The long wait for long-acting HIV prevention and treatment formulations.

Large randomised studies of new long-acting medications for the prevention and treatment of HIV have shown high effectiveness and acceptability. Although modelling studies indicate these agents could be fundamental in HIV elimination, coordination of their entry into health-care markets is crucial, especially in low-income and middle-income countries with high HIV prevalence, where coordination is low despite UNAIDS flagging that global HIV targets will not be met. Research and implementation projects are tightly controlled by originator pharmaceutical companies, with only a small percentage of eligible people living with or affected by HIV benefiting from these projects. WHO, financial donors, manufacturers, and governments need to consider urgent coordinated action from stakeholders worldwide, akin to the successful introduction of dolutegravir into treatment programmes across low-income and middle-income countries. Without this immediate coordination, large-scale access to long-acting agents for HIV will be delayed, potentially extending into the 2030s. This delay is unacceptable considering the established global HIV targets.

Analytical treatment interruption in children living with HIV: position statement from the EPIICAL consortium.

Analytical treatment interruption (ATI) is widely acknowledged as an essential component of studies to advance our understanding of HIV cure, but discussion has largely been focused on adults. To address this gap, we reviewed evidence related to the safety and utility of ATI in paediatric populations. Three randomised ATI trials using CD4 T-cell and clinical criteria to guide restart of antiretroviral therapy (ART) have been conducted. These trials found low risks associated with ATI in children, including reassuring findings pertaining to neurocognitive outcomes. Similar to adults treated during acute infection, infants treated early in life have shifts in virological and immunological parameters that increase their likelihood of achieving ART-free viral control. Early ART limits the size and diversity of the viral reservoir and shapes effective innate and HIV-specific humoral and cellular responses. Several cases of durable ART-free viral control in early treated children have been reported. We recommend that, where appropriate for the study question and where adequate monitoring is available, ATI should be integrated into ART-free viral control research in children living with HIV. Paediatric participants have the greatest likelihood of benefiting and potentially the most years to prospectively realise those benefits. Excluding children from ATI trials limits the evidence base and delays access to interventions.

Sustained aviremia despite anti-retroviral therapy non-adherence in male children after in utero HIV transmission.

After sporadic reports of post-treatment control of HIV in children who initiated combination anti-retroviral therapy (cART) early, we prospectively studied 284 very-early-cART-treated children from KwaZulu-Natal, South Africa, after vertical HIV transmission to assess control of viremia. Eighty-four percent of the children achieved aviremia on cART, but aviremia persisting to 36 or more months was observed in only 32%. We observed that male infants have lower baseline plasma viral loads (P = 0.01). Unexpectedly, a subset (n = 5) of males maintained aviremia despite unscheduled complete discontinuation of cART lasting 3-10 months (n = 4) or intermittent cART adherence during 17-month loss to follow-up (n = 1). We further observed, in vertically transmitted viruses, a negative correlation between type I interferon (IFN-I) resistance and viral replication capacity (VRC) (P < 0.0001) that was markedly stronger for males than for females (r = -0.51 versus r = -0.07 for IFN-α). Although viruses transmitted to male fetuses were more IFN-I sensitive and of higher VRC than those transmitted to females in the full cohort (P < 0.0001 and P = 0.0003, respectively), the viruses transmitted to the five males maintaining cART-free aviremia had significantly lower replication capacity (P < 0.0001). These data suggest that viremic control can occur in some infants with in utero-acquired HIV infection after early cART initiation and may be associated with innate immune sex differences.

Infective endocarditis in pediatric patients: a decade of insights from a leading Spanish heart surgery reference center.

