[Community onset of methicillin resistant Staphylococcus aureus infections in previously healthy or health care-associated children in Argentina]. / Infecciones por Staphylococcus aureus resistente a meticilina adquiridas en la comunidad en niños antes sanos y en niños relacionados al hospital en la Argentina.

INTRODUCTION: Community-acquired methicillin-resistant Staphylococcus aureus infections (CA-MRSA) are prevalent in several countries of the world. These infections seem to differ clinically from those occurring within the health care system (HCS-MRSA). OBJECTIVE: To compare clinical characteristics of infections by CA-MRSA and HCA-MRSA in the same community. MATERIAL AND METHODS: Prospective, multicentric and comparative study. Children with clinically and microbiologically documented CA-MRSA were included. RESULTS: Between 11/2006 and 11/2007, 840 infections caused by S. aureus were diagnosed. Of them 582 (68%) were community-acquired. Among these 356 (61%) were CA-MRSA. In this group, 75 (21%) were HCA-MRSA and 281 (79%) CA-MRSA. The median age was 36 months (range: 1-201). Chronic skin disease (13) and chronic disease of CNS (9) were the underlying disease predominant. Children with CA-MRSA had more frequency of previous antibiotic treatment (63 vs 34%) and previous medical consult (76 vs 52%), invasive procedures (31 vs 8%), surgery (15 vs 0.3%) and fever (94 vs 74%) (p = < 05). Children with CA-MRSA had subcutaneous abscesses (34 vs 15%) (p = < .05) more frequently. Bacteremia and sepsis rate was similar in both groups (21 vs 18%) and 17 vs 11%) respectively) (p = NS). Antibiotic resistance was more frequent in children with HCA-MRSA: Rifampin (7 vs 1%), trimethoprim-sulphametoxazole (7 vs 1%) and clindamycin (25 vs 9%) (p = < .05). Four children (5%) with HCA-MRSA infections died and 3 (1%) mCA-MRSA group (p = .05). CONCLUSION: Children with HCA-MRSA infections more frequent antibiotic resistance than CA-MRSA should be reconsider the empiric antibiotic treatment of community-acquired infections in children in our area.

Prevalencia de bacterias enteropatógenas en niños que asisten a un hospital pediátrico en Resistencia, Chaco, Argentina / Prevalence of enteropathogenic bacteria in children attending a pediatric hospital in Resistencia, Chaco, Argentina

La enfermedad diarreica aguda continúa siendo uno de los problemas de salud pública más serios en los países en desarrollo, en los que constituye una de las causas principales de enfermedad y muerte en los niños menores de 5 años. Su epidemiología es totalmente dependiente de la región geográfica, nivel socio económico, costumbres y hábitos de la población.El objetivo del presente trabajo fue determinar la prevalencia de agentes etiológicos bacterianos causantes de diarrea aguda, en niños atendidos en un Hospital Pediátrico de Resistencia, Chaco, en el año 2013.Se investigó la presencia de Shigella spp., Salmonella spp., Campylobacte rspp., Escherichia coli O157:H7 en muestras de materia fecal de niños con enfermedad diarreica aguda. Sobre 823 muestras de materia fecal analizadas en el período mencionado, 93 resultaron positivas para alguno de los enteropatógenos estudiados (Tasa de recuperación del 11,3%).Las frecuencias de aislamiento de los enteropatógenos fueron: Shigella spp (82,8%), Salmonella spp (9,7%), Campylobacter spp (6,5%), y E. coli O157:H7 (1%).Con respecto a las especies, dentro del género Shigella predominó S. flexneri (60/77) seguida de S. sonnei (13/77) y S. boydii (4/77). Con excepción de E. coli O157, en el presente trabajo no se estudiaron los diferentes tipos patogénicos.Como en el resto del país, S. flexneri continúa siendo el agente etiológico más frecuentemente aislado. Este es el primer informe sobre la presencia de Campylobacter en coprocultivos en la provincia del Chaco.

