ABSTRACT
INTRODUCTION: In 2012, PCV13 was introduced into the National Immunization Program in Argentina, 2+1 schedule for children <2 years. Coverage rates for 1st and 3rd doses were 69% and 41.0% in 2012, 98% and 86% in 2013; 99% and 89% in 2014, respectively. The aims of this study were to evaluate impact of PCV13 on Consolidated Pneumonia (CP) and Pneumococcal Pneumonia (PP) burden, and to describe epidemiological-clinical pattern of PP during the three-year period following vaccine introduction. METHODS: Hospital-based study at 10 pediatric surveillance units in Argentina. CP and PP discharge rates per 10,000 hospital discharges were compared between the pre-vaccination period 2007-2011 (preVp), the year of intervention (2012) and the post-vaccination period 2013-2014 (postVp). RESULTS: Significant reduction in CP and PP discharge rates was observed in patients <5 years [% reduction (95%CI)]: 10.2% (6.3; 14.0) in 2012 and 24.8% (21.3; 28.2) in postVp for CP discharge rate; 59.5% (48.0; 68.5) in 2012 and 68.8% (58.3; 76.6) in postVp for PP discharge rate. Significant changes were also observed in children ≥5 years, mainly in PP discharge rate. A total of 297 PP cases were studied; 59.3% male; 31.3% <2 years; 42.9% had received PCV13 in 2012 and 84.5% in posVp. Case fatality rate was 3.4%. PCV13 serotypes decreased from 83.0% (39/47) in 2012 to 64.2% (52/81) in postVp, p = 0.039. CONCLUSIONS: After PCV13 introduction, significant reduction in CP and PP discharge rates was observed in hospitalized children <5 years. In patients ≥5 years, PP discharge rate also decreased significantly.
Subject(s)
Hospitals, Pediatric/statistics & numerical data , Pneumococcal Vaccines/immunology , Adolescent , Argentina/epidemiology , Child , Child, Preschool , Female , Humans , Infant , Infant, Newborn , Male , Pneumonia, Pneumococcal/epidemiology , Pneumonia, Pneumococcal/prevention & control , Retrospective Studies , Serogroup , Vaccines, Conjugate/immunologyABSTRACT
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.
Subject(s)
Humans , Male , Female , Infant, Newborn , Infant , Child, Preschool , Child , Adolescent , Staphylococcal Infections/mortality , Methicillin-Resistant Staphylococcus aureus , Argentina/epidemiology , Epidemiologic Studies , Cross-Sectional Studies , Community-Acquired Infections/mortality , Hospitalization , Hospitals, PediatricABSTRACT
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.
Subject(s)
Methicillin-Resistant Staphylococcus aureus , Staphylococcal Infections/mortality , Adolescent , Argentina/epidemiology , Child , Child, Preschool , Community-Acquired Infections/mortality , Cross-Sectional Studies , Epidemiologic Studies , Female , Hospitalization , Hospitals, Pediatric , Humans , Infant , MaleABSTRACT
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.
Subject(s)
Immunization Schedule , Vaccination/statistics & numerical data , Cross-Sectional Studies , Female , Humans , Infant , Infant, Newborn , Male , Time FactorsABSTRACT
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.
Subject(s)
Humans , Male , Female , Infant , Child, Preschool , Immunization , Vaccination Coverage , Observational Studies as Topic , Demography , VaccinationABSTRACT
OBJECTIVES: The aim of this study was to identify the clinical, radiological, and bacteriological features, risk factors, and outcome of neonates with bone and joint infections. STUDY DESIGN: Observational, retrospective, and analytical study of 77 patients less than 2 months of age, admitted to a tertiary neonatal intensive care unit (NICU) with the diagnosis of bone or joint infection, based on clinical, radiological, and microbiological criteria. RESULTS: Seventy-seven patients with 99 acute osteoarthritis foci in a 16 year period were included in the study. Risk factors for infection could be identified in 69% of the patients. The hip was the most frequent. Staphylococcus aureus was the main isolated microorganism. Twenty-nine infants (38%) had sequelae. Hip involvement, culture positive, and Staphylococcus aureus isolation were risk factors associated with sequelae. CONCLUSION: Osteoarticular infection is unusual in the neonate; however it is associated with an elevated incidence of sequelae. This mandates for a high degree of suspicion to diagnose this potentially disabling entity.
