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Objective. To evaluate the use of TMP-SMX compared with other options available for the treatment of children with community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) infections. Data Sources. The following databases were searched: Medline and PreMedline (OivdSP interface); Excerpta Medica Database (EMBASE; Elsevier interface); Cumulative Index to the Nursing and Allied Health Literature (CINAHL; EbscoHost interface); Sciences Citation Index Expanded (SCI-EXPANDED; Web of Science interface); Cochrane Library (Wiley interface); Scopus (Elsevier interface), and DARE, HTA (CRD interface). The search strategy was the one developed by SIGN to identify randomized clinical trials and systematic reviews. Also, we conducted a hand review of all reference lists of included studies. No language or data limits were added. The last search was done on October 1, 2015. Main key words were trimethoprim or trimethoprim-sulfamethoxazole combination and Staphylococcus aureus. Study Selection. Only randomized controlled trials comparing TMP-SMX versus any other antibiotic as the first-line treatment in CA-MRSA infections in children were included. Articles were reviewed by 2 reviewers, and in case of discrepancy, the final decision was made by the study coordinator. Data Extraction. Only 27 out of 364 articles identified were randomized controlled trials and only 4 fulfilled the eligibility criteria (Jadad score >3). Data Synthesis. Evidence found only referred to use of TMP-SMX in soft tissue infections. Heterogeneity among studies precluded meta-analysis. Conclusions. Available evidence is not conclusive to promote or refuse TMP-SMX as first-line treatment in CA-MRSA infections in children. Additional well-designed studies are required to fsurther elucidate this issue.
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BACKGROUND: Bone and joint infections (BJI) are relatively common in children, and community -acquired methicillin resistant Staphylococcus aureus (CA-MRSA) is the leading cause in some countries. AIM: To evaluate epidemiological data, clinical and microbiological features and outcome of BJI. METHODS: A prospective descriptive study was conducted. RESULTS: 40 patients (p) completed the study. Bacterial cultures were positives in 30 p (75%): CA-MRSA was found in 19 p, methicillin-sensitive S. aureus in 6 p, and others in 5 p. Cultures were negatives in 10 p (25%). Median treatment duration was 28 days (r: 21-40 d); Analyzing patients with CA-MRSA positive cultures separately, initial CRP was higher (Md 76 vs 50 mg/L, p < 0.02), normalization occurred later (Md 14 days vs 7days, p < 0.03), and duration of treatment (Md 32 days vs 23, p < 0.004) as well as hospital stay (Md 9 days vs 7, p = 0.12) were longer. Sequelae were present in 3 p and 1 relapsed: All of them with CA-SAMR. CONCLUSION: CA-MRSA was the leading cause of BJI and was associated with higher CRP on admission, later normalization and longer treatment duration. Complications as drainage requirement, and sequelae were common in those p.
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Antibacterianos/uso terapêutico , Artrite Infecciosa/microbiologia , Staphylococcus aureus Resistente à Meticilina/isolamento & purificação , Osteomielite/microbiologia , Infecções Estafilocócicas/microbiologia , Adolescente , Antibacterianos/farmacologia , Artrite Infecciosa/tratamento farmacológico , Criança , Pré-Escolar , Infecções Comunitárias Adquiridas/tratamento farmacológico , Infecções Comunitárias Adquiridas/microbiologia , Feminino , Humanos , Lactente , Masculino , Staphylococcus aureus Resistente à Meticilina/efeitos dos fármacos , Testes de Sensibilidade Microbiana , Osteomielite/tratamento farmacológico , Estudos Prospectivos , Infecções Estafilocócicas/tratamento farmacológicoRESUMO
BACKGROUND: Febrile neutropenia in children with onco-hematological diseases is an important cause of morbidity and mortality and requires early and adequate empirical treatment. This systematic review was conducted to evaluate if piperacillin/ tazobactan (PTZ) monotherapy leads to a lower incidence of therapeutic failures than comparators. METHODS: A literature search was carried out in Embase, and MEDLINE databases using the search terms ('febrile neutropenia' OR hemato oncology OR haemato oncology OR 'immunocompromised host' OR 'immunocompromised patient' OR 'chemotherapy-induced febrile neutropenia') AND (piperacillin OR tazobactam OR 'piperacillin plus tazobactam' OR 'piperacillin/tazobactam' OR 'piperacillin-tazobactam' OR tazocin OR 'piperacillin-tazobactam drug combination')), Efficacy endpoint was treatment failure rate. The safety end-point was absence of any adverse effects (AE). RESULTS: Eleven studies were included. No heterogeneity was detected ( I 2 0%). The risk of failure was not superior for piperacillin/tazobactan to comparators (Global RR: 0.94; IC95% 0.83 a 1.07). Rates of adverse events were similar among studies. No publication bias was detected (p 0.36). CONCLUSIONS: This systematic review and meta-analysis showed that treating episodes of febrile neutropenia in oncology pediatric patients, the risk of failure for PTZ was not superior to comparators. Adverse events were similar to the comparators.
