Real-World Use of Electronic Patient-Reported Outcome (ePRO) Tools Integrated in the Electronic Medical Record During Radiation Therapy for Head and Neck Cancer: Feasibility Study.

Purpose Use of electronic patient-reported outcome (ePRO) tools in routine oncology practice can be challenging despite evidence showing they can improve survival, improve patient and practitioner satisfaction, and reduce medical resource utilization. Head and neck cancer (HNC) patients receiving radiation therapy (RT) may be a group that would particularly benefit from interventions focused on early symptom management. Methods Patients undergoing definitive RT for HNC were enrolled in a feasibility study and received ePRO surveys integrated within the electronic medical record (EMR) on a weekly basis during RT. After completion of each ePRO survey, a radiation oncology registered nurse documented the findings and subsequent interventions within the EMR. Results Thirty-four patients with HNC who received curative RT at a single center were enrolled. The total number of surveys completed was 194 with a median of 7 surveys per patient (range 1-8). There was a total of 887 individual abnormal findings reported on the ePROs, and the authors found that all 887 had a corresponding documented intervention. Post-treatment practitioner questionnaires highlighted that ePROs were felt to be helpful for the care team in providing care to HNC patients. Conclusion For patients with HNC receiving RT, ePROs can be effectively utilized to address patient symptoms within an integrated health care system. Creating an infrastructure for the use of ePROs integrated within the EMR in routine care requires an approach that accounts for local workflows and buy-in from patients and the entire care team.

[Kawasaki disease and multisystem inflammatory syndrome in children. Differences, and similarities in a pediatric center in Mexico]. / Enfermedad de Kawasaki y síndrome inflamatorio multisistémico en niños. Diferencias y similitudes en un centro pediátrico de México.

OBJECTIVE: To evaluate the differences and similarities in clinical picture, laboratory findings and outcomes between children's with Kawasaki Disease (KD) versus multisystem inflammatory syndrome (MIS-C). METHODS: We conducted a retrospective, comparative study from children with Kawasaki Disease (KD) hospi-talized in Sinaloa Pediatric Hospital from January 1, 2004, to March 31, 2020, and patients with multisystem inflammatory syndrome (MIS-C) according with World Health Organization (WHO) case definition criteria be-tween May 1, 2020 and May 31, 2021. Demographic characteristics, epidemiological data, clinical features, laboratory findings, type of treatment and clinical outcomes were compared among both groups. RESULTS: Eighty-one patients were included (62 patients with KD and 19 with MIS-C). several clinical and lab-oratory differences were found among these two entities. Median age was lower in KD vs. MIS-C (25 vs 79 months). Those finding more frequent in KD were male gender (64.5 vs. 47.4%), Mucocutaneous features (93.5 vs. 63.2%): Oral changes (83.9 vs. 63.2%) and extremity changes (77.4 vs. 57.9%); complete form of KD was (75.8 vs. 47.4%), Coronary artery aneurysm (16.1 vs. 11.8%). Secondly, findings that were more frequent in MIS-C than KD were Gastrointestinal involvement (89.4 vs. 9.6%), shock (57.9 vs. 3.2%), neurological symp-toms (63.1 vs. 11.2%), kidney involvement (52.6 vs. 16.1%), heart disease in general (52.9% vs 29%): Myocardial dysfunction (23.5 vs. 11.3%) and pericardial effusion (17.6 vs. 2.9%). Lymphocyte count (2.07 + 2.03 vs. 4.28 + 3.01/mm3), platelet count (197.89 + 187.51 vs. 420.37 + 200.08/mm3); serum albumin (2.29 + 0.65 vs. 3.33 + 0.06g/dL), and CPR (21.4 + 11.23 vs. 14.26 + 12.37 mg/dL). KD vs. MIS-C types of Treatment: IVIG (96.8 vs. 94.7%), systemic steroids (4.82 vs. 94.7%), IVIG resistance (19.4 vs. 15.8). Finally, mortality in KD was 0% and 5.3% in MIS-C. CONCLUSIONS: Similarities were found in both groups such as fever, rash, and conjunctivitis. Nevertheless, signifi-cant differences such as severity of clinical presentation with multi-organ involvement and worst inflammato-ry response were found more frequently in MIS-C group than KD group, requiring more fluid replacement, use of inotropic agents and higher steroids dosages. Also, mortality rate was higher in patients with MIS-C thanpatients with KD. Similar results have been observed in other studies where both disorders were compared.

