Lactante sano con reactivación de citomegalovirus en contexto de bronquiolitis por metapneumovirus / Healthy infant with cytomegalovirus reactivation in the setting of metapneumovirus bronchiolitis

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Prescripción antibiótica en los pacientes hospitalizados desde Urgencias. Estudio multicéntrico / Prescribing of antibiotics in patients admitted from Emergency Departments: a multicenter study

Introducción: La patología infecciosa constituye el principal motivo de consulta en Urgencias y es causa frecuente de ingreso hospitalario con antibióticos. Nuestros objetivos son: 1) conocer la prevalencia y las patologías atendidas en Urgencias que son motivo de ingreso con antibiótico; 2) conocer los métodos microbiológicos empleados, y 3) analizar las características del tratamiento antibiótico indicado. Material y métodos: Estudio prospectivo multicéntrico realizado en 22 hospitales españoles. Se incluyeron los pacientes menores de 18 años atendidos en Urgencias el día 14 de cada mes entre junio de 2009 y mayo de 2010 a los que se indicó ingreso hospitalario con antibiótico sistémico. Se excluyeron los pacientes que ingresaron en la Unidad de Cuidados Intensivos. Resultados: Consultaron en Urgencias 30.632 pacientes, 1.446 (4,7%) ingresaron, 395 (27,3%) de ellos con antibiótico. Habían recibido antibiótico previo al ingreso 95 (24,1%) pacientes. A 320 (81%) niños se les realizó algún examen microbiológico, siendo el hemocultivo (69,9%) y el urocultivo (30,9%) los más solicitados. Los principales diagnósticos fueron neumonía (29,4%), infección de orina (15,4%) y síndrome febril sin foco (12,1%). Se pautaron 25 antibióticos distintos, siendo los más prescritos cefotaxima (27,8%) y amoxicilina-ácido clavulánico (23,4%). El 80,8% de los niños recibieron un único antimicrobiano y la vía parenteral fue la más empleada (93,7%). Conclusiones: Se prescribió antibiótico a uno de cada 4 pacientes que precisó ingreso hospitalario. La neumonía fue la etiología más frecuente. El hemocultivo fue el examen microbiológico más solicitado. La mayoría de las prescripciones correspondieron a un número reducido de antibióticos betalactámicos (AU)

Introduction: The infectious disease is the main source of care demand in Pediatric Emergency Departments (PED) and is a frequent cause of hospital admission with antibiotics. Our objectives are: 1) to determine the diseases that are seen in PED that required admission with antibiotics; 2) to determine the microbiological methods used and, 3) to analyze the characteristics of the indicated treatment. Material and methods: A prospective multicenter study was conducted in 22 Spanish hospitals. We included patients younger than 18 years seen in PED on day 14 of each month between June 2009 and May 2010 who required hospitalization with systemic antibiotics. Patients admitted to Intensive Care Unit were excluded. Results: There were 30,632 consultations in the PED during the study period. A total of 1,446 (4.7%) patients were hospitalized, 395 (27.3%) of them with antibiotics. Ninety-five patients (24.1%) had received antibiotics before admission. Three hundred twenty (81%) children underwent at least one microbiological test, with blood culture (69.9%) and urine culture (30.9%) being the most requested ones. The main diagnoses at admission were pneumonia (29.4%), urinary tract infection (15.4%), and fever without source (12.1%). Twenty five different antibiotics were prescribed, with cefotaxime (27.8%) and amoxicillin-clavulanate (23.4%) being the most prescribed ones. A single antibiotic was prescribed to 80.8% of patients, and parenteral administration was the most indicated (93.7%). Conclusions: Antibiotic therapy was prescribed in one in every 4 patients who required admission to hospital. Pneumonia was the most common source. Blood culture was the most frequent microbiological test requested in the PED. A limited number of beta-lactam antibiotics represented the majority of antibiotic prescriptions (AU)

[Prescribing of antibiotics in patients admitted from Emergency Departments: a multicenter study]. / Prescripción antibiótica en los pacientes hospitalizados desde Urgencias. Estudio multicéntrico.

INTRODUCTION: The infectious disease is the main source of care demand in Pediatric Emergency Departments (PED) and is a frequent cause of hospital admission with antibiotics. Our objectives are: 1) to determine the diseases that are seen in PED that required admission with antibiotics; 2) to determine the microbiological methods used and, 3) to analyze the characteristics of the indicated treatment. MATERIAL AND METHODS: A prospective multicenter study was conducted in 22 Spanish hospitals. We included patients younger than 18 years seen in PED on day 14 of each month between June 2009 and May 2010 who required hospitalization with systemic antibiotics. Patients admitted to Intensive Care Unit were excluded. RESULTS: There were 30,632 consultations in the PED during the study period. A total of 1,446 (4.7%) patients were hospitalized, 395 (27.3%) of them with antibiotics. Ninety-five patients (24.1%) had received antibiotics before admission. Three hundred twenty (81%) children underwent at least one microbiological test, with blood culture (69.9%) and urine culture (30.9%) being the most requested ones. The main diagnoses at admission were pneumonia (29.4%), urinary tract infection (15.4%), and fever without source (12.1%). Twenty five different antibiotics were prescribed, with cefotaxime (27.8%) and amoxicillin-clavulanate (23.4%) being the most prescribed ones. A single antibiotic was prescribed to 80.8% of patients, and parenteral administration was the most indicated (93.7%). CONCLUSIONS: Antibiotic therapy was prescribed in one in every 4 patients who required admission to hospital. Pneumonia was the most common source. Blood culture was the most frequent microbiological test requested in the PED. A limited number of beta-lactam antibiotics represented the majority of antibiotic prescriptions.