RESUMO
Tuberculosis is an important public health problem. It is estimated that around 5-10% of patients with tuberculosis present with central nervous system involvement; meningitis and tuberculoma being two of the most frequent manifestations. The paradoxical reaction in patients undergoing antituberculosis treatment is infrequent, nevertheless it is an important consideration in patients, who after an appropriate initial response to specific treatment, present with worsening clinical and radiological signs or the appearance of new lesions.
Assuntos
Antituberculosos/efeitos adversos , Tuberculose Meníngea/tratamento farmacológico , Tuberculose Pulmonar/tratamento farmacológico , Adolescente , Corticosteroides/uso terapêutico , Antituberculosos/uso terapêutico , Feminino , Humanos , Imunocompetência , Imageamento por Ressonância Magnética , Tuberculoma Intracraniano/tratamento farmacológico , Tuberculose Meníngea/diagnóstico , Tuberculose Pulmonar/diagnósticoRESUMO
INTRODUCTION: Community-acquired methicillin-resistant Staphylococcus aureus infections (CA-MRSA) are prevalent in several countries of the world. These infections seem to differ clinically from those occurring within the health care system (HCS-MRSA). OBJECTIVE: To compare clinical characteristics of infections by CA-MRSA and HCA-MRSA in the same community. MATERIAL AND METHODS: Prospective, multicentric and comparative study. Children with clinically and microbiologically documented CA-MRSA were included. RESULTS: Between 11/2006 and 11/2007, 840 infections caused by S. aureus were diagnosed. Of them 582 (68%) were community-acquired. Among these 356 (61%) were CA-MRSA. In this group, 75 (21%) were HCA-MRSA and 281 (79%) CA-MRSA. The median age was 36 months (range: 1-201). Chronic skin disease (13) and chronic disease of CNS (9) were the underlying disease predominant. Children with CA-MRSA had more frequency of previous antibiotic treatment (63 vs 34%) and previous medical consult (76 vs 52%), invasive procedures (31 vs 8%), surgery (15 vs 0.3%) and fever (94 vs 74%) (p = < 05). Children with CA-MRSA had subcutaneous abscesses (34 vs 15%) (p = < .05) more frequently. Bacteremia and sepsis rate was similar in both groups (21 vs 18%) and 17 vs 11%) respectively) (p = NS). Antibiotic resistance was more frequent in children with HCA-MRSA: Rifampin (7 vs 1%), trimethoprim-sulphametoxazole (7 vs 1%) and clindamycin (25 vs 9%) (p = < .05). Four children (5%) with HCA-MRSA infections died and 3 (1%) mCA-MRSA group (p = .05). CONCLUSION: Children with HCA-MRSA infections more frequent antibiotic resistance than CA-MRSA should be reconsider the empiric antibiotic treatment of community-acquired infections in children in our area.
Assuntos
Infecções Comunitárias Adquiridas/microbiologia , Infecção Hospitalar/microbiologia , Staphylococcus aureus Resistente à Meticilina/isolamento & purificação , Infecções Estafilocócicas/microbiologia , Adolescente , Antibacterianos/uso terapêutico , Argentina/epidemiologia , Criança , Pré-Escolar , Infecções Comunitárias Adquiridas/tratamento farmacológico , Infecções Comunitárias Adquiridas/epidemiologia , Infecção Hospitalar/tratamento farmacológico , Infecção Hospitalar/epidemiologia , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Estudos Prospectivos , Infecções Estafilocócicas/tratamento farmacológico , Infecções Estafilocócicas/epidemiologiaRESUMO
INTRODUCTION: Community-acquired methicillin-resistant Staphylococcus aureus infections are a common, serious problem in pediatrics. OBJETIVE: To describe antibiotic resistance in community-acquired Staphylococcus aureus (SA) bacteremias. To compare the characteristics of SA bacteremias in terms of methicillin resistance. MATERIALS AND METHODS: Prospective cohort enrolled between January 2010 and December 2014. Inclusion criteria: infants and children between 30 days old and 16 years old hospitalized at the Hospital de Pediatria J. P. Garrahan due to community-acquired infections with SA growth identification in blood cultures. Exclusion criteria: having a history of recent hospitalization, attending a health care facility, living in a closed community, or having a venous catheter. Microbiological, demographic, and clinical characteristics were compared in terms of methicillin susceptibility. Statistical analysis: Stata10. RESULTS: A total of 208 children were included; boys: 141 (68%). Their median age was 60 months old (interquartile range: 29-130). Thirty-four patients (16%) had an underlying disease. Methicillin-resistant Staphylococcus aureus was identified in 136 children (65%). The rate of resistance to clindamycin was 9%. Significant statistical differences were observed in the rate of underlying disease, persistent bacteremia, sepsis at the time of admission, secondary source of infection, admission to the intensive care unit, and surgery requirement. Twelve patients (6%) died; community-acquired methicillin-resistant Staphylococcus aureus was identified in all of them. CONCLUSIONS: In the studied cohort, methicillin-resistant S taphylococcus aureus was predominant. The rate of resistance to clindamycin was 9%. Community-acquired methicillin-resistant Staphylococcus aureus infections prevailed among healthy children. Among patients with methicillin-resistant Staphylococcus aureus infections there was a higher rate of persistent bacteremia, admission to the ICU and surgery.
INTRODUCCIÓN: Las infecciones por Staphylococcus aureus meticilino resistente adquirido en la comunidad son un problema grave y frecuente en pediatría. OBJETIVO: Describir la resistencia a los antibióticos enlas infecciones bacteriémicas por Staphylococcus aureus (SA) de la comunidad. Comparar las características de las infecciones bacteriémicas por SA según la resistencia a la meticilina. Material y métodos. Cohorte prospectiva entre enero de 2010 y diciembre de 2014. Criterios de inclusión: niños de entre 30 días y 16 años de edad hospitalizados en el Hospital de Pediatría J. P. Garrahan por infecciones adquiridas en la comunidad, con desarrollo de SA en hemocultivos. Criterios de exclusión: antecedente de internación reciente, asistencia a un centro relacionado con los cuidados de la salud, vivir en una comunidad cerrada o catéter venoso. Se compararon características microbiológicas, demográficas y clínicas según la sensibilidad a la meticilina. Análisis estadístico: Stata10. RESULTADOS: Se incluyeron 208 niños; varones: 141 (68%). La mediana de edad fue 60 meses (rango intercuartilo 29-130). Tenían enfermedad de base 34 pacientes (16%). En 136 niños (65%), se identificó Staphylococcus aureus meticilino resistente. La resistencia a la clindamicina fue 9%. Se encontraron diferencias estadísticas significativas en la frecuencia de enfermedad subyacente, bacteriemia persistente, sepsis al momento del ingreso, foco secundario de infección, ingreso a unidades de cuidados intensivos y necesidad de cirugía. Fallecieron 12 pacientes (6%); todos tuvieron identificación de Staphylococcus aureus meticilino resistente adquirido en la comunidad. CONCLUSIONES: En la cohorte estudiada, predominó el Staphylococcus aureus meticilino resistente. La resistencia a la clindamicina fue del 9%. Las infecciones por Staphylococcus aureus meticilino resistente adquirido en la comunidad predominaron en niños sanos. En los pacientes con Staphylococcus aureus meticilino resistente, fue más frecuente la bacteriemia persistente, el ingreso a unidades de cuidados intensivos y la cirugía.
