INTRODUCTION: Sequential antibiotic therapy (SAT) is safe and economical. However, the unnecessary use of intravenous (IV) administration usually occurs. The objective of this work was to get to know the effectiveness of an intervention to implement the SAT in a teaching hospital in Brazil. METHODS: This was a prospective and interventional study, historically controlled, and was conducted in the Hospital de Clínicas, Universidade Federal de Uberlândia, State of Minas Gerais, Brazil, a high complexity teaching hospital having 503 beds. In each of the periods, from 04/04/05 to 07/20/05 (pre-intervention) and from 09/24/07 to 12/20/07 (intervention), 117 patients were evaluated. After the pre-intervention period, guidelines were developed which were implemented during the intervention period along with educational measures and a reminder system added to the patients' prescription. RESULTS: In the pre-intervention and intervention periods, the IV antibiotics were used as treatment for a average time of 14.8 and 11.8 days, respectively. Ceftriaxone was the antibiotic most prescribed in both periods (23.4% and 21.6% respectively). Starting from the first prescription of antibiotics, the average length of hospitalization time was 21.8 and 17.5 days, respectively. The SAT occurred only in 4 and 5 courses of treatment, respectively, and 12.8% and 18.8% of the patients died in the respective periods. CONCLUSIONS: Under the presented conditions, the evaluated intervention strategy is ineffective in promoting the exchange of the antibiotic administration from IV to oral treatment (SAT).

INTRODUÇÃO: O objetivo deste estudo foi determinar a epidemiologia das três infecções hospitalares (IH) mais comuns - sepse, pneumonia e infecção do trato urinário (ITU) - em uma unidade de terapia intensiva pediátrica (UTIP) de um país em desenvolvimento e definir os fatores de risco associados com IH. MÉTODOS:Nós desenvolvemos um estudo prospectivo de incidência de IH em uma única UTIP, entre agosto/2009 e agosto/2010. Foi conduzida uma vigilância ativa pelo National Healthcare Safety Network (NHSN) na Unidade e as crianças com IH (casos) foram comparadas com um grupo (controles) em um estudo caso-controle. RESULTADOS: Nós analisamos 172 pacientes, 22,1% com IH, 71,1% adquirida na Unidade. A densidade de incidência de sepse, pneumonia e ITU por 1.000 pacientes/dia foram 17,9, 11,4, e 4,3, respectivamente. Os agentes mais comuns na sepse foram Enterococcus faecalis e Escherichia coli (18% cada), e Staphylococcus epidermidis foram isolados em 13% dos casos. Nas pneumonias Staphylococcus aureus foram os agentes mais comuns (3,2%), e nas ITUs os agentes mais frequentes foram os fungos (33,3%). A presença de IH foi associada com tempo de hospitalização prolongado, uso de procedimentos invasivos (CVC, sonda nasogástrica) e uso de antibióticos. Os dois últimos foram fatores independentes para o desenvolvimento de IH. CONCLUSÕES: A incidência de IH adquirida na Unidade foi alta, associada a fatores de risco extrínsecos.

INTRODUCTION: This study aimed to determine the epidemiology of the three most common nosocomial infections (NI), namely, sepsis, pneumonia, and urinary tract infection (UTI), in a pediatric intensive care unit (PICU) in a developing country and to define the risk factors associated with NI. METHODS: We performed a prospective study on the incidence of NI in a single PICU, between August 2009 and August 2010. Active surveillance by National Healthcare Safety Network (NHSN) was conducted in the unit and children with NI (cases) were compared with a group (matched controls) in a case-control fashion. RESULTS: We analyzed 172 patients; 22.1% had NI, 71.1% of whom acquired it in the unit. The incidence densities of sepsis, pneumonia, and UTI per 1,000 patients/day were 17.9, 11.4, and 4.3, respectively. The most common agents in sepsis were Enterococcus faecalis and Escherichia coli (18% each); Staphylococcus epidermidis was isolated in 13% of cases. In pneumonias Staphylococcus aureus was the most common cause (3.2%), and in UTI the most frequent agents were yeasts (33.3%). The presence of NI was associated with a long period of hospitalization, use of invasive devices (central venous catheter, nasogastric tube), and use of antibiotics. The last two were independent factors for NI. CONCLUSIONS: The incidence of NI acquired in this unit was high and was associated with extrinsic factors.

