Changes in Invasive Pneumococcal Disease in the Paediatric Population in the Second COVID-19 Pandemic Year.

Incidence of invasive pneumococcal disease (IPD) decreased worldwide in 2020, coinciding with the implementation of measures to reduce COVID-19 transmission. We evaluated the impact of the COVID-19 pandemic on healthcare demand and IPD in children in 2021 compared to the pre-pandemic period (2018-2019) and the early pandemic period (2020) in a study carried out during 2018-2021 in Catalonia. Incidence rates were compared by calculating the incidence rate ratio (IRR), and expressing percentage changes in IRR as (1-IRR)x100. Compared to 2018-2019, emergency room (ER) visits declined by 21% in 2021 (p < 0.001), mainly in the first quarter (-39%), and compared to 2020, ER visits increased by 22% in 2021 (p < 0.001), except in the first quarter. IPD incidence overall was 11.0 in 2018-2019 and 4.6 in 2021 (-58%, p < 0.001); the reduction in incidence was similar in the 0-4 age group and was higher in the first quarters. Compared to 2020, in 2021, IPD incidence decreased during the first quarter (-86%, p < 0.001), but increased from 0.0 to 1.2 in the second quarter (p = 0.02) and from 0.6 to 2.1 (p=0.03) in the fourth quarter. The decreased IPD incidence observed in 2021 compared to 2018-2019 (most especially in the first quarter) was greater than the decrease in healthcare demand and PCR test requests. Compared to 2020, IPD incidence decreased in the first quarter when a second state of alarm was in force. In 2021, compared to 2018-2019, there was a greater reduction in PCV13 serotypes than in non-PCV13 serotypes.

Effect of COVID-19 Pandemic on Invasive Pneumococcal Disease in Children, Catalonia, Spain.

We analyzed the effect of COVID-19 on healthcare demand and invasive pneumococcal disease in children in Catalonia, Spain. Compared with 2018-2019, we noted large reductions in healthcare activities and incidence of invasive pneumococcal disease in 2020. These changes likely resulted from nonpharmaceutical measures implemented during the COVID-19 pandemic.

The impact of COVID-19 lockdown on children with recurrent wheezing and asthma in Spain.

AIM: The rapid spread of a novel human coronavirus SARS-CoV-2 led to drastic measures world-wide. Most countries were forced to declare a national lockdown. We studied the effect of lockdown measures on the level of asthma control and maintenance treatment in children with recurrent wheezing and asthma during the first wave of COVID-19 in Spain. METHODS: We analysed children with recurrent wheezing or asthma before and after the implementation of the lockdown, by using a questionnaire aimed to examine pre-existing respiratory disorders, step treatment and level of asthma control before/after lockdown, COVID history and laboratory testing including IgG SARS-CoV-2. RESULTS: We enrolled 475 asthmatic and pre-school wheezers (60.6% males), mean age 5.6 years. There were no differences in asthma treatment comparing both periods: 81.7% maintained the same treatment (P = 0.103). According to child asthma-control questionnaire, 87.7% remained well controlled during confinement. Nearly, a third of children (34.9%) needed reliever treatment, mainly in older children. Determination of IgG SARS-CoV-2 was performed in 233 children (49.1%) of whom 17 (7.3%) tested positive. Seven patients positive to IgG SARS-CoV-2 were assisted in the emergency department and two required hospital admission. CONCLUSIONS: During COVID-19 lockdown in Spain, most children with recurrent wheezing and asthma remained well controlled from their underlying disease and did not modify greatly their maintenance treatments. Unexpectedly, we also observed that those children who tested positive to SARS-CoV-2 IgG showed a significant increase in paediatric hospital admissions and attendances to urgent care settings.

Necrotizing pneumonia due to Streptococcus pneumoniae in children during the period of non-systematic use of PCV13 in Catalonia, Spain.

