Características clínicas y microbiológicas de infecciones de piel y partes blandas en pacientes pediátricos de dos hospitales de Buenos Aires / Skin and soft tissue infections in pediatrics

Las infecciones de piel y partes blandas (IPPB) en niños son una de las principales causas de prescripción de antimicrobianos. El objetivo del estudio fue describir las características clínicas y microbiológicas de las IPPB ambulatorias de niños asistidos en dos hospitales zonales. Se realizó un estudio prospectivo entre el 1/11/2017 y el 1/11/2018. Se incluyeron pacientes entre 1 mes y 15 años internados en dos hospitales. Se evaluó: edad, sexo, localidad, factores predisponentes, tipo de IPPB, muestras biológicas realizadas, aislamiento microbiológico, tratamiento empírico indicado y evolución del cuadro. Se realizó antibiograma y determinación genética. Se calculó chi2, IC95, OR; α=5%. N= 94. 58,7% masculinos. 12 pacientes <1 año, 85 >1 año (promedio de edad 4 años, 1-15). El 36% de Tandil y 63,8% de Florencio Varela. El 59,6% corresponden a IPPB purulentas. Se aislaron microorganismos en un 59,6%. Los aislamientos principales: SAMR (40,4%), SAMS (7,4%), S. agalactiae (2,1%) y S. pyogenes (2,1%). El 100% de SAMR son portadores de gen mecA y SCCmec tipo IV, sin multirresistencia. No hubo diferencia estadística entre los factores de riesgo evaluados para el desarrollo de IPPB por SAMR. El 52,1% de los niños recibió tratamiento antibiótico combinado, siendo la más indicada TMS-SMX + CLI en 36 eventos. (38,3%). La evolución fue favorable: no hubo diferencia significativa entre el subgrupo que se aisló SAMR y el que no se aisló SAMR; 91,9% (34/37) y 92,6% (50/54) correspondientemente (chi2: 0,01; p= 0,97 IC95: 0,26-3,88). El principal agente etiológico fue SAMRco, debiendo adecuar los tratamientos a este microorganismo.

Skin and soft tissue infections (SSIs) in children are one of the main causes of antimicrobial prescription. The aim of the study was to describe the clinical and microbiological characteristics of outpatient SSIs in children attended in two hospitals. A prospective study was conducted between 11/1/2017 and 11/1/2018. Patients between 1 month and 15 years old, hospitalized were included. We evaluated: age, sex, locality, predisposing factors, type of IPPB, biological samples taken, microbiological isolation, empirical treatment indicated and evolution of the condition. An antibiogram and genetic determination were performed. Chi2, CI95, OR; α=5% were calculated. N= 94. 58.7% male. 12 patients <1 year, 85 >1 year (mean age 4 years, 1-15). 36% were from Tandil and 63.8% from Florencio Varela. 59.6% corresponded to purulent SSIs. The diagnostic yield was 59.6%. Main isolates: MRSA (40.4%), MSSA (7.4%), S. agalactiae (2.1%) and S. pyogenes (2.1%). 100% of MRSA carried the mecA gene and SCCmec type IV, with no multidrug resistance. There was no statistical difference between the risk factors evaluated. 52.1% of children received combined antibiotic treatment, the most indicated being TMS-SMX + CLI in 36 events. (38,3%). Evolution was favorable: there was no significant difference between the subgroup that isolated MRSA and the subgroup that did not isolate MRSA; 91.9% (34/37) and 92.6% (50/54) respectively (chi2: 0.01; p= 0.97 CI95: 0.26-3.88). The main etiological agent was MRSA, and treatments should be adapted to this microorganism

ENCAPSULACIÓN DEL PÉPTIDO ANTIMICROBIANO AP7121 PARA SU ADMINISTRACIÓN POR VÍA ORAL / Encapsulation of antimicrobial peptide AP7121 for oral administration

El péptido antimicrobiano AP7121, producido por Enterococcus faecalis CECT7121, presenta actividad bactericida sobre patógenos Gram positivos. Sin embargo, su vía de administración oral está inhibida por la acidez gástrica y enzimas proteolíticas digestivas. El objetivo del presente trabajo fue analizar la eficacia de la encapsulación de AP7121 para su administración por vía oral. Para ello, se realizó la encapsulación del péptido antimicrobiano mediante la formación de gotas de alginato de sodio estéril 2,2% conteniendo AP7121 (30,0 mg/L) y circulando en dispositivo extrusor. Se evaluó la actividad inhibitoria de cápsulas obtenidas mediante la determinación de la Concentración Inhibitoria Mínima de AP7121 (CIMAP7121), con Listeria monocytogenes ATCC 19111 (LM, CIMAP7121: 0,8 mg/L). Asimismo, se investigó la estabilidad del péptido antimicrobiano frente a las enzimas proteolíticas tripsina, α-quimotripsina, proteinasa K y pronasa E (1 mg/mL) y se evaluó el efecto del pH utilizando una solución de HCl, pH=2,0. Las cápsulas obtenidas fueron uniformes y se obtuvo una concentración final de AP7121 de 29,7±0,3 mg/L con una CIMAP7121: 0,8 mg/L para LM. Frente a enzimas proteolíticas, no se observó descenso de actividad, permaneciendo inalterable en las cápsulas (CIMAP7121 de LM: 0,8 mg/L). Luego de la exposición a pH=2,0, se observó pérdida significativa de actividad a las 4 h de exposición. Los resultados obtenidos habilitarían la utilización de AP7121 en cápsulas para su administración por vía oral, dada su resistencia al pH ácido estomacal y enzimas proteolíticas, factores limitantes para su uso sin protección de su actividad.

