[Clindamycin as adjuvant therapy in Staphilococcal skin scalded syndrome]. / Clindamicina como terapia adyuvante en el síndrome de piel escaldada estafilocócica.

Staphylococcal scalded skin syndrome (SSSS) is a dermatologic disease caused by exotoxins produced by Staphylococcus aureus. The disease presents as a painful cutaneous rash that culminates with the detachment of the superficial dermis. The usual treatment is antibiotics with beta-lactamase resistant penicillin. We report the case of a patient who presented with SSSS with initial torpid evolution despite antibiotic treatment and after the introduction of clindamycin IV experienced a very significant improvement. Concerns about the increase of methicillin resistant Staphylococcus aureus (MRSA) and the pathophysiology of this disease make bacteriostatic spectrum antistaphylococcal antibiotics, such as clindamycin, strong candidates for consideration as a first-line therapeutic arsenal for the treatment of SSSS.

[Domiciliary mechanical ventilation in children: a Spanish multicentre study]. / Ventilación mecánica domiciliaria en niños: estudio multicéntrico español.

INTRODUCTION: Domiciliary mechanical ventilation (DMV) use is increasing in children. Few studies have analysed the characteristics of patients using this technique. MATERIALS AND METHODS: An observational, descriptive, transversal, multicentre study was conducted on patients between 1 month and 16 years of age dependent on domiciliary mechanical ventilation. RESULTS: A total of 163 patients with a median age of 7.6 years from 17 Spanish hospitals were studied. The main reasons for DMV were neuromuscular disorders. The median age at beginning of DMV was 4.6 years. Almost three-quarters (71.3%) received non-invasive ventilation. Patients depending on invasive ventilation were younger, started DMV at an earlier age, and had more hours of mechanical ventilation per day. The large majority (80.9%) used DMV during sleep time only, and 11.7% during the whole day. Only 3.4% of patients had external health assistance. Just under half (48.2%) were being followed up in specific DMV or multidisciplinary clinics. Almost three-quarters (72.1%) of patients attended school (42.3% with adapted schooling). Only 47.8% of school patients had specific caregivers in their schools. CONCLUSIONS: DMV in children is used in a very heterogeneous group of patients, and in an important number of patients it is started before the third year of life. Despite there being a significant proportion of patients with a high dependency on DMV, few families receive specific support at home or at school, and health care surveillance is variable and poorly coordinated.

Reduction in pediatric invasive pneumococcal disease in the Basque Country and Navarre, Spain, after introduction of the heptavalent pneumococcal conjugate vaccine.

This study evaluated the incidence of invasive pneumococcal disease, identified the causal serotypes, and tracked the evolution of the antibiotic susceptibility of Streptococcus pneumoniae isolates in the regions of the Basque Country and Navarre, Spain, before and after the introduction of the heptavalent pneumococcal conjugate vaccine. The study included all children aged between birth and 5 years diagnosed with bacteremia, meningitis, or bacteremic pneumonia caused by pneumococci. By the second year after introduction of the heptavalent pneumococcal conjugate vaccine, compared with the period 1998-2001, the incidence of invasive disease decreased by 64.3% in children less than 12 months of age, by 39.7% in children less than 24 months of age, and by 37.5% in children less than 60 months of age. The prevalence of clinical isolates of S. pneumoniae that lacked susceptibility to penicillin decreased by 58.2% among children less than 60 months of age. With an estimated coverage by four-dose heptavalent pneumococcal conjugate vaccine of 28-45% in 2003, the number of invasive pneumococcal infections in the Basque Country and in Navarre fell significantly after just 2 years of immunization, underscoring the importance of improving vaccination coverage under a universal childhood immunization program.

[Activity of a short-stay observation unit in an emergency department of a tertiary hospital. A two-year experience]. / Actividad de una unidad de observación en un servicio de urgencias de un hospital terciario: dos años de experiencia.

