Infecciones por Chlamydia trachomatis en una unidad de cuidados intensivos neonatales / Chlamydia trachomatis infections in a neonatal intensive care unit

Las infecciones por Chlamydia trachomatis han aumentado su prevalencia, especialmente en jóvenes embarazadas. Esto adquiere relevancia en pediatría por el elevado riesgo de transmisión vertical al neonato y su potencial gravedad en el lactante. Estas infecciones requieren de un alto índice de sospecha, por cuadro clínico atípico y signos radiológicos inespecíficos. Los métodos diagnósticos convencionales presentan limitaciones para su detección. Las técnicas moleculares son las recomendadas por su elevada sensibilidad, especificidad y rapidez, lo cual permite una terapéutica adecuada y oportuna. En este estudio, desarrollado en una unidad de cuidados intensivos neonatales de un hospital de alta complejidad durante 12 años, se describieron las características de la población, su presentación clínica y evolución. La detección microbiológica se realizó por métodos moleculares. Se incluyeron 29 pacientes (p) con infección por C. trachomatis (3,9% del total de muestras enviadas),13 p con infección respiratoria y 16 p con compromiso ocular. La mediana de edad fue de 19 días al momento del diagnóstico y el 65% de las gestantes tenía <25 años. Veinticuatro p (83%) eran recién nacidos a término y 23 p (79%) previamente sanos. Nueve p (31%) presentaron fiebre al momento del ingreso y 12 (41%) eosinofilia. De los 13 p con enfermedad respiratoria, 9 (69%) consultaron por tos y 11 (85%) con hipoxemia, con requerimientos de oxígeno en 8 (61%), asistencia respiratoria mecánica en 3 (23%) y uno (16%) requirió ECMO. Los hallazgos radiológicos mostraron un patrón intersticial inespecífico. Nueve p (31%) presentaron coinfección y uno falleció asociado a influenza A (AU)

The prevalence of Chlamydia trachomatis infections has increased, especially among young pregnant women. This is of particular relevance in pediatrics due to the high risk of motherto-child transmission and the potential severity of the infection in infants. A high index of suspicion is required for these infections due to the atypical clinical features and non-specific radiological signs. The usefulness of conventional diagnostic methods is limited. Molecular techniques are recommended because of their high sensitivity, specificity, and speed, allowing for adequate and timely treatment. In this 12-year study conducted in a neonatal intensive care unit of a tertiary-care hospital, patient characteristics, clinical presentation, and outcome are described. Microbiological detection was performed using molecular methods. Twenty-nine patients with C. trachomatis infection (3.9% of the total samples submitted), of whom 13 had respiratory tract infection and 16 ocular involvement, were included. The median age at diagnosis was 19 days and 65% of the mothers were <25 years old. Twenty-four p (83%) were term newborns and 23 patients (79%) were previously healthy. On admission, 9 patients (31%) had fever and 12 (41%) had eosinophilia. Of the 13 patients with respiratory tract involvement, 9 (69%) consulted for cough and 11 (85%) had hypoxemia, requiring oxygen in 8 (61%), mechanical ventilation in 3 (23%), and ECMO in 1 (16%). Radiological findings showed a nonspecific interstitial pattern. Nine patients (31%) presented with coinfection, one of whom died due to an associated influenza A infection (AU)

Infecciones neonatales tardías

Introducción: La infección neonatal constituye una de las enfermedades más comunes debido a la susceptibilidad de estos pacientes. Esta infección puede llegar a la sepsis neonatal e incrementar la mortalidad. Objetivo: Determinar las características clínicas y epidemiológicas de la infección neonatal tardía. Métodos: Estudio descriptivo retrospectivo y transversal de registros de neonatos ingresados en el servicio de neonatología del Hospital "William Soler Ledea" entre los años 2017-2019 con diagnóstico de infección. Se excluyeron aquellos registros de neonatos infectados intervenidos quirúrgicamente. Las variables estudiadas fueron: epidemiológicas, factores de riesgo, clínicas y paraclínicas. Se emplearon técnicas de estadísticas descriptivas como porcentajes, razón, media o promedio. Resultados: La muestra estuvo conformada por 1078 registros de pacientes para una tasa de infección de 59,4 × 100 ingresos. Los factores de riesgo prenatales y connatales obtuvieron razón de prevalencia < 1. Los factores de riesgo posnatales con mayor prevalencia fueron el sexo masculino (57,6 %) y el cateterismo venoso central (53,6 %). De 83 a 88 % de los neonatos infectados presentaron alteraciones del perfil hematopoyético. Las infecciones respiratorias, de piel y de partes blandas se presentaron en 36 % de los neonatos y fueron las bacterias grampositivas los principales microorganismos aislados. Hubo 11 pacientes fallecidos para una tasa de mortalidad del 22,9 %. Conclusiones: La morbilidad por infección tardía es notable, predominan los factores de riesgo posnatales y el sexo masculino; la prematuridad y el bajo peso tuvieron la mayor representación en los fallecidos.

Introduction: Neonatal infection is one of the most common diseases due to the sensitivity of these patients. This infection can lead to neonatal sepsis and increase mortality. Objective: Determine the clinical and epidemiological characteristics of late neonatal infection. Methods: Retrospective and cross-sectional descriptive study of records on neonates admitted to the neonatology service of "William Soler Ledea" Hospital in the period 2017-2019 with a diagnosis of infection. Records of infected infants undergoing surgery were excluded. The variables studied were: epidemiological, risk factors, clinical and paraclinical. Descriptive statistical techniques such as percentages, ratio, mean or average were used. Results: The sample consisted of 1078 patient´s records, with an infection rate of 59.4 × 100 admissions. Prenatal and conatal risk factors obtained prevalence ratio < 1. The postnatal risk factors with the highest prevalence were male sex (57.6%) and central venous catheterization (53.6%). From 83 to 88% of infected neonates had alterations in the hematopoietic profile. Respiratory, skin and soft tissue infections occurred in 36% of the neonates and gram-positive bacteria were the main isolated microorganisms. There were 11 patients who died representing a mortality rate of 22.9%. Conclusions: Morbidity due to late infection is remarkable, postnatal risk factors predominate and male sex; prematurity and low weight had the highest representation in the deceased ones.

