Phenotypic and genotypic characterization of oxacillin-susceptible and mecA positive Staphylococcus aureus strains isolated in Uruguay.

The aim of this study was to characterize phenotypically and genotypically 27 mecA positive Staphylococcus aureus strains with oxacillin MICs of ≤2µg/ml by Vitek 2, isolated in different regions of Uruguay. Susceptibility to oxacillin and cefoxitin was studied by gradient diffusion, disk diffusion to cefoxitin, and Phoenix and MicroScan systems. PBP2a was determined. SCCmec typing was performed and the isolates were compared by PFGE. Twenty-six isolates were susceptible to oxacillin; one strain was susceptible to cefoxitin by disk diffusion and 3 strains by gradient diffusion. Phoenix and MicroScan panels detected methicillin resistance in 25 and 27 strains, respectively. Twenty-six strains tested positive for PBP2a. Twenty-six strains carried SCCmec V and 24 belonged to pulsotype A. One strain carried SCCmec IV and did not belong to pulsotype A. Cefoxitin disk diffusion test and PBP2a detection correctly identified 26 of these 27 strains as MRSA. PFGE results suggest the dissemination of a cluster of MRSA carrying SCCmec V.

Detection of Vancomycin Resistance among Methicillin-Resistant Staphylococcus aureus Strains Recovered from Children with Invasive Diseases in a Reference Pediatric Hospital.

Vancomycin is the cornerstone in treating methicillin-resistant Staphylococcus aureus (MRSA) infections. However, therapeutic failures can occur when MRSA strains with decreased susceptibility to glycopeptides (DSG) are involved. The aim of this study was to detect and characterize DSG in MRSA recovered from children with invasive diseases at a reference pediatric hospital between 2009 and 2019. Fifty-two MRSA strains were screened using agar plates with vancomycin 3 and 4 mg/L (BHI-3 and BHI-4); the VITEK2 system; and standard and macro E-tests. Suspicious hVISA were studied by population analysis profiling-area under the curve (PAP-AUC), and wall thickness was analyzed by transmission electron microscopy. Neither VRSA nor VISA were detected in this set. As only three strains met the hVISA criteria, the PAP-AUC study included 12 additional MRSA strains that grew one colony on BHI-4 plates or showed minimum inhibitory concentrations of vancomycin and/or teicoplanin ≥ 1.5 mg/L. One strain was confirmed as hVISA by PAP-AUC. The wall thickness was greater than the vancomycin-susceptible control strain; it belonged to ST30 and carried SCCmec IV. As expected, a low frequency of hVISA was found (1.9%). The only hVISA confirmed by PAP-AUC was not detected by the screening methods, highlighting the challenge that its detection represents for microbiology laboratories.

Dermatomyositis as paraneoplastic syndrome of peritoneal and ovarian relapse after long-term complete remission in patient with metastatic bilateral breast cancer.

Dermatomyositis is a rare disease characterised by inflammatory muscle affection and characteristic cutaneous changes. When occuring in a patient with cancer, dermatomyositis may indicate recurrence or progression and poor outcome. Herein, the treatment of metastatic breast cancer, metastatic pattern, characteristics of long-term survivors, and link between dermatomyositis and breast cancer are discussed and the literature reviewed. We report a 57-year old female patient with metastatic bilateral breast cancer whose ovarian and peritoneal relapse after long-term remission was disclosed by occurence of paraneoplastic dermatomyositis. The patient previously had a 15-year long disease free-period after primary treatment for breast cancer before onset of pulmonary dissemination. Following antracycline-based chemotherapy, the complete remission lasting another 15 years was accomplished. Dermatomyositis had been resolved upon induction of second-line taxane-based chemotherapy. After completion of six cycles of gemcitabine and paclitaxel chemotherapy, check-up revealed further progression. The patient subsequently underwent six cycles of third-line CAP chemotherapy (cyclofosfamide, doxorubicine, cisplatin) but disease progressed and oral capecitabine chemotherapy was initiated. The patient received four cycles of capecitabine followed by further vast progression and finally expired following massive pulmonary embolism. Our case stresses the need of thorough staging and check-up when dermatomyositis arises in patients with breast cancer, regardless of previous stable long-term complete remission. Furthermore, we believe that treatment with curative intent in young patients with metastatic breast cancer, who have good performance statuses and no comorbidities is required, because it is more likely to produce long-term complete remission. However, following disease relapse a poor outcome can be expected.

Extended-spectrum ß-lactamases and plasmid-mediated quinolone resistance in enterobacterial clinical isolates in the paediatric hospital of Uruguay.

OBJECTIVES: To analyse the prevalence of resistance to ß-lactams and plasmid-mediated quinolone resistance in Enterobacteriaceae in the paediatric hospital of Uruguay. METHODS: A total of 368 enterobacterial isolates collected between 1 May and 30 November 2009 were studied for the presence of extended-spectrum ß-lactamases (ESBLs), qnr alleles and aac(6')Ib by phenotypic and molecular methods. The genomic context and transferability of ß-lactamase and qnr genes were examined by PCR and conjugation, respectively. RESULTS: The proportion of inpatients having an infection caused by ESBL-producing enterobacteria was 0.23% (16/7073) in paediatrics wards, 0.64‰ (3/4696) in the neonatology department and 0.03‰ (1/32 557) in the emergency department. ESBL-carrying enterobacteria constituted a total of 21.6% (16/74), 13% (3/23) and 0.37% (1/271) when samples were obtained from paediatrics wards, the neonatology department and the emergency department, respectively. Overall, CTX-M-2 (n = 7), CTX-M-9 (n = 3), CTX-M-8 (n = 2), CTX-M-15 (n = 1), SHV-5 (n = 5) and SHV-2 (n = 2) ß-lactamases were detected. Thirteen out of 20 ESBL-producing isolates also carried the aac(6')Ib gene, and the cr variant was detected in one of them. qnr alleles were detected in four isolates comprising two qnrA1 genes, a qnrB8-like variant and a new qnrB gene showing 26 amino acid differences from QnrB1. CONCLUSIONS: The proportion of ESBL-producing enterobacteria in Uruguay's paediatric hospital during the study period was 2.3 per 1000 hospitalized patients. The number of different microorganisms detected, as well as the various EBSLs, suggests the occurrence of sporadic episodes instead of nosocomial outbreaks. Nevertheless, the presence of new resistance genes reinforces the necessity for permanent surveillance programmes.

