Predictive Analysis of Healthcare Resource Utilization after Elective Spine Surgery.

Introduction: The management of degenerative spine pathology continues to be a significant source of costs to the US healthcare system. Besides surgery, utilization of healthcare resources after spine surgery drives costs. The responsibility of managing costs is gradually shifting to patients and providers. Patient-centered predictors of healthcare utilization after elective spine surgery may identify targets for cost reduction and value creation. Therefore, our study aims to quantify patterns of healthcare utilization and identify risk factors that predict high healthcare utilization after elective spine surgery. Methods: A total of 623 patients who underwent elective spine surgery at a tertiary academic medical center by one of three fellowship-trained orthopedic spine surgeons between 2013 and 2018 were identified in this retrospective cohort study. Healthcare utilization was quantified including advanced spine imaging, emergency and urgent care visits, hospital readmission, reoperation, PT/OT referrals, opioid prescriptions, epidural steroid injections, and pain management referrals. Patient variables, namely, the Charlson comorbidity index (CCI) and the American Society of Anesthesiologists (ASA) classification system, were assessed as potential predictors for healthcare utilization. Results: Among all patients, a wide range of health utilization was identified. Age, body mass index, Charlson Comorbidity Index, and American Society of Anesthesiology class were identified as positive predictors of postoperative healthcare utilization including emergency department visits, spine imaging studies, opioid and nerve blocker prescriptions, inpatient rehabilitation, any referrals, and pain management referrals. Conclusions: Markers of patient health-such as CCI and ASA class-may be used to predict healthcare utilization following elective spine surgery. Identifying at-risk patients and addressing these challenges prior to surgery is an important step to deliver efficient postoperative care. Level of Evidence: 3.

Factores asociados a muerte en niños con COVID-19 en México / Mortality risk factors in Mexican children with COVID-19

Resumen Introducción: Se informa que la mayoría de los niños afectados por SARS-CoV-2 cursan asintomáticos y que en ellos la mortalidad por COVID-19 es baja; en México se desconoce la información al respecto en este grupo de la población. Objetivo: Evaluar los factores de riesgo asociados a mortalidad en niños mexicanos con COVID-19. Método: Análisis secundario de la base de datos de la Dirección General de Epidemiología. Se incluyeron niños menores de 19 años, en quienes se confirmó SARS-CoV-2 mediante RT-PCR. Resultados: Se incluyeron 1443 niños. La mediana de edad fue de ocho años; 3.3 % ingresó a la unidad de cuidados intensivos, 1.8 % requirió ventilación mecánica asistida y la mortalidad fue de 1.9 %. En los modelos multivariados, el desarrollo de neumonía constituyó el principal factor de riesgo de mortalidad, con razón de momios (RM) de 6.45 (IC 95 % 1.99, 20.89); los pacientes que requirieron intubación tuvieron RM de 8.75 (IC 95 % 3.23, 23.7). Conclusiones: Los niños con COVID 19 tienen alta mortalidad en México, por lo que en ellos se debe procurar evitar la neumonía, especialmente en los menores de cuatro años, con riesgo cardiovascular o inmunosupresión.

Abstract Introduction: Most children affected by SARS-CoV-2 are reported to be asymptomatic, and COVID-19-related mortality in them is low; in Mexico, there is a lack of information on the subject in this population group. Objective: To assess the risk factors associated with mortality in Mexican children with COVID-19. Method: Secondary analysis of the General Directorate of Epidemiology database. Children younger than 19 years, in whom SARS-CoV-2 infection was confirmed by RT-PCR, were included. Results: 1443 children were included. Median age was eight years; 3.3 % were admitted to the intensive care unit, 1.8 % required assisted mechanical ventilation, and mortality was 1.9 %. In multivariate models, the development of pneumonia was the main risk factor for mortality, with an odds ratio (OR) of 6.45 (95 % CI 1.99, 20.89); patients who required intubation had an OR of 8.75 (95 % CI 3.23, 23.7). Conclusions: Children with COVID-19 exhibit high mortality in Mexico, and avoiding pneumonia should therefore be tried in them, especially in children younger than four years with cardiovascular risk or immunosuppression.

