Legionelosis: Recomendaciones para la prevención, la vigilancia epidemiológica y el control de casos y brotes / Legionellosis: Recommendations for prevention, epidemiological surveillance and control of cases and outbreaks

La enfermedad de los legionarios es un importante problema de salud pública particularmente por su frecuente presentación en forma de brotes, tanto comunitarios como nosocomiales, y por su letalidad, especialmente en personas de edad avanzada o con otras enfermedades. La notificación oportuna de casos y/o brotes de enfermedad y la investigación epidemiológica permiten la identificación de la/s fuentes de exposición y la adopción de medidas de prevención y control adecuadas. Las infecciones por Legionella son más frecuentes entre adultos mayores de 50 años, hombres, fumadores y huéspedes inmunocomprometidos o con ciertas enfermedades crónicas subyacentes. La infección en niñas/os es rara, con ≤ 1% de los casos de neumonía causada por Legionella, y puede ser asintomática o leve y no detectada. La Legionella puede multiplicarse si el agua no es tratada de manera adecuada o si los sistemas de agua no son mantenidos adecuadamente.

Effectiveness of mRNA-1273, BNT162b2, and BBIBP-CorV vaccines against infection and mortality in children in Argentina, during predominance of delta and omicron covid-19 variants: test negative, case-control study.

OBJECTIVE: To estimate the effectiveness of a two dose vaccine schedule (mRNA-1273, BNT162b2, and BBIBP-CorV) against SARS-CoV-2 infection and covid-19 related death and short term waning of immunity in children (3-11 years old) and adolescents (12-17 years old) during periods of delta and omicron variant predominance in Argentina. DESIGN: Test negative, case-control study. SETTING: Database of the National Surveillance System and the Nominalized Federal Vaccination Registry of Argentina. PARTICIPANTS: 844 460 children and adolescents without previous SARS-CoV-2 infection eligible to receive primary vaccination schedule who were tested for SARS-CoV-2 by polymerase chain reaction or rapid antigen test from September 2021 to April 2022. After matching with their corresponding controls, 139 321 (60.3%) of 231 181 cases remained for analysis. EXPOSURES: Two dose mRNA-1273, BNT162b2, and BBIBP-CorV vaccination schedule. MAIN OUTCOME MEASURES: SARS-CoV-2 infection and covid-19 related death. Conditional logistic regression was used to estimate the odds of SARS-CoV-2 infection among two dose vaccinated and unvaccinated participants. Vaccine effectiveness was estimated as (1-odds ratio)×100%. RESULTS: Estimated vaccine effectiveness against SARS-CoV-2 infection was 61.2% (95% confidence interval 56.4% to 65.5%) in children and 66.8% (63.9% to 69.5%) in adolescents during the delta dominant period and 15.9% (13.2% to 18.6%) and 26.0% (23.2% to 28.8%), respectively, when omicron was dominant. Vaccine effectiveness declined over time, especially during the omicron period, from 37.6% (34.2% to 40.8%) at 15-30 days after vaccination to 2.0% (1.8% to 5.6%) after ≥60 days in children and from 55.8% (52.4% to 59.0%) to 12.4% (8.6% to 16.1%) in adolescents.Vaccine effectiveness against death related to SARS-CoV-2 infection during omicron predominance was 66.9% (6.4% to 89.8%) in children and 97.6% (81.0% to 99.7%) in adolescents. CONCLUSIONS: Vaccine effectiveness in preventing mortality remained high in children and adolescents regardless of the circulating variant. Vaccine effectiveness in preventing SARS-CoV-2 infection in the short term after vaccination was lower during omicron predominance and decreasing sharply over time. TRIAL REGISTRATION: National Registry of Health Research IS003720.

Carbapenem-resistant Enterobacteriaceae bloodstream infections: A case-control study from a pediatric referral hospital in Argentina.

