[Cost of therapeutic failure of ampicillin plus amikacin in the treatment of early neonatal sepsis]. / Costo económico marginal del fracaso terapéutico con ampicilina más amikacina en el tratamiento de la sepsis neonatal temprana.

OBJECTIVE: To evaluate the marginal cost of therapeutic failure with Ampicillin/amikacin as the first-line antibiotic treatment of early-onset neonatal sepsis (ENS). METHODS: Out of a total of 121 newborns, 86 failed to respond to Ampicillin/amikacin when it was used as first-line treatment within their first 72h of life. All of them were admitted to the NICU between 2001 and 2005 with suspicion of sepsis. After this failure to respond, vancomycin and/or cefotaxime were used as the second treatment option for these newborns. Using a full cost method we performed a cost analysis with an activity-based-costing (ABC) perspective, identifying the costs generated by these 86 patients. RESULTS: The costs comprising medication, hospitalization, supplies and clinical staff salaries were higher when vancomycin and/or cefotaxime were used (350,924 dollars or 275,116 euros) compared to those generated with an Ampicillin/amikacin regimen (159,251 dollars or 124,878 euros). When compared as protective factors, the relative risk was 1.09 (95% CI; 0.39-2.1 P=0.8) for Ampicillin/amikacin vs. 0.02 (95% CI; 0.04-0.32 P<0.05) for vancomycin and/or cefotaxime. CONCLUSIONS: Even though vancomycin and/or cefotaxime are initially more costly, there is a cost saving derived from the use of this antibiotic treatment as the first-line therapeutic option instead of as a rescue therapy when a lower-efficacy regimen (Ampicillin/amikacin) has failed.

[Disparity in the criteria for including patients with neonatal sepsis in scientific medical studies. Are we swimming in a sea without limits?]. / Disparidad en los criterios para incluir pacientes con sepsis neonatal en estudios médicos científicos. 'Nadamos en un mar sin límites?

OBJECTIVE: To characterize disparity in the criteria used for patient enrollment in clinical research on neonatal sepsis. MATERIAL AND METHODS: We used MEDLINE to identify clinical research in neonatal sepsis published in English from 1993 to 2005. We used the criteria of the International Consensus Conference Panel: International Pediatric Sepsis Consensus Conference: Definitions for Sepsis and Organ Dysfunction in Pediatrics (IPSCC) published in 2005 as an arbitrary standard in each of the articles. Articles were considered to define neonatal sepsis clearly if they mentioned the criteria and described the values used. Articles were considered not to define neonatal sepsis clearly if they used the phrase "septic patients were included" without describing the variables or values used for inclusion. RESULTS: We identified 150 articles, of which 26.6 % specified the criteria and values of the IPSCC. The remaining 110 articles did not mention the values or the variables used to define neonatal sepsis. CONCLUSION: There is a disparity in the criteria used to operatively define neonatal sepsis in clinical studies performed in distinct parts of the world.

Bacteriospermia and male infertility: a method for increasing the sensitivity of semen culture.

OBJECTIVE: To test a method for increasing the sensitivity of semen culture. Design-Prospective and transverse. Setting-Andrology clinic at a tertiary care health institution in Mexico City. PATIENTS: 65 infertile patients with abnormal semen, bacteriospermia detected on Gram stain and at least two previous negative semen cultures (<3 months) were included to test routine semen culture and a method including centrifugation of semen at 10,00 rpm for 20 minutes. Localization cultures were also carried out in all patients. MAIN OUTCOME MEASURE: Bacterial isolation in semen samples. RESULTS: Routine semen culture was positive in 22% of patients, while centrifuged aliquots of the same semen sample were positive in 52% of patients (chi2 = 6.60, P < .01). Enterococcus was isolated in 43% of patients, E. coli in 24%, coagulase-negative Staphylococcus in 19%, and U. urealyticum in 14%. Ninety percent of isolates corresponded to specimens from the urethra and the prostato-vesicular region. CONCLUSION: Sensitivity of semen culture increased with centrifugation of semen samples. Localization pattern and type of isolates suggest that these patients had chronic prostatitis and that episodic elimination of bacteria might also explain false negative semen cultures in patients with chronic asymptomatic infection of the accessory sex glands.

[The outcome of pregnancies complicated by rubella, 1990-1997]. / Resultado de los embarazos complicados con rubéola, 1990-1997.

OBJECTIVE: To describe the experience of management of pregnant women complicated with rubella and to evaluate the perinatal outcome. MATERIAL AND METHODS: A total of 67 pregnant women with positive IgM test for rubella were studied in the period from January 1st, 1990 to October 31st, 1997. Sixty-six of these women were followed until the end of gestation, in 4 patients an elective abortion was performed and 1 patient had a molar pregnancy. The effects of rubella on gestation and on the product were evaluated in sixty-one of the patients. Anti-rubella IgM was determined at birth and positive infants were subjected to evaluation by echocardiogram, brainstem auditory evoked potentials (BAEP) and ophthalmological study. RESULTS: Mean age of the patients was 24.7 +/- 5.5 years; 28 patients were primigravidae. Pregnancies were normal showing no complications due to the rubella episode. In 35 cases (52.2%), the viral infection occurred during the first trimester of pregnancy, in 23 cases (34.5%) during the second and in 9 (13.3%) during the third. Seventy-one percent of infants born to mothers infected during the first trimester of pregnancy were also infected, and 51.6% developed congenital rubella syndrome. The most frequent manifestations of CRS were: prematurity, low birth weight and alterations of the BAEP. CONCLUSIONS: In Mexico, rubella is still a cause of fetal damage, which shows the need for preventive strategies, such as universal vaccination, to avoid rubella infection during pregnancy.

