ABSTRACT
INTRODUCCIÓN: La infección nosocomial (IN) es un problema frecuente en las Unidades de Cuidados Intensivos Pediátricas (UCIP), con una mortalidad atribuible hasta del 11%.ObjetivoDescribir la epidemiología de la IN en las UCIP españolas. Iniciar una estrategia estandarizada de control de la IN para disponer de tasas de incidencia pediátricas en nuestro medio. Pacientes y método: Estudio multicéntrico y prospectivo del 1 al 31 de marzo de 2007. Se utilizaron los criterios diagnósticos y la metodología de cálculo de incidencia de IN del Centers for Disease Control and Prevention. Se estudió especialmente la IN relacionada con dispositivos invasivos: catéter venoso central (CVC), ventilación mecánica (VM), sondaje vesical (SV). RESULTADOS: Se estudiaron 300 pacientes en 6 UCIP, diagnosticándose 17 episodios en 16 pacientes (5,3% de los ingresados). La tasa de IN fue de 13,8 infecciones/1.000 pacientes-día. La edad media de los infectados fue de 2,31 años (± 3,43), 9 fueron varones. Existieron factores de riesgo en 7 casos. Las localizaciones fueron: bacteriemia relacionada con catéter en 7 pacientes (6,7/1000 días CVC), neumonía asociada a VM en 4 (9,4/1.000 días VM), infección urinaria asociada a SV en 4 (5,5/1000 días SV), un caso de bacteriemia primaria y una infección de herida quirúrgica. Los microorganismos aislados fueron: 9 bacilos gramnegativos, 4 Candidas, 2 estafilococos plasmocoagulasa negativos, 1 Haemophilus y 1 Staphylococcus aureus. Siete aislamientos fueron de microorganismos resistentes. No hubo ningún exitus atribuible a la IN. CONCLUSIONES: La epidemiología de la IN fue similar a la publicada en otros países de nuestro entorno. La vigilancia de la IN es esencial para un correcto manejo y para ello es fundamental tener un patrón de análisis y referencia común
INTRODUCTION: Nosocomial infection (NI) is a common complication in paediatric critical care units (PICU), with an associated mortality up to 11%.OBJECTIVE: To describe NI epidemiology in the national PICU. To initiate an standard NI control measures to obtain paediatric incidence rates. PATIENTS AND METHOD: Multicentre prospective study from 1 to 31 march 2007. Centre Disease Control diagnosis and methodological criteria were used. It was specially analyzed NI related to invasive devices: central venous catheter (CVC), mechanical ventilation (MV), urinary catheter (UC). RESULTS: There were recruited 300 patients from 6 PICU, with 17 NI episodes in 16 patients (5,3% from admitted). NI rates resulted in 13,8 infections/1000 patients-day. Middle age from infected patients was 2,31 years (±3,43), 9 males. Risk factors were found in 7 cases. NI location was: catheter-related bloodstream infection in 7 patients (6,7/1000 days CVC), ventilator associated pneumonia in 4 (9,4/1000 MV days), urinary-tract infection associated with UC in4 (5,5/1000 UC days), one case of primary bloodstream infection and one surgical site infection. Isolated microorganisms were: 9 gram negatives bacillus, 4 Candida, 2 plasmocoagulase negative staphylococcus, 1 Haemophilus and 1 Staphylococcus aureus. Seven isolations were resistant microorganisms. There weren't any died related to NI. CONCLUSIONS: NI epidemiology was similar to published data in our near countries. NI surveillance, with a standardized method of analysis is essential to the NI correct manage
Subject(s)
Humans , Male , Female , Infant , Child, Preschool , Child , Intensive Care Units, Pediatric/statistics & numerical data , Cross Infection/epidemiology , Communicable Disease Control/organization & administration , Prospective Studies , Length of Stay/statistics & numerical dataABSTRACT
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Subject(s)
Humans , Child , Sepsis/therapy , Shock, Septic/therapy , Systemic Inflammatory Response Syndrome/diagnosis , Practice Guidelines as Topic , Resuscitation/methods , Hemodynamics/physiology , Extracorporeal Membrane Oxygenation , Blood Component Transfusion , Respiration, ArtificialABSTRACT
INTRODUCTION: Intrapleural fibrinolytic instillation has been used in the treatment of loculated pleural effusions and empyemas and has reduced the need for surgical intervention. Currently, the most commonly used fibrinolytic is urokinase, although the doses have not yet been standardized in children. The aim of the present study was to evaluate the utility of urokinase in the treatment of infectious pleural effusions in children. MATERIAL AND METHODS: A retrospective study was performed of children with infectious pleural effusions admitted to the pediatric intensive care unit (PICU) between January 2000 and December 2003. Age, sex, clinical features, laboratory tests, response to urokinase treatment and clinical course during hospital stay were analyzed. RESULTS: Thirty-one children were treated. The mean age was 38.1 months (SD: 22). There were 18 boys and 13 girls. The most frequent month of diagnosis was November and the number of admission significantly increased from 2002 onwards. The most frequent antibiotic therapy used before admission to the PICU was cefotaxime associated with vancomycin (41 %), followed by cefotaxime alone (16 %). Positive cultures for Streptococcus pneumoniae were found in 11 patients (35 %). Pleural loculation was found in 14 patients (45 %). Treatment with intrapleural urokinase was used in 23 patients (74 %). The mean chest tube drainage was 140 ml (SD: 175) in the 24 hours before urokinase instillation and was 406 ml (SD: 289) in the 48 hours after fibrinolytic therapy (p < 0.05). Twenty-one patients (91 %) who received urokinase treatment had a good response. There were no complications during the treatment. The mean length of stay in the PICU was 5.8 days (SD: 2.6). CONCLUSIONS: The incidence of complicated pleural effusions due to S. pneumoniae has increased in the last few years, despite antibiotic therapy. Intrapleural urokinase is an effective treatment, including in empyemas without loculation. None of our patients required thoracotomy and there were few adverse effects.
