Immunogenicity, reactogenicity and safety of the 10-valent pneumococcal nontypeable Haemophilus influenzae protein D conjugate vaccine (PHiD-CV) in Mexican infants.

The immunogenicity and safety of the 10-valent pneumococcal conjugate vaccine, PHiD-CV, have been documented in European and Asian studies. In this open study conducted in Mexico (NCT00489554), 230 healthy infants received three doses of PHiD-CV and DTPa-HBV-IPV/Hib vaccines at 2, 4 and 6 months of age and two doses of oral human rotavirus vaccine at 2 and 4 months. Serotype-specific pneumococcal responses and opsonophagocytic activity (OPA) were measured one month post-dose 3. PHiD-CV's primary vaccination course was highly immunogenic against each of the 10 pneumococcal vaccine serotypes and carrier protein D. Antibody responses against pneumococcal serotypes and protein D were generally higher in Mexican infants compared with European antibody responses, and functional OPA responses were also higher or in the same range. The most frequent solicited local symptom was pain, with high but similar incidences of grade 3 pain reported at both injection sites (up to 15% of all doses). PHiD-CV was well tolerated, with no serious adverse events considered as causally related to vaccination. Most solicited symptoms were mild and there was no increase in incidence of solicited symptoms with successive vaccine doses.

Outbreak of Candida parapsilosis in a neonatal intensive care unit: a health care workers source.

Nosocomial neonatal candidiasis is a major problem in infants, which require intensive therapy. The subjects of the present study were three preterm infants admitted to the neonatal intensive care unit of the General Hospital "Dr. Manuel Gea Gonzalez". The infants developed Candida parapsilosis infection on the mean age of 13.6 day of life. Prior to fungemia, infants had received assisted ventilation and hyperalimentation through central venous catheter. Sequence analysis of the internal transcribed spacer gene ruled out other Candida species and revealed that the eight isolates were C. parapsilosis. The isolates were examined based on their molecular relation by random amplified polymorphic DNA analysis. The profiles allowed the identification of two main genotypes of C. parapsilosis as the outbreak cause and as a result of the cross-infection with health care workers' hands. We conclude that C. parapsilosis commonly colonize through horizontal transmission due to the staff's noncompliance of hand hygiene procedures.

High heterogeneity, mixed infections and new genotypes in human congenital toxoplasmosis cases in the mega-metropolis of Central Mexico.

Mexico presents high prevalence of Toxoplasma gondii infection, including the congenital form, but there are few data about the genetic diversity of the parasite, so we attempted parasite isolation and genotyping in nine mother/children pairs with congenital toxoplasmosis (CT), living in the Valley of Mexico, who were part of a 30 cases cohort that started 12 years ago. They were recruited through research projects which included pre- and postnatal screening of congenital infections or directly CT, and cases referred to INP for management because they had clinical abnormalities. Genotyping was performed by PCR-RFLP of SAG1, SAG2, SAG3, BTUB GRA6, c22-8, c29-2, L358, PK1 and Apico markers, followed by sequencing. Sixty seven percent of samples were typed for the SAG3 locus, 39% for Apico and 33% for BTUB, while Alt. SAG2, GRA6 and c29-2 types could be labelled in less cases. Type I alleles predominated, followed by II and III. We isolated the first strain obtained from humans in Mexico and found three genotypes not previously found in the world. The presence of ToxoDB#10 clonal type was documented in one pair, as well as mixed infections in five mothers. No relation of genotype or parasite load with clinical signs was found. In conclusion, we encountered great genetic diversity and mixed T. gondii infections among mother/children pairs with congenital toxoplasmosis in the mega-metropolis of the Valley of Mexico.

