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1.
J Hosp Infect ; 125: 1-20, 2022 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-35390396

RESUMO

BACKGROUND: Optimal management of central venous catheter-related, or -associated, bloodstream infections (CRBSI or CLABSI) in children is not established. AIM: To evaluate success of catheter salvage strategies in paediatric patients. METHODS: Studies were retrieved from medical databases and article reference lists. Data were collected relating to clinical outcomes of two treatments: systemic antibiotics alone or in association with antimicrobial lock therapy (ALT). Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated from a mixed logistic effects model. Heterogeneity was summarized using I2 statistics. Publication bias was investigated by Egger's regression test and funnel plots. FINDINGS: From 345 identified publications, 19 met inclusion criteria (total of 914 attempted salvage strategies). To achieve successful catheter salvage, in CRBSI the addition of ALT was superior to systemic antibiotics alone (OR: -0.40; 95% CI: -1.41, 0.62): 77% (95% CI: 69, 85; I2 = 42.5%; P = 0.12) and 68% of success (95% CI: 59, 77; I2 = 0; P < 0.05), respectively. CRBSI recurrence was less common in studies that used ALT compared with systemic antibiotics alone: 5% (95% CI: 0, 13; I2 = 59.7%; P = 0.03) and 18% of recurrence (95% CI: 9, 28; I2 = 0; P < 0.05), respectively. Recurrences were low with both antibiotic locks and ethanol lock. No clear benefits of ALT addition compared to systemic antibiotic only were found in CLABSI (OR: -0.81; 95% CI: -0.80, 2.43). CONCLUSION: The addition of an antimicrobial lock solution to systemic antibiotic may be beneficial for successful catheter salvage in paediatric patients with CRBSI, depending on aetiology, whereas no statistically significant difference between systemic antibiotic with or without addition of an antimicrobial lock solution was found regarding CLABSI.


Assuntos
Anti-Infecciosos , Bacteriemia , Infecções Relacionadas a Cateter , Cateterismo Venoso Central , Cateteres Venosos Centrais , Desinfetantes , Sepse , Antibacterianos/uso terapêutico , Anti-Infecciosos/uso terapêutico , Bacteriemia/tratamento farmacológico , Infecções Relacionadas a Cateter/tratamento farmacológico , Cateterismo Venoso Central/efeitos adversos , Cateteres Venosos Centrais/efeitos adversos , Criança , Humanos , Sepse/tratamento farmacológico
2.
Spat Stat ; 49: 100543, 2022 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-34631400

RESUMO

The impact of the COVID-19 pandemic varied significantly across different countries, with important consequences in the definition of control and response strategies. In this work, to investigate the heterogeneity of this crisis, we analyse the spatial patterns of deaths attributed to COVID-19 in several European countries. To this end, we propose a Bayesian nonparametric approach, based on mixture of Gaussian processes coupled with Dirichlet process, to group the COVID-19 mortality curves. The model provides a flexible framework for the analysis of time series data, allowing the inclusion in the clustering procedure of different features of the series, such as spatial correlations, time varying parameters and measurement errors. We evaluate the proposed methodology on the death counts recorded at NUTS-2 regional level for several European countries in the period from March 2020 to February 2021.

3.
Eur Rev Med Pharmacol Sci ; 25(2): 941-949, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-33577049

RESUMO

OBJECTIVE: Kisspeptin, neuropeptide involved in puberty beginning and regulation of pituitary-gonadal axis, has been shown to stimulate antioxidant defenses in murine models. Its levels are greater in females than males and also in obese prepubertal girls. Therefore, our aim was to evaluate sex-related differences in prepubertal obese patients and the relationships of Kisspeptin with metabolic/hormonal parameters. PATIENTS AND METHODS: We studied Kisspeptin concentrations in 54 children (22 males and 32 females, Tanner stage 1), 5-12 ys, classified according to Cole's criteria into 17 overweight and 37 obese; 25 normal-weight children, aged 6-12 years, were studied as controls. We evaluated metabolic (glucose and insulin levels after oral glucose load, total- LDL- HDL-cholesterol, triglycerides, uric acid) and hormonal (fT3, fT4, TSH, IGF-1, leptin) parameters. Moreover, total antioxidant capacity (TAC) was evaluated by spectrophotometric method, using the system H202-metmyoglobin-ABTS. Kisspeptin levels were measured by RIA. RESULTS: We did not find significant differences between obese and normal-weight children, but obese males presented significantly lower levels than females. Kisspeptin did not correlate with BMI, HOMA-IR, Insulin peak levels and TAC; a significant correlation was found between Kisspeptin and fT3 (r2=0.25; p=0.003) in the obese group; leptin levels, significantly greater in obese vs. overweight and control children, significantly correlated with TAC (r2=0.39; p=0.03). CONCLUSIONS: These data suggest that both hormones could modulate antioxidants, Kisspeptin indirectly via influence on thyroid hormones, and Leptin by a direct effect. This mechanism seems to be sex-related, not attributable to peripheral steroid levels. Further studies can clarify the complex interrelationship between central and peripheral Kisspeptin secretion and oxidative stress in children obesity.