Background: Antibiotic-resistant gram-negative bloodstream infections (BSI) remain a leading cause morbidity and mortality in pediatric patients with a high impact on the public health system. Data in resource-limited countries, including those in Latin America and the Caribbean region, are scarce. The aim of the study was to identify risk factors for acquiring carbapenem-resistant Enterobacteriaceae (CRE) bacteremia in children and to assess the use of resources. Methods: A retrospective case-control study was conducted to analyze demographic, epidemiological, clinical, microbiological, and outcome data as well as the use of resources between 2014 and 2019. Univariate and logistic regression analysis was performed in order to identify risk factors associated with CRE-BSI. The R software version 4.1.2 was used. Results: A total of 46 cases with CRE-BSI and 92 controls with gram-negative non-CRE-BSI were included. No statistical difference was observed regarding: median age (36 months; IQR, 11.2-117 vs. 48 months, IQR 13-119), male sex (50 vs. 60%), and underlying disease (98 vs. 91%) in cases vs. controls, respectively. The most frequent mechanism of CRE bacteremia were: KPC in 74%, OXA in 15%, and NDM in 6.5%. A total of 54.3% of cases vs. 32.6 % (p = 0.016) of controls were admitted to the pediatric intensive care unit (PICU), and 48 vs. 21% (p = 0.001) required mechanical ventilation. Bacteremia secondary to intra-abdominal infection was observed in 56.5% of cases vs. 35% of controls (p = 0.032). Previous colonization with CRE was detected in 76% of cases vs. 8% of controls. Combination antimicrobial treatment was most frequent in cases vs. control (100 vs. 56.5%). No difference was observed in median length of hospital stay (22 days; IQR, 19-31 in cases vs. 17.5 days; IQR, 10-31 in controls; p = 0.8). Overall case fatality ratio was 13 vs. 5.5%, respectively. The most statistically significant risk factors included previous PICU stay (OR, 4; 95%CI, 2-8), invasive procedures/surgery (OR, 3; 95%CI, 1-7), central venous catheter placement (OR, 6.5; 95%CI, 2-19), urinary catheter placement (OR, 9; 95%CI 4-20), mechanical ventilation (OR, 4; 95%CI, 2-10), liver transplantation (OR, 8; 95%CI, 2-26), meropenem treatment (OR, 8.4; 3.5-22.6) in univariate analysis. The logistic regression model used for multivariate analysis yielded significant differences for previous meropenem treatment (OR, 13; 95%CI, 3-77; p = 0.001), liver transplantation (OR, 13; 95%CI, 2.5-100; p = 0.006), and urinary catheter placement (OR, 9; 95%CI, 1.4-94; p = 0.03). Conclusion: CRE-BSI affects hospitalized children with underlying disease, mainly after liver transplantation, with previous urinary catheter use and receiving broad-spectrum antibiotics, leading to high PICU requirement and mortality. These risk factors will have to be taken into account in our region in order to establish adequate health policies and programs to improve antimicrobial stewardship.

Multisystem Inflammatory Syndrome Temporally Related to COVID-19 in Children From Latin America and the Caribbean Region: A Systematic Review With a Meta-Analysis of Data From Regional Surveillance Systems.

Background: With the emergence of the COVID-19 pandemic, increasing numbers of cases of the multisystem inflammatory syndrome in children (MIS-C) have been reported worldwide; however, it is unclear whether this syndrome has a differential pattern in children from Latin America and the Caribbean (LAC). We conducted a systematic review and meta-analysis to analyze the epidemiological, clinical, and outcome characteristics of patients with MIS-C in LAC countries. Methods: A systematic literature search was conducted in the main electronic databases and scientific meetings from March 1, 2020, to June 30, 2021. Available reports on epidemiological surveillance of countries in the region during the same period were analyzed. Results: Of the 464 relevant studies identified, 23 were included with 592 patients with MIS-C from LAC. Mean age was 6.6 years (IQR, 6-7.4 years); 60% were male. The most common clinical manifestations were fever, rash, and conjunctival injection; 59% showed Kawasaki disease. Pool proportion of shock was 52%. A total of 47% of patients were admitted to the pediatric intensive care unit (PICU), 23% required mechanical ventilation, and 74% required vasoactive drugs. Intravenous gamma globulin alone was administered in 87% of patients, and in combination with steroids in 60% of cases. Length of hospital stay was 10 days (IQR, 9-10) and PICU stay 5.75 (IQR, 5-6). Overall case fatality ratio was 4% and for those hospitalized in the PICU it was 7%. Conclusion: Limited information was available on the clinical outcomes. Improvements in the surveillance system are required to obtain a better epidemiologic overview in the region.