Public health and economic impact of switching from a trivalent to a quadrivalent inactivated influenza vaccine in Mexico.

Most influenza vaccines in Mexico are trivalent, containing two influenza A strains and a single B strain. Quadrivalent influenza vaccines (QIVs) extend protection by including an additional B strain to cover both co-circulating B lineages. Here, we retrospectively estimated how a switch to QIV in Mexico would have impacted influenza-related health outcomes over the 2010/2011 to 2015/2016 influenza seasons, and prospectively estimated the budget impact of using QIV in Mexico's national immunization program from 2016/2017 to 2020/2021. For the retrospective estimation, we used an age-stratified static model incorporating Mexico-specific input parameters. For the prospective estimation, we used a budget impact model based on retrospective attack rates considering predicted future vaccination coverage. Between 2010/2011 and 2015/2016, a switch to QIV would have prevented 270,596 additional influenza cases, 102,000 general practitioner consultations, 140,062 days of absenteeism, 3,323 hospitalizations, and 312 deaths, saving Mex$214 million (US$10.8 million) in third-party payer costs. In the prospective analysis, a switch to QIV was estimated to prevent an additional 225,497 influenza cases, 85,000 general practitioner consultations, 116,718 days of absenteeism, 2,769 hospitalizations, and 260 deaths, saving Mex$178 million (US$9 million) in third-party payer costs over 5 years. Compared to the trivalent vaccine, the benefit and costs saved with QIV were sensitive to the distribution of influenza A vs. B cases and trivalent vaccine effectiveness against the mismatched B strain. These results suggest switching to QIV in Mexico would benefit healthcare providers and society by preventing influenza cases, morbidity, and deaths, and reducing associated use of medical resources.

Factors associated with death in children with COVID-19 in Mexico.

INTRODUCTION: Most children affected by SARS-CoV-2 are reported to be asymptomatic, and COVID-19-related mortality in them is low; in Mexico, there is a lack of information on the subject in this population group. OBJECTIVE: To assess the risk factors associated with mortality in Mexican children with COVID-19. METHOD: Secondary analysis of the General Directorate of Epidemiology database. Children younger than 19 years, in whom SARS-CoV-2 infection was confirmed by RT-PCR, were included. RESULTS: 1443 children were included. Median age was eight years; 3.3 % were admitted to the intensive care unit, 1.8 % required assisted mechanical ventilation, and mortality was 1.9 %. In multivariate models, the development of pneumonia was the main risk factor for mortality, with an odds ratio (OR) of 6.45 (95 % CI: 1.99, 20.89); patients who required intubation had an OR of 8.75 (95 % CI: 3.23, 23.7). CONCLUSIONS: Children with COVID-19 exhibit high mortality in Mexico, and avoiding pneumonia should therefore be tried in them, especially in children younger than four years, with cardiovascular risk or immunosuppression. INTRODUCCIÓN: Se informa que la mayoría de los niños afectados por SARS-CoV-2 cursan asintomáticos y que en ellos la mortalidad por COVID-19 es baja; en México se desconoce la información al respecto en este grupo de la población. ­. OBJETIVO: Evaluar los factores de riesgo asociados a mortalidad en niños mexicanos con COVID-19. MÉTODO: Análisis secundario de la base de datos de la Dirección General de Epidemiología. Se incluyeron niños menores de 19 años, en quienes se confirmó SARS-CoV-2 mediante RT-PCR. RESULTADOS: Se incluyeron 1443 niños. La mediana de edad fue de ocho años; 3.3 % ingresó a la unidad de cuidados intensivos, 1.8 % requirió ventilación mecánica asistida y la mortalidad fue de 1.9 %. En los modelos multivariados, el desarrollo de neumonía constituyó el principal factor de riesgo de mortalidad, con razón de momios (RM) de 6.45 (IC 95 % 1.99, 20.89); los pacientes que requirieron intubación tuvieron RM de 8.75 (IC 95 % 3.23, 23.7). CONCLUSIONES: Los niños con COVID 19 tienen alta mortalidad en México, por lo que en ellos se debe procurar evitar la neumonía, especialmente en los menores de cuatro años, con riesgo cardiovascular o inmunosupresión.