Factores de riesgo materno y neonatal en la infección probada de inicio precoz en pretérminos / Maternal and neonatal risk factors for early-onset infection proven in the preterm term / Fatores de risco maternos e neonatais em infecção de início precoce comprovado em pré-períodos

RESUMEN Introducción: la infección neonatal es un síndrome clínico que constituye una causa importante de morbilidad y mortalidad neonatal. Objetivo: determinar la relación existente entre algunos factores maternos y neonatales y la ocurrencia de las infecciones de inicio precoz probada en el servicio de neonatología del Hospital General Docente Universitario Carlos M. de Céspedes en el periodo de enero del 2014 a diciembre de 2019. Métodos: se realizó una investigación analítica de casos y controles cuya muestra estaba constituida por 450 neonatos diagnosticados con infección precoz probada y 900 controles con una relación de 1 caso por 2 controles. Resultados: en relación a las variables maternas la edad de la madre, con O.R 1.74, un IC. 95% (1.28- 2.34) con p. 0,003, la edad gestacional menor de 31 semanas un O.R:2.14. y una p:0.006, la infección vaginal un OR:5.19, y p:0.000, la infección urinaria OR: 4.99, y p:0.000; el parto distócico como factor de riesgo un OR:0.98, una p:0.923, el resto de las variables maternas como tiempo de roturas de membranas mayor de 18 horas, el líquido amniótico anormal (fétido y/o purulento), el tiempo total de parto prolongado y el politacto p<0.05; la corioamnionitis clínica e histológica con p<0.05; el peso del neonato menor de 1000 gramos y de 1000-1499 gramos con p:0.004 y 0.02 respectivamente, el sexo masculino con OR:1.82 y p:0.000 y el puntaje de Apgar menor de 7 al primer y quinto minuto de vida p<0.05 Conclusiones: las variables maternas excepto parto distócico fueron significativas, y las variables neonatales estudiadas resultaron significativas.

SUMMARY Introduction: Neonatal infection is a clinical syndrome that constitutes an important cause of neonatal morbidity and mortality. Objective: to determine the relationship between some maternal and neonatal factors and the occurrence of early-onset infections tested in the neonatology service of the General University Teaching Hospital Carlos M. de Céspedes in the period from January 2014 to December 2019. Methods: an analytical investigation of cases and controls was carried out whose sample consisted of 450 neonates diagnosed with proven early infection and 900 controls with a ratio of 1 case to 2 controls. Results: in relation to maternal variables, the age of the mother, with O.R 1.74, an IC. 95% (1.28-2.34) with p:0.003, the gestational age less than 31 weeks an O.R: 2.14, and a p: 0.006, vaginal infection an OR: 5.19, and p: 0.000, urinary infection OR: 4.99, and p: 0.000; dystocic delivery as a risk factor an OR: 0.98 y p: 0.923, the rest of the maternal variables such as membrane rupture time greater than 18 hours, abnormal amniotic fluid (fetid and / or purulent), the total time of prolonged labor and the politact p <0.05; clinical and histological chorioamnionitis with p <0.05; the weight of the neonate less than 1000 grams and 1000-1499 grams with p: 0.004 and 0.02 respectively, the male sex with OR: 1.82 and p: 0.000 and the Apgar score less than 7 at the first and fifth minute of life p <0.05. Conclusions: the maternal variables except dystocic delivery were significant, and the neonatal variables studied were significant.

RESUMO Introdução: A infecção neonatal é uma síndrome clínica que é uma das principais causas de morbidade e mortalidade neonatal. Objetivo: determinar a relação entre alguns fatores maternos e neonatais e a ocorrência de infecções de início precoce testadas no serviço de neonatologia do Hospital Geral Universitário Carlos M. de Céspedes no período de janeiro de 2014 a dezembro de 2019. Métodos: Foi realizada uma investigação analítica de casos e controles cuja amostra consistia em 450 recém-nascidos diagnosticados com infecção precoce comprovada e 900 controles com razão de 1 caso a 2 controles. Resultados: em relação às variáveis maternas a idade da mãe, com O.R. 1,74, ic. 95% (1,28- 2,34) com p.0,003, idade gestacional inferior a 31 semanas por O.R:2,14. e p:0.006, infecção vaginal a OR:5.19, e p:0.000, a infecção do trato urinário OR: 4,99, e p:0.000; parto distópico como fator de risco or:0.98, p:0.923, o resto das variáveis maternas como tempo de ruptura da membrana maior que 18 horas, fluido amniótico anormal (fétido e/ou purulento), tempo total de entrega prolongada e politácto p<0,05; cooamnionite clínica e histológica com p<0,05; peso neonato inferior a 1000 gramas e 1000-1499 gramas com p:0.004 e 0,02, respectivamente, o sexo masculino com OR:1.82 e p:0.000 e o Escore de Apgar inferior a 7 ao primeiro e quinto minuto de vida p<0,05. Conclusões: variáveis maternas exceto parto distópico foram significativas, e as variáveis neonatais estudadas foram significativas.

Epidemiological and bacteriological profile of neonatal bacterial infections seen in hospital pediatric in Antananarivo

Background: Neonatal bacterial infection is one of the leading causes of new-born morbidity and mortality. Bacterial ecology is not known in our unit, no study has been devoted to this subject. This work aimed to determine the germs responsible for neonatal bacterial infections and their level of sensitivity to the usual antibiotics.Methods: This is a retrospective descriptive study conducted in the Neonatology Department from January 1, 2018 to April 30, 2019 (16 months) including all newborns under 29 days hospitalized during the study period and possessing positive bacteriological results regardless of the site of collection (blood, urine, cerebrospinal fluid).Results: The diagnosis of neonatal infection was confirmed in 47 cases, i.e. 26.1% of suspicions of neonatal bacterial infection hospitalized during the study period. The female predominance was found with a sex ratio of 0.81. The most frequently isolated germs are, in order of frequency, coagulase-negative staphylococci (10 cases), Escherichia coli (7 cases), Enterobacter cloacae (5 cases), Klebsiella pneumoniae (5 cases) and Enterobacter aerogenes (5 cases). Of the 47 cases studied, 16 cases were multidrug-resistant infections including 7 cases i.e. 14.9% of nosocomial infections. The majority of Enterobacteria are strains producing broad spectrum beta lactamases (12 cases to 22). The molecules that remained effective were mainly Imipenem and Amikacin.Conclusions: Neonatal infection remains a real public health problem. The emergence of multi-resistant bacteria complicates the management. The knowledge of bacterial ecology on a wider population is an important asset in its prevention and management.

