Effect of High Altitude on the Survival of COVID-19 Patients in Intensive Care Unit: A Cohort Study.

Purpose: The effect of high altitude ( ≥ 1500 m) and its potential association with mortality by COVID-19 remains controversial. We assessed the effect of high altitude on the survival/discharge of COVID-19 patients requiring intensive care unit (ICU) admission for mechanical ventilation compared to individuals treated at sea level. Methods: A retrospective cohort multi-center study of consecutive adults patients with a positive RT-PCR test for COVID-19 who were mechanically ventilated between March and November 2020. Data were collected from two sea-level hospitals and four high-altitude hospitals in Ecuador. The primary outcome was ICU and hospital survival/discharge. Survival analysis was conducted using semi-parametric Cox proportional hazards models. Results: Of the study population (n = 670), 35.2% were female with a mean age of 58.3 ± 12.6 years. On admission, high-altitude patients were more likely to be younger (57.2 vs. 60.5 years old), presented with less comorbidities such as hypertension (25.9% vs. 54.9% with p-value <.001) and diabetes mellitus (20.5% vs. 37.2% with p-value <.001), less probability of having a capillary refill time > 3 sec (13.7% vs. 30.1%, p-value <.001), and less severity-of-illness condition (APACHE II score, 17.5 ± 8.1 vs. 20 ± 8.2, p < .01). After adjusting for key confounders high altitude is associated with significant higher probabilities of ICU survival/discharge (HR: 1.74 [95% CI: 1.46-2.08]) and hospital survival/discharge (HR: 1.35 [95% CI: 1.18-1.55]) than patients treated at sea level. Conclusions: Patients treated at high altitude at any time point during the study period were 74% more likely to experience ICU survival/discharge and 35% more likely to experience hospital survival/discharge than to the sea-level group. Possible reasons for these findings are genetic and physiological adaptations due to exposure to chronic hypoxia.

Sensor Fusion for Social Navigation on a Mobile Robot Based on Fast Marching Square and Gaussian Mixture Model.

Mobile robot navigation has been studied for a long time, and it is nowadays widely used in multiple applications. However, it is traditionally focused on two-dimensional geometric characteristics of the environments. There are situations in which robots need to share space with people, so additional aspects, such as social distancing, need to be considered. In this work, an approach for social navigation is presented. A multi-layer model of the environment containing geometric and topological characteristics is built based on the fusion of multiple sensor information. This is later used for navigating the environment considering social distancing from individuals and groups of people. The main novelty is combining fast marching square for path planning and navigation with Gaussian models to represent people. This combination allows to create a continuous representation of the environment from which smooth paths can be extracted and modified according to dynamically captured data. Results prove the practical application of the method on an assistive robot for navigating indoor scenarios, including a behavior for crossing narrow passages. People are efficiently detected and modeled to assure their comfort when robots are around.

FM2 Path Planner for UAV Applications with Curvature Constraints: A Comparative Analysis with Other Planning Approaches.

This paper studies the Fast Marching Square (FM2) method as a competitive path planner for UAV applications. The approach fulfills trajectory curvature constraints together with a significantly reduced computation time, which makes it overperform with respect to other planning methods of the literature based on optimization. A comparative analysis is presented to demonstrate how the FM2 approach can easily adapt its performance thanks to the introduction of two parameters, saturation α and exponent ß, that allow a flexible configuration of the paths in terms of curvature restrictions, among others. The main contributions of the method are twofold: first, a feasible path is directly obtained without the need of a later optimization process to accomplish curvature restrictions; second, the computation speed is significantly increased, up to 220 times faster than other optimization-based methods such as, for instance, Dubins, Euler-Mumford Elastica and Reeds-Shepp. Simulation results are given to demonstrate the superiority of the method when used for UAV applications in comparison with the three previously mentioned methods.

Multi-LiDAR Mapping for Scene Segmentation in Indoor Environments for Mobile Robots.

