Correlation between urinary and serum NT-proBNP in acute bronchiolitis: A pilot study.

BACKGROUND AND AIMS: We aimed to analyze the correlation of urinary with serum N-terminal pro-brain natriuretic peptide (NT-proBNP) concentrations and its association with severity in acute bronchiolitis. MATERIAL AND METHODS: A pilot observational study was conducted between October 1, 2021 and March 31, 2022 including acute bronchiolitis cases who attended our institution. Serum and urinary NT-proBNP concentrations were determined using the Alere i NT-proBNP assay in time-matched urine and blood samples. The Mann-Whitney U test, Spearman's correlations, and simple linear regression were utilized to analyze the association of urine NT-proBNP levels with serum NT-proBNP and with variables indicative of severe bronchiolitis. RESULTS: Seventeen infants (median age 68 [IQR: 36-91] days) with 36 time-matched samples were included. The urine NT-proBNP was positively and strongly correlated with the serum NT-proBNP concentrations (Spearman's ρ = 0.81 & R2  coefficient = 0.751; p < 0.001), and increased with higher C-reactive protein, (p = 0.004), procalcitonin (p = 0.001), and pCO2 (p = 0.029) levels. The initial urinary NT-proBNP concentrations were higher in those infants that required ventilatory support compared with those without this outcome (1.85 [IQR: 1.16-2.44] vs. 0.63 [IQR: 0.45-0.84] pg/mg); p < 0.001); and resulted positively and strongly correlated with the duration of the ventilatory support (Spearman's ρ = 0.76; p < 0.001) and the length of stay hospitalization (Spearman's ρ = 0.84; p < 0.001). CONCLUSION: The urinary NT-proBNP concentrations could be a reliable surrogate for serum NT-proBNP levels and resulted elevated in cases of acute bronchiolitis with complicated evolution, suggesting a potential as a noninvasive tool to assess severity in this setting.

Ventilator-associated events in children: A multicentre prospective cohort study.

BACKGROUND: The Centres for Disease Control and Prevention (CDC) broadened the focus of surveillance from ventilator-associated pneumonia to ventilator-associated event (VAE) for quality purposes. No paediatric definition of VAE (PaedVAE) has been accurately validated. We aimed to analyse the incidence and impact on patient outcomes resulting from the application of the adult and two paediatric VAE (PaedVAE) criteria. SECONDARY OBJECTIVE: to evaluate VAE/PaedVAE as factors associated with increased duration of mechanical ventilation (MV) and Paediatric Intensive Care Unit (PICU) stay. METHODS: Multicentre observational prospective cohort study in 15 PICUs in Spain. VAEs were assessed using the 2013/2015 CDC classification. PaedVAE were assessed using the CDC definition based on mean airway pressure (MAP-PaedVAE) versus a paediatric definition based on positive end-expiratory pressure (PEEP-PaedVAE). Children who underwent MV ≥ 48 h were included. RESULTS: A total of 3626 ventilator-days in 391 patients were analysed. The incidence of VAE, MAP-PaedVAE and PEEP-PaedVAE was 8.55, 5.24 and 20.96 per 1000 ventilator-days, respectively. The median time [IQR] for VAE, MAP-PaedVAE and PEEP-PaedVAE development from the MV onset was 4 [3-12.5], 4 [3-14], and 5 [3-7.75] days, respectively. Among survivors, all three were associated with increased MV duration (> 7 days) and PICU stay (> 10 days) at univariate analysis. Multivariate analysis showed that PEEP-PaedVAE was the only definition independently associated with MV above 7 days [OR = 4.86, 95% CI (2.41-10.11)] and PICU stay [OR = 3.49, 95% CI (1.68-7.80)] above ten days, respectively. CONCLUSIONS: A VAE definition based on slight PEEP increases should be preferred for VAE surveillance in children.

Vitamin D Levels and Cardiopulmonary Status in Infants with Acute Bronchiolitis.

