Extended-Spectrum b-Lactamase-Producing Enterobacteriaceae Causing Community-Acquired Urinary Tract Infections in Children in Colombia.

OBJECTIVE: To characterize the pediatric patients presenting at the two pediatric centers in Bogotá, with first isolate urine culture of community-acquired extended-spectrum b-lactamase (ESBL)-producing enterobacteriaceae. METHODS: Review of microbiological data of children between January, 2012 and December, 2018, obtained using the WHONET software. RESULTS: A total of 2657 Escherichia coli, Klebsiella spp and Proteus mirabilis - positive urine cultures were obtained within a 6-year period; data of 132 patients were finally selected. Frequency of ESBL-producing bacteria infections in community-acquired urinary tract infections (UTI) was 5%: 123 E. coli (93.2%), 7 K. pneumoniae (5.2%), 1 K. oxytoca (0.8%), and 1 P. mirabilis (0.8%). CONCLUSION: A predominance of female sex, preschool children, and lower tract urinary infections were found, as well as a low frequency of comorbidities. Adequate sensitivity to amikacin and nitrofurantoin was found in this study.

Pulmonary tuberculosis in a Pediatric Reference Hospital in Bogotá, Colombia.

BACKGROUND: In Colombia, epidemiological and clinical information related to pediatric tuberculosis (TB) is scarce. Data are needed to define the impact of the disease and to strengthen measures for detection and treatment. It is proposed to analyze the pediatric population diagnosed with pulmonary TB in a national reference institution. METHODS: Retrospective observational study including pediatric patients with pulmonary and miliary TB, and pulmonary and extrapulmonary involvement, treated between January 1, 2008 and December 31, 2016. A descriptive analysis of the selected variables was done. RESULTS: A total of 93 cases of diagnosed TB were identified, of which 61 cases were classified as pulmonary (65.6%). The location of TB occurred only in lungs in 51 patients (83.6%), was miliar in 3 (4.9%), pulmonary and extrapulmonary involvement in 7 patients (11.5%). The mean age was 7.5 years (0.5-18 years). Clinical criteria used for diagnosis was related to 98.3% of the cases, whereas radiological criteria in 90.2%. Bacteriological criterion was met in 42.6% of the cases. The most frequent symptoms were coughing (83.6%), fever (63.9%), and weight loss (26.2%); human immunodeficiency virus co-infection occurred in 3 cases (4.9%). During treatment, 5 mortality cases were recorded, although they were not attributable to TB. CONCLUSIONS: The epidemiological characterization of pediatric patients with pulmonary TB helps to achieve a better diagnostic approach in this population. Improving monitoring and follow-up activities in children with pulmonary TB, as well as promoting actions for adequate prevention and treatment is highly necessary.

Extrapulmonary tuberculosis in colombian children: Epidemiological and clinical data in a reference hospital.

BACKGROUND: The pediatric population is at increased risk of disseminated and extrapulmonary tuberculosis (TB). There is little information on children affected by this entity. The demographic, clinical, and outcome characteristics of the treatment of children with extrapulmonary TB, treated at a national reference institution between January 1, 2008, and December 31, 2016, are described and analyzed in this work. MATERIALS AND METHODS: This was a retrospective observational study. Cases of extrapulmonary TB were identified, and variables were collected based on each criterion used for diagnosis and treatment outcomes. A descriptive analysis of the variables collected was performed. RESULTS: Ninety-three cases were identified, of which 32 (34.4%) met the criteria for extrapulmonary TB. The mean age was 10.2 years (range 0.8-17 years), and the most frequent site of extrapulmonary TB was lymph node 40.6%, meningeal 21.9%, and ocular 18.8%. Bacteriological confirmation was obtained in 8 cases (25%) while the remaining 24 cases (75%) were classified as cases of clinically diagnosed TB. Two patients (6.2%) died during treatment although their decease was not attributable to TB. CONCLUSION: The clinical criterion was fundamental to establish the diagnosis. The microbiological isolation rate was low. Molecular biology tools increase bacteriological performance although their extended use is limited by cost. Regional multicenter studies are required to identify the target population and the tools necessary for timely management and treatment.

Factores de riesgo asociados a complicaciones por Bordetella pertussis en la Fundación Hospital de la Misericordia, 2009-2013 / Risk factors associated with complications of Bordetella pertussis at the Fundacion Hospital de la Misericordia, 2009-2013

Objetivo: Caracterizar factores de riesgo asociados a complicaciones en los pacientes con tosferina en 2009-2013. Materiales y métodos: Estudio de casos y controles. Identificación de factores de riesgo asociados a complicaciones en pacientes con Bordetella pertussis , confirmados con reacción en cadena de la polimerasa. Resultados: Se caracterizó a 96 pacientes. Un total de 76% eran menores de 6 meses, media de 4,56 ± 6,8 meses. El 58,3% eran niños y el 41,5%, niñas. Un 51% tuvo alguna complicación. Al 58% se les hospitalizó en cuidado crítico. Un 9,4% tuvo sepsis y el 14,6% requirió ventilación asistida. Un 4,2% fallecieron. La media de estancia en cuidado crítico fue de 8,75 días ( ± 85) y hospitalaria de 13,92 días ( ± 12,81). Se identificaron los siguientes factores de riesgo asociados a complicación: noción de contagio (OR: 2,20), ausencia de vacunación (OR: 3,31). Clínica: cianosis (OR: 4,07), deshidratación (OR: 2,72), taquicardia (OR: 2,64), taquipnea (OR: 3,94), desaturación (OR: 3,34). Paraclínica: coinfección bacteriana (OR: 7,66), linfocitosis (OR: 3,18), trombocitosis (OR: 3,038). Conclusión: Los antecedentes, clínica y paraclínicos pueden definir pacientes con infección por Bordetella pertussis en riesgo de complicaciones e ingreso en cuidado crítico.

Objective: To characterize the risk factors associated with complications in patients infected with Bordetella pertussis , 2009-2013. Material and methods: Case-control study. Identification of risk factors associated with complications in patients with Bordetella pertussis , confirmed by polymerase chain reaction. Results: A total of 96 patients were characterized. 76% were younger than 6 months, mean 4.56 ± 6.8 months; there were 58.3% boys and 41.5% girls. A total of 51% had complications. Some 58% were hospitalized in critical care. Sepsis occurred in 9.4% patients, and 14.6% required assisted ventilation. A total of 4.2% died. The mean critical care stay was 8.75 days ( ± 85) and the mean hospital stay was 13.92 ± 12.81 days. The following risk factors associated with complications were identified: notion of contagion (OR: 2.20), no vaccination (OR: 3.31). Clinical: (OR: 4.07) cyanosis, dehydration (OR: 2.72), tachycardia (OR: 2.64), tachypnea (OR: 3.94), desaturation (OR: 3.34). Paraclinical: Bacterial co-infection (OR: 7.66), lymphocytosis (OR: 3.18), thrombocytosis (OR: 3.038). Conclusion: Background, clinical and paraclinical factors can identify patients with B. pertussis infection at risk for complications and admission to the critical care unit.