Nowadays, most mobile robot applications use two-dimensional LiDAR for indoor mapping, navigation, and low-level scene segmentation. However, single data type maps are not enough in a six degree of freedom world. Multi-LiDAR sensor fusion increments the capability of robots to map on different levels the surrounding environment. It exploits the benefits of several data types, counteracting the cons of each of the sensors. This research introduces several techniques to achieve mapping and navigation through indoor environments. First, a scan matching algorithm based on ICP with distance threshold association counter is used as a multi-objective-like fitness function. Then, with Harmony Search, results are optimized without any previous initial guess or odometry. A global map is then built during SLAM, reducing the accumulated error and demonstrating better results than solo odometry LiDAR matching. As a novelty, both algorithms are implemented in 2D and 3D mapping, overlapping the resulting maps to fuse geometrical information at different heights. Finally, a room segmentation procedure is proposed by analyzing this information, avoiding occlusions that appear in 2D maps, and proving the benefits by implementing a door recognition system. Experiments are conducted in both simulated and real scenarios, proving the performance of the proposed algorithms.

A Multirobot System in an Assisted Home Environment to Support the Elderly in Their Daily Lives.

The increasing isolation of the elderly both in their own homes and in care homes has made the problem of caring for elderly people who live alone an urgent priority. This article presents a proposed design for a heterogeneous multirobot system consisting of (i) a small mobile robot to monitor the well-being of elderly people who live alone and suggest activities to keep them positive and active and (ii) a domestic mobile manipulating robot that helps to perform household tasks. The entire system is integrated in an automated home environment (AAL), which also includes a set of low-cost automation sensors, a medical monitoring bracelet and an Android application to propose emotional coaching activities to the person who lives alone. The heterogeneous system uses ROS, IoT technologies, such as Node-RED, and the Home Assistant Platform. Both platforms with the home automation system have been tested over a long period of time and integrated in a real test environment, with good results. The semantic segmentation of the navigation and planning environment in the mobile manipulator for navigation and movement in the manipulation area facilitated the tasks of the later planners. Results about the interactions of users with the applications are presented and the use of artificial intelligence to predict mood is discussed. The experiments support the conclusion that the assistance robot correctly proposes activities, such as calling a relative, exercising, etc., during the day, according to the user's detected emotional state, making this is an innovative proposal aimed at empowering the elderly so that they can be autonomous in their homes and have a good quality of life.

Path Planning and Collision Risk Management Strategy for Multi-UAV Systems in 3D Environments.

Multi-UAV systems are attracting, especially in the last decade, the attention of researchers and companies of very different fields due to the great interest in developing systems capable of operating in a coordinated manner in complex scenarios and to cover and speed up applications that can be dangerous or tedious for people: search and rescue tasks, inspection of facilities, delivery of goods, surveillance, etc. Inspired by these needs, this work aims to design, implement and analyze a trajectory planning and collision avoidance strategy for multi-UAV systems in 3D environments. For this purpose, a study of the existing techniques for both problems is carried out and an innovative strategy based on Fast Marching Square-for the planning phase-and a simple priority-based speed control-as the method for conflict resolution-is proposed, together with prevention measures designed to try to limit and reduce the greatest number of conflicting situations that may occur between vehicles while they carry out their missions in a simulated 3D urban environment. The performance of the algorithm is evaluated successfully on the basis of certain conveniently chosen statistical measures that are collected throughout the simulation runs.

Multi UAV Coverage Path Planning in Urban Environments.

Coverage path planning (CPP) is a field of study which objective is to find a path that covers every point of a certain area of interest. Recently, the use of Unmanned Aerial Vehicles (UAVs) has become more proficient in various applications such as surveillance, terrain coverage, mapping, natural disaster tracking, transport, and others. The aim of this paper is to design efficient coverage path planning collision-avoidance capable algorithms for single or multi UAV systems in cluttered urban environments. Two algorithms are developed and explored: one of them plans paths to cover a target zone delimited by a given perimeter with predefined coverage height and bandwidth, using a boustrophedon flight pattern, while the other proposed algorithm follows a set of predefined viewpoints, calculating a smooth path that ensures that the UAVs pass over the objectives. Both algorithms have been developed for a scalable number of UAVs, which fly in a triangular deformable leader-follower formation with the leader at its front. In the case of an even number of UAVs, there is no leader at the front of the formation and a virtual leader is used to plan the paths of the followers. The presented algorithms also have collision avoidance capabilities, powered by the Fast Marching Square algorithm. These algorithms are tested in various simulated urban and cluttered environments, and they prove capable of providing safe and smooth paths for the UAV formation in urban environments.

