RESUMO
BACKGROUND: Thrombopenia is correlated with sepsis and mortality in pediatric intensive care units. The purpose of this study was to find an association between thrombopenia and the microorganism type to guide the choice of empiric antibiotic therapy in infected critically ill children. MATERIALS AND METHODS: We conducted a prospective descriptive study, including all newborns, infants, and children admitted to a pediatric surgical intensive care unit from 1st January to 31st December 2009. We identified patients who developed an infection and/or thrombopenia (platelet count less than 100,000/mm(3)) during hospitalization. RESULTS: One hundred ninety-seven patients were included (57 newborns, 41 infants, 99 children). Ninety patients developed 100 infectious episodes during the study period. Of the 57 newborns enrolled in the study, 31 (54%) developed 37 infections. Seventy-six microorganisms (55 Gram-negative bacilli [GNB], 17 Gram-positive cocci, two Gram-negative cocci, two fungal pathogens) were identified during 65 infectious episodes in 55 patients. Thirty-four episodes of thrombopenia were observed in 30 patients. Thrombopenia was observed only in infected patients (P<0.001). Thrombopenia was associated with infections caused by GNB (26/28 vs 20/37, P=0.001) and by Klebsiella (16/28 vs 6/37, P=0.001) and may be associated with infections caused by GNB producing extended-spectrum beta-lactamases (P=0.07). Gram-positive cocci infections were correlated to the non-occurrence of thrombopenia (P=0.02). Postoperative peritonitis was also significantly associated with thrombopenia (P=0.03). The mortality rate in our patients was 12.7% (22.8% in neonates). There was an association between thrombopenia and death in univariate analysis (11/25 vs 19/172, P<0.001). Multivariate logistic regression analysis did not confirm thrombopenia as an independent predictive factor of mortality in children. CONCLUSION: Because of the relatively high proportion of resistant GNB, an empiric antibiotic therapy combining a carbapenem and an aminoglycoside may be indicated in infected critically ill children developing thrombopenia.
Assuntos
Infecções por Bactérias Gram-Negativas/epidemiologia , Sepse/microbiologia , Trombocitopenia/epidemiologia , Pré-Escolar , Estado Terminal , Feminino , Bactérias Gram-Negativas/isolamento & purificação , Mortalidade Hospitalar , Humanos , Lactente , Recém-Nascido , Unidades de Terapia Intensiva Pediátrica , Masculino , Peritonite/epidemiologia , Complicações Pós-Operatórias , Estudos Prospectivos , Sepse/epidemiologia , Tunísia/epidemiologiaAssuntos
Encefalopatias Metabólicas , Hiponatremia , Nefrectomia , Complicações Pós-Operatórias , Encefalopatias Metabólicas/diagnóstico , Encefalopatias Metabólicas/terapia , Feminino , Humanos , Hiponatremia/diagnóstico , Hiponatremia/terapia , Lactente , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/terapiaRESUMO
OBJECTIVE: The aim of our study was to determine risk factors associated with nosocomial infections in children hospitalized for skin burn. STUDY DESIGN: Prospective study including children hospitalized for skin burn. METHODS: We collected demographic characteristic, mode of admission, mechanism of burn, extent of burn surface by the tables of Lund and Browder, depth of the lesions according to clinical criteria and evolution, type of invasive care (urinary catheterization, central catheterization or mechanical ventilation), nosocomial infection and its time of occurrence, prescription of empirical antibiotic therapy and evolution during hospitalization. The criteria for "American Burn Association" were used to define a severe burn in children. RESULTS: One hundred eighty-two children were included. In univariate analysis, six risk factors were significantly associated with the occurrence of nosocomial infection: extent of burn surface, severe burn, urinary catheterization and its duration and central catheterization and its duration. Extent of burn surface greater than 10% of total body surface is an independent factor of the occurrence of nosocomial infection (P=0.009) in Multivariate analysis. CONCLUSION: In our study, extent of burn surface greater than 10% of total body surface is as an independent risk factor for the occurrence of nosocomial infection.
Assuntos
Queimaduras/complicações , Infecção Hospitalar/epidemiologia , Infecção dos Ferimentos/epidemiologia , Antibacterianos/uso terapêutico , Queimaduras/classificação , Infecções Relacionadas a Cateter/tratamento farmacológico , Infecções Relacionadas a Cateter/epidemiologia , Infecções Relacionadas a Cateter/etiologia , Cateterismo Venoso Central/efeitos adversos , Criança , Pré-Escolar , Infecção Hospitalar/tratamento farmacológico , Infecção Hospitalar/etiologia , Feminino , Humanos , Incidência , Lactente , Masculino , Pneumonia Associada à Ventilação Mecânica/tratamento farmacológico , Pneumonia Associada à Ventilação Mecânica/epidemiologia , Pneumonia Associada à Ventilação Mecânica/etiologia , Estudos Prospectivos , Recidiva , Fatores de Risco , Índice de Gravidade de Doença , Fatores Socioeconômicos , Tunísia/epidemiologia , Cateterismo Urinário/efeitos adversos , Infecção dos Ferimentos/tratamento farmacológico , Infecção dos Ferimentos/etiologiaRESUMO
INTRODUCTION: Staphylococcus aureus, Kingella kingae and ß-hemolytic streptococcus are presently the most frequently identified bacteria in child haematogenous osteoarticular infection. OBJECTIVE: To determine the microbiological profile (bacteria and antibiotic susceptibility) of osteoarticular infections in a paediatric hospital, so as to adapt treatment protocols to the ecology of the bacteria isolated. PATIENTS AND METHODS: Prospective descriptive study, including children admitted for acute osteomyelitis or septic arthritis. A series of blood cultures was performed systematically on admission. In case of surgery, local samples were taken for bacteriology. Antibiotherapy was initiated and subsequently adapted to the bacteriological findings. RESULTS: One hundred and six children were included. Thirty-five were under (Group 1) and 71 over 3 years of age (Group 2). Ninety-five underwent surgery. Peroperative samples were positive in 61 cases and blood culture in 23. Bacteria were isolated in 22 patients in G1. Extended-spectrum ß-lactamase-producing Klebsiella pneumoniae was isolated in five neonates who had passed through intensive care. Staphylococcus aureus was the most frequently isolated bacterium in G2 (n=40), and was methicillin-resistant (MRSA) in six children. DISCUSSION: Methicillin-susceptible Staphylococcus aureus was the most frequently isolated microorganism. Other than neonates who had passed through intensive care and the six patients with community-acquired MRSA infection, all isolated bacteria were susceptible to second-generation cephalosporins. LEVEL OF EVIDENCE: II, prospective descriptive prognostic study.