Borja Gomez

Osakidetza · Pediatric Emergency Department

Objectives To analyse the performance of blood enterovirus and parechovirus PCR testing (ev-PCR) for invasive bacterial infection (IBI) (isolation of a single bacterial pathogen in a blood or cerebrospinal fluid culture) when evaluating well-appearing infants ≤90 days of age with fever without a source (FWS). Methods We describe the well-appearing...

Aim To describe the characteristics of febrile oncology patients seen in the Paediatric Emergency Department and microbiological characteristics of the invasive bacterial infections (IBIs) diagnosed. Methods We conducted a prospective observational study of febrile oncology patients seen between 2016 and 2022. We divided haematologic cancers by th...

Objective To analyse the performance of the urine Gram stain for predicting a positive urine culture (UC) in young infants with fever without source (FWS) and pyuria. Design Observational study; secondary analysis of a prospective registry-based cohort study. Setting Paediatric emergency department; tertiary teaching hospital. Patients Infants ≤...

Background Salmonella spp. is an uncommon microorganism in bloodstream infections among pediatric patients in our setting, although in developing countries it is the most common causative organism in blood cultures. Methods We describe the children presenting to pediatric emergency departments and diagnosed with Salmonella bacteremia (SB) and iden...

OBJECTIVES To analyze the performance of commonly used blood tests in febrile infants ≤90 days of age to identify patients at low risk for invasive bacterial infection (bacterial pathogen in blood or cerebrospinal fluid) by duration of fever. METHODS We conducted a secondary analysis of a prospective single-center registry that includes all consec...

Background Febrile infants with an infection by influenza or enterovirus are at low risk of invasive bacterial infection (IBI). Objective To determine the prevalence of IBI among febrile infants ≤90 days old with a positive COVID-19 test. Methods MEDLINE, Embase, Cochrane Central Register databases, Web of Science, ClinicalTrials.gov and grey lit...

Background: Staphylococcus aureus has become the leading cause of bacteremia among previously healthy children older than 5 years. Methods: We aimed to describe the infants presenting to pediatric emergency departments and diagnosed with S. aureus bacteremia (SAB) and identify predictors (clinical and laboratory variables) of poor outcome (compl...

The research network of the Spanish Pediatric Emergency Society (RISeuP-SPERG Network) needs to establish its research agenda relevant to pediatric emergency medicine (PEM) to guide the development of future projects, as other networks have done before. The aim of our study was to identify priority areas in PEM for a collaborative network of pediat...

Aim: Managing febrile infants has evolved without a generally accepted standard of care. We aimed to design quality indicators for managing infants ≤90 days old presenting to emergency departments (EDs) with fever without source. Methods: This multicentre Delphi study was carried out by the Febrile Infant Study Group of the Spanish Pediatric Eme...

Introduction: Urinary tract infection (UTI) is the leading cause of bacterial infection in infants younger than 3 months of age with fever without a source. Objective: The objective of the study was to analyze the characteristics of emergency department presentations of febrile infants younger than 3 months of age with a UTI and identify risk fa...

Objectives: The first cases of infection by SARS-CoV-2 in the Spanish pediatric population were reported on early March 2020. Although most were mild or asymptomatic, new forms of clinical presentation and severity were reported with the evolution of the pandemic. We aimed to describe demographics, clinical features, and management of children wit...

Background Bronchiolitis is a major source of morbimortality among young children worldwide. Non-pharmaceutical interventions (NPIs) implemented to reduce the spread of SARS-CoV-2 may have had an important impact on bronchiolitis outbreaks, as well as major societal consequences. Discriminating between their respective impacts would help define opt...

Background During the initial phase of the Coronavirus Disease 2019 (COVID-19) pandemic, reduced numbers of acutely ill or injured children presented to emergency departments (EDs). Concerns were raised about the potential for delayed and more severe presentations and an increase in diagnoses such as diabetic ketoacidosis and mental health issues....

Objective: To compare the rates of invasive bacterial infection (IBI) (bacterial pathogen in blood or cerebrospinal fluid) and urinary tract infection (UTI) in febrile infants between 42 and 90 days of age who had and had not been vaccinated in the previous 48 hours. Design: Observational study; secondary analysis of a prospective registry-based...