BACKGROUND: Some studies have observed an increased incidence of necrotizing pneumonia (NP) in recent years. This might be related to the emergence of non-vaccine S. pneumoniae serotypes after PCV7 introduction although it is suggested that evolutionary factors may have modified the virulence and the interactions of pneumococci. The aim of this study was to clinically and microbiologically define NP in the population served by the three major paediatric hospitals in Barcelona (Catalonia, Spain). METHODS: A prospective observational study was conducted in patients <18 years hospitalized due to invasive pneumococcal disease (January 2012-June 2016). Data of confirmed cases of pneumococcal NP (diagnosed by culture or DNA detection and serotyped) were collected. PCV13 was not systematically administered in Catalonia during the study period, but was available in the private market so the vaccination coverage in children increased from 48.2% to 74.5%. RESULTS: 35 cases of NP were identified. 77.1% of cases were associated with empyema. In the first 4 years, a trend to a decrease in NP incidence was observed (p=0.021), especially in children <5 years (p=0.006). Serotype 3 was responsible for 48.6% of NP cases. Five patients with NP due to serotype 3 were fully vaccinated for their age with PCV13. CONCLUSIONS: Serotype 3 has a preeminent role in pneumococcal NP and was associated with all PCV13 vaccination failures. Although in our series the incidence does not seem to be increasing, evolution of pneumococcal NP rates should be monitored after inclusion of PCV13 in the systematic calendar.

Necrotizing pneumonia due to Streptococcus pneumoniae in children during the period of non-systematic use of PCV13 in Catalonia, Spain / Neumonía necrosante por Streptococcus pneumoniae en niños durante el periodo de uso no sistemático de la PCV13 en Cataluña, España

Background: Some studies have observed an increased incidence of necrotizing pneumonia (NP) in recent years. This might be related to the emergence of non-vaccine S. pneumoniae serotypes after PCV7 introduction although it is suggested that evolutionary factors may have modified the virulence and the interactions of pneumococci. The aim of this study was to clinically and microbiologically define NP in the population served by the three major paediatric hospitals in Barcelona (Catalonia, Spain). Methods: A prospective observational study was conducted in patients <18 years hospitalized due to invasive pneumococcal disease (January 2012–June 2016). Data of confirmed cases of pneumococcal NP (diagnosed by culture or DNA detection and serotyped) were collected. PCV13 was not systematically administered in Catalonia during the study period, but was available in the private market so the vaccination coverage in children increased from 48.2% to 74.5%. Results: 35 cases of NP were identified. 77.1% of cases were associated with empyema. In the first 4 years, a trend to a decrease in NP incidence was observed (p=0.021), especially in children <5 years (p=0.006). Serotype 3 was responsible for 48.6% of NP cases. Five patients with NP due to serotype 3 were fully vaccinated for their age with PCV13. Conclusions: Serotype 3 has a preeminent role in pneumococcal NP and was associated with all PCV13 vaccination failures. Although in our series the incidence does not seem to be increasing, evolution of pneumococcal NP rates should be monitored after inclusion of PCV13 in the systematic calendar.(AU)

Antecedentes: En algunos estudios se ha observado un aumento de la incidencia de neumonía necrosante (NN) en los últimos años. Dicho aumento podría estar asociado a la aparición de serotipos de S. pneumoniae no vacunales después de la introducción de la PCV7, aunque se sugiere que factores evolutivos podrían haber modificado la virulencia y las interacciones de los neumococos. El objetivo de este estudio fue definir clínica y microbiológicamente la NN en la población tratada en los 3 hospitales pediátricos principales de Barcelona (Cataluña, España). Métodos: Se llevó a cabo un estudio observacional prospectivo en pacientes <18 años hospitalizados a causa de una enfermedad neumocócica invasiva (enero de 2012-junio de 2016). Se recopilaron datos de casos confirmados de NN neumocócica (diagnosticada mediante cultivo o detección de ADN y serotipado). La PCV13 no se administró de forma sistemática en Cataluña durante el periodo del estudio, pero se encontraba disponible en el mercado privado, por lo que la cobertura de vacunación en niños pasó del 48,2 al 74,5%. Resultados: Se identificaron 35 casos de NN. El 77,1% de los casos estuvieron asociados a un empiema. En los primeros 4 años se observó una tendencia decreciente de la incidencia de NN (p=0,021), especialmente en niños <5 años (p=0,006). El serotipo 3 causó el 48,6% de los casos. Cinco pacientes con NN debida al serotipo 3 estaban completamente vacunados para su edad con la PCV13. Conclusiones: El serotipo 3 desempeña un papel prominente en la NN neumocócica y se asoció a todos los fracasos de vacunación de la PCV13. Aunque en nuestra serie la incidencia no parece estar aumentando, debe controlarse la evolución de las tasas de NN neumocócica tras la inclusión de la PCV13 en el calendario sistemático.(AU)

Pediatric Gaucher disease with intermediate type 2-3 phenotype associated with parkinsonian features and levodopa responsiveness.

