Newborn Screening for Primary T- and B-Cell Immune Deficiencies—A Prospective Study in Andalucía

Background: Quantification of T-cell-receptor-excision circles (TRECs) and kappa-deleting-recombination-excision circles (KRECs) from dried blood spots (DBS) allows detection of neonates with severe T-cell and/or B-cell lymphopenia that are potentially affected by severe combined immunodeficiency (SCID), as well as X-linked agammaglobulinemia (XLA). Methods: Determination of TRECs and KRECs using a triplex RT-PCR (TRECS-KRECS-β-actin) assay from prospectively collected DBS between February 2014 and December 2016 in three hospitals in Seville, Spain. Cut-off levels were TRECs 700/punch. Internal (SCID, XLA, ataxia telangiectasia) and external controls (CDC) were included. Results: A total of 8943 DBS samples obtained from 8814 neonates were analysed. Re-punching was necessary in 124 samples (1.4%) due to insufficient β-actin values (<700 copies/punch). Preterm neonates (GA < 37 weeks) and neonates with a BW < 2500 g showed significantly lower TRECs and KRECs levels (p < 0.001). Due to repeated pathological results, ten neonates were re-sampled (0.11%), of which five neonates (0.055%) confirmed the pathological results: one case was a fatal chromosomopathy (TRECs 1/KRECs 4); two were extreme premature newborns (TRECs 0/KRECs 0 and TRECs 1/KRECs 20 copies/punch); and 2 neonates were born to mothers receiving azathioprine during pregnancy (TRECs 92/KRECs 1 and TRECs 154/KRECs 3 copies/punch). All controls were correctly identified. Conclusions: Severe T- and B-cell lymphopenias were correctly identified by the TRECS-KRECS-β-actin assay. Prematurity and low BW are associated with lower TREC and KREC levels. Extreme prematurity and maternal immune suppressive therapy can cause false positive results of TRECs and KRECs values.Fondo de Investigaciones Sanitarias (FIS), Instituto de Salud Carlos III PI13/01104Ayudas para contratos de formación en Investigación Rio Hortega. Instituto de Salud Carlos II

Posicionamiento de la sociedad Española de infectología pediátrica sobre la implementación, ejecución y monitorización de los programas de optimización de uso de antimicrobianos (PROA) en pediatría hospitalaria

Pediatría; Resistencia antibióticaPaediatrics; Antimicrobial resistancePediatria; Resistència antibiòticaIn the past few years, antimicrobial resistance has increased, becoming a serious public health problem. The irrational use of antimicrobials is one of the main contributors to antimicrobial resistance. The paediatric population is not free from this problem, as antimicrobials are widely prescribed in this age group, often inappropriately. The introduction of antimicrobial stewardship programmes (ASPs) has proven crucial in curbing the emergence of antimicrobial resistance. At the international level, the need to develop specific paediatric ASPs has been recognised on account of the differences between adult and paediatric patients as concerns infection and approaches to diagnosis and treatment. For this reason, paediatric ASPs should be multidisciplinary programmes led by paediatric infectious disease specialists and use specific paediatric indicators (such as days of treatment, antimicrobial susceptibility patterns in the paediatric population, or clinical indicators) to help identify areas of improvement and develop effective targeted interventions. On the other hand, the support and leadership of the pertinent scientific societies are also essential. The purpose of this document is to present the position of the Sociedad Española de Infectología Pediátrica (SEIP, Spanish Society of Paediatric Infectious Diseases) concerning the implementation of paediatric ASPs in hospitals in Spain and to provide tools to facilitate their application in hospitals throughout the regional health care systems in the country.Durante los últimos años ha habido un aumento en la aparición de resistencias antimicrobianas, lo cual supone un grave problema de salud pública. El mal uso de antimicrobianos es un factor determinante en su desarrollo. La población pediátrica no queda exenta de dicha problemática ya que la prescripción de antibióticos en pediatría es elevada y en muchas ocasiones inadecuada. La incorporación de los programas de optimización de uso de antimicrobianos (PROA) ha resultado ser una medida crucial para disminuir el riesgo en la aparición de resistencias antibióticas. A nivel internacional se reconoce la necesidad de crear PROAs específicos en pediatría (PROA-P) debido a las diferencias existentes entre pacientes adultos y pediátricos en referencia a las infecciones, así como al abordaje tanto diagnóstico como terapéutico de las mismas. Por esta misma razón, los PROA-P deben ser programas multidisciplinares liderados por especialistas en infecciones pediátricas y trabajar con indicadores específicos pediátricos (DOT, patrones de sensibilidad antibiótica de población pediátrica, indicadores clínicos…) que permitan detectar puntos de mejora y establecer estrategias dirigidas eficaces. Por otro lado, es imprescindible el apoyo y liderazgo por parte de las distintas sociedades científicas implicadas. El objetivo de este documento es dar a conocer el posicionamiento de la Sociedad Española de Infectología Pediátrica (SEIP) sobre la implementación de los PROA pediátricos hospitalarios en nuestro territorio así como aportar herramientas que ayuden en la aplicación de dichos programas en los diferentes hospitales de las distintas regiones sanitarias del país

