Prevalencia de colonización rectovaginal por Streptococcus agalactiae en mujeres gestantes atendidas en un hospital de segundo nivel en Honduras

Introducción. Streptococcus agalactiae, conocido actualmente como estreptococo del grupo B (EGB), es el principal microorganismo que coloniza el tracto genitourinario en pacientes gestantes, llegando a causar consecuencias graves en el neonato, como sepsis neonatal, neumonía y meningitis. Objetivo. Determinar la prevalencia de EGB en mujeres gestantes del Hospital Nacional Dr. Mario Catarino Rivas, en Honduras. Materiales y métodos. Estudio descriptivo, prospectivo, transversal. Se utilizó un muestreo por conveniencia, se enroló un total de 143 gestantes entre las 34 y 40 semanas de gestación atendidas en el servicio de ginecología y obstetricia del Hospital Nacional Dr. Mario Catarino Rivas, durante enero de 2020 a junio del 2021. Los cultivos se prepararon de acuerdo con la metodología recomendada por los Centers for Disease Control and Prevention, agregándose el agar chromID Strepto B. Se empleó estadística descriptiva para el análisis. Resultados. La edad promedio de las gestantes fue 26 ± 7,4 años. La prevalencia de EGB en la población fue del 3,5%, encontrando 5 casos positivos. Conclusión. La prevalencia de colonización por EGB en mujeres embarazadas es variable y puede no estar asociada a factores de riesgo para ser colonizada, resultando en complicaciones sanitarias neonatales y maternas. Ello pone de manifiesto la necesidad de búsqueda activa de estreptococos del grupo B en las gestantes.

Introduction: Streptococcus agalactiae, currently known as group B streptococcus (GBS) is the main microorganism that colonizes the genitourinary tract in pregnant women, causing serious consequences in the neonate, such as neonatal sepsis, pneumonia, and meningitis. Objective: To determine the prevalence of GBS in pregnant women at the Dr. Mario Catarino Rivas National Hospital in Honduras. Materials and methods: Descriptive, prospective, cross-sectional study. A total of 143 pregnant women between 34-40 weeks of gestation attended at the gynecology and obstetrics service of the Dr. Mario Catarino Rivas National Hospital in Honduras from January 2020 to June 2021 were enrolled. Cultures were developed following the methodology recommended by the Centers for Disease Control and Prevention and Strepto B chromID agar was added. Descriptive statistics were used for analysis. Results: The mean age of the pregnant women was 26 ± 7.4 years. The prevalence of GBS in the study population was 3.5%, with 5 positive cases. Conclusion: The prevalence of GBS colonization in pregnant women is variable and may not be associated with risk factors for colonization, resulting in neonatal and maternal health complications. This highlights the need for active search for group B Streptococcus in pregnant women.

Prevalencia de sepsis neonatal confirmada microbiológicamente en una maternidad de la Ciudad Autó noma de Buenos Aires / Prevalence of microbiologically confirmed neonatal sepsis at a maternity center in the City of Buenos Aires

Introducción. En neonatos internados es frecuente sospechar sepsis neonatal, pero solo en el 25 % al 30 % se confirma con cultivos positivos. La selección del esquema antibiótico basándose en la epidemiología local favorece el uso racional y minimiza sus efectos colaterales. Objetivo primario. Describir la prevalencia de sepsis precoz y tardía con rescate microbiológico y sus características clínicas. Población y método. Estudio transversal retrospectivo, realizado del 1 de enero de 2013 al 31 de diciembre de 2017, en una maternidad pública de Argentina, que incluyó todos los recién nacidos internados en la unidad con diagnóstico de sepsis precoz y tardía con rescate microbiológico, y aquellos reingresados dentro del mes de vida. Resultados. Ingresaron 3322 recién nacidos, 1296 evaluados por sospecha de sepsis precoz, cultivos positivos en 25 (1,9 %; tasa: 0,86 ‰). El 52 % eran menores de 33 semanas de edad gestacional. Microorganismos: Escherichia coli 5, Listeria monocytogenes 4, Streptococcus agalactiae (SGB) 3, Streptococcus pneumoniae 3. Sepsis tardía (tasa 8,73 ‰), el 68 % ocurridas en menores de 33 semanas. Microorganismos intrahospitalarios: Staphylococcus coagulasa negativos 115, Staphylococcus aureus 47, Escherichia coli 30, Cándida spp. 16, Enterococcus faecalis 13, Klebsiella pneumoniae 11 y Streptococcus agalactiae 10. En los reingresos: E. coli 11, S. aureus 12, SGB 3 y Haemophilus influenzae 3. Conclusiones. Se observa en el período estudiado una frecuencia de sepsis precoz similar a los reportes internacionales, con predominio de E. coli y L. monocytogenes. La tasa de sepsis tardía presentó una tendencia descendente en los años analizados, con predominio de los cocos grampositivos

Introduction. Neonatal sepsis is often suspected in hospitalized newborn infants, but only in 25­30% of cases it is confirmed via a positive culture. Selecting the antibiotics based on local epidemiology favors their rational use and minimizes their side effects. Primary objective. To describe the prevalence of early- and late-onset sepsis with microorganism isolation and their clinical characteristics. Population and method. Retrospective, cross-sectional study conducted between 01-01-2013 and 12-31-2017 in a public maternity center of Argentina in all hospitalized newborn infants with a diagnosis of early- and late-onset sepsis with microorganism isolation, and those re-admitted in their first month of life. Results. A total of 3322 newborn infants were admitted; 1296 were assessed for suspected early- onset sepsis; 25 had a positive culture (1.9%; rate: 0.86‰). Of these, 52% were born before 33 weeks of gestation. Microorganisms: Escherichia coli 5, Listeria monocytogenes 4, Streptococcus agalactiae (SGB) 3, Streptococcus pneumoniae 3. Also, 68% of late-onset sepsis cases (rate: 8.73‰) occurred in infants born before 33 weeks of gestation. Hospital-acquired microorganisms: coagulase-negative Staphylococcus 115, Staphylococcus aureus 47, Escherichia coli 30, Candida spp. 16, Enterococcus faecalis 13, Klebsiella pneumoniae 11, and Streptococcus agalactiae 10. In re-admissions: E. coli 11, S. aureus 12, SGB 3, and Haemophilus influenzae 3. Conclusions. During the study period, the frequency of early-onset sepsis was similar to international reports, with a predominance of E. coli and L. monocytogenes. The rate of late-onset sepsis showed a downward trend in the analyzed years, with a predominance of Gram-positive cocci.

¿Cómo evaluar la sepsis neonatal de inicio precoz? Estudio comparativo de tres estrategias de detección / How to assess early-onset neonatal sepsis? Comparison of three detection strategies