E. coli outbreak in a neonate intensive care unit in a general hospital in Mexico City.

Nosocomial infections are a major cause of morbidity and mortality among neonates admitted to neonatal intensive care units (NICUs). The aim of this paper was to describe an outbreak of Escherichia coli among infants admitted to the NICU of the General Hospital "Dr. Manuel Gea Gonzalez" in May of 2008. The isolated E. coli strains were identified using standard biochemical methods. The susceptibilities of these strains were analysed by determining their minimal inhibitory concentrations. Following this, their molecular relationships to each other were assessed by pulsed field gel electrophoresis (PFGE) analysis and corroborated by serology. Twelve E. coli strains were isolated from blood, urine, or indwelling catheter samples from five cases of preterm infants within a 3-day period. Patients were admitted to the NICU of the general hospital and, during the outbreak, developed sepsis caused by E. coli. For four of the patients, the average age was 23 days, while one patient was a 3-month-old infant. Prior to sepsis, the infants had received assisted ventilation and hyperalimentation through a central venous catheter. Two profiles were observed by PFGE; profile A was identified as the outbreak's cause and an outcome of cross-infection, while profile B showed genetic differences but serologically it was identified as part of the same serotype. We conclude that E. coli colonised the patients through horizontal transmission. A focal source of the microorganism in this outbreak was not identified, but cross-transmission through handling was the most probable route.

Reducción postintervención de las bacteriemias relacionadas a líneas vasculares en Unidades de Cuidados Intensivos Pediátrica y Neonatal / Post intervention reduction of bacteremias related to vascular catheters into Neonatal and Pediatrics Intensive Care

Introducción. La bacteriemia relacionada a línea vascular (BRLV) es una de las principales complicaciones en los pacientes a quienes se les instala un catéter intravascular. Las acciones educativas han mostrado disminución en la tasa de BRLV en diferentes estudios. Objetivos: conocer la tasa de BRLV en las Unidades de Cuidados Intensivos Pediátrica y Neonatal de un hospital general, implementar las acciones preventivas y cuantificar el impacto. Métodos. Se comparó la tasa de BRLV, antes y después de una intervención educativa, en un grupo de pacientes con edades desde recién nacidos hasta 15 años. La tasa de BRLV se obtuvo dividiendo el número de éstas entre el número de días-catéter y se multiplicó por 1 000. El diagnóstico de BRLV se basó en la definición de la Norma Oficial Mexicana del año 2005 para bacteriemia relacionada a línea y terapia intravascular. Resultados. En el primer período se encontraron 25 casos de BRLV en 2 280 días-catéter con una tasa 10.9 x 1 000 días-catéter; después de las acciones educativas se presentaron 16 BRLV en 2 850 días-catéter y la tasa disminuyó a 5.6, con una P de 0.001. Conclusiones. Las acciones educativas para disminuir la tasa de BRLV fueron efectivas.

Introduction. Intravascular catheter-related infection is the major complication in patients with intravascular catheter. Intravascular catheter-related infection rate is derived by dividing the number of these infections between day-line vascular catheters and multiplied x 1 000. The rates have been reported to be as high as 11.3 x 1 000 catheter-days, increasing hospitalization days, morbidity and mortality. Educational initiatives decrease the rate of intravascular catheter-related infections according to different studies. We undertook this study to determine the rate of intravascular catheter-related infections in pediatric and neonatal intensive care units in a general hospital, as well as to establish preventive educational actions and quantify their impact. Methods. We compared the rate of intravascular catheter-related infections before and after an educational intervention. Results. During the first period, we found 25 intravascular catheter-related infections in 2 280 catheter-days with a rate of 10.9 x 1 000 catheter-days. Following the educational initiatives, we found 16 intravascular catheter-related infections in 2 850 catheter-days and the rate decreased to 5.6, which was statistically significant. Conclusions. Educational initiatives aimed at decreasing the rate of intravascular catheter-related infections were shown to be effective.

El error médico en la prescripción de medicamentos y el impacto de una intervención educativa / Impact of an educational intervention on medical prescribing errors

