Journal of Pediatric infectious diseases最新文献

Objective Community-acquired pneumonia with abnormal liver function is not uncommon. There is no systematic study on the clinical characteristics of liver dysfunction in children with community-acquired pneumonia. We aimed to evaluate the characteristics and prognosis of liver dysfunction in children with community-acquired pneumonia.

Methods This study was a multicenter prospective study involving 26 hospitals in Sichuan Province from June 2020 to June 2021. The characteristics of liver dysfunction in children with community-acquired pneumonia were recorded and analyzed according to different factors such as age, medical condition, level of transaminase in liver function, and time for liver function recovery.

Results A total of 4,623 hospitalized children with pneumonia were included. Among them, 592 children had liver dysfunction, accounting for the 12.8% (592/4,623). The degree of liver function injury was more obvious in infants and in children of severe pneumonia group (average ranks were 288.95 and 319.34). The liver lesion was more serious in the group of children less than 1 year old (p = 0.000). The median time to recovery of liver function was 8 days (interquartile range: 6–15.5 days), whereas the fastest recovery was 3 days, and the longest recovery period was 162 days.

Conclusion Community-acquired pneumonia with abnormal liver function is very common. Young age and severe pneumonia are risk factors for liver dysfunction. The recovery time of liver enzymes is not short. Infants and children with severe pneumonia need closer follow-up.

Multisystem inflammatory syndrome of children (MIS-C) is a clinical picture that entered the medical nomenclature after the coronavirus disease 2019 pandemic. Although it primarily affects older children, there have been a limited number of cases reported during the neonatal period. Herein we present a patient, a late preterm infant, with severe MIS-C-related cerebral sinus venous thrombosis who was successfully treated with therapeutic plasma exchange. Practitioners can consider therapeutic plasma exchange as a safe and effective option for the treatment of critically ill MIS-C cases.

Objective In severely burned patients, fungal infections are among the most devastating complications. Candidemia is an important cause of mortality with an increasing incidence despite advances in burn care management. Higher affected body surface area, long intensive care unit (ICU) stay, flame burn, third-degree burn, and previous bacterial infections were associated with the development of candidemia. Candidemia in patients with major burns admitted to an ICU of a tertiary burns center is investigated.

Methods Patients hospitalized in the ICU of Adana City Training and Research Hospital from July 1, 2017, to November 10, 2020, were included. The demographic and clinical variables, the Candida species isolated from blood cultures and their antifungal susceptibilities, need for grafting, complications, and rate of mortality are evaluated retrospectively. Patients were grouped as “candidemia” or “noncandidemia” according to whether or not they experienced Candida bloodstream infection.

Results A total of 371 patients were included; the mean age was 22.02 ± 20.9 years. Most patients were male (69.5%). The percentage of burned surface area was 25.93 ± 17.6. The mean ICU stay was 16.95 ± 16.3 days. There were 90 candidemia episodes in 69 patients. The most commonly isolated Candida species were C. parapsilosis, C. tropicalis, and C. albicans. The mortality rates in the candidemia and noncandidemia groups were 24.6 and 5.6%, respectively (p < 0.001).

Conclusion Adhering to isolation rules, early wound debridement and closure, avoidance of catheters where possible, and avoidance of the early use of broad-spectrum antibiotics are important measures in reducing candidemia in patients with major burns. Candidemia was associated with greater burn surface areas, duration of hospital stay, and larger numbers of interventional procedures. However, previous bacterial infection receiving prolonged antibiotic therapy was the greatest risk factor of candidemia. Culture results are important to select the antifungal agent with high susceptibility, but results are not rapidly available. There is need for early clinical prediction measures to inform early and effective antifungal treatment.

Objective In 2020, in-line with the recommendations of the Turkish Neonatal Society, a new palivizumab indication was added for preterm infants with 29^0/7 to 31^6/7 weeks of gestational age. This study aimed to determine the risk factors of hospitalizations due to lower respiratory tract infections (LRTIs) and respiratory syncytial virus (RSV) in preterm infants (29^0/7–31^6/7 weeks of gestational age) who were or were not within the scope of palivizumab indication during the first two RSV seasons (2018–2019 and 2019–2020) and the next two RSV seasons (2020–2021 and 2021–2022) to evaluate the validity of the new indication of palivizumab reimbursement scope.

Methods This study was a two-center retrospective and prospective cohort study and included all preterm infants (29^0/7–31^6/7 weeks) aged 90 days and younger during the RSV season (October–March). The primary outcome was to compare the hospitalization rates between patients who received palivizumab and those who did not. The secondary outcome was to identify the risk factors for patients hospitalized due to LRTIs.