Introducción: La sepsis neonatal de inicio precoz puede causar morbimortalidad importante, sobre todo si se retrasa su identificación. La disminución de su incidencia en las últimas décadas motiva que sea importante encontrar un equilibrio entre reducir las pruebas complementarias y seguir detectando los pacientes afectos. Comparamos 3 estrategias de detección en pacientes con factores de riesgo: E1. Cribado analítico; E2. Calculadora de riesgo de sepsis neonatal; E3. Observación clínica. Pacientes y métodos: Estudio observacional retrospectivo, en recién nacidos con edad gestacional ≥34 semanas y con factores de riesgo o sintomatología compatible con sepsis neonatal de inicio precoz. Se analizaron los resultados de nuestra unidad con cribado analítico (E1) y se comparó con las otras 2 estrategias (E2 y E3) para valorar modificar nuestro protocolo. Resultados: Se incluyeron 754 pacientes cuyos factores de riesgo más frecuentes fueron la rotura prologada de membranas (35,5%) y la colonización materna por Streptococcus agalactiae (38,5%). Las E2 y E3 disminuirían la realización de analíticas (E1 56,8% de los pacientes; E2 9,9%; E3 22,4%; p<0,01), los ingresos hospitalarios (E1 11%; E2 6,9%; E3 7,9%; p<0,01) y la administración de antibioterapia (E1 8,6%; E2 6,7%; E3 6,4%; p<0,01). Trece pacientes se diagnosticaron de sepsis, las cuales se hubieran detectado con E2 y E3, salvo un paciente con bacteriemia asintomática por Enterococcusfaecalis. Ningún paciente con clínica leve y autolimitada en que no se inició antibioterapia, se diagnosticó posteriormente de sepsis. Conclusiones: La observación clínica estrecha parece una opción segura y podría disminuir la realización de pruebas complementarias, la tasa de hospitalización y el uso de antibioterapia innecesaria. Mantener una conducta expectante en pacientes con sintomatología leve y autolimitada en las primeras horas de vida parece no relacionarse con la no identificación de sepsis. (AU)

Introduction: Early-onset neonatal sepsis can cause significant morbidity and mortality, especially if it is not detected early. Given the decrease in its incidence in the past few decades, it is important to find a balance between reducing the use of diagnostic tests and continuing to detect affected patients. We compared 3 detection strategies in patients with risk factors (RFs) for infection: laboratory screening (S1), the neonatal sepsis risk calculator (S2) and clinical observation (S3). Patients and methods: Retrospective observational study in neonates born at 34 weeks or gestation or later and with RFs or symptoms compatible with early-onset neonatal sepsis. We analysed outcomes in our unit with the use of laboratory screening (S1) and compared them with the other two strategies (S2 and S3) to contemplate whether to modify our protocol. Results: The study included 754 patients, and the most frequent RFs were prolonged rupture of membranes (35.5%) and maternal colonization by Streptococcus agalactiae (38.5%). Strategies S2 and S3 would decrease the performance of laboratory tests (S1, 56.8% of patients; S2, 9.9%; S3, 22.4%; P<.01), hospital admissions (S1, 11%; S2, 6.9%; S3, 7.9%; P<.01) and the use of antibiotherapy (S1, 8.6%; S2, 6.7%; S3, 6.4%; P<.01). Sepsis was diagnosed in 13 patients, and it would have been detected with S2 and S3 except in 1 patient who had asymptomatic bacteriemia by Enterococcusfaecalis. No patient with mild and self-limited symptoms in whom antibiotherapy was not started received a diagnosis of sepsis later on. Conclusions: Close clinical observation seems to be a safe option and could reduce the use of diagnostic tests, hospital admission and unnecessary antibiotherapy. The watchful waiting approach in patients with mild and self-limiting symptoms in the first hours post birth does not appear to be associated with failure to identify sepsis. (AU)

How to assess early-onset neonatal sepsis? Comparison of three detection strategies.

INTRODUCTION: Early-onset neonatal sepsis (EONS) can cause significant morbidity and mortality, especially if it is not detected early. Given the decrease in its incidence in the past few decades, it is important to find a balance between reducing the use of diagnostic tests and continuing to detect affected patients. We compared 3 detection strategies in patients with risk factors (RFs) for infection: laboratory screening (S1), the Neonatal Sepsis Risk Calculator (S2) and clinical observation (S3). PATIENTS AND METHODS: Retrospective observational study in neonates born at 34 weeks of gestation or later and with RFs or symptoms compatible with EONS. We analysed outcomes in our unit with the use of laboratory screening (S1) and compared them with the other two strategies (S2 and S3) to contemplate whether to modify our protocol. RESULTS: The study included 754 patients, and the most frequent RFs were prolonged rupture of membranes (35.5%) and maternal colonization by Streptococcus agalactiae (38.5%). Strategies S2 and S3 would decrease the performance of laboratory tests (S1, 56.8% of patients; S2, 9.9%; S3, 22.4%; P < 0.01), hospital admissions (S1, 11%; S2, 6.9%; S3, 7.9%; P < 0.01) and the use of antibiotherapy (S1, 8.6%; S2, 6.7%; S3, 6.4%; P < 0.01). Sepsis was diagnosed in 13 patients, and it would have been detected with S2 and S3 except in 1 patient who had asymptomatic bacteriemia by Enterococcus faecalis. No patient with mild and self-limited symptoms in whom antibiotherapy was not started received a diagnosis of sepsis later on. CONCLUSION: Close clinical observation seems to be a safe option and could reduce the use of diagnostic tests, hospital admission and unnecessary antibiotherapy. The watchful waiting approach in patients with mild and self-limiting symptoms in the first hours post birth does not appear to be associated with failure to identify sepsis.

Sepsis neonatal: Diagnóstico y tratamiento

La sepsis neonatal es causa importante de morbilidad y mortalidad. La OMS reporta que anualmente mueren 2,4 millones de bebés durante el primer mes de vida, siendo la sepsis neonatal una de las principales causas. El objetivo es actualizar en el diagnóstico y tratamiento de la sepsis neonatal. En esta investigación se realizó una revisión de la literatura para sintetizar hallazgos relevantes sobre sepsis neonatal, que se define como afección sistémica, caracterizada por cambios hemodinámicos y otras manifestaciones clínicas, como respuesta desregulada a la infección. La sepsis neonatal precoz se relaciona con factores de riesgo maternos y los microorganismos causantes son del tracto genitourinario materno, mientras que la tardía es causada por gérmenes intrahospitalarios, en neonatos con estancia hospitalaria prolongada y sometidos a procedimientos invasivos. Los signos y síntomas de sepsis neonatal son inespecíficos, lo que hace difícil su diagnóstico, se recomienda identificar factores de riesgo y evaluación clínica minuciosa. Los establecimientos de salud deben realizar vigilancia epidemiológica de gérmenes más frecuentes y sensibilidad antibiótica, para garantizar tratamiento antibiótico adecuado.

Neonatal sepsis is a major cause of morbidity and mortality. The WHO reports that 2.4 million babies die annually during the first month of life, with neonatal sepsis being one of the main causes. The objective is to update the diagnosis and treatment of neonatal sepsis. In this research, a review of the literature was carried out to synthesize relevant findings on neonatal sepsis, which is defined as a systemic condition, characterized by hemodynamic changes and other clinical manifestations, as a deregulated response to infection. Early-onset neonatal sepsis is related to maternal risk factors and the causative microorganisms are from the maternal genitourinary tract, while late-onset sepsis is caused by nosocomial germs, in neonates with prolonged hospital stay and subjected to invasive procedures. The signs and symptoms of neonatal sepsis are nonspecific, which makes its diagnosis difficult, it is recommended to identify risk factors and a thorough clinical evaluation. Health establishments must carry out epidemiological surveillance of the most frequent germs and antibiotic sensitivity, to guarantee adequate antibiotic treatment.

Caracterización de la infección asociada a la asistencia sanitaria en la Neonatología del hospital materno provincial

Introducción: Las infecciones asociadas a la asistencia sanitaria constituyen un problema de salud actual en los servicios de Neonatología. En los últimos tiempos su complejidad ha aumentado debido a que la atención brindada a neonatos inmaduros, susceptibles a la colonización microbacteriana, se encuentra mediada por el uso de procedimientos invasivos que facilitan la entrada de las infecciones. Objetivo: Caracterizar la infección asociada a la asistencia sanitaria en la Neonatología del hospital materno provincial. Métodos: Se realizó un estudio observacional descriptivo retrospectivo de corte transversal con el objetivo de caracterizar la infección asociada a la asistencia sanitaria en la Neonatología del Hospital Materno Provincial Ana Betancourt de Mora en la provincia Camagüey, período comprendido del 1ro de enero al 31 de diciembre del año 2022. El universo de estudio estuvo constituido por todos los neonatos ingresados en el servicio de Neonatología y la muestra a discreción la conformaron los 143 pacientes con sepsis nosocomial. Resultados: Los neonatos con infección asociada a la asistencia sanitaria más afectados fueron los de edad gestacional entre las 31-36 semanas, peso 1 500-2 499 gramos, parto vía cesárea. Como factores maternos la infección de vías urinarias/vaginosis y los neonatales la prematuridad seguido por el catéter epicutáneo; en cuanto a la localización la infección respiratoria con mayor número de casos y los gérmenes Gram negativos el Enterobacter gergoviae con la mayor incidencia. Conclusiones: Tanto la modificación como el conocimiento de los factores de riesgo serán impactos favorables para su disminución.

Introduction: Infections associated with health care (IAAS) are a current health problem in Neonatology services. In recent times, its complexity has increased because the care provided to immature neonates, susceptible to mycobacterial colonization, is mediated by the use of invasive procedures that facilitate the entry of germs. Objective: To characterize healthcare associated infections in the Neonatology of the provincial maternity hospital. Methods: A cross-sectional retrospective descriptive observational study was carried out with the aim of characterizing the infection associated with health care in the Neonatology of the Ana Betancourt de Mora Provincial Maternity Hospital in the province of Camagüey, from January 1st to December 31st, 2022. The study universe consisted of all neonates admitted to the Neonatology service and the sample at discretion was made up of 143 patients with nosocomial sepsis. Results: The most affected neonates with healthcare-associated infection were those of gestational age between 31-36 weeks, weight 1500-2499 grams, delivery via cesarean section. As maternal factors urinary tract infection / vaginosis and neonatal prematurity followed by the epicutaneous catheter; regarding the location, the respiratory infection with the highest number of cases and the Gram negative germs the Enterobacter gergoviae with the highest incidence. Conclusions: Both the modification and the knowledge of the risk factors will be favorable impacts for their reduction.

The impact and interaction of TLR2 and IRF-5 gene polymorphisms on the susceptibility to neonatal sepsis / 中国医师杂志

Objective:To investigate the impact and interaction of Toll like receptor 2 (TLR2) and interferon regulatory factor 5 (IRF-5) gene polymorphisms on the susceptibility to neonatal sepsis.Methods:A total of 78 cases of neonatal septicemia patients admitted to Baoding Children′s Hospital from July 2018 to August 2021 were prospectively selected as the study group, and 78 cases of healthy newborns in the same period were selected as the control group. The TLR2 and IRF-5 gene polymorphisms and the levels of inflammatory markers [C-reactive protein (CRP), tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6)] in different genotypes of infants were compared between the two groups. We evaluated the relationship between TLR2 and IRF-5 genotypes, inflammatory markers, and susceptibility to neonatal sepsis, and analyzed the interaction between their gene polymorphisms and susceptibility to neonatal sepsis.Results:There were significant differences in the distribution of TLR2 (rs3804099) and IRF-5 (rs2004640) loci genotype and Allele frequency between the two groups (all P<0.05); The serum CRP, TNF-α, and IL-6 levels in children with TLR2 (rs3804099) genotype TT genotype [(111.12±30.87)mg/L, (77.50±20.02)pg/ml, (40.27±11.31)pg/ml] were higher than those in children with CC/CT genotype [(72.46±24.51)mg/L, (54.18±17.65)pg/ml, (28.34±9.05)pg/ml], and the differences were statistically significant (all P<0.05). The serum CRP, TNF-α, and IL-6 levels [(113.90±28.94)mg/L, TNF-α (79.84±19.82)pg/ml, IL-6 (41.05±11.49)pg/ml] in children with the IRF-5 (rs2004640) TT genotype were higher than those in children with the GG/GT genotype [(70.88±22.16)mg/L, (52.27±16.73)pg/ml, (27.96±9.75)pg/ml], and the differences were statistically significant (all P<0.05). The TT genotypes at TLR2 (rs3804099) and IRF-5 (rs2004640) loci were positively correlated with serum CRP, TNF-α, and IL-6 levels (all P<0.05); The TT genotypes at TLR2 (rs3804099) and IRF-5 (rs2004640) loci were independent risk factors for susceptibility to neonatal sepsis (all P<0.05); The TT genotype at the TLR2 (rs3804099) locus and the TT genotype at the IRF-5 (rs2004640) locus exhibited a positive interaction in susceptibility to neonatal sepsis ( OR=7.467, γ=1.728). Conclusions:TLR2 (rs3804099) TT genotype and IRF-5 (rs2004640) TT genotype significantly increase the susceptibility to neonatal sepsis, and there is a positive interaction between the two.

Plan de implementación de Dosis Unitaria en el servicio de neonatología en el Hospital Cochabamba / Plan for the Implementation of the Unit Dose in the Neonatology Service of Cochabamba Hospital / Plano de Implementação de Dose Unitária no Serviço de Neonatologia do Hospital Cochabamba

En la actualidad la sepsis neonatal es uno de los principales diagnósticos en el servicio de Neonatología del Hospital Cochabamba, el medicamento de mayor elección para el tratamiento farmacológico de esta infección es la Amicacina, con la probabilidad de causar hipoacusia neonatal, la hipoacusia o disminución de la percepción auditiva, es un problema de especial importancia durante la infancia, ya que el desarrollo intelectual y social del niño está íntimamente ligado a las aferencias auditivas al sistema nervioso central, cuyo potencial discapacitante y minusvalidante depende en gran medida de la precocidad con que se realice el diagnóstico y se instaure el tratamiento y la rehabilitación. Objetivo. Diseñar un plan de implementación de Dosis Unitaria para contribuir a disminuir la hipoacusia en los pacientes neonatos. Materiales y Métodos se realizó un estudio documental basado en los registros de las Historias clínicas de los pacientes, realizándose un estudio descriptivo y retrospectivo. Se utilizaron los métodos empíricos como la encuesta, la entrevista y la observación científica, con el fin de demostrar y obtener un diagnóstico fidedigno, apoyándose con fuentes y estudios sobre la hipoacusia como sustento teórico. Resultados. Ante la evidencia de la existencia de la hipoacusia neonatal, como posible efecto adverso del uso farmacológico de la amicacina, se obtiene como resultado de la investigación la necesidad imperiosa de un plan de implementación en Dosis Unitaria para el servicio de neonatología del Hospital. Conclusiones. Los pacientes neonatos recibirán una atención segura, eficaz y humanizada con base a una implementación de Dosis Unitaria.

At present, neonatal sepsis is one of the main diagnoses in the Neonatology service of the Cochabamba Hospital, the drug of choice for the pharmacological treatment of this infection is Amicacin, with the probability of causing neonatal hypoacusis, the hypoacusis or decrease in auditory perception, is a problem of special importance during childhood, since the intellectual and social development of the child is intimately linked to the auditory afferents to the central nervous system, whose disabling and handicapping potential depends to a great extent on the precocity with which the diagnosis is made and the treatment and rehabilitation are established. Objective. To design a plan for the implementation of Unit Dose to contribute to the reduction of hearing loss in neonatal patients. Materials and Methods. A documentary study was carried out based on the patients' medical records, performing a descriptive and retrospective study. Empirical methods such as survey, interview and scientific observation were used in order to demonstrate and obtain a reliable diagnosis, supported by sources and studies on hypoacusis as theoretical support. Results. In view of the evidence of the existence of neonatal hypoacusis, as a possible adverse effect of the pharmacological use of amikacin, it is obtained as a result of the research the imperative need of an implementation plan in Unit Dose for the neonatology service of the Hospital. Conclusions. Neonatal patients will receive safe, effective and humanized care based on a Unit Dose implementation.

