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1.
Pediatr Infect Dis J ; 38(12): 1230-1235, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31738339

RESUMO

BACKGROUND: Congenital cytomegalovirus infection (CMVc) affects 0.7%-6% of recent births. Among its clinical manifestations are low weight and length at birth. OBJECTIVE: Describe the growth patterns of children with CMVc in their early years. METHODS: Observational, multicenter study of patients with CMVc. Anthropometric data were collected during the first 2 years of life and compared with World Health Organization standards. RESULTS: Anthropometric characteristics of 383 children with CMVc were studied, of which 198 (51%) were symptomatic at birth. At birth, 9% were small for gestational age (SGA) in terms of their weight and length and 17% had microcephaly. At 24 ± 3 months, 10% had a weight and length ≤2 SD, and 13% a head circumference ≤2 SD. Of those who were SGA at birth, at 24 ± 3 months >20% remained at ≤2 SD of their weight and length. Conversely, 75% of children with low weight or length at 24 ± 3 had not been SGA at birth. 20% of infants with microcephaly at birth remained with microcephaly, and 10% of those without microcephaly developed it at 24 ± 3 months. The average growth rate in length and weight was normal. Patients who were symptomatic at birth, premature and with motor and neurocognitive impairment had a significantly higher risk of low weight and length at 24 ± 3 months. CONCLUSION: Around 10% of children with CMVc are at ≤2 SD in weight, length and head circumference at 24 ± 3 months. The lack of adequate growth is associated with symptoms at birth, prematurity and motor and neurocognitive impairment. Growth impairment could be incorporated into the symptomatic spectrum of CMVc.

2.
An Pediatr (Barc) ; 91(5): 351.e1-351.e13, 2019 Nov.
Artigo em Espanhol | MEDLINE | ID: mdl-31635925

RESUMO

A progressive increase in the incidence of infections caused by multidrug-resistant microorganisms is being reported. Among these resistant microorganisms, the main threats are extended-spectrum ß-lactamase-, AmpC-, and carbapenemase-producing Gram-negative bacilli, methicillin-resistant Staphylococcus aureus and vancomycin-resistant Enterococcus faecium. To address this important problem, it is essential to establish pediatric Antimicrobial Stewardship programs, perform active epidemiological surveillance and develop an adequate infection control policy. The therapeutic approach of these infections is often complex, frequently requiring antibiotics with less experience in children. In this position document made by the Spanish Association of Pediatrics and the Spanish Society of Pediatric Infectious Diseases, the epidemiology and treatment of these infections are reviewed according to the best available evidence.

4.
Eur J Clin Microbiol Infect Dis ; 38(11): 2097-2102, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31359255

RESUMO

According to many guidelines, gentamicin is the empirical parenteral treatment for children with community-acquired urinary tract infection (CA-UTI). However, increasing resistance rates are reported. The purpose of this study is to analyze risk factors for presenting with a UTI caused by a community-acquired gentamicin-resistant Escherichia coli in children in our hospital and to describe their clinical outcome. A retrospective case-control local study was performed in a tertiary care hospital from January 2014 to December 2016. Cases and controls were children below 14 years old diagnosed in the Emergency Department with febrile CA-UTI caused by gentamicin-resistant and gentamicin-susceptible febrile E. coli strains, respectively. During the study period, 54 cases were included and compared with 98 controls. Patients with chronic conditions were more likely to present with a UTI due to gentamicin-resistant E. coli (OR 3.27; 95% CI 1.37-7.8, p < 0.05), as well as children receiving antibiotic prophylaxis (OR 3.5; 95% CI 1.2-10.1, p < 0.05). Cases had longer hospital stays than controls (5.8 ± 5 days vs. 4.4 ± 4 days, p = 0.017). Gentamicin-resistant strains associated higher rates of cefuroxime (29% vs. 3%), cefotaxime (27% vs. 0%), and quinolone resistance (40.7% vs. 6%) (p < 0.01) and produced more frequently extended-spectrum beta-lactamases (ESBL) (20% vs. 0%, p < 0.01) and carbapenemases (7.4% vs. 0%; p = 0.015). All gentamicin-resistant strains were amikacin-sensitive. The presence of chronic conditions and antibiotic prophylaxis could be potential risk factors for gentamicin-resistant E. coli CA-UTI in children. Simultaneous resistance to cephalosporins, quinolones, and ESBL/carbapenemase production is frequent in these strains.