Assuntos
Bacteriemia/tratamento farmacológico , Bacteriemia/microbiologia , Infecções Estafilocócicas/tratamento farmacológico , Infecções Estafilocócicas/microbiologia , Staphylococcus aureus/efeitos dos fármacos , Criança , Pré-Escolar , Estudos de Coortes , Infecções Comunitárias Adquiridas/tratamento farmacológico , Infecções Comunitárias Adquiridas/microbiologia , Feminino , Humanos , Masculino , Staphylococcus aureus Resistente à Meticilina , Testes de Sensibilidade Microbiana , Fatores de TempoRESUMO
Staphylococcus aureus is a major etiologic agent of infections in children from the community and the hospital setting. The severity of these conditions is associated with virulence factors, including the Panton-Valentine leukocidin. Both methicillin resistant and sensitive Staphylococcus aureus produce this leukocidin although with varying frequency. We present two children with severe infection by sensitive Staphylococcus aureus producer of Panton-Valentine leukocidin with musculoskeletal and endovascular complications. It is essential the suspected diagnosis, appropriate antibiotic treatment and early surgical management to improve the approach of these infections. Epidemiological surveillance should be mantained to detect the frequency of infections caused by these bacteria.
Staphylococcus aureus es uno de los principales agentes etiológicos de infecciones en niños provenientes de la comunidad y del ámbito hospitalario. La gravedad de estos cuadros se asocia a factores de virulencia, entre los que se encuentra la leucocidina de Panton-Valentine. Tanto Staphylococcus aureus resistente como sensible a la meticilina producen esta leucocidina, aunque con frecuencia variable. Presentamos a dos niños con infección grave por Staphylococcus aureus sensible a la meticilina productor de leucocidina de Panton-Valentine con complicaciones osteoarticulares y endovasculares. Es fundamental la sospecha diagnóstica, el tratamiento antibiótico adecuado y el manejo quirúrgico precoz para mejorar el abordaje de estas infecciones. Se debe mantener la vigilancia epidemiológica para detectar la frecuencia de las infecciones causadas por estas bacterias.
Assuntos
Antibacterianos/farmacologia , Toxinas Bacterianas/biossíntese , Exotoxinas/biossíntese , Leucocidinas/biossíntese , Meticilina/farmacologia , Infecções Estafilocócicas , Staphylococcus aureus/efeitos dos fármacos , Staphylococcus aureus/metabolismo , Criança , Feminino , Humanos , Masculino , Testes de Sensibilidade Microbiana , Índice de Gravidade de Doença , Infecções Estafilocócicas/diagnóstico , Infecções Estafilocócicas/microbiologia , Infecções Estafilocócicas/terapiaRESUMO
Infections caused by Gram-positive bacteria remain a major cause of morbidity and mortality. Teicoplanin is a glycopeptide antibiotic with similar spectrum to vancomycin. Easy administration and dosage encourage its use in children, particularly due to its long half-life which allows single daily dose regimens. We evaluated the efficacy of teicoplanin in severe infections in children due to Gram-positive organisms. We retrospectively analyzed 171 children with proven or suspected Gram-positive infection treated with teicoplanin between January 1996 and December 2000. Of them, 166 cases were valuable for clinical assessment. Staphylococcus aureus (72) and coagulase-negative staphylococci (38) were the most frequent pathogens isolated. Osteoarthritis (35) and catheter-related infections (31) were the predominant clinical foci. The cure and improvement rates were 88% (150 patients) and 5% (9 patients) respectively. There were 7 (4%) cases of therapeutic failure. Mean treatment duration was 10 +/- 34.3 days (range: 1-205). Adverse events were registered in 11 patients (6%, 15 adverse events). In this study population, teicoplanin was safe and effective in the ambulatory treatment of severe Gram-positive infections in children.
Assuntos
Assistência Ambulatorial , Antibacterianos/uso terapêutico , Infecções por Bactérias Gram-Positivas/tratamento farmacológico , Teicoplanina/uso terapêutico , Adolescente , Adulto , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Estudos Retrospectivos , Infecções Estafilocócicas/tratamento farmacológico , Resultado do TratamentoRESUMO
Invasive pneumococcal diseases are the main cause of morbidity and mortality in children. In the Hospital "Prof. Dr. Juan P. Garrahan", between October 1st , 2008 and September 30th, 2011 all invasive pneumococcal diseases with positive blood cultures were retrospectively studied before the implementation of the universal immunization schedule with the 13-valent pneumococcal conjugate vaccine. A total of 124 patients were identified, and their mean age was 48.3 months (range: 1-216). In this population, 58.9% (n: 73) were OVER 2 years old and 89% (n: 65) of them had an underlying disease. The most frequent clinical presentation was pneumonia. The most frequent S. pneumoniae serotypes identified were: 14 (22.5%, n: 25), 6 (14.4%, n: 16), 19 (8.1%, n: 9), 23 (7.2%, n: 8), 1 (6.3%, n: 7), 5 (4.5%, n: 5), and 7 (7.2%, n: 8). Of the S. pneumoniae serotypes in this series, 82.2% is included in the 13-valent pneumococcal conjugate vaccine. Continuous epidemiological surveillance is essential to further identify the epidemiology and study the evolution of invasive pneumococcal disease in Argentina.