Posterior Thoracolumbar Instrumented Fusion for Burst Fractures: A Meta-analysis.

STUDY DESIGN: This was a meta-analysis study. OBJECTIVE: To compare different posterior spine fixation methods for burst fracture fixation. SUMMARY OF BACKGROUND DATA: This study was performed to elucidate if the current body of literature supports one posterior spinal fusion fixation method for burst fracture to minimize the rate of implant failure and progression of posttraumatic kyphosis. MATERIALS AND METHODS: An extensive electronic search was conducted using PubMed for pertinent articles. The articles were examined against the inclusion and exclusion criteria. Data pertaining to kyphosis angle, Frankel score, vertebral level, blood loss, operation time, hospital stay, postoperative bracing, instrument failure, complications, and follow-up were collected. A random effects model was chosen due to variation among the individual studies' patient populations and surgical methods. RESULTS: A total of 23 publications were eventually deemed eligible according to the criteria and included into this study. The group with 2 levels above and 1 below with intermediate screws had the greatest maintenance of spine kyphosis and lowest implant failure at final follow-up (P<0.001). There was no difference between the periods of hospital stay (P=0.788) and blood loss (P=0.154) among different tiers. CONCLUSIONS: A fixation method consisting of 2 levels above and 1 below with intermediate screws for the thoracolumbar burst fractures showed the highest correction of kyphosis angle both at immediate and final follow-up and also the lowest implant failure at final follow-up.

Safe zone for irrigation and debridement of psoas abscess through a dorsal spinal approach.

PURPOSE: This cadaver study was initiated to identify safe zones for psoas abscess debridement using a dorsal spinal approach. METHODS: Twenty total specimens were dissected and lumbar transverse process (TP) and psoas muscles were identified. The distance from the lateral psoas muscle to the transverse process tip was measured. The lumbar plexus was dissected from the psoas and the distance from the TP to the lateral border of the lumbar plexus was measured. The area between the lateral edge of the psoas and lumbar plexus at each lumbar level was considered a safe zone of approach for entry into the psoas muscle for abscess debridement. RESULTS: The most lateral portion of the lumbar plexus was 9.3 mm medial to the superior tip of the L1 TP and 9.2 mm medial to the inferior tip at L1, it was 11.8 and 11.7 mm medial at L2, 10.5 and 9.8 mm medial at L3, 6.6 and 6.2 mm medial at L4, and 1.0 and 0.9 mm medial at L5. The distances from the TP tip to the lateral edge of the psoas muscle were 5.7 and 5.5 mm medial to the superior and inferior tip of the TP at L1, 5.1 and 4.7 mm medial at L2, 2.5 and 1.8 mm medial at L3, 0.4 and 0 mm medial at L4 and 3.7 and 3.8 mm lateral at L5. CONCLUSIONS: This study provides landmarks to avoid the critical structures in the lumbar spine.

Two-wheel vehicular trauma: an age-based analysis.

We retrospectively reviewed a series of 516 patients with motorcycle (n=353) and bicycle (n=162) injuries; 384 patients (74%) were younger than age 50 years and 132 (26%) were older. No significant differences by age group were seen in gender, helmet use, substance use, complications, or mortality. Older patients had more severe (Injury Severity Score [ISS] greater than 15) injuries (35 vs 18%; P<0.001), longer intensive care unit stay (1.8 vs 0.9 days; P=0.03), and more frequent discharge to subacute facilities (27 vs 10%; P<0.001). When analyzed by vehicle type, fewer older bicyclists used helmets (63 vs 99%; P<0.001) and more sustained severe head injuries (42 vs 16%; P=0.002) and critical (ISS greater than 25) overall injuries (19 vs 6%; P=0.033). Among older patients, independent predictors of mortality included emergent intubation (P<0.001), critical injury (P=0.006), severe head/neck injury (P=0.027), tachycardia at presentation (P=0.014), and female gender (P=0.026). We conclude that motorcycle and bicycle accidents cause major injuries in older patients with substantial use of hospital and posthospital resources. Older bicyclists are vulnerable to head injury and to greater functional decline. Helmet use among older bicyclists should be a direct target for a public health campaign.