OBJECTIVO: Evaluar las diferencias y similitudes en el cuadro clínico, los hallazgos de laboratorio y desenlaces médicos de pacientes pediátricos con enfermedad de Kawasaki versus síndrome inflamatorio multisistémico. MÉTODOS: Estudio comparativo y retrospectivo, efectuado en niños con enfermedad de Kawasaki, atendidos en el Hospital Pediátrico de Sinaloa, entre el 1 de enero de 2004 al 31 de marzo de 2020, y pacientes con sín-drome inflamatorio multisistémico (según los criterios de la Organización Mundial de la Salud), del 1 de mayo de 2020 al 31 de mayo de 2021. Se evaluaron las características demográficas, epidemiológicos y clínicas, además de los hallazgos de laboratorio, tipo de tratamiento y desenlaces clínicos en ambos grupos. RESULTADOS: Se incluyeron 81 pacientes: 62 con enfermedad de Kawasaki y 19 con síndrome inflamatorio mul-tisistémico. Se encontraron varias diferencias clínicas y de laboratorio en ambas alteraciones. La mediana de edad fue menor en pacientes con enfermedad de Kawasaki versus síndrome inflamatorio multisistémico (25 vs 79 meses). La mayoría de los pacientes con enfermedad de Kawasaki fueron hombres (64.5 vs 47.4%), con características mucocutáneas (93.5 vs 63.2%): cambios orales (83.9 vs 63.2%) y cambios en las extremidades (77.4 vs 57.9%); la forma completa de enfermedad de Kawasaki fue 75.8 vs 47.4%, concomitante con aneuris-ma de la arteria coronaria (16.1 vs 11.8%). Los hallazgos más frecuentes en sujetos con síndrome inflamatorio multisistémico fueron: afectación gastrointestinal (89.4 vs 9.6 %), choque (57.9 vs 3.2%), síntomas neurológicos (63.1 vs 11.2%), afectación renal (52.6 vs 16.1%) y cardiopatías en general (52.9 vs 29%): disfunción miocárdica (23.5 vs 11.3%) y derrame pericárdico (17.6 vs 2.9%). La concentración media de linfocitos fue: 2.07 + 2.03 vs4.28 + 3.01/mm3), plaquetas (197.89 + 187.51 vs 420.37 + 200.08/mm3); albúmina sérica (2.29 + 0.65 vs 3.33 + 0.06 g/dL) y PCR (21.4 + 11.23 vs 14.26 + 12.37 mg/dL). Los tratamientos en enfermedad de Kawasaki vssíndrome inflamatorio multisistémico: IVIG (96.8 vs 94.7%), corticosteroides sistémicos (4.82 vs 94.7%), resis-tencia a IVIG (19.4 vs 15.8). La mortalidad fue de 0 vs 5.3%. CONCLUSIONES: Se encontraron similitudes en cuanto a síntomas en ambos grupos (fiebre, exantema y conjun-tivitis); no obstante, hubo diferencias significativas respecto de las manifestaciones clínicas, con afección multiorgánico y peor respuesta inflamatoria en pacientes con síndrome inflamatorio multisistémico, incluso mayor requerimiento de reposición de líquidos, administración de agentes inotrópicos, dosis más altas de corticosteroides, y elevada tasa de mortalidad. Estos resultados se han observado en otros estudios, donde se compararon ambos trastornos.

