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2018, Number 1

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Rev Mex Pediatr 2018; 85 (1)

Therapeutic behavior of physicians after the results of pathogen detection tests in children with acute diarrhea

Hernández-Avendaño Y, Díaz-Madero S, Rendón-Macías ME, Iglesias-Leboreiro J, Bernárdez-Zapata I

Language: Spanish
References: 16
Page: 5-10
PDF size: 228.74 Kb.


ABSTRACT

Objective: To determine the impact of molecular tools for detection of viral or bacterial pathogens on the antibiotic therapeutic decision in acute diarrhea. Material and methods: Retrospective study of 385 diarrheic patients with at least one of the following tests performed: rapid-test for rotavirus and adenovirus antigens (RAT), Molecular PCR for viral-bacterial (PCR), and stool culture (SC). Patients were grouped as follow: watery diarrhea with or without fever, and dysentery with or without fever. We analyzed the decision of initiation, change or suspension of empirical antibiotics according to the tests results. Results: 361 patients had watery diarrhea with or without fever and 24 with dysentery. Among the former, 62.5% SC, 54% RAT and 24.6% PCR were performed, and in dysentery group, 80.9% SC, 62% RAT and 47% PCR. In 64% of patients with watery diarrheas, an empiric antibiotic treatment was given, but in two (0.5%) patients antibiotics were suspended after a viral detection. Of the 36% patients not treated with antibiotics, in five (4%) were added after bacteria was detected; 91.6% (22/24) of dysenteric cases received empiric antibiotic. Of the two remaining patients, only one recieved them after positive bacteria result. Conclusions: The results of the molecular tools to determine etiological agents had little influence in the antibiotic therapeutic.


REFERENCES

  1. Coria LJ, Villalpando CS, Gómez BD, Treviño MA. Aspectos microbiológicos y epidemiológicos para el uso racional de antibióticos en niños con gastroenteritis bacteriana aguda. Rev Mex Pediatr. 2001; 68(5): 200-215.

  2. Guillén A, Lucho J. Retos y problemas en el diagnóstico microbiológico en diarrea. Rev Peru Med Exp Salud Pública. 2011; 28(1): 116-120.

  3. Vila J, Álvarez M, Buesa J, Castillo J. Diagnóstico microbiológico de las infecciones gastrointestinales. Enferm Infecc Microbiol Clin. 2009; 27(7): 406-411. doi: 10.1016/j. eimc.2008.11.009.

  4. Churgay CA, Aftab Z. Gastroenteritis in children: Part I. Diagnosis. Am Fam Physician. 2012; 85(11): 1059-1062.

  5. CaJacob NJ, Cohen MB. Update on diarrhea. Pediatr Rev. 2016; 37(8): 313-322. doi: 10.1542/pir.2015-0099.

  6. Brandt KG, Castro AM, Silva GA. Acute diarrhea: evidence-based management. J Pediatr (Rio J). 2015; 91(6 Suppl 1): S36-43. doi. org/10.1016/j.jped.2015.06.002.

  7. Corcoran MS, Van Well GTJ, Van Loo IHM. Diagnosis of viral gastroenteritis in children: interpretation of real-time PCR results and relation to clinical symptoms. Eur J Clin Microbiol Infect Dis. 2014; 33(10): 1663-1673. doi. 10.1007/s10096-014-2135-6.

  8. Koletzko S, Osterrieder S. Acute infectious diarrhea in children. Dtsch Arztebl Int. 2009; 106(33): 539-548. doi: 10.3238/ arztebl.2009.0539

  9. Sandoval AM, Ramos RJ, Ramírez A. Prevención, diagnóstico y tratamiento de la enfermedad diarreica aguda en niños de dos meses a cinco años en el primero y segundo nivel de atención. Mex SSA. 2008. http://www.cenetec.salud.gob.mx/interior/gpc.html

  10. Churgay CA, Aftab Z. Gastroenteritis in children: Part II. Prevention and management. Am Fam Physician. 2012; 85(11): 1066-1070.

  11. Diarrhea and vomiting caused by gastroenteritis, diagnosis, assessment and management in children younger than 5 years. Clinical Guideline. 2009. http://www.nice.org.uk/nicemedia/pdf/ CG84FullGuideline.pdf

  12. Álvarez M, Buesa J, Castillo J, Vila J. Diagnóstico microbiológico de las infecciones gastrointestinales. 30. Procedimientos en Microbiología Clínica. Cercenado Mansilla E, Cantón Moreno R (editores). Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica (SEIMC); 2008.

  13. Méndez AS, Pérez RE. La PCR múltiple en microbiología clínica. Enferm Infecc Microbiol Clin. 2004; 22(3): 183-192. www.elsevier. es, day 11/10/2017.

  14. Wiegering V, Kaiser J, Tappe D, Weissbrich B, Morbach H, Girschick HJ. Gastroenteritis in childhood: a retrospective study of 650 hospitalized pediatric patients. Int J Infect Dis. 2011; 15: e401-407. doi: 10.1016/j.ijid.2011.02.006

  15. Graves NS. Acute gastroenteritis. Prim Care. 2013; 40(3): 727-741.

  16. Hernández CC, Aguilera AM, Castro EG. Situación de las enfermedades gastrointestinales en México. Enf Inf Microbiol. 2011; 31(4): 137-151.




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