Assuntos
Antioxidantes/análise , Kisspeptinas/sangue , Obesidade Infantil/sangue , Índice de Massa Corporal , Estudos de Casos e Controles , Criança , Pré-Escolar , Feminino , Humanos , Resistência à Insulina , Leptina/análise , Masculino , Caracteres Sexuais , Espectrofotometria
4.
J Anesth Analg Crit Care ; 1(1): 24, 2021 Dec 14.
Artigo em Inglês | MEDLINE | ID: mdl-37386530

RESUMO

BACKGROUND: Life-threatening streptococcal sepsis nowadays represents an uncommon event in previously healthy infants and children. Critically ill patients suffering from severe streptococcal sepsis complications may present with pre-antibiotic era clinical pictures and require a timely clinical approach to achieve restitutio ad integrum. RESULTS: We report a series of four patient groups affected by an uncommon life-threatening streptococcal sepsis, each of them exhibiting some distinct features. Streptococcus Agalactiae sepsis was associated with cerebral thrombotic/ischaemic lesions, whereas severe cardiogenic shock was prominent in the Streptococcus Viridans group; Streptococcus Faecalis and ß-hemolytic group A Streptococcus patients mostly reported lung complications. CONCLUSIONS: Previous antibiotic treatments should not delay aggressive treatment in the intensive care setting. Early diagnostic suspicion, as well as appropriate and aggressive treatment provided within an intensive care setting are crucial for the clinical outcome.

5.
J Biol Regul Homeost Agents ; 34(3 Suppl. 2): 53-56. ADVANCES IN MUSCULOSKELETAL DISEASES AND INFECTIONS - SOTIMI 2019, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32856440

RESUMO

Panton-Valentine leukocidin (PVL) represents an important virulence factor for many strains of Staphylococcus aureus. PVL is an esotoxin causing leucocyte destruction and tissue necrosis. We report on a case of osteomyelitis involving the hip joint with thromblophlebitis complicated by necrotizing pneumonia and life-threatening septic shock. The child required advance respiratory support for 14 days with circulatory support for 7 days in ICU (intensive care unit), surgical draninage via arthrotomy of hip joint and second-line antibiotic treatment for 1 month. Among a wide literature, in Europe over half of Panton-Valentine St. Aureus (PVL-SA) is MSSA. Investigations for PVL are not always available determining an under-recognition of the episodes. Data on prevalence of PVL-SA in Italy are scarce. With this clinical report, we emphasize the recognition of clinical features that must lead to suspect PVL-SA osteomyelitis in children, providing their adequate management.


Assuntos
Osteomielite , Pneumonia Necrosante , Tromboflebite , Toxinas Bacterianas , Criança , Europa (Continente) , Exotoxinas , Humanos , Itália , Leucocidinas , Osteomielite/diagnóstico por imagem , Staphylococcus aureus
10.
J Hosp Infect ; 98(1): 46-52, 2018 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-28917570

