dos microrganismos foi realizada de acordo com as características de cultura da bactéria, morfológicas, tintoriais e bioquímicas. Foram identificadas colônias de estreptococos, aeromonas e edwardsiella, nas espécies de tilápia, cará, curimba e surubim. Os resultados demonstraram que foram identificadas as bactérias nas pisciculturas de policultivo da região de Lavras, sul de Minas Gerais. Portanto, há uma necessidade de maior controle sanitário e o desenvolvimento de outros estudos para tratamentos de doenças relacionadas a esses patógenos.

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Fish diseases represent a significant limiting factor in aquaculture systems. Among the many pathogens, bacteria are probably the most significant group of etiological agents. Thus, the objective of this work was to isolate and to report the incidence of streptococcosis and other possible pathogens in fish polyculture systems in the region of Lavras, state of Minas Gerais, Brazil. Fish samples were randomly collected from seven fish polyculture systems in the region, including the following municipalities: Lavras, Itutinga, Itumirim, Nepomuceno, Carrancas, São Sebastião da Vitória, and Ingaí. The specimens analyzed were: Tilapia (Oreochromis niloticus), Dourado (Salminus brasiliensis), Cará (Geophagus brasiliensis), Curimba (Prochilodus lineatus), Surubim (Pseudoplatystoma corruscans), and Piracanjuba (Brycon orbignyanus). Samples of kidney, brain, liver, spleen, and intestinal tract, and skin scraping was collected and sown in a culture medium. After the incubation period, the microorganisms were identified according to the culture, morphology, dyeing, and biochemical characteristics of the bacteria. Colonies of Streptococci, Aeromonas, and Edwardsiella were identified in Tilapia, Cara, Curimba, and Surubim fish species. The results showed the identification of the bacteria in fish polyculture systems in the region of Lavras, southern Minas Gerais. Therefore, greater sanitary control and the development of other studies to treat diseases related to these pathogens are necessary.(AU)

As doenças em peixes representam um fator limitante nos sistemas de aquicultura, e as bactérias, dentre vários patógenos, provavelmente constituam o grupo de agente etiológicos economicamente mais significante. Desta forma, o objetivou-se com este trabalho, isolar e relatar a ocorrência da estreptococose e outros prováveis patógenos em pisciculturas de policultivo da região de Lavras MG. Foram coletadas amostras aleatórias de peixes em sete criatórios de policultivo de peixes da região, que englobam os seguintes munícipios: Lavras, Itutinga, Itumirim, Nepomuceno, Carrancas, São Sebastião da Vitória e Ingaí. Exemplares de tilápia, dourado, cará, curimba, surubim e piracanjuba foram analisados. Amostras de órgãos dos peixes foram coletadas e semeadas em meio de cultura. Após o período de incubação, a identificação dos microrganismos foi realizada de acordo com as características de cultura da bactéria, morfológicas, tintoriais e bioquímicas. Foram identificadas colônias de estreptococos, aeromonas e edwardsiella, nas espécies de tilápia, cará, curimba e surubim. Os resultados demonstraram que foram identificadas as bactérias nas pisciculturas de policultivo da região de Lavras, sul de Minas Gerais. Portanto, há uma necessidade de maior controle sanitário e o desenvolvimento de outros estudos para tratamentos de doenças relacionadas a esses patógenos.(AU)

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RESUMEN Fundamento: El niño quemado es por definición un paciente quirúrgico, traumatizado y extremadamente complejo por las repercusiones vitales, funcionales, estéticas y psicológicas que presenta. Objetivo: Describir el comportamiento de las quemaduras de los niños en el Servicio de Quemados del Hospital Provincial General Camilo Cienfuegos de Sancti Spíritus para el manejo adecuado en la atención de urgencias. Metodología: Se realizó un estudio descriptivo, retrospectivo de corte transversal; la población de estudio fueron los 94 menores de 18 años atendidos en el servicio. Se tuvo en cuenta la edad, el sexo, el agente causal, el lugar de ocurrencia, la extensión y profundidad de las lesiones. Resultados: La edad que predominó fue de 0-4 años con incidencia superior en los varones. La mayor parte de las lesiones se produjeron en la casa y los agentes etiológicos fueron: los líquidos calientes o hirvientes y los metales calientes; siguió en frecuencia el indicador calle con el rozamiento y los accidentes por los rayos de bicicleta. Según su profundidad predominaron las quemaduras dérmicas A y AB y la extensión menor de 5 %. Conclusiones: La edad más frecuente en que se presentaron lesiones por quemaduras en la edad pediátrica fue de 0-4 años con mayor incidencia en los varones. Las quemaduras que predominaron fueron las dérmicas A y AB. La etiología más frecuente: las escaldaduras y los metales calientes y las lesiones de segundo grado. Es importante por ello el correcto manejo de urgencia del paciente quemado pediátrico, así como tener en cuenta medidas para la prevención de las quemaduras de los niños en la comunidad.

ABSTRACT Background: The burned child is by definition a surgical patient, traumatized and extremely complex due to the vital, functional, aesthetic and psychological repercussions that he presents. Objective: To describe the behavior of the burns of children in the Burns Service at Camilo Cienfuegos General Provincial Hospital of Sancti Spíritus for the adequate management of emergency care. Methodology: A descriptive, retrospective cross-sectional study was carried out; the population studied was 94 children under 18 years assisted in the service. Age, sex, causal agent, place of occurrence, extent and depth of injuries were taken into account. Results: The predominant age was 0-4 years with a higher incidence in males. Most of the injuries occurred in the house and the etiological agents were: hot or boiling liquids and hot metals; followed by the indicator referred to frictions and accidents by bicycle spokes in the street. According to their depth, the skin burns A and AB predominated and the extension was less than 5%. Conclusions: The most frequent age in which burns injuries occurred in the pediatric age was 0-4 years with the highest incidence in males. The prevailing burns were skin burns A and AB. The most frequent etiology: scalds and hot metals and second degree injuries. Therefore, the correct emergency management of the burned pediatric patient is important, as well as taking into account some measures for the prevention of burns of children in the community.

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O presente trabalho teve como objetivo identificar os principais gêneros bacterianos causadoresde mastite, em estudo de 91 amostras de leite, recebidas pelo Laboratório de Microbiologia daClínica Escola de Medicina Veterinária do Centro Universitário Luterano de Ji-Paraná/RO. A mastiteé um processo inflamatório da glândula mamária que acomete principalmente as vacas leiteirasdevido a uma má-higienização no momento da ordenha. É dividida em subclínica e clínica, emque a subclínica não apresenta sinais visíveis e, na maioria das vezes, passa despercebida pelosprodutores rurais, ao contrário da clínica, que é detectada através de alterações visíveis, sendo aindasubdividida em duas categorias: ambiental e contagiosa. Os resultados detectaram como agentescausadores de mastite os gêneros Staphylococcus sp, com 25,27%; Streptococcus sp,,16,48%;Escherichia coli com 9,89%; Enterobacter sp com 8,79%; Proteus sp com 8,79%; Pseudomonassp com 7,69%, Corynebacterium sp com 6,59%; Klebsiella sp,com 3,29%; Citrobactersp com1,09%; , Seratia e Proteus com 1,09%, e Bacilos com 1,09%.(AU)

The present study had as objective to identify the main bacterial genera causing mastitis,in a study of 91 milk samples, received by the Microbiology Laboratory of the Clinical School of Veterinary Medicine of the Lutheran University Center of Ji-Paraná/RO. Mastitis is an inflammatoryprocess of the mammary gland, which mainly affects dairy cows due to poor hygiene at the timeof milking. It is divided into subclinical and clinical, where the subclinical shows no visible signsand most often goes unnoticed by rural producers, unlike the clinic that is detected through visiblechanges, being further subdivided into two categories: environmental and contagious. The resultsshowed that the genera Staphylococcus sp, with 25.27%; Streptococcus sp., 16.48%; Escherichiacoli with 9.89%; Enterobacter sp with 8.79%; Proteus sp with 8.79%; Pseudomonas sp with 7.69%,Corynebacterium sp with 6.59%; Klebsiella sp, with 3.29%; Citrobacter sp with 1.09%; , Seratiaand Proteus with 1.09%, and Bacillus with 1.09%.(AU)

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O presente trabalho teve como objetivo identificar os principais gêneros bacterianos causadoresde mastite, em estudo de 91 amostras de leite, recebidas pelo Laboratório de Microbiologia daClínica Escola de Medicina Veterinária do Centro Universitário Luterano de Ji-Paraná/RO. A mastiteé um processo inflamatório da glândula mamária que acomete principalmente as vacas leiteirasdevido a uma má-higienização no momento da ordenha. É dividida em subclínica e clínica, emque a subclínica não apresenta sinais visíveis e, na maioria das vezes, passa despercebida pelosprodutores rurais, ao contrário da clínica, que é detectada através de alterações visíveis, sendo aindasubdividida em duas categorias: ambiental e contagiosa. Os resultados detectaram como agentescausadores de mastite os gêneros Staphylococcus sp, com 25,27%; Streptococcus sp,,16,48%;Escherichia coli com 9,89%; Enterobacter sp com 8,79%; Proteus sp com 8,79%; Pseudomonassp com 7,69%, Corynebacterium sp com 6,59%; Klebsiella sp,com 3,29%; Citrobactersp com1,09%; , Seratia e Proteus com 1,09%, e Bacilos com 1,09%.

The present study had as objective to identify the main bacterial genera causing mastitis,in a study of 91 milk samples, received by the Microbiology Laboratory of the Clinical School of Veterinary Medicine of the Lutheran University Center of Ji-Paraná/RO. Mastitis is an inflammatoryprocess of the mammary gland, which mainly affects dairy cows due to poor hygiene at the timeof milking. It is divided into subclinical and clinical, where the subclinical shows no visible signsand most often goes unnoticed by rural producers, unlike the clinic that is detected through visiblechanges, being further subdivided into two categories: environmental and contagious. The resultsshowed that the genera Staphylococcus sp, with 25.27%; Streptococcus sp., 16.48%; Escherichiacoli with 9.89%; Enterobacter sp with 8.79%; Proteus sp with 8.79%; Pseudomonas sp with 7.69%,Corynebacterium sp with 6.59%; Klebsiella sp, with 3.29%; Citrobacter sp with 1.09%; , Seratiaand Proteus with 1.09%, and Bacillus with 1.09%.

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Objetivou-se neste artigo realizar uma revisão bibliográfica referente a importante patógeno causador de rara, porém grave infecção de origem alimentar, a Listeria monocytogenes. A Listeriose consiste em uma doença bacteriana em que o agente etiológico é transmitido por alimentos contaminados, especialmente os de origem animal. Carnes e produtos cárneos industrializados, leite e seus derivados consistem nas principais fontes de perigo para a saúde pública. O patógeno está amplamente distribuído na natureza, podendo ser isolado no solo e na água, na vegetação, no esgoto e nas fezes. Inicialmente foi considerado causador de doença nos animais domésticos e silvestres, e posteriormente relacionado também aos seres humanos. A partir da década de 1980, foi identificado e responsabilizado por surtos cuja via de transmissão foram alimentos contaminados. Afeta em quase 90% dos casos,grupos de risco específicos da população: idosos, crianças, gestantes e pessoas com deficiência no sistema imunológico. Pode causar aborto, natimortalidade, parto prematuro ou grave sepse no recém-nascido. Nos idosos e imunodeprimidos, meningite e septicemia são os principais sinais clínicos da doença. As taxas de mortalidade são elevadas, portanto medidas preventivas durante o processo produtivo nas indústrias de alimentos são fundamentais para reduzir a contaminação cruzada no ambiente, entre equipamentos, manipuladores e alimentos.(AU)