5.
An Pediatr (Barc) ; 90(6): 400.e1-400.e9, 2019 Jun.
Artigo em Espanhol | MEDLINE | ID: mdl-30979681

RESUMO

Urinary tract infection (UTI) is defined as the growth of microorganisms in a sterile urine culture in a patient with compatible clinical symptoms. The presence of bacteria without any symptoms is known as asymptomatic bacteriuria, and does not require any treatment. In neonates and infants, fever is the guiding sign to suspecting a UTI. Classic urinary tract symptoms become more important in older children. Urine cultures collected before starting antibiotics is always required for diagnosis. Clean-catch (midstream) specimens should be collected for urine culture. In the case of non-toilet-trained children, specimens must be obtained by urinary catheterisation, or suprapubic puncture in neonates and infants. Specimens collected by urine bag should not be used for urine culture. There are no significant differences in the clinical evolution and prognosis between oral versus short intravenous followed by oral antibiotic. Empirical antibiotic therapy should be guided by local susceptibility patterns. Second-generation cephalosporin (children under 6 years) and fosfomycin trometamol (over 6 years), are the empiric therapy recommended in this consensus. In the case of pyelonephritis, recommended antibiotic treatment are third-generation cephalosporins (outpatient care) or, if admission is required, aminoglycosides. Ampicillin should be added in infants less than 3 months old. Antibiotic de-escalation should be always practiced once the result of the urine culture is known.

6.
Vaccine ; 37(16): 2200-2207, 2019 Apr 10.
Artigo em Inglês | MEDLINE | ID: mdl-30902478

RESUMO

Streptococcus pneumoniae is a major cause of morbidity and mortality worldwide. Using the data from the HERACLES clinical surveillance study (2007-2016), we describe the population impact of the 13-valent pneumococcal conjugate vaccine (PVC13) on invasive pneumococcal disease (IPD) in children <15 years of age in the Community of Madrid, Spain. After six years of the inclusion of PCV13 in the vaccination calendar (2010-2016), and despite changes in the Regional Immunization Programme that limited its availability, the net benefit incidence rate (IR) of IPD fell by 70.1% (IRR 0.3 [95% CI: 0.22-0.4]; p ≤ 0.001), mainly due to a significant reduction (91%) in the PCV13 serotypes (IRR 0.09 [95% CI: 0.05-0.16], p ≤ 0.001). Furthermore, no significant changes were detected in the IR of IPD caused by non-PCV13 serotypes. The IRs of the aggressive, resistant and most prevalent serotype in the analysed population, the 19A serotype, dramatically decreased from the beginning to the end of the study (98%) [IRR 0.03 (95% CI: 0.00-0.19), p ≤ 0.001], to its almost total disappearance. Remarkably, this reduction led to a pronounced decline in the percentage of cefotaxime-resistant isolates and the incidence of meningitis cases. Assessment of the clinical impact revealed a reduction in the number of all clinical presentations of IPD, confirming the effectiveness of the PCV13. Finally, PCV13 detected by PCR is predicted to have a stronger impact than the one based on culture methods, which can overlook more than 20% of cases of IPD, mainly pleural empyemas.