OBJECTIVES: To describe the characteristics of the activity of a short stay observation unit (SSOU) in a tertiary hospital, and to analyze its influence on the hospitalization rate. MATERIAL AND METHODS: The activity of the SSOU during the first 2 years after opening is described. Descriptive variables were registered. Hospitalization activity during the first 5 months after opening the unit was compared with the activity during the same period in the previous year. RESULTS: From June 1, 2001 to May 31, 2003, 74,989 patients were admitted to the emergency department (ED) and 2,438 (3.25 %) were transferred to the SSOU. The mean age of the patients was 64.55 months. The mean length of stay was 5 hours and 50 minutes. The main discharge diagnoses were gastrointestinal disease (30.2 %), accidents (15 %), respiratory illness (12.5 %) and febrile syndrome (9.8 %). The hospitalization rate in patients admitted to the ED was 5.8 % from June 1, 2000 to October 1, 2000 and was 4.28 % in the same period in 2001. The mean diagnosis-related group (DRG)-weight was 0.8648 in 2000 and was 0.9078 in 2001. Total weight was 680.66 in 2000 and 495.69 in 2001, allowing an approximate saving of 329,162 Euros. CONCLUSIONS: The opening of the SSOU has been useful in the assessment and treatment of common childhood diseases and has helped reduce the hospitalization rate, increase the complexity of inpatients and lower costs.

[Study of the incidence of invasive pneumococcal disease in neonates and childre aged less than 5 years in the Basque country and Navarre (Spain)]. / Estudio de la incidencia de enfermedad neumocócica invasora entre 0-5 años en el País Vasco y Navarra.

BACKGROUND: Streptococcus pneumoniae is the most commonly reported bacterial cause of bacteremia and bacteremic pneumonia and the second most frequent cause of meningitis. OBJECTIVE: To establish the incidence, characteristics and serotypes causing invasive pneumococcal disease in children aged less than 5 years in two Autonomous Communities in Spain, the Basque country and Navarre, between 31 May 1988 and 1 June 2001. PATIENTS AND METHODS: We performed a descriptive, observational and retrospective study. The study population was composed of children diagnosed with invasive pneumococcal disease in the public and private hospitals with a pediatrics departments. Invasive pneumococcal disease was defined as isolation of S. pneumoniae in blood, cerebrospinal fluid or any other sterile biological fluid. Medical records were reviewed and demographic and diagnostic variables were analyzed. Age-adjusted frequency rates were established for both regions using direct standardization. Confidence intervals were obtained by Poisson distribution. SPSS for Windows 10.0 and Epidat 2.1 were used for the analysis. Data were obtained from the 1999 municipal population census. RESULTS: One hundred seventy-one children aged 0-5 years were included. A total of 40.9 % (70 patients) were aged less than 12 months and 68.4 % were aged 0-2 years; 16.4 % had received drug therapy before diagnosis. The most common forms of presentation were occult bacteremia (45.6 %), bacteremic pneumonia (27.5 %) and meningitis (14.6 %). The most frequent complications involved the respiratory tract, with pleural effusion in 23 % of cases of pneumonia. The standardized annual incidence rate of invasive pneumococcal disease (cases per 100,000) in children aged 0-59 months was 58.82 (95 % CI: 27.99-89.65) in Navarre and 55.35 (95 % CI: 38.81-71.88) in the Basque Country. In children aged 0-23 months, the overall incidence was 93.49 cases per 100,000 children (95 % CI: 77.32-112.04) and in infants aged 0-11 months, it was 110,21 cases per 100,000 children (95 % CI: 85.91-139.24). The incidence rates for meningitis and bacteremia in children aged 0-23 months was 15.98 (95 % CI: 9.76-24.68) and 51.14 (95 % IC: 39.38-65.30) cases per 100.000 children. Fifty-nine strains were serotyped. The most frequent serotypes/groups were 1, 4, 6B, 14, 18C, 19 and 23F. A total of 52.15 % of the serotypes were penicillin-susceptible and 93 % were cefotaxime-susceptible. The serotypes/groups with the highest rates of resistance were 6B, 14,19, 23F and 35. CONCLUSION: Our incidence rates are similar to those observed in other countries such as the United States and are higher than those reported for the rest of Europe. Vaccine coverage is similar to that described in other articles.