Atualmente, a sepse neonatal é um dos principais diagnósticos no serviço de Neonatologia do Hospital de Cochabamba. O medicamento de escolha para o tratamento farmacológico desta infecção é a Amicacina, com a probabilidade de causar hipoacusia neonatal, hipoacusia ou diminuição da percepção auditiva, é um problema de especial importância durante a infância, já que o desenvolvimento intelectual e social da criança está intimamente ligado aos aferentes auditivos do sistema nervoso central, cujo potencial incapacitante e deficiente depende em grande parte de quão cedo o diagnóstico é feito e como o tratamento e a reabilitação são estabelecidos. Objetivo. Elaborar um plano para a implementação da Unidade Dose para contribuir para a redução da perda auditiva em pacientes neonatais. Materiais e Métodos. Foi realizado um estudo documental baseado nos registros das histórias clínicas dos pacientes, realizando um estudo descritivo e retrospectivo. Métodos empíricos como pesquisa, entrevista e observação científica foram utilizados para demonstrar e obter um diagnóstico confiável, apoiado por fontes e estudos sobre hipoacusia como suporte teórico. Resultados. Dada a evidência da existência de hipoacusia neonatal, como um possível efeito adverso do uso farmacológico do amikacin, os resultados da pesquisa mostram a necessidade imperativa de um plano de implementação na Unidade Dose para o serviço de neonatologia do Hospital. Conclusões. Os pacientes neonatais receberão um cuidado seguro, eficaz e humanizado com base na implementação de uma dose unitária.

Infección tardía por Streptococcus agalactiae asociada a la leche humana: reporte de 3 casos clínicos / Streptococcus agalactiae late onset infection associated with human milk: three cases report

La infección por estreptococo ß-hemolítico del grupo B o Streptococcus agalactiae puede causar morbilidad grave y mortalidad en los recién nacidos, especialmente en prematuros. Las estrategias de prevención actuales han sido eficaces en reducir la frecuencia de sepsis neonatal temprana ocasionada por transmisión vertical. La incidencia de sepsis tardía por dicho microrganismo no se ha modificado y la vía de infección es menos clara. En niños amamantados, la transmisión a través de la leche materna es posible. Se presentan tres casos de infección tardía por estreptococo ß-hemolítico del grupo B en recién nacidos prematuros alimentados con leche materna cuyas madres tenían mastitis. En todos los casos, tanto en el cultivo de la leche materna como en los hemocultivos de los neonatos se desarrolló el mismo microrganismo.

Group B ß-hemolytic Streptococcus or Streptococcus agalactiae is a major cause of morbidity and mortality in neonates, especially in premature infants. Current prevention strategies have been effective in reducing the frequency of early onset neonatal sepsis caused by vertical transmission. The incidence of late onset sepsis due to this microorganism has not changed and the route of infection is less clear. In breastfed infants, transmission through breast milk is possible. We report three cases of late group B ß-hemolytic streptococcal infection in breastfed preterm infants whose mothers had mastitis. In all cases, both the breast milk culture and the blood cultures of the neonates developed the same microorganism.

Características clínico-epidemiológicas de sepsis neonatal temprana en un hospital público, Lima, Perú

Objetivo: Determinar características clínico-epidemiológicas de neonatos con sepsis neonatal temprana en hospital público, Lima-Perú, 2016-2017. Materiales y métodos: Estudio observacional, retrospectivo. Se consideró todos los neonatos nacidos vivos en el Hospital Nacional Dos de Mayo diagnosticados con sepsis neonatal temprana el 2016-2017, excepto historias clínicas incompletas, totalizando 303. Se estudiaron variables maternas (edad, educación, estado civil, control prenatal, RPM, tipo de parto, infección urinaria, corioamnionitis, anemia) y neonatales (sexo, edad gestacional, peso, Apgar 1/5 minutos, clínica, hemocultivo, agente aislado, tratamiento y sensibilidad antibiótica). El programa Excel se usó para el procesamiento de datos; SPSSv25 para el análisis descriptivo. Se calculó incidencia de sepsis neonatal temprana. Resultados: Incidencia de sepsis neonatal temprana en 67,08/1000 nacidos vivos en el 2016 y 12,785 en el 2017, la cual fue confirmada en 2,98 (2016) y 4,7 (2017). 45 % de madres sin control prenatal adecuado o sin controles; la cuarta parte presentó anemia, infección urinaria, antecedente de aborto. Clínica de neonatos: taquipnea (52,80 %), taquicardia (17,50 %), hipotonía (18,20 %), fiebre (9,20 %); tratamiento ampicilina-amikacina en sepsis probable (86,54 %) y sepsis confirmada (85 %). Se aisló gérmenes en 8,40 % de casos, mayoría Gram positivos; Staphylococcus coagulasa-negativa, el más frecuente, resistente a clindamicina, oxacilina, ampicilina, cefotaxima, gentamicina y sensible a linezolid, vancomicina. Burkholderia gladioli, única bacteria Gram negativa encontrada, sensible a levofloxacino, ciprofloxacino, ceftriaxona, pero resistente a gentamicina y amikacina. Conclusiones: Clínica de sepsis neonatal temprana caracterizada por taquipnea, taquicardia, hipotonía y fiebre. Bacterias Gram positivas las más aisladas; predominó Staphylococcus coagulasa-negativa.

Objective: To determine the clinical-epidemiological characteristics of newborns with early-onset neonatal sepsis in a public hospital in Lima, Peru, 2016-2017. Materials and methods: An observational, retrospective study of 303 newborns born in Hospital Nacional Dos de Mayo, diagnosed with early-onset neonatal sepsis (2016-2017) and with complete medical records. Maternal variables: age, education, marital status, prenatal care, PROM, type of delivery, UTI, chorioamnionitis, anemia; neonatal variables: sex, gestational age, weight, Apgar, clinical signs, hemoculture, isolated organism, treatment, antibiotic sensitivity. Data processed in Excel and analyzed in SPSS Statistics V25. The incidence of early-onset neonatal sepsis was determined. Results: Incidence of early-onset neonatal sepsis: 67.08/1,000 (2016) and 127.85/1,000 (2017) live births. Incidence of confirmed early-onset neonatal sepsis: 2.98 (2016) and 4.7 (2017). Out of all mothers, 45 % received no adequate prenatal checkup or no checkups; 25 % presented anemia, UTI, history of abortion. Newborns had tachypnea (52.80 %), tachycardia (17.50 %), hypotonia (18.20 %), fever (9.20 %). The therapy included ampicillin-amikacin for probable (86.54 %) and confirmed (85 %) sepsis. Germs, mostly gram positive, were isolated from 8.4 % of the newborns. Coagulase-negative Staphylococcus was the most common bacteria, resistant to clindamycin, oxacillin, ampicillin, cefotaxime, gentamicin, and sensitive to linezolid, vancomycin. Burkholderia gladioli was the only identified gramnegative organism, sensitive to levofloxacin, ciprofloxacin, ceftriaxone but resistant to gentamicin, amikacin. Conclusions: The clinical presentation of neonatal sepsis included tachypnea, tachycardia, hypotonia and fever. Grampositive bacteria were the most commonly isolated species, prevailing coagulase-negative Staphylococci.

Adherencia a las recomendaciones de prevención de la sepsis neonatal temprana asociada a la colonización por Streptococcus agalactiae en una institución de referencia en Bogotá, Colombia, 2019 / Adherence to recommendations for preventing early neonatal sepsis associated with Streptococcus agalactiae colonization in a referral center in Bogotá, Colombia, 2019

RESUMEN Objetivos: Evaluar la adherencia a las recomendaciones de tamización para la prevención de la sepsis neonatal, describir la prevalencia de colonización por estreptococo del grupo B y los desenlaces perinatales asociados a la colonización por esta bacteria. Materiales y métodos: Estudio de cohorte retrospectiva que incluyó gestantes a término y sus recién nacidos, en una clínica universitaria privada de alta complejidad en Bogotá, entre el 1 de julio y el 31 de diciembre de 2019. Se evaluó la adherencia a la tamización y a la profilaxis antibiótica intraparto para las gestantes colonizadas con EGB, la prevalencia de colonización y los desenlaces perinatales adversos tempranos. Resultados: Se incluyeron 1.928 mujeres. La adherencia a la tamización fue de 68,0 % (IC 95 %: 66-70,1), a la administración de antibióticos intraparto de 87,9 % (IC 95 %: 87,8 -88), pero hubo uso no indicado de antibióticos en 14,7 % de mujeres para una adherencia final a profilaxis antibiótica de 86,3 %. La prevalencia de colonización por EGB fue 12,5 % (IC 95 %: 10,7-14,3), la incidencia de hospitalización neonatal fue de 27,5 % (IC 95 %: 16,3-33,7); no hubo casos de mortalidad ni sepsis neonatal temprana atribuibles al estado de tamización, colonización o profilaxis antibiótica para EGB. Conclusiones: Se requieren nuevos estudios en otras instituciones para determinar la adherencia a esta guía, en especial en aquellas regiones que atienden usuarias adscritas al régimen subsidiado, con cobertura a la población más vulnerable, así como nuevos estudios poblacionales de prevalencia de EGB y costo-efectividad de la estrategia de tamización universal en comparación con la profilaxis antibiótica basada en factores de riesgo.

ABSTRACT Objectives: To assess adherence to screening recommendations for the prevention of neonatal sepsis, and describe the prevalence of colonization by Group B streptococcus (GBS) as well as the perinatal outcomes associated with colonization by this bacterium. Material and methods: Retrospective cohort study that included pregnant women at term and their newborns, seen at a private high-complexity clinic in Bogota, between July 1 and December 31, 2019. Adherence to screening and intrapartum antibiotic prophylaxis in pregnant women colonized with group B streptococcus, as well as the prevalence of colonization and early adverse perinatal outcomes were assessed. Results: Overall, 1928 women were included. Adherence to screening was 68.0 % (95 % CI: 66-70.1) and 87.9 % to intrapartum antibiotic administration (95 % CI: 87.8-88); non-indicated use of antibiotics occurred in 14.7 % of the women, for 86.3 % final adherence to antibiotic prophylaxis. The prevalence of GBS colonization was 12.5 % (95 % CI: 10.7-14.3); the incidence of neonatal hospitalization was 27.5 % (95 % CI: 16.3-33.7). There were no cases of mortality or early neonatal sepsis attributable to screening status, colonization or prophylactic antibiotics for GBS. Conclusions: Additional studies in other centers are required in order to determine adherence to this guideline, particularly in those that receive users affiliated to the subsidized regime which covers the most vulnerable population. Also, new population studies of GBS prevalence and cost-effectiveness of universal screening compared to risk factor-based antibiotic prophylaxis are needed.

Efectividad de la autotoma del exudado vaginorrectal para el cribado prenatal de la infección por Streptococcus agalactiae. Estudio GALL / Effectiveness of the vagino-rectal exudate self-sampling for prenatal screening of Streptococcus agalactiae infection. GALL study

Objetivo: Evaluar la efectividad de la autotoma del exudado vaginorrectal para el cribado prenatal de la infección por EGB e identificar barreras y facilitadores que encuentra la gestante para esta intervención. Diseño: Estudio transversal de pruebas diagnósticas. Participantes y emplazamiento: Participaron 213 gestantes que acudieron a la consulta de la matrona de atención primaria en 6 centros de salud del Servicio Vasco de Salud/Osakidetza en Bizkaia, que cumplían los criterios de inclusión y aceptaban participar en el estudio. Mediciones principales: Se comparó el resultado del cultivo vaginorrectal obtenido por la gestante con el resultado del cultivo vaginorrectal tomado por la matrona en consulta el mismo día, y se recogieron barreras y facilitadores encontrados por las mujeres en la autotoma. Resultados: Se ha observado que la autotoma como prueba para detectar el EGB tiene una sensibilidad del 93,3% (IC 95%, 78,7-98,2), una especificidad del 99,4% (IC 95%, 96,5-99,9), un valor predictivo positivo del 96% (IC 95% 82,8-99,4) y un valor predictivo negativo del 98,8% (IC 95%, 95,6-99,7). El 27,3% de los encuestadas encontraron alguna dificultad en la recogida, solo el 4,8% no se vieron capacitadas, el 84,2% se sintieron cómodas, el 99,5% consideraron la información proporcionada adecuada y completa, al 94,7% no le resultaron complicados los pasos a seguir, y el 96% están satisfechas con el estudio. Conclusiones: La autotoma del exudado vaginorrectal para la detección del EGB ha resultado ser válida y fiable, lo que permitiría ofrecer esta opción a las gestantes en el cribado sistemático de la infección por EGB.(AU)

Objetive: To evaluate the effectiveness of vagino-rectal swab autotomy for prenatal screening for GBS infection and to identify the barriers and facilitators encountered by the pregnant woman for this intervention. Design: Cross-sectional study of diagnostic tests. Participants and site: A total of 213 pregnant women who attended the primary care midwife's office in 6 health centers of the Basque Health Service/Osakidetza in Bizkaia, who met the inclusion criteria and agreed to participate in the study, participated in the study. Main measurements: The result of the vagino-rectal culture obtained by the pregnant woman was compared with the result of the vagino-rectal culture taken by the midwife in consultation on the same day, and the barriers and facilitators encountered by the women in the self-test were collected. Results: Self-testing as a test for GBS was found to have a sensitivity of 93.3% (95% CI 78.7–98.2), a specificity of 99.4% (95% CI 96.5–99.9), a positive predictive value of 96% (95% CI 82.8–99.4) and a negative predictive value of 98.8% (95% CI 95.6–99.7). 27.3% of respondents encountered some difficulty in the collection, only 4.8% did not feel qualified, 84.2% felt comfortable, 99.5% considered the information provided to be adequate and complete, 94.7% did not find the steps to follow complicated, and 96% were satisfied with the study. Conclusions: Self-collection of vagino-rectal exudate for GBS detection has proved to be valid and reliable, which would make it possible to offer this option to pregnant women in the systematic screening for GBS infection.(AU)

Sepsis neonatal precoz: recomendaciones para su abordaje en la práctica clínica / Early neonatal sepsis: recommendations for approach in clinical practice / Sepse neonatal precoce: recomendações para sua abordagem na prática clínica

La sepsis neonatal precoz se define como la que se manifiesta en las primeras 72 horas de vida. Es una importante causa de morbilidad y mortalidad neonatal. Su incidencia es inversamente proporcional a la edad gestacional. Los microorganismos considerados como frecuentes son Streptoccocus del grupo B, Escherichia coli y Listeria monocytogenes. El diagnóstico de sepsis precoz se basa principalmente en la presencia de factores de riesgo como la corioamnionitis y la edad gestacional. Los signos clínicos son inespecíficos y los exámenes paraclínicos disponibles actualmente, como los reactantes de fase aguda (proteína C reactiva y procalcitonia) tienen escaso valor predictivo positivo. Se realizó una revisión bibliográfica de las últimas publicaciones disponibles sobre sepsis neonatal precoz en recién nacidos, en cuanto a su sospecha, confirmación diagnóstica y tratamiento. A partir de las últimas publicaciones se confeccionó una guía para el manejo clínico de los recién nacidos con sospecha de sepsis precoz.