Histoplasmosis en Argentina: serie de casos en niños / Histoplasmosis in Argentina: case series in children

ANTECEDENTES: La histoplasmosis es una micosis sistémica endémica en América con pocos casos reportados en pediatría. OBJETIVOS: Describir la epidemiología, formas clínicas y evolución de la histoplasmosis en niños de un hospital pediátrico en Argentina. MÉTODOS: El estudio, retrospectivo y descriptivo, se llevó a cabo entre enero de 2008 y diciembre de 2016 en el Hospital de Pediatría «Prof. Dr. Juan Pedro Garrahan», e incluyó pacientes menores de 18 años con cuadro clínico, serología, cultivos y/o hallazgos histológicos compatibles con histoplasmosis. Se estudiaron 13 pacientes (siete niños y seis niñas, con una mediana de edad de 9 años y rango intercuartílico de 3,4 a 13 años), de los cuales tres niños (23%) provenían de la provincia de Buenos Aires, tres de la provincia de Santa Fe (23%) y siete (54%) de otras provincias. RESULTADOS: Diez pacientes (77%) presentaron la forma diseminada de la enfermedad y tres (23%) la forma pulmonar (23%); ocho niños (62%) tenían otras comorbilidades. La serología fue positiva en siete casos (54%), los cultivos fueron positivos en nueve pacientes (69%) y en diez casos (77%) se identificaron hallazgos histológicos compatibles con histoplasmosis. Todos los pacientes recibieron anfotericina B (liposomal en siete casos y desoxicolato en seis). Diez pacientes (77%) continuaron el tratamiento con itraconazol y tres pacientes (23%) fallecieron por causas no relacionadas con la histoplasmosis. CONCLUSIONES: En la serie analizada predominaron los pacientes con histoplasmosis diseminada asociada a otra enfermedad. La mortalidad no estuvo directamente relacionada con la infección

BACKGROUND: Histoplasmosis is a fungal disease, endemic in South America, and seldom reported in paediatrics. AIMS: To report the epidemiology, clinical features and outcome of children diagnosed with histoplasmosis in an Argentinian Children's Hospital. METHODS: A retrospective and descriptive study was performed from January 2008 to December 2016 in Hospital de Pediatría 'Prof. Dr. Juan Pedro Garrahan'. Patients under 18 years with clinical features, serological tests, cultures and/or histological findings compatible with histoplasmosis were included. Thirteen patients were selected (seven male and six female; mean age was 9 years with interquartile range 3.4-13); three children (23%) were from Buenos Aires province, three (23%) from Santa Fe province, and seven (54%) from other provinces. RESULTS: In ten cases (77%) the clinical form was disseminated, and it was pulmonary in three (23%). Eight cases (62%) suffered other comorbidities. Serological tests were positive in seven patients (54%), with positive cultures obtained in nine patients (69%). Histological findings compatible with histoplasmosis were found in 10 cases (77%). All patients received treatment with amphotericin B (liposomal formulation in seven cases, deoxycholate in six), with 10 patients continuing with oral itraconazole. Three patients (23%) died from causes unrelated to histoplasmosis. CONCLUSIONS: The majority of children in the series had comorbidities and disseminated histoplasmosis. Mortality was not directly associated with histoplasmosis

[Histoplasmosis in Argentina: case series in children]. / Histoplasmosis en Argentina: serie de casos en niños.

BACKGROUND: Histoplasmosis is a fungal disease, endemic in South America, and seldom reported in paediatrics. AIMS: To report the epidemiology, clinical features and outcome of children diagnosed with histoplasmosis in an Argentinian Children's Hospital. METHODS: A retrospective and descriptive study was performed from January 2008 to December 2016 in Hospital de Pediatría 'Prof. Dr. Juan Pedro Garrahan'. Patients under 18 years with clinical features, serological tests, cultures and/or histological findings compatible with histoplasmosis were included. Thirteen patients were selected (seven male and six female; mean age was 9 years with interquartile range 3.4-13); three children (23%) were from Buenos Aires province, three (23%) from Santa Fe province, and seven (54%) from other provinces. RESULTS: In ten cases (77%) the clinical form was disseminated, and it was pulmonary in three (23%). Eight cases (62%) suffered other comorbidities. Serological tests were positive in seven patients (54%), with positive cultures obtained in nine patients (69%). Histological findings compatible with histoplasmosis were found in 10 cases (77%). All patients received treatment with amphotericin B (liposomal formulation in seven cases, deoxycholate in six), with 10 patients continuing with oral itraconazole. Three patients (23%) died from causes unrelated to histoplasmosis. CONCLUSIONS: The majority of children in the series had comorbidities and disseminated histoplasmosis. Mortality was not directly associated with histoplasmosis.