Haemophilus influenzae type b invasive infections in children hospitalized between 2000 and 2017 in a Pediatric Reference Hospital (PRH).

BACKGROUND: Uruguay incorporated the conjugate vaccine against Haemophilus influenzae b (Hib) in 1994. In 2008, the vaccine was changed from one with natural conjugated capsular polysaccharide to one with a synthetic polysaccharide component. We describe the frequency and characteristics of invasive Hib infections in children hospitalized in a Pediatric Reference Hospital (PRH) between January 1st, 2000 and December 31st, 2017. METHODS: Sterile site Hib isolations from hospitalized children were included. Clinical and microbiological characteristics were analyzed. Favorable conditions for the infection were considered: incomplete immunization, immunodeficiencies and associated pathologies. Two periods are described: 1, prior to vaccine change (1/1 st/2000- 12/31/08) and 2, post-change (1/1 st/09- 12/31st/17). RESULTS: 45 children were hospitalized: 5 in the first period and 40 in the second. The hospitalization rate per 10,000 discharges was 0.41 (95% CI 0.05-0.77) and 4.2/10,000 (95% CI 2.89-5.48), respectively (p < 0.01). The diagnoses at discharge were: meningitis/ventriculitis (20), pneumonia (16), bacteremia (3), epiglottitis (1), arthritis (1), cellulitis (3) and obstruction of the upper airway (1). Four children presented comorbidities. Twenty seven received less than 3 doses of anti-Hib vaccination and 18 were properly vaccinated (2 were immunodeficient). The median hospitalization was 14 days, 18 children required intensive therapy. CONCLUSIONS: Observed change may be due to: incomplete primary series, inhomogeneous vaccine coverage and immunogenicity of the synthetic polysaccharide. To reduce this public health problem, epidemiological surveillance.

[Active surveillance of febrile seizures associated to DPT vaccines in a sentinel hospital in Uruguay]. / Vigilancia activa de convulsiones febriles vinculadas a vacuna pentavalente en un hospital centinela en Uruguay.

BACKGROUND: Febrile seizures are VAERS often associated with whole-cells Diphtheria-Pertussis-Tetanus vaccines. AIM: To analyze the association of febrile seizures with the administration of pentavalent vaccine in children under two-years-old assisted in the Centro Hospitalario Pereira Rossell (CHPR), in Montevideo during 2014. METHODS: Self-controlled case series study. We included children from Montevideo from two to 24-month-old at the time of admission, with diagnosis of febrile seizure at the time of discharge. We estimated the relative risk in three time periods: 0 to 3 days (risk period), 4 to 14 days (wash-out) and more than 14 days after vaccination (no-risk). RESULTS: We recorded 135 febrile seizures in 114 children, 16 of whom presented two or more events. The total number of events was 7 (5.2%) in risk periods and 8 (5.9%) in wash-out periods. The risk period showed a significantly increased risk (RR = 4.14, CI 95% = [1.73; 8.36]). CONCLUSIONS: This work allowed us to establish a national base line for the risk of febrile seizures associated with pentavalent vaccination, by using for the first time in the country a methodology specifically designed for this goal.

Hospitalizaciones por diarrea con sangre en un centro pediátrico de referencia en Uruguay

Introducción: La diarrea con sangre es un motivo frecuente de admisión hospitalaria en niños, con gastroenteritis aguda; en la mayoría de los casos se tratan de infecciones leves y autolimitadas, pero pueden producirse complicaciones graves. Objetivos: Describir la etiología y características clínico- evolutivas de los niños menores de 15 años hospitalizados por diarrea con sangre en el Hospital Pediátrico, Centro Hospitalario Pereira Rossell entre los años 2012- 2023. Materiales y métodos: Estudio retrospectivo mediante revisión de historias y registros de laboratorio. Variables: demográficas, estado nutricional, hidratación, motivos de hospitalización, ingreso unidades de cuidados intensivos (UCI), enteropatógenos, tratamientos, evolución. Resultados: Se incluyeron 229 niños, mediana de edad de 8 meses; sexo masculino 61%; eutróficos 88%, bien hidratados 55%, con comorbilidades 11%, prematurez 6,5%. El motivo de hospitalización fue diarrea con sangre/disentería sin otro síntoma 45%. Se solicitó coprovirológico/coprocultivo en 98% y detección por técnicas de ácidos nucleicos en materia fecal 5,2%. Se identificó al menos un agente patógeno en 34,3%: Shigella sp. 38%; Salmonella sp. 19,5%; coinfecciones en 12%. Se indicaron antibióticos a 86%; ceftriaxona 62%, azitromicina 35%. Ingresaron a UCI 6,5% (15), presentaron complicaciones 10/14, fallo renal agudo 5 y alteraciones del medio interno 3. La mayoría presentó buena evolución. Conclusiones: La diarrea con sangre/disentería continúa siendo una causa importante de hospitalización afectando en su mayoría a niños sanos menores de 5 años. Los patógenos detectados con mayor frecuencia fueron bacterias principalmente Shigella sp., Salmonella sp. y E coli diarreogénicas. Se reportó alta prescripción de antibióticos, cumpliendo en la mayoría de los casos con las recomendaciones.