Assuntos
Infecções Pneumocócicas/diagnóstico , Infecções Pneumocócicas/microbiologia , Streptococcus pneumoniae/classificação , Adolescente , Criança , Pré-Escolar , Feminino , Hospitais Pediátricos , Humanos , Lactente , Masculino , Vacinas Pneumocócicas , Estudos Retrospectivos , Sorotipagem , Centros de Atenção Terciária , Vacinas ConjugadasRESUMO
Introducción. Las infecciones por Staphylococcus aureus meticilino resistente adquirido en la comunidad son un problema grave y frecuente en pediatría. Objetivo. Describir la resistencia a los antibióticos enlas infecciones bacteriémicas por Staphylococcus aureus (SA) de la comunidad. Comparar las características de las infecciones bacteriémicas por SA según la resistencia a la meticilina. Material y métodos. Cohorte prospectiva entre enero de 2010 y diciembre de 2014. Criterios de inclusión: niños de entre 30 días y 16 años de edad hospitalizados en el Hospital de Pediatría J. P. Garrahan por infecciones adquiridas en la comunidad, con desarrollo de SA en hemocultivos. Criterios de exclusión: antecedente de internación reciente, asistencia a un centro relacionado con los cuidados de la salud, vivir en una comunidad cerrada o catéter venoso. Se compararon características microbiológicas, demográficas y clínicas según la sensibilidad a la meticilina. Análisis estadístico: Stata10. Resultados. Se incluyeron 208 niños; varones: 141 (68%). La mediana de edad fue 60 meses (rango intercuartilo 29-130). Tenían enfermedad de base 34 pacientes (16%). En 136 niños (65%), se identificó Staphylococcus aureus meticilino resistente. La resistencia a la clindamicina fue 9%. Se encontraron diferencias estadísticas significativas en la frecuencia de enfermedad subyacente, bacteriemia persistente, sepsis al momento del ingreso, foco secundario de infección, ingreso a unidades de cuidados intensivos y necesidad de cirugía. Fallecieron 12 pacientes (6%); todos tuvieron identificación de Staphylococcus aureus meticilino resistente adquirido en la comunidad. Conclusiones. En la cohorte estudiada, predominó el Staphylococcus aureus meticilino resistente. La resistencia a la clindamicina fue del 9%. Las infecciones por Staphylococcus aureus meticilino resistente adquirido en la comunidad predominaron en niños sanos. En los pacientes con Staphylococcus aureus meticilino resistente, fue más frecuente la bacteriemia persistente, el ingreso a unidades de cuidados intensivos y la cirugía.
Introduction. Community-acquired methicillin-resistant Staphylococcus aureus infections are a common, serious problem in pediatrics.Objective. To describe antibiotic resistance in community-acquired Staphylococcus aureus (SA) bacteremias. To compare the characteristics of SA bacteremias in terms of methicillin resistance.Material and methods. Prospective cohort enrolled between January 2010 and December 2014. Inclusion criteria: infants and children between 30 days old and 16 years old hospitalized at the Hospital de Pediatría J. P. Garrahan due to community-acquired infections with SA growth identification in blood cultures. Exclusion criteria: having a history of recent hospitalization, attending a health care facility, living in a closed community, or having a venous catheter. Microbiological, demographic, and clinical characteristics were compared in terms of methicillin susceptibility. Statistical analysis: Stata10.Results. A total of 208 children were included; boys: 141 (68%). Their median age was 60 months old (interquartile range: 29-130). Thirty-four patients (16%) had an underlying disease. Methicillin-resistant Staphylococcus aureus was identified in 136 children (65%). The rate of resistance to clindamycin was 9%. Significant statistical differences were observed in the rate of underlying disease, persistent bacteremia, sepsis at the time of admission, secondary source of infection, admission to the intensive care unit, and surgery requirement. Twelve patients (6%) died; community-acquired methicillin-resistant Staphylococcus aureus was identified in all of them.Conclusions. In the studied cohort, methicillin-resistant Staphylococcus aureus was predominant. The rate of resistance to clindamycin was 9%. Community-acquired methicillin-resistant Staphylococcus aureus infections prevailed among healthy children. Among patients with methicillin-resistant Staphylococcus aureusinfections there was a higher rate of persistent bacteremia, admission to the ICU and surgery
Assuntos
Humanos , Masculino , Lactente , Pré-Escolar , Criança , Adolescente , Infecções Estafilocócicas/microbiologia , Infecções Estafilocócicas/tratamento farmacológico , Staphylococcus aureus/efeitos dos fármacos , Bacteriemia/microbiologia , Bacteriemia/tratamento farmacológico , Fatores de Tempo , Testes de Sensibilidade Microbiana , Estudos de Coortes , Infecções Comunitárias Adquiridas/microbiologia , Infecções Comunitárias Adquiridas/tratamento farmacológico , Staphylococcus aureus Resistente à MeticilinaRESUMO
Staphylococcus aureus es uno de los principales agentes etiológicos de infecciones en niños provenientes de la comunidad y del ámbito hospitalario. La gravedad de estos cuadros se asocia a factores de virulencia, entre los que se encuentra la leucocidina de Panton-Valentine. Tanto Staphylococcus aureus resistente como sensible a la meticilina producen esta leucocidina, aunque con frecuencia variable. Presentamos a dos niños con infección grave por Staphylococcus aureus sensible a la meticilina productor de leucocidina de Panton-Valentine con complicaciones osteoarticulares y endovasculares. Es fundamental la sospecha diagnóstica, el tratamiento antibiótico adecuado y el manejo quirúrgico precoz para mejorar el abordaje de estas infecciones. Se debe mantener la vigilancia epidemiológica para detectar la frecuencia de las infecciones causadas por estas bacterias.
Staphylococcus aureus is a major etiologic agent of infections in children from the community and the hospital setting. The severity of these conditions is associated with virulence factors, including the Panton-Valentine leukocidin. Both methicillin resistant and sensitive Staphylococcus aureus produce this leukocidin although with varying frequency. We present two children with severe infection by sensitive Staphylococcus aureus producer of Panton-Valentine leukocidin with musculoskeletal and endovascular complications. It is essential the suspected diagnosis, appropriate antibiotic treatment and early surgical management to improve the approach of these infections. Epidemiological surveillance should be mantained to detect the frequency of infections caused by these bacteria.
