RESUMO
Los recién nacidos tienen un alto riesgo de morbimortalidad asociada a infecciones durante su estancia en unidades de cuidado intensivo neonatal, a lo que se asocia un aumento progresivo de infecciones por microorganismos multi-resistentes que requiere el uso de nuevos antimicrobianos. Presentamos el caso de una recién nacida de pretérmino de 36 semanas que cursó con una infección del tracto urinario bacteriémica por Klebsiella pneumoniae productora de carbapenemasa tratada de forma efectiva con 14 días de cefazi- dima-avibactam, sin efectos adversos observados. Según nuestro conocimiento, este es el primer caso reportado en nuestro país del uso de este antimicrobiano en población neonatal. Se necesita más información sobre la eficacia y seguridad de ceftazidima-avibactam en este grupo de pacientes.
Neonates are high risk patients regarding morbimortality secondary to infections during their neonatal intensive care unit stay, which is associated to a progressive increase in the report of multidrug resistant organism infections, that require the use of new antimicrobial. We report the case of a 36-week preterm with an urinary tract infection with bacteriemia caused by carbapenemase- producing Klebsiella pneumoniae treated effectively with 14 day of ceftazidime-avibactam, without observed adverse effects. To our knowledge, this is the first case report in our country of the use of this antibiotic in neonatal population. More information is needed regarding efficacy and safety of ceftazidime-avibactam in this group of patients.
Assuntos
Humanos , Feminino , Recém-Nascido , Infecções Urinárias/tratamento farmacológico , Infecções por Klebsiella/tratamento farmacológico , Ceftazidima/uso terapêutico , Compostos Azabicíclicos/uso terapêutico , beta-Lactamases/biossíntese , Recém-Nascido Prematuro , Terapia Intensiva Neonatal , Farmacorresistência Bacteriana Múltipla , Combinação de Medicamentos , Inibidores de beta-Lactamases/uso terapêutico , Klebsiella pneumoniae/enzimologia , Antibacterianos/uso terapêuticoRESUMO
Resumen La Sociedad Chilena de Infectología, a través de su Comité de Infecciones Neonatales, en conjunto con la Sociedad Chilena de Obstetricia y Ginecología, proponen un documento de diagnóstico y manejo de la Infección por Citomegalovirus en la Mujer Embarazada y el Recién Nacido. Esta guía aborda el manejo de la infección en el binomio, su enfrentamiento diagnóstico y terapéutico, orientado al equipo de salud que atiende a mujeres embarazadas y recién nacidos con infección por citomegalovirus (CMV) en Chile. Considera la situación epidemiológica global y latinoamericana, con recomendaciones para la evaluación clínica y de laboratorio; establece criterios de diagnóstico, propone enfoques terapéuticos de acuerdo a la situación clínica, analiza las medidas de prevención y establece una propuesta nacional para el seguimiento de esta enfermedad. Se ha puesto especial énfasis en entregar, de forma práctica, y con la mayor evidencia posible, las recomendaciones para el manejo del binomio con infección por CMV.
Abstract The Chilean Society of Infectology, through its Neonatal Infections Committee in conjunction with the Chilean Society of Obstetrics and Gynecology, propose a document for the Diagnosis and Management of Cytomegalovirus Infection in Pregnant Woman and Newborn Infant. This guideline suggests the management of mother and child infection, its diagnostic and therapeutic options. Considers the global and Latin American epidemiology, with recommendations for clinical and laboratory evaluation; diagnostic criteria, therapeutic approaches according to the clinical situation, analyzes prevention measures and establishes a national proposal for monitoring this disease.
Assuntos
Humanos , Feminino , Gravidez , Recém-Nascido , Lactente , Complicações Infecciosas na Gravidez/diagnóstico , Complicações Infecciosas na Gravidez/tratamento farmacológico , Infecções por Citomegalovirus/diagnóstico , Infecções por Citomegalovirus/tratamento farmacológico , Infecções por Citomegalovirus/transmissão , Chile , Gestantes , GinecologiaRESUMO
Resumen La Sociedad Chilena de Infectología, a través de su Comité de Infecciones Neonatales, en conjunto con la Sociedad Chilena de Obstetricia y Ginecología, proponen un documento de diagnóstico y manejo de la infección por citomegalovirus (CMV) en la mujer embarazada y el recién nacido. Esta guía aborda el manejo de la infección en el binomio, su enfrentamiento diagnóstico y terapéutico, orientado al equipo de salud que atiende a mujeres embarazadas y recién nacidos con infección por CMV en Chile. Considera la situación epidemiológica global y latinoamericana, con recomendaciones para la evaluación clínica y de laboratorio; establece criterios de diagnóstico, propone enfoques terapéuticos de acuerdo a la situación clínica, analiza las medidas de prevención y establece una propuesta nacional para el seguimiento de esta enfermedad. Se ha puesto especial énfasis en entregar, de forma práctica, y con la mayor evidencia posible, las recomendaciones para el manejo del binomio con infección por CMV.