Results Of the 122 preterm infants included in the study, 48.3% (n = 59) were in the prophylaxis group (Group 1) and 51.7% (n = 63) were in the non-prophylaxis group (Group 2). It was noteworthy that 53.8% (n = 14) of the 26 infants hospitalized due to LRTIs were in Group 1 and 46.2% (n = 12) were in Group 2 (p = 0.682). Of the RSV PCR-positive infants, 62.5%(n = 5) were in Group 1 and 37.5% (n = 3) were in Group 2 (p = 0.30). The median length of hospitalization was similar in the groups (p = 0.123).

Conclusion The indication for palivizumab prophylaxis can be determined more clearly for our country in light of national multicenter studies with an increased sample size.

Objective To evaluate the effectiveness and safety of using tigecycline as a salvage therapy in critically ill children who did not respond to other antibiotics.

Methods We conducted a retrospective cohort analysis that included children who received tigecycline for at least 48 hours and four doses during their pediatric intensive care unit admission. Demographic and clinical features of the subjects were evaluated through a comprehensive review of medical records. The effectiveness of tigecycline was assessed by thoroughly evaluating clinical and microbiological outcomes.

Results During the study period, 72 pediatric patients with 88 episodes of infection received tigecycline according to antimicrobial susceptibility in 62.5% of cases and empirically in 37.5%. The median duration of tigecycline therapy was 10 days (range, 2–33 days). Klebsiella pneumoniae (n = 17, 30.9%) was the most frequently isolated pathogen, followed by Acinetobacter baumannii (n = 10, 18.1%). Ventilator-associated pneumonia was the most common infection (n = 29). Of the 55 isolated pathogens, 43 were multidrug-resistant (MDR), and 2 were extensively drug-resistant (XDR) gram-negative bacteria. Clinical response and microbiological clearance were achieved in 42 and 50.9% of episodes, respectively. The overall mortality was 40.9%, with an attributable mortality rate of 29.5%.

Conclusion Tigecycline could be used as a salvage therapy for critically ill pediatric patients infected with MDR or XDR pathogens in the lack of alternative treatment options.

Objective Mild symptoms are the norm for children with coronavirus disease-2019 (COVID-19), but data on the Omicron form are few. One of the most frequent neurological symptoms of COVID-19 in children is febrile seizure (FS).

Methods Patients with FS who visited the pediatric fever clinic between December 6 and December 31, 2022, when the Omicron version of SARS-CoV-2 was the predominant strain, were included in this retrospective, single-center analysis.

Results Children who tested positive for COVID-19 had a 5.58% incidence of FSs. Compared to patients without COVID-19, a greater percentage of COVID-19 patients (29.5 vs. 7.5%, p < 0.01) experienced complex FSs. In the COVID-19-positive group, four cases were critically unwell and were admitted to the Intensive Care Unit (1.4 vs. 0%, p < 0.01), and the admission proportion was greater (18.9 vs. 1.9%, p < 0.01). The proportion of lactic acid and IL-6 increase was larger in the COVID-19-positive group (33.5 vs. 21.5%, 22.1 vs. 17.8%, p = 0.022, p = 0.006, respectively).

Conclusion Infections with COVID-19 in children have been linked to FSs in the Omicron era. To fully understand the neuropathogenesis of seizures in children with COVID-19, more research is required.

Objective Analyzing the clinical and microbiological characteristics of coronavirus disease 2019 (COVID-19) infection in children seems essential to determine their role in the etiopathogenesis of the disease.

Methods A prospective, longitudinal, and observational study, including children with severe acute respiratory syndrome coronavirus-2 infection, in the Barcelona Metropolitan Region (Spain), was performed. The recruitment pathways were: (1) children who attended a summer school and were included in an active surveillance study and (2) children who were visited in the Emergency Department of Hospital Sant Joan de Déu with symptoms. Close contacts with positive polymerase chain reaction (PCR) results were also included. The children recruited were followed up for 5 weeks. Evaluation of participants included a questionnaire for COVID-19 symptoms, nasopharyngeal swabbing for real-time PCR at 0, 7, and 14 days (weekly repeated up to week 5 if it resulted positive at 14 days), and serology testing at the recruitment and at the fifth week of follow-up.

Results A total of 90 children were recruited, of which 32% were asymptomatic. Transmission was studied in 70/90 children, and in 12 cases (17%), transmission to other children or adults was observed. No clinical or epidemiological differences were found between children who transmitted and those who did not. At the end of the follow-up, 11% of nasopharyngeal PCR remained positive. The serological response was studied in 73/90 children, and 80.82% of children seroconverted.

