Dermatología Clínica Pediátrica Acceso abierto

Abstracto

Congreso de pediatría 2019: Infecciones del torrente sanguíneo en niños de Bielorrusia - Serhiyenka EN - Universidad Médica Estatal de Bielorrusia

Serhiyenka ES

Resumen :

En un estudio retrospectivo de 2009 a 2017 se identificó el patrón etiológico de la bacteriemia. Solo durante el período asignado se cultivaron 655 patógenos de hemocultivos de 515 pacientes de 3 semanas a 18 años de edad. Según los resultados del estudio, la proporción de bacterias gramnegativas fue del 31,7%, bacterias grampositivas del 61,9%, hongos del 6,4%. La fungemia se registró en años diferentes del 2,2 (2013) al 14,7% (2010) de todos los hemocultivos fantásticos. Candida parapsilosis prevalece en la estructura de los patógenos (64,3%) y 27 casos (64,3%) del género Torulopsis. Entre los microorganismos aislados predominaron los estafilococos (41%), el segundo lugar en frecuencia de aislamiento lo ocuparon microorganismos no fermentadores (16,7%), el tercer lugar los microorganismos de la familia Enterobacteriacae (14,1%) y el cuarto lugar los estreptococos (10,8%). El espectro de microorganismos gramnegativos de la propia familia Enterobacteriacae (n=86) es diverso: Escherichia – 10,5%, Salmonella – 5,8%, Shigella – 25,6%, Proteus mirabilis – 1,15%, Providencia stuartii – 1,15%, Serratia – 15,1%, Klebsiella – 27,9%, Enterobacter – 10,5% y otros – 2 (2,3%). En 102 (16,7%) episodios de bacteriemia se aislaron bacterias gramnegativas no fermentadoras, predominando entre ellas Acinetobacter (47,1%), Pseudomonas (20,6%), Achromobacter (12,7%) y Stenotrophomonas maltophilia (7, 8%). La estructura de las bacterias gramnegativas (n=404) se identificó entre los estafilococos (62,1%), siendo las especies coagulasa-negativas las más frecuentemente aisladas (84,5%). De todos los estafilococos (n=251), se detectó S. aureus con una frecuencia del 15,1%, siendo la más frecuente S. dermis (63,3% de los casos). Los estreptococos (n=66) se identifican entre Str. pneumoniae (27,3%) y Str. agalacia (19,7%) y Str. Grupos viridans (15,2%). Se aislóon enterococos en 31 pacientes (5,1%), con una frecuencia casi igual dominada por Enterococcus faecalis y Enterococcus faecium (41,9% y 38,7%, respectivamente). Durante el periodo de estudio se aislaron 7 (1,1%) cepas de Corynebacterium spp.

Blood cultures continue to be the mainstay of laboratory diagnosis of bloodstream infections (BSIs) in babies and youngsters. Recovery of a pathogen is effective, because it confirms the prognosis of bacteremia and allows for identity and susceptibility trying out at the organism to optimize antimicrobial therapy and length. A bad blood subculture is simply as critical, because it regulations out cases of bacteremia and prompts continued research of different infectious or noninfectious etiologies or cessation of useless empirical antimicrobial therapy.

The majority of research related to the laboratory diagnosis of BSI cognizance at the person populace. Thus, this minireview can be committed to kids and the multifactorial factors worried in obtaining an most excellent pediatric blood tradition specimen, consisting of timing, quantity, and bottle selection. Lastly, a discussion on the rapid diagnostic strategies presently to be had and their impact on pediatric control and results will be reviewed.

The two above studies mentioned correlation among blood cultures that were fantastic with noncontaminant micro-organism and ok blood extent (prevalence rates of 60% to 71%). In comparison, the research determined that procurement of low blood quantity inversely correlated with blood tradition infection fees. 60-5 percent of effective blood cultures deemed to be contaminants had insufficient blood volume, and restoration of contaminant turned into two times as probably while inadequate blood volume became obtained (5.1% versus 2.8%). These findings further aid the need of acquiring enough blood tradition volume, as the recovery of contaminants has been suggested in 25% to 69% of all fantastic blood cultures in pediatric patients and is associated with needless antimicrobial therapy, prolonged hospitalization, and incurred cost. It isn't in particular clean why low extent blood cultures are more prone to yield contaminants; one idea is that the purchase of contaminants is unbiased of blood extent, and as a substitute the collection of larger blood extent dilutes the awareness of the contaminant present inside the blood subculture bottle, lowering the danger of detection at some point of the incubation duration.

In conclusion, there are restricted records to set up the top-rated series quantity in children, and most people of records is extrapolated from research in grownup populations. A safe and suitable technique is that the collection of blood ought to be proportionate to the patient's total blood quantity and, greater specifically, the affected person's weight. There is a lack of consensus among the present day pointers for pediatric blood collection. The maximum current suggestions from the Infectious Diseases Society of America (IDSA) and the American Society of Microbiology (ASM) advocate the collection of 3% to 4% of overall affected person blood quantity in sufferers weighing <12.7 kg and 1.8% to 2.7% in patients weighing>12.8 kg