Infective endocarditis (IE) is a rare disease in children and is associated with significant morbidity and mortality. In recent years, significant changes have occurred in pediatric care that could have influenced the microbiology and presentation of IE. The aim of this work was to study epidemiological, microbiological, and clinical features of IE treated at a Pediatric Cardiac Surgery Reference Center located in Madrid (Spain) in a 10-years' period. A descriptive observational retrospective study was performed, including pediatric patients < 16 years old with definite or possible IE admitted to a reference center between January 2012 and December 2021. Thirty-two IE episodes were identified. Twenty-eight (87.5%) had congenital heart disease (CHD), 8 (25.0%) were preterm infants, 1 (3.1%) was immunocompromised and 6 (18.8%) had other chronic conditions; in 11 (34.4%) episodes more than one underlying condition was associated. In 20 (62.5%) episodes there was an indwelling central venous catheter (CVC); children with other comorbidities (preterm, immunocompromised, other chronic conditions) were more likely to have a CVC at diagnosis compared with patients with isolated CHD (p < 0.001). Thirty-six microbiological isolates were obtained in the 32 episodes; 4 (12.5%) episodes had 2 isolated microorganisms. Microbiological isolates were 20 (55.6%) Gram-positive bacteria (GPB), 10 (27.8%) non-HACEK Gram-negative bacteria (GNB), 1 (2.8%) HACEK-group bacterium, 4 (11.1%) fungi and 1 (2.8%) Coxiella burnetii. In 10 (31.3%) episodes, patients were colonized by multidrug-resistant bacteria (MDRB) and the etiology of IE in 3 (30.0%) of those episodes was the colonizing MDRB. MDRB colonization was associated with MDRB IE (p = 0.007). The most common complication was septic embolism: 11 (34.4%) episodes (9 pulmonary and 2 cerebral). In-hospital mortality was 6.3% (n = 2), all of them due to underlying conditions and not to IE or its complications. Clinical features and complications of IE episodes caused by non-HACEK GNB and those caused by GPB were compared, finding no statistically significant differences.    Conclusion: Risk factors for developing IE, the proportion of embolic complications, and mortality rate were consistent with previously published findings. Proportion of IE cases attributed to non-HACEK GNB was higher than previously reported, suggesting an evolving epidemiology of IE. One-third of children colonized with MDRB subsequently developed IE caused by the same MDRB strains, so empirical coverage of MDRB organisms must be considered when IE is suspected in MDRB colonized patients. No significant differences in clinical features and complications were observed when comparing IE episodes caused by non-HACEK GNB and those caused by GPB, however larger cohort studies are needed. What is Known: • Infective endocarditis (IE) is a rare disease in children, associated with significant morbidity and mortality. • The main risk factor for developing IE in children is an underlying congenital heart disease. What is New: • With current changing epidemiology in pediatric IE, a higher proportion of IE caused by non-HACEK Gram-negative bacteria should be expected. • A significant percentage of children colonized by multidrug-resistant bacteria can develop an IE due to those bacteria.

Swissped-RECOVERY: masked independent adjudication for the interpretation of non-randomised treatment in a two-arm open-label randomised controlled trial (methylprednisolone vs immunoglobulins) in Paediatric Inflammatory Multisystem Syndrome Temporally Associated with SARS-CoV-2 (PIMS-TS) involving 10 secondary and tertiary paediatric hospitals in Switzerland.

OBJECTIVES: In trials of acute severe infections or inflammations frequent administration of non-randomised treatment (ie, intercurrent event) in response to clinical events is expected. These events may affect the interpretation of trial findings. Swissped-RECOVERY was set up as one of the first randomised controlled trials worldwide, investigating the comparative effectiveness of anti-inflammatory treatment with intravenous methylprednisolone or intravenous immunoglobulins in children and adolescents with Paediatric Inflammatory Multisystem Syndrome Temporally Associated with SARS-CoV-2 (PIMS-TS). We present one approach towards improving the interpretation of non-randomised treatment in a randomised controlled trial. DESIGN: This is a pre-planned ancillary analysis of the Swissped-RECOVERY trial, a randomised multicentre open-label two-arm trial. SETTING: 10 Swiss paediatric hospitals (secondary and tertiary care) participated. PARTICIPANTS: Paediatric patients hospitalised with PIMS-TS. INTERVENTIONS: All patient-first intercurrent events, if applicable, were presented to an independent adjudication committee consisting of four international paediatric COVID-19 experts to provide independent clinical adjudication to a set of standardised questions relating to whether additional non-randomised treatments were clinically indicated and disease classification at the time of the intercurrent event. RESULTS: Of 41 treatments in 75 participants (24/41 (59%) and 17/41 (41%) in the intravenous methylprednisolone and immunoglobulin arms of the trial, respectively), two-thirds were considered indicated. The most common treatment (oral glucocorticoids, 14/41, 35%) was mostly considered not indicated (11/14, 79%), although in line with local guidelines. Intercurrent events among patients with Shock-like PIMS-TS at baseline were mostly considered indicated. A significant proportion of patients with undifferentiated PIMS-TS at baseline were not attributed to the same group at the time of the intercurrent event (6/12 unchanged, 4/12 Kawasaki disease-like, 2/12 Shock-like). CONCLUSION: The masked adjudication of intercurrent events contributes to the interpretation of results in open-label trials and should be incorporated in the future. TRIAL REGISTRATION NUMBERS: SNCTP000004720 and NCT04826588.

