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1.
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.

3.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-30268590

RESUMO

INTRODUCTION: Antimicrobial defined daily dose (DDD), has limitations for antimicrobial consumption measurement in paediatrics. An alternative DDD design applicable for children is proposed. METHODS: Children (<16 years-old) from 10 Spanish hospitals during a 12-months period were included. Weight for age (50th percentile) was calculated for the median age of the cohort using standardized World Health Organization tables. DDD (g) for each antimicrobial was calculated by multiplying the obtained weight times the recommended dose (mg/kg) of the antimicrobial for the most common infectious indication. RESULTS: A total of 40,575 children were included. Median age was 4.17 (IQR: 1.36-8.98) and 4.81 (IQR: 1.42-9.60) years for boys and girls, respectively. Mean weight for this age was 17.08kg. Standardized DDD for representative antimicrobials were calculated. CONCLUSIONS: A useful method for antimicrobial DDD measurement in paediatrics has been proposed and should be validated in future studies for its use in paediatric antimicrobial stewardship programmes.

4.
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.

5.
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
6.
Enferm Infecc Microbiol Clin ; 35(9): 556-562, 2017 Nov.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-28284685

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.

7.
Clin Infect Dis ; 64(10): 1335-1342, 2017 May 15.
Artigo em Inglês | MEDLINE | ID: mdl-28158709

RESUMO

Background: DNA detection of human cytomegalovirus (hCMV) in cerebrospinal fluid (CSF) by polymerase chain reaction (PCR) is a marker of central nervous system (CNS) involvement in congenital hCMV infection (cCMV), but its prognostic value is unknown. Methods: A multicenter, retrospective study was performed using the Spanish Congenital Cytomegalovirus Infection Database (REDICCMV; http://www.cmvcongenito.es). Newborns with cCMV and a lumbar puncture performed were included and classified according to their hCMV-PCR in CSF result (positive/negative). Clinical characteristics, neuroimaging abnormalities, plasma viral load, and audiological and neurological outcomes of both groups were compared. Results: A total of 136 neonates were included in the study: 21 (15.4%) with positive CSF hCMV-PCR and 115 (84.6%) with negative results. Seventeen patients (81%) in the positive group were symptomatic at birth compared with 52.2% of infants in the negative group (odds ratio [OR], 3.86; 95% confidence interval [CI], 1.28-14.1; P = .01). Only 4 asymptomatic newborns (6.8%) had a positive CSF hCMV-PCR. There were no differences between groups regarding the rate of microcephaly, neuroimaging abnormalities, neurological sequelae at 6 months of age, or plasma viral load. Sensorineural hearing loss (SNHL) at birth was associated with a positive CSF hCMV-PCR result (OR, 3.49; 95% CI, 1.08-11.27; P = .04), although no association was found at 6 months of age. Conclusions: A positive hCMV-PCR result in CSF is associated with symptomatic cCMV and SNHL at birth. However, no differences in neuroimaging studies, plasma viral load, or outcomes at 6 months were found. These results suggest that hCMV-PCR in CSF may not be a useful prognostic marker in cCMV.


Assuntos
Infecções por Citomegalovirus/congênito , Infecções por Citomegalovirus/diagnóstico , Citomegalovirus/isolamento & purificação , DNA Viral/líquido cefalorraquidiano , Infecções Assintomáticas , Citomegalovirus/genética , Infecções por Citomegalovirus/complicações , DNA Viral/sangue , DNA Viral/isolamento & purificação , Feminino , Doenças Fetais/virologia , Seguimentos , Perda Auditiva Neurossensorial/virologia , Humanos , Lactente , Recém-Nascido , Masculino , Microcefalia/virologia , Neuroimagem , Reação em Cadeia da Polimerase/métodos , Estudos Retrospectivos , Saliva/virologia , Punção Espinal , Carga Viral
8.
Rev. méd. hered ; 27(3): 139-145, jul.-sept. 2016. tab
Artigo em Espanhol | LILACS | ID: biblio-982874

RESUMO

Objetivos: Determinar la asociación entre infección viral del tracto respiratorio bajo en los dos primeros años devida con el desarrollo de sibilancias respiratorias recurrentes reversibles (SRRR), en niños. Material y métodos: Estudio caso-control incluyendo 400 niños; relación caso-control de 1:1 (α= 5%; β= 20%). Se incluyeron niñoscon diagnóstico de sibilancias respiratorias recurrentes reversibles que acudieron al Hospital Nacional CayetanoHeredia en los servicios de Emergencia y Consulta Externa entre mayo del 2009 y agosto del 2009, clasificándose como casos. Se asignaron 200 controles similares en edad, sexo y servicio de procedencia. Se registró el antecedente de infección viral del tracto respiratorio bajo en los dos primeros años de vida, mediante encuesta directa conlos padres y corroborándose con la historia clínica de los pacientes...


Objectives: To determine the association between lower viral respiratory tract infection in the first two years of lifeand the development of reversible recurrent respiratory wheezing (RRRW) in children. Methods: Case-control (1:1)study involving 400 children (α= 5%; β= 20%). Cases were children with RRRW who attended the emergency room and the outpatient clinic of Hospital Nacional Cayetano Heredia between may and august 2009, controls were 200children matched by age, gender and service of attendance. The history of viral upper respiratory tract infectionwas obtained by interviewing parents and it was corroborated with chart review...


