[Invasive pneumococcal pneumonia in children 0-24 months old: does bacterial resistance affect outcome]. / Neumonía neumocócica invasiva en niños de 0 a 24 meses: influye la resistencia bacteriana en la evolución?

INTRODUCTION: In Uruguay community acquired bacterial pneumonia is a significant cause of morbidity and mortality. S. pneumoniae is the most frequent agent. The disease is more severe in children less than two years old. The relationship between pneumococcal penicillin resistance and outcome is still an unresolved problem. OBJECTIVES: To compare the outcome of children 0 to 24 months old hospitalized in the Hospital Pediátrico-Centro Hospitalario Pereira Rossell, with invasive pneumococcal pneumonia caused by S. pneumoniae susceptible and resistant to penicillin. PATIENTS AND METHODS: Children 0 to 24 months old with invasive pneumococcal pneumonia, admitted between January 1st 1998 and December 31st 2005 were included. Susceptibility to penicillin was defined as a MIC < 0.06 microg/ml, reduced susceptibility was defined as a MIC of 0.1 to 1 microg/ml (intermediate) and as a MIC >or= 2 microg/ml (resistant). Outcome was evaluated with the following criteria: empyema, sepsis, septic shock, mechanical ventilation, and death. Length of hospital stay and outcome were compared in both groups. RESULTS: Inclusion criteria were met by 168 children. S. pneumoniae was susceptible to penicillin in 90 children and with reduced susceptibility in 78. Both groups were similar in age, comorbidity, nutritional status and initial antibiotic treatment. There were no significant differences in outcome and length of hospital stay. CONCLUSIONS: S. pneumoniae resistance to penicillin did not affect the outcome of pneumonia in this group of children.

[Intrapleural streptokinase in the treatment of complicated parapneumonic empyema]. / Instilación intrapleural de estreptoquinasa en el tratamiento del empiema paraneumónico complicado.

INTRODUCTION: Parapneumonic empyema is a frequent cause of admission in the Pediatric Hospital of the Pereira Rossell Hospital Center. In January 2005, we implemented a treatment protocol that included intrapleural streptokinase (STK) for children with complicated parapneumonic empyema as an alternative to surgery. OBJECTIVES: To describe the results of intrapleural STK in the treatment of hospitalized children with complicated parapneumonic empyema and to compare these results with those of early thoracotomy. PATIENTS AND METHODS: Children with complicated parapneumonic empyema admitted between January 1st 2004 and October 1st 2005 were included. The children were divided into two groups: a historical group, composed of children hospitalized between January 1st and December 31st 2004, treated with conventional thoracotomy before day 8 of chest drain placement and a prospective group, composed of children hospitalized between January 1st and October 1st 2005, treated with intrapleural STK before day 8 of chest drain placement. The variables used to compare outcome and treatment complications were duration of chest tube drainage after the treatment procedure, complications, re-admission, length of hospital stay, and death. RESULTS: The results in both groups were similar. Length of hospital stay showed no significant differences. Duration of chest tube drainage after intrapleural STK was significantly shorter than after thoracotomy (p < 0.001). In the thoracotomy group a significantly higher proportion of patients required partial atypical pneumonectomy (p = 0.051). There were no deaths. CONCLUSIONS: Intrapleural STK is a valid alternative for the treatment of children with complicated parapneumonic empyema.