Analysis of clinically isolated bacterial tendency and drug resistance from neonatal ward in a tertiary children's hospital in Chongqing during 2010-2015 / 中国感染与化疗杂志

Objective The changing patterns of pathogenic isolates and antibiotic susceptibility in Chongqing's neonates between 2010 and 2015 were investigated for the purpose to provide evidence for rational use of antibiotics and control of nosocomial infections.Methods The distribution of pathogenic bacteria and antibiotic susceptibility were analyzed.Identification and antibiotic susceptibility testing were carried out using BD Phoenix 100 automated system and the conventional Kirby-Bauer method.The results were interpreted in accordance with the breakpoints of the Clinical and Laboratory Standards Institute.Results A total of 10 569 pathogenic bacterial strains were isolated during the period,most of which were gram-negative bacteria (80.8 ％,8 540/10 569),primarily Klebsiella pneumoniae (29.3 ％),followed by Escherichia coli (16.7 ％),Acinetobacter baumanmii (9.9 ％),Enterobacter cloacae (8.6 ％) and Pseudornonas aeruginosa (3.3 ％).Gram-positive strains accounted for 14.1％ (1 490/10 569),mainly Staphylococcus aureus (7.8％),Staphylococcus epidermidis (2.2 ％),and Staphylococcus haemolyticus (1.8 ％).Imipenem and meropenem showed high activity against Enterobacteriaceae (＜ 10％ resistant),followed by P.aeruginosa (＞ 10 ％ resistant),and A.baumannii (＞20％ resistant).The prevalence of carbapenem-resistant strains was 8,4 ％ in K.pneumoniae and 2.9 ％ in E.coli isolates,No gram-positive isolates were resistant to vancomycin,teicoplanin or linezolid.Conclusions K.pneumoniae was the most frequently isolated pathogen in the neonates treated in Children's Hospital of Chongqing Medical University.The prevalence of A.baumannii isolates is increasing.Carbapenem-resistant Enterobacteriaceae strains are emerging.

Aspectos clínicos y epidemiológicos en pacientes con infección neonatal / Clinical epidemiological aspects in patients with neonatal infection

Se realizó un estudio descriptivo, prospectivo y transversal de 69 pacientes con infección neonatal nacidos en el Hospital Docente Materno Sur "Mariana Grajales Coello" de Santiago de Cuba, desde enero de 2012 hasta diciembre de 2013, con vistas a caracterizarles según aspectos clinicoepidemiológicos. Entre los resultados principales predominaron la infección de inicio precoz (72,5 %), los bajo peso pretérminos (82,6 %), las infecciones sistémicas (59,4), la infección vaginal como factor de riesgo materno más frecuente (47,8 %), la dificultad respiratoria (50,7 %), así como los gérmenes gramnegativos como los principales factores causales. Las infecciones de inicio precoz mostraron mayor mortalidad, aunque de manera global hubo una supervivencia elevada.

A descriptive, prospective and cross-sectional study of 69 patients with neonatal infection, born in "Mariana Grajales Coello" Teaching Southern Maternal Hospital in Santiago de Cuba, was carried out from January, 2012 to December, 2013, aimed at characterizing them according to clinical epidemiological aspects. Among the main results the early onset of infection (72.5%), preterm low weight (82.6%), systemic infections (59.4%), vaginal infection as the most frequent maternal risk factor (47.8%), respiratory failure (50.7%), as well as the gramnegative pathogens as the main causative factors prevailed. The early onset of infections showed higher mortality, although in a global way there was a high survival.

Periventricular leukomalacia in a preterm neonate with early onset Capnocytophaga sepsis

Capnocytophaga sputigena is a slow-growing, capnophilic, gram negative, anaerobic, fusiform bacilli residing in oropharyngeal cavity of mammals. In humans, it causes localized periodontal infections and sporadic invasive infections in immunocompromised persons. Infrequently, it does cause chorioamnionitis and perinatal infections and is generally of lower morbidity risk in fetus and neonates. We describe a rare case report of early-onset neonatal Capnocytophaga sepsis with culture negative meningitis in preterm infant who developed early cystic periventricular leukomalacia in second week of life. Though neonatal Capnocytophaga infection is probably under-reported due to its fastidious nature and subclinical infection in mother, this case reminds that Capnocytophaga may be responsible for some occult cases of early neonatal septicemia, and that the organism may be more virulent in premature neonates with possibility of development of periventricular leukomalacia and neurological morbidities.

Presentación de un caso con toxoplasmosis congénita / Case presentation: congenital Toxoplasmosis

La toxoplasmosis, enfermedad conocida como “Parasitosis del Siglo XX”, cobra importancia en los neonatos cuyas madres se infectaron por primera vez durante la gestación. El objetivo del trabajo es presentar el caso de un recién nacido de 40 semanas con toxoplasmosis congénita. El peso al nacer fue de 3 500 g, Apgar 2/3. Requirió intubación orotraqueal y resucitación cardiopulmonar inmediata. Hubo presencia de líquido amniótico meconial, tiempo de rotura de membranas de 14 h, antecedentes maternos de sepsis vaginal, y con un descenso detenido de la presentación lo que llevó a cesárea de urgencia. A las 4 h de vida desarrolla cuadro de coagulación intravascular diseminada, acompañado de hipotonía marcada, mirada fija sin respuesta pupilar ni esfuerzo respiratorio. A las 48 h aparece insuficiencia renal aguda con evolución rápida a fallo múltiple de órganos. Ultrasonido de cráneo con aumento de la ecogenicidad cerebral, borramiento de las circunvoluciones cerebrales y ventrículos laterales dilatados. Evolución tórpida, sin recuperación neurológica, alteraciones del medio interno y trastornos del equilibrio ácido-base e hidroelectrolítico, empeoramiento progresivo de la función cardiaca y respiratoria, fallece a los 21 días de vida.