Acute diarrheal disease remains one of the most serious problems of public health in developing countries, which is one of the leading causes of illness and death in children under 5 years. Its epidemiology is totally dependent on the geographic region, socioeconomic status, customs and habits of the population.The aim of this study was to determine the prevalence of bacterial etiologic agents causing acute diarrhea in children attending a Pediatric Hospital in the city of Resistencia, Chaco, during 2013.In this work Shigella spp, Salmonella sp, Campylobacter spp, Escherichia coli O157:H7 were investigatedAmong 823 stool samples analyzed, 93 were positive for any of the enteropathogens studied (recovery rate 11.3%).The frequency of isolation of enteric pathogens were: Shigella spp (82.8%), Salmonella spp (9.7%), Campylobacter spp (6.5%), and E. coli O157: H7 (1%).Respect to genus Shigella, Shigella flexneri was the prevalent (60/77) followed by S. sonnei (13/77) and S. boydii (4/77). With the exception of E. coli O157 in the present work the other pathogenic types were not studied.As in the rest of the country, S. flexneri remains the most frequently isolated etiologic agent. This is the first report about the presence of Campylobacter in stool cultures in the province of Chaco

[Community-acquired methicillin-resistant Staphylococcus aureus infections in children: multicenter trial]. / Estudio multicéntrico sobre las infecciones pediátricas por Staphylococcus aureus meticilino-resistente provenientes de la comunidad en la Argentina.

INTRODUCTION: Methicillin-resistant Staphylococcus aureus (MRSA) isolates are increasingly frequent causes of skin and soft-tissue infections or invasive infections in many communities. Local data are scarce. OBJECTIVE: To determine the frequency, clinical features and outcome of infections caused by MRSA. MATERIAL AND METHODS: Prospective and multicentric study of surveillance for community-acquired S. aureus infections in children from Argentina. Infections meeting the definition of community-acquired were identified. Demographic and clinical data were collected. Antibiotic susceptibilities were determined in the clinical microbiology laboratory with the methodology of the NCCLS. RESULTS: From November 2006 to November 2007, 840 S. aureus infections were diagnosed, 447 of them were community-acquired. One hundred and thirty-five children with underlying disease or previous hospital admission were excluded. Two hundred and eighty one (62%) infections were community-acquired MRSA (CA-MRSA). The median age of children was 36 months (r:1-201), 60% were male. Among the CA-MRSA isolates, 62% were obtained from children with skin and soft-tissue infections, and 38% from children with invasive infections. Of them, osteomyelitis, arthritis, empyema and pneumonia were prevalent. Eigthteen percent of children had bacteremia and 11% sepsis. The rate of clindamycin resistance of CA-MRSA isolates was 10% and 1% for trimethoprim-sulfamethoxazole. Only 31% of children had appropriate treatment at admission. The median time of treatment delayed was 72 h. The median time of parenteral treatment was 6 days (r:1-70). In 72% of patients surgical treatment was required. Three children died (1%). CONCLUSIONS: CA-MRSA isolates account for a high percentage and number of infections in children of Argentina. Community surveillance of CA-MRSA infections is critical to determine the appropriate empiric antibiotic treatment for either local or invasive infections. Clindamycin resistance was under 15% in the strains tested. Clindamycin should be use when CA-MRSA infection is suspected in children.

Etiology of fungaemia and catheter colonisation in Argentinean paediatric patients.

Yeast strains obtained from blood cultures and catheters from intensive care units (ICU) and hospitalised oncology paediatrics were studied. Yeast were the first cause of catheter colonisation (51/627), and the third cause of bloodstream infection (44/6065). In catheter, the most frequent species were Candida albicans (34%), C. parapsilosis (27.7%) and C. tropicalis (15%). In blood, C. albicans (40.8%), C. parapsilosis (26.6%), C. tropicalis (15%). Malassezia furfur and Malassezia sympodialis were isolated from catheters from ICU patients. All isolates were susceptible to amphotericin B, 88.8% to itraconazole and 91.9% to fluconazole. Candida albicans and C. tropicalis strains resistant to fluconazole and itraconazol were detected. These results reveal a change in the predominant role of C. albicans as cause of candidemia in hospitalised children and the emergence of antifungal resistant species. These variations emphasise the importance of performing a permanent surveillance to observe and assess them.

