Aspectos epidemiológicos, clínicos y microbiológicos en pacientes menores de 5 años con neumonía bacteriana / Epidemiological, clinical and microbiologic aspects in patients under 5 years with bacterial pneumonia

Introducción: Las infecciones respiratorias agudas abarcan entre 20 y 40 % del total de todas las hospitalizaciones y 20 - 34 % de las muertes en menores de 5 años de edad, fundamentalmente a expensas de neumonía. Objetivo: Describir aspectos epidemiológicos, clínicos y microbiológicos en pacientes menores de 5 años con neumonía bacteriana. Métodos: Se realizó un estudio descriptivo y transversal de 39 pacientes con neumonía y aislamientos bacterianos en hemocultivos, líquido pleural y/o exudados nasofaringeos, ingresados en el Hospital Infantil Docente Sur Antonio María Béguez Cesar de Santiago de Cuba, desde enero de 2018 hasta diciembre de 2019. Se analizaron variables de interés, tales como edad, sexo, factores de riesgo, sintomatología y cultivos microbiológicos. Se utilizaron la frecuencia absoluta y el porcentaje como medidas de resumen. Resultados: Prevalecieron los pacientes entre 1 - 4 años de edad, el sexo femenino y los hemocultivos con estafilococos coagulasa negativo, así como neumococos, estos últimos también aislados en exudados nasofaríngeos. Los factores de riesgo más frecuentes fueron infección respiratoria aguda previa, uso anticipado de antibióticos, asistencia a círculo infantil, supresión precoz de lactancia materna, fiebre, tos, tiraje y alteraciones del murmullo vesicular. Predominaron la insuficiencia respiratoria aguda y el derrame pleural como complicaciones. Se notificó más gravedad en los lactantes y ocurrieron 2 decesos, para una letalidad de 1,47 %. Conclusiones: La conjunción de factores de riesgo detectados, la baja positividad de los cultivos, la identificación de bacterias prevalentes en hemocultivos y el descenso de la letalidad resultaron de interés en el estudio.

Introduction: Acute respiratory infections take in between 20 and 40 % of all the hospitalizations and 20 - 34% of deaths in children under 5 years, fundamentally at the expense of pneumonia. Objective: To describe epidemiologic, clinical and microbiologic aspects in patients under 5 years with bacterial pneumonia. Methods: A descriptive and cross-sectional study of 39 patients with pneumonia and bacterial isolations in hemocultures, pleural fluid and/or nasopharyngeal swabs was carried out. They were admitted to Antonio María Béguez Cesar Southern Teaching Children Hospital in Santiago de Cuba, from January, 2018 to December, 2019. Variables of interest were analyzed, such as age, sex, risk factors, symptomatology and microbiologic cultures. The absolute frequency and the percentage as summary measures were used. Results: There was a prevalence of patients among 1 - 4 years, female sex and the hemocultures with negative coagulase staphylococcu, as well as pneumococus, these last ones also isolated in nasopharingeal swabs. The most frequent risk factors were previous acute respiratory infection, premature use of antibiotics, attendance to day care center, early suppression of breastfeeding, fever, cough, tirage and changes of the vesicular breath sound. The acute respiratory failure and pleural effusion as complications prevailed. More seriousness was notified in infants and there were 2 deaths, for a letality of 1.47 %. Conclusions: The combination of detected risk factors, low positivity of the cultures, identification of bacterias prevalents in hemocultures and the decrease of letality was of interest in the study.

Patrones imagenológicos en pacientes menores de 5 años con diagnóstico de neumonía bacteriana / Imaging patterns in patients under 5 years with diagnosis of bacterial pneumonia

Introducción: La radiografía de tórax constituye el mejor método de diagnóstico para la confirmación clínica de la neumonía, aunque existen discrepancias en relación con su causalidad. Objetivo: Describir los patrones imagenológicos según variables clínicas, epidemiológicas y microbiológicas en pacientes menores de 5 años ingresados por neumonía bacteriana. Métodos: Se realizó un estudio descriptivo, prospectivo y transversal de 84 pacientes con diagnóstico de neumonía y aislamiento bacteriano en hemocultivos y/o líquido pleural. Como variables analizadas figuraron: edad, sexo, factores de riesgo, manifestaciones clínicas, así como resultados de los estudios imagenológicos de tórax y de los cultivos microbiológicos. Como medidas de resumen se utilizaron la frecuencia absoluta y el porcentaje. Resultados: En la serie predominaron la consolidación alveolar (57,1 %), el grupo de 1-4 años y el sexo masculino, así como también el uso de tratamiento antimicrobiano previo al ingreso, la supresión precoz de lactancia materna y la presencia de fumadores en casa como principales factores de riesgo. La fiebre, la tos, la taquipnea, el tiraje, la rinorrea y los estertores húmedos resultaron ser las manifestaciones clínicas más frecuentes y prevaleció el neumococo en pacientes con patrón de condensación alveolar (64,6 %). Conclusiones: El patrón de consolidación alveolar estuvo relacionado con causa predominantemente neumocócica, con múltiples factores de riesgo y con síntomas típicos de neumonía bacteriana.

Introduction: Chest radiography is the best diagnostic method for clinical confirmation of pneumonia, although there are discrepancies in its relation to causation. Objective: To describe imaging patterns according to clinical, epidemiological, and microbiological variables, in patients under five years of age admitted for bacterial pneumonia. Methods: descriptive, prospective, and cross-sectional study of 84 patients diagnosed with pneumonia and bacterial isolation in blood cultures and / or pleural fluid. Variables of interest were operationalized, with frequency, and percentage calculations being performed. Results: alveolar consolidation (57.1 %) prevailed in preschoolers, male sex, with previous antimicrobial treatment, early suppression of breastfeeding, and smoking at home. Fever, cough, tachypnea, retraction, rhinorrhea, and wet rales were the most frequent symptoms. Pneumococcus prevailed (64.6 %) in patients with alveolar condensation pattern. Conclusions: the pattern of alveolar consolidation was consistent with pneumococcal causality predominantly; with multiple risk factors and typical clinical presentation of bacterial pneumonia.

Internações por Condições Sensíveis à Atenção Primária de Menores de um ano, de 2008 a 2014, no estado de São Paulo, Brasil / Primary Health Care-Sensitive Hospitalizations in children under one year of age, from 2008 to 2014, in the State of São Paulo, Brazil

Resumo Este estudo teve o objetivo de descrever as causas e as tendências de Internações por Condições Sensíveis à Atenção Primária (ICSAP) em menores de um ano, entre 2008 e 2014, no estado de São Paulo, Brasil. Trata-se de um delineamento ecológico, baseado em dados secundários do Sistema de Informações Hospitalares. Classificaram-se as internações segundo o diagnóstico principal e a Lista Brasileira de ICSAP, considerando as seguintes faixas etárias: Neonatais precoce, Neonatal tardia e Pós-neonatal. Para a análise de tendência das internações foram ajustados modelos de regressão linear. Ocorreram 851.713 internações de Menores de um ano, sendo 22,6% por ICSAP. As principais reduções das frequências de internação foram: Pneumonias bacterianas (-7,10%) e Desvios nutricionais (-7,70) em Neonatal precoce. As elevações foram: Doenças relacionadas ao pré-natal e parto (+10,14%) e Doenças imunizáveis e condições evitáveis em Pós-neonatal (+14,13%), com destaque para coqueluche e sífilis congênita. Os resultados mostram uma deficiência no cuidado à saúde infantil na atenção primária no estado de São Paulo, enquanto que as tendências de internações estimadas podem auxiliar no planejamento de estratégias para diminuir os agravos e os gastos no setor terciário de atenção em saúde.

