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Benito N, Martínez-Pastor JC, Lora-Tamayo J, Ariza J, Baeza J, Belzunegui-Otano J, Cobo J, Del-Toro MD, Fontecha CG, Font-Vizcarra L, Horcajada JP, Morata L, Murillo O, Nolla JM, Núñez-Cuadros E, Pigrau C, Portillo ME, Rodríguez-Pardo D, Sobrino-Díaz B, Saavedra-Lozano J. Executive summary: Guidelines for the diagnosis and treatment of septic arthritis in adults and children, developed by the GEIO (SEIMC), SEIP and SECOT. Enferm Infecc Microbiol Clin (Engl Ed) 2024; 42:208-214. [PMID: 37919201 DOI: 10.1016/j.eimce.2023.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 07/14/2023] [Indexed: 11/04/2023]
Abstract
Infection of a native joint, commonly referred to as septic arthritis, is a medical emergency because of the risk of joint destruction and subsequent sequelae. Its diagnosis requires a high level of suspicion. These guidelines for the diagnosis and treatment of septic arthritis in children and adults are intended for use by any physician caring for patients with suspected or confirmed septic arthritis. They have been developed by a multidisciplinary panel with representatives from the Bone and Joint Infections Study Group (GEIO) belonging to the Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC), the Spanish Society of Paediatric Infections (SEIP) and the Spanish Society of Orthopaedic Surgery and Traumatology (SECOT), and two rheumatologists. The recommendations are based on evidence derived from a systematic literature review and, failing that, on the opinion of the experts who prepared these guidelines. A detailed description of the background, methods, summary of evidence, the rationale supporting each recommendation, and gaps in knowledge can be found online in the complete document.
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Affiliation(s)
- Natividad Benito
- Unidad de Enfermedades Infecciosas - Hospital de la Santa Creu i Sant Pau, Institut d'Investigació Biomèdica Sant Pau (IIB), Universitat Autònoma de Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC-CIBER de Enfermedades Infecciosas), ISCIII, Madrid, Spain; The University of Queensland, UQ Centre for Clinical Research, Australia.
| | - Juan Carlos Martínez-Pastor
- Servicio de Cirugía Ortopédica y Traumatología - Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Jaime Lora-Tamayo
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC-CIBER de Enfermedades Infecciosas), ISCIII, Madrid, Spain; Servicio de Medicina Interna, Hospital Univ. 12 de Octubre, Instituto de Investigación Biomédica "imas12" Hospital 12 de Octubre, Madrid, Spain
| | - Javier Ariza
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC-CIBER de Enfermedades Infecciosas), ISCIII, Madrid, Spain; Servicio de Enfermedades Infecciosas - Hospital Universitari de Bellvitge, IDIBELL, Universitat de Barcelona, Spain
| | - José Baeza
- Servicio de Cirugía Ortopédica, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | | | - Javier Cobo
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC-CIBER de Enfermedades Infecciosas), ISCIII, Madrid, Spain; Servicio de Enfermedades Infecciosas - Hospital Ramón y Cajal, IRYCIS, Madrid, Spain
| | - María-Dolores Del-Toro
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC-CIBER de Enfermedades Infecciosas), ISCIII, Madrid, Spain; Unidad Clínica de Enfermedades Infecciosas y Microbiología - Hospital Universitario Virgen Macarena, Instituto de Biomedicina de Sevilla (IBIS)/CSIC, Universidad de Sevilla, Seville, Spain
| | - Cesar G Fontecha
- Servicio de Ortopedia y Traumatología pediátricas - Hospital Sant Joan de Déu, Barcelona, Spain
| | - Lluís Font-Vizcarra
- Servicio de Cirugía Ortopédica y Traumatología - Hospital Moisés Broggi-Hospital general d'Hospitalet, Consorcio Sanitari Integral, Barcelona, Spain
| | - Juan P Horcajada
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC-CIBER de Enfermedades Infecciosas), ISCIII, Madrid, Spain; The University of Queensland, UQ Centre for Clinical Research, Australia; Servicio de Enfermedades Infecciosas - Hospital del Mar, IMIM, Universitat Pompeu Fabra, Barcelona, Spain
| | - Laura Morata
- Servicio de Enfermedades Infecciosas - Hospital Clínic, IDIBAPS, Universitat de Barcelona, Barcelona, Spain
| | - Oscar Murillo
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC-CIBER de Enfermedades Infecciosas), ISCIII, Madrid, Spain; Servicio de Enfermedades Infecciosas - Hospital Universitari de Bellvitge, IDIBELL, l'Hospitalet de Llobregat, Barcelona, Spain
| | - Joan M Nolla
- Servicio de Reumatología - Hospital Universitari de Bellvitge, IDIBELL, Universitat de Barcelona, Barcelona, Spain
| | - Esmeralda Núñez-Cuadros
- Servicio de Pediatría, Unidad de Reumatología Pediátrica - Hospital Regional Universitario de Málaga, Spain
| | - Carlos Pigrau
- Servicio de Enfermedades Infecciosas - Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Hospital Universitari, Universitat Autònoma de Barcelona, Barcelona, Spain; Clínica Creu Blanca, Barcelona, Spain
| | | | - Dolors Rodríguez-Pardo
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC-CIBER de Enfermedades Infecciosas), ISCIII, Madrid, Spain; Servicio de Enfermedades Infecciosas - Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Hospital Universitari, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Beatriz Sobrino-Díaz
- Servicio de Enfermedades Infecciosas - Hospital Regional Universitario de Málaga, IBIMA, Málaga, Spain
| | - Jesús Saavedra-Lozano
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC-CIBER de Enfermedades Infecciosas), ISCIII, Madrid, Spain; Servicio de Pediatría, Sección de Enfermedades Infecciosas - Hospital General Universitario Gregorio Marañón, Universidad Complutense de Madrid, Madrid, Spain
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2
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Ramírez de Arellano E, Saavedra-Lozano J, Villalón P, Jové-Blanco A, Grandioso D, Sotelo J, Gamell A, González-López JJ, Cervantes E, Gónzalez MJ, Rello-Saltor V, Esteva C, Sanz-Santaeufemia F, Yagüe G, Manzanares Á, Brañas P, Ruiz de Gopegui E, Carrasco-Colom J, García F, Cercenado E, Mellado I, Del Castillo E, Pérez-Vazquez M, Oteo-Iglesias J, Calvo C. Clinical, microbiological, and molecular characterization of pediatric invasive infections by Streptococcus pyogenes in Spain in a context of global outbreak. mSphere 2024; 9:e0072923. [PMID: 38440985 DOI: 10.1128/msphere.00729-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Accepted: 02/15/2024] [Indexed: 03/06/2024] Open
Abstract
In December 2022, an alert was published in the UK and other European countries reporting an unusual increase in the incidence of Streptococcus pyogenes infections. Our aim was to describe the clinical, microbiological, and molecular characteristics of group A Streptococcus invasive infections (iGAS) in children prospectively recruited in Spain (September 2022-March 2023), and compare invasive strains with strains causing mild infections. One hundred thirty isolates of S. pyogenes causing infection (102 iGAS and 28 mild infections) were included in the microbiological study: emm typing, antimicrobial susceptibility testing, and sequencing for core genome multilocus sequence typing (cgMLST), resistome, and virulome analysis. Clinical data were available from 93 cases and 21 controls. Pneumonia was the most frequent clinical syndrome (41/93; 44.1%), followed by deep tissue abscesses (23/93; 24.7%), and osteoarticular infections (11/93; 11.8%). Forty-six of 93 cases (49.5%) required admission to the pediatric intensive care unit. iGAS isolates mainly belonged to emm1 and emm12; emm12 predominated in 2022 but was surpassed by emm1 in 2023. Spread of M1UK sublineage (28/64 M1 isolates) was communicated for the first time in Spain, but it did not replace the still predominant sublineage M1global (36/64). Furthermore, a difference in emm types compared with the mild cases was observed with predominance of emm1, but also important representativeness of emm12 and emm89 isolates. Pneumonia, the most frequent and severe iGAS diagnosed, was associated with the speA gene, while the ssa superantigen was associated with milder cases. iGAS isolates were mainly susceptible to antimicrobials. cgMLST showed five major clusters: ST28-ST1357/emm1, ST36-ST425/emm12, ST242/emm12.37, ST39/emm4, and ST101-ST1295/emm89 isolates. IMPORTANCE Group A Streptococcus (GAS) is a common bacterial pathogen in the pediatric population. In the last months of 2022, an unusual increase in GAS infections was detected in various countries. Certain strains were overrepresented, although the cause of this raise is not clear. In Spain, a significant increase in mild and severe cases was also observed; this study evaluates the clinical characteristics and the strains involved in both scenarios. Our study showed that the increase in incidence did not correlate with an increase in resistance or with an emm types shift. However, there seemed to be a rise in severity, partly related to a greater rate of pneumonia cases. These findings suggest a general increase in iGAS that highlights the need for surveillance. The introduction of whole genome sequencing in the diagnosis and surveillance of iGAS may improve the understanding of antibiotic resistance, virulence, and clones, facilitating its control and personalized treatment.
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Affiliation(s)
- Eva Ramírez de Arellano
- Laboratorio de Referencia e Investigación en Resistencia a Antibióticos e Infecciones Relacionadas con la Asistencia Sanitaria, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
- CIBER de Enfermedades Infecciosas (CIBERINFEC). Instituto Salud Carlos III, Madrid, Spain
| | - Jesús Saavedra-Lozano
- CIBER de Enfermedades Infecciosas (CIBERINFEC). Instituto Salud Carlos III, Madrid, Spain
- Servicio de Pediatría, Hospital General Universitario Gregorio Marañón. Universidad Complutense, Madrid, Spain
| | - Pilar Villalón
- Laboratorio de Referencia e Investigación en Taxonomía, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Madrid, Spain
| | - Ana Jové-Blanco
- Servicio de Pediatría, Hospital General Universitario Gregorio Marañón. Universidad Complutense, Madrid, Spain
| | - David Grandioso
- Servicio de Microbiología, Hospital Universitario La Paz, Madrid, Spain
| | - Jared Sotelo
- Laboratorio de Referencia e Investigación en Resistencia a Antibióticos e Infecciones Relacionadas con la Asistencia Sanitaria, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
- CIBER de Enfermedades Infecciosas (CIBERINFEC). Instituto Salud Carlos III, Madrid, Spain
| | - Anna Gamell
- Servicio de Enfermedades Infecciosas, Hospital San Joan de Déu, Barcelona, Spain
| | - Juan José González-López
- CIBER de Enfermedades Infecciosas (CIBERINFEC). Instituto Salud Carlos III, Madrid, Spain
- Servicio de Microbiología, Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | - Eloísa Cervantes
- Servicio de Pediatría, Hospital Virgen de la Arrixaca, Murcia, Spain
| | | | | | - Cristina Esteva
- Servicio de Microbiología, Hospital San Joan de Dèu, Barcelona, Spain
| | | | - Genoveva Yagüe
- Servicio de Microbiología, Hospital Virgen de la Arrixaca, Murcia, Spain
| | | | - Patricia Brañas
- Servicio de Microbiología, Hospital 12 de Octubre, Madrid, Spain
| | - Enrique Ruiz de Gopegui
- CIBER de Enfermedades Infecciosas (CIBERINFEC). Instituto Salud Carlos III, Madrid, Spain
- Servicio de Microbiología, Hospital Universitario Son Espases, Instituto de Investigación Sanitaria Illes Balears (IdiSBA), Palma, Spain
| | | | - Federico García
- CIBER de Enfermedades Infecciosas (CIBERINFEC). Instituto Salud Carlos III, Madrid, Spain
- Servicio de Microbiología, Hospital San Cecilio, Instituto de Investigación IbS.GRANADA, Granada, Spain
| | - Emilia Cercenado
- Servicio de Microbiología Clínica y Enfermedades Infecciosas, Hospital Universitario Gregorio Marañón, Madrid, Spain
- CIBER de Enfermedades Respiratorias (CIBERES). Instituto Salud Carlos III, Madrid, Spain
| | - Isabel Mellado
- Servicio de Pediatría y Enfermedades Infecciosas, Hospital Universitario La Paz, Fundación IdiPaz Madrid, Spain. Red de Investigación Traslación en Infectología Pediátrica (RITIP), Universidad Autónoma de Madrid, Madrid, Spain
| | - Elena Del Castillo
- Servicio de Pediatría. Hospital Materno Infantil de Badajoz, Badajoz, Spain
| | - María Pérez-Vazquez
- Laboratorio de Referencia e Investigación en Resistencia a Antibióticos e Infecciones Relacionadas con la Asistencia Sanitaria, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
- CIBER de Enfermedades Infecciosas (CIBERINFEC). Instituto Salud Carlos III, Madrid, Spain
| | - Jesús Oteo-Iglesias
- Laboratorio de Referencia e Investigación en Resistencia a Antibióticos e Infecciones Relacionadas con la Asistencia Sanitaria, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
- CIBER de Enfermedades Infecciosas (CIBERINFEC). Instituto Salud Carlos III, Madrid, Spain
| | - Cristina Calvo
- CIBER de Enfermedades Infecciosas (CIBERINFEC). Instituto Salud Carlos III, Madrid, Spain
- Servicio de Pediatría y Enfermedades Infecciosas, Hospital Universitario La Paz, Fundación IdiPaz Madrid, Spain. Red de Investigación Traslación en Infectología Pediátrica (RITIP), Universidad Autónoma de Madrid, Madrid, Spain
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3
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Rodríguez-Molino P, González Sánchez A, Noguera-Julián A, Soler-García A, Martínez Paz P, Méndez-Echevarría A, Baquero-Artigao F, González Muñoz M, Ruíz-Serrano MJ, Monsonís M, Sánchez León R, Saavedra-Lozano J, Santiago-García B, Sainz T. QuantiFERON-TB reversion in children and adolescents with tuberculosis. Front Immunol 2024; 15:1310472. [PMID: 38576621 PMCID: PMC10991797 DOI: 10.3389/fimmu.2024.1310472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 02/28/2024] [Indexed: 04/06/2024] Open
Abstract
We analyzed 136 children with tuberculosis disease or infection and a positive QuantiFERON-TB (QFT) assay, followed-up for a median of 21 months (0.4-11years). QFT reversed in 16.9% of cases, with significant decreases in TB1 (-1.72 vs. -0.03 IU/ml, p=0.001) and TB2 (-1.65 vs. -0.43 IU/ml, p=0.005) levels compared to non-reverters. We found a higher QFT reversion rate among children under 5 years (25.0% vs 11.9%, p=0.042), and those with TST induration <15mm (29% vs 13.3%, p=0.055). Our data reveal that, although QFT test remained positive in the majority of children, reversion occurred in 16% of cases in a progressive and stable pattern. Younger age and reduced TST induration were associated with QFT reversion.
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Affiliation(s)
- Paula Rodríguez-Molino
- General Pediatrics, Infectious and Tropical Diseases Department, Hospital La Paz, Madrid, Spain
- La Paz Research Institute (IdiPAZ), Madrid, Spain
- Universidad Autónoma de Madrid (UAM), Madrid, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Infecciosas (CIBERINFEC), Madrid, Spain
| | | | - Antoni Noguera-Julián
- Malalties Infeccioses i Resposta Inflamatòria Sistèmica en Pediatria, Servei de Malalties Infeccioses Patologia Importada, Institut de Recerca Pediàtrica Sant Joan de Déu, Barcelona, Spain
- Departament de Cirurgia i Especialitats Medicoquirúrgiques, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública, Instituto de Salud Carlos III, Madrid, Spain
- Red de Investigación Translacional en Infectología Pediátrica (RITIP), Madrid, Spain
| | - Aleix Soler-García
- Malalties Infeccioses i Resposta Inflamatòria Sistèmica en Pediatria, Servei de Malalties Infeccioses Patologia Importada, Institut de Recerca Pediàtrica Sant Joan de Déu, Barcelona, Spain
| | - Patricia Martínez Paz
- General Pediatrics, Infectious and Tropical Diseases Department, Hospital La Paz, Madrid, Spain
| | - Ana Méndez-Echevarría
- General Pediatrics, Infectious and Tropical Diseases Department, Hospital La Paz, Madrid, Spain
- La Paz Research Institute (IdiPAZ), Madrid, Spain
- Universidad Autónoma de Madrid (UAM), Madrid, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Infecciosas (CIBERINFEC), Madrid, Spain
| | - Fernando Baquero-Artigao
- General Pediatrics, Infectious and Tropical Diseases Department, Hospital La Paz, Madrid, Spain
- La Paz Research Institute (IdiPAZ), Madrid, Spain
- Universidad Autónoma de Madrid (UAM), Madrid, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Infecciosas (CIBERINFEC), Madrid, Spain
| | | | - María Jesús Ruíz-Serrano
- Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañon, Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
- Centro de Investigación Biomédica en Red (CIBER) de Enfermedades Respiratorias - CIBERES, Madrid, Spain
| | - Manuel Monsonís
- Servei de Microbiologia, Hospital Sant Joan de Déu, Barcelona, Spain
| | - Rocío Sánchez León
- General Pediatrics, Infectious and Tropical Diseases Department, Hospital La Paz, Madrid, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Infecciosas (CIBERINFEC), Madrid, Spain
| | - Jesús Saavedra-Lozano
- Infectious Diseases Department, General Pediatrics, Hospital Gregorio Marañón, Madrid, Spain
| | - Begoña Santiago-García
- Centro de Investigación Biomédica en Red en Enfermedades Infecciosas (CIBERINFEC), Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
- Infectious Diseases Department, General Pediatrics, Hospital Gregorio Marañón, Madrid, Spain
| | - Talía Sainz
- General Pediatrics, Infectious and Tropical Diseases Department, Hospital La Paz, Madrid, Spain
- La Paz Research Institute (IdiPAZ), Madrid, Spain
- Universidad Autónoma de Madrid (UAM), Madrid, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Infecciosas (CIBERINFEC), Madrid, Spain
- Red de Investigación Translacional en Infectología Pediátrica (RITIP), Madrid, Spain
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4
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Mellado-Sola I, Cobo-Vázquez E, Calvo-Fernandez A, Cervantes E, Coca A, Calderón-Llopis B, Saavedra-Lozano J, Calvo C. Mediastinitis secondary to invasive infection by group A Streptococcus in Spain. Eur J Pediatr 2024; 183:503-507. [PMID: 37889290 DOI: 10.1007/s00431-023-05288-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 10/09/2023] [Accepted: 10/13/2023] [Indexed: 10/28/2023]
Abstract
This study describes 5 mediastinitis cases secondary to invasive group A Streptococcus (iGAS) disease in a recent outbreak in Spain. Among 398 iGAS cases between January 2019-March 2023, 5 (1.3%) were mediastinitis, 4 occurring in December 2022, all secondary to pneumonia or deep neck infection. We outline the clinical outcome with a review of the scarce pediatric literature. Conclusion: mediastinistis is a rare but severe complication of iGAS and a high level of suspicion is required to diagnose it. What is Known: • Group A Streptococcus can cause invasive and severe infections in children. • Mediastinitis is a severe complication from some bacterial infections, mainly secondary due to deep-neck abscesses. What is New: • Mediastinitis is an unrecognized complication due to an invasive group A Streptococcus (iGAS) infection. • In cases of a deep-neck abscess or complicated pneumonia a high clinical suspicion of iGAS mediastinitis is required, especially when the clinical course is not favorable.