Toxoplasmosis, known as the "Twentieth century parasites disease", becomes important in infants whose mothers were infected for the first time during pregnancy. The aim of this work is to present the case of a 40 weeks newborn with congenital toxoplasmosis. The birth weight was 3 500 g, Apgar 2/3. Immediate endotracheal intubation and cardiopulmonary resuscitation was required. There were meconium, 14-hour membrane rupture time, maternal history of vaginal sepsis, detained presentation prompting emergency caesarean section. At 4 hours of life, disseminated intravascular coagulation develops, accompanied by marked hypotonia, staring with no pupillary response or respiratory effort. At 48 hours, acute renal failure appears with rapid progression of multiple organ failure. Skull ultrasound showed increased brain echogenicity, effacement of the cerebral convolutions and dilated lateral ventricles. Torpid evolution, with no neurological recovery, internal disorders and disorders of acid-base and electrolyte balance, progressive deterioration of the cardiac and respiratory functions, dies at 21 days of life. Decease occurs at 21 days of life.

¿Se deben o no utilizar antibióticos profilácticos en el paciente recién nacido a término con factores de riesgo de infección neonatal? / Is it due or not to use prophylactic antibiotics in term newborn with risk factors for neonatal infection patient?

Objetivos: Evaluación en la Clínica General San Diego de Barranquilla de febrero de 2014 a diciembre de 2015 de los recién nacidos con factores de riesgo para infección y el beneficio de usar o no antibióticos profilácticos como preventivos de sepsis neonatal y el análisis de la morbilidad asociada. Material y métodos: Estudio prospectivo donde se analizan 155 casos en los cuales se utilizó o no antibiótico profiláctico en paciente con factores de ries-go de sepsis. Resultados: De un total de 4159 nacimientos, 155 recién nacidos (3,72 %) presentaron factores de riesgo; de estos pacientes en 74 se usaron antibióticos (grupo 1) y en 81 no se usaron antibióticos (grupo 2). En ninguno de los grupos se presentaron casos positivos de sepsis.

Objectives: Evaluation of newborns with risk factors for developing neonatal sepsis at San Diego General Clinic in Barranquilla between February 2014 to December 2015, and the benefit of using prophylactic antibiotics as a prevention for neonatal sepsis. Methods: A prospective study was performed in which 155 cases were followed and analyzed, both with and without antibiotic prophylaxis, in patients with risk factors for sepsis to determine whether it affects morbidity or not. Analyzes were performed. Results: From a total of 4159 births, 155 new born(3.72 %) presented risk factors; antibiotics were used in 74 patients and in 81 patients there were no use of anti-biotics.

Association of clinical and laboratory parameters of patients with neonatal sepsis

Abstract:@#Neonatal sepsis is one of the leading causes of death among newborns, and diagnoses is a challenge to clinicians. @*Objectives@#The present study describes and compares clinical, and hematological profile of neonates, and culture positive and culture negative neonatal sepsis, Children’s Hospital. @*Methods@#This is a cross sectional study. About with neonatal sepsis with a complete blood count were included in the study. Charts were retrieved from section. Primary outcome measures are the following: increased WBC, increased ANC, IT ratio more than nucleated RBCs. @*Results@#Forty-seven (35%) subjects had a positive (65%) patients had a negative blood culture. The significantly associated with clinical sepsis (negative p=0.04). On the other hand, the odds of having a 2.29 times more when the patient has poor suck compared not present with poor suck (OR 2.29, p=0.04). There association with the patients’ demographic and having neonatal sepsis. Conclusion: There was no significant difference in culture or a negative blood culture among any demogr hematological profile tested between culture proven neonatal sepsis. Hence, in clinical sepsis, it is still acceptable despite a normal complete blood count and or a negative blood culture.

Enfermedad neumoccócica invasora en recién nacidos, antes y después de la vacunación universal con vacuna conjugada 7 y 13 valente en Uruguay / Pneumococcal invasive disease in newborns before and after 7-valent and 13-valent universal pneumococcal vaccination in Uruguay

Introduction: Streptococcus pneumoniae infections are not frequent in neonates, but presents high morbidity and mortality. In 2008, the 7-valent pneumococcal conjugate vaccine (PCV) was introduced in the childhood vaccination schedule and then replaced by 13-valent PCV in 2010. First dose is given at 2 months of age. Protection of neonates is expected with universal vaccination. Objective: To describe the clinical presentation, microbiology and outcome of neonates with pneumococcal invasive infections (PII) detected in two hospitals in Uruguay in 2001-2007 (pre-vaccination), 2008 (intervention) and 2009-2013 (post-vaccination). Methods: A descriptive, retrospective study was done at Pereira Rossell Hospital and Paysandú Hospital. All isolates of S. pneumoniae obtained from normally sterile fluids were included. Data were obtained from the clinical records and the microbiology laboratory. A statistical analysis with absolute frequencies, relative, rates and relative risk was performed. Results: 25 neonates were enrolled with diagnosis of: sepsis (n = 13), meningitis (n = 9), bacteremia (n = 1), pneumonia with empyema (n = 1) and pneumonia (n = 1). The incidence of PII in the prevaccination period was 19/25, with a rate of 0.30/1,000 births, compared to post-vaccination rate of 0.04/1,000. The relative risk was 5.9. 6/20 (30%) cases of death were reported (meningitis n = 3; sepsis n = 2; empyema n = 1). Most common serotypes were 5 and 1 (14/25) and 24/25 strains were susceptible to penicillin. Discussion: The symptoms were indistinguishable to infections caused by other pathogens. PII cases decreased and no deaths occurred in the post-vaccination period. No increase in non-vaccine serotypes was observed.