7.
J Matern Fetal Neonatal Med ; 32(4): 617-625, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-28978246

RESUMO

INTRODUCTION: Cytomegalovirus (CMV) is the leading cause of congenital infection worldwide. Data about the management of CMV infection in pregnant women are scarce, and treatment options are very limited. The aim of the study is to investigate the effectiveness of cytomegalovirus hyperimmune globulin (CMV-HIG) for the prevention and treatment of congenital CMV (cCMV) infection. MATERIALS AND METHODS: A retrospective observational study was conducted in three tertiary hospitals in Madrid. In the period 2009-2015, CMV-HIG (Cytotect® CP Biotest, Biotest) treatment was offered to all pregnant women with primary CMV infection and/or detection of CMV-DNA in amniotic fluid in participating centers. Women were divided into prevention and treatment groups (PG and TG, respectively). Those with primary CMV infection who had not undergone amniocentesis comprised the PG and received monthly CMV-HIG (100 UI/kg). If CMV-DNA was subsequently detected in amniotic fluid, one extra dose of CMV-HIG (200 UI/kg) was given 4 weeks after the last dose. Those women were considered to be part of the PG group despite detection of CMV-DNA in amniotic fluid. In the case of a negative result in CMV-DNA detection in amniotic fluid or if amniocentesis was not performed, monthly HIG was given up to the end of the pregnancy. RESULTS: Thirty-six pregnant women were included. Median gestational age at birth was 39 weeks (interquartile range: 38-40) and two children (5.5%) were premature (born at 28 and 34 weeks' gestation). Amniocentesis was performed in 30/36 (83.4%) pregnancies and CMV PCR was positive in 21 of them (70%). One fetus with a positive PCR in amniotic fluid that received one dose of HIG after amniocentesis presented a negative CMV-PCR in urine at birth, and was asymptomatic at 12 months of age. Twenty-four children were infected at birth, and 16/21 (76.2%) presented no sequelae at 12 months, while two (9.5%) had a mild unilateral hearing loss and three (14.3%) severe hearing loss or neurological sequelae. Seventeen women were included in the PG and 19 in the TG. In the PG 7/17 (41%) fetuses were infected, one pregnancy was terminated due to abnormalities in cordocentesis and one showed a mild hearing loss at 12 months of age. In the TG, 18/19 children (95%) were diagnosed with cCMV, while the remaining neonate had negative urine CMV at birth. Eight out of the 19 fetuses (42.1%) showed CMV related abnormalities in the fetal US before HIG treatment. Complete clinical assessment in the neonatal period and at 12 months of age was available in 16 and 15 children, respectively. At birth 50% were symptomatic and at 12 months of age, 4/15 (26.7%) showed a hearing loss and 3/15 (20%) neurologic impairment. Fetuses with abnormalities in ultrasonography before HIG presented a high risk of sequelae (odds ratios: 60; 95%CI: 3-1185; p = .007). DISCUSSION: Prophylactic HIG administration in pregnant women after CMV primary infection seems not to reduce significantly the rate of congenital infection, but is safe and it could have a favorable effect on the symptoms and sequelae of infected fetuses. The risk of long-term sequelae in fetuses without US abnormalities before HIG is low, so it could be an option in infected fetuses with normal imaging. On the other hand, the risk of sequelae among infected fetuses with abnormalities in fetal ultrasonography before HIG despite treatment is high.


Assuntos
Infecções por Citomegalovirus/terapia , Doenças Fetais/prevenção & controle , Imunoglobulinas Intravenosas/administração & dosagem , Complicações Infecciosas na Gravidez/terapia , Adulto , Amniocentese , Líquido Amniótico/virologia , Infecções por Citomegalovirus/congênito , Infecções por Citomegalovirus/prevenção & controle , Feminino , Doenças Fetais/virologia , Humanos , Lactente , Recém-Nascido , Transmissão Vertical de Doença Infecciosa/prevenção & controle , Gravidez , Complicações Infecciosas na Gravidez/virologia , Estudos Retrospectivos , Espanha , Centros de Atenção Terciária , Ultrassonografia Pré-Natal
10.
Pediatr Infect Dis J ; 2018 Sep 07.
Artigo em Inglês | MEDLINE | ID: mdl-30199483