Background: To describe the infants presenting to pediatric emergency departments (PEDs) and diagnosed with group B Streptococcus (GBS) late-onset disease (LOD) bacteremia and identify risk factors for severe infection and pediatric intensive care unit (PICU) admission. Methods: Observational study and subanalysis of a multicenter prospective re...

Objective: This study aimed to analyze the prevalence of invasive bacterial infection (IBI) among infants younger than 90 days with fever without source according to the degree of fever. Methods: We performed a secondary analysis of a multicenter study with 19 participating Spanish pediatric emergency departments that included 3401 febrile infan...

Background To investigate the impact of the COVID-19 pandemic and infection prevention measures on children visiting emergency departments across Europe. Methods Routine health data were extracted retrospectively from electronic patient records of children aged <16 years, presenting to 38 emergency departments (ED) in 16 European countries for the...

Objective To evaluate the impact of introducing the Step-by-Step approach on care quality in young febrile infants. Design Observational study including infants ≤90 days old with fever without source seen in a paediatric emergency department 5 years before (n=1222) and after (n=1151) its introduction. Quality of care was evaluated in terms of adhe...

Objective To analyse the impact of blood enterovirus and human parechovirus PCR (ev-PCR) testing in young infants with fever without a source (FWS). Design Observational study, subanalysis of a prospective registry. Setting Paediatric emergency department. Patients Infants ≤90 days of age with FWS seen between September 2015 and August 2019 with...

A new paediatric multisystem inflammatory syndrome, linked to SARS-CoV-2 (MIS-Paed), has been described. The clinical picture is variable and is associated with an active or recent infection due to SARS-CoV-2. A review of the existing literature by a multidisciplinary group of paediatric specialists is presented in this document. Later, they make r...

We carried out a retrospective cohort study of 271 previously healthy children younger than 14 years old diagnosed with invasive bacterial infection in an emergency department. Of them, 72 (26.6%) had previous visits to the emergency department. Not identifying children with an invasive bacterial infection and not administering antibiotics on the f...

Objectives: To determine the prevalence of invasive bacterial infections (IBIs) and adverse events in afebrile infants with acute otitis media (AOM). Methods: We conducted a 33-site cross-sectional study of afebrile infants ≤90 days of age with AOM seen in emergency departments from 2007 to 2017. Eligible infants were identified using emergency...

Objectives To develop and validate a prediction rule to identify well-appearing febrile infants aged ≤90 days with an abnormal urine dipstick at low risk of invasive bacterial infections (IBIs, bacteraemia or bacterial meningitis). Design Ambispective, multicentre study. Setting The derivation set in a single paediatric emergency department (ED)...

Resumen Se ha descrito un nuevo síndrome inflamatorio multisistémico pediátrico vinculado a SARS-CoV-2. Este cuadro presenta una expresividad clínica variable y se asocia a infección activa o reciente por SARS-CoV-2. En este documento se revisa la literatura existente por parte de un grupo multidisciplinar de especialistas pediátricos. Posteriormen...

Aim Escherichia coli (E. coli) is a known cause of paediatric bacteraemia. The main objective was to characterize the emergency department (ED) presentations of paediatric E. coli bacteraemia; secondarily, to identify those related to greater severity. Methods This was a sub‐study of a multicentre cross‐sectional prospective registry including all...

Objective To validate the Febrile Infant Working Group of the Pediatric Emergency Care Applied Research Network (PECARN) clinical prediction rule on an independent cohort of infants with fever without a source (FWS). Design Secondary analysis of a prospective registry. Setting Paediatric emergency department of a tertiary teaching hospital. Pati...

La enfermedad por SARS-CoV-2 y por extensión el SIM-PedS son condiciones a menudo complejas y multiorgánicas. Tal como ha ocurrido en la población adulta, los pacientes pediátricos se beneficiarán de un abordaje multidisciplinar y coordinado por parte de pediatras de diferentes subespecialidades. En este documento se desarrolla y describe un protoc...