[AIDS and pregnancy]. / SIDA y embarazo.

Near 70 per cent of Mexican women infected by the Human Immunodeficiency virus (HIV) are between 15 and 44 years old, in this women sexual transmission are the most frequent route of infection. The objective of this article was to describe the obstetric course and perinatal repercussion of the HIV-Positive pregnant women with medical care at the Instituto Nacional de Perinatología, Mexico city between January 1994 to December 1996. Nineteen women were studied, sexual transmission was the route of infection in 16 of them. One had diagnostic criteria for AIDS, the others 18 had HIV asymptomatic infection. At delivery 18 a term products were born. The mean of the newborn weight was 3159 g. At moment of this report 4 children (22%) have been diagnosed as HIV infected, all of them dead during their first year of life.

[Usefulness of fresh wet mount examination in the diagnosis of vaginal candidiasis]. / Utilidad del examen en fresco para el diagnóstico de candidiasis vaginal.

A prospective study was done at the Clinic for Sexually Transmitted Diseases of the Department of Infectology, Instituto Nacional de Perinatología, Mexico City, in order to validate the fresh wet mount examination as a confirmatory test for vaginal candidiasis. Ninety six patients with cervico-vaginal infection were included, 22 of them had clinical candidiasis (22.9%). The fresh wet mount examination showed the presence of yeast and/or pseudomycelium in all 2 samples (100%). The presence of Candida in the cultures was confirmed in 18 of the 22 specimens (81.8). Negative in 71/96 (73.9%) (Three cultures were not processed). The fresh wet mount examination had a sensitivity of 100% and a specificity of 94.8%. The positive predictive value was 88.8% while the negative predictive value was 100%. It can be concluded that the fresh wet mount examination is very recommendable, useful, economic and easy to practice at the physician's office for the confirmation of vaginal candidiasis.

[Measles and pregnancy. Evolution and management]. / Sarampión y embarazo. Evolución y manejo.

Measles is a highly infectious disease. In Mexico, nevertheless the postvaccine era, continue being an endemic disease. It has been described that measles increase the maternal mortality, because pregnant women have a more severe clinical course of the disease; measles also has negative repercussion on pregnancy, increasing the frequency of premature labor. We report two pregnant women complicated with measles, both of them had a clinical course of the disease and they didn't have obstetric or neonatal complications.

[Prevalence of serologic markers of hepatitis A, B, C, and D viruses in pregnant women]. / Prevalencia de marcadores serológicos de los virus de la hepatitis A, B, C y D en embarazadas.

OBJECTIVE: To determine the seroprevalence of hepatitis A, B, C and D virus infection among pregnant women attending a perinatal care hospital. MATERIAL AND METHODS: A prospective study was carried out to determine the seroprevalence of hepatitis A virus IgG antibodies (anti-HAV), hepatitis B virus markers (anti-HBcAg and HBsAg) and hepatitis C virus antibodies (anti-HCV) in pregnant women. In HBsAg positive cases. HBeAg and hepatitis D virus antibodies (anti-HDV) were investigated. All analyses were performed with the ELISA technique. RESULTS: Of the 1500 pregnant women studied. 93.3% were positive for anti-HAV IgG. The HBsAg seroprevalence was 0.26% and anti-HCV seroprevalence was 0.53%. There were no patients with HBeAg or anti-HDV. CONCLUSIONS: A higher seroprevalence of HBsAg was found in this study than in other studies of pregnant Mexican women. We propose that HBsAg screening become a routine prenatal test.

[Ceftriaxone vs. cefazolin in obstetrical surgical prevention]. / Ceftriaxona vs. cefazolina en la profilaxis quirúrgica obstétrica.

The cesarean section is associated with a high incidence of puerperal infections. The antibiotic prophylaxis in obstetric surgery may reduce infectious complications, nevertheless antibiotic prophylaxis only has proved to be effective in women with risk factors for the occurrence of infection. We made a comparative study of the prophylactic efficacy of the ceftriaxone a single dose versus cefazolin three doses, in women with risk factor for infection. There were enrolled 100 patients, 50 in each group. Six percent of the ceftriaxone group patients developed puerperal infections while 12% of the cefazolin group women developed this complication. The statistic analysis don't show difference between the groups. We consider the single dose prophylactic schema is better because its application is easier, administration is safety and reduces the risk of adverse reactions.

[Nosocomial infections of gynecologic-obstetrical origin at a perinatal care hospital]. / Infecciones nosocomiales de origen gineco-obstétrico en un hospital de atención perinatal.