RESUMO

BACKGROUND: Detection of cytomegalovirus (CMV) DNA by real-time polymerase chain reaction (rt-PCR) in dried blood spots (DBS) collected for newborn screening has been assessed for retrospective diagnosis of congenital CMV (cCMV) infection, with variable results (sensitivities ranging from 34% to 100%). We aimed to assess the accuracy of this technique in Spain in a large patient series. METHODS: Ambispective, multicenter study including patients with confirmed cCMV from the Spanish Registry of cCMV patients (REDICCMV). cCMV was established on the presence of CMV DNA in any body fluid, by positive culture findings, or by molecular techniques during the first 2 weeks of life. Children in whom cCMV had been excluded were used as negative controls. Neonatal DBS samples were collected from both groups. The presence of CMV DNA was assessed by rt-PCR (RealStar CMV, Altona, Hamburg, Germany) in a central laboratory. RESULTS: One-hundred and three patients and 81 controls from 10 hospitals were included. The performance of CMV DNA determination in DBS for the diagnosis of cCMV was as follows (95% CI): sensitivity 0.56 (0.47-0.65), specificity 0.98 (0.91-0.99), positive likelihood ratio 22.81 (5.74-90.58), negative likelihood ratio 0.45 (0.36-0.56). Sensitivity increased with the birth viral load (bVL) log category. In cCMV patients, lower bVL was the single variable associated with a negative DBS rt-PCR result (p=0.017). CONCLUSION: The sensitivity of CMV rt-PCR in DBS in our series was low and correlated with the bVL. Thus, a negative DBS result would not rule out cCMV infection, especially in patients with a low viremia level at birth.

11.
Enferm. infecc. microbiol. clín. (Ed. impr.) ; 36(6): 357-361, jun.-jul. 2018. tab
Artigo em Espanhol | IBECS | ID: ibc-176586

RESUMO

Introducción: Nuestro objetivo principal fue revisar los aspectos clínicos, microbiológicos y epidemiológicos de la infección asociada a Clostridium difficile en pediatría (2010-2015), comparando los diagnósticos realizados por detección de toxinas en heces y por PCR a tiempo real del gen de la toxina B. Métodos: Este estudio retrospectivo incluyó a 82 pacientes pediátricos. La detección de C. difficile toxigénico se realizó de manera secuencial, en heces diarreicas y bajo solicitud expresa. Resultados: El 39% de los pacientes procedían de Hemato-Oncología y >50% recibió previamente cefalosporinas. La presencia de fiebre asociada a diarrea fue más frecuente en el grupo de detección positiva de toxinas y no recibir antibioterapia específica fue más frecuente en el grupo con PCR positiva, sin diferencias estadísticamente significativas. Conclusión: Destacamos la presencia de infecciones en niños menores de 2 años. Sería recomendable realizar un diagnóstico de infección asociada a C. difficile en pacientes pediátricos, siempre que la sospecha clínica lo requiera


Introduction: Our main objective was a revision of clinical, microbiological and epidemiological results of Clostridium difficile-associated infection in paediatric patients (2010-2015). We compared the diagnoses performed by detection of toxins in feces and those performed by real-time PCR. Methods: This retrospective study included 82 paediatric patients. Detection of toxigenic C. difficile was performed sequentially, in diarrheal feces and under clinical request. Results: A total of 39% of the patients were attended at Haematology-oncology Unit and >50% of them had previously received cephalosporins. Fever associated with diarrhea was more frequent in the group of toxin detection, whereas not receiving specific antibiotic treatment was more frequent in the group of positive PCR, without statistically significant differences. Conclusions: We highlight the presence of C. difficile infection in children under 2 years old. A diagnostic testing in selected paediatric patients would be advisable when there is clinical suspicion of infection


Assuntos
Humanos , Masculino , Feminino , Recém-Nascido , Lactente , Pré-Escolar , Clostridium difficile/genética , Infecções por Clostridium/diagnóstico , Infecções por Clostridium/microbiologia , Toxinas Bacterianas/genética , Fezes/microbiologia , Diarreia/microbiologia , Reação em Cadeia da Polimerase em Tempo Real , Estudos Retrospectivos
12.
Pediatr Infect Dis J ; 2018 May 10.
Artigo em Inglês | MEDLINE | ID: mdl-29750764

