Resumen de Factores de riesgo asociados a crecimiento bacteriano en sistemas derivativos de líquido cefalorraquídeo en pacientes pediátricos

José de Jesús Vargas Lares, Angélica Rocío Andrade Aguilera, Rafael Díaz Peña, Juan Carlos Barrera de León

• español

  Objetivo: Determinar factores de riesgo asociados a crecimiento bacteriano en sistemas derivativos de líquido cefalorraquídeo (LCR) en pacientes pediátricos. Método: Estudio de casos y controles de enero-diciembre/2012, se incluyeron pacientes < 16 años portadores de hidrocefalia que requirieron colocación o recolocación de sistema derivativo. Se consideraron casos a niños con cultivos con crecimiento bacteriano y controles con crecimiento negativo. Estadística inferencial con chi cuadrada y U de Mann Whitney. Asociación de riesgo con razón de momios (OR). Resultados: Se revisaron 746 registros, casos n = 99 (13%) y controles n = 647 (87%). Masculino 58 (57%) vs. 297 (46%) p = 0.530. Edad casos: mediana 5 meses y controles 1 año (p = 0.02). Mediana de peso 7 kg vs. 10 kg (p = 0.634). Intervenciones quirúrgicas mediana n = 2 (1-8) vs. n = 1 (1-7). Tasa de infección 13.2%. Principal etiología estenosis de acueducto n = 29 (29%) vs. n = 150 (23%) p = 0.530. No comunicante n = 50 (51%) vs. 396 (61%) p = 0.456. Microorganismos predominantes: Enterobacterias, Pseudomonas y Enterococcus. No uso de apósito yodado OR = 2.6 (1.8-4.3), uso de conector OR = 6.8 (1.9-24.0), recambio del sistema OR = 2.0 (1.3-3.1), ayudante sin cubrebocas OR = 9.7 (2.3-42.0). Conclusiones: Ser lactante, de peso bajo, no aplicación de apósito yodado, uso de conector durante el procedimiento, derivación previa, no apego a la técnica aséptica fueron factores asociados a ependimitis.

• English

  Objective: To determine risk factors associated with bacterial growth in systems derived from cerebrospinal fluid in pediatric patients. Methods: Case and controls study from January to December 2012, in patients aged < 16 years who were carriers of hydrocephalus and who required placement or replacement of derivative system. Cases were considered as children with cultures with bacterial growth and controls with negative bacterial growth. Inferential statistics with Chi-squared and Mann-Whitney U tests. Association of risk with odds ratio. Results: We reviewed 746 registries, cases n = 99 (13%) and controls n = 647 (87%). Masculine gender 58 (57%) vs. feminine gender 297 (46%) (p = 0.530). Age of cases: median, five months and controls, one year (p = 0.02). Median weight, 7 vs. 10 kg (p = 0.634). Surgical interventions: median n = 2 (range, 1-8) vs. n = 1 (range, 1-7). Infection rate, 13.2%. Main etiology ductal stenosis, n = 29 (29%) vs. n = 50 (23%) (p = 0.530).

  Noncommunicating, n = 50 (51%) vs. 396 (61%) (p = 0.456). Predominant microorganisms: enterobacteria, pseudomonas, and enterococcus. Non-use of iodized dressing OR = 2.6 (range, 1.8-4.3), use of connector OR = 6.8 (range, 1.9-24.0), System replacement OR = 2.0 (range, 1.3-3.1), assistant without surgical facemask OR = 9.7 (range, 2.3-42.0). Conclusions: Being a breastfeeding infant, of low weight, non-application of iodized dressing, use of connector, previous derivation, and lack of adherence to aseptic technique were all factors associated with ependymitis. (Gac Med Mex. 2015;151:695-701) Corresponding author: Juan Carlos Barrera de León, jcbarrer@hotmail.com