INTRODUCTION: Gaucher disease (GD) is an autosomal recessive lysosomal storage disorder caused by a deficiency of acid ß-glucosidase encoded by the GBA gene. In patients with GD, childhood onset parkinsonian features have been rarely described. METHODS: Twin siblings with GD are described, including clinical follow-up and treatment response. Bone marrow, enzyme activity studies and genotyping were performed. RESULTS: By age 9 months, symptoms at onset were thrombocytopenia and splenomegaly. By age 2, hypokinesia, bradykinesia and oculomotor apraxia were observed. By age 5 a complete rigid hypokinetic syndrome was stablished in both patients, including bradykinesia, tremor and rigidity. Treatment with imiglucerase, miglustat, ambroxol and levodopa were performed. Levodopa showed a good response with improvement in motor and non-motor skills. Foamy cells were found in the bone marrow study. Glucocerebrosidase activity was 28% and 26%. Sanger sequencing analysis identified a missense mutation and a complex allele (NP_000148: p.[(Asp448His)]; [(Leu422Profs*4)]) in compound heterozygosity in GBA gene. CONCLUSIONS: Two siblings with neuronopathic GD with an intermediate form between type 2 and 3, with a systemic and neurological phenotype are described. The complex neurological picture included a hypokinetic-rigid and tremor syndrome that improved with levodopa treatment. These conditions together have not been previously described in pediatric GD. We suggest that in children with parkinsonian features, lysosomal storage disorders must be considered, and a levodopa trial must be performed. Moreover, this report give support to the finding that GBA and parkinsonian features share biological pathways and highlight the importance of lysosomal mechanisms in parkinsonism pathogenesis, what might have therapeutic implications.

Características de los pacientes con enfermedad neumocócica invasora que requieren ingreso en la unidad de cuidados intensivos / Characteristics of patients with invasive pneumococcal disease requiring admission to intensive care units

INTRODUCCIÓN: La enfermedad neumocócica invasora (ENI) puede requerir ingreso en la unidad de cuidados intensivos pediátricos (UCIP). El objetivo de este trabajo es analizar las características epidemiológicas, clínicas y microbiológicas asociadas a la ENI que predisponen el ingreso en la UCIP. MATERIAL Y MÉTODOS: Estudio prospectivo de casos diagnosticados con ENI en tres hospitales pediátricos de Barcelona entre enero de 2012 y junio de 2016. Se analizaron las asociaciones entre el ingreso en la UCIP y las variables epidemiológicas, clínicas y microbiológicas. RESULTADOS: Se incluyeron 263 casos con ENI. El 19% (n = 50) requirió ingreso en la UCIP. El 100% (7) de los pacientes con shock séptico, 84,2% (16) con meningitis y 15,2% (23) con neumonía complicada ingresaron en la UCIP. Las complicaciones más frecuentes fueron pulmonares (35,2%) y neurológicas (39,5%). La razón entre ingreso y no ingreso en la UCIP fue 4,17 veces mayor en los sujetos con enfermedad de base. Los serotipos asociados al ingreso en la UCIP fueron el 19A (23% del total de este serotipo), el 14 (20%), el 3 (17%) y el serotipo 1 (12,5%). CONCLUSIONES: La ENI requiere ingreso en la UCIP en caso de shock séptico y meningitis, no así, de entrada, la neumonía complicada. El porcentaje de ingresos es mayor en los niños con enfermedad de base. El ingreso en la UCIP conlleva una estancia más prolongada, así como complicaciones durante la fase aguda y secuelas, sobre todo, neurológicas. Los serotipos de los pacientes que ingresaron en la UCIP fueron, predominantemente, serotipos vacunales

