OBJECTIVE: Determine the rate and outcome of nosocomial infection (NI) in pediatric intensive care unit patients in a developing country. DESIGN: Prospective cohort study using the Centers for Disease Control and Prevention definitions to diagnose nosocomial infection and NNISS (National Nosocomial Infection Surveillance System) methodology. SETTING: São Paulo Hospital - Universidade Federal de São Paulo - Brazil, a 700-bed teaching hospital with an 8-bed pediatric intensive care unit. PARTICIPANTS: All 515 children consecutively admitted to the pediatric intensive care unit from April 1996 to October 1997. RESULTS: The NI incidence was 18.3% and the mean infection rate per 1,000 patient days was 46.1; the ventilator-associated pneumonia rate was 18.7 per 1,000 ventilator days; the central line-associated bloodstream infection rate was 10.2 per 1,000 central line days; and the urinary tract catheter-associated infection rate was 1.8 per 1,000 catheter days. Pneumonia was the most common NI (31.6%), followed by bloodstream infections (17.3%), and surgical site infection (17.3%). Gram-negative bacterias were the most common pathogens identified in the NIs (54.8%), followed by Gram-positive bacterias (23.8%), and yeasts. CONCLUSION: Pneumonia was the most common type of NI. A high incidence of ventilator-associated pneumonia and central line-associated bloodstream infections was found, whereas the urinary tract catheter-associated infection rate was low. Gram-negative bacterias were the most common etiologic agents identified in the unit, and yeasts were frequently found. Pediatric patients have characteristics of their own, with major differences when compared to the adult population.

We evaluated the clinical presentation and determined the ocular and neurologic sequelae in children with congenital toxoplasmosis in Brazil, taking into consideration the shortage of national publications on this disease. Follow-up evaluations were made of 43 children with congenital toxoplasmosis referred to Santa Casa de São Paulo, during a period of at least five years. Selection of the cases was based in clinical and laboratory criteria. A clear predominance of children with subclinical presentation of the disease at birth (88%) was found. Of the 43 children, 22 (51%) developed neurological manifestations. Using skull radiography, we detected neuroradiologic alterations in seven children (16%) and with tomography in 33 children (77%). Neurological sequelae were identified in 15 children (54%) in the group with cerebral calcifications and in 7 (47%) in the group without cerebral calcifications. We observed chorioretinitis in 95% of the cases. Reactivation of cicatricial lesions and the emergence of new ocular lesions were observed in five cases. The most frequent neurological manifestation was a delay in neuropsychomotor development. Most remarkable was the finding that cerebral calcifications were not associated with a higher incidence of neurological sequelae among the children. Chorioretinitis was the main ocular sequel of the infection, found in nearly all children; it can manifest years from birth, even in children submitted to specific therapy during the first year of life, highlighting the importance of a follow-up of these children.

OBJETIVO: avaliar a prevalência e os fatores de risco para a colonização nasofaríngea e determinar o padrão de suscetibilidade à penicilina de cepas isoladas da nasofaringe de crianças com rinofaringite aguda. METODOLOGIA: No período de 16/6/97 a 20/5/98 foram coletados 400 Swabs da nasofaringe de crianças com idade entre três meses e cinco anos que apresentavam quadro clínico de rinofaringite aguda. A identificação do S. pneumoniae foi realizada através do teste de optoquina e solubilidade em bile. Todas as cepas foram triadas através do disco de oxacilina 1mg, sendo avaliada, posteriormente, a concentração inibitória mínima para penicilina pelo método do E-teste. RESULTADOS: A prevalência da colonização nasofaríngea pelo S. pneumoniae foi de 35%. A análise dos fatores de risco associados à colonização nasofaríngea indicou que as crianças que eram institucionalizadas e que tinham irmãos menores de cinco anos apresentaram uma taxa maior de colonização. A prevalência de cepas não suscetíveis à penicilina foi de 16%. Todas as cepas apresentaram resistência intermediária (0,1mcg/ ml £ CIM £ 1,0 mcg/ ml ). Das 19 cepas com resistência à penicilina, 7 tinham resistência intermediária (37%), e duas (11%) resistência elevada ao cotrimoxazol. Não foi observada resistência à ceftriaxona, amoxicilina, claritromicina ou cloranfenicol. CONCLUSÕES: Concluímos que a prevalência da colonização nasofaríngea pelo pneumococo, em crianças menores de cinco anos com quadro de rinofaringite aguda, foi de 34,8%; as que eram institucionalizadas e tinham irmãos menores apresentaram uma maior taxa de colonização. A resistência à penicilina ocorreu em 15,6% dos isolados, não sendo detectada nenhuma cepa com resistência elevada. A taxa de resistência bacteriana encontrada foi bastante próxima à encontrada em estudo de infecções invasivas. Este fato sugere que os isolados de pneumococo da nasofaringe de crianças com infecção respiratória alta podem ser usados na vigilância da resistência antimicrobiana numa determinada comunidade.

OBJECTIVE: to determine the prevalence and risk factors for nasopharyngeal colonization by, and to evaluate antimicrobial susceptibility of Streptococcus pneumoniae strains in children with acute rhinopharyngitis. METHODS: we collected nasopharyngeal swab specimens from 400 children aged 3 months to 5 years and with clinical status of acute rhinopharyngitis from June 16, 1997 to May 20, 1998 at the outpatient clinics of two hospitals in the city of São Paulo. Nasopharyngeal specimens were collected pernasally using a calcium alginate swab and plated immediately after collection onto trypticose soy agar with 5% sheep blood and garamicin 5 mcg/ml. Penicillin susceptibility was determined by oxacillin 1 mcg disk screening test and the minimal inhibitory concentration by the E-test. RESULTS: Pneumococci were recovered from 139 children, indicating a colonization prevalence of 35%. The risk factors analyzed indicated that the colonization was more prevalent in children attending day-care centers, children with siblings younger than 5 years, and children with recent use of antimicrobial agents. The prevalence of penicillin non-susceptible strains was of 16 % (20 strains). All strains were intermediately resistant (0.1mcg/ ml < MIC < 1.0 mcg/ ml). Out of the penicillin intermediately resistant strains, 7 (37%) showed intermediate resistance to cotrimoxazol and 2 (11%) full resistance to trimethoprim-sulfamethoxazole. No strains were resistant to ceftriaxone, amoxicillin, clarithromicin, or chloramphenicol. CONCLUSIONS: our findings indicate that the prevalence of nasopharyngeal colonization by Streptococcus pneumoniae in children with upper respiratory infections was of 34.8%. Children attending day-care centers and children with younger siblings showed higher levels of colonization The results of prevalence of bacterial resistance were similar to those of studies regarding invasive infections, thus indicating that nasopharyngeal isolates of Streptococcus pneumoniae can be used in the surveillance of antimicrobial resistance in a defined geographical area.