OBJECTIVES: To determine the prevalence of pneumococcal serotypes and antimicrobial susceptibility in patients with meningitis, and to evaluate the implications for vaccine coverage. METHODS: Pneumococcal strains obtained from normally sterile fluids from patients admitted with meningitis were isolated at the Hospital de Clínicas of the Universidade Federal de Uberlândia, Minas Gerais State, and sent to the Instituto Adolfo Lutz, city of São Paulo, São Paulo State, for further identification, serotyping, and antimicrobial susceptibility determination. RESULTS: From April 1999 to April 2009, 338 pneumococcal strains were isolated, and 72 obtained from patients with meningitis, were analyzed. Patients' ages varied from one month to 82.2 years (mean of 18.4 ± 22.9 years; median of 5.2 years) and 46 (63.9%) patients were male. Strains were isolated from cerebrospinal fluid [66 occasions (91.7%)] and blood [6 occasions (8.3%)]. The most commonly identified serotypes were 14, 19F, 3, 7F, 6A, 6B, 10A, 18C, 23F, 5, and 34. Of the 20 [27.8%] oxacillin-resistant strains, 17 [23.6%] were resistant to penicillin and nine [12.5%] to ceftriaxone, both resistance patterns being more common in children aged two years or less and during the 2005-2009 period. CONCLUSIONS: Resistance to penicillin and ceftriaxone was detected in 23.6% and 12.5% of the strains, respectively, and predominated in children aged two years or less and during the 2005-2009 period. There were 24 different serotypes of pneumococcus and 79.8% of the serotypes were represented in the 7-valent conjugated vaccine [PVC7].

OBJETIVO: Avaliar o perfil de sorotipos e a sensibilidade aos antimicrobianos de cepas de pneumococo obtidas de crianças e as implicações na formulação de vacinas pneumocócicas. MÉTODOS: Cepas de pneumococo isoladas no Hospital de Clínicas da Universidade Federal de Uberlândia, Uberlândia (MG), a partir de pacientes com doença invasiva, foram enviadas ao Instituto Adolfo Lutz, São Paulo (SP), para confirmação da identificação, sorotipagem e determinação da sensibilidade aos antimicrobianos. RESULTADOS: De abril de 1999 a dezembro de 2008, foram avaliadas 142 cepas de pneumococo obtidas de crianças de até 5 anos de idade. Setenta e cinco (52,8%) eram de pacientes do sexo masculino, e a idade variou de 1 a 60 meses (média de 19±15,4 meses e mediana de 15 meses). Os diagnósticos clínicos mais comuns foram pneumonia [92 casos (64,8%)] e meningite [33 casos (23,2%)], e as principais fontes de recuperação foram sangue [61 amostras (43%)], líquido pleural [52 (36,6%)] e liquor [28 (19,7%)]. Os sorotipos mais comuns foram o 14, 5, 6B, 1, 6A, 18C, 19A, 3, 9V, 19F, 23F, 9N e 10A. Foram detectadas 14 (9,9%) cepas penicilina-resistentes, restritas aos sorotipos 14, 6B, 19F, 19A e 23F e predominantes no período de 2004 a 2008 (p = 0,000). Foi detectada sensibilidade diminuída ao cotrimoxazol (79,5%), à eritromicina e à clindamicina (11,3% cada) e à ceftriaxona (5,6%). CONCLUSÕES: A resistência à penicilina foi detectada em 9,9% das cepas e predominou no período de 2004 a 2008. Foram identificados 20 diferentes sorotipos de pneumococo, e a cifra de cobertura pela vacina 7-valente atualmente disponível (PN CRM7) é de 71,9%.