Introduction: Bloody diarrhea is a common reason for hospital admission in children with acute gastroenteritis; In most cases these are mild and self-limiting infections, but serious complications can occur. Goals: To describe the etiology and clinical-evolutionary characteristics of children under 15 years of age hospitalized for bloody diarrhea at the Pediatric Hospital, Centro Hospitalario Pereira Rossell between the years 2012-2023. Materials and methods: Retrospective study through review of histories and laboratory records. Variables: demographics, nutritional status, hydration, reason for hospitalization, intensive care unit (ICU) admission, enteropathogens, treatments, evolution. Results: 229 children were included, median age 8 months; male sex 61%; eutrophic 88%, well hydrated 55%, with comorbidities 11%, prematurity 6.5%. The reason for hospitalization was bloody diarrhea/dysentery without other symptoms 45%. Coprovirological/coproculture was requested in 98% and detection by nucleic acid techniques in fecal matter was requested in 5,2%. At least one pathogenic agent was identified in 34,3%: Shigella sp. 38%; Salmonella sp 19,5%; coinfections in 12%. Antibiotics were indicated for 86%; ceftriaxone 62%, azithromycin 35%. Were admitted to the ICU 6,5% (15), 10/14 had complications, 5 had acute kidney failure and 3 had alterations in the internal environment. The majority had a good evolution. Conclusions: Bloody diarrhea/dysentery continues to be an important cause of hospitalization, affecting mostly healthy children under 5 years of age. The most frequently detected pathogens were bacteria, mainly Shigella sp., Salmonella sp. and diarrheagenic E coli. High prescription of antibiotics was reported, complying in most cases with the recommendations.

Introdução: A diarreia com sangue é um motivo comum de internação hospitalar em crianças com gastroenterite aguda; Na maioria dos casos, estas são infecções leves e autolimitadas, mas podem ocorrer complicações graves. Metas: Descrever a etiologia e as características clínico-evolutivas de crianças menores de 15 anos internadas por diarreia sanguinolenta no Hospital Pediátrico Centro Hospitalario Pereira Rossell entre os anos de 2012-2023. Materiais e métodos: Estudo retrospectivo por meio de revisão de histórias e registros laboratoriais. Variáveis: dados demográficos, estado nutricional, hidratação, motivo da internação, internação em unidade de terapia intensiva (UTI), enteropatógenos, tratamentos, evolução. Resultados: foram incluídas 229 crianças, mediana de idade 8 meses; sexo masculino 61%; eutrófico 88%, bem hidratado 55%, com comorbidades 11%, prematuridade 6,5%. O motivo da internação foi diarreia sanguinolenta/disenteria sem outros sintomas 45%. O estudo coprovirologico/coprocultivo foi solicitado em 98% e a detecção por técnicas de ácidos nucleicos em matéria fecal foi solicitada em 5,2%. Pelo menos um agente patogênico foi identificado em 34,3%: Shigella sp. 38%; Salmonella sp. 19,5%; coinfecções em 12%. Os antibióticos foram indicados para 86%; ceftriaxona 62%, azitromicina 35%. Foram internados em UTI 6,5% (15), 10/14 apresentaram complicações, 5 tiveram insuficiência renal aguda e 3 apresentaram alterações no meio interno, a maioria teve boa evolução. Conclusões: A diarreia/disenteria com sangue continua a ser uma causa importante de hospitalização, afetando sobretudo crianças saudáveis ​​com menos de 5 anos de idade. Os patógenos mais frequentemente detectados foram bactérias, principalmente Shigella sp., Salmonella sp. e E. coli diarreiogênica. Foi relatada elevada prescrição de antibióticos, cumprindo na maioria dos casos as recomendações.

[Incidence of group B streptococcal early-onset sepsis in infants born at Centro Hospitalario Pereira Rossell between 2007-2015]. / Incidencia de sepsis precoz por Streptococcus agalactiae en recién nacidos del Centro Hospitalario Pereira Rossell en el período 2007-2015.

BACKGROUND: Group B Streptococcus (GBS) disease remains the leading cause of early-onset sepsis (EOS) in developed countries despite effective prophylaxis strategies. AIMS: To describe the incidence, clinical features and mortality of GBS EOS in infants born at Centro Hospitalario Pereira Rossell (CHPR) and analyse failure of adherence to prevention strategies. METHODS: Retrospective review of EOS cases between 2007 and 2015 collected from the bacteriology laboratory database. RESULTS: Fifteen cases of GBS EOS were identified, with an incidence of 0.23% during the study period. Intrapartum antibiotic prophylaxis (IAP) was not administered in any of the cases. All infants were symptomatic within the first 15 hours of life, mainly due to respiratory signs (80%). In one case, GBS was isolated from spinal fluid. Mortality rate was 20%. All deaths occurred in the first 24 hours of life, corresponding two thirds to preterm infants. CONCLUSION: The incidence of GBS EOS at CHPR was similar to other centers where IAP is implemented. Better adherence to prophylaxis strategies could reduce the incidence.

Pneumococcal Meningitis Before and After Universal Vaccination With Pneumococcal Conjugate Vaccines 7/13, Impact on Pediatric Hospitalization in Public and Nonpublic Institutions, in Uruguay.

This is the first study showing the impact of 13-valent pneumococcal conjugate vaccine on pneumococcal meningitis in Latin America; a significant (63.5%) reduction in hospitalization was observed during the first 6 years after starting vaccination. A 90% reduction of pneumococcal conjugate vaccines 7/13 serotypes was observed (P < 0.0001). After vaccination, all strains were penicillin susceptible. Mortality had a reduction of 71%.

