Assessment of the Plans to Optimize Antimicrobial Use in the Pediatric Population in Catalan Hospitals: The VINCat Pediatric PROA SHARP Survey.

In Spain, many programs have been introduced in recent years to optimize antimicrobial stewardship in pediatric care (known as pediatric PROA). However, information on the current situation of these programs is scarce. The present study assesses current antimicrobial use in pediatric care in the hospitals of Catalonia affiliated with the VINCat pediatric PROA group. Between December 2020 and January 2021, an electronic survey related to the design and use of PROA was administered to members of PROA teams in our hospital network. The survey was conducted at 26 hospitals. Twelve percent of the hospitals had pediatric PROA in operation, 42% were included in adult PROA, and 46% carried out pediatric PROA activities but not as part of an established program. At 81%, the pediatric PROA team included a pediatrician, in 58% a pharmacist, and in 54% a microbiologist. The main activities were monitoring the use of antimicrobials and bacterial resistance. Twenty-seven percent measured indicators regularly. The VINCat Pediatric PROA group's hospitals have implemented measures for optimizing antimicrobial stewardship, but few have a pediatric PROA program in place. Specific measures and indicators must be defined, and the resources available should be increased. The development of pediatric PROA should be monitored in the coming years.

Household Severe Acute Respiratory Syndrome Coronavirus 2 Transmission and Children: A Network Prospective Study.

BACKGROUND: The role of children in household transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) remains unclear. We describe the epidemiological and clinical characteristics of children with coronavirus disease 2019 (COVID-19) in Catalonia, Spain, and investigate the household transmission dynamics. METHODS: A prospective, observational, multicenter study was performed during summer and school periods (1 July 2020-31 October 2020) to analyze epidemiological and clinical features and viral household transmission dynamics in COVID-19 patients aged <16 years. A pediatric index case was established when a child was the first individual infected. Secondary cases were defined when another household member tested positive for SARS-CoV-2 before the child. The secondary attack rate (SAR) was calculated, and logistic regression was used to assess associations between transmission risk factors and SARS-CoV-2 infection. RESULTS: The study included 1040 COVID-19 patients. Almost half (47.2%) were asymptomatic, 10.8% had comorbidities, and 2.6% required hospitalization. No deaths were reported. Viral transmission was common among household members (62.3%). More than 70% (756/1040) of pediatric cases were secondary to an adult, whereas 7.7% (80/1040) were index cases. The SAR was significantly lower in households with COVID-19 pediatric index cases during the school period relative to summer (P = .02) and compared to adults (P = .006). No individual or environmental risk factors associated with the SAR. CONCLUSIONS: Children are unlikely to cause household COVID-19 clusters or be major drivers of the pandemic, even if attending school. Interventions aimed at children are expected to have a small impact on reducing SARS-CoV-2 transmission.

Infecció per SARS-CoV-2 I escolarització / No disponible

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COVID-19. Tots som metges: ens necessiten, ens necessitem / No disponible

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Clinical Presentations and Outcomes Related to Tuberculosis in Children Younger Than 2 Years of Age in Catalonia.

Introduction: Children younger than 2 years have an increased risk of complications associated with tuberculosis (TB) due to the immaturity of the innate and adaptive immune response. We aimed to identify TB clinical presentations and outcomes as well as risk factors for complications in this age group. Materials and Methods: Multicenter, retrospective, cross-sectional study of TB cases in children aged <2 years in Catalonia (2005-2013). Epidemiological and clinical data were collected from the hospital medical records. TB complications, sequelae included, were defined as any tissue damage generating functional or anatomical impairment after being diagnosed or after TB treatment being completed. Statistical analyses were based on bivariate chi-square and multivariate logistic regression, and it was carried out with Stata® version 13.1. Odds ratios (OR) and its 95% confidence intervals were calculated (CI). Results: A total of 134 patients were included, 50.7% were male, the median [IQR] age was 13[8-18] months, and 18.7% (25/134) showed TB-associated complications. Pulmonary TB was diagnosed in 94.0% (126/134) of children, and the most common complications were lobar collapse (6/126). TB meningitis was diagnosed in 14/134 (10.4%), and hydrocephalus and mental impairment occurred in 1 and 2 patients, respectively. Two patients with spinal TB developed vertebral destruction and paraplegia, respectively. Only one of the patients died. At multivariate level, tachypnea (OR = 4.24; 95% CI 1.17-15.35) and meningeal (OR = 52.21; 95% CI 10.05-271.2) or combined/extrapulmonary forms (OR = 11.3; 95% CI 2.85-45.1) were associated with the development of TB complications. Discussion: TB complications are common in children under 2 years old. Extrapulmonary TB forms in this pediatric age remain a challenge and require prompt diagnosis and treatment in order to prevent them. The presence of tachypnea at the time of TB diagnosis is an independent associated factor to the development of TB complications in infants. This clinical sign should be closely monitored in patients in this age group. It is necessary to perform further studies in this age group in a prospective design in order to understand whether there are other factors associated to TB complications.

