ABSTRACT
Background Understanding antibiotic profiles and their resistance patterns can improve hospital quality care and optimize clinical outcomes. This paper characterizes the use of meropenem in the National Children's Hospital of Caja Costarricense del Seguro Social (CCSS) in Costa Rica, and its role in antibiotic stewardship. Methods This is a retrospective observational study from hospitalized patients under 13 years of age that received meropenem as part of their treatment. Patients were identified through medical and pharmacy records. Data was summarized using frequencies and percentages for categorical variables, means and standard deviations for normally distributed continuous variables, and medians with interquartile ranges (IQR) for non-normally distributed continuous variables. Results A total of 181 of the 309 selected patients met inclusion criteria. Median age was 21 months (IQR: 4.0-79.0). Mean length of stay was 31 days (16.0-58.0). The most frequent diagnosis was septic shock (29%). 87% of patients received at least one antibiotic prior to receiving meropenem; 71% of patients received a second antibiotic simultaneously with meropenem. In 113 (62%) cases, meropenem was prescribed as empirical therapy. The most frequent isolate was extended-spectrum ß-lactamase Escherichia coli (24%). 74% of patients who received meropenem as targeted therapy had a favorable outcome. Conclusions Meropenem can be used as monotherapy for complicated, multi-drug resistant, gram negative, bacterial infections, due to its susceptibility profile, convenient dosing schedule, and minimum adverse effects. However, it should be restricted to cases where no other drug is available in order to safeguard its value.
ABSTRACT
Resumen Introducción: Streptococcus gallolyticus subsp. pasteurianus es un coco grampositivo, catalasa negativo, perteneciente al grupo D de Lancefield, que se encuentra relacionado con cuadros de sepsis neonatal, específicamente con meningitis. Caso clínico: Se reporta el caso de un paciente de 2 meses con un cuadro de meningitis por S. gallolyticus subsp. pasteurianus. Se describen la sintomatología y el abordaje diagnóstico y terapéutico. Asimismo, se realiza una revisión de la literatura que evidencia el subdiagnóstico de este agente como causa de meningitis en pediatría. Conclusiones: Este caso representa el primer aislamiento de este agente en el Hospital Nacional de Niños de Costa Rica, de la Caja Costarricense de Seguro Social.
Abstract Background: Streptococcus gallolyticus subsp. pasteurianus is a positive Gram stain, catalase negative coccus that belongs to the Lancefield group D. It is associated with clinical manifestations such as neonatal sepsis and meningitis. Case report: The case of a 2-month-old male patient with meningitis caused by S. gallolyticus subsp. pasteurianus is described. Moreover, the symptoms, diagnosis, and management of the patient are discussed. Also, a review of the literature was conducted showing the sub-diagnosis of this agent as a cause of meningitis in pediatrics. Conclusions: This case represents the first detection of this agent in the National Children's Hospital of Costa Rica, which is part of the Caja Costarricense de Seguro Social.
Subject(s)
Humans , Infant, Newborn , Sepsis , Streptococcus gallolyticus , Streptococcus , Costa RicaABSTRACT
Introducción: Streptococcus gallolyticus subsp. pasteurianus es un coco grampositivo, catalasa negativo, perteneciente al grupo D de Lancefield, que se encuentra relacionado con cuadros de sepsis neonatal, específicamente con meningitis. Caso clínico: Se reporta el caso de un paciente de 2 meses con un cuadro de meningitis por S. gallolyticus subsp. pasteurianus. Se describen la sintomatología y el abordaje diagnóstico y terapéutico. Asimismo, se realiza una revisión de la literatura que evidencia el subdiagnóstico de este agente como causa de meningitis en pediatría. Conclusiones: Este caso representa el primer aislamiento de este agente en el Hospital Nacional de Niños de Costa Rica, de la Caja Costarricense de Seguro Social.
