Infección invasiva por «Staphylococcus aureus» resistente a meticilina de origen comunitario en pacientes pediátricos sanos / Invasive infection caused by community acquired methicillin resistant Staphylococcus aureus on healthy pediatric patients

Staphylococcus aureus resistente a meticilina de adquisición comunitaria (SARM-AC) es una bacteria implicada en infecciones de diversa gravedad y localización. En este trabajo exponemos la actualidad de las infecciones por SARM-AC en pediatría, y lo ilustramos con dos ejemplos de infección virulenta en pacientes pediátricos sanos. El primer caso corresponde a una paciente con artritis séptica y neumonía necrosante por SARM-AC, y el segundo a un lactante con pleuroneumonía por SARM-AC. Ambos casos son un claro ejemplo de la relevancia de esta infección emergente en pediatría (AU)

The community acquired methicillin resistant Staphylococcus aureus (CA-MRSA) is a bacterium that is frequently involved in severe infections and various locations. In this article we describe the actual state of CA-MRSA infections in pediatrics, and we illustrate it with two examples of virulent infection in healthy pediatric patients. The first case is in a patient with septic arthritis and necrotizing pneumonia caused by CA-MRSA, and the second one is in an unweaned baby with pleuropneumonia caused by CA-MRSA. Both cases are a clear example of the importance of this emerging infection in pediatrics (AU)

La bacteriemia asociada al catéter venoso central: implementación de un nuevo protocolo de consenso / Catheter-associated bloodstream infections: Implementation of a new consensus protocol

Introducción: La bacteriemia asociada al catéter venoso central (BA-CVC) es altamente prevalente y a menudo está asociada a complicaciones fatales. Algunos estudios han demostrado que la aplicación de intervenciones preventivas podría ayudar a reducir y a controlar este tipo de infección. Objetivos: Determinar si la puesta en marcha de un nuevo protocolo de consenso sobre la manipulación y el mantenimiento del catéter venoso central (CVC) puede reducir la BA-CVC en pacientes pediátricos. Evaluar su cumplimiento en las unidades de cuidados intensivos (UCI). Método: Estudio prospectivo en las UCI pediátricos (UCIP) y neonatales (UCIN), hematología, oncología y plantas de hospitalización de un hospital materno-infantil de tercer nivel de Barcelona. El estudio se divide en 2 períodos: antes (primer semestre) y después (segundo semestre) de la puesta en marcha del nuevo protocolo en el año 2007. Los cambios más relevantes han sido colocar una conexión hermética en la parte proximal y distal (entre la línea y la jeringa) del catéter, y etiquetar la línea de medicación y el apósito con la fecha de colocación del catéter. Evaluación del cumplimiento mediante check-list en las UCIP y en las UCIN en el segundo período del estudio. Cálculo de la tasa de bacteriemia por 1.000 catéteres al día. Resultados: Las tasas de bacteriemia por 1.000 catéteres al día antes y después de la puesta en marcha del nuevo protocolo han sido de 5,7 y 4,9 en la UCIP; de 24,6 y 18,0 en la UCIN; de 7,6 y 4,6 en hematología y oncología, y de 11,9 y 10,3 y en plantas de hospitalización. En relación con el cumplimiento del protocolo, en más del 95% de los casos la conexión hermética proximal estaba colocada y formaba parte del CVC, y hasta en el 85% de los casos el catéter estaba etiquetado con la fecha de colocación en las 2 UCI. Conclusiones: Un protocolo consensuado de manipulación y de mantenimiento del CVC y la formación del personal sanitario permiten controlar la BA-CVC en unidades de alto riesgo. Se ratifica la importancia de la vigilancia epidemiológica como medida de control de la infección nosocomial (AU)