Aim: This study analysed the association between a positive nitrite dipstick test and an invasive bacterial infection (IBI) in infants younger than 90 days of age with fever without source (FWS). Methods: We performed a secondary analysis of data from a prospective multicentre study of infants up to 90 days of age with FWS undergoing care in 19...

Background: The objective is to compare the prevalence of serious bacterial infection (SBI) and invasive bacterial infection (IBI) in febrile infants <60 days of age and in those between 61 and 90 days. Methods: Prospective registry-based cohort study including all the infants ≤90 days with fever without a source evaluated in a pediatric emergen...

Objective Research in European Paediatric Emergency Medicine (REPEM) network is a collaborative group of 69 paediatric emergency medicine (PEM) physicians from 20 countries in Europe, initiated in 2006. To further improve paediatric emergency care in Europe, the aim of this study was to define research priorities for PEM in Europe to guide the deve...

OBJECTIVE: Research in European Paediatric Emergency Medicine (REPEM) network is a collaborative group of 69 paediatric emergency medicine (PEM) physicians from 20 countries in Europe, initiated in 2006. To further improve paediatric emergency care in Europe, the aim of this study was to define research priorities for PEM in Europe to guide the dev...

Objectives To determine the performance of procalcitonin (PCT), C reactive protein (CRP) and absolute neutrophil count (ANC) in identifying invasive bacterial infection (IBI) among well-appearing infants ≤21 days old with fever without source and no leukocyturia. To compare this performance with that in those 22–90 days old. Design Substudy of a p...

The names of the three authors (Borja Gómez, Santiago Mintegi, and Juan J. García-García) were inadvertently removed during the production of the original article. The names of the authors are correctly captured here.

Fever is one of the most common chief complaints at any Pediatric Primary care Center. Most well-appearing patients with fever without source after an initial medical history and physical exam will have a viral infection. However, infants have a higher risk for having a bacterial infection, mainly urinary tract infections and occult bacteremias. Fo...

Objective To assess the diagnostic value of existing clinical prediction models (CPM; ie, statistically derived) in febrile young infants at risk for serious bacterial infections. Methods A systematic literature review identified eight CPMs for predicting serious bacterial infections in febrile children. We validated these CPMs on four validation...

Objective To determine the prevalence of invasive bacterial infections (IBI, pathogenic bacteria in blood or cerebrospinal fluid) in infants less than 90 days old with fever without a source related to the presence or absence of fever on arrival to the emergency department (ED). Design Prospective registry-based cohort study. Setting Paediatric E...

Recent studies have shown changes in the aetiology of serious bacterial infections in febrile infants ≤90 days of age. The aim of this study was to describe the current microbiology and outcomes of these infections in Spain.

In 2015, a predictive model for invasive bacterial infection (IBI) in febrile young infants with altered urine dipstick was published. The aim of this study was to externally validate a previously published set of low risk criteria for invasive bacterial infection in febrile young infants with altered urine dipstick. Retrospective multicenter study...

Background and objectives: Guidelines from the American Academy of Pediatrics define urinary tract infection (UTI) as the growth of greater than 50,000 ufc/mL of a single bacterium in a urine culture with a positive urine dipstick or with a urinalysis associated. Our objective was to evaluate the adequacy of this cutoff point for the diagnosis of...

Background: Recent studies have shown changes in the aetiology of serious bacterial infections in febrile infants ≤ 90 days of age. The aim of this study was to describe the current microbiology and outcomes of these infections in Spain. Material and methods: Sub-analysis of a prospective multicentre study focusing on febrile infants of less tha...

Objective: To analyse the outpatient management of selected febrile infants younger than 90 days without systematic lumbar puncture and antibiotics. Methods: A prospective registry-based cohort study including all the infants ≤90 days with fever without a source (FWS) who were evaluated in a paediatric emergency department (ED) over a 7-year per...

Background: A sequential approach to young febrile infants on the basis of clinical and laboratory parameters, including procalcitonin, was recently described as an accurate tool in identifying patients at risk for invasive bacterial infection (IBI). Our aim was to prospectively validate the Step-by-Step approach and compare it with the Rochester...