Abstract The scope of this article is to describe the trends of primary health care-sensitive (PHC) hospitalizations in children under one year of age between 2008 and 2014 in the State of São Paulo, Brazil. It is an ecological study with descriptive and analytical characteristics, based on secondary data from the national health information system. Hospitalizations were classified according to the Brazilian list of PHC hospitalizations considering the Early Neonatal, Late Neonatal and Post-Neonatal age groups. Linear regression models were adjusted for trend analysis of the 851,713 hospitalizations of children under one year of age analyzed, of which 22.6% were PHC-related. The main groups with decreases were: Bacterial pneumonia (-7.10%) and Nutritional disorders (-7.70%) in the Early neonatal phase. The main increases were: Disease related to prenatal/childbirth (+10.14%) and Immunosuppressive diseases and avoidable conditions in Post-neonatal (+14.13%) infants, among which pertussis and congenital syphilis were the main causes of hospitalization. The results showed a deficiency in the primary health care system for infants in the State of Sao Paulo. The estimated trends should be used for planning cost-effective strategies to prevent and control causes of hospitalization in children under one year of age.

Hospitalizations due to primary care-sensitive conditions among children under five years of age: cross-sectional study / Internações por condições sensíveis à atenção primária em crianças menores de cinco anos: estudo transversal

ABSTRACT CONTEXT AND OBJECTIVE: Hospitalizations due to primary care-sensitive conditions constitute an important indicator for monitoring the quality of primary healthcare. This study aimed to describe hospitalizations due to primary care-sensitive conditions found among children under five years of age (according to their age and sex), in two cities in Paraíba, Brazil. DESIGN AND SETTING: Cross-sectional study carried out in the municipalities of Cabedelo and Bayeux, in Paraíba, Brazil. METHODS: Data were collected from four public pediatric hospitals in Paraíba that receive children from these municipalities. Hospital admission authorizations were consulted to gather information on the children's profile and the characteristics of their hospitalizations. Differences in the causes of admissions and the respective lengths of hospital stay length were analyzed according to age group and sex. RESULTS: The proportion of hospital admissions due to primary care-sensitive conditions was 82.4%. The most frequent causes were: bacterial pneumonia (59.38%), infectious gastroenteritis and its complications (23.59%) and kidney and urinary tract infection (9.67%). Boys had higher frequency of hospitalizations due to primary care-sensitive conditions than girls. The median hospitalization due to primary care-sensitive conditions was found to be four days. The duration of hospital stays due to primary care-sensitive conditions was significantly longer than those due to conditions that were not sensitive to primary care. CONCLUSIONS: High rates of hospital admissions due to primary care-sensitive conditions were highlighted, especially among children of male sex, with long periods of hospitalization.

RESUMO CONTEXTO E OBJETIVO: As internações por condições sensíveis à atenção primária constituem importante indicador para o monitoramento da qualidade da atenção primária à saúde. O presente estudo objetivou descrever as internações por condições sensíveis à atenção primária em crianças menores de cinco anos (por idade e sexo) em duas cidades da Paraíba. TIPO DE ESTUDO E LOCAL: Estudo transversal realizado nos municípios de Cabedelo e Bayeux, ­Paraíba, Brasil. MÉTODOS: Coletaram-se os dados nos quatro hospitais públicos pediátricos da Paraíba que internam crianças residentes nos municípios estudados. A partir das autorizações de internação hospitalar, colheram-se informações relativas ao perfil da criança e características das internações. Analisaram-se as diferenças nas causas de internações e respectivos tempos de hospitalização segundo faixa etária e sexo. RESULTADOS: A proporção de internação por condição sensível à atenção primária foi de 82,4%. As causas mais frequentes foram: pneumonias bacterianas (59,38%), gastroenterites infecciosas e suas complicações (23,59%) e infecção do rim e trato urinário (9,67%). Meninos apresentaram maior frequência de internações por condições sensíveis à atenção primária do que meninas. Verificou-se mediana de quatro dias de hospitalização para as condições sensíveis à atenção primária. O tempo de hospitalização por condição sensível à atenção primária foi significantemente maior do que o tempo da condição não sensível à atenção primária. CONCLUSÕES: Ressaltam-se altas taxas de internações por condições sensíveis à atenção primária, principalmente em crianças do sexo masculino, com longos períodos de hospitalização.

Risk factors for the development of postoperative pneumonia after cardiac surgery / Factores de riesgo para desarrollar neumonía postquirúrgica en pacientes operados de cirugía cardiaca

Abstract Objective Identify risk factors that determine pneumonia development in patients who have undergone cardiac surgery. Methods Prospective study of a single cohort in a postoperative intensive care unit at a tertiary care center, encompassing all patients undergoing cardiac surgery from January to July 2014. Results 31 postoperative pneumonia cases were enrolled out of 211 patients (14.6%). The following independent risk factors were identified: hypertension (OR: 3.94, p = 0.01), chronic renal failure (OR: 13.67, p = 0.02), reintubation (OR: 22.29, p = 0.001) and extubation after 6 h (OR: 15.81, p = 0.005). Conclusions Main determinants for pneumonia after surgery were hypertension, chronic renal failure, extubation after 6 h and reintubation.

Resumen Objetivo Identificar los factores de riesgo para desarrollar neumonía en el periodo postquirúrgico de pacientes sometidos a cirugía cardiaca. Método Estudio de cohorte prospectiva que incluye pacientes > 18 años sometidos a cirugía cardiaca de enero a julio de 2014, en el Instituto Nacional de Cardiología Ignacio Chávez, México D.F. Se considera un valor de p < 0.05 como significativo. Resultados De un total de 211 pacientes operados, se diagnosticaron 31 casos de neumonía postquirúrgica (14.6%). Se identificaron los siguientes factores de riesgo independientes para desarrollar neumonía: la hipertensión arterial sistémica (OR: 3.94, p = 0.01), el antecedente de insuficiencia renal crónica (OR: 13.67, p = 0.02). La reintubación (OR: 22.29, p = 0.001) y permanecer intubado por más de 6 horas (OR: 15.81, p = 0.005). Conclusiones Los principales factores de riesgo independientes para desarrollar neumonía en el periodo postquirúrgico son la preexistencia de hipertensión arterial sistémica o insuficiencia renal crónica, la reintubación y permanecer intubado durante más de 6 h.