Phenotypic and genotypic characterization of oxacillin-susceptible and mecA positive Staphylococcus aureus strains isolated in Uruguay / Caracterización fenotípica y genotípica de cepas de Staphylococcus aureus sensibles a oxacilina y mecA positivas aisladas en Uruguay

Abstract The aim of this study was to characterize phenotypically and genotypically 27 mecApositive Staphylococcus aureus strains with oxacillin MICs of ≤2 g/ml by Vitek 2, isolated indifferent regions of Uruguay. Susceptibility to oxacillin and cefoxitin was studied by gradient dif-fusion, disk diffusion to cefoxitin, and Phoenix and MicroScan systems. PBP2a was determined.SCCmec typing was performed and the isolates were compared by PFGE. Twenty-six isolateswere susceptible to oxacillin; one strain was susceptible to cefoxitin by disk diffusion and 3strains by gradient diffusion. Phoenix and MicroScan panels detected methicillin resistance in25 and 27 strains, respectively. Twenty-six strains tested positive for PBP2a. Twenty-six strainscarried SCCmec V and 24 belonged to pulsotype A. One strain carried SCCmec IV and did notbelong to pulsotype A. Cefoxitin disk diffusion test and PBP2a detection correctly identified 26of these 27 strains as MRSA. PFGE results suggest the dissemination of a cluster of MRSA carryingSCCmec V.

Resumen El objetivo de este estudio fue caracterizar fenotípicamente y genotípicamente 27 cepas de Staphylococcus aureus positivas para mecA y con CIM de oxacilina <2 pg/ml según Vitek 2, obtenidas en diferentes regiones del país. La sensibilidad frente a la oxacilina y la cefoxitina se estudió por difusión en gradiente, por disco-difusión (cefoxitina) y por los sistemas Phoenix y MicroScan. Se analizó la portación de PBP2a, se realizó la tipificación de SCCmec y las cepas se compararon mediante PFGE. Resultaron sensibles a oxacilina por difusión en gradiente 26 cepas; una fue sensible a cefoxitina por disco-difusión y 3 lo fueron por difusión en gradiente. Los sistemas Phoenix y MicroScan detectaron resistencia a meticilina en 25 y 27 cepas, respectivamente. Asimismo, 26 cepas portaban PBP2a y 26 cepas mostraron presencia de SCCmec V, 24 correspondieron al pulsotipo A. Una portaba SCCmec IV y no perteneció al pulsotipo A. La prueba de disco-difusión con cefoxitina y la detección de PBP2a identificaron 26 de 27 cepas como MRSA. La PFGE sugiere la diseminación de un grupo MRSA con SCCmec V. © 2022 Asociación Argentina de Microbiología. Publicado por Elsevier Espana, S.L.U. Este es un artículo Open Access bajo la licencia CC BY-NC-ND (https://creativecommons.org/licenses/by-nc-nd/4.0/).

Neumonía necrotizante en niños: 10 años de experiencia en un hospital pediátrico de referencia / Necrotizing pneumonia in children: 10 years of experience in a Pediatric Reference Hospital / Pneumonia necrosante em crianças: 10 anos de experiência em um Hospital Pediátrico de Referência

Resumen: Introducción: neumonía necrotizante (NN) es una complicación frecuente en niños hospitalizados por neumonía adquirida en la comunidad (NAC), caracterizada por importante morbilidad. En 2009, se elaboró una definición de caso, que permitió unificar criterios y racionalizar recursos en la asistencia de estos niños. Objetivo: describir características clínicas y evolutivas de niños que desarrollaron NN en los últimos 10 años. Metodología: estudio descriptivo de niños hospitalizados por NN entre 1/1/2009 y 31/12/2018. Definición de caso: neumatoceles y uno o más de los siguientes criterios: mal estado general, fiebre persistente o recurrente, leucocitosis mayor a 30.000 o menor a 5.000/mm3, proteína C reactiva mayor a 120 mg/dl, láctico deshidrogenasa en líquido pleural mayor a 2.500 UI/L y/o fístula broncopleural (FBP). Se describieron características epidemiológicas, clínicas, etiológicas y evolutivas. Resultados: se diagnosticó NN en 197 niños (7,92% de las hospitalizaciones por NAC), con número anual de casos y tasas/10.000 egresos variables. La mediana de edad fue de 25 meses; 89,8% eran sanos. La fiebre previa al diagnóstico tuvo mediana de cinco días. Tenían neumonía multilobar 58%, insuficiencia respiratoria 62%, sepsis 19%, empiema 80% y fístula bronquio-pleural 51%. Persistieron con fiebre mediana por siete días. Requirieron cuidados intensivos 46% y asistencia ventilatoria mecánica 18%. Los reactantes de fase aguda al ingreso fueron elevados. Se identificó agente etiológico en 102 casos, S. pneumoniae en 92. Fallecieron dos niños. Conclusiones: NN fue una complicación frecuente en niños hospitalizados por NAC. La presentación clínica y la evolución fueron graves. La identificación etiológica fue elevada, la mayoría correspondió a S. pneumoniae. La mortalidad fue baja.

Summary: Introduction: necrotizing pneumonia (NP) is a complication of community-acquired pneumonia (CAP) in hospitalized children, with significantly high morbidity. A case definition was devised in 2009, which enabled physicians to unify criteria and rationalize resources for the assistance of children with NP. Objective: describe clinical characteristics and evolution of children who developed NP. Methodology: descriptive study, NP hospitalized children between 1/1/2009 and 12/31/2018. Case definition: pneumatoceles and one or more of the following criteria: malaise, persistent/recurrent fever, white blood cell count over 30,000 or less than 5.000/mm3, C-reactive protein over 120 mg/dL, lactic dehydrogenase in pleural fluid over 2,500UI/L and/or bronchopleural fistula (BPF). Clinical, epidemiological, etiological and evolutionary characteristics were described. Results: NP was diagnosed in 197 children (7.92% of CAP hospitalizations), with variable annual cases and annual rate/10,000 discharges. Children had a median age of 25 months; 89.8% were previously healthy. They presented fever prior to diagnosis, median 5 days, multilobar pneumonia 58%, respiratory failure 62%, sepsis 19%, empyema 80% and BPF 51%, persistent fever median 7 days. 46% required intensive care and 18% required assisted mechanical ventilation. Acute phase reactants on admission were high. An etiological agent was identified in 102 cases, S.pneumoniae in 92. Two children died. Conclusions: NP was a frequent complication in CAP hospitalized children. Clinical presentation and evolution were severe. The etiological identification was high, most of them corresponded to S. pnuemoniae. Mortality was low.