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Neoplasias , Neutropenia , Antibacterianos/efeitos adversos , Criança , Quimioterapia Combinada , Humanos , Neoplasias/complicações , Neoplasias/tratamento farmacológico , Neutropenia/induzido quimicamente , Neutropenia/tratamento farmacológico , Ácido Penicilânico/efeitos adversos , Piperacilina/efeitos adversosRESUMO
OBJECTIVE: To evaluate the differential characteristics of SARS-COV-2 associated inflammatory multisystem syndrome (MIS-C) in children. METHODS: A retrospective cohort study was conducted. The definition of MIS- C was based on WHO criteria. Temporally related COVID-19 patients were included as controls. RESULTS: 25 patients with MIS-C and 75 controls were included. Multivariate multiple logistic regression model of variables that showed to be significant in univariate analysis revealed that age ≥2 years (OR 24.7; 95% CI 1.03 -592.4; P=0.048), lymphopenia (OR 9.03, 95%CI 2.05-39.7; P=0.004), and platelet count <150x109/L (OR 11.7; 95% CI 1.88-75.22; P=0.009) were significantly associated with MIS-C. Presence of underlying disease seemed to reduce the risk of MIS-C (OR 0.06; 95% CI 0.01-0.3). CONCLUSIONS: MIS-C was more common in patients older than 2 years and in those with lymphopenia or thrombocytopenia. Underlying disease appears to reduce the risk of MIS-C.
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COVID-19 , Argentina/epidemiologia , Criança , Pré-Escolar , Humanos , Estudos Retrospectivos , SARS-CoV-2 , Síndrome de Resposta Inflamatória SistêmicaRESUMO
Introduction: Antibiotic resistance is an increasingly growing health problem worldwide, so it is imperative to look for new, more effective antibiotics. Ceftaroline has a broad spectrum of activity against clinically relevant Grampositive strains, including methicillin-resistant Staphylococcus aureus and resistant Streptococcus pneumoniae strains, as well as Gram-negative pathogens implicated in skin and soft tissue infections or community-acquired pneumonia; it is therefore a potential therapeutic option. We conducted a systematic review to assess whether ceftaroline was safer and more effective than comparators. Material and methods: A comprehensive bibliographic search was done to identify experimental clinical trials that compared the safety and effectiveness of ceftaroline to a comparator in the pediatric population. The rate of therapeutic failure was used to determine the effectiveness, while the presence of any adverse event was considered for safety. Results: Three studies were identified: two in community-acquired pneumonia and one in skin and soft tissue infections. No study showed a difference in the risk for therapeutic failure, relative risk (RR): 0.97 (0.54-1.73), or safety criterion, RR: 0.79 (0.51-1.23). Conclusions: The available evidence suggests that ceftaroline may be a valid therapeutic option for the management of skin and soft tissue infections or community-acquired pneumonia in pediatric patients. No studies with a high-quality of evidence were observed in other types of infections or in patients admitted to the critical care unit.
Introducción. La resistencia a los antibióticos plantea un problema de salud mundial cada vez mayor, por lo que la búsqueda de nuevos y más efectivos antibióticos es prioritaria. La ceftarolina tiene un amplio espectro de actividad contra cepas Gram-positivas clínicamente relevantes, que incluyen el Staphylococcus aureus meticilino resistente y cepas de Streptococcus pneumoniae resistentes, así como algunos patógenos Gram-negativos implicados en infecciones de piel y tejidos blandos o en la neumonía adquirida en la comunidad; es una potencial opción terapéutica. Se realizó una revisión sistemática que evaluó si la ceftarolina era más efectiva y segura que los comparadores. Material y métodos. Se realizó una búsqueda bibliográfica exhaustiva para identificar estudios clínicos experimentales que compararan la seguridad y eficacia de la ceftarolina con un comparador en la población pediátrica. El criterio de evaluación de eficacia fue la tasa de fracaso terapéutico y, para seguridad, la presencia de cualquier efecto adverso. Resultados. Se identificaron tres estudios, 2 de neumonía adquirida en la comunidad y uno de infecciones de piel y tejidos blandos. En ninguno, se detectó diferencia en el riesgo de fracaso terapéutico, RR 0,97 (0,54-1,73), ni en el criterio de seguridad, RR 0,79 (0,51-1,23). Conclusiones. La evidencia disponible sugiere que la ceftarolina podría ser una opción terapéutica válida en el tratamiento de las infecciones de piel y tejidos blandos o neumonía adquirida en la comunidad en pacientes pediátricos. No se encontraron trabajos de alta calidad de evidencia en otro tipo de infecciones o en pacientes admitidos en la Unidad de Cuidados Críticos.