Impacto de la vacuna neumocócica conjugada 13-valente en la incidencia de neumonía consolidante en menores de 5 anos en el partido de Pilar, Buenos Aires: estudio de base poblacional / Impact of the 13-valent pneumococcal conjugate vaccine on the incidence of consolidated pneumonia in children younger than 5 years old in Pilar, Buenos Aires: A population-based study

Introducción. En enero de 2012, en Argentina, fue introducida la vacuna neumocócica conjugada 13-valente (13-Valent Pneumococcal Conjugate Vaccine; PCV13, por sus siglas en inglés) en el Calendario Nacional, en menores de 2 anos. La cobertura en el partido de Pilar en 2012 fue > 90% para las primeras 2 dosis y 60% para la tercera. Objetivo. Medir la efectividad de la PCV13 en la reducción de la incidencia de neumonías consolidantes (NC), durante los dos anos siguientes a su introducción en el Calendario. Métodos. Estudio prospectivo debase poblacional en Pilar. Se incluyeron todos los menores de 5 anos con signos clínicos de neumonía atendidos en hospitales de referencia (ambulatorios y hospitalizados) en los primeros 2 anos de la incorporación (2012-2013). Se comparó la incidencia anual de NC con el período basal 2003-2005. Evaluación clínica-radiológica, según criterio de la Organización Mundial de la Salud. Resultados. Se incluyeron 666 pacientes con sospecha clínica de neumonía. Se diagnosticó NC en 309 pacientes; 52,1% de mujeres, 70,2% menores de 2 anos y 56,4% vacunado con PCV13; 4,5% (14/309) con bacteriología confirmada (S. pneumoniae: 4; N. meningitidis: 4; S. aureus: 2; otros: 4). Se observó una reducción significativa en la incidencia de NC (por 100000 niños menores de 5 anos) entre los períodos pre y posvacunal de 750 (204/27209) a 561 (171/30 475) en 2012 y 453 (138/30 475) en 2013; efectividad de 25,2% y 39,6%, respectivamente. Reducción en menores de 1 año: 33,9% en 2012 y 44,6% en 2013; y en niños de 12-23 meses: 57,9% en 2013. No se observaron diferencias significativas en las incidencias en edades mayores. Conclusiones. Luego de la introducción de la PCV13 en el Calendario de Vacunación en Argentina, se observó una reducción rápida y significativa en la incidencia de NC, principalmente en menores de 1 año en 2012 y menores de 2 anos en 2013.

Introduction. In January 2012, Argentina introduced the 13-valent pneumococcal conjugate vaccine (PCV13) in its immunization schedule for children younger than 2 years old. Coverage in Pilar in 2012 reached>90% for the first two doses and 60% for the third dose. Objective. To measure the effectiveness of PCV13 to reduce the incidence of consolidated pneumonia (CP)in the two-year period following its introduction in the immunization schedule. Methods. Prospective, population-based study conducted in Pilar. All children younger than 5 year sold with clinical signs of pneumonia assisted at the reference hospitals (both inpatients and utpatients) in the first two years since the vaccine introduction (2012-2013) were included. The annual incidence of CP was compared to the 2003-2005 baseline period. Clinical and radiological assessments were done as per the World Health Organization's criteria. Results. Six hundred and sixty-six patients with clinical suspicion of pneumonia were included. CP was diagnosed in 309 patients; 52.1% were girls, 70.2% were younger than 2 years old, and 56.4% had been immunized with the PCV13; 4.5% (14/309) had bacteriological confirmation (S. pneumoniae: 4; N. meningitidis: 4; S. aureus: 2; others: 4). A significant reduction in the incidence of CP (per 100 000 children younger than 5 years old) was observed between the pre- and postimmunization periods, from 750 (204/27209) to 561 (171/30 475) in 2012 and to 453 (138/30 475) in 2013; effectiveness accounted for 25.2% and 39.6%, respectively. Reduction in infants younger than 1 year old: 33.9% in 2012 and 44.6% in 2013; and in children aged 12-23 months old: 57.9% in 2013. No significant differences were observed in the incidence of CP at an older age. Conclusions. Following the introduction of PCV13 in Argentina's immunization schedule, a fast and significant reduction in the incidence of CP was observed, mainly in infants younger than 1 year old in 2012 and in children younger than 2 years old in 2013.

Incidencia de egresos por neumonía en niños menores de 24 meses antes y después de la implementación de la vacuna conjugada antineumocócica 10-valente en el Programa Nacional de Inmunizaciones de Chile / Incidence of admissions due to pneumonia in children under 24 months old before and after the introduction of the 10-valent pneumococcal conjugate vaccine into the National Immunization Program of Chile

Introducción: Streptococcus pneumoniae es la primera causa de neumonía bacteriana en niños, principalmente en hospitalizados. La vacuna antineumocócica 10-valente fue introducida al Programa Nacional de Inmunizaciones de Chile el año 2011. El objetivo de este estudio fue determinar la incidencia de egresos por neumonía en niños < 24 meses en el Hospital Dr. Luis Calvo Mackenna, Santiago, Chile, antes y después de la implementación de vacuna antineumocócica 10-valente en el Programa Nacional de Inmunizaciones. Pacientes y método: Estudio de vigilancia pasiva; se estudiaron los pacientes < 24 meses egresados desde el Hospital Dr. Luis Calvo Mackenna entre los años 2009-2013 con diagnóstico de neumonía bacteriana. Los datos fueron obtenidos desde el Servicio de Estadística del Hospital Dr. Luis Calvo Mackenna. Se evaluó la incidencia de neumonía durante el período prevacuna (2009-2010) y posvacuna (2012-2013). Resultados: Durante el período de estudio se observó un promedio de 4.321 egresos/año en niños < 24 meses (rango: 3.587-4.702), con una disminución significativa desde el período pre- al posvacuna (4.644 versus 4.013; p < 0,001). La incidencia media de egresos por neumonía varió de 3,4/100.000 a 1,5/100.000 en el período pre- y posvacuna, respectivamente (p = 0,009), con un promedio anual de casos de neumonía de 157 en el primer período y de 62 en el segundo (p < 0,001) y una disminución de incidencia entre ambos períodos del 56%. Conclusión: Este estudio corrobora la información obtenida en otros países, mostrando una disminución en la incidencia de neumonía al implementar la vacuna antineumocócica a nivel poblacional. Es necesaria una vigilancia permanente para evaluar si este efecto se mantiene en el tiempo y se expande a poblaciones de mayor edad.

