Enfermedad invasiva por Streptococcus pyogenes: cambios en la incidencia y factores pronósticos / Invasive disease due to Streptococcus pyogenes: Changes in incidence and prognostic factors

Introducción: La enfermedad invasiva por Streptococcus del grupo A (EISGA) es una infección grave en niños, habiéndose comunicado un aumento de incidencia en los últimos años. Objetivo: Evaluar las características y evolución de la EISGA en niños y determinar cambios en la incidencia o gravedad. Material y métodos: Estudio retrospectivo de niños ≤ 16 años evaluados en un hospital terciario pediátrico de Madrid y diagnosticados de EISGA (junio 2005-julio 2013). Se analizó la epidemiología, clínica, microbiología y tratamiento, evaluándose cambios a lo largo del periodo estudiado y parámetros asociados a gravedad. Resultados: Se incluyeron 55 niños con EISGA; 33 (60%) mujeres, con una mediana de 48,5 (20,5-88,9) meses. Los síndromes clínicos más frecuentes fueron celulitis/absceso subcutáneo (21,8%), absceso ORL (20%), neumonía (16,4%), infección osteoarticular (16,4%) y mastoiditis (12,7%). La incidencia de EISGA (casos/105 urgencias/año) aumentó de 5,6 (4,2-7,2) entre junio 2005-mayo 2009 a 18,9 (15,1-26) entre junio 2009-mayo 2013; p = 0,057. El 63,6% (n = 35) y el 18,2% (n = 10) de los pacientes precisaron cirugía e ingreso en UCIP, respectivamente. Los niños en UCIP fueron más pequeños (26,5 vs. 52,6 meses; p = 0,116), presentaron proteína C reactiva más elevada (24,5 vs. 10,7 mg/dl; p < 0,001) y mayor frecuencia de neumonía (60 vs. 7%; p < 0,001). En el análisis multivariante solo la proteína C reactiva fue factor de riesgo de ingreso en UCIP (OR: 1,14 [1,004-1,286]; p = 0,04). No hubo secuelas. Conclusiones: Se objetivó un aumento de la incidencia de EISGA en niños en nuestro medio, siendo la menor edad, la presencia de neumonía y la proteína C reactiva elevada los parámetros asociados a gravedad en esta serie

Introduction: Invasive group A streptococcal disease (iGASD) is a serious infection in children. Several studies have shown an increased incidence in the past years. Objective: To evaluate the characteristics and outcome of iGASD in children, and to determine changes in incidence or severity. Material and methods: A retrospective study was conducted on children ≤ 16 years evaluated in a tertiary paediatric hospital in Madrid, and diagnosed with iGASD (June 2005-July 2013). An analysis was made of the demographics, symptomatology, microbiology, and treatment. The changes throughout the period studied were evaluated, as well as parameters associated with disease severity. Results: The study included a total of 55 children with iGASD, with 33 (60%) females, and a median age of 48.5 (20.5-88.9) months. The most frequent clinical syndromes were cellulitis/subcutaneous abscess (21.8%), ENT abscess (20%), pneumonia (16.4%), osteoarticular infection (16.4%), and mastoiditis (12.7%). The incidence of iGASD (cases/105 emergencies/year) increased from 5.6 (4.2-7.2) between June 2005-May 2009 to 18.9 (15.1-26) between June 2009-May 2013; P = .057. Surgery and admission to PICU was required by 35 (63.6%) and 10 (18.2%) patients, respectively. Children in PICU were younger (26.5 vs 52.6 months, P = .116), had a higher C-reactive protein (24.5 vs 10.7 mg/dl, P < .001) and higher frequency of pneumonia (60 vs 7%, P < .001). In the multivariate analysis, only C-reactive protein was a risk factor for admission to PICU (OR: 1.14 [1.004-1.286], P = .04). There were no sequelae. Conclusions: An increased incidence of iGASD was observed in the children in this study. Lower age, pneumonia, and higher C-reactive protein were associated with disease severity in this series

[Invasive disease due to Streptococcus pyogenes: Changes in incidence and prognostic factors]. / Enfermedad invasiva por Streptococcus pyogenes: cambios en la incidencia y factores pronósticos.