Introducción. El error médico se define como la falla de una acción planeada, para ser completada como se pretende, o un plan equivocado que puede generar costos extras para el hospital y el paciente. Existen diferentes tipos de error médico, uno de ellos es en la prescripción de medicamentos. Material y métodos. Se realizó un estudio comparativo en dos fases; en la primera se determinó la frecuencia y causas del error en la medicación; en la segunda se analizó la respuesta a medidas correctivas. En la primera fase se revisaron los expedientes de pacientes hospitalizados en las diferentes áreas de la Subdirección de Pediatría en un período de dos meses. Se cuantificó el porcentaje de errores en la medicación, tipo de error, fármacos, día de la semana, horario y vía de administración. Con los resultados se aplicaron acciones correctivas; posteriormente se realizó la segunda fase del estudio para determinar el porcentaje de disminución. Se utilizó estadística descriptiva, pruebas de Chi cuadrada y t de Student. Resultados. En la primera fase se revisaron 232 expedientes, 57.3% tuvieron uno o más errores, con un total de 397, que corresponde a 2.9 por expediente. En la segunda fase se analizaron 226 expedientes, detectando 17.6% con errores, 111 en total, y de 2.7 por expediente. La disminución por expediente fue en 41.7%, y en el total 71% con diferencia significativa (P < 0.05), mientras que en errores por expediente sólo disminuyó 3.5% con una P no significativa. Conclusión. Se demuestra que las actividades de supervisión y verificación en las indicaciones médicas, apegándose a protocolos de atención médica, rutas críticas y manuales de prescripción pediátrica, sí influyen en la disminución del error en la prescripción, dándose a conocer un decálogo de seguridad del paciente pediátrico.

Introduction. A medical error is the failure of a planned action to be completed as intended or the use of a wrong plan to achieve an aim; it can generate extra costs for the hospital or the patient including permanent disability or death. Objective: To determine frequency and causes of error in medication. Predicated on the results of the first objective, the second objective, was to diminish prescribing errors by 50%, after applying the educational intervention which stressed preventive measures. Material and methods. The study was carried out in 2 parts; the first part consisted of a retrospective study reviewing the records of hospitalized patients in different pediatrics services during a 2 months period. We quantified the percentage of errors in medication, type of error, drugs, day of the week, schedule, and administration way. Preventive measures were introduced and a second study was carried out in order to determine the impact of the educational intervention on the medical errors. We used descriptive statistics, chi square test and Student t. Results. In the first part of the study we reviewed 232 charts; we identified prescription errors in 57.3% of the patient records. The total number of errors was 397, or 2.9 errors per chart. In the follow up study we reviewed 226 charts and detected prescription errors in only 17.6% of the charts. A total of 111 or 1.5 per chart. The decrease total errors 71% (P < 0.05), but the decrease per chart was only a 3.5%. Conclusion. The number of prescription errors identified in this study was inordinately high. Not surprisingly, the educational intervention which stressed preventive measures had a significant impact inreducing prescription errors during the period of study, stressing the need for continuous chart review to comply with quality assurance, and ensure patient safety.

Linfadenitis histiocítica necrosante (enfermedad de Kikuchi-Fujimoto) / Histiocytic necrotizing lymphadenitis (Kikuchi -Fujimoto's disease)

Introducción. La enfermedad de Kikuchi-Fujimoto es una linfadenitis histiocítica necrosante poco frecuente, sobre todo en la edad pediátrica. Caso clínico. Niña de 9 años de edad con historia de fiebre, adenomegalias y pérdida de peso que requirió biopsia de ganglios, reportándose una linfadenitis necrosante (enfermedad de Kikuchi-Fujimoto); respondió a antiinflamatorios, pero presentó una recaída 5 años después. Conclusión. Debe sospecharse enfermedad de Kikuchi-Fujimoto en todo paciente con fiebre, adenomegalias, pérdida de peso y mal estado general, sobre todo cuando se ha descartado etiología infecciosa y un proceso oncológico. El diagnóstico definitivo es por medio de biopsia de alguno de los ganglios afectados.

Introduction. Kikuchi-Fujimoto's disease is a histiocytic necrotizing lymphadenitis, not frequent in children. Case report. Nine year-old girl with history of fever, adenomegaly and loss of weight that required a lymph node biopsy which was interpreted as necrotizing lymphadenitis (Kikuchi-Fujimoto's disease), she responded to anti inflammatory medication but presented a relapse 5 years later. Conclusion. Kikuchi-Fujimoto's disease should be suspected in the patients with fever, lymphadenitis, and weight loss after infectious and malignant etiologies have been ruled out. The definitive diagnosis is skin biopsy.