RESUMEN
BACKGROUND: Urinary tract infections (UTIs) are a common source of bacterial infections in childhood. Making a proper diagnosis is important but requires invasive urine collection techniques. We aimed to derive a clinical decision rule to identify non-toilet-trained febrile girls at high risk for UTIs to restrict urethral catheterizations (UCs) to this high-risk group of patients. METHODS: We included all non-toilet-trained girls with a positive microscopic urinalysis from urine collected by sterile bag in a prospective cohort study to derive a model to predict UTI assessed by urine culture from UC. RESULTS: Thirty-seven patients were included. Absence of another source of fever on examination and the child's unusual behaviour were found to be independent predictors of UTI. The corresponding model offered an 85% sensitivity [95% confidence interval (CI): 56-96], with a 59% specificity (95% CI: 30-83) for UTI. The internal cross-validation by bootstrap led to an 85% sensitivity (95% CI: 68-100), and a 59% specificity (95% CI: 35-83). CONCLUSION: We derived a clinical decision model to selectively identify young febrile girls at high risk for UTI with a positive microscopic analysis and propose UC with an 85% sensitivity, which would avoid approximately 60% of unnecessary UCs; although further validation is necessary before daily clinical use.
Asunto(s)
Fiebre/etiología , Cateterismo Urinario , Infecciones Urinarias/diagnóstico , Preescolar , Infecciones por Escherichia coli/complicaciones , Infecciones por Escherichia coli/diagnóstico , Femenino , Humanos , Lactante , Recién Nacido , Infecciones por Klebsiella/complicaciones , Infecciones por Klebsiella/diagnóstico , Klebsiella pneumoniae/aislamiento & purificación , Estudios Prospectivos , Infecciones por Proteus/complicaciones , Infecciones por Proteus/diagnóstico , Proteus mirabilis/aislamiento & purificación , Reproducibilidad de los Resultados , Sensibilidad y Especificidad , Procedimientos Innecesarios , Infecciones Urinarias/complicaciones , Orina/microbiologíaRESUMEN
Suppurative parotidis is an uncommon disease in newborns, with limited information available on its pathogenesis and management: approximately 50 cases have been reported in the literature. Diagnosis is based on clinical signs. The predominant organism is Staphylococcus aureus. The administration of empiric antimicrobial therapy is an essential part of the management in very young patients. Prognosis is good and recurrence of the disease is unusual. We describe a 21-day-old newborn who presented with fever and unilateral swelling of the parotid region, and provide a literature review.
Asunto(s)
Parotiditis/diagnóstico , Infecciones Estafilocócicas/diagnóstico , Enfermedad Aguda , Combinación Amoxicilina-Clavulanato de Potasio/uso terapéutico , Quimioterapia Combinada , Femenino , Estudios de Seguimiento , Gentamicinas/uso terapéutico , Humanos , Recién Nacido , Parotiditis/tratamiento farmacológico , Infecciones Estafilocócicas/tratamiento farmacológico , Supuración , UltrasonografíaRESUMEN
Enterocolitis is the most serious complication of Hirschsprung disease. Early management of these patients can decrease the severity of this complication. Hirschsprung disease is more common in patients with trisomy 21 than in the general population. Furthermore, the risk of developing enterocolitis is higher in this population. We report on an infant with trisomy 21 who developed enterocolitis as a complication of Hirschsprung disease that was diagnosed late when the infant presented with septic shock leading to death of the patient.