Hemocultivos en urgencias pediátricas. Guía práctica de recomendaciones: indicaciones, técnica de extracción, procesamiento e interpretación / Blood cultures in the paediatric emergency department. Guidelines and recommendations on their indications, collection, processing and interpretation

El hemocultivo (HC) es el método diagnóstico de elección ante la sospecha de bacteriemia, siendo una de las técnicas microbiológicas más solicitadas en pediatría. Diversos cambios han acontecido en los últimos años como la introducción de nuevas vacunas, el aumento creciente de pacientes portadores de catéteres vasculares centrales, o la irrupción de los sistemas automáticos de procesamiento de los HC. Dichos cambios han propiciado la revisión y la actualización de los distintos aspectos relacionados con esta técnica con el fin de optimizar su uso. Se presenta una guía práctica sobre recomendaciones acerca de la extracción, el procesamiento y la interpretación de los HC elaborada por la Sociedad Española de Urgencias de Pediatría y la Sociedad Española de Infectología Pediátrica. Tras revisar la información científica disponible, se presentan una serie de recomendaciones para cada uno de los siguientes apartados: indicaciones en Urgencias, técnica de extracción, transporte y procesamiento de la muestra, factores a tener en cuenta en situaciones especiales (indicaciones e interpretación de resultados en el paciente inmunodeprimido y/o portador de catéter vascular central, indicaciones de HC para anaerobios), diferenciación entre bacteriemia y contaminación ante un HC con crecimiento bacteriano y actitud a tomar ante un HC positivo en el paciente con fiebre sin foco

Blood culture (BC) is the gold standard when a bacteraemia is suspected, and is one of the most requested microbiological tests in paediatrics. Some changes have occurred in recent years: the introduction of new vaccines, the increasing number of patients with central vascular catheters, as well as the introduction of continuous monitoring BC systems. These changes have led to the review and update of different factors related to this technique in order to optimise its use. A practice guideline is presented with recommendations on BC, established by the Spanish Society of Paediatric Emergency Care and the Spanish Society for Paediatric Infectious Diseases. After reviewing the available scientific evidence, several recommendations for each of the following aspects are presented: BC indications in the Emergency Department, how to obtain, transport and process cultures, special situations (indications and interpretation of results in immunosuppressed patients and/or central vascular catheter carriers, indications for anaerobic BC), differentiation between bacteraemia and contamination when a BC shows bacterial growth and actions to take with a positive BC in patients with fever of unknown origin

[Blood cultures in the paediatric emergency department. Guidelines and recommendations on their indications, collection, processing and interpretation]. / Hemocultivos en urgencias pediátricas. Guía práctica de recomendaciones: indicaciones, técnica de extracción, procesamiento e interpretación.

Blood culture (BC) is the gold standard when a bacteraemia is suspected, and is one of the most requested microbiological tests in paediatrics. Some changes have occurred in recent years: the introduction of new vaccines, the increasing number of patients with central vascular catheters, as well as the introduction of continuous monitoring BC systems. These changes have led to the review and update of different factors related to this technique in order to optimise its use. A practice guideline is presented with recommendations on BC, established by the Spanish Society of Paediatric Emergency Care and the Spanish Society for Paediatric Infectious Diseases. After reviewing the available scientific evidence, several recommendations for each of the following aspects are presented: BC indications in the Emergency Department, how to obtain, transport and process cultures, special situations (indications and interpretation of results in immunosuppressed patients and/or central vascular catheter carriers, indications for anaerobic BC), differentiation between bacteraemia and contamination when a BC shows bacterial growth and actions to take with a positive BC in patients with fever of unknown origin.

Vacunación antigripal universal en pediatría, ¿sí o no? / Universal immunisation against influenza in paediatrics, yes or no?

Introducción: Las recomendaciones sobre la vacunación antigripal no son homogéneas entre los países, con llamativas diferencias entre las recomendaciones actuales entre Estados Unidos y Europa. Objetivo: El objetivo del estudio es analizar la eficacia, la efectividad y la seguridad de las actuales vacunas antigripales (vacuna inactivada trivalente y vacuna de virus vivos adaptada al frío [LAIV]) en niños sanos para intentar responder a la pregunta: vacunación antigripal universal en pediatría, ¿sí o no?. Material y métodos: Se planteó un esquema de trabajo sobre la base de los 5 pasos característicos de la medicina basada en la evidencia o en pruebas científicas: a) pregunta; b) búsqueda; c) valoración; d) aplicabilidad, y e) adecuación. Resultados: Seleccionamos 9 revisiones sistemáticas que contestaban a nuestra pregunta clínica, publicadas entre 2005 y 2012, y que aglutinan la mejor información (ensayos clínicos aleatorizados, estudios de cohortes y estudios de casos-controles). Conclusiones: La vacuna antigripal en la infancia tiene una adecuada relación entre beneficios-costes-riesgos. En todas las revisiones sistemáticas la eficacia de la vacuna antigripal oscila entre el 58 y el 65%, y la efectividad entre el 28 y el 61%. La eficacia y la efectividad aumentan con la edad y hay escasos estudios para permitir una adecuada evidencia en menores de 2 años. Se plantean futuras líneas de trabajo: más y mejores ensayos clínicos sobre vacunas antigripales en lactantes de 6-23 meses; seguir investigando para conseguir mejores vacunas antigripales (adicción de adyuvantes, mayores dosis entre 6 y 23 meses y estudiar la vacuna LAIV entre 6 y 23 meses), y mejorar la predicción de las cepas vacunales responsables del brote epidémico (AU)

