[Meningoencefalitis: etiología infecciosa en pacientes pediátricos de un hospital de referencia]. / Meningoencephalitis: infectious etiology in pediatric patients at a reference hospital.

Introducción: Las causas de meningoencefalitis, meningitis o encefalitis pueden ser infecciosas o no infecciosas. Para el diagnóstico microbiológico se requieren cultivos y pruebas moleculares. El objetivo del estudio fue describir las causas infecciosas de meningoencefalitis y su presentación clínica. Métodos: Estudio transversal realizado en el Hospital Civil de Guadalajara Dr. Juan I. Menchaca. Se incluyeron pacientes mayores de 28 días de vida con síndrome de meningitis, encefalitis o meningoencefalitis. Se identificó la etiología infecciosa mediante cultivos, tinciones de Gram y pruebas moleculares de líquido cefalorraquídeo. Se compararon las características de pacientes con y sin diagnóstico etiológico. Resultados: Se incluyeron en el estudio 50 pacientes con meningoencefalitis (n = 25), meningitis (n = 19) o encefalitis (n = 6). La mediana de edad fue de un año y el 62% de los pacientes fueron de sexo masculino. Se realizó diagnóstico etiológico infeccioso en el 42%: el 65.2% (n = 15) se debió a virus y el 34.8% (n = 8) a bacterias. En los pacientes con diagnóstico etiológico, se presentó un mayor número de leucocitos en líquido cefalorraquídeo (92 leu/mm3 vs. 12 leu/mm3, p = 0.001). Fue más frecuente el antecedente de gastroenteritis (razón de momios [RM]: 3.5; intervalo de confianza al 95% [IC 95%]: 1.007-12.1; p = 0.04) y ante la exploración, fue más frecuente la rigidez de cuello (RM: 3.8; IC 95%: 1-15.2; p = 0.04). Conclusiones: El 42% de los pacientes con meningitis, encefalitis o meningoencefalitis tuvieron diagnóstico etiológico infeccioso. La causa más frecuente fue el enterovirus. Background: The etiologies of meningoencephalitis, meningitis or encephalitis may be infectious or non-infectious. For the microbiological diagnosis it is necessary to perform cultures and molecular tests. The objective of this study was to describe the infectious causes of meningoencephalitis and their clinical presentation. Methods: Cross-sectional study performed at the Hospital Civil de Guadalajara Dr. Juan I. Menchaca. Patients older than 28 days of life with meningitis, encephalitis or meningoencephalitis syndrome were included in the study. Infectious etiology was identified through cultures, Gram stains, and molecular tests of cerebrospinal fluid. The characteristics of patients with and without etiological diagnosis were compared. Results: Fifty patients with meningoencephalitis (n = 25), meningitis (n = 19) or encephalitis (n = 6) were included in the study. The mean age was one year and 62% were male. An infectious etiological diagnosis was performed in 42%; 65.2 % (n = 15) were viruses and 34.8% (n = 8) bacteria. In patients with etiological diagnosis, a higher number of leukocytes were found in cerebrospinal fluid (92 leu/mm3 vs. 12 leu/mm3, p = 0.001); the history of gastroenteritis was more frequent (odds ratio [OR]: 3.5; 95% confidence interval (CI): 1.007-12.1; p = 0.04) and upon examination, neck stiffness was more common (OR: 3.8; 95% CI: 1-15.2; p = 0.04). Conclusions: 42 % of the patients with meningitis, encephalitis or meningoencephalitis had an infectious etiological diagnosis; the most frequent cause was enterovirus.

Meningoencefalitis: etiología infecciosa en pacientes pediátricos de un hospital de referencia / Meningoencephalitis: infectious etiology in pediatric patients at a reference hospital

Resumen Introducción: Las causas de meningoencefalitis, meningitis o encefalitis pueden ser infecciosas o no infecciosas. Para el diagnóstico microbiológico se requieren cultivos y pruebas moleculares. El objetivo del estudio fue describir las causas infecciosas de meningoencefalitis y su presentación clínica. Métodos: Estudio transversal realizado en el Hospital Civil de Guadalajara Dr. Juan I. Menchaca. Se incluyeron pacientes mayores de 28 días de vida con síndrome de meningitis, encefalitis o meningoencefalitis. Se identificó la etiología infecciosa mediante cultivos, tinciones de Gram y pruebas moleculares de líquido cefalorraquídeo. Se compararon las características de pacientes con y sin diagnóstico etiológico. Resultados: Se incluyeron en el estudio 50 pacientes con meningoencefalitis (n = 25), meningitis (n = 19) o encefalitis (n = 6). La mediana de edad fue de un año y el 62% de los pacientes fueron de sexo masculino. Se realizó diagnóstico etiológico infeccioso en el 42%: el 65.2% (n = 15) se debió a virus y el 34.8% (n = 8) a bacterias. En los pacientes con diagnóstico etiológico, se presentó un mayor número de leucocitos en líquido cefalorraquídeo (92 leu/mm3 vs. 12 leu/mm3, p = 0.001). Fue más frecuente el antecedente de gastroenteritis (razón de momios [RM]: 3.5; intervalo de confianza al 95% [IC 95%]: 1.007-12.1; p = 0.04) y ante la exploración, fue más frecuente la rigidez de cuello (RM: 3.8; IC 95%: 1-15.2; p = 0.04). Conclusiones: El 42% de los pacientes con meningitis, encefalitis o meningoencefalitis tuvieron diagnóstico etiológico infeccioso. La causa más frecuente fue el enterovirus.

Abstract Background: The etiologies of meningoencephalitis, meningitis or encephalitis may be infectious or non-infectious. For the microbiological diagnosis it is necessary to perform cultures and molecular tests. The objective of this study was to describe the infectious causes of meningoencephalitis and their clinical presentation. Methods: Cross-sectional study performed at the Hospital Civil de Guadalajara Dr. Juan I. Menchaca. Patients older than 28 days of life with meningitis, encephalitis or meningoencephalitis syndrome were included in the study. Infectious etiology was identified through cultures, Gram stains, and molecular tests of cerebrospinal fluid. The characteristics of patients with and without etiological diagnosis were compared. Results: Fifty patients with meningoencephalitis (n = 25), meningitis (n = 19) or encephalitis (n = 6) were included in the study. The mean age was one year and 62% were male. An infectious etiological diagnosis was performed in 42%; 65.2 % (n = 15) were viruses and 34.8% (n = 8) bacteria. In patients with etiological diagnosis, a higher number of leukocytes were found in cerebrospinal fluid (92 leu/mm3 vs. 12 leu/mm3, p = 0.001); the history of gastroenteritis was more frequent (odds ratio [OR]: 3.5; 95% confidence interval (CI): 1.007-12.1; p = 0.04) and upon examination, neck stiffness was more common (OR: 3.8; 95% CI: 1-15.2; p = 0.04). Conclusions: 42 % of the patients with meningitis, encephalitis or meningoencephalitis had an infectious etiological diagnosis; the most frequent cause was enterovirus.

Risk factors for severe bronchiolitis caused by respiratory virus infections among Mexican children in an emergency department.