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Affiliation(s)
- I Mellado-Sola
- Pediatric and Infectious Diseases Department, La Paz University Hospital, Institute for Health Research (IdiPAZ), Pº Castellana, 261, Madrid, 28046, Spain.
| | - E Cobo-Vázquez
- Department of Pediatrics. Hospital, Universitario Fundación de Alcorcón, Alcorcón, Madrid, Spain
- Program in Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | - A Calvo-Fernandez
- Pediatric Intensive Care Unit, La Paz University Hospital, Madrid, Spain
| | - E Cervantes
- Pediatrics and Infectious Diseases Department, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain
| | - A Coca
- Pediatric Intensive Care Unit, Ramón y Cajal University Hospital, Madrid, Spain
| | - B Calderón-Llopis
- Pediatric Intensive Care Unit, La Paz University Hospital, Madrid, Spain
| | - J Saavedra-Lozano
- Pediatric Infectious Diseases Unit, Department of Pediatrics, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Biomedical Research Network Centre for Infectious Diseases (CIBERINFEC), Carlos III Health Institute, Madrid, Spain
- Translational Research Network in Pediatric Infectious Diseases (RITIP), Madrid, Spain
- Hospital Institute of Health Research (IiSGM), Madrid, Spain
- Universidad Complutense de Madrid, Madrid, Spain
| | - C Calvo
- Pediatric and Infectious Diseases Department, La Paz University Hospital, Institute for Health Research (IdiPAZ), Pº Castellana, 261, Madrid, 28046, Spain
- Biomedical Research Network Centre for Infectious Diseases (CIBERINFEC), Carlos III Health Institute, Madrid, Spain
- Translational Research Network in Pediatric Infectious Diseases (RITIP), Madrid, Spain
- Universidad Autónoma de Madrid, Madrid, Spain
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5
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Aguilera-Alonso D, Escosa-García L, Epalza C, Bravo-Queipo-de-Llano B, Camil Olteanu F, Cendejas-Bueno E, Orellana MÁ, Cercenado E, Saavedra-Lozano J. Antibiotic resistance in bloodstream isolates from high-complexity paediatric units in Madrid, Spain: 2013-2021. J Hosp Infect 2023; 139:33-43. [PMID: 37331378 DOI: 10.1016/j.jhin.2023.05.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 05/19/2023] [Indexed: 06/20/2023]
Abstract
BACKGROUND Antimicrobial resistance (AMR) has become a significant challenge in high-complexity healthcare settings. AIM To evaluate the prevalence of AMR in bloodstream isolates from high-complexity paediatric units in Spain over a nine-year period. METHODS A retrospective observational multicentre study was conducted in three tertiary hospitals, analysing bloodstream isolates from patients aged <18 years admitted to the paediatric intensive care, neonatology, and oncology-haematology units between 2013 and 2021. Demographics, antimicrobial susceptibility, and resistance mechanisms were analysed in two periods (2013-2017 and 2017-2021). FINDINGS In all, 1255 isolates were included. AMR was more prevalent in older patients and those admitted to the oncology-haematology unit. Multidrug resistance was observed in 9.9% of Gram-negative bacteria (GNB); 20.0% of P. aeruginosa vs 8.6% of Entero-bacterales (P < 0.001), with an increase in Enterobacterales from 6.2% to 11.0% between the first and the second period (P = 0.021). Difficult-to-treat resistance was observed in 2.7% of GNB; 7.4% of P. aeruginosa vs 1.6% of Enterobacterales (P < 0.001), with an increasing trend in Enterobacterales from 0.8% to 2.5% (P = 0.076). Carbapenem resistance among Enterobacterales increased from 3.5% to 7.2% (P = 0.029), with 3.3% producing carbapenemases (67.9% VIM). Meticillin resistance was observed in 11.0% of S. aureus and vancomycin resistance in 1.4% of Enterococcus spp., with both rates remaining stable throughout the study period. CONCLUSION This study reveals a high prevalence of AMR in high-complexity paediatric units. Enterobacterales showed a concerning increasing trend in resistant strains, with higher rates among older patients and those admitted to oncology-haematology units.
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Affiliation(s)
- D Aguilera-Alonso
- Paediatric Infectious Diseases Unit, Department of Paediatrics, Hospital Gregorio Marañón, Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain.
| | - L Escosa-García
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain; Department of Paediatrics, Infectious, and Tropical Diseases, Hospital La Paz, Madrid, Spain; Instituto de Investigación Hospital Universitario La Paz (IdiPaz), Madrid, Spain
| | - C Epalza
- Paediatric Infectious Diseases Unit, Hospital Universitario 12 de Octubre, Madrid, Spain; Instituto de Investigación Hospital 12 de Octubre (imas12), Madrid, Spain
| | - B Bravo-Queipo-de-Llano
- Department of Paediatrics, Infectious, and Tropical Diseases, Hospital La Paz, Madrid, Spain
| | - F Camil Olteanu
- Paediatric Infectious Diseases Unit, Hospital Universitario 12 de Octubre, Madrid, Spain; Department of Paediatrics, Hospital Universitario de Guadalajara, Guadalajara, Spain
| | - E Cendejas-Bueno
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain; Department of Microbiology, Hospital Universitario La Paz-Cantoblanco-Carlos III, Madrid, Spain
| | - M Á Orellana
- Instituto de Investigación Hospital 12 de Octubre (imas12), Madrid, Spain; Department of Microbiology, Hospital Universitario 12 de Octubre, Madrid, Spain; Complutense University of Madrid, Madrid, Spain
| | - E Cercenado
- Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain; Clinical Microbiology and Infectious Diseases Department, Hospital Gregorio Marañón, Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain; Complutense University of Madrid, Madrid, Spain
| | - J Saavedra-Lozano
- Paediatric Infectious Diseases Unit, Department of Paediatrics, Hospital Gregorio Marañón, Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain; Complutense University of Madrid, Madrid, Spain
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6
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Cobo-Vázquez E, Aguilera-Alonso D, Carbayo T, Figueroa-Ospina LM, Sanz-Santaeufemia F, Baquero-Artigao F, Vázquez-Ordoñez C, Carrasco-Colom J, Blázquez-Gamero D, Jiménez-Montero B, Grasa-Lozano C, Cilleruelo MJ, Álvarez A, Comín-Cabrera C, Penin M, Cercenado E, Del Valle R, Roa MÁ, Diego IGD, Calvo C, Saavedra-Lozano J. Epidemiology and clinical features of Streptococcus pyogenes bloodstream infections in children in Madrid, Spain. Eur J Pediatr 2023:10.1007/s00431-023-04967-5. [PMID: 37140702 DOI: 10.1007/s00431-023-04967-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 03/24/2023] [Accepted: 03/31/2023] [Indexed: 05/05/2023]
Abstract
Studies have shown increased invasive Group A Streptococcus (GAS) disease, including bloodstream infections (GAS-BSI). However, the epidemiological data of GAS-BSI are limited in children. We aimed to describe GAS-BSI in children in Madrid, over 13 years (2005-2017). Multicenter retrospective cohort study from 16 hospitals from Madrid, Spain. Epidemiology, symptomatology, laboratory, treatment, and outcome of GAS-BSI in children ≤ 16 years were analyzed. 109 cases of GAS-BSI were included, with incidence rate of 4.3 episodes/100,000 children attended at the emergency department/year. We compared incidence between two periods (P1: 2005-June 2011 vs P2: July 2011-2017) and observed a non-significant increase along the study period (annual percentage change: + 6.0% [95%CI: -2.7, + 15.4]; p = 0.163). Median age was 24.1 months (IQR: 14.0-53.7), peaking during the first four years of life (89/109 cases; 81.6%). Primary BSI (46.8%), skin and soft tissue (21.1%), and osteoarticular infections (18.3%) were the most common syndromes. We compared children with primary BSI with those with a known source and observed that the former had shorter hospital stay (7 vs. 13 days; p = 0.003) and received intravenous antibiotics less frequently (72.5% vs. 94.8%; p = 0.001) and for shorter duration of total antibiotic therapy (10 vs. 21 days; p = 0.001). 22% of cases required PICU admission. Factors associated with severity were respiratory distress, pneumonia, thrombocytopenia, and surgery, but in multivariate analysis, only respiratory distress remained significant (adjusted OR:9.23 [95%CI: 2.16-29.41]). Two children (1.8%) died. Conclusion: We observed an increasing, although non-significant, trend of GAS-BSI incidence within the study. Younger children were more frequently involved, and primary BSI was the most common and less severe syndrome. PICU admission was frequent, being respiratory distress the main risk factor. What is known: • In recent decades, several reports have shown a worldwide increase in the incidence of invasive Group A streptococcal disease (GAS), including bloodstream infection (BSI). Recently, there have been a few reports showing an increase in severity as well. • There needs to be more information on the epidemiology in children since most studies predominantly include adults. What is new: • This study, carried out in children with GAS-BSI in Madrid, shows that GAS-BSI affects mostly younger children, with a broad spectrum of manifestations, needing PICU admission frequently. Respiratory distress was the leading risk factor for severity, whereas primary BSI seemed to be less severe. • We observed an increasing, although non-significant, trend of GAS-BSI incidence in recent years (2005-2017).
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Affiliation(s)
- Elvira Cobo-Vázquez
- Department of Pediatrics, Hospital Universitario Fundación de Alcorcón, Servicio de Pediatría, Calle Budapest Nº1, 28922, Alcorcón, Madrid, Spain
- PhD Program in Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | - David Aguilera-Alonso
- PhD Program in Medicine, Universidad Complutense de Madrid, Madrid, Spain.
- Pediatric Infectious Diseases Unit, Department of Pediatrics, Hospital General Universitario Gregorio Marañón. CIBER de enfermedades infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Servicio de Pediatría, Calle de O'Donnell, Madrid, 28009, Madrid, Spain.
| | - Tania Carbayo
- Department of Neonatology, Hospital Universitario, 12 de Octubre, Madrid, Spain
| | | | | | - Fernando Baquero-Artigao
- Department of Infectious Diseases and Tropical Pediatrics, Hospital Universitario La Paz and IdiPaz Foundation, Madrid, Spain
- RITIP, Translational Research Network in Pediatric Infectious Diseases, CIBER de enfermedades infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Universidad Autónoma, Madrid, Spain
| | | | - Jaime Carrasco-Colom
- Pediatric Infectious Diseases Unit, Department of Pediatrics, Hospital Universitario La Moraleja, Madrid, Spain
- Pediatric Infectious Diseases Unit, Department of Pediatrics, Hospital Universitari Son Espases, Palma de Mallorca, Spain
| | - Daniel Blázquez-Gamero
- Pediatric Infectious Diseases Unit, Department of Pediatrics, Hospital Universitario 12 de Octubre, Instituto de Investigación Hospital 12 de Octubre (imas12). Universidad Complutense, RITIP, Madrid, Spain
| | | | - Carlos Grasa-Lozano
- Department of Infectious Diseases and Tropical Pediatrics, Hospital Universitario La Paz and IdiPaz Foundation, Madrid, Spain
- RITIP, Translational Research Network in Pediatric Infectious Diseases, CIBER de enfermedades infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Universidad Autónoma, Madrid, Spain
- Department of Pediatrics, Hospital Universitario de Fuenlabrada, Fuenlabrada, Madrid, Spain
| | - María José Cilleruelo
- Department of Pediatrics, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
| | - Ana Álvarez
- Department of Pediatrics, Hospital Universitario de Getafe, Getafe, Madrid, Spain
| | - Cristina Comín-Cabrera
- Department of Pediatrics, Hospital Universitario de Torrejón, Torrejón de Ardoz, Madrid, Spain
| | - María Penin
- Department of Pediatrics, Hospital, Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, Spain
| | - Emilia Cercenado
- Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón, CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
| | - Rut Del Valle
- Department of Pediatrics, Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Madrid, Spain
| | - Miguel Ángel Roa
- Department of Pediatrics, Hospital Universitario de Móstoles, Móstoles, Madrid, Spain
| | | | - Cristina Calvo
- Department of Infectious Diseases and Tropical Pediatrics, Hospital Universitario La Paz and IdiPaz Foundation, Madrid, Spain
- RITIP, Translational Research Network in Pediatric Infectious Diseases, CIBER de enfermedades infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Universidad Autónoma, Madrid, Spain
| | - Jesús Saavedra-Lozano
- Pediatric Infectious Diseases Unit, Department of Pediatrics, Hospital General Universitario Gregorio Marañón, CIBER de enfermedades infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Universidad Complutense, Madrid, Spain
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7
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Cobo-Vázquez E, Aguilera-Alonso D, Carrasco-Colom J, Calvo C, Saavedra-Lozano J. Increasing incidence and severity of invasive Group A streptococcal disease in Spanish children in 2019-2022. Lancet Reg Health Eur 2023; 27:100597. [PMID: 36895202 PMCID: PMC9989682 DOI: 10.1016/j.lanepe.2023.100597] [Citation(s) in RCA: 18] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 02/07/2023] [Accepted: 02/08/2023] [Indexed: 03/01/2023]
Affiliation(s)
- Elvira Cobo-Vázquez
- Department of Pediatrics, Hospital Universitario Fundación de Alcorcón, Alcorcón, Madrid, Spain
- PhD Program in Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | - David Aguilera-Alonso
- PhD Program in Medicine, Universidad Complutense de Madrid, Madrid, Spain
- Pediatric Infectious Diseases Unit, Department of Pediatrics, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
- Centro de Investigación Biomedica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
- Corresponding author. Hospital General Universitario Gregorio Marañón, Servicio de Pediatría, Calle de O'Donnell, 28009, Madrid, Spain.
| | - Jaime Carrasco-Colom
- Pediatric Infectious Diseases Unit, Department of Pediatrics, Hospital Universitari Son Espases, Palma de Mallorca, Spain
| | - Cristina Calvo
- Centro de Investigación Biomedica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
- Pediatrics, Infectious and Tropical Diseases Department, Hospital Universitario La Paz, Instituto Investigación Hospital La Paz (IDIPaz), Madrid, Spain
| | - Jesús Saavedra-Lozano
- Pediatric Infectious Diseases Unit, Department of Pediatrics, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
- Centro de Investigación Biomedica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
- Universidad Complutense, Madrid, Spain
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8
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Gutiérrez-Vélez A, Castro-Rodríguez C, Jové-Blanco A, Aguilera-Alonso D, Rincón-López EM, Lobo AH, Navarro Gómez M, Hernández-Sampelayo T, Alonso-Fernández R, Saavedra-Lozano J. Acute Epstein-Barr virus infection: Diagnostic challenge in young children, risk factors for hospitalization and cytomegalovirus co-detection. Acta Paediatr 2023; 112:1287-1295. [PMID: 36938920 DOI: 10.1111/apa.16760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Revised: 01/31/2023] [Accepted: 03/16/2023] [Indexed: 03/21/2023]
Abstract
AIM Acute Epstein-Barr virus (aEBV) and cytomegalovirus (CMV) infections frequently have similar manifestations. We aim to evaluate the characteristics of aEBV infection, risk factors for hospitalization, and differences according to CMV IgM detection (EBV-CMV co-detection) in children. METHODS Retrospective, single-center study including patients <16 years diagnosed with aEBV infection (positive anti-EBV IgM/Paul-Bunnell test, and acute symptomatology). EBV-CMV co-detection was defined as positive CMV IgM. Factors associated with age, hospitalization and EBV-CMV co-detection were analyzed in a multivariate analysis. RESULTS 149 patients were included (median age 4.6 years). Most frequent manifestations were fever (77%), cervical lymphadenopathy (64%), and elevated liver enzymes (54%). Younger children had lower rate of positive Paul-Bunnell test (35 vs 87%; p<0.01), but higher rate of EBV-CMV co-detection (54 vs 29%; p=0.03). These children tended to have less typical symptoms of infectious mononucleosis and higher hospitalization rate. The overall antibiotic prescription was 49%. Hospitalization (27 children; 18%) was independently associated with prior antibiotic therapy and anemia. Sixty-two cases (42%) had EBV-CMV co-detection, which was independently associated with elevated liver enzymes and younger age. CONCLUSION In this study, younger children with aEBV infection presented more frequently with atypical clinical symptoms, had higher EBV-CMV co-detection rates and were more often hospitalized. Hospitalization was associated with prior antibiotic prescription.
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Affiliation(s)
| | | | - Ana Jové-Blanco
- Pediatric Emergency Unit, Department of Pediatrics, Hospital General Universitario Gregorio Marañón
| | - David Aguilera-Alonso
- Pediatric Infectious Diseases Unit, Department of Pediatrics, Hospital General Universitario Gregorio Marañón. Complutense University, Madrid. CIBERINFEC
| | - Elena María Rincón-López
- Pediatric Infectious Diseases Unit, Department of Pediatrics, Hospital General Universitario Gregorio Marañón. Complutense University, Madrid. CIBERINFEC
| | - Alicia Hernanz Lobo
- Pediatric Infectious Diseases Unit, Department of Pediatrics, Hospital General Universitario Gregorio Marañón. Complutense University, Madrid. CIBERINFEC
| | - Marisa Navarro Gómez
- Pediatric Infectious Diseases Unit, Department of Pediatrics, Hospital General Universitario Gregorio Marañón. Complutense University, Madrid. CIBERINFEC
| | - Teresa Hernández-Sampelayo
- Pediatric Infectious Diseases Unit, Department of Pediatrics, Hospital General Universitario Gregorio Marañón. Complutense University, Madrid. CIBERINFEC
| | | | - Jesús Saavedra-Lozano
- Pediatric Infectious Diseases Unit, Department of Pediatrics, Hospital General Universitario Gregorio Marañón. Complutense University, Madrid. CIBERINFEC
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9
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Soriano-Ramos M, Esquivel-De la Fuente E, Albert Vicent E, de la Calle M, Baquero-Artigao F, Domínguez-Rodríguez S, Cabanes M, Gómez-Montes E, Goncé A, Valdés-Bango M, Viñuela-Benéitez MC, Muñoz-Chápuli Gutiérrez M, Saavedra-Lozano J, Cuadrado Pérez I, Encinas B, Castells Vilella L, de la Serna Martínez M, Tagarro A, Rodríguez-Molino P, Giménez Quiles E, García Alcázar D, García Burguillo A, Folgueira MD, Navarro D, Blázquez-Gamero D. The role of the T-cell mediated immune response to Cytomegalovirus infection in intrauterine transmission. PLoS One 2023; 18:e0281341. [PMID: 36745589 PMCID: PMC9901742 DOI: 10.1371/journal.pone.0281341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Accepted: 01/23/2023] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION Prognostic markers for fetal transmission of Cytomegalovirus (CMV) infection during pregnancy are poorly understood. Maternal CMV-specific T-cell responses may help prevent fetal transmission and thus, we set out to assess whether this may be the case in pregnant women who develop a primary CMV infection. METHODS A multicenter prospective study was carried out at 8 hospitals in Spain, from January 2017 to April 2020. Blood samples were collected from pregnant women at the time the primary CMV infection was diagnosed to assess the T-cell response. Quantitative analysis of interferon producing specific CMV-CD8+/CD4+ cells was performed by intracellular cytokine flow cytometry. RESULTS In this study, 135 pregnant women with a suspected CMV infection were evaluated, 60 of whom had a primary CMV infection and samples available. Of these, 24 mothers transmitted the infection to the fetus and 36 did not. No association was found between the presence of specific CD4 or CD8 responses against CMV at the time maternal infection was diagnosed and the risk of fetal transmission. There was no transmission among women with an undetectable CMV viral load in blood at diagnosis. CONCLUSIONS In this cohort of pregnant women with a primary CMV infection, no association was found between the presence of a CMV T-cell response at the time of maternal infection and the risk of intrauterine transmission. A detectable CMV viral load in the maternal blood at diagnosis of the primary maternal infection may represent a relevant biomarker associated with fetal transmission.
