[Increase in severe acute respiratory infections in children during the last phase of the COVID-19 pandemic]. / Incremento de infecciones respiratorias agudas graves en niños durante la última etapa de la pandemia COVID-19.

OBJECTIVE: The COVID-19 pandemic has caused a variation in the circulation of respiratory pathogens. Our aim was to analyze the epidemiology of severe acute respiratory infections (SARI) in children during 3 years of the COVID-19 pandemic, in comparison with a previous period. METHODS: An observational study was conducted in a tertiary hospital in Spain, which analyzed the frequency and characteristics of patients admitted for SARI in the Pediatric Intensive Care Unit (PICU) during the COVID-19 pandemic (1 March 2020 to 28 February 2023), compared to pre-pandemic period (1 March 2017 to 29 February 2020). RESULTS: A total of 268 patients were included (59.6% males). The median age was 9.6 months (IQR 1.7 - 37). In the pre-pandemic period, there were 126 admissions with an average of 42 admissions/year. During the pandemic, there were 142 admissions, observing a significant reduction in admissions in the first year (12 admissions/year), in contrast to 82 admissions during the third year, which represented an increase of 95% compared to the average of admissions/year in pre-pandemic. In addition, in the last year there was evidence of an increase in viral coinfections in relation to pre-pandemic period (54.9% vs 39.7%; p=0.032). There were no differences in length of hospital stay or PICU stay. CONCLUSIONS: During the last year, coinciding with low rates of hospitalization for COVID in Spain, we observed a notable increase in admissions to the PICU for SARI. Probably, the prolonged period of low exposure to pathogens due to the measures adopted during the pandemic might have caused a decrease in population immunity with a rise in severe respiratory infections.

[Recommended antibiotic therapy in episodes of urinary tract infection]. / Tratamiento antibiótico recomendado en episodios de infección urinaria.

The present article reviews the scientific evidence available on antibiotic treatment of urinary tract infection in childhood. The information from clinical trials is of little use in decision making, because many of these studies evaluate antibiotics with a high level of resistance in Spain. Although some studies allow certain antibiotics to be identified as sufficiently effective, they do not permit clear hierarchies in the choice of therapy to be established. Nevertheless, data are available from clinical trials and systematic reviews on the efficacy of different routes of administration or regimens and on treatment duration, although this information is of doubtful clinical application in some patient groups. If cystitis in older boys is excluded, the distinction between upper and lower urinary tract infection is of little use. Consequently, differentiating between high- and low-risk infections according to the patient's age and the presence of fever and/or general repercussions is preferable. Finally, the choice of antibiotic will largely depend on the antimicrobial resistances of urinary pathogens in Spain.