Fluconazole and itraconazole resistance of yeasts isolated from the bloodstream and catheters of hospitalized pediatric patients.

BACKGROUND: In critically ill children, Candida species and other yeasts appear as an important nosocomial pathogen. The emerging fungal pathogens are usually less susceptible to azole compounds, and the management of such infections could be problematic. METHODS: 6,065 bloodstream cultures and 627 catheters from intensive care units and hospitalized oncology pediatric patients were studied. Antifungal susceptibility testing of isolates was performed according to the reference broth microdilution method describedby the National Committee for Clinical Laboratory Standards (M27-A). RESULTS: We found a low activity of fluconazole (FCZ) and itraconazole (ITZ) against Candida glabrata, C. albicans, C. tropicalis and C. haemulonii. Resistant strains to FCZ and ITZ were detected. CONCLUSION: Results reveal the emergence of antifungal-resistant species and a change in the predominant role of C. albicans as a cause of candidemia in hospitalized children.

Infecciones por Staphylococcus aureus resistente a meticilina adquiridas en la comunidad en niños antes sanos y en niños relacionados al hospital en la Argentina / Community onset of methicillin resistant Staphylococcus aureus infections in previously healthy or health care-associated children en Argentina

Introduction: Community-acquired methicillin-resistant Staphylococcus aureus infections (CA-MRSA) are prevalent in several countries of the world. These infections seem to differ clinically from those occurring within the health care system (HCS-MRSA). Objective: To compare clinical characteristics of infections by CA-MRSA and HCA-MRSA in the same communitty. Material and Methods: Prospective, multicentric and comparative study. Children with clinically and microbiologicaly documented CA-MRSA were included. Results: Between 11/2006 and 11/2007, 840 infections caused by S. aureus were diagnosed. Of them 582 (68 percent) were community-acquired. Among these 356 (61 percent) were CA-MRSA. In this group, 75 (21 percent) were HCA-MRSA and 281 (79 percent) CA-MRSA. The median age was 36months (range: 1-201). Chronic skindisease (13) and chronic disease of CNS (9) were the underlying disease predominant. Children with CA-MRSAhad more frequency of previous antibiotic treatment (63 vs 34 percent) and previous medical consult (76 vs 52 percent), invasive procedures (31 vs 8 percent), surgery (15 vs 0,3 percent) and fever (94 vs 74 percent) (p = <05). Children with CA-MRSAhad subcutaneous abscesses (34 vs 15 percent) (p = <.05) more frequently. Bacteremia and sepsis rate was similar in both groups (21 vs 18 percent) and 17 vs 11 percent) respectively) (p = NS). Antibiotic resistance was more frequent in children with HCA-MRSA: Rifampin (7 vs 1 percent), trimethoprim-sulphametoxazole (7 vs 1 percent) and clindamycin (25 vs 9 percent) (p = <.05). Four children (5 percent) with HCA-MRSA infections died and 3 (1 percent) mCA-MRSAgroup (p = .05). Conclusión: Children with HCA-MRSA infections more frequent antibiotic resistance than CA-MRSA should be reconsider the empiric antibiotic treatment of community-acquired infections in children in our área.