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Antibacterianos/uso terapêutico , Infecções Bacterianas/tratamento farmacológico , Cefalosporinas/uso terapêutico , Infecções Bacterianas/microbiologia , Cefalosporinas/efeitos adversos , Criança , Farmacorresistência Bacteriana , Humanos , Resultado do Tratamento , CeftarolinaRESUMO
BACKGROUND: Resistance to antibiotics is steadily increasing. Ceftaroline has a broad spectrum of activity against clinically relevant gram-positive strains including methicillin-resistant Staphylococcus aureus. OBJECTIVES: This systematic review was conducted to evaluate whether ceftaroline is effective and safe, leading to a lower rate of treatment failures than comparators. MATERIAL AND METHODS: Studies were included if they were comparing the efficacy and safety of ceftaroline with other antibiotics. DATA SOURCES: Using the search terms 'ceftaroline' or 'ceftaroline fosamil', a search strategy was developed. The efficacy endpoint was the rate of treatment failure, while the safety endpoint was the incidence of adverse events. Heterogeneity bias was estimated using the Q-test, and publication bias was estimated using Egger's test. Null hypothesis was rejected if p value was less than 0.05. RESULTS: Only 10 studies were included. SYNTHESIS OF RESULTS: The risk of treatment failure was significantly lower for ceftaroline than for comparators, and cumulative meta-analysis showed that the effect size was relevant and precise. Pooled risk ratio was 0.79 (95% confidence interval = 0.65-0.95). The rates of adverse events were similar among the studies, and there were no statistically significant differences between groups. For this endpoint, there was a significant heterogeneity among studies (p = 0.03). Pooled risk ratio for adverse events was 0.98 (95% confidence interval = 0.87-1.10), without a statistical difference. DISCUSSION: The risk of treatment failure was significantly lower for ceftaroline than comparators, while the rate of adverse events was similar. To the best of our knowledge, this is the first systematic review on the efficacy and safety of ceftaroline including children and adults. A limitation is that no randomized controlled trials were found in non-complicated skin- and soft-tissue infection and non-community-acquired pneumonia infections; only few cases with methicillin-resistant Staphylococcus aureus isolations and no patients admitted to the intensive care unit were evaluated. INTERPRETATION: Ceftaroline may be an option of treatment in complicated skin- and soft-tissue infection and community-acquired pneumonia.
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BACKGROUND: The aim of this study was to assess whether daptomycin is safer and more efficacious than comparators for the treatment of serious infection caused by gram-positive microorganisms. METHODS: Electronic databases (Medline, EMBASE, the Cochrane Central Register of Controlled Trials and clinical registered trials) were searched to identify randomized controlled trials (RCTs) that assessed the efficacy and safety of daptomycin versus therapy with any other antibiotic comparator. Two reviewers independently applied selection criteria, performed a quality assessment and extracted the data. Heterogeneity was assessed, and a random-effects or fixed-effects model, when appropriate, was used for estimates of risk ratio (RR). The primary outcome assessed was the risk of clinical treatment failure among the intention-to-treat population and the presence of any treatment related adverse event (AEs). RESULTS: A total of seven trials fulfilled the inclusion criteria. Daptomycin treatment failure rates were no different to comparator regimens (RR = 0.96; CI 95% 0.86-1.06). No significantly different treatment related AEs were identified when comparing groups (RR = 0.91; CI 95% 0.83-1.01). CONCLUSIONS: No significant differences in treatment failure rates and safety were found using daptomycin or any of the comparators treatment.
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BACKGROUND: It is uncertain whether amnioinfusion (infusion of saline into the amniotic cavity) in women who have thick meconium staining of the amniotic fluid reduces the risk of perinatal death, moderate or severe meconium aspiration syndrome, or both. METHODS: We performed a multicenter trial in which 1998 pregnant women in labor at 36 or more weeks of gestation who had thick meconium staining of the amniotic fluid were stratified according to the presence or absence of variable decelerations in fetal heart rate and then randomly assigned to amnioinfusion or to standard care. The composite primary outcome measure was perinatal death, moderate or severe meconium aspiration syndrome, or both. RESULTS: Perinatal death, moderate or severe meconium aspiration syndrome, or both occurred in 44 infants (4.5 percent) of women in the amnioinfusion group and 35 infants (3.5 percent) of women in the control group (relative risk, 1.26; 95 percent confidence interval, 0.82 to 1.95). Five perinatal deaths occurred in the amnioinfusion group and five in the control group. The rate of cesarean delivery was 31.8 percent in the amnioinfusion group and 29.0 percent in the control group (relative risk, 1.10; 95 percent confidence interval, 0.96 to 1.25). CONCLUSIONS: For women in labor who have thick meconium staining of the amniotic fluid, amnioinfusion did not reduce the risk of moderate or severe meconium aspiration syndrome, perinatal death, or other major maternal or neonatal disorders.