INTRODUCTION: Invasive group A streptococcal disease (iGASD) is a serious infection in children. Several studies have shown an increased incidence in the past years. OBJECTIVE: To evaluate the characteristics and outcome of iGASD in children, and to determine changes in incidence or severity. MATERIAL AND METHODS: A retrospective study was conducted on children≤16 years evaluated in a tertiary paediatric hospital in Madrid, and diagnosed with iGASD (June 2005-July 2013). An analysis was made of the demographics, symptomatology, microbiology, and treatment. The changes throughout the period studied were evaluated, as well as parameters associated with disease severity. RESULTS: The study included a total of 55 children with iGASD, with 33 (60%) females, and a median age of 48.5 (20.5-88.9) months. The most frequent clinical syndromes were cellulitis/subcutaneous abscess (21.8%), ENT abscess (20%), pneumonia (16.4%), osteoarticular infection (16.4%), and mastoiditis (12.7%). The incidence of iGASD (cases/105 emergencies/year) increased from 5.6 (4.2-7.2) between June 2005-May 2009 to 18.9 (15.1-26) between June 2009-May 2013; P=.057. Surgery and admission to PICU was required by 35 (63.6%) and 10 (18.2%) patients, respectively. Children in PICU were younger (26.5 vs 52.6 months, P=.116), had a higher C-reactive protein (24.5 vs 10.7mg/dl, P<.001) and higher frequency of pneumonia (60 vs 7%, P<.001). In the multivariate analysis, only C-reactive protein was a risk factor for admission to PICU (OR: 1.14 [1.004-1.286], P=.04). There were no sequelae. CONCLUSIONS: An increased incidence of iGASD was observed in the children in this study. Lower age, pneumonia, and higher C-reactive protein were associated with disease severity in this series.

Cómo ven la especialidad las nuevas generaciones de microbiólogos / How the new generations of microbiologists view the specialty

A pesar del importante papel de la microbiología clínica en nuestro sistema de salud, esta disciplina no está exenta de retos ni de dificultades. Para adaptarse a los nuevos tiempos es necesario: a) realizar cambios importantes en la tecnología y evolucionar hacia técnicas moleculares para ofrecer soluciones diagnósticas o terapéuticas rápidas; b) poner a punto métodos de diagnóstico de infecciones emergentes o importadas; c) asesorar en la interpretación de los resultados microbiológicos; d) favorecer la implantación de técnicas de diagnóstico de tipo point-of-care y asesorar sobre su utilización y desarrollo; e) instaurar sistemas de calidad en el laboratorio; f) apoyarse en la informática y en otras tecnologías para enviar información al clínico en tiempo real y para establecer una comunicación más eficiente con los médicos de atención primaria, con los laboratorios de salud pública y con las autoridades sanitarias; g) diseñar sistemas de trabajo en red con profesionales de otras disciplinas, y h) promover programas de formación continuada. Solamente si los laboratorios de microbiología clínica están bien preparados, serán capaces de adoptar las novedades tecnológicas, nuestra disciplina alcanzará una mayor importancia dentro del sistema sanitario y obtendrá un mayor protagonismo social y reconocimiento por parte de las autoridades sanitarias

Despite their pivotal role in the Spanish healthcare system, clinical microbiology laboratories are experiencing difficult times and tough challenges. The following changes are required to adapt to the new situation: a) the use of molecular diagnostics to provide rapid diagnosis; b) the development of diagnostic capabilities to identify emerging or imported infectious diseases; c) the ability to advise on the interpretation of microbiological results; d) encouragement of the implantation of point-of-care testing and assessment of its performance and development; e) the implantation of quality control systems in the laboratory; f) the implementation of laboratory information systems to support real-time communication between hospital and community clinicians, public health laboratories and managers; g) the design of networking systems with professionals from other disciplines, and h) the promotion of training and teaching programs. Only if they are well prepared will clinical microbiology laboratories be able to implant the new technologies, be recognized as a cornerstone of the healthcare system, and achieve better recognition by society at large, hospital administrators and healthcare authorities