Journal of the Pediatric Infectious Diseases Society最新文献

Fluoroquinolones are used to prevent bloodstream infections in pediatric hematopoietic cell transplant (HCT) recipients. We performed a retrospective cohort study in 799 pediatric HCT patients to evaluate the association between fluoroquinolone prophylaxis and VRE colonization. Propensity score analyses were performed. Fluoroquinolone prophylaxis was not associated with VRE colonization.

AmpC-mediated cephalosporin resistance occurs in 1.0% to 3.3% of Escherichia coli isolates due to production of either plasmid-mediated AmpC (p-AmpC) or chromosomal AmpC (c-AmpC). Data on the prevalence and molecular characteristics of AmpC-producing E. coli in pediatric patients are limited. We analyzed E. coli clinical strains with resistance phenotype consistent with AmpC production isolated from patients at a pediatric hospital in Japan between 2015 and 2022. Sequence types, resistance genes, and relevant mutations were identified through whole genome sequencing. Promoter and attenuator regions of the chromosomal ampC gene were examined and the presence of plasmid-mediated ampC genes was determined. Among 2,081 E. coli strains, 80 (3.8%) from 27 patients demonstrated the AmpC phenotype. The median patient age was 55 months, with 92.6% having underlying diseases, mainly renal and urinary tract abnormalities. Of the 27 strains, p-AmpC was found in 9 strains including 6 strains belonging to ST131, while c-AmpC was identified in 18 strains including 9 ST73 strains and 4 ST12 strains. ST131 and ST73 were the major AmpC-E. coli lineages isolated from children with underlying diseases. Most ST131 strains harbored p-ampC, while all ST73 strains acquired cephalosporin resistance by c-AmpC production through promoter and attenuator mutations, suggesting the presence of both AmpC mechanisms in a lineage-specific manner in E. coli identified among hospitalized children.

Background: Studies of pediatric osteoarticular infections (OAIs) mostly focus on acute hematogenous osteomyelitis (AHO) and acute bacterial arthritis (ABA). A comprehensive descriptive analysis of pediatric OAIs, including subacute, chronic, and non-hematogenous types, is lacking.

Methods: A detailed analysis of all pediatric OAIs was undertaken at two academic centers, Hasbro Children's Hospital, Providence, RI, and Nationwide Children's Hospital, Columbus, OH. Infections were classified as AHO (with or without suppurative arthritis), isolated ABA, subacute or chronic hematogenous osteomyelitis (SCHO), non-hematogenous osteoarticular infection (NHI), or hardware-associated osteoarticular infection (HOI). Clinical, radiological, and laboratory characteristics were compared.

Results: A total of 582 consecutive cases of OAIs were included: 295 AHO (51%), 88 ABA (15%), 76 NHI (13%), 73 HOI (13%), and 50 SCHO (9%). Median age was significantly higher for HOI (14.5 years), NHI (11.8) and SCHO (10.4) than for AHO (9) and ABA (5) (P<0.001). Patients with AHO or ABA were more likely (P < 0.001) to be febrile (each 84%) compared with other groups (45-56%), and had higher biomarkers of inflammation (WBC, erythrocyte sedimentation rate, C-reactive protein). A causative organism was identified in 74% of cases, mostly from tissue specimens (78%). Staphylococcus aureus was the most common organism across infection types (34-55% of cases), while polymicrobial infection was common in NHI (22%) and HOI (21%). Chronic morbidity complicated infections in 89 (15%) patients, the majority of whom (66%) had SCHO, NHI, or HOI.

Conclusions: SCHO, NHI and HOI accounted for a significant proportion of pediatric OAIs and contributed disproportionately to chronic morbidity.

Background: The Infectious Diseases Society of America (IDSA) publishes annual guidance on the treatment of antimicrobial-resistant (AMR) gram-negative infections. Within the AMR guidance, suggested dosages of antibiotics for adults infected with AMR pathogens are provided. This document serves as a companion document to the IDSA guidance to assist pediatric specialists with dosing β-lactam agents for the treatment of AMR infections in children.

Methods: A panel of 13 pediatric infectious diseases specialists, including 11 pharmacists and two physicians, reviewed existing pharmacokinetic/pharmacodynamic, animal, and clinical data for newer β-lactam agents that are available in the United States and suggested for the treatment of AMR infections (i.e., cefiderocol, ceftazidime-avibactam, ceftazidime-avibactam & aztreonam, ceftolozane-tazobactam, imipenem-cilastatin-relebactam, meropenem-vaborbactam, sulbactam-durlobactam). Suggested dosing for ampicillin-sulbactam is also provided given complexities in appropriate dosing for carbapenem-resistant Acinetobacter baumannii infections.