The antimicrobial peptide AP7121, produced by Enterococcus faecalis CECT7121, presents bactericidal activity on Gram-positive pathogens. However, its administration via oral route is inhibited by gastric acidity and proteolytic digestive enzymes. The objective of this work was to analyze the effectiveness of the encapsulation of AP7121 for oral administration. In order to do this, the encapsulation of the antimicrobial peptide was performed by forming sterile 2.2% sodium alginate drops containing AP7121 (30.0 mg / L) and circulating in an extruder device. The inhibitory activity of the obtained capsules was evaluated by determining the Minimum Inhibitory Concentration of AP7121 (MICAP7121), with Listeria monocytogenes ATCC 19111 (LM, MICAP7121: 0.8 mg / L). Likewise, the stability of the antimicrobial peptide was investigated against trypsin, α-chymotrypsin, proteinase K and pronase E (1 mg / mL) proteolytic enzymes, and the effect of pH was evaluated using an HCl, pH = 2.0 solution. The capsules obtained were uniform and a final AP7121 concentration of 29.7 ± 0.3 mg / L with a MIC AP7121: 0.8 mg / L for ML was obtained. Against proteolytic enzymes, no decrease in activity was observed, remaining unchanged in the capsules (MICAP7121 of LM: 0.8 mg / L). After exposure to pH = 2.0, a significant loss of activity was observed after 4 h of exposure. The results obtained would enable the use of AP7121 in capsules for oral administration given its resistance to stomach acid pH and proteolytic enzymes, factors that limit the use without protection of its activity.

Adult bacteremic pneumococcal pneumonia acquired in the community. Aprospective study on 101 patients

Our objective was to describe incidence, clinical, radiographic and microbiological features of bacteremic pneumococcal pneumonia (BPP) in our environment. A total of 101 patients (7 were treated as outpatients), older than 18 years of age suffering BPP were prospectively evaluated. The incidence was 2.8 cases per 1000 admissions, 50 were males, mean age was 59.9 years (19-97), mortality was 11.8%. Eighty three percent of fatalities occurred within 3 days of admission. Mortality rate increased with advancing age. Fever, cough and chest pain were the commonest presenting symptoms and 44% of patients had extrapulmonary manifestations. Cigarette smoking, chronic obstructive lung disease, alcoholism and congestive heart failure (CHF) were the commonest underlying conditions. CHF was more frequent in non-survivors (p = 0.002). A lobar pattern at chest radiograph predominated in survivors and a diffuse pattern in non-survivors (p = 0.007). Pleural effusion (20.7%), empyema (7.9%) and respiratory failure (7.9%) were the main complications. Underlying diseases were present in 100% of non-survivors (p = 0.03). Ninety four percent of patients were treated with beta-lactam antibiotics. Streptococcus pneumoniae was isolated from sputum in 6 cases. Three out of 101 S. pneumoniae isolates recovered from blood samples (one from each patient) presented organisms resistant to penicillin. We observed an incidence of BPP that is similar to the observed in other countries. There are clinical and radiographic differences between survivors and non-survivors. Penicillin-resistant S. pneumoniae is still an unusual problem in our area (AU)

Adult bacteremic pneumococcal pneumonia acquired in the community. A prospective study on 101 patients.

Our objective was to describe incidence, clinical, radiographic and microbiological features of bacteremic pneumococcal pneumonia (BPP) in our environment. A total of 101 patients (7 were treated as outpatients), older than 18 years of age suffering BPP were prospectively evaluated. The incidence was 2.8 cases per 1000 admissions, 50 were males, mean age was 59.9 years (19-97), mortality was 11.8

. Eighty three percent of fatalities occurred within 3 days of admission. Mortality rate increased with advancing age. Fever, cough and chest pain were the commonest presenting symptoms and 44

of patients had extrapulmonary manifestations. Cigarette smoking, chronic obstructive lung disease, alcoholism and congestive heart failure (CHF) were the commonest underlying conditions. CHF was more frequent in non-survivors (p = 0.002). A lobar pattern at chest radiograph predominated in survivors and a diffuse pattern in non-survivors (p = 0.007). Pleural effusion (20.7

), empyema (7.9

) and respiratory failure (7.9

) were the main complications. Underlying diseases were present in 100

of non-survivors (p = 0.03). Ninety four percent of patients were treated with beta-lactam antibiotics. Streptococcus pneumoniae was isolated from sputum in 6 cases. Three out of 101 S. pneumoniae isolates recovered from blood samples (one from each patient) presented organisms resistant to penicillin. We observed an incidence of BPP that is similar to the observed in other countries. There are clinical and radiographic differences between survivors and non-survivors. Penicillin-resistant S. pneumoniae is still an unusual problem in our area.

Meningitis a enterococcus faecalis / Meningitis due to Enteroccocus faecalis

Enterococcus faecalis meningitis is an infrequent entity that accounts for less than 1 percent of all suppurative meningitis in the adult. Usually, this infection affects patients with compromised host defenses or those who have congenital or acquired CNS lesions mainly as intrahospitalary infections. An 85 year old woman from our community (Tandil county) without any predisposed condition, was admitted in the hospital in an unconscious state (grade 3 Glasgows index), meningeal signs and purulent CSF, from which E. faecalis was isolated. The patient was treated with IV Ampicillin and Gentamycin (17 days), intrathecal Gentamycin (4 days) and ]V dexametasona (6 days). The clinical and bacteriological remission was achieved, without any sequel or relapse during 2 years follow up.(AU)