Introduction: Streptococcus pneumoniae is the leading cause of bacterial pneumonia in children, especially in the hospitalized population. The 10-valent pneumococcal vaccine was included in the National Immunization Program of Chile in 2011. This study aims to evaluate the incidence of pneumonia in hospitalized children < 24 months of age in the Luis Calvo Mackenna Hospital before and after the introduction of the pneumococcal vaccine into the National Immunization Program. Patients and methods: Passive surveillance study. Patients < 24 months with discharge diagnosis of bacterial pneumonia from Luis Calvo Mackenna Hospital were studied between 2009 and 2013. Data were obtained from the Luis Calvo Mackenna Hospital's Statistical Service. The incidence of pneumonia was evaluated in the pre-vaccination period (2009-2010) and in the post-vaccination period (2012-2013). Results: During the study period, an average of 4,321 discharges/year was observed in children < 24 months (range: 3,587-4,702), with a significant decrease from pre- to post-vaccination vaccine period (4,644 vs 4,013, P < .001). The average incidence of pneumonia ranged from 3.4/100,000 to 1.5/100,000 in the pre- and post-vaccine period, respectively (P = .009), with an annual mean of 157 cases of pneumonia in the pre-vaccine period, and 62 cases in the postvaccine period (P < .001) and a decrease in incidence between the two periods of 56%. Conclusion: This study confirms information previously obtained in other countries, which show a decrease in the incidence of pneumonia associated with the implementation of a pneumococcal vaccine at the population level. Ongoing surveillance is required to evaluate if this effect is maintained over time and expands to older populations.

First reported case of pneumonia caused by Cedecea lapagei in America

Cedecea represents a genus in the Enterobacteriaceae family that has been rarely associated with human infection. The clinical relevance of Cedecea lapagei has yet to be elucidated. This is the first reported case of pneumonia due to C. lapagei in a patient with acute promyelocytic leukemia.

Neumonía necrotizante en niños hospitalizados en el hospital pediátrico Centro Hospitalario Pereira Rossell en el año 2010 / Necrotizing pneumonia in children hospitalized at children's hospital Centro Hospitalario Pereira Rossell Hospital in 2010

Tras la incorporación en Uruguay de vacunas conjugadas neumocócicas (PCV), se registró un descenso en las hospitalizaciones por neumonía bacteriana adquirida en la comunidad (NAC) en el Hospital Pediátrico del Centro Hospitalario Pereira Rossell (HP-CHPR). Así mismo, en los últimos años se asistió a niños que desarrollaron neumonía necrotizante (NN). Se denomina NN a casos de NAC en los que la inflamación determina isquemia y necrosis del parénquima, con formación de neumatoceles y fístula broncopleural, cuando ésta se produce en la periferia del pulmón. Son pacientes graves, con mal estado general, fiebre persistente y requieren hospitalizaciones prolongadas. Los neumatoceles se diagnostican en la radiografía y/o la tomografía computada de tórax. Se realizó la descripción de los niños con NAC hospitalizados en el HP-CHPR, que evolucionaron a NN en el año 2010. Se diagnosticaron 28 niños, con un promedio de edad de 36 meses, la mayoría sanos y eutróficos. Los neumatoceles fueron identificados en la radiografía de tórax en casi todos los pacientes. Presentaron en promedio 7 días de fiebre. La mayoría evolucionó con complicaciones pulmonares y/o extrapulmonares. Diez niños requirieron ingreso a unidad de terapia intensiva. Las hospitalizaciones tuvieron una duración de hasta 43 días. Ningún paciente falleció. En la mitad de los casos se identificó Streptococcus pneumoniae. Todas las cepas aisladas eran sensibles a penicilina. Ninguno de los pacientes en los que se aisló cepas contenidas en las PCV estaba adecuadamente vacunado. La NN es una complicación grave de NAC, que ocurre en niños sanos. Determina hospitalizaciones prolongadas y gran morbilidad. Es importante mantener la vigilancia de los ingresos hospitalarios por NAC y sus complicaciones luego de la vacunación universal con PCV...

Etiología de las neumonías adquiridas en comunidad en la población infantil / Etiology in community acquired pneumonia in children population

Respiratory infections of lower respiratory tract remain a major cause of mortality in young children worldwide, particularly in developing countries. The Community Acquired Pneumonia (CAP), the infectious etiology pneumonia acquired by a previously healthy individual outside a hospital. In 2012, WHO stated that S. pneumoniae and H. influenzae type b (Hib) are the first and second most common cause of bacterial pneumonia in children, respectively, whereas Respiratory Syncytial Virus is the most frequent cause of viral pneumonia. The assessment and treatment of a child with a respiratory infection of lower airways becomes a challenge as not only the clinical manifestations of infection by viruses, bacteria or atypical bacteria may overlap, but also coinfections occur frequently. The etiological agents of pneumonia in children can be divided into three groups: common bacteria(S. pneumoniae, H. influenzae, S. aureus, M. catarrhalis, S. pyogenes, B. pertussis, M. tuberculosis, among others),respiratory viruses (RSV, Influenza A and B, Parainfluenza 1, 2 and 3, Adenovirus, Rhinovirus, Coronavirus, Metapneumovirus, Bocavirus, Enterovirus, Varicella Zoster, among others) and atypical pathogens (M. pneumoniae, C. pneumoniae, C. trachomatis, L. pneumophila, C. burnetii, among others). The etiological diagnosis of CAP in pediatric patients is supported by laboratory tests that generate direct or indirect evidence of the causal germ. The search for the causing agent becomes a challenge, primarily due to the limitation in obtaining appropriate samples and the difficulty to identify the etiological agent and differentiate between colonization and infection. With the available methods, a specific germ is expected to be detected from 16 to 85 percent of the cases, making it difficult to determine the true incidence of these infections. In addition, the variety of diagnostic techniques used in clinical trials and interpretation of the results in the absence...

Las infecciones respiratorias de vías aéreas inferiores siguen siendo una de las principales causas de mortalidad en niños pequeños alrededor del mundo, particularmente en países en desarrollo. La Neumonía Adquirida en la Comunidad (NAC), es la neumonía de etiología infecciosa que adquiere un individuo previamente sano, fuera de un hospital. En el 2012, la OMS, establece que S. pneumoniae y H. influenzae tipo b (Hib) son la primera y segunda causa más común de etiología bacteriana en niños, respectivamente; mientras que el Virus Sincitial Respiratorio es la causa más frecuente de neumonía viral. La evaluación y el manejo de un niño con una infección respiratoria de vías aéreas inferiores, se convierte un reto ya que no sólo las manifestaciones clínicas de las infecciones por virus, bacterias o bacterias atípicas pueden solaparse, sino que también ocurren frecuentemente coinfecciones. Los agentes etiológicos de las neumonías en niños se pueden dividir en 3 grupos: bacterias comunes (S. pneumoniae, H. influenza, S. aureus, M. catarrhalis, S. pyogenes, B. pertussis, M. tuberculosis, entre otros), virus respiratorios (VSR, Influenza A y B, Parainfluenza 1, 2 y 3, Adenovirus, Rhinovirus, Coronavirus, Metapneumovirus, Bocavirus,Enterovirus, Varicela, entre otros) y gérmenes atípicos (M. pneumoniae, C. pneumoniae, C. trachomatis, L. pneumophila, Coxiella burnetii, entre otros). El diagnóstico etiológico de NAC en el paciente pediátrico se apoya en pruebas de laboratorio que generan una evidencia directa o indirecta del germen causal. La búsqueda del agente causal se convierte en un reto debido principalmente a la limitación para obtener muestras adecuadas y a la dificultad de identificar el agente etiológico y diferenciar entre colonización e infección. Con los métodos disponibles se estima que se puede detectar un germen específico entre el 16 al 85 por ciento de los casos; lo cual dificulta la determinación de la incidencia real de estas infecciones...