INTRODUCTION: Patients with invasive pneumococcal disease (IPD) may require admission into paediatric intensive care units (PICU). The aim of this study is to analyse the epidemiological, clinical, and microbiological characteristics associated with IPD that may require admission to the PICU. MATERIAL AND METHODS: A prospective study was conducted on cases of IPD diagnosed in three Paediatric Hospitals in Barcelona between January 2012 and June 2016. An analysis was made of the associations between the admission to PICU and the epidemiological, clinical, and microbiological variables. RESULTS: A total of 263 cases with IPD were included, of which 19% (n = 50) required admission to PICU. Patients with septic shock (7; 100%), meningitis (16; 84.2%), and those with complicated pneumonia (23; 15.2%) were admitted to the PICU. The most frequent complications were pulmonary (35.2%) and neurological (39.5%). The ratio between admission and non-admission to PICU was 4.7 times higher in subjects with an underlying disease. The serotypes associated with PICU admission were 19A (23% of the total of this serotype), serotype 14 (20%), serotype 3 (17%), and serotype 1 (12.5%). CONCLUSIONS: IPD required PICU admission in cases of septic shock and meningitis, and less so with complicated pneumonia. The percentage of admissions is greater in children with an underlying disease. Admission into the PICU involves a longer stay, complications during the acute phase, as well as sequelae, particularly neurological ones. The serotypes of the patients that were admitted to PICU were predominantly vaccine serotypes

[Characteristics of patients with invasive pneumococcal disease requiring admission to intensive care units]. / Características de los pacientes con enfermedad neumocócica invasora que requieren ingreso en la unidad de cuidados intensivos.

INTRODUCTION: Patients with invasive pneumococcal disease (IPD) may require admission into paediatric intensive care units (PICU). The aim of this study is to analyse the epidemiological, clinical, and microbiological characteristics associated with IPD that may require admission to the PICU. MATERIAL AND METHODS: A prospective study was conducted on cases of IPD diagnosed in three Paediatric Hospitals in Barcelona between January 2012 and June 2016. An analysis was made of the associations between the admission to PICU and the epidemiological, clinical, and microbiological variables. RESULTS: A total of 263 cases with IPD were included, of which 19% (n = 50) required admission to PICU. Patients with septic shock (7; 100%), meningitis (16; 84.2%), and those with complicated pneumonia (23; 15.2%) were admitted to the PICU. The most frequent complications were pulmonary (35.2%) and neurological (39.5%). The ratio between admission and non-admission to PICU was 4.7 times higher in subjects with an underlying disease. The serotypes associated with PICU admission were 19A (23% of the total of this serotype), serotype 14 (20%), serotype 3 (17%), and serotype 1 (12.5%). CONCLUSIONS: IPD required PICU admission in cases of septic shock and meningitis, and less so with complicated pneumonia. The percentage of admissions is greater in children with an underlying disease. Admission into the PICU involves a longer stay, complications during the acute phase, as well as sequelae, particularly neurological ones. The serotypes of the patients that were admitted to PICU were predominantly vaccine serotypes.

Necrotizing pneumonia due to Streptococcus pneumoniae in children during the period of non-systematic use of PCV13 in Catalonia, Spain.

BACKGROUND: Some studies have observed an increased incidence of necrotizing pneumonia (NP) in recent years. This might be related to the emergence of non-vaccine S. pneumoniae serotypes after PCV7 introduction although it is suggested that evolutionary factors may have modified the virulence and the interactions of pneumococci. The aim of this study was to clinically and microbiologically define NP in the population served by the three major paediatric hospitals in Barcelona (Catalonia, Spain). METHODS: A prospective observational study was conducted in patients <18 years hospitalized due to invasive pneumococcal disease (January 2012-June 2016). Data of confirmed cases of pneumococcal NP (diagnosed by culture or DNA detection and serotyped) were collected. PCV13 was not systematically administered in Catalonia during the study period, but was available in the private market so the vaccination coverage in children increased from 48.2% to 74.5%. RESULTS: 35 cases of NP were identified. 77.1% of cases were associated with empyema. In the first 4 years, a trend to a decrease in NP incidence was observed (p=0.021), especially in children <5 years (p=0.006). Serotype 3 was responsible for 48.6% of NP cases. Five patients with NP due to serotype 3 were fully vaccinated for their age with PCV13. CONCLUSIONS: Serotype 3 has a preeminent role in pneumococcal NP and was associated with all PCV13 vaccination failures. Although in our series the incidence does not seem to be increasing, evolution of pneumococcal NP rates should be monitored after inclusion of PCV13 in the systematic calendar.

