Virus respiratorio sincicial. Patrón clínico epidemiológico en niños internados en un hospital pe... more Virus respiratorio sincicial. Patrón clínico epidemiológico en niños internados en un hospital pediátrico durante los años 2000-2013 Respiratory syncytial virus. Clinical and epidemiological pattern in pediatric patients admitted to a children's hospital between 2000 and 2013
Background Respiratory syncytial virus (RSV) is the leading cause of acute lower respiratory infe... more Background Respiratory syncytial virus (RSV) is the leading cause of acute lower respiratory infection (ALRI) in children. We aimed to describe the clinical–epidemiological pattern and risk factors for mortality associated with RSV infection. Methods Prospective, cross-sectional study of ALRI in children admitted to a Children’s Hospital among 2000–2018. Viral diagnosis was made by fluorescent antibody techniques or real-time PCR. We compared clinical–epidemiological characteristics of RSV infection in nonfatal vs. fatal cases. Multiple logistic regression was used to identify independent predictors of mortality. Results From a total 16,018 patients with ALRI, 13,545(84.6%) were tested for respiratory viruses, 6047 (45%) were positive: RSV 81.1% (4,907), influenza 7.5% (456), parainfluenza 6.9% (419) and adenovirus 4.4% (265). RSV had a seasonal epidemic pattern coinciding with months of lowest average temperature. RSV mortality rate: 1.7% (83/4,855). Fatal cases had a higher propor...
Introduction In 2012, PCV13 was introduced into the National Immunization Program in Argentina, 2... more Introduction In 2012, PCV13 was introduced into the National Immunization Program in Argentina, 2+1 schedule for children <2 years. Coverage rates for 1st and 3rd doses were 69% and 41.0% in 2012, 98% and 86% in 2013; 99% and 89% in 2014, respectively. The aims of this study were to evaluate impact of PCV13 on Consolidated Pneumonia (CP) and Pneumococcal Pneumonia (PP) burden, and to describe epidemiological-clinical pattern of PP during the three-year period following vaccine introduction. Methods Hospital-based study at 10 pediatric surveillance units in Argentina. CP and PP discharge rates per 10,000 hospital discharges were compared between the pre-vaccination period 2007-2011 (preVp), the year of intervention (2012) and the post-vaccination period 2013-2014 (postVp).
Background. Parechovirus-A3 (PeV-A3) is an emerging pathogen causing sepsis and meningoencephalit... more Background. Parechovirus-A3 (PeV-A3) is an emerging pathogen causing sepsis and meningoencephalitis in neonates and young infants. We previously reported that maternal antibodies against PeV-A3 are important to protect neonates and young infants from the infection. We showed that all neonates and infants who developed PeV-A3-related diseases had low neutralizing antibody titers (NATs) against PeV-A3 at the onset of disease, subsequently developed high NATs at 3 and 6 months of age. Subsequent changes in NATs against PeV-A3 in children who suffered from PeV-A3related diseases are currently unknown. Additionally, their long-term neurological outcome is not well described in such population. Methods. Subjects were PeV-A3-infected infants less than 4 months in Niigata, Japan during 2013-2014, and follow-up serum samples were obtained longitudinally from the patients at 3, 6 months, 1 and 3 years after the infection. NATs against PeV-A3 were measured using LLC-MK2 cells. Neurological outcomes of the patients were evaluated by their pediatricians at their study visits. Results. We evaluated 45, 34, 33, 26, and 16 serum samples at onset, 3, 6 months, 1 and, 3 years after the infection, respectively. All 45 serum samples at onset had low NATs against PeV-A3 less than 1:32 which was regarded as a cutoff to prevent PeV-A3 infection. Subsequently, the NATs had elevated to the high level (≥1:512) after the infection in all patients. Three years after the infection, all patients except one achieved normal neurodevelopmental milestones. Only one patient who was diagnosed as severe status epileptics due to meningoencephalitis had developmental delay with difficulties in sitting and walking with support. Conclusion. This study showed that NATs against PeV-A3 sustained high levels in patients who had severe PeV-A3-related diseases in their neonatal or young infantile periods. Neurological outcomes of the patients who suffered from PeV-A3-related diseases seem to be excellent, except for the case with complicated clinical course.