OBJECTIVE: To determine the prevalence of serotypes and antimicrobial susceptibility of strains of pneumococcus in children and to evaluate the implications for vaccine formulation. METHODS: Strains of pneumococcus obtained from children admitted with invasive diseases were isolated at Hospital de Clínicas of Universidade Federal de Uberlândia, Uberlândia, Brazil, and sent to Instituto Adolfo Lutz, São Paulo, Brazil, for further identification, serotyping, and determination of antimicrobial susceptibility. RESULTS: From April 1999 to December 2008, 142 strains of pneumococcus, obtained from children under 5 years of age, were analyzed. Seventy-five (52.8%) patients were male, and the age ranged from 1 to 60 months (mean age = 19±15.4 months; median = 15 months). The most common diagnoses were pneumonia [92 cases (64.8%)] and meningitis [33 cases (23.2%)]. The strains were mostly isolated from blood [61 samples (43%)], pleural fluid [52 samples (36.6%)], and cerebrospinal fluid [28 samples (19.7%)]. The most common serotypes were 14, 5, 6B, 1, 6A, 18C, 19A, 3, 9V, 19F, 23F, 9N, and 10A. There were 14 [9.9%] penicillin-resistant strains, which was detected only in the following serotypes: 14, 6B, 19F, 19A, and 23F, being predominant from 2004 to 2008 (p = 0.000). There was reduced susceptibility to co-trimoxazole (79.5%), erythromycin and clindamycin (11.3% each), and ceftriaxone (5.6%). CONCLUSIONS: Penicillin resistance was detected in 9.9% of the strains, being predominant from 2004 to 2008. Twenty different pneumococcal serotypes were identified, and 71.9% of the serotypes were represented in the 7-valent conjugate vaccine (PN CRM7) currently available.

OBJETIVO: Avaliar impacto dos novos pontos de corte de sensibilidade à penicilina nas taxas de resistência de cepas de pneumococo obtidas de crianças com pneumonia. MÉTODOS: Cepas de pneumococo isoladas no laboratório de análises clínicas do Hospital de Clínicas de Uberlândia, Uberlândia (MG), a partir de amostras de pacientes internados foram enviadas ao Instituto Adolfo Lutz, Sao Paulo (SP), para confirmação da identificação, sorotipagem e determinação da sensibilidade aos antimicrobianos. RESULTADOS: De abril de 1999 a dezembro de 2008 foram enviadas ao Instituto Adolfo Lutz 330 cepas de pneumococo, sendo 195 (59%) provenientes de pacientes com diagnóstico de pneumonia. Destas, foram analisadas 100 cepas de pacientes com idade ≤ 12 anos; a idade dos pacientes variou de 1 a 12,6 anos, com média de 2,4 e mediana de 1,7 anos; 47 pacientes eram do sexo masculino; as fontes de recuperação foram sangue (42%) e líquido pleural (58%). Foram detectadas 35 cepas oxacilina-resistentes: segundo os critérios do Clinical and Laboratory Standards Institute (CLSI) de 2007 [concentração inibitória mínima (CIM) ≤ 0,06 µg/mL para sensibilidade (S), 0,12 a 1 µg/mL para resistência intermediária (RI) e ≥ 2 µg/mL para resistência plena (RP)], 22 cepas apresentaram RI e 11, RP para penicilina. De acordo com os critérios atuais do CLSI de 2008 (≤ 2 µg/mL para S, 4 µg/mL para RI e ≥ 8 µg/mL para RP) apenas uma cepa confirmou RI à penicilina. Detectou-se resistência a cotrimoxazol (80%), tetraciclina (21%), eritromicina (13%), clindamicina (13%) e ceftriaxona (uma cepa, simultaneamente resistente a penicilina). CONCLUSÕES: Com a aplicação dos novos pontos de corte para sensibilidade in vitro, as taxas de resistência a penicilina caíram 97%, de 33 para 1%.