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Síndrome de Aspiração de Mecônio/prevenção & controle , Complicações do Trabalho de Parto/terapia , Cloreto de Sódio/uso terapêutico , Líquido Amniótico , Feminino , Sofrimento Fetal , Humanos , Mortalidade Infantil , Recém-Nascido , Doenças do Recém-Nascido/prevenção & controle , Infusões Parenterais , Gravidez , Resultado da Gravidez , Falha de TratamentoRESUMO
INTRODUCCIÓN: Los estudios sobre la infección fúngica invasora (IFI) por Fusarium spp en pacientes pediátricos con patología hemato-oncológica, son escasos, correspondiendo en general a series clínicas descriptas en forma retrospectiva, lo que dificulta conocer en profundidad sus características y evolución. OBJETIVO: Analizar la evolución fatal de la IFI causada por Fusarium spp en pacientes pediátricos con patología hemato-oncológica, llevándose a cabo una revisión sistemática. MATERIAL Y MÉTODOS: La búsqueda bibliográfica se realizó con fecha 23 de marzo de 2023, en las principales bases de datos (Medline (a través de PubMed), Embase (a través de Embase-Elsevier), The Cochrane Library (a través de Wiley), Cinahl (a través de EbscoHOST), SCI-EXPANDED y Scielo (a través de la WOS) y Scopus (a través de Scopus-Elsevier) y libre (mediante el motor Google) y revisando las citas de los artículos incluidos. RESULTADOS: Se rescataron 1.341 artículos, de los cuales se descartaron 931 por diversas razones. Mediante el análisis de los textos completos, finalmente se incluyeron 11 estudios. Todos los estudios eran de nivel 4 (serie de casos). Se detectó una notoria heterogeneidad (p < 0,008) entre los mismos. La mediana de la frecuencia de muerte observada implicó a un tercio de los afectados (Md 33 %; Q1:22,7-Q4:75). CONCLUSIONES: La mortalidad por IFI por Fusarium spp fue alta en niños con patología hemato-oncológica, en especial en aquellos con neutropenia profunda y mala respuesta al tratamiento de su enfermedad de base
BACKGROUND: Studies on invasive fungal infection (IFI) by Fusarium spp in pediatric patients with hemato-oncological pathology are scarce and limited and a few series of cases described retrospectively, which makes it difficult to fully understand their characteristics and outcome. With the aim of analyzing the fatal evolution of these patients, this systematic review was carried out. METHODS: The literature search was performed up to March 23, 2023, in the main databases, as Medline (through PubMed), Embase (through Embase-Elsevier), The Cochrane Library (through Wiley), Cinahl (through EbscoHOST), SCI-EXPANDED and Scielo (through WOS) and Scopus (through Scopus-Elsevier) and free (through the Google engine) and reviewing the citations of the included articles. RESULTS: 1341 articles were retrieved, of which 931 were discarded for various reasons. By analyzing its full texts, 11 studies were finally included. It was observed that heterogeneity among them was relevant (p < 0.008). Median frequency of death involved one third of those affected (Md 33%; Q1:22,7-Q4:75). CONCLUSIONS: Mortality due to IFI due to Fusarium spp was high in children with hemato-oncological pathology, especially in those with severe neutropenia and poor response to treatment of their underlying disease.
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Humanos , Criança , Neoplasias Hematológicas/complicações , Fusariose/mortalidade , Infecções Fúngicas Invasivas/mortalidade , Fatores de Risco , Neoplasias Hematológicas/mortalidade , FusariumRESUMO
BACKGROUND: Voriconazole is a second-generation triazole. It has excellent bioavailability and broad antifungal spectrum; thus, it is an attractive option for patients at high risk of invasive fungal infections (IFIs). Comparing efficacy and safety of voriconazole with other antifungals in prophylaxis or treatment of IFIs would be useful to draw conclusions regarding prevention and therapeutics of these infections. AIM: To assess efficacy and safety of voriconazole compared with other options as prophylaxis or treatment of IFIs in haematology-oncology patients. MATERIALS AND METHODS: A literature search was performed in MEDLINE database using the search term 'voriconazole' and completed with manual search. STUDY SELECTION: Randomized controlled trials (RCTs) comparing voriconazole with other antifungal agents or placebo. DATA EXTRACTION: Seven studies fulfilled the eligibility criteria. RESULTS: Five studies compared voriconazole to another comparator as prophylaxis of IFIs and two as treatment. Pooled results showed that voriconazole was more effective than the comparator (RR = 1.17; 95%CI = 1.01-1.34), but heterogeneity was significant (Q test 32.7; p = .00001). Sub-analysis according to prophylaxis showed RR = 1.17; 95%CI = 1.00-1.37; while as treatment, RR = 1.23; 95%CI = 0.68-2.22. Risk of adverse events was not different from that observed for the comparator (RR = 1.06, 95%CI = 0.66-1.72) though significant heterogeneity was detected (p < .01). CONCLUSIONS: Voriconazole was as effective and safe as comparators, probably better as prophylaxis than as treatment, but limitations due to variability in the sample size of studies, differences in the age of patients, and heterogeneity between studies' outcome measures indicate the need for further research.
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Antifúngicos/administração & dosagem , Antifúngicos/efeitos adversos , Hospedeiro Imunocomprometido/efeitos dos fármacos , Voriconazol/administração & dosagem , Voriconazol/efeitos adversos , Adolescente , Antifúngicos/uso terapêutico , Criança , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos , Humanos , Infecções Fúngicas Invasivas/tratamento farmacológico , Infecções Fúngicas Invasivas/prevenção & controle , Leucemia Mieloide Aguda/complicações , Micoses/tratamento farmacológico , Micoses/prevenção & controle , Leucemia-Linfoma Linfoblástico de Células Precursoras/complicações , Ensaios Clínicos Controlados Aleatórios como Assunto , Voriconazol/uso terapêutico , Adulto JovemRESUMO
There is limited information on the use of posaconazole in children. This retrospective and descriptive study was conducted to evaluate the clinical, microbiological characteristics and evolution of patients treated with posaconazole between August 2010 and March 2017. We included 16 children. Median age: 161 months (interquartile range -IQR- 69-173 m). All had underlying disease and a proven invasive fungal infection. The most frequent isolated were Mucor spp. and Aspergillus spp. The mean posaconazole dose was 600 mg/day (400-800 mg/day) and the median duration of treatment was 223 days (IQR 48-632). Ten patients had adverse effects, but only one required suspension of the antifungal treatment due to hydroelectrolytic disorders.
La información sobre el uso de posaconazol en niños es escasa. Se realizó este estudio descriptivo retrospectivo entre agosto de 2010 y marzo de 2017 para evaluar las características clínicas, microbiológicas y la evolución de los pacientes tratados con posaconazol. Se incluyeron 16 niños. Mediana de edad: 161 meses (rango intercuartílico RIC 69-173 m). Todos tenían enfermedad subyacente y presentaban infección fúngica invasiva probada. Los aislamientos más frecuentes fueron Mucor spp. y Aspergillus spp. La dosis media de posaconazol fue 600 mg/ día (400-800 mg/día) y la mediana de duración del tratamiento, 223 días (RIC 48-632). Diez pacientes presentaron efectos adversos, pero solo uno requirió suspensión del antifúngico debido a alteraciones hidroelectrolíticas.
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Antifúngicos/uso terapêutico , Infecções Fúngicas Invasivas/tratamento farmacológico , Triazóis/uso terapêutico , Adolescente , Antifúngicos/administração & dosagem , Antifúngicos/efeitos adversos , Criança , Pré-Escolar , Relação Dose-Resposta a Droga , Hospitais Pediátricos , Humanos , Infecções Fúngicas Invasivas/microbiologia , Estudos Retrospectivos , Centros de Atenção Terciária , Fatores de Tempo , Triazóis/administração & dosagem , Triazóis/efeitos adversosRESUMO
INTRODUCCIÓN: En los niños, la bacteriemia debida a Burkholderia cepacia, es considerada una complicación grave y conducente a una elevada mortalidad. Con el objetivo de conocer la mortalidad asociada a esa condición, se realizó una revisión sistemática de la literatura médica. MATERIAL Y MÉTODOS: Se aplicó una estrategia de búsqueda bibliográfica con las palabras claves: "bacteriemia por B. cepacia", "humanos", "niños" y "adolescentes", como únicos filtros. Se informan la mediana y los valores intercuartílicos de la frecuencia de la mortalidad reportada por los estudios incluidos. RESULTADOS: Se identificaron 92 estudios potencialmente útiles. De ellos, se descartaron 81, incluyéndose finalmente, 11 estudios. Se trató de descripciones retrospectivas de casos, salvo uno de ellos, que respondió a un diseño analítico caso-control. La mediana de la mortalidad reportada por esta revisión, fue 0 (Q25 = 0 y Q75 = 28,57%). INTERPRETACIÓN: Si bien la evidencia disponible es escasa y de baja calidad, sugiere que el curso clínico de esta afección no siempre resulta en una elevada mortalidad.
BACKGROUND: Bacteremia due to Burkolderia cepacia in children is considered a severe complication and associated with high mortality incidence. In order to know the level of mortality associated with it, this systematic review of the literature was carried out. METHODS: A search strategy was carried out with the keywords: "bacteremia by B cepacia and human" and "children" and "adolescents" as filters. Global frequency of mortality reported by the included studies was calculated and informed as median (Q2) and its interquartile values (Q1 and Q3). RESULTS: The search identified 92 potentially useful studies. Of these, 81 were discarded, and then remained 11 studies to be included. One out of 11 studies is an analytic case-control design. Rest are retrospective case series. Related mortality median was 0 (Q25 = 0 and Q75 = 28,57%). CONCLUSION: Although the available evidence is scarce and of low quality, it suggests that clinical course of this condition does not always lead to high mortality rates.
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Humanos , Criança , Bacteriemia/mortalidade , Infecções por Burkholderia/mortalidade , Burkholderia cepaciaRESUMO
The experience using anidulafungin for the treatment of invasive fungal infections in pediatrics is limited. In this article, we describe our experience in 55 children. Anidulafungin was administered intravenously at a loading dose of 3 mg/kg once daily, followed by 1.5 mg/kg every 24 hours over a mean period of 14 days (range: 7-22 days). Patients' median age was 114 months old (interquartile range: 32-168 months old). All patients had underlying diseases. Among patients with bone marrow transplant, the difference in white blood cell count, transaminase levels, and renal function at baseline and at the end of anidulafungin administration was not significant. No adverse events were reported and no patient died from an anidulafungin-related cause. Anidulafungin may be considered an alternative for the prophylaxis or treatment of invasive fungal infections in pediatrics but methodologically robust studies are needed to confirm this.
La experiencia con anidulafungina en el tratamiento de infecciones fúngicas invasivas en pediatría es escasa. Se presenta nuestra experiencia en 55 niños. La anidulafungina se administró por vía intravenosa en la dosis de carga de 3 mg/kg en una sola dosis diaria, seguida de 1,5 mg/kg cada 24 h durante una media de 14 días (rango, 7-22 d.). La mediana de edad de los pacientes fue de 114 meses (rango intercuartílico, 32-168 m.). Todos los pacientes tenían enfermedades subyacentes. En los trasplantados de médula ósea, la diferencia entre el valor inicial y al final de la administración del fármaco en el recuento de glóbulos blancos, valores de transaminasas y función renal no fue significativo. Ninguno de los pacientes tuvo eventos adversos o murió por causas relacionadas con anidulafungina. La anidulafungina podría ser una opción para la profilaxis o el tratamiento de las infecciones fúngicas invasivas en pediatría, aunque se requieren estudios metodológicamente sólidos para probarlo.