Endocarditis infecciosa en pacientes pediátricos de Andalucía (España), 2008-2020

[EN] Introduction: Paediatric infective endocarditis (IE) is a serious condition associated with significant mortality. Information in Spain is limited and comes from case series from single centres. The aim was to describe the epidemiology, clinical features, microbiology and outcome of paediatric IE in Andalusia. Patients and methods: Multi-centre descriptive observational retrospective study of patients 140 mg/L were independent predictors of complicated IE. Conclusions: Our findings emphasise the high morbidity of paediatric IE. The information provided could be useful for the identification of epidemiological and clinical profiles of children with IE and complicated forms.[ES] Introducción: La endocarditis infecciosa (EI) pediátrica es un cuadro grave con mortalidad significativa. La información en España es limitada y procede de series de casos de centros únicos. El objetivo fue describir la epidemiología, la clínica, la microbiología y los resultados de la EI pediátrica en Andalucía. Pacientes y métodos: Estudio descriptivo observacional retrospectivo multicéntrico de pacientes 140 mg/l fueron predictores independientes de EI complicada. Conclusiones: Los hallazgos del estudio subrayan la elevada morbilidad de la EI pediátrica. La información generada podría favorecer la identificación de los perfiles epidemiológicos y clínicos de los niños con EI y formas complicadas.Peer reviewe

Asociación entre infección viral del tracto respiratorio bajo en los dos primeros años de vida y el desarrollo de sibilancias recurrentes en niños de 3 a 8 años

Objetivos: Determinar la asociación entre infección viral del tracto respiratorio bajo en los dos primeros años de vida con el desarrollo de sibilancias respiratorias recurrentes reversibles (SRRR), en niños. Material y métodos: Estudio caso-control incluyendo 400 niños; relación caso-control de 1:1 (α= 5%; β= 20%). Se incluyeron niños con diagnóstico de sibilancias respiratorias recurrentes reversibles que acudieron al Hospital Nacional Cayetano Heredia en los servicios de Emergencia y Consulta Externa entre mayo del 2009 y agosto del 2009, clasificándose como casos. Se asignaron 200 controles similares en edad, sexo y servicio de procedencia. Se registró el antecedente de infección viral del tracto respiratorio bajo en los dos primeros años de vida, mediante encuesta directa con los padres y corroborándose con la historia clínica de los pacientes. Resultados: Se encontró un odds ratio (OR) de 14,52 (IC 95%:6,47-32,59) para la asociación entre las variables estudiadas. Utilizando atopia familiar como parámetro de estratificación se obtuvo un OR de Mantel-Haenszel de 13,14 (IC 95%: 5,82-29,67) para la asociación entre infección viral del tracto respiratorio bajo con el desarrollo de sibilancias respiratorias. Conclusiones: Los resultados sugieren que los niños que presentan SRRR, tienen 14,52 veces más probabilidades de haber presentado infección viral del tracto respiratorio bajo en los 2 primeros años de vida, que los niños que no presentan SRRR. Esta asociación es independiente del antecedente de atopia familiar

En respuesta a: “Dosis diaria definida ajustada por peso: una propuesta para la medición de consumo antimicrobiano en pediatría”

Peer reviewe

Efficacy and Safety of Continuous Infusion of Vancomycin in Children: A Systematic Review

This article belongs to the Section Antibiotics Use and Antimicrobial Stewardship.Vancomycin is used to treat a wide variety of infections within the pediatric population. In adults, continuous infusion of vancomycin (CIV) has been evaluated as an alternative to intermittent infusion of vancomycin (IIV) with potential advantages. In children, the use of CIV is increasing; however, data is currently limited. The objective is to provide efficacy and safety evidence for CIV within this population. The review was carried out following PRISMA guidelines. A bibliographic search was performed for studies on PubMed and EMBASE. Clinical trials and observational studies that reported clinical efficacy and/or target attainment of CIV in pediatrics were included. Articles were reviewed to assess their design and target population, characteristics of vancomycin treatment and the main findings in terms of safety and efficacy. A total of 359 articles were identified, of which seven met the inclusion criteria. All of them evaluated the target attainment, six assessed safety but only three assessed clinical efficacy. The best administration method for this antibiotic within the pediatric population is still unknown due to limited evidence. However, studies conducted thus far suggest pharmacokinetic advantages for CIV. Further investigation is required, in particular for studies comparing IIV with CIV for clinical efficacy and toxicity outcomes.L.H.-H. was supported by the Instituto de Salud Carlos III, Subprograma Rio Hortega (grant CM19/00152)