Kullback-Leibler Divergence-Based Differential Evolution Markov Chain Filter for Global Localization of Mobile Robots.

One of the most important skills desired for a mobile robot is the ability to obtain its own location even in challenging environments. The information provided by the sensing system is used here to solve the global localization problem. In our previous work, we designed different algorithms founded on evolutionary strategies in order to solve the aforementioned task. The latest developments are presented in this paper. The engine of the localization module is a combination of the Markov chain Monte Carlo sampling technique and the Differential Evolution method, which results in a particle filter based on the minimization of a fitness function. The robot's pose is estimated from a set of possible locations weighted by a cost value. The measurements of the perceptive sensors are used together with the predicted ones in a known map to define a cost function to optimize. Although most localization methods rely on quadratic fitness functions, the sensed information is processed asymmetrically in this filter. The Kullback-Leibler divergence is the basis of a cost function that makes it possible to deal with different types of occlusions. The algorithm performance has been checked in a real map. The results are excellent in environments with dynamic and unmodeled obstacles, a fact that causes occlusions in the sensing area.

ADAM: a robotic companion for enhanced quality of life in aging populations.

One of the major problems of today's society is the rapid aging of its population. Life expectancy is increasing, but the quality of life is not. Faced with the growing number of people who require cognitive or physical assistance, new technological tools are emerging to help them. In this article, we present the ADAM robot, a new robot designed for domestic physical assistance. It mainly consists of a mobile base, two arms with grippers and vision systems. All this allows the performance of physical tasks that require navigation and manipulation of the environment. Among ADAM's features are its modularity, its adaptability to indoor environments and its versatility to function as an experimental platform and for service applications. In addition, it is designed to work respecting the user's personal space and is collaborative, so it can learn from experiences taught by them. We present the design of the robot as well as examples of use in domestic environments both alone and in collaboration with other domestic platforms, demonstrating its potential.

Risk factors for COVID-19 and their association with mortality in Ecuadorian patients admitted to the ICU: A retrospective cohort multicentric study.

Several risk factors were associated with mortality in patients with coronavirus disease 2019 (COVID-19) infection in intensive care units (ICU). We assessed the effect of risk factors related to the characteristics and clinical history of the population, laboratory test results, drug management, and type of ventilation on the probability of survival/discharge from the ICU. A retrospective cohort multicentric study of adults with COVID-19 admitted to the ICU between March 2020 and December 2021. Data were collected from 6 hospitals in 5 cities in Ecuador. The primary outcome was ICU survival/discharge. Survival analysis was conducted using semi-parametric Cox proportional hazards models. Of those admitted to the ICU with COVID-19, (n = 991), mean age was 56.76 ±â€…13.14, and 65.9% were male. Regarding the primary outcome, 51.1% (n = 506) died and 48.9% (n = 485) survived. Of the group that died, their mean age was higher than the survivors (60.7 vs 52.60 years, respectively), and they had a higher prevalence of comorbidities such as arterial hypertension (37.2% vs 20.4%, respectively) and diabetes mellitus (26.9% vs 15.7%, respectively), with P < .001. In ventilatory management, 32.7% of patients used noninvasive ventilation and high-flow nasal cannula, and 67.3% required invasive ventilatory support. After adjusting for confounders, Cox regression analysis showed that patients were less likely to be discharged alive from the ICU if they met the following conditions: arterial hypertension (hazard ratio [HR] = 0.83 95% CI 0.723-0.964), diabetes mellitus (HR = 0.80 95% CI 0.696-0.938), older than 62 years (HR = 0.86 95% CI 0.790-0.956), obese (body mass index ≥ 30) (HR = 0.78 95% CI 0.697-0.887), 1 unit increase in SOFA score (HR = 0.94 95% CI 0.937-0.961), PaO2/FiO2 ratio <100 mm Hg (HR = 0.84 95% CI 0.786-0.914), and the use of invasive mechanical ventilation (HR = 0.68 95% CI 0.614-0.769). Risk factors associated with increased mortality were older age, obesity, arterial hypertension, and diabetes. Factors such as male gender, chronic obstructive pulmonary disease, acute kidney injury, and cancer reported in other investigations did not have the same effect on mortality in our study.