Introduction: Catheter-associated bloodstream infection is highly prevalent and often associated with fatal complications. Some studies have shown that applying preventive interventions could help to reduce and control this type of infection. Objective: To determine whether a new consensus protocol for the manipulation and maintenance of central venous catheters would decrease catheter-associated bloodstream infections (CA-BSIs) in paediatric patients. To evaluate its compliance in intensive care units. Method: Prospective study in the paediatric (PICU) and neonatal (NICU) intensive cares units, haematology, oncology and hospital wards in a Maternal and Paediatric reference Hospital in Barcelona. The study period is divided into two periods: before (first semester) and after the start of the new protocol (second semester) in 2007. The most important changes have been the insertion of the hermetic connection in the proximal and distal site (between the line and the syringe) of the central venous catheter (CVC), the labelling of the medication line and the CVC with the date of placement. A check-list to evaluate compliance was introduced in both intensive care units (paediatrics and neonatal) during the second study period. The rates of bloodstream infection per 1000 catheter-days were assessed. Results: The rate of bloodstream infections per 1000 catheter-days before and after the start of the new protocol was 5.7 and 4.9 in PICU; 24.6 and 18.0 in NICU; 7.6 and 4.6 in haematology-oncology, and 11.9 and 10.3 in hospital wards. As regards compliance to the protocol, we found that proximal sealed connectors were used in more than 95% of the cases and up to 85% of the central venous catheter were labelled with the insertion date in both intensive care units. Conclusions: A consensus protocol for the use and maintenance of central venous catheters and healthcare worker training helped to control the rate of CA-BSIs. We reaffirm the importance of epidemiological surveillance as a measure for controlling nosocomial infections (AU)

[Catheter-associated bloodstream infections: implementation of a new consensus protocol]. / La bacteriemia asociada al catéter venoso central: implementación de un nuevo protocolo de consenso.

INTRODUCTION: Catheter-associated bloodstream infection is highly prevalent and often associated with fatal complications. Some studies have shown that applying preventive interventions could help to reduce and control this type of infection. OBJECTIVE: To determine whether a new consensus protocol for the manipulation and maintenance of central venous catheters would decrease catheter-associated bloodstream infections (CA-BSIs) in paediatric patients. To evaluate its compliance in intensive care units. METHOD: Prospective study in the paediatric (PICU) and neonatal (NICU) intensive cares units, haematology, oncology and hospital wards in a Maternal and Paediatric reference Hospital in Barcelona. The study period is divided into two periods: before (first semester) and after the start of the new protocol (second semester) in 2007. The most important changes have been the insertion of the hermetic connection in the proximal and distal site (between the line and the syringe) of the central venous catheter (CVC), the labelling of the medication line and the CVC with the date of placement. A check-list to evaluate compliance was introduced in both intensive care units (paediatrics and neonatal) during the second study period. The rates of bloodstream infection per 1000 catheter-days were assessed. RESULTS: The rate of bloodstream infections per 1000 catheter-days before and after the start of the new protocol was 5.7 and 4.9 in PICU; 24.6 and 18.0 in NICU; 7.6 and 4.6 in haematology-oncology, and 11.9 and 10.3 in hospital wards. As regards compliance to the protocol, we found that proximal sealed connectors were used in more than 95% of the cases and up to 85% of the central venous catheter were labelled with the insertion date in both intensive care units. CONCLUSIONS: A consensus protocol for the use and maintenance of central venous catheters and healthcare worker training helped to control the rate of CA-BSIs. We reaffirm the importance of epidemiological surveillance as a measure for controlling nosocomial infections.

[Nosocomial infections in pediatric patients following cardiac surgery]. / Infección nosocomial en postoperados de cirugía cardíaca.