Abstract The Chilean Society of Infectology, through its Neonatal Infections Committee in conjunction with the Chilean Society of Obstetrics and Gynecology, propose a document for the Diagnosis and Management of Cytomegalovirus Infection in Pregnancy and Newborn. This guideline suggests the management of mother and child infection, its diagnostic and therapeutic options. Considers the global and Latin American epidemiology, with recommendations for clinical and laboratory evaluation, diagnostic criteria, therapeutic approaches according to the clinical situation, analyzes prevention measures and establishes a national proposal for monitoring this disease.
Assuntos
Humanos , Feminino , Gravidez , Recém-Nascido , Complicações Infecciosas na Gravidez/diagnóstico , Complicações Infecciosas na Gravidez/terapia , Infecções por Citomegalovirus/diagnóstico , Infecções por Citomegalovirus/terapia , Doenças do Recém-Nascido/diagnóstico , Doenças do Recém-Nascido/terapia , Diagnóstico Pré-Natal , Anormalidades Congênitas/diagnóstico , Anormalidades Congênitas/terapia , Infecções por Citomegalovirus/congênitoRESUMO
Resumen Streptococcus equi subespecie zooepidemicus es una cocácea grampositiva, p-hemolítica, considerada parte de la microbiota de los equinos y un patógeno oportunista en otros animales. La infección en humanos es poco frecuente, pero suele manifestarse como cuadros graves. Se ha asociado al contacto con animales, especialmente caballos, y al consumo de productos lácteos no pasteurizados. Presentamos el caso de una bacteriemia en un binomio madre-hijo por este agente, asociado al consumo de quesos artesanales. Pese a que la penicilina es el tratamiento de elección, la recién nacida fue tratada en forma exitosa con ampicilina y la madre con ceftriaxona. Ninguna de ellas presentó complicaciones asociadas a la bacteriemia. A nuestro conocimiento, este es el primer reporte de infección connatal por este agente.
Abstract Streptococcus equi subspecies zooepidemicus is a Gram-positive, P-hemolytic coccus considered part of the commensal flora in horses and an opportunistic pathogen in other animals. Infection in humans is rare, but it usually manifests as serious symptoms, it has been associated with contact with animals, especially horses, and the consumption of unpasteurized dairy products. In this report we describe a case of bacteremia of the mother-child binomial by this agent, associated with the consumption of artisan cheeses. Although penicillin is the treatment of choice, the newborn was successfully treated with ampicillin and the mother with ceftriaxone, none of them presented complications associated with bacteremia. To our knowledge, this is the first report of connatal infection by this agent.
Assuntos
Humanos , Feminino , Recém-Nascido , Adulto , Infecções Estreptocócicas/diagnóstico , Bacteriemia/diagnóstico , Infecções Estreptocócicas/etiologia , Infecções Estreptocócicas/tratamento farmacológico , Ceftriaxona/uso terapêutico , Queijo/efeitos adversos , Bacteriemia/etiologia , Bacteriemia/tratamento farmacológico , Streptococcus equi , Relações Mãe-FilhoRESUMO
Resumen La aparición de la enfermedad por SARS-CoV-2 el año 2020 nos enfrentó a un aumento creciente y exponencial de pacientes con riesgo vital por falla respiratoria catastrófica y multisistémica que deben ser sometidos a ECMO para sobrevivir. Esto ha generado en nuestro país la aparición de Unidades de Tratamiento (ECMO) en hospitales en que antes no se disponía de este recurso o se realizaba como parte de las intervenciones en Unidades de Cuidados Intensivos (UCI), lo que constituye un nuevo desafío a los programas de control y prevención de infecciones de los centros de salud. Dado que al momento de la redacción de este documento no existe normativa nacional específica que se refiera a este tema, se propone un enfoque para prevención, control y vigilancia de infecciones asociadas a atención de salud en pacientes ECMO. Se presenta una revisión de los riesgos específicos a que están expuestos estos pacientes, definiendo qué medidas de prevención se requieren, proponiendo un conjunto de medidas específicas para instalación y mantención, así como orientación respecto de antibioprofilaxis y se sugiere qué eventos infecciosos vigilar.
Abstract The advent of SARS-CoV-2 disease in 2020 confronts us with a growing and exponential increase in patients at life risk due to catastrophic and multisystemic respiratory failure in need of extracorporeal membrane oxygenation (ECMO) to survive. This has generated in our country the establishment of ECMO treatment Units in hospitals where it was not carried out before or was carried out as part the interventions in Intensive Care Units (ICU), becoming a new challenge to the infection control and prevention programs. Given that at the time of writing this document there are no specific national regulations that refer to this issue, an approach is proposed for the prevention control and surveillance of nosocomial acquired infections in ECMO patients. A review of the specific risks to which these patients are exposed is presented, defining which prevention measures are required, proposing a specific bundle for installation and maintenance, as well as guidance regarding antibioprophylaxis and suggesting which infectious events to monitor.
