Infecciones por Staphylococcus aureus meticilino resistente adquirido en la comunidad: hospitalización y riesgo de letalidad en 10 centros pediátricos de Argentina / Community-acquired methicillin-resistant Staphylococcus aureus infections: hospitalization and case fatality risk in 10 pediatric facilities in Argentina

Introducción. Las infecciones por Staphylococcus aureusmeticilino resistente adquirido en la comunidad (SAMR-C) son prevalentes en Argentina y el mundo; pueden tener evolución grave. Objetivos: Estimar tasa de hospitalización y factores de riesgo de letalidad de la infección por SAMR-C. Métodos. Estudio analítico transversal. Se incluyeron todos los pacientes < 15 años con infección por Staphylococcus aureusadquirido en la comunidad (SA-C) hospitalizados en 10 centros pediátricos, entre enero/2012-diciembre/2014. Resultados. Del total de 1141 pacientes con infección por SA-C, 904 (79,2%) fueron SAMR-C. La tasa de hospitalización de casos de SAMR-C (por 10 000 egresos) en < 5 años fue 27,6 en 2012, 35,2 en 2013 y 42,7 en 2014 (p= 0,0002). El grupo de 2-4 años fue el más afectado: 32,2, 49,4 y 54,4, respectivamente (p= 0,0057). Las presentaciones clínicas fueron infección de piel y partes blandas (IPPB): 66,2%; neumonía:11,5%; sepsis/bacteriemia: 8,5%; osteomielitis: 5,5%; artritis: 5,2%; absceso de psoas: 1,0%; pericarditis/endocarditis: 0,8%; meningitis: 0,6%; otras: 0,7%. La resistencia antibiótica fue, para eritromicina, 11,1%; clindamicina, 11,0%; gentamicina, 8,4%; trimetoprima-sulfametoxazol: 0,6%. Todas las cepas fueron sensibles a vancomicina. La letalidad fue 2,2% y los factores de riesgo asociados fueron --#91;OR (IC 95%)--#93; edad > 8 años (2,78; 1,05-7,37), neumonía (6,37; 2,37-17,09), meningitis (19,53; 2,40-127,87) y sepsis/bacteriemia (39,65; 11,94-145,55). Conclusiones. La tasa de infección por SAMR-C fue alta; la tasa de hospitalización aumentó en 2013-14; el grupo de 2-4 años fue el más afectado. Presentaron mayor riesgo de letalidad los > 8 años y las clínicas de neumonía, meningitis y sepsis.

Introduction. Community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) infections are prevalent both in Argentina and worldwide, and they may have a severe clinical course. Objectives: To estimate the hospitalization rate and case fatality risk factors of CA-MRSA infection. Methods. Cross-sectional, analytical study. All patients < 15 years old with community-acquired Staphylococcus aureus (CA-SA) infections admitted to 10 pediatric facilities between January 2012 and December 2014 were included. Results. Out of 1141 patients with CA-SA, 904 (79.2%) had CA-MRSA. The rate of hospitalization of CA-MRSA cases (per 10 000 discharges) among patients < 5 years old was 27.6 in 2012, 35.2 in 2013, and 42.7 in 2014 (p = 0.0002). The 2-4-year-old group was the most affected one: 32.2, 49.4, and 54.4, respectively (p = 0.0057). The clinical presentations included skin and soft tissue infections: 66.2%, pneumonia: 11.5%, sepsis/bacteremia: 8.5%, osteomyelitis: 5.5%, arthritis: 5.2%, psoas abscess: 1.0%, pericarditis/endocarditis: 0.8%, meningitis: 0.6%, and other: 0.7%. In terms of antibiotic resistance, 11.1% had resistance to erythromycin; 8.4%, to gentamicin; and 0.6%, to trimethoprim-sulfamethoxazole. All strains were susceptible to vancomycin. The case fatality rate was 2.2% and associated risk factors were (odds ratio --#91;95% confidence interval--#93;) age > 8 years (2.78, 1.05-7.37), pneumonia (6.37, 2.3717.09), meningitis (19.53, 2.40-127.87), and sepsis/bacteremia (39.65, 11.94-145.55). Conclusions. The rate of CA-MRSA infection was high; the rate of hospitalization increased in the 2013-2014 period; the 2-4-year-old group was the most affected one. A higher case fatality risk was observed among patients > 8 years old and those with the clinical presentations of pneumonia, meningitis, and sepsis.

Community-acquired methicillin-resistant Staphylococcus aureus infections: hospitalization and case fatality risk in 10 pediatric facilities in Argentina. / Infecciones por Staphylococcus aureus meticilino resistente adquirido en la comunidad: hospitalización y riesgo de letalidad en 10 centros pediátricos de Argentina.

