ABSTRACT
Background: Invasive fungal infections (IFI) cause prolonged hospitalizations and increase the possibility of death among patients with cancer and febrile neutropenia (FN). Up to 10 percent of febrile neutropenic episodes may be caused by IFI. Aim: To estimate the incidence of IFI among a large group of Chilean children with cancer and FN. Patients and Methods: Clinical and laboratory information was collected from a data base provided by the "Programa Infantil Nacional de Drogas Antineoplásicas" (PINDA) that included 445 FN episodes occurring in five hospitals in Santiago, Chile. This information was used to identify children that presented with signs and symptoms compatible with an IFI. According to predefined criteria based on a literature review, IFI episodes were categorized as "proven", "probable" or "possible". Results: A total of 41/445 episodes (9.2 percent) were compatible with an IFI of which 4 (0.9 percent) were proven, 23 (5.2 percent) probable, and 14 (3.1 percent) possible. Hospitalization was longer (27 vs 8 days, p <.01), new infectious foci appeared with higher frequency (71 vs 38 percent, p <.01), and mortality was higher (10 vs 1.6 percent, p <.001) in children with IFI compatible episodes, when compared to children who did not have an IFI. Conclusions: The estimated incidence of IFI in Chilean children with cancer and FN ranged between 6-9 percent depending on the stringency of criteria selection used for classification. This estimate is similar to that reported by other studies. The low detection yield of clinically compatible IFI underscores the need of improved diagnosis of fungal infections in this population
Subject(s)
Humans , Male , Child, Preschool , Adolescent , Female , Mycoses , Neoplasms , Fungemia , Fever , Mycoses , Neutropenia , Antineoplastic Agents/adverse effectsABSTRACT
Background: Penicillin and third generation cephalosporin resistant pneumococcal isolates have emerged in Chile, mainly in the pediatric population. These isolates complicate therapeutic alternatives, specially among patients with central nervous system infections. Aim: To assess the frequency of penicillin and third generation cephalosporin resistance among isolates obtained from pediatric patients with invasive pneumococcal infections, and to study serotypes and clinical risk factors associated with resistance. Material and methods: Microbiological isolates obtained from children between April 1994 and May 1999 with pneumococcal invasive infections, were serotyped and analyzed according to their susceptibility to penicillin and cefotaxime by E-test and broth microdilution testing. Potential risk factors studied included patient's age, previous antibiotic use or admissions, comorbidity, and serotypes. Results: Seventy eight patients were studied. Penicillin-resistant pneumococcal isolates were detected in 35.9 percent of cases (21.8 percent with intermediate and 14.1 percent with high level resistance) without significant variation among different clinical conditions. Most of the high level penicillin-resistant pneumoccocal isolates had MIC ü4 µg/mL (8 out of 11 strains). One third of penicillin-resistant isolates also expressed cefotaxime resistance. Multivariate analysis indicated an age ²36 months (OR=6.8; IC 95 percent: 1.4 to 33.5) and serotype 14 (OR=6.3; IC 95 percent: 1.7 to 23.3) as factors associated with penicillin resistance. Conclusions: One third of the invasive pneumococcal isolates obtained from pediatric patients were resistant to penicillin. Risk factors involved a younger age and pneumococcal isolates belonging to serotype 14
Subject(s)
Humans , Male , Female , Infant , Child, Preschool , Streptococcus pneumoniae , Penicillin Resistance , Microbial Sensitivity Tests , Cefotaxime , Risk Factors , Pneumococcal Infections/drug therapyABSTRACT