The aim of this article is to review literature concerning the major causative pathogen of rare but severe foodborne infection, Listeria monocytogenes. Listeriosis is a bacterial disease in which the etiological agent is transmitted by contaminated food, especially of animal origin. Meat and processed meat products, milk and dairy products consist of the main sources of danger to public health. The pathogen is widely distributed in nature and can be isolated in soil and water, on vegetation, sewage and faeces. Initially it was expected to cause disease in domestic and wild animals, and later also related to humans. From the 1980s, was blamed for outbreaks identified and the route of transmission were contaminated foods. Affects almost 90% of cases, specific risk groups of the population: the elderly, children, pregnant women and people with disabilities in the immune system. Can cause miscarriage, stillbirth, preterm delivery, or severe sepsis in the newborn. ln elderly and immunocompromised, meningitis and septicemia are the main clinical signs of the disease. Mortality rates are high, so preventive measures during the production process in food industries are essential to reduce cross-contamination in the environment, including equipment, and food handlers.(AU)

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Foodborne diseases outbreaks have worldwide distribution, occurring in both developing and developed countries. They affect large portion of the population. There were conducted a survey of notifications of food poisoning in the city of Porto Alegre since 2005 to 2009. Confirmed outbreaks by the agent involved were characterized according to the number of people exposed, interviewed patients and sick persons, etiologic agent identified, food involved, predisposing factors, clinical symptoms and place of occurrence. During the study period, 4,292 people were exposed to poisoning, 1,558 were interviewed and 499 were sickened. The main etiological agent was Salmonella sp. (41.2%) and much of the food incriminated corresponded to meat products (37.9%) and eggs and preparations containing this ingredient (20.7%). The predisposing factor determining in outbreaks evaluated was the possibility of cross contamination (41.4%). Symptoms that were more common were diarrhea (99.2%), abdominal distension (98.6%) and cramps (98%). It was observed that most cases of poisoning, both in the preparation and consumption occurred in residences. The results show that it is necessary to disclose the community the importance of the research work of outbreaks so they can collaborate and help promote the health of the city. It also shows the need to educate workers in the field of food, through training, and also educate the general population on hygiene practices and proper food handling. (AU)

Os surtos de Doenças Transmitidas por Alimentos (DTAs) têm distribuição mundial e acometem uma parcela muito grande da população. Tendo em vista a importância deste tema, foi realizado um levantamento de notificações de toxinfecções alimentares no município de Porto Alegre durante os anos de 2005 a 2009. Os surtos confirmados através da identificação do agente causal foram caracterizados quanto ao número de pessoas, aos alimentos envolvidos, aos fatores predisponentes, à sintomatologia clínica e aos locais de ocorrência. No período estudado, 4.292 pessoas ficaram expostas à DTAs, 1.558 foram entrevistadas e 499 ficaram doentes. O principal agente etiológico envolvido foi a Salmonella sp. (41,2%) e grande parte dos alimentos incriminados correspondeu a produtos cárneos (37,9%), e ovos e preparações contendo este ingrediente (20,7%). O fator predisponente mais frequente foi a possibilidade de contaminação cruzada (41,4%). Os sintomas que se apresentaram mais comuns foram diarreia (99,2%), distensão abdominal (98,6%) e cólica (98%). Observou-se que a maior parte dos casos de toxinfecção, tanto no preparo quanto no consumo, ocorreram em residências. Os achados demonstram a necessidade de melhor qualificar os trabalhadores na área de alimentação, por meio de treinamentos, bem como instruir também a população em geral sobre higiene e práticas adequadas de manipulação de alimentos. (AU)