Exposición prenatal al monóxido de carbono y material particulado y su asociación con preeclampsia, en Colombia / Prenatal exposure to carbon monoxide and particulate matter and its association with preeclampsia in Colombia

Resumen OBJETIVO: Determinar la asociación entre la exposición a emisiones vehiculares de PM10 y monóxido de carbono y la preeclampsia en Manizales, Colombia. MATERIALES Y MÉTODOS: Estudio relacional, retrospectivo, de casos y controles efectuado entre julio de 2014 y julio de 2015 en pacientes con preeclampsia, residentes en la zona urbana de Manizales, Colombia. Se usó el sitio de residencia para la estimación de la exposición y la concentración de contaminantes a través de un instrumento de determinación de exposición a emisiones de PM10 y monóxido de carbono (toneladas por año por cada 250 metros cuadrados). Se utilizaron dos definiciones de exposición: cuartil superior (Q4) en comparación con los cuartiles restantes (Q1-Q3) y otra: comparación de los cuatro cuartiles tomando como referencia el primero (Q1). Se ajustaron modelos de regresión logística con el fin de explorar el efecto de la exposición. RESULTADOS: Se incluyeron 222 pacientes: 74 casos y 148 controles. No se observó relación entre la concentración de PM10 en el área de residencia de la madre y la probabilidad de preeclampsia con la primera definición de exposición (RM de 1.013 [IC95%: 0.35 a 2.97; p = 0.981] y la segunda [Q2; p = 0.562], [Q3; p = 0.347], [Q4; p=0.887]). Para el caso del monóxido de carbono tampoco se encontró relación estadística en las dos definiciones (RM: 0.829 [IC95%: 0.29 a 2.39] p = 0.729.). CONCLUSIONES: No se observó asociación entre las concentraciones de exposición a PM10 y monóxido de carbono y la aparición de preeclampsia durante los tiempos descritos.

Abstract OBJECTIVE: To determine the association between exposure to PM10 and carbon monoxide vehicle emissions and preeclampsia in Manizales, Colombia. MATERIALS AND METHODS: This was a relational, retrospective, case-control study in patients with pregnancy complicated by preeclampsia, residents of Manizales-Colombia between July 2014 and July 2015. The place of residence was used to estimate exposure and the concentration of pollutants through an instrument for determining exposure to PM10 and CO emissions (tons per year for every 250 square meters). Two definitions of exposure were used: upper quartile (Q4) vs the remaining quartiles (Q1-Q3) and another: comparison of the four quartiles taking the first quartile (Q1) as a reference. Logistic regression models were fitted in order to explore the effect of exposure. RESULTS: 222 patients were included, 74 cases and 148 controls. No relationship was observed between the concentration of PM10 in the mother's area of residence and the probability of presenting preeclampsia with both the first definition of exposure (OR of 1.013 (95%CI: 0.35 to 2.97) p = 0.981) as with the second (Q2 (p=0.562), Q3 (p = 0.347), Q4 (p = 0.887)). In the case of OC, no statistical relationship was found in the two definitions (OR: 0.829 (95%CI: 0.29 to 2.39) p = 0.729). CONCLUSIONS: No association was observed between the levels of exposure to PM10 and CO and the appearance of preeclampsia in pregnant women during the times described.

Acidic deep eutectic solvent assisted isolation of lignin containing nanocellulose from thermomechanical pulp.

Nanocellulose is a promising material but its isolation generally requires unrecyclable hazardous chemicals and high energy consumption and its overall yield is low due to the use of high purity cellulose as precursor. In order to overcome these shortcomings, in this study, thermomechanical pulp (TMP) was investigated as a precursor for isolating lignin containing nanocellulose (LNC) using an environmentally friendly acidic deep eutectic solvent (DES) pre-treatment. Flat "ribbon" like LNCs (around 7.1 nm wide, 3.7 nm thick) with uniformly distributed lignin nanoparticles of 20-50 nm in diameter were successfully obtained at 57 % yield under optimum pre-treatment conditions (90 °C, 6 h, 1:1 oxalic acid dihydrate to choline chloride ratio). The LNCs exhibit cellulose Iß structure, high lignin content (32.6 %), and high thermal stability (Tmax of 358 °C). In general, green acidic DES pre-treatment has shown high efficiency in converting high lignin content biomass into value-added LNC, which benefits both lignocellulose utilization and environmental protection.

Concurrent cetuximab versus platinum-based chemoradiation for the definitive treatment of locoregionally advanced head and neck cancer.

BACKGROUND: The purpose of this study was to present our experience utilizing cetuximab and platinum-based concurrent chemoradiotherapy for the definitive treatment of head and neck squamous cell carcinoma (HNSCC). METHODS: Patients (n = 177) who received definitive concurrent chemoradiotherapy for HNSCC were stratified into 3 groups: receiving cetuximab monotherapy (n = 24), cetuximab and chemotherapy combination (n = 33), or platinum-based chemotherapy without cetuximab (n = 120). Primary endpoints were freedom from relapse, event-free survival, and overall survival (OS). RESULTS: Patients receiving cetuximab monotherapy were older with lower Karnofsky performance status (KPS) and higher Charlson comorbidity scores compared with those treated with combination cetuximab and chemotherapy or platinum-based concurrent chemoradiotherapy. Patients treated with platinum-based concurrent chemoradiotherapy exhibited significantly better freedom from relapse, event-free survival, and OS compared with those receiving cetuximab monotherapy or cetuximab and chemotherapy combination therapies (all p < .05). Differences between patients receiving cetuximab monotherapy and platinum-based concurrent chemoradiotherapy held on multivariate Cox regression. CONCLUSION: This study suggests that platinum-based concurrent chemoradiotherapy is superior to cetuximab-based monotherapy for the definitive treatment of HNSCC.

[Norovirus detection in children with community-acquired or nosocomial diarrhea at Guillermo Grant Benavente Hospital in Concepción, Chile]. / Detección de norovirus en niños con diarrea adquirida en la comunidad o nosocomial en el Hospital Guillermo Grant Benavente de Concepción, Chile.

INTRODUCTION: Norovirus (NoV) are RNA viruses highly contagious, stable in the environment, genetically variable, and the most common cause of viral sporadic acute gastroenteritis worldwide. This is the first study carried out in Concepcion, Chile, to investigate the presence of NoV as an etiologic agent of viral diarrheas in hospitalized children. Objective. To detect the presence and genogroup of NoV in children with diarrhea and to compare it with rotavirus (RV) and adenovirus (AdV). MATERIAL AND METHODS: A one year descriptive, prospective study in children 0-14 years old. A single diarrheic stool sample per patient was analyzed for the presence of NoV, RV and AdV. Clinical data were unknown at the moment of sampling. Real time RT-PCR with Taqman™ probes for NoV and the immunocromatography VIKIA™ kit for RoV /AV detection were used. RESULTS: Infection for NoV (25.5%) was significantly higher than for RV (15.9%) and AdV (6.2%). It was even greater in infants younger than 2yr. old (n: 103): NoV 34%, RV 17.5%, AdV 7.8%. Children 2-4 yr. old had 11.8% infection of NoV and RV. Children older than 4, only had 12% RV and 4% AdV. Children hospitalized for diarrhea (n: 92) had: 21.7% of both NoV and RV, and 7.6% AdV; whereas children hospitalized for other causes (n: 53) had 32.1% NoV,5.7% RV and 3.8% AV. The proportion of infection due to NoV was significantly higher in males (31.5%) than in females (19.4%). The average frequency during the year was higher for NoV (30.3%) than for RV (14.7%) except in summer. CONCLUSION: The presence of NoV was higher than RV in children with diarrhea. NoV infection showed defined characteristics regarding age, gender, seasonal occurrence and nosocomial transmission that are important epidemiological features.

Detección de norovirus en niños con diarrea adquirida en la comunidad o nosocomial en el Hospital Guillermo Grant Benavente de Concepción, Chile / Norovirus detection in children with community-acquired or nosocomial diarrhea at Guillermo Grant Benavente Hospital in Concepción, Chile

Introduction: Norovirus (NoV) are RNA viruses highly contagious, stable in the environment, genetically variable, and the most common cause of viral sporadic acute gastroenteritis worldwide. This is the first study carried out in Concepcion, Chile, to investigate the presence of NoV as an etiologic agent of viral diarrheas in hospitalized children. Objective. To detect the presence and genogroup of NoV in children with diarrhea and to compare it with rotavirus (RV) and adenovirus (AdV). Material and Methods: A one year descriptive, prospective study in children 0-14 years old. A single diarrheic stool sample per patient was analyzed for the presence of NoV, RV and AdV. Clinical data were unknown at the moment of sampling. Real time RT-PCR with Taqman™ probes for NoV and the immunocromatography VIKIA™ kit for RoV /AV detection were used. Results: Infection for NoV (25.5%) was significantly higher than for RV (15.9%) and AdV (6.2%). It was even greater in infants younger than 2yr. old (n: 103): NoV 34%, RV 17.5%, AdV 7.8%. Children 2-4 yr. old had 11.8% infection of NoV and RV. Children older than 4, only had 12% RV and 4% AdV. Children hospitalized for diarrhea (n: 92) had: 21.7% of both NoV and RV, and 7.6% AdV; whereas children hospitalized for other causes (n: 53) had 32.1% NoV,5.7% RV and 3.8% AV. The proportion of infection due to NoV was significantly higher in males (31.5%) than in females (19.4%). The average frequency during the year was higher for NoV (30.3%) than for RV (14.7%) except in summer. Conclusion: The presence of NoV was higher than RV in children with diarrhea. NoV infection showed defined characteristics regarding age, gender, seasonal occurrence and nosocomial transmission that are important epidemiological features.

Introducción: Los norovirus (NoV) son virus ARN altamente contagiosos, resistentes, variables genéticamente y una de las etiologías más frecuente de gastroenteritis viral esporádica mundial. Este es el primer trabajo en Concepción, Chile, de búsqueda de NoV como etiología viral de diarreas en niños hospitalizados. Objetivo: Determinar la presencia y genogrupo de NoV en niños con diarrea y compararla con la frecuencia de rotavirus (RV) y adenovirus (AdV). Material y Método: Estudio descriptivo, prospectivo de un año, en niños de 0-14 años ingresados por diarrea aguda o que la adquirieron dentro del hospital. La muestra de deposiciones diarreica se tomó una sola vez por paciente. Las fichas clínicas se analizaron al finalizar el estudio etiológico. Para la detección de NoV se utilizó RPC-TR a en tiempo real con sondas Taqman® y para detección de RV/AdV, el kit VIKIA® de inmunocromatografia. Resultados: La infección por NoV (25,5%) fue significativamente más frecuente que por RV (15,9%) y AdV (6,2%). La mayor presencia de infección fue en pacientes bajo2 años de edad (n: 103): NoV 34,0%, RV 17,5%, AdV 7,8%. La detección en niños hospitalizados por diarrea fue: NoV y RV 21,7% cada uno; AdV 7,6%. En niños con diarrea nosocomial hospitalizados por otras causas se detectó NoV en 32,1%, RV en 5,7% y AdV en 3,8%. La presencia de NoV fue significativamente mayor en varones (31,5%) que en niñas (19,4%). El promedio de diarreas durante el año fue mayor para NoV (30,3%) que para RV(14,7%), excepto en verano. Discusión y Conclusión: La presencia de NoV fue mayor que la de RoV en niños con diarrea y con una tendencia nosocomial que podría deberse a las características del virus que favorece infecciones de ambiente confinado, como hospitales, asilos y cruceros. La infección por NoV presentó características definidas, en edad, género, ocurrencia estacional y relevancia nosocomial, que aportan datos epidemiológicos importantes.

Radiologic assessment of retropharyngeal node involvement in oropharyngeal carcinomas stratified by HPV status.

Radiation of retropharyngeal nodes (RPN) results in increased toxicities. This study assessed characteristics associated with RPN involvement in 165 oropharynx cancer patients. Factors associated with involvement were stage N2c-3 disease and stage N2b disease with either advanced T-stage, ⩾3 involved cervical LN, and ⩾1 involved contralateral LN, or lateral/posterior subsites.

[Invasive fungal infections in children with cancer, neutropenia and fever, in Chile]. / Infección micótica profunda en niños con cáncer, neutropenia y fiebre, en Chile.