Introduction: The recommendations on influenza vaccination are not homogeneous between countries, with striking differences between the current recommendations in United States and Europe. Objective: The objective of the study is to determine the efficacy, effectiveness and safety of the current flu vaccine (trivalent inactivated vaccine and adapted to the cold [LAIV] live virus vaccine) in healthy children, and to try and answer the following question: universal immunization against influenza in Paediatrics, yes or no?. Material and methods: A scheme of work based on the five standard steps of evidence or science-based medicine was used: 1) question, 2) search, 3) valuation, 4) applicability and5) adequacy. Results: Nine systematic reviews, published between 2005 and 2012, were selected that answered our clinical question, and which included the best available information (randomized clinical trials, cohort studies and case studies). Conclusions: The flu vaccine in childhood has the right cost - benefit - risk relationship. In all systematic reviews the efficacy of the flu vaccine varied between 58%-65%, and effectiveness between 28%-61%. Both efficacy and effectiveness increase with age, and there are limited studies showing sufficient evidence in children < 2 years. There are further areas to develop: more and better clinical trials on influenza vaccines in infants from 6 to 23 months; further research to achieve better influenza vaccines (addition of adjuvants, higher doses in children between 6 and 23 months, and study the LAIV vaccine in children between 6 and 23 months);and improvement in the prediction of vaccine strains responsible for the outbreak (AU)

[Universal immunisation against influenza in paediatrics, yes or no?]. / Vacunación antigripal universal en pediatría, ¿sí o no?

INTRODUCTION: The recommendations on influenza vaccination are not homogeneous between countries, with striking differences between the current recommendations in United States and Europe. OBJECTIVE: The objective of the study is to determine the efficacy, effectiveness and safety of the current flu vaccine (trivalent inactivated vaccine and adapted to the cold [LAIV] live virus vaccine) in healthy children, and to try and answer the following question: universal immunization against influenza in Paediatrics, yes or no? MATERIAL AND METHODS: A scheme of work based on the five standard steps of evidence or science-based medicine was used: 1) question, 2) search, 3) valuation, 4) applicability and 5) adequacy. RESULTS: Nine systematic reviews, published between 2005 and 2012, were selected that answered our clinical question, and which included the best available information (randomised clinical trials, cohort studies and case studies). CONCLUSIONS: The flu vaccine in childhood has the right cost - benefit - risk relationship. In all systematic reviews the efficacy of the flu vaccine varied between 58%-65%, and effectiveness between 28%-61%. Both efficacy and effectiveness increase with age, and there are limited studies showing sufficient evidence in children < 2 years. There are further areas to develop: more and better clinical trials on influenza vaccines in infants from 6 to 23 months; further research to achieve better influenza vaccines (addition of adjuvants, higher doses in children between 6 and 23 months, and study the LAIV vaccine in children between 6 and 23 months); and improvement in the prediction of vaccine strains responsible for the outbreak.

Diagnóstico de la tuberculosis en la edad pediátrica. Documento de consenso de la Sociedad Española de Infectología Pediátrica (SEIP) y la Sociedad Española de Neumología Pediátrica (SENP) / Diagnosis of tuberculosis in pediatrics. Consensus document of the Spanish Society of Pediatric Infectology (SEIP) and the Spanish Society of Pediatric Pneumology (SENP)

La tuberculosis continúa siendo uno de los problemas sanitarios más importantes en el mundo. En países desarrollados se está asistiendo a un aumento de casos, incluidos los niños, por diferentes motivos. El más determinante parece ser la inmigración procedente de zonas con elevada endemia de tuberculosis. Es prioritario que se establezcan las medidas necesarias para optimizar el diagnóstico precoz y adecuado de las distintas formas clínicas de tuberculosis en niños. Para ello, la Sociedad Española de Infectología Pediátrica (SEIP) y la Sociedad Española de Neumología Pediátrica (SENP), ambas pertenecientes Asociación Española de Pediatría, han decidido realizar el presente documento de consenso con el objetivo de unificar los criterios de actuación diagnóstica en la edad pediátrica (AU)