Background. Escherichia coli has been thought to be an uncommon cause of community-acquired pneum... more Background. Escherichia coli has been thought to be an uncommon cause of community-acquired pneumonia (CAP). Large epidemiological data on E. coli CAP (E-CAP) and its comparison to pneumococcal CAP (P-CAP) are lacking. Methods. A multi-center retrospective cohort study of adult patients (aged ≥ 18 years) admitted to 140 US hospitals with pneumonia and/or sepsis from 2010-2015, included in the Premier Research database. Patients with community-onset infection, antibiotic treatment beginning within the first 2 hospital days, and continued for at least 3 consecutive days were included. Patients were excluded if they had been transferred from another acute care facility, had cystic fibrosis, had a hospital length of stay of 1 day or less, co-existent urinary tract infection, gastrointestinal/ intra-abdominal infection, or simultaneous presence of other CAP pathogens. Pneumonia and sepsis were identified by ICD-9 codes. Results. A total of 13,165 patients met the inclusion criteria, of which 1,247 had E. coli CAP. Majority of patients with E-CAP were nonnursing home residents (90.2%, 1,125/1,247). 69.3% (864/1,247) patients with E-CAP presented with"sepsis syndrome' compared with only 48.1% in other Gram-negative CAP and 62.5% in P-CAP. Aspiration pneumonia was diagnosed in 5.9% (73/1,247) with E-CAP. Blood cultures were positive in 59.9% (748/1,247) of patients with E-CAP with 84.8% positivity in patients with sepsis syndrome. Patients with E-CAP compared with P-CAP were more likely to require ICU-level care (42.6% vs. 38.2%), mechanical ventilation (19.3% vs. 15.7%), and require vasopressors (21% vs. 13.8%). In-hospital mortality was 14.8% in E-CAP compared with 7.4% in P-CAP. The median cost of hospitalization was great in E-CAP than P-CAP ($12,420.1 vs. $9,857.5) Re-admission within 30 days was greater among patients with E-CAP than P-CAP (5.4% vs. 4%). 36.8% of isolates were resistant to fluoroquinolones, 10.4% to ceftriaxone and 18.1% to aminoglycosides. Only 10/1,247(0.8%) were multi-drug-resistant. Conclusion. E. coli is an important cause of severe CAP, with higher mortality, greater need for ICU-level care, and higher re-admission rates than patients with pneumococcal pneumonia. The rate of fluoroquinolone resistance was high and empiric quinolones should be used with caution for patients who are critically ill due to E-CAP Disclosures.
Influenza is an important cause of acute lower respiratory tract infection (aLRTI), hospitalizati... more Influenza is an important cause of acute lower respiratory tract infection (aLRTI), hospitalization, and mortality in children. This study aimed to describe the clinical and epidemiologic patterns and infection factors associated with influenza, and compare case features of influenza A and B. In a prospective, cross-sectional study, patients admitted for aLRTI, between 2000 and 2015, were tested for respiratory syncytial virus, adenovirus, influenza, or parainfluenza, and confirmed by fluorescent antibody (FA) or real-time polymerase chain reaction (RT-PCR) assay of nasopharyngeal aspirates. Of 14,044 patients, 37.7% (5290) had FA- or RT-PCR-confirmed samples that identified influenza in 2.8% (394/14,044; 91.4% [360] influenza A, 8.6% [34] influenza B) of cases. Influenza frequency followed a seasonal epidemic pattern (May-July, the lowest average temperature months). The median age of cases was 12 months (interquartile range: 6-21 months); 56.1% (221/394) of cases were male. Consol...
Background: Respiratory Syncytial Virus (RSV) is the main agent that causes Acute Lower Respirato... more Background: Respiratory Syncytial Virus (RSV) is the main agent that causes Acute Lower Respiratory Tract Infection (ALRI) in children. Objective: to describe the clinical and epidemiological pattern and the lethality factors associated to RSV infection. Methods: Prospective, cross sectional study of patients admitted for ALRI at "R.Gutiérrez" Children Hospital, 2000-2014. Virological diagnosis of respiratory virus: RSV, adenovirus (AV), influenza (IF) and parainfluenza (PIV) was made by fluorescent antibody assay of nasopharyngeal aspirates or real time-PCR (IF). Results: from a total of 13.309 patients included, 38.6%(5118) had positive samples; RSV was predominant all through the study period 81% (4146/5118) without significant annual variations (71-88). It shows a seasonal epidemic pattern (median of epidemiological weeks of viral activity onset and offset:19-35) and agrees with the lowest average temperature months. RSV was followed by IF: 7.4%, PIF:6% and AV:4.5%. From 5118 RSV cases the median of age was 7 months (0-216 months), 74%<1 year, 43%<6 months, 20%<3 months; 56.5% males; most frequent clinical feature was bronchiolitis 60.6%; 27% recorded previous admissions for respiratory causes. Comorbidity was found in 41.5% (1717/4146) being the most frequents: recurrent obstructive bronchitis (74%) and congenital heart disease (14%). Complications were detected in 25% of cases, 6.5% had nosocomial infections. Lethality was 1.9 %(78/4108). From 78 RSV fatal cases the median of age of was 5 months (0-180 months), 27%<3months; most frequent clinical feature was pneumonia 53%. Comorbidity was found in 65.4% (51/78) being the most frequents: recurrent obstructive bronchitis 50.9% (26/51) and congenital heart disease 33%(17/51).Moderate to severe malnourishment OR 2.28 (1.19-4.36) p<0.01, congenital cardiopathy 3.53 (1.95-6.39) p<0.01 and the presence of chronic neurological disease OR 3.25 (1.65-6.39) p<0.01 were the independent predictors for VSR lethality. Conclusion: RSV showed an epidemic pattern (May-July) and affected mostly young children. RSV lethality was more associated with malnourishment, congenital cardiopathy and the presence of chronic neurological disease.