RESUMO

BACKGROUND: In recent years there is an increasing interest in the use of linezolid for the treatment of tuberculosis (TB). METHODS: Patients under 18 years of age who received linezolid within the Spanish Pediatric TB Network (pTBred) from 2001 to 2016 were retrospectively included. Treatment characteristics, adverse events (AEs) and outcomes were analyzed. RESULTS: Fifteen children were included (53% male) with a median age of 3.6 years (IQR: 1.6-6.2). Median follow up was 54 months (IQR: 38-76). The reasons for linezolid use were drug-resistant TB (DR-TB) in eight (53%) patients, drug-induced liver injury (DILI) in five (33%) patients and chronic liver disease (CLD) in two (13%) patients. Four children (26%) were on immunosuppressive therapy when TB was diagnosed. Five children (33%) were diagnosed with extrapulmonary TB. The median duration of linezolid treatment was 13 months (IQR: 7.5-17). Nine patients had 13 linezolid-related AEs. Hematologic toxicity was observed in eight patients (53%) and gastrointestinal intolerance in 3 patients (20%). In two patients linezolid dose was reduced and in two patients linezolid was discontinued because of AEs. A 2- year-old girl went back to her country of birth and was lost to follow-up. No relapses were observed among the other 14 patients (93%). CONCLUSIONS: Linezolid may be considered when treating children with drug resistant TB but also in the cases of patients with chronic liver disease or drug induced liver injury. However, AEs should be closely monitored. Further studies are needed to determine the optimum dosage and the optimal duration of linezolid treatment in children.

14.
An. pediatr. (2003. Ed. impr.) ; 88(1): 52.e1-52.e12, ene. 2018. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-170646

RESUMO

La tuberculosis (TB) es la enfermedad infecciosa más importante del mundo, asociando enorme morbimortalidad. La TB pediátrica ha sido una epidemia oculta por su escasa capacidad infectiva y menor incidencia comparada con adultos. El informe-OMS 2015 estimó un millón de niños enfermos de TB en el mundo y 169.000 fallecidos. En Europa, el problema acuciante es la tuberculosis multirresistente, con tasas del 16% en nuevos diagnósticos, especialmente en países del este. En 2014, 219.000 niños se infectaron por cepas-MDR en Europa, 2.120 desarrollaron enfermedad. España es el país de Europa con mayor número de casos pediátricos, con una incidencia en 2014: 4,3/100.000 habitantes. La mortalidad por TB pediátrica en nuestro país es excepcional, pero las formas extrapulmonares ocasionan importantes complicaciones. La TB resistente en niños en España presenta una prevalencia > 4%, superando incluso la notificada en adultos. Estos datos reflejan que la TB en niños en nuestro medio continúa siendo un problema de salud pública prioritario. Las dificultades diagnósticas del niño y la falta de formulaciones pediátricas óptimas son el mayor desafío para control de TB infantil. El Grupo de expertos de TB pediátrica realiza un análisis de las nuevas tendencias internacionales y guías terapéuticas de tuberculosis en niños, según nuevas evidencias disponibles; y considera una prioridad actualizar las guías pediátricas nacionales de exposición a TB, infección tuberculosa latente y enfermedad, y particularmente los casos de resistencia a fármacos. Este documento, por tanto, sustituye a todos los previos en cuanto a las pautas terapéuticas, aunque siguen estando vigentes las indicaciones diagnósticas (AU)


Tuberculosis (TB) is the most important infectious disease all over the world, with a high morbidity and mortality. Pediatric tuberculosis has been a neglected epidemic, due to the difficulties in assessing its global impact, reduced incidence and lower infectivity compared to adults. In 2015, the WHO reported 1 million cases of paediatric TB and 169,000 deaths. In Europe, the emergence of MDR TB is a major concern, representing 16% of the new diagnosis in Eastern Europe. In 2014, it was estimated that about 219,000 children were infected by MDR-TB-strains in Europe, and 2,120 developed the disease. Spain is the Western European country with more paediatric cases, with an incidence 4.3/100,000 inhabitants in 2014. Paediatric tuberculosis mortality in Spain is rare, but extra-pulmonary disease is associated with significant complications. The prevalence of paediatric drug resistant TB in Spain is over 4%, higher than the estimated incidence in adult population, representing mayor difficulties for therapeutic intervention. These data reveal that paediatric TB is still a Public Health priority in our country. The difficulties in diagnosis and the lack of optimal paediatric drug formulations are the major challenges for controlling the childhood's tuberculosis epidemic. A group of national paeditric TB experts has reviewed the international guidelines and the most recent evidences, and has established new recommendations for the management of paediatric TB contacts, latent infection and active TB disease, especially focused in drug resistant cases. This document replaces the former national guidelines from the Spanish Society for Pediatric Infectios Diseases, although the prior recommendations on the diagnosis remain valid (AU)