INTRODUCTION: Community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) infections are prevalent both in Argentina and worldwide, and they may have a severe clinical course. OBJECTIVES: To estimate the hospitalization rate and case fatality risk factors of CA-MRSA infection. METHODS: Cross-sectional, analytical study. All patients < 15 years old with community-acquired Staphylococcus aureus (CA-SA) infections admitted to 10 pediatric facilities between January 2012 and December 2014 were included. RESULTS: Out of 1141 patients with CA-SA, 904 (79.2%) had CA-MRSA. The rate of hospitalization of CA-MRSA cases (per 10 000 discharges) among patients < 5 years old was 27.6 in 2012, 35.2 in 2013, and 42.7 in 2014 (p = 0.0002). The 2-4-year-old group was the most affected one: 32.2, 49.4, and 54.4, respectively (p = 0.0057). The clinical presentations included skin and soft tissue infections: 66.2%, pneumonia: 11.5%, sepsis/bacteremia: 8.5%, osteomyelitis: 5.5%, arthritis: 5.2%, psoas abscess: 1.0%, pericarditis/endocarditis: 0.8%, meningitis: 0.6%, and other: 0.7%. In terms of antibiotic resistance, 11.1% had resistance to erythromycin; 8.4%, to gentamicin; and 0.6%, to trimethoprim-sulfamethoxazole. All strains were susceptible to vancomycin. The case fatality rate was 2.2% and associated risk factors were (odds ratio [95% confidence interval]) age > 8 years (2.78, 1.05-7.37), pneumonia (6.37, 2.3717.09), meningitis (19.53, 2.40-127.87), and sepsis/bacteremia (39.65, 11.94-145.55). CONCLUSIONS: The rate of CA-MRSA infection was high; the rate of hospitalization increased in the 2013-2014 period; the 2-4-year-old group was the most affected one. A higher case fatality risk was observed among patients > 8 years old and those with the clinical presentations of pneumonia, meningitis, and sepsis.

INTRODUCCIÓN: Las infecciones por Staphylococcus aureusmeticilino resistente adquirido en la comunidad (SAMR-C) son prevalentes en Argentina y el mundo; pueden tener evolución grave. OBJETIVOS: Estimar tasa de hospitalización y factores de riesgo de letalidad de la infección por SAMR-C. MÉTODOS: Estudio analítico transversal. Se incluyeron todos los pacientes < 15 años con infección por Staphylococcus aureusadquirido en la comunidad (SA-C) hospitalizados en 10 centros pediátricos, entre enero/2012-diciembre/2014. RESULTADOS: Del total de 1141 pacientes con infección por SA-C, 904 (79,2%) fueron SAMR-C. La tasa de hospitalización de casos de SAMR-C (por 10 000 egresos) en < 5 años fue 27,6 en 2012, 35,2 en 2013 y 42,7 en 2014 (p= 0,0002). El grupo de 2-4 años fue el más afectado: 32,2, 49,4 y 54,4, respectivamente (p= 0,0057). Las presentaciones clínicas fueron infección de piel y partes blandas (IPPB): 66,2%; neumonía:11,5%; sepsis/bacteriemia: 8,5%; osteomielitis: 5,5%; artritis: 5,2%; absceso de psoas: 1,0%; pericarditis/endocarditis: 0,8%; meningitis: 0,6%; otras: 0,7%. La resistencia antibiótica fue, para eritromicina, 11,1%; clindamicina, 11,0%; gentamicina, 8,4%; trimetoprima-sulfametoxazol: 0,6%. Todas las cepas fueron sensibles a vancomicina. La letalidad fue 2,2% y los factores de riesgo asociados fueron [OR (IC 95%)] edad > 8 años (2,78; 1,05-7,37), neumonía (6,37; 2,37-17,09), meningitis (19,53; 2,40-127,87) y sepsis/bacteriemia (39,65; 11,94-145,55). CONCLUSIONES: La tasa de infección por SAMR-C fue alta; la tasa de hospitalización aumentó en 2013-14; el grupo de 2-4 años fue el más afectado. Presentaron mayor riesgo de letalidad los > 8 años y las clínicas de neumonía, meningitis y sepsis.

[Delayed vaccine schedule and missed opportunities for vaccination in children up to 24 months. A multicenter study]. / Esquemas atrasados de vacunación y oportunidades perdidas de vacunación en niños de hasta 24 meses: estudio multicéntrico.

INTRODUCTION: Delayed vaccine schedule (DVS) and missed opportunities of vaccination (MOV) are some of the main causes of low coverage in children ≤24 month in Argentina. OBJECTIVES: To determine the prevalence of DVS and the rate of MOV during the frst 24 months of life and risk factors for their occurrence. POPULATION AND METHODS: We conducted a survey among children ≤24 month's caregivers at five hospitals in different departments, between August-December/2008. RESULTS: Total enrolled: 1591 children; 54.2% male, median of age 8 months (0-24 months). Eighty percent concurred with vaccine-card, 75.9% consulted by pathology. Overall DVS rate: 39.7%. Most common DVS reason: the current mild disease: 38.5%. Overall MOV rate: 19.8%. Most common MOV reason: no detection of the need to vaccinate 47.8%. DTPHib and OPV vaccines had a higher risk of DVS and MOV. DVS independent predictors: age ≥6 months, administration for additionally recommended vaccines and prolonged waiting in the last vaccination. MOV independent predictors were: age ≥6 months, no compliance with prior care, and not asking for vaccines. CONCLUSION: We found a high proportion of MOV and mainly of DVS; they were associated mostly to false contraindications, lack of questioning on vaccines and difficulties in the quality of care provided to parents.