Subject(s)
Bacterial Infections/microbiology , Cross Infection/microbiology , Gram-Negative Bacteria/isolation & purification , Gram-Positive Bacteria/isolation & purification , Osteoarthritis/microbiology , Acute Disease , Cross Infection/complications , Female , Humans , Infant , Infant, Newborn , Male , Osteoarthritis/complications , Retrospective Studies , Risk Factors , Severity of Illness IndexABSTRACT
OBJECTIVES: The aim of this study was to identify the clinical, radiological, and bacteriological features, risk factors, and outcome of neonates with bone and joint infections. STUDY DESIGN: Observational, retrospective, and analytical study of 77 patients less than 2 months of age, admitted to a tertiary neonatal intensive care unit (NICU) with the diagnosis of bone or joint infection, based on clinical, radiological, and microbiological criteria. RESULTS: Seventy-seven patients with 99 acute osteoarthritis foci in a 16 year period were included in the study. Risk factors for infection could be identified in 69 percent of the patients. The hip was the most frequent. Staphylococcus aureus was the main isolated microorganism. Twenty-nine infants (38 percent) had sequelae. Hip involvement, culture positive, and Staphylococcus aureus isolation were risk factors associated with sequelae. CONCLUSION: Osteoarticular infection is unusual in the neonate; however it is associated with an elevated incidence of sequelae. This mandates for a high degree of suspicion to diagnose this potentially disabling entity.
Subject(s)
Female , Humans , Infant , Infant, Newborn , Male , Bacterial Infections/microbiology , Cross Infection/microbiology , Gram-Negative Bacteria/isolation & purification , Gram-Positive Bacteria/isolation & purification , Osteoarthritis/microbiology , Acute Disease , Cross Infection/complications , Osteoarthritis/complications , Retrospective Studies , Risk Factors , Severity of Illness IndexABSTRACT
INTRODUCTION: IE is a rare infection in children. Scarce reports with large number of patients are published. METHODS: Between January 1988 to December 2000 we analyzed all cases of IE cases admitted to our hospital. RESULTS: 86 cases of IE (4.9/10,000 admissions) in 86 children were diagnosed. The median age was 7.6 years. In 77% of patient previous cardiac disease was detected, interventricular defects and Tetralogy of Fallot were the more frequent. Three percent of children had rheumatic heart disease. Thirty-six percent of children had previous heart surgery. Fifty-seven percent have been received previous antibiotics. Eighty-seven percent had positive blood cultures, being the S. aureus and S. viridans the predominantly. Forty-eight percent of children had complications. The metabolic disorders and the nosocomial infections were the most frequent. Twenty-four percent required surgery, 24% of them in the first week of the diagnosis. The mortality in operated children was 19%. In the multivariate analysis we could observe that children with more than 7 years and S. aureus isolation in blood cultures had more incidence of complications and posterior surgery (p < 0.05). Children with S. aureus IE had longer duration of fever, more incidence of complications than patients with S. viridans IE (p < 0.05). Ten percent of children were treated as outpatients. The global mortality was 12,8%. Previous surgery (OR = 6.89; IC 95% 1.54-30.7) and previous antibiotic treatment (OR = 9.98; IC 95% 1.12-88.8) were the factors related with higher mortality in the multivariate analysis. S. aureus was the predominat pathogen and caused more morbidity and mortality than S. viridans IE. CONCLUSION: Children with IE with previous surgery and previous antibiotic treatment died with more frequency.
