ABSTRACT
OBJECTIVE: To describe the clinical and laboratory characteristics of patients with sepsis admitted to a high-complexity healthcare center in Latin America. PATIENTS AND METHOD: Descriptive observational study. Patients between one month to 17 years of age with sepsis diagnosis were included. Studied variables included demographics, clinical and laboratory characteristics, and treatment administered, determining predictors of mortality. A descriptive analysis was performed using the Chi-square or Fisher test. RESULTS: 186 patients were included and 72% of them had comorbidities. Respiratory disease was the most frequent source of sepsis (29%), followed by gastrointestinal infection (11%) and catheter-related bacteremia (11%). 60% of patients had at least one organ dysfunction, the most frequent being respiratory dysfunction (70%). 60% of the patients presented multiple organ dysfunction syndrome (MODS). Blood cultures showed a positive result in 37% of cases. The two most common first-hour interventions included IV resuscitation fluids (67%) and antibiotics (36%). Vasopressor support and mechanical ventilation were used in 33% and 34% of patients, respectively. Overall mortality was 12% and was higher in patients diagnosed with MODS (59%) or who presented with some organ dysfunction. CONCLUSION: Organ dysfunction was frequent. Patients with some type of organ dysfunction or MODS presented higher mortality. Despite global and institutional guidelines focused on improving diagnosis and treatment, in less than half of the patients sepsis was adequately detected and first-hour IV fluids and antibiotics administration rates were below 70%.
Subject(s)
Multiple Organ Failure , Sepsis , Humans , Child , Multiple Organ Failure/etiology , Prognosis , Sepsis/diagnosis , Sepsis/therapy , Hospitals , Anti-Bacterial Agents/therapeutic useABSTRACT
Se presenta el caso de un paciente pediátrico de 10 años, inmunosuprimido con corticosteroides y metotrexato por enfermedad reumatológica de base, que presentó varicela visceral con manifestaciones atípicas tales como compromiso pulmonar, hepático y alteraciones hematológicas. Inicialmente, no tuvo manifestaciones cutáneas, las cuales desarrolló a los ocho días de evolución, por lo cual requirió apoyo en la unidad de cuidados intensivos pediátricos y manejo multidisciplinario. La varicela es una enfermedad exantemática frecuente, considerada benigna con presentación leve y de resolución espontánea, en pacientes sin compromiso inmunitario. Por el contrario, la infección por este virus en pacientes inmunosuprimidos es una entidad que amenaza potencialmente la vida, principalmente cuando se presenta con compromiso visceral. Se debe considerar la posibilidad de infección por el virus varicela zóster en pacientes con disfunción hepática inexplicable asociada a dolor abdominal o lumbar, bajo condiciones de inmunosupresión, aun en ausencia de exposición viral o compromiso en piel; tanto la complicación hepática como la de los otros sistemas se han relacionado con alta morbimortalidad. Un alto índice de sospecha de varicela grave en el paciente inmunosuprimido, es importante para el diagnóstico y manejo oportuno.
We report the case of a 10 years old pediatric patient immunosuppressed with steroids and methotrexate for rheumatological disease who presents atypical varicella with visceral involvement such as lung, liver and blood disorders, without skin manifestations initially which development to the 8-day, requiring support in pediatric intensive care unit and multidisciplinary management. Chickenpox is a common rash illness, considered benign with a mild and limited in immunocompetent patients. By contrast, infection with this virus in immunosuppressed patients is an entity that potentially life threatening, especially when presented with visceral involvement. Infection with varicella-zoster virus should be considered in patients with unexplained liver dysfunction associated with abdominal or back pain under conditions of immunosuppression, even in the absence of viral exposure or skin compromise, The hepatic involvement as both of the other systems has been associated with high morbidity and mortality. A high index of suspicion of severe varicella in immunosuppressed patients is important for diagnosis and timely management.