Resumo: Introdução: a pneumonia necrosante (PN) é uma complicação da pneumonia adquirida na comunidade (PAC) em crianças hospitalizadas, com morbidade significativamente elevada. Em 2009, elaborou-se uma definição de caso, que possibilitou aos médicos unificar critérios e racionalizar recursos para o atendimento à criança com PN. Objetivo: descrever as características clínicas e evolutivas de crianças que desenvolveram PN nos últimos 10 anos. Metodologia: estudo descritivo de crianças internadas por PN entre 01/01/2009 e 31/12/2018. Definição de caso: pneumatoceles e um ou mais dos seguintes critérios: mau estado geral, febre persistente ou recorrente, leucocitose superior a 30.000 ou inferior a 5.000 / mm3, proteína C reativa superior a 120 mg / dl, desidrogenase láctica no líquido pleural superior 2.500 UI / L e / ou fístula broncopleural (BPF). Descreveram-se características epidemiológicas, clínicas, etiológicas e evolutivas. Resultados: a PN foi diagnosticada em 197 crianças (7,92% das internações por PAC), com número de casos e taxas anuais variáveis/10.000 altas. A idade média foi de 25 meses; 89,8% eram saudáveis. A febre antes do diagnóstico teve uma mediana de 5 dias. Eles tinham 58% de pneumonia multilobar, 62% de insuficiência respiratória, 19% de sepse, 80% de empiema e 51% de FBP. Eles persistiram com febre mediana por 7 dias. 46% necessitaram de cuidados intensivos e 18% de assistência ventilatória mecânica. Os reagentes de fase aguda na admissão foram elevados. Em 102 casos foi identificado um agente etiológico, S. pneumoniae em 92. 2 crianças morreram. Conclusões: NP é uma complicação frequente em crianças hospitalizadas por PAC. O quadro clínico e a evolução foram graves. A identificação etiológica foi alta, a maioria correspondeu a S. pneumoniae. A mortalidade foi baixa.

[A strategy for the management of hospitalized children with acute lower respiratory infections]. / Estrategia de atención de niños hospitalizados por infecciones respiratorias agudas bajas.

OBJECTIVES: To improve the quality of care provided to hospitalized children having acute lower respiratory infections (ALRI), to increase the knowledge on this health condition, and to broaden the utilization of health care resources through a program called "Winter Plan". METHODS: The program comprised the use of guidelines for diagnosis and treatment, disease-oriented hospitalizations to provide an increased level of care, management of health care resources and implementation of computerized medical records. Systematic investigation of viral etiology was performed in order to rationalize the use of medications and reduce nosocomial infections. RESULTS: During program implementation (19/V-19/IX/99), 3,317 children were admitted; 1,347 (40.61%) had ALRI, of which 1,096 (81%) were included in the study. Of them, 71% aged less than 1 year. Most ALRI were viral (68%). Admission criteria were: oxygen saturation <95%, tachypnea, retractions or pleural effusion (92.4% of the children). The demand magnitude prevented compliance with isolation guidelines in all cases. Treatment guidelines were followed in a high percentage of cases: 73% of children having bronchiolitis and 72% of those with viral pneumonia received no antibiotics and 96% of children with bacterial pneumonia were put on antibiotics as recommended; use of bronchodilators and corticosteroids was reduced. Medication costs were reduced especially in the corticosteroid group, which meant a greater impact on hospitalization costs. CONCLUSIONS: To decrease ALRI morbidity and mortality there is a need to continue improving the quality of health care during hospitalization and to reinforce health promotion actions and preventive programs at the primary level.

Evaluación de la confianza y satisfacción del Programa Nacional de Vacunaciones en Montevideo, Uruguay, entre mayo y octubre de 2016 / Assessment of trust and satisfaction levels of the Uruguayan National Vaccination Program carried out between May-October 2016 / Avaliação da confiança e satisfação do Programa Nacional de Vacinação em Montevidéu, Uruguai, entre maio e outubro de 2016

Resumen: Introducción: las altas coberturas alcanzadas en el Programa Nacional de Vacunaciones (PNV) parecen indicar una adecuada adhesión al Certificado Esquema de Vacunación (CEV). No hay evaluaciones que reflejen lo percibido desde la comunidad. Objetivo: evaluar la confianza y satisfacción en Montevideo acerca de la vacunación y las estrategias actuales de comunicación social del PNV del Ministerio de Salud. Material y método: encuesta con preguntas cerradas con escala semicuantitativa a ≥de 18 años con un niño ≤de 5 años a cargo en Montevideo en el año 2016. Se evaluó la confianza, satisfacción con el PNV y las estrategias de comunicación social. Resultados: se encuestaron 384 personas. Consideró importante la vacunación para prevenir enfermedades de los niños el 92,7% de las personas encuestadas y el 81,5% de los adultos (p<0,01). Refirió satisfacción con las vacunas del CEV el 89,9% y con la información brindada por su médico el 82,8%. El 69% de los encuestados consideró que algunas vacunas son más importantes, de los cuales 62% evitaría al menos una, principalmente la vacuna antigripal y el antivirus del papiloma humano. El 43% refirió haber estado informado de alguna actividad sobre vacunas recientemente, 65% a través de las redes sociales. Conclusiones: estos resultados muestran niveles de confianza y satisfacción altos con el PNV. Es necesario fortalecer la importancia de la vacunación en adultos. Las redes sociales podrían ser una de las vías de comunicación privilegiadas para llegar a la población.