Early neonatal sepsis is defined as that type of sepsis with an onset within the first 72 hours of life and that is a major cause of neonatal morbidity and mortality. Its incidence is inversely proportional to its gestational age. Frequent microorganisms are group B Streptococcus, Escherichia coli and Listeria monocytogenes. Early sepsis diagnosis is mainly based on the presence of risk factors such as chorioamnionitis and gestational age. Clinical signs are non-specific and currently available paraclinical tests such as acute phase reactants (C-reactive protein and procalcitonin) have little positive predictive value. A bibliographic review of the suspicion, diagnostic confirmation and treatment on Early Neonatal Sepsis in newborns in the latest papers and guidelines were prepared for the clinical treatment of newborns with suspected early sepsis.

A sepse neonatal precoce é definida como aquela que se manifesta nas primeiras 72 horas de vida e que é uma das principais causas de morbidade e mortalidade neonatal. Sua incidência é inversamente proporcional à idade gestacional. Os microrganismos considerados frequentes são o Streptococcus grupo B, Escherichia coli e Listeria monocytogenes. O diagnóstico de sepse precoce baseia-se principalmente na presença de fatores de risco como a coioamnionite e a idade gestacional. Os sinais clínicos são inespecíficos e os testes para-clínicos atualmente disponíveis, como reagentes de fase aguda (proteína C-reativa e procalcitonia) têm pouco valor preditivo positivo. Fizemos uma revisão bibliográfica das últimas publicações disponíveis sobre sepse neonatal precoce em recém-nascidos em termos de suspeita e confirmação diagnóstica e tratamento. Com base nas últimas publicações, elaboramos um guia para o manejo clínico de recém-nascidos com suspeita de sepse precoce.

Sepsis precoz, osteoartritis y meningitis: a propósito de un caso clínico / Early sepsis, osteoarthritis and meningitis: a clinical case / Sepse precoce, osteoartrite e meningite: relato de caso

Se expone el caso de un recién nacido que desarrolló sepsis connatal precoz a Streptococcus agalactiae, con meningitis aguda supurada y osteoartritis de rodilla izquierda. Como factor de riesgo la madre no tenía realizado el exudado rectovaginal, pesquisa que detecta la colonización por estreptococo del grupo B (EGB). Se aisló el germen en hemocultivo y en líquido de punción articular. Recibió tratamiento antibiótico adecuado a la sensibilidad del microorganismo y según pauta de sepsis con meningitis, evolucionando favorablemente. En este trabajo se describe la epidemiología de la sepsis neonatal y los cambios ocurridos luego de la implementación de la profilaxis antibiótica en el preparto.

We hereby present the case of a newborn with early connatal sepsis due to Streptococcus agalactiae, with acute suppurative meningitis and left knee osteoarthritis. As a risk factor, the mother had not performed the rectus vaginal exudate screening that detects colonization by Group B Streptococcus (GBS). The germ was isolated in blood culture and in joint puncture fluid. The patient received germ-sensitive antibiotic treatment for meningitis sepsis and evolved favorably. This paper describes the epidemiology of neonatal sepsis and the changes that have occurred after the administration of the antibiotic prophylaxis during pregnancy.

Apresentamos o caso de um recém-nascido com sepse neonatal precoce por Streptococcus agalactiae, com meningite supurativa aguda e osteoartrite de joelho esquerdo. Como fator de risco, a mãe não realizou teste de exsudato vaginal do reto que detecta a colonização por estreptococos do grupo B (SGB). O germe foi isolado em hemocultura e líquido de punção articular. A paciente recebeu tratamento com antibióticos germinativos para padrão meningite sepse e evoluiu favoravelmente. Este artigo descreve a epidemiologia da sepse neonatal e as mudanças ocorridas após a administração da profilaxia antibiótica durante a gravidez.

[Effectiveness of the vagino-rectal exudate self-sampling for prenatal screening of Streptococcus agalactiae infection. GALL study]. / Efectividad de la autotoma del exudado vaginorrectal para el cribado prenatal de la infección por Streptococcus agalactiae. Estudio GALL.

OBJETIVE: To evaluate the effectiveness of vagino-rectal swab autotomy for prenatal screening for GBS infection and to identify the barriers and facilitators encountered by the pregnant woman for this intervention. DESIGN: Cross-sectional study of diagnostic tests. PARTICIPANTS AND SITE: A total of 213 pregnant women who attended the primary care midwife's office in 6 health centers of the Basque Health Service/Osakidetza in Bizkaia, who met the inclusion criteria and agreed to participate in the study, participated in the study. MAIN MEASUREMENTS: The result of the vagino-rectal culture obtained by the pregnant woman was compared with the result of the vagino-rectal culture taken by the midwife in consultation on the same day, and the barriers and facilitators encountered by the women in the self-test were collected. RESULTS: Self-testing as a test for GBS was found to have a sensitivity of 93.3% (95% CI 78.7-98.2), a specificity of 99.4% (95% CI 96.5-99.9), a positive predictive value of 96% (95% CI 82.8-99.4) and a negative predictive value of 98.8% (95% CI 95.6-99.7). 27.3% of respondents encountered some difficulty in the collection, only 4.8% did not feel qualified, 84.2% felt comfortable, 99.5% considered the information provided to be adequate and complete, 94.7% did not find the steps to follow complicated, and 96% were satisfied with the study. CONCLUSIONS: Self-collection of vagino-rectal exudate for GBS detection has proved to be valid and reliable, which would make it possible to offer this option to pregnant women in the systematic screening for GBS infection.

Fatores perinatais associados à sepse neonatal precoce em uma maternidade-escola do sul do Brasil / Perinatal factors associated with early neonatal sepsis in the maternity ward of a teaching hospital in southern brazil

Introdução: Sepse neonatal é uma condição potencialmente fatal, que constitui um problema de saúde pública de impacto global e é responsável por taxas expressivas de morbidade e mortalidade. O objetivo deste artigo é estimar os fatores associados à sepse neonatal precoce em uma maternidade-escola do sul do Brasil. Métodos: Realizou-se estudo de caso-controle para observar eventual associação entre fatores relacionados à sepse neonatal precoce e características clínicas e sociodemográficas maternas e fatores perinatais dos recém-nascidos, utilizando-se dados de prontuários de pacientes no período entre 2014 e 2017. A amostra foi composta por 293 binômios mãe/recém-nascido, sendo 1 caso para 2 controles. Todas as variáveis com valores de p< 0,05 na análise bivariada foram incluídas em uma análise multivariada por meio de Regressão Logística. Resultados: Idade gestacional menor que 37 semanas (OR 19,6 IC 95% 5,3; 73,0) (p<00,1) e presença de fator de risco para Streptococcus agalactiae beta hemolítico (SGB) (OR 5,1 IC 95% 1,2; 21,8) (p=0,027) foram as exposições independentemente associadas à sepse neonatal precoce. Conclusão: Identificou-se maior chance de desenvolver sepse neonatal precoce quando prematuridade e fatores de risco maternos para SGB estão presentes. Assim, medidas mais eficazes de prevenção e controle desses fatores são de extrema importância.

