[Microbiological and epidemiological analysis, and clinical outcome of patients with bloodstream infection from an Esquel hospital in the period 2007-200]. / Análisis microbiológico, epidemiológico y evolución clinica de los pacientes con bacteriemia en el Hospital Zonal de Esquel en el período 2007-2009.

In order to evaluate the bacteremic episodes, the blood cultures performed in 867 patients during a 29-month period were reviewed. The incidence of significant bloodstream infections was 10/1000 admissions/year. About 47% of bacteremias were community-acquired (CAB), 22% nosocomial (NB), and 31% health care-associated (HCAB). The five most common pathogens were: Streptococcus pneumoniae, Staphylococcus aureus, Escherichia coli, Enterococcus spp. and coagulase-negative staphylococci, whereas the main sources were: respiratory, intraabdominal and unknown. The major organism in CAB was S. pneumoniae, and S. aureus in NB and HCAB. The ineffective empirical-antimicrobial-therapy [IEAT (total 26.5%)] was much higher in NB and HCAB vs. CAB (p < 0.05). There was no significant difference in mortality and IEAT between known vs. unknown sources. Old age (> 70 yrs), previous antibiotic therapy, hospitalization in clinical medical services, Enterococcus spp. and methicillin-resistant Staphylococcus isolates were more associated with IEAT (p < 0.05). Previous antibiotic therapy and longer hospital stays were more common in NB vs. CAB and HCAB (p < 0.05). Overall and septicemia-associated mortality was 28.9% and 21.7%, respectively. Univariate associations with increased mortality (p < 0.05) included: hypothermia, WBC < 1499/mm3, hypotension, presentation with septic-shock, hospital-stay 10 days, and polymicrobial bacteremia. The early administration of effective empirical antimicrobial therapy according to our epidemiological characteristics and an aggressive hemodynamic treatment in presence of septic shock could reduce bacteremia-associated morbidity and mortality, costs and length of hospital stays.

Análisis microbiológico, epidemiológico y evolución clínica de los pacientes con bacteriemia en el Hospital Zonal de Esquel en el período 2007-2009 / Microbiological and epidemiological analysis, and clinical outcome of patients with bloodstream infection from an Esquel hospital in the period 2007-2009

Con el objetivo de analizar los episodios de bacteriemia, se revisaron los informes de los hemocultivos y las historias clínicas de 867 pacientes atendidos en el Hospital Zonal de Esquel en un período de 29 meses. La incidencia de bacteriemias significativas fue de 10/1000 admisiones/año. El 47% fueron bacteriemias adquiridas en la comunidad (BAC), el 22% fueron bacteriemias nosocomiales (BNO) y el 31% fueron bacteriemias asociadas al cuidado de salud (BACS). Los 5 grupos de microorganismos predominantes fueron Streptococcus pneumoniae, Staphylococcus aureus, Escherichia coli, Enterococcus spp. y estafilococos coagulasa negativos. Los focos infecciosos más comunes fueron el respiratorio, el abdominal y desconocido. S. pneumoniae prevaleció en las BAC y S. aureus en las BNO y en las BACS. La terapia antibiótica empírica inicial inefectiva (ATBI) alcanzó el 26,5% de los casos, y fue mayor en las BNO y las BACS que en las BAC (p < 0,05). No hubo mayor mortalidad ni ATBI en bacteriemias con foco desconocido comparadas con aquellas de foco conocido. La edad (≥ 70 años), la terapia antimicrobiana previa, la internación en clínica médica y el aislamiento de Enterococcus spp. y de estafilococos resistentes a la meticilina se asociaron con ATBI (p < 0,05). La antibioticoterapia previa y la mayor estadía hospitalaria predominaron en las BNO comparadas con las BAC y las BACS (p < 0,05). La mortalidad global y la atribuida a bacteriemias fueron 28,9% y 21,7%, respectivamente. Por análisis univariado se asociaron con una mayor mortalidad (p < 0,05) la hipotermia, el RGB < 1499/mm³, la hipotensión arterial, la presentación con shock séptico, la estadía hospitalaria ≤ 10 días y la infección polimicrobiana. La administración precoz del esquema terapéutico empírico adecuado y el tratamiento hemodinámico agresivo de los pacientes con shock al inicio de la bacteriemia podrían reducir la morbimortalidad, la duración de la hospitalización, y por ende, los costos asociados a las bacteriemias.

In order to evaluate the bacteremic episodes, the blood cultures performed in 867 patients during a 29-month period were reviewed. The incidence of significant bloodstream infections was 10/1000 admissions/year. About 47% of bacteremias were community-acquired (CAB), 22% nosocomial (NB), and 31% health care-associated (HCAB). The five most common pathogens were: Streptococcus pneumoniae, Staphylococcus aureus, Escherichia coli, Enterococcus spp. and coagulase-negative staphylococci, whereas the main sources were: respiratory, intraabdominal and unknown. The major organism in CAB was S. pneumoniae, and S. aureus in NB and HCAB. The ineffective empirical-antimicrobial-therapy [IEAT (total 26.5%)] was much higher in NB and HCAB vs. CAB (p < 0.05). There was no significant difference in mortality and IEAT between known vs. unknown sources. Old age (≥ 70 yrs), previous antibiotic therapy, hospitalization in clinical medical services, Enterococcus spp. and methicillin-resistant Staphylococcus isolates were more associated with IEAT (p < 0.05). Previous antibiotic therapy and longer hospital stays were more common in NB vs. CAB and HCAB (p < 0.05). Overall and septicemia-associated mortality was 28.9% and 21.7%, respectively. Univariate associations with increased mortality (p < 0.05) included: hypothermia, WBC < 1499/mm³, hypotension, presentation with septic-shock, hospital-stay ≤ 10 days, and polymicrobial bacteremia. The early administration of effective empirical antimicrobial therapy according to our epidemiological characteristics and an aggressive hemodynamic treatment in presence of septic shock could reduce bacteremia-associated morbidity and mortality, costs and length of hospital stays.

Pharyngeal gonorrhea in young children.

Among 16,100 visits to a pediatric clinic, 103 children (0.6%) fulfilled criteria for child abuse and 16 of the 103 patients (15.5%) suffered sexual abuse. Throat cultures from 13 children were positive for Neisseria gonorrhoeae in 7 patients (54%). Ages of infected children ranged from 2.5 to 9 years with a mean age of 4.9 years. N. gonorrhoeae was also isolated from cervical (four) and rectal (one) cultures in four of seven patients tested. No child had symptoms related to the oropharynx. All children were treated with a single dose of 100,000 units aqueous procaine penicillin G per kg intramuscularly and 25 mg probenecid per kg orally. Three of the seven children required retreatment for persistently positive pharyngeal cultures. All cases could be traced to sexual abuse by a male contact. Routine culturing of the oropharynx for N. gonorrhoeae in abused children and their siblings may uncover some unsuspected sexual abuse cases.