INTRODUCTION: Nosocomial infection (NI) is a possible complication in patients who undergo cardiac surgery, and represents an important cause of morbidity and mortality. This study was undertaken to determine the NI rate, main risk factors, and microbial spectrum in a paediatric intensive care unit (PICU) for this group of patients. PATIENTS AND METHODS: A prospective review was performed, including all patients admitted to the PICU after cardiac surgery between December 2003 and November 2004. NI was defined according to Centers for Disease Control criteria. RESULTS: Sixty-nine patients were included. Sixteen patients (23.2 %) acquired at least one episode of NI. The NI rate was 4.9 per 100 patient-days. The most common NI was pneumonia, followed by urinary tract infection. There were no episodes of sepsis. No patients died from infectious causes. The main aetiological organism was Haemophilus influenzae, associated with 41.6 % of pneumonias, and followed by Pseudomonas aeruginosa. No multiresistant organisms were isolated. There was a statistically significant association between the duration of use of external devices (mechanical ventilation, urinary and central venous catheterization) and development of NI. CONCLUSIONS: Aggressive monitoring and support devices are the main risk factors for NI. Based on our data, we suggest early removal of these. Presumed NI should be diagnosed according standard criteria before starting antibiotic therapy, and treatment modified depending on culture results.

Infección nosocomial en postoperados de cirugía cardíaca / Nosocomial infections in pediatric patients following cardiac surgery

Introducción: La infección nosocomial es una de las posibles complicaciones en pacientes sometidos a cirugía cardíaca, además de ser una causa importante de morbimortalidad. El objetivo de este estudio es determinar la tasa de infecciones nosocomiales en este grupo de pacientes, los principales factores de riesgo asociados y su espectro microbiano en una unidad de cuidados intensivos pediátricos (UCIP). Pacientes y métodos: Se realizó un estudio prospectivo incluyendo todos los pacientes ingresados en la UCIP entre diciembre de 2003 y noviembre de 2004. Se utilizaron los criterios de los Centers for Disease Control (CDC) para la definición de infección nosocomial. Resultados: Se incluyeron un total de 69 pacientes; 16 de ellos (23,2 %) presentaron al menos un episodio de infección nosocomial. La tasa fue 4,9 por 100 pacientes-día. La infección nosocomial más frecuente fue la neumonía, seguida de la infección del tracto urinario. No hubo ningún episodio de sepsis. El principal microorganismo etiológico fue Haemophilus influenzae asociado al 41,6 % de las neumonías, seguido por Pseudomonas aeruginosa. No se aislaron microorganismos multirresistentes. Se halló una asociación estadísticamente significativa entre la duración del uso de dispositivos externos como ventilación mecánica, catéteres venosos centrales y sonda urinaria con el desarrollo de infección nosocomial. Ningún paciente falleció a causa de estas infecciones. Conclusiones: Los dispositivos externos utilizados para soporte y monitorización de este tipo de pacientes son un factor de riesgo importante para el desarrollo de infección nosocomial. Basándonos en nuestros resultados, sugerimos su retirada precoz. El diagnóstico presuntivo de infección nosocomial debe realizarse con criterios estándar antes de iniciar la antibioterapia, modificando la misma según el resultado de los cultivos (AU)

Introduction: Nosocomial infection (NI) is a possible complication in patients who undergo cardiac surgery, and represents an important cause of morbidity and mortality. This study was undertaken to determine the NI rate, main risk factors, and microbial spectrum in a paediatric intensive care unit (PICU) for this group of patients. Patients and methods: A prospective review was performed, including all patients admitted to the PICU after cardiac surgery between December 2003 and November 2004. NI was defined according to Centers for Disease Control criteria. Results: Sixty-nine patients were included. Sixteen patients (23.2 %) acquired at least one episode of NI. The NI rate was 4.9 per 100 patient-days. The most common NI was pneumonia, followed by urinary tract infection. There were no episodes of sepsis. No patients died from infectious causes. The main aetiological organism was Haemophilus influenzae, associated with 41.6 % of pneumonias, and followed by Pseudomonas aeruginosa. No multiresistant organisms were isolated. There was a statistically significant association between the duration of use of external devices (mechanical ventilation, urinary and central venous catheterization) and development of NI. Conclusions: Aggressive monitoring and support devices are the main risk factors for NI. Based on our data, we suggest early removal of these. Presumed NI should be diagnosed according standard criteria before starting antibiotic therapy, and treatment modified depending on culture results (AU)