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Artículo del día: Más sobre sepsis. Identification and treatment of paediatric sepsis: getting the balance right

Artículo del día: Más sobre sepsis. Identification and treatment of paediatric sepsis: getting the balance right | GPI AEPap | Scoop.it
Recent National Institute for Health and Care Excellence (NICE) guidance on sepsis1 defines clinical criteria to guide the management of a child presenting with suspected infection (table 1). In children with suspected infection, presence of a ‘high-risk’ criterion should lead to intravenous access, parenteral antibiotic administration and consideration of intravenous fluid boluses, unless a senior decision-making doctor (DMD; defined as a Specialist Trainee (ST) 4 paediatrician, or ST4 emergency physician for older children) makes an alternative diagnosis.

View this table:

Table 1
Summarised criteria for stratifying risk of severe illness or death from sepsis in children <12 years of age1



Since clinical screening criteria for sepsis are non-specific,2 many children without sepsis may receive antibiotic treatment for each case of true sepsis. NICE guidance might unintentionally exacerbate this, diverting …
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NOVEDADES en GUÍA ABE: Completamos la trilogía de hongos y levaduras con la entrada actualizada de Pitiriasis Versicolor

NOVEDADES en GUÍA ABE: Completamos la trilogía de hongos y levaduras con la entrada actualizada de Pitiriasis Versicolor | GPI AEPap | Scoop.it
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Un tema recurrente y común en la práctica clínica diaria: Hasta que punto son fiables las escalas de valoración de la FSF en lactantes pequeños: Risk Stratification of Febrile Infants ≤60 Days Old ...

Video Abstract

OBJECTIVES: To evaluate the Rochester and modified Philadelphia criteria for the risk stratification of febrile infants with invasive bacterial infection (IBI) who do not appear ill without routine cerebrospinal fluid (CSF) testing.

METHODS: We performed a case-control study of febrile infants ≤60 days old presenting to 1 of 9 emergency departments from 2011 to 2016. For each infant with IBI (defined as a blood [bacteremia] and/or CSF [bacterial meningitis] culture with growth of a pathogen), controls without IBI were matched by site and date of visit. Infants were excluded if they appeared ill or had a complex chronic condition or if data for any component of the Rochester or modified Philadelphia criteria were missing.

RESULTS: Overall, 135 infants with IBI (118 [87.4%] with bacteremia without meningitis and 17 [12.6%] with bacterial meningitis) and 249 controls were included. The sensitivity of the modified Philadelphia criteria was higher than that of the Rochester criteria (91.9% vs 81.5%; P = .01), but the specificity was lower (34.5% vs 59.8%; P < .001). Among 67 infants >28 days old with IBI, the sensitivity of both criteria was 83.6%; none of the 11 low-risk infants had bacterial meningitis. Of 68 infants ≤28 days old with IBI, 14 (20.6%) were low risk per the Rochester criteria, and 2 had meningitis.

CONCLUSIONS: The modified Philadelphia criteria had high sensitivity for IBI without routine CSF testing, and all infants >28 days old with bacterial meningitis were classified as high risk. Because some infants with bacteremia were classified as low risk, infants discharged from the emergency department without CSF testing require close follow-up.
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Vuelta al cole recordando un tema "viejuno" pero a la par siempre novedoso: Vacunación frente a tuberculosis | Enfermedades Infecciosas y Microbiología Clínica

Vuelta al cole recordando un tema "viejuno" pero a la par siempre novedoso: Vacunación frente a tuberculosis | Enfermedades Infecciosas y Microbiología Clínica | GPI AEPap | Scoop.it
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Los Reyes Magos nos traen más artículos sobre resistencias antimicrobianas: Cuantifying drivers of antibiotic resistance in humans: a systematic review

Los Reyes Magos nos traen más artículos sobre resistencias antimicrobianas: Cuantifying drivers of antibiotic resistance in humans: a systematic review | GPI AEPap | Scoop.it
Mitigating the risks of antibiotic resistance requires a horizon scan linking the
quality with the quantity of data reported on drivers of antibiotic resistance in
humans, arising from the human, animal, and environmental reservoirs. We did a systematic
review using a One Health approach to survey the key drivers of antibiotic resistance
in humans. Two sets of reviewers selected 565 studies from a total of 2819 titles
and abstracts identified in Embase, MEDLINE, and Scopus (2005–18), and the European
Centre for Disease Prevention and Control, the US Centers for Disease Control and
Prevention, and WHO (One Health data).
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Propósitos de año nuevo: Actualizarse para ofrecer lo mejor a nuestros pacientes. ¿Seguiremos recomendando el "probióticos para todos" en las GEAs?: Lactobacillus rhamnosus GG versus Placebo for Ac...