Introduction: Neonatal sepsis is a potentially fatal condition that constitutes a public health problem worldwide, being responsible for significant rates of morbidity and mortality. The objective of this study was to identify factors associated with early neonatal sepsis in the maternity ward of a teaching hospital in Southern Brazil. Methods: We conducted a case-control study to identify if factors related to early neonatal sepsis are associated with maternal clinical and sociodemographic characteristics and perinatal factors of infants, using data from patient records between 2014 and 2017. The sample consisted of 293 mother/newborn binomials, 1 case for 2 controls. All variables with p-values < 0.05 in the bivariate analysis were included in a multivariate analysis using logistic regression. Results: A gestational age < 37 weeks (odds ratio [OR] 19.6; 95%CI 5.3; 73.0) (p < 00.1) and the presence of a risk factor for beta-hemolytic Streptococcus agalactiae (GBS) (OR 5.1; 95%CI 1.2; 21.8) (p = 0.027) were independently associated with early neonatal sepsis. Conclusions: Prematurity and the presence of maternal risk factors for GBS increase the likelihood of developing early neonatal sepsis. Thus, more effective measures to prevent and control these factors are extremely important.

Introduction of the neonatal sepsis calculator at a low-dependency special care nursery in Australia.

BACKGROUND: The neonatal early onset sepsis calculator (Sepsis Calculator) is a screening tool for managing neonates at risk of early onset sepsis (EOS). In large tertiary centers it has been found to reduce empiric antibiotic use in newborns with suspected EOS by up to half, without missing EOS confirmed by blood culture. AIMS: To evaluate the effect of implementation of the Sepsis Calculator at a low-dependency special care nursery in Australia on rates of antibiotic treatment for suspected EOS in newborns, and, to determine the compliance rate in applying the Sepsis Calculator. METHODS: We undertook a retrospective medical record audit at The Women's at Sandringham Hospital during two two-month periods; pre- and post-introduction of the Sepsis Calculator. The management of infants suspected of EOS and length of stay post-delivery were compared. Compliance with Sepsis Calculator use was measured. RESULTS: 526 infants were included: 266 in period 1 and 260 in period 2. There was no significant change in the proportion of infants who received empirical antibiotics for suspected EOS following introduction of the Sepsis Calculator (6 of 266 during period 1; 2.2% vs. 8 of 260 during period 2; 3.1%; p = .558). The median length of stay (LOS) of infants born to GBS positive mothers who received inadequate antibiotic prophylaxis, decreased from 39.5 h (IQR 28.4 to 47.4) to 25.5 h (IQR 22.2 to 34.2), p = .004 after Sepsis Calculator implementation. The compliance rate for Sepsis Calculator use was 82.3% (214 of 260). CONCLUSIONS: While we did not see a reduction in empirical antibiotic use, this is likely due to the already low baseline antibiotic treatment rate at our institution. Further exploration of how the calculator benefits infants and improves care in non-tertiary special care nurseries, including evaluating LOS, is needed.

Mortalidad por sepsis neonatal entre los años 2016 y 2020 en Chile: una mirada nacional / Mortality due to neonatal sepsis between 2016 and 2020 in Chile: a national perspective

Introducción: La sepsis neonatal (SN) es una infección sistémica que ocurre antes de los 90 días de vida y que representa una amenaza potencialmente mortal. Esta investigación busca describir la tendencia de defunción por SN en Chile, durante el periodo 2016-2020. Materiales y métodos: Estudio descriptivo observacional, que incluyó a niños fallecidos por SN (n=249) en el periodo 2016-2020 en Chile según datos del departamento de estadísticas e información de salud de Chile. Las variables estudiadas fueron: año de fallecimiento, grupo etario, sexo, región y agente etiológico. No se requirió comité de ética. Resultados: El 2020 tuvo la menor tasa de mortalidad por SN (0,17) y el 2017 la mayor (0,31). El grupo etario de 0-2 días de nacido tuvo la mayor tasa de mortalidad (0,07), mientras que el grupo de 27-28 días corresponde a la menor (0,00). La región de Antofagasta tuvo la mayor mortalidad (0,44) y la región de Magallanes la menor (0,11). La tasa de mortalidad promedio en hombres corresponde a 0,12 y en mujeres a 0,10. En el 89,16% de los casos no se identificó el agente etiológico. Discusión: La mayor mortalidad en 2017 podría deberse a una proporción más alta de nacimientos pretérmino en dicho año. La mayor cantidad de defunciones a menor edad cronológica estaría relacionada con su inmadurez inmunológica. La no detección del agente etiológico pudo deberse al bajo rendimiento de los hemocultivos. Sin embargo, faltan más investigaciones acerca de la incidencia y mortalidad por sepsis neonatal.

Introduction: Neonatal sepsis (NS) is a systemic infection that occurs before 90 days of life and represents a life-threatening threat. This research seeks to describe the trend of death by NS in Chile, during the period 2016-2020. Materials and methods: Observational descriptive study, which included children who died due to NS (n=249) in the period 2016-2020 in Chile, according to data from the Department of Statistics and Health Information of Chile. The variables studied were: year of death, age group, sex, region and etiological agent. No ethics committee was required. Results: 2020 had the lowest mortality rate due to NS (0.17) and 2017 the highest (0.31). The age group of 0-2 days of birth had the highest mortality rate (0.07), while the group of 27-28 days corresponds to the lowest (0.00). The Antofagasta region had the highest mortality (0.44) and the Magallanes region the lowest (0.11). The average mortality rate in men corresponds to 0.12 and in women to 0.10. In 89.16% of the cases, the etiological agent was not identified. Discussion: The higher mortality in 2017 could be due to a higher proportion of preterm births in that year. The greater number of deaths at a lower chronological age would be related to their immunological immaturity. The non-detection of the etiological agent could be due to the low yield of the blood cultures. However, more research on the incidence and mortality from neonatal sepsis is lacking.

Infección grave por estreptococo del grupo B en la Unidad de Cuidados Intensivos Pediátricos del Centro Hospitalario Pereira Rossell entre los años 2007 y 2017 / Serious infection due to group B Streptococcus at the Pediatric Intensive Care Unit of the Pereira Rossell Children's Hospital between 2007 and 2017 / Infecção grave causada por Estreptococo do grupo B na Unidade de Terapia Intensiva do Centro Hospitalar Pediátrico Pereira Rossell entre os anos 2007 e 2017

Introducción: el estreptococo del grupo B (EGB) es una causa frecuente de sepsis neonatal. La enfermedad precoz disminuyó su incidencia por la profilaxis antibiótica, a diferencia de la sepsis tardía, que aumentó su incidencia en los últimos años. Objetivo: conocer la incidencia de la sepsis tardía en el período 2016-2017 en el Centro Hospitalario Pereira Rossell (CHPR). El secundario, describir las características epidemiológicas y clínicas de sepsis tardía por EGB en niños ingresados a la Unidad de Cuidados Intensivos de Niños (UCIN) del CHPR en el período 2007-2017. Resultados: la incidencia calculada de sepsis tardía por EGB fue de 0,53 casos/1000 recién nacidos (RN) vivos. Entre los años 2007 y 2017 ingresaron cinco niños por sepsis tardía por EGB a la UCIN del CHPR. La presentación clínica más frecuentes fue fiebre sin foco y meningitis. Se obtuvieron tres aislamientos en sangre de EBG y tres en líquido cefalorraquídeo (dos en cultivo y otro por detección de ADN). Ninguno falleció. Los casos con meningitis presentaron alteraciones en la tomografía de cráneo. Un niño fue pretérmino. Conclusiones: la sepsis tardía se vincula a importante morbimortalidad en pediatría. No se ha establecido cuáles son los principales factores de riesgo asociados a una enfermedad grave ni las políticas para disminuir su incidencia.