Assuntos
Humanos , Masculino , Feminino , Criança , Infecções Estafilocócicas/diagnóstico , Infecções Estafilocócicas/microbiologia , Infecções Estafilocócicas/terapia , Staphylococcus aureus/efeitos dos fármacos , Staphylococcus aureus/metabolismo , Toxinas Bacterianas/biossíntese , Exotoxinas/biossíntese , Leucocidinas/biossíntese , Meticilina/farmacologia , Antibacterianos/farmacologia , Índice de Gravidade de Doença , Testes de Sensibilidade MicrobianaRESUMO
BACKGROUND: Community-acquired methicillin-resistant Staphylococcus aureus (CAMRSa) emerged in recent years. Few studies analyzed the impact of these infections in bacteremias (B). OBJECTIVES: To analyze clinical, epidemiological, microbiological and outcome of CASa B between two periods (Period I: 1993-2004, and Period II: 2004-2007). MATERIAL AND METHODS: Retrospective, observational and comparative study. All children older than 1 month of age and CASaB were included. RESULTS: During the study period 647 SaB were diagnosed (Period I: 499 and Period II: 148). Of them, 140 (28%) and 49 (33%) were CSaB, respectively. The median age of patients was 5.9 and 4.8 years, respectively (p= NS). Clinical foci of infection and septic shock were more frequent in the period I (78% vs. 47%) and (5% vs. 16%) (p <0.05), respectively. Skin infection and septic shock were similar in both periods (78% vs. 67% and 5% vs. 8%; p= NS). Four CAMRSa B (3%) were diagnosed during the first period. One predisposing factor was identified in all cases. Inversely, 23 cases (47%) were diagnosed during the Period II (p <0.05). Resistance rates to clindamycin and gentamicin were more high during the second period (10% vs. 2% and 20% vs. 3%, respectively) (p <0.05). Patients in the second period had longer antibiotic treatment (X 16.6 vs. 10.1 days) and more frequent inappropriate treatment at admission (53% vs. 5%) (p <0.05). Hospital stay time was longer during de first period (19.2 vs. 12.2 days) (p <0.05). The mortality rate was higher in the first period (13% vs. 4%) (p= NS). CONCLUSION: A significant increase of CAMRSa B were detected in recent years. It is necessary to evaluate the empirical treatment of severe community infections in children in our country.
Assuntos
Bacteriemia , Infecções Estafilocócicas , Argentina , Bacteriemia/diagnóstico , Bacteriemia/tratamento farmacológico , Bacteriemia/epidemiologia , Bacteriemia/microbiologia , Pré-Escolar , Infecções Comunitárias Adquiridas/diagnóstico , Infecções Comunitárias Adquiridas/tratamento farmacológico , Infecções Comunitárias Adquiridas/epidemiologia , Infecções Comunitárias Adquiridas/microbiologia , Feminino , Humanos , Masculino , Estudos Retrospectivos , Infecções Estafilocócicas/diagnóstico , Infecções Estafilocócicas/tratamento farmacológico , Infecções Estafilocócicas/epidemiologia , Infecções Estafilocócicas/microbiologia , Fatores de TempoRESUMO
OBJECTIVE: To evaluate the cost-effectiveness of the antiseptic-impregnated catheter compared with conventional catheters in preventing catheter- related blood stream infections (CR-BSI). DESIGN: Cost-effectiveness analysis; clinical trial, experimental, randomized, controlled, prospective, open label. Patients and methods. A 172 patient cohort, under 1-year-old or less than 10 kg, postoperative cardiovascular children with central venous catheters (CVC) admitted to Cardiac Intensive Care Unit (UCI 35) at Hospital Nacional de Pediatría "Prof. Dr. Juan P. Garrahan", since September 2005 to December 2007. Demographic and CVC data were retrieved to compare: age, gender, weight, diagnosis, surgery, CVC days, costs and complications. Intervention. CVC Arrow, double-lumen, > 48 h of duration; intervention group: antiseptic-impregnated CVC vs. control group: CVC without antiseptics (conventional). RESULTS: The incidence of CR-IE (CR-Infected Events: colonization, local infection and/or CRBSI; combined end point) was 27% for antiseptic- impregnated CVC vs. 31% for conventional catheters (p= 0.6) with similar accumulated incidence of CR- BSI: 2.8 vs. 3.3 per 1000 dayscatheter. We found no differences between groups, except in weight: median 4.0 kg (r 2-17) vs. 4.7 kg (r 2-9) p= 0.0002 and age, median 2 months (r 1- 48) vs. 5 months (r 1- 24) p= 0.0019 in antiseptic-impregnated CVC group. These differences, though statistically significant were clinically non relevant. Median cost per patient during intensive care stay in the conventional CVC group was $3.417 (359-9.453) and in the antiseptic-impregnated-CVC group was $4.962 (239-24.532), p= 0.10. CONCLUSIONS: The use of antiseptic-impregnated CVC compared with conventional CVC did not decrease CR-BSI in this population. The cost per patients was higher in the antiseptic impregnated CVC group. These results do not support the routine use of this type of CVC in our population.
Assuntos
Infecções Relacionadas a Cateter/economia , Infecções Relacionadas a Cateter/prevenção & controle , Cateterismo Venoso Central/efeitos adversos , Cateterismo/economia , Anti-Infecciosos Locais , Pré-Escolar , Análise Custo-Benefício , Feminino , Humanos , Lactente , Masculino , Estudos ProspectivosRESUMO
Las enfermedades invasivas por neumococo constituyen la principal causa de morbimortalidad en los niños. En el Hospital "Prof. Dr. Juan P. Garrahan" se estudiaron retrospectivamente todas las infecciones invasivas por neumococo con hemocultivos positivos entre el 1 de octubre de 2008 y el 30 de septiembre de 2011, antes de la vacunación universal con la vacuna conjugada de 13 serotipos. Se identificaron 124 pacientes, con una media de edad de 48,3 meses (r: 1-216). El 58,9% de la población era mayor de 2 años (n: 73) y el 89% (n: 65) de ellos tenían una enfermedad de base. La principal forma de presentación fue la neumonía. Los serotipos de S. pneumoniae más frecuentes fueron: 14 (22,5%, n: 25), 6 (14,4%, n: 16), 19 (8,1%, n: 9), 23 (7,2%, n: 8), 1 (6,3%, n: 7), 5 (4,5%, n: 5) y 7 (7,2%, n: 8). El 82,8% de los serotipos de S. pneumoniae de esta serie están incluidos en la vacuna conjugada de 13 serotipos. Es esencial mantener la vigilancia epidemiológica para identificar la evolución y epidemiología de la enfermedad invasiva por neumococo en la Argentina.
