Guadalupe Pérez

Motivos de la prescripción inadecuada de antibióticos en un hospital pediátrico de alta complejidad

OBJETIVO: Determinar los motivos de la prescripcion inadecuada de antibioticos y detectar oportunidades de mejorar la prescripcion de dichos medicamentos en el caso de pacientes pediatricos hospitalizados en unidades de cuidados intermedios e intensivos. METODOS: Estudio prospectivo, descriptivo y longitudinal de pacientes pediatricos internados en unidades de cuidados intermedios e intensivos que recibian antibioticos por via parenteral, con excepcion de los recien nacidos, pacientes de la unidad de quemados y pacientes en profilaxis quirurgica. Se realizo un analisis univariado y regresion logistica multiple. RESULTADOS: Se estudio a 376 pacientes, con una mediana de edad de 50 meses (rango intercuartilo [RIC] 14,5-127 meses). Del total de pacientes estudiados, 75,0% tenia una enfermedad de base o mas. De esos ultimos, 40,6% tenia una patologia oncologica y 33,5%, neurologica; el restante 25,9% presentaba otras enfermedades de base. El tratamiento antibiotico fue inadecuado en 35,6% de los pacientes estudiados (n = 134). En 73 (54,4%) de los 134 casos, el uso inadecuado se debio al tipo de antibiotico recetado, la dosis administrada o la duracion del tratamiento. Los 61 (45,5%) casos restantes no tenian indicacion de tratamiento antibiotico. En el analisis multivariado, los factores de riesgo de uso inadecuado de antibioticos fueron: la administracion de ceftriaxona: OR 2 (IC 95% 1,3-3,7; P = 0,02); infeccion agudade vias respiratorias inferiores: OR 1,8 (IC 95%1, 1-3,3; P < 0,04); la aparicion de fiebre sin foco en el paciente internado: OR 5,55 (IC 95% 2,5-12; P < 0,0001) y la neutropenia febril OR 0,3 (IC 95% 0,1-0,7) P = 0,009. CONCLUSIONES: Los cuadros clinicos mejor caracterizados presentaron menor uso inadecuado de antibioticos. Se identificaron practicas de prescripcion que podrian ser mejoradas mediante la elaboracion y difusion de guias de manejo del uso de antibioticos en pacientes internados.

Community-acquired Staphylococcus aureus bacteremia in children: a cohort study for 2010-2014.

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.

Fungal infections in a pediatric burn care

OBJECTIVE Retrospective description of fungal infections in a specialized intensive care burn unit. RESULTS A total of 41 (21%) of 195 patients admitted from January 2002 to March 2006 developed fungal infections at any site. The median age of patients was 48 months (interquartile range: 18-84), and the affected burn surface was 40% (interquartile range 30 and 65% The median time lapse between admission and fungal infections was 13 days (interquartile range 8-20 d) The most frequent site of isolation was burnt wound in 38 patients (93%) and in blood cultures in 3 patients (7%). In 93% of patients bacterial infections were also found. The predominant fungus recovered was Candida spp in 20 patients (49%); followed by Aspergillus sp in 6 patients (15%), Anphotericin B was the drug of choice. The median time of complete treatment was 23 days (interquartile range: 15-30). One patient died (2%) from causes related to fungal infection. CONCLUSION A total of 41 (21%) of 195 patients admitted from January 2002 to March 2006 developed fungal infections. Candida sp was the most frequently found. Mortality was low.

Is Trimethoprim-Sulfamethoxazole a Valid Alternative in the Management of Infections in Children in the Era of Community-Acquired Methicillin-Resistant Staphylococcus aureus? A Comprehensive Systematic Review

Objective. To evaluate the use of TMP-SMX compared with other options available for the treatment of children with community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) infections. Data Sources. The following databases were searched: Medline and PreMedline (OivdSP interface); Excerpta Medica Database (EMBASE; Elsevier interface); Cumulative Index to the Nursing and Allied Health Literature (CINAHL; EbscoHost interface); Sciences Citation Index Expanded (SCI-EXPANDED; Web of Science interface); Cochrane Library (Wiley interface); Scopus (Elsevier interface), and DARE, HTA (CRD interface). The search strategy was the one developed by SIGN to identify randomized clinical trials and systematic reviews. Also, we conducted a hand review of all reference lists of included studies. No language or data limits were added. The last search was done on October 1, 2015. Main key words were trimethoprim or trimethoprim-sulfamethoxazole combination and Staphylococcus aureus. Study Selection. Only randomized controlled trials comparing TMP-SMX versus any other antibiotic as the first-line treatment in CA-MRSA infections in children were included. Articles were reviewed by 2 reviewers, and in case of discrepancy, the final decision was made by the study coordinator. Data Extraction. Only 27 out of 364 articles identified were randomized controlled trials and only 4 fulfilled the eligibility criteria (Jadad score >3). Data Synthesis. Evidence found only referred to use of TMP-SMX in soft tissue infections. Heterogeneity among studies precluded meta-analysis. Conclusions. Available evidence is not conclusive to promote or refuse TMP-SMX as first-line treatment in CA-MRSA infections in children. Additional well-designed studies are required to fsurther elucidate this issue.

695Bone and Joint Infections in Children in the Era of Community- Acquired Meticillin- Resistant S. aureus

Acquired MeticillinResistant S. aureus Maria Teresa Rosanova, PhD; Sandra Gimenez; Rosa Bologna; Ana Buchovsky; Griselda Berberian, MD; Natalia Escudé; Guadalupe Perez; Claudia Sarkis; Jose L Pinheiro; Roberto Lede; Epídemiology and Infectious Diseases, Hospital de Pediatria JP Garrahan, Buenos Aires, Argentina; Hospital J P Garrahan, Buenos Aires, Argentina; Epidemiology and Infectious Diseases, Hospital J P Garrahan, Buenos Aires, Argentina; Epidemiology and Infectious Disease, Hospital de Pediatría Juan P. Garrahan, Buenos Aires, Argentina; Hospital J. P. Garrahan, Buenos Aires, Argentina; Universidad Abierta Interamericana (UAI), Buenos Aires, Argentina