Background: Meningococcal disease (MD) is a medical emergency and a serious public health problem... more Background: Meningococcal disease (MD) is a medical emergency and a serious public health problem. As new meningococcal vaccines become available, MD surveillance is crucial to provide baseline epidemiologic data before implementing preventive measures. We estimated MD incidence and epidemiology in Argentina using hospital-based surveillance. Methods: Three-year prospective active surveillance in patients ≤15 years of age was conducted at 6 pediatric hospital sentinel units (March 2012 to February 2015). Results: Of 184,360 hospitalized patients, 1444 (0.78%) had suspected meningitis or MD. Of these, 268 (19%) presented probable acute bacterial meningitis or MD, 168 (63%) were culture positive and 51 (30%) tested positive for Neisseria meningitidis. Of 100 culture-negative cases, 30 had positive meningococcal polymerase chain reaction. Thirteen patients presented other uncommon MD manifestations, resulting in a total of 94 MD cases and an annual incidence of 5.1/10 4 hospitalized patients [95% confidence interval (CI): 4-6]. Fifty-four (57%) patients were males, 48% were <1 year of age and the median age was 12.5 months (1 month to 15 years). Clinical presentations were the following: meningococcemia and meningitis (37%), meningitis (30%), meningococcemia (16%), arthritis (10%), bacteremia (5%) and pneumonia (2%). Twenty-eight percent had complications. Nine children died (case fatality rate: 10%), and 8 had sequelae. Serogroups were identified for 84 isolates. Serogroup W was associated with age <1 year (odds ratio: 3.18; 95% CI: 1.14-8.99); meningococcemia was associated with mortality (P = 0.0038). Conclusions: Highest rates of MD were observed among young infants. This study provides baseline data to estimate the impact of introducing meningococcal vaccines in Argentina.
Artículo original Resumen Introducción. Streptococcus pneumoniae (Sp) causa enfermedades invasiva... more Artículo original Resumen Introducción. Streptococcus pneumoniae (Sp) causa enfermedades invasivas de alta morbimortalidad, registrándose en la última década un aumento de la resistencia antibiótica. Material y métodos. Con el objetivo de estudiar la epidemiología del Sp, su susceptibilidad antibiótica y los factores de riesgo de resistencia a penicilina (RP), se evaluaron en forma prospectiva 274 pacientes con infecciones invasivas por Sp internados en el HNRG entre 1993 y 1999, inclusive. La mediana de edad fue de 21,5 meses (rango 1-180), la relación varón/mujer fue de 1,7:1; 11,8% eran desnutridos de II-III grado; 52,6% tenía enfermedad de base (respiratoria crónica o recidivante, 38,9%). A partir del aislamiento bacteriológico de Sp se realizó el seguimiento clínico-epidemiológico del paciente. Resultados. De 293 presentaciones clínicas, la más frecuente fue neumonía (64,2%), siguiendo meningitis (11,6%), sepsis/bacteriemia (10,9%), peritonitis (7,8%) y 16 pacientes presentaron formas asociadas.