Neumonía adquirida en la comunidad en niños y adolescentes / Community-acquired pneumonia in children and adolescents

La neumonía tiene una alta morbilidad y mortalidad en países en desarrollo y en Cuba sigue siendo un problema de salud importante. El propósito de este trabajo es ofrecer información actualizada a los profesionales de la atención primaria de salud acerca de la neumonía en los primeros años de vida. La neumonía adquirida en la comunidad ocurre en sujetos que conviven en ella, por un fallo en los mecanismos de defensa a nivel de las vías aéreas frente diversos agentes infecciosos que difieren según la edad del paciente, siendo Streptococcus pneumoniae el más importante en la infancia. Su diagnóstico es fundamentalmente clínico y la taquipnea es el mejor signo predictor en niños menores de 5 años; las pruebas de laboratorio no son estrictamente necesarias en la atención primaria, donde tampoco están indicados estudios microbiológicos y la radiografía de tórax no debe hacerse de forma rutinaria. Ante complicaciones y otros criterios, el paciente debe ser hospitalizado para su tratamiento y control. Se recomienda tratamiento antibiótico en todos los casos, en función de la edad del paciente. La prevención es de vital importancia en el control de esta enfermedad. Se trata de una enfermedad curable que puede ser fatal, sobre todo en niños, por lo que resulta necesario conocer su importancia como problema de la salud pública y tener un conocimiento actualizado acerca de su etiología, patogenía, diagnóstico y las estrategias para su tratamiento y prevención.

Pneumonia brings high morbidity and mortality to developing countries and it is still a substantial health problem in Cuba. The objective of this paper was to provide the primary health care professionals with updated information about pneumonia in the childhood. Community-acquired pneumonia appears in individuals living in the community as a result of a failure in the mechanisms of defense at airways against the action of infective agents that vary with the patient's age. Streptococcus pneumonia is the most significant in childhood. The diagnosis is basically clinical whereas tachypnea found in children under 5 years of age is the main predictive signal. Neither lab tests nor microbiological studies are strictly indispensable at primary health care level; furthermore, X-rays should not be made as part of a routine. In the face of complications and other criteria, the patient must be admitted to the hospital for treatment and monitoring. It is recommended to apply antibiotics in all the cases, depending on the patient's age. Prevention is vital to control the disease. Pneumonia is a typically curable disease, but it is often deadly, particularly in children; therefore, it is necessary to keep the perception on the weight of pneumonia as a public health problem and to have clear and updated knowledge about the etiology, the pathogenesis and the diagnosis of this disease, as well as the strategies to be pursued to prevent, to manage and to treat it.

Nosocomial infections in a pediatric intensive care unit of a developing country: NHSN surveillance / Infecções hospitalares em unidade de terapia intensiva pediátrica de um país em desenvolvimento: vigilância NHSN

INTRODUCTION: This study aimed to determine the epidemiology of the three most common nosocomial infections (NI), namely, sepsis, pneumonia, and urinary tract infection (UTI), in a pediatric intensive care unit (PICU) in a developing country and to define the risk factors associated with NI. METHODS: We performed a prospective study on the incidence of NI in a single PICU, between August 2009 and August 2010. Active surveillance by National Healthcare Safety Network (NHSN) was conducted in the unit and children with NI (cases) were compared with a group (matched controls) in a case-control fashion. RESULTS: We analyzed 172 patients; 22.1% had NI, 71.1% of whom acquired it in the unit. The incidence densities of sepsis, pneumonia, and UTI per 1,000 patients/day were 17.9, 11.4, and 4.3, respectively. The most common agents in sepsis were Enterococcus faecalis and Escherichia coli (18% each); Staphylococcus epidermidis was isolated in 13% of cases. In pneumonias Staphylococcus aureus was the most common cause (3.2%), and in UTI the most frequent agents were yeasts (33.3%). The presence of NI was associated with a long period of hospitalization, use of invasive devices (central venous catheter, nasogastric tube), and use of antibiotics. The last two were independent factors for NI. CONCLUSIONS: The incidence of NI acquired in this unit was high and was associated with extrinsic factors.

INTRODUÇÃO: O objetivo deste estudo foi determinar a epidemiologia das três infecções hospitalares (IH) mais comuns - sepse, pneumonia e infecção do trato urinário (ITU) - em uma unidade de terapia intensiva pediátrica (UTIP) de um país em desenvolvimento e definir os fatores de risco associados com IH. MÉTODOS:Nós desenvolvemos um estudo prospectivo de incidência de IH em uma única UTIP, entre agosto/2009 e agosto/2010. Foi conduzida uma vigilância ativa pelo National Healthcare Safety Network (NHSN) na Unidade e as crianças com IH (casos) foram comparadas com um grupo (controles) em um estudo caso-controle. RESULTADOS: Nós analisamos 172 pacientes, 22,1% com IH, 71,1% adquirida na Unidade. A densidade de incidência de sepse, pneumonia e ITU por 1.000 pacientes/dia foram 17,9, 11,4, e 4,3, respectivamente. Os agentes mais comuns na sepse foram Enterococcus faecalis e Escherichia coli (18% cada), e Staphylococcus epidermidis foram isolados em 13% dos casos. Nas pneumonias Staphylococcus aureus foram os agentes mais comuns (3,2%), e nas ITUs os agentes mais frequentes foram os fungos (33,3%). A presença de IH foi associada com tempo de hospitalização prolongado, uso de procedimentos invasivos (CVC, sonda nasogástrica) e uso de antibióticos. Os dois últimos foram fatores independentes para o desenvolvimento de IH. CONCLUSÕES: A incidência de IH adquirida na Unidade foi alta, associada a fatores de risco extrínsecos.