RESUMO

BACKGROUND: Prevention of legionellosis remains a critical issue in healthcare settings where monochloramine (MC) disinfection was recently introduced as an alternative to chlorine dioxide in controlling Legionella spp. contamination of the hospital water network. Continuous treatments with low MC doses in some instances have induced a viable but non-culturable state (VBNC) of Legionella spp. AIM: To investigate the occurrence of such dormant cells during a long period of continuous MC treatment. METHODS: Between November 2010 and April 2015, 162 water and biofilm samples were collected and Legionella spp. isolated in accordance with standard procedures. In sampling sites where MC was <1.5mg/L, VBNC cells were investigated by ethidium monoazide bromide (EMA)-real-time polymerase chain reaction (qPCR) and 'resuscitation' test into Acanthamoeba polyphaga CCAP 1501/18. According to the Health Protection Agency protocol, free-living protozoa were researched in 60 five-litre water samples. FINDINGS: In all, 136 out of 156 (87.2%) of the samples taken from sites previously positive for L. pneumophila ST269 were negative by culture, but only 47 (34.5%) negative by qPCR. Although no positive results were obtained by EMA-qPCR, four out of 22 samples associated with MC concentration of 1.3 ± 0.5mg/L showed VBNC legionella resuscitation. The presence of the amoeba A. polyphaga in the hospital water network was demonstrated. CONCLUSION: Our study is the first report evidencing the emergence of VNBC legionella during a long period of continuous MC treatment of a hospital water network, highlighting the importance of keeping an appropriate and uninterrupted MC dosage to ensure the control of legionella colonization in hospital water supplies.


Assuntos
Cloraminas/farmacologia , Desinfetantes/farmacologia , Legionella/efeitos dos fármacos , Legionella/isolamento & purificação , Microbiologia da Água , Acanthamoeba/isolamento & purificação , Acanthamoeba/microbiologia , Azidas/metabolismo , Inibidores Enzimáticos/metabolismo , Hospitais , Legionella/fisiologia , Viabilidade Microbiana/efeitos dos fármacos , Reação em Cadeia da Polimerase em Tempo Real/métodos
11.
J Hosp Infect ; 98(1): 60-63, 2018 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-28890285

RESUMO

In hospital water systems legionellae may be resistant to disinfectants in pipework, which is a problem particularly in areas where there is low flow or stagnation of water. We evaluated legionella colonization of a water network of an Italian hospital after time flow taps (TFTs) installation in proximity to dead legs. The water volume flushed was 64 L/day from May 2016, and 192 L/day from December 2016. Before TFTs installation, Legionella pneumophila sg2-14 was detected in all points (4 × 104 ± 3.1 × 104 cfu/L). All sites remained positive (2.9 × 104 ± 1.9 × 104 cfu/L) through November 2016. From December 2016 legionella persisted in one point only (2 × 102 to 6.8 × 103 cfu/L). TFTs with chemical disinfection may reduce legionella colonization associated with dead legs.


Assuntos
Legionella pneumophila/isolamento & purificação , Microbiologia da Água , Contagem de Colônia Microbiana , Hospitais , Itália
12.
Ann Ig ; 30(6): 509-516, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30614500

RESUMO

BACKGROUND: The European Food Safety Authority (EFSA) has identified some risk factors for the occurrence of side effects linked to energy drinks (EDs) consumption by young people. EDs consumption has been evaluated in a sample of students in Italy together with some aspects of their lifestyle. METHODS: The survey was performed in two high schools from September 2016 to June 2017. 583 students between 14 to 18 years were recruited and a standard questionnaire (EFSA checklist) was used to collect information on responders characteristics, beverages consumption, EDs with alcohol, and EDs and sports. RESULTS: Despite 350 out of 583 responders (60%) consumed EDs, only 146 out of 583 (25%) were EDs-alcohol consumers. Moreover, 208 out of 379 (55%) of all physically active adolescents reported frequent EDs consumption before sport trainings. CONCLUSIONS: Study results highlight the need for primary prevention measures in communication campaigns and training delivered by school to limit potential health threats related to excess of EDs consumption.


Assuntos
Consumo de Bebidas Alcoólicas/epidemiologia , Bebidas Energéticas/estatística & dados numéricos , Estilo de Vida , Esportes/estatística & dados numéricos , Estudantes/estatística & dados numéricos , Adolescente , Lista de Checagem , Bebidas Energéticas/efeitos adversos , Feminino , Humanos , Itália/epidemiologia , Masculino , Instituições Acadêmicas , Inquéritos e Questionários
13.
J Hosp Infect ; 97(2): 169-174, 2017 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-28546028

