Effectiveness of palivizumab immunoprophylaxis in infants with respiratory syncytial virus disease in Colombia.

INTRODUCTION: Respiratory syncytial virus (RSV) is one of the most important childhood infections. OBJECTIVE: To evaluate the effectiveness and safety of palivizumab immunoprophylaxis in preterm infants at a high risk of severe respiratory syncytial virus infection during the RSV season in Colombia. METHODOLOGY: A prospective observational non-comparative multicenter study in six Colombian cities. At the beginning of the RSV infection season, palivizumab prophylaxis, up to five doses, was administered to infants born at ≤32 weeks of gestation, infants younger than six months, infants under one year of age with bronchopulmonary dysplasia (BPD), infants one year or less of age with hemodynamically significant acyanotic and non-acyanotic congenital heart disease (CHD), and with follow-up during the immunoprophylaxis until one month after the last dose. RESULTS: The study enrolled 600 patients, 91.8% of which were born at ≤ 32 weeks of gestation. BPD was observed in 54.9% of infants. 49% were born at < 32 weeks gestation and presented BPD. 6.9% had hemodynamically significant acyanotic and non-acyanotic CHD 53.3% received three or more doses of palivizumab. The mean interval between doses was 39.6 days. 1.8% of patients were hospitalized due to a confirmed RSV infection. Overall mortality was 1.2%, whereas the mortality by RSV in infants undergoing prophylaxis was 0.2%. CONCLUSIONS: Palivizumab was a clinically effective, well-tolerated treatment in the Colombian population. The safety profile of palivizumab reflects the findings from previous studies in developed countries.

Etiología de la Sepsis Neonatal

De los 100 pacientes incluidos en el estudio, se documentó la sepsis en 74 niños, en 48 de estos pacientes se aislaron microorganismos en sangre (66.2 por ciento). En los hemocultivos los gérmenes aislados con mayor frecuencia fueron Enterobacter aerogens (31.2 por ciento), Klebsiella sp. (27 por ciento) y Staphylococcus epidermidis (22.9 por ciento). En cultiv os de L.C.R. se aislaron 2 Klebsiellas sp; 2 Escherichia coli y 1 Staphylococcus epidermis, todos estos gérmenes coincidieron con el aislado en el hemocultivo respectivo, excepto 1 Escherichia coli, que en el hemocultivo fue negativo. De los pacientes en los cuales se hizo aislamiento de microorganismos (49) se pudo hacer punción lumbar y procesar el L.C.R. en 32 de ellos, comprobáandose la miningitis en el 15.6 por ciento. La V.S.G., la proteína C reactiva y la haptoglobina furon las pruebas coadyuvantes que más aportaron al diagnóstico de sepsis neonatal. Los gérmenes aislados mostraron baja sensibilidad a la ampicilina, droga considerada tradicionalmente como de primera elección en el inicio del manejo de la sepsis. La misma observación en relación a la sensibilidad se obtuvo en el caso del Staphylococcus epidermidis frente a la oxaciclina. La ampicilina debe dejar de utilizarse durante algún tiempo en los hospitales en los cuales se hizo el estudio, debido a la baja sensibilidad de los gérmenes