Severe bronchiolitis is the most common reason for hospitalization among children younger than 2 years. This study analyzed the prevalence of community-acquired respiratory virus infection and the risk factors for hospitalization of Mexican children with severe bronchiolitis treated in an Emergency department.This retrospective study included 134 children 2 years or younger with severe viral bronchiolitis, and 134 healthy age-matched controls. The study period was September 2012 to January 2015. We determined the viral etiology and coinfections with multiple viruses and compared the risk factors detected in children with severe viral bronchiolitis with those in the control group.A total of 153 respiratory viruses in these 134 patients, single or mixed infections, were identified: respiratory syncytial virus (RSV) type A or B was the most frequently detected (23.6% and 17.6%, respectively), followed by rhinovirus (RV; 16.3%) and parainfluenza virus (PIV) type 3 (12.4%). Coinfections of 2 respiratory viruses were found in 14.2% of cases; all cases had either RSV type A or B with another virus, the most common being parainfluenza virus or rhinovirus. Exposure to cigarette smoking was independently associated with hospitalization for severe bronchiolitis (OR, 3.5; 95% CI, 1.99-6.18; P = .0001), and having completed the vaccination schedule for their age was a protective factor against adverse outcome (OR, 0.55; 95% CI, 0.35-0.87; P = .010).RSV is a common infection among young children with severe bronchiolitis; thus, developing a vaccine against RSV is essential. Campaigns to reinforce the importance of avoiding childhood exposure to cigarette smoke are also needed.

Bacteriemia relacionada con catéter venoso central: incidencia y factores de riesgo en un hospital del occidente de México / Central venous-catheter related bacteremia: incidence and risk factors in a hospital in western México

Resumen: Introducción: El catéter venoso central (CVC) es necesario para la monitorización y tratamiento de pacientes en estado crítico; sin embargo, su uso incrementa el riesgo de bacteriemia. El objetivo del estudio fue cuantificar la incidencia de bacteriemia relacionada con catéter venoso central (BRCVC) e identificar los factores asociados con esta infección. Métodos: Se realizó un estudio de cohorte prospectivo en un hospital de concentración del occidente de México. Para conocer la asociación entre BRCVC y las variables en estudio, se realizó un análisis multivariado con regresión de Cox. Resultados: Se estudiaron 204 pacientes con CVC. La edad promedio fue de 4.6 años; el 66.2% fue del sexo masculino. Los sitios de inserción del catéter fueron la vena subclavia (72.5%, n = 148), la vena yugular (20.1%, n = 41) o la vena femoral (7.4%, n = 15). La incidencia de BRCVC fue de 6.5 eventos por 1,000 días catéter. Los microorganismos identificados fueron cocos Gram positivos (37.5%, n = 6), bacilos Gram negativos (37.5%, n = 6) y Candida albicans (25%, n = 4). Se observó que la mayor manipulación del catéter por día se asoció con bacteriemia (HR 1.14, IC95% 1.06-1.23), mientras que el uso de antibióticos intravenosos mostró un efecto protector (HR 0.84, IC95% 0.76-0.92). Conclusiones: Además de las medidas máximas de precaución al momento de colocar o manipular el catéter, es conveniente disminuir lo más posible las desconexiones entre el equipo de venoclisis y el CVC. Los antibióticos mostraron un efecto protector; sin embargo, se debe considerar el riesgo de favorecer resistencias antimicrobianas.

Abstract: Background: Central venous catheters (CVC) are needed for monitoring and treatment of critically ill patients; however, their use increases the risk of bacteremia. The aim of the study was to quantify the incidence of central venous catheter-related bacteremia (CVCRB) and to identify factors associated with this infection. Methods: A prospective cohort study was conducted in a concentration hospital of western Mexico. The association of CVCRB and study variables was investigated using multivariate Cox regression analysis. Results: Two hundred four patients with CVC were studied. The average age was 4.6 years; 66.2% were male. Insertion sites of the catheters were subclavian vein 72.5% (n = 148), jugular vein 20.1% (n = 41) and femoral vein 7.4% (n = 15). CVCRB incidence was 6.5 events/1,000 catheter days; microorganisms identified were gram-positive cocci 37.5% (n = 6), gram-negative bacilli 37.5% (n = 6) and Candida albicans 25% (n = 4). It was observed that the increase in catheter manipulations per day was associated with bacteremia (HR 1.14, 95% CI 1.06 - 1.23), whereas the use of intravenous antibiotics showed a protective effect (HR 0.84, 95% CI 0.76-0.92). Conclusions: In addition to strategies of maximum caution when placing or manipulating the catheter, we recommend decreasing, as much as possible, disconnects between the CVC and infusion line. Antibiotics showed a protective effect, but the outcome is uncertain and promotion of antimicrobial resistance should be considered.

[Central venous-catheter related bacteremia: incidence and risk factors in a hospital in western México]. / Bacteriemia relacionada con catéter venoso central: incidencia y factores de riesgo en un hospital del occidente de México.

BACKGROUND: Central venous catheters (CVC) are needed for monitoring and treatment of critically ill patients; however, their use increases the risk of bacteremia. The aim of the study was to quantify the incidence of central venous catheter-related bacteremia (CVCRB) and to identify factors associated with this infection. METHODS: A prospective cohort study was conducted in a concentration hospital of western Mexico. The association of CVCRB and study variables was investigated using multivariate Cox regression analysis. RESULTS: Two hundred four patients with CVC were studied. The average age was 4.6 years; 66.2% were male. Insertion sites of the catheters were subclavian vein 72.5% (n = 148), jugular vein 20.1% (n = 41) and femoral vein 7.4% (n = 15). CVCRB incidence was 6.5 events/1,000 catheter days; microorganisms identified were gram-positive cocci 37.5% (n = 6), gram-negative bacilli 37.5% (n = 6) and Candida albicans 25% (n = 4). It was observed that the increase in catheter manipulations per day was associated with bacteremia (HR 1.14, 95% CI 1.06 - 1.23), whereas the use of intravenous antibiotics showed a protective effect (HR 0.84, 95% CI 0.76-0.92). CONCLUSIONS: In addition to strategies of maximum caution when placing or manipulating the catheter, we recommend decreasing, as much as possible, disconnects between the CVC and infusion line. Antibiotics showed a protective effect, but the outcome is uncertain and promotion of antimicrobial resistance should be considered.

Etiología y patrones de resistencia antimicrobiana en sepsis neonatal temprana y tardía, en una Unidad de Terapia Intensiva Neonatal / Etiology and antimicrobial resistance patterns in early and late neonatal sepsis in a Neonatal Intensive Care Unit

Introducción. La sepsis neonatal es una de las principales causas de muerte en recién nacidos. El tratamiento antimicrobiano empírico se sustenta en información epidemiológica y pruebas de susceptibilidad antimicrobiana. El objetivo del estudio fue describir los agentes etiológicos y su sensibilidad antimicrobiana enreciénnacidos con sepsis temprana (SNTe) o tardía (SNTa) de una Unidad de Terapia Intensiva Neonatal. Métodos. Estudio transversal realizado en un hospital de concentración del occidente de México. Se determinó la resistencia antimicrobiana de los gérmenes aislados en sangre o líquido cefalorraquídeo de pacientes con SNTe o SNTa nosocomial. Resultados. Se aislaron bacterias o levaduras en 235 cultivos de 67 eventos de SNTe y 166 eventos de SNTa. Del total de aislamientos, las bacterias más frecuentes fueron enterobacterias (51,5%), seguidas de Streptococcus spp. en SNTe y Staphylococcus spp. en SNTa. En cuanto a las enterobacterias de adquisición nosocomial, el 40% fueron productoras de betalactamasas de espectro extendido. En especies de Staphylococcus, la resistencia a oxacilina se registró en el 65,5%. En las enterobacterias (n: 121), la frecuencia de resistencia a amikacina, piperacilina-tazobactam y meropenem fue menor del 3%. En bacterias no fermentadoras, no se observó resistencia a amikacina, ciprofloxacino y cefepime; sin embargo, el número de aislamientos fue escaso. Conclusiones. Las bacterias identificadas con mayor frecuencia en SNTe fueron enterobacterias (67,6%) y Streptococcus spp. (17,6%), mientras que, en SNTa, fueron enterobacterias (44,9%) y Staphylococcus spp. (34,7%). El 40% de las enterobacterias de adquisición nosocomial fueron productoras de betalactamasas de espectro extendido y el 65,5% de Staphylococcus spp. mostraron resistencia a oxacilina.(AU)

Introduction. Neonatal sepsis is one of the main causes of death among newborn infants. Empirical antimicrobial treatment is based on epidemiological information and antimicrobial susceptibility tests. The objective of this study was to describe etiologic agents and their antimicrobial susceptibility among newborn infants with early-onset neonatal sepsis (EONS) or late-onset neonatal sepsis (LONS) at a Neonatal Intensive Care Unit. Methods. Cross-sectional study conducted at a tertiary referral hospital in Western Mexico. Determination of antimicrobial resistance of microorganisms isolated in blood or cerebrospinal fluid of patients with EONS or nosocomial LONS. Results. Yeasts and bacteria were isolated from 235 cultures corresponding to 67 events of EONS and 166 events of LONS. Of all isolates, the most common bacteria were Enterobacteriaceae (51.5%), followed by Streptococcus spp. in EONS, and by Staphylococcus spp. in LONS. Of all nosocomial Enterobacteriaceae, 40% were extended spectrum beta-lactamase producing bacteria. Among Staphylococcus species, resistance to oxacillin was recorded in 65.5%. Among Enterobacteriaceae (n: 121), resistance to amikacin, piperacillin-tazobactam, and meropenem was below 3%. Non-fermenting bacteria did not show resistance to amikacin, ciprofloxacin or cefepime; however, the number of isolates was scarce. Conclusions.The most commonly identified bacteria in EONS were Enterobacteriaceae (67.6%) and Streptococcus spp. (17.6%), and Enterobacteriaceae (44.9%) and Staphylococcus spp. (34.7%) in LONS. Forty percent ofnosocomial Enterobacteriaceae were extended spectrum beta-lactamase producing bacteria, and 65.5% of Staphylococcus spp. showed resistance to oxacillin.(AU)

Etiología y patrones de resistencia antimicrobiana en sepsis neonatal temprana y tardía, en una Unidad de Terapia Intensiva Neonatal / Etiology and antimicrobial resistance patterns in early and late neonatal sepsis in a Neonatal Intensive Care Unit

Introducción. La sepsis neonatal es una de las principales causas de muerte en recién nacidos. El tratamiento antimicrobiano empírico se sustenta en información epidemiológica y pruebas de susceptibilidad antimicrobiana. El objetivo del estudio fue describir los agentes etiológicos y su sensibilidad antimicrobiana enreciénnacidos con sepsis temprana (SNTe) o tardía (SNTa) de una Unidad de Terapia Intensiva Neonatal. Métodos. Estudio transversal realizado en un hospital de concentración del occidente de México. Se determinó la resistencia antimicrobiana de los gérmenes aislados en sangre o líquido cefalorraquídeo de pacientes con SNTe o SNTa nosocomial. Resultados. Se aislaron bacterias o levaduras en 235 cultivos de 67 eventos de SNTe y 166 eventos de SNTa. Del total de aislamientos, las bacterias más frecuentes fueron enterobacterias (51,5%), seguidas de Streptococcus spp. en SNTe y Staphylococcus spp. en SNTa. En cuanto a las enterobacterias de adquisición nosocomial, el 40% fueron productoras de betalactamasas de espectro extendido. En especies de Staphylococcus, la resistencia a oxacilina se registró en el 65,5%. En las enterobacterias (n: 121), la frecuencia de resistencia a amikacina, piperacilina-tazobactam y meropenem fue menor del 3%. En bacterias no fermentadoras, no se observó resistencia a amikacina, ciprofloxacino y cefepime; sin embargo, el número de aislamientos fue escaso. Conclusiones. Las bacterias identificadas con mayor frecuencia en SNTe fueron enterobacterias (67,6%) y Streptococcus spp. (17,6%), mientras que, en SNTa, fueron enterobacterias (44,9%) y Staphylococcus spp. (34,7%). El 40% de las enterobacterias de adquisición nosocomial fueron productoras de betalactamasas de espectro extendido y el 65,5% de Staphylococcus spp. mostraron resistencia a oxacilina.