RESUMO

BACKGROUND: Patients receiving haemodialysis are exposed to a large volume of dialysis fluid. The Italian Society of Nephrology (ISN) has published guidelines and microbial quality standards on dialysis water (DW) and solutions to ensure patient safety. AIM: To identify microbial and chemical hazards, and evaluate the quality of disinfection treatment in DW plants. METHODS: In 2015 and 2016, water networks and DW plants (closed loop and online monitors) of nine dialysis wards of Italian hospitals, hosting 162 dialysis beds overall, were sampled on a monthly basis to determine the parameters provided by ISN guidelines. Chlorinated drinking water was desalinated by reverse osmosis and distributed to the closed loop which feeds all online monitors. Disinfection with peracetic acid was performed in all DW plants on a monthly basis. FINDINGS: Over the 24-month study period, seven out of nine DW plants (78%) recorded negative results for all investigated parameters. Closed loop contamination with Burkholderia cepacia was detected in a DW plant from January 2015 to March 2015. Pseudomonas aeruginosa was isolated from March 2016 to May 2016 in the closed loop of another DW plant. These microbial contaminations were eradicated by shock disinfection with sodium hypochlorite and peracetic acid, followed by water flushing. CONCLUSION: These results highlight the importance of chemical and physical methods of DW disinfection. The maintenance of control measures in water plants hosted in dialysis wards ensures a microbial risk reduction for all dialysis patients.


Assuntos
Desinfecção/métodos , Água Potável/análise , Soluções para Hemodiálise/análise , Microbiologia da Água , Burkholderia cepacia/isolamento & purificação , Infecção Hospitalar/prevenção & controle , Água Potável/química , Água Potável/microbiologia , Departamentos Hospitalares , Humanos , Itália , Nefrologia , Ácido Peracético/farmacologia , Guias de Prática Clínica como Assunto , Pseudomonas aeruginosa/isolamento & purificação , Diálise Renal , Sociedades Médicas , Purificação da Água/métodos , Abastecimento de Água
14.
J Hosp Infect ; 96(2): 172-176, 2017 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-28073586

RESUMO

BACKGROUND: Waterborne pathogens such as Pseudomonas spp. and Legionella spp. may persist in hospital water networks despite chemical disinfection. Point-of-use filtration represents a physical control measure that can be applied in high-risk areas to contain the exposure to such pathogens. New technologies have enabled an extension of filters' lifetimes and have made available faucet hollow-fibre filters for water ultrafiltration. AIM: To compare point-of-use filters applied to cold water within their period of validity. METHODS: Faucet hollow-fibre filters (filter A), shower hollow-fibre filters (filter B) and faucet membrane filters (filter C) were contaminated in two different sets of tests with standard bacterial strains (Pseudomonas aeruginosa DSM 939 and Brevundimonas diminuta ATCC 19146) and installed at points-of-use. Every day, from each faucet, 100 L of water was flushed. Before and after flushing, 250 mL of water was collected and analysed for microbiology. FINDINGS: There was a high capacity of microbial retention from filter C; filter B released only low Brevundimonas spp. counts; filter A showed poor retention of both micro-organisms. CONCLUSION: Hollow-fibre filters did not show good micro-organism retention. All point-of-use filters require an appropriate maintenance of structural parameters to ensure their efficiency.


Assuntos
Água Potável/microbiologia , Sistemas Automatizados de Assistência Junto ao Leito , Ultrafiltração/métodos , Purificação da Água/métodos , Caulobacteraceae/isolamento & purificação , Pseudomonas aeruginosa/isolamento & purificação
15.
J Hosp Infect ; 95(1): 46-52, 2017 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-27939245

RESUMO

BACKGROUND: Enhanced environmental cleaning practices are among the most accepted measures for controlling the spread of carbapenem-resistant Acinetobacter baumannii (CR-Ab). AIM: To evaluate the impact of heightened cleaning on an ongoing CR-Ab outbreak in a burn intensive care unit (BICU) of an Italian teaching hospital, where chlorhexidine-60% isopropyl alcohol was applied as a complementary disinfectant on high-touch surfaces. METHODS: Compliance with the microbial limit proposed for the BICU by AFNOR-NF-S90-351 (20 colony-forming units/100cm2) was assessed by plate count, and compared with the results obtained with intracellular adenosine triphosphate (ATP) detection. Genotyping was performed using pulsed-field gel electrophoresis. FINDINGS: During the standard cleaning regimen, three out of 23 samples (13%) gave results over the AFNOR limit and five (21.7%) showed unacceptable ATP levels with 100 relative light units/100cm2 as the benchmark limit (sensibility 86.4%, specificity 92.2%). Following improvement of the cleaning procedure, only two samples out of 50 (4%) did not satisfy the microbiological criteria and seven (14%) exceeded the ATP limit. In a successive phase, eight of 30 samples collected showed unacceptable results (27%). CONCLUSIONS: Adding chlorhexidine-60% isopropyl alcohol as complementary disinfectant proved to be effective for reducing environmental microbial contamination, ATP levels and CR-Ab infection/colonization in patients admitted to the BICU. Real-time monitoring by ATP assay was useful for managing the cleaning schedule and reducing hospital infections, although the calculated values must be interpreted as cleanliness indicators rather than risk indicators.