Invasive pneumococcal diseases are the main cause of morbidity and mortality in children. In the Hospital "Prof. Dr. Juan P. Garrahan", between October 1st , 2008 and September 30th, 2011 all invasive pneumococcal diseases with positive blood cultures were retrospectively studied before the implementation of the universal immunization schedule with the 13-valent pneumococcal conjugate vaccine. A total of 124 patients were identified, and their mean age was 48.3 months (range: 1-216). In this population, 58.9% (n: 73) were OVER 2 years old and 89% (n: 65) of them had an underlying disease. The most frequent clinical presentation was pneumonia. The most frequent S. pneumoniae serotypes identified were: 14 (22.5%, n: 25), 6 (14.4%, n: 16), 19 (8.1%, n: 9), 23 (7.2%, n: 8), 1 (6.3%, n: 7), 5 (4.5%, n: 5), and 7 (7.2%, n: 8). Of the S. pneumoniae serotypes in this series, 82.2% is included in the 13-valent pneumococcal conjugate vaccine. Continuous epidemiological surveillance is essential to further identify the epidemiology and study the evolution of invasive pneumococcal disease in Argentina.
Assuntos
Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Infecções Pneumocócicas/diagnóstico , Infecções Pneumocócicas/microbiologia , Streptococcus pneumoniae/classificação , Hospitais Pediátricos , Vacinas Pneumocócicas , Estudos Retrospectivos , Sorotipagem , Centros de Atenção Terciária , Vacinas ConjugadasRESUMO
Tuberculosis is an important public health problem. It is estimated that around 5-10% of patients with tuberculosis present with central nervous system involvement; meningitis and tuberculoma being two of the most frequent manifestations. The paradoxical reaction in patients undergoing antituberculosis treatment is infrequent, nevertheless it is an important consideration in patients, who after an appropriate initial response to specific treatment, present with worsening clinical and radiological signs or the appearance of new lesions.
La tuberculosis (TBC) es un problema de importancia en salud pública. Se estima que alrededor de 5 a 10% de los pacientes con TBC presentan compromiso de sistema nervioso central, siendo la meningitis y el tuberculoma las manifestaciones más frecuentes. La reacción paradojal en pacientes con tratamiento antituberculoso es infrecuente, sin embargo, es importante considerarla en pacientes que durante la terapia, luego de una respuesta inicial apropiada, presentan un empeoramiento clínico y/o radiológico o aparición de nuevas lesiones.
Assuntos
Adolescente , Feminino , Humanos , Antituberculosos/efeitos adversos , Tuberculose Meníngea/tratamento farmacológico , Tuberculose Pulmonar/tratamento farmacológico , Corticosteroides/uso terapêutico , Antituberculosos/uso terapêutico , Imunocompetência , Imageamento por Ressonância Magnética , Tuberculoma Intracraniano/tratamento farmacológico , Tuberculose Meníngea/diagnóstico , Tuberculose Pulmonar/diagnósticoRESUMO
INTRODUCTION: Methicillin-resistant Staphylococcus aureus (MRSA) isolates are increasingly frequent causes of skin and soft-tissue infections or invasive infections in many communities. Local data are scarce. OBJECTIVE: To determine the frequency, clinical features and outcome of infections caused by MRSA. MATERIAL AND METHODS: Prospective and multicentric study of surveillance for community-acquired S. aureus infections in children from Argentina. Infections meeting the definition of community-acquired were identified. Demographic and clinical data were collected. Antibiotic susceptibilities were determined in the clinical microbiology laboratory with the methodology of the NCCLS. RESULTS: From November 2006 to November 2007, 840 S. aureus infections were diagnosed, 447 of them were community-acquired. One hundred and thirty-five children with underlying disease or previous hospital admission were excluded. Two hundred and eighty one (62%) infections were community-acquired MRSA (CA-MRSA). The median age of children was 36 months (r:1-201), 60% were male. Among the CA-MRSA isolates, 62% were obtained from children with skin and soft-tissue infections, and 38% from children with invasive infections. Of them, osteomyelitis, arthritis, empyema and pneumonia were prevalent. Eigthteen percent of children had bacteremia and 11% sepsis. The rate of clindamycin resistance of CA-MRSA isolates was 10% and 1% for trimethoprim-sulfamethoxazole. Only 31% of children had appropriate treatment at admission. The median time of treatment delayed was 72 h. The median time of parenteral treatment was 6 days (r:1-70). In 72% of patients surgical treatment was required. Three children died (1%). CONCLUSIONS: CA-MRSA isolates account for a high percentage and number of infections in children of Argentina. Community surveillance of CA-MRSA infections is critical to determine the appropriate empiric antibiotic treatment for either local or invasive infections. Clindamycin resistance was under 15% in the strains tested. Clindamycin should be use when CA-MRSA infection is suspected in children.
Assuntos
Staphylococcus aureus Resistente à Meticilina , Infecções Estafilocócicas , Adolescente , Criança , Pré-Escolar , Infecções Comunitárias Adquiridas/diagnóstico , Infecções Comunitárias Adquiridas/terapia , Feminino , Humanos , Lactente , Masculino , Estudos Prospectivos , Infecções Estafilocócicas/diagnóstico , Infecções Estafilocócicas/terapiaRESUMO
Objetivo: Evaluar la costo-eficacia de catéteres venosos centrales con antisépticos comparados con catéteres convencionales en la prevención de episodios infecciosos asociados. Diseño: Análisis de costo-eficacia; ensayo clínico, experimental, aleatorizado, controlado, abierto. Población y métodos: Pacientes con catéteres venosos centrales, menores de 1 año o 10 kg, posquirúrgicos cardiovasculares. Se compararon las características de los pacientes y la permanencia, costos y complicaciones de los catéteres venosos centrales. Intervención: Catéter venoso central Arrow®, doble lumen, > 48 h de duración; grupo de intervención: catéteres con antiséptico contra grupo control: catéteres convencionales. Resultados: Se estudiaron 172 catéteres pertenecientes a 149 pacientes. La tasa cruda de episodios infecciosos asociados fue del 27% en los catéteres con antisépticos y 31% en los catéteres convencionales (p= 0,6), con incidencia acumulada similar de bacteriemia asociada a catéter: 2,8 contra 3,3 por 1000 días-catéter. No se encontraron diferencias entre los grupos, excepto en el menor peso: mediana 4,0 kg (r 2-17) contra 4,7 kg (r 2-9) p= 0,0002 y edad mediana 2 m (r 1-48) contra 5 m (r 1-24) p= 0,0019 en la población de catéteres venosos centrales con antisépticos. Estas diferencias se consideraron clínicamente irrelevantes. El costo promedio por paciente internado en el grupo con catéter convencional fue $ 3.417 (359-9.453) y en el grupo catéter con antisépticos fue de $ 4.962 (239-24.532), p= 0,10. Conclusiones: El uso de catéteres venosos centrales con antisépticos comparado con el de catéteres convencionales no redujo los episodios infecciosos asociados, con una tendencia de mayor costo en el grupo de catéteres con antisépticos. Estos resultados no respaldan el uso de estos catéteres en nuestro medio.