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Antifúngicos/uso terapêutico , Equinocandinas/uso terapêutico , Micoses/tratamento farmacológico , Adolescente , Anidulafungina , Argentina , Criança , Pré-Escolar , Humanos , Estudos Prospectivos , Centros de Atenção Terciária , Atenção Terciária à SaúdeRESUMO
INTRODUCCIÓN: La neutropenia febril en niños con patología oncohematològica requiere un tratamiento empírico precoz y adecuado. Esta revisión sistemática se realizó para evaluar si piperacilina/tazobactam (PTZ) monoterapia es más efectiva y segura que los comparadores, en niños con episodios de neutropenia febril de causa oncológica. MATERIAL Y MÉTODOS: Se realizó una búsqueda bibliográfica en Embase, MEDLINE utilizando los términos de búsqueda (('febrile neutropenia' OR hemato oncology OR haemato oncology OR 'immunocompromised host' OR 'immunocompromised patient' OR 'chemotherapy-induced febrile neutropenia') AND (piperacillin OR tazobactam OR 'piperacillin plus tazobactam' OR 'piperacillin/tazobactam' OR 'piperacillin-tazobactam' OR tazocin OR 'piperacillin-tazobactam drug combination')). El criterio de valoración de eficacia fue la incidencia de fracaso terapéutico. El punto final de seguridad fue la ausencia de cualquier efecto adverso (EA). RESULTADOS: Se identificaron 1.388 estudios, de los cuales se incluyeron 11 que cumplían los criterios de elegibilidad. Los estudios presentaron notable homogeneidad ( I 2 0%) y no se detectó sesgo de publicación (p 0,36). El riesgo de fracaso terapéutico de PTZ no fue mayor que en los comparadores (RR global: 0,94; IC95% 0,83 a 1,07) como tampoco lo fue, la incidencia de EA. CONCLUSIONES: El riesgo de fracaso terapéutico no fue superior para la PTZ como monoterapia frente a los comparadores
BACKGROUND: Febrile neutropenia in children with onco-hematological diseases is an important cause of morbidity and mortality and requires early and adequate empirical treatment. This systematic review was conducted to evaluate if piperacillin/ tazobactan (PTZ) monotherapy leads to a lower incidence of therapeutic failures than comparators. METHODS: A literature search was carried out in Embase, and MEDLINE databases using the search terms ('febrile neutropenia' OR hemato oncology OR haemato oncology OR 'immunocompromised host' OR 'immunocompromised patient' OR 'chemotherapy-induced febrile neutropenia') AND (piperacillin OR tazobactam OR 'piperacillin plus tazobactam' OR 'piperacillin/tazobactam' OR 'piperacillin-tazobactam' OR tazocin OR 'piperacillin-tazobactam drug combination')), Efficacy endpoint was treatment failure rate. The safety end-point was absence of any adverse effects (AE). RESULTS: Eleven studies were included. No heterogeneity was detected ( I 2 0%). The risk of failure was not superior for piperacillin/tazobactan to comparators (Global RR: 0.94; IC95% 0.83 a 1.07). Rates of adverse events were similar among studies. No publication bias was detected (p 0.36). CONCLUSIONS: This systematic review and meta-analysis showed that treating episodes of febrile neutropenia in oncology pediatric patients, the risk of failure for PTZ was not superior to comparators. Adverse events were similar to the comparators.
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Humanos , Neoplasias/complicações , Neoplasias/tratamento farmacológico , Neutropenia/tratamento farmacológico , Piperacilina/efeitos adversos , Hospedeiro Imunocomprometido , Ácido Penicilânico/efeitos adversos , Quimioterapia Combinada , Antibacterianos/efeitos adversos , Neutropenia/induzido quimicamenteRESUMO
INTRODUCTION: Invasive fungal infections are a significant cause of morbidity and mortality in children. Caspofungin is an echinocandin used as an alternative treatment in the prevention and/or treatment of certain invasive fungal infections in children, although compared to the standard treatment there is little evidence on its efficacy and safety. OBJECTIVE: To evaluate the efficacy and safety of caspofungin compared with other antifungal drugs for the prevention and/or treatment of invasive fungal infections in children. MATERIALS AND METHODS: The objective of the initial search strategy was to identify randomized controlled studies of acceptable methodological quality (Jadad scale >3), through the key word "caspofungin", conducted in patients with an age range from 0 to 18 years old. RESULTS: The objective of the initial search strategy was to identify randomized controlled studies of acceptable methodological quality (Jadad scale >3), through the key word "caspofungin", conducted in patients with an age range from 0 to 18 years old. CONCLUSIONS: This systematic review suggests that caspofungin could be considered as an alternative drug in children for the prevention and treatment of invasive fungal infections. However, given the small number of existing publications, more studies are required to reach definite conclusions.
