[Staphylococcus aureus infections in the intensive care unit: clinical and epidemiological characteristics]. / Infecciones por Staphylococcus aureus en cuidados intensivos: características clínicas y epidemiológicas.

INTRODUCTION: There has been an increase in invasive Staphylococcus Aureus infections over the last few years, which have required admission to the pediatric intensive care unit (PICU). PATIENTS AND METHODS: All patients with S. aureus infection who were admitted to PICU were enrolled in a retrospective study (January 2006-June 2010). The patients were classified into 2 groups: community-acquired infection (Group 1) and nosocomial infection (Group 2). We recorded epidemiological data, type of S. aureus (methicillin-susceptible S. aureus [MSSA], methicillin-resistant S. aureus [MRSA]), risk factors, site of infection, presence of hemodynamic instability, respiratory support, and mortality. RESULTS: A total of 51 patients were enrolled, 21 belonging to Group 1 and 30 to Group 2. The median age was lower in Group 1 (1.6 years vs 3.2 years; P=.009). MSSA was isolated in 88% of cases. MRSA was detected in 6/51 (12%) of cases, which were isolated in the later study period (January 2009-June 2010). The risk factors for infection were: immunosuppression, venous catheter, institutionalization, mechanical ventilation, previous surgery, previous trauma and chronic osteomyelitis. A large majority (83%) of the patients with MRSA infection had risk factors. The type of infection was varied, with respiratory tract infection being the most common (75%). Hemodynamic instability was observed in 43% of patients. Most patients (86%) required respiratory support. One patient in Group 1 died of necrotizing pneumonia caused by MSSA. CONCLUSIONS: Infections by S. aureus in children are severe and have a high morbidity. Respiratory infection was the most common in our series. Isolation of MSSA is common in these infections, although, an increase in the number of infections by MRSA was observed during the latter part of the study.

[Severe bronchiolitis. Changes in epidemiology and respiratory support]. / Bronquiolitis grave. Cambios epidemiológicos y de soporte respiratorio.

INTRODUCTION: Bronchiolitis generates lots of admissions during the cold months in the paediatric intensive care units (PICU). New forms of respiratory support are being used and could improve the care of these patients. OBJECTIVES: To analyse the epidemiological and respiratory support changes of children admitted to the PICU. PATIENTS AND METHODS: An observational, retrospective, descriptive and analytical study of patients with the diagnosis of bronchiolitis admitted to the PICU of a tertiary hospital during the respiratory syncytial virus (RSV) epidemic months between 2005 and 2010. RESULTS: A total of 229 patients were admitted, of whom 83% were infected with RSV. The mean age was 1.48 months, with children under 3 months being the greatest number of admissions (73.3%). December was the month with the highest number of admissions (52%). Mortality was 0.9%. The mean time of stay in the PICU and on respiratory assistance were 4 and 3 days, respectively (no significant differences between the periods studied). Patients with RSV bronchiolitis were younger than the negative RSV (mean 2.61 months and 4.05 months, P=.023). Active respiratory support was required in 73% of cases. The percentage of patients who required active respiratory support increased over the years (Z=3.81, P=.00014), especially high flow nasal oxygen therapy (Z=3.62, P=.00028). An inverse relationship was observed between patient age and length of stay in PICU (Beta=-0.245, P ≤.0001) and days on respiratory support (Beta=-0.167, P=.039). CONCLUSIONS: Most patients admitted to the PICU are less than 3 months old. Mortality was 0.9%. Respiratory support (especially non-invasive mechanical ventilation and high flow nasal oxygen therapy) is used increasingly often. The youngest patients need more days in PICU and more respiratory support.

[Toxic shock syndrome in children. Report of four cases]. / Síndrome del shock tóxico en niños. Presentación de 4 casos.

We report four children with toxic shock syndrome admitted in the pediatric intensive care unit of our hospital during the past year. All the children had the five criteria established by the Centers for Disease Control for the diagnosis of this syndrome. In all four there was a probable point of entry of the infection: maxillar sinusitis in one, pneumonia in two and surgical wound in the other. No bacteria that could have caused the infection were isolated in any of the children, which suggests a staphylococcal origin for this syndrome. Evolution was good in all of the children due to aggressive treatment that included inotropic support, volemic expansion and antibiotics. Two of the children, who suffered adult respiratory distress syndrome, required prolonged respiratory support.

[Uremic hemolytic syndrome. Analysis of 43 cases]. / Síndrome hemolítico urémico. Análisis de 43 casos.

OBJECTIVE: The purpose of this study was to describe the epidemiological, clinical and evolution features of hemolytic uremic syndrome (HUS). PATIENTS AND METHODS: A retrospective study of 43 cases of HUS during the last 14 years (1984-1998) was performed. RESULTS: The mean age of the patients was 3.2 years, the incidence during the summer season was the highest and 39 cases (90%) previously had acute gastroenteritis. All children had acute renal failure, 32 of them (74%) required peritoneal dialysis. Anuria was found in 22 case (51%) and the mean duration was 10.3 days. The most frequent complications were: Hypertension in 21 cases (48%), peritonitis in 9 cases (20%), seizures in 8 patients (16%) and 3 deaths (6%). The mean hospital stay was 14.5 days. After one year of ambulatory control, 76% of the children were completely recovered and only two cases (6%) had chronic renal failure. Seizures associated significantly with a bad prognosis (p < 0.05). CONCLUSIONS: HUS has a very important morbimortality. Seizures in the acute phase were associated with a bad prognosis. Anuria for more than 7 days and oliguria for more than 15 days were also predictors of a worse prognosis, but this was not significant.

Brain death and evoked potentials in pediatric patients.

OBJECTIVE: To define the evoked potential responses (auditory and somatosensory) obtained from pediatric brain-dead patients. DESIGN: Prospective study over an 8-yr period (1988-1996). SETTING: A 14-bed pediatric intensive care unit in a multidisciplinary regional referral center (teaching hospital). PATIENTS: Fifty-one pediatric patients with clinically established brain death. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Auditory brainstem and somatosensory evoked potentials were performed with a mean evolution time of 24 hrs after clinical brain death. The first brainstem auditory evoked potential recording was compatible with the diagnosis in 45 patients (90%): 27 patients (53%) did not respond, wave I was patent in 16 (7 bilateral, 6 from the left side, and 3 from the right side), and 2 patients evoked waves I and II in one or both ears. Gross anomalies were found in the remaining six patients. Sixteen patients were tested for somatosensory evoked potentials. N13 identifiable wave (62.5% of the patients) or a flat record were the obtained findings. Electric silence was noted initially on the electroencephalogram (EEG) in only 14 of 29 patients. Later flattening was observed in seven patients. Missing brainstem evoked response was noted earlier than cortical electric silence (range, 12-144 hrs). Any central wave could be pointed out in the evoked potentials of patients with an isoelectric EEG. CONCLUSIONS: Evoked potential is useful in confirming the diagnosis of brain death in infants and in children as well as in adults. The test can be performed at bedside without interfering with patient care, and results are similar to those obtained in adult patients. Flattening of the EEG requires more time than achieving compatible evoked-potential responses.