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2.
Arch Argent Pediatr ; 114(6): e444-e447, 2016 Dec 01.
Artigo em Espanhol | MEDLINE | ID: mdl-27869430

RESUMO

X-linked agammaglobulinemia is a primary humoral immunodeficiency. It is a recessive X-linked disorder characterized by low or absent circulating mature B cells, hypo/agammaglobulinemia and no humoral response to immunizations due to mutations along chromosome X. It is characterized by severe, recurrent and difficult treatment infections. It is diagnosed in the first 6 months of life in children; the only sign of alarm is the absent or decreased size of tonsils and lymph nodes, but it is not always present. The main cornerstones of treatment are immunoglobulin replacement therapy to maintain serum levels above 500-700 mg/dl and infection control; this allows these patients to do their day-to-day activities. We report a 2 year old boy with X-linked agammaglobulinemia, with no history of interest, who presented with P. aeruginosa sepsis. He had an excellent clinical improvement without further important infections after intravenous immunoglobulin replacement therapy.


Assuntos
Agamaglobulinemia/complicações , Doenças Genéticas Ligadas ao Cromossomo X/complicações , Infecções por Pseudomonas/etiologia , Pseudomonas aeruginosa , Sepse/etiologia , Pré-Escolar , Humanos , Masculino
3.
Enferm. infecc. microbiol. clín. (Ed. impr.) ; 34(5): 286-292, mayo 2016. tab, graf
Artigo em Inglês | IBECS | ID: ibc-152541

RESUMO

Introduction: Nosocomial infections (NI) are a major healthcare problem. National surveillance systems enable data to be compared and to implement new measures to improve our practice. Methods: A multicentre, prospective, descriptive and observational study was conducted using the data from surveillance system for nosocomial infections created in 2007 for Spanish pediatric intensive care units. Data were collected for one month, between 01 and 31 March, for every study year (2008–2012). The objective was to report 5-years of NI surveillance data, as well as trends in infections by multidrug resistant organisms in Spanish pediatric intensive care units. Results: A total of 3667 patients were admitted to the units during the study period. There were 90 (2.45%) patients with nosocomial infections. The mean rates during the 5 years study were: central line-associated bloodstream infection, 3.8/1000 central venous catheter-days, Ventilator-associated pneumonia 7.5/1000 endotracheal tube-days, and catheter-associated urinary tract infections 4.1/1000 urinary catheter-days. The comparison between the 2008 and 2009 rates for nosocomial infections did not show statistically significant differences. All rates homogeneously decreased from 2009 to 2012: central line-associated bloodstream infection 5.83 (95% CI 2.67–11.07) to 0.49 (95% CI 0.0125–2.76),P = 0.0029; ventilator-associated pneumonia 10.44 (95% CI 5.21–18.67) to 4.04 (95% CI 1.48–8.80),P = 0.0525; and Catheter-associated urinary tract infections 7.10 (95% CI 3.067–13.999) to 2.56 (95% CI 0.697–6.553), P = 0.0817; respectively. The microorganism analysis: 63 of the 99 isolated bacteria (63.6%) were Gram-negative bacteria (36.5% were resistant), 19 (19.2%) Gram-positive bacteria, and 17 (17.2%) were Candida spp. infections. Conclusions: The local surveillance systems provide information for dealing with nosocomial infections rates (AU)


Introducción: Las infecciones nosocomiales son un problema de salud pública. Los sistemas nacionales de vigilancia permiten comparar datos e implementar medidas para mejorar la práctica asistencial. Método: Estudio multicéntrico, prospectivo, descriptivo y observacional. En 2007 se creó un sistema de vigilancia para infección nosocomial en las Unidades de Cuidados Intensivos Pediátricas Españolas. Se recogieron datos durante un mes (Marzo) por año (2008–2012). El objetivo fue reportar las tasas de los 5 años de vigilancia de la infección nosocomial y la evolución de las infecciones por microorganismos multirresistentes. Resultados: Ingresaron 3667 pacientes. Número de pacientes con infección nosocomial: 90 (2.45%). Tasas medias de los 5 años de estudio: Bacteriemia relacionada con catéter 3.8/1000 días de catéter venoso central, Neumonía asociada a la ventilación mecánica 7.5/1000 días de tubo endotraqueal e Infecciones urinarias asociadas a sonda 4.1/1000 días de sonda urinaria. La comparación de tasas entre 2008 y 2009 no mostró diferencias estadísticamente significativas. Todas las tasas se redujeron homogéneamente desde 2009 a 2012: Bacteriemia relacionada con catéter 5.83 (95% CI 2.67–11.07) a 0.49 (95% CI 0.0125–2.76), P = 0.0029; Neumonía asociada a la ventilación mecánica 10.44 (95% CI 5.21–18.67) a 4.04 (95% CI 1.48–8.80), P = 0.0525; Infecciones urinarias asociadas a sonda 7.10 (95% CI 3.067–13.999) a 2.56 (95% CI 0.697–6.553), P = 0.0817; respectivamente. Microorganismos: 63 de 99 (83.6%) microorganismos aislados fueron bacterias gram-negativas (36.5% resistentes), 19 (19.2%) bacterias gram-positivas y 17 (17.2%) infecciones por Candida spp. Conclusiones: Los sistemas de vigilancia local aportan información para mejorar las tasas de infección nosocomial (AU)