BACKGROUND: To assess association of Vitamin D deficiency with cardiac and pulmonary status in infants with acute bronchiolitis. METHODS: Infants hospitalized with acute bronchiolitis were enrolled and classified as those with serum 25 hydroxyvitamin D (25-OHD) below or equal and above 20 ng/mL. The primary outcomes were cardiopulmonary involvement defined by elevation of NT-ProBNP, alteration of echocardiographic parameters and respiratory support requirements. The secondary outcomes were the need for PICU admission and duration of hospitalization. RESULTS: Ninety two (50 males) infants with median (IQR) age 1 (0.5 - 3) months were included with median (IQR) serum 25 - OHD level 27.4 (11.4 - 40.3) ng/mL. Forty-three (47%) patients had serum below 20 ng/mL with left ventricle dysfunction (P=0.008), right ventricle dysfunction (P=0.008) and pulmonary hypertension (P=0.007) on echocardiography than those with serum 25 - OHD > 20 ng/mL. The median (IQR) serum NT - ProBNP levels were higher in those with low 25 - OHD levels than normal 25 - OHD levels [2232.2 (461.4 - 4313.3) and 830.4 (312.7 - 2579.5)], respectively; P=0.003. Low 25-OHD levels were associated with increased risk for PICU admission (OR 3.9 (95% CI 1.5-10.1); P=0.004), higher rates of non-invasive ventilation, (P= 0.048), mechanical ventilation (P=0.005), and longer duration of hospitalization (P=0.015). CONCLUSION: Low serum vitamin D level was associated with clinical severity and impaired cardiac and pulmonary status in infants with acute bronchiolitis.

Characterization of Cardiopulmonary Interactions and Exploring Their Prognostic Value in Acute Bronchiolitis: A Prospective Cardiopulmonary Ultrasound Study.

We aimed to delineate cardiopulmonary interactions in acute bronchiolitis and to evaluate the capacity of a combined cardiopulmonary ultrasonography to predict the need for respiratory support. This was a prospective observational single-center study that includes infants <12 month of age admitted to a hospital due to acute bronchiolitis. All the included patients underwent clinical, laboratory and cardiopulmonary ultrasonographic evaluation at the same time point within 24 h of hospital admission. The existence of significant correlation between cardiac and respiratory parameters was the primary outcome. The association of different cardiopulmonary variables with the need of respiratory support higher than O2, the length of stay hospitalization, the PICU stay and the duration of respiratory support were a secondary outcome. We enrolled 112 infants (median age 1 (0.5-3) months; 62% males) hospitalized with acute bronchiolitis. Increased values of the pulmonary variables (BROSJOD score, pCO2 and LUS) showed moderate correlations with NT-proBNP and all echocardiographic parameters indicative of pulmonary hypertension and myocardial dysfunction (Tei index). Up to 36 (32%) infants required respiratory support during the hospitalization. This group presented with higher lung ultrasound score (p < 0.001) and increased values of NT-proBNP (p < 0.001), the Tei index (p < 0.001) and pulmonary artery pressures (p < 0.001). All the analyzed respiratory and cardiac variables showed moderate-to-strong correlations with the LOS of hospitalization and the time of respiratory support. Lung ultrasound and echocardiography showed a moderate-to-strong predictive accuracy for the need of respiratory support in the ROC analysis, with the AUC varying from 0.74 to 0.87. Those cases of bronchiolitis with a worse pulmonary status presented with a more impaired cardiac status. Cardiopulmonary ultrasonography could be a useful tool to easily identify high-risk populations for complicated acute bronchiolitis hospitalization.

Levels of lactic acid's concordance with pH in pediatric parapneumonic pleural effusion.

Purpose of the article: The indication of pleural drainage in parapneumonic pleural effusion (PPE) is still controversial. Pleural fluid's (PF) pH is widely used as an indicator of the need for pleural drainage. We hypothesized that PF's lactate will have a high concordance with pH, and thus, may be a valuable tool to determine the need for pleural drainage in pediatric PPE. MATERIALS AND METHODS: We performed a descriptive, prospective study sequentially enrolling those pediatric patients admitted to a tertiary University Hospital with a PPE between 2008 and 2018. Patients were classified in two groups: drainable PPE (pH < 7) and non-drainable PPE (pH > 7). Correlation with the pH, the area under the curve (AUC), and the sensitivity and specificity values for lactate and other parameters (glucose, and LDH) were analysed too. RESULTS: 72 patients with a median age of 4 years (interquartile range 2.25-6) were included. Both groups were homogeneous. Lactate levels were higher in the drainable PPE group (p < 0.001), and a strong inverse correlation between pH and lactate was found (r: -0.7; p < 0.001). A lactate cut-off value of 60.5 mmol/L, exhibit an AUC of 0.86 with a sensitivity of 70% and a high specificity (97.9%) to predict a pH < 7. CONCLUSIONS: Our data indicates that lactate in PF presents a strong correlation with pH and could potentially serve as a highly specific biomarker of the need for pleural drainage.