Summary: Objective: assess trust and satisfaction levels of the Uruguayan National Vaccination Program and its social communication strategies carried out by the Ministry of Health by the population of Montevideo. Material and method: a survey was carried out to ≥18 year- old adults in charge of a ≤5 year-old children. Closed questions were asked using a semi quantitative rating scale in Montevideo in 2016. Trust and satisfaction levels regarding the NIP and the social communication strategies used were assessed. Results: 384 people were surveyed. 92.7% considered vaccination was important to prevent diseases in children and in adults (81.5%) (p <0.01). 89.9% were satisfied with the Vaccination Program and 82.8% with the level of information provided by doctors. 69% considered some of the vaccines being most important, such as vaccines against Influenza or Human Papillomavirus. 43% reported having recently received any type of information regarding vaccines, and 65% received it through social networks. Conclusions: these results show high levels of trust and satisfaction with the NIP. It is necessary to stress the importance of vaccination compliance in adults. Social networks could be the main means of communication to reach such population.

Resumo: Objetivo: avaliar os níveis de confiança e satisfação do Programa Uruguaio Nacional de Vacinação e suas estratégias de comunicação social desenvolvidas pelo Ministério da Saúde por parte da população de Montevidéu. Material e método: Realizamos uma pesquisa a adultos ≥18 anos responsáveis por pelo menos uma criança com menos de 5 anos de idade. Fizemos perguntas fechadas e utilizamos uma escala de avaliação semi-quantitativa em Montevidéu em 2016. Avaliamos os níveis de confiança e satisfação em relação ao NIP e as estratégias de comunicação social utilizadas. Resultados: 384 pessoas foram pesquisadas. 92,7% consideraram a vacinação importante para prevenir doenças em crianças e adultos (81,5%) (p <0,01). 89,9% mostraram-se satisfeitos com o Programa de Vacinação e 82,8% com o nível de informação fornecido pelos médicos. 69% consideraram algumas das vacinas as mais importantes, como as vacinas contra Influenza ou Papiloma Vírus Humano. 43% relataram ter recebido recentemente algum tipo de informação sobre vacinas e 65% deles receberam a informação através de redes sociais. Conclusões: Estes resultados mostram altos níveis de confiança e satisfação com o NIP. É necessário enfatizar a importância da adesão à vacinação em adultos. As redes sociais poderiam ser o principal meio de comunicação para atingir essa população

Changes in hospitalizations for pneumonia after universal vaccination with pneumococcal conjugate vaccines 7/13 valent and haemophilus influenzae type b conjugate vaccine in a Pediatric Referral Hospital in Uruguay.

BACKGROUND: In 1994, Uruguay included Haemophilus influenzae b (Hib) conjugated vaccine in a 3 + 1 schedule. In March 2008, 7-valent pneumococcal conjugate vaccines (PCV7) was included in a 2 +1 schedule. In 2010, 13-valent PCV replaced PCV7. Catch-up immunization was offered. The aim of this study was to describe the etiology of community-acquired pneumonia (CAP) in children 0-14 years of age hospitalized at the Hospital Pediatrico-Centro Hospitalario Pereira Rossell between 2003 and 2012. METHODS: Annual hospitalization rates (per 10,000 discharges) for CAP and bacterial-confirmed CAP in children 0-14 years of age was described prior PCV7 vaccination (2003-2007), during the year of implementation of PCV7 (2008) and after the introduction of PCV7 (2009-2012). Data regarding age, strains isolated from pleural fluid and/or blood, vaccination status, pneumococcal and H. influenzae serotypes were obtained from Hospital Pediatrico-Centro Hospitalario Pereira Rossell databases and vaccination records. RESULTS: Hospitalization rates for CAP and pneumococcal CAP between prevaccine years and the last year after introduction of vaccination with PCV (2012) significantly decreased by 78.1% and 92.4%, respectively. Significant reduction for 13-valent PCV vaccine serotypes and significant increase for nonvaccine serotypes was observed. A decrease in Staphylococcus aureus pneumonia was observed. Hospitalization rates for H. influenzae CAP remain stable before and after pneumococcal vaccination. CONCLUSIONS: Three years after PCV7/13 introduction into the routine vaccination schedule, there was a rapid and significant reduction in rates of CAP and P-CAP. An increase of etiology of CAP by other agents was not observed.

Vigilancia activa de convulsiones febriles vinculadas a vacuna pentavalente en un hospital centinela en Uruguay / Active surveillance of febrile seizures associated to DPT vaccines in a sentinel hospital in Uruguay

Resumen Introducción: Las convulsiones febriles son eventos supuestamente atribuidos a la vacunación e inmunización (ESAVI) frecuentemente asociados a vacuna difteria - tétanos- pertussis a células completas. Objetivo: Analizar la asociación de convulsiones febriles con la administración de la vacuna pentavalente en niños bajo 2 años de edad asistidos en el Centro Hospitalario Pereira Rossell durante el año 2014. Material y Métodos: Estudio de series de casos auto-controlados. Se incluyeron niños procedentes de Montevideo con 2 a 24 meses de edad con diagnóstico de convulsión febril. Se estimó el riesgo relativo (RR) de los períodos de riesgo (0 a 3 días) y de lavado (4a 14 días), en comparación con el período de no riesgo (más de 14 días). Resultados: Se registraron 135 convulsiones febriles, que ocurrieron en 114 niños; 16 niños presentaron dos o más episodios. El total de eventos ocurridos en el período de riesgo fueron 7 (5,2%) y 8 (5,9%) en el período de lavado. El período de riesgo mostró un RR significativo de 4,14 (IC 95%: 1,73; 8,36). Conclusiones: Este trabajo permitió establecer una línea de base nacional sobre el riesgo de convulsiones febriles asociadas con la vacunación pentavalente al utilizar por primera vez en el país una metodología específica para tal fin.