Tuberculosis is one of the most important health problems worldwide. There are an increased number of cases, including children, due to different reasons in developed countries. The most likely determining cause is immigration coming from high endemic areas. Measures to optimize early and appropriate diagnosis of the different forms of tuberculosis in children are a real priority. Two Societies of the Spanish Pediatric Association (Spanish Society of Pediatric Infectology and Spanish Society of Pediatric Pneumology) have agreed this Consensus Document in order to homogenize diagnostic criteria in pediatric patients (AU)

Diagnóstico de la tuberculosis en la edad pediátrica / Diagnosis of tuberculosis in paediatrics

La tuberculosis continúa siendo uno de los problemas sanitarios más importantes en el mundo. En países desarrollados se está asistiendo a un aumento de casos, incluidos los niños, por diferentes motivos. El más determinante parece ser la inmigración procedente de zonas con elevada endemia de tuberculosis. Es prioritario que se establezcan las medidas necesarias para optimizar el diagnóstico precoz y adecuado de las distintas formas clínicas de tuberculosis en niños. Para ello, la Sociedad Española de Infectología Pediátrica y la Sociedad Española de Neumología Pediátrica ambas pertenecientes a la Asociación Española de Pediatría, han decidido realizar el presente documento de consenso, con el objetivo de unificar los criterios de actuación diagnóstica en la edad pediátrica (AU)

Tuberculosis is one of the most important health problems worldwide. There are an increasing number of cases, including children, due to different reasons in developed countries. The most likely determining cause is immigration from highly endemic areas. Measures to optimise early and appropriate diagnosis of the different forms of tuberculosis in children are a real priority. Two Societies of the Spanish Paediatric Association (Spanish Society of Paediatric Infectology and Spanish Society of Paediatric Pneumology) have agreed this Consensus Document in order to homogenise diagnostic criteria in paediatric patients (AU)

[Diagnosis of tuberculosis in paediatrics]. / Diagnóstico de la tuberculosis en la edad pediátrica.

Tuberculosis is one of the most important health problems worldwide. There are an increasing number of cases, including children, due to different reasons in developed countries. The most likely determining cause is immigration from highly endemic areas. Measures to optimise early and appropriate diagnosis of the different forms of tuberculosis in children are a real priority. Two Societies of the Spanish Paediatric Association (Spanish Society of Paediatric Infectology and Spanish Society of Paediatric Pneumology) have agreed this Consensus Document in order to homogenise diagnostic criteria in paediatric patients.

[Diagnosis of tuberculosis in pediatrics. Consensus document of the Spanish Society of Pediatric Infectology (SEIP) and the Spanish Society of Pediatric Pneumology (SENP)]. / Diagnóstico de la tuberculosis en la edad pediátrica. Documento de consenso de la Sociedad Española de Infectología Pediátrica (SEIP) y la Sociedad Española de Neumología Pediátrica (SENP).

Tuberculosis is one of the most important health problems worldwide. There are an increased number of cases, including children, due to different reasons in developed countries. The most likely determining cause is immigration coming from high endemic areas. Measures to optimize early and appropriate diagnosis of the different forms of tuberculosis in children are a real priority. Two Societies of the Spanish Pediatric Association (Spanish Society of Pediatric Infectology and Spanish Society of Pediatric Pneumology) have agreed this Consensus Document in order to homogenize diagnostic criteria in pediatric patients.

Calidad de vida, satisfacción y adherencia terapéutica en dermatitis atópica / Quality of life, satisfaction and therapeutic adherence in atopic dermatitis

Obejtivos: Evaluar la Calidad de Vida Relacionada con la Salud (CVRS) de los cuidadores de pacientes pediátricos con dermatitis atópica (DA) mediante el cuestionario Parents Index of Quality of Life in Atopic Dermatitis (PIQOL-AD) y el cuestionario EuroQoL-5D (EQ-5D) y conocer la satisfacción y la adherencia terapçeutica mediante el cuestionario Morisky Green. Métodos: Estudio observacional, multicéntrico y ambispectivo de 9 meses de seguimiento. 372 pacientes menores de 12 años con DA de 78 centros españoles distribuidos en dos grupos; pacientes de 0-23 meses y de 24 meses a 12 años. Se recogieron variables de gravedad (IGA, EASI), de CVRS, pregutnas sobre satisfacción con tratamiento y el cuestionario de adherencia. Resultados: La edad media (DE) de los pacientes fue de 4,2 (3,2) años. Las puntuaciones del PIQoL-AD se relacionaron con la gravedad del paciente (p<0.0001). Mayor preocupación por; "tener cuidado con la ropa que debía llevar el niño" (84,6%) y "por el aspecto del niño" (80,8%). Relación entre gravedad (IGA) y las puntuaciones EQ-5D; a mayor gravedad, mayor porcentaje de cuidadores con problemas en dolor/malestar y ansiedad/depresión. A los 9 meses la puntuación de la EVA de los cuidadores aumentó de forma estadísticamente significativa. El 83% de los cuidadores con pacientes sin casi enfermedad declararon estar muy o bastante satisfechos y el 25.3% una adherencia alta al tratamiento. Conclusiones: La gravedad de la DA es el factor que más condiciona con el tratamiento y en el grado de cumplimiento terapéutico

