Evaluación del riesgo de infecciones alimentarias en pacientes internados en un hospital pediátrico de alta complejidad y su sistema de prevención / Risk assesment of food infections in patient in a pediatric tertiary-care hospital and its prevention

The Garrahan Hospital is a tertiary-care center for pediatrics patients with complex diseases. Infections, including food-borne infections, contribute considerably to the morbidity and mortality in this population at risk. In order to prevent food-borne infections, the Foodservice Area has developed a preventive process approach system of Hazard Analysis and Critical Control Point (process approach HACCP) in food production and service. Objective: To conduct a thorough review and assessment of risk from food borne pathogens according to the pathology of patients or the therapeutic practice used, and to standardize food production and service. With the criterion "degree of safety at the time of service" preventive measures were standardized. The food was classified into four levels of process. One or more food levels are indicated according to risk, and if necessary individual adjustments are made.

El hospital Garrahan brinda asistencia a pacientes pediátricos con patologías complejas. Las infecciones, incluidas las alimentarias, contribuyen considerablemente en la morbilidad y mortalidad en esta población en riesgo. Con la finalidad de prevenir infecciones alimentarias, el Área de Alimentación desarrolla un Sistema Preventivo de Análisis de Peligros y Puntos Críticos de Control con enfoque en procesos (HACCP process approach) en la producción y servicio de alimentos. Objetivo: realizar una exhaustiva revisión y evaluación de los patógenos alimentarios de riesgo según patología o práctica terapéutica de los pacientes y estandarizar la producción y servicio de alimentos. Con el criterio "grado de inocuidad al momento del servicio" se estandarizaron las medidas preventivas. La alimentación fue clasificada en cuatro niveles de proceso. A cada grupo de población asistida, según riesgo, se le indica uno o más niveles de alimentación y se realizan los ajustes individuales necesarios.

[In vitro activity of linezolid against clinical isolates of methicillin-resistant Staphylococcus aureus]. / Actividad in vitro de la linezolida en aislamientos clínicos de Staphylococcus aureus resistentes a la meticilina.

In recent years, there has been a dramatic increase in the number of infections caused by multidrug-resistant Gram-positive microorganisms, making necessary the search for alternative antibacterial agents. Linezolid is a new synthetic antimicrobial agent with activity against multidrug-resistant Gram-positive cocci. The objective of this study was to determine the in vitro activity of linezolid against 74 clinical isolates of methicillin-resistant Staphylococcus aureus. Minimal inhibitory concentrations were determined by an agar dilution method following NCCLS criteria. Vancomycin, teicoplanin, rifampicin, trimethoprim-sulfamethoxazole and linezolid were studied at concentrations ranging from 128 to 0.008 mg/l. All of the isolates were susceptible to vancomycin, teicoplanin, and linezolid while four strains (5.4%) were resistant to rifampicin and five (6.7%) to trimethoprim-sulfamethoxazole. Linezolid showed excellent in vitro activity against 74 clinical isolates of methicillin-resistant Staphylococcus aureus with an MIC ranging from 0.25 to 2 mg/l

Standard case management of pneumonia in hospitalized children in Uruguay, 1997 to 1998.

OBJECTIVE: To report the results of the use of antimicrobial guidelines for the management of children with community-acquired bacterial pneumonia. METHODS: Admittance and discharge criteria and algorithms for diagnosis and treatment were established. The decision to treat with antibiotics was based on radiologic findings in pneumonia with pulmonary consolidation and left to the attending physician's criteria in the remaining cases. The use of antibiotics was limited to penicillin and derivatives (ampicillin, amoxicillin) and macrolides. RESULTS: Of the 1163 children treated as bacterial pneumonia, hospitalized in public and private health facilities in Montevideo from September, 1997, through September, 1998, standard case management was applied in 1082 (93%). Age distribution was: <1 month, 1%; between 1 and 11 months, 29%; between 1 and 5 years, 50%; >5 years, 20%. Chest radiography showed evidence of pulmonary consolidation in 843 children (73%). Bacteria were detected in blood culture and/or pleural fluid of 57 children (5%). In 51 the identified microorganism was Streptococcus pneumoniae, susceptible to penicillin in 30, intermediate in 6 and resistant in 5 (maximum MIC, 4 microg/ml); in 10 cases etiologic diagnosis was made by antigen detection. Empyema was present in 62 children (5.3%); 38 (3.27%) required treatment in an intensive care unit; and 5 (0.4%) died. CONCLUSIONS: Compliance with standard case management was highly satisfactory. Outcome of children treated with penicillin and derivatives was good, including children with empyema and pneumatocele and two patients with penicillin-resistant S. pneumoniae. At the present time S. pneumoniae resistant to penicillin is not an important problem in children with pneumonia in Uruguay. Surveillance of identified microorganisms and their antimicrobial susceptibility must continue.