Background: Febrile seizures are VAERS often associated with whole-cells Diphtheria-Pertussis-Tetanus vaccines. Aim: To analyze the association of febrile seizures with the administration of pentavalent vaccine in children under two-years-old assisted in the Centro Hospitalario Pereira Rossell (CHPR), in Montevideo during 2014. Methods: Self-controlled case series study. We included children from Montevideo from two to 24-month-old at the time of admission, with diagnosis of febrile seizure at the time of discharge. We estimated the relative risk in three time periods: 0 to 3 days (risk period), 4 to 14 days (wash-out) and more than 14 days after vaccination (no-risk). Results: We recorded 135 febrile seizures in 114 children, 16 of whom presented two or more events. The total number of events was 7 (5.2%) in risk periods and 8 (5.9%) in wash-out periods. The risk period showed a significantly increased risk (RR = 4.14, CI 95% = [1.73; 8.36]). Conclusions: This work allowed us to establish a national base line for the risk of febrile seizures associated with pentavalent vaccination, by using for the first time in the country a methodology specifically designed for this goal.

Incidencia de sepsis precoz por Streptococcus agalactiae en recién nacidos del Centro Hospitalario Pereira Rossell en el período 2007-2015 / Incidence of group B streptococcal early-onset sepsis in infants born at Centro Hospitalario Pereira Rossell between 2007-2015

Resumen Introducción La infección por Streptococcus agalactiae (β-hemolítico del grupo B (SGB) continúa siendo una de las principales causas de sepsis precoz en países desarrollados a pesar de la implementación de profilaxis efectiva. Objetivos Describir la incidencia, características clínicas y mortalidad de sepsis precoz por SGB en recién nacidos del Centro Hospitalario Pereira Rossell (CHPR), y analizar las fallas de adherencia a las estrategias de prevención. Métodos Estudio retrospectivo de descripción de casos entre los años 2007 a 2015 identificados a partir de la base de datos del laboratorio de bacteriología. Resultados Se identificaron 15 casos de sepsis neonatal precoz a SGB con una incidencia en el período de estudio de 0,23‰. La quimioprofilaxis intraparto no fue realizada en caso alguno. Todos los recién nacidos se presentaron sintomáticos en las primeras 15 h de vida. La dificultad respiratoria fue el signo más frecuente (80%). En un caso se aisló SGB de líquido cefalorraquídeo. La mortalidad fue de 20%. Todas las muertes ocurrieron en las primeras 24 h de vida, siendo dos tercios prematuros. Conclusión La incidencia de sepsis precoz por SGB en el CHPR fue similar a la incidencia en centros donde se realiza quimioprofilaxis. Una mejor adherencia a las estrategias de prevención podría disminuir la incidencia.

Background: Group B Streptococcus (GBS) disease remains the leading cause of early-onset sepsis (EOS) in developed countries despite effective prophylaxis strategies. Aims: To describe the incidence, clinical features and mortality of GBS EOS in infants born at Centro Hospitalario Pereira Rossell (CHPR) and analyse failure of adherence to prevention strategies. Methods: Retrospective review of EOS cases between 2007 and 2015 collected from the bacteriology laboratory database. Results: Fifteen cases of GBS EOS were identified, with an incidence of 0.23% during the study period. Intrapartum antibiotic prophylaxis (IAP) was not administered in any of the cases. All infants were symptomatic within the first 15 hours of life, mainly due to respiratory signs (80%). In one case, GBS was isolated from spinal fluid. Mortality rate was 20%. All deaths occurred in the first 24 hours of life, corresponding two thirds to preterm infants. Conclusion: The incidence of GBS EOS at CHPR was similar to other centers where IAP is implemented. Better adherence to prophylaxis strategies could reduce the incidence.

Seguimiento de eventos supuestamente atribuibles a la vacunación e inmunización (ESAVI) graves notificados al Ministerio de Salud Pública entre 2010 y 2014 / Follow up of severe adverse effects supposedly attributable to vaccination or immunization reported to the Ministry of Public Health between 2010 and 2014

Introducción: un evento adverso supuestamente atribuible a la vacunación o inmunización es aquel evento negativo que ocurre luego de administrar una vacuna y que puede ser atribuido a la misma. El objetivo fue caracterizar y realizar un seguimiento de los eventos adversos graves notificados al Sistema Nacional de Farmacovigilancia del Ministerio de Salud Pública durante 2010-2014. Material y método: se realizó un estudio transversal de la evolución de los individuos afectados, mediante encuesta telefónica. Las variables para caracterizar las posibles complicaciones en la evolución fueron: tratamiento requerido, tiempo hasta la recuperación, tipo de recuperación o de incapacidad y muerte. Se evaluó la conducta frente a la futura vacunación. Se utilizaron definiciones de la Colaboración Brighton y de la Organización Mundial de la Salud para describir los eventos. Resultados: entre 2010 y 2014 se notificaron 107 eventos graves correspondientes a 79 individuos, de los cuales se analizaron 53. La mayoría de los eventos graves se asociaron a desórdenes neurológicos, siendo el más frecuente convulsión. Ninguno de estos pacientes presentó secuelas; 48 individuos se recuperaron completamente, cinco presentaron secuelas a largo plazo. Ningún evento determinó la muerte al momento de finalizar el estudio. Conclusiones: los resultados de este trabajo son los primeros que analizan la evolución de los eventos adversos graves notificados al Sistema Nacional de Farmacovigilancia. Es importante sensibilizar al equipo de salud en la notificación y fortalecer los protocolos nacionales de seguimiento en base a esta experiencia.