Introducción: Streptococcus pneumoniae infrecuentemente produce infecciones en recién nacidos (RN), presentando elevada morbi-mortalidad. En Uruguay, en 2008 se incorporó al calendario de inmunizaciones infantil la vacuna conjugada neumocóccica (VCN) 7 valente, (sustituída por VCN13 en 2010). La vacunación comienza a los dos meses de vida. Se espera que la vacunación universal tenga impacto en la protección de RN. Objetivo: Describir la presentación clínica, microbiología y evolución de RN con enfermedad neumocóccica invasora (ENI), identificados en dos hospitales de Uruguay, años 2001-2007 (pre-vacunación), 2008 (intervención) y 2009-2013 (post-vacunación). Material y Métodos: Estudio descriptivo, retrospectivo. Lugar: Hospital Pereira Rossell y Hospital Paysandú. Se incluyeron todos los aislados de S. pneumoniae a partir de líquidos normalmente estériles. Fuente de datos: laboratorios de bacteriología e historias clínicas. Análisis estadístico: frecuencias absolutas, relativas, tasas y riesgo relativo. Resultados: RN con ENI: 25, sepsis (n: 13), meningitis (n: 9), bacteriemia (n: 1), neumonía con empiema (n: 1), neumonía (n: 1). Incidencia de ENI en el período pre-vacunación 19/25, tasa 0,30/1.000 nacimientos; tasa post-vacunación: 0,04/1.000. Riesgo relativo 5,9. Fallecimientos: 6/20 (30%): meningitis (n: 3), sepsis (n: 2), empiema (n: 1). Los serotipos más frecuentes fueron: 5 y 1 (14/25). Susceptibles a penicilina: 24/25. Discusión: Los síntomas fueron indistinguibles de infecciones causadas por otros patógenos. Disminuyeron los casos de ENI y no ocurrieron fallecimientos en el período post-vacunación. No aumentaron los serotipos no vacunales.

Dynamic change of PCT,hs-CRP and WBC count in neonatal infection and its clinical significance / 国际检验医学杂志

Objective To investigate the dynamic change of procalcitonin (PCT ) and hypersensitive C‐reactive protein (hs‐CRP) in neonatal infection and its clinical significance .Methods 176 neonates with infection in our hospital from August 2013 to July 2014 were selected and treated by the routine therapy of anti‐infection ,oxygen inhalation ,etc .,and divided into the improvement group(89 cases) ,non‐change group(48 cases) and deterioration group(39 cases) according to the curative effect after 20 d therapy . Serum PCT and hs‐CRP levels were detected before treatment(T0) ,on 5 d(T1) ,10 d(T2) ,15 d(T3) and 20 d(T4) of treatment by adopting the enzyme linked immunosorbent assay(ELISA) .Results The PCT ,hs‐CRP levels and WBC count before treatment had no significant difference among 3 groups(P>0 .05);the PCT and hs‐CRP levels after treatment in the improvement group showed the significantly declining trend ,which reached the lowest at T4 (P0 .05) .In terms of WBC count ,the WBC count in all the cases showed a rising first and then decreasing trend ,the WBC count at T4 in the improvement group was lower than before treatment(P0 .05);the Spearman analysis results after treatment showed that the serum PCT ,hs‐CRP levels and WBC count were negatively correlated with efficacy (r1 = -0 .764 ,P1 <0 .05;r2 = -0 .724 ,P2 <0 .05 ;r3 = -0 .573 ,P3 <0 .05) .Conclu‐sion PCT and hs‐CRP can effectively reflect the therapeutic effect of neonatal infection ,and is closely correlated with the patient′s own immune status ,which can be taken as one of reference indicators for formulating the treatment scheme and evaluating progno‐sis ,and is worth for further clinical promotion .

The study of risk factors for neonatal Streptococcus agalactiae infection and sensitivity analysis of antibacterials / 国际检验医学杂志

Objective To analyze the related risk factors of neonatal Streptococcus agalactiae infection and sensitivity of antibac‐terials ,in order to provide for provide evidence for the prevention and treatment of neonatal infection .Methods A total of 1 200 neonatal blood ,gastric juice ,pus specimens ,and maternal reproductive tract specimens were collected from Jan .2013 to Dec .2013 for bacterial culture and drug sensitive test .And clinical data about types of neonatal diseases ,maternal infection status ,mode of de‐livery ,medication in late pregnancy ,situation of neonatal death were retrospectively analyzed .Results A total of 80 cases of neo‐nates were infected by Streptococcus agalactiae ,,and the neonates diagnosed with septicemia ,omphalitis ,premature birth ,intrau‐terine infection and aspiration pneumonia were accounted for 8 .75% ,10 .00% ,15 .00% ,22 .50% and 43 .75% ,respectively .The positive rate of Streptococcus agalactiae infection in mother′s reproductive tract specimens was 51 .25% ,and the results of drug sensitive test were consistent with those of neonates .9 cases of cesarean section ,accounted for 11 .25% ;71 cases of natural child‐birth ,accounted for 88 .75% .In the 80 strains of Streptococcus agalactiae ,the sensitivity of vancomycin ,linezolid ,penicillin and ceftriaxone were all 100 .00% ,and resistance rates of Streptococcus agalactiae to erythromycin ,clindamycin and levofloxacin were higher ,and were 77 .50% ,57 .50% and 33 .75% respectively .Conclusion Maternal Streptococcus agalactiae carriers and mode of delivery may be risk factors for neonatal Streptococcus agalactiae infection .Obstetricians should pay attention to routine screening of Streptococcus agalactiae in perinatal pregnant women ,the laboratory should improve the efficacy in detecting Streptococcus aga‐lactiae and provide the results of antibacterials resistance of Streptococcus agalactiae immediately ,in order to provide references for clinical rational drug use .