Impacto clínico y epidemiológico de las infecciones por varicela en niños previo a la introducción de la vacuna al Calendario Nacional de Argentina / Clinical and epidemiological impact of varicella infection in children prior to the introduction of the varicella vaccine in the national immunization schedule of Argentina

Introducción. En Argentina, se estiman 400 000 casos anuales de varicela. Dado el subregistro de casos existentes, la carga de enfermedad real se desconoce. Objetivo. Evaluar la carga de enfermedad por varicela antes de la introducción de la vacuna al Calendario Nacional. Materiales y métodos. Estudio retrospectivo, analítico, observacional, realizado en tres centros asistenciales del país. Revisión de los registros de consultas ambulatorias a los Servicios de Urgencias y de las historias clínicas de las internaciones por varicela en pacientes < 18 años. Período: 1/2011-12/2013. Resultados. Fueron asistidas un total de 382782 consultas ambulatorias; 3367 (0,88 %) correspondieron a consultas por varicela; el 57,6 %, < 4 años. Requirieron internación 164 (4,9 %) con una tasa de hospitalización global de 65,3/10000 hospitalizados/año (IC 95 %: 55,4-76,5); tasa de hospitalización en niños sanos: 57,2/10 000 (IC 95 %: 67,7-48,0); mediana de edad: 31,5 meses. Las causas de internación más frecuentes fueron infecciones de piel y/o partes blandas (61,1 %) y respiratorias (10,1 %). El 54,3 % recibió tratamiento con aciclovir, y el 73,1 %, con antibióticos. Presentaron bacteriemia 5/67 (7,5 %), todas por cocos Gram(+) y en inmunocompetentes. De los 19 pacientes inmunocomprometidos, el 36,8 % tuvo complicaciones (5 infecciones de piel y/o partes blandas y 2 neumonías). La mediana de días de internación fue 4, significativamente más prolongada en pacientes inmunocomprometidos. Un paciente requirió cuidados intensivos. No hubo fallecidos. Conclusión. La carga de enfermedad registrada fue significativa, con impacto considerable en pacientes sin patología de base.

Introduction. In Argentina, an estimated 400 000 varicella cases occur annually. Given the under-recording of existing cases, the actual burden of disease is unknown. Objective. To assess the burden of varicella before the introduction of the varicella vaccine in the national immunization schedule. Materials and methods. Retrospective, analytical, observational study carried out in three hospitals of Argentina. Review of medical records from outpatient visits to the Emergency Department and from patients younger than 18 years hospitalized for varicella. Period: 1/2011-12/2013. Results. A total of 382 782 outpatients were seen; 3367(0.88%) corresponded to visits due to varicella; 57.6 % were < 4 years old. A total of 164 (4.9 %) patients required hospitalization, with an overall hospitalization rate of 65.3/10 000 hospitalized patients/year (95 % confidence interval -#91;CI-#93;: 55.4-76.5); hospitalization rate in healthy children: 57.2/10 000 (95 % CI: 67.7-48.0); median age: 31.5 months. The most common causes of hospitalization were skin and/or soft tissue infections (61.1 %) and respiratory infections (10.1 %). Also, 54.3 % were treated with acyclovir and 73.1 %, with antibiotics. Bacteremia developed in 5/67 patients (7.5 %), all cases were caused by Gram-positive cocci and occurred in immunocompetent patients. Out of 19 immunocompromised patients, 36.8 % had complications (5 skin and/or soft tissue infection and 2 pneumonia cases). The median length of stay was 4 days, which is significantly more prolonged in immunocompromised patients. One patient required intensive care. No patient died. Conclusion. The burden of disease was significant, with a considerable impact in patients without an underlying disease.

