Características de la apendicitis aguda en un hospital de tercer nivel. Análisis de la implantación de un programa de optimización antibiótica / Characteristics of acute appendicitis at a tertiary hospital: analyzing the implementation of an antibiotic optimization program

Introducción: La apendicitis aguda (AA) es la patología quirúrgicamás frecuente en Pediatría. Las publicaciones sobre la antibioterapia másadecuada como profilaxis y tratamiento de la AA en niños son limitadas. Material y métodos: Se realizó un análisis retrospectivo en pacien-tes menores de 14 años hospitalizados con AA. Se comparó el períodoprevio a la implantación del programa de optimización del uso de losantimicrobianos (PROA), pre-PROA (septiembre 2017-marzo 2019) yposterior, post-PROA (abril 2019-septiembre 2019). Resultados:Se incluyeron 206 pacientes: 139 del período pre-PROA y 67 post-PROA. Destacamos la mayor utilización de biterapia(ceftriaxona y metronidazol) y monoterapia (cefoxitina) en el períodopost-PROA (p= 0,0001), con ucción del uso de amoxicilina-clavu-lánico y piperacilina-tazobactam como terapia empírica (p= 0,0001).Para determinar el paso a terapia oral, se estableció el cumplimentode criterios clínicos (estado afebril, tránsito mantenido, tolerancia oraladecuada y con buen control del dolor vía oral) y analíticos (descensode la PCR al menos un 20-50% del valor máximo y leucocitos ≤ 12.000/mm3). Esto permitió un incremento de la secuenciación del tratamientooral en el período post-PROA (p= 0,03). No hubo diferencias en laestancia hospitalaria ni complicaciones entre ambos períodos, aunquese emplearon antimicrobianos de menor espectro con terapia oral deforma más precoz en la etapa post-PROA. Conclusiones: Es recomendable la implementación del PROA enpatologías quirúrgicas y elaborar protocolos adaptados al perfil micro-biológico y resistencias de cada unidad.(AU)

Introduction: Acute appendicitis (AA) is the most frequent surgi-cal pathology in pediatrics. However, publications discussing the mostadequate antibiotic therapy for AA prophylaxis and treatment in childrenare limited. Materials and methods: A retrospective analysis of patients under14 years of age hospitalized as a result of AA was carried out. Theperiods pre- and post- implementation of an antimicrobial optimizationprogram (AOPR) were compared. The pre-AOPR period went fromSeptember 2017 to March 2019, while the post-AOPR period went fromApril 2019 to September 2019. Results: 206 patients were included, 139 in the pre-AOPR group,and 67 in the post-AOPR group. Dual therapy (ceftriaxone + metro-nidazole) and single therapy (cefoxitin) were more commonly usedin the post-AOPR group (p= 0.0001), with reduced use of amoxicil-lin + clavulanic acid and piperacillin + tazobactam as an empiricaltherapy (p= 0.0001). To determine whether conversion to oral therapywas feasible or not, a number of clinical (no fever, sustained transit,adequate tolerance with satisfactory oral pain control) and blood test(a 20-50% CRP decrease from its highest level and a ≤ 12,000/mm 3leukocyte count) criteria were established. This allowed conversion tooral treatment to increase in the post-AOPR period (p=0.03). No dif-ferences in terms of hospital stay or complications were found betweenperiods, but narrower spectrum oral antimicrobials were used earlierin the post-AOPR period. Conclusions: Implementing an AOPR for surgical pathologies andestablishing protocols adapted to the resistance and microbiologicalprofile found at each unit is strongly recommended.(AU)

Characteristics of acute appendicitis at a tertiary hospital: analyzing the implementation of an antibiotic optimization program. / Características de la apendicitis aguda en un hospital de tercer nivel. Análisis de la implantación de un programa de optimización antibiótica.

