Tamara Viviani S

Tratamiento intravenoso inicial abreviado en 70 pacientes pediátricos con infecciones osteo-articulares

Las infecciones osteoarticulares (IOA) son poco frecuentes en pediatria. Existe controversia acerca de la optima duracion y la via de administracion de la terapia antimicrobiana. Objetivo: Caracterizar y describir la evolucion y complicaciones en ninos con IOA que recibieron 7 dias iniciales de terapia endovenosa, completando 4 a 6 semanas de terapia total. Pacientes y Metodos: Estudio descriptivo, que incluyo a 70 ninos con diagnostico de IOA, entre marzo de 2003 y diciembre de 2004 en un hospital pediatrico, quienes recibieron tratamiento endovenoso abreviado a 7 dias, seguido de terapia oral por 3 a 5 semanas. Resultados: La incidencia de IOA fue de 1,8: 10.000 ninos bajo 15 anos de edad. El promedio de edad fue 6,4 ± 4,4 anos. Sesenta por ciento presentaba artritis septica, 36% osteomielitis y 4% osteoartritis. En 80% la infeccion se localizo en extremidades inferiores. Los cultivos fueron positivos en 59%. En 46,5% se aislo Staphylococcus aureus. Siete ninos evolucionaron con dolor persistente o elevacion significativa de PCR y requirieron prolongar la terapia endovenosa y/o total, sin presentar complicaciones a corto plazo. Conclusiones: Siete dias de terapia antimicrobiana intravenosa parece ser efectivo y recomendable para el tratamiento, en su fase inicial, de las infecciones osteo-articulares

Tratamiento selectivo de los episodios de neutropenia febril en niños con cáncer: Comité de Infectología, Programa Infantil Nacional de Drogas Antineoplásicas (PINDA)

El manejo de los pacientes pediatricos con cancer y neutropenia febril (NF) requiere de su clasificacion en alto o bajo riesgo de adquirir infecciones bacterianas invasoras (IBI), con el fin de implementar estrategias selectivas de tratamiento. Basados en nuestra experiencia y publicaciones internacionales al respecto, proponemos recomendaciones para el diagnostico y manejo de ninos con cancer y NF, categorizadas segun riesgo de IBI. Todos los pacientes pediatricos que presenten episodios de NF deben ser ingresados al hospital por al menos 24 horas. Durante este lapso se efectuara su evaluacion clinica y de laboratorio con el objeto de clasificar el riesgo de este episodio y precisar el (los) posible(s) foco(s). Los pacientes de alto riesgo deben continuar internados hasta su recuperacion. Los de bajo riesgo pueden ser manejados en forma ambulatoria. La eleccion de la terapia antimicrobiana inicial y los criterios para su ajuste deberan basarse en el hallazgo o no de focos infecciosos y en los patrones epidemiologicos e institucionales de susceptibilidad. La reevaluacion de ambos grupos debe ser periodica (al menos en los dias 3, 5 y 7 de evolucion), y la respuesta terapeutica sera clasificada como favorable o desfavorable segun criterios clinicos y parametros de laboratorio preestablecidos

Manejo de la infección del tracto urinario en lactantes febriles: Experiencia de tratamiento antimicrobiano intravenoso ambulatorio

Objective: To describe the feasibility, effectiveness and safety of intravenous (iv) outpatient treatment in 2 to 24 month-old children with febrile urinary tract infection (UTI). Method: Children presenting to the ER, between April 2003-2005, with fever and no identifiable focus who had a diagnosis of UTI were randomized to receive iv antibiotic in the hospital or in an outpatient facility. Children were started on amikacin or ceftriaxona according to physician criteria followed by antimicrobial adjustment based on urine culture result and a later switch to an oral antimicrobial. Urine cultures were performed during and after completing the antimicrobial course. Adherence and effectiveness of antimicrobial treatment and treatment-associated complications were analyzed. Results: The study included 112 patients, 58 inpatient children and 54 outpatient children, with an average age of 7.7 months. Duration of iv treatment did not differ among groups (2.8 days (SD 1.2) 2.7 +0.91 days in inpatients vs 2.9 + 1.9 days in outpatients (p = 0.22). In 100% of outpatient children and 100% of inpatient children (overall 101/101) urine cultures were negative on day 5. None of the children had a treatment-associated complication. Cost analysis yielded 73% of saving money (overall cost for inpatient treatment US 9,815 vs outpatient treatment US 2,650). Conclusions: Outpatient iv treatment in patients between 2 and 24 months with UTI and fever was effective, safe and of lower cost

Compromiso pulmonar en la infección por virus de inmunodeficiencia humana en niños