Severe manifestations of SARS-CoV-2 in children and adolescents: from COVID-19 pneumonia to multisystem inflammatory syndrome: a multicentre study in pediatric intensive care units in Spain.

BACKGROUND: Multisystem inflammatory syndrome temporally associated with COVID-19 (MIS-C) has been described as a novel and often severe presentation of SARS-CoV-2 infection in children. We aimed to describe the characteristics of children admitted to Pediatric Intensive Care Units (PICUs) presenting with MIS-C in comparison with those admitted with SARS-CoV-2 infection with other features such as COVID-19 pneumonia. METHODS: A multicentric prospective national registry including 47 PICUs was carried out. Data from children admitted with confirmed SARS-CoV-2 infection or fulfilling MIS-C criteria (with or without SARS-CoV-2 PCR confirmation) were collected. Clinical, laboratory and therapeutic features between MIS-C and non-MIS-C patients were compared. RESULTS: Seventy-four children were recruited. Sixty-one percent met MIS-C definition. MIS-C patients were older than non-MIS-C patients (p = 0.002): 9.4 years (IQR 5.5-11.8) vs 3.4 years (IQR 0.4-9.4). A higher proportion of them had no previous medical history of interest (88.2% vs 51.7%, p = 0.005). Non-MIS-C patients presented more frequently with respiratory distress (60.7% vs 13.3%, p < 0.001). MIS-C patients showed higher prevalence of fever (95.6% vs 64.3%, p < 0.001), diarrhea (66.7% vs 11.5%, p < 0.001), vomits (71.1% vs 23.1%, p = 0.001), fatigue (65.9% vs 36%, p = 0.016), shock (84.4% vs 13.8%, p < 0.001) and cardiac dysfunction (53.3% vs 10.3%, p = 0.001). MIS-C group had a lower lymphocyte count (p < 0.001) and LDH (p = 0.001) but higher neutrophil count (p = 0.045), neutrophil/lymphocyte ratio (p < 0.001), C-reactive protein (p < 0.001) and procalcitonin (p < 0.001). Patients in the MIS-C group were less likely to receive invasive ventilation (13.3% vs 41.4%, p = 0.005) but were more often treated with vasoactive drugs (66.7% vs 24.1%, p < 0.001), corticosteroids (80% vs 44.8%, p = 0.003) and immunoglobulins (51.1% vs 6.9%, p < 0.001). Most patients were discharged from PICU by the end of data collection with a median length of stay of 5 days (IQR 2.5-8 days) in the MIS-C group. Three patients died, none of them belonged to the MIS-C group. CONCLUSIONS: MIS-C seems to be the most frequent presentation among critically ill children with SARS-CoV-2 infection. MIS-C patients are older and usually healthy. They show a higher prevalence of gastrointestinal symptoms and shock and are more likely to receive vasoactive drugs and immunomodulators and less likely to need mechanical ventilation than non-MIS-C patients.

Topical Pharyngeal Lidocaine Reduces Respiratory Adverse Events During Upper Gastrointestinal Endoscopies Under Ketamine Sedation in Children.

