ABSTRACT
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Subject(s)
Female , Infant , Humans , Atrophy , Myelitis, Transverse/complications , Spinal Cord/pathology , Spinal Cord Diseases , Spinal Cord Diseases/etiology , Spinal Cord Diseases/pathology , Magnetic Resonance ImagingSubject(s)
Liver Transplantation/adverse effects , Postoperative Complications/etiology , Adolescent , Adult , Cardiovascular Diseases/etiology , Child , Child, Preschool , Humans , Infant , Infections/etiology , Liver Transplantation/mortality , Nutritional Physiological Phenomena , Postoperative Period , Renal Insufficiency/etiology , Respiratory Tract Diseases/etiologyABSTRACT
OBJECTIVE: To assess the effectiveness of selective digestive decontamination (SDD) on the control of nosocomial infection (NI) in critically ill pediatric patients. DESIGN: A prospective, randomized, non-blinded and controlled clinical microbiology study. SETTING: The pediatric intensive care unit (PICU) of a tertiary level pediatric university hospital. CRITERIA FOR INCLUSION: Patients 1 month to 14 years old, who underwent some kind of manipulation or instrumentation (mechanical ventilation, vascular cannulation, monitoring of intracranial pressure, thoracic or abdominal drainage, bladder catheterization, peritoneal dialysis, etc.) and/or presented a neurological coma requiring a stay in the PICU of 3 or more days. PATIENTS: Over a period of 2 years, 244 patients met the inclusion criteria; 18 patients were withdrawn because of protocol violation. The treatment group comprised 116 patients and the control group, 110 patients. INTERVENTION: The treatment group received a triple therapy of colimycin, tobramycin and nystatin administered orally or via nasogastric tube every 6 hours. All patients with mechanical ventilation or immune-depression received decontamination treatment of the oropharyngeal cavity with hexitidine (Oraldine 0.5 mg/ml) every 6-8 hours in accordance with the PICU's conventional protocol. METHOD: Up to 10 types of nosocomial infection were diagnosed following criteria of the Centers for Disease Control (CDC). The severity and manipulation of the patients on admission was assessed using the therapeutic intervention scoring system (TISS) and multi-organ system failure scores (MOSF). MEASUREMENTS AND MAIN RESULTS: UNIVARIANT ANALYSIS: SDD did not significantly reduce the incidence of NI, antibiotic use, the length of stay, or mortality; although a small percentage of respiratory and urinary tract infections was detected, catheter-related bacteremia was the most common infection. MULTIVARIANT ANALYSIS: Controlling the risk factors for each child through log regression showed that SDD acted as a protective factor for more than 90% of the sample with respect to the appearance of respiratory and urinary tract infections, reducing the risk of such infections to 1/5 and 1/3, respectively. CONCLUSIONS: SDD was effective in controlling respiratory and urinary tract infections in children admitted to the PICU, but it did not reduce the incidence of other types of nosocomial infection.
Subject(s)
Antibiotic Prophylaxis , Cross Infection/prevention & control , Drug Therapy, Combination/therapeutic use , Intensive Care Units, Pediatric , Adolescent , Child , Child, Preschool , Colistin/therapeutic use , Cross Infection/epidemiology , Cross Infection/etiology , Digestive System/microbiology , Female , Hexetidine/therapeutic use , Humans , Infant , Male , Multiple Organ Failure , Multivariate Analysis , Nystatin/therapeutic use , Prospective Studies , Regression Analysis , Respiratory Tract Infections/prevention & control , Severity of Illness Index , Tobramycin/therapeutic use , Urinary Tract Infections/prevention & controlABSTRACT
We report a case of systemic lupus erythematosus (SLE) in a 15-year-old girl with severe neurological disease, platelet function disorder and pulmonary haemorrhage, which remitted after plasmapheresis. The patient developed protein-losing enteropathy shrinking lung, and acute pancreatitis with pseudocyst formation. These infrequent complication of SLE are discussed.