Position statement of the Spanish Society of Paediatric Infectious Diseases on the introduction, implementation and assessment of antimicrobial stewardship programmes in hospital paediatrics

In the past few years, antimicrobial resistance has increased, becoming a serious public health problem. The irrational use of antimicrobials is one of the main contributors to antimicrobial resistance. The paediatric population is not free from this problem, as antimicro-bials are widely prescribed in this age group, often inappropriately. The introduction of antimicrobial stewardship programmes (ASPs) has proven crucial in cur-bing the emergence of antimicrobial resistance. At the international level, the need to develop specific paediatric ASPs has been recognised on account of the differences between adult and paediatric patients as concerns infection and approaches to diagnosis and treatment. For this reason, paediatric ASPs should be multidisciplinary programmes led by paediatric infectious disease specialists and use specific paediatric indicators (such as days of treatment, antimicro-bial susceptibility patterns in the paediatric population, or clinical indicators) to help identify areas of improvement and develop effective targeted interventions. On the other hand, the support and leadership of the pertinent scientific societies are also essential. The purpose of this document is to present the position of the Sociedad Espanola de Infectologia Pediatrica (SEIP, Spanish Society of Paediatric Infectious Diseases) concerning the implementation of paediatric ASPs in hospitals in Spain and to provide tools to facilitate their application in hospitals throughout the regional health care systems in the country. (c) 2022 Asociacion Espanola de Pediatr & iacute;a. Published by Elsevier Espana, S.L.U. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/ 4.0/)

High Rates of SARS-CoV-2 Family Transmission in Children of Healthcare Workers During the First Pandemic Wave in Madrid, Spain: Serologic Study.

Data on SARS-CoV-2 transmission among children living with healthcare workers (HCWs) are scarce. A cross-sectional study was performed at a tertiary Hospital in Madrid, including children of HCW who suffered from SARS-CoV-2 infection between March and May 2020. Children underwent enzyme-linked immunosorbent serological study for detecting SARS-CoV-2 antibodies: VIRCELL IgG assay. One hundred thirteen children from 69 HCWs with confirmed SARS-CoV-2 infection were recruited: 47 children had positive IgG (41.6%). Children secondary attack rate was 43.7% (25% if both parents have had asymptomatic infection; 39.5% if one parent was symptomatic; and 47% when both parents had symptoms). Having a positive sibling was associated with a positive IgG result (odds ratio = 12.2; 95% confidence interval: 4.4-33.7, P We observed a very high SARS-CoV-2 transmission in children of HCW during the first pandemic wave, especially when both parents were symptomatic. Having a positive sibling was associated with seroconversion, supporting the important role of family clusters in the transmission of SARS-CoV-2

Development of Antimicrobial Defined Daily Dose (DDD) for the Pediatric Population

Antimicrobial stewardship programs (ASPs) optimize antimicrobial use, improve patient outcomes, and reduce resistance. To assess the effectiveness of ASPs, it is necessary to have indicators that can be widely used. Defined daily dose (DDD) was designed by WHO for the adult population as a consumption indicator. However, there are no DDDs adapted to the pediatric population. The main objective of this study is to establish the most appropriate DDD values in this population. An observational, retrospective, multicenter study was conducted. Antimicrobial prescriptions were collected from pediatric wards of seven Spanish tertiary hospitals for 2 years. The DDDs obtained from the prescriptions were compared with the theoretical DDDs agreed upon in the first stage. To select the optimal DDD, the following were analyzed: power value, magnitude obtained from the differences in the DDD, statistical significance, and degree of agreement in the stipulated doses. A total of 4788 prescriptions were collected. Pediatric DDD was defined for 30 different antimicrobials. A potency >80% was obtained in 24 antibiotics. 51.2% of the selected DDD correspond to Phase I and 39.5% from Phase II. Pediatric DDD of different antimicrobials was obtained, providing an indicator that can be used globally in different hospitals to analyze the consumption and efficacy of ASPs