Background: group B streptococcus (GBS) is a common cause of neonatal sepsis. Early disease decreased its incidence due to antibiotic prophylaxis. Late sepsis increased its incidence in recent years. Objectives: to know the incidence of late onset EGB sepsis in the period 2016-2017 at the Pereira Rossell Hospital Center (CHPR), and secondly, to describe the epidemiological characteristics and the clinical presentation of late onset sepsis due to GBS in children admitted to the Children's Intensive Care Unit (UCIN) of the CHPR in the period 2007-2017. Results: the calculated incidence of late sepsis due to GBS was 0.53 cases/1000 live newborns. Between 2007-2017, 5 children were admitted due to GBS late sepsis at the UCIN. The most frequent clinical presentation was fever without focus and meningitis. 3 isolates were obtained in EBG blood cultures and 3 in cerebrospinal fluid (2 in culture and another by DNA detection). None of them died. Cases with meningitis showed abnormalities in the brain tomography. 1 of the 5 was preterm. Conclusions: late sepsis is associated with significant morbidity and mortality in pediatric patients. The main risk factors associated with serious disease and the policies needed to reduce its incidence have not been established.

Introdução: o estreptococo do grupo B (SGB) é uma causa frequente de sepse neonatal. A doença precoce diminuiu sua incidência devido à profilaxia antibiótica, ao contrário da sepse tardia, que aumentou sua incidência nos últimos anos. Objetivo: conhecer a incidência de sepse tardia no período 2016-2017 no Centro Hospitalar Pereira Rossell (CHPR) e descrever as características epidemiológicas e clínicas da sepse tardia por SGB em crianças internadas na Unidade de Terapia Intensiva Infantil (UTIN) do CHPR no período de 2007-2017. Resultados: a incidência calculada de sepse tardia por SGB foi de 0,53 casos/1000 recém-nascidos vivos (RNs). Entre 2007-2017, 5 crianças foram internadas na UTIN do CHPR por sepse tardia devido a GBS. A apresentação clínica mais frequente foi febre sem causa e meningite. 3 isolados de EBG foram obtidos no sangue e 3 no líquido cefalorraquidiano (2 em cultura e outro por detecção de DNA). Nenhum dos pacientes morreu. Os casos com meningite apresentaram alterações na tomografia de crânio. Uma criança era pré-termo. Conclusões: a sepse tardia está associada a significativa morbimortalidade em pediatria. Os principais fatores de risco associados a uma doença grave e as políticas para reduzir sua incidência ainda não foram estabelecidas.

Infecciones intrahospitalarias por estafilococo coagulasa negativo en una unidad de neonatología / Coagulase negative streptococci nosocomial infections at a neonatal intensive care unit / Infecções intra-hospitalares por estafilococo coagulasa negativa numa unidade de neonatologia

Introducción: la sepsis tardía por estafilococo coagulasa negativo (SCoN) es una causa común de morbimortalidad en la unidad neonatal. Los SCoN son los microorganismos más frecuentemente involucrados con aproximadamente el 50% de los casos. El objetivo de este estudio es analizar la incidencia y las características de los neonatos portadores de sepsis tardía por SCoN. Materiales y métodos: se realizó un estudio descriptivo, longitudinal, retrospectivo. Se utilizaron las bases de datos del laboratorio de microbiología del hospital y las historias clínicas electrónicas para obtener la información. El período de estudio analizado fueron los años 2018 y 2019 en la unidad de cuidados intensivos e intermedios de recién nacidos del Centro Hospitalario Pereira Rossell. Resultados: obtuvimos una incidencia de 2,5% de los ingresos a cuidados intensivos e intermedios (25 pacientes). La edad gestacional al nacer fue de 28 semanas (25,0-35,0) y la mediana del peso fue de 1.070 g (730,0-2.365,0). La media de edad gestacional posmenstrual al momento del diagnóstico fue de 32,92±7,921 semanas. Por sospecha de sepsis precoz, 17 pacientes habían recibido un curso de antibióticos previo. El signo clínico más frecuentemente observado fue el deterioro del estado general, en 11 pacientes, seguido de distensión abdominal en 6 y fiebre en 5. Dentro de los SCoN, el más frecuentemente aislado fue el Staphylococcus epidermidis (13 pacientes); 22 pacientes recibieron tratamiento, 18 de ellos con vancomicina-meropenem y 4 con monoterapia con vancomicina. Conclusión: estos patógenos representan una causa importante de morbimortalidad en la unidad neonatal, particularmente en pacientes que presentan mayor gravedad y mayor necesidad de soporte vital. Se necesitan pautas claras de interpretación del rol de estos microorganismos y de abordaje de pacientes con riesgo de sepsis tardía, incluyendo el tratamiento antibiótico empírico.

Introduction: Coagulase Negative Staphylococci (CoNS) late onset sepsis is a common cause of morbidity and mortality in the neonatal intensive care unit (NICU). CoNS are the most frequently isolated microorganisms and total 50% of cases. The objective of this study is to analyze the incidence and characteristics of newborns carriers of late onset CoNS. Materials and methods: we performed a descriptive, retrospective, longitudinal study. Data was obtained from the hospital's microbiology laboratory database and electronic medical records. Patients included were those admitted to NICU during the period between 2018 and 2019. Results: we obtained an incidence of 2.5% of patients admitted to the NICU (25 patients). Median gestational age at birth was 28 weeks 25.0-35.0 and median birth weight was 1.070 g 730.0-2365.0. Mean gestational age at the time of diagnosis was 32.92±7.921 weeks. 17 patients had received an antibiotics course at birth because of early onset sepsis suspicion. The most frequently observed clinical symptom was deterioration of general condition, 11 patients, followed by abdominal distention in 6 and fever in 5. Among CoNS, the most frequently isolated pathogen was Staphylococcus epidermidis (13 patients). 22 patients received treatment, 18 a combination of vancomycin and meropenem and 4 received vancomycin monotherapy. Conclusion: these pathogens are a common cause of morbidity and mortality in the newborn intensive care unit, particularly in patients with more serious conditions and in those who require more advanced life support measures. Clearer interpretation of their role is needed as well as to determine a proper approach to patients at risk of late onset sepsis, including empiric antibiotic treatment.

Sepse tardia para Staphylococcus coagulase negativa (SCoN) é uma causa comum de morbidade e mortalidade na unidade neonatal. SCoNs são os microrganismos mais frequentemente envolvidos e representam aproximadamente 50% dos casos. O objetivo deste estudo é analisar a incidência e as características de neonatos com sepse tardia por SCoN. Materiais e métodos: foi realizado um estudo descritivo, longitudinal e retrospectivo. Usamos os bancos de dados do laboratório de microbiologia e prontuários médicos eletrônicos de nosso hospital para obter as informações. O período de estudo analisado foi de 2018 e 2019 na unidade de terapia intensiva e intermediária para recém-nascidos do Centro Hospitalar Pereira Rossell. Resultados: obtivemos uma incidência de 2,5% de internações em Terapia Intensiva e Intermediária (25 pacientes). A idade gestacional ao nascer foi de 28 semanas 25,0-35,0 e o peso médio foi de 1070g 730,0-2365,0. A média da idade gestacional pós-menstrual no momento do diagnóstico foi de 32,92 ± 7,921 semanas. 17 pacientes haviam recebido um curso anterior de antibióticos por suspeita de sepse precoce. O sinal clínico mais frequentemente observado foi deterioração do estado geral em 11 pacientes, seguido por distensão abdominal em 6 e febre em 5. Dentre os SCoN, o mais isolado foi o Staphylococcus Epidermidis (13 pacientes). 22 pacientes receberam tratamento, 18 deles com Vancomicina-Meropenem e 4 com Vancomicina em monoterapia. Conclusão: esses patógenos representam uma importante causa de morbimortalidade na unidade neonatal, principalmente em pacientes com maior gravidade e maior necessidade de suporte de vida. Orientações claras são necessárias para interpretar o papel desses microrganismos e para abordar pacientes com risco de sepse tardia, incluindo tratamento com antibióticos.