Assuntos
Infecções por Acinetobacter/prevenção & controle , Acinetobacter baumannii/isolamento & purificação , Infecção Hospitalar/prevenção & controle , Desinfecção/métodos , Zeladoria Hospitalar/métodos , Medições Luminescentes/métodos , Resistência beta-Lactâmica , Infecções por Acinetobacter/epidemiologia , Infecções por Acinetobacter/microbiologia , Acinetobacter baumannii/efeitos dos fármacos , Antibacterianos/farmacologia , Unidades de Queimados , Carbapenêmicos/farmacologia , Infecção Hospitalar/epidemiologia , Infecção Hospitalar/microbiologia , Transmissão de Doença Infecciosa/prevenção & controle , Desinfetantes/administração & dosagem , Microbiologia Ambiental , Fidelidade a Diretrizes , Hospitais de Ensino , Humanos , Unidades de Terapia Intensiva , Itália/epidemiologia , Controle de Qualidade
17.
Ann Ig ; 27(5): 718-25, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26661913

RESUMO

BACKGROUND: Despite the increase of community acquired cases of legionellosis in Italy over the last years, the Italian guidelines do not give indications for prevention and control of Legionella in the hot water networks (or centralized conditioning systems) of residential buildings. We performed a survey on eight medium sized apartment buildings in the Pisa district to assess the prevalence of Legionella spp. in the water network and the respondance to drinking water requisites at the point of use, according to the Italian norms. METHODS: For each building two hot water and three cold water samples (located at water entrance from the aqueduct network into the building pipework, at the exit from pressure autoclave, and at a remote tap) were collected. RESULTS: Legionella was detected in 20% of residential buildings, mostly in those with a central hot water production system. CONCLUSIONS: The study highlights a condition of potential risk for susceptible population subgroups and supports the need for measures of risk assessment and control.


Assuntos
Legionella/isolamento & purificação , Microbiologia da Água , Abastecimento de Água/normas , Habitação , Humanos , Itália/epidemiologia , Medição de Risco/métodos
18.
J Perinatol ; 35(2): 90-4, 2015 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-25211284

RESUMO

OBJECTIVE: To compare the effectiviness of spiramycin/cotrimoxazole (Sp/C) versus pyrimethamine/sulfonamide (Pyr/Sul) and spiramycin alone (Spy) on mother-to-child transmission of toxoplasmosis infection in pregnancy. STUDY DESIGN: Retrospective study of pregnant women evaluated for suspected toxoplasmosis between 1992 and 2011. RESULT: A total of 120 mothers and their 123 newborns were included. Prenatal treatment consisted of spiramycin in 43 mothers (35%), spiramycin/cotrimoxazole in 70 (56.9%) and pyrimethamine/sulfonamide in 10 (8.1%). A trend toward reduction in toxoplasmosis transmission was found when Sp/C was compared with Pyr/Sul and particularly with Spy alone (P=0.014). In particular, Spy increased the risk of congenital infection when compared with Sp/C (odds ratio (OR) 4.368; 95% CI: 1.253 to 15.219), but there was no significant reduction when Sp/C was compared with Pyr/Sul (OR 1.83; 95% CI: 0.184 to 18.274). CONCLUSION: The treatment based on Sp/C has significant efficacy in reducing maternal-fetal transmission of Toxoplasma gondii when compared with Pyr/Sul and particularly to Spy. Randomized controlled trials would be required.


