Bacteriemias verticales: ¿tratar o no tratar?
Vertically transmitted bacteriemias: to treat or not to treat?
R. López Almaraz
, M.aJ. Hernández González, E. Doménech Martínez
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Servicio de Neonatología. Hospital Universitario de Canarias. La Laguna. Tenerife
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Dalmau Serra" "autores" => array:1 [ 0 => array:2 [ "nombre" => "J." "apellidos" => "Dalmau Serra" ] ] ] ] ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1695403301786717?idApp=UINPBA00005H" "url" => "/16954033/0000005400000002/v1_201307051539/S1695403301786717/v1_201307051539/es/main.assets" ] "es" => array:14 [ "idiomaDefecto" => true "titulo" => "Bacteriemias verticales: ¿tratar o no tratar?" "tieneTextoCompleto" => 0 "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "160" "paginaFinal" => "164" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "R. López Almaraz, M.<span class="elsevierStyleSup">a</span>J. Hernández González, E. Doménech Martínez" "autores" => array:3 [ 0 => array:4 [ "nombre" => "R." "apellidos" => "López Almaraz" "email" => array:1 [ 0 => "edomenec@ull.es" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "M.<span class="elsevierStyleSup">a</span>J." "apellidos" => "Hernández González" ] 2 => array:2 [ "nombre" => "E." "apellidos" => "Doménech Martínez" ] ] "afiliaciones" => array:1 [ 0 => array:1 [ "entidad" => "Servicio de Neonatología. Hospital Universitario de Canarias. La Laguna. Tenerife" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "*" "correspondencia" => "Correspondencia: Dr. R. López Almaraz. Asiria, 40, ático. 38320 La Cuesta. Tenerife." ] ] ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Vertically transmitted bacteriemias: to treat or not to treat?" ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2000-07-01" "fechaAceptado" => "2000-11-01" "PalabrasClave" => array:2 [ "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec186591" "palabras" => array:3 [ 0 => "<span class="elsevierStyleItalic">Bacteriemia vertical</span>" 1 => "<span class="elsevierStyleItalic">Sospecha de sepsis precoz</span>" 2 => "<span class="elsevierStyleItalic">Streptococcus agalactiae</span>" ] ] ] "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Key words" "identificador" => "xpalclavsec186592" "palabras" => array:3 [ 0 => "<span class="elsevierStyleItalic">Vertically transmitted bacteriemias</span>" 1 => "<span class="elsevierStyleItalic">Suspected early onset neonatal sepsis</span>" 2 => "<span class="elsevierStyleItalic">Group B streptococcus</span>" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "es" => array:1 [ "resumen" => "<span class="elsevierStyleSectionTitle">Objetivo</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Analizar la incidencia, etiología y tratamiento posterior de los recién nacidos en 1997 diagnosticados de bacteriemia vertical y sospecha de sepsis.</p> <span class="elsevierStyleSectionTitle">Material y métodos</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">El total de recién nacidos en dicho período fue de 2.365. Se revisaron las historias clínicas de los diagnosticados de bacteriemia y se dividieron en dos grupos: <span class="elsevierStyleItalic">a</span>) bacteriemias verticales, según las recomendaciones del Grupo Castrillo, y <span class="elsevierStyleItalic">b</span>) sospechosos de sepsis, por hemocultivo y datos analíticos indicativos de infección, pero sin síntomas. Se analizaron el peso al nacimiento, sexo, edad gestacional, factores de riesgo de infección neonatal, sintomatología, datos de laboratorio de infección y microorganismo causal. Posteriormente, se analizó la evolución clinicoanalítica de los tratados y los no tratados.</p> <span class="elsevierStyleSectionTitle">Resultados</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Se diagnosticaron 10 bacteriemias verticales (incidencia de 4,2 × 1.000 recién nacidos vivos) y 17 sospechas de sepsis (7,18 3 1.000 recién nacidos vivos). Todos presentaron factores de riesgo de infección neonatal, el más frecuente fue la rotura prolongada de membranas (≥ 18 h), por lo que se realizó detección de sepsis (hemograma, proteína C reactiva a las 12 y 36-48 horas de vida y hemocultivo). En ambos grupos, el microorganismo más frecuente aparecido fue <span class="elsevierStyleItalic">Estreptococcus agalactiae</span>, y fue el causante del 30% de las bacteriemias y del 41,2% de la sospecha de sepsis. Se trataron a todos los sospechosos de sepsis y dos de las bacteriemias verticales sin incidencias, las otras ocho no tratadas se siguieron clinicoanalíticamente durante un año manteniéndose asintomáticos en todo momento.</p> <span class="elsevierStyleSectionTitle">Conclusiones</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">El germen más frecuente en las bacteriemias, como en las sepsis verticales, fue <span class="elsevierStyleItalic">S. agalactiae</span>.</p><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Ninguno de los pacientes no tratados desarrolló sepsis tardía ni meningitis. Ante los resultados obtenidos, se aporta una nueva justificación para no tratar las bacteriemias, manteniendo un seguimiento clínico estrecho.</p>" ] "en" => array:1 [ "resumen" => "<span class="elsevierStyleSectionTitle">Objective</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">To analyze the incidence, etiology and management of infants born in 1977 with vertically transmitted bacteriemia or suspected early onset neonatal sepsis.</p> <span class="elsevierStyleSectionTitle">Patients and methods</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">The total number of newborn infants in this period was 2,365. We revised the clinical histories of the infants diagnosed with bacteriemia and classified them into two groups: <span class="elsevierStyleItalic">a</span>) those with vertically transmitted bacteriemias, according to the recommendations of the Castrillo Group, and <span class="elsevierStyleItalic">b</span>) those with suspected early onset neonatal sepsis in whom blood culture was positive and analytical data suggested bacterial infection but who showed no clinical symptoms of vertically transmitted sepsis. Birthweight, sex, gestational age, risks factors for neonatal infection, clinical signs and laboratory tests suggestive of bacterial infection and microbiological agents were analyzed. The clinical and analytical evolution of the treated and untreated newborn infants was studied.</p> <span class="elsevierStyleSectionTitle">Results</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Ten newborn infants were diagnosed with vertically transmitted bacteriemia (an incidence of 4.2 × 1,000 live newborn infants) and 17 were diagnosed with suspected early onset neonatal sepsis (7.8 × 1,000 live newborns). All the infants had risk factors for neonatal sepsis. The most common of these was prolonged membrane rupture (≥ 18 hours) due to which sepsis screening was carried out (hemogram, C-reactive protein at 12 and 36-48 hours of life, and blood culture). In both groups the most commonly isolated microorganism was group B streptococcus, which was found in 30 % of vertically transmitted bac-teriemias and in 41.2 % of suspected early onset neonatal sepsis. All the newborn infants with suspected sepsis and two with vertically transmitted bacteriemia were treated without incident. The remaining eight infants with untreated vertically transmitted bacteremia were followed-up clinically and analytically for one year, and remained asymptomatic.</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">The most common microorganism in vertically transmitted bacteriemia and suspected early onset neonatal sepsis was group B streptococcus. None of the untreated infants developed late sepsis or meningitis. Our findings suggest that non-treatment of asymptomatic infants with vertically transmitted bacteriemias is appropriate as long as close clinical surveillance is maintained.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "Bibliografía" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:28 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Bacterial sepsis and meningitis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "J.O. Klein" 1 => "S. Maray" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "LibroEditado" => array:5 [ "titulo" => "Infectious diseases of the fetus and newborn infant" "paginaInicial" => "835" "paginaFinal" => "890" "edicion" => "4.<span class="elsevierStyleSup">a</span>" "serieFecha" => "1995" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2." 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| año/Mes | Html | Total | |
|---|---|---|---|
| 2024 Noviembre | 1 | 19 | 20 |
| 2024 Octubre | 34 | 62 | 96 |
| 2024 Septiembre | 27 | 43 | 70 |
| 2024 Agosto | 41 | 83 | 124 |
| 2024 Julio | 34 | 41 | 75 |
| 2024 Junio | 37 | 38 | 75 |
| 2024 Mayo | 34 | 32 | 66 |
| 2024 Abril | 37 | 40 | 77 |
| 2024 Marzo | 27 | 33 | 60 |
| 2024 Febrero | 31 | 43 | 74 |
| 2024 Enero | 30 | 39 | 69 |
| 2023 Diciembre | 16 | 17 | 33 |
| 2023 Noviembre | 24 | 40 | 64 |
| 2023 Octubre | 32 | 35 | 67 |
| 2023 Septiembre | 15 | 38 | 53 |
| 2023 Agosto | 19 | 29 | 48 |
| 2023 Julio | 36 | 40 | 76 |
| 2023 Junio | 20 | 40 | 60 |
| 2023 Mayo | 23 | 30 | 53 |
| 2023 Abril | 22 | 24 | 46 |
| 2023 Marzo | 17 | 29 | 46 |
| 2023 Febrero | 22 | 27 | 49 |
| 2023 Enero | 17 | 34 | 51 |
| 2022 Diciembre | 25 | 34 | 59 |
| 2022 Noviembre | 39 | 49 | 88 |
| 2022 Octubre | 22 | 54 | 76 |
| 2022 Septiembre | 16 | 33 | 49 |
| 2022 Agosto | 23 | 55 | 78 |
| 2022 Julio | 23 | 47 | 70 |
| 2022 Junio | 60 | 39 | 99 |
| 2022 Mayo | 38 | 56 | 94 |
| 2022 Abril | 54 | 47 | 101 |
| 2022 Marzo | 33 | 58 | 91 |
| 2022 Febrero | 33 | 34 | 67 |
| 2022 Enero | 21 | 52 | 73 |