Assuntos
Humanos , Oxigenação por Membrana Extracorpórea/efeitos adversos , Infecção Hospitalar/prevenção & controle , Infecção Hospitalar/epidemiologia , Fatores de Risco , Controle de Infecções , SARS-CoV-2 , COVID-19/terapia , Unidades de Terapia IntensivaRESUMO
Multisystem inflammatory syndrome temporally associated with COVID-19 (MIS-C) is a post-infectious complication described in children and adolescents with previous exposure to SARS-CoV-2. Because of its potential to evolve to severe disease -including cardiovascular impairment and multiple organ failure it requires a prompt diagnosis and appropriate management, including intensive care for most cases. These guidelines compile recent information from scientific literature, from our local clinical experiences during the past pandemic year, and have been discussed by experts. The recommendations provided are meant to help the clinical work of health teams attending the pediatric population.
Assuntos
COVID-19 , Pandemias , Adolescente , Criança , Humanos , SARS-CoV-2 , Síndrome , Síndrome de Resposta Inflamatória SistêmicaRESUMO
Resumen El síndrome inflamatorio multisistémico asociado a COVID-19 (SIM-COVID-19) es una complicación post-infecciosa descrita en niños y adolescentes con antecedente de exposición a SARS-CoV-2. Su potencial de evolución clínica grave, con compromiso hemodinámico y de falla de múltiples órganos lo convierten en una identidad que requiere de sospecha temprana, rápido diagnóstico y manejo adecuado, incluyendo terapia intensiva en la mayoría de los casos. Las siguientes recomendaciones recopilan información de la literatura científica, de la experiencia nacional en este año de pandemia y han sido consensuadas con expertos. Se presentan como guías de manejo de modo de facilitar el trabajo de equipos de salud a cargo de la atención pediátrica.
Abstract Multisystem inflammatory syndrome temporally associated with COVID-19 (MIS-C) is a post-infectious complication described in children and adolescents with previous exposure to SARS-CoV-2. Because of its potential to evolve to severe disease -including cardiovascular impairment and multiple organ failure it requires a prompt diagnosis and appropriate management, including intensive care for most cases. These guidelines compile recent information from scientific literature, from our local clinical experiences during the past pandemic year, and have been discussed by experts. The recommendations provided are meant to help the clinical work of health teams attending the pediatric population.
Assuntos
Humanos , Criança , Adolescente , Síndrome de Resposta Inflamatória Sistêmica/diagnóstico , COVID-19/complicações , Fenótipo , Síndrome de Resposta Inflamatória Sistêmica/terapia , Diagnóstico Diferencial , Pandemias , SARS-CoV-2RESUMO
The advent of SARS-CoV-2 disease in 2020 confronts us with a growing and exponential increase in patients at life risk due to catastrophic and multisystemic respiratory failure in need of extracorporeal membrane oxygenation (ECMO) to survive. This has generated in our country the establishment of ECMO treatment Units in hospitals where it was not carried out before or was carried out as part the interventions in Intensive Care Units (ICU), becoming a new challenge to the infection control and prevention programs. Given that at the time of writing this document there are no specific national regulations that refer to this issue, an approach is proposed for the prevention control and surveillance of nosocomial acquired infections in ECMO patients. A review of the specific risks to which these patients are exposed is presented, defining which prevention measures are required, proposing a specific bundle for installation and maintenance, as well as guidance regarding antibioprophylaxis and suggesting which infectious events to monitor.
Assuntos
COVID-19 , Oxigenação por Membrana Extracorpórea , Oxigenação por Membrana Extracorpórea/efeitos adversos , Humanos , Controle de Infecções , Unidades de Terapia Intensiva , SARS-CoV-2RESUMO
Streptococcus equi subspecies zooepidemicus is a Gram-positive, P-hemolytic coccus considered part of the commensal flora in horses and an opportunistic pathogen in other animals. Infection in humans is rare, but it usually manifests as serious symptoms, it has been associated with contact with animals, especially horses, and the consumption of unpasteurized dairy products. In this report we describe a case of bacteremia of the mother-child binomial by this agent, associated with the consumption of artisan cheeses. Although penicillin is the treatment of choice, the newborn was successfully treated with ampicillin and the mother with ceftriaxone, none of them presented complications associated with bacteremia. To our knowledge, this is the first report of connatal infection by this agent.
Assuntos
Bacteriemia , Infecções Estreptocócicas , Streptococcus equi , Animais , Bacteriemia/diagnóstico , Bacteriemia/tratamento farmacológico , Ceftriaxona , Cavalos , Humanos , Relações Mãe-Filho , Infecções Estreptocócicas/complicações , Infecções Estreptocócicas/diagnóstico , Infecções Estreptocócicas/tratamento farmacológicoRESUMO
The Chilean Society of Infectology, through its Neonatal Infections Committee in conjunction with the Chilean Society of Obstetrics and Gynecology, propose a document for the Diagnosis and Management of Cytomegalovirus Infection in Pregnant Woman and Newborn Infant. This guideline suggests the management of mother and child infection, its diagnostic and therapeutic options. Considers the global and Latin American epidemiology, with recommendations for clinical and laboratory evaluation; diagnostic criteria, therapeutic approaches according to the clinical situation, analyzes prevention measures and establishes a national proposal for monitoring this disease.