Background: Pediatric patients in treatment for cancer can have fatal bacterial infections. Thus, in the presence of fever or other signs infection, antimicrobials have to be prescribed empirically. Aim: To know the causative agents of bacteremia in children with cancer, their changes with time and between different hospitals and their patterns of susceptibility. Material and methods: We reviewed the blood cultores of children with cancer in five hospitals of Santiago, from 1994 at 1998. Results: During the study period, 707 agents were isolated. The most frequently isolated species or genus were coagulase negative Staphylococcus (43 percent), Staphylococcus aureus (16 percent), Escherichia coli (9 percent), Klebsiella spp. (8 percent), Pseudomonas spp. (5 percent) and Candida spp. (4 percent). Coagulase negative Staphylococcus was 55 percent resistant to meticilin and S. aureus was 44 percent resistant. Enterobacteriae had 15 percent resistance to gentamicin and amikacin, 2 percent to imipenem, 26 percent to ceftriaxone, 21 percent to cefotaxim and 20 percent to ceftazidim. Among non fermenting agents resistance was 6 percent for imipenem, 9 percent for amikacin 10 percent for ciprofloxacin, 19 percent for ceftazidim and 22 percent for cefoperazone. The resistance of Streptococcus spp. (non pneumoniae) to penicillin reached 50 percent and that of Enterococcus spp. was of 33 percent. Conclusions: Treatment for pediatric patients with cancer must be modified and new guidelines including more active medications for patients at risk for bacteremia, should be devised
Subject(s)
Humans , Male , Female , Bacteremia , Neoplasms , Bacteria , Anti-Bacterial Agents/therapeutic useABSTRACT
La infeccióm del tracto urinario (ITU), patología infecciosa altamente prevalente, debe ser confirmada por un diagnóstico microbiológico. El Comité de Microbiología Clínica de la Sociedad Chilena de Infectología realizó una encuesta retrospectiva para conocer la situación actual de algunos laboratorios asistenciales sobre metodología y criterios diagnósticos empleados empleados en el diagnóstico de ITU. Respondieron la encuesta 15 centros hospitalarios y laboratorios privados recopilándose información sobre 49.632 urocultivos. Es destacable que la totalidad de los laboratorios consideraron como criterio microbiológico de ITU un recuento microbiano > 100.000 ufc/ml. No fue posible analizar datos con recuentos inferiores por no disponerse de datos métodos sobre obtención de muestra, resultados del estudio microscópico (sedimiento urinario) concominate y sintomatología clínica. Utilizando este criterio diagnóstico la positividad varió entre 2,3 por ciento en varones y 33 por ciento en mujeres, porcentajes con una mayor dispersión en niños. Sólo 13 por ciento de las intituciones procesaron la muestra de orina en conocimiento del tiempo transcurrido desde la obtención de la muestra. Todos los laboratorios utilizaron el mismo criterio para considerar contaminada una muestra: > 3 microorganismo; algunos de ellos registraron 17 por ciento de contaminación. Si bien esta encuesta fue retrospectiva limitando la calidad del diagnóstico de situación, ella motivó al Comite de Microbiología Clínica a elaborar recomendaciones para el diagnóstico microbiológico de la infección urinaria
Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Urinary Tract Infections/diagnosis , Urine/microbiology , Colony Count, Microbial , Data Collection/statistics & numerical data , Retrospective Studies , Sedimentation , Bacteriological Techniques/statistics & numerical data , Urinalysis/methodsABSTRACT
La septicemia representó el 7,2% (58 casos) de la morbilidad en la UCIN del Hospital Roberto del Río en 1990-91. En la mitad de los pacientes la infeción fue intercurrente: el 75,9% era del sexo masculino, el 59% pesaban al nacer menos de 2500 g (5<1000), el microorganismo más frecuentemente aislado fue el S. aureus seguido del S. coagulasa-negativa. En los RN diminutos, los oportunistas, la mayor parte de las cepas eran sensibles a amikacina, todas a vancomicina. Se encontró cierta asociación entre: S. coagulasa-negativa y enterocolitis necrotizante, entre S. grupo B y meningitis, entre S. aureus y artritis, y entre enterobacterias y urosepsis. La mortalidad alcanzó al 50%, mayor (no significativo), en las formas intercurrentes, en los niños de peso inferior a 1000 g y en la septicemias asociadas a enfermedades básicas graves