| 2021 Diciembre | 53 | 47 | 100 |
| 2021 Noviembre | 35 | 81 | 116 |
| 2021 Octubre | 38 | 66 | 104 |
| 2021 Septiembre | 20 | 55 | 75 |
| 2021 Agosto | 28 | 37 | 65 |
| 2021 Julio | 19 | 35 | 54 |
| 2021 Junio | 23 | 64 | 87 |
| 2021 Mayo | 21 | 50 | 71 |
| 2021 Abril | 24 | 93 | 117 |
| 2021 Marzo | 73 | 35 | 108 |
| 2021 Febrero | 83 | 29 | 112 |
| 2021 Enero | 48 | 34 | 82 |
| 2020 Diciembre | 41 | 29 | 70 |
| 2020 Noviembre | 23 | 14 | 37 |
| 2020 Octubre | 19 | 21 | 40 |
| 2020 Septiembre | 20 | 15 | 35 |
| 2020 Agosto | 12 | 13 | 25 |
| 2020 Julio | 27 | 16 | 43 |
| 2020 Junio | 20 | 7 | 27 |
| 2020 Mayo | 24 | 24 | 48 |
| 2020 Abril | 30 | 14 | 44 |
| 2020 Marzo | 22 | 15 | 37 |
| 2020 Febrero | 30 | 11 | 41 |
| 2020 Enero | 30 | 13 | 43 |
| 2019 Diciembre | 30 | 17 | 47 |
| 2019 Noviembre | 17 | 22 | 39 |
| 2019 Octubre | 13 | 11 | 24 |
| 2019 Septiembre | 21 | 26 | 47 |
| 2019 Agosto | 27 | 14 | 41 |
| 2019 Julio | 29 | 33 | 62 |
| 2019 Junio | 32 | 46 | 78 |
| 2019 Mayo | 23 | 49 | 72 |
| 2019 Abril | 19 | 24 | 43 |
| 2019 Marzo | 17 | 12 | 29 |
| 2019 Febrero | 15 | 15 | 30 |
| 2019 Enero | 18 | 11 | 29 |
| 2018 Diciembre | 24 | 15 | 39 |
| 2018 Noviembre | 16 | 11 | 27 |
| 2018 Octubre | 26 | 18 | 44 |
| 2018 Septiembre | 15 | 4 | 19 |
| 2018 Junio | 1 | 0 | 1 |
| 2018 Mayo | 5 | 0 | 5 |
| 2018 Abril | 12 | 0 | 12 |
| 2018 Marzo | 6 | 0 | 6 |
| 2018 Febrero | 6 | 0 | 6 |
| 2018 Enero | 5 | 0 | 5 |
| 2017 Diciembre | 6 | 0 | 6 |
| 2017 Noviembre | 9 | 0 | 9 |
| 2017 Octubre | 7 | 0 | 7 |
| 2017 Septiembre | 10 | 0 | 10 |
| 2017 Agosto | 12 | 0 | 12 |
| 2017 Julio | 8 | 2 | 10 |
| 2017 Junio | 18 | 17 | 35 |
| 2017 Mayo | 17 | 4 | 21 |
| 2017 Abril | 11 | 3 | 14 |
| 2017 Marzo | 14 | 3 | 17 |
| 2017 Febrero | 5 | 5 | 10 |
| 2017 Enero | 8 | 2 | 10 |
| 2016 Diciembre | 33 | 8 | 41 |
| 2016 Noviembre | 31 | 6 | 37 |
| 2016 Octubre | 35 | 12 | 47 |
| 2016 Septiembre | 37 | 5 | 42 |
| 2016 Agosto | 22 | 2 | 24 |
| 2016 Julio | 15 | 3 | 18 |
| 2016 Mayo | 1 | 0 | 1 |
| 2016 Marzo | 1 | 2 | 3 |
| 2015 Diciembre | 3 | 0 | 3 |
| 2015 Octubre | 1 | 0 | 1 |
| 2015 Agosto | 2 | 0 | 2 |
| 2015 Julio | 4 | 0 | 4 |
| 2015 Junio | 3 | 0 | 3 |
| 2015 Mayo | 8 | 1 | 9 |
| 2015 Abril | 10 | 0 | 10 |
| 2015 Marzo | 5 | 2 | 7 |
| 2015 Febrero | 6 | 0 | 6 |
| 2015 Enero | 8 | 0 | 8 |
| 2014 Diciembre | 8 | 2 | 10 |
| 2014 Noviembre | 2 | 0 | 2 |
| 2014 Octubre | 3 | 0 | 3 |
| 2014 Septiembre | 2 | 4 | 6 |
| 2014 Agosto | 5 | 1 | 6 |
| 2014 Julio | 5 | 2 | 7 |
| 2014 Junio | 11 | 0 | 11 |
| 2014 Mayo | 22 | 1 | 23 |
| 2014 Abril | 11 | 1 | 12 |
| 2014 Marzo | 5 | 6 | 11 |
| 2014 Febrero | 11 | 7 | 18 |
| 2014 Enero | 20 | 6 | 26 |
| 2013 Diciembre | 19 | 8 | 27 |
| 2013 Noviembre | 14 | 8 | 22 |
| 2013 Octubre | 28 | 6 | 34 |
| 2013 Septiembre | 16 | 5 | 21 |
| 2013 Agosto | 6 | 6 | 12 |
| 2013 Julio | 5 | 4 | 9 |
| 2013 Junio | 2 | 1 | 3 |
| 2013 Mayo | 4 | 2 | 6 |
| 2013 Abril | 4 | 1 | 5 |
| 2013 Marzo | 5 | 3 | 8 |
| 2013 Febrero | 16 | 6 | 22 |
| 2013 Enero | 27 | 3 | 30 |
| 2012 Diciembre | 8 | 0 | 8 |
| 2012 Noviembre | 19 | 3 | 22 |
| 2012 Octubre | 8 | 1 | 9 |
| 2012 Septiembre | 0 | 1 | 1 |
| 2012 Agosto | 1 | 0 | 1 |
| 2001 Febrero | 3118 | 0 | 3118 |
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