Original Article from The New England Journal of Medicine — Lactobacillus rhamnosus GG versus Placebo for Acute Gastroenteritis in Children
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Propósitos de año nuevo: Actualizarse para ofrecer lo mejor a nuestros pacientes. ¿Seguiremos recomendando el "probióticos para todos" en las GEAs?: Lactobacillus rhamnosus GG versus Placebo for Acute Gastroenteritis in Children | NEJM
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Algo ligerito para acabar el año. Casi clínico 1: Second-trimester Ultrasound and Neuropathologic Findings in Congenital Zika Virus Infection: PIDJ

Algo ligerito para acabar el año. Casi clínico 1: Second-trimester Ultrasound and Neuropathologic Findings in Congenital Zika Virus Infection: PIDJ | GPI AEPap | Scoop.it
rates and intracerebral calcification, ventriculomegaly and corpus callosum dysgenesis detected by ultrasound at 18 weeks o
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Nuestra recomendación del día viene calentita desde las Canarias: Paediatric invasive pneumococcal disease on the island of Gran Canaria: 16-year prospective study (2001–2016) | EIMC

Nuestra recomendación del día viene calentita desde las Canarias: Paediatric invasive pneumococcal disease on the island of Gran Canaria: 16-year prospective study (2001–2016) | EIMC | GPI AEPap | Scoop.it
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¿Qué ha pasado con la ENI y cuáles son los serotipos responsables en Madrid? Más en nuestro artículo del día:"Evolución de la enfermedad neumocócica invasora y sus serotipos en la Comunidad de Madr...

¿Qué ha pasado con la ENI y cuáles son los serotipos responsables en Madrid? Más en nuestro artículo del día:"Evolución de la enfermedad neumocócica invasora y sus serotipos en la Comunidad de Madr... | GPI AEPap | Scoop.it
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Nuestro artículo recomendado del día: ¿Es válida la ecografía torácica para diagnosticar una neumonía en urgencias pediátricas? - Evidencias en pediatría

Nuestro artículo recomendado del día: ¿Es válida la ecografía torácica para diagnosticar una neumonía en urgencias pediátricas? - Evidencias en pediatría | GPI AEPap | Scoop.it
Albi Rodríguez MS, Martínez MV. ¿Es válida la ecografía torácica para diagnosticar una neumonía en urgencias pediátricas? Evid Pediatr. 2018;14:28.
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Nuestro artículo recomendado del día: Estrategias para optimizar el uso de antimicrobianos. Med Clin North Am

Nuestro artículo recomendado del día: Estrategias para optimizar el uso de antimicrobianos. Med Clin North Am | GPI AEPap | Scoop.it
Med Clin North Am. 2018 Sep;102(5):831-843. doi: 10.1016/j.mcna.2018.04.006. Review
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The State of Vaccine Confidence 2016: Global Insights Through a 67-Country Survey

The State of Vaccine Confidence 2016: Global Insights Through a 67-Country Survey | GPI AEPap | Scoop.it
Public trust in immunization is an increasingly important global health issue. Losses
in confidence in vaccines and immunization programmes can lead to vaccine reluctance
and refusal, risking disease outbreaks and challenging immunization goals in high-
and low-income settings. National and international immunization stakeholders have
called for better monitoring of vaccine confidence to identify emerging concerns before
they evolve into vaccine confidence crises.
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Ya tenemos colgada la selección bibliográfica de Diciembre en la página del GPI, muchos artículos muy interesantes. ¡No te la pierdas!

Ya tenemos colgada la selección bibliográfica de Diciembre en la página del GPI, muchos artículos muy interesantes. ¡No te la pierdas! | GPI AEPap | Scoop.it
Bibliografía diciembre 2018Top ten
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Nueva entrada actualizada de Guía-ABE: Infecciones por VHS

Nueva entrada actualizada de Guía-ABE: Infecciones por VHS | GPI AEPap | Scoop.it
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Brote de infección por enterovirus causantes de afectación neurológica grave en un hospital terciario | Anales de Pediatría

Brote de infección por enterovirus causantes de afectación neurológica grave en un hospital terciario | Anales de Pediatría | GPI AEPap | Scoop.it
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No olvidemos el triángulo epidemiológico de John Snow: no todo es huésped y patógeno: Associations of Neighborhood-Level Social Determinants of Health with Bacterial Infections in Young, Febrile In...