Clinical and epidemiological impact of varicella infection in children prior to the introduction of the varicella vaccine in the national immunization schedule of Argentina. / Impacto clínico y epidemiológico de las infecciones por varicela en niños previo a la introducción de la vacuna al Calendario Nacional de Argentina.

INTRODUCTION: In Argentina, an estimated 400 000 varicella cases occur annually. Given the under-recording of existing cases, the actual burden of disease is unknown. OBJECTIVE: To assess the burden of varicella before the introduction of the varicella vaccine in the national immunization schedule. MATERIALS AND METHODS: Retrospective, analytical, observational study carried out in three hospitals of Argentina. Review of medical records from outpatient visits to the Emergency Department and from patients younger than 18 years hospitalized for varicella. Period: 1/2011-12/2013. RESULTS: A total of 382 782 outpatients were seen; 3367(0.88%) corresponded to visits due to varicella; 57.6 % were < 4 years old. A total of 164 (4.9 %) patients required hospitalization, with an overall hospitalization rate of 65.3/10 000 hospitalized patients/year (95 % confidence interval |#91;CI|#93;: 55.4-76.5); hospitalization rate in healthy children: 57.2/10 000 (95 % CI: 67.7-48.0); median age: 31.5 months. The most common causes of hospitalization were skin and/or soft tissue infections (61.1 %) and respiratory infections (10.1 %). Also, 54.3 % were treated with acyclovir and 73.1 %, with antibiotics. Bacteremia developed in 5/67 patients (7.5 %), all cases were caused by Gram-positive cocci and occurred in immunocompetent patients. Out of 19 immunocompromised patients, 36.8 % had complications (5 skin and/or soft tissue infection and 2 pneumonia cases). The median length of stay was 4 days, which is significantly more prolonged in immunocompromised patients. One patient required intensive care. No patient died. CONCLUSION: The burden of disease was significant, with a considerable impact in patients without an underlying disease.

Introducción. En Argentina, se estiman 400 000 casos anuales de varicela. Dado el subregistro de casos existentes, la carga de enfermedad real se desconoce. Objetivo. Evaluar la carga de enfermedad por varicela antes de la introducción de la vacuna al Calendario Nacional. Materiales y métodos. Estudio retrospectivo, analítico, observacional, realizado en tres centros asistenciales del país. Revisión de los registros de consultas ambulatorias a los Servicios de Urgencias y de las historias clínicas de las internaciones por varicela en pacientes < 18 años. Período: 1/2011-12/2013. Resultados. Fueron asistidas un total de 382782 consultas ambulatorias; 3367 (0,88 %) correspondieron a consultas por varicela; el 57,6 %, < 4 años. Requirieron internación 164 (4,9 %) con una tasa de hospitalización global de 65,3/10000 hospitalizados/año (IC 95 %: 55,4-76,5); tasa de hospitalización en niños sanos: 57,2/10 000 (IC 95 %: 67,7-48,0); mediana de edad: 31,5 meses. Las causas de internación más frecuentes fueron infecciones de piel y/o partes blandas (61,1 %) y respiratorias (10,1 %). El 54,3 % recibió tratamiento con aciclovir, y el 73,1 %, con antibióticos. Presentaron bacteriemia 5/67 (7,5 %), todas por cocos Gram(+) y en inmunocompetentes. De los 19 pacientes inmunocomprometidos, el 36,8 % tuvo complicaciones (5 infecciones de piel y/o partes blandas y 2 neumonías). La mediana de días de internación fue 4, significativamente más prolongada en pacientes inmunocomprometidos. Un paciente requirió cuidados intensivos. No hubo fallecidos. Conclusión. La carga de enfermedad registrada fue significativa, con impacto considerable en pacientes sin patología de base.