INTRODUCTION: Acute appendicitis (AA) is the most frequent surgical pathology in pediatrics. However, publications discussing the most adequate antibiotic therapy for AA prophylaxis and treatment in children are limited. MATERIAL AND METHODS: A retrospective analysis of patients under 14 years of age hospitalized as a result of AA was carried out. The periods pre- and post- implementation of an antimicrobial optimization program (AOPR) were compared. The pre-AOPR period went from September 2017 to March 2019, while the post-AOPR period went from April 2019 to September 2019. RESULTS: 206 patients were included, 139 in the pre-AOPR group, and 67 in the post-AOPR group. Dual therapy (ceftriaxone + metronidazole) and single therapy (cefoxitin) were more commonly used in the post-AOPR group (p= 0.0001), with reduced use of amoxicillin + clavulanic acid and piperacillin + tazobactam as an empirical therapy (p= 0.0001). To determine whether conversion to oral therapy was feasible or not, a number of clinical (no fever, sustained transit, adequate tolerance with satisfactory oral pain control) and blood test (a 20-50% CRP decrease from its highest level and a ≤ 12,000/mm3 leukocyte count) criteria were established. This allowed conversion to oral treatment to increase in the post-AOPR period (p=0.03). No differences in terms of hospital stay or complications were found between periods, but narrower spectrum oral antimicrobials were used earlier in the post-AOPR period. CONCLUSIONS: Implementing an AOPR for surgical pathologies and establishing protocols adapted to the resistance and microbiological profile found at each unit is strongly recommended.

INTRODUCCION: La apendicitis aguda (AA) es la patología quirúrgica más frecuente en Pediatría. Las publicaciones sobre la antibioterapia más adecuada como profilaxis y tratamiento de la AA en niños son limitadas. MATERIAL Y METODOS: Se realizó un análisis retrospectivo en pacientes menores de 14 años hospitalizados con AA. Se comparó el período previo a la implantación del programa de optimización del uso de los antimicrobianos (PROA), pre-PROA (septiembre 2017-marzo 2019) y posterior, post-PROA (abril 2019-septiembre 2019). RESULTADOS: Se incluyeron 206 pacientes: 139 del período pre-PROA y 67 post-PROA. Destacamos la mayor utilización de biterapia (ceftriaxona y metronidazol) y monoterapia (cefoxitina) en el período post-PROA (p= 0,0001), con reducción del uso de amoxicilina-clavulánico y piperacilina-tazobactam como terapia empírica (p= 0,0001). Para determinar el paso a terapia oral, se estableció el cumplimento de criterios clínicos (estado afebril, tránsito mantenido, tolerancia oral adecuada y con buen control del dolor vía oral) y analíticos (descenso de la PCR al menos un 20-50% del valor máximo y leucocitos ≤ 12.000/mm3). Esto permitió un incremento de la secuenciación del tratamiento oral en el período post-PROA (p= 0,03). No hubo diferencias en la estancia hospitalaria ni complicaciones entre ambos períodos, aunque se emplearon antimicrobianos de menor espectro con terapia oral de forma más precoz en la etapa post-PROA. CONCLUSIONES: Es recomendable la implementación del PROA en patologías quirúrgicas y elaborar protocolos adaptados al perfil microbiológico y resistencias de cada unidad.

Safety of magnetic resonance imaging in preterm infants.

AIM: As we progress in our knowledge of preterm brain injury, cohort studies are focusing in neuroimaging preterm infants in the first days of life. Magnetic resonance (MR) is the most powerful neuroimaging modality and valuable in understanding perinatal brain injury. The main purpose of the study is to evaluate the safety of MR imaging in very low birth weight (VLBW) infants at our hospital settings where the scanner is located at some distance from the neonatal intensive care unit (NICU). SUBJECTS AND METHODS: This is a prospective study of 33 VLBW infants who underwent early MR imaging (MRI), within 10 days after birth and term corrected age MRI. The study period included June to December 2008. RESULTS: A total of 46 MRI were performed on 33 preterm infants. The mean total time the infants stayed in the bore of the magnet was 13.04 min. No incidences occurred during transfer or during the scans, and no significant changes were found in heart rate, oxygen saturation and temperature. CONCLUSIONS: At our hospital settings, the process of transport and MR imaging have been proven to be safe and not to disturb any of the variables measured. MRI should not be restricted to centres with neonatal MR system or MR-compatible incubator, as long as the process is coordinated and supervised by a multidisciplinary team.

Resolución del trombo intracardíaco con urocinasa local en bajas dosis en un gran prematuro / Resolution of intracardiac thrombi with local low dose urokinase in an extremely low birth weight premature infant

No disponible