Infeccions per ricketsia i borrèlia / No disponible

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Borrèlia / No disponible

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Epidemiology and surveillance of pertussis among infants in Catalonia, Spain, during 1997-2001.

BACKGROUND: Despite high levels of vaccination coverage in Spain and Catalonia (98% in 2002), pertussis is a significant cause of morbidity among infants. The study aim was to estimate the incidence of hospitalizations for pertussis among infants from 1997 through 2001 in Catalonia. METHODS: A retrospective review of records for patients <12 months of age with a diagnosis of pertussis (International Classification of Diseases, 9th revision, code 033) at discharge from 11 Catalonian hospitals was performed. RESULTS: Three hundred forty-six patients were identified, 62 (1997), 28 (1998), 59 (1999), 150 (2000) and 47 (2001), of whom 284 (82%) were <4 months of age. The incidence of hospitalizations because of whooping cough from 1997 through 2001 in Catalonia was estimated at 118 cases per 100,000 inhabitants <12 months of age. Symptoms included paroxysmal cough (95%), cyanosis (67.9%), vomiting (36.7%) and apneic episodes (27.7%). Three infants (0.8%) died, all <2 months of age. Two hundred thirty-four patients (67.6%) were unvaccinated (222 patients were <3 months of age). Six patients (1.7%) were fully vaccinated (3 doses). Considering that only 220 patients <12 months of age were reported through the Catalonian Notification System in 1997-2001, at least 126 hospitalizations (36.4%) for pertussis were not reported to this system (mean difference per year, 32.6%; range, 8.4-56%). CONCLUSIONS: In this study, hospitalizations exceeded the number of notifications by at least 32.6%; therefore, the real incidence is likely to be greatly underestimated. Pertussis incidence remains high among infants, most of whom are <4 months of age and have had no or 1 dose of vaccine.

Experiencia en la evaluación de tutores de especialistas en formación / Experience in the evaluation of speciality training tutors

Introducción: Exponemos nuestra experiencia en la evaluación de tutores ligada a una pauta para incentivar la acción tutorial en el programa de formación de especialistas MIR y FIR. Material y Métodos: Se han diseñado dos cuestionarios de evaluación, uno para el jefe de la unidad docente y otro para la comisión de docencia, la suma de los resultados obtenidos en cada uno de ellos sirve para calcular el porcentaje global de objetivos alcanzado. Los cuestionarios se han aplicado a 38 tutores, anualmente, en los años 2000, 2001 y 2002. Se han utilizado las pruebas de Wilcoxon y de Spearman, aplicando la corrección de Bonferroni, para valorar las diferencias interanuales y la correlación intraanual de los resultados. Resultados: Los tutores han obtenido un porcentaje medio de objetivos del 92,6 por ciento en 2000, del 89,1 por ciento en 2001 y del 89,9 por ciento en 2002. El cuestionario evaluado por la comisión de docencia no muestra diferencias interanuales, mientras que el valorado por los jefes de unidad muestra diferencias entre los años 2000 y 2002 (P<0,01). Las evaluaciones de los jefes de unidad y de la comisión de docencia no mostraron correlación significativa. Discusión: La evaluación, dentro del sistema de formación MIR, es uno de los campos en los que se debe seguir avanzando. Evaluar y reconocer la labor tutorial puede ser un mecanismo de gran utilidad para mejorar el sistema de formación especializada. De acuerdo con la metodología utilizada, los resultados de nuestro estudio muestran que los tutores cumplen sus funciones adecuadamente. La herramienta evaluadora que se ha utilizado posee suficiente estabilidad en los resultados y poder de discriminación, durante el periodo estudiado (AU)

Invasive disease caused by Haemophilus influenzae: the sensitivity of statutory reporting.

PURPOSE: The objective of the study was to investigate the sensitivity of the statutory reporting of Haemophilus influenzae invasive disease (HIID) during the period between 1996 and 1997 in Catalonia, Spain. METHODS: The incidence of HIID reported passively by clinicians was compared with the cases detected by a system of microbiological surveillance. In all cases isolated, the age of the patient, the clinical form and the serotype were investigated. RESULTS: Sixty-six cases were passively reported and 111 were detected by microbiological surveillance. Overall sensitivity of reporting was 59.5% (95% CI, 50.7-69.1), with differences being observed according to the variables studied. The highest values were obtained in children under 5 years (87.8%; 95% CI, 73.7-95.9), in cases with meningitis and/or sepsis (64.3%; 95% CI, 50.4-76.6) and in serotype b (73.0%; 95% CI, 60.3-83.4). In the logistical regression analysis, only age under 5 years was associated with greater reporting (OR= 9.8; 95% CI, 2.5-37.8). CONCLUSIONS: Reported morbidity in children under 5 years is a good estimate of the true incidence of HIID in Catalonia (underreporting was 12.2%), but not for those above this age in whom the underreporting was 57.2%.