Antibiotic prescription in intensive care units in Latin America

The intensive care units (ICUs) are often considered as the epicenters of antibiotic resistance. Therefore, the total antibiotic consumption is approximately ten fold greater in ICU wards than in general hospital wards. The aim of this study was to evaluate the current use of antibiotics in Latin American ICUs. Three cross-sectional (one-day point) prevalence studies were undertaken in 43 Latin American ICUs. Of 1644 patients admitted, 688 received antibiotic treatment on the days of the study (41.8 %) and, 392 cases (57 %) were due to nosocomial-acquired infections. Of all infections, 22 % (151/688) corresponded to septic shock; and 22 % (151/688) to nosocomial pneumonia (50/151 [33 %], ventilator-associated pneumonia). In 485 patients (70.5 %), cultures were performed before starting antibiotic treatment. The most common microorganisms isolated were extended-spectrum ß-lactamase Enterobacteriaceae, (30.5 %), and Pseudomonas aeruginosa (17 %). Carbapenems (imipenem or meropenem) were the antibiotics most frequently prescribed (151/688, 22 %), followed by vancomycin (103/688, 15 %), piperacillin-tazobactam (86/688, 12.5 %) and broad-spectrum cephalosporins (mainly cefepime) (83/688, 12 %). In summary, carbapenems were the most frequent antibiotics prescribed in Latin American ICUs. This practice seems justified for the high rates of ESBL-producing Gram-negatives found in our patients. Beyond this reason, the problem of bacterial resistance in LA requires that physicians improve the use of carbapenems. The high prevalence of carbapenem-resistant A. baumannii and P. aeruginosa in the region, along with the prevalence of carbapenem-resistant Enterobacteriaceae, have increased markedly. A comprehensive evidence-based stewardship program based on local antimicrobial use and resistance problems should be implemented in our clinical settings.

Prescripción de antibióticos en unidades de cuidados intensivos de Latinoamérica. Las unidades de cuidados intensivos (UCI) son a menudo consideradas el epicentro de la resistencia a los antibióticos. En este sentido, el consumo total de antibióticos es aproximadamente diez veces mayor en las UCI que en las salas de internación general. El objetivo de este estudio fue evaluar el hábito prescriptivo de antibióticos en las UCI de varios países de Latinoamérica. A tal fin, se realizó un estudio transversal con tres evaluaciones puntuales de un día de duración cada una, para determinar la prevalencia del uso de antibióticos en las 43 UCI ubicadas en distintos países del continente americano. De los 1644 pacientes admitidos, 688 estaban recibiendo tratamiento antibiótico en los días en que se realizó el relevamiento (41,8 %), en 392 casos (57 %), debido a infecciones nosocomiales. De todas las infecciones, 22 % (151/688) correspondieron a shock séptico y 22 % (151/688) a neumonía nosocomial (de estas últimas, el 33 % [50/151] fueron neumonías asociadas a ventilación mecánica). En 485 pacientes (70,5 %) se obtuvieron cultivos antes del inicio del tratamiento antibiótico. Entre los aislamientos, los microorganismos más comúnmente aislados fueron las enterobacterias productoras de ß-lactamasas de espectro extendido (BLEE) (30,5 %) y Pseudomonas aeruginosa (17 %). Los carbapenems (imipenem o meropenem) fueron los antibióticos prescriptos con mayor frecuencia (151/688, 22 %), seguidos por la vancomicina (103/688, 15 %), la piperacilina-tazobactama (86/688, 12,5 %) y las cefalosporinas de amplio espectro (principalmente cefepima) (83/688, 12 %). En conclusión, los carbapenems fueron los antibióticos más frecuentemente prescriptos en las UCI de los países latinoamericanos evaluados. Esta práctica podría estar justificada por las altas tasas de enterobacterias productoras de BLEE halladas en los pacientes de esas regiones. Más allá de esta razón, el problema de la resistencia bacteriana en muchos países del continente requiere que los médicos optimicen el uso de los carbapenems, ya que la prevalencia de aislamientos resistentes a este grupo de antimicrobianos se ha incrementado marcadamente, tanto en A. baumannii y P. aeruginosa como en enterobacterias. Frente a este panorama, en todos estos países se torna necesario implementar programas de optimización del uso de antibióticos, basados en la epidemiología y en las tasas de resistencia locales.

Evaluación de predictores clínicos de bacteriemia en adultos hospitalizados por neumonía adquirida en la comunidad / Evaluation of clinical predictors of bacteremia in adults hospitalized for community-acquired pneumonia

OBJETIVO: Identificar elementos clínicos sencillos que hagan posible determinar adecuadamente los casos con mayor probabilidad de presentar aislamientos bacterianos en los hemocultivos. MÉTODOS: Estudio de casos y controles con pacientes internados por neumonía adquirida en la comunidad entre 1998 y 2009, definiéndose como casos a los pacientes que presentaron hemocultivos positivos y como controles a aquellos con hemocultivos negativos. Se registraron variables demográficas y clínicas y se las sometió a un análisis bivariado. Las que presentaron diferencias estadísticamente significativas entre los grupos fueron introducidas en un modelo de regresión logística para definir predictores independientes y generar un modelo de predicción clínica. RESULTADOS: De los 322 pacientes estudiados, 15,2 por ciento tuvo hemocultivos positivos. Diez variables mostraron diferencias significativas, pero solo tres (temperatura <38°C, sodio <135 mEq/L y puntaje CURB-65) fueron seleccionadas para el análisis multivariado. El modelo desarrollado mostró escasa capacidad para predecir el resultado de los hemocultivos (R² = 0,176; Hosmer-Lemeshow: P = 0,338). CONCLUSIONES: Los datos obtenidos en esta serie no evidenciaron elementos clínicos con capacidad suficiente para predecir el resultado de los hemocultivos.

OBJECTIVE: Identify simple clinical elements that can be used to adequately determine the cases with the highest probability of presenting bacterial isolates in blood cultures. METHODS: Case-control study with patients hospitalized for community-acquired pneumonia from 1998-2009. Patients with positive blood cultures were defined as cases, and patients with negative blood cultures were defined as controls. The demographic and clinical variables were recorded and a bivariate analysis was conducted. The variables with statistically significant differences between the groups were introduced in a logistic regression model in order to define the independent predictors and generate a clinical prediction model. RESULTS: A total of 15.2 percent of the 322 patients studied had positive blood cultures. Ten variables showed significant differences, but only three variables (temperature <38°C, sodium <135 mEq/L and CURB-65 score) were selected for the multivariate analysis. The model developed showed limited capacity to predict the result of the blood cultures (R² = 0.176; Hosmer-Lemeshow: P = 0.338). CONCLUSIONS: The data obtained in this series did not demonstrate clinical elements with sufficient capacity to predict the result of the blood cultures.

Profile of bacterial pneumonia during Hajj.

Background & objectives The congregation of a large number of people during Hajj seasons from different parts of the world in overcrowded conditions within a confined area for a long period of time presents many public health challenges and health risks. One of the main health problems of the crowding is ease transmission of pneumonia by air droplets. This study was aimed to determine the most common causes of bacterial pneumonia during the 2005 Hajj season and to relate the findings with clinical conditions. Methods A total of 141 patients with suspected pneumonia from the three main tertiary care hospitals in Makkah, Saudi Arabia, were investigated during Hajj season, 2005. Sputum and serum samples were collected and investigated for the possible presence of typical or atypical causative agents. Results Of the 141 clinically suspected pneumonia cases, 76 (53.9%) were confirmed positive by microbiological tests. More than 94 per cent of the confirmed cases were in the age group >50 yr, and 56.6 per cent of the cases were men. The most frequent isolates were Candida albicans (28.7%) and Pseudomonas aeruginosa (21.8%), followed by Legionella pneumophila (14.9%) and Klabsiella pneumoniae (9.2%). More than one causative pathogens were isolated in 15 patients (16.3%), and 55 per cent of patients were diabetic. Interpretation & conclusions Clinicians should be aware that typical pneumonia treatment regimens may not work well during the Hajj season due to the wide variety of isolated organisms. This necessitates taking a sputum sample before starting treatment for identification and sensitivity testing. Special precautions need to be taken for >50 yr old patients.