[Streptococcus pneumoniae serotype replacement in nasopharyngeal colonization in children vaccinated with PCV7 in Mexico]. / Reemplazo de serotipos de Streptococcus pneumoniae en niños con vacuna conjugada antineumocóccica 7V en México.

OBJECTIVE: To assess the impact of pneumococcal conjugate vaccine (PCV7) immunization on pneumococcal nasopharyngeal colonization with S. pneumoniae (SPN). MATERIAL AND METHODS: We studied two groups with different vaccination schedules, group I (2-6 months of age) 3+1 and group II (7 -11 months) 2+1, with a booster at 15 months. Nasopharyngeal cultures were obtained before administering each vaccination dose and after booster. Paired and global analyses were carried out of the proportions of children colonized by SPN, vaccine serotype, no vaccine serotype and resistance to penicillin. RESULTS: A total of 183 children were enrolled; 93 in group I and 90 in group II. In group I, there was a decrease in vaccine serotypes in the third sample. In group II, there was an increase in non-vaccine serotypes and a decrease in vaccine serotypes before booster. Both groups showed a trend toward decreased resistance to penicillin. CONCLUSION: PCV7 caused serotype replacement in nasopharyngeal colonization before the booster.

Reemplazo de serotipos de Streptococcus pneumoniae en niños con vacuna conjugada antineumocóccica 7V en México / Streptococcus pneumoniae serotype replacement in nasopharyngeal colonization in children vaccinated with PCV7 in Mexico

OBJETIVO: Evaluar el efecto de la inmunización con vacuna neumocóccica conjugada 7 valente (VCN7), sobre la colonización nasofaríngea por S. pneumoniae (SPN). MATERIAL Y MÉTODOS: Se estudiaron dos grupos con diferente esquema de vacunación: grupo I (2-6 meses de edad) 3+1, grupo II (7-11 meses) 2+1, con refuerzo a los 15 meses de edad. Se realizaron cultivos nasofaríngeos antes de cada inmunización y posterior al refuerzo; se analizó de forma global y pareada las proporciones de los niños colonizados por SPN, serotipos vacunales, no vacunales y resistencia a la penicilina. RESULTADOS: Se incluyeron 183 niños; 93 en el grupo I y 90 en el grupo II. En el grupo I disminuyeron los serotipos vacunales en la 3ª muestra. En el grupo II aumentaron los serotipos no vacunales y disminuyeron los serotipos vacunales antes del refuerzo. En ambos grupos hay una tendencia a disminuir la resistencia a penicilina. CONCLUSIÓN: La VCN7 ocasiona un reemplazo de serotipos en la colonización nasofaríngea antes del refuerzo.

OBJECTIVE: To assess the impact of pneumococcal conjugate vaccine (PCV7) immunization on pneumococcal nasopharyngeal colonization with S. pneumoniae (SPN). MATERIAL AND METHODS: We studied two groups with different vaccination schedules, group I (2-6 months of age) 3+1 and group II (7 -11 months) 2+1, with a booster at 15 months. Nasopharyngeal cultures were obtained before administering each vaccination dose and after booster. Paired and global analyses were carried out of the proportions of children colonized by SPN, vaccine serotype, no vaccine serotype and resistance to penicillin. RESULTS: A total of 183 children were enrolled; 93 in group I and 90 in group II. In group I, there was a decrease in vaccine serotypes in the third sample. In group II, there was an increase in non-vaccine serotypes and a decrease in vaccine serotypes before booster. Both groups showed a trend toward decreased resistance to penicillin. CONCLUSION: PCV7 caused serotype replacement in nasopharyngeal colonization before the booster.