Results: Consensus-based suggested dosing for β-lactam agents used to treat AMR infections in neonates, infants, children, and adolescents and relevant supporting evidence are provided. Content is up to date as of December 1st, 2024. Gaps and limitations to existing data are discussed.

Conclusion: Optimizing antibiotic dosing is critical to improving the outcomes of children with AMR infections.

Background: Respiratory syncytial virus (RSV) poses a global health challenge, particularly among younger children. While the disease burden in Japan has been preliminarily quantified in short-term or inpatient settings, a comprehensive understanding of outpatient settings at a national level is still lacking.

Methods: In this retrospective cohort study, we followed 697 802 children until they reached 60 months of age, amounting to 25 680 468 million person-months, using two nationally representative databases from the fiscal years 2005-2021. We analyzed trends in the epidemiology of RSV infections and associated outpatient health resource use.

Results: Incidence rates of RSV and associated hospitalizations among infants showed fluctuations of 50-100 cases and 20-30 hospitalizations per 1000 person-years, respectively, during the 2010s. These rates dropped to 8.7 cases and 2.2 hospitalizations per 1000 person-years in 2020, then returned to the same levels in the 2010s. Similar patterns were noted for RSV testing, outpatient visits, healthcare cost, and the proportion of cases hospitalized (case-hospitalization risk). Whereas antibiotic use decreased from 56.4% in 2005 to 27.8% in 2021, palivizumab use increased from 95.2 to 195.9 days of therapy per 1000 person-years. Applying the calculated incidence rates to national data, annual outpatient healthcare costs for RSV infections were estimated to be 7-9 billion JPY (50-64 million USD) for children aged < 60 months in the late 2010s.

Conclusions: Our study highlights the changes in epidemiology and outpatient health resource utilization for children with RSV infections. These findings are valuable for policymakers and clinicians aiming to develop strategies, including newly developed maternal vaccines and single-dose long-acting monoclonal antibodies.

Background: Respiratory infections cause a significant amount of morbidity and mortality in pediatric and young adult patients with malignancy. Bronchoscopy with bronchoalveolar lavage (BAL) is frequently utilized in the diagnostic process, but which patients would most benefit is poorly understood.

Methods: A retrospective study from 2013 to 2022 examined patients with active malignancy who underwent bronchoscopy with BAL. Positive and negative clinical impacts were assessed by 3 independent reviewers according to predetermined criteria. Mixed-effects logistic regression was performed to identify factors associated with positive and negative clinical impact.

Results: In total, 145 bronchoscopies met inclusion criteria with a median patient age of 12 years (interquartile range 5-17). A total of 30.3% of bronchoscopies had a positive clinical impact with 17.2% leading to a new diagnosis, most commonly Pneumocystis jirovecii pneumonia (PJP) (7.6%). Comparatively, 18.6% had a negative clinical impact, most commonly from a procedural complication (13.1%). Trimethoprim-sulfamethoxazole (TMP-SMX) initiation for treatment of suspected PJP prior to BAL (adjusted odds ratio [aOR] 11.20, 95% CI 1.32-95.29) was associated with positive clinical impact. Requirement for ICU-level care (aOR 18.85, 95% CI 3.60-98.69) or oxygen supplementation by nasal cannula prior to BAL (aOR 18.41, 95% CI 4.78-70.95) were associated with negative clinical impact while prior invasive ventilation (aOR 0.09, 95% CI 0.01-0.58) was associated with the absence of negative clinical impact.

Conclusions: Patients with potential respiratory infections with high clinical suspicion for PJP who had been started on treatment TMP-SMX prior to BAL benefit most from bronchoscopy with BAL. Patients intubated prior to BAL who were deemed clinically safe for bronchoscopy tolerated the procedure better than those in the ICU not requiring intubation or those requiring supplemental oxygen via nasal cannula.

This prospective cohort study from Malawi updates our understanding of the burden of bacterial infections and drug resistance in children <5 years hospitalized with severe acute malnutrition. Urinary tract infection was diagnosed in 20% and bacteremia in 10%. Resistance to first- and second-line antibiotics occurred in >1/3 of the bacteria isolated.