Late-onset Group B Streptococcus Bacteremia Evaluated in the Pediatric Emergency Department and Risk Factors for Severe Infection.

BACKGROUND: To describe the infants presenting to pediatric emergency departments (PEDs) and diagnosed with group B Streptococcus (GBS) late-onset disease (LOD) bacteremia and identify risk factors for severe infection and pediatric intensive care unit (PICU) admission. METHODS: Observational study and subanalysis of a multicenter prospective registry. Setting: pediatric emergency department. Inclusion criteria: infants between 7 and 89 days of age with positive blood culture for GBS seen between 2011 and 2016 at any of 22 Spanish PEDs. Main outcome: risk factors (clinical and laboratory variables) for severe infection (sepsis/septic shock or meningitis) and PICU admission. Second, the prevalence of poor outcomes (acute complications, sequelae or death). RESULTS: Among 118 patients with LOD, 74 (62.7%) presented a severe infection: 66 sepsis/septic shock (11 with associated meningitis) and 8 meningitis. Thirty-five patients (29.7%) were admitted to a PICU. An altered Pediatric Assessment Triangle (PAT) upon arrival and leukopenia were the only independent risk factors for severe infection [odds ratio (OR): 43.6; 95% confidence interval (CI): 8.1-235.7, P < 0.01] and PICU admission (OR: 11.6; 95% CI: 1.5-91.4; P < 0.019), respectively. Six patients (5.1%) developed a poor outcome, including 2 deaths (1.7%); all had an altered PAT, elevated procalcitonin (range 4.7-100 ng/ml), and were diagnosed with sepsis/septic shock and admitted to a PICU. Four developed leukopenia. CONCLUSIONS: Infants with GBS LOD frequently develop sepsis/septic shock and bacterial meningitis, associated with non-negligible morbidity and mortality. Clinical appearance was the only risk factor for severe infection, whereas leukopenia was related to PICU admission.

Taquicardia como factor pronóstico de morbimortalidad en pacientes sin enfermedad previa con fiebre en urgencias pediátricas / Tachycardia as a prognostic factor for morbidity and mortality in patients without previous pathology with fever in pediatric emergencies

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Infección por adenovirus que requiere ingreso hospitalario: epidemiología, datos analíticos y manejo / Adenovirus infections that require hospital admission: epidemiology, laboratory findings and approach

Introducción: las infecciones por adenovirus tienen una presentación clínica variable y son una importante causa de morbilidad en la infancia. Frecuentemente reciben tratamiento antibiótico de forma innecesaria. Este estudio busca analizar las características de los pacientes con infección por adenovirus y ver si difieren de aquellos con infección bacteriana. Pacientes y métodos: se estudiaron 174 pacientes ingresados en un hospital terciario desde enero de 2009 hasta agosto de 2017 a los que se les detectó adenovirus. Se analizaron las variables clínicas y analíticas y se compararon con las de una muestra de pacientes diagnosticados de infección bacteriana confirmada en el mismo centro en 2016. Resultados: la tasa de pacientes con infección por adenovirus fue de 1,58/100 ingresos. El 64% eran varones, siendo la edad media de 17 meses. Los que solo presentaban síntomas gastrointestinales tenían una menor edad y resultados analíticos más favorables que los que solo mostraban síntomas respiratorios. Un 24,5% presentaban coinfección por otro virus, observándose en este grupo una mayor estancia hospitalaria (7,93 frente a 6,17 días, p = 0,006). Los criterios analíticos de infección bacteriana grave no mostraron diferencias significativas al comparar entre los pacientes infectados por adenovirus y los que tenían una infección bacteriana confirmada, excepto una diferencia mínima, aunque estadísticamente significativa, al comparar las cifras de proteína C reactiva. Conclusiones: las variables analíticas y clínicas estudiadas no son suficientes para discriminar entre infección bacteriana y por adenovirus. Sería adecuado descartar infección por adenovirus sistemáticamente antes de instaurar tratamiento antibiótico

Introduction: adenovirus infections have a heterogeneous clinical presentation and are an important cause of childhood morbidity. They are frequently and unnecessarily treated with antibiotics. In this study, we analysed the characteristic of patients with adenovirus infections in order to determine whether they differed from those of patients with bacterial infection. Patients and methods: the study included 174 patients admitted to a tertiary care hospital between January 2009 and August 2017 who tested positive for adenovirus. We analysed the clinical and laboratory findings in these patients and compared them to those of a group of patients that received a diagnosis of confirmed bacterial infection in the same hospital in 2016. Results: the incidence of adenovirus was of 1.58 cases per 100 admissions. Sixty-four percent of the sample was male, and the mean age was 17 months. Patients that presented with gastrointestinal symptoms alone were younger and had more favourable laboratory findings compared to patients with respiratory symptoms alone. Coinfection with another virus was found in 24.5%, and this group had a longer length of stay (7.93 versus 6.17 days, p = 0.006). We found no significant differences in the laboratory criteria indicative of severe bacterial infection between the patients with adenovirus infection and the controls with a confirmed bacterial infection except for a very small, although statistically significant, difference in the levels of C-reactive protein. Conclusions: the clinical and laboratory parameters analysed in our study are not sufficient to discriminate between bacterial infection and adenovirus infection. Thus, it would be appropriate to rule out adenovirus infection before initiating antibiotic treatment