ABSTRACT
Las infecciones de piel y partes blandas (IPPB) en niños son una de las principales causas de prescripción de antimicrobianos. El objetivo del estudio fue describir las características clínicas y microbiológicas de las IPPB ambulatorias de niños asistidos en dos hospitales zonales. Se realizó un estudio prospectivo entre el 1/11/2017 y el 1/11/2018. Se incluyeron pacientes entre 1 mes y 15 años internados en dos hospitales. Se evaluó: edad, sexo, localidad, factores predisponentes, tipo de IPPB, muestras biológicas realizadas, aislamiento microbiológico, tratamiento empírico indicado y evolución del cuadro. Se realizó antibiograma y determinación genética. Se calculó chi2, IC95, OR; α=5%. N= 94. 58,7% masculinos. 12 pacientes <1 año, 85 >1 año (promedio de edad 4 años, 1-15). El 36% de Tandil y 63,8% de Florencio Varela. El 59,6% corresponden a IPPB purulentas. Se aislaron microorganismos en un 59,6%. Los aislamientos principales: SAMR (40,4%), SAMS (7,4%), S. agalactiae (2,1%) y S. pyogenes (2,1%). El 100% de SAMR son portadores de gen mecA y SCCmec tipo IV, sin multirresistencia. No hubo diferencia estadística entre los factores de riesgo evaluados para el desarrollo de IPPB por SAMR. El 52,1% de los niños recibió tratamiento antibiótico combinado, siendo la más indicada TMS-SMX + CLI en 36 eventos. (38,3%). La evolución fue favorable: no hubo diferencia significativa entre el subgrupo que se aisló SAMR y el que no se aisló SAMR; 91,9% (34/37) y 92,6% (50/54) correspondientemente (chi2: 0,01; p= 0,97 IC95: 0,26-3,88). El principal agente etiológico fue SAMRco, debiendo adecuar los tratamientos a este microorganismo.
Skin and soft tissue infections (SSIs) in children are one of the main causes of antimicrobial prescription. The aim of the study was to describe the clinical and microbiological characteristics of outpatient SSIs in children attended in two hospitals. A prospective study was conducted between 11/1/2017 and 11/1/2018. Patients between 1 month and 15 years old, hospitalized were included. We evaluated: age, sex, locality, predisposing factors, type of IPPB, biological samples taken, microbiological isolation, empirical treatment indicated and evolution of the condition. An antibiogram and genetic determination were performed. Chi2, CI95, OR; α=5% were calculated. N= 94. 58.7% male. 12 patients <1 year, 85 >1 year (mean age 4 years, 1-15). 36% were from Tandil and 63.8% from Florencio Varela. 59.6% corresponded to purulent SSIs. The diagnostic yield was 59.6%. Main isolates: MRSA (40.4%), MSSA (7.4%), S. agalactiae (2.1%) and S. pyogenes (2.1%). 100% of MRSA carried the mecA gene and SCCmec type IV, with no multidrug resistance. There was no statistical difference between the risk factors evaluated. 52.1% of children received combined antibiotic treatment, the most indicated being TMS-SMX + CLI in 36 events. (38,3%). Evolution was favorable: there was no significant difference between the subgroup that isolated MRSA and the subgroup that did not isolate MRSA; 91.9% (34/37) and 92.6% (50/54) respectively (chi2: 0.01; p= 0.97 CI95: 0.26-3.88). The main etiological agent was MRSA, and treatments should be adapted to this microorganism
Subject(s)
Humans , Male , Female , Infant, Newborn , Infant , Child, Preschool , Child , Adolescent , Skin Diseases, Infectious/microbiology , Staphylococcal Infections/microbiology , Staphylococcus aureus/isolation & purification , Soft Tissue Infections/microbiology , Skin Diseases, Infectious/drug therapy , Staphylococcus aureus/genetics , Logistic Models , Prospective Studies , Risk Factors , Soft Tissue Infections/drug therapy , Drug Therapy, Combination , Methicillin-Resistant Staphylococcus aureus/isolation & purification , Methicillin-Resistant Staphylococcus aureus/genetics , Anti-Bacterial Agents/therapeutic useABSTRACT
Reportamos el caso de un ninÌo con diagnoÌstico de Sepsis a foco gastrointestinal que evoluciona de manera desfavorable con compromiso respiratorio. Ya instaurados tratamientos de sosteÌn, se evaluÌa cuadro cliÌnico en contexto de epidemiologiÌa positiva para contacto con roedores, presentando serologiÌa Virus Andes reactiva.
We report the case of a child with Sepsis and gastrointestinal focus that evolves unfavorably with respiratory compromise. Once supportive treatments have been established, the clinical picture is evaluated in the context of positive epidemiology for contact with rodents, presenting reactive Andes Virus serology.
Subject(s)
Hantavirus Infections , Pediatrics , Gastrointestinal TractSubject(s)
Humans , Infant, Newborn , Infant , Child, Preschool , Child , Neonatology , Pediatrics , Perinatology , Internship and Residency , Internship and Residency/legislation & jurisprudence , Internship and Residency , Internship and Residency/methods , Internship and Residency/standards , Internship and Residency/statistics & numerical data , Internship and Residency/trendsABSTRACT
Paciente de 14 años, con dolor abdominal en la fosa ilíaca izquierda, al que se le diagnosticó hematoma del psoas, con sospecha de sobreinfección. Se describe esta patología, y aspectos de su tratamiento.