Subject(s)
Empyema, Pleural/therapy , Plasminogen Activators/therapeutic use , Pleura/metabolism , Pleural Effusion/therapy , Urokinase-Type Plasminogen Activator/therapeutic use , Child, Preschool , Combined Modality Therapy , Empyema, Pleural/epidemiology , Empyema, Pleural/microbiology , Exudates and Transudates/microbiology , Female , Humans , Incidence , Male , Plasminogen Activators/administration & dosage , Pleural Effusion/epidemiology , Pleural Effusion/microbiology , Retrospective Studies , Seasons , Streptococcus pneumoniae/isolation & purification , Suction/methods , Urokinase-Type Plasminogen Activator/administration & dosageABSTRACT
Introducción: La instilación intrapleural de agentes fibrinolíticos se ha utilizado como tratamiento de derrames pleurales tabicados y de empiemas, disminuyendo la necesidad de intervención quirúrgica. La urocinasa es el fibrinolítico más utilizado aunque en pediatría las dosis no están claramente estandarizadas. El objetivo del estudio fue evaluar la utilidad de la urocinasa intrapleural como tratamiento de los derrames pleurales complicados. Material y métodos: Se realizó un estudio retrospectivo de los derrames pleurales ingresados en la unidad de cuidados intensivos pediátricos (UCIP) entre enero de 2000 y diciembre de 2003. Se recogieron las variables de edad, sexo, sintomatología, pruebas complementarias, respuesta al tratamiento con urocinasa y evolución durante su ingreso. Resultados: Se estudiaron 31 casos, la edad media fue de 38,1 meses (desviación estándar [DE]: 22); 18 varones y 13 mujeres. El mes de mayor incidencia fue noviembre, y existió un aumento significativo del número de ingresos a partir del año 2002. El tratamiento antibiótico más frecuente antes del ingreso en UCIP fue la asociación de cefotaxima y vancomicina (41 %), seguido de cefotaxima (16 %). Se obtuvieron cultivos positivos a S. pneumoniae en 11 casos (35 %). Se demostró derrame tabicado en 14 casos (45 %). El tratamiento con urocinasa intrapleural se realizó en 23 casos (74 %), observándose un aumento significativo del drenaje pleural tras su aplicación, con un drenaje medio 24 h previo a la urocinasa de 140 ml (DE: 175) frente a 406 ml (DE: 289) 48 h después (p < 0,05). Respondieron favorablemente al tratamiento 21 casos (91 %) y no existieron complicaciones importantes durante su administración. La duración media del drenaje torácico fue de 5,2 días (DE: 2,97). La estancia media en la UCIP fue de 5,8 días (DE: 2,6). Conclusiones: Existe una mayor incidencia en los últimos años de derrames pleurales complicados secundarios a S. pneumoniae a pesar del tratamiento antibiótico. La urocinasa intrapleural es un tratamiento efectivo incluso en empiemas no tabicados, no precisando en ningún caso la intervención quirúrgica y con escasos efectos secundarios
Introduction: Intrapleural fibrinolytic instillation has been used in the treatment of loculated pleural effusions and empyemas and has reduced the need for surgical intervention. Currently, the most commonly used fibrinolytic is urokinase, although the doses have not yet been standardized in children. The aim of the present study was to evaluate the utility of urokinase in the treatment of infectious pleural effusions in children. Material and methods: A retrospective study was performed of children with infectious pleural effusions admitted to the pediatric intensive care unit (PICU) between January 2000 and December 2003. Age, sex, clinical features, laboratory tests, response to urokinase treatment and clinical course during hospital stay were analyzed. Results: Thirty-one children were treated. The mean age was 38.1 months (SD: 22). There were 18 boys and 13 girls. The most frequent month of diagnosis was November and the number of admission significantly increased from 2002 onwards. The most frequent antibiotic therapy used before admission to the PICU was cefotaxime associated with vancomycin (41 %), followed by cefotaxime alone (16 %). Positive cultures for Streptococcus pneumoniae were found in 11 patients (35 %). Pleural loculation was found in 14 patients (45 %). Treatment with intrapleural urokinase was used in 23 patients (74 %). The mean chest tube drainage was 140 ml (SD: 175) in the 24 hours before urokinase instillation and was 406 ml (SD: 289) in the 48 hours after fibrinolytic therapy (p < 0.05). Twenty-one patients (91 %) who received urokinase treatment had a good response. There were no complications during the treatment. The mean length of stay in the PICU was 5.8 days (SD: 2.6). Conclusions: The incidence of complicated pleural effusions due to S. pneumoniae has increased in the last few years, despite antibiotic therapy. Intrapleural urokinase is an effective treatment, including in empyemas without loculation. None of our patients required thoracotomy and there were few adverse effects