Representações sociais de infecção neonatal elaboradas por enfermeiras / Social representations of the neonatal infection produced by nurses / Representaciones sociales de infección en el neonato desarrolladas por enfermeras

O estudo objetivou apreender as representações sociais da infecção neonatal elaboradas por enfermeiras e analisar a relação dessas representações com a assistência ao recém-nascido com infecção. Pesquisa descritiva e exploratória realizada com 25 enfermeiras de uma maternidade pública de Teresina-PI, no período de março a abril de 2010. Os dados foram produzidos por meio de entrevista semiestruturada, processados pelo software Alceste 4.8. Os resultados foram cinco classes: prevenção e controle das infecções neonatais; o cuidado de enfermagem; riscos e implicações das infecções neonatais; a infecção neonatal: um problema de saúde pública e permanência hospitalar. As enfermeiras manifestaram preocupação com a infecção neonatal, no entanto fragilidades de gestão dificultam a articulação entre as equipes. Reconhecem a importância do cuidado humanizado, ao tempo em que relatam os fatores de risco para o desenvolvimento da infecção e a mortalidade neonatal relacionada ao tempo de permanência hospitalar.

The objective of this study was to understand the social representations of the neonatal infection produced by nurses and analyze the relationship of these representations with the assistance to newborns with infection. Exploratory described research with 25 nurses from a public maternity hospital of Teresina-PI, the period from march to april de 2010. Data were produced by semi-structured interview was processed in ALCESTE 4.8 software. The results were presented in five classes: the road to prevention of neonatal infections; the nursing care to newborns with infection; risks to the development of infections and their implications; neonatal infection as a health problem; the prolonged hospitalization. The nurses showed concern with of neonatal infection, however weaknesses impeding performace management body of the team. Recognize the importance of humane care, the time that report the risk for development factors linked to infection and damage caused by it, which constitute a cause of neonatal mortality related to hospital stay.

El objetivo del estudio fue aprender las representaciones sociales de infección en el neonato desarrolladas por enfermeras y analizar la relación de estas representaciones con la asistencia a los recién nacidos con infección. Investigación descriptiva y exploratoria realizada con 25 enfermeras de una maternidad pública de Teresina-PI-Brasil, en el período de marzo a abril de 2010. Los datos fueron producidas por entrevista semiestructurada, procesados en el software ALCESTE 4,8. Los resultados fueron cinco clases: prevención y control de las infecciones neonatales; el cuidado de enfermería; riesgos e Implicaciones de las infecciones neonatales; la infección neonatal: un problema de salud pública y estancia hospitalaria. Las enfermeras manifestaron preocupación ante la infección en el neonato, sin embargo, debilidades de gestión dificultan el desempeño articulado del equipo. Reconocen la importancia del cuidado humanizado, al tiempo en que relatan acerca de los factores de riesgo asociados con el desarrollo de la infección, y la mortalidad neonatal, relacionada con la duración de estancia hospitalaria.

Chlamydia trachomatis infection in a sample of northern Brazilian pregnant women: prevalence and prenatal importance

There are limited data regarding prevalence of Chlamydia trachomatis infection among northern Brazilian pregnant women. OBJECTIVE: The purpose of this study was to estimate the prevalence of chlamydial infection among pregnant women in their third trimester and to determine the repercussion of this infection on their offspring. METHODS: In the first phase of this study 100 pregnant women receiving prenatal care in a local public university hospital were examined to assess the prevalence of genital C. trachomatis infection by polymerase chain reaction technique. In the second phase, 88 pregnant women were prospectively evaluated for premature rupture of membranes, puerperal consequences associated with chlamydial infection, and neonates were checked for low-birth weight. RESULTS: The prevalence rate of chlamydial infection was 11%, and 72.7% of the positive participants were predominantly less than 30 years of age (p = 0.1319). A total of 36.4% of the participants had premature rupture of membranes (p = 0.9998). Neither low-birth weight infants nor preterm delivery were observed. A cohort of 16 newborn babies were followedup up to 60 days of life to ascertain outcome: 50% had respiratory symptoms. Neonates born to infected mothers had a higher risk to develop respiratory symptoms in the first 60 days of life. CONCLUSION: The scarcity of data about the effects of chlamydial infection on pregnancy and neonatal outcomes justified this study. Diagnosing and treating chlamydial infection during the third trimester of pregnancy may prevent neonate infection. Therefore, preventive screening should be seen as a priority for early detection of asymptomatic C. trachomatis infection as part of local public health strategies.

Sepsis neonatal tardía por Streptococcus pyogenes / Late neonatal sepsis caused by Streptococcus pyogenes

Actualmente, Streptococcus grupo A es una causa infrecuente de infección en el período neonatal. La descripción de casos de infección grave en el recién nacido es esporádica. Presentamos un recién nacido de 12 días de vida que acudió al servicio de urgencias por síndrome febril sin foco, que durante su ingreso desarrolló afectación neurológica y sistémica. Describimos la presentación clínica, la evolución y el tratamiento. El aislamiento de Streptococcus grupo A en el hemocultivo confrma la sepsis tardía por este germen con probable meningitis asociada.

Currently, the group A Streptococcus is a unusual cause of infection in the neonatal period. The description of cases of severe infection in the newborn is sporadic. We present a 12-days-old newborn attended at the emergency room for fever without focus, which developed neurological and systemic involvement during admission. Clinical presentation, evolution and treatment are described. Blood culture isolation of group A Streptococcus confrmed late sepsis by this bacteria, probably with associated meningitis.