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Affiliation(s)
- María Soriano-Ramos
- Department of Neonatology, Hospital Universitario 12 de Octubre, Madrid, Spain
- Instituto de Investigación Hospital 12 de Octubre (imas12), Fundación Biomédica del Hospital Universitario 12 de Octubre (FBHU12O), Madrid, Spain
- * E-mail:
| | - Estrella Esquivel-De la Fuente
- Instituto de Investigación Hospital 12 de Octubre (imas12), Fundación Biomédica del Hospital Universitario 12 de Octubre (FBHU12O), Madrid, Spain
| | - Eliseo Albert Vicent
- Microbiology Department, Hospital Clínico Universitario de Valencia, Valencia, Spain
| | | | - Fernando Baquero-Artigao
- Department of Infectious Diseases and Tropical Pediatrics, Hospital Universitario Infantil La Paz, Madrid, Spain
| | - Sara Domínguez-Rodríguez
- Instituto de Investigación Hospital 12 de Octubre (imas12), Fundación Biomédica del Hospital Universitario 12 de Octubre (FBHU12O), Madrid, Spain
| | - María Cabanes
- Obstetrics Department, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, Spain
| | - Enery Gómez-Montes
- Obstetrics Department, Fetal Medicine Unit, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Anna Goncé
- Fetal Medicine Research Center, BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Déu), Institut Clínic de Ginecología, Obstetricia i Neonatologia, Institut d’Investigacions Biomèdiques August Pi i Sunyer, Universitat de Barcelona, Barcelona, Spain
| | - Marta Valdés-Bango
- Fetal Medicine Research Center, BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Déu), Institut Clínic de Ginecología, Obstetricia i Neonatologia, Institut d’Investigacions Biomèdiques August Pi i Sunyer, Universitat de Barcelona, Barcelona, Spain
| | - Mª Carmen Viñuela-Benéitez
- Obstetrics Department, Hospital Gregorio Marañón, Complutense University, Health Research Institute Gregorio Marañón, Madrid, Spain
| | - Mar Muñoz-Chápuli Gutiérrez
- Obstetrics Department, Hospital Gregorio Marañón, Complutense University, Health Research Institute Gregorio Marañón, Madrid, Spain
| | - Jesús Saavedra-Lozano
- Hospital General Universitario Gregorio Marañón, Pediatric Infectious Diseases Unit, Universidad Complutense, Madrid, Spain
| | | | - Begoña Encinas
- Obstetrics Department, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
| | - Laura Castells Vilella
- Department of Neonatology, Hospital Universitari General de Catalunya, Grupo Quiron Salud, Sant Cugat del Vallès, Barcelona, Spain
| | | | - Alfredo Tagarro
- Paediatrics Department, Paediatrics Research Group, Hospital Universitario Infanta Sofía, Universidad Europea de Madrid, Madrid, Spain
| | - Paula Rodríguez-Molino
- Department of Infectious Diseases and Tropical Pediatrics, Hospital Universitario Infantil La Paz, Madrid, Spain
| | - Estela Giménez Quiles
- Microbiology Department, Hospital Clínico Universitario de Valencia, Valencia, Spain
| | - Diana García Alcázar
- Obstetrics Department, Fetal Medicine Unit, Hospital Universitario 12 de Octubre, Madrid, Spain
| | | | | | - David Navarro
- Microbiology Department, Hospital Clínico Universitario de Valencia, Valencia, Spain
| | - Daniel Blázquez-Gamero
- Instituto de Investigación Hospital 12 de Octubre (imas12), Fundación Biomédica del Hospital Universitario 12 de Octubre (FBHU12O), Madrid, Spain
- Pediatric Infectious Diseases Unit, Hospital Universitario 12 de Octubre, Universidad Complutense, RITIP, Madrid, Spain
| | - the CYTRIC Study Group
- Pediatric Infectious Diseases Unit, Hospital Universitario 12 de Octubre, Universidad Complutense, RITIP, Madrid, Spain
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10
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Ravn C, Neyt J, Benito N, Abreu M, Achermann Y, Bozhkova S, Coorevits L, Ferrari M, Gammelsrud K, Gerlach UJ, Giannitsioti E, Gottliebsen M, Jørgensen N, Madjarevic T, Marais L, Menon A, Moojen D, Pääkkönen M, Pokorn M, Pérez-Prieto D, Renz N, Saavedra-Lozano J, Sabater-Martos M, Sendi P, Tevell S, Vogely C, Soriano A, the SANJO guideline group. Guideline for management of septic arthritis in native joints (SANJO). J Bone Jt Infect 2023; 8:29-37. [PMID: 36756304 PMCID: PMC9901514 DOI: 10.5194/jbji-8-29-2023] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
This clinical guideline is intended for use by orthopedic surgeons and physicians who care for patients with possible or documented septic arthritis of a native joint (SANJO). It includes evidence and opinion-based recommendations for the diagnosis and management of patients with SANJO.
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Affiliation(s)
- Christen Ravn
- Dept. of Orthopaedic Surgery and Traumatology, Aarhus University
Hospital, Aarhus, Denmark,Members of the Steering Committee for the EBJIS Guideline Project on SANJO,shared first authorship
| | - Jeroen Neyt
- Dept. of Orthopedic Surgery, University Hospitals Ghent, Ghent, Belgium,Members of the Steering Committee for the EBJIS Guideline Project on SANJO,shared first authorship
| | - Natividad Benito
- Dept. of Infectious Diseases, Hospital de la Santa Creu i Sant Pau,
Barcelona, Spain,Members of the Steering Committee for the EBJIS Guideline Project on SANJO
| | | | - Yvonne Achermann
- Dept. of Internal Medicine, Hospital Zollikerberg, Zürich, Switzerland
| | - Svetlana Bozhkova
- Dept. of Prevention and Treatment of Wound Infection, Vreden National Medical Research Center of Traumatology and Orthopedics, St. Petersburg, Russia
| | | | - Matteo Carlo Ferrari
- Dept. of Internal Medicine, IRCCS Ospedale Galeazzi Sant'Ambrogio,
Milano, Italy
| | | | - Ulf-Joachim Gerlach
- Dept. of Septic Orthopedic Surgery and Traumatology, BG Klinikum
Hamburg, Hamburg, Germany
| | | | - Martin Gottliebsen
- Dept. of Orthopaedic Surgery and Traumatology, Aarhus University
Hospital, Aarhus, Denmark
| | | | | | - Leonard Marais
- Dept. of Orthopaedic Surgery, University of KwaZulu-Natal, Durban, South Africa
| | - Aditya Menon
- Dept. of Orthopaedics, P.D. Hinduja Hospital and Medical Research
Centre, Mumbai, India
| | - Dirk Jan Moojen
- Dept. of Orthopaedic and Trauma Surgery, OLVG Amsterdam, Amsterdam, the Netherlands
| | - Markus Pääkkönen
- Dept. of Orthopaedics and Traumatology, Turku University Hospital,
Turku, Finland
| | - Marko Pokorn
- Dept. of Infectious Diseases, Ljubjana University Medical Center,
Ljubjana, Slovenia
| | - Daniel Pérez-Prieto
- Dept. of Orthopaedic Surgery and Traumatology, Hospital del Mar,
Barcelona, Spain
| | - Nora Renz
- Dept. of Infectious Diseases, Bern University Hospital, Bern, Switzerland
| | - Jesús Saavedra-Lozano
- Dept. of Pediatric Infectious Diseases Unit, Gregorio Marañón
Hospital, Madrid, Spain
| | - Marta Sabater-Martos
- Dept. of Orthopaedic Surgery and Traumatology, Hospital Clínic,
Barcelona, Spain
| | - Parham Sendi
- Dept. of Infectious Diseases, University Hospital of Basel, Basel, Switzerland,Institute for Infectious Diseases, University of Bern, Bern, Switzerland
| | - Staffan Tevell
- Dept. of Infectious Diseases, Karlstad Hospital and Centre for Clinical
Research, Karlstad, Sweden
| | - Charles Vogely
- Dept. of Orthopedic Surgery, University Medical Center Utrecht, Utrecht, the
Netherlands,Members of the Steering Committee for the EBJIS Guideline Project on SANJO,shared last authorship
| | - Alex Soriano
- Dept. of Infectious Diseases, Hospital Clínic, Barcelona, Spain,Members of the Steering Committee for the EBJIS Guideline Project on SANJO,shared last authorship
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11
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Tagarro A, Domínguez-Rodríguez S, Mesa JM, Epalza C, Grasa C, Iglesias-Bouzas MI, Fernández-Cooke E, Calvo C, Villaverde S, Torres-Fernández D, Méndez-Echevarria A, Leoz I, Fernández-Pascual M, Saavedra-Lozano J, Soto B, Aguilera-Alonso D, Rivière JG, Fumadó V, Martínez-Campos L, Vivanco A, Pilar-Orive FJ, Alcalá P, Ruiz B, López-Machín A, Oltra M, Moraleda C. Treatments for multi-system inflammatory syndrome in children - discharge, fever, and second-line therapies. Eur J Pediatr 2023; 182:461-466. [PMID: 36282324 PMCID: PMC9595092 DOI: 10.1007/s00431-022-04649-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 09/28/2022] [Accepted: 10/05/2022] [Indexed: 01/21/2023]
Abstract
Scarce evidence exists about the best treatment for multi-system inflammatory syndrome (MIS-C). We analyzed the effects of steroids, intravenous immunoglobulin (IVIG), and their combination on the probability of discharge over time, the probability of switching to second-line treatment over time, and the persistence of fever 2 days after treatment. We did a retrospective study to investigate the effect of different treatments on children with MIS-C from 1 March 2020 to 1 June 2021. We estimated the time-to-event probability using a Cox model weighted by propensity score to balance the baseline characteristics. Thirty of 132 (22.7%) patients were initially treated with steroids alone, 29/132 (21.9%) with IVIG alone, and 73/132 (55%) with IVIG plus steroids. The probability of early discharge was higher with IVIG than with IVIG plus steroids (hazard ratio [HR] 1.65, 95% CI 1.11-2.45, p = 0.013), but with a higher probability of needing second-line therapy compared to IVIG plus steroids (HR 3.05, 95% CI 1.12-8.25, p = 0.028). Patients on IVIG had a higher likelihood of persistent fever than patients on steroids (odds ratio [OR] 4.23, 95% CI 1.43-13.5, p = 0.011) or on IVIG plus steroids (OR 4.4, 95% CI 2.05-9.82, p < 0.001). No differences were found for this endpoint between steroids or steroids plus IVIG. Conclusions: The benefits of each approach may vary depending on the outcome assessed. IVIG seemed to increase the probability of earlier discharge over time but also of needing second-line treatment over time. Steroids seemed to reduce persistent fever, and combination therapy reduced the need for escalating treatment. What is Known: • Steroids plus intravenous immunoglobulin, compared with intravenous immunoglobulin alone for multi-system inflammatory syndrome (MIS-C) might reduce the need for hemodynamic support and the duration of fever, but the certainty of the evidence is low. What is New: • Intravenous immunoglobulin, steroids, and their combination for MIS-C may have different outcomes. • In this study, intravenous immunoglobulin increased the probability of discharge over time, steroids reduced persistent fever, while combination therapy reduced the need for second-line treatments.
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Affiliation(s)
- Alfredo Tagarro
- Fundación de Investigación Biomédica Hospital 12 de Octubre, Instituto de Investigación 12 de Octubre (imas12), Madrid, Spain.
- RITIP (Translational Research Network On Paediatric Infectious Diseases), Madrid, Spain.
- Paediatrics Department, Hospital Universitario Infanta Sofía, Madrid, Spain.
| | - Sara Domínguez-Rodríguez
- Fundación de Investigación Biomédica Hospital 12 de Octubre, Instituto de Investigación 12 de Octubre (imas12), Madrid, Spain
| | - Juan Miguel Mesa
- Paediatrics Department, Hospital Universitario Infanta Sofía, Madrid, Spain
- Paediatrics Research Group, Universidad Europea de Madrid, Madrid, Spain
| | - Cristina Epalza
- Paediatric Infectious Diseases Unit, Department of Paediatrics, Hospital Universitario, Unidad Pediátrica de Investigación y Ensayos Clínicos (UPIC), Instituto de Investigación Hospital 12 Octubre, Madrid, Spain
- Universidad Complutense de Madrid, Madrid, Spain
| | - Carlos Grasa
- Paediatrics, Infectious and Tropical Diseases Department, Hospital Universitario La Paz, Instituto Investigación Hospital La Paz (IDIPaz), Madrid, Spain
- CIBER en Enfermedades Infecciosas (CIBERINFEC), RITIP (Translational Research Network On Paediatric Infectious Diseases), Instituto de Salud Carlos III, Madrid, Spain
| | | | - Elisa Fernández-Cooke
- Paediatric Infectious Diseases Unit, Department of Paediatrics, Hospital Universitario, Unidad Pediátrica de Investigación y Ensayos Clínicos (UPIC), Instituto de Investigación Hospital 12 Octubre, Madrid, Spain
| | - Cristina Calvo
- Paediatrics, Infectious and Tropical Diseases Department, Hospital Universitario La Paz, Instituto Investigación Hospital La Paz (IDIPaz), Madrid, Spain
- CIBER en Enfermedades Infecciosas (CIBERINFEC), RITIP (Translational Research Network On Paediatric Infectious Diseases), Instituto de Salud Carlos III, Madrid, Spain
| | - Serena Villaverde
- Fundación de Investigación Biomédica Hospital 12 de Octubre, Instituto de Investigación 12 de Octubre (imas12), Madrid, Spain
| | - David Torres-Fernández
- Paediatric Infectious Diseases Unit, Department of Paediatrics, Hospital Universitario, Unidad Pediátrica de Investigación y Ensayos Clínicos (UPIC), Instituto de Investigación Hospital 12 Octubre, Madrid, Spain
| | - Ana Méndez-Echevarria
- Paediatrics, Infectious and Tropical Diseases Department, Hospital Universitario La Paz, Instituto Investigación Hospital La Paz (IDIPaz), Madrid, Spain
| | - Inés Leoz
- Paediatrics Intensive Care Unit, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | | | - Jesús Saavedra-Lozano
- Pediatric Infectious Diseases Unit, Department of Pediatrics, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Unidad de Investigación Materno-Infantil Fundación Familia Alonso (UDIMIFFA), Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
- CIBER en Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Beatriz Soto
- Paediatrics Department, Hospital Universitario de Getafe, Getafe, Madrid, Spain
| | - David Aguilera-Alonso
- Fundación de Investigación Biomédica Hospital 12 de Octubre, Instituto de Investigación 12 de Octubre (imas12), Madrid, Spain
- Pediatric Infectious Diseases Unit, Department of Pediatrics, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Unidad de Investigación Materno-Infantil Fundación Familia Alonso (UDIMIFFA), Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
- CIBER en Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Jacques G Rivière
- Infectious Diseases and Paediatric Immunology Unit, Department of Paediatrics, Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | - Victoria Fumadó
- Paediatric Infectious Diseases Unit, Department of Paediatrics, Hospital Universitario Sant Joan de Deu, Barcelona, Spain
| | - Leticia Martínez-Campos
- Paediatric Infectious Diseases Unit, Department of Paediatrics, Hospital Universitario Torrecárdenas, Almeria, Spain
| | - Ana Vivanco
- Paediatrics Intensive Care Unit, Hospital Central de Asturias, Asturias, Spain
| | | | - Pedro Alcalá
- Paediatrics Department, Hospital General de Alicante, Alicante, Spain
| | - Beatriz Ruiz
- Paediatrics Department, Hospital Reina Sofía, Córdoba, Spain
| | | | - Manuel Oltra
- Paediatrics Department, Hospital La Fe, Valencia, Spain
| | - Cinta Moraleda
- Fundación de Investigación Biomédica Hospital 12 de Octubre, Instituto de Investigación 12 de Octubre (imas12), Madrid, Spain
- Paediatric Infectious Diseases Unit, Department of Paediatrics, Hospital Universitario, Unidad Pediátrica de Investigación y Ensayos Clínicos (UPIC), Instituto de Investigación Hospital 12 Octubre, Madrid, Spain
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12
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Hernanz-Lobo A, Santos-Sebastián M, Lancharro A, Saavedra-Lozano J, Rincón-López E, Aguilera-Alonso D, García-Santiago M, Bustos-Fonseca MJ, Ruiz-Serrano MJ, Gordillo-Gutiérrez I, Hernández-Sampelayo T, Rodríguez-Baena E, Córdoba-Deorador E, López-Suárez A, Navarro-Gómez ML, Santiago-García B. Use of computed tomography for the diagnosis of TB during a paediatric outbreak. Int J Tuberc Lung Dis 2022; 26:1183-1185. [PMID: 36447313 DOI: 10.5588/ijtld.22.0183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Affiliation(s)
- A Hernanz-Lobo
- Pediatric Infectious Diseases Unit, Department of Pediatrics, Gregorio Marañón University Hospital, Madrid, Spain, Gregorio Marañón Research Health Institute (IiSGM), Madrid, Spain, Biomedical Research Centre Network for Infectious Diseases (CIBERINFEC), Carlos III Health Institute, Madrid, Spain
| | - M Santos-Sebastián
- Pediatric Infectious Diseases Unit, Department of Pediatrics, Gregorio Marañón University Hospital, Madrid, Spain, Gregorio Marañón Research Health Institute (IiSGM), Madrid, Spain, Biomedical Research Centre Network for Infectious Diseases (CIBERINFEC), Carlos III Health Institute, Madrid, Spain
| | - A Lancharro
- Pediatric Radiology Department, Gregorio Marañón University Hospital, Madrid, Spain
| | - J Saavedra-Lozano
- Pediatric Infectious Diseases Unit, Department of Pediatrics, Gregorio Marañón University Hospital, Madrid, Spain, Gregorio Marañón Research Health Institute (IiSGM), Madrid, Spain, Biomedical Research Centre Network for Infectious Diseases (CIBERINFEC), Carlos III Health Institute, Madrid, Spain, Complutense University, Madrid, Spain
| | - E Rincón-López
- Pediatric Infectious Diseases Unit, Department of Pediatrics, Gregorio Marañón University Hospital, Madrid, Spain, Gregorio Marañón Research Health Institute (IiSGM), Madrid, Spain, Biomedical Research Centre Network for Infectious Diseases (CIBERINFEC), Carlos III Health Institute, Madrid, Spain
| | - D Aguilera-Alonso
- Pediatric Infectious Diseases Unit, Department of Pediatrics, Gregorio Marañón University Hospital, Madrid, Spain, Gregorio Marañón Research Health Institute (IiSGM), Madrid, Spain, Biomedical Research Centre Network for Infectious Diseases (CIBERINFEC), Carlos III Health Institute, Madrid, Spain
| | | | | | - M J Ruiz-Serrano
- Microbiology and Infectious Diseases Department, Gregorio Marañón University Hospital, Madrid, Spain, Biomedical Research Centre Network for Respiratory Diseases (CIBERES)
| | - I Gordillo-Gutiérrez
- Pediatric Radiology Department, Gregorio Marañón University Hospital, Madrid, Spain
| | - T Hernández-Sampelayo
- Pediatric Infectious Diseases Unit, Department of Pediatrics, Gregorio Marañón University Hospital, Madrid, Spain
| | | | | | - A López-Suárez
- Pediatric Infectious Diseases Unit, Department of Pediatrics, Gregorio Marañón University Hospital, Madrid, Spain, Gregorio Marañón Research Health Institute (IiSGM), Madrid, Spain
| | - M L Navarro-Gómez
- Pediatric Infectious Diseases Unit, Department of Pediatrics, Gregorio Marañón University Hospital, Madrid, Spain, Gregorio Marañón Research Health Institute (IiSGM), Madrid, Spain, Biomedical Research Centre Network for Infectious Diseases (CIBERINFEC), Carlos III Health Institute, Madrid, Spain, Complutense University, Madrid, Spain
| | - B Santiago-García
- Pediatric Infectious Diseases Unit, Department of Pediatrics, Gregorio Marañón University Hospital, Madrid, Spain, Gregorio Marañón Research Health Institute (IiSGM), Madrid, Spain, Biomedical Research Centre Network for Infectious Diseases (CIBERINFEC), Carlos III Health Institute, Madrid, Spain
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13
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Hernández-Rupérez MB, Seoane-Reula E, Villa Á, Lancharro Á, Marín Arriaza M, Saavedra-Lozano J. Chronic Q Fever as Recurrent Osteoarticular Infection in Children: Case Report and Literature Review. Pediatr Infect Dis J 2022; 41:e489-e494. [PMID: 36223236 DOI: 10.1097/inf.0000000000003655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Q fever osteomyelitis has been rarely reported in children. This infection has an unclear pathophysiology and the optimal therapy is unknown. We report a 2-year-old girl with Coxiella burnetti recurrent multifocal osteomyelitis: femur, metatarsal, cuneiform, and calcaneus. We highlight the complicated diagnosis and management of this case and the importance of considering Q fever in children with chronic-recurrent multifocal osteomyelitis.
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Affiliation(s)
- María Belén Hernández-Rupérez
- From the Pediatric Infectious Disease Unit, Department of Pediatrics, Gregorio Marañón University Hospital, Madrid, Spain
| | - Elena Seoane-Reula
- Pediatric Immuno-Allergy Unit, Department of Allergy, Hospital General Universitario Gregorio Marañón, Madrid, Spain.,Primary Immunodeficiency Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain.,Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Ángel Villa
- Primary Immunodeficiency Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Ángel Lancharro
- Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Mercedes Marín Arriaza
- Primary Immunodeficiency Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain.,Clinical Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain.,CIBER de Enfermedades Respiratorias (CIBERES CB06/06/0058), Instituto Salud Carlos III, Madrid, Spain.,Medicine Department, Faculty of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | - Jesús Saavedra-Lozano
- Primary Immunodeficiency Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain.,Pediatric Infectious Disease Unit, Department of Pediatrics, Hospital General Universitario Gregorio Marañón, Madrid, Spain.,CIBER de Enfermedades Infecciosas, Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto Salud Carlos III, Madrid, Spain.,‖Department of Pediatrics, Faculty of Medicine, Universidad Complutense de Madrid, Madrid, Spain
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14
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Alcobendas Rueda RM, Núñez E, Martín L, Hernández MB, Saavedra-Lozano J, Udaondo C, Murias S, Remesal A, Calvo C. Oral Versus Intravenous Antibiotics for Pediatric Osteoarticular Infection: When and to Whom? Pediatr Infect Dis J 2022; 41:e351-e357. [PMID: 35763692 DOI: 10.1097/inf.0000000000003619] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Osteoarticular infections (OAIs) are typically treated initially with intravenous antibiotics. The objective of this study was to evaluate whether an exclusive oral treatment in selected children may be appropriate. METHODS The Spanish Network of Osteoarticular Infections is a nationwide multicenter registry comprising 37 hospitals in Spain. The registry prospectively includes clinical characteristics and outcome of children with OAI. One of the hospitals from RioPed offers oral treatment to children meeting certain criteria. Patients were classified into 2 groups. Group 1: management with initial intravenous antibiotic therapy. Group 2: patients exclusively treated with oral antibiotics. A comparison between the 2 groups was performed. RESULTS We compared 893 children who initially received intravenous antibiotics (group 1) with 64 children who received exclusively oral therapy (group 2). Patients from group 2 were younger (33.9 vs. 20.3 months; P = 0.001), had a lower percentage of Staphylococcus aureus (23.3% vs. 3.1%; P < 0.001), a higher proportion of Kingella kingae (12.1% vs. 28.1%; P = 0.001), higher erythrocyte sedimentation rate/C-reactive protein (CRP) ratio (1.4 interquartile range 0.6-3.6 vs. 3.3 interquartile range 1.7-5.7; P < 0.001) and showed lower rate of fever (63% vs. 48.8%; P = 0.024) than in group 1. Complications were not found in group 2. CONCLUSIONS An exclusively oral administration could be a safe option in selected patients with OAI. Low-risk criteria are proposed: good general condition, no underlying disease, 6 months to 3 years old, appropriate oral tolerance, C-reactive protein <80 mg/L, erythrocyte sedimentation rate/C-reactive protein ratio ≥0.67, no skin injury, no recent surgery, no cervical spondylodiscitis and no local complications at onset.
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Affiliation(s)
| | - Esmeralda Núñez
- Pediatrics Department, Hospital Materno-Infantil, Málaga, Spain
| | - Laura Martín
- Pediatrics Department, Hospital Materno-Infantil, Málaga, Spain
| | | | - Jesús Saavedra-Lozano
- Pediatric Infectious Diseases Unit, Hospital General Universitario Gregorio Marañón, Universidad Complutense de Madrid
| | - Clara Udaondo
- From the, Pediatric Rheumatology Unit, Hospital Universitario La Paz
| | - Sara Murias
- From the, Pediatric Rheumatology Unit, Hospital Universitario La Paz
| | - Agustin Remesal
- From the, Pediatric Rheumatology Unit, Hospital Universitario La Paz
| | - Cristina Calvo
- Pediatric Infectious Diseases Department, Hospital Universitario La Paz, Madrid, Spain
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15
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Aguilera-Alonso D, Solís-García G, Noguera-Julian A, González-Martín J, Román Cobeña A, Baquero-Artigao F, Toro Rueda C, Rodríguez-Molino P, Bloise Sánchez I, Vallmanya T, Bernet-Sánchez A, Minguell Domingo L, Rubio A, Saavedra-Lozano J, Ruiz-Serrano MJ, Blázquez-Gamero D, López-Roa P, Gomez-Pastrana D, López Prieto MD, López Medina EM, Gil-Brusola A, Martín Nalda A, Soriano-Arandes A, Tórtola T, Falcon-Neyra L, González Galán V, Tebruegge M, Santiago-García B. Accuracy of Xpert Ultra for the diagnosis of paediatric tuberculosis in a low TB burden country: a prospective multicentre study. Thorax 2022; 77:1023-1029. [PMID: 36357344 DOI: 10.1136/thorax-2021-218378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 07/28/2022] [Indexed: 11/04/2022]
Abstract
IntroductionChildhood pulmonary tuberculosis (TB) remains a diagnostic challenge. This study aimed to evaluate the performance of Xpert Ultra for the diagnosis of pulmonary TB in children in a low TB prevalence setting.MethodsProspective, multicentre, diagnostic accuracy study. Children with clinical or radiological suspicion of pulmonary TB were recruited at 11 paediatric units in Spain. Up to three gastric or sputum specimens were taken on 3 consecutive days, and analysed by Xpert MTB/RIF, Xpert Ultra and culture in parallel.Results86 children were included (median age 4.9 years, IQR 2.0–10.0; 51.2% male). The final diagnosis was pulmonary TB in 75 patients (87.2%); 33 (44.0%) were microbiologically confirmed. A total of 219 specimens, comprising gastric aspirates (n=194; 88.6%) and sputum specimens (n=25; 11.4%), were analysed. Using culture as reference standard and comparing individual specimens, the sensitivity was 37.8% (14/37) for Xpert MTB/RIF and 81.1% (30/37) for Xpert Ultra (p<0.001); specificity was 98.4% (179/182) and 93.4% (170/182), respectively (p=0.02). In the per-patient analysis, considering positive results on any specimen, the sensitivity was 42.9% (9/21) for Xpert MTB/RIF and 81.0% for Xpert Ultra (17/21, p=0.01); specificity was 96.9% (63/65) and 87.7% (57/65, p=0.07), respectively.ConclusionsIn children with pulmonary TB in a low burden setting, Xpert Ultra has significantly higher sensitivity than the previous generation of Xpert assay and only marginally lower specificity. Therefore, in children undergoing evaluation for suspected pulmonary TB, Xpert Ultra should be used in preference to Xpert MTB/RIF whenever possible.
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16
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Vazquez-Alejo E, Tarancon-Diez L, Carrasco I, Vigil-Vázquez S, Muñoz-Chapuli M, Rincón-López E, Saavedra-Lozano J, Santos-Sebastián M, Aguilera-Alonso D, Hernanz-Lobo A, Santiago-García B, de León-Luis JA, Muñoz P, Sánchez-Luna M, Navarro ML, Muñoz-Fernández MÁ. SARS-CoV2 Infection During Pregnancy Causes Persistent Immune Abnormalities in Women Without Affecting the Newborns. Front Immunol 2022; 13:947549. [PMID: 35911743 PMCID: PMC9330630 DOI: 10.3389/fimmu.2022.947549] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 06/20/2022] [Indexed: 12/21/2022] Open
Abstract
SARS-CoV2 infection in pregnancy and exposed newborns is poorly known. We performed a longitudinal analysis of immune system and determined soluble cytokine levels in pregnant women infected with SARS-CoV2 and in their newborns. Women with confirmed SARS-CoV2 infection and their exposed uninfected newborns were recruited from Hospital General Universitario Gregorio Marañón. Peripheral blood mononuclear cells (PBMCs), cord cells and plasma were collected at birth and 6 months later. Immunophenotyping of natural killer (NK), monocytes and CD4/CD8 T-cells were studied in cryopreserved PBMCs and cord cells by multiparametric flow cytometry. Up to 4 soluble pro/anti-inflammatory cytokines were assessed in plasma/cord plasma by ELISA assay. SARS-CoV2-infected mothers and their newborns were compared to matched healthy non-SARS-CoV2-infected mothers and their newborns. The TNFα and IL-10 levels of infected mothers were higher at baseline than those of healthy controls. Infected mothers showed increased NK cells activation and reduced expression of maturation markers that reverted after 6 months. They also had high levels of Central Memory and low Effector Memory CD4-T cell subsets. Additionally, the increased CD4- and CD8-T cell activation (CD154 and CD38) and exhaustion (TIM3/TIGIT) levels at baseline compared to controls remained elevated after 6 months. Regarding Treg cells, the levels were lower at infected mothers at baseline but reverted after 6 months. No newborn was infected at birth. The lower levels of monocytes, NK and CD4-T cells observed at SARS-CoV2-exposed newborns compared to unexposed controls significantly increased 6 months later. In conclusion, SARS-CoV2 infection during pregnancy shows differences in immunological components that could lead newborns to future clinical implications after birth. However, SARS-CoV2 exposed 6-months-old newborns showed no immune misbalance, whereas the infected mothers maintain increased activation and exhaustion levels in T-cells after 6 months.
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Affiliation(s)
- Elena Vazquez-Alejo
- Immunology Section, Laboratory of ImmunoBiology Molecular, Hospital General Universitario Gregorio Marañón (HGUGM), HIV-HGM BioBank, Madrid, Spain
| | - Laura Tarancon-Diez
- Immunology Section, Laboratory of ImmunoBiology Molecular, Hospital General Universitario Gregorio Marañón (HGUGM), HIV-HGM BioBank, Madrid, Spain
| | - Itzíar Carrasco
- Infectious Diseases in Paediatric Population, Gregorio Marañón Research Institute (IiSGM) and University Hospital, Madrid, Spain
- CIBER of Infectious Diseases (CIBERINFEC), Madrid, Spain
| | - Sara Vigil-Vázquez
- Department of Neonatology, Hospital General Universitario Gregorio Marañón (HGUGM), Madrid, Spain
| | - Mar Muñoz-Chapuli
- Department of Obstetrics and Gynecology, Hospital General Universitario Gregorio Marañón (HGUGM), Madrid, Spain
| | - Elena Rincón-López
- Infectious Diseases in Paediatric Population, Gregorio Marañón Research Institute (IiSGM) and University Hospital, Madrid, Spain
- Infectious Diseases Section, Department of Paediatrics, Hospital General Universitario Gregorio Marañón (HGUGM), Madrid, Spain
- CIBER of Infectious Diseases (CIBERINFEC), Madrid, Spain
| | - Jesús Saavedra-Lozano
- Infectious Diseases in Paediatric Population, Gregorio Marañón Research Institute (IiSGM) and University Hospital, Madrid, Spain
- Infectious Diseases Section, Department of Paediatrics, Hospital General Universitario Gregorio Marañón (HGUGM), Madrid, Spain
- Faculty of Medicine, Universidad Complutense de Madrid, Madrid, Spain
- CIBER of Infectious Diseases (CIBERINFEC), Madrid, Spain
| | - Mar Santos-Sebastián
- Infectious Diseases in Paediatric Population, Gregorio Marañón Research Institute (IiSGM) and University Hospital, Madrid, Spain
- Infectious Diseases Section, Department of Paediatrics, Hospital General Universitario Gregorio Marañón (HGUGM), Madrid, Spain
- CIBER of Infectious Diseases (CIBERINFEC), Madrid, Spain
| | - David Aguilera-Alonso
- Infectious Diseases in Paediatric Population, Gregorio Marañón Research Institute (IiSGM) and University Hospital, Madrid, Spain
- Infectious Diseases Section, Department of Paediatrics, Hospital General Universitario Gregorio Marañón (HGUGM), Madrid, Spain
- CIBER of Infectious Diseases (CIBERINFEC), Madrid, Spain
| | - Alicia Hernanz-Lobo
- Infectious Diseases in Paediatric Population, Gregorio Marañón Research Institute (IiSGM) and University Hospital, Madrid, Spain
- Infectious Diseases Section, Department of Paediatrics, Hospital General Universitario Gregorio Marañón (HGUGM), Madrid, Spain
- CIBER of Infectious Diseases (CIBERINFEC), Madrid, Spain
| | - Begoña Santiago-García
- Infectious Diseases in Paediatric Population, Gregorio Marañón Research Institute (IiSGM) and University Hospital, Madrid, Spain
- Infectious Diseases Section, Department of Paediatrics, Hospital General Universitario Gregorio Marañón (HGUGM), Madrid, Spain
- CIBER of Infectious Diseases (CIBERINFEC), Madrid, Spain
| | - Juan Antonio de León-Luis
- Department of Obstetrics and Gynecology, Hospital General Universitario Gregorio Marañón (HGUGM), Madrid, Spain
- Faculty of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | - Patricia Muñoz
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón (HGUGM), CIBER Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - Manuel Sánchez-Luna
- Department of Neonatology, Hospital General Universitario Gregorio Marañón (HGUGM), Madrid, Spain
- Faculty of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | - María Luisa Navarro
- Infectious Diseases in Paediatric Population, Gregorio Marañón Research Institute (IiSGM) and University Hospital, Madrid, Spain
- Infectious Diseases Section, Department of Paediatrics, Hospital General Universitario Gregorio Marañón (HGUGM), Madrid, Spain
- Faculty of Medicine, Universidad Complutense de Madrid, Madrid, Spain
- CIBER of Infectious Diseases (CIBERINFEC), Madrid, Spain
| | - Mª Ángeles Muñoz-Fernández
- Immunology Section, Laboratory of ImmunoBiology Molecular, Hospital General Universitario Gregorio Marañón (HGUGM), HIV-HGM BioBank, Madrid, Spain
- *Correspondence: M Ángeles Muñoz-Fernández,
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Aguilera-Alonso D, Kirchschläger Nieto S, Ara Montojo MF, Sanz Santaeufemia FJ, Saavedra-Lozano J, Soto B, Caminoa MB, Berzosa A, Prieto Tato L, Cercenado E, Tagarro A, Molina Arana D, Alonso Sanz M, Romero Gómez MP, Chaves Sánchez F, Baquero-Artigao F. Staphylococcus aureus Community-acquired Pneumonia in Children After 13-Valent Pneumococcal Vaccination (2008-2018): Epidemiology, Clinical Characteristics and Outcomes. Pediatr Infect Dis J 2022; 41:e235-e242. [PMID: 35333816 DOI: 10.1097/inf.0000000000003503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The epidemiology of community-acquired pneumonia (CAP) has changed, influenced by sociosanitary conditions and vaccination status. We aimed to analyze the recent epidemiology of bacterial CAP in hospitalized children in a setting with high pneumococcal vaccination coverage and to describe the clinical characteristics of pediatric Staphylococcus aureus CAP. METHODS Children <17 years old hospitalized from 2008 to 2018 with bacterial CAP in 5 tertiary hospitals in Spain were included. Cases with pneumococcal CAP were randomly selected as comparative group following a case-control ratio of 2:1 with S. aureus CAP. RESULTS A total of 313 bacterial CAP were diagnosed: Streptococcus pneumoniae CAP (n = 236, 75.4%), Streptococcus pyogenes CAP (n = 43, 13.7%) and S. aureus CAP (n = 34, 10.9%). Throughout the study period, the prevalence of S. pyogenes increased (annual percentage change: +16.1% [95% CI: 1.7-32.4], P = 0.031), S. pneumoniae decreased (annual percentage change: -4.4% [95 CI: -8.8 to 0.2], P = 0.057) and S. aureus remained stable. Nine isolates of S. aureus (26.5%) were methicillin-resistant. Seventeen cases (50%) with S. aureus CAP had some pulmonary complication and 21 (61.7%) required intensive care. S. pneumoniae CAP showed a trend toward higher prevalence of pulmonary complications compared with S. aureus CAP (69.1% vs. 50.0%, P = 0.060), including higher frequency of pulmonary necrosis (32.4% vs. 5.9%, P = 0.003). CONCLUSIONS The incidence of S. aureus CAP in children remained stable, whereas the prevalence of pneumococcal CAP decreased and S. pyogenes CAP increased. Patients with S. aureus presented a high frequency of severe outcomes, but a lower risk of pulmonary complications than patients with S. pneumoniae.