Conclusion No differences in epidemiological characteristics were found between children who transmitted and those who did not. PCR can be persistently positive for more than 5 weeks. The majority of patients who suffer from the disease produce antibodies against it.

Objective Studies have shown that more than one viral agent is not uncommonly detected simultaneously in respiratory tract infections of children. The aim of this study was to analyze our single-center experience with the seasonal distribution, clinical and laboratory outcomes of respiratory viruses, and coinfections in hospitalized children during the coronavirus disease 2019 (COVID-19) pandemic.

Methods During the pandemic period of June 1, 2021 to February 1, 2022, 156 pediatric patients hospitalized with non-COVID-19 respiratory tract infections were retrospectively analyzed. Among these children, 92 were found to be positive for respiratory pathogens. These children's ages, genders, polymerase chain reaction results, and blood parameters were analyzed.

Results The median age of the patients was 8 months (10 days–17.1 years) and 63% were male. A total of 16.3% of the patients were neonates (0–28 days), 55.4% were infants (1–24 months), 16.3% were preschool (2–5 years), and 12% were school-aged (5–18 years); 73.9% of the patients were hospitalized in the pediatric ward, 16.3% in the neonatal intensive care unit, and 9.8% in the pediatric intensive care unit. In 76.5% of hospitalized patients, only one pathogen was identified. Respiratory syncytial virus was detected as a causative agent of either mono- or coinfections in 78.4% of all patients. There was no statistical difference between inflammatory parameters in the patients infected with single or multiple viral agents.

Conclusion As a result of the precautions taken during the pandemic, we found that the viral distribution of respiratory tract infections changed. In addition, we believe that hematological parameters are not useful for distinguishing between mono- and coinfections.

Objective Late-onset sepsis (LOS) is a major public health burden globally. Newborns with very low birth weight (VLBW) are at high risk of mortality related to LOS. The protective effect of breast milk feeding against many infections has been studied but data on the effect of breast milk feeding on LOS mortality are limited. In this study, we aimed to evaluate the risk factors for LOS-related mortality.

Methods This single-center, case–control study was conducted retrospectively from August 2013 to July 2018. VLBW newborns with ≤32 weeks of gestational age who had culture-proven LOS were included in the study. Demographics, clinical and laboratory data, and parenteral and enteral feeding details within 72 hours before LOS episodes were extracted from electronic and paper medical records.

Results A total of 190 LOS episodes were identified in 168 VLBW newborns with a median birth weight of 888 (695–1,143) g. Lower birth weight (adjusted odds ratio [aOR] 0.81, 95% confidence interval [CI] [0.69–0.96], p = 0.01), C-section delivery (aOR 0.38, 95% CI [0.17–0.84], p = 0.02), gram-negative (aOR 4.97, 95% CI [2.01–12.28], p = 0.001) and polymicrobial sepsis (aOR 6.29, 95% CI [1.34–29.47], p = 0.03), and lower breast milk feeding 72 hours before LOS episodes (aOR 0.89, 95% CI [0.80–0.99], p = 0.03) were independently associated with higher odds of LOS related death.

Conclusion Gram-negative sepsis was associated with higher odds of LOS mortality and C-section delivery was associated with lower odds of LOS mortality. Additionally, every 10 mL/kg/day increase in breast milk feeding was associated with 11% lower odds of LOS mortality although this finding should be interpreted cautiously as there may be unadjusted confounders due to the study design.

Objective In this study, our objective is to compare the demographic, clinical, laboratory, and echocardiographic findings of patients with multisystem inflammatory syndrome in children (MIS-C) and Kawasaki's disease (KD) diagnosed in the prepandemic period.

Methods We retrospectively collected data from all pediatric patients who met the Centers for Disease Control and Prevention's MIS-C case definition and who met the American Heart Association's definition of complete KD before the coronavirus disease 2019 pandemic.

Results A total of 37 patients diagnosed with MIS-C and 40 patients diagnosed with complete KD were included. Gastrointestinal findings were significantly higher in the MIS-C group than in the KD group (vomiting [p = 0.009], diarrhea [p = 0.009]). The incidence of thrombocytopenia (48.6%) was significantly higher in the MIS-C group. Regarding inflammatory markers, procalcitonin and ferritin were significantly higher in the MIS-C group (p = 0.032 and p = 0.006) and the erythrocyte sedimentation rate was higher in the KD group (p < 0.001). Pericardial effusion and mitral valve regurgitation were significantly more frequent in the MIS-C group (p = 0.024 and p = 0.001).

Conclusion Although they have similar findings, our current study findings show that MIS-C and KD differ from each other with different clinical and laboratory features. We think that these differences will help clinicians in diagnosis and patient management.