BACKGROUND: Upper gastrointestinal endoscopies (UGEs) performed under ketamine sedation may increase the risk of respiratory adverse events (RAEs) due to pharyngeal stimulation. Topical lidocaine prevents general anesthesia-induced laryngospasm. OBJECTIVE: Our objective was to determine whether topical lidocaine may reduce the incidence of RAEs induced by pharyngeal stimulation in UGEs performed on children sedated with ketamine. METHODS: We conducted a single-center prospective study. We included every patient admitted for an elective diagnostic UGE under ketamine sedation who received lidocaine prior to the technique. Patients requiring any other medication were excluded. Our main outcome measure was the number of desaturation episodes. We then compared these results with those obtained in an historic group who did not receive topical lidocaine, in which we registered a total of 54 desaturation episodes. RESULTS: In total, 88 children (52.3% boys) were included. The median age was 7 years [interquartile range (IQR) 3-11]. The mean duration of the procedure was 6.5 ± 2.4 min, and the median initial ketamine dose was 1.76 mg/kg (IQR 1.56-2.03). The total number of desaturation episodes was 3 (3.4%), and two of these occurred prior to the introduction of the endoscope. This result represents a lower incidence than in previously reported series, and a significant decrease (p < 0.0001) with respect to the 54 RAEs registered in the historic group of 87 children. CONCLUSIONS: Topical lidocaine premedication significantly reduced the incidence of RAEs in children during UGEs under ketamine sedation. Our findings should be confirmed by a double-blind randomized controlled trial.

Trends in nosocomial infections and multidrug-resistant microorganisms in Spanish pediatric intensive care units / Tendencia de la infección nosocomial y microorganismos multirresistentes en unidades de cuidados intensivos pediátricas en España

INTRODUCTION: Nosocomial infections (NI) are a major healthcare problem. National surveillance systems enable data to be compared and to implement new measures to improve our practice. METHODS: A multicentre, prospective, descriptive and observational study was conducted using the data from surveillance system for nosocomial infections created in 2007 for Spanish pediatric intensive care units. Data were collected for one month, between 01 and 31 March, for every study year (2008-2012). The objective was to report 5-years of NI surveillance data, as well as trends in infections by multidrug resistant organisms in Spanish pediatric intensive care units. RESULTS: A total of 3667 patients were admitted to the units during the study period. There were 90 (2.45%) patients with nosocomial infections. The mean rates during the 5 years study were: central line-associated bloodstream infection, 3.8/1000 central venous catheter-days, Ventilator-associated pneumonia 7.5/1000 endotracheal tube-days, and catheter-associated urinary tract infections 4.1/1000 urinary catheter-days. The comparison between the 2008 and 2009 rates for nosocomial infections did not show statistically significant differences. All rates homogeneously decreased from 2009 to 2012: central line-associated bloodstream infection 5.83 (95% CI 2.67-11.07) to 0.49 (95% CI 0.0125-2.76), P = 0.0029; ventilator-associated pneumonia 10.44 (95% CI 5.21-18.67) to 4.04 (95% CI 1.48-8.80), P = 0.0525; and Catheter-associated urinary tract infections 7.10 (95% CI 3.067-13.999) to 2.56 (95% CI 0.697-6.553), P = 0.0817; respectively. The microorganism analysis: 63 of the 99 isolated bacteria (63.6%) were Gram-negative bacteria (36.5% were resistant), 19 (19.2%) Gram-positive bacteria, and 17 (17.2%) were Candida spp. infections. CONCLUSIONS: The local surveillance systems provide information for dealing with nosocomial infections rates

INTRODUCCIÓN: Las infecciones nosocomiales son un problema de salud pública. Los sistemas nacionales de vigilancia permiten comparar datos e implementar medidas para mejorar la práctica asistencial. MÉTODO: Estudio multicéntrico, prospectivo, descriptivo y observacional. En 2007 se creó un sistema de vigilancia para infección nosocomial en las Unidades de Cuidados Intensivos Pediátricas Españolas. Se recogieron datos durante un mes (Marzo) por año (2008-2012). El objetivo fue reportar las tasas de los 5 años de vigilancia de la infección nosocomial y la evolución de las infecciones por microorganismos multirresistentes. RESULTADOS: Ingresaron 3667 pacientes. Número de pacientes con infección nosocomial: 90 (2.45%). Tasas medias de los 5 años de estudio: Bacteriemia relacionada con catéter 3.8/1000 días de catéter venoso central, Neumonía asociada a la ventilación mecánica 7.5/1000 días de tubo endotraqueal e Infecciones urinarias asociadas a sonda 4.1/1000 días de sonda urinaria. La comparación de tasas entre 2008 y 2009 no mostró diferencias estadísticamente significativas. Todas las tasas se redujeron homogéneamente desde 2009 a 2012: Bacteriemia relacionada con catéter 5.83 (95% CI 2.67-11.07) a 0.49 (95% CI 0.0125-2.76), P = 0.0029; Neumonía asociada a la ventilación mecánica 10.44 (95% CI 5.21-18.67) a 4.04 (95% CI 1.48-8.80), P = 0.0525; Infecciones urinarias asociadas a sonda 7.10 (95% CI 3.067-13.999) a 2.56 (95% CI 0.697-6.553), P = 0.0817; respectivamente. Microorganismos: 63 de 99 (83.6%) microorganismos aislados fueron bacterias gram-negativas (36.5% resistentes), 19 (19.2%) bacterias gram-positivas y 17 (17.2%) infecciones por Candida spp. CONCLUSIONES: Los sistemas de vigilancia local aportan información para mejorar las tasas de infección nosocomial