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Affiliation(s)
- David Aguilera-Alonso
- From the Pediatric Infectious Diseases Unit, Department of Pediatrics, Hospital General Universitario Gregorio Marañón, Unidad de Investigación Materno-Infantil Fundación Familia Alonso (UDIMIFFA), Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
- CIBER en Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | | | | | | | - Jesús Saavedra-Lozano
- From the Pediatric Infectious Diseases Unit, Department of Pediatrics, Hospital General Universitario Gregorio Marañón, Unidad de Investigación Materno-Infantil Fundación Familia Alonso (UDIMIFFA), Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
- CIBER en Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Beatriz Soto
- Department of Pediatrics, Hospital de Getafe, Madrid, Spain
| | | | - Arantxa Berzosa
- Department of Pediatrics, Hospital Clinico San Carlos, Madrid, Spain
| | - Luis Prieto Tato
- Department of Pediatric Infectious Diseases, Hospital Universitario Doce de Octubre, Madrid, Spain
| | - Emilia Cercenado
- Department of Microbiology, Hospital General Universitario Gregorio Marañón, CIBERES, Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, Madrid, Spain
| | - Alfredo Tagarro
- Department of Pediatrics, Hospital Infanta Sofía, Madrid, Spain
| | | | | | - María Pilar Romero Gómez
- CIBER en Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
- Department of Microbiology, Hospital Universitario La Paz, Madrid, Spain
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Rincón-López EM, Navarro Gómez ML, Hernández-Sampelayo Matos T, Aguilera-Alonso D, Dueñas Moreno E, Bellón Cano JM, Saavedra-Lozano J, Del Mar Santos Sebastián M, García Morín M, Beléndez Bieler C, Lorente Romero J, Cela de Julián E. Risk-score based strategy to minimize antibiotic exposure in children with sickle cell disease and fever. Infection 2021; 50:499-505. [PMID: 34596837 PMCID: PMC8484827 DOI: 10.1007/s15010-021-01702-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 09/16/2021] [Indexed: 11/21/2022]
Abstract
Severe bacterial infections (SBI) have become less frequent in children with sickle cell disease (SCD) in the last decades. However, because of their potential risk of SBI, they usually receive empirical therapy with broad-spectrum antibiotics when they develop fever and are hospitalized in many cases. We performed a prospective study including 79 SCD patients with fever [median age 4.1 (1.7–7.5) years, 78.5% males; 17 of the episodes were diagnosed with SBI and 4 of them were confirmed] and developed a risk score for the prediction of SBI. The optimal score included CRP > 3 mg/dl, IL-6 > 125 pg/ml and hypoxemia, with an AUC of 0.91 (0.83–0.96) for the prediction of confirmed SBI and 0.86 (0.77–0.93) for possible SBI. We classified the patients in 3 groups: low, intermediate and high risk of SBI. Our risk-score-based management proposal could help to safely minimize antibiotic treatments and hospital admissions in children with SCD at low risk of SBI.
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Affiliation(s)
- Elena María Rincón-López
- Department of Pediatrics, Pediatric Infectious Diseases Unit, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain. .,PhD Program in Medicine, Universidad Complutense de Madrid, Madrid, Spain. .,Servicio de PediatríaSección Enfermedades Infecciosas, Hospital Materno-Infantil Gregorio Marañón, c/ O'Donnell, 48-50, 28009, Madrid, Spain.
| | - María Luisa Navarro Gómez
- Department of Pediatrics, Pediatric Infectious Diseases Unit, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain.,Universidad Complutense de Madrid, Madrid, Spain
| | - Teresa Hernández-Sampelayo Matos
- Department of Pediatrics, Pediatric Infectious Diseases Unit, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain.,Universidad Complutense de Madrid, Madrid, Spain
| | - David Aguilera-Alonso
- Department of Pediatrics, Pediatric Infectious Diseases Unit, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
| | - Eva Dueñas Moreno
- Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
| | | | - Jesús Saavedra-Lozano
- Department of Pediatrics, Pediatric Infectious Diseases Unit, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain.,Universidad Complutense de Madrid, Madrid, Spain
| | - María Del Mar Santos Sebastián
- Department of Pediatrics, Pediatric Infectious Diseases Unit, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
| | - Marina García Morín
- Department of Pediatrics. Pediatric Hematology and Oncology Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Cristina Beléndez Bieler
- Department of Pediatrics. Pediatric Hematology and Oncology Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Jorge Lorente Romero
- Department of Pediatrics. Pediatric Emergency Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Elena Cela de Julián
- Universidad Complutense de Madrid, Madrid, Spain.,Department of Pediatrics. Pediatric Hematology and Oncology Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain
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Rincón-López EM, Navarro Gómez ML, Hernández-Sampelayo Matos T, Aguilera-Alonso D, Dueñas Moreno E, Saavedra-Lozano J, Santiago García B, Santos Sebastián MDM, García Morín M, Beléndez Bieler C, Lorente Romero J, Cela de Julián E. Interleukin 6 as a marker of severe bacterial infection in children with sickle cell disease and fever: a case-control study. BMC Infect Dis 2021; 21:741. [PMID: 34344349 PMCID: PMC8329904 DOI: 10.1186/s12879-021-06470-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 07/26/2021] [Indexed: 11/15/2022] Open
Abstract
Background Etiological diagnosis of fever in children with sickle cell disease (SCD) is often challenging. The aim of this study was to analyze the pattern of inflammatory biomarkers in SCD febrile children and controls, in order to determine predictors of severe bacterial infection (SBI). Methods A prospective, case–control study was carried out during 3 years, including patients younger than 18 years with SCD and fever (cases) and asymptomatic steady-state SCD children (controls). Clinical characteristics and laboratory parameters, including 10 serum proinflammatory cytokines (IL-1β, IL-2, IL-4, IL-6, IL-8, IL-10, IL-12p70, IL-17a, IFN-γ and TNF-α) and comparisons among study subgroups were analyzed. Results A total of 137 patients (79 cases and 58 controls) were included in the study; 78.5% males, median age 4.1 (1.7–7.5) years. Four cases were diagnosed with SBI, 41 viral infection (VI), 33 no proven infection (NPI) and 1 bacterial-viral coinfection (the latter excluded from the subanalyses). IL-6 was significantly higher in patients with SBI than in patients with VI or NPI (163 vs 0.7 vs 0.7 pg/ml, p < 0.001), and undetectable in all controls. The rest of the cytokines analyzed did not show any significant difference. The optimal cut-off value of IL-6 for the diagnosis of SBI was 125 pg/mL, with high PPV and NPV (PPV of 100% for a prevalence rate of 5, 10 and 15% and NPV of 98.7%, 97.3% and 95.8% for those prevalences rates, respectively). Conclusion We found that IL-6 (with a cut-off value of 125 pg/ml) was an optimal marker for SBI in this cohort of febrile SCD children, with high PPV and NPV. Therefore, given its rapid elevation, IL-6 may be useful to early discriminate SCD children at risk of SBI, in order to guide their management. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-021-06470-4.
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Affiliation(s)
- Elena María Rincón-López
- Department of Pediatrics, Pediatric Infectious Diseases Unit, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, c/O'Donnell 48-50, 28009, Madrid, Spain. .,PhD Program in Medicine, Universidad Complutense de Madrid, Madrid, Spain.
| | - María Luisa Navarro Gómez
- Department of Pediatrics, Pediatric Infectious Diseases Unit, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, c/O'Donnell 48-50, 28009, Madrid, Spain.,Universidad Complutense de Madrid, Madrid, Spain
| | - Teresa Hernández-Sampelayo Matos
- Department of Pediatrics, Pediatric Infectious Diseases Unit, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, c/O'Donnell 48-50, 28009, Madrid, Spain.,Universidad Complutense de Madrid, Madrid, Spain
| | - David Aguilera-Alonso
- Department of Pediatrics, Pediatric Infectious Diseases Unit, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, c/O'Donnell 48-50, 28009, Madrid, Spain
| | - Eva Dueñas Moreno
- Department of Pediatrics, Pediatric Infectious Diseases Unit, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, c/O'Donnell 48-50, 28009, Madrid, Spain
| | - Jesús Saavedra-Lozano
- Department of Pediatrics, Pediatric Infectious Diseases Unit, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, c/O'Donnell 48-50, 28009, Madrid, Spain.,Universidad Complutense de Madrid, Madrid, Spain
| | - Begoña Santiago García
- Department of Pediatrics, Pediatric Infectious Diseases Unit, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, c/O'Donnell 48-50, 28009, Madrid, Spain
| | - María Del Mar Santos Sebastián
- Department of Pediatrics, Pediatric Infectious Diseases Unit, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, c/O'Donnell 48-50, 28009, Madrid, Spain
| | - Marina García Morín
- Department of Pediatrics, Pediatric Hematology and Oncology Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Cristina Beléndez Bieler
- Department of Pediatrics, Pediatric Hematology and Oncology Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Jorge Lorente Romero
- Department of Pediatrics, Pediatric Emergency Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Elena Cela de Julián
- Universidad Complutense de Madrid, Madrid, Spain.,Department of Pediatrics, Pediatric Hematology and Oncology Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain
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Domínguez-Rodríguez S, Villaverde S, Sanz-Santaeufemia FJ, Grasa C, Soriano-Arandes A, Saavedra-Lozano J, Fumadó V, Epalza C, Serna-Pascual M, Alonso-Cadenas JA, Rodríguez-Molino P, Pujol-Morro J, Aguilera-Alonso D, Simó S, Villanueva-Medina S, Iglesias-Bouzas MI, Mellado MJ, Herrero B, Melendo S, De la Torre M, Del Rosal T, Soler-Palacin P, Calvo C, Urretavizcaya-Martínez M, Pareja M, Ara-Montojo F, Ruiz Del Prado Y, Gallego N, Illán Ramos M, Cobos E, Tagarro A, Moraleda C. A Bayesian Model to Predict COVID-19 Severity in Children. Pediatr Infect Dis J 2021; 40:e287-e293. [PMID: 34250967 DOI: 10.1097/inf.0000000000003204] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND We aimed to identify risk factors causing critical disease in hospitalized children with COVID-19 and to build a predictive model to anticipate the probability of need for critical care. METHODS We conducted a multicenter, prospective study of children with SARS-CoV-2 infection in 52 Spanish hospitals. The primary outcome was the need for critical care. We used a multivariable Bayesian model to estimate the probability of needing critical care. RESULTS The study enrolled 350 children from March 12, 2020, to July 1, 2020: 292 (83.4%) and 214 (73.7%) were considered to have relevant COVID-19, of whom 24.2% required critical care. Four major clinical syndromes of decreasing severity were identified: multi-inflammatory syndrome (MIS-C) (17.3%), bronchopulmonary (51.4%), gastrointestinal (11.6%), and mild syndrome (19.6%). Main risk factors were high C-reactive protein and creatinine concentration, lymphopenia, low platelets, anemia, tachycardia, age, neutrophilia, leukocytosis, and low oxygen saturation. These risk factors increased the risk of critical disease depending on the syndrome: the more severe the syndrome, the more risk the factors conferred. Based on our findings, we developed an online risk prediction tool (https://rserver.h12o.es/pediatria/EPICOAPP/, username: user, password: 0000). CONCLUSIONS Risk factors for severe COVID-19 include inflammation, cytopenia, age, comorbidities, and organ dysfunction. The more severe the syndrome, the more the risk factor increases the risk of critical illness. Risk of severe disease can be predicted with a Bayesian model.
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Affiliation(s)
- Sara Domínguez-Rodríguez
- From the Fundación de Investigación Biomédica Hospital 12 de Octubre, Instituto de Investigación 12 de Octubre (imas12), Madrid, Spain
- RITIP (Translational Research Network in Paediatric Infectious Diseases), Madrid, Spain
- Paediatric Infectious Diseases Unit, Department of Paediatrics, Hospital Universitario 12 Octubre, Madrid, Spain
| | - Serena Villaverde
- From the Fundación de Investigación Biomédica Hospital 12 de Octubre, Instituto de Investigación 12 de Octubre (imas12), Madrid, Spain
- RITIP (Translational Research Network in Paediatric Infectious Diseases), Madrid, Spain
- Paediatric Infectious Diseases Unit, Department of Paediatrics, Hospital Universitario 12 Octubre, Madrid, Spain
| | | | - Carlos Grasa
- RITIP (Translational Research Network in Paediatric Infectious Diseases), Madrid, Spain
- Paediatrics, Infectious and Tropical Diseases Department, Hospital Universitario La Paz, Instituto Investigación Hospital La Paz (IDIPaz), Madrid, Spain
| | - Antoni Soriano-Arandes
- Pediatric Infectious Diseases and Immunodeficiencies Unit, Hospital Universitari Vall d'Hebron, Vall d'Hebron Research Institute, Barcelona, Catalonia, Spain
| | - Jesús Saavedra-Lozano
- Paediatric Infectious Diseases Unit, Department of Paediatrics, Hospital Universitario Gregorio Marañón, Madrid, Spain
| | - Victoria Fumadó
- Paediatric Infectious Diseases Unit, Department of Paediatrics, Hospital Universitario Sant Joan de Deu Barcelona, Barcelona, Spain
| | - Cristina Epalza
- From the Fundación de Investigación Biomédica Hospital 12 de Octubre, Instituto de Investigación 12 de Octubre (imas12), Madrid, Spain
- RITIP (Translational Research Network in Paediatric Infectious Diseases), Madrid, Spain
- Paediatric Infectious Diseases Unit, Department of Paediatrics, Hospital Universitario 12 Octubre, Madrid, Spain
| | - Miquel Serna-Pascual
- From the Fundación de Investigación Biomédica Hospital 12 de Octubre, Instituto de Investigación 12 de Octubre (imas12), Madrid, Spain
- RITIP (Translational Research Network in Paediatric Infectious Diseases), Madrid, Spain
- Paediatric Infectious Diseases Unit, Department of Paediatrics, Hospital Universitario 12 Octubre, Madrid, Spain
| | | | - Paula Rodríguez-Molino
- RITIP (Translational Research Network in Paediatric Infectious Diseases), Madrid, Spain
- Paediatrics, Infectious and Tropical Diseases Department, Hospital Universitario La Paz, Instituto Investigación Hospital La Paz (IDIPaz), Madrid, Spain
| | - Joan Pujol-Morro
- Pediatric Infectious Diseases and Immunodeficiencies Unit, Hospital Universitari Vall d'Hebron, Vall d'Hebron Research Institute, Barcelona, Catalonia, Spain
| | - David Aguilera-Alonso
- Paediatric Infectious Diseases Unit, Department of Paediatrics, Hospital Universitario Gregorio Marañón, Madrid, Spain
| | - Silvia Simó
- Paediatric Infectious Diseases Unit, Department of Paediatrics, Hospital Universitario Sant Joan de Deu Barcelona, Barcelona, Spain
| | - Sara Villanueva-Medina
- From the Fundación de Investigación Biomédica Hospital 12 de Octubre, Instituto de Investigación 12 de Octubre (imas12), Madrid, Spain
- RITIP (Translational Research Network in Paediatric Infectious Diseases), Madrid, Spain
- Paediatric Infectious Diseases Unit, Department of Paediatrics, Hospital Universitario 12 Octubre, Madrid, Spain
| | | | | | | | - Susana Melendo
- Pediatric Infectious Diseases and Immunodeficiencies Unit, Hospital Universitari Vall d'Hebron, Vall d'Hebron Research Institute, Barcelona, Catalonia, Spain
| | | | - Teresa Del Rosal
- RITIP (Translational Research Network in Paediatric Infectious Diseases), Madrid, Spain
- Paediatrics, Infectious and Tropical Diseases Department, Hospital Universitario La Paz, Instituto Investigación Hospital La Paz (IDIPaz), Madrid, Spain
| | - Pere Soler-Palacin
- Pediatric Infectious Diseases and Immunodeficiencies Unit, Hospital Universitari Vall d'Hebron, Vall d'Hebron Research Institute, Barcelona, Catalonia, Spain
| | | | | | - Marta Pareja
- Paediatrics Department, Complejo Hospitalario Universitario de Albacete, Albacete, Spain
| | - Fátima Ara-Montojo
- Paediatrics Department, Hospital Universitario Quironsalud Madrid, Madrid, Spain
| | | | - Nerea Gallego
- Paediatrics Department, Hospital Universitari Son Espases, Palma de Mallorca, Spain
| | - Marta Illán Ramos
- Paediatrics Department, Hospital Universitario Clínico San Carlos, Madrid, Spain
| | - Elena Cobos
- From the Fundación de Investigación Biomédica Hospital 12 de Octubre, Instituto de Investigación 12 de Octubre (imas12), Madrid, Spain
- RITIP (Translational Research Network in Paediatric Infectious Diseases), Madrid, Spain
- Paediatric Infectious Diseases Unit, Department of Paediatrics, Hospital Universitario 12 Octubre, Madrid, Spain
| | - Alfredo Tagarro
- From the Fundación de Investigación Biomédica Hospital 12 de Octubre, Instituto de Investigación 12 de Octubre (imas12), Madrid, Spain
- RITIP (Translational Research Network in Paediatric Infectious Diseases), Madrid, Spain
- Paediatric Infectious Diseases Unit, Department of Paediatrics, Hospital Universitario 12 Octubre, Madrid, Spain
- Paediatrics Department, Hospital Universitario Infanta Sofía, Paediatrics Research Group, Universidad Europea de Madrid, Madrid, Spain
| | - Cinta Moraleda
- From the Fundación de Investigación Biomédica Hospital 12 de Octubre, Instituto de Investigación 12 de Octubre (imas12), Madrid, Spain
- RITIP (Translational Research Network in Paediatric Infectious Diseases), Madrid, Spain
- Paediatric Infectious Diseases Unit, Department of Paediatrics, Hospital Universitario 12 Octubre, Madrid, Spain
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Solís-García G, Darriba Valles JV, Gil de Sagredo Del Corral OL, Vázquez López M, Aguado A, Saavedra-Lozano J. Subdural and subarachnoid empyema as a complication of an acute meningococcal meningitis. Arch Dis Child 2021; 106:188. [PMID: 31630118 DOI: 10.1136/archdischild-2019-318036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/04/2019] [Indexed: 11/04/2022]
Affiliation(s)
| | | | | | - María Vázquez López
- Neuropediatrics, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Alejandra Aguado
- Radiology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Jesús Saavedra-Lozano
- Pediatric Infectious Diseases, Hospital General Universitario Gregorio Maranon, Madrid, Spain
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Sanjuán-Benita L, Saavedra-Lozano J, Aguilera-Alonso D. Short-course Antibiotic Regimens in Community-Acquired Pneumonia in Children. Arch Bronconeumol 2020; 56:835-836. [PMID: 33069463 DOI: 10.1016/j.arbres.2020.08.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 08/10/2020] [Accepted: 08/11/2020] [Indexed: 11/19/2022]
Affiliation(s)
- Lucía Sanjuán-Benita
- Sección de Enfermedades Infecciosas, Servicio de Pediatría, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - Jesús Saavedra-Lozano
- Sección de Enfermedades Infecciosas, Servicio de Pediatría, Hospital General Universitario Gregorio Marañón, Madrid, España; Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, España; Universidad Complutense de Madrid, Madrid, España
| | - David Aguilera-Alonso
- Sección de Enfermedades Infecciosas, Servicio de Pediatría, Hospital General Universitario Gregorio Marañón, Madrid, España; Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, España.