Prevalence of Neisseria meningitidis carriers in children under five years of age and teenagers in certain populations of Mexico City.

OBJECTIVE: To carry out a pilot study to discover the frequency of colonization in healthy children under five years old and teenagers, as well as the distribution of the different N. meningitidis serogroups isolated from nasopharyngeal samples collected from the population under study. MATERIAL AND METHODS: The population included youth between 15 and 19 years old living in social rehabilitation centers (SRC) and university teenagers (UT) as well as children under the age of five attending day care centers (DCC) in Mexico City. Nasopharyngeal exudates were processed using standard microbiological techniques in order to identify Nm, the serogroup, type and subtype of these isolates. RESULTS: A total of 2 310 samples (774 SRC, 800 UT and 736 DCC) were taken. Total prevalence of Nm was 1.6 per cent. In teenagers living in SRC the prevalence was 2.9%. The most frequent serogroups were Y (29.7%), C (24.3%) and B (10.8%). CONCLUSIONS: The prevalence of carriers in the study environment was significant (1.6%) and similar to countries in which the invasive illness is much more frequent.

Prevalence of Neisseria meningitidis carriers in children under five years of age and teenagers in certain populations of Mexico City / Prevalencia de portadores de Neisseria meningitidis en niños menores de cinco años de edad y adolescentes en determinadas poblaciones de la Ciudad de México

OBJECTIVE: To carry out a pilot study to discover the frequency of colonization in healthy children under five years old and teenagers, as well as the distribution of the different N. meningitidis serogroups isolated from nasopharyngeal samples collected from the population under study. MATERIAL AND METHODS: The population included youth between 15 and 19 years old living in social rehabilitation centers (SRC) and university teenagers (UT) as well as children under the age of five attending day care centers (DCC) in Mexico City. Nasopharyngeal exudates were processed using standard microbiological techniques in order to identify Nm, the serogroup, type and subtype of these isolates. RESULTS: A total of 2 310 samples (774 SRC, 800 UT and 736 DCC) were taken. Total prevalence of Nm was 1.6 per cent. In teenagers living in SRC the prevalence was 2.9 percent. The most frequent serogroups were Y (29.7 percent), C (24.3 percent) and B (10.8 percent). CONCLUSIONS: The prevalence of carriers in the study environment was significant (1.6 percent) and similar to countries in which the invasive illness is much more frequent.

OBJETIVO: Realizar un estudio piloto que permita conocer la frecuencia de colonización en niños sanos menores de cinco años y adolescentes, así como la distribución de serogrupos de los aislamientos de Neisseria meningitidis (Nm) obtenidos de la nasofaringe de la población estudiada. MATERIAL Y MÉTODOS: Se incluyeron, jóvenes entre los 15 y 19 años de edad, de centros de readaptación social (CRS) y adolescentes universitarios (AU), así como niños menores de cinco años que asisten a estancias infantiles (EI) en la Ciudad de México. Se tomaron exudados nasofaríngeos y fueron procesados, usando las técnicas microbiológicas clásicas, para identificar Nm, serogrupo, tipo y subtipo de estos aislamientos. RESULTADOS: Se incluyeron un total de 2310 muestras (774 CRS, 800 AU y 736 EI). La prevalencia total de Nm fue 1.6 por ciento y en los adolescentes de CRS fue 2.9 por ciento. Los serogrupos más frecuentes son; Y (29.7 por ciento), C (24.3 por ciento) y B (10.8 por ciento). CONCLUSIÓN: La prevalencia de portadores en nuestro medio fue significativa (1.6 por ciento) y similar a los países en los que la enfermedad invasiva es mucho más frecuente.

Streptococcus pneumoniae isolates in healthy children attending day-care centers in 12 states in Mexico.