OBJECTIVE: To evaluate the impact of new penicillin susceptibility breakpoints on resistance rates of pneumococcal strains collected from children with pneumonia. METHODS: Pneumococcal strains collected from patients admitted with pneumonia were isolated at the clinical analysis lab of Hospital de Clínicas de Uberlândia, Uberlândia, Brazil, and sent to Instituto Adolfo Lutz, São Paulo, Brazil, for further identification, serotyping and determination of antimicrobial susceptibility. RESULTS: From April 1999 to December 2008, 330 strains of pneumococcus were sent to Instituto Adolfo Lutz; of these, 195 (59%) were collected from patients with pneumonia. One hundred strains collected from patients ≤ 12 years old were analyzed. The patients' age ranged from 1 to 12.6 years old (with mean age of 2.4 and median of 1.7 years). Forty-seven patients were male. The strains were isolated from blood (42%) and pleural fluid (58%). There were 35 oxacillin-resistant strains: according to the criteria defined by the Clinical and Laboratory Standards Institute (CLSI) in 2007 [minimum inhibitory concentration (MIC) ≤ 0.06 µg/mL for susceptibility (S), 0.12 to 1 µg/mL for intermediate resistance (IR), and ≥ 2 µg/mL for full resistance (FR)], 22 strains had IR and 11 strains had FR. According to the current breakpoints defined by the CLSI in 2008 (≤ 2 µg/mL for S, 4 µg/mL for IR and ≥ 8 µg/mL for FR), only one strain had IR to penicillin. There was resistance to co-trimoxazole (80%), tetracycline (21%), erythromycin (13%), clindamycin (13%), and ceftriaxone (one strain simultaneously resistant to penicillin). CONCLUSIONS: When the new breakpoints for in vitro susceptibility were applied, penicillin resistance rates dropped 97%, from 33 to 1%.

Respiratory syncytial virus (RSV) is responsible for annual respiratory infection outbreaks in infants and young children worldwide, frequently causing bronchiolitis and pneumonia. We evaluated clinical and epidemiological features of acute respiratory infections (ARIs) caused by respiratory syncytial virus (RSV) in children less than five years old. Nasopharyngeal aspirate samples from children with ARI symptoms, attended at the 'Hospital das Clínicas' - Federal University of Uberlândia, MG, Brazil, were collected and tested for RSV by the immunofluorescence assay (IFA). Patients' clinical and epidemiological data were also obtained. From April 2000 to June 2003, 317 nasopharyngeal samples were collected from children less than 54 months old. Seventy-six samples (24.0%) were positive for RSV, with 53% (40/76) obtained from male patients. Hospitalization occurred in 50% (38/76) of the cases, with an average period of 10.6 days, in most cases (87%, 33/38) occurring in children less than 12 months of age. Although an association between this age group and the presentation of more severe clinical symptoms was observed, such as bronchiolitis in 51% (27/53) of the patients and pneumonia in 19% (10/53), no patients died. RSV was found from February to August, with the highest incidence in May. Conclusions: RSV is an important agent that causes ARIs; the clinical manifestations varied from mild to severe and patients frequently required hospitalization; RSV mostly affected children less than one year old.

OBJETIVO: Monitorizar a tendência de ocorrência e identificar surtos de infecções hospitalares utilizando diagramas de controles. MÉTODOS: No período de janeiro de 1998 a dezembro de 2000, a ocorrência de infecções hospitalares foi avaliada em uma coorte de 460 pacientes, internados em uma Unidade de Terapia Intensiva Pediátrica de um hospital universitário, segundo os conceitos e critérios da metodologia do sistema "National Nosocomial Infection Surveillance", do "Centers for Disease Control" (EUA). Os gráficos foram construídos de acordo com a distribuição probabilística de Poisson. Quatro linhas horizontais foram plotadas. A linha central foi representada pela incidência média das infecções hospitalares no período estudado e as linhas de alerta superior e de controle superior foram calculadas a partir de dois e três desvios-padrão acima da incidência média das infecções hospitalares, respectivamente. Os surtos de infecção hospitalar foram identificados quando sua incidência mensal permaneceu acima da linha do limite de controle superior. RESULTADOS: A incidência média de infecções hospitalares por mil pacientes dia foi de 20. Um surto de infecção do trato urinário foi identificado em julho de 2000, cuja taxa de infecção foi de 63 por mil pacientes dia, ultrapassando a linha de controle superior, configurando um período epidêmico. CONCLUSÕES: A utilização dos diagramas de controle do nível endêmico, tanto por avaliação global e sítio específica, possibilitou identificar e distinguir das variações naturais nas taxas de ocorrência de infecções hospitalares aquelas de causas incomuns, como os surtos ou epidemias, dispensando o uso de cálculos e testes de hipóteses.