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23
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Gutiérrez-Vélez A, Solís-García G, Saavedra-Lozano J, Hernanz Lobo A. [Tick-borne lymphadenopathy, an emergent disease in Europe]. An Pediatr (Barc) 2020; 94:120-121. [PMID: 32386932 DOI: 10.1016/j.anpedi.2020.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 03/16/2020] [Indexed: 10/24/2022] Open
Affiliation(s)
- Ana Gutiérrez-Vélez
- Servicio de Pediatría, Hospital General Universitario Gregorio Marañón, Madrid, España.
| | - Gonzalo Solís-García
- Servicio de Pediatría, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - Jesús Saavedra-Lozano
- Sección de Enfermedades Infecciosas, Servicio de Pediatría, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - Alicia Hernanz Lobo
- Sección de Enfermedades Infecciosas, Servicio de Pediatría, Hospital General Universitario Gregorio Marañón, Madrid, España
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Santiago-García B, Rincón-López EM, Ponce Salas B, Aguilar de la Red Y, Garrido Colino C, Martínez Fernández-Llamazares C, Saavedra-Lozano J, Hernández-Sampelayo Matos T. Effect of an intervention to improve the prescription of antifungals in pediatric hematology-oncology. Pediatr Blood Cancer 2020; 67:e27963. [PMID: 31407514 DOI: 10.1002/pbc.27963] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 07/23/2019] [Accepted: 07/24/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND The use of antifungals has expanded in pediatric hematology-oncology, and the need to develop pediatric-based surveillance and education activities is becoming crucial. The aims of this study were to evaluate the impact of a multidisciplinary protocol on the adequacy of antifungal prescription in a pediatric hematology-oncology unit and to assess the effect of an educational intervention to improve the knowledge of prescribing pediatricians over time. METHODS A multidisciplinary team established a protocol for the management of invasive fungal disease (IFD). The use of antifungals before (January 2012-May 2013) and after the protocol (June 2013-December 2015) was evaluated. Prescribing pediatricians attended a training course on IFD and were evaluated before 0, 6, and 12 months after the intervention. RESULTS During the study period, antifungal agents were used in 185 episodes (56 children, 39.3% females), and were administered as prophylaxis (58.9%), empiric (34.6%), or targeted therapy (6.5%). Antifungal prescriptions were inadequate in 7% of the episodes, related to drug selection (53.8%), dosage (38.5%) and route of administration (7.7%). After protocol implementation, inadequate prescriptions decreased 9.9% (15.2% vs 5.3%; P = .04). Following the educational activity, the percentage of adequate responses to the questionnaire improved significantly compared to baseline, and persisted over time (19.7% improvement at 0 months [P < .0001]; 21.1% at 6 months [P < .0001]; 16.6% at 12 months [P = .002]). CONCLUSIONS The establishment of multidisciplinary protocols and education activities improved the quality of antifungal prescription and the knowledge of prescribers regarding antifungal therapy. Therefore, these activities may be important for the implementation of antifungal stewardship programs in pediatrics.
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Affiliation(s)
- Begoña Santiago-García
- Pediatric Infectious Diseases Unit, Department of Pediatrics, Gregorio Marañón Hospital, Gregorio Marañón Health Research Institute, Madrid, Spain
| | - Elena María Rincón-López
- Pediatric Infectious Diseases Unit, Department of Pediatrics, Gregorio Marañón Hospital, Gregorio Marañón Health Research Institute, Madrid, Spain
| | | | | | - Carmen Garrido Colino
- Pediatric Hematology-Oncology Unit, Department of Pediatrics, Gregorio Marañón Hospital, Madrid, Spain
| | | | - Jesús Saavedra-Lozano
- Pediatric Infectious Diseases Unit, Department of Pediatrics, Gregorio Marañón Hospital, Gregorio Marañón Health Research Institute, Madrid, Spain
| | - Teresa Hernández-Sampelayo Matos
- Pediatric Infectious Diseases Unit, Department of Pediatrics, Gregorio Marañón Hospital, Gregorio Marañón Health Research Institute, Madrid, Spain
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- Pediatric Infectious Diseases Unit, Department of Pediatrics, Gregorio Marañón Hospital, Gregorio Marañón Health Research Institute, Madrid, Spain
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Núñez Cuadros E, Calvo Rey C, Saavedra-Lozano J. [Evaluation of the impact of the Spanish consensus document on the approach to osteoarticular infections in Spain through the Paediatrics Osteoarticular Infections Network (RIOPED)]. An Pediatr (Barc) 2020; 93:289-296. [PMID: 31980415 DOI: 10.1016/j.anpedi.2019.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 11/13/2019] [Accepted: 11/19/2019] [Indexed: 10/25/2022] Open
Abstract
INTRODUCTION In 2014 the Consensus Document produced by the Spanish Paediatric Societies (SEIP-SERPE-SEOP) was published to help in the diagnosis and treatment of osteoarticular infections (OAI). In 2015 the RIOPed was considered as a multidisciplinary national network for the investigation into OAI. The aim of this study was to assess the level of adaption to the recommendations established in the Consensus during one year of follow-up. MATERIAL AND METHODS A prospective, national multicentre study was carried out in 37 hospitals between September 2015 and September 2016. The study included patients >16years-old with a diagnosis of OAI, confirmed by microbiological isolation, or probable: septic arthritis (SA) with >40,000 white cells in synovial fluid, or osteomyelitis (OM)/spondylodiscitis (SD) with a compatible imaging test. The results were compared with those obtained in a retrospective study conducted between 2008 and 2012. RESULTS A total of 235 cases were included, of which 131 were OM, 79 SA, 30 OA, and 15 SD. As regards the complementary tests that the Consensus considered mandatory to perform, radiography was carried out on 87.8% of the cases, a blood culture on 91.6%, and culture of the synovial fluid in 99% of SA. A magnetic resonance (MR) was performed on 71% of the OM cases. The choice of intravenous empirical antibiotic treatment was adapted to the recommendations in 65.1% of cases, and in 62.3% for the oral treatment. Surgery was performed in 36.8% of SA cases (85.7% arthrotomy), with a significant decrease compared to the retrospective study (P=.014). Only 58.5% of cases followed the recommendations on the duration of the treatment; however, a lower duration of intravenous treatment was observed. CONCLUSIONS In general, the level of adaptation to the recommendations that were set by the Expert Group, is good for the complementary tests, and acceptable as regards the choice of antibiotic treatment, although inadequate in almost 40% of cases. A decrease in hospital stay was achieved.
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Affiliation(s)
- Esmeralda Núñez Cuadros
- Hospitalización Pediátrica, Unidad de Reumatología Pediátrica, Unidad Asistencial de Pediatría, Hospital Regional Universitario de Málaga, Málaga, España
| | - Cristina Calvo Rey
- Servicio de Pediatría y Enfermedades Infecciosas, Hospital Universitario La Paz, Fundación IdiPaz. TEDDY Network (European Network of Excellence for Pediatric Clinical Research), Madrid, España; Red de Investigación Traslacional en Infectología Pediátrica (RITIP), España.
| | - Jesús Saavedra-Lozano
- Red de Investigación Traslacional en Infectología Pediátrica (RITIP), España; Sección de Enfermedades Infecciosas, Servicio de Pediatría, Hospital Universitario Gregorio Marañón, Universidad Complutense, Madrid, España
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Maturana Martínez D, Aguilera-Alonso D, García Mancebo J, Navarro ML, Hernández Sampelayo T, Rincón López EM, Santiago-García B, Saavedra-Lozano J, Santos M, Cercenado E. Enfermedad meningocócica invasiva en niños y adultos en un hospital terciario: epidemiología reciente y factores pronósticos. An Pediatr (Barc) 2019; 91:296-306. [DOI: 10.1016/j.anpedi.2018.12.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Revised: 11/25/2018] [Accepted: 12/15/2018] [Indexed: 11/25/2022] Open
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Suárez-Arrabal MC, Sánchez Cámara LA, Navarro Gómez ML, Santos Sebastián MDM, Hernández-Sampelayo T, Cercenado Mansilla E, Saavedra-Lozano J. [Invasive disease due to Streptococcus pyogenes: Changes in incidence and prognostic factors]. An Pediatr (Barc) 2019. [PMID: 30837112 DOI: 10.1016/j.anpedi.2018.12.017)] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Invasive group A streptococcal disease (iGASD) is a serious infection in children. Several studies have shown an increased incidence in the past years. OBJECTIVE To evaluate the characteristics and outcome of iGASD in children, and to determine changes in incidence or severity. MATERIAL AND METHODS A retrospective study was conducted on children≤16 years evaluated in a tertiary paediatric hospital in Madrid, and diagnosed with iGASD (June 2005-July 2013). An analysis was made of the demographics, symptomatology, microbiology, and treatment. The changes throughout the period studied were evaluated, as well as parameters associated with disease severity. RESULTS The study included a total of 55 children with iGASD, with 33 (60%) females, and a median age of 48.5 (20.5-88.9) months. The most frequent clinical syndromes were cellulitis/subcutaneous abscess (21.8%), ENT abscess (20%), pneumonia (16.4%), osteoarticular infection (16.4%), and mastoiditis (12.7%). The incidence of iGASD (cases/105 emergencies/year) increased from 5.6 (4.2-7.2) between June 2005-May 2009 to 18.9 (15.1-26) between June 2009-May 2013; P=.057. Surgery and admission to PICU was required by 35 (63.6%) and 10 (18.2%) patients, respectively. Children in PICU were younger (26.5 vs 52.6 months, P=.116), had a higher C-reactive protein (24.5 vs 10.7mg/dl, P<.001) and higher frequency of pneumonia (60 vs 7%, P<.001). In the multivariate analysis, only C-reactive protein was a risk factor for admission to PICU (OR: 1.14 [1.004-1.286], P=.04). There were no sequelae. CONCLUSIONS An increased incidence of iGASD was observed in the children in this study. Lower age, pneumonia, and higher C-reactive protein were associated with disease severity in this series.
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Affiliation(s)
- María Carmen Suárez-Arrabal
- Sección de Enfermedades Infecciosas, Servicio de Pediatría, Hospital General Universitario Gregorio Marañón, Madrid, España.
| | - Luis Alberto Sánchez Cámara
- Sección de Enfermedades Infecciosas, Servicio de Pediatría, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - María Luisa Navarro Gómez
- Sección de Enfermedades Infecciosas, Servicio de Pediatría, Hospital General Universitario Gregorio Marañón, Madrid, España; Universidad Complutense de Madrid, Madrid, España
| | - María Del Mar Santos Sebastián
- Sección de Enfermedades Infecciosas, Servicio de Pediatría, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - Teresa Hernández-Sampelayo
- Sección de Enfermedades Infecciosas, Servicio de Pediatría, Hospital General Universitario Gregorio Marañón, Madrid, España; Universidad Complutense de Madrid, Madrid, España
| | - Emilia Cercenado Mansilla
- Universidad Complutense de Madrid, Madrid, España; Servicio de Microbiología y Enfermedades Infecciosas, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - Jesús Saavedra-Lozano
- Sección de Enfermedades Infecciosas, Servicio de Pediatría, Hospital General Universitario Gregorio Marañón, Madrid, España; Universidad Complutense de Madrid, Madrid, España
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Maturana Martínez D, Aguilera-Alonso D, García Mancebo J, Navarro ML, Hernández Sampelayo T, Rincón López EM, Santiago-García B, Saavedra-Lozano J, Santos M, Cercenado E. Invasive meningococcal disease in children and adults in a tertiary level hospital. Recent epidemiology and prognostic factors. An Pediatr (Barc) 2019. [DOI: 10.1016/j.anpede.2019.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Bautista F, Engelhard D, Rizzari C, Baka M, Saavedra-Lozano J, Lopez-Medina E, Nasmyth-Miller C, Hernández-Sánchez J, Sturm S. Pharmacokinetics and Pharmacodynamics of Conventional-Dose vs Triple-Dose Oseltamivir in Severely Immunocompromised Children With Influenza. Open Forum Infect Dis 2019; 6:ofz430. [PMID: 31660381 PMCID: PMC6809794 DOI: 10.1093/ofid/ofz430] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Accepted: 09/25/2019] [Indexed: 11/28/2022] Open
Abstract
This randomized phase 1b study evaluated the pharmacokinetics/pharmacodynamics of conventional-dose (30–75 mg twice daily [BID]) vs triple-dose (90–225 mg BID; weight-adjusted) oseltamivir for treatment of influenza in severely immunocompromised children <13 years. Oseltamivir carboxylate (OC) Cmax and AUC0-12h were ~2-fold higher with triple-dose vs conventional-dose oseltamivir. Increased dose/exposure of oseltamivir/OC did not improve virological outcomes or reduce viral resistance. Median time to cessation of viral shedding was similar with triple-dose and conventional-dose oseltamivir (150.7 vs 157.1 hours, respectively); median time to alleviation of baseline fever was longer with conventional-dose oseltamivir (28.4 vs 11.3 hours). No new safety signals were identified.
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Affiliation(s)
- Francisco Bautista
- Pediatric Hematology, Oncology and Stem Cell Transplantation Department, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | - Dan Engelhard
- Department of Pediatrics, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Carmelo Rizzari
- Pediatric Hematology-Oncology Unit, Department of Pediatrics, MBBM Foundation, ASST-Monza, University of Milano-Bicocca, Monza, Italy
| | - Margarita Baka
- Department of Pediatric Oncology, Aglaia Kyriakou Children's Hospital, Athens, Greece
| | - Jesús Saavedra-Lozano
- Infectious Disease Unit, Department of Pediatrics, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Eduardo Lopez-Medina
- Department of Pediatrics, Universidad del Valle, Centro Médico Imbanaco and Centro de Estudios en Infectología Pediátrica, Cali, Colombia
| | | | | | - Stefan Sturm
- Roche Innovation Center Basel, Roche Pharmaceutical Research and Early Development, Basel, Switzerland
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Aguilera-Alonso D, Escosa-García L, Goycochea-Valdivia WA, Soler-Palacín P, Saavedra-Lozano J, Rodrigo C, Cercenado E, Ramos JT, Baquero-Artigao F. [Position statement of the Spanish Association of Paediatrics-Spanish Society of Paediatric Infectious Diseases (AEP-SEIP) on the treatment of multidrug-resistant bacterial infections]. An Pediatr (Barc) 2019; 91:351.e1-351.e13. [PMID: 31635925 DOI: 10.1016/j.anpedi.2019.08.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Accepted: 08/29/2019] [Indexed: 12/16/2022] Open
Abstract
A progressive increase in the incidence of infections caused by multidrug-resistant microorganisms is being reported. Among these resistant microorganisms, the main threats are extended-spectrum β-lactamase-, AmpC-, and carbapenemase-producing Gram-negative bacilli, methicillin-resistant Staphylococcus aureus and vancomycin-resistant Enterococcus faecium. To address this important problem, it is essential to establish pediatric Antimicrobial Stewardship programs, perform active epidemiological surveillance and develop an adequate infection control policy. The therapeutic approach of these infections is often complex, frequently requiring antibiotics with less experience in children. In this position document made by the Spanish Association of Pediatrics and the Spanish Society of Pediatric Infectious Diseases, the epidemiology and treatment of these infections are reviewed according to the best available evidence.
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Affiliation(s)
- David Aguilera-Alonso
- Sección de Enfermedades Infecciosas, Servicio de Pediatría, Instituto de Investigación Sanitaria, Hospital General Universitario Gregorio Marañón, Madrid, España.
| | - Luis Escosa-García
- Servicio de Pediatría, Enfermedades Infecciosas y Patología Tropical, Hospital La Paz, Universidad Autónoma de Madrid, Madrid, España
| | | | - Pere Soler-Palacín
- Unitat de Patologia Infecciosa i Immunodeficiències de Pediatria, Hospital Vall d'Hebron, Universidad Autónoma de Barcelona, Barcelona, España
| | - Jesús Saavedra-Lozano
- Sección de Enfermedades Infecciosas, Servicio de Pediatría, Instituto de Investigación Sanitaria, Hospital General Universitario Gregorio Marañón, Madrid, España; Universidad Complutense de Madrid, España
| | - Carlos Rodrigo
- Servicio de Pediatría, Hospital Germans Trias i Pujol, Universidad Autónoma de Barcelona, Barcelona, España
| | - Emilia Cercenado
- Servicio de Microbiología y Enfermedades Infecciosas, Hospital General Universitario Gregorio Marañón, Universidad Complutense de Madrid, Madrid, España; CIBERES, Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, CB06/06/0058, Madrid, España
| | - José Tomás Ramos
- Servicio de Pediatría, Hospital Clínico San Carlos, Universidad Complutense de Madrid, Madrid, España
| | - Fernando Baquero-Artigao
- Servicio de Pediatría, Enfermedades Infecciosas y Patología Tropical, Hospital La Paz, Universidad Autónoma de Madrid, Madrid, España
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Rincón-López EM, Navarro Gómez ML, Hernández-Sampelayo Matos T, Saavedra-Lozano J, Aguilar de la Red Y, Hernández Rupérez B, Cela de Julián E. Low-risk factors for severe bacterial infection and acute chest syndrome in children with sickle cell disease. Pediatr Blood Cancer 2019; 66:e27667. [PMID: 30740900 DOI: 10.1002/pbc.27667] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Revised: 01/23/2019] [Accepted: 01/25/2019] [Indexed: 01/06/2023]
Abstract
INTRODUCTION The rate of bacterial infections in children with sickle cell disease (SCD) has decreased in recent years, mainly due to penicillin prophylaxis and vaccination. OBJECTIVES To determine the rate of severe bacterial infection (SBI) in a cohort of children with SCD and to describe low-risk factors for confirmed SBI (CSBI) and acute chest syndrome (ACS). METHODS This 11-year retrospective cohort study included children with febrile SCD admitted to a reference hospital in Spain. A case-control study was performed comparing patients diagnosed with SBI to those without SBI, and subanalyses for groups with CSBI and ACS were carried out. RESULTS A total of 316 febrile episodes were analyzed; 69 (21.8%) had confirmed or possible SBI. Thirteen of those had CSBI (4.1%), eight urinary tract infection, and five bacteremia/sepsis. Among the cases of possible SBI, the majority had ACS (54/56; 96.4%). Age >3 years, absence of central venous catheter, hemodynamic stability, and procalcitonin <0.6 ng/ml were low-risk factors for CSBI, whereas normal oxygen saturation and C-reactive protein <3 mg/dl were low-risk factors for ACS, with negative predictive values (NPV) of 98.3%, 97.4%, 96%, 97.2%, 87.5%, and 85.8%, respectively. CONCLUSION In this cohort of children with SCD who were well vaccinated and received adequate prophylaxis, we found a low rate of bacteremia and CSBI. We described several low-risk factors for CSBI and ACS, all of them with a high NPV. These findings may help to develop a risk score to safely select the patients that could be managed with a more conservative approach.
