RESUMEN
The aim of this article is to compare number of attendances to pediatric emergencies and hospital admissions, considering a period time in which measures of social distancing and restriction or urban mobility were in course, with the same period in previous years to the pandemic. We performed a case-series study in two pediatric emergencies and hospital admission between 16th March and 16th April 2020 (first month of social distancing in Rio de Janeiro State, Brazil). Data were compared with the same period, in the two previous years, using Analysis of variance (ANOVA). A p value <0.05 was considered as statistically significant. The number of attendances in the Unit A and B, respectively, were 6.579 and 1.538 in 2018; 5.750 and 1.430 in 2019 and 1.762 and 375 in 2020. The number of hospital admissions in the Unit A and B, respectively, were 823 and 199 in 2018; of 721 and 188 in 2019; and 325 and 135 in 2020. In both units, there was a statistically significant reduction of attendances and hospitals admissions when 2020 year was compared with the two previous years (p>0.0001). Relative percentage of acute respiratory diseases and influenza-like illness was 36.7%, 36.5% and 29.2%, respectively in 2018, 2019 and 2020 in the Unit A; and 25.9%, 24.2% and 24.5%, respectively for the same years, in the Unit B. We concluded that there was a statistically significant reduction of attendances and hospitals admissions in the pediatric emergencies evaluated, being the results attributed to social distancing and restriction of urban mobility during the period studied.
O objetivo deste artigo foi comparar o número de atendimentos em emergências pediátricas e internações hospitalares, considerando um período de tempo no qual vigoravam medidas de distanciamento social e restrição de mobilidade urbana, com o mesmo período em anos anteriores à pandemia da COVID-19. Realizamos um estudo de uma série de casos de atendimentos em duas emergências pediátricas e internações hospitalares entre 16 de março e 16 de abril de 2020 (primeiro mês de distanciamento social no Estado do Rio de Janeiro). Os dados foram comparados com o mesmo período dos dois anos anteriores, através de análise de variância (ANOVA). Um valor de p <0.05 foi considerado estatisticamente significativo. O número de atendimentos nas unidades A e B, respectivamente, foi de 6.579 e 1.538 em 2018; de 5.750 e 1.430 em 2019 e 1.762 e 375 em 2020. O número de internações nas unidades A e B, respectivamente, foi de 823 e 199 em 2018; de 721 e 188 em 2019; e 325 e 135 em 2020. Houve redução estatisticamente significativa de atendimentos e internações quando o ano de 2020 foi comparado com os anos anteriores nas duas unidades (p<0.0001). O percentual relativo de atendimentos de doenças respiratórias agudas e síndromes gripais foi de 36,7%, 36,5% e 29,2%, respectivamente em 2018, 2019 e 2020 na Unidade A; e 25,9%, 24,2% e 24,5%, respectivamente aos mesmos anos na Unidade B. Concluímos que houve redução estatisticamente significativa no número de atendimentos e internações nas emergências pediátricas avaliadas, sendo o resultado atribuído ao distanciamento social e restrição de mobilidade urbana no período avaliado.
RESUMEN
Antibiotic consumption (AC) is a key component of antimicrobial stewardship programs to recognize local patterns of antibiotic use. Our aim was to measure AC in neonatal units, including neonatal (NICU)/paediatric (PICU) intensive care units in different countries. We conducted a multicenter, retrospective, cohort study in three NICUs, one neonatal ward, and three PICUs with a total of 84 beds. Global and individual AC in days of therapy (DOT) and DOT per 1000 patient-days were assessed. During the study period, 2567 patients were admitted, corresponding to 4961 patient-days in neonatal units and 9243 patient-days in PICUs. Multidrug-resistant Gram-negative bacteria and methicillin-resistant Staphylococcus aureus were more frequent in Brazil than in Germany. Average AC was 386.5 and 1335.5 DOT/1000PD in German and Brazilian neonatal units, respectively. Aminopenicillins plus 3rd generation cephalosporins were the most commonly prescribed antibiotics in German neonatal units, while aminopenicillins plus aminoglycosides were the class most commonly used in Brazilian NICU. Average AC was 888.1 and 1440.7 DOT/1000PD in German and Brazilian PICUs, respectively. Antipseudomonal penicillins were most commonly used in the German PICU, and glycopeptides were the most frequently prescribed in Brazilian PICUs. Carbapenems represented 2.3-14% of total DOTs in German neonatal units and 4% in the Brazilian NICU and 13.0% in the German PICU and 6-12.2% in Brazilian PICUs. We concluded that different patterns of most commonly prescribed antibiotics were observed in neonatal units and PICUs in these two countries, probably related to different local patterns of antibiotic resistance, with a higher antibiotic consumption in Brazilian study units.