Background: Little is known about the value of leukopenia for assessing the risk of having a bacterial infection in young febrile infants. Methods: Infants under 90 days of age with fever without source were prospectively recruited between October 2011 and September 2013 in 19 Spanish Pediatric Emergency Departments. We analyzed the prevalence o...

Classical criteria differ on when to perform cerebrospinal fluid (CSF) analysis in infants less than 90 days of age with fever without a source (FWS). Our objectives were to analyze the prevalence and microbiology of bacterial meningitis in this group and its prevalence in relation to clinical and laboratory risk factors. This is a sub-study of a p...

Background Clinical prediction rules (CPRs) are developed to aid the identification of serious infections (SI), but their value in young febrile infants remains unclear. Aim To systematically review existing CPRs and subsequently validate these CPRs in two external cohorts of young febrile infants at risk for SI in the Netherlands1 (N = 925; ≤1 yea...

Introduction Much effort has been put in the past years to create and assess accurate tools for the management of febrile infants. However, no optimal strategy has been so far identified. A sequential approach evaluating, first, the appearance of the infant, second, the age and result of the urinanalysis and, finally, the results of the blood bioma...

A blood culture (BC) is frequently requested in both patients with a suspected occult bacteremia/invasive infection as well as those with certain focal infections. Few data are available on the characteristics of patients in whom a bacteremia is identified in the Pediatric Emergency Department (PED). A prospective multicenter registry was establish...

AimThere is limited evidence about the diagnostic value of urine dipsticks in young febrile infants. The aim of this study was to determine whether urine dipsticks would identify positive urine cultures in febrile infants of less than 90-days-of-age.Methods This study was a sub-analysis of a prospective multi-centre study developed in 19 Spanish pa...

Pediatric emergency medicine (PEM) has been developing rapidly but heterogeneously in many European countries in recent years, and many national PEM societies have been founded to improve the quality of care of ill and injured children and adolescents. Key facets of any such improvement are the development, delivery and translation of high-quality...

BACKGROUND: Vaccine-serotype (VT) invasive pneumococcal disease (IPD) rates declined substantially following introduction of 7-valent pneumococcal conjugate vaccine (PCV7) into national immunization programs. Increases in non-vaccine-serotype (NVT) IPD rates occurred in some sites, presumably representing serotype replacement. We used a standardize...

Much effort has been put in the past years to create and assess accurate tools for the management of febrile infants. However, no optimal strategy has been so far identified. A sequential approach evaluating, first, the appearance of the infant, second, the age and result of the urinanalysis and, finally, the results of the blood biomarkers, includ...

Introduction and purpose of the study With this study we aimed to describe a “true world” picture of severe paediatric ‘community-acquired’ septic shock and establish the feasibility of a future prospective trial on early goal-directed therapy in children. During a 6-month to 1-year retrospective screening period in 16 emergency departments (ED) in...

Background and objective: Procalcitonin (PCT) has been introduced in many European protocols for the management of febrile children. Its value among young, well-appearing infants, however, is not completely defined. Our objective was to assess its performance in diagnosing serious bacterial infections and specifically invasive bacterial infections...

Introduction Selected young febrile infants with urinary tract infection (UTI) and lower risk for associated bacteremia can be managed as outpatients. Different biomarkers are useful in the management of febrile young infants but their role in this specific population has not been clarified. Objective To analyze the relationship between blood bioma...

Background In the last decade, the procalcitonin (PCT) has been introduced in many protocols for the management of the febrile child. However, its value among young well-appearing infants is not completely defined. Objective To assess the value of PCT in diagnosing serious bacterial infections and specifically invasive bacterial infections (IBIs) i...

Background and objectives: The "Lab-score" combining C-reactive protein, procalcitonin and urine dipstick results has recently been derived and validated as an accurate tool for predicting severe bacterial infections (SBIs) in children with fever without source. We aimed to assess the Lab-score usefulness in predicting SBI, especially invasive bac...

The objective of this study was to describe the characteristics of the enteroviral meningitis diagnosed in a pediatric emergency department among infants younger than 3 months with fever without source and its short-term evolution. This was a retrospective, cross-sectional, 6-year descriptive study including all infants younger than 3 months who pr...