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Affiliation(s)
- Elena María Rincón-López
- Infectious Diseases Unit, Department of Pediatrics, Hospital General Universitario Gregorio Marañón, Madrid, Spain.,PhD Program in Medicine, Universidad Complutense, Madrid, Spain
| | - María Luisa Navarro Gómez
- Infectious Diseases Unit, Department of Pediatrics, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | | | - Jesús Saavedra-Lozano
- Infectious Diseases Unit, Department of Pediatrics, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | | | | | - Elena Cela de Julián
- Pediatric Hematology and Oncology Unit, Department of Pediatrics, Hospital General Universitario Gregorio Marañón, Madrid, Spain
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32
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Suárez-Arrabal MC, Sánchez Cámara LA, Navarro Gómez ML, Santos Sebastián MDM, Hernández-Sampelayo T, Cercenado Mansilla E, Saavedra-Lozano J. [Invasive disease due to Streptococcus pyogenes: Changes in incidence and prognostic factors]. An Pediatr (Barc) 2019; 91:286-295. [PMID: 30837112 DOI: 10.1016/j.anpedi.2018.12.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2018] [Revised: 12/16/2018] [Accepted: 12/17/2018] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Invasive group A streptococcal disease (iGASD) is a serious infection in children. Several studies have shown an increased incidence in the past years. OBJECTIVE To evaluate the characteristics and outcome of iGASD in children, and to determine changes in incidence or severity. MATERIAL AND METHODS A retrospective study was conducted on children≤16 years evaluated in a tertiary paediatric hospital in Madrid, and diagnosed with iGASD (June 2005-July 2013). An analysis was made of the demographics, symptomatology, microbiology, and treatment. The changes throughout the period studied were evaluated, as well as parameters associated with disease severity. RESULTS The study included a total of 55 children with iGASD, with 33 (60%) females, and a median age of 48.5 (20.5-88.9) months. The most frequent clinical syndromes were cellulitis/subcutaneous abscess (21.8%), ENT abscess (20%), pneumonia (16.4%), osteoarticular infection (16.4%), and mastoiditis (12.7%). The incidence of iGASD (cases/105 emergencies/year) increased from 5.6 (4.2-7.2) between June 2005-May 2009 to 18.9 (15.1-26) between June 2009-May 2013; P=.057. Surgery and admission to PICU was required by 35 (63.6%) and 10 (18.2%) patients, respectively. Children in PICU were younger (26.5 vs 52.6 months, P=.116), had a higher C-reactive protein (24.5 vs 10.7mg/dl, P<.001) and higher frequency of pneumonia (60 vs 7%, P<.001). In the multivariate analysis, only C-reactive protein was a risk factor for admission to PICU (OR: 1.14 [1.004-1.286], P=.04). There were no sequelae. CONCLUSIONS An increased incidence of iGASD was observed in the children in this study. Lower age, pneumonia, and higher C-reactive protein were associated with disease severity in this series.
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Affiliation(s)
- María Carmen Suárez-Arrabal
- Sección de Enfermedades Infecciosas, Servicio de Pediatría, Hospital General Universitario Gregorio Marañón, Madrid, España.
| | - Luis Alberto Sánchez Cámara
- Sección de Enfermedades Infecciosas, Servicio de Pediatría, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - María Luisa Navarro Gómez
- Sección de Enfermedades Infecciosas, Servicio de Pediatría, Hospital General Universitario Gregorio Marañón, Madrid, España; Universidad Complutense de Madrid, Madrid, España
| | - María Del Mar Santos Sebastián
- Sección de Enfermedades Infecciosas, Servicio de Pediatría, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - Teresa Hernández-Sampelayo
- Sección de Enfermedades Infecciosas, Servicio de Pediatría, Hospital General Universitario Gregorio Marañón, Madrid, España; Universidad Complutense de Madrid, Madrid, España
| | - Emilia Cercenado Mansilla
- Universidad Complutense de Madrid, Madrid, España; Servicio de Microbiología y Enfermedades Infecciosas, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - Jesús Saavedra-Lozano
- Sección de Enfermedades Infecciosas, Servicio de Pediatría, Hospital General Universitario Gregorio Marañón, Madrid, España; Universidad Complutense de Madrid, Madrid, España
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33
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Goycochea-Valdivia WA, Baquero-Artigao F, Del Rosal T, Frick MA, Rojo P, Echeverría MJ, Noguera-Julian A, Bringué X, Saavedra-Lozano J, Vives-Oñós I, Moliner E, Cilleruelo MJ, Cuadrado I, Colino E, Castells L, Tagarro A, Vilas J, Soler-Palacin P, Blázquez-Gamero D. Cytomegalovirus DNA Detection by Polymerase Chain Reaction in Cerebrospinal Fluid of Infants With Congenital Infection: Associations With Clinical Evaluation at Birth and Implications for Follow-up. Clin Infect Dis 2018; 64:1335-1342. [PMID: 28158709 DOI: 10.1093/cid/cix105] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2016] [Accepted: 01/31/2017] [Indexed: 12/20/2022] Open
Abstract
Background DNA detection of human cytomegalovirus (hCMV) in cerebrospinal fluid (CSF) by polymerase chain reaction (PCR) is a marker of central nervous system (CNS) involvement in congenital hCMV infection (cCMV), but its prognostic value is unknown. Methods A multicenter, retrospective study was performed using the Spanish Congenital Cytomegalovirus Infection Database (REDICCMV; http://www.cmvcongenito.es). Newborns with cCMV and a lumbar puncture performed were included and classified according to their hCMV-PCR in CSF result (positive/negative). Clinical characteristics, neuroimaging abnormalities, plasma viral load, and audiological and neurological outcomes of both groups were compared. Results A total of 136 neonates were included in the study: 21 (15.4%) with positive CSF hCMV-PCR and 115 (84.6%) with negative results. Seventeen patients (81%) in the positive group were symptomatic at birth compared with 52.2% of infants in the negative group (odds ratio [OR], 3.86; 95% confidence interval [CI], 1.28-14.1; P = .01). Only 4 asymptomatic newborns (6.8%) had a positive CSF hCMV-PCR. There were no differences between groups regarding the rate of microcephaly, neuroimaging abnormalities, neurological sequelae at 6 months of age, or plasma viral load. Sensorineural hearing loss (SNHL) at birth was associated with a positive CSF hCMV-PCR result (OR, 3.49; 95% CI, 1.08-11.27; P = .04), although no association was found at 6 months of age. Conclusions A positive hCMV-PCR result in CSF is associated with symptomatic cCMV and SNHL at birth. However, no differences in neuroimaging studies, plasma viral load, or outcomes at 6 months were found. These results suggest that hCMV-PCR in CSF may not be a useful prognostic marker in cCMV.
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Affiliation(s)
| | | | - Teresa Del Rosal
- Pediatric Infectious Diseases Unit, Hospital Universitario La Paz, Madrid
| | - Marie-Antoinette Frick
- Pediatric Infectious Diseases and Immunodeficiencies Unit, Hospital Universitari Vall d Hebrón, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona
| | - Pablo Rojo
- Pediatric Infectious Diseases Unit, Hospital Universitario 12 de Octubre, Universidad Complutense, Instituto de Investigación Hospital 12 de Octubre (i+12), Madrid
| | | | - Antoni Noguera-Julian
- Malalties infeccioses i resposta inflamatòria sistèmica en pediatria. Unitat d'Infeccions, Servei de Pediatria. Institut de Recerca Pediàtrica Hospital Sant Joan de Déu, Barcelona.,Departament de Pediatria, Universitat de Barcelona.,CIBER de Epidemiología y Salud Pública (Ciberesp, Spain) Barcelona
| | - Xavier Bringué
- Department of Pediatrics and Neonatal Unit, Hospital Universitario Arnau de Vilanova, Lleida
| | | | - Isabel Vives-Oñós
- Pediatric Infectious Diseases and Immunodeficiencies Unit, Hospital Universitari Vall d Hebrón, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona.,Department of Pediatrics, Hospital Quirónsalud Barcelona
| | - Elisenda Moliner
- Pediatric Infectious Diseases Unit, Hospital de la Santa Creu y Sant Pau, Barcelona
| | | | | | - Elena Colino
- Pediatric Infectious Diseases Unit, Hospital Las Palmas de Gran Canaria
| | - Laura Castells
- Department of Pediatrics and Neonatology Unit, Hospital Universitario General de Cataluña, Barcelona
| | - Alfredo Tagarro
- Department of Pediatrics, Hospital Universitario Infanta Sofía, Universidad Europea de Madrid; and
| | - Javier Vilas
- Department of Pediatric Infectious Diseases, Complejo Hospitalario de Pontevedra, Spain
| | - Pere Soler-Palacin
- Pediatric Infectious Diseases and Immunodeficiencies Unit, Hospital Universitari Vall d Hebrón, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona
| | - Daniel Blázquez-Gamero
- Pediatric Infectious Diseases Unit, Hospital Universitario 12 de Octubre, Universidad Complutense, Instituto de Investigación Hospital 12 de Octubre (i+12), Madrid
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Gijón M, Bellusci M, Petraitiene B, Noguera-Julian A, Zilinskaite V, Sanchez Moreno P, Saavedra-Lozano J, Glikman D, Daskalaki M, Kaiser-Labusch P, Falup-Pecurariu O, Montagnani C, Prieto L, Gené A, Trumpulyte G, Kulecnikova I, Lepe JA, Cercenado E, Kudinsky R, Makri A, Huppertz HI, Bleotu L, Cocchi P, García-Hierro P, Vitkauskiene A, Fortuny C, Zukovskaja V, Neth O, Santos M, Rokney A, Petra M, Lixandru R, Galli L, Guillén S, Chaves F, Rojo Conejo P. Factors associated with severity in invasive community-acquired Staphylococcus aureus infections in children: a prospective European multicentre study. Clin Microbiol Infect 2016; 22:643.e1-6. [PMID: 27107685 DOI: 10.1016/j.cmi.2016.04.004] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Revised: 03/17/2016] [Accepted: 04/05/2016] [Indexed: 11/30/2022]
Abstract
Staphylococcus aureus is the main pathogen responsible for bone and joint infections worldwide and is also capable of causing pneumonia and other invasive severe diseases. Panton-Valentine leukocidin (PVL) and methicillin-resistant S. aureus (MRSA) have been studied as factors related with severity in these infections. The aims of this study were to describe invasive community-acquired S. aureus (CA-SA) infections and to analyse factors related to severity of disease. Paediatric patients (aged 0-16 years) who had a CA-SA invasive infection were prospectively recruited from 13 centres in 7 European countries. Demographic, clinical and microbiological data were collected. Severe infection was defined as invasive infection leading to death or admission to intensive care due to haemodynamic instability or respiratory failure. A total of 152 children (88 boys) were included. The median age was 7.2 years (interquartile range, 1.3-11.9). Twenty-six (17%) of the 152 patients had a severe infection, including 3 deaths (2%). Prevalence of PVL-positive CA-SA infections was 18.6%, and 7.8% of the isolates were MRSA. The multivariate analysis identified pneumonia (adjusted odds ratio (aOR) 13.39 (95% confidence interval (CI) 4.11-43.56); p 0.008), leukopenia at admission (<3000/mm(3)) (aOR 18.3 (95% CI 1.3-259.9); p 0.03) and PVL-positive infections (aOR 4.69 (95% CI 1.39-15.81); p 0.01) as the only factors independently associated with severe outcome. There were no differences in MRSA prevalence between severe and nonsevere cases (aOR 4.30 (95% CI 0.68- 28.95); p 0.13). Our results show that in European children, PVL is associated with more severe infections, regardless of methicillin resistance.
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Affiliation(s)
- M Gijón
- Pediatric Infectious Diseases, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - M Bellusci
- Pediatric Infectious Diseases, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - B Petraitiene
- Pediatric Infectious Diseases, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - A Noguera-Julian
- Pediatric Infectious Diseases, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - V Zilinskaite
- Pediatric Infectious Diseases, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - P Sanchez Moreno
- Pediatric Infectious Diseases, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - J Saavedra-Lozano
- Pediatric Infectious Diseases, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - D Glikman
- Pediatric Infectious Diseases, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - M Daskalaki
- Pediatric Infectious Diseases, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - P Kaiser-Labusch
- Pediatric Infectious Diseases, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - O Falup-Pecurariu
- Pediatric Infectious Diseases, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - C Montagnani
- Pediatric Infectious Diseases, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - L Prieto
- Pediatric Infectious Diseases, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - A Gené
- Pediatric Infectious Diseases, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - G Trumpulyte
- Pediatric Infectious Diseases, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - I Kulecnikova
- Pediatric Infectious Diseases, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - J A Lepe
- Pediatric Infectious Diseases, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - E Cercenado
- Pediatric Infectious Diseases, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - R Kudinsky
- Pediatric Infectious Diseases, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - A Makri
- Pediatric Infectious Diseases, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - H I Huppertz
- Pediatric Infectious Diseases, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - L Bleotu
- Pediatric Infectious Diseases, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - P Cocchi
- Pediatric Infectious Diseases, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - P García-Hierro
- Pediatric Infectious Diseases, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - A Vitkauskiene
- Pediatric Infectious Diseases, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - C Fortuny
- Pediatric Infectious Diseases, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - V Zukovskaja
- Pediatric Infectious Diseases, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - O Neth
- Pediatric Infectious Diseases, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - M Santos
- Pediatric Infectious Diseases, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - A Rokney
- Pediatric Infectious Diseases, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - M Petra
- Pediatric Infectious Diseases, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - R Lixandru
- Pediatric Infectious Diseases, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - L Galli
- Pediatric Infectious Diseases, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - S Guillén
- Pediatric Infectious Diseases, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - F Chaves
- Pediatric Infectious Diseases, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - P Rojo Conejo
- Pediatric Infectious Diseases, Hospital Universitario 12 de Octubre, Madrid, Spain.
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Saavedra-Lozano J, Calvo C, Huguet Carol R, Rodrigo C, Núñez E, Pérez C, Merino R, Rojo P, Obando I, Downey F, Colino E, García J, Cilleruelo M, Torner F, García L. Documento de Consenso SEIP-SERPE-SEOP sobre etiopatogenia y diagnóstico de la osteomielitis aguda y artritis séptica no complicadas. An Pediatr (Barc) 2015; 83:216.e1-10. [DOI: 10.1016/j.anpedi.2014.08.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2014] [Accepted: 08/18/2014] [Indexed: 10/24/2022] Open
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Saavedra-Lozano J, Calvo C, Huguet Carol R, Rodrigo C, Núñez-Cuadros E, Pérez Méndez C, Merino R, Rojo P, Obando I, Downey F, Colino E, García J, Cilleruelo M, Torner F, García L. SEIP-SERPE-SEOP consensus document on aetiopathogenesis and diagnosis of uncomplicated acute osteomyelitis and septic arthritis. Anales de Pediatría (English Edition) 2015. [DOI: 10.1016/j.anpede.2015.07.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Saavedra-Lozano J, Calvo C, Huguet Carol R, Rodrigo C, Núñez E, Obando I, Rojo P, Merino R, Pérez C, Downey FJ, Colino E, García JJ, Cilleruelo MJ, Torner F, García L. [Response to the letter to the editor from SEOP as regards the SEIP-SERPE-SEOP consensus document on the treatment of uncomplicated acute osteomyelitis and septic arthritis]. An Pediatr (Barc) 2015; 83:224. [PMID: 26318251 DOI: 10.1016/j.anpedi.2015.07.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Accepted: 07/06/2015] [Indexed: 10/23/2022] Open
Affiliation(s)
| | - C Calvo
- Sociedad Española de Infectología Pediátrica (SEIP); Sociedad Española de Reumatología Pediátrica (SERPE)
| | | | - C Rodrigo
- Sociedad Española de Infectología Pediátrica (SEIP)
| | - E Núñez
- Sociedad Española de Infectología Pediátrica (SEIP); Sociedad Española de Reumatología Pediátrica (SERPE)
| | - I Obando
- Sociedad Española de Infectología Pediátrica (SEIP)
| | - P Rojo
- Sociedad Española de Infectología Pediátrica (SEIP)
| | - R Merino
- Sociedad Española de Reumatología Pediátrica (SERPE)
| | - C Pérez
- Sociedad Española de Infectología Pediátrica (SEIP)
| | - F J Downey
- Sociedad Española de Ortopedia Pediátrica (SEOP)
| | - E Colino
- Sociedad Española de Infectología Pediátrica (SEIP)
| | - J J García
- Sociedad Española de Infectología Pediátrica (SEIP)
| | | | - F Torner
- Sociedad Española de Ortopedia Pediátrica (SEOP)
| | - L García
- Sociedad Española de Infectología Pediátrica (SEIP)
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Santiago B, Guerra L, García-Morín M, González E, Gonzálvez A, Izquierdo G, Martos A, Santos M, Navarro M, Hernández-Sampelayo M, Saavedra-Lozano J. Aislamiento de Clostridium difficile en niños hospitalizados con diarrea. An Pediatr (Barc) 2015; 82:417-25. [DOI: 10.1016/j.anpedi.2014.07.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Revised: 06/02/2014] [Accepted: 07/15/2014] [Indexed: 12/13/2022] Open
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Santiago B, Guerra L, García-Morín M, González E, Gonzálvez A, Izquierdo G, Martos A, Santos M, Navarro M, Hernández-Sampelayo M, Saavedra-Lozano J. Clostridium difficile isolation in children hospitalized with diarrhoea. Anales de Pediatría (English Edition) 2015. [DOI: 10.1016/j.anpede.2015.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Saavedra-Lozano J, Calvo C, Huguet Carol R, Rodrigo C, Núñez E, Obando I, Rojo P, Merino R, Pérez C, Downey F, Colino E, García J, Cilleruelo M, Torner F, García L. SEIP–SERPE–SEOP Consensus document on the treatment of uncomplicated acute osteomyelitis and septic arthritis. Anales de Pediatría (English Edition) 2015. [DOI: 10.1016/j.anpede.2014.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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41
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Saavedra-Lozano J, Calvo C, Huguet Carol R, Rodrigo C, Núñez E, Obando I, Rojo P, Merino R, Pérez C, Downey FJ, Colino E, García JJ, Cilleruelo MJ, Torner F, García L. [SEIP-SERPE-SEOP Consensus document on the treatment of uncomplicated acute osteomyelitis and septic arthritis]. An Pediatr (Barc) 2014; 82:273.e1-273.e10. [PMID: 25444035 DOI: 10.1016/j.anpedi.2014.10.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2014] [Accepted: 10/02/2014] [Indexed: 11/30/2022] Open
Abstract
This is a Consensus Document of the Spanish Society of Paediatric Infectious Diseases (Sociedad Española de Infectología Pediatrica), Spanish Society of Paediatric Rheumatology (Sociedad Española de Reumatología Pediátrica) and the Spanish Society of Paediatric Orthopaedics (Sociedad Española de Ortopedia Pediátrica), on the treatment of uncomplicated acute osteomyelitis and septic arthritis. A review is presented on the medical and surgical treatment of acute osteoarticular infection, defined as a process with less than 14 days of symptomatology, uncomplicated and community-acquired. The different possible options are evaluated based on the best available scientific knowledge, and a number of evidence-based recommendations for clinical practice are provided.