Serotype and clonal distribution dynamics of invasive pneumococcal strains after PCV13 introduction (2011-2016): Surveillance data from 23 sites in Catalonia, Spain.

BACKGROUND: The objective of this study is to describe incidence and shifts of serotype and clonal distribution of invasive Streptococcus pneumoniae strains in four different age groups (<5 years, 5-17 years, 18-64 years and >65 years) during a period of intermediate PCV13 vaccination coverage (2011-2016) in Catalonia, Spain. METHODS: We included all pneumococcal strains systematically sent to the Catalan support laboratory for molecular surveillance of invasive pneumococcal disease (IPD) located at Hospital Sant Joan de Deu, Barcelona. Two study periods were considered: 2011-13, early PCV13 vaccination period (EVP) and 2014-2016, late vaccination period (LVP). RESULTS: A total of 2142 strains were included in the study. Five years after intermediate introduction of PCV13 in our population, a significant decrease of overall incidence of IPD in children <5 years was observed (incidence rate ratio 0.5, 95% confidence interval 0.4-0.8). However, in seniors older than 65 years, a significant increase of overall incidence of IPD was observed (IRR 1.4, 95% CI 1.1-1.7). The contribution of PCV13 vaccine serotypes to IPD declined significantly in all age groups: from 59% to 38.1% in <5 years; 82.7% to 59% in 5-17 years, 47.8% to 34.1% in 18-64 years and 48.2% to 37% in >65 years. Results found when comparing both periods were consistent with IRRs observed year by year. In children <5 years, the three major serotypes detected were 1, 24F and 19A in EVP vs 24F, 14 and 10A in LVP. Among patients 5-17 years the first three serotypes were 1, 12F and 14 both in EVP and LVP. Among adults 18-64, the three major serotypes detected were 1, 12F and 8 vs 8, 12F and 3, respectively. Finally, in patients >65 years the most frequently isolated serotypes were 3, 19A and 7F vs 3, 14 and 12F, respectively. Regarding clonal complexes (CCs) expressing mainly PCV13 serotypes, significant decreases of the proportions of CC306, CC191 and CC320 were observed, while CC156 showed a significant increase. As for CCs expressing mostly non-PCV13 serotypes, significant increases in ST989, CC53 and CC404 were showed. CONCLUSIONS: Despite low vaccine coverage in our setting a significant decrease of incidence of IPD was observed in children younger than 5 years. The modest indirect protection against vaccine serotypes causing IPD in elderly indicate the need for the inclusion of more serotypes in future high-valent PCV and vaccinating old adults should be considered.

"El dia de l'antibiòtic": una eina per sensibilitzar sobre l'ús correcte d'antimicrobians / "El día del antibiótico": una herramienta para sensibilizar sobre el uso correcto de los antimicrobianos / "Antibiotic day": a tool for the correct use of antimicrobials

FONAMENT: El Pla de Salut de Catalunya 2016-2020 promou la implantació de projectes que disminueixin les resistències antibiòtiques. OBJECTIU: Valorar «El dia de l'antibiòtic» com una eina per fer control de qualitat I seguiment de l'ús dels antibiòtics. MÈTODE: Recollida de dades de pacients hospitalitzats en un centre pediàtric de segon nivell, per un membre del comitè d'infeccioses sense intervenció en la pràctica assistencial I amb desconeixement dels facultatius del centre. La recollida es fa aleatòriament dos dies a l'any durant 2016, 2017 I gener de 2018. S'obtenen: edat, pes, motiu I dies d'ingrés, antibiòtic, dosi, via, durada, cultius, tractament a l'ingrés I durant l'hospitalització, I compliment dels protocols interns. Es comuniquen els resultats als responsables dels pacients. S'avalua el cost que va representar la despesa d'antibiòtics durant els dos anys. RESULTATS: Al 2016, tres pacients ingressen amb una dosi incorrecta, dos amb una durada allargada I tres amb un espectre massa ample. Al 2017, dos pacients no segueixen el protocol, dos reben una dosi incorrecta I dos un antibiòtic d'espectre massa ample. Al 2018, un pacient rep antibiòtic amb un espectre massa ample. Tot això comporta un canvi en el protocol de la pneumònia adquirida a la comunitat (PAC). Es calcula una disminució de la despesa del 13,2%. CONCLUSIONS: La revisió anònima de la prescripció antibiòtica ha provocat un canvi en la mentalitat del pediatre per tal de emprar l'antibiòtic adient. El seguiment acurat de protocols interns ha fet que es modifiqui el protocol de PAC minvant l'espectre antibiòtic empíric. La despesa econòmica ha millorat un 13%