Objective: To evaluate the cost-effectiveness of the antiseptic-impregnated catheter compared with conventional catheters in preventing catheter-related blood stream infections (CR-BSI). Design: Cost-effectiveness analysis; clinical trial, experimental, randomized, controlled, prospective, open label. Patients and methods: A 172 patient cohort, under 1-year-old or less than 10 kg, postoperative cardiovascular children with central venous catheters (CVC) admitted to Cardiac Intensive Care Unit (UCI35) at Hospital Nacional de Pediatría "Prof. Dr. Juan P. Garrahan", since September 2005 to December 2007. Demographic and CVC data were retrieved to compare: age, gender, weight, diagnosis, surgery, CVC days, costs and complications. Intervention. CVC Arrow, double-lumen, > 48 h of duration; intervention group: antiseptic-impregnated CVC vs. control group: CVC without antiseptics (conventional). Results. The incidence of CR-IE (CR-Infected Events: colonization, local infection and/or CRBSI; combined end point) was 27% for antiseptic-impregnated CVC vs. 31% for conventional catheters (p= 0.6) with similar accumulated incidence of CR- BSI: 2.8 vs. 3.3 per 1000 days catheter. We found no differences between groups, except in weight: median 4.0 kg (r 2-17) vs. 4.7 kg (r 2-9) p= 0.0002 and age, median 2 months (r 1-48) vs. 5 months (r 1- 24) p= 0.0019 in antiseptic-impregnated CVC group. These differences, though statistically significant were clinically non relevant. Median cost per patient during intensive care stay in the conventional CVC group was $3.417 (359-9.453) and in the antiseptic-impregnated-CVC group was $4.962 (239-24.532), p= 0.10. Conclusions: The use of antiseptic-impregnated CVC compared with conventional CVC did not decrease CR-BSI in this population. The cost per patients was higher in the antiseptic impregnated CVC group. These results do not support the routine use of this type of CVC in our population.
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INTRODUCTION: Cytomegalovirus disease is one of the complications of allogeneic stem cell transplantation (SCT). The objective of this study was to determine the frequency of CMV infection and CMV disease in children undergoing allogeneic SCT, and in whom antigenemia and bronchoalveolar lavage (BAL) were performed for early detection of CMV infection. METHODS: A total of 59 consecutive children who underwent allogeneic-identical, related SCT were prospectively evaluated. The patients were classified into: group 1 (low risk), donor and recipient CMV-seronegative; group 2 (intermediate risk), donor and/or recipient CMV-seropositive; and group 3 (high risk), recipient with acute graft-versus-host disease (GVHD) resistant to steroid therapy. Weekly antigenemia was carried out in all the patients until day 1100. In antigenemia-negative patients in group 2, BAL was performed on day 145. Patients in groups 1 and 2 with positive antigenemia or BAL received ganciclovir until day 1100. In group-3 children, ganciclovir was given until GVHD was controlled. RESULTS: The frequency of CMV infection and CMV disease was 45% and 1.5%, respectively. Testing for CMV in BAL in group-2 patients increased the frequency of early diagnosis by 10%. Ganciclovir was administered to 57% of the patients in this study. CONCLUSION: As compared to other series, a lower frequency of CMV disease and a reduction in ganciclovir use were observed with this strategy.
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Antivirais/uso terapêutico , Infecções por Citomegalovirus/prevenção & controle , Ganciclovir/uso terapêutico , Transplante de Células-Tronco , Adolescente , Adulto , Sangue/virologia , Líquido da Lavagem Broncoalveolar/virologia , Criança , Pré-Escolar , Citomegalovirus/isolamento & purificação , Infecções por Citomegalovirus/diagnóstico , Infecções por Citomegalovirus/tratamento farmacológico , Feminino , Humanos , Lactente , Masculino , Estudos Prospectivos , Transplante HomólogoRESUMO
Objetivo. Evaluar la costo-eficacia de catéteres venosos centrales con antisépticos comparados con catéteres convencionales en la prevenciónde episodios infecciosos asociados.Diseño: Análisis de costo-eficacia; ensayo clínico, experimental, aleatorizado, controlado, abierto.Población y métodos. Pacientes con catéteres venosos centrales, menores de 1 año o 10 kg, posquirúrgicos cardiovasculares. Se compararonlas características de los pacientes y la permanencia, costos y complicaciones de los catéteres venosos centrales.Intervención. Catéter venoso central Arrow®, doble lumen, > 48 h de duración; grupo de intervención:catéteres con antiséptico contra grupocontrol: catéteres convencionales.Resultados. Se estudiaron 172 catéteres pertenecientes a 149 pacientes. La tasa cruda de episodios infecciosos asociados fue del 27 por ciento en los catéteres con antisépticos y 31 por ciento en los catéteres convencionales (p= 0,6), con incidencia acumulada similar de bacteriemia asociada a catéter: 2,8contra 3,3 por 1000 días-catéter. No se encontraron diferencias entre los grupos, excepto en el menor peso: mediana 4,0 kg (r 2-17) contra 4,7 kg (r2-9) p= 0,0002 y edad mediana 2 m (r 1-48) contra 5 m (r 1-24) p= 0,0019 en la población de catéteres venosos centrales con antisépticos. Estas diferencias se consideraron clínicamente irrelevantes.El costo promedio por paciente internado en el grupo con catéter convencional fue pesos 3.417 (359-9.453) y en el grupo catéter con antisépticos fue de pesos 4.962 (239-24.532), p= 0,10.Conclusiones. El uso de catéteres venosos centralescon antisépticos comparado con el de catéteres convencionales no redujo los episodios infecciosos asociados, con una tendencia de mayor costo en el grupo de catéteres con antisépticos.Estos resultados no respaldan el uso deestos catéteres en nuestro medio.