The Tower Building Task: A Behavioral Tool to Evaluate Recreational Risk-Taking.

Risk-taking is a fundamental aspect of life spanning diverse contexts. Despite many tests being readily available, the behavioral assessment of risk propensity in recreational contexts, where decisions are not necessarily motivated by monetary gains or losses, is not well represented. As the tower building task (TBT) shares features of recreational activities, we evaluated whether it could assess risk-taking in this type of scenario. In the TBT, participants use standard-size wooden blocks to build the tallest tower they can within a 10 min period. In the current study we (i) examined methodological modifications to the task to either promote or reduce risky behavior and (ii) tested possible associations between the TBT scores and those of two commonly used risk-taking evaluations: The Balloon Analogue Risk Task (BART) and the Sensation Seeking Scale (SSS). We found that limiting the number of permitted collapses decreased the willingness to take risks, whereas challenging participants to exceed a "record" height increased risk-taking. TBT scores of one of the conditions correlated with scores of the BART and the SSS, particularly with the subscale addressing recreational activities. These findings suggest that the TBT offers a potentially useful means of evaluating risk-taking behaviors akin to those of the recreational domain.

Marine Applications of the Fast Marching Method.

Path planning is general problem of mobile robots, which has special characteristics when applied to marine applications. In addition to avoid colliding with obstacles, in marine scenarios, environment conditions such as water currents or wind need to be taken into account in the path planning process. In this paper, several solutions based on the Fast Marching Method are proposed. The basic method focus on collision avoidance and optimal planning and, later on, using the same underlying method, the influence of marine currents in the optimal path planning is detailed. Finally, the application of these methods to consider marine robot formations is presented.

Cancer risk associated with living at high altitude in Ecuadorian population from 2005 to 2014.

BACKGROUND AND AIMS: Cancer is a leading cause of death in Ecuador with high social and economic impact. This study aims to determinate the influence of living at a high altitude on the risk of developing or dying from cancer among the Ecuadorian population. METHODS: This is an ecological and epidemiological analysis of cancer mortality and prevalence rates, based on national data from the Ecuadorian National Statistics and Census Institute, corresponding to the period between 2005 and 2014. This study includes the analysis of various types of cancer: gastric, colorectal, hepatic/bile duct, breast, uterine/cervix, and lymphatic/hematopoietic, using rates of mortality and prevalence. Additionally, the association between the risk of getting or dying from cancer and living at high altitude was investigated. This comparison was made between the population living in Highlands, over 2000 meters above sea level, and low-lying regions. RESULTS: Living at high altitude was associated with a higher prevalence of cancer and also with a high mortality rate due to cancer. Risk of getting cancer was related to living at a higher altitude, as well as an increased risk of death by cancer: gastric (OR:1.204; p<0.001), colorectal (OR:1.421; p<0.001), hepatic/bile duct (OR:1.184; p<0.001), breast (OR:1.067; p=0.030), or lymphatic/hematopoietic neoplasms (OR:1.135; p<0.001). CONCLUSIONS: Through an epidemiologic analysis, the association between developing or dying from cancer and living at high altitude was obtained. However, further researche is needed to clarify these findings, something that could have a substantial impact on cancer prevention.

Clinical characterization and antimicrobial resistance of Escherichia coli in pediatric patients with urinary tract infection at a third level hospital of Quito, Ecuador.

BACKGROUND: Urinary tract infections (UTI) are among the most common infections in pediatric patients. The main etiopathogenic agent is Escherichia coli. The purpose of this study was to determine the antimicrobial resistance pattern of E. coli in pediatric patients and to understand their main clinical and laboratory manifestations. METHODS: Fifty-nine patients were included in the study and classified into two groups: hospitalization (H) and external consultation (EC). Every patient presented urine cultures with the isolation of E. coli that included an antibiogram. Clinical signs and symptoms, urinalysis, complete blood count (CBC) and serum inflammatory markers were analyzed. RESULTS: The most common clinical manifestations were fever (H: 76.5%; EC: 88%), vomiting (H: 32.4%; EC: 32%), hyporexia (H: 20.6%; EC: 16%), abdominal pain (H: 20.6%: EC: 28%), and dysuria (H: 14.7%; EC: 32%). Ten patients (16.95%) presented UTI for extended spectrum beta-lactamase (ESBL) E. coli. Ampicillin, nalidixic acid, and trimethoprim-sulfamethoxazole showed a higher resistance rate, being ampicillin the most significant (H: 88.2%; EC: 92%). Leukocyturia, bacteriuria and urine nitrites were frequent alterations in urinalysis (H: 52.9%; EC: 92%). In ESBL E. coli patients, a positive correlation was found between leukocytes in CBC and C-reactive protein (r = 0.9, p < 0.01). Diarrhea and foul-smelling urine were associated with E. coli resistance. CONCLUSIONS: The presence of leukocytes, bacteria, nitrites and the Gram stain are the most common indicators. Nitrofurantoin and phosphomycin are good therapeutic options. However, an antibiogram must be conducted to determine the best therapeutic agent.

Hemophagocytic lymphohistiocytosis associated with visceral leishmaniasis. Review of cases reported

Introduction: Leishmaniasis is a tropical and subtropical disease highly reported in Southeast Asia, East Africa, Latin America, and the Mediterranean basin, with an incidence of two million new cases by year and 500,000 cases of visceral leishmaniasis. One of the more severe and rare complications of visceral leishmaniasis is hemophagocytic lymphohistiocytosis. Objective: To describe the clinical characteristics of hemophagocytic lymphohistiocytosis associated with visceral leishmaniasis Methods: We performed a literature review based on the case reports indexed in MEDLINE/PubMed. Results: Twenty-five cases were included; 52 percent under two years of age. All cases presented splenomegaly and 84 percent hepatomegaly. Cytopenias were described in all patients: 100 prcent thrombocytopenia, 96 percent anemia, and 84 percent leukopenia or neutropenia. Hypertriglyceridemia and hypofibrinogenemia were found in 68 percent and 32 percent, respectively, and hyperferritinemia in 80 percent. Additionally, hemophagocytosis was documented in 84 percent, with Leishmania detection in 92 percent. All patients were treated against Leishmania: 80% with liposomal amphotericin B. regarding the treatment for hemophagocytic lymphohistiocytosis; corticosteroid were used in 36 percent, endovenous immunoglobulin in 28 percent, cyclosporine in 28 prcent and etoposide in 16 percent The complications reported included gastrointestinal hemorrhage (8 percent), disseminated intravascular coagulation (8 percent), autoimmune hemolytic anemia (12 percent), multiple-organ dysfunction/septic shock (12 prcent), petechial rash (16 percent), and four patients deceased. Variables such as fever (p=0.031), hemoglobin level (p=0.031), platelet count (p=0.0048), and ferritin (p=0.0072) were associated with mortality Conclusions: During visceral leishmaniasis, the hemophagocytic syndrome is a rare condition that mainly affects pediatric patients, but with excellent outcomes using liposomal amphotericin B. However, there is a lack of strong evidence to make a recommendation(AU)

Introducción: La leishmaniasis es una enfermedad tropical y subtropical con una elevada incidencia, dos millones de casos nuevos por año y 500 000 de leishmaniasis visceral. La linfohistiocitosis hemofagocítica es una complicación grave y rara de la leishmaniasis visceral. Objetivo: Describir las características clínicas de la linfohistiocitosis hemofagocítica asociada con leishmaniasis visceral. Métodos: Se realizó una revisión bibliográfica basada en los informes de casos indexados en MEDLINE/PubMed. Se identificaron 34 publicaciones; después de analizarlas en función de los criterios de inclusión se trabajó con 22 trabajos. Resultados: En los trabajos incluidos se informaron 25 casos; el 52 por ciento fueron pacientes menores de 2 años. Todos presentaron esplenomegalia y 84 por ciento hepatomegalia. Se describieron citopenias en todos los pacientes: 100 por ciento trombocitopenia, 96 por ciento anemia y 84 por ciento leucopenia o neutropenia. Se encontró hipertrigliceridemia e hipofibrinogenemia en 68 por ciento y 32 por ciento, respectivamente, e hiperferritinemia en 80 por ciento. Todos los pacientes fueron tratados contra leishmania, 80 por ciento con anfotericina B liposomal. Las complicaciones incluyeron: hemorragia gastrointestinal, coagulación intravascular diseminada, anemia hemolítica autoinmune, falla multiorgánica/shock séptico, erupción petequial y cuatro pacientes fallecieron. Conclusiones: En la leishmaniasis visceral, el síndrome hemofagocítico es una afección poco frecuente que afecta principalmente a pacientes pediátricos. Para el tratamiento, usando la anfotericina B liposomal se obtienen excelentes resultados; sin embargo, la evidencia es insuficiente para hacer una recomendación(AU)