FUNDAMENTO: El Plan de Salud de Catalunya 2016-2020 promueve la implantación de proyectos que disminuyan las resistencias antibióticas. OBJETIVO: Valorar «El día del antibiótico» como herramienta para el control de la calidad y el seguimiento de la utilización de los antibióticos. MÉTODO: Recogida de datos de pacientes hospitalizados en un centro pediátrico de segundo nivel, por un miembro del comité de infecciones sin intervención asistencial y con desconocimiento de los facultativos asistenciales. La recogida se hace aleatoriamente dos días al año durante 2016, 2017 y enero de 2018. Se recoge: edad, peso, motivo y días de ingreso, antibiótico, dosis, vía, duración, cultivos, tratamiento al ingreso y durante la hospitalización, y cumplimiento de los protocolos internos. Se comunican los resultados a los responsables de los pacientes. Se evalúa el coste del gasto de antibióticos durante los dos años. RESULTADOS: En 2016, tres pacientes ingresan con dosis incorrectas, dos con duración alargada y tres con espectro demasiado amplio. En 2017, dos pacientes no siguen el protocolo, dos reciben dosis incorrectas y dos un antibiótico de espectro demasiado amplio. En 2017 se cambia el protocolo de neumonía adquirida en la comunidad (NAC). En 2018, un paciente recibe antibiótico con un espectro demasiado amplio. Se calcula una disminución de gastos del 13,2%. CONCLUSIONES: La revisión anónima de la prescripción antibiótica ha producido un cambio en la mentalidad del pediatra con el fin de utilizar el antibiótico adecuado. El seguimiento estricto de protocolos internos facilitó la modificación del protocolo de NAC disminuyendo el espectro antibiótico empírico. El gasto económico mejoró un 13%

BACKGROUND: The Catalonia Health Plan 2016-2020 promotes the implementation of projects that reduce antibiotic resistance in health centers. OBJECTIVE: To evaluate «Antibiotic Day» as a tool for quality control and monitoring of the use of antibiotics. METHOD: Collection of data from a second level pediatric hospital by a member of the infectious disease committee without intervention in clinical practice and without the prior knowledge of the hospital staff. Twice a year, with randomly selected dates for 2016, 2017 and January 2018, the following data were collected for patients receiving antibiotics: age, weight, cause and days of admission, antibiotic dose, route, days of treatment, cultures, treatment during hospitalization and upon discharge, and compliance with internal protocols. The results were communicated to the primary care providers. The antibiotic-associated cost for the two-year period was calculated. RESULTS: In 2016, three patients were admitted with an incorrect dose, two with prolonged duration and three received antibiotics of wider spectrum than indicated. In 2017, two patients did not follow the protocol, two received incorrect doses, and two received antibiotics of wider spectrum than required. In 2017, the Community Acquired Pneumonia Protocol (CAP) was modified. In 2018, one patient received an antibiotic of wider spectrum that indicated. Hospital expenses decreased by 13.2% during the study period. CONCLUSIONS: The implementation of "Antibiotic Day" resulted in a change in the antibiotic prescription practices with the use of antibiotics with narrower spectrum. The careful monitoring of internal protocols has led to the modification of the CAP protocol, which is used to reduce the empirical antibiotic spectrum. Economic waste has improved by 13%

Complicated pneumococcal pneumonia with pleural effusion or empyema in the 13-valent pneumococcal conjugate vaccine era.

AIM: The aim was to analyze the epidemiological, microbiological and clinical characteristics of patients with complicated pneumococcal pneumonia with pleural effusion (PE) or empyema. METHOD: Prospective study in three Catalan hospitals in persons aged <18 years diagnosed with complicated pneumonia with PE or empyema with isolation of Streptococcus pneumoniae in blood or pleural fluid by culture or real-time PCR between January 2012 and June 2016. Patients were divided into <2 years and 2-17 years age groups. Epidemiological, microbiological, and clinical data of patients were compared annually in both groups. PCV13 vaccination coverage increased from 48.2% in 2012 to 74.5% in 2015. RESULTS: We included 143 patients. The incidence of pneumococcal pneumonia was 6.83 cases × 10-5 persons/year in cases with PE or empyema and 2.09 cases × 10-5 person-years in cases without (rate ratio [RR]: 3.27; 2.25-4.86; P < 0.001). Empyema was more frequent than PE (79.7% vs 20.3%, P < 0.005). Of 143 cases studied, 93 (65.0%, P < 0.001) were diagnosed by real-time-PCR, 43 (30.1%) by culture and RT-PCR and 7 (4.9%) by culture only. PCV13 serotypes were more frequent in complicated than in uncomplicated pneumonia (116/142, 81.7% vs 27/45, 60.0%; P = 0.003), especially serotype 1 (41/142, 28.9% vs 6/45, 13.3%, P : 0.036). From 2012 to 2015 there was a significant reduction in serotype 1 (16/43, 37.2% vs 3/27, 11.1%, P = 0.026), and a trend to an increase in non-PCV13 serotypes (6/43, 14% vs 9/27, 33.3%, P = 0.054). CONCLUSIONS: A directly proportional relationship was observed between the reduction in pneumonia complicated with PE or empyema and a significant reduction in PCV13 serotypes, especially serotype 1, coinciding with increased PCV13 coverage.

Vaccine Failures in Patients Properly Vaccinated with 13-Valent Pneumococcal Conjugate Vaccine in Catalonia, a Region with Low Vaccination Coverage.

Vaccine failures occurring with 13-valent pneumococcal conjugate vaccine (PCV13) in 3 pediatric hospitals in Barcelona (2012-2013) are described. PCV13 vaccine failure was defined as the occurrence of an invasive pneumococcal infection in children properly vaccinated by PCV13. Among 84 patients with invasive pneumococcal infection, 32 had received at least one dose of PCV13. Seventeen of them had invasive pneumococcal infection produced by a PCV13 serotype. Among those, 9 patients were considered to have a PCV13 vaccine failure. Serotype 3 was isolated in 6 patients, serotype 19A in 2 and serotype 6B in 1.

La reanimació cardiopulmonar pediàtrica a l’escola / No disponible

No disponible

Derrame pleural paraneumónico: casuística de un hospital de segundo nivel / ârapneumonic pleural effusion: the application of general ethical principles in a paediatric hospital in Barcelona

Introducción. En los últimos años, en nuestro medio se ha podido constatar un aumento en el diagnóstico de pleuroneumonía bacteriana en la infancia. Embassament pleural parapneumònic: casuística d’un hospital pediàtric a Barcelona Alvaro Díaz-Conradi 1, Ramon Clapes 1, Orencio Urraca 1, Adriana Cordon 2, Nora Ruggieri 3, Jorge Canals 4, José Luis Peiró 4, Carmen Muñoz-Almagro 5 1 Servei de Pediatria. 2 Servei de Radiologia. 3 Servei de Pneumologia. 4 Servei de Cirurgia. Hospital de Nens de Barcelona. 5 Servei de Microbiologia. Hospital Sant Joan de Déu. Barcelona Objetivo. Evaluar las características clínicas, radiológicas y microbiológicas, así como el tratamiento y la evolución de los pacientes que han requerido ingreso en un hospital pediátrico de 35 camas con el diagnóstico de neumonía complicada con derrame y que requirieron drenaje pleural. Método. Durante 4 años, desde enero de 2005 hasta diciembre de 2008, ingresaron 33 pacientes diagnosticados de pleuroneumonía complicada que requirieron drenaje pleural y fibrinolíticos endopleurales. Resultados. Se distinguieron 2 períodos: 2005-2006 y 2007- 2008. Se demuestra un aumento de las neumonías ingresadas durante el período 2007-2008 del 2,4% (OIC 95%: 2,1-2,8%), así como un aumento de las pleuroneumonías diagnosticadas del 3,9% en el segundo período en relación con el número de neumonías ingresadas. La ecografía ha constituido una buena herramienta para el diagnóstico y seguimiento sin irradiar al paciente. La etiología ha sido predominantemente neumocócica, determinada sobre todo por Real-Time-PCR en líquido pleural, y el tratamiento estándar, la cefotaxima. Durante el período 2007-2008 se observa que la instilación precoz de urocinasa antes de la aparición de septos endopleurales disminuye el tiempo de estancia hospitalaria en 1,8 días (p = 0,04) respecto al período anterior. Conclusiones. El drenaje pleural con aspiración continuada e instilación de urocinasa endopleural sigue siendo un método eficaz en el tratamiento del empiema en un hospital pediátrico(AU)