Plasma Protein Biomarkers Distinguish Multisystem Inflammatory Syndrome in Children From Other Pediatric Infectious and Inflammatory Diseases.

BACKGROUND: Multisystem inflammatory syndrome in children (MIS-C) is a rare but serious hyperinflammatory complication following infection with severe acute respiratory syndrome coronavirus 2. The mechanisms underpinning the pathophysiology of MIS-C are poorly understood. Moreover, clinically distinguishing MIS-C from other childhood infectious and inflammatory conditions, such as Kawasaki disease or severe bacterial and viral infections, is challenging due to overlapping clinical and laboratory features. We aimed to determine a set of plasma protein biomarkers that could discriminate MIS-C from those other diseases. METHODS: Seven candidate protein biomarkers for MIS-C were selected based on literature and from whole blood RNA sequencing data from patients with MIS-C and other diseases. Plasma concentrations of ARG1, CCL20, CD163, CORIN, CXCL9, PCSK9 and ADAMTS2 were quantified in MIS-C (n = 22), Kawasaki disease (n = 23), definite bacterial (n = 28) and viral (n = 27) disease and healthy controls (n = 8). Logistic regression models were used to determine the discriminatory ability of individual proteins and protein combinations to identify MIS-C and association with severity of illness. RESULTS: Plasma levels of CD163, CXCL9 and PCSK9 were significantly elevated in MIS-C with a combined area under the receiver operating characteristic curve of 85.7% (95% confidence interval: 76.6%-94.8%) for discriminating MIS-C from other childhood diseases. Lower ARG1 and CORIN plasma levels were significantly associated with severe MIS-C cases requiring inotropes, pediatric intensive care unit admission or with shock. CONCLUSION: Our findings demonstrate the feasibility of a host protein biomarker signature for MIS-C and may provide new insight into its pathophysiology.

Remdesivir for COVID-19 in Hospitalized Children: A Phase 2/3 Study.

OBJECTIVES: Remdesivir decreases the risk of SARS-CoV-2 infection progressing to severe disease in adults. This study evaluated remdesivir safety and pharmacokinetics in infants and children. METHODS: This was a phase 2/3, open-label trial in children aged 28 days to 17 years hospitalized for polymerase chain reaction-confirmed SARS-CoV-2 infection. Participants received for ≤10 days once-daily intravenous remdesivir doses defined using physiologically based pharmacokinetic modeling (for ≥40 kg, 200 mg day 1, then 100 mg/day; for age ≥28 days and ≥3 to <40 kg, 5 mg/kg day 1, then 2.5 mg/kg/day). Sparse pharmacokinetic samples were analyzed using population-pharmacokinetic approaches for remdesivir and metabolites GS-704277 and GS-441524. RESULTS: Among 53 participants, at enrollment the median (Q1, Q3) number of days of COVID-19 symptoms was 5 (3, 7) and hospitalization was 1 (1, 3). Underlying conditions included obesity in 19 (37%), asthma in 11 (21%), and cardiac disorders in 11 (21%). Median duration of remdesivir treatment was 5 days (range, 1-10). Remdesivir treatment had no new apparent safety trends. Two participants discontinued treatment because of adverse events including elevated transaminases; both had elevated transaminases at baseline. Three deaths occurred during treatment (and 1 after). When compared with phase 3 adult data, estimated mean pediatric parameters (area under the concentration-time curve over 1 dosing interval, AUCτ, Cmax, and Cτ) were largely overlapping but modestly increased (remdesivir, 33%-129%; GS-704277, 37%-124%; GS-441524, 0%-60%). Recovery occurred for 62% of participants on day 10 and 83% at last assessment. CONCLUSIONS: In infants and children with COVID-19, the doses of remdesivir evaluated provided drug exposure similar to adult dosing. In this study with a small sample size, no new safety concerns were observed.