Please cite this article in press as: Gentile A, et al. Influenza vaccine: Delayed vaccination sc... more Please cite this article in press as: Gentile A, et al. Influenza vaccine: Delayed vaccination schedules and missed opportunities in children under 2 years old. Vaccine (2015),
Antibiotics are the most prescribed drugs in pediatric intensive care units (PICU) with high impa... more Antibiotics are the most prescribed drugs in pediatric intensive care units (PICU) with high impact in pathogens resistance and costs. Evaluate prescription patterns and consumption of antibiotics. From July 2006 to January 2007, monthly cross-sectional cuts were done on antibiotics use at the 1st and 7th days of prescription. A monthly antibiotics consumption average was then calculated. Of 81 patients, 41 received antibiotics, of which 34 were treated for at least seven days. 1. Mean antibiotics / patient: 83 antibiotics were used at the initial empirical treatment (meropenem 18%, vancomycin 16.8%, amikacin 16.8%, cefotaxime 13.2%, ceftazidime 6%, clarithromycin 6%, piperacillin-tazobactam 4.8%, colistin 4.8%). mean: 2 antibiotics/patient. 98 antibiotics were used at the 7th day (vancomycin 17.3%, meropenem 16.3%, amikacin 9.8%, minocycline 9.8%, colistin 9.1%, amphotericin 6.1%, trimethoprim-sulfamethoxazole 4%, ceftazidime 5.1%). Mean: 2.8 antibiotics/patient. 2. Percentage of s...
Delayed vaccine schedule (DVS) and missed opportunities of vaccination (MOV) are some of the main... more Delayed vaccine schedule (DVS) and missed opportunities of vaccination (MOV) are some of the main causes of low coverage in children ≤24 month in Argentina. To determine the prevalence of DVS and the rate of MOV during the frst 24 months of life and risk factors for their occurrence. We conducted a survey among children ≤24 month's caregivers at five hospitals in different departments, between August-December/2008. Total enrolled: 1591 children; 54.2% male, median of age 8 months (0-24 months). Eighty percent concurred with vaccine-card, 75.9% consulted by pathology. Overall DVS rate: 39.7%. Most common DVS reason: the current mild disease: 38.5%. Overall MOV rate: 19.8%. Most common MOV reason: no detection of the need to vaccinate 47.8%. DTPHib and OPV vaccines had a higher risk of DVS and MOV. DVS independent predictors: age ≥6 months, administration for additionally recommended vaccines and prolonged waiting in the last vaccination. MOV independent predictors were: age ≥6 mo...
In Argentina, pandemic influenza pH1N1 caused nearly 10,000 confirmed cases with high impact in p... more In Argentina, pandemic influenza pH1N1 caused nearly 10,000 confirmed cases with high impact in pediatrics. To describe clinical and epidemiological characteristics and analyse the risk factor of lethality in children hospitalized with infection pH1N1 confirmed by PCR. We identifed all suspected cases (according to Ministry of health) in 34 centers and we included all the confirmed cases of 0-18 years from 1/4/09 to 31/8/09 in a retrospective cohort study. The viral diagnosis was confirmed by RT-PCR method. Data are expressed in percentages, average, median, standard deviation, and range (IQR) as appropriate; and as a measure of association, relative risk (RR), with 95% confidence interval (95%CI). Multiple logistic regression was conducted to determine the independent risk predictors. Total number of suspected cases were: 2367; PCR was performed to 47.8% (n: 1131) being positive for pH1N1 65.5% (n: 741/1131); 57.2% males; 61.5% <24 months, median age: 14 months (IQR 6-46 months)...
Artículo original Resumen Introducción. Streptococcus pneumoniae (Sp) causa enfermedades invasiva... more Artículo original Resumen Introducción. Streptococcus pneumoniae (Sp) causa enfermedades invasivas de alta morbimortalidad, registrándose en la última década un aumento de la resistencia antibiótica. Material y métodos. Con el objetivo de estudiar la epidemiología del Sp, su susceptibilidad antibiótica y los factores de riesgo de resistencia a penicilina (RP), se evaluaron en forma prospectiva 274 pacientes con infecciones invasivas por Sp internados en el HNRG entre 1993 y 1999, inclusive. La mediana de edad fue de 21,5 meses (rango 1-180), la relación varón/mujer fue de 1,7:1; 11,8% eran desnutridos de II-III grado; 52,6% tenía enfermedad de base (respiratoria crónica o recidivante, 38,9%). A partir del aislamiento bacteriológico de Sp se realizó el seguimiento clínico-epidemiológico del paciente. Resultados. De 293 presentaciones clínicas, la más frecuente fue neumonía (64,2%), siguiendo meningitis (11,6%), sepsis/bacteriemia (10,9%), peritonitis (7,8%) y 16 pacientes presentaron formas asociadas.
En los últimos años, en la Argentina, se han producido cambios epidemiológicos en la incidencia d... more En los últimos años, en la Argentina, se han producido cambios epidemiológicos en la incidencia de los distintos agentes causantes de MAB. Según datos del Ministerio de Salud y Medio Ambiente,4,5 N. meningitidis fue el agen-te más prevalente en la década de 1990, se ...