Subject(s)
Endocarditis, Bacterial/mortality , Adolescent , Anti-Bacterial Agents/therapeutic use , Argentina/epidemiology , Bacteremia/complications , Bacteremia/epidemiology , Child , Child, Preschool , Disease Susceptibility , Endocarditis, Bacterial/diagnostic imaging , Endocarditis, Bacterial/etiology , Endocarditis, Bacterial/surgery , Heart Defects, Congenital/complications , Heart Defects, Congenital/epidemiology , Humans , Postoperative Complications/mortality , Rheumatic Heart Disease/complications , Rheumatic Heart Disease/epidemiology , Risk Factors , Staphylococcal Infections/etiology , Staphylococcal Infections/microbiology , Staphylococcal Infections/mortality , Staphylococcal Infections/surgery , Staphylococcus aureus/isolation & purification , Staphylococcus aureus/pathogenicity , Streptococcal Infections/etiology , Streptococcal Infections/microbiology , Streptococcal Infections/mortality , Streptococcal Infections/surgery , Superinfection , Ultrasonography , Viridans Streptococci/isolation & purification , Viridans Streptococci/pathogenicity , VirulenceABSTRACT
Con el objetivo de validar el uso de un perfil de bajo riesgo de mortalidad, y evaluar la eficacia de un esquema de tratamiento secuencial parenteral-oral en niños con neutropenia y fiebre durante la terapia de enfermedades malignas, se llevó a cabo un estudio prospectivo entre mayo de 1997 y diciembre de 1999. En el período de estudio fueron incluídos 247 episodios de neutropenia y fiebre en 215 pacientes. Los niños en tratamiento por enfermedades malignas que presentaban: neutropia (recuento absoluta de neutrófilos<500/mm3), fiebre (> 38§C) buen estado general, que no presentaban un foco clínico de riesgo, que no tenían factores comorbilidad severos asociados, sin bacteriemia y familias continente, fueron elegidos para recibir un tratamiento inicial con ceftrixona y amikacina en el hospital seguido de cefixima o ciprofloxacina por vía oral en forma ambulatoria hasta completar 7 días. La edad media de los niños fue de 64 meses (r: 8-200). El 48 porciento (118) tuvo leucemia y el 57 porciento (141) catéteres endovasculares. El 47 porciento (122) tuvo foco clínico de infección, donde predominó la infección respiratoria alta (81 porciento). El tiempo medio de fiebre fue de 1.1 días (r: 1-8) y de neutropenia 3.9 días (r: 1-9). El 61 porciento (150) de los niños fue dado de alta con neutropenia. La media de internación fue de 1.5 días. Se registraron 4 fallos (1.6 porciento), los cuáles fueron tratados satisfactoriamente y ninguno presentó complicaciones mayores, falleció o abandonó el tratamiento. El perfil de riesgo utilizado fue seguro, y el tratamiento secuencial fue eficaz en el manejo de los niños con neutropenia y fiebre de origen hemato-oncológico y bajo riesgo de mortalida.
Subject(s)
Humans , Infant , Child, Preschool , Child , Adolescent , Male , Female , Drug Therapy/adverse effects , Fever/mortality , Neoplasms/drug therapy , Neutropenia/mortality , Anti-Bacterial Agents/therapeutic use , Fever/drug therapy , Neutropenia/drug therapy , Prospective Studies , Risk Factors , Treatment OutcomeABSTRACT
Con el objetivo de validar el uso de un perfil de bajo riesgo de mortalidad, y evaluar la eficacia de un esquema de tratamiento secuencial parenteral-oral en niños con neutropenia y fiebre durante la terapia de enfermedades malignas, se llevó a cabo un estudio prospectivo entre mayo de 1997 y diciembre de 1999. En el período de estudio fueron incluídos 247 episodios de neutropenia y fiebre en 215 pacientes. Los niños en tratamiento por enfermedades malignas que presentaban: neutropia (recuento absoluta de neutrófilos<500/mm3), fiebre (> 38ºC) buen estado general, que no presentaban un foco clínico de riesgo, que no tenían factores comorbilidad severos asociados, sin bacteriemia y familias continente, fueron elegidos para recibir un tratamiento inicial con ceftrixona y amikacina en el hospit
