Seguimiento de los resultados de Microbiología y del tratamiento antibiótico empírico prescrito en un Servicio de Urgencias / Follow-up of the results of Microbiology Laboratory and the empiric treatment prescribed in an Emergency Department

Introducción: la gestión deficiente de los resultados del Laboratorio de Microbiología tiene un efecto negativo en la seguridad del paciente y en el manejo adecuado de los antibióticos. El objetivo de este estudio es analizar el seguimiento de los resultados microbiológicos en un Servicio de Urgencias de Pediatría y su impacto en la toma de decisiones terapéuticas. Material y métodos: estudio descriptivo retrospectivo realizado mediante revisión de resultados microbiológicos e historias clínicas electrónicas de los niños de 0 a 15 años atendidos en el periodo de un año. Resultados: se solicitaron 921 pruebas correspondientes a 837 pacientes, mayoritariamente urocultivos (416), hemocultivos (175) y coprocultivos (136). El laboratorio informó 246 microorganismos, fundamentalmente bacterias (91%). Se prescribieron antimicrobianos a 333 pacientes. Tras la revisión de los resultados microbiológicos, se modificó el tratamiento en 109 pacientes (13%): 96 interrupciones del antimicrobiano prescrito, tres cambios y diez prescripciones nuevas. Se notificaron los resultados a 381 pacientes, 218 del grupo de los resultados positivos y 163 en el de los negativos. El urocultivo fue la muestra implicada en el 63% de las modificaciones terapéuticas. Conclusiones: el seguimiento de las pruebas microbiológicas de los pacientes que acuden a Urgencias y la modificación de los tratamientos antimicrobianos prescritos pueden ser herramientas útiles en la mejora del uso de antimicrobianos en los Servicios de Urgencias Pediátricas (AU)

Introduction: the poor management of the results of microbiological cultures has a negative impact on patient safety due to the misuse of antibiotics. The aim of this study is to analyze the follow-up of the results of the microbiological results in an Emergency Department of Pediatrics and its impact on treatment decisions. Patients and methods: a retrospective descriptive study was conducted by reviewing microbiological results and medical records of children from 0 to 15 years assisted in the Emergency Department in the period of one year. Results: 921 tests were requested corresponding to 837 patients, mostly urine cultures (45.2%), blood cultures (19%) and stool cultures (14.6%). Laboratory reported 246 microorganisms, mainly bacteria (91%). Antimicrobials were prescribed to 333 patients. After the reviewing of the microbiological results, treatment was modified in 109 (13%) patients: 96 interruptions, 3 changes and 10 new prescriptions. The results were reported to 381 patients, 218 in the positive results group and 163 in the negative results group. The urine culture was the sample involved in 63% of therapeutic modifications. Conclusions: monitoring of microbiological tests on patients attending emergency department and modification of antimicrobial treatments prescribed may improve the use of antimicrobials in the Emergency Departments (AU)

[Second solid tumors in childhood. Review based on three cases]. / Segundos tumores sólidos en la infancia. Revisión a propósito de tres casos.

As children with cancer survive longer, the incidence of second malignant neoplasms has increased considerably. We describe here three cases of second solid tumors after 12, 8 and 2 years of initial diagnosis of cancer: one osteosarcoma of left maxilla in a previously treated child with bilateral retinoblastoma, a temporal astrocytoma associated with acute lymphoblastic leukemia and a glioblastoma multiforme in a girl with neurofibromatosis de Von Recklinghausen, after Non Hodgkin lymphoma, respectively. We review the literature about the influence of genetic, immunologic and therapeutic factors involved in the appearance of these second tumors.

[Familial hemophagocytic lymphohistiocytosis: survival of a case treated by polychemotherapy]. / Linfohistiocitosis familiar hemofagocítica (LHFH): supervivencia de un caso tratado con poliquimioterapia.

A case of familial hemophagocytic limphohistiocytosis (FHLH) is presented in a 16 months old infant, with clinical picture of prolonged fever, cutaneous purpura, generalized lymphadenopathy and progressive hepatosplenomegaly and laboratory of severe pancytopenia, hypofibrinogenemia and hypertriglyceridemia, with elevation of the pre-beta fraction in the lipidogram, all this compatible with this disease. She also showed bone marrow and ganglionar biopsy infiltrated by histiocytic cells with hemophagocytosis. The patient received chemotherapy with cycles VP-16, vincristine (VCR) and intrathecal methotrexate (MTX), alternating every two-three weeks with VACP, during one year, with resolution of clinical and laboratory parameters after two months of this treatment without relapses. The survival from diagnosis is 39 months.

[Thrombopenic purpura in childhood: follow-up study of 133 cases and current perspectives on treatment]. / Púrpura trombopénica en la infancia: revisión evolutiva de 133 casos y perspectivas actuales de tratamiento.

The authors review 133 cases of idiopathic thrombocytopenic purpura (ITP), through 17 years of follow-up in children from 2 months to 13 years of age. The clinical presentation of hemorrhagic signs, laboratory findings and different treatments employed are analyzed with special reference to recent treatment of these children.