Assuntos
Humanos , Masculino , Feminino , Lactente , Pré-Escolar , Criança , Cuidados Críticos/métodos , Infecção Hospitalar/epidemiologia , Resistência a Múltiplos Medicamentos , Unidades de Terapia Intensiva Pediátrica/estatística & dados numéricos , Monitoramento Epidemiológico/organização & administração , Doenças Transmissíveis/epidemiologia
4.
Enferm Infecc Microbiol Clin ; 34(5): 286-92, 2016 May.
Artigo em Inglês | MEDLINE | ID: mdl-26364857

RESUMO

INTRODUCTION: Nosocomial infections (NI) are a major healthcare problem. National surveillance systems enable data to be compared and to implement new measures to improve our practice. METHODS: A multicentre, prospective, descriptive and observational study was conducted using the data from surveillance system for nosocomial infections created in 2007 for Spanish pediatric intensive care units. Data were collected for one month, between 01 and 31 March, for every study year (2008-2012). The objective was to report 5-years of NI surveillance data, as well as trends in infections by multidrug resistant organisms in Spanish pediatric intensive care units. RESULTS: A total of 3667 patients were admitted to the units during the study period. There were 90 (2.45%) patients with nosocomial infections. The mean rates during the 5 years study were: central line-associated bloodstream infection, 3.8/1000 central venous catheter-days, Ventilator-associated pneumonia 7.5/1000 endotracheal tube-days, and catheter-associated urinary tract infections 4.1/1000 urinary catheter-days. The comparison between the 2008 and 2009 rates for nosocomial infections did not show statistically significant differences. All rates homogeneously decreased from 2009 to 2012: central line-associated bloodstream infection 5.83 (95% CI 2.67-11.07) to 0.49 (95% CI 0.0125-2.76), P=0.0029; ventilator-associated pneumonia 10.44 (95% CI 5.21-18.67) to 4.04 (95% CI 1.48-8.80), P=0.0525; and Catheter-associated urinary tract infections 7.10 (95% CI 3.067-13.999) to 2.56 (95% CI 0.697-6.553), P=0.0817; respectively. The microorganism analysis: 63 of the 99 isolated bacteria (63.6%) were Gram-negative bacteria (36.5% were resistant), 19 (19.2%) Gram-positive bacteria, and 17 (17.2%) were Candida spp. infections. CONCLUSIONS: The local surveillance systems provide information for dealing with nosocomial infections rates.


Assuntos
Infecção Hospitalar/epidemiologia , Farmacorresistência Bacteriana Múltipla , Unidades de Terapia Intensiva Pediátrica , Adolescente , Candida/isolamento & purificação , Criança , Pré-Escolar , Infecção Hospitalar/microbiologia , Feminino , Bactérias Gram-Negativas/isolamento & purificação , Bactérias Gram-Positivas/isolamento & purificação , Humanos , Lactente , Recém-Nascido , Unidades de Terapia Intensiva , Masculino , Pneumonia Associada à Ventilação Mecânica/epidemiologia , Estudos Prospectivos , Espanha/epidemiologia , Infecções Urinárias/epidemiologia
5.
Intensive Care Med ; 39(6): 1095-103, 2013 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-23532315

RESUMO

PURPOSE: Our objective was to assess whether SpO2/FiO2 (SF) ratio could be a useful NIV outcome predictor in children with acute respiratory failure (ARF) and tried to develop a predictive model of NIV failure. METHODS: Prospective, observational, multicenter study. Episodes of ARF-fulfilling inclusion criteria from 15 January 2010 to 14 January 2011 were treated with NIV according to a pre-established protocol. Clinical variables were collected at baseline and at 1, 2, 6, 12 and 24 h. Failure criterion was the need for endotracheal intubation. Failures were considered as "early" if occurring ≤6 h after NIV initiation, "intermediate" if occurring between 6 and 24 h, and "late" if occurring after 24 h. Variables with a p < 0.1 in univariate analysis corrected by age were included in multivariate analysis. Models were calculated based on multivariate analysis. RESULTS: During the study period, 390 episodes were included. NIV success rate was 81.3 %. Among ARF causes, failure occurred most frequently in ARDS episodes. The failure predictive model for the whole sample included SF ratio at 1 h, age and PRISM III-24 (area under the curve AUC of 0.755). For early NIV failures, SF ratio at 1 h was the only variable within model (AUC 0.748). The analysis of intermediate NIV failures identified 3 variables independently linked to NIV outcome: PRISM III-24, RR decrease at 6 h, and SF ratio at 6 h (AUC 0.895). No model was identified for late NIV failure. CONCLUSIONS: SF ratio is a reliable predictor of early NIV failure in children.


Assuntos
Ventilação não Invasiva , Consumo de Oxigênio/fisiologia , Oxigênio/sangue , Insuficiência Respiratória/terapia , Gasometria , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Monitorização Fisiológica , Valor Preditivo dos Testes , Prognóstico , Estudos Prospectivos , Falha de Tratamento
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