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.

[Accidental ingestion of superwarfarins]. / Ingesta accidental de superwarfarinas.

Superwarfarins were developed around 1970 in order to resolve the resistance developed by the rodents to the previously existing rodenticides. Superwarfarins cause, nowadays, most of the poisonings due to rodenticides. However, in our environment, it has been extremely uncommon to attend children with such poisonings. We present five children aged less than 4 years with unintentional ingestion of a superwarfarin, admitted in a Pediatric Emergency Department in 1 year time, and a revision of the literature.

Ingesta accidental de superwarfarinas / Accidental ingestion of superwarfarins

Las denominadas superwarfarinas se desarrollaron a partir de la década de 1970 como solución a las resistencias que habían desarrollado los roedores a los raticidas hasta entonces existentes. Las superwarfarinas motivan hoy en día la mayoría de las intoxicaciones por raticidas, aunque, en nuestro país, han sido excepcionales en edad pediátrica. Se presentan cinco casos correspondientes a ingestas accidentales de superwarfarinas en menores de 4 años atendidos en 1 año en un servicio de urgencias pediátrico y una revisión de la literatura médica (AU)

Superwarfarins were developed around 1970 in order to resolve the resistance developed by the rodents to the previously existing rodenticides. Superwarfarins cause, nowadays, most of the poisonings due to rodenticides. However, in our environment, it has been extremely uncommon to attend children with such poisonings. We present five children aged less than 4 years with unintentional ingestion of a superwarfarin, admitted in a Pediatric Emergency Department in 1 year time, and a revision of the literatura (AU)