Assuntos
Humanos , Criança , Tuberculose/tratamento farmacológico , Mycobacterium tuberculosis/patogenicidade , Antibióticos Antituberculose/uso terapêutico , Padrões de Prática Médica , Tuberculose Latente/epidemiologia , Resistência Microbiana a Medicamentos , Exposição Ambiental/efeitos adversos
15.
Enferm Infecc Microbiol Clin ; 36(6): 357-361, 2018 Jun - Jul.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-28689671

RESUMO

INTRODUCTION: Our main objective was a revision of clinical, microbiological and epidemiological results of Clostridium difficile-associated infection in paediatric patients (2010-2015). We compared the diagnoses performed by detection of toxins in feces and those performed by real-time PCR. METHODS: This retrospective study included 82 paediatric patients. Detection of toxigenic C. difficile was performed sequentially, in diarrheal feces and under clinical request. RESULTS: A total of 39% of the patients were attended at Haematology-oncology Unit and >50% of them had previously received cephalosporins. Fever associated with diarrhea was more frequent in the group of toxin detection, whereas not receiving specific antibiotic treatment was more frequent in the group of positive PCR, without statistically significant differences. CONCLUSIONS: We highlight the presence of C. difficile infection in children under 2years old. A diagnostic testing in selected paediatric patients would be advisable when there is clinical suspicion of infection.

17.
An Pediatr (Barc) ; 88(1): 52.e1-52.e12, 2018 Jan.
Artigo em Espanhol | MEDLINE | ID: mdl-28729186

RESUMO

Tuberculosis (TB) is the most important infectious disease all over the world, with a high morbidity and mortality. Pediatric tuberculosis has been a neglected epidemic, due to the difficulties in assessing its global impact, reduced incidence and lower infectivity compared to adults. In 2015, the WHO reported 1 million cases of paediatric TB and 169,000 deaths. In Europe, the emergence of MDR TB is a major concern, representing 16% of the new diagnosis in Eastern Europe. In 2014, it was estimated that about 219,000 children were infected by MDR-TB-strains in Europe, and 2,120 developed the disease. Spain is the Western European country with more paediatric cases, with an incidence 4.3/100,000 inhabitants in 2014. Paediatric tuberculosis mortality in Spain is rare, but extra-pulmonary disease is associated with significant complications. The prevalence of paediatric drug resistant TB in Spain is over 4%, higher than the estimated incidence in adult population, representing mayor difficulties for therapeutic intervention. These data reveal that paediatric TB is still a Public Health priority in our country. The difficulties in diagnosis and the lack of optimal paediatric drug formulations are the major challenges for controlling the childhood's tuberculosis epidemic. A group of national paeditric TB experts has reviewed the international guidelines and the most recent evidences, and has established new recommendations for the management of paediatric TB contacts, latent infection and active TB disease, especially focused in drug resistant cases. This document replaces the former national guidelines from the Spanish Society for Pediatric Infectios Diseases, although the prior recommendations on the diagnosis remain valid.