Primer caso de infección fúngica invasora por Candida fabianii en un paciente pediátrico no neonatal / First report of invasive fungal disease by Candida fabianii in a non-neonatal paediatric patient

Antecedentes. Las enfermedades fúngicas invasoras se han incrementado en los últimos años, y las de especies del género Candida son las de etiología más común. Candida albicans, Candida parapsilosis, Candida tropicalis, Candida glabrata y Candida krusei son las responsables de la mayoría de las infecciones fúngicas. El objetivo de este trabajo es describir el primer aislamiento en sangre de Candida fabianii en un paciente pediátrico no neonatal. Caso clínico. Varón de 2 años de edad con síndrome de intestino corto, malnutrición severa y raquitismo hipofosfatémico carencial, que ingresó en la unidad de cuidados intensivos pediátricos por una infección respiratoria de vías bajas y sospecha de pseudoobstrucción intestinal. Precisó varios ciclos de antibioterapia de amplio espectro por infecciones por Pseudomonas aeruginosa y Escherichia coli. Tras la corrección quirúrgica de su patología intestinal comenzó con un nuevo episodio de sepsis, del que se aislaron levaduras por cultivo. La identificación se realizó mediante espectrometría de masas por el sistema MALDI-TOF (Bruker Daltonic). El resultado obtenido fue el de C. fabianii (anamorfo)/Pichia fabianii (teleomorfo), con un score de 2,149. Se inició un tratamiento antifúngico con caspofungina, con buena evolución del paciente. Conclusiones. Es importante realizar técnicas de biología molecular para la identificación de este tipo de especies, aunque la espectrometría de masas ofreció un diagnóstico fiable y rápido. El tratamiento con caspofungina fue eficaz (AU)

Background. Invasive fungal diseases have increased in recent years. Candida species are the most common aetiology. Candida albicans, Candida parapsilosis, Candida tropicalis, Candida glabrata and Candida krusei are the cause of most of them. The aim of this work is to describe the first isolation of Candida fabianii in the blood of a non-neonatal paediatric patient. Case report. A 2 year-old male with short bowel syndrome, severe malnutrition, and hypophosphataemic rickets deficiency was admitted to paediatric intensive care due to a respiratory tract infection and suspicion of an intestinal pseudo-obstruction. He received several cycles of broad-spectrum antibiotics for several infections due to Pseudomonas aeruginosa and Escherichia coli. After the surgical correction of the intestinal disorder he suffered a new episode of sepsis where yeasts were isolated by culture. The species identification was performed by means of mass spectrometry (MALDI-TOF system, Bruker Daltonic). The identity of the isolate was C. fabianii (anamorph)/Pichia fabianii (teleomorph) with a score of 2.149. Antifungal treatment with caspofungin was prescribed, with good progress of the patient. Conclusions. Molecular techniques are important for the identification of these species, although mass spectrometry offered a reliable and rapid diagnosis. Treatment with caspofungin was effective (AU)

Trends in nosocomial infections and multidrug-resistant microorganisms in Spanish pediatric intensive care units.