Background. In recent years, we have seen an increase in the diagnosis of bacterial pleuropneumonia in children around us. Objective. To evaluate the clinical, radiological, and microbiological characteristics, as well as the treatment and evolution of patients hospitalised in a 35-bed paediatric hospital with the diagnosis of pneumonia complicated with effusion, and who required pleural drainage. Method. For four years, from January of 2005 until December of 2008, 33 patients entered the hospital diagnosed with complicated pleuropneumonia requiring pleural fluid drainage and endopleural fibrinolytics. Results. Two periods were distinguished: 2005-2006 and 2007- 2008. There was an increase of 2.4% (OIC 95%: 2.1- 2.8%) in hospitalisation for pneumonia during the period 2007-2008, as well as an increase of 3.9% in the pleuropneumonia diagnosed in the second period, with respect to hospitalised pneumonia. Ultrasound scanning has been a useful tool for diagnosis and follow-up without radiating the patient. The cause was mainly pneumococcal, determined especially by Real-Time-PCR (Real-Time Polymerase Chain Reaction) in pleural liquid. The most frequently used treatment was cefotaxime. During the 2007-2008 period it was shown that instillation of urokinase before the appearance of endopleural septums decreases the length of hospitalisation by 1.8 days (p = 0.04) with respect to the period 2005-2006. Conclusions. Pleural drainage under continuous aspiration and endopleural instillation of urokinase continue to be an effective method in the treatment of empyemas in a paediatric hospital(AU)

Cursos de reanimación cardiopulmonar pediátrica básica para padres y educadores / Training in basic cardiopulmonary resuscitation for parents and educators

Fundamento. Las maniobras de reanimación cardiopulmonar (RCP) pediátrica son útiles cuando comienzan antes de los 4 minutos de haberse producido la parada cardiorespiratoria. Los adultos que normalmente cuidan a los niños (padres y maestros) tienen que conocer estas maniobras. Objetivo. Determinar las características de los alumnos que han realizado el curso de RCP, así como su grado de aceptación y el grado de eficacia, en una consulta privada de pediatría de Terrassa. Método. Entre noviembre de 1999 y junio del 2002 se realizaron 20 cursos de RCP básica dirigidos a padres y maestros de escuela, con 279 alumnos, con una media de 6,1 alumnos por sesión (rango 3-12). Todos los cursos siguieron las recomendaciones de Grupo Español de Reanimación Cardiopulmonar Pediátrica y Neonatal. Resultados. El 75.5 por ciento de los alumnos fueron mujeres. El 61.3 por ciento del total fueron maestros, el 31 por ciento madres y padres, el 5.8 por ciento canguros, el 1 por ciento abuelos y abuelas, y otro 1 por cientovariado. Hay diferencias estadísticamente significativas entre la evaluación teórica inicial y la final (5.3 v. 8.5; p < 0.001). La evaluación práctica refleja que la maniobra más dificultosa por parte del alumno es la apertura de la vía aérea. El 87 por ciento de los alumnos se consideran preparados para realizar una RCP básica al finalizar el curso. Discusión. La población femenina está más sensibilizada. La evaluación teórica y práctica sirve como indicador de la eficacia de los cursos. La encuesta de satisfacción es un buen método de control de calidad. Nuestra experiencia indica que los padres y los maestros aceptan su puesto dentro de la cadena de supervivencia (AU)