Febrile infants <3 months of age have a greater risk for serious bacterial infection (SBI). The risk is inversely correlated with age. Most protocols recommend admitting to hospital all febrile infants <28 days of age. However, as the prevalence of SBI is not homogenous in this age group, some authors have considered decreasing this cut-off age, al...

We performed a 7-year registry-based retrospective study. We included 1365 infants younger than 3 months of age with fever without a source; 81 (5.9%) had <5000 leukocytes/mm(3). Among the 1021 well-appearing 29- to 90-day-old infants, prevalence of serious bacterial infection (SBI) was 13.8% for those with a normal white blood cell count, 6.8% for...

Objectives Primary objectives: to assess the safety and the effectiveness (analysing the behaviour of the patient) with the use of nitrous oxide during the performance of painful procedures in the Paediatric Emergency Departments (PED); secondary objectives: to evaluate the manageability of the method and its acceptance by both the medical team and...

From 1996 to 2009, we analyzed changes in pneumococcal disease (PD) in Utah children aged <18 years using International Classification of Diseases, ninth revision coded hospital discharges. We observed a sustained decrease in the incidence of PD among children <5 years in 2001–2004 (−36%) and 2005–2009 (−34%) compared with 1996–2000 (pre-7-valent p...

To describe the characteristics of patients diagnosed with invasive bacterial infections (IBIs) in a Paediatric Emergency Department (PED) following the introduction of the heptavalent pneumococcal conjugated vaccine (PCV7). Descriptive retrospective study of children under 14 years of age diagnosed with IBIs in a PED of a tertiary hospital between...

Primary objectives: to assess the safety and the effectiveness (analysing the behaviour of the patient) with the use of nitrous oxide during the performance of painful procedures in the Paediatric Emergency Departments (PED); secondary objectives: to evaluate the manageability of the method and its acceptance by both the medical team and the patien...

We included 3088 well-appearing infants aged between 3 and 36 months with fever without a source with a blood culture done as part of their study of fever. Rate of positive blood cultures for Streptococcus pneumoniae occult bacteremia (OB) was 0.58%. Rate of OB caused by PCV7-serotypes and nonvaccine serotypes were 0.16% and 0.42%, respectively. A...

We included 3088 well-appearing infants aged between 3 and 36 months with fever without a source with a blood culture done as part of their study of fever. Rate of positive blood cultures for Streptococcus pneumoniae occult bacteremia (OB) was 0.58%. Rate of OB caused by PCV7-serotypes and nonvaccine serotypes were 0.16% and 0.42%, respectively. A...

(1) To assess the rate of bacteremia in febrile infants less than 3 months of age admitted to a pediatric emergency department at a tertiary hospital; (2) to describe the bacteria isolated; and (3) to analyze factors related to increased probability of having a positive blood culture. A retrospective, cross-sectional, 5-year descriptive study that...

We included 685 consecutive previously healthy well appearing infants younger than 3 months with fever without known source admitted to an Emergency Department without routinely performing lumbar punctures (LP). LP was performed in 198 infants. Of these, 36 (18.1%) showed pleocytosis. Two infants less than 15 days were diagnosed with bacterial meni...

We included 381 febrile infants less than 3 months with a blood culture and a rapid influenza test done as part of study of fever. The prevalence of serious bacterial infections was significantly lower in patients in the positive rapid influenza test (RIT) group (3/113; 2.65%; 95% CI: 0-5.6) than in patients in the negative RIT group (47/268; 17.5%...

Superwarfarins were developed around 1970 in order to resolve the resistance developed by the rodents to the previously existing rodenticides. Superwarfarins cause, nowadays, most of the poisonings due to rodenticides. However, in our environment, it has been extremely uncommon to attend children with such poisonings. We present five children aged...

Superwarfarins were developed around 1970 in order to resolve the resistance developed by the rodents to the previously existing rodenticides. Superwarfarins cause, nowadays, most of the poisonings due to rodenticides. However, in our environment, it has been extremely uncommon to attend children with such poisonings. We present five children aged...