BACKGROUND: Invasive fungal infections (IFI) cause prolonged hospitalizations and increase the possibility of death among patients with cancer and febrile neutropenia (FN). Up to 10% of febrile neutropenic episodes may be caused by IFI. AIM: To estimate the incidence of IFI among a large group of Chilean children with cancer and FN. PATIENTS AND METHODS: Clinical and laboratory information was collected from a data base provided by the "Programa Infantil Nacional de Drogas Antineoplásicas" (PINDA) that included 445 FN episodes occurring in five hospitals in Santiago, Chile. This information was used to identify children that presented with signs and symptoms compatible with an IFI. According to predefined criteria based on a literature review, IFI episodes were categorized as "proven", "probable" or "possible". RESULTS: A total of 41/445 episodes (9.2%) were compatible with an IFI of which 4 (0.9%) were proven, 23 (5.2%) probable, and 14 (3.1%) possible. Hospitalization was longer (27 vs 8 days, p < .01), new infectious foci appeared with higher frequency (71 vs 38%, p < .01), and mortality was higher (10 vs 1.6%, p < .001) in children with IFI compatible episodes, when compared to children who did not have an IFI. CONCLUSIONS: The estimated incidence of IFI in Chilean children with cancer and FN ranged between 6-9% depending on the stringency of criteria selection used for classification. This estimate is similar to that reported by other studies. The low detection yield of clinically compatible IFI underscores the need of improved diagnosis of fungal infections in this population.

[Resistance to Streptococcus pneumoniae to penicillin and its association with clinical and epidemiological factors]. / Resistencia de Streptococcus pneumoniae a penicilina y su asociación con factores clínicos y epidemiológicos.

BACKGROUND: Penicillin and third generation cephalosporin resistant pneumococcal isolates have emerged in Chile, mainly in the pediatric population. These isolates complicate therapeutic alternatives, specially among patients with central nervous system infections. AIM: To assess the frequency of penicillin and third generation cephalosporin resistance among isolates obtained from pediatric patients with invasive pneumococcal infections, and to study serotypes and clinical risk factors associated with resistance. MATERIAL AND METHODS: Microbiological isolates obtained from children between April 1994 and May 1999 with pneumococcal invasive infections, were serotyped and analyzed according to their susceptibility to penicillin and cefotaxime by E-test and broth microdilution testing. Potential risk factors studied included patient's age, previous antibiotic use or admissions, comorbidity, and serotypes. RESULTS: Seventy eight patients were studied. Penicillin-resistant pneumococcal isolates were detected in 35.9% of cases (21.8% with intermediate and 14.1% with high level resistance) without significant variation among different clinical conditions. Most of the high level penicillin-resistant pneumoccocal isolates had MIC > or = 4 micrograms/mL (8 out of 11 strains). One third of penicillin-resistant isolates also expressed cefotaxime resistance. Multivariate analysis indicated an age < or = 36 months (OR = 6.8; IC 95%: 1.4 to 33.5) and serotype 14 (OR = 6.3; IC 95%: 1.7 to 23.3) as factors associated with penicillin resistance. CONCLUSIONS: One third of the invasive pneumococcal isolates obtained from pediatric patients were resistant to penicillin. Risk factors involved a younger age and pneumococcal isolates belonging to serotype 14.

Resistencia a los antimicrobianos en agentes causantes de infección del tracto urinario en 11 hospitales chilenos: proyecto PRONARES / Antimicrobial resistance of agents causing urinary tract infections in 11 chilean hospitals: PRONARES project

Background: the computer program WHONET generates a common database to analyze local or general antimicrobial resistance of bacteria. A surveillance of agents causing urinary tract infections in Chile has been performed using this program. Aim: to report the results after 12 months of urinary tract infection agent surveillance. Material and methods: since november, 1997, a surveillance of in vitro antimicrobial resistance, using agar diffusion techniques, has been performed in 20 to 40 bacterial strains per month, isolated from 11 hospitals in the country. Results have been analyzed using WHONET program. Results: in first 12 months, 3144 strains, 1625 coming from outpatients, have been studied. Seventy four percent of isolated strains were E. coli, 19 percent were other enterobacteria, 4.1 percent were non fermenting bacilli and 2.1 percent were Gram (+) cocci. Sixty five percent of E coli strains were resistant to ampicillin, 11 percent to cefazolin, 2.5 percent to cefuroxime, 19 percent to ceftriaxone, 9 percent to ceftazidime, 4.2 percent to gentamicin 1.3 percent to amikacin, 5.6 percent to ciprofloxacin, 8.4 percent to grepafloxacin, 4.3 percent to nitrofurantoin and 43 percent to trimeproprim/sulphamethoxazole. Eighty two percent of other enterobacteria strains were resistant to ampicillin, 45.5 percent to cefazolin, 33.5 percent to cefuroxime, 26.6 percent to ceftriaxone, 21.5 percent to ceftazidime, 30.3 percent to gentamicin 17.2 percent to amikacin, 21 percent to ciprofloxacin, 16.3 percent to grepafloxacin, 48.2 percent to nitrofurantoin and 44.6 percent to trimeproprim/sulphamethoxazole. There were differences in betalactamic resistance among hospitals. Conclusions: noteworthy is the high resistance rates to third generation cephalosporins, evidenced when the new cutoff values for E coli and klebsiella spp are used. This national surveillance provides updated information on antimicrobial resistance of agents causing urinary tract infections

Infecciones por staphylococcus aureus meticilino resistente: Hospital Roberto del Río / Staphylococcus aureus, methicilin resistant infections at Hospital Roberto del Río, 1991-1992

Las infecciones por Staphylococcus aureus siguen siendo un problema importante, especialmente aquellas causadas por las cepas resistentes a meticilina. Se decidió realizar un estudio restrospectivo con el objeto de conocer la frecuencia real de infecciones estafilocócicas y analizar aquellas producidas por las cepas resistentes. Se revisaron los hemocultivos positivos a Staphylococcus aureus en el laboratorio del Hospital Roberto del Río en el período comprendido entre el 1 de enero de 1991 y el 31 de diciembre de 1992, encontrándose 121 hemocultivos positivos, 58 de los cuales (48 por ciento) resultaron meticilino resistente por la técnica de Kirby Bauer. El estudio mostró 25 recién nacidos (RN) y 22 niños que se comportaron como grupos distintos por lo que el análisis se realizó por separado. En el grupo de niños 13/22 casos son intrahospitalarios los que se produjeron en prácticamente todos los servicios del hospital. Ocurrieron 4 muertes en el grupo. En 9/22 niños no se encontró factores de riesgo de infección. Del grupo de niños RN 20/25 casos corresponden a infección segura por Staphylococcus aureus meticilino resistente, 13/22 son intrahospitalarios. Fallecieron 10/25 casos, siendo la infección responsable en 6 casos. Se concluye que el 48 por ciento de los hemocultivos en que se aisló Staphylococcus aureus resultó ser resistente a la meticilina, correspondiendo un número semejante a niños y recién nacidos. En el grupo de niños la mitad de los casos corresponde a infecciones seguras, a diferencia de los RN en que el 80 por ciento (20/25) tienen una infección segura. La mitad de los casos en niños proviene de la comunidad hecho que se repite en el grupo de RN. El foco más frecuente es el pulmonar en ambos grupos. La mitad de los niños no tiene factores de riesgo a diferencia del grupo de RN donde el 84 por ciento (21/25) tiene al menos uno. En el grupo de RN la mortalidad fue mayor que en el grupo de niños (40 por ciento vs 18 por ciento)

Etiología de la septicemia acíclica en el adulto / Etiology of non cyclic septicemia in adults

Se analizan aspectos clínicos y microbiológicos de 200 pacientes con diagnóstico clínico de septicemia, hospitalizados en el Servicio de Medicina y en la Unidad de Cuidados Intensivos del Hospital San Juan de Dios entre 1975 y 1985. Los hemocultivos fueron positivos en 178 casos (89%), aislándose con mayor frecuencia Escherichia coli (39,3%); Klebsiella sp. (26,4%); Staphylococcus aureus (12,9%); Proteus sp. (5,1%); Pseudomona aeruginosa (3,9%); flora polimicrobiana (4,5%) y otros en menores porcentajes. En 141 (79,2%) de los 178 casos con confirmación bacteriológica, se precisó el foco primario, siendo lo más frecuente el urinario (48,2%); el vascular (14,2%) y el cutáneo (10,6%). La mortalidad global de la casuística estudiada fue de 47,2% y aumentó a 86,4% si se consideran los pacientes con hemocultivos negativos. La menor mortalidad correspondió a las septicemias por Escherichia coli (38,6%)