OBJECTIVE: To monitor occurrence trends and identify clusters of nosocomial infection (NI) using statistical process control (SPC) charts. METHODS: Between January 1998 and December 2000 nosocomial infection occurrence was evaluated in a cohort of 460 patients admitted to the Pediatric Intensive Care Unit of a university hospital, according to the concepts and criteria proposed by the National Nosocomial Infection Surveillance System of the Centers for Disease Control, in the United States. Graphs were plotted using Poisson statistical distribution, including four horizontal lines: center line (CL), upper warning limit (UWL) and upper control limit (UCL). The CL was the arithmetic mean NI rate calculated for the studied period; UWL and UCL were drawn at 2 and 3 standard deviations above average NI rates, respectively. Clusters were identified when NI rates remained above UCL. RESULTS: Mean NI incidence was 20 per 1,000 patient days. One urinary tract infection cluster was identified in July 2000, with an infection rate of 63 per 1,000 patient days, exceeding UCL and characterizing a period of epidemic. CONCLUSIONS: The use of SPC charts for controlling endemic levels of NI, through both global and site-specific evaluation, allowed for the identification of uncommon variations in NI rates, such as outbreaks and epidemics, and for their distinction from the natural variations observed in NI occurrence rates, without the need for calculations and hypothesis testing.

OBJETIVO: Monitorizar a tendência de ocorrência e identificar surtos de infecções hospitalares utilizando diagramas de controles. MÉTODOS: No período de janeiro de 1998 a dezembro de 2000, a ocorrência de infecções hospitalares foi avaliada em uma coorte de 460 pacientes, internados em uma Unidade de Terapia Intensiva Pediátrica de um hospital universitário, segundo os conceitos e critérios da metodologia do sistema "National Nosocomial Infection Surveillance", do "Centers for Disease Control" (EUA). Os gráficos foram construídos de acordo com a distribuição probabilística de Poisson. Quatro linhas horizontais foram plotadas. A linha central foi representada pela incidência média das infecções hospitalares no período estudado e as linhas de alerta superior e de controle superior foram calculadas a partir de dois e três desvios-padrão acima da incidência média das infecções hospitalares, respectivamente. Os surtos de infecção hospitalar foram identificados quando sua incidência mensal permaneceu acima da linha do limite de controle superior. RESULTADOS: A incidência média de infecções hospitalares por mil pacientes dia foi de 20. Um surto de infecção do trato urinário foi identificado em julho de 2000, cuja taxa de infecção foi de 63 por mil pacientes dia, ultrapassando a linha de controle superior, configurando um período epidêmico. CONCLUSÕES: A utilização dos diagramas de controle do nível endêmico, tanto por avaliação global e sítio específica, possibilitou identificar e distinguir das variações naturais nas taxas de ocorrência de infecções hospitalares aquelas de causas incomuns, como os surtos ou epidemias, dispensando o uso de cálculos e testes de hipóteses.

OBJECTIVE: To monitor occurrence trends and identify clusters of nosocomial infection (NI) using statistical process control (SPC) charts. METHODS: Between January 1998 and December 2000 nosocomial infection occurrence was evaluated in a cohort of 460 patients admitted to the Pediatric Intensive Care Unit of a university hospital, according to the concepts and criteria proposed by the National Nosocomial Infection Surveillance System of the Centers for Disease Control, in the United States. Graphs were plotted using Poisson statistical distribution, including four horizontal lines: center line (CL), upper warning limit (UWL) and upper control limit (UCL). The CL was the arithmetic mean NI rate calculated for the studied period; UWL and UCL were drawn at 2 and 3 standard deviations above average NI rates, respectively. Clusters were identified when NI rates remained above UCL. RESULTS: Mean NI incidence was 20 per 1,000 patient days. One urinary tract infection cluster was identified in July 2000, with an infection rate of 63 per 1,000 patient days, exceeding UCL and characterizing a period of epidemic. CONCLUSIONS: The use of SPC charts for controlling endemic levels of NI, through both global and site-specific evaluation, allowed for the identification of uncommon variations in NI rates, such as outbreaks and epidemics, and for their distinction from the natural variations observed in NI occurrence rates, without the need for calculations and hypothesis testing.