PACTA-Ped: programa de optimización de antimicrobianos en un hospital de tercer nivel en España / PACTA-Ped: Antimicrobial stewardship programme in a tertiary care hospital in Spain

Introducción: La lucha contra la resistencia a los antimicrobianos es actualmente prioritaria; son necesarios esfuerzos para mejorar la prescripción y reducir la propagación de infecciones en el entorno pediátrico. Métodos: Estudio longitudinal prospectivo sobre el uso de antimicrobianos realizado desde el inicio del programa de optimización del uso de antimicrobianos (PROA) en enero de 2016 hasta diciembre de 2017 (período 2; P2) en el hospital infantil. Los resultados obtenidos se han comparado retrospectivamente con el periodo anterior al inicio del PROA (2014-2015, periodo 1; P1). La población estudiada fueron niños ingresados que recibieron antimicrobianos de amplio espectro, antifúngicos o tratamiento antibiótico intravenoso durante más de 5 días.Resultados: Durante el P2 se incluyeron un total de 160 pacientes. Los antibióticos más comunes para los que se realizó una recomendación fueron: meropenem (41,6%) y cefotaxima (23,4%). En el 45% de los episodios se recomendó «no cambiar» el antimicrobiano prescrito. La tasa de aceptación de las recomendaciones por parte de los facultativos responsables fue del 89%. Se objetivó una disminución promedio del 27,8 y del 22,9% en los días de tratamiento (DOT)/1.000 días de ingreso y el número de tratamientos iniciados/1.000 ingresos, respectivamente. El uso de carbapenémicos, cefalosporinas y glucopéptidos disminuyó del P1 al P2. El coste medio anual del tratamiento antimicrobiano pasó de 150.356€/año durante en el P1 a 98.478€/año en el P2. Conclusiones: Nuestro PROA conllevó una disminución significativa en el uso de antibióticos y antifúngicos de amplio espectro. Los costes asociados con la prescripción de antimicrobianos disminuyeron desde el inicio del PROA y resultó una acción coste-efectiva durante el período de estudio.(AU)

Introduction: Fighting against antimicrobial resistance is a current priority, and further efforts need to be made to improve antimicrobial prescribing and reduce the spread of infections in paediatric care settings. Methods: We conducted a prospective longitudinal study on the use of antimicrobials from the time the antimicrobial stewardship programme (ASP) was introduced in January 2016 to December 2017 (period 2 [P2]) in our children's hospital. We compared the obtained results on antimicrobial prescribing with retrospective data from the period preceding the introduction of the ASP (2014–2015, period 1 [P1]). The sample consisted of paediatric in patients who received broad-spectrum antimicrobials, antifungals or intravenous antibiotherapy lasting more than 5 days. We compared the use of antimicrobials in P1 versus P2. Results: A total of 160 patients were included during P2. The antibiotics for which a recommendation was made most frequently were meropenem (41.6%) and cefotaxime (23.4%). In 45% of care episodes, the consultant recommended “no change” to the prescribed antimicrobial. The final rate of acceptance of received recommendations by the prescribing physicians was 89%. We found average decreases of 27.8% in the days of treatment per 1000 inpatient days and 22.9% in the number of antimicrobial starts per 1000 admissions in P2. The use of carbapenems, cephalosporins and glycopeptides decreased in P2 compared to P1. The average annual cost of antimicrobial treatment decreased from €150 356/year during P1 to €98 478/year in P2. Conclusion: Our ASP achieved a significant decrease in the use of broad-spectrum antibiotics and antifungals. The costs associated with antimicrobial prescribing decreased following the introduction of the ASP, which was a cost-effective action in this study period.(AU)

Etiology and outcome of febrile children coming from the tropics / Etiología del síndrome febril en el niño proveniente del trópico