Asunto(s)
Antibacterianos/uso terapéutico , Programas de Optimización del Uso de los Antimicrobianos/estadística & datos numéricos , Utilización de Medicamentos/estadística & datos numéricos , Unidades de Cuidado Intensivo Neonatal , Unidades de Cuidado Intensivo Pediátrico , Centros Médicos Académicos/estadística & datos numéricos , Adolescente , Antibacterianos/administración & dosificación , Brasil , Niño , Preescolar , Farmacorresistencia Bacteriana Múltiple , Femenino , Alemania , Bacterias Gramnegativas/efectos de los fármacos , Humanos , Lactante , Recién Nacido , Masculino , Staphylococcus aureus Resistente a Meticilina/efectos de los fármacos , Estudios RetrospectivosRESUMEN
A comprehensive cohort study including an entomological surveillance component can contribute to our knowledge of clinical aspects and transmission patterns of arbovirosis. This article describes the implementation of a populational-based birth cohort study that included an entomological surveillance component, and its associated challenges in a low-income community of Rio de Janeiro, Brazil. The participants were recruited in two periods: from 2012 to 2014, and from 2015 to 2017. The children had scheduled pediatric consultations and in case of fever. Epidemiological, clinical data and biological samples were collected at pediatric visits. Active febrile surveillance was performed by telephone calls, social networking, message apps, and household visits. A total of 387 newborns and 332 new children were included during the first and second recruitment periods, respectively. By July 2017, there were 451 children on follow-up. During the study, 2,759 pediatric visits were performed: 1,783 asymptomatic and 976 febrile/rash consultations. The number of febrile or rash consultations increased 3.5-fold after the use of media tools for surveillance. No temporal pattern, seasonality or peak of febrile cases was observed during the study period. A total of 10,105 adult mosquitoes (including 3,523 Aedes spp. and 6,582 Culex quinquefasciatus) and 46,047 Aedes eggs were collected from households, schools, and key sites. Although challenging, this structured sentinel populational-based birth cohort is relevant to the knowledge of risks and awareness of emerging pathogens.
Asunto(s)
Aedes/clasificación , Infecciones por Arbovirus/epidemiología , Mosquitos Vectores/clasificación , Animales , Infecciones por Arbovirus/diagnóstico , Infecciones por Arbovirus/transmisión , Brasil/epidemiología , Preescolar , Estudios de Cohortes , Entomología , Femenino , Humanos , Lactante , Recién Nacido , Áreas de Pobreza , Población UrbanaRESUMEN
Abstract: A comprehensive cohort study including an entomological surveillance component can contribute to our knowledge of clinical aspects and transmission patterns of arbovirosis. This article describes the implementation of a populational-based birth cohort study that included an entomological surveillance component, and its associated challenges in a low-income community of Rio de Janeiro, Brazil. The participants were recruited in two periods: from 2012 to 2014, and from 2015 to 2017. The children had scheduled pediatric consultations and in case of fever. Epidemiological, clinical data and biological samples were collected at pediatric visits. Active febrile surveillance was performed by telephone calls, social networking, message apps, and household visits. A total of 387 newborns and 332 new children were included during the first and second recruitment periods, respectively. By July 2017, there were 451 children on follow-up. During the study, 2,759 pediatric visits were performed: 1,783 asymptomatic and 976 febrile/rash consultations. The number of febrile or rash consultations increased 3.5-fold after the use of media tools for surveillance. No temporal pattern, seasonality or peak of febrile cases was observed during the study period. A total of 10,105 adult mosquitoes (including 3,523 Aedes spp. and 6,582 Culex quinquefasciatus) and 46,047 Aedes eggs were collected from households, schools, and key sites. Although challenging, this structured sentinel populational-based birth cohort is relevant to the knowledge of risks and awareness of emerging pathogens.
