Prevalence of Children With Complex Chronic Conditions in PICUs of Argentina: A Prospective Multicenter Study.

OBJECTIVES: To determine the prevalence of children with complex chronic conditions in PICUs in Argentina. To describe the demographic profile, clinical course and outcomes in PICU of children with complex chronic condition in comparison to previously healthy children. DESIGN: Prospective, observational multicenter study. SETTING: Nineteen PICUs located in Argentina belonging to public and private institutions. PATIENTS: All children admitted to the participating PICUs between March 1, 2015, and February 28, 2016. INTERVENTIONS: None. MEASUREMENT AND MAIN RESULTS: We analyzed 3,483 PICU admissions. The prevalence of complex chronic condition was 48.06% (95% CI, 46.39-49.72). Cardiovascular complex chronic condition was predominant (22.24% [421/1,893]), followed by neuromuscular complex chronic condition (18.75% [355/1,893]) and malignant disease 17.7% (335/1,893). Technologic dependence was present in 22.22% of the patients (372 of 1,674). Predominant admission diagnosis was postoperative (36.6%) and respiratory disease (28.32%). Children with complex chronic condition had higher mortality than previously healthy patients (odds ratio, 2.74; 95% CI, 2.01-3.73). The risk of prolonged stay (≥ 26 d) was also higher (odds ratio, 1.44; 95% CI, 1.10-1.89). Rate utilization of the following devices was higher in patients with complex chronic condition: mechanical ventilation (odds ratio, 1.35; 95% CI, 1.12-1.63), central venous catheter (odds ratio, 1.24; 95% CI, 1.04-1.48), and arterial monitoring (odds ratio, 1.33; 95% CI, 1.09-1.63). CONCLUSIONS: We observed a high prevalence of patients with complex chronic condition in this sample of argentine PICUs. These patients presented higher mortality and resource use than previously healthy children. This information is valuable to understand the impact that patients with complex chronic condition have on PICU performance and enables proper planning of care.

Performance of the Pediatric Index of Mortality 3 Score in PICUs in Argentina: A Prospective, National Multicenter Study.

OBJECTIVE: To assess the performance of the Pediatric Index of Mortality 3 score in a population of children admitted to PICUs in Argentina. DESIGN: Prospective, national, multicenter study. SETTING: Forty-nine PICUs located in Argentina belonging to public and private institutions. PATIENTS: All children between 1 month and 16 years old admitted to the participating PICUs between May 15, 2016, and February 15, 2017. INTERVENTIONS: None. MEASUREMENT AND MAIN RESULTS: A total of 6,602 patients were enrolled in the study. The observed mortality was 8% (531/6,602), whereas mortality predicted by Pediatric Index of Mortality 3 was 6.16% (407 deaths). The standardized mortality rate was 1.3 (95% CI, 1.20-1.42). The area under the receiver operating characteristic curve was 0.83 (95% CI, 0.82-0.85). The Hosmer-Lemeshow test showed that the difference between the mortality observed and the mortality predicted by Pediatric Index of Mortality 3 was statistically significant (χ, 135.63; p < 0.001). CONCLUSIONS: The Pediatric Index of Mortality 3 score adequately discriminated patients who died from those who survived in our population. However, the observed mortality was higher than predicted by the score. The use of an updated instrument such as Pediatric Index of Mortality 3 will allow an actual comparison between pediatric intensive care provided in the country and care provided internationally. This might also allow future planning of pediatric intensive care services in Argentina.

[Community-acquired methicillin-resistant Staphylococcus aureus infections in children: multicenter trial]. / Estudio multicéntrico sobre las infecciones pediátricas por Staphylococcus aureus meticilino-resistente provenientes de la comunidad en la Argentina.

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.

Estudio multicéntrico sobre las infecciones pediátricas por Staphylococcus aureus meticilino resistente provenientes de la comunidad en la Argentina / Community acquired methicillin resistant Staphylococcus aureus infections in children: multicenter trial

En los últimos años se ha informacion diversas partes del mundo la aparición deinfecciones extrahospitalarias causadas por S.aureus resistentes a la meticilina (SAMRC). Losdatos de nuestro país son muy escasos y de informesindividuales.Objetivo. Determinar la frecuencia, las característicasclínicas y la evolución final de las infeccionescausadas por SAMRC.Material y métodos. Estudio prospectivo y multicéntricode vigilancia de las infecciones extrahospitalariaspor S. aureus en niños de la Argentina. Seincluyeron niños con alguna infección clínica y microbiológicamentedocumentada por S. aureus. Lasensibilidad a los antibióticos de las cepas aisladasse investigó según normas NCCLS.Resultados. Entre 11/2006 y 11/2007 se diagnosticaron840 infecciones por S. aureus. De ellas, 582(69 por ciento) fueron comunitarias. Se excluyeron 135 niñoscon enfermedad de base o internación previa enhospitales. Para el análisis se incluyeron 447 infecciones,de las cuales 281 (62 por ciento) fueron causadas porSAMRC. La mediana de edad fue de 36 meses (r: 1-201). Un 60 por ciento fueron varones. Prevalecieron lasinfecciones de piel y partes blandas (62 por ciento). Las infeccionesosteoarticulares, el empiema pleural y laneumonía fueron las formas invasivas más frecuentes.El 18 por ciento presentó bacteriemia y el 11 por ciento sepsis. El10 por ciento de las cepas fue resistente a clindamicina y el1 por ciento a trimetoprima-sulfametoxazol. Sólo el 31 por ciento tuvoun tratamiento concordante al ingreso. La medianade retraso en el tratamiento adecuado fue de 72 h. Lamediana del tratamiento parenteral fue de 6 días (r:1-70). El 72 por ciento requirió tratamiento quirúrgico, principalmentedrenaje de colecciones purulentas (87 por ciento).Fallecieron 3 niños (1 por ciento).Conclusiones. La tasa de infecciones causadas porSAMRC es alta en niños de nuestro país. Esto constituyeun alerta epidemiológico, particularmentepara los pediatras.