Nosocomial infections (NI) are still a major cause of morbidity among gynecology & obstetrics patients (GOP). At the Instituto Nacional de Perinatología (INPer), during 1989, there was an overall NI rate of 2.37 per 100 GOP discharged, while specific NI rates for the subgroups of puerperal and gynecologic surgery patients were 2.11 and 6.3 respectively. Endometritis and infected surgical wounds were the most frequent type of NI, having a multimicrobial etiology. There was a significant increase in hospital days of stay for those patients who developed NI. It is clearly necessary to improve the surveillance of NI as well as the collaboration among different wards dealing with GOP, in order to find more effective and efficient ways to prevent the development of NI.

[Post-exposure antirabies prophylaxis in pregnant women]. / Profilaxis antirrábica postexposición en mujeres gestantes.

Rabies infection in humans is still a major public health problem. A review of the literature shows 25 cases of pregnant human exposure to rabies virus. We report two patients with rabies exposure during the second and third trimester of pregnancy, that received immunization respectively with Vero cell vaccine and Fuenzalida vaccine. There were no repercutions in the products or in the mothers attributed to the prophylaxis, which appear safe when given during pregnancy. Because of the high likelihood of fatal disease following a rabid animal bite, this cases report supports the recommendation that pregnancy is not a contraindication to post-rabies exposure immunoprophylaxis.

[Systemic neonatal infection by Streptococcus pneumoniae. A case report]. / Infección sistémica neonatal por Streptococcus pneumoniae. Informe de un caso.

The neonatal sepsis by Streptococcus pneumoniae is a clinical manifestation well know, but very often reported. It's role as an etiologic agent is limited to sporadic references in the medical literature, since 1972 only about fifty cases of septicaemia and/or meningitis have been reported. In the Instituto Nacional de Perinatología, from a whole of 560 confirmed cases of septicaemia in the newborn within the last 6 years, only one has been documented as systemic infections by S. pneumoniae. This was a 32.2 gestational aged male patient, with antecedent of maternal chorioamnionitis. This patient presented early-onset sepsis and died during the first 12 hours of life. Presence of S. pneumoniae was found in the blood culture. The type of clinical presentation and its correlation to the perinatal infection is discussed.

[Perinatal transmission of AIDS. Experience at the National Institute of Perinatology]. / SIDA de transmisión perinatal. Experiencia del Instituto Nacional de Perinatología.

From January 1989 to February 1992, 19 pregnant women infected with human immunodeficiency virus (HIV) were attended at the Instituto Nacional de Perinatologia in Mexico City, all of them at the end of pregnancy as well as 15 of their offspring. Sexual transmission was found in 15 patients; the initial classification of 16 was CDC II, only one case with AIDS, and during pregnancy 2 cases changed their clinical status. Absolute CD4 count in 2 cases was lower 20%, None of 10 had positive VDRL and one case showed a positive PPD. All neonates were at term and eutrophics. During their first 3 months of life, 2 had an infectious disease and died. The serologic follow-up at the moment reports 3 having HIV infection (20%), 3 no HIV infection and 9 in study are sero-positive.

[Streptococcus group B in the etiology of neonatal infection]. / Streptococcus del grupo B en la etiología de la infección neonatal.

Group B Streptococcus (GBS) causes maternal infections during perinatal period and serious neonatal infections. Their frequency in our country is still unknown. This study analyzed the clinical and epidemiological characteristics of 13 neonates inborn at the Instituto Nacional de Perinatología with early or late onset group B streptococcal infection. The incidence of early onset diseases (EOGBS) was 0.7 cases/1,000 live births among 20,054 inborn, and 1 case/20,000 live births of late onset diseases. EOGBS was more common in preterm newborn (median 33.2 w), low birth weight (median 2.025 g) with several maternal risk factors. Lethality rate was 38.5% (5/13). GBS is a recent important pathogen in our institute that must be investigated in another institution of our country. Group B Streptococcus; neonatal septicemia; neonatal pneumonia.

[Neonatal systemic infection caused by Listeria monocytogenes]. / Infección sistémica neonatal por Listeria monocytogenes.

Listeria monocytogenes is a gram positive cocco-bacillus which causes perinatal infections and also attacks immunocompromised hosts. Little is known about it in our medium. As part of a prospective study on neonatal systemic infections, its participation at the National Institute of Perinatology was researched. During a period of 18 months, 9,283 live newborns were observed, 141 of them were diagnosed with neonatal septicemia. During this period seven neonates had systemic infections due to Listeria monocytogenes: three had septicemia (two of these with meningitis) and all seven cases had pneumonia. The gestational age of the neonates was 26.1 to 41 weeks (X + DS = 35 + 4.3), with a weight of 830 g to 2,975 g (X + DS 1,958 + 773), four out of seven weighed less than 2,000 grams. The most frequent clinical manifestation was respiratory related causing a need for a differential diagnosis with hyaline membrane disease, transitory tachypnea and meconium swallowing at birth. All of the strains isolated were found to be susceptible to ampicillin, penicillin, gentamicin and amikacin; requiring high CMI levels of cephalosporins.