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Introducción: La neumonía adquirida en la comunidad (NAC) representa una de las principales causas de morbi-mortalidad en Pediatría. Su etiología es variable. Material y métodos: Cohorte prospectiva.1/04/2012 al 31/03/2013. Criterios de inclusión: edad entre 1 mes y 15 años, internados en el Hospital de Pediatría Juan P. Garrahan, Rx de tórax y clínica compatible con NAC. Análisis estadístico: Epi info 3.2.2. Resultados: n: 305, 55,4% (n: 169) varones. Edad (mediana) 13,3 meses (rango: 1-180). Enfermedad de base 47,9% (n: 146). Se identificó agente etiológico de NAC en 50,8% (n: 155); de ellos 79,3% (n: 119) fueron virus y 31,3% (n: 47) bacterias. En 11 pacientes (7,1%), ya incluidos en las cifras anteriores, se detectó una coinfección bacteria-virus. Tuvieron bacteriemia 7,9% (n: 24). Los virus identificados más frecuentemente fueron VSR (60,5%; n: 72), ADV (18,5%; n: 22) y Parainfluenza (8,4%; n: 10). Streptococcus pneumoniae representó el 38,2% (n: 18) y Staphylococcus aureus 36.2% (n: 17) de los aislamientos bacterianos (n: 47). Requirieron UCI el 17% (n: 52) de los niños y 1,6% (n: 5) fallecieron por una causa relacionada con la infección. La duración de la internación fue 11,02 días (r: 2-104). Predominaron los menores de 2 años (68,5%; n: 209). Los mayores de 2 años tuvieron más derrame pleural (13,4% vs 39,6%; OR 0,3; IC 95% 0,2 a 0,5; p 0,001), condensación lobar (37,3% vs 49%; OR 0,76; IC 95% 0,58 a 0,99) y pulmonar (5,3% vs 12,5%; OR 0,42; IC 95% 0,14 a 0,92) que los menores. Los virus fueron más frecuentes en los menores de 2 años que en los mayores. (51,1% vs 13,5%; OR 6,5; IC 95% 3,43 a 12,48). Conclusiones: La identificación del agente etiológico es alta si se emplean métodos convencionales (cultivos) y de biología molecular. Las infecciones virales predominaron en los menores de 2 años (AU)

Introduction: Community-acquired pneumonia (CAP) is one of the main causes of morbidity and mortality in pediatrics. Its etiology is variable. Material and methods: Prospective cohort study.1/04/2012 to 31/03/2013. Inclusion criteria: Age between 1 month and 15 years, admission to the Pediatric Hospital Juan P. Garrahan, chest x-rays and clinical features compatible with CAP. Statistical analysis: Epi info 3.2.2. Results: n: 305, 55.4% (n: 169) boys. Age (median) 13.3 months (range: 1-180). Underlying disease 47.9% (n: 146). The etiological agent of CAP was identified in 50.8% (n: 155); of which 79.3% (n: 119) were viruses and 31.3% (n: 47) bacteria. In 11 patients (7.1%), included in the previous numbers, a bacteria-virus coinfection was found. Bacteremia was observed in 7.9% (n: 24). The most frequently identified viruses were SRV (60.5%; n: 72), ADV (18.5%; n: 22), and parainfluenza (8,4%; n: 10). Streptococcus pneumoniae accounted for 38.2% (n: 18) and Staphylococcus aureus for 36.2% (n: 17) of the bacterial isolates (n: 47). Of all children, 17% (n: 52) required ICU admission and 1.6% (n: 5) died because of infection-related causes. Median hospital stay was 11,02 days (r: 2-104). There was a predominance of children under 2 years of age (68.5%; n: 209). Children older than 2 years more frequently had pleural effusion (13.4% vs 39.6%; OR 0.3; 95% CI 0.2 to 0.5; p 0001), and lobular (37.3% vs 49%; OR 0.76; 95% CI 0.58 to 0.99) and pulmonary condensation (5.3% vs 12.5%; OR 0.42; 95% CI 0.14 to 0.92) than younger patients. Viruses were more frequently found in children under 2 years of age than in the older patients (51.1% vs 13.5%; OR 6.5; 95% CI 3.43 to 12.48). Conclusions: The possibility to identify the etiological agent is high when using conventional methods (cultures) and molecular biology. Viral infections predominated in children younger than 2 years of age (AU)

