Journal of the Pediatric Infectious Diseases Society最新文献

In a retrospective single-center cohort study of 460 children with Kawasaki Disease, initial treatment with low-dose aspirin and intravenous immunoglobulin (IVIG) resulted in similar coronary artery outcomes and IVIG retreatment rates compared to high-dose aspirin and IVIG. These findings support consideration of low-dose aspirin for the management of acute-phase Kawasaki Disease.

Background: The bacterial determinants of Group A Streptococcus (GAS) associated with either invasive (IGASI) or non-invasive (NIGASI) infections remain controversial.

Methods: From 2014 to 2018, French children hospitalized for an IGASI were enrolled in a prospective multicenter study aimed at identifying bacterial virulence factors and predisposing immunologic and genetic factors. During the same period, age- and date-matched control children with NIGASI were enrolled. Whole genome sequencing was performed for all GAS isolates. The 27 specific single nucleotide polymorphisms characterizing the M1UK lineage were searched among the emm-1 isolates.

Results: A total of 192 GAS isolates were sequenced: 94 from the IGASI group and 98 from the NIGASI group. The emm-1 genotype predominated in the IGASI group (36% vs 11% in NIGASI group, p<.05) and was followed by emm-4, emm-12 and emm-3 (12%, 11% and 10% respectively). In the NIGASI group, emm-89 predominated (21% vs 7% in the IGASI group, p<.05). Among the 45 emm-1 isolates, 12 (27%) carried the mutations characterizing clone M1UK in both groups (7 in IGASI group and 5 in NIGASI group). The superantigenic toxins SpeA and SpeJ, SIC protein and FCT type 1 pilus predominated in the IGASI group but were linked to emm-1 strains. Insertions/deletions in the covS regulator gene were observed in 5 invasive isolates versus 1 non-invasive isolate.

Conclusions: Genotype emm-1 GAS strains remained the main cause of invasive infections in French children, associated to specific GAS virulence factors and should be monitored together with the rapid spread of the M1UK lineage.

Brief description: emm-1 GAS strains remained the main cause of invasive infections in French children, and 27% were from the M1UK lineage. The superantigenic toxins SpeA and SpeJ, SIC protein and FCT type 1 pilus were significantly associated with invasive infections but were linked to emm-1 strains.

Background and objectives: Dissolving microneedle patches (dMNPs) are a novel vaccine delivery method that may enhance acceptability and uptake. However, more data on their use in children is needed.

Methods: We performed a single-center, unblinded study at Emory University to evaluate the safety, reactogenicity, and acceptability of placebo dMNPs applied to the skin of healthy infants and children. Each participant received a dMNP on Day 1, and if well tolerated, could receive second and third dMNPs on Day 8 applied to different anatomical sites. Solicited local and systemic adverse events (AEs) were collected for 7 days following dMNP application. Unsolicited AEs, serious adverse events (SAEs), and new-onset medical conditions (NOMCs) were collected through the study. Parents were surveyed to assess dMNP acceptability.

Results: Between August 2018 and April 2019, 25 participants 6 weeks to 24 months of age were enrolled. All participants received one placebo dMNP applied to the wrist, and 23/25 received second and third placebo dMNPs. Overall, dMNPs were safe and well tolerated with minimal local reactogenicity. Systemic reactogenicity was generally mild but Grade 2 and 3 irritability were observed. There were no SAEs or NOMCs following the application of any dMNP. Parental acceptability of dMNPs was high, and parents reported that having a dMNP administered by a healthcare worker would increase their likelihood of obtaining a recommended vaccine for their child.

Conclusions: Placebo dMNPs were safe and well-tolerated in infants and young children. These data support the continued development of pediatric dMNP vaccines.

Background: Hepatitis C Virus (HCV) in pregnancy has increased, leading to increased perinatally exposed infants. Although universal HCV screening in pregnancy is recommended, pediatric cases remain undiagnosed. We examine the cost-effectiveness of universal HCV screening among children at age 2 and 10, when other routine blood testing is recommended.

Methods: An HCV natural history Markov model evaluated the cost-effectiveness of universal HCV screening independently at ages 2 and 10 compared to the currently recommended risk-based screening of children born to those with HCV. Based on previous literature, we assumed a 0.05% pediatric HCV chronic prevalence (0.73% chronic prevalence among pregnant persons and 7.2% vertical transmission). In the status-quo scenario, we assumed 23% of children with prenatal HCV exposure were screened. We assessed costs (USD), quality-adjusted life years (QALYs), and the incremental cost-effectiveness ratio (ICER, $ per QALY gained) compared to a willingness-to-pay threshold (WTP) of $50,000/QALY. We explored parameter uncertainty, including pediatric HCV chronic prevalence and screening rates, in multiple sensitivity analyses.

Results: Universal HCV screening at age 2 was cost-effective (ICER=$8,774/QALY gained) compared to the status-quo risk-based screening. The lowest pediatric HCV chronic prevalence in which universal screening remained cost-effective under a WTP of $50,000/QALY was 0.007%. At age 10, universal screening was cost-effective compared to risk-based screening (ICER=$4,404/gained) and was cost-effective at the lowest HCV prevalence in children of 0.006%. Models at both age 2 and 10 were robust to sensitivity analyses.

Conclusions: Universal HCV screening in childhood is cost-effective. Guidelines should consider recommending universal screening nationally, particularly if it can be conducted along with other routine pediatric blood draws.

Background: During the COVID-19 pandemic, school closures led to loss of school-based resources and substantial learning losses for children. To facilitate the return to in-person learning, schools across the US partnered with health agencies to implement strategies such as on-site and at-home COVID-19 testing programs. We aimed to quantify the cost-effectiveness of SCALE-UP Counts, a project that used text messaging and health navigation interventions to promote equitable COVID-19 testing among K-12 school students and their families.

Methods: Families of children from sixteen K-12 schools in Utah were randomly assigned to one of three intervention arms from 2022-2023: unidirectional text messages regarding availability of free COVID-19 test kits [UC], intensive bidirectional text messaging with testing guidance and ability to request test kits [ITM], and intensive bidirectional text messaging plus health navigation [ITM + HN]. