Tendencias en la etiología de la meningitis bacteriana aguda en niños chilenos período 1989-1998: impacto de la vacuna anti-H influenzae tipo b Hib / Etiology of acute bacterial meningitis in chilean children from 1989 to 1998: impact of anti H influenzae type b vaccine

Background: Acute bacterial meningitis still has a high mortality and rate of complications. Aim: To assess the impact of anti H influenzae vaccination on the epidemiology of acute bacterial meningitis in Chilean children. Material and methods: A retrospective study of hospital discharge records of patients with acute bacterial meningitis. Causative agents were studied globally, by hospital and by age group. The changes in etiology from 1989 to 1995 were also assessed. Between 1996 and 1998, only those patients with acute bacterial meningitis caused by H influenzae were recollected. Results: In the period prior to vaccination (1989-1995), 1000 cases were registered. The main causative agents were N meningitidis in 33.8 percent, H influenzas type b in 21.9 percent and S pneumoniae in 15.4 percent. The incidence of H influenzae decreased in the period from 36.4 to 9.9 percent (p<0.001) and the incidence of N meningitidis increased from 22.9 to 52.1 percent (p <0.001). The incidence of S pneumoniae did not change significantly. H influenzae predominated in children between 4 and 24 months of age and N meningitidis predominated in children over 25 months of age. In the period after the introduction of vaccination (1995-1998), there was a further decrease in the incidence of H influenzae from 10 to 2 percent (p <0.001). Until 1997, there was a considerable increase in the incidence of N meningitidis, specially in children over 25 months of age. It declined in 1998 to 38 percent. Conclusions: There was a reduction in the incidence of acute bacterial meningitis caused by H influenzae prior to the introduction of the vaccine against H influenzae type b. The decrease was more pronounced after the introduction of the vaccine

Síndrome febril prolongado en preescolares y escolares / Prolonged fever syndrome in preschool and school children

Se presenta el análisis retrospectivo de 76 pacientes con SFP, hospitalizados en un centro infantil de Santiago entre enero 1989 y mayo 1995, de los cuales 51,3 por ciento corresponden al sexo femenino, 25 por ciento de ellos menores de 5 años. No se obtuvo diagnóstico etiológico en 42,1 por ciento de los casos. De las entidades diagnósticadas, 15,7 por ciento correspondió a fiebre tifoidea y 7,9 por ciento a infección urinaria. No se evidenció diferencia de incidencias en los diferentes años ni en diversas estaciones. El rendimiento de los distintos exámenes fue variable y se analizan en los resultados

Rendimiento del cultivo no discriminado de catéteres endovenosos / Yielding of the unselected intravenous catheter culture

The usefulness of the practice of cultivate every intravenous catheter used in one children hospital was assesed looking for a relation between the culture result and the ocurrence of severe infections during the next fifteen days after the catheter removal. Also correlation with the kind of vein, the way of placing and the lenght of the use of the catheter as risk factors os severe infections post catheter removal. The medical and bacteriological features from 188 of a total 208 catheters cultured from 1º january until 31 december 1992, in the Roberto del Río Hospital (Santiago, Chile) were reviewed from the medical and laboratory records. In 122 cultures there was bacterial growing, but only 32 were followed by severe infections and 7 seven of them resulted of diagnostic value. Otherwise, in the 66 episodes with negative catheter culture ocurred a similar frecuency of severe infections post catheter removal as in the positive, in this review appears as lacking of usefulness. Moreover no relation could be found between severe infection post catheter removal and type of vein, way of setting and lenght of the catheters. In conclusion: we consider unnecessary the routine culture of all catheters and recomends prospective study with others procedures such as direct gram staining of the catheter and/or simultaenous blood culture through the catheter and from a peripheral vein