Neumonía aguda de la comunidad y hemorragia pulmonar por leptospirosis en el área metropolitana Buenos Aires / Community acquired pneumonia and pulmonary hemorrhage in leptospirosis in the Buenos Aires metropolitan area

El objetivo del trabajo es comunicar los hallazgos epidemiológicos, clínicos y de diagnóstico de la neumonía y hemorragia pulmonar por leptospirosis, en el período enero 2007 a octubre 2009. Un 64% (20/31) de pacientes con diagnóstico de leptospirosis tuvieron neumonía. Quince de ellos (75%) presentaron neumonía grave, de los cuales siete (35%) desarrollaron hemorragia pulmonar. En diez enfermos (32%) el motivo de consulta e inicio del cuadro clínico fue una gastroenteritis secretoria con fiebre y dolor abdominal. La ictericia sólo se manifestó en once pacientes (35%). La técnica de reacción en cadena de la polimerasa (PCR) fue útil para el diagnóstico en muestra obtenida post mortem. De un hemocultivo se aisló una cepa clasificada dentro del serogrupo canicola. Se clasificaron las neumonías en tres tipos: neumonías de curso no grave con escasa repercusión general; neumonías graves asociadas a formas clínicas sistémicas con ictericia, insuficiencia renal, trombocitopenia y hemorragia pulmonar; también de curso grave, no asociada a ictericia, insuficiencia renal o trombocitopenia grave. El tratamiento antibiótico iniciado en los primeros días de enfermedad (promedio 3.2 días) no tuvo influencia en la evolución de las neumonías graves. Se plantea además considerar tres formas clínicas de leptospirosis: anictérica, ictérica (con sus variantes evolutivas) y hemorragia pulmonar.

The aim of this paper is to report the epidemiological, clinical and diagnosis findings of pneumonia and pulmonary hemorrhage observed in patients with leptospirosis in the period January 2007 to October 2009. A 64% (20/31) of patients diagnosed with leptospirosis presented pneumonia. Fifteen of them (75%) had severe pneumonia, of which seven (35%) were pulmonary hemorrhage. In ten patients (32%) reason for consultation and clinical early stage was a secretory gastroenteritis with fever and abdominal pain. Jaundice was only expressed in eleven patients (35%). The technique of chain reaction (PCR) was useful for diagnosis in samples obtained post mortem. A strain classified in serogroup canicola was isolated from blood culture. Pneumonia was classified into three types: non-severe pneumonia course with little overall impact; severe pneumonia associated with systemic clinical forms with jaundice, renal failure, thrombocytopenia, and pulmonary hemorrhage, and of serious course, not associated with jaundice, kidney failure or thrombocytopenia. Antibiotic treatment started in the early stages of disease (average 3.2 days) had no influence on the development of severe pneumonia. It is puggested to consider three clinical forms of leptospirosis: anicteric, icteric (with its evolutionary variants) and pulmonary hemorrhage.

Perfil clínico, epidemiológico e etiológico de pacientes com pneumonia adquirida na comunidade internados em um hospital geral da microrregião de Sumaré, SP / Clinical, epidemiological, and etiological profile of inpatients with community-acquired pneumonia at a general hospital in the Sumaré microregion of Brazil

OBJETIVO: Analisar aspectos clínicos, etiológicos e epidemiológicos das pneumonias adquiridas na comunidade (PAC) em indivíduos internados. MÉTODOS: Foram estudados prospectivamente 66 pacientes com PAC maiores de 14 anos no Hospital Estadual Sumaré, localizado na cidade de Sumaré (SP), entre outubro de 2005 e setembro de 2007. Coletamos dados sobre história clínica, exame clínico, escore pneumonia severity index (PSI) e exames laboratoriais (hemocultura, bacterioscopia/cultura de escarro, sorologias para Chlamydophila pneumoniae, Mycoplasma pneumoniae e Legionella pneumophila, além de antígenos urinários de Legionella sp. e Streptococcus pneumoniae). RESULTADOS: A idade média dos pacientes foi de 53 anos, a maioria tinha baixa escolaridade, e 55,7 por cento apresentavam pelo menos uma comorbidade no momento da internação. O percentual de idosos vacinados contra influenza entre os internados foi significativamente menor que os da comunidade dos municípios da microrregião de Sumaré (52,6 por cento vs. > 70 por cento). A febre foi menos frequente entre os idosos (p < 0,05). A evolução clínica se associou com o escore PSI, mas não com a idade. A etiologia foi confirmada em 31 (50,8 por cento) dos casos, sendo 21 (34,4 por cento) devido a S. pneumoniae, detectado principalmente pelo antígeno urinário; seguido de C. pneumoniae, em 5 (8,2 por cento). Receberam alta hospitalar por cura 80,3 por cento dos pacientes. A taxa de letalidade foi de 4,9 por cento. CONCLUSÕES: O conhecimento do perfil etiológico de PAC no âmbito regional favorece a escolha adequada da terapia empírica, que é particularmente relevante em pacientes idosos e naqueles com comorbidades. A falta da vacinação contra influenza em idosos é um fator de risco de internação por PAC.

OBJECTIVE: To analyze the clinical, etiological, and epidemiological aspects of community-acquired pneumonia (CAP) in hospitalized individuals. METHODS: We prospectively studied 66 patients (> 14 years of age) with CAP admitted to the Hospital Estadual Sumaré, located in the Sumaré microregion of Brazil, between October of 2005 and September of 2007. We collected data related to clinical history, physical examination, pneumonia severity index (PSI) scores, and laboratory tests (blood culture; sputum smear microscopy and culture; serology for Chlamydophila pneumoniae, Mycoplasma pneumoniae, and Legionella pneumophila; and detection of Legionella sp. and Streptococcus pneumoniae antigens in urine). RESULTS: The mean age of patients was 53 years. Most had a low level of education, and 55.7 percent presented with at least one comorbidity at the time of hospitalization. The proportion of elderly people vaccinated against influenza was significantly lower among the inpatients than in the general population of the Sumaré microregion (52.6 percent vs. > 70 percent). Fever was less common among the elderly patients (p < 0.05). The clinical evolution was associated with the PSI scores but not with age. The etiology was confirmed in 31 cases (50.8 percent) and was attributed to S. pneumoniae, principally detected by the urinary antigen test, in 21 (34.4 percent), followed by C. pneumoniae, in 5 (8.2 percent). The mortality rate was 4.9 percent, and 80.3 percent of the patients were classified as cured at discharge. CONCLUSIONS: The knowledge of the etiologic profile of CAP at the regional level favors the appropriate choice of empirical treatment, which is particularly relevant in elderly patients and in those with comorbidities. The lack of influenza vaccination in elderly patients is a risk factor for hospitalization due to CAP.