OBJECTIVE: The aim of this study was to determine the prevalence of asymptomatic nasopharyngeal carriage of Streptococcus pneumoniae, which is a major factor in the transmission of this bacterium. MATERIAL AND METHODS: Nasopharyngeal cultures were performed on children attending 32 day-care centers in 12 states in Mexico. RESULTS: Streptococcus pneumoniae was isolated from the nasopharynx of 829 out of 2,777(29.9%) subjects aged two months to six years. All children lived in urban areas and 80% spent more than six hours daily in a day-care center. Streptococcus pneumoniae serotypes most frequently identified were: 19F (23%), 6B (15.6%), 23F (11.2%) and 6A (14.9%). Thirty-six percent of the isolates were susceptible to penicillin. CONCLUSIONS: Serotype distribution suggests the possible benefits that could be obtained from the heptavalent pneumococcal conjugate vaccine.

Streptococcus pneumoniae isolates in healthy children attending day-care centers in 12 states in Mexico

OBJECTIVE: The aim of this study was to determine the prevalence of asymptomatic nasopharyngeal carriage of Streptococcus pneumoniae, which is a major factor in the transmission of this bacterium. MATERIAL AND METHODS: Nasopharyngeal cultures were performed on children attending 32 day-care centers in 12 states in Mexico. RESULTS: Streptococcus pneumoniae was isolated from the nasopharynx of 829 out of 2 777(29.9 percent) subjects aged two months to six years. All children lived in urban areas and 80 percent spent more than six hours daily in a day-care center. Streptococcus pneumoniae serotypes most frequently identified were: 19F (23 percent), 6B (15.6 percent), 23F (11.2 percent) and 6A (14.9 percent). Thirty-six percent of the isolates were susceptible to penicillin. CONCLUSIONS: Serotype distribution suggests the possible benefits that could be obtained from the heptavalent pneumococcal conjugate vaccine.

OBJETIVO: La intención de este estudio fue determinar la prevalencia de portadores nasofaríngeos asintomáticos de Streptococcus pneumoniae, el cual es el principal factor en la transmisión de esta bacteria. MATERIAL Y MÉTODOS: Los cultivos nasofaríngeos fueron realizados en niños que asisten a 32 estancias infantiles en 12 estados de México. RESULTADOS: Streptococcus pneumoniae fue aislado de la nasofaringe de 829 (29.9 por ciento) niños de los 2 777 incluidos en el estudio con un rango de edad de 2 meses a 6 años. Todos los niños vivían en áreas urbanas y 80 por ciento permanecían más de seis horas diarias en la estancia infantil. Los serotipos de Streptococcus pneumoniae más frecuentemente identificados fueron: 19F (23 por ciento), 6B (15.6 por ciento), 23F (11.2 por ciento) y 6 A (14.9 por ciento). Treinta y seis por ciento de los aislamientos fueron susceptibles a penicilina. CONCLUSIONES: La distribución de serotipos nos da una idea de los posibles beneficios que podrían obtenerse de la vacuna neumocóccica conjugada heptavalente.

In vitro antimicrobial susceptibility in clinical isolates of Enterococcus species.

OBJECTIVE: To describe the antimicrobial activity of several antimicrobial agents against 97 clinical significant isolates of Enterococcus spp. MATERIAL AND METHODS: During a 2-year prospective study at Instituto Nacional de Pediatria (National Institute of Pediatrics) in Mexico City. Ninety seven strains of Enterococcus spp. (60 E faecalis and 37 E. faecium) were tested against 11 antibiotics. Susceptibility tests were performed with agar, according to the standards of the sNational Committee for Clinical Laboratory Standards (NCCLS). Isolates were screened for high-level resistance (HLR) to beta-lactams, aminoglycosides, glycopeptides and other antibiotics, as well as for vancomycin-phenotypes. Differences between proportions were evaluated with chi 2 of Fisher exact fest. RESULTS: Overall resistance rates to the antibiotics tested were: 17/97 (17.5%) to penicillin, ampicillin, amoxicillin-clavulanate and imipenem. There was neither HLR nor beta-lactamase production; 74/97 (48.4%) were resistant to erythromycin; 60% to ciprofloxacin; 31/97 (32%) to gentamicin, and 55/97 (56.7%) to streptomycin. Seven strains were vancomycin-resistant enterococci (VRE), all of them identified as E. faecium; 5/7 with Van A and 2/7 with Van B phenotypes. All the isolates were susceptible to linezolid. The difference in susceptibility among species was significant. CONCLUSIONS: Mutidrug-resistant enterococci is a real problem and continuous surveillance is necessary. The microbiology laboratory is the first line of defense against the spread of multiantibiotic-resistan enterococci in the hospital environment. All the strains recovered should be tested for susceptibility to ampicillin, streptomycin, gentamicin and glycopeptides. The English version of this paper is available too at: http://www.insp.mx/salud/index.html.