Expression of syntaxin 8 in visceral adipose tissue is increased in obese patients with type 2 diabetes and related to markers of insulin resistance and inflammation.

BACKGROUND AND AIMS: Obesity is associated with increased adipose tissue inflammation as well as with the development of type 2 diabetes (T2D). Syntaxin 8 (STX8) is a protein required for the transport of endosomes. In this study we analyzed the relationship of STX8 with the presence of T2D in the context of obesity. METHODS: With this purpose, 21 subjects (seven lean [LN], eight obese normoglycemic [OB-NG] and six obese with type 2 diabetes [OB-T2D]) were included in the study. Gene and protein expression levels of STX8 and GLUT4 were analyzed in visceral adipose tissue (VAT). RESULTS: mRNA (p = 0.008) and protein (p <0.001) expression levels of STX8 were significantly increased in VAT of OB-T2D patients. Moreover, gene expression levels of SLC2A4 (GLUT4) were downregulated (p = 0.002) in VAT of obese patients. We found that STX8 was positively correlated (p <0.05) with fasting glucose concentrations, plasma glucose 2 h after an OGTT and C-reactive protein. Interestingly, the expression of STX8 was negatively correlated (p <0.05) with the expression of SLC2A4 in VAT. CONCLUSIONS: Increased STX8 expression in VAT appears to be associated with the presence of T2D in obese patients through a mechanism that may involve GLUT4.

Dysentery by CTX-M Type ESBL Producing Shigella flexneri / Disentería por Shigella flexneri productora de BLEE tipo CTX-M

According to the World Health Organization, diarrheal infections cause 525 000 deaths of children under five years of age every year, and shigellosis. Shigellosis is a relevant cause of dysentery, which increases the morbidity and mortality in pediatric patients. Therefore, emergingthe emergence of antimicrobial resistant strains of Shigella is a concerningworrisome problem worldwide. We report the case of a 7-year-old patient with acute dysentery caused by CTX-M Type ESBL Producing Shigella flexneri, being. This was the first case treated in the Specialties Hospital of Specialties of the Armed Forces N°1, in Quito, Ecuador. The antibiogram demonstrated sensibilityshowed sensitivity to ampicillin-sulbactam. As a result, after five days of microbiologically directed treatment, the patient improved his condition without relapse. Proper clinical diagnoses and accurate laboratory studies like stool culture and antibiogram are crucial to givingindicate an appropriate therapy in infections caused by Shigella and other enteric bacilli(AU)

Según la Organización Mundial de la Salud, las infecciones diarreicas provocan 525 000 muertes de niños menores de cinco años de edad cada año. La shigelosis es una causa importante de disentería que aumenta la morbilidad y mortalidad de los pacientes pediátricos. Es por eso que el surgimiento de cepas de Shigella resistentes a los antibióticos es un preocupante problema a nivel mundial. Presentamos el caso de un paciente de 7 años de edad con disentería aguda provocada por Shigella flexneri productora de BLEE tipo CTX-M. Se trata del primer caso tratado en el Hospital de Especialidades de las Fuerzas Armadas Nº 1, en Quito, Ecuador. El antibiograma mostró sensibilidad a la combinación ampicilina/sulbactam. Al cabo de cinco días de tratamiento microbiológico, el paciente mejoró su estado y no se produjeron recaídas. Un diagnóstico clínico correcto, así como estudios precisos de laboratorio como los cultivos de heces y los antibiogramas, son vitales para indicar una terapia apropiada en las infecciones causadas por Shigella y otros bacilos entéricos(AU)