20.
Enferm. infecc. microbiol. clín. (Ed. impr.) ; 35(9): 556-562, nov. 2017. ilus, tab
Artigo em Inglês | IBECS | ID: ibc-168881

RESUMO

Introduction: Information about paediatric in-hospital antimicrobial usage and prescribing patterns to guide improvement strategies is scant. We aim to use an evaluation of the prevalence and appropriateness of antimicrobial prescription to identify antimicrobial stewardship priorities in children. Methods: A cross-sectional point study was performed on hospitalised paediatric patients in a Spanish tertiary hospital, assessing the prevalence of antimicrobial prescription (PAP) and appropriateness of antimicrobial prescription (AAP). AAP was defined as a correct indication plus an appropriate prescribing pattern (dose, spectrum and interval). Evaluation was performed using established antimicrobial guidelines. Other factors that may have a bearing on antimicrobial prescription were also analysed. Results: A total of 171 patients were included. PAP was 49.7% (85/171) and AAP was 60.9% (91/161). The most common indications for antimicrobial use were antimicrobial prophylaxis (28.3%, 32/113) and pneumonia (8.2%, 8/113). Overall, 161 antimicrobials were prescribed (1.9 antimicrobials per patient): 55.3% (89/161) were empiric, 16.1% (26/161) were targeted and 28.6% (46/161) were prophylactic. Amoxicillin/clavulanate (8.2%, 14/171) and sulfamethoxazole/trimethoprim (8.2%, 14/171) were the most prescribed antimicrobials. The prescription of antifungals (11.7%, 20/171) and antivirals (1.8%, 3/171) was analysed. Major causes of inappropriate antibiotic use were prolonged prescriptions (21.7%, 35/161) and use of agents with an excessively broad coverage spectrum (21.1%, 34/161). PAP and AAP varied between wards and antimicrobials. Conclusions: Measurement of PAP and AAP offers valuable information for detecting priorities in hospital settings and monitoring antimicrobial usage prior to the development of antimicrobial stewardship programmes. In our setting, the main areas for improvement are duration of therapy and proper use of broad-spectrum antimicrobials (AU)


Introducción: La información sobre el uso hospitalario de antimicrobianos en pediatría para orientar estrategias de mejora es escasa. Proponemos utilizar la evaluación de prevalencia y adecuación de la prescripción antimicrobiana para identificar prioridades en programas de optimización de uso de antimicrobianos en niños. Métodos: Se realizó un estudio de corte transversal en niños hospitalizados en un centro terciario español evaluando la prevalencia de prescripción antimicrobiana (PPA) y la proporción de adecuación en prescripción antimicrobiana (PAA). Se definió la PAA como una correcta indicación más un apropiado patrón de prescripción del antimicrobiano (dosis, espectro e intervalo) según guías establecidas. Se analizaron también otros factores con influencia potencial en prescripción. Resultados: Se incluyeron 171 pacientes, obteniendo una PPA=49,7% (85/171) y PAA=60,9% (91/161). Profilaxis antimicrobiana (28,3%, 32/113) y neumonía (8,2%, 8/113) fueron las indicaciones más frecuentes. Se realizaron 161 prescripciones antimicrobianas (1,9 antimicrobianos por paciente): 55,3% (89/161) empíricas; 16,1% (26/161) dirigidas y 28,6% (46/161) profilácticas. Amoxicilina/ácido clavulánico (8,2%, 14/171) y trimetoprim/sulfametoxazol (8,2%, 14/171) fueron los antimicrobianos más prescritos. Se analizó la prescripción antifúngica (11,7%, 20/171) y antiviral (1,8%, 3/171). Las principales causas de uso inapropiado de antibióticos fueron el uso prolongado (21,7%, 35/161) y espectros de cobertura demasiado amplios (21,1%, 34/161). La PPA y PAA variaron según área de hospitalización y antimicrobianos. Conclusiones: La PPA y PAA ofrecen información valiosa para detectar prioridades en hospitales previamente al desarrollo de programas de optimización de uso de antimicrobianos y monitorizar el uso de antimicrobianos. En nuestro centro la duración del tratamiento y el espectro antimicrobiano excesivo fueron las principales áreas a mejorar (AU)


Assuntos
Humanos , Prescrições de Medicamentos/estatística & dados numéricos , Antibacterianos/uso terapêutico , Melhoria de Qualidade/tendências , Estudos Transversais , Estatísticas Hospitalares
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