Assuntos
Humanos , Masculino , Feminino , Lactente , Anti-Infecciosos Locais/uso terapêutico , Cateterismo Venoso Central , Controle de Infecções , Consentimento Livre e Esclarecido , Cirurgia Torácica , Interpretação Estatística de DadosRESUMO
Introducción. Escasos estudios han evaluado el impacto de S. aureus meticilino-resistente proveniente de la comunidad en bacteriemias. Objetivos. Analizar las características epidemiológicas, microbiológicas, clínicas y de evolución de los niños con bacteriemias por S. aureus (SA) provenientes de la comunidad. Material y métodos. Estudio retrospectivo, observacional y comparativo (Período I: 1993-2004 y Período II: 2004-2007). Se incluyeron niños mayores de 1 mes con bacteriemias por S. aureus provenientes de la comunidad. Resultados. Se registraron 647 bacteriemias por SA (Período I: 499 y Período II: 148), 140 (28%) y 49 (33%) fueron de la comunidad en cada período. La edad (media) fue 5,9 y 4,8 años, respectivamente (p= NS). La presencia de foco clínico de infección y shock séptico fue semejante en ambos períodos (78 contra 67%; p= NS). La celulitis prevaleció durante el segundo período (56 contra 40%) (p= NS). En el primer período se detectaron 4 niños con bacteriemias por SA de la comunidad resistentes a meticilina (3%) mientras que en el segundo período ocurrieron 23 casos (47%) (p <0,05). La resistencia a clindamicina y gentamicina fue mayor en el segundo período (10% contra 2% y 20% contra 3%, respectivamente) (p <0,05). En el período II hubo mayor duración del tratamiento antibiótico (media: 16,6 contra 10,1; p < 0,05) y mayor porcentual de tratamiento discordante (53 por ciento contra por ciento)(p <0,05). Durante el primer período fue mayor el tiempo de internación (19,2 contra 12,2 días) (p <0,05). La mortalidad fue más alta durante el primer período (14% contra 5%) (p= NS). Conclusión. Se registró un aumento significativo de niños con bacteriemias por SA de la comunidad resistentes a meticilina a partir de 2004. Estomotivó la revaloración del tratamiento empírico de estos niños con infección grave.
Background. Community-acquired methicillinresistant Staphylococcus aureus (CAMRSa) emerged in recent years. Few studies analyzed the impact of these infections in bacteremias (B). Objectives. To analyze clinical, epidemiological, microbiological and outcome of CASa B between two periods (Period I: 1993-2004, and Period II: 2004-2007).Material and methods. Retrospective, observational and comparative study. All children older than 1 month of age and CASa B were included. Results. During the study period 647 SaB werediagnosed (Period I: 499 and Period II: 148). Of them, 140 (28%) and 49 (33%) were CSa B, respectively. The median age of patients was 5.9 and4.8 years, respectively (p= NS). Clinical foci of infection and septic shock were more frequent in the period I (78% vs. 47%) and (5% vs. 16%) (p <0.05), respectively. Skin infection and septicshock were similar in both periods (78% vs. 67% and 5% vs. 8%; p=NS). Four CAMRSa B (3%) were diagnosed during the first period. One predisposing factor was identified in all cases. Inversely, 23 cases (47%) were diagnosed during the Period II (p<0.05). Resistance rates to clindamycin and gentamicin were more highduring the second period (10% vs. 2% and 20% vs. 3%, respectively) (p <0.05). Patients in the second period had longer antibiotic treatment (X16.6 vs. 10.1 days) and more frequent inappropriate treatment at admission (53% vs. 5%) (p <0.05). Hospital stay time was longer during de first period (19.2 vs. 12.2 days) (p <0.05). Themortality rate was higher in the first period (13% vs. 4%) (p=NS). Conclusion. A significant increase of CAMRSa B were detected in recent years. It is necessary to evaluate the empirical treatment of severe community infections in children in our country.
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Humanos , Masculino , Adolescente , Feminino , Lactente , Pré-Escolar , Criança , Bacteriemia/epidemiologia , Bacteriemia/etiologia , Bacteriemia/microbiologia , Infecções Comunitárias Adquiridas , Resistência a Meticilina , Staphylococcus aureus , Estudos Observacionais como Assunto , Estudos RetrospectivosRESUMO
INTRODUCTION: IE is a rare infection in children. Scarce reports with large number of patients are published. METHODS: Between January 1988 to December 2000 we analyzed all cases of IE cases admitted to our hospital. RESULTS: 86 cases of IE (4.9/10,000 admissions) in 86 children were diagnosed. The median age was 7.6 years. In 77% of patient previous cardiac disease was detected, interventricular defects and Tetralogy of Fallot were the more frequent. Three percent of children had rheumatic heart disease. Thirty-six percent of children had previous heart surgery. Fifty-seven percent have been received previous antibiotics. Eighty-seven percent had positive blood cultures, being the S. aureus and S. viridans the predominantly. Forty-eight percent of children had complications. The metabolic disorders and the nosocomial infections were the most frequent. Twenty-four percent required surgery, 24% of them in the first week of the diagnosis. The mortality in operated children was 19%. In the multivariate analysis we could observe that children with more than 7 years and S. aureus isolation in blood cultures had more incidence of complications and posterior surgery (p < 0.05). Children with S. aureus IE had longer duration of fever, more incidence of complications than patients with S. viridans IE (p < 0.05). Ten percent of children were treated as outpatients. The global mortality was 12,8%. Previous surgery (OR = 6.89; IC 95% 1.54-30.7) and previous antibiotic treatment (OR = 9.98; IC 95% 1.12-88.8) were the factors related with higher mortality in the multivariate analysis. S. aureus was the predominat pathogen and caused more morbidity and mortality than S. viridans IE. CONCLUSION: Children with IE with previous surgery and previous antibiotic treatment died with more frequency.