Introduction: adverse events supposedly attributable to vaccination or immunization are negative events that follow immunization and may be attributed to it. The study aimed to characterize and follow up severe adverse effects reported to the National Pharmacovigilance System of the Ministry of Public Health during 2010-2014. Method: a transversal study of the evolution of the individuals affected was performed by means of a telephone survey. Variables used to characterize possible complications were the following: treatment required, time until recovery, type of recovery, disability and death. Behavior upon the following vaccination was also evaluated. Definitions from Brighton Collaboration and the World Health Organization were used to describe the events. Results: 107 cases of severe events were reported between 2010 and 2014, which corresponded to 79 individuals, 53 of which were analysed. Most of the severe events were associated to neurological disorders, seizures being the most frequent one. None of the patients evidenced sequelae, 48 individuals fully recovered, five presented long-term sequelae. No event resulted in a cause of the death at the time the study was completed. Conclusions: this is the first study that analyses the evolution of severe adverse effects reported to the National Pharmacovigilance System. It is important to sensitize the health team in terms of notifications and to strengthen the national follow-up protocols based on this experience.

Introdução: um evento adverso supostamente atribuível a vacinação ou imunização é aquele evento negativo que ocorre depois da administração de uma vacina e que pode ser atribuído a mesma. O objetivo deste trabalho foi caracterizar e realizar um seguimento dos eventos adversos graves notificados ao Sistema Nacional de Farmacovigilância do Ministério de Salud Pública durante o período 2010-2014. Material e método: realizou-se um estudo transversal da evolução dos indivíduos afetados por entrevista telefônica. As variáveis empregadas para caracterizar as possíveis complicações na evolução foram: tratamento requerido, tempo até a recuperação, tipo de recuperação ou de incapacidade, e morte. Avaliou-se a conduta relacionada a uma futura vacinação. Foram utilizadas as definições da Colaboração Brighton e da Organização Mundial da Saúde para descrever os eventos. Resultados: no período 2010-2014 foram notificados 107 eventos graves correspondentes a 79 indivíduos, 53 dos quais foram analisados. A maioria dos eventos graves estavam associados a distúrbios neurológicos, sendo a convulsão o mais frequente. Nenhum destes pacientes apresentou sequelas; 48 indivíduos se recuperaram completamente, cinco apresentaram sequelas a longo prazo. Até o final deste estudo nenhum evento havia causado a morte de um paciente. Conclusões: os resultados deste trabalho são os primeiros que analisam a evolução dos eventos adversos graves notificados ao Sistema Nacional de Farmacovigilância. Considerando esta experiência é importante sensibilizar a equipe de saúde sobre a importância da notificação e fortalecer os protocolos nacionais de seguimento.

[Psychoactive Drug Use by Youth in a Post Armed-Conflict Region]. / Consumo de sustancias psicoactivas (SPA) en jóvenes de una región en posconflicto armado.

INTRODUCTION: There are no studies in Colombia on the use of psychoactive substances (PAS) by post armed-conflict population to serve as guide for prevention programs and to account for the potential impact armed conflict may have upon this area. OBJECTIVE: To describe the use of PAS in young students in a post-conflict region. METHODOLOGY: A quantitative-descriptive study involving the totality of students of the township of Viotá, Department of Cundinamarca, Colombia (1,304 participants). The World Health Survey for Schoolchildren was applied. RESULTS: Alcohol is the substance with the highest percentage of lifetime prevalence; during the last month, it was observed that the highest percentage of people start PAS use between the age of 8 and 13, while 42% of youngsters have experienced at least one drunkenness episode. It was found that 43.4% have been exposed to alcohol in their families while 35.1% were exposed to tobacco at school or in their neighborhoods. 84.5% stated their intention to continue consuming tobacco during the next year. CONCLUSIONS: Results show lower consumption percentages in comparison to school youngsters in Bogotá, Colombia, which may indicate that the armed conflict has not increased consumption levels in this population. Based on the results, certain elements to be taken into account are proposed for the implementation of prevention programs with this population.

Impact of universal pneumococcal vaccination on hospitalizations for pneumonia and meningitis in children in Montevideo, Uruguay.

BACKGROUND: In March 2008, Uruguay included PCV7 into the routine vaccination program, in a 2 + 1 schedule for children <2 years of age. Catch-up immunization was offered to children born in 2007. Greater than 95% of children received their first and second doses. The aim of this study was to assess the effect of this strategy. METHODS: Annual hospitalization rates (per 10,000 discharges) for community-acquired pneumonia (CAP) in children <14 years of age and pneumococcal meningitis are described prior to PCV7 vaccination (2005-2007), during the year of implementation (2008) and following vaccine introduction (2009). Data regarding age, diagnosis, vaccination status, and pneumococcal serotype were obtained from Hospital Pereira Rossell databases and vaccination records. RESULTS: Comparison of hospitalization rates for CAP and pneumococcal-CAP (P-CAP) between prevaccine years (2005-2007) and the year after vaccination (2009) decreased significantly in all children by 56% and 48.2%, respectively. Significant reduction was observed for vaccine serotype P-CAP (serotype 14 P-CAP decreased from 26.6 to 2.5 per 10,000 discharges) in children <2 years of age. A significant reduction in pneumococcal meningitis of 59% was seen in this age group; median rates prevaccination decreased from 17 (12.2-24.9) to 7 (3-11.8) after the administration of vaccine. No vaccine failures for P-CAP or pneumococcal meningitis were seen in fully immunized children. CONCLUSIONS: One year after PCV7 introduction into the routine vaccination schedule of Uruguay, there was a rapid and significant reduction in rates of CAP, P-CAP, and pneumococcal meningitis in children <2 years of age.