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Affiliation(s)
| | - C Calvo
- Sociedad Española de Infectología Pediátrica (SEIP); Sociedad Española de Reumatología Pediátrica (SERPE)
| | | | - C Rodrigo
- Sociedad Española de Infectología Pediátrica (SEIP)
| | - E Núñez
- Sociedad Española de Infectología Pediátrica (SEIP); Sociedad Española de Reumatología Pediátrica (SERPE)
| | - I Obando
- Sociedad Española de Infectología Pediátrica (SEIP)
| | - P Rojo
- Sociedad Española de Infectología Pediátrica (SEIP)
| | - R Merino
- Sociedad Española de Reumatología Pediátrica (SERPE)
| | - C Pérez
- Sociedad Española de Infectología Pediátrica (SEIP)
| | - F J Downey
- Sociedad Española de Ortopedia Pediátrica (SEOP)
| | - E Colino
- Sociedad Española de Infectología Pediátrica (SEIP)
| | - J J García
- Sociedad Española de Infectología Pediátrica (SEIP)
| | | | - F Torner
- Sociedad Española de Ortopedia Pediátrica (SEOP)
| | - L García
- Sociedad Española de Infectología Pediátrica (SEIP)
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de Mulder M, Yebra G, Navas A, de José MI, Gurbindo MD, González-Tomé MI, Mellado MJ, Saavedra-Lozano J, Muñoz-Fernández MÁ, de Ory SJ, Ramos JT, Holguín Á. High drug resistance prevalence among vertically HIV-infected patients transferred from pediatric care to adult units in Spain. PLoS One 2012; 7:e52155. [PMID: 23284913 PMCID: PMC3524105 DOI: 10.1371/journal.pone.0052155] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2012] [Accepted: 11/09/2012] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Antiretroviral treatment (ART) has contributed to increased life expectancy of HIV-1 infected children. In developed countries, an increasing number of children reaching adulthood are transferred to adult units. The objectives were to describe the demographic and clinical features, ART history, antiviral drug resistance and drug susceptibility in HIV-1 perinatally infected adolescents transferred to adult care units in Spain from the Madrid Cohort of HIV-1 infected children. METHODS Clinical, virological and immunological features of HIV-1 vertically infected patients in the Madrid Cohort of HIV-infected children were analyzed at the time of transfer. Pol sequences from each patient were recovered before transfer. Resistance mutations according to the InternationaI AIDS Society 2011 list were identified and interpreted using the Stanford algorithm. Results were compared to the non-transferred HIV-1 infected pediatric cohort from Madrid. RESULTS One hundred twelve infected patients were transferred to adult units between 1997 and 2011. They were mainly perinatally infected (93.7%), with a mean nadir CD4+-T-cells count of 10% and presented moderate or severe clinical symptoms (75%). By the time of transfer, the mean age was 18.9 years, the mean CD4+T-cells count was 627.5 cells/ml, 64.2% presented more than 350 CD4+T-cells/ml and 47.3% had ≤ 200 RNA-copies/ml. Most (97.3%) were ART experienced receiving Highly Active ART (HAART) (84.8%). Resistance prevalence among pretreated was 50.9%, 76.9% and 36.5% for Protease Inhibitors (PI), Nucleoside Reverse Transcriptase Inhibitors (NRTI) and Non-NRTI (NNRTI), respectively. Resistance mutations were significantly higher among transferred patients compared to non-transferred for the PI+NRTI combination (19% vs. 8.4%). Triple resistance was similar to non-transferred pediatric patients (17.3% vs. 17.6%). CONCLUSION Despite a good immunological and virological control before transfer, we found high levels of resistance to PI, NRTI and triple drug resistance in HIV-1 infected adolescents transferred to adult units.
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Affiliation(s)
- Miguel de Mulder
- HIV-1 Molecular Epidemiology Laboratory, Microbiology and Parasitology Department, Hospital Universitario Ramón y Cajal, IRYCIS and CIBER-ESP, Madrid, Spain
| | - Gonzalo Yebra
- HIV-1 Molecular Epidemiology Laboratory, Microbiology and Parasitology Department, Hospital Universitario Ramón y Cajal, IRYCIS and CIBER-ESP, Madrid, Spain
| | - Adriana Navas
- Pediatrics Department, Hospital Universitario Infanta Leonor, Madrid, Spain
| | | | | | | | | | - Jesús Saavedra-Lozano
- Pediatrics Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | | | - Santiago Jiménez de Ory
- Molecular Immunobiology Laboratory, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - José Tomás Ramos
- Pediatrics Department, Hospital Universitario de Getafe, Madrid, Spain
| | - África Holguín
- HIV-1 Molecular Epidemiology Laboratory, Microbiology and Parasitology Department, Hospital Universitario Ramón y Cajal, IRYCIS and CIBER-ESP, Madrid, Spain
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Méndez-Echevarría A, González-Muñoz M, Mellado MJ, Baquero-Artigao F, Blázquez D, Penín M, Navarro ML, Saavedra-Lozano J, Hernandez-Sampelayo MT, González-Tomé I, Calvo C, Ruiz M, Ramos JT, Guillén S, Velazquez R, Pérez B, Martínez J, Pérez E. Interferon-γ release assay for the diagnosis of tuberculosis in children. Arch Dis Child 2012; 97:514-6. [PMID: 21543457 DOI: 10.1136/adc.2010.202069] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
AIMS To compare the QuantiFERON-TB GOLD In Tube test (QTF) and the tuberculin skin test (TST) in children. METHODS A prospective study was carried out in nine hospitals in Madrid, Spain. TST and QTF were performed in immigrants, tuberculosis (TB) contacts and patients with TB disease (TBD). RESULTS 459 children were included. Disagreement between the tests was more frequently observed among latent tuberculosis infection (LTBI) cases (54%; 38/70) than in non-infected or TBD cases (0.8%; 3/369) (p<0.01). There were more BCG-vaccinated children among LTBI cases with negative QTF (76%) than among LTBI cases with positive QTF (40%) (p<0.001). Agreement between tests in BCG-vaccinated children was lower than in non-vaccinated cases (p<0.05). Tests in TB exposed patients showed better agreement than in non-exposed children (p<0.05). CONCLUSIONS Agreement of both tests was excellent in TBD cases, non-vaccinated children and non-infected patients. A significant number of QTF negative results were observed among LTBI cases, especially in BCG-vaccinated children. Agreement was better in exposed children.
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Affiliation(s)
- Ana Méndez-Echevarría
- Paediatric Department, La Paz Hospital, Paseo de la Castellana 261, 28046 Madrid, Spain.
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Pérez Moreno J, Saavedra-Lozano J, García Leal R, Ferreras Ferreras B, Peinador García M, Santos Sebastián M. [Difficulty in diagnosing infections in cerebrospinal fluid shunts]. An Pediatr (Barc) 2012; 77:143-5. [PMID: 22541589 DOI: 10.1016/j.anpedi.2012.03.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2011] [Revised: 11/07/2011] [Accepted: 03/10/2012] [Indexed: 11/28/2022] Open
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Saavedra-Lozano J, Garrido C, Catalán P, González F. [Children with cancer and respiratory viral infection: epidemiology, diagnosis and treatment options]. Enferm Infecc Microbiol Clin 2010; 29:40-51. [PMID: 21183254 PMCID: PMC7103288 DOI: 10.1016/j.eimc.2010.04.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2009] [Revised: 04/26/2010] [Accepted: 04/30/2010] [Indexed: 11/26/2022]
Abstract
Community-adquired respiratory viral infection is the most common cause of febrile infection in children, and an important cause of infection to consider in children with cancer. Nevertheless, there are few well-designed, controlled studies in this population, which makes it difficult to understand the importance, behaviour and management of these viruses in immunocompromised children. New diagnostic techniques in PCR-based microbiology, could provide many opportunities for early diagnosis, preventing the spread of the virus and to implement the correct therapy. It is important to design appropriate prospective studies to assess these types of infections in children with cancer. In this review we analyse the main studies published in the literature, evaluating the epidemiology, diagnosis and management of children with cancer and respiratory viral infection.
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Affiliation(s)
- Jesús Saavedra-Lozano
- Servicio de Pediatría, Hospital General Universitario Gregorio Marañón, Madrid, España.
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Saavedra-Lozano J, Ramos JT, Sanz F, Navarro ML, de José MI, Martín-Fontelos P, Mellado MJ, Leal JAL, Rodriguez C, Luque I, Madison SJ, Irlbeck D, Lanier ER, Ramilo O. Salvage therapy with abacavir and other reverse transcriptase inhibitors for human immunodeficiency-associated encephalopathy. Pediatr Infect Dis J 2006; 25:1142-52. [PMID: 17133160 DOI: 10.1097/01.inf.0000246976.40494.af] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND HIV-associated encephalopathy (HIV-AE) is a severe neurologic condition that affects HIV-infected children. The potential benefit of antiretroviral (ARV) agents with good cerebrospinal fluid (CSF) penetration remains to be defined. Abacavir (ABC) achieves good CSF concentrations and studies of high-dose ABC showed benefit in adults with HIV dementia. The present study evaluated the safety and virologic, immunologic and neuropsychological responses of an ARV regimen including high-dose ABC in children with HIV-AE. METHODS Children between 3 months and 18 years old and abacavir-naive with HIV-AE and virologic failure were eligible. RESULTS : Seventeen children (16 ARV-experienced) were enrolled and 14 children completed 48 weeks of therapy. The overall tolerability was good; 2 children had a possible hypersensitivity reaction. At week 48, 53% and 59% of the children achieved HIV RNA levels below the limit of quantitation in plasma and CSF, respectively. The median (25%-75% range) change of HIV RNA from baseline to week 48 was -2.29 (-0.81 to -2.47) log10 copies/mL in plasma and -0.94 (0 to -1.13) log10 copies/mL in CSF. The mean increases in CD4 (+/-standard error of mean) cell count and CD4% were 427 (+/-169) cells/mm and 8% (+/-2), respectively. Concentrations of soluble tumor necrosis factor receptor II were reduced in plasma and CSF. Children less than 6 years of age demonstrated significant neuropsychological improvement at week 48. CONCLUSIONS In the present study with a limited number of children, highly active ARV therapy including high-dose ABC showed a safety profile similar to standard dose ABC and provided clinical, immunologic and virologic response in children with HIV-AE at week 48. Children less than 6 years of age also demonstrated significant neuropsychological improvement.
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Saavedra-Lozano J, McCoig CC, Cao Y, Vitetta ES, Ramilo O. Zidovudine, lamivudine, and abacavir have different effects on resting cells infected with human immunodeficiency virus in vitro. Antimicrob Agents Chemother 2004; 48:2825-30. [PMID: 15273087 PMCID: PMC478513 DOI: 10.1128/aac.48.8.2825-2830.2004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
We have previously described an in vitro model for the evaluation of the effects of different immunomodulatory agents and immunotoxins (ITs) on cells latently infected with human immunodeficiency virus (HIV). We demonstrated that latently infected, replication-competent cells can be generated in vitro after eliminating CD25+ cells with an IT. Thus, by selectively killing the productively infected cells with an anti-CD25 IT we can generate a population of latently infected cells. CD25- cells generated in this manner were treated with nucleoside analog reverse transcriptase inhibitors and subsequently activated with phytohemagglutinin in the presence of the drugs. The antiviral activities of zidovudine (ZDV), lamivudine (3TC), and abacavir (ABC) were evaluated by using this model. 3TC and ABC demonstrated significant activity in decreasing HIV production from recently infected resting cells following their activation, whereas the effect of ZDV was more modest. These results suggest that the differences in antiviral activity of nucleoside analogs on resting cells should be considered when designing drug combinations for the treatment of HIV infection. The model presented here offers a convenient alternative for evaluating the mechanism of action of new antiretroviral agents (J. Saavedra, C. Johnson, J. Koester, M. St. Claire, E. Vitteta, O. Ramilo, 37th Intersci. Conf. Antimicrob. Agents Chemother., abstr. I-59, 1997).
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Affiliation(s)
- Jesús Saavedra-Lozano
- Cancer Immunobiology Center, University of Texas Southwestern Medical Center, Dallas, Texas 75390-9063, USA
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Mejías A, Chávez-Bueno S, Ríos AM, Saavedra-Lozano J, Fonseca Aten M, Hatfield J, Kapur P, Gómez AM, Jafri HS, Ramilo O. Anti-respiratory syncytial virus (RSV) neutralizing antibody decreases lung inflammation, airway obstruction, and airway hyperresponsiveness in a murine RSV model. Antimicrob Agents Chemother 2004; 48:1811-22. [PMID: 15105140 PMCID: PMC400529 DOI: 10.1128/aac.48.5.1811-1822.2004] [Citation(s) in RCA: 84] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2003] [Revised: 08/17/2003] [Accepted: 01/19/2004] [Indexed: 11/20/2022] Open
Abstract
Numerous studies have described a strong association between respiratory syncytial virus (RSV) infection in infancy and the development of recurrent wheezing and airway hyperresponsiveness. We evaluated the effect of an anti-RSV neutralizing monoclonal antibody (palivizumab) on different aspects of RSV disease by using a murine model. BALB/c mice were intranasally inoculated with RSV A2. Palivizumab or an isotype-matched control antibody was administered once at 24 h before inoculation, 1 h after inoculation, or 48 h after inoculation. Regardless of the timing of administration, all mice treated with the neutralizing antibody showed significantly decreased RSV loads in bronchoalveolar lavage (BAL) and lung specimens compared with those of infected controls. Pulmonary histopathologic scores, airway obstruction measured by plethysmography, and airway hyperresponsiveness after methacholine challenge were significantly reduced in mice treated with the anti-RSV antibody 24 h before inoculation compared with those for untreated controls. Concentrations of interferon-gamma, interleukin-10, macrophage inflammatory protein 1alpha, regulated on activation normal T-cell expressed and secreted (RANTES), and eotaxin in BAL fluids were also significantly reduced in mice treated with palivizumab 24 h before inoculation. This study demonstrates that reduced RSV replication was associated with significant modulation of inflammatory and clinical markers of acute disease severity and significant improvement of the long-term pulmonary abnormalities. Studies to determine whether strategies aimed at preventing or reducing RSV replication could decrease the long-term morbidity associated with RSV infection in children should be considered.
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Affiliation(s)
- Asunción Mejías
- Department of Pediatrics, Division of Pediatric Infectious Diseases, University of Texas Southwestern Medical Center at Dallas and Children's Medical Center of Dallas, Dallas, Texas 75390-9063, USA
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Saavedra-Lozano J, Cao Y, Callison J, Sarode R, Sodora D, Edgar J, Hatfield J, Picker L, Peterson D, Ramilo O, Vitetta ES. An anti-CD45RO immunotoxin kills HIV-latently infected cells from individuals on HAART with little effect on CD8 memory. Proc Natl Acad Sci U S A 2004; 101:2494-9. [PMID: 14983037 PMCID: PMC356978 DOI: 10.1073/pnas.0308381100] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
CD4+ CD45RO+ T cells are the major latent viral reservoir in HIV-infected individuals and hence a major obstacle in curing the disease. An anti-CD45RO immunotoxin (IT) can decrease the number of both productively and latently infected CD4+ T cells obtained from HIV-infected individuals with detectable viremia. In this study, we determined whether this IT could also kill latently infected replication-competent CD4+ T cells obtained from infected individuals without detectable plasma viremia. Our results demonstrate that ex vivo treatment with the anti-CD45RO IT significantly reduced the frequency of these cells. In contrast, the IT had only a modest effect on the cytomegalovirus-specific memory responses of CD8+ T cells. These results suggest that purging latent cells from infected individuals on highly active antiretroviral therapy with the anti-CD45RO IT might reduce the HIV latent reservoir without seriously compromising CD8+ T cell memory responses.
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Affiliation(s)
- J Saavedra-Lozano
- Cancer Immunobiology Center, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
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McCoig C, Castrejón MM, Saavedra-Lozano J, Castaño E, Báez C, Lanier ER, Sáez-Llorens X, Ramilo O. Cerebrospinal fluid and plasma concentrations of proinflammatory mediators in human immunodeficiency virus-infected children. Pediatr Infect Dis J 2004; 23:114-8. [PMID: 14872175 DOI: 10.1097/01.inf.0000109247.67480.7a] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The pathogenesis of HIV encephalopathy is poorly understood especially in children. Studies suggest that HIV replication and the release of proinflammatory mediators in the central nervous system contribute to the pathogenesis of HIV dementia in adults. METHODS Cerebrospinal fluid (CSF) and plasma samples from 23 HIV-infected children were longitudinally analyzed at Weeks 0, 8, 16 and 48 for HIV RNA and concentrations of the following proinflammatory mediators: monocyte chemotactic protein-1 (MCP-1), tumor necrosis factor-alpha, regulated upon activation, normal T cell expressed and secreted (RANTES), macrophage-inflammatory protein (MIP)-1-alpha, MIP-1-beta and matrix metalloproteinase-9 (MMP-9). RESULTS All 23 children had detectable concentrations of MCP-1 in the CSF at all time points evaluated. However, of the remaining of proinflammatory mediators measured in CSF at baseline, only a few children had detectable concentrations: tumor necrosis factor-alpha, n = 1; RANTES, n = 5; MMP-9, n = 9; MIP-1-alpha and MIP-1-beta, n = 0. A reduction from baseline to Week 48 was observed in CSF concentrations of MCP-1 and, among children with detectable values, MMP-9, which paralleled declines in CSF HIV RNA. CONCLUSION These results suggest that MCP-1 and MMP-9 may be involved in the pathogenesis of central nervous system disease in HIV-infected children.
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Affiliation(s)
- Cynthia McCoig
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, USA
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