Clinical characterization and antimicrobial resistance of Escherichia coli in pediatric patients with urinary tract infection at a third level hospital of Quito, Ecuador / Caracterización clínica y resistencia antimicrobiana de Escherichia coli en pacientes pediátricos con infección del tracto urinario en un hospital de tercer nivel en Quito, Ecuador

Abstract: Background: Urinary tract infections (UTI) are among the most common infections in pediatric patients. The main etiopathogenic agent is Escherichia coli. The purpose of this study was to determine the antimicrobial resistance pattern of E. coli in pediatric patients and to understand their main clinical and laboratory manifestations. Methods: Fifty-nine patients were included in the study and classified into two groups: hospitalization (H) and external consultation (EC). Every patient presented urine cultures with the isolation of E. coli that included an antibiogram. Clinical signs and symptoms, urinalysis, complete blood count (CBC) and serum inflammatory markers were analyzed. Results: The most common clinical manifestations were fever (H: 76.5%; EC: 88%), vomiting (H: 32.4%; EC: 32%), hyporexia (H: 20.6%; EC: 16%), abdominal pain (H: 20.6%: EC: 28%), and dysuria (H: 14.7%; EC: 32%). Ten patients (16.95%) presented UTI for extended spectrum beta-lactamase (ESBL) E. coli. Ampicillin, nalidixic acid, and trimethoprim-sulfamethoxazole showed a higher resistance rate, being ampicillin the most significant (H: 88.2%; EC: 92%). Leukocyturia, bacteriuria and urine nitrites were frequent alterations in urinalysis (H: 52.9%; EC: 92%). In ESBL E. coli patients, a positive correlation was found between leukocytes in CBC and C-reactive protein (r = 0.9, p < 0.01). Diarrhea and foul-smelling urine were associated with E. coli resistance. Conclusions: The presence of leukocytes, bacteria, nitrites and the Gram stain are the most common indicators. Nitrofurantoin and phosphomycin are good therapeutic options. However, an antibiogram must be conducted to determine the best therapeutic agent.

Resumen: Introducción: Las infecciones de tracto urinario (ITU) se encuentran entre las más frecuentes en pediatría, siendo Escherichia coli el principal agente etiopatogénico. El objetivo de este estudio fue determinar el patrón de resistencia antimicrobiana de E. coli en pacientes pediátricos y conocer sus principales manifestaciones clínicas y de laboratorio. Métodos: Se incluyeron en el estudio 59 pacientes en dos grupos: hospitalización (H) y consulta externa (CE). En cada uno se realizó un urocultivo y un antibiograma con aislamiento de E. coli. Se analizaron signos y síntomas, uroanálisis, hemograma y marcadores séricos de inflamación. Resultados: Las manifestaciones clínicas más frecuentes fueron fiebre (H: 76.5%; CE: 88%), vómito (H: 32.4%; CE: 32%), hiporexia (H: 20.6%; CE: 16%), dolor abdominal (H: 20.6%: CE: 28%) y disuria (H: 14.7%; CE: 32%). Diez pacientes (16.95%) presentaron ITU por E. coli beta-lactamasa de espectro extendido (BLEE). La ampicilina, ácido nalidíxico y trimetroprim con sulfametoxazol mostraron alta resistencia, siendo ampicilina la más significativa (H: 88.2%, CE: 92%). Leucocituria, bacteriuria y nitritos en orina fueron frecuentes en el uroanálisis. En pacientes con E. coli BLEE se encontró una correlación positiva entre los leucocitos y la proteína C reactiva (r = 0.9, p < 0.01). La diarrea y el mal olor en la orina se asociaron con resistencia de E. coli. Conclusiones: La leucocituria, la bacteriuria, los nitritos y la tinción Gram son los indicadores más frecuentes de ITU. La nitrofurantoina y fosfomicina son buenas opciones terapéuticas. Sin embargo, debe realizarse un antibiograma para determinar el mejor tratamiento.