No olvidemos el triángulo epidemiológico de John Snow: no todo es huésped y patógeno: Associations of Neighborhood-Level Social Determinants of Health with Bacterial Infections in Young, Febrile In... | GPI AEPap | Scoop.it
To examine the sociodemographic characteristics of one population of young, febrile
infants and identify associations between neighborhood-level social determinants of
health (SDHs) with bacterial infections.
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Mycobacterium lentiflavum como causa principal de linfadenitis en población pediátrica | Enfermedades Infecciosas y Microbiología Clínica

Mycobacterium lentiflavum como causa principal de linfadenitis en población pediátrica | Enfermedades Infecciosas y Microbiología Clínica | GPI AEPap | Scoop.it
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Propósitos de año nuevo: Leer  un artículo de la actualidad bibliográfica del GPI al día: Kawasaki Disease Outcomes and Response to Therapy in a Multiethnic Community: A 10-Year Experience

Propósitos de año nuevo: Leer  un artículo de la actualidad bibliográfica del GPI al día: Kawasaki Disease Outcomes and Response to Therapy in a Multiethnic Community: A 10-Year Experience | GPI AEPap | Scoop.it
To describe the epidemiology, response to therapy, and outcomes of Kawasaki disease
in a multiethnic community with a large Hispanic and Asian population.
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Propósitos de año nuevo: Leer un artículo de la actualidad bibliográfica del GPI al día: Kawasaki Disease Outcomes and Response to Therapy in a Multiethnic Community: A 10-Year Experience
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Y el segundo caso clínico: Congenital Pneumonia Owing to Mycoplasma pneumoniae

Y el segundo caso clínico: Congenital Pneumonia Owing to Mycoplasma pneumoniae | GPI AEPap | Scoop.it
A 33-week-old gestational age male infant was admitted to the neonatal intensive care
unit for severe respiratory distress syndrome. He was born vaginally after spontaneous
preterm labor without maternal fever, genitourinary tract infection, or biological
sign of infection. An initial absolute neutrophil count was 45 000/mm3 and C-reactive
protein peaked at 44 mg/L on day 2 of life. The initial hemoglobin value was 100 g/L.
He rapidly developed refractory hypoxemia with pulmonary arterial hypertension and
hemodynamic failure that required high-frequency oscillatory ventilation, surfactant
therapy, inhaled nitric oxide, red blood cells transfusion for neonatal anemia, hemodynamic
support with volume expansion, and norepinephrine infusion.
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Y el segundo caso clínico: Congenital Pneumonia Owing to Mycoplasma pneumoniae
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Parece que los pediatras no lo hacemos mal del todo: Variability in Antibiotic Prescribing for Upper Respiratory Illnesses by Provider Specialty

Parece que los pediatras no lo hacemos mal del todo: Variability in Antibiotic Prescribing for Upper Respiratory Illnesses by Provider Specialty | GPI AEPap | Scoop.it
To evaluate variation in antibiotic prescribing between pediatric and nonpediatric
providers for common upper respiratory illnesses.
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Características de las cepas de neumococo colonizantes tras tratamiento de  OMA: "Resistant Streptococcus pneumoniae strains in children with acute otitis media– high risk of persistent colonizatio...

Características de las cepas de neumococo colonizantes tras tratamiento de  OMA: "Resistant Streptococcus pneumoniae strains in children with acute otitis media– high risk of persistent colonizatio... | GPI AEPap | Scoop.it
Despite advances in the development of pneumococcal conjugate vaccines, acute otitis media (AOM) is a common childhood infection, caused mainly by Streptococcus pneumoniae. It has been suggested that persistence of pneumococcal nasopharyngeal carriag
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Más de antibioterapia e infecciones respiratorias: "Variation in Outpatient Antibiotic Dispensing for Respiratory Infections in Children by Clinician Specialty and Treatment Setting" PIDJ

