Objective: To describe the feasibility, effectiveness and safety of intravenous (iv) outpatient treatment in 2 to 24 month-old children with febrile urinary tract infection (UTI). Method: Children presenting to the ER, between April 2003-2005, with fever and no identifiable focus who had a diagnosis of UTI were randomized to receive iv antibiotic in the hospital or in an outpatient facility. Children were started on amikacin or ceftriaxona according to physician criteria followed by antimicrobial adjustment based on urine culture result and a later switch to an oral antimicrobial. Urine cultures were performed during and after completing the antimicrobial course. Adherence and effectiveness of antimicrobial treatment and treatment-associated complications were analyzed. Results: The study included 112 patients, 58 inpatient children and 54 outpatient children, with an average age of 7.7 months. Duration of iv treatment did not differ among groups (2.8 days (SD 1.2) 2.7 +0.91 days in inpatients vs 2.9 + 1.9 days in outpatients (p = 0.22). In 100% of outpatient children and 100% of inpatient children (overall 101/101) urine cultures were negative on day 5. None of the children had a treatment-associated complication. Cost analysis yielded 73% of saving money (overall cost for inpatient treatment US 9,815 vs outpatient treatment US 2,650). Conclusions: Outpatient iv treatment in patients between 2 and 24 months with UTI and fever was effective, safe and of lower cost Key words: Urinary tract infection, children, outpatient parenteral antimicrobial treatment. Palabras clave: Infección del tracto urinario, niños, tratamiento antimicrobiano parenteral ambulatorio. IntroducciónL a infección del tracto urinario (ITU) corresponde a una de las patologías infecciosas más frecuentes de la infancia, presentándose en ~ 8% de los niñas y ~ 2% de los varones bajo siete años de edad [1][2][3][4][5] . En nuestro medio, es un motivo frecuente de visita a los servicios de urgencia, alcanzando a 1,35% del total de consultas y una tasa de hospitalización de 10% en una experiencia nacional 6 . En lactantes con síndrome febril sin foco, la ITU es su causa en ~7,5% de los casos bajo ocho semanas de vida, 5,3% bajo un año de edad y 4,1% bajo dos años 7,8 . En estudios nacionales se ha reportado que en niños entre seis semanas y tres años de edad con infección bacteriana confirmada, la ITU representa el 80,2% de ellas 9 . Algunas investigaciones han demostrado que la probabilidad de daño de parénquima renal secundario a infección urinaria varía de acuerdo a la edad, siendo mayor en niños bajo dos años, lo que justifica el tratamiento inicial apropiado en este grupo etario 10 .De acuerdo a algunos autores, la hospitalización de los pacientes con ITU debería considerarse siempre en las primeras seis semanas de vida, en pacientes bajo cinco años con compromiso sistémico o hemodinámico y cuando no sea posible asegurar una buena tolerancia (vómitos, rechazo), adherencia a la terapia oral y accesibilidad al servicio de salud. Así mismo, se podr...

Human metapneumovirus was detected in 15 of 123 children (12%) younger than 3 years of age hospitalized for treatment of acute respiratory infection between July and November 2004. The virus was detected by RT-PCR directly from nasopharyngeal swabs and/or from supernatants after cell culture. Children infected with hMPV were mostly younger than one year of age (67%), all presenting with fever and cough. The main cause for hospitalization was the need for oxygen therapy (73%). Four hMPV positive children had an identifiable co-morbid condition but had a similar clinical evolution when compared to previously healthy infants. Chest radiography showed an increase in interstitial infiltrates with focal consolidation in 6 children. Obstructive bronchial syndrome and bronchiolitis, with or without pneumonia, were the most frequent diagnosis associated with hMPV positivity. A rapid and sensitive diagnostic method is required to improve diagnosis and treatment of these patients.

Disseminated and fatal adenovirus infection in an immunocompromised child Severe adenovirus (ADV) infections have become increasingly important in immunocompromised patients, mainly in pediatric stem cell transplant recipients. We report a case of disseminated ADV infection leading to death in a 12-year-old stem cell transplant recipient. The diagnosis was confirmed by viral isolation and viral genome detection in tissues and blood. Main issues associated with infection, diagnosis and therapeutic alternatives are reviewed. This case should alert clinicians to suspect and study this agent in high risk patients and highlights the importance of having antiviral drugs for ADV available in Chile.

Endocarditis caused by Streptococcus pneumoniae in children is an infrequent disease, corresponding to 3-7% of all cases of endocarditis. However, it is highly relevant because of its severity with the possibility of producing valvular ring abscesses and destruction, and high mortality that reaches up to 61% if medical and surgical treatment are not started early in the course of the illness. Over 50% of cases are associated to other sites of infection such as meningitis, pneumonia, sinusitis or mastoiditis. We report a 10-months-old infant who was admitted with meningitis and endocarditis due to S. pneumoniae, who presented with severe heart failure and required aortic valve replacement. A review of the literature of endocarditis caused by S. pneumoniae in pediatrics is presented.