INTRODUCCIÓN: Las infecciones fúngicas invasivas son una importante causa de morbimortalidad en pediatría. La caspofungina es una equinocandina utilizada como alternativa en la prevención y/o tratamiento de ciertas infecciones fúngicas invasivas en niños, aunque con poca evidencia sobre su eficacia y seguridad en comparación con el tratamiento habitual. OBJETIVO: Evaluar la eficacia y seguridad de la caspofungina comparada con otros antifúngicos en la prevención y/o tratamiento de infecciones fúngicas invasivas en pediatría. MATERIAL Y MÉTODOS: La estrategia de búsqueda inicial tuvo como objetivo identificar estudios controlados aleatorizados de aceptable calidad metodológica (escala de Jadad ã 3) mediante la palabra clave "caspofungin" realizados en pacientes de entre los 0 y los 18 años. RESULTADOS: Solo 3 publicaciones cumplieron los criterios de inclusión. De ellas, 2 fueron en población pediátrica y una en neonatal. No se documentó una mayor incidencia de efectos adversos para la caspofungina y su eficacia no se diferenció de otros antifúngicos (RR típico 1,47; IC 95%: 0,78-2,79). CONCLUSIONES: Esta revisión sistemática sugiere que la caspofungina podría considerarse como una alternativa para su indicación en pediatría en la prevención y tratamiento de las infecciones fúngicas invasivas. Sin embargo, dado el pequeño número de publicaciones existentes, se requieren más estudios para alcanzar conclusiones definitivas.
Assuntos
Antifúngicos/uso terapêutico , Equinocandinas/uso terapêutico , Lipopeptídeos/uso terapêutico , Micoses/tratamento farmacológico , Caspofungina , Criança , Humanos , Resultado do TratamentoRESUMO
Studies about risk factors for mortality in burn children are scarce and are even less in the follow up of this population across time. Usually, after complete event attendance, children are not follow-up as risk patients, burn injury affects all facets of life. Integration of professionals from different disciplines has enabled burn centers to develop collaborative methods of assessing the quality of care delivered to patients with burns. In this editorial we comment the paper of Duke et al. The authors highlight the importance of maintaining a long-term monitoring of children who suffered burns. The importance of this original study is to promote the reconsideration of clinical guides of long-term follow-up of burn patients.
RESUMO
UNLABELLED: C-reactive protein (CRP) and procalcitonin(PCT) levels may distinguish between a systemic inflammatory response and an infection in burn children. OBJECTIVES: To establish the operative capability of CRP and PCT to diagnose infections and mortality. METHODS: Burn patients admitted to the hospital with clinical suspicion of an infection were included. CRP and PCT were measured and their operative diagnostic capabilities were calculated. RESULTS: Forty-eight patients (p) were included.Their median age was 49 months old (r: 17-86).The median burned surface area was 40% (r: 30-48%); 28 p (58%) had type AB and type B burn wounds. Infection was confirmed in 32 p (66.7%);the most common infection was burn-related sepsis (24 p, 75%), followed by burn wound infection (6 p, 19%). Eight patients (17%) died.It was not possible to establish CRP sensitivity and specificity because it was high in all patients,regardless of mortality, survival or the presence of infection. In relation to infections, PCT had a 90.6% sensitivity (95% confidence interval [CI]:75.8-96.8%), a 18.8% specificity (95% CI: 6.6-43%),a 69% positive predictive value (PPV) and a 50%negative predictive value (NPV). In relation to 30-day mortality, sensitivity was 100% (95% CI:67.6-100%), specificity 15% (95% CI: 7.1-29.1%),PPV 19% (95% CI: 10-33.3%) and NPV 100%(95% CI: 61-100%). CONCLUSIONS: In pediatric burn patients, neither CRP nor PCT showed an adequate operative capability to detect an infection or a fatal outcome.
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Infecções Bacterianas/sangue , Infecções Bacterianas/diagnóstico , Queimaduras/sangue , Queimaduras/mortalidade , Proteína C-Reativa/análise , Calcitonina/sangue , Infecções Bacterianas/etiologia , Queimaduras/complicações , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Valor Preditivo dos Testes , Estudos ProspectivosRESUMO
UNLABELLED: Studies about risk factors for mortality in burn children are scarce. We conducted this study to evaluate the risk factors for mortality in pediatric burn patients. We included 110 patients. Mean age was 31.5 months (range: 1 to 204). The burn surface was between 1% and 95%(median 27%) Type of burn was: A or superfitial in 39 patients (36%), AB or intermediate in 19 (17%), and B or full thickness in 52 (47%). Inhalatory injury was present in 52 patients (47%). Invasive procedures were: venous catheter, 90 patients (82%), arterial catheter, 83 patients (75.5%), urinary catheter, 86 patients (78%), and mechanical ventilation, 75 patients (68%). In 84 patients, 128 infections were diagnosed. in 53 cases (48%). Multiresistant Pseudomonas aeruginosa and Acynetobacter baumannii were the most common organisms isolated. The median length of hospital stay was 33 days (r: 8-139 days). Seventeen patients (15%) died and 14 of them of infection-related causes. Age ≤ <4 years, Garcés 4, full thickness burn, ≥ 40% burn surface, presence of inhalatory syndrome, use of venous catheter, arterial catheter, urinary catheter and mechanical ventilation, positive blood cultures, colistin use in documented multiresistant infections, antifungal use and graft requirement, were identified as risks factors for mortality in the univariate analysis. By multivariate analysis: age ≤ 4 years, Garcés 4, colistin use in multiresistant infections, mechanical ventilation and graft requirement were independent variables related with mortality. CONCLUSIONS: In this series of burn children age ≤ 4 years, Garces index score 4, colistin use in documented multiresistant infections, mechanical ventilation and graft requirement were identified as independent variables related with mortality.
