Comparative effectiveness of intravenous vs oral antibiotics for postdischarge treatment of acute osteomyelitis in children.

IMPORTANCE: Postdischarge treatment of acute osteomyelitis in children requires weeks of antibiotic therapy, which can be administered orally or intravenously via a peripherally inserted central catheter (PICC). The catheters carry a risk for serious complications, but limited evidence exists on the effectiveness of oral therapy. OBJECTIVE: To compare the effectiveness and adverse outcomes of postdischarge antibiotic therapy administered via the PICC or the oral route. DESIGN, SETTING, AND PARTICIPANTS: We performed a retrospective cohort study comparing PICC and oral therapy for the treatment of acute osteomyelitis. Among children hospitalized from January 1, 2009, through December 31, 2012, at 36 participating children's hospitals, we used discharge codes to identify potentially eligible participants. Results of medical record review confirmed eligibility and defined treatment group allocation and study outcomes. We used within- and across-hospital propensity score-based full matching to adjust for confounding by indication. INTERVENTIONS: Postdischarge administration of antibiotics via the PICC or the oral route. MAIN OUTCOMES AND MEASURES: The primary outcome was treatment failure. Secondary outcomes included adverse drug reaction, PICC line complication, and a composite of all 3 end points. RESULTS: Among 2060 children and adolescents (hereinafter referred to as children) with osteomyelitis, 1005 received oral antibiotics at discharge, whereas 1055 received PICC-administered antibiotics. The proportion of children treated via the PICC route varied across hospitals from 0 to 100%. In the across-hospital (risk difference, 0.3% [95% CI, -0.1% to 2.5%]) and within-hospital (risk difference, 0.6% [95% CI, -0.2% to 3.0%]) matched analyses, children treated with antibiotics via the oral route (reference group) did not experience more treatment failures than those treated with antibiotics via the PICC route. Rates of adverse drug reaction were low (<4% in both groups) but slightly greater in the PICC group in across-hospital (risk difference, 1.7% [95% CI, 0.1%-3.3%]) and within-hospital (risk difference, 2.1% [95% CI, 0.3%-3.8%]) matched analyses. Among the children in the PICC group, 158 (15.0%) had a PICC complication that required an emergency department visit (n = 96), a rehospitalization (n = 38), or both (n = 24). As a result, the PICC group had a much higher risk of requiring a return visit to the emergency department or for hospitalization for any adverse outcome in across-hospital (risk difference, 14.6% [95% CI, 11.3%-17.9%]) and within-hospital (risk difference, 14.0% [95% CI, 10.5%-17.6%]) matched analyses. CONCLUSIONS AND RELEVANCE: Given the magnitude and seriousness of PICC complications, clinicians should reconsider the practice of treating otherwise healthy children with acute osteomyelitis with prolonged intravenous antibiotics after hospital discharge when an equally effective oral alternative exists.

Pediatric renal abscess: a 10-year single-center retrospective analysis.

OBJECTIVE: The objective of this retrospective series is to describe the demographics and treatment of patients with renal abscesses and to determine if abscess size influences management. METHODS: We reviewed all pediatric cases of renal abscesses treated over a 10-year period in our medical center. Clinical, laboratory, imaging data, and treatment modalities were analyzed. RESULTS: Thirty-six patients were evaluated, with renal abscesses found in all age groups. The median age was 9.3 years, and 64% of patients affected were female. Fever and abdominal pain were the most common clinical symptoms. A premorbid genitourinary condition was present in 310/a of patients. Previous urinary tract infection was documented in 31% of the cases. Initial elevation of C-reactive protein or erythrocyte sedimentation rate, when obtained, was observed in >80% of cases. Abnormal urinalysis was recognized in two-thirds of encounters. Escherichia coli, the most common microorganism isolated, was found in half the cases. Staphylococcus aureus was isolated in 11%. Ultrasound and computed tomography were the most used diagnostic imaging modalities. Eighty-nine percent of the patients who received intravenous antibiotics alone as an initial treatment regimen did not require percutaneous drainage or surgery. CONCLUSIONS: Ten of the 14 patients with an abscess size > or =3 cm had an invasive intervention, but only 1 of these 10 had an initial 48-hour trial of antibiotics alone. In contrast, only 2 of the 22 patients who had an abscess size <3 cm received an invasive intervention (Fisher P= .0002). We conclude that conservative treatment with intravenous antibiotics may be a reasonable initial approach.

Dipstick uroanálisis: diagnóstico presuntivo de infección urinaria? / Dipstick urinary tests: diagnostic

En el artículo se realiza revisión breve de la metodología paraclínica de laboratorio fundamentada en el uroanálisis: recuento leucocitúrico, recuento bacteriano, tinción gram, estudios de sedimento y pruebas de "Dipstick": Detección de actividad de leucocito esterasa y determinación de nitrito urinaria

Imagenología en infección urinaria: Gammagrafía renal en infección urinaria alta / Imagenology in urinary infection: renal gammagraphy in high renal infection

La infección urinaria es el primer motivo de consulta en la especialidad de Nefrología Infantil y tiene importancia su diagnóstico y tratamiento temprano con la finalidad de prevenir lesión irreversible renal y evitar así la alta prevalencia de enfermedad renal terminal. La revisión bibliográfica tiene el propósito de informar al pediatra general de la utilización de una "nueva" metodología diagnóstica: Gammagrafía Cortical Renal para la evaluación de la infección urinaria alta: Pielonefritis Aguda. La investigación cintilográfica cortical ofrece mayor sensibilidad estadística que el ultrasonograma -71 por ciento versus 43 por ciento - en la detección de lesión parenquimatosa aguda. Sin embargo, en Venezuela- práctica hospitalaria - existe limitación de recursos tecnológicos por lo que debe ser individualizado cada caso en el plan de estudio habitual de la infección urinaria