In vitro antimicrobial susceptibility in clinical isolates of Enterococcus species

OBJECTIVE: To describe the antimicrobial activity of several antimicrobial agents against 97 clinical significant isolates of Enterococcus spp. MATHERIAL AND METHODS: During a 2-year prospective study at Instituto Nacional de Pediatria (National Institute of Pediatrics) in Mexico City. Ninety seven strains of Enterococcus spp. (60 E. faecalis and 37 E. faecium) were tested against 11 antibiotics. Susceptibility tests were performed with agar, according to the standards of the sNational Committee for Clinical Laboratory Standards (NCCLS). Isolates were screened for high-level resistance (HLR) to beta-lactams, aminoglycosides, glycopeptides and other antibiotics, as well as for vancomycin-phenotypes. Differences between proportions were evaluated with chi2 of Fisher exact fest. RESULTS: Overall resistance rates to the antibiotics tested were: 17/97 (17.5 percent) to penicillin, ampicillin, amoxicillin-clavulanate and imipenem. There was neither HLR nor beta-lactamase production; 74/97 (48.4 percent) were resistant to erythromycin; 60 percent to ciprofloxacin; 31/97 (32 percent) to gentamicin, and 55/97 (56.7 percent) to streptomycin. Seven strains were vancomycin-resistant enterococci (VRE), all of them identified as E. faecium; 5/7 with Van A and 2/7 with Van B phenotypes. All the isolates were susceptible to linezolid. The difference in susceptibility among species was significant. CONCLUSIONS: Mutidrug-resistant enterococci is a real problem and continuous surveillance is necessary. The microbiology laboratory is the first line of defense against the spread of multiantibiotic-resistan enterococci in the hospital environment . All the strains recovered should be tested for susceptibility to ampicillin, streptomycin, gentamicin and glycopeptides

Sepsis neonatal por Streptococcus pneumoniae serotipo 1 / Streptococcus pneumoniae serotype 1 septicemia in a newborn

Introducción. Streptococcus pneumoniae es raramente descrito como agente etiológico en sepsis neonatal.Caso clínico. Se reporta el caso de un neonato de 30 semanas de edad gestacional que ingresó a la Unidad de Cuidados Intensivos Neonatales con diagnóstico de sepsis temprana por S. pneumoniae serotipo 1 que se manifestó con datos de dificultad respiratoria. Al inicio el paciente evolucionó favorablemente, pero falleció a los 23 días de vida extrauterina por sepsis nosocomial y hemorragia pulmonar. Conclusión. Se presenta el caso de un recién nacido con sepsis por S. pneumoniae serotipo 1, también se describen los principales serotipos de neumococo aislados en la población pediátrica del hospital, y el patrón de resistencia a antibióticos. Se revisa la literatura y se proponen medidas preventivas para evitar infección perinatal por este microorganismo.

Estado actual de la influenza. Avances en la prevención 1998-1999 (primera parte) / Current state of influenza

Se revisan las características epidemiológicas, clínicas, de diagnóstico y prevención de la infección por influenza. Se da información concerniente a la vacuna y agentes antivirales disponibles para el control de esta infección durante el periodo de 1998-1999. El principal cambio incluye información acerca de: a) los cultivos virales de influenza incluidas en la vacuna trivalente para 1998-1999; b) la vacunación en embarazadas y mujeres que amamantan; c) efectos colaterales y reacciones adversas, y d) importancia de la vacunación en pacientes de alto riesgo y personal al cuidado de la salud