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Queimaduras/mortalidade , Adolescente , Argentina/epidemiologia , Queimaduras/microbiologia , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Tempo de Internação , Masculino , Estudos Prospectivos , Fatores de RiscoRESUMO
Introducción. La resistencia a los antibióticos plantea un problema de salud mundial cada vez mayor, por lo que la búsqueda de nuevos y más efectivos antibióticos es prioritaria. La ceftarolina tiene un amplio espectro de actividad contra cepas Gram-positivas clínicamente relevantes, que incluyen el Staphylococcus aureus meticilino resistente y cepas de Streptococcus pneumoniae resistentes, así como algunos patógenos Gram-negativos implicados en infecciones de piel y tejidos blandos o en la neumonía adquirida en la comunidad; es una potencial opción terapéutica. Se realizó una revisión sistemática que evaluó si la ceftarolina era más efectiva y segura que los comparadores. Material y métodos. Se realizó una búsqueda bibliográfica exhaustiva para identificar estudios clínicos experimentales que compararan la seguridad y eficacia de la ceftarolina con un comparador en la población pediátrica. El criterio de evaluación de eficacia fue la tasa de fracaso terapéutico y, para seguridad, la presencia de cualquier efecto adverso. Resultados. Se identificaron tres estudios, 2 de neumonía adquirida en la comunidad y uno de infecciones de piel y tejidos blandos. En ninguno, se detectó diferencia en el riesgo de fracaso terapéutico, RR 0,97 (0,54-1,73), ni en el criterio de seguridad, RR 0,79 (0,51-1,23). Conclusiones. La evidencia disponible sugiere que la ceftarolina podría ser una opción terapéutica válida en el tratamiento de las infecciones de piel y tejidos blandos o neumonía adquirida en la comunidad en pacientes pediátricos. No se encontraron trabajos de alta calidad de evidencia en otro tipo de infecciones o en pacientes admitidos en la Unidad de Cuidados Críticos.
Introduction. Antibiotic resistance is an increasingly growing health problem worldwide, so it is imperative to look for new, more effective antibiotics. Ceftaroline has a broad spectrum of activity against clinically relevant Grampositive strains, including methicillin-resistant Staphylococcus aureus and resistant Streptococcus pneumoniae strains, as well as Gram-negative pathogens implicated in skin and soft tissue infections or community-acquired pneumonia; it is therefore a potential therapeutic option. We conducted a systematic review to assess whether ceftaroline was safer and more effective than comparators. Material and methods. A comprehensive bibliographic search was done to identify experimental clinical trials that compared the safety and effectiveness of ceftaroline to a comparator in the pediatric population. The rate of therapeutic failure was used to determine the effectiveness, while the presence of any adverse event was considered for safety. Results. Three studies were identified: two in community-acquired pneumonia and one in skin and soft tissue infections. No study showed a difference in the risk for therapeutic failure, relative risk (RR): 0.97 (0.54-1.73), or safety criterion, RR: 0.79 (0.51-1.23). Conclusions. The available evidence suggests that ceftaroline may be a valid therapeutic option for the management of skin and soft tissue infections or community-acquired pneumonia in pediatric patients. No studies with a high-quality of evidence were observed in other types of infections or in patients admitted to the critical care unit.
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Humanos , Lactente , Pré-Escolar , Criança , Adolescente , Segurança , Eficácia , Revisão Sistemática , CefalosporinasRESUMO
INTRODUCTION: Burns are the third cause of accidental deaths among children. Approximately 50-60% of these deaths are the result of an infection. OBJECTIVE: To determine infection related risk factors in burned children. POPULATION AND METHODS: All patients admitted to the Burn Unit of Hospital "Prof. Dr. Juan P. Garrahan" between June 2007 and December 2009 were included. The epidemiology of hospital-acquired infections and the associated outcome measures were determined. Groups of infected and non-infected children were compared using Student's t test or the Mann-Whitney Rank Sum test, as applicable. Dichotomous outcome measures were analyzed with the X2 test using Yates' correction. In order to assess the predictive value of independent outcome measures, the multiple logistic regression model was applied. RESULTS: In this cohort of 110 children, 128 hospital-acquired infections were recorded in 84 patients. There were 17 deaths (15%); 14 out of these 17 (82%) were related to infection. Infection-related factors included the percentage of burned body surface area; the highest Garces' index; burn depth; antibiotic prophylaxis; the use of topical antibiotics; the presence of a central venous line, an arterial line, a urinary catheter, mechanical ventilation support, escharotomy, and the need of a graft. The multivariate analysis showed a higher risk of infection with the use of central venous lines (RR: 5.15; 95% CI: 1.44-18.46), antibiotic prophylaxis (RR: 5.22; 95% CI: 1.26-21.63), and graft requirement (RR: 3.65; 95% CI: 1.08-12.37). CONCLUSIONS: The presence of lines or catheters, antibiotic prophylaxis, and graft requirement were independent risk factors for infection in burned children.