Más de antibioterapia e infecciones respiratorias: "Variation in Outpatient Antibiotic Dispensing for Respiratory Infections in Children by Clinician Specialty and Treatment Setting" PIDJ | GPI AEPap | Scoop.it
.
Methods:
This retrospective, observational cross-sectional study used data from the HealthCore Integrated Research Environment containing claims from 14 commercial health plans for 2012 to 2014. Children (2–17 years) with first-episode ARI were identified by diagnosis of acute otitis media (AOM), sinusitis, pharyngitis, bronchitis or URI with no competing infections or chronic illnesses. Treatment setting was where diagnoses were made: primary care offices, urgent care centers (UCC), retail health clinics (RHCs) or emergency departments. Primary outcome measure was antibiotic prescription fills from pharmacies within 2 days of start of ARI episode.
Results:
For URI, the highest proportions in antibiotic dispensing were ordered by office-based or UCC family physicians (28% and 30%, respectively) and office-based or UCC nurse practitioners/physician assistants (30% and 29%, respectively). Across all settings and specialties, there was high proportion of antibiotic dispensing for bronchitis (75%). Overall, 48% of 544,531 children diagnosed with ARI filled antibiotics. Nurse practitioners/physician assistants in RHC made the most diagnoses of AOM (24%) and streptococcal pharyngitis (22%).
Conclusions:
Outreach efforts to decrease antibiotic dispensing for URI can be focused on office-based and UCC family physicians and nurse practitioners/physician assistants. All specialties need widespread interventions to reduce antibiotic dispensing for bronchitis. RHC nurse practitioners/physician assistants can be targeted to reduce high proportion of AOM and streptococcal pharyngiti
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Más de antibioterapia e infecciones respiratorias: "Variation in Outpatient Antibiotic Dispensing for Respiratory Infections in Children by Clinician Specialty and Treatment Setting" PIDJ
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Y la segunda recomendación del día, más sobre estrategias de prescripción: Advances in optimizing the prescription of antibiotics in outpatient settings

Y la segunda recomendación del día, más sobre estrategias de prescripción: Advances in optimizing the prescription of antibiotics in outpatient settings | GPI AEPap | Scoop.it
The inappropriate use of antibiotics can increase the likelihood of antibiotic resistance and adverse events. In the United States, nearly a third of antibiotic prescriptions in outpatient settings are unnecessary, and the selection of antibiotics and duration of treatment are also often inappropriate. Evidence shows that antibiotic prescribing is influenced by psychosocial factors, including lack of accountability, perceived patient expectations, clinician workload, and habit. A varied and growing body of evidence, including meta-analyses and randomized controlled trials, has evaluated interventions to optimize the use of antibiotics. Interventions informed by behavioral science—such as communication skills training, audit and feedback with peer comparison, public commitment posters, and accountable justification—have been associated with improved antibiotic prescribing. In addition, delayed prescribing, active monitoring, and the use of diagnostics are guideline recommended practices that improve antibiotic use for some conditions. In 2016, the Centers for Disease Control and Prevention released the Core Elements of Outpatient Antibiotic Stewardship , which provides a framework for implementing these interventions in outpatient settings. This review summarizes the varied evidence on drivers of inappropriate prescription of antibiotics in outpatient settings and potential interventions to improve their use in such settings.
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Y la segunda recomendación del día, más sobre estrategias de prescripción: Advances in optimizing the prescription of antibiotics in outpatient settings
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Ya tenemos colgada la selección bibliográfica de Diciembre en la página del GPI, muchos artículos muy interesantes. ¡No te la pierdas!

Ya tenemos colgada la selección bibliográfica de Diciembre en la página del GPI, muchos artículos muy interesantes. ¡No te la pierdas! | GPI AEPap | Scoop.it
Bibliografía diciembre 2018Top ten
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Grupo de Patología Infecciosa AEPap's curator insight, December 13, 2018 10:33 AM
Ya tenemos colgada la selección bibliográfica de Diciembre en la página del GPI, muchos artículos muy interesantes. ¡No te la pierdas!
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The State of Vaccine Confidence 2016: Global Insights Through a 67-Country Survey

The State of Vaccine Confidence 2016: Global Insights Through a 67-Country Survey | GPI AEPap | Scoop.it
Public trust in immunization is an increasingly important global health issue. Losses
in confidence in vaccines and immunization programmes can lead to vaccine reluctance
and refusal, risking disease outbreaks and challenging immunization goals in high-
and low-income settings. National and international immunization stakeholders have
called for better monitoring of vaccine confidence to identify emerging concerns before
they evolve into vaccine confidence crises.
more...
No comment yet.