Introduction: International travelers have grown significantly over last years, as well as imported diseases from tropical areas. Information in pediatric population is scarce. We describe demographic and clinical characteristics of febrile children coming from the tropics. Methods: Retrospective review of patients under 18 years old, presenting at a tertiary hospital and surrounding primary health care centers between July 2002 and July 2018 with a stay in a tropical region during the previous year. Patients were selected from microbiological charts of thick smears for malaria or dengue serologies. Results: 188 patients were studied: 52.7% were born in Spain with a median age of 3.0 years old (IQR 1.5–8.0). Main regions of stay were Sub-Saharan Africa (54.8%) and Latin America (29.8%), mostly for visiting their friends and relatives (56.3%), followed by recent arrival migrants (32.4%). Only 34% of travelers attended pre-travel consultation. More than 80% of these febrile children attended directly the Emergency Room. The most frequent diagnoses were febrile syndrome without source (56.4%), respiratory condition (15.4%) and acute diarrhea (11.7%). Around a half (52.1%) were managed as outpatients, but 46.2% were hospitalized and 7.4% were admitted to Intensive Care Unit. No specific diagnosis was achieved in 24% of cases. However, 29.7% were diagnosed with malaria. Conclusion: Children with fever coming from tropical areas were at risk of severe infectious diseases. Malaria was diagnosed in one out of four and 7% required admission in PICU. This information emphasizes the need of reinforcing training about tropical diseases among first line physicians.(AU)

Introducción: Los viajes internacionales han aumentado en los últimos años, así como las enfermedades importadas. Los datos en edad pediátrica son escasos. El objetivo de este estudio es describir las características clínico-epidemiológicas del niño con fiebre que viene del trópico. Métodos: Revisión retrospectiva de pacientes menores de 18 años que, tras una estancia en zona tropical en el último año, acuden con fiebre a un hospital terciario y centros de salud de área entre julio de 2002 y julio de 2018. Se seleccionaron a través de los registros de gotas gruesas o serologías de dengue. Resultados: Se incluyeron 188 pacientes. El 52,7% habían nacido en España, con edad mediana de 3 años (RIC 1,5-8,0). Las regiones de procedencia del viaje fueron África Sub-Sahariana (54,8%) y Latinoamérica (29,8%). Los motivos principales fueron visitar a allegados (56,3%), seguidos de inmigrantes de llegada reciente (32,4%). Solo el 34% de los viajeros habían realizado consulta pre-viaje. Más del 80% acudieron directamente a Urgencias. Los diagnósticos más frecuentes fueron síndrome febril sin focalidad (56,4%), enfermedad respiratoria (15,4%) y diarrea aguda (11,7%). La mitad (52,1%) fueron dados de alta, pero 46,2% fueron ingresados, y el 7,4% requirió Cuidados Intensivos. No se halló una etiología específica en el 24% de los casos. Sin embargo, el 29,7% tuvieron malaria. Conclusión: El síndrome febril en un niño procedente del trópico puede implicar enfermedades graves. Uno de cada cuatro tuvo malaria, y el 7% requirió cuidados intensivos. Por ello, es necesario reforzar la formación en enfermedades tropicales en los médicos de primera línea.(AU)

Diagnóstico precoz de la infección por el virus de la inmunodeficiencia humana-1 en niños: programa de prevención de la transmisión maternoinfantil en Guinea Ecuatorial / Early diagnosis of human immunodeficiency virus-1 in infants: The prevention of mother-to-child transmission program in Equatorial Guinea