Assuntos
Transmissão Vertical de Doenças Infecciosas/prevenção & controle , Complicações Parasitárias na Gravidez , Pirimetamina/administração & dosagem , Espiramicina/administração & dosagem , Sulfanilamidas/administração & dosagem , Toxoplasmose Congênita/prevenção & controle , Toxoplasmose , Combinação Trimetoprima e Sulfametoxazol/administração & dosagem , Adulto , Anti-Infecciosos/administração & dosagem , Combinação de Medicamentos , Feminino , Humanos , Recém-Nascido , Itália , Gravidez , Complicações Parasitárias na Gravidez/tratamento farmacológico , Complicações Parasitárias na Gravidez/parasitologia , Cuidado Pré-Natal/métodos , Estudos Retrospectivos , Sulfanilamida , Toxoplasma/efeitos dos fármacos , Toxoplasma/isolamento & purificação , Toxoplasmose/tratamento farmacológico , Toxoplasmose/parasitologia , Toxoplasmose/transmissão , Resultado do Tratamento
19.
Mediterr J Hematol Infect Dis ; 6(1): e2014033, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-24804006

RESUMO

Tuberculosis is a diffusive infectious disease whose typical behaviour differentiates it from other infectious diseases spread by human-to-human transmission (flu, chicken pox, cholera, etc.) that follow a classic epidemic pattern. Indeed, in the presence of a known source of Koch bacilli that is capable of spreading the bacteria by air, not all exposed individuals inhale the bacteria, not all those who inhale them absorb them, not all those who absorb the bacteria are unable to eliminate them, not all who are able to eliminate them do so using delayed hypersensitivity, not all those who react with delayed hypersensitivity suffer lasting tissue damage (among other things, minor), not all who suffer tissue damage have anatomical sequelae, and not all those who have anatomical sequelae, however minimal, become carriers of bacilli in the latent period. The vast majority (90-95%) of the latter - which are in any case a portion, not the totality of those exposed - remain asymptomatic throughout their lives and never develop active tuberculosis. Based on these biological characteristics and the legal concepts of "epidemic" and "disease," it becomes highly problematic, if not impossible, to assert both that tuberculosis can cause events of sufficient magnitude to be associated with the crime of "epidemic," and that the mere diagnosis of a latent tuberculosis infection is sufficient to assume the presence of an illness legally prosecutable in criminal proceedings or a disability prosecutable in civil proceedings. Furthermore, clinically apparent tuberculosis is a temporarily-and in some cases permanently-disabling condition, and in certain work environments, even with the difficulties caused by the lack of available effective diagnostic tools and the insidious behaviour of the disease in the early stages, targeted monitoring to identify other persons who may become ill is appropriate.

20.
Eur Rev Med Pharmacol Sci ; 18(4): 485-92, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-24610614

RESUMO

In Italy viper bites represent an uncommon event, though envenomation can cause severe complications, more in children than adults, because of dose/body size ratio. We present a case series within a selected population: 10 Italian cases (from Rome surroundings) of viperbites requiring PICU admission, over a 5-year interval. Five children showed a systemic involvement, whereas the remaining patients showed a damage. All were managed and closely monitored in an ICU setting. Relevant clinical findings and therapeutic approach, ICU course and complications have been recorded. Age range was 3-15 years with mean age of 6,9 (SD±4,58) years; 2 patients needed respiratory support beyond oxygen supplementation. Most patients underwent fluid loading, while hemodynamic support was given to4/10. Median PICU stay was 60 hours (IQR=24.0-75.5). No mortality was reported. Indications and precautions for administration of antivenom in the last years have been reviewed: early treatment seems to reduce mortality/morbidity, though representing a threat for children. Current recommendations for the treatment of viper envenomation have been described, based on a literature's review and the application of these knowledges to clinical reality of our PICUs. Therefore, paediatric patients with systemic or rapidly evolving symptoms should be monitored carefully for the development of bite-related complications in an ICU setting mostly in younger children.


Assuntos
Antivenenos/uso terapêutico , Cuidados Críticos/métodos , Unidades de Terapia Intensiva Pediátrica , Mordeduras de Serpentes/terapia , Viperidae , Adolescente , Fatores Etários , Animais , Fármacos Cardiovasculares/uso terapêutico , Criança , Pré-Escolar , Terapia Combinada , Cuidados Críticos/normas , Medicina Baseada em Evidências , Feminino , Hidratação , Hemodinâmica , Humanos , Unidades de Terapia Intensiva Pediátrica/normas , Masculino , Oxigenoterapia , Guias de Prática Clínica como Assunto , Valor Preditivo dos Testes , Respiração Artificial , Cidade de Roma , Mordeduras de Serpentes/complicações , Mordeduras de Serpentes/diagnóstico , Mordeduras de Serpentes/fisiopatologia , Fatores de Tempo , Resultado do Tratamento
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