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Endocardite Bacteriana/mortalidade , Adolescente , Antibacterianos/uso terapêutico , Argentina/epidemiologia , Bacteriemia/complicações , Bacteriemia/epidemiologia , Criança , Pré-Escolar , Suscetibilidade a Doenças , Endocardite Bacteriana/diagnóstico por imagem , Endocardite Bacteriana/etiologia , Endocardite Bacteriana/cirurgia , Cardiopatias Congênitas/complicações , Cardiopatias Congênitas/epidemiologia , Humanos , Complicações Pós-Operatórias/mortalidade , Cardiopatia Reumática/complicações , Cardiopatia Reumática/epidemiologia , Fatores de Risco , Infecções Estafilocócicas/etiologia , Infecções Estafilocócicas/microbiologia , Infecções Estafilocócicas/mortalidade , Infecções Estafilocócicas/cirurgia , Staphylococcus aureus/isolamento & purificação , Staphylococcus aureus/patogenicidade , Infecções Estreptocócicas/etiologia , Infecções Estreptocócicas/microbiologia , Infecções Estreptocócicas/mortalidade , Infecções Estreptocócicas/cirurgia , Superinfecção , Ultrassonografia , Estreptococos Viridans/isolamento & purificação , Estreptococos Viridans/patogenicidade , VirulênciaRESUMO
BACKGROUND: Recent reports and previous randomized trials conducted at the authors' institution suggested that children with lower risk febrile neutropenic (LRFN) may benefit from substitution of oral antibiotic therapy for parenteral therapy. The objective of this study was to determine the efficacy of parenteral-oral outpatient therapy in the management of children with LRFN who were receiving treatment for malignant disease. METHODS: From August 2000 to April 2002, 135 children with a median age of 7.5 years (range, 1.6-15.8 years) who had a total of 177 episodes of LRFN were included in a prospective, randomized, single-institution trial. Children with LRFN received a single dose of ceftriaxone and amikacin and completed a risk-assessment work-up. All patients were discharged immediately and, at 24 hours, were allocated randomly to two groups: Group A (89 episodes) received oral ciprofloxacin, and Group B (88 episodes) received intravenous ceftriaxone. RESULTS: Most patients (61% in Group A and 51% in Group B) were receiving treatment for leukemia (P value not significant [NS]). Twenty-eight children (31%) in Group A and 22 children (25%) in Group B displayed unexplained fever (P value NS). No significant differences in sites of initial infection were found between the two groups. The median duration of neutropenia was 4.2 days and 4.7 days for Group A and Group B, respectively (P value NS); the median duration of fever was 2.3 days and 2.6 days, respectively (P value NS); and the median duration of antibiotic treatment was 4.5 days and 4.8 days, respectively (P value NS). The overall results of the study were excellent. Only four treatment failures in Group A (5%) and 6 treatment failures in Group B (7%) were observed. These patients were readmitted to the hospital and did well with appropriate treatment. CONCLUSIONS: In children with LRFN who are receiving treatment for malignant disease, outpatient oral ciprofloxacin after 24 hours of a single dose of intravenous ceftriaxone and amikacin was as safe and efficacious as parenteral ceftriaxone. Outpatient management and early antibiotic withdrawal were safe for both groups.
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Antibacterianos/administração & dosagem , Febre/tratamento farmacológico , Neutropenia/tratamento farmacológico , Administração Oral , Adolescente , Assistência Ambulatorial , Amicacina/uso terapêutico , Antineoplásicos/efeitos adversos , Argentina , Ceftriaxona/uso terapêutico , Criança , Pré-Escolar , Ciprofloxacina/uso terapêutico , Feminino , Humanos , Lactente , Leucemia/tratamento farmacológico , Masculino , Neutropenia/etiologia , RiscoRESUMO
Introduction: Community-acquired methicillin-resistant Staphylococcus aureus infections (CA-MRSA) are prevalent in several countries of the world. These infections seem to differ clinically from those occurring within the health care system (HCS-MRSA). Objective: To compare clinical characteristics of infections by CA-MRSA and HCA-MRSA in the same communitty. Material and Methods: Prospective, multicentric and comparative study. Children with clinically and microbiologicaly documented CA-MRSA were included. Results: Between 11/2006 and 11/2007, 840 infections caused by S. aureus were diagnosed. Of them 582 (68 percent) were community-acquired. Among these 356 (61 percent) were CA-MRSA. In this group, 75 (21 percent) were HCA-MRSA and 281 (79 percent) CA-MRSA. The median age was 36months (range: 1-201). Chronic skindisease (13) and chronic disease of CNS (9) were the underlying disease predominant. Children with CA-MRSAhad more frequency of previous antibiotic treatment (63 vs 34 percent) and previous medical consult (76 vs 52 percent), invasive procedures (31 vs 8 percent), surgery (15 vs 0,3 percent) and fever (94 vs 74 percent) (p = <05). Children with CA-MRSAhad subcutaneous abscesses (34 vs 15 percent) (p = <.05) more frequently. Bacteremia and sepsis rate was similar in both groups (21 vs 18 percent) and 17 vs 11 percent) respectively) (p = NS). Antibiotic resistance was more frequent in children with HCA-MRSA: Rifampin (7 vs 1 percent), trimethoprim-sulphametoxazole (7 vs 1 percent) and clindamycin (25 vs 9 percent) (p = <.05). Four children (5 percent) with HCA-MRSA infections died and 3 (1 percent) mCA-MRSAgroup (p = .05). Conclusión: Children with HCA-MRSA infections more frequent antibiotic resistance than CA-MRSA should be reconsider the empiric antibiotic treatment of community-acquired infections in children in our área.
Introducción: Staphylococcus aureus meticilina-resistente proveniente de la comunidad (SAMRC) es altamente prevalente en diversos países del planeta. Objetivos: Realizar un análisis clínico comparativo entre las infecciones por SAMRC en niños antes sanos (SAMR-CO) y aquellos con S. aureus MR en pacientes con patologías previas (SAMR-RH). Material y Métodos: Estudio multicéntrico, prospectivo y comparativo. Fueron incluidos los niños que tenían infección clínica y microbiológicamente documentada por SAMRC. Resultados: Entre 11/2006 y 11/2007 fueron diagnosticadas 840 infecciones porS. aureus. De ellas 582 (69 por ciento) fueron detectadas en la comunidad. Entre estas 356 (61 por ciento) fueron SAMRC. Entre estas últimas 75 (21 por ciento) fueron SAMR-RH y 281 (79 por ciento) SAMR-CO. La mediana de edad fue de 36 meses (rango: 1-201). Las enfermedades de base más frecuentes fueron: dermatopatías crónicas (13) y enfermedad crónica del SNC (9). Los niños con infección por SAMR-RH presentaron con mayor frecuencia tratamiento antimicrobiano previo (63 vs 34 por ciento), consultas médicas previas (76 vs 52 por ciento), procedimiento invasor previo (31 vs 8 por cientoo), cirugía (15 vs 0,3 por ciento) y fiebre al momento de la consulta (94 vs 74 por ciento) (p < 0,05). Los niños con infección por SAMR-CO tuvieron con mayor frecuencia abscesos subcutáneos (34 vs 15 por ciento) (p < 0,05). La tasa de bacteriemia y se sepsis fue semejante en ambos grupos (21 vs 18 por ciento y 17 vs 11 por ciento)) (p =NS). La resistencia a antimicrobianos fue mayor en niños con SAMR-RH: rifampicina (7 vs l por cientoo), cotrimoxazol (7 vs 1 por ciento) y clindamicina (25 vs 9 por ciento) (p < 0,05). Fallecieron 4 niños con SAMR-RH (5 por ciento) y 3 niños con SAMR-CO (1 por ciento) (p = 0,05). Conclusión: Los niños con SAMR-RH presentan mayor tasa de resistencia a antimicrobianos que SAMR-CO. Debe replantearse el tratamiento antimicrobiano empírico en niños con ...