Virus respiratorio sincicial. Patrón clínico epidemiológico en niños internados en un hospital pe... more Virus respiratorio sincicial. Patrón clínico epidemiológico en niños internados en un hospital pediátrico durante los años 2000-2013 Respiratory syncytial virus. Clinical and epidemiological pattern in pediatric patients admitted to a children's hospital between 2000 and 2013
Background Respiratory syncytial virus (RSV) is the leading cause of acute lower respiratory infe... more Background Respiratory syncytial virus (RSV) is the leading cause of acute lower respiratory infection (ALRI) in children. We aimed to describe the clinical–epidemiological pattern and risk factors for mortality associated with RSV infection. Methods Prospective, cross-sectional study of ALRI in children admitted to a Children’s Hospital among 2000–2018. Viral diagnosis was made by fluorescent antibody techniques or real-time PCR. We compared clinical–epidemiological characteristics of RSV infection in nonfatal vs. fatal cases. Multiple logistic regression was used to identify independent predictors of mortality. Results From a total 16,018 patients with ALRI, 13,545(84.6%) were tested for respiratory viruses, 6047 (45%) were positive: RSV 81.1% (4,907), influenza 7.5% (456), parainfluenza 6.9% (419) and adenovirus 4.4% (265). RSV had a seasonal epidemic pattern coinciding with months of lowest average temperature. RSV mortality rate: 1.7% (83/4,855). Fatal cases had a higher propor...
Introduction In 2012, PCV13 was introduced into the National Immunization Program in Argentina, 2... more Introduction In 2012, PCV13 was introduced into the National Immunization Program in Argentina, 2+1 schedule for children <2 years. Coverage rates for 1st and 3rd doses were 69% and 41.0% in 2012, 98% and 86% in 2013; 99% and 89% in 2014, respectively. The aims of this study were to evaluate impact of PCV13 on Consolidated Pneumonia (CP) and Pneumococcal Pneumonia (PP) burden, and to describe epidemiological-clinical pattern of PP during the three-year period following vaccine introduction. Methods Hospital-based study at 10 pediatric surveillance units in Argentina. CP and PP discharge rates per 10,000 hospital discharges were compared between the pre-vaccination period 2007-2011 (preVp), the year of intervention (2012) and the post-vaccination period 2013-2014 (postVp).
Background. Parechovirus-A3 (PeV-A3) is an emerging pathogen causing sepsis and meningoencephalit... more Background. Parechovirus-A3 (PeV-A3) is an emerging pathogen causing sepsis and meningoencephalitis in neonates and young infants. We previously reported that maternal antibodies against PeV-A3 are important to protect neonates and young infants from the infection. We showed that all neonates and infants who developed PeV-A3-related diseases had low neutralizing antibody titers (NATs) against PeV-A3 at the onset of disease, subsequently developed high NATs at 3 and 6 months of age. Subsequent changes in NATs against PeV-A3 in children who suffered from PeV-A3related diseases are currently unknown. Additionally, their long-term neurological outcome is not well described in such population. Methods. Subjects were PeV-A3-infected infants less than 4 months in Niigata, Japan during 2013-2014, and follow-up serum samples were obtained longitudinally from the patients at 3, 6 months, 1 and 3 years after the infection. NATs against PeV-A3 were measured using LLC-MK2 cells. Neurological outcomes of the patients were evaluated by their pediatricians at their study visits. Results. We evaluated 45, 34, 33, 26, and 16 serum samples at onset, 3, 6 months, 1 and, 3 years after the infection, respectively. All 45 serum samples at onset had low NATs against PeV-A3 less than 1:32 which was regarded as a cutoff to prevent PeV-A3 infection. Subsequently, the NATs had elevated to the high level (≥1:512) after the infection in all patients. Three years after the infection, all patients except one achieved normal neurodevelopmental milestones. Only one patient who was diagnosed as severe status epileptics due to meningoencephalitis had developmental delay with difficulties in sitting and walking with support. Conclusion. This study showed that NATs against PeV-A3 sustained high levels in patients who had severe PeV-A3-related diseases in their neonatal or young infantile periods. Neurological outcomes of the patients who suffered from PeV-A3-related diseases seem to be excellent, except for the case with complicated clinical course.