Objectives: To evaluate the Health-Related Quality of Life (HRQoL) of the pediatric patient´s caregivers with Atopic Dermatitis (AD) measured by Parents Index of Quality of Life in Atopic Dermatitis questionnaire (PIQOL-AD) and EuroQoL-5D questionnaire (EQ-5D) and know the treatment satisfaction and therapeutic compliance using Morisky Green questionnaire. Methods: Observationa, multicentric and ambispective study with a 9 months of prospective phase. 372 patients <= 12 years old with AD from 78 centers of Spain. Patients were allocated in two defferent groups, patients from 0-23 months and patients from 24 months to 2 years old. Patients with AD and whose caregiver may attend all study visits. We collect severity variables (Investigator´s Global Assessment (IGA), EASI), HRQoL (EQ-5D, PIQoL.AD), questions about treatment satisfaction and Morisky Green questionnaire. Results: Mean age (ED) was 4,2 (3,2) years old. PIQoL-AD scores have correlation with patient severity (p<0,001). Patient´s caregivers major concerns were about "be careful with the clothes that the children may wear" (84,6%) and "skin´s childrens aspects" (80.8%). Relationship between severity (IGA) and EQ-5D questionnaire scores. After 9 months of follow up, scores of analogical visual scales (AVS) of EQ-5D increased statistically significant, 83% of the patient´s caregivers with less severity declare to be more or quite satisfied with the treatment. The scores of the adherence questionnaire showed that 25,3% of the patients had a high adherence to the treatment. Conclusions: Results shows that severity of AD is the most conditioning factor in the caregivers day life, in the treatment satisfaction and adherence compliance (AU)

¿Cuál es la importancia de la erradicación bacteriana en el tratamiento de la infección respiratoria? / What is the importance of bacterial eradication in the treatment of respiratory tract infections?

En los últimos años se ha producido un aumento significativo en la prevalencia de resistencias de los principales patógenos respiratorios a la mayoría de los antibióticos utilizados en el ámbito extrahospitalario que ha comprometido en muchos casos el tratamiento empírico de algunas infecciones respiratorias, siendo de especial interés el progresivo aumento de las tasas de resistencia de Streptococcus pneumoniae a macrólidos y penicilina y de S. pyogenes a macrólidos. Varios estudios han confirmado la asociación entre consumo de antibióticos y desarrollo de resistencia en S. pneumoniae y S. pyogenes. Sin embargo, ni todos los antibióticos tienen la misma capacidad de selección de resistencias, ni todos se ven afectados de la misma manera. El objetivo del tratamiento antimicrobiano en las infecciones del tracto respiratorio es la erradicación bacteriológica. Los parámetros farmacodinámicos pueden utilizarse para predecir la erradicación bacteriológica de los antimicrobianos (AU)

[Pneumococcal disease and its prevention. The heptavalent pneumococcal conjugate vaccine]. / La enfermedad neumocócica y su prevención. Vacuna neumocócica conjugada heptavalente.

Pneumococcal disease is a major cause of morbidity, hospitalization and mortality. Two age groups show a greater incidence and severity of the disease: children under the age of 5 years (mainly during the first 2 years of life) and adults aged more than 65 years. The heptavalent pneumococcal conjugate vaccine, which was commercialized in Spain in June 2001, is efficacious in children aged less than 2 years and, unlike the non-conjugate 23-valent vaccine, it induces immunological memory. In Spain the heptavalent vaccine covers 80 % of serotypes causing pneumococcal invasive disease and acute otitis media in children aged 2-59 months. The heptavalent vaccine has been shown to be immunogenic, efficacious and safe. It has proven efficacy in the prevention of invasive disease caused by the seven vaccine serotypes. In addition, it significantly decreases pneumonia and also prevent acute otitis media. The vaccine is preferably indicated in children aged less than 2 years; children aged 2-5 years may also benefit from the vaccine but those in risk groups should be prioritized. Greater knowledge of the epidemiology of pneumococcal disease and the efficiency of this vaccine in Spain will determine whether it should be included in the immunization schedule.