ANTECEDENTES: En los últimos años se han realizado grandes esfuerzos en el programa de prevención de la transmisión de la madre al hijo (PTMH) de VIH en Guinea Ecuatorial (GE). El objetivo de este estudio fue describir los resultados del programa de PTMH en 2 centros sanitarios de Guinea Ecuatorial. MÉTODOS: Estudio observacional prospectivo realizado en el Hospital Regional de Bata y Centro de Salud María Rafols en Bata, GE. Se analizaron las características epidemiológicas, clínicas y microbiológicas de las madres infectadas por el VIH-1 y de sus hijos. Se recogieron muestras sanguíneas en papel de filtro (DBS) en los lactantes expuestos (noviembre de 2012-diciembre de 2013) y se analizaron con la técnica Siemens VERSANT HIV-1 RNA v1.0 (kPCR). RESULTADOS: Sesenta y ocho pares de madres y niños fueron incluidos. La mayoría de las mujeres estaban asintomáticas (88,2% con estadio clínicoI de la OMS). Cuarenta y siete mujeres (69,2%) recibieron tratamiento antirretroviral durante el embarazo. Cuarenta y cinco niños (66,1%) recibieron profilaxis posnatal con antirretrovirales. La mediana de edad en el momento de inclusión fue de 2,4meses (rango 1,2-4,9). Se confirmó la infección en 2 niños, y un niño falleció antes de poder descartarse la infección. La tasa de transmisión del VIH-1 fue del 2,9% (IC95%: 0,2-10,5). CONCLUSIONES: Este estudio ha permitido evaluar el programa de PTMH en base a las técnicas de diagnóstico precoz. La identificación precoz de los pacientes infectados por el VIH-1 es fundamental para el inicio oportuno del tratamiento y evitar la mortalidad asociada a la infección

BACKGROUND: Great efforts have been made in the last few years in order to implement the prevention of mother-to-child transmission (PMTCT) program in Equatorial Guinea (GQ). The aim of this study was to evaluate the rates of mother-to-child HIV transmission based on an HIV early infant diagnosis (EID) program. METHODS: A prospective observational study was performed in the Regional Hospital of Bata and Primary Health Care Centre Maria Rafols, Bata, GQ. Epidemiological, clinical, and microbiological characteristics of HIV-1-infected mothers and their exposed infants were recorded. Dried blood spots (DBS) for HIV-1 EID were collected from November 2012 to December 2013. HIV-1 genome was detected using Siemens VERSANT HIV-1 RNA 1.0 kPCR assay. RESULTS: Sixty nine pairs of women and infants were included. Sixty women (88.2%) had WHO clinical stage 1. Forty seven women (69.2%) were on antiretroviral treatment during pregnancy. Forty five infants (66.1%) received postnatal antiretroviral prophylaxis. Age at first DBS analysis was 2.4 months (IQR 1.2-4.9). One infant died before a HIV-1 diagnosis could be ruled out. Two infants were HIV-1 infected and started HAART before any symptoms were observed. The rate of HIV-1 transmission observed was 2.9% (95%CI 0.2-10.5). CONCLUSIONS: The PMTCT rate was evaluated for the first time in GQ based on EID. EID is the key for early initiation of antiretroviral therapy and to reduce the mortality associated with HIV infection

Mission to assess readiness for validation of the elimination of mother to child transmission of HIV: Latvia, 23–27 May 2016

The WHO Regional Office for Europe, in partnership with UNAIDS and also UNICEF, UNFPA and other partners including ECDC and civil society, leads the process for the elimination of MTCT of HIV and CS in the WHO European Region and provides secretariat support. This is the report of a technical support mission to Latvia in response to the request of the MOH of Latvia to assess country readiness for validation of the elimination of mother to child transmission of HIV. The major goal and objectives of the mission included the review of the progress achieved in Latvia on the elimination of mother to child transmission of HIV, the assessment of the country readiness for elimination validation and, based on the mission findings, preparing recommendations to accelerate progress towards achieving elimination and elimination validation as appropriate.

Diagnóstico precoz de la infección congénita por citomegalovirus: oportunidades perdidas / Early diagnosis of congenital cytomegalovirus infection: lost opportunities

Introducción: La infección por citomegalovirus (CMV) es la infección congénita más frecuente en Europa. El 10% de los niños infectados presentan síntomas al nacimiento, y hasta el 30-40% tienen algún grado de hipoacusia. Métodos Se ha realizado un estudio descriptivo retrospectivo incluyendo todos los pacientes diagnosticados de infección congénita por CMV fuera del período neonatal a lo largo de 4 años a partir de las muestras de sangre del talón en papel de filtro del cribado metabólico neonatal. Resultados Presentamos 5 pacientes diagnosticados de infección congénita por CMV fuera del periodo neonatal. Los principales motivos de consulta fueron la hipoacusia y/o el retraso psicomotor en los primeros meses de vida. Conclusión La infección por CMV puede ser poco sintomática al nacimiento y presentarse como un déficit auditivo y/o retraso psicomotor en la infancia. Es preciso un alto grado de sospecha para establecer un diagnóstico temprano que permita ofrecer tratamiento específico y mejorar el pronóstico a largo plazo (AU)