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RESUMO

La úlcera de córnea bacteriana o queratitis es una condición seria que puede llevar a la pérdida de la visión. La selección del tratamiento se basa en estudios microbiológicos y en el patrón de sensibilidad en un área geográfica determinada. El objetivo de este estudio fue conocer la sensibilidad y la mejor terapia empírica para el tratamiento de pacientes con queratitis bacteriana; de la Cátedra de Oftalmología del Hospital de Clínicas, y cuyas muestras fueron tomadas en el laboratorio de Microbiología del Instituto de Investigaciones en Ciencias de la Salud. Se revisaron las fichas de todos los pacientes con queratitis en cuyos cultivos se aislaron bacterias, desde julio de 2003 a diciembre de 2006. De 175 pacientes con queratitis, se encontró que 73 eran de origen bacteriano, encontrándose más de una bacteria en algunas muestras. De las 87 bacterias,; estafilococos coagulasa negativo (Scn: 27,6%) fueron predominantes, seguido de Staphylococcus aureus (Sau: 11,2%), Streptococcus pneumoniae (Spn: 10,3%), Pseudomonas aeruginosa (Pae: 12,6%) y Acinetobacter sp Ac - 8%). El 100% de los aislados de Scn y Sau, fue sensible a ciprofloxacina y a oxacilina, 89% y 100% a gentamicina, 80% y 88% a tobramicina, respectivamente. Todos los aislados de Spn fueron sensibles a eritromicina, de igual manera todos los aislados de Pae y Ac- a ciprofloxacina y tobramicina; 73% y 100% a gentamicina, respectivamente. El 93% de los pacientes recibió tratamiento empírico de colirio antibiótico reforzado (CAR) de cefazolina 50 mg/ml y gentamicina 16mg/ml; y 7% ciprofloxacina al 0,3%. En esta serie, para las úlceras de córnea debidas a estafilococos y a bacilos gramnegativos no fermentadores, la droga de elección es la ciprofloxacina, y debida a S. pneumoniae, eritromicina. En base a los datos obtenidos se concluye que la combinación de cefazolina y ciprofloxacina es un esquema terapéutico empírico que puede ser recomendado para las queratitis bacterianas.

Bacterial corneal ulcer or keratitis is a serious condition that can lead to visual loss. Treatment selection is based on microbiologic studies and in susceptibility pattern of the especific geographical area. The objective of this study was to determine the susceptibility and best empirical treatment of patients with bacterial keratitis of the Chair of Ophthalmology of the Hospital de Clinicas whose samples were collected in the Microbiology Laboratory of the Instituto de Investigaciones en Ciencias de la Salud. A retrospective review of the medical records of all culture-positive bacterial keratitis seen from July 2003 to December 2006 was performed. Out of 175 patients with keratitis 73 were found to be of bacterial ethiology. Of the 87 bacteria, coagulase-negative staphylococci (Scn: 27.6%) was predominant followed by Staphylococcus aureus (Sau: 11.2%), Streptococcus pneumoniae (Spn: 10.3%), Pseudomonas aeruginosa (Pae: 12.6%) and Acinetobacter sp (Ac- 8%). All Scn and Sau isolates showed susceptibility to ciprofloxacin and oxacillin, 89% and 100% to gentamicin and 80% and 88% to tobramycin, respectively. All Spn isolates were susceptible to eritromicin; all Pae and Ac- isolates were susceptible to ciprofloxacin and tobramycin, 73% and 100% to gentamicin, respectively. Ninety three percent of the patients received an empirical treatment with a reinforced antibiotic eyedrops of cefazolin 50 mg/ml and gentamicine 16mg/ml; and 7% with ciprofloxacine 0.3%. In this series, for the corneal ulcer due to Staphylococcus species and non-fermenting Gram-negative rods, the drug of choice is ciprofloxacin and for S. pneumoniae is eritromicin. Based in the results of this study, it can said that cefazolin and ciprofloxacin combination is an empirical therapeutic scheme that could be recommended for bacterial keratitis.

Assuntos