Valor predictivo de algunos exámenes de laboratorio clínico en la infección neonatal bacteriana precoz / Prognostic value of some clinical laboratory examinations related to an early bacterial neonatal infection

El diagnóstico microbiológico de la infección neonatal de inicio precoz es complejo. En la mayoría de los recién nacidos se inicia el tratamiento ante la sospecha clínica y la positividad de algunos reactantes de fase aguda y el hemograma. Se analizó el valor predictivo utilizando como método de referencia el hemocultivo periférico o el hallazgo anatomopatológico de infección de algunos exámenes de laboratorio clínico de forma aislada. El estudio se realizó en el total de los casos, 32 neonatos con infección de inicio precoz probada y probable, y por localización de la infección. Ni la proteína C-reactiva positiva ni las alteraciones de los leucocitos totales fueron buenos predictores de sepsis de inicio precoz de cualquier localización. La trombocitopenia impresionó ser un marcador competente pero no resultó así al calcular el intervalo de confianza al 95 por ciento. Al excluir la localización pulmonar, la proteína C-reactiva positiva se convirtió en un marcador competente. Ninguno de los neonatos con infección pulmonar probada tuvo resultados positivos en los exámenes clínicos realizados. No se cuenta de momento con ninguna prueba de laboratorio clínico capaz de predecir con certeza la presencia de infección de inicio precoz de cualquier localización. La proteína C-reactiva cualitativa es un marcador competente de infección precoz del torrente sanguíneo y de meninges en los neonatos.

Microbiological diagnosis of neonatal infection of early onset is complex. In most of newborns diagnosis is started if there is a clinical suspicion and the positivity of some acute-phase reactants and the hemogran. Prognostic value was analyzed using as reference method the peripheral hemoculture or the pathological anatomy findings of infection in some of clinical laboratory examinations in an isolated way. Study was performed in all the cases, in 32 neonates presenting with a proven and probable early onset infection, and by infection localization. Neither positive reactive C protein nor total white cells alterations were good predictors of an early onset sepsis of any localization. Thrombocytopenia was a significant marker but not to estimate the 95 percent-confidence index (CI). In the exclusion of pulmonary localization, the positive reactive C protein became a significant marker. In none of neonates presenting a proven pulmonary infection it had positive results in clinical examinations performed. For the moment is not available a laboratory test able to predict with accuracy the presence of an early onset infection of any localization. Qualitative reactive C protein is a significant marker of an early infection of bloodstream and the meninges in neonates.

Diagnosis of neonatal group B Streptococcus sepsis by nested-PCR of residual urine samples

Group B streptococcus (GBS) remains the most common cause of early-onset sepsis in newborns. Laboratory gold-standard, broth culture methods are highly specific, but lack sensitivity. The aim of this study was to validate a nested-PCR and to determine whether residue volumes of urine samples obtained by non invasive, non sterile methods could be used to confirm neonatal GBS sepsis. The nested-PCR was performed with primers of the major GBS surface antigen. Unavailability of biological samples to perform life supporting exams, as well as others to elucidate the etiology of infections is a frequent problem concerning newborn patients. Nevertheless, we decided to include cases according to strict criteria: newborns had to present with signs and symptoms compatible with GBS infection; at least one of the following biological samples had to be sent for culture: blood, urine, or cerebrospinal fluid; availability of residue volumes of the samples sent for cultures, or of others collected on the day of hospitalization, prior to antibiotic therapy prescription, to be analyzed by PCR; favorable outcome after GBS empiric treatment. In only one newborn GBS infection was confirmed by cultures, while infection was only presumptive in the other three patients (they fulfilled inclusion criteria but were GBS-culture negative). From a total of 12 biological samples (5 blood, 3 CSF and 4 urine specimen), eight were tested by culture methods (2/8 were positive), and 8 were tested by PCR (7/8 were positive), and only 4 samples were simultaneously tested by both methods (1 positive by culture and 3 by PCR). In conclusion, although based on a restricted number of neonates and samples, our results suggest that the proposed nested-PCR might be used to diagnose GBS sepsis as it has successfully amplified the three types of biological samples analyzed (blood, urine and cerebrospinal fluid), and was more sensitive than culture methods as PCR in urine confirmed diagnosis...

O estreptococo do grupo B (GBS) constitui a causa mais freqüente de sepse neonatal precoce. O teste de referência continua sendo o isolamento em cultura, apesar de apresentar problemas de sensibilidade. O objetivo do presente estudo foi validar uma técnica de dupla amplificação e determinar a possibilidade do uso de amostras residuais de urina colhidas por método não invasivo, não estéril, para a confirmação da sepse por GBS em recém-nascidos. As amostras foram amplificadas com primers do principal gene de superfície do GBS. A insuficiência de volume de material biológico para a realização de exames para suporte de vida, além de outros necessários à identificação do agente etiológico de infecções é muito freqüente em recém-nascidos. Mesmo assim, decidimos definir critérios bastante rigorosos para a inclusão de pacientes na casuística: os recém-nascidos deveriam apresentar sinais e sintomas compatíveis com infecção pelo GBS; deveriam ter tido ao menos uma amostra enviada para cultura, podendo ser sangue, urina ou líquor; disponibilidade de volumes residuais dessas amostras, ou de outras colhidas no dia da hospitalização, antes da introdução da antibioticoterapia, de forma a possibilitar a análise por PCR, e evolução favorável com a antibioticoterapia empírica. Em apenas um dos quatro recém-nascidos a infecção foi confirmada por cultura, enquanto nos outros três casos a infecção foi considerada presuntiva (pacientes preencheram os critérios de inclusão, mas o GBS não foi isolado). De um total de 12 amostras dos quatro pacientes (5 de sangue, 3 de líquor e 4 de urina), 8 foram testadas por cultura (2 foram positivas), 8 foram testadas por PCR (7 foram positivas), e apenas 4 pelos dois métodos simultaneamente (1 positiva por cultura e 3 por PCR). Concluímos que apesar do número restrito de pacientes e de amostras testadas, os resultados apresentados sugerem que a amplificação proposta poderia ser usada para o diagnóstico...