Assuntos
Masculino , Feminino , Humanos , Pré-Escolar , Criança , Pneumonia Viral , Sons Respiratórios , Doenças Respiratórias , Estudos de Casos e Controles
9.
Bol. méd. Hosp. Infant. Méx ; 67(4): 315-326, jul.-ago. 2010. ilus, tab
Artigo em Espanhol | LILACS-Express | ID: lil-701032

RESUMO

Introducción. La asociación entre factores perinatales para el desarrollo de rinitis alérgica es controversial. El objetivo de este trabajo es determinar la asociación entre prematuridad, bajo peso al nacer y lactancia materna exclusiva con rinitis alérgica, en pacientes pediátricos que acuden al Hospital Nacional Cayetano Heredia (HNCH). Métodos. Es un estudio tipo caso-control. Se realizó un cuestionario mediante entrevista directa a los padres para encontrar síntomas de rinitis alérgica, clasificando a los niños como casos y controles. El tamaño de la muestra fue de 366 niños, 122 casos y 244 controles (a= 5%; b= 20%). Se consignaron también los antecedentes de peso al nacer, edad de gestación y lactancia materna exclusiva con los padres; la información se corroboró con la historia clínica de los pacientes y la cartilla de control de crecimiento y desarrollo. Resultados. Ingresaron 369 niños de 2 a 7 años que acudieron a consulta externa de pediatría del Hospital Nacional Cayetano Heredia, entre agosto del 2006 y junio de 2007; de estos, 156 cumplieron con los criterios de caso y 213 cumplieron con los criterios de controles. Se encontró una razón de momios (RM) de 0.53 (IC 95%, 0.35, 0.80, P=0.0025) para la asociación entre rinitis alérgica y lactancia materna exclusiva. La razón de momios para rinitis alérgica y bajo peso al nacer fue de 0.55 (IC 95%, 0.27, 1.12, P=0.0658) y para rinitis alérgica y prematuridad fue de 1.20 (IC 95%, 0.67, 2.17, P=0.5414). Se realizó, además, el análisis estratificado para la relación entre rinitis alérgica y lactancia materna exclusiva con las variables de antecedente de atopia familiar y de exposición temprana a humo de tabaco, se utilizó como prueba estadística la prueba de Mantel-Haenszel. Se encontró una razón de momios Mantel-Haenszel de 0.52 (IC 95%, 0.33, 0.78, P=0.0025) para la asociación entre rinitis alérgica y lactancia materna exclusiva con el antecedente de atopia familiar; y una razón de momios Mantel-Haenszel de 0.56 (IC 95%, 0.36, 0.84, P=0.0064) para la asociación entre rinitis alérgica y lactancia materna exclusiva con el antecedente de exposición temprana a humo de tabaco. Conclusión. Nuestros resultados apoyan un efecto protector para rinitis alérgica en niños que reciben lactancia materna exclusiva; no se encontró asociación entre prematuridad y bajo peso al nacer con rinitis alérgica. Esta asociación protectora no se ve alterada por los antecedentes de atopia familiar ni de exposición temprana al humo del tabaco.


Background. The association among perinatal factors for the development of allergic rhinitis is controversial. The aim of this study was to determine the association among prematurity, low birth weight, and exclusive breastfeeding with allergic rhinitis in pediatric patients from the Hospital Nacional Cayetano Heredia (HNCH). Methods. We carried out a case-control study with a sample size of 366 children (122 cases and 244 controls) (a = 5%; b = 20%). A questionnaire was completed through direct interview with the parents to assess allergic rhinitis symptoms in order to classify the children as cases or controls. Previous medical history such as birth weight, gestational age and exclusive breastfeeding were entered and verified with the clinical chart of the patients as well as with the growth and development chart. Results. There were 369 children included in the study aged 2 to 7 years. They were seen as outpatients at the Pediatric Service at HNCH between August 2006 and June 2007. Of these children, 156 met the criteria for cases and 213 were identified as controls. An odds ratio (OR) of 0.53 was found (95% CI 0.35-0.80, p = 0.0025) for the association between allergic rhinitis and exclusive breastfeeding. Also, an OR of 0.55 (95% CI 0.27-1.12, p = 0.0658) was found for allergic rhinitis and low birth weight and an odds ratio of 1.20 (95% CI 0.67-2.17, p = 0.5414) was found for allergic rhinitis and prematurity. A stratified analysis was executed to evaluate the relationship between allergic rhinitis and exclusive breastfeeding with a family history of atopy and early environmental tobacco smoke exposure. Mantel-Haenszel statistical test was used for this purpose: OR of 0.52 was found (95% CI, 0.33-0.78, p = 0.0025) for the association between allergic rhinitis and exclusive breastfeeding with family history of atopy. Mantel-Haenszel odds ratio of 0.56 (95% CI 0.36-0.84, p = 0.0064) was found for the association between allergic rhinitis and exclusive breastfeeding with early environmental tobacco smoke exposure. Conclusions. Our results support a protective effect for allergic rhinitis in children who receive exclusive breastfeeding. We did not find any association between prematurity and low birth weight with the subsequent development of allergic rhinitis. The previously described protective effect is seemingly not altered by family history of atopy or early exposure to environmental tobacco smoke.

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