Introduction. Neonatal sepsis is one of the main causes of death among newborn infants. Empirical antimicrobial treatment is based on epidemiological information and antimicrobial susceptibility tests. The objective of this study was to describe etiologic agents and their antimicrobial susceptibility among newborn infants with early-onset neonatal sepsis (EONS) or late-onset neonatal sepsis (LONS) at a Neonatal Intensive Care Unit. Methods. Cross-sectional study conducted at a tertiary referral hospital in Western Mexico. Determination of antimicrobial resistance of microorganisms isolated in blood or cerebrospinal fluid of patients with EONS or nosocomial LONS. Results. Yeasts and bacteria were isolated from 235 cultures corresponding to 67 events of EONS and 166 events of LONS. Of all isolates, the most common bacteria were Enterobacteriaceae (51.5%), followed by Streptococcus spp. in EONS, and by Staphylococcus spp. in LONS. Of all nosocomial Enterobacteriaceae, 40% were extended spectrum beta-lactamase producing bacteria. Among Staphylococcus species, resistance to oxacillin was recorded in 65.5%. Among Enterobacteriaceae (n: 121), resistance to amikacin, piperacillin-tazobactam, and meropenem was below 3%. Non-fermenting bacteria did not show resistance to amikacin, ciprofloxacin or cefepime; however, the number of isolates was scarce. Conclusions.The most commonly identified bacteria in EONS were Enterobacteriaceae (67.6%) and Streptococcus spp. (17.6%), and Enterobacteriaceae (44.9%) and Staphylococcus spp. (34.7%) in LONS. Forty percent ofnosocomial Enterobacteriaceae were extended spectrum beta-lactamase producing bacteria, and 65.5% of Staphylococcus spp. showed resistance to oxacillin.

Etiology and antimicrobial resistance patterns in early and late neonatal sepsis in a Neonatal Intensive Care Unit.

INTRODUCTION: Neonatal sepsis is one of the main causes of death among newborn infants. Empirical antimicrobial treatment is based on epidemiological information and antimicrobial susceptibility tests. The objective of this study was to describe etiologic agents and their antimicrobial susceptibility among newborn infants with early-onset neonatal sepsis (EONS) or late-onset neonatal sepsis (LONS) at a Neonatal Intensive Care Unit. METHODS: Cross-sectional study conducted at a tertiary referral hospital in Western Mexico. Determination of antimicrobial resistance of microorganisms isolated in blood or cerebrospinal fluid of patients with EONS or nosocomial LONS. RESULTS: Yeasts and bacteria were isolated from 235 cultures corresponding to 67 events of EONS and 166 events of LONS. Of all isolates, the most common bacteria were Enterobacteriaceae (51.5%), followed by Streptococcus spp. in EONS, and by Staphylococcus spp. in LONS. Of all nosocomial Enterobacteriaceae, 40% were extended spectrum beta-lactamase producing bacteria. Among Staphylococcus species, resistance to oxacillin was recorded in 65.5%. Among Enterobacteriaceae (n: 121), resistance to amikacin, piperacillin-tazobactam, and meropenem was below 3%. Non-fermenting bacteria did not show resistance to amikacin, ciprofloxacin or cefepime; however, the number of isolates was scarce. CONCLUSIONS: The most commonly identified bacteria in EONS were Enterobacteriaceae (67.6%) and Streptococcus spp. (17.6%), and Enterobacteriaceae (44.9%) and Staphylococcus spp. (34.7%) in LONS. Forty percent ofnosocomial Enterobacteriaceae were extended spectrum beta-lactamase producing bacteria, and 65.5% of Staphylococcus spp. showed resistance to oxacillin.