Pulmonary complications in children infected by human immunodeficiency virus (HIV) are common and may be the first manifestation of acquired immunodeficiency syndrome (AIDS). The aim of our study was to review pulmonary diseases and complications in pediatric patients with HIV infection in a large tertiary hospital in Santiago, Chile. We performed a retrospective, descriptive analysis of 17 patients with HIV infection controlled at the Hospital Dr. Sotero del Rio. Respiratory complications/diseases were: overall pneumonia (n: 14), recurrent pneumonia (n: 10), citomegalovirus associated pneumonia (n: 4), Pneumocystis jiroveci associated pneumonia (n: 1) pulmonary tuberculosis (n: 1), lymphoid interstitial pneumonia (n: 3) and chronic pulmonary disease (n: 7). Microorganisms isolated were mostly atypical and frequently associated with severe and chronic pulmonary damage. A high degree of suspicion is required to detect atypical microorganisms promptly, in order to rapidly implement pathogen targeted therapy that could potentially decrease the possibility of sequelae.

Endocarditis por Streptococcus pneumoniae en niños: Presentación de un caso clínico y revisión de la literatura

Endocarditis caused by Streptococcus pneumoniae in children is an infrequent disease, corresponding to 3-7% of all cases of endocarditis. However, it is highly relevant because of its severity with the possibility of producing valvular ring abscesses and destruction, and high mortality that reaches up to 61% if medical and surgical treatment are not started early in the course of the illness. Over 50% of cases are associated to other sites of infection such as meningitis, pneumonia, sinusitis or mastoiditis. We report a 10-months-old infant who was admitted with meningitis and endocarditis due to S. pneumoniae, who presented with severe heart failure and required aortic valve replacement. A review of the literature of endocarditis caused by S. pneumoniae in pediatrics is presented.

Etiología del síndrome febril prolongado en niños

Etiology of Prolonged Fever in Children Background: Prolonged fever (PF) is an uncommon entity in children, produced by diverse etiologies that differ according to geographic areas and national socioeconomical status. Objective: To determine etiologic diagnosis of PF in children from the southeast area of Santiago. Methods: A prospectivedescriptive study performed in 35 patients with PF, age between 6 months - 15 years, referred to the Pediatrics Infectious Diseases Unit of Hospital Sotero del Rio during 2005 and 2006. Results: In 74% of cases an etiologic diagnosis was established, predominantly infectious diseases (68%) and rheumatologic disorders (6%). The most frequent infections observed were Bartonella henselae (17%), urinary tract infection (11%) and Epstein Barr virus infection (5.7%). Conclusions: PF in children from the southeast area of Santiago is caused by multiple etiologies, mainly infections with a high incidence of Bartonella

Síndrome febril sin foco y sospecha de infección bacteriana en niños entre 6 semanas y 36 meses

ABSTRACT Clinical presentation of Febrile Syndrome Without Apparent Focus and bacterialinfection suspicion in children between 6 weeks and 36 months-old Background: Unknown fever (UF) is a frequent pathology in children and its main etiology are viralinfections. The identification of bacterial infection with antibiotics requirements is still on debate. Objective:Determine the characteristics of patients with suspicion of an invasive bacterial infection (IBI) andevaluate the contribution of C reactive protein (CRP) and leukocytes with absolute neutrophyl count(ANC). Method: Prospective-descriptive study of 640 patients between 6 weeks and 36 months-old, withUF and IBI suspicion, admitted in Infectology from the Emergency Room of Hospital Sotero del Riobetween 2005 - 2007. Results: 53,7% of cases had a confirmed IBI, most commonly urinary tract infection(80,17%). A significantly difference was found between CRP, leukocytes and ANC, but the Roc curve didnot show a relevant difference. It was not possible to determine a specific level of CRP, leukocytes andANC for a better IBI discrimination.(Key words: Febrile syndrome, fever, antibiotics, CRP, ANC, urinary tract infection).Rev Chil Pediatr 2008; 79 (4): 388-392RESUMENIntroduccion: El sindrome febril sin foco (SFSF) es una patologia frecuente en ninos, su principal causason infecciones virales. La identificacion de los pacientes que requieren antibioticos, sigue siendo un temade debate. Objetivo: Evaluar parametros clinicos y de laboratorio y su utilidad para la decision deindicacion de antibiotico en ninos de 6 semanas a 3 anos que consultan al servicio de urgencia y sudiagnostico es un SFSF con sospecha de infeccion bacteriana. Pacientes y Metodos: Estudio descriptivoprospectivo realizado en 640 pacientes entre 6 semanas y 36 meses de edad, hospitalizados o derivados ainfectologia desde la urgencia del Hospital Dr. Sotero del Rio, en quienes se sospecho IBI, durante los anos