C. Rodrigo Gonzalo de Liria

Meningitis neumocócica en niños españoles: incidencia, serotipos y resistencia antibiótica. Estudio prospectivo multicéntrico

Objetivo Conocer la incidencia, asi como los serotipos implicados y los patrones de resistencia antibiotica de meningitis producidas por Streptococcus pneumoniae en ninos espanoles. Material y metodo Estudio prosp ectivo, multicentrico, realizado en 5 comunidades autonomas (Cataluna, Galicia, Madrid, Navarra y Pais Vasco) a lo largo de 1 ano (1 de febrero de 2000 a 31 de enero de 2001). Se incluyeron todos los ninos entre 0 y 14 anos con meningitis neumococica diagnosticados por sintomatologia y liquido cefalorraquideo (LCR) sugerente con aislamiento de S. pneumoniae en LCR/sangre por metodos habituales o por tecnica de reaccion en cadena de la polimerasa (PCR), de la totalidad de hospitales de las comunidades autonomas estudiadas. La serotipia se realizo mediante la reaccion de quellung y/o immunoblotting y susceptibilidad a antibioticos por la tecnica de dilucion en agar. La poblacion infantil de 0–14 anos de estas comunidades es de 2.290.304 ninos. Resultados Se encontraron 52 casos. Uno tenia menos de 2meses de edad, 25 (48 %) entre 2 y 12 meses y 12 (23 %) entre 12 y 24 meses. La incidencia anual por 100.000 ninos en el primer y segundo ano de vida fue de 17,75 casos (intervalo de confianza [IC] al 95 %, 11,59–26,01) y 8,39 casos (IC 95 %, 4,67–15,79) respectivamente, siendo en los primeros 2 y 5 anos de vida de 13,13 (IC 95 %, 9,29–18,02) y 6,29 (IC 95 %, 4,57–8,45) casos, respectivamente. Casi la mitad de las cepas aisladas (47,6 %) mostraron sensibilidad disminuida a la penicilina. El serotipo 19F fue el mas frecuente (12 casos: 28,6%). El 80 % de los serotipos aislados estuvieron incluidos en la formulacion de la vacuna conjugada heptavalente. Conclusion La incidencia de meningitis neumococica en ninos de las 5 comunidades autonomas espanolas es elevada, casi el doble que la encontrada en un estudio previo de diseno retrospectivo, realizado en la misma poblacion 1–3 anos antes. Casi todos los serotipos aislados estan incluidos en la vacuna conjugada heptavalente. La mitad de las cepas mostraron sensibilidad disminuida a la penicilina.

Vacunación antigripal universal en pediatría, ¿sí o no?

INTRODUCTION The recommendations on influenza vaccination are not homogeneous between countries, with striking differences between the current recommendations in United States and Europe. OBJECTIVE The objective of the study is to determine the efficacy, effectiveness and safety of the current flu vaccine (trivalent inactivated vaccine and adapted to the cold [LAIV] live virus vaccine) in healthy children, and to try and answer the following question: universal immunization against influenza in Paediatrics, yes or no? MATERIAL AND METHODS A scheme of work based on the five standard steps of evidence or science-based medicine was used: 1) question, 2) search, 3) valuation, 4) applicability and 5) adequacy. RESULTS Nine systematic reviews, published between 2005 and 2012, were selected that answered our clinical question, and which included the best available information (randomised clinical trials, cohort studies and case studies). CONCLUSIONS The flu vaccine in childhood has the right cost - benefit - risk relationship. In all systematic reviews the efficacy of the flu vaccine varied between 58%-65%, and effectiveness between 28%-61%. Both efficacy and effectiveness increase with age, and there are limited studies showing sufficient evidence in children < 2 years. There are further areas to develop: more and better clinical trials on influenza vaccines in infants from 6 to 23 months; further research to achieve better influenza vaccines (addition of adjuvants, higher doses in children between 6 and 23 months, and study the LAIV vaccine in children between 6 and 23 months); and improvement in the prediction of vaccine strains responsible for the outbreak.

Cuál es la importancia de la erradicación bacteriana en el tratamiento de la infección respiratoria

During the last few years, increasing antibiotic resistance amongst the major respiratory pathogens in the community has compromised the choice of empirical therapy for some respiratory tract infections. Of special interest has been the progressive increase in the resistance rates of Streptococcus pneumoniae to macrolides and penicillin, and of S. pyogenes to macrolides. Several studies have confirmed the association between community use of certain antibiotics and the development of resistance in S. pneumoniae and S. pyogenes. Nevertheless, not all the antibiotics have the same ability to select resistance and not all microorganisms are affected in the same way. The aim of antimicrobial therapy in respiratory tract infections is bacterial eradication. Pharmacokinetic and pharmacodynamics can be used to predict bacteriological eradication with antimicrobial therapy.

Hemocultivos en urgencias pediátricas. Guía práctica de recomendaciones: indicaciones, técnica de extracción, procesamiento e interpretación

Blood culture (BC) is the gold standard when a bacteraemia is suspected, and is one of the most requested microbiological tests in paediatrics. Some changes have occurred in recent years: the introduction of new vaccines, the increasing number of patients with central vascular catheters, as well as the introduction of continuous monitoring BC systems. These changes have led to the review and update of different factors related to this technique in order to optimise its use. A practice guideline is presented with recommendations on BC, established by the Spanish Society of Paediatric Emergency Care and the Spanish Society for Paediatric Infectious Diseases. After reviewing the available scientific evidence, several recommendations for each of the following aspects are presented: BC indications in the Emergency Department, how to obtain, transport and process cultures, special situations (indications and interpretation of results in immunosuppressed patients and/or central vascular catheter carriers, indications for anaerobic BC), differentiation between bacteraemia and contamination when a BC shows bacterial growth and actions to take with a positive BC in patients with fever of unknown origin.

Calendario vacunal de la Asociación Española de Pediatría (AEP) 2001-2002

La Asociación Española de Pediatría creó en 1994 el Comité Asesor de Vacunas con el fin de asesorar a los pediatras en temas vacunales y realizar recomendaciones de calendario vacunal. Las últimas recomendaciones son para el período 2001-2002, en las que lo más significativo es la indicación de la vacunación con vacuna antipoliomielítica inactivada (VPI) en sustitución de la vacuna oral atenuada (VPO). Se incide nuevamente en la conveniencia de incluir la vacuna contra la varicela en los esquemas vacunales del niño sano.