Introducción: Staphylococcus aureus meticilina-resistente proveniente de la comunidad (SAMRC) es altamente prevalente en diversos países del planeta. Objetivos: Realizar un análisis clínico comparativo entre las infecciones por SAMRC en niños antes sanos (SAMR-CO) y aquellos con S. aureus MR en pacientes con patologías previas (SAMR-RH). Material y Métodos: Estudio multicéntrico, prospectivo y comparativo. Fueron incluidos los niños que tenían infección clínica y microbiológicamente documentada por SAMRC. Resultados: Entre 11/2006 y 11/2007 fueron diagnosticadas 840 infecciones porS. aureus. De ellas 582 (69 por ciento) fueron detectadas en la comunidad. Entre estas 356 (61 por ciento) fueron SAMRC. Entre estas últimas 75 (21 por ciento) fueron SAMR-RH y 281 (79 por ciento) SAMR-CO. La mediana de edad fue de 36 meses (rango: 1-201). Las enfermedades de base más frecuentes fueron: dermatopatías crónicas (13) y enfermedad crónica del SNC (9). Los niños con infección por SAMR-RH presentaron con mayor frecuencia tratamiento antimicrobiano previo (63 vs 34 por ciento), consultas médicas previas (76 vs 52 por ciento), procedimiento invasor previo (31 vs 8 por cientoo), cirugía (15 vs 0,3 por ciento) y fiebre al momento de la consulta (94 vs 74 por ciento) (p < 0,05). Los niños con infección por SAMR-CO tuvieron con mayor frecuencia abscesos subcutáneos (34 vs 15 por ciento) (p < 0,05). La tasa de bacteriemia y se sepsis fue semejante en ambos grupos (21 vs 18 por ciento y 17 vs 11 por ciento)) (p =NS). La resistencia a antimicrobianos fue mayor en niños con SAMR-RH: rifampicina (7 vs l por cientoo), cotrimoxazol (7 vs 1 por ciento) y clindamicina (25 vs 9 por ciento) (p < 0,05). Fallecieron 4 niños con SAMR-RH (5 por ciento) y 3 niños con SAMR-CO (1 por ciento) (p = 0,05). Conclusión: Los niños con SAMR-RH presentan mayor tasa de resistencia a antimicrobianos que SAMR-CO. Debe replantearse el tratamiento antimicrobiano empírico en niños con ...

Estudio multicéntrico sobre las infecciones pediátricas por Staphylococcus aureus meticilino resistente provenientes de la comunidad en la Argentina / Community acquired methicillin resistant Staphylococcus aureus infections in children: multicenter trial

En los últimos años se ha informacion diversas partes del mundo la aparición deinfecciones extrahospitalarias causadas por S.aureus resistentes a la meticilina (SAMRC). Losdatos de nuestro país son muy escasos y de informesindividuales.Objetivo. Determinar la frecuencia, las característicasclínicas y la evolución final de las infeccionescausadas por SAMRC.Material y métodos. Estudio prospectivo y multicéntricode vigilancia de las infecciones extrahospitalariaspor S. aureus en niños de la Argentina. Seincluyeron niños con alguna infección clínica y microbiológicamentedocumentada por S. aureus. Lasensibilidad a los antibióticos de las cepas aisladasse investigó según normas NCCLS.Resultados. Entre 11/2006 y 11/2007 se diagnosticaron840 infecciones por S. aureus. De ellas, 582(69 por ciento) fueron comunitarias. Se excluyeron 135 niñoscon enfermedad de base o internación previa enhospitales. Para el análisis se incluyeron 447 infecciones,de las cuales 281 (62 por ciento) fueron causadas porSAMRC. La mediana de edad fue de 36 meses (r: 1-201). Un 60 por ciento fueron varones. Prevalecieron lasinfecciones de piel y partes blandas (62 por ciento). Las infeccionesosteoarticulares, el empiema pleural y laneumonía fueron las formas invasivas más frecuentes.El 18 por ciento presentó bacteriemia y el 11 por ciento sepsis. El10 por ciento de las cepas fue resistente a clindamicina y el1 por ciento a trimetoprima-sulfametoxazol. Sólo el 31 por ciento tuvoun tratamiento concordante al ingreso. La medianade retraso en el tratamiento adecuado fue de 72 h. Lamediana del tratamiento parenteral fue de 6 días (r:1-70). El 72 por ciento requirió tratamiento quirúrgico, principalmentedrenaje de colecciones purulentas (87 por ciento).Fallecieron 3 niños (1 por ciento).Conclusiones. La tasa de infecciones causadas porSAMRC es alta en niños de nuestro país. Esto constituyeun alerta epidemiológico, particularmentepara los pediatras.