OBJETIVO: Avaliar o perfil de sorotipos e a susceptibilidade aos antimicrobianos de cepas de Streptococcus pneumoniae obtidas em espécimes clínicos de pacientes com doença invasiva, bem como suas implicações na formulação de vacinas pneumocócicas. MÉTODOS: Cepas de pneumococo isoladas no Laboratório de Análises Clínicas do Hospital de Clínicas da Universidade Federal de Uberlândia a partir de amostras clínicas de pacientes com doença invasiva foram identificadas e enviadas ao Instituto Adolfo Lutz em São Paulo para confirmação da identificação, sorotipagem e determinação da susceptibilidade aos antimicrobianos. RESULTADOS: De abril de 1999 a março de 2003, foram isoladas 148 cepas invasivas de pneumococo, sendo 84 (56,7%) provenientes de pacientes do sexo masculino. A idade variou de um dia a 88,83 anos, com média de 21,33+25,82 anos e mediana de 4,42 anos. Os diagnósticos clínicos mais comuns foram pneumonia (91 casos; 61,4%), meningite (32 casos; 21,6%) e bacteremia sem foco evidente (15 casos; 10,1%). As principais fontes de recuperação foram sangue (76 amostras; 51,3%), líquido pleural (39; 26,3%) e liquor (30; 20,2%). No total, foram identificados 23 diferentes sorotipos entre 143 amostras testadas, sendo os mais comuns os seguintes: 14, 3, 1, 5, 6A, 6B e 18C. Dentre 30 (20,2%) cepas oxacilina-resistentes, 23 (15,5%) confirmaram a resistência à penicilina (12,8% com nível intermediário e 2,7%, com nível pleno), que esteve restrita aos sorotipos 14, 23F, 19A e 6B, predominando em indivíduos com até dois anos de idade (p = 0,0008). Foi detectada susceptibilidade diminuída ao cotrimoxazol (63,4%), à eritromicina (8,3%), à clindamicina (8,7%) e à ofloxacina (0,8%). A resistência à cefotaxima foi detectada em três das 30 cepas testadas (2% das 148), todas elas com resistência confirmada à penicilina. Não foi observada resistência a cloranfenicol, rifampicina ou vancomicina. CONCLUSÕES: A resistência à penicilina foi detectada em 15,5% das cepas e predominou em crianças abaixo de dois anos de idade. Foram identificados 23 diferentes sorotipos de Streptococcus pneumoniae em pacientes internados com doença invasiva, e a maioria dos sorotipos (82,6%) e das cepas (90,2%) está incluída na vacina polissacarídica 23-valente. As cifras para a vacina 7-valente, atualmente disponível (PN CRM7), são de 46,7% dos sorotipos e 63,6% das cepas, obtidos de crianças com até cinco anos de idade.

OBJECTIVE: To determine the prevalence of serotypes and antimicrobial susceptibility of invasive strains of Streptococcus pneumoniae and to discuss the implications of these findings for vaccine formulation. METHODS: Strains of Streptococcus pneumoniae obtained from normally sterile fluids from patients admitted with invasive diseases were isolated and identified at the Hospital de Clínicas, Universidade Federal de Uberlândia, state of Minas Gerais, and forwarded to Instituto Adolfo Lutz, state of São Paulo, for further identification, serotyping and determination of antimicrobial susceptibility. RESULTS: From April 1999 to March 2003, 148 invasive strains of Streptococcus pneumoniae were obtained. The age of patients ranged from 1 day to 88.83 years (mean: 21.33+25.82 years; median: 4.42 years). Eighty-four (56.7%) patients were male. The most common diagnoses were pneumonia (91 cases; 61.4%), meningitis (32 cases; 21.6%) and occult bacteremia (15 cases; 10.1%). Strains were isolated mostly from blood (76 occasions; 51.3%), pleural fluid (39 occasions; 26.3%) and cerebrospinal fluid (30 occasions; 20.2%). There were 23 different serotypes, and the most common were 14, 3, 1, 5, 6A, 6B and 18C. Among 30 (20.2%) oxacillin-resistant strains, 23 (15.5%) were confirmed as resistant to penicillin (12.8% intermediate resistance and 2.7% full resistance). Oxacillin-resistant strains were restricted to serotypes 14, 23F, 19A and 6B. Resistance to penicillin varied with age, being more common in children under two years of age (p=0.0008). We observed decreased sensibility to sulfamethoxazole-trimethoprim (92 isolates; 63.4%), to erythromycin (12 isolates; 8.3%), to clindamycin (12 isolates ;8.7%), to ofloxacin (one strain; 0.8%) and to cefotaxime (three strains; 2%; also resistant to penicillin). All isolates were susceptible to chloramphenicol, rifampin and vancomycin. CONCLUSIONS: The decreased susceptibility to penicillin, detected in 15.5% of the strains was predominant in children under two years of age. There were 23 different Streptococcus pneumoniae serotypes. The 23-valent polysaccharide vaccine covers 82.6% of the serotypes and 90.2% of the invasive strains isolated in this population. In addition, 46.7% of the serotypes and 63.6% of the strains isolated from children until five years of age are covered in the currently available 7-valent conjugated vaccine (PN CRM7).