Brote de bacteriemia nosocomial y colonización por Serratia marcescens en una Unidad de Cuidado Intensivo Neonatal / Nosocomial bacteremia and gastrointestinal tract colonization outbreak of Serratia marcescens in Neonatal Intensive Care Unit

Introducción. Se presenta la descripción de un brote de bacteriemia y colonización gastrointestinal nosocornial por Serratia marcescens en una Unidad de Cuidado Intensivo Neonatal (UCIN) de un hospital de tercer nivel. Material y métodos. El período epidémico fue considerado del 17 de mayo al 17 de junio de 2006. Se definió como caso a cualquier paciente con cultivo positivo para S. marcescens durante el período epidémico, ya que no se había identificado ningún cultivo positivo para esta bacteria en 6 meses de período pre-epidémico. Para identificar factores de riesgo de desarrollo de infección/colonización por S. mareescens, se compararon los casos con pacientes controles, definidos como aquéllos expuestos durante el período del brote sin aislamiento de esta bacteria. Todos los aislamientos de microorganismos fueron genotipificados por restricción con endonucleasa y electroforesis en gel por campos pulsados (PFGE). Resultados. Durante el período epidémico se identificaron 7 pacientes con cultivos positivos para S. marcescens y 12 controles. El paciente índice tuvo hemocultivo positivo y cuadro clínico de bacteriemia nosocomial, seguido por un caso de ventriculitis con cultivo positivo para S. marcescens en líquido cefalorraquídeo. Los otros 5 casos tuvieron aislamiento de S. marcescens en coprocultivos. Los cultivos de soluciones intravenosas y superficies inanimadas fueron negativos. El análisis univariado demostró que los pacientes con infección/colonización por S. marcescens tuvieron una estancia hospitalaria más prolongada (52 vs 27.9 días, P < 0.05), mayor frecuencia de alimentación enteral y presencia de sonda orogástrica al compararse con los controles. El patrón de PFGE fue idéntico en todos los aislamientos de S. mareescens. El reforzamiento de precauciones de contacto, incluyendo lavado de manos, además de cierre temporal de la UCIN, controló el problema de brote. Conclusión. El análisis epidemiológico complementado con técnicas de epidemiología molecular en este estudio aporta evidencia de un brote de 2 casos de bacteriemia nosocomial por transmisión cruzada de S. marcescens a través de un reservorio gastrointestinal. Estos hallazgos confirman la importancia que tienen las medidas de precauciones de contacto como el lavado de manos en el manejo de pacientes de la UCIN para prevenir infecciones nosocomiales y control de brotes.

Introduction. We investigated an outbreak of Serratia marcescens bloodstream infection (BSI)/colonization in patients from a Neonatal Intensive Care Unit (NICU) in a tertiary care pediatric Hospital. Material and methods. May 17 through June 17, 2006 was considered as the study period. A case was defined as any patient with S. marcescens-positive culture in the NICU during the outbreak period because no S. marcescens was identified in this area within 6 month of pre-epidemic period. To identify risk factors we compared patients with S. marcescens positive-cultures with controls exposed to the cases during the outbreak period without positive cultures. Genotyping of all S. marcescens isolates were evaluated by restriction endonuclease and pulsed-field gel electrophoresis (PFGE). Results. Seven S. marcescens positive cultures were identified; the index case had a positive blood culture with diagnosis of BSI, followed by a patient with CSF positive culture with diagnosis of ventriculitis and BSI. The remaining 5 cases had concurrent S. marcescens isolates from stool cultures (colonization). Environmental cultures (water, IV solutions and inanimate surfaces) were negative for these bacteria. According to univariate analysis, patients with S. marcescens stayed in the NICU longer than controls (52 vs 27.9 days, P < 0.05), they were more likely to have an orogastric tube in place and to receive enteral nutrition. All the S. marcescens had an identical pattern of PFGE analysis. Contact precaution, including hand washing, was reinforced in addition to temporary closing of the NICU in order to control the outbreak. Conclusions. This outbreak of S. marcescens was studied using epidemiological analysis and molecular biology techniques, confirming cross-transmission between cases associated to a possible gastrointestinal reservoir. Our findings underscore the importance of hand hygiene and other contact precaution methods in hospital settings, such as NICU.

Prevalência da Infecção Hospitalar em Unidades de Neonatologia de Salvador e Região Metropolitana / Prevalence of Hospital Infection in Neonatology Units in Salvador and the Metropolitan Region

Infecção Hospitalar (IH) é importante causa de morbidade e mortalidade no período neonatal, por ser mais freqüente, em virtude dos riscos relacionados às condições imunológicas; aos procedimentos diagnósticos e terapêuticos e a qualidade dos cuidados dispensados. Considerando ser um tema que vem sendo objeto de preocupação dos profissionais de saúde, resolveu-se realizar um estudo com objetivo de analisar a prevalência das IH em unidades de neonatologia de instituições de saúde de Salvador e Região Metropolitana. Realizou-se um estudo transversal que incluiu todos os neonatos internados em 17 Instituições de Saúde de Salvador e Região Metropolitana, em outubro de 2001.Foram utilizados dados secundários da Secretaria de Saúde do Estado da Bahia, onde os critérios utilizados para diagnosticar as infecções, foram do CDC e do Ministério da Saúde. Encontrou-se uma prevalência de 30% (52) dos neonatos com IH e 35,6% (62) episódios de IH. A maior freqüência de IH foi encontrada nas instituições públicas 73% (38). Das 62 infecções ativas, a infecção do trato respiratório foi a mais prevalente com 8,62% (15), seguida das infecções perinatais inespecíficas e sistêmicas com 7,5% (13) e de pele com 5,17% (9). Apenas 30.7% dos neonatos com IH dispunham de resultados microbiológicos nos prontuários. Os principais microrganismos identificados foram os Staphylococcus epidermidis, Pseudomonas aeruginosa e Candida sp com 20% cada Dos neonatos estudados, 56,9% (99) faziam uso de antimicrobiano no dia da pesquisa Os antimicrobianos mais frequentes no tratamento das IH dos neonatos foram as Penicilinas sintéticas com 24,5%, seguido dos amonoglicosídeos com 16,3% e cefalosporinas com 14,3%. Verificou-se associação positiva significante entre neonatos prematuros, internados em unidade de tratamento intensivo e semi intensivo, e em uso de procedimentos invasivos, com a infecção hospitalar. Esses resultados demonstram a necessidade de ações de impacto como: medidas de prevenção e controle, levantamento dos agentes causais das IH, promoção de campanhas educativas, implementação de um sistema de vigilância epidemiológica efetivo para acompanhar a evolução do problema e estabelecer medidas apropriadas.(AU)