ABSTRACT
Objetivo. Establecer la incidencia de infección respiratoria y los patrones de colonización faríngea en niños que asisten a guarderías. Material y métodos. Se realizó un estudio de cohorte en niños menores de cuatro años de edad, de uno u otro sexo, asistentes a la guardería del Hospital Infantil de México Federico Gómez, de la Ciudad de México, durante abril a octubre de 1999. Se registró la presencia de infección de vías aéreas superiores cada semana, y de colonización cada tres meses, mediante un exudado nasofaríngeo. Se hizo estadística descriptiva de las variables analizadas. Se determinaron tasas de infección respiratoria aguda. Resultados. Se estudiaron 85 niños, 40 del sexo femenino (47 por ciento) y 45 del sexo masculino (53 por ciento) durante un total de 9 090 niños/día de seguimiento. Tres niños tenían antecedentes de atopia (3.52 por ciento), seis niños antecedentes de asma (7.05 por ciento), y 39 eran expuestos a tabaquismo pasivo (45.88 por ciento). Se diagnosticaron 246 rinofaringitis (95.3 por ciento), nueve otitis media aguda (3.48 por ciento), tres bronquiolitis (1.16 por ciento), para un total de 258 eventos de infección respiratoria aguda. La tasa de incidencia global fue de 10.35 infecciones por niño/año de observación (IC 95 por ciento 8.7-12.0). La incidencia de otitis y bronquiolitis fue de 0.36 y 0.12 eventos por niño/año de observación. Se tomaron cultivos nasofaríngeos con una prevalencia de colonización para S. pneumoniae de 20.4 por ciento, H. influenzae no tipificable 13.1 por ciento y Moraxella catarrhalis 8.1 por ciento. Conclusiones. Los resultados no sólo demuestran una alta prevalencia de colonización debido a cepas invasivas, sino que también revelan una tasa de incidencia de infección respiratoria aguda del doble de lo reportado en estudios de comunidad. Estos resultados ayudan a caracterizar un problema pobremente documentado en nuestro país.
Objective. To assess the incidence of acute respiratory infections and bacterial colonization in children attending a daycare center. Material and Methods. A cohort study was conducted from April to Octuber 1999, among 85 children aged under four years, who attended the daycare center at Hospital Infantil de Mexico (Mexico City's Children's Hospital) "Federico Gómez". Acute respiratory infection incidence rates and quarterly point prevalence figures of nasopharyngeal colonization were obtained. Data were analyzed using descriptive statistics. Results. A total of 85 children were studied (40 girls and 45 boys) during 9 090 children-days of follow-up. Three children had a history of atopia (3.5 percent), six a history of asthma (7. percent), and 39 (46 percent) were exposed to passive smoking. There were 258 events of respiratory tract infection for an incidence rate of 10.3 infections per person-year (95 percent CI 8.7-12.0). The main clinical syndromes were pharyngitis (95 percent), acute otitis media (3.5 percent), and bronchiolitis (1 percent). The incidence rates of otitis and bronchiolitis were 0.36 and 0.12 per child-year of observation, respectively. The prevalence figures of nasopharyngeal colonization for the three main bacteria were: S. pneumoniae 20.4 percent; nontypable H. influenzae 13 percent; and Moraxella catarrhalis 8 percent. Conclusions. Study results show a high prevalence of colonization due to invasive strains, as well as a two-fold incidence rate of acute respiratory infection, higher than those reported in community surveys. These results add to the description of this poorly documented infectious disease in Mexico.
Subject(s)
Child, Preschool , Female , Humans , Infant , Male , Respiratory Tract Infections/epidemiology , Acute Disease , Child Day Care Centers , Cohort Studies , Follow-Up StudiesABSTRACT
OBJECTIVE: To define epidemiologic relationships to determine the prevalence and potential risk factors for nasopharyngeal colonization by antibiotic-resistant pneumococci, their serotypes and their antibiotic susceptibility patterns in children attending a daycare center (DCC). MATERIAL AND METHODS: A prospective cohort study was conducted among children (n = 53) attending the DCC at Hospital Infantil de MÚxico Federico Gómez, which is staffed by 20 employees. Patients were enrolled in the study during a two-year period from September 1997 to September 1999. All the participants were followed prospectively, swabbing them every four months. The strains recovered were typed and screened for susceptibility to several antibiotics. The daycare records were reviewed also. Odds ratios and fisher's exact test: or chi square test of significance were computed from contingency tables as appropriate. Exact 95 confidence intervals were computed for odds ratios. Data analysis was performed using Epi statistics program version 6.04 a. RESULTS: Pneumococci were recovered from 45/53 of the infants at one or more visits. A total of 178 isolates were carried. The carriage rate was 47. Only 7 adults acquired pneumococci during the study. Types 6, 14, 19 and 23 were prevalent and represented 77 of the total. Antibiotic-resistant strains were higher to penicillin and erythromycin. CONCLUSIONS: Children were frequent carriers of pneumococci, the rate of carriage was high in infancy and tended to decrease with age. The types commonly carried by children were the same as those causing invasive disease. There is a high proportion of carriers with antibiotic-resistant S. pneumoniae strains. Children who have had frequent antimicrobial courses are at particular risk.