[Nosocomial infections. Experience at a third-level pediatric hospital]. / Infecciones nosocomiales. Experiencia en un hospital pediátrico de tercer nivel.

OBJECTIVE: To describe the results of an epidemiologic surveillance program, from 1990 to the first semester of 1997, in a new high-specialty pediatric hospital and perform a comparison with previous reports. MATERIAL AND METHODS: The total number and type of nosocomial infections, the incidence rate and density incidence for department and division, for different age groups and according to immune statues were registered. RESULTS: The global incidence of nosocomial infections during the period was 25.7 per 100 discharges, with a progressive decrease during the last three years. Although immunocompromised patients had more infections than immunocompetent ones, the difference was not significative. The three most common infections were: pneumonia, vascular line infections and upper respiratory tract infections. It is possible that upper respiratory tract infections are contributing to the elevation of global incidence rates of nosocomial infections. CONCLUSIONS: The change of infection epidemiology regarding previous experience has led to the implementation of programs to prevent the most frequent problems. It is necessary to intensify the different prevention programs and to increase their reach in order to cut down costs in a short term.

[Design and applicability of a clinical guide for appropriate attention in acute respiratory infections]. / Diseño y aplicabilidad de una guía clínica para la atención apropiada en las infecciones respiratorias agudas.

Clinical guidelines provide continuing education and help physicians in the clinical decision-making process. Clinical guidelines to manage acute respiratory infections (ARI) were developed comprehensively from a perspective where prevention, diagnosis, treatment and the patient's education were considered. Methodology. The guideline development process was comprised of two stages: 1. The building stage consisted of several steps: definition of the problem, definition of the potential users of the guidelines, and the appropriate level of care; review of updated bibliographies, and validation using the Delphi technique. 2. The start-up stage consisted of evaluating the guidelines applicable to out-patient settings. Twenty family physicians participated, using the guidelines with 115 patients. Agreement between the family physicians' diagnosis and the criteria stated in the guidelines was tested using unweighted kappa. Differences in the use of the guidelines to manage ARI patients were tested by using the X2 test or the exact Fisher test. Results. Development of guidelines considered the patient's age group. Therefore, guidelines to manage patients under five years of age and to manage patients above this age were constructed. The application of the guidelines was increased from 40 to 60%. As a result, inappropriate prescribing of antibiotics and cough syrups decreased. Although the guidelines could be helpful in treating ARI, its efficacy and effectiveness remain to be tested.

[Susceptibility of Staphylococcus aureus to penicillin, dicloxacillin, gentamycin, erythromycin, and rifampicin]. / Susceptibilidad de Staphylococcus aureus a la penicilina, dicloxacilina, gentamicina eritromicina y rifampicina.

Sensitivity tests to different antimicrobial agents were performed in 290 strains of S. aureus isolated from healthy population and from patients with various infectious diseases. Resistance to penicillin G varied from 80 to 97% and beta-lactamase production was demonstrated in all strains with CMI greater than 1 microgram/ml. Resistance to other drugs was variable: gentamicin 29.4%, erythromycin 24.5% and rifampicin 12%. All strains were sensitive to isoxazolyl penicillins with CMI less than 1 microgram/ml. There was no difference in the sensitivity pattern to antibiotics between strains isolated from community or from hospital acquired infections with reference to the antimicrobial resistance pattern.

[Haemophilus influenzae sensitivity to ampicillin and chloramphenicol in children in Mexico City]. / Sensibilidad de Haemophilus influenzae a la ampicilina y al cloranfenicol en niños de la ciudad de México.

The sensitivity to chloramphenicol and ampicillin of 127 strains of H. influenzae was tested. One hundred and one strains were obtained from the pharyngeal exudate of 828 healthy carriers under 5 years of age and 26 from the spinal fluid of children with meningoencephalitis. Sixty per cent of isolations corresponded to type b; 40 per cent were non typical and we only identified one type e. All H. influenzae obtained from spinal fluid corresponded to type b. The frequency of healthy carriers was greater in intrafamily contacts of children with H. influenza meningoencephalitis (p less than 0.01). Percentages of resistance to ampicillin varied between 6 and 23% for the different groups; we found no statistical difference among them (p less than 0.2). The prevalence of H. influenza resistant to ampicillin in the population studied was 1.2% for type b strains and 0.2% for non typical bacteria. Fourteen per cent of penicillin resistant type b strains were identified; all 127 isolations were to chloramphenicol; therefore, we recommend this drug instead of ampicillin for the treatment of H. influenza infections, with the exception of acute otitis media.

Screening for ampicillin resistant Hemophilus influenzae and penicillin resistant Streptococcus Pneumoniae in healthy carriers.

800 samples of pharyngeal exudate were taken from healthy children and 28 healthy intrafamilial contacts of children with meningitis caused by H. influenzae type b. H. influenzae type be was isolated in 8.7 per cent of nursery children, H. influenzae type e in 0.12 per cent and non typifiable H. influenzae in 5.8 per cent. On intrafamilial contacts, 32 per cent had H. influenzae type b and non typifiable in 3.5 per cent. Percent age of ampicillin resistant H. influenzae type b was 14 per cent. No strains were found resistant to chloramphenicol. S. pneumoniae was isolated in 37 per cent of pharyngeal exudate samples. 25.5 per cent of strains tested were penicillin sensitive; 74.5 per cent has a decrease sensitivity. Based on these results we consider chloramphenicol to the the first drug of choice for treatment of severe H. influenzae infections and penicillin for S. pneumoniae infections recommending in the latter higher doses when dealing with central nervous system infections.

Susceptibilidad de Staphylococcus aureus a la penicilina, dicloxacilina, gentamicina eritromicina y rifampicima. / Susceptibility of Staphylococcus aureus to penicillin, dicloxacillin, gentamicin, erythromycin and rifampicin

Se efectuo la sensibilidad a diferentes antimicrobianos de 290 cepas de S.aureus, obtenidas de poblacion sana y enfermos con patologia diversa. Los porcentajes de resistencia a la penicilina G en los grupos estudiados variaron de 80 a 97 por ciento y se demostro produccion de betalactamasas en todas las cepas con CMI>1 ug/ml para este antibiotico. En el caso de gentamicina, eritromicina y rifampicina los porcentajes de resistencia fueron de 29,4, 24,5 y 12 por ciento respectivamente. Todas las cepas fueron sensibles a dicloxacilina, el 94,2 por ciento tuvieron CMI< 1 ug/ml y no encontramos diferencia en el patron de sensibilidad a los antibioticos probados entre las cepas procedentes de comunidad y las de adquisicion hospitalaria