Introduction: Cytomegalovirus (CMV) infection is the most common congenital infection in Europe. Symptoms are present at birth in 10% of infected children, and up to 30-40% have some degree of hearing loss after the newborn period. Methods: A retrospective study was performed over a period of 4 years and included all patients with congenital CMV infection diagnosed after the neonatal period using the dried blood spots from neonatalmetabolic screening. Results: We present 5 patients diagnosed with congenital CMV infection outside the neonatal period. The main reasons for consultation were hearing loss and/or neurological impairment in the first few months of life. Discussion: Congenital CMV infection may be mildly symptomatic at birth, and present as hearing loss and/or neurological impairment in infancy. Therefore, a high degree of suspicion is necessary in order to make an accurate diagnosis and start specific treatment to improve the outcome (AU)

Emergencia de un clon de Staphylococcus aureus resistente a meticilina de origen comunitario en la población pediátrica del sur de Madrid / Emergence of a single clone of community-associated methicillin-resistant Staphylococcus aureus in southern Madrid children

Introducción. El aparente incremento en el número de aislamientos de Staphylococcus aureus resistentes a meticilina (SARM) en pacientes pediátricos atendidos en nuestro hospital nos llevó a estudiar sus características microbiológicas, epidemiológicas y clínicas. Se estudió con especial atención su posible origen comunitario. Métodos. Se realizó un estudio retrospectivo de todos los pacientes pediátricos atendidos en el Hospital 12 de Octubre con aislamientos clínicos de SARM. El período de estudio fue de enero de 2002 a junio de 2005. Se distinguió entre infecciones de adquisición intrahospitalaria, asociada o relacionada con el sistema sanitario, y extrahospitalaria (adquirida en la comunidad). Los aislamientos de SARM se estudiaron mediante electroforesis en campo pulsante (ECP), tipificación del elemento SCCmec y determinación de la presencia del gen que codifica la leucocidina de Panton-Valentine (LPV). Resultados. Se aisló SARM de 17 pacientes. De éstos, 7 aislamientos (42,2%) eran de origen comunitario, correspondientes a 4 casos de infección cutánea y/o de partes blandas, dos otitis y una piomiositis bacteriémica. De los 7 aislamientos de origen comunitario, seis tenían el mismo patrón de ECP (genotipo D), presentaban el tipo IV de SSCmec, producían la toxina LPV y eran únicamente resistentes a la oxacilina. Conclusión. Este estudio constata, creemos que por primera vez en España, la presencia de estas cepas comunitarias de SARM. El posible incremento en la incidencia de infecciones por SARM en niños fuera del ambiente hospitalario tiene importantes implicaciones tanto para las posibles estrategias de salud pública como para el tratamiento correcto (AU)

Introduction. The observation of an increasing number of methicillin-resistant Staphylococcus aureus (MRSA) isolated from children prompted us to study the microbiological, epidemiological and clinical characteristics of these isolates. The possibility of some of them being community-acquired focused particularly our attention. Methods. A retrospective analysis of all children with MRSA isolated at the Doce de Octubre hospital between January 2002 and June 2005 was conducted. Infections were clasified as community-acquired, hospital-acquired, or health-care associated. Isolates of MRSA were studied by pulsed-field gel electrophoresis (PFGE) and SSCmec typing. The presence of the gene encoding the Panton-Valentine leukocidin was also detected by PCR. Results. MRSA were isolated from 17 patients. Seven isolates (42.2%) were community-acquired, corresponding to four cases of skin or soft-tissue infections, two otitis cases and one bacteremic pyomiositis. Six of seven community-acquired isolates had the same ECP pattern (genotype D), presented a type IV SSCmec, and were LPV toxin-producing and meticilin- resistant with no other associated resistances. Conclusion. To our knowledge, this study shows the presence of these community-acquired MRSA strains for the first time in Spain. The evidence of an apparently clonal spreading of community-acquired MRSA infections in children has important implications for public health and treatment strategies (AU)