INTRODUCTION: Nosocomial infections (NI) are a major healthcare problem. National surveillance systems enable data to be compared and to implement new measures to improve our practice. METHODS: A multicentre, prospective, descriptive and observational study was conducted using the data from surveillance system for nosocomial infections created in 2007 for Spanish pediatric intensive care units. Data were collected for one month, between 01 and 31 March, for every study year (2008-2012). The objective was to report 5-years of NI surveillance data, as well as trends in infections by multidrug resistant organisms in Spanish pediatric intensive care units. RESULTS: A total of 3667 patients were admitted to the units during the study period. There were 90 (2.45%) patients with nosocomial infections. The mean rates during the 5 years study were: central line-associated bloodstream infection, 3.8/1000 central venous catheter-days, Ventilator-associated pneumonia 7.5/1000 endotracheal tube-days, and catheter-associated urinary tract infections 4.1/1000 urinary catheter-days. The comparison between the 2008 and 2009 rates for nosocomial infections did not show statistically significant differences. All rates homogeneously decreased from 2009 to 2012: central line-associated bloodstream infection 5.83 (95% CI 2.67-11.07) to 0.49 (95% CI 0.0125-2.76), P=0.0029; ventilator-associated pneumonia 10.44 (95% CI 5.21-18.67) to 4.04 (95% CI 1.48-8.80), P=0.0525; and Catheter-associated urinary tract infections 7.10 (95% CI 3.067-13.999) to 2.56 (95% CI 0.697-6.553), P=0.0817; respectively. The microorganism analysis: 63 of the 99 isolated bacteria (63.6%) were Gram-negative bacteria (36.5% were resistant), 19 (19.2%) Gram-positive bacteria, and 17 (17.2%) were Candida spp. infections. CONCLUSIONS: The local surveillance systems provide information for dealing with nosocomial infections rates.

[First report of invasive fungal disease by Candida fabianii in a non-neonatal paediatric patient]. / Primer caso de infección fúngica invasora por Candida fabianii en un paciente pediátrico no neonatal.

BACKGROUND: Invasive fungal diseases have increased in recent years. Candida species are the most common aetiology. Candida albicans, Candida parapsilosis, Candida tropicalis, Candida glabrata and Candida krusei are the cause of most of them. The aim of this work is to describe the first isolation of Candida fabianii in the blood of a non-neonatal paediatric patient. CASE REPORT: A 2 year-old male with short bowel syndrome, severe malnutrition, and hypophosphataemic rickets deficiency was admitted to paediatric intensive care due to a respiratory tract infection and suspicion of an intestinal pseudo-obstruction. He received several cycles of broad-spectrum antibiotics for several infections due to Pseudomonas aeruginosa and Escherichia coli. After the surgical correction of the intestinal disorder he suffered a new episode of sepsis where yeasts were isolated by culture. The species identification was performed by means of mass spectrometry (MALDI-TOF system, Bruker Daltonic). The identity of the isolate was C.fabianii (anamorph)/Pichia fabianii (teleomorph) with a score of 2.149. Antifungal treatment with caspofungin was prescribed, with good progress of the patient. CONCLUSIONS: Molecular techniques are important for the identification of these species, although mass spectrometry offered a reliable and rapid diagnosis. Treatment with caspofungin was effective.

Does nebulized epinephrine improve the efficacy of hypertonic saline solution in the treatment of hospitalized moderate acute bronchiolitis? A double blind, randomized clinical trial.

BACKGROUND: Nebulized 3% hypertonic saline solution (HSS 3%) has proven to reduce hospital stay in infants with acute bronchiolitis, as compared with nebulized physiological saline solutions. There are no studies assessing the effectiveness of nebulized epinephrine in patients treated with HSS 3%. The aim of this study was to compare the length of stay (LOS) in hospitalized patients treated with HSS 3% with placebo vs. HSS 3% with epinephrine. Secondarily we aimed to assess the effectiveness and safety of both treatments. METHODS: We performed a prospective, randomized, double-blind, parallel-group study, including infants hospitalized for moderate acute bronchiolitis. Both groups received standard life support and were randomly treated with nebulized HSS 3% (7 mL) with either placebo 3 mL or epinephrine 3 mL. Nebulizations were initially administered every four hours and this interval was modified according to the patient's response. RESULTS: Sixty-four infants were included, 32 patients in each group. No statistically significant differences were found between the two groups (P=0.948) in length of stay, disease severity, SatO2, respiratory rate or heart rate. On the third day of hospitalization, severity and respiratory rate in the HSS 3%+E presented a non statistically significant trend to an earlier improvement, (P=0.063 and P=0.096 repectively). No adverse events occurred. Four patients (two from each group) required transfer to the pediatric intensive care unit. CONCLUSIONS: With a third of the final estimated sample, we find a trend to an earlier clinical recovery in the epinephrine group, even though no statistical significant differences in LOS were found. The study needs to be continued until the total sample is recruited.