Esquemas atrasados de vacunacion y oportunidades perdidas de vacunacion en niños de hasta 24 meses: estudio multicentrico / Delayed vaccine schedule and missed opportunities for vaccination in children up to 24 months: a multicenter study

Introduccion. Los esquemas atrasados de vacunacion (EAV) y las oportunidades perdidas de vacunacion (OPV) en niños constituyen algunas de las principales causas de baja cobertura. Objetivos: Determinar tasas de EAV y OPV en niños menor o igual 24 meses y los factores asociados a su ocurrencia. Poblacion y metodos. Encuesta a los cuidadores de niños menor o igual 24 meses a la salida de los consultorios de clinica pediatrica y de guardia en 5 hospitales de diferentes provincias, entre agosto diciembre de 2008. Resultados. Total enrolado: 1591 niños; 54,2 por ciento varones, mediana de edad 8 meses (0-24); 80,1 por ciento tenia carnet; 75,9 por ciento consultaba por patologia. Tasa global EAV: 39,7 por ciento. Motivo mas frecuente de atraso: enfermedad actual leve: 38,5 por ciento. Tasa global OPV: 19,8 por ciento. Motivo mas frecuente de OPV: no deteccion de la necesidad de vacunar: 47,8 por ciento. Cuadruple y Sabin presentaron mayor riesgo de EAV y OPV. Predictores independientes de EAV: edad mayor o igual 6 meses, administracion de vacunas fuera de calendario y espera prolongadaen la ultima vacunacion; y de OPV: edad mayor o igual 6 meses, no conformidad con la atencion previa, falta de interrogatorio por vacunas. Conclusiones. Se hallo una proporcion importante de OPV y principalmente de EAV; estas se vincularon, en su mayor parte, a falsas contraindicaciones,falta de interrogatorio por vacunas y a dificultades en la calidad de atencion brindada a los padres.

Introduction. Delayed vaccine schedule (DVS) and missed opportunities of vaccination (MOV) are some of the main causes of low coverage in children /6 months, no compliance with prior care, and not asking for vaccines.Conclusion. We found a high proportion of MOV and mainly of DVS; they were associated mostly to false contraindications, lack of questioning onvaccines and difficulties in the quality of care provided to parents.

Human rotavirus vaccine is highly efficacious when coadministered with routine expanded program of immunization vaccines including oral poliovirus vaccine in Latin America.

BACKGROUND: The efficacy of a rotavirus vaccine against severe rotavirus gastroenteritis when coadministered with routine Expanded Program on Immunization (EPI) vaccines including oral polio vaccine (OPV) was evaluated in this study. METHODS: Double-blind, randomized (2:1), placebo-controlled study conducted across 6 Latin American countries. Healthy infants (N = 6568) 6 to 12 weeks of age received 2 doses of RIX4414 vaccine or placebo following a 0, 1- to 2-month schedule. Routine vaccines including OPV were coadministered according to local EPI schedule. Vaccine efficacy (VE) against severe rotavirus gastroenteritis caused by circulating wild-type rotavirus from 2 weeks post-Dose 2 until 1 year of age was calculated with 95% confidence interval [CI]. Safety was assessed during the entire study period. Immunogenicity of RIX4414 and OPV was also assessed. RESULTS: During the efficacy follow-up period (mean duration = 7.4 months), 7 and 19 cases of severe rotavirus gastroenteritis were reported in the vaccine and placebo groups, respectively, with a VE of 81.6% (95% CI: 54.4-93.5). VE against severe rotavirus gastroenteritis caused by G1 type was 100% (95% CI: <0-100) and 80.6% (95% CI: 51.4-93.2) against the pooled non-G1 rotavirus types, respectively. There was no difference (P = 0.514) in the incidence of serious adverse events reported in the 2 groups. Antirotavirus IgA seropositivity rate at 1 to 2 months post-Dose 2 was 61.4% (95% CI: 53.7-68.6) in the RIX4414 group; similar seroprotection rates (≥96.0%) against the 3 antipoliovirus types was observed 1 month post-Dose 3 of OPV in both groups. CONCLUSION: RIX4414 was highly efficacious against severe rotavirus gastroenteritis caused by the circulating wild-type rotavirus (G1 and non-G1) when coadministered with routine EPI vaccines including OPV.