Alteraciones clínicas y epidemiológicas por neumonía bacteriana en una unidad de cuidados intensivos pediátricos / Clinical epidemiological changes due to bacterial pneumonia in a pediatric intensive care unit

Introducción: Las infecciones respiratorias agudas constituyen actualmente una de las principales causas de morbilidad y mortalidad de los niños menores de 5 años en los países en desarrollo, de las cuales, las neumonías provocan entre 80 y 90 por ciento de las muertes. Objetivo: Caracterizar a los lactantes e infantes hospitalizados por neumonía bacteriana, según variables clinicoepidemiológicas. Métodos: Se realizó un estudio descriptivo y trasversal de 68 pacientes con neumonía bacteriana, que ingresaron en la Unidad de Cuidados Intensivos Pediátricos del Hospital Infantil Norte Dr Juan de la Cruz Martínez Maceira de Santiago de Cuba, desde enero hasta diciembre del 2005. Resultados: De los afectados, 58,8 por ciento tenían menos de 4 años y 73,5 por ciento pertenecían al sexo masculino. En la casuística predominaron los diagnosticados con neumonía e insuficiencia respiratoria (que constituyó la complicación conducente al ingreso). El estafilococo coagulasa negativo fue el microorganismo más aislado. Conclusiones: Las neumonías continúan siendo un problema de salud en la infancia, con primacía en las edades inferiores a los 4 años.

Introduction: Currently, acute respiratory diseases are one of main causes of morbidity and mortality in children under 5 years of age in developing countries, including pneumonias that are responsible for 80 and 90 per cent of deaths. Objective: To characterize infants and children hospitalized due to bacterial pneumonia according clinical epidemiological variates. Methods: A descriptive and cross-sectional study was carried out in 68 patients with bacterial pneumonia, who were admitted to the Pediatric Care Intensive Unit of Dr Juan de la Cruz Martínez Maceira Northern Children Hospital in Santiago de Cuba, from January to December 2005. Results: Of those affected, 58, 8 per cent were under 4 of age and 73,5 per cent were male. Those diagnosed with pneumonia and respiratory failure (that constituted the complication leading to admission) prevailed in the case material. Negative-coagulase staphylococcus was the most isolated organism. Conclusions: Pneumonias continue being a health problem in childhood with predominance in ages under four.

Multi-center surveillance for pneumonia & meningitis among children (<2 yr) for Hib vaccine probe trial preparation in India.

Background & objectives: Severe clinical pneumonia and meningitis caused by Haemophilus influenzae type b in children less than 5 yr old is preventable by use of Hib vaccine. However, data on Hib burden in India are limited. To support an evidence-based decision for Hib vaccine introduction in India, a vaccine probe study was planned. This paper presents the results of the preparatory phase for such a study, which aimed to determine the feasibility of conducting a randomized vaccine probe study and to estimate the incidence of all causes of pneumonia and meningitis. The preparatory study included population-based, hospital-based and carriage surveillance. Methods: Children aged 18-24 months and were enrolled at PGIMER, Chandigarh, CMC, Vellore and NICED, Kolkata, from July 2005 to December 2006. At the time of enrollment, parents were informed about the signs and symptoms of pneumonia and meningitis, and were encouraged to take the child to study hospitals for treatment. Hospitalized children less than two years of age suspected of having pneumonia and/or meningitis were enrolled in study hospitals, whether or not they were from the cohort population. Patients were examined clinically and received chest radiograph for suspected cases of pneumonia or lumbar puncture for suspected cases of meningitis. Blood culture was done for both pneumonia and meningitis patients. Cerebrospinal fluid (CSF) was tested for biochemistry, culture, latex agglutination test and polymerase chain reaction. Nasopharyngeal swabs were collected from healthy children less than 2 yr of age at immunization clinics to estimate Hib carriage. Results: A cohort of 17,951 children were recruited for the population-based arm. The incidence of severe clinical pneumonia ranged from 2717 to 7890 per 100,000 child-years of observation; suspected meningitis ranged from 1971 to 2433 per 100,000 child-years of observation. In the hospital-based study 7/90 (7.8%), 29/98 (29.6%) and 38/181 (21.0%) of CSF samples with cell count ≥100 WBCs/mm3 were purulent at Chandigarh, Kolkata and Vellore respectively. Of these purulent CSF samples, Hib was detected in 2, 6 and 11 cases, respectively. The Hib nasopharyngeal carriage prevalence ranged from 6.0 - 7.6 per cent. Interpretation & conclusions: Incidence of severe clinical pneumonia is comparable with other studies from India but that of suspected meningitis is higher. Although rates of Hib meningitis cannot be calculated from a hospital-based study, there is evidence of Hib meningitis in these study settings. Hib carriage prevalence indicates that Hib is present and circulating in these study areas. There is a significant burden of pneumonia and meningitis among children in India. Continued strengthening of laboratory capacity and bacterial surveillance systems are necessary.

Aspects épidémio-cliniques des pneumopathies aigues bactériennes de l'adulte au CHU Yalgado Ouedraogo

Introduction : Les pneumopathies bactériennes sont des infections respiratoires basses par atteinte du parenchyme pulmonaire, dont l'agent étiologique est une bactérie autre que le bacille tuberculeux. En pratique, le traitement repose sur une antibiothérapie probabiliste. Ce qui requiert une connaissance de l'épidémiologie des germes responsables dans une région donnée, à un moment donné. Patients et méthode : Ainsi afin de mieux appréhender essentiellement les aspects bactériologiques et thérapeutique des pneumo-pathies bactériennes de l'adulte au Burkina Faso, nous avons réalisé une revue documentaire de deux ans. Résultats : Les germes les plus fréquemment identifiés ont été respectivement Streptococcus pneumoniae (32,6%), Klebsiella pneumoniae (21%) et Staphylococcus aureus (13,9%). Les bactéries Gram négatif ont représenté 53,5% des germes isolés et l'Acinetobacter n'a été retrouvé que chez les patients à sérologie VIH positive. Le streptocoque a été sensible à l'association amoxicilline + acide clavulanique dans 91,7% des cas, à la ceftriaxone dans 83,3% des cas, à l'ampicilline et à l'amoxicilline dans 66,7% des cas. L'évolution clinique de nos patients a été favorable dans 74,5% des cas et soldé par un décès dans 21,8% des cas. L'évolution était significativement plus défavorable chez les patients éthyliques (p=0,001), ainsi que les malades tabagiques (p=0,02).Conclusion : La forte morbi-morbidité par pneumopathie aigue pourrait être améliorée grâce à une meilleure connaissance et à une mise à jour régulière de l'écologie bactérienne locale