Objetivo: analisar o perfil etiológico e alguns aspectos epidemiológicos das crianças com meningite bacteriana, internadas em um hospital público universitário. Métodos: foram seguidas, prospectivamente, as crianças internadas com meningite bacteriana, diagnosticada segundo os critérios clínicos e laboratoriais habituais. Foram excluídos os casos de meningite pós-trauma, de meningite na vigência de derivação liquórica, ou de defeitos congênitos do tubo neural, e de meningite tuberculosa. Resultados: foram analisadas 415 crianças internadas com diagnóstico de meningite bacteriana, no Hospital de Clínicas da Universidade Federal de Uberlândia, no período de 01/01/1987 a 31/01/2001. O agente etiológico foi identificado em 315 pacientes (75,9%), sendo de modo definitivo em 289 (69,3%) e presuntivo, por intermédio da bacterioscopia, em outros 26 (6,6%). Os agentes mais comumente identificados foram o Haemophilus influenzae b (54,2%), o meningococo (20,6%) e o pneumococo (18,1% dos 315 pacientes). O tratamento antimicrobiano prévio, detectado em 47,2% dos casos, causou uma diminuição significante no rendimento das culturas de sangue (de 50,8% para 38,7%) e de liquor (71,7% para 57,6%). Houve um predomínio do acometimento de crianças com idade até 48 meses pelo Haemophilus influenzae b, particularmente em relação ao meningococo. A letalidade geral foi de 10,1%, com diferença significante entre a letalidade do pneumococo, de 17,5%, e a do meningococo, de 4,6%. Conclusões: as crianças afetadas por Haemophilus influenzae b e por pneumococo foram mais jovens que aquelas com meningite por meningococo. A hemocultura e a cultura de liquor continuam sendo importantes recursos laboratoriais para o diagnóstico etiológico da meningite bacteriana, apesar do impacto negativo causado em seu rendimento pelo tratamento antibiótico prévio. Os agentes mais comumente isolados foram o Haemophilus influenzae b, o meningococo e o pneumococo. A meningite bacteriana continua tendo uma importante mortalidade entre as crianças, principalmente quando causada pelo pneumococo.

Objective: To determine the etiologic profile and analyze some epidemiological aspects of children with bacterial meningitis admitted to a public teaching hospital. Methods: A prospective study was conducted on children with clinical and laboratory diagnosis of bacterial meningitis, admitted to Hospital das Clínicas da Universidade Federal de Uberlândia, from January 1987 to January 2001. Patients with meningitis associated with trauma, intracranial devices or malformations of the neural tube, and tuberculosis, were not included in the study. Results: From a total of 415 children with bacterial meningitis, the etiologic agent was detected in 315 (75.9%): Haemophilus influenzae b in 54.2%, meningococci in 20.6%, pneumococci in 18.1% and other agents, in 6.9%. Previous antibiotic treatment, observed in 47.2% of the cases, led to a significant decrease in positive blood cultures (from 50.8% to 38.7%) and in cerebrospinal fluid cultures (from 71.7% to 57.6%). Among children younger than 48 months Haemophilus influenzae b was predominant, particularly when compared to meningococci. The overall mortality was 10.1%, with a significant difference between the rates of pneumococcal (17.5%) and meningococcal meningitis (4.6%). Conclusions: Children affected by Haemophilus influenzae b and by pneumococci were younger than those with meningitis caused by meningococci. The blood and/or cerebrospinal fluid culture remains an important laboratory tool for etiologic diagnosis, despite the negative impact caused by antibiotic previous treatment. The agents most commonly detected were Haemophilus influenzae b, meningococci and pneumococci. Bacterial meningitis continues to present an important mortality among children, particularly when caused by pneumococci.