Uso de posaconazol en niños: experiencia en un hospital pediátrico de alta complejidad / Use of posaconazole in children: Experience in a tertiary pediatric hospital

La información sobre el uso de posaconazol en niños es escasa. Se realizó este estudio descriptivo retrospectivo entre agosto de 2010 y marzo de 2017 para evaluar las características clínicas, microbiológicas y la evolución de los pacientes tratados con posaconazol. Se incluyeron 16 niños. Mediana de edad: 161 meses (rango intercuartílico -RIC- 69-173 m). Todos tenían enfermedad subyacente y presentaban infección fúngica invasiva probada. Los aislamientos más frecuentes fueron Mucor spp. y Aspergillus spp. La dosis media de posaconazol fue 600 mg/día (400-800 mg/día) y la mediana de duración del tratamiento, 223 días (RIC 48-632). Diez pacientes presentaron efectos adversos, pero solo uno requirió suspensión del antifúngico debido a alteraciones hidroelectrolíticas.

There is limited information on the use of posaconazole in children. This retrospective and descriptive study was conducted to evaluate the clinical, microbiological characteristics and evolution of patients treated with posaconazole between August 2010 and March 2017. We included 16 children. Median age: 161 months (interquartile range -IQR-69-173m). All had underlying disease and a proven invasive fungal infection. The most frequent isolated were Mucor spp. and Aspergillus spp. The mean posaconazole dose was 600 mg /day (400-800 mg/day) and the median duration of treatment was 223 days (IQR 48-632). Ten patients had adverse effects, but only one required suspension of the antifungal treatment due to hydroelectrolytic disorders.

[Use of posaconazole in children: Experience in a tertiary pediatric hospital]. / Uso de posaconazol en niños: experiencia en un hospital pediátrico de alta complejidad.

There is limited information on the use of posaconazole in children. This retrospective and descriptive study was conducted to evaluate the clinical, microbiological characteristics and evolution of patients treated with posaconazole between August 2010 and March 2017. We included 16 children. Median age: 161 months (interquartile range -IQR- 69-173 m). All had underlying disease and a proven invasive fungal infection. The most frequent isolated were Mucor spp. and Aspergillus spp. The mean posaconazole dose was 600 mg/day (400-800 mg/day) and the median duration of treatment was 223 days (IQR 48-632). Ten patients had adverse effects, but only one required suspension of the antifungal treatment due to hydroelectrolytic disorders.

La información sobre el uso de posaconazol en niños es escasa. Se realizó este estudio descriptivo retrospectivo entre agosto de 2010 y marzo de 2017 para evaluar las características clínicas, microbiológicas y la evolución de los pacientes tratados con posaconazol. Se incluyeron 16 niños. Mediana de edad: 161 meses (rango intercuartílico ­RIC­ 69-173 m). Todos tenían enfermedad subyacente y presentaban infección fúngica invasiva probada. Los aislamientos más frecuentes fueron Mucor spp. y Aspergillus spp. La dosis media de posaconazol fue 600 mg/ día (400-800 mg/día) y la mediana de duración del tratamiento, 223 días (RIC 48-632). Diez pacientes presentaron efectos adversos, pero solo uno requirió suspensión del antifúngico debido a alteraciones hidroelectrolíticas.

Osteomielitis en niños quemados: diez años de experiencia / Osteomyelitis in burn children: Ten years of experience

La osteomielitis en pacientes quemados es infrecuente. Objetivo: Describir las características clínicas, microbiológicas y de evolución de niños quemados con osteomielitis internados en un hospital de alta complejidad. Objetivo. Describir las características clínicas, microbiológicas y evolutivas de niños con diagnóstico de osteomielitis internados en una Unidad de Quemados Pediátrica de alta complejidad. Métodos: Estudio retrospectivo y descriptivo realizado durante el período de enero de 2007 a enero de 2017. Resultados: Sobre un total de 600 niños quemados, 12 presentaron osteomielitis (incidencia del 2%). Once pacientes presentaron quemadura por fuego directo. La mediana de edad fue 42,5 meses (rango intercuartílico -RIC- 27-118 meses) y de superficie quemada fue 33,5% (RIC 18,5-58%). La osteomielitis se diagnosticó con una mediana de 30 días posquemadura. Las localizaciones más frecuentes fueron las extremidades superiores y la calota. La fiebre fue la manifestación clínica más común. Los microorganismos más frecuentemente aislados en el tejido óseo fueron hongos en 9 pacientes. Todos presentaron anatomía patológica compatible. La mediana de tratamiento fue 44,5 días (RIC 34,5-65,5 días). Seis pacientes presentaron secuelas motoras y 1 paciente falleció. Conclusión: La etiología fúngica fue la más frecuente. La mitad de los pacientes presentó secuelas funcionales y solo un paciente falleció.