Utilidad del screening ecocardiográfico en las infecciones neumocócicas invasivas / Usefulness of echocardiographic screening in invasive pneumococcal infections

No disponible

Pneumonia and purulent pericarditis caused by Streptococcus pneumoniae: an uncommon association in the antibiotic era.

Bacterial pericarditis in children has become a rare entity in the modern antibiotic era. The most common pathogen is Staphylococcus aureus, being Streptococcus pneumoniae an exceptional cause. We present 2 children, who were diagnosed of pneumonia complicated with a pleural effusion that developed a purulent pericarditis with signs of cardiac tamponade. One of them had received 4 doses of the 7-valent conjugated pneumococcal vaccine. Systemic antibiotics and pericardial and pleural drainages were used. Pneumococcal antigens were positive in pleural and pericardial fluids in both cases, and S. pneumoniae was isolated from pleural effusion in one of them. Both children fully recovered, and none of them developed constrictive pericarditis, although 1 case presented a transient secondary left ventricular dysfunction. Routine immunization with 10- and 13-valent vaccines including a wider range of serotypes should further decrease the already low incidence.

Per-species risk factors and predictors of invasive Candida infections in patients admitted to pediatric intensive care units: development of ERICAP scoring systems.

BACKGROUND: Prediction rules for invasive Candida infection (ICI) are available for adult but not for infants and children managed in pediatric intensive care units (PICU). METHODS: Observational study in 24 PICU with prospective phase (all children admitted during 1 year) and retrospective review of ICI records. Four logistic regression models were performed using ICI by Candida spp., Candida albicans, Candida parapsilosis or Candida tropicalis as dependent variables. Scores were constructed. RESULTS: One hundred and twenty five ICI (47 C. albicans, 37 C. parapsilosis, 19 C. tropicalis and 22 others) and 1022 controls were included. Incidence (cases/100 PICU admissions): 4.22 (all Candida), 2.44 (C. albicans), 1.41 (C. parapsilosis), 0.19 (C. tropicalis). ICI was associated [Area under the receiver operating characteristics curve (AUC) = 0.764, 95% confidence interval (CI) = 0.719-0.809, P < 0.001] with pre-PICU hospitalization ≥ 15 days [odds ratio (OR) = 3.3; score: +3], fever (OR = 2.6; +2), thrombopenia (OR = 2.0; +1) and parenteral nutrition (OR=2.4; +2). Additionally, the following associations were noted: C. albicans ICI (AUC = 0.716, 95% CI = 0.640-0.792, P < 0.001) with chronic metabolic disease (OR = 10.7; score:+4), surgical digestive process (OR = 2.8; +1), fever (OR = 2.8; +1) and parenteral nutrition (OR = 2.3; +1); C. parapsilosis ICI (AUC = 0.808, 95% CI = 0.739-0.877, P < 0.001) with previous colonization (OR = 7.1; score:+3), tracheostomy (OR = 5.1; +2), parenteral nutrition (OR = 4.3; +2), thrombopenia (OR = 3.6; +1) and previous bacterial infection (OR = 3.0; +1) and ICI by C. tropicalis (AUC = 0.941, 95% CI=0.886-0.995, P < 0.001) with thrombopenia (OR = 53.8; score: +10), neutropenia (OR = 7.2; +1), pre-PICU hospitalization ≥ 15 days (OR = 17.2; +3) and hematologic (OR = 22.4; +4) and cardiovascular infectious processes (OR = 5.5; +1). Specificity was >90% for cut offs of 5 (all Candida), 3 (C. albicans), 3 (C. parapsilosis) and 11 (C. tropicalis). CONCLUSIONS: Once validated, these scores may help for identification of ICI by specific species allowing adequate empiric/prophylactic treatment.