Descreve-se caso de cardiopatia chagásica em menino de nove anos, natural e procedente do sulde Goiás, que desenvolveu insuficiência cardíaca congestiva quatro meses antes do óbito. As reações sorológicaspara doença de Chagas eram reagentes, epositivo o xenodiagnóstico. Os eletrocardiogramas mostraram taquicardia sinusal, extra-sístoles ventriculares e supraventriculares, hemibloqueio anterior esquerdo, bloqueio completo do ramo direito e sinais de sobrecarga de câmaras. O exame ecocardiográfico evidenciou dilatação de câmaras com hipocontratilidade difusa. O quadro se agravou progressivamente, complicando-se por vários episódios pneumônicos, o último dos quais provocou o óbito. A necrópsia, verificou-se, no coração, inflama ção crônica dos três folhetos, com miocardite crônica fibrosante predominando no septo interventricular e no ventrículo esquerdo. As estruturas componentes do sistema excito-condutor mostraram processoflogístico crônico, essencialmente exsudativo, ora discreto, ora moderado. No sistema nervoso autônomo intracardíaco constataram-se focos esparsos de discreta periganglionite crônica, e raros fenômenos degenerativos dos neurônios sem despopulação neuronal.

A case of decompensated chagasic cardiopathy in a nine-year-old boy from the south of the State of Goiás, is described. He developed congestive heart failure four months before death. The sorological reaction for Chagas ' disease and the xenodiagnosis were positive. Electrocardiograms showed sinusal tachycardia, ventricular and supraventricular extrasystoles, left anterior hemiblock, complete right bundle branch block and signs of chambers overload. The echocardiogram demonstraded chamber dilatation with diffuse hypocontractility. He presented a downhill course complicated with several pneumonic episodes, the last one just before death. At necropsy, the heart, exhibited a chronicpancarditis with fibrosing chronic myocarditis involving mainly the interventricular septum and left ventricle. The heart conduction system showed slight to moderate exsudative, inflammatory changes. Scattered foci of slight chronic periganglionitis and rare degenerative phenomena of ganglionar cells were found in intracardiac autonomic nervous, without neuronal depopulation.

Os autores comparam a eficácia sorológica e a proteção clinica obtidas com três esquemas diferentes de vacinação contra o sarampo, em crianças eutróficas, na cidade de São Paulo, Brasil. Duzentas e quarenta e duas crianças foram divididas em três grupos. Grupo A, compreendendo 117 crianças primovacinadas antes dos 12 meses de idade e revacinadas com 12 ou mais meses de idade. Grupo B, compreendendo 46 crianças vacinadas com dose única, antes dos 12 meses de idade. Grupo C, compreendendo 79 crianças vacinadas com dose única, aos 12 ou mais meses de idade. A média geométrica do título de anticorpos no grupo A foi 790,1; no grupo B, 251,1; e no grupo C, 550,3. Não houve diferença estatisticamente significante entre os grupos A e C. A exposição ao vírus do sarampo foi provavelmente semelhante em todos os grupos. As crianças dos grupos A e C apresentaram risco de adoecimento semelhante após vacinação, enquanto que tal risco foi maior no grupo B quando comparado aos outros dois grupos. Os resultados obtidos neste estudo falam a favor do uso, em países em desenvolvimento, de um programa de vacinação contra o sarampo que inclua uma primeira dose àos oito meses de idade e revacinação após os 12 meses de idade.

The authors compare the serologic efficacy and the clinical protection afforded by three different measles vaccination schemes in adequately nourished children in São Paulo city, Brazil. Two hundred forty two children were divided into three groups. Group A, comprising 117 children who had received the vaccine before 12 months of age and a second dose at 12 months of age or more. Group B, comprising 46 children who had received only one dose, before 12 months of age. Group C, comprising 79 children who had received only one dose, at 12 months of age or more. The geometric mean titer of antibodies in Group A was 790.1; in Group B, 251.1; and in Group C, 550.3. There was no statistically significant difference between Groups A and C. The exposure to the measles virus was probably similar in all groups, and the children in Groups A and C had similar chances of acquiring the disease after vaccination whereas in Group B the chances were higher when compared to the other two groups. The results obtained in this study favor the use, in developing countries, of a vaccination program against measles that includes an early first dose at eight months of age and revaccination after 12 months of age.