Osteomyelitis is uncommon among burn patients. Objective: To describe the clinical, microbiological, and evolutionary characteristics of burn children with osteomyelitis hospitalized in a tertiary care facility. Methods: Retrospective and descriptive study conducted between January 2007 and January 2017. Results: Out of 600 burn children, 12 developed osteomyelitis (incidence: 2%). Eleven patients had a burn caused by direct fire. Patients' median age was 42.5 months (interquartile range --#91;IQR--#93;: 27-118 months), and their median burned surface area was 33.5% (IQR: 18.5-58%). Osteomyelitis was diagnosed at a median period of 30 days following the burn injury. The most common locations were the upper limbs and the cranial vault. Fever was the most frequent clinical manifestation. The most common microorganisms isolated in bone tissue were fungi in 9 patients. All showed compatible anatomopathological findings. The treatment lasted a median of 44.5 days (IQR: 34.5-65.5 days). Six patients had motor sequelae and 1 died. Conclusion: Fungal osteomyelitis was the most commonly observed etiology. Half of patients had functional sequelae and only 1 patient died.

Osteomyelitis in burn children: Ten years of experience. / Osteomielitis en niños quemados: diez años de experiencia.

INTRODUCTION: Osteomyelitis is uncommon among burn patients. OBJECTIVE: To describe the clinical, microbiological, and evolutionary characteristics of burn children with osteomyelitis hospitalized in a tertiary care facility. METHODS: Retrospective and descriptive study conducted between January 2007 and January 2017. RESULTS: Out of 600 burn children, 12 developed osteomyelitis (incidence: 2%). Eleven patients had a burn caused by direct fire. Patients' median age was 42.5 months (interquartile range [IQR]: 27-118 months), and their median burned surface area was 33.5% (IQR: 18.5-58%). Osteomyelitis was diagnosed at a median period of 30 days following the burn injury. The most common locations were the upper limbs and the cranial vault. Fever was the most frequent clinical manifestation. The most common microorganisms isolated in bone tissue were fungi in 9 patients. All showed compatible anatomopathological findings. The treatment lasted a median of 44.5 days (IQR: 34.5-65.5 days). Six patients had motor sequelae and 1 died. CONCLUSION: Fungal osteomyelitis was the most commonly observed etiology. Half of patients had functional sequelae and only 1 patient died.

INTODUCCIÓN: La osteomielitis en pacientes quemados es infrecuente. OBJETIVO: Describir las características clínicas, microbiológicas y de evolución de niños quemados con osteomielitis internados en un hospital de alta complejidad. OBJETIVO: Describir las características clínicas, microbiológicas y evolutivas de niños con diagnóstico de osteomielitis internados en una Unidad de Quemados Pediátrica de alta complejidad. MÉTODOS: Estudio retrospectivo y descriptivo realizado durante el período de enero de 2007 a enero de 2017. RESULTADOS: Sobre un total de 600 niños quemados, 12 presentaron osteomielitis (incidencia del 2%). Once pacientes presentaron quemadura por fuego directo. La mediana de edad fue 42,5 meses (rango intercuartílico -RIC- 27-118 meses) y de superficie quemada fue 33,5% (RIC 18,5-58%). La osteomielitis se diagnosticó con una mediana de 30 días posquemadura. Las localizaciones más frecuentes fueron las extremidades superiores y la calota. La fiebre fue la manifestación clínica más común. Los microorganismos más frecuentemente aislados en el tejido óseo fueron hongos en 9 pacientes. Todos presentaron anatomía patológica compatible. La mediana de tratamiento fue 44,5 días (RIC 34,5-65,5 días). Seis pacientes presentaron secuelas motoras y 1 paciente falleció. CONCLUSIÓN: La etiología fúngica fue la más frecuente. La mitad de los pacientes presentó secuelas funcionales y solo un paciente falleció.