Epidemiology and clinical features of Streptococcus pyogenes bloodstream infections in children in Madrid, Spain.

Studies have shown increased invasive Group A Streptococcus (GAS) disease, including bloodstream infections (GAS-BSI). However, the epidemiological data of GAS-BSI are limited in children. We aimed to describe GAS-BSI in children in Madrid, over 13 years (2005-2017). Multicenter retrospective cohort study from 16 hospitals from Madrid, Spain. Epidemiology, symptomatology, laboratory, treatment, and outcome of GAS-BSI in children ≤ 16 years were analyzed. 109 cases of GAS-BSI were included, with incidence rate of 4.3 episodes/100,000 children attended at the emergency department/year. We compared incidence between two periods (P1: 2005-June 2011 vs P2: July 2011-2017) and observed a non-significant increase along the study period (annual percentage change: + 6.0% [95%CI: -2.7, + 15.4]; p = 0.163). Median age was 24.1 months (IQR: 14.0-53.7), peaking during the first four years of life (89/109 cases; 81.6%). Primary BSI (46.8%), skin and soft tissue (21.1%), and osteoarticular infections (18.3%) were the most common syndromes. We compared children with primary BSI with those with a known source and observed that the former had shorter hospital stay (7 vs. 13 days; p = 0.003) and received intravenous antibiotics less frequently (72.5% vs. 94.8%; p = 0.001) and for shorter duration of total antibiotic therapy (10 vs. 21 days; p = 0.001). 22% of cases required PICU admission. Factors associated with severity were respiratory distress, pneumonia, thrombocytopenia, and surgery, but in multivariate analysis, only respiratory distress remained significant (adjusted OR:9.23 [95%CI: 2.16-29.41]). Two children (1.8%) died.   Conclusion: We observed an increasing, although non-significant, trend of GAS-BSI incidence within the study. Younger children were more frequently involved, and primary BSI was the most common and less severe syndrome. PICU admission was frequent, being respiratory distress the main risk factor. What is known: • In recent decades, several reports have shown a worldwide increase in the incidence of invasive Group A streptococcal disease (GAS), including bloodstream infection (BSI). Recently, there have been a few reports showing an increase in severity as well. • There needs to be more information on the epidemiology in children since most studies predominantly include adults. What is new: • This study, carried out in children with GAS-BSI in Madrid, shows that GAS-BSI affects mostly younger children, with a broad spectrum of manifestations, needing PICU admission frequently. Respiratory distress was the leading risk factor for severity, whereas primary BSI seemed to be less severe. • We observed an increasing, although non-significant, trend of GAS-BSI incidence in recent years (2005-2017).

Fallo multiorgánico tras la recuperación de la circulación espontánea en la parada cardiaca en el niño / Multiple organ failure after spontaneous return of circulation in cardiac arrest in children

Objetivo: Estudiar la incidencia del fallo multiorgánico (FMO) y el valor pronóstico de las puntuaciones de FMO en los niños que se han recuperado de una parada cardiaca (PC) intrahospitalaria. Pacientes y métodos: Estudio unicéntrico, observacional, retrospectivo, en niños menores de 16 años, que presentaron una PC intrahospitalaria y alcanzaron la recuperación de la circulación espontánea (RCE). Se registraron las puntuaciones de las escalas de gravedad (PRISM y PIM II) y FMO (PELOD y P-MODS), la mortalidad y la causa del fallecimiento. Resultados: Se estudió a 41 niños (70,7% varones), con una mediana de edad de 38 meses. Durante el ingreso falleció el 41,5% (el 14,6% en las primeras 48h y un 7,3% en los siguientes 5 días). En las primeras 48 h, las puntuaciones de gravedad clínica y de FMO fueron más altas en los fallecidos que en los supervivientes (PRISM 29 frente a 21), p = 0,125, PIM II (26,8% frente a 9,2%), p = 0,021, PELOD (21 frente a 12), p = 0,005, y P-MODS (9 frente a 6), p = 0,001. Entre el 5.° y el 7.° día las puntuaciones de las 4 escalas fueron también mayores en los fallecidos, pero solo las escalas PELOD (20,5 frente a 11), p = 0,002, y P-MODS (6,5 frente a 3), p = 0,003, alcanzaron significación estadística. Conclusiones: La mortalidad de los niños que se recuperan de una PC es elevada. El FMO tras la RCE de una PC en el niño se asocia a una mayor mortalidad (AU)

Objective: To assess the frequency of the multiple organ failure and the prognostic value of multiple organ failure scores in children who have recovered from an in-hospital cardiac arrest. Patients and methods: A single centre, observational, and retrospective study was conducted on children between 1 month and 16 years old who suffered an in-hospital cardiac arrest and achieved return of spontaneous circulation (ROSC). In the first 24-48hours and between the fifth and the seventh day after ROSC, a record was made of the scores on paediatric severity (PRISM and PIM II) and multiple organ failure scales (PELOD and P-MODS), along with the clinical and analytical data, and including monitoring and treatment, mortality and cause of death. Results: Of the total of 41 children studied, 70.7% male were male, and the median age was 38 months. The overall mortality during admission was 41.5%, with 14.6% dying in the first 48hours, and 7.6% in the following 3 to 5 days. In the first 48hours, clinical severity and multiple organ failure scores were higher in the patients that died than in survivors (PRISM 29 vs. 21) P= .125, PIM II (26.8% vs. 9.2%) P=.02, PELOD (21 vs. 12) P= .005, and P-MODS (9 vs. 6) P= .001. Between the fifth and seventh day, the scores on the four scales were also higher in patients who died, but only those of the PELOD (20.5 vs. 11) p= .002 and P-MODS (6.5 vs. 3) P= .003 reached statistical significance. Conclusions: Mortality in children after return of spontaneous circulation after cardiac arrest is high. The multiple organ failure after return of spontaneous circulation after cardiac arrest in children is associated with increased mortality (AU)

[Multiple organ failure after spontaneous return of circulation in cardiac arrest in children]. / Fallo multiorgánico tras la recuperación de la circulación espontánea en la parada cardiaca en el niño.

OBJECTIVE: To assess the frequency of the multiple organ failure and the prognostic value of multiple organ failure scores in children who have recovered from an in-hospital cardiac arrest. PATIENTS AND METHODS: A single centre, observational, and retrospective study was conducted on children between 1 month and 16 years old who suffered an in-hospital cardiac arrest and achieved return of spontaneous circulation (ROSC). In the first 24-48hours and between the fifth and the seventh day after ROSC, a record was made of the scores on paediatric severity (PRISM and PIM II) and multiple organ failure scales (PELOD and P-MODS), along with the clinical and analytical data, and including monitoring and treatment, mortality and cause of death. RESULTS: Of the total of 41 children studied, 70.7% male were male, and the median age was 38 months. The overall mortality during admission was 41.5%, with 14.6% dying in the first 48hours, and 7.6% in the following 3 to 5 days. In the first 48hours, clinical severity and multiple organ failure scores were higher in the patients that died than in survivors (PRISM 29 vs. 21) P=.125, PIM II (26.8% vs. 9.2%) P=.02, PELOD (21 vs. 12) P=.005, and P-MODS (9 vs. 6) P=.001. Between the fifth and seventh day, the scores on the four scales were also higher in patients who died, but only those of the PELOD (20.5 vs. 11) p=.002 and P-MODS (6.5 vs. 3) P=.003 reached statistical significance. CONCLUSIONS: Mortality in children after return of spontaneous circulation after cardiac arrest is high. The multiple organ failure after return of spontaneous circulation after cardiac arrest in children is associated with increased mortality.