Background. Escherichia coli has been thought to be an uncommon cause of community-acquired pneum... more Background. Escherichia coli has been thought to be an uncommon cause of community-acquired pneumonia (CAP). Large epidemiological data on E. coli CAP (E-CAP) and its comparison to pneumococcal CAP (P-CAP) are lacking. Methods. A multi-center retrospective cohort study of adult patients (aged ≥ 18 years) admitted to 140 US hospitals with pneumonia and/or sepsis from 2010-2015, included in the Premier Research database. Patients with community-onset infection, antibiotic treatment beginning within the first 2 hospital days, and continued for at least 3 consecutive days were included. Patients were excluded if they had been transferred from another acute care facility, had cystic fibrosis, had a hospital length of stay of 1 day or less, co-existent urinary tract infection, gastrointestinal/ intra-abdominal infection, or simultaneous presence of other CAP pathogens. Pneumonia and sepsis were identified by ICD-9 codes. Results. A total of 13,165 patients met the inclusion criteria, of which 1,247 had E. coli CAP. Majority of patients with E-CAP were nonnursing home residents (90.2%, 1,125/1,247). 69.3% (864/1,247) patients with E-CAP presented with"sepsis syndrome' compared with only 48.1% in other Gram-negative CAP and 62.5% in P-CAP. Aspiration pneumonia was diagnosed in 5.9% (73/1,247) with E-CAP. Blood cultures were positive in 59.9% (748/1,247) of patients with E-CAP with 84.8% positivity in patients with sepsis syndrome. Patients with E-CAP compared with P-CAP were more likely to require ICU-level care (42.6% vs. 38.2%), mechanical ventilation (19.3% vs. 15.7%), and require vasopressors (21% vs. 13.8%). In-hospital mortality was 14.8% in E-CAP compared with 7.4% in P-CAP. The median cost of hospitalization was great in E-CAP than P-CAP ($12,420.1 vs. $9,857.5) Re-admission within 30 days was greater among patients with E-CAP than P-CAP (5.4% vs. 4%). 36.8% of isolates were resistant to fluoroquinolones, 10.4% to ceftriaxone and 18.1% to aminoglycosides. Only 10/1,247(0.8%) were multi-drug-resistant. Conclusion. E. coli is an important cause of severe CAP, with higher mortality, greater need for ICU-level care, and higher re-admission rates than patients with pneumococcal pneumonia. The rate of fluoroquinolone resistance was high and empiric quinolones should be used with caution for patients who are critically ill due to E-CAP Disclosures.
Influenza is an important cause of acute lower respiratory tract infection (aLRTI), hospitalizati... more Influenza is an important cause of acute lower respiratory tract infection (aLRTI), hospitalization, and mortality in children. This study aimed to describe the clinical and epidemiologic patterns and infection factors associated with influenza, and compare case features of influenza A and B. In a prospective, cross-sectional study, patients admitted for aLRTI, between 2000 and 2015, were tested for respiratory syncytial virus, adenovirus, influenza, or parainfluenza, and confirmed by fluorescent antibody (FA) or real-time polymerase chain reaction (RT-PCR) assay of nasopharyngeal aspirates. Of 14,044 patients, 37.7% (5290) had FA- or RT-PCR-confirmed samples that identified influenza in 2.8% (394/14,044; 91.4% [360] influenza A, 8.6% [34] influenza B) of cases. Influenza frequency followed a seasonal epidemic pattern (May-July, the lowest average temperature months). The median age of cases was 12 months (interquartile range: 6-21 months); 56.1% (221/394) of cases were male. Consol...
Background: Respiratory Syncytial Virus (RSV) is the main agent that causes Acute Lower Respirato... more Background: Respiratory Syncytial Virus (RSV) is the main agent that causes Acute Lower Respiratory Tract Infection (ALRI) in children. Objective: to describe the clinical and epidemiological pattern and the lethality factors associated to RSV infection. Methods: Prospective, cross sectional study of patients admitted for ALRI at "R.Gutiérrez" Children Hospital, 2000-2014. Virological diagnosis of respiratory virus: RSV, adenovirus (AV), influenza (IF) and parainfluenza (PIV) was made by fluorescent antibody assay of nasopharyngeal aspirates or real time-PCR (IF). Results: from a total of 13.309 patients included, 38.6%(5118) had positive samples; RSV was predominant all through the study period 81% (4146/5118) without significant annual variations (71-88). It shows a seasonal epidemic pattern (median of epidemiological weeks of viral activity onset and offset:19-35) and agrees with the lowest average temperature months. RSV was followed by IF: 7.4%, PIF:6% and AV:4.5%. From 5118 RSV cases the median of age was 7 months (0-216 months), 74%<1 year, 43%<6 months, 20%<3 months; 56.5% males; most frequent clinical feature was bronchiolitis 60.6%; 27% recorded previous admissions for respiratory causes. Comorbidity was found in 41.5% (1717/4146) being the most frequents: recurrent obstructive bronchitis (74%) and congenital heart disease (14%). Complications were detected in 25% of cases, 6.5% had nosocomial infections. Lethality was 1.9 %(78/4108). From 78 RSV fatal cases the median of age of was 5 months (0-180 months), 27%<3months; most frequent clinical feature was pneumonia 53%. Comorbidity was found in 65.4% (51/78) being the most frequents: recurrent obstructive bronchitis 50.9% (26/51) and congenital heart disease 33%(17/51).Moderate to severe malnourishment OR 2.28 (1.19-4.36) p<0.01, congenital cardiopathy 3.53 (1.95-6.39) p<0.01 and the presence of chronic neurological disease OR 3.25 (1.65-6.39) p<0.01 were the independent predictors for VSR lethality. Conclusion: RSV showed an epidemic pattern (May-July) and affected mostly young children. RSV lethality was more associated with malnourishment, congenital cardiopathy and the presence of chronic neurological disease.
Background: Meningococcal disease (MD) is a medical emergency and a serious public health problem... more Background: Meningococcal disease (MD) is a medical emergency and a serious public health problem. As new meningococcal vaccines become available, MD surveillance is crucial to provide baseline epidemiologic data before implementing preventive measures. We estimated MD incidence and epidemiology in Argentina using hospital-based surveillance. Methods: Three-year prospective active surveillance in patients ≤15 years of age was conducted at 6 pediatric hospital sentinel units (March 2012 to February 2015). Results: Of 184,360 hospitalized patients, 1444 (0.78%) had suspected meningitis or MD. Of these, 268 (19%) presented probable acute bacterial meningitis or MD, 168 (63%) were culture positive and 51 (30%) tested positive for Neisseria meningitidis. Of 100 culture-negative cases, 30 had positive meningococcal polymerase chain reaction. Thirteen patients presented other uncommon MD manifestations, resulting in a total of 94 MD cases and an annual incidence of 5.1/10 4 hospitalized patients [95% confidence interval (CI): 4-6]. Fifty-four (57%) patients were males, 48% were <1 year of age and the median age was 12.5 months (1 month to 15 years). Clinical presentations were the following: meningococcemia and meningitis (37%), meningitis (30%), meningococcemia (16%), arthritis (10%), bacteremia (5%) and pneumonia (2%). Twenty-eight percent had complications. Nine children died (case fatality rate: 10%), and 8 had sequelae. Serogroups were identified for 84 isolates. Serogroup W was associated with age <1 year (odds ratio: 3.18; 95% CI: 1.14-8.99); meningococcemia was associated with mortality (P = 0.0038). Conclusions: Highest rates of MD were observed among young infants. This study provides baseline data to estimate the impact of introducing meningococcal vaccines in Argentina.
Artículo original Resumen Introducción. Streptococcus pneumoniae (Sp) causa enfermedades invasiva... more Artículo original Resumen Introducción. Streptococcus pneumoniae (Sp) causa enfermedades invasivas de alta morbimortalidad, registrándose en la última década un aumento de la resistencia antibiótica. Material y métodos. Con el objetivo de estudiar la epidemiología del Sp, su susceptibilidad antibiótica y los factores de riesgo de resistencia a penicilina (RP), se evaluaron en forma prospectiva 274 pacientes con infecciones invasivas por Sp internados en el HNRG entre 1993 y 1999, inclusive. La mediana de edad fue de 21,5 meses (rango 1-180), la relación varón/mujer fue de 1,7:1; 11,8% eran desnutridos de II-III grado; 52,6% tenía enfermedad de base (respiratoria crónica o recidivante, 38,9%). A partir del aislamiento bacteriológico de Sp se realizó el seguimiento clínico-epidemiológico del paciente. Resultados. De 293 presentaciones clínicas, la más frecuente fue neumonía (64,2%), siguiendo meningitis (11,6%), sepsis/bacteriemia (10,9%), peritonitis (7,8%) y 16 pacientes presentaron formas asociadas.