Resumo: Estudos de coorte com um componente de vigilância epidemiológica podem contribuir para nosso conhecimento dos aspectos clínicos e dos padrões de transmissão de arboviroses. Este artigo descreve a implementação de um estudo de coorte de nascimento de base populacional que incluiu um componente de vigilância entomológica e desafios relacionados numa comunidade desfavorecida do Rio de Janeiro, Brasil. Os participantes foram recrutados em dois períodos: de 2012-2014 e de 2015-2017. As crianças tiveram consultas pediátricas agendadas e em caso de febre. Dados epidemiológicos, clínicos e amostras biológicas foram coletadas nas visitas pediátricas. A vigilância ativa febril foi realizada por meio de ligações telefônicas, redes sociais, aplicativos de mensagens e visitas domiciliares. Um total de 387 recém-nascidos e 332 novas crianças foram incluídas durante o primeiro e segundo períodos de recrutamento, respectivamente. Em Julho de 2017, havia 451 crianças em seguimento. Durante o estudo, foram realizadas 2.759 visitas pediátricas: 1.783 assintomáticas e 976 consultas por febre/exantema. O número de consultas por febre ou exantema aumentou 3,5 vezes após uso de ferramentas de mídia para vigilância. Nenhum padrão temporal, sazonalidade ou pico de casos de febre foi observado durante o período do estudo. Um total de 10.105 mosquitos adultos (incluindo 3.523 Aedes spp. e 6.582 Culex quinquefasciatus) e 46.047 ovos foram coletados de domicílios, escolas, e pontos estratégicos. Apesar dos desafios, esta coorte de nascimento sentinela de base populacional é relevante para o conhecimento dos riscos e de patógenos emergentes.
Resumen: Un estudio completro de cohorte que incluya una vigilancia entomológica puede contribuir a nuestro conocimiento de aspectos clínicos y patrones de transmisión de arbovirosis. Este artículo describe la implementación de un estudio poblacional de cohorte de nascimientos que incluyó el componente de vigilancia entomológica y los desafios asociados en una comunidad desfavorecida de Río de Janeiro, Brasil. Los participantes fueron captados en dos periodos: de 2012 a 2014 y de 2015 a 2017. Los niños tenían fijadas consultas pediátrica regulares y por fiebre. Durante las visitas pediátricas, se recogieron datos epidemiológicos y clínicos, así como muestras biológicas. Se realizó una vigilancia activa de la fiebre mediante llamadas telefónicas, redes sociales, aplicaciones de mensajes, y visitas a domicilio. Un total de 387 recién nacidos y 332 nuevos niños fueron incluidos durante el primer y segundo período de reclutamiento, respectivamente. En julio de 2017 se había realizado un seguimiento a 451 niños. Durante el estudio, se realizaron 2.759 visitas pediátricas: 1.783 asintomáticas y 976 por fiebre/urgencias. El número de consultas por fiebre o urgencias aumentó 3.5-veces tras el uso de herramientas de comunicación para la viglancia. No se observaron patrones temporales, estacionalidad o casos de picos de fiebre durante el periodo de estudio. Un total of 10.105 mosquitos adultos (incluyendo 3.523 Aedes spp. y 6.582 Culex quinquefasciatus) y 46.047 huevos fueron recogidos de viviendas, escuelas, y lugares estratégicos. A pesar de los retos, esta cohorte de nacimiento estructurada y supervisada, basada en población es relevante para el conocimiento de los riesgos y la concienciación sobre patógenos emergentes.