Please cite this article in press as: Gentile A, et al. Influenza vaccine: Delayed vaccination sc... more Please cite this article in press as: Gentile A, et al. Influenza vaccine: Delayed vaccination schedules and missed opportunities in children under 2 years old. Vaccine (2015),
Antibiotics are the most prescribed drugs in pediatric intensive care units (PICU) with high impa... more Antibiotics are the most prescribed drugs in pediatric intensive care units (PICU) with high impact in pathogens resistance and costs. Evaluate prescription patterns and consumption of antibiotics. From July 2006 to January 2007, monthly cross-sectional cuts were done on antibiotics use at the 1st and 7th days of prescription. A monthly antibiotics consumption average was then calculated. Of 81 patients, 41 received antibiotics, of which 34 were treated for at least seven days. 1. Mean antibiotics / patient: 83 antibiotics were used at the initial empirical treatment (meropenem 18%, vancomycin 16.8%, amikacin 16.8%, cefotaxime 13.2%, ceftazidime 6%, clarithromycin 6%, piperacillin-tazobactam 4.8%, colistin 4.8%). mean: 2 antibiotics/patient. 98 antibiotics were used at the 7th day (vancomycin 17.3%, meropenem 16.3%, amikacin 9.8%, minocycline 9.8%, colistin 9.1%, amphotericin 6.1%, trimethoprim-sulfamethoxazole 4%, ceftazidime 5.1%). Mean: 2.8 antibiotics/patient. 2. Percentage of s...
Delayed vaccine schedule (DVS) and missed opportunities of vaccination (MOV) are some of the main... more Delayed vaccine schedule (DVS) and missed opportunities of vaccination (MOV) are some of the main causes of low coverage in children ≤24 month in Argentina. To determine the prevalence of DVS and the rate of MOV during the frst 24 months of life and risk factors for their occurrence. We conducted a survey among children ≤24 month's caregivers at five hospitals in different departments, between August-December/2008. Total enrolled: 1591 children; 54.2% male, median of age 8 months (0-24 months). Eighty percent concurred with vaccine-card, 75.9% consulted by pathology. Overall DVS rate: 39.7%. Most common DVS reason: the current mild disease: 38.5%. Overall MOV rate: 19.8%. Most common MOV reason: no detection of the need to vaccinate 47.8%. DTPHib and OPV vaccines had a higher risk of DVS and MOV. DVS independent predictors: age ≥6 months, administration for additionally recommended vaccines and prolonged waiting in the last vaccination. MOV independent predictors were: age ≥6 mo...
In Argentina, pandemic influenza pH1N1 caused nearly 10,000 confirmed cases with high impact in p... more In Argentina, pandemic influenza pH1N1 caused nearly 10,000 confirmed cases with high impact in pediatrics. To describe clinical and epidemiological characteristics and analyse the risk factor of lethality in children hospitalized with infection pH1N1 confirmed by PCR. We identifed all suspected cases (according to Ministry of health) in 34 centers and we included all the confirmed cases of 0-18 years from 1/4/09 to 31/8/09 in a retrospective cohort study. The viral diagnosis was confirmed by RT-PCR method. Data are expressed in percentages, average, median, standard deviation, and range (IQR) as appropriate; and as a measure of association, relative risk (RR), with 95% confidence interval (95%CI). Multiple logistic regression was conducted to determine the independent risk predictors. Total number of suspected cases were: 2367; PCR was performed to 47.8% (n: 1131) being positive for pH1N1 65.5% (n: 741/1131); 57.2% males; 61.5% <24 months, median age: 14 months (IQR 6-46 months)...
Artículo original Resumen Introducción. Streptococcus pneumoniae (Sp) causa enfermedades invasiva... more Artículo original Resumen Introducción. Streptococcus pneumoniae (Sp) causa enfermedades invasivas de alta morbimortalidad, registrándose en la última década un aumento de la resistencia antibiótica. Material y métodos. Con el objetivo de estudiar la epidemiología del Sp, su susceptibilidad antibiótica y los factores de riesgo de resistencia a penicilina (RP), se evaluaron en forma prospectiva 274 pacientes con infecciones invasivas por Sp internados en el HNRG entre 1993 y 1999, inclusive. La mediana de edad fue de 21,5 meses (rango 1-180), la relación varón/mujer fue de 1,7:1; 11,8% eran desnutridos de II-III grado; 52,6% tenía enfermedad de base (respiratoria crónica o recidivante, 38,9%). A partir del aislamiento bacteriológico de Sp se realizó el seguimiento clínico-epidemiológico del paciente. Resultados. De 293 presentaciones clínicas, la más frecuente fue neumonía (64,2%), siguiendo meningitis (11,6%), sepsis/bacteriemia (10,9%), peritonitis (7,8%) y 16 pacientes presentaron formas asociadas.
En los últimos años, en la Argentina, se han producido cambios epidemiológicos en la incidencia d... more En los últimos años, en la Argentina, se han producido cambios epidemiológicos en la incidencia de los distintos agentes causantes de MAB. Según datos del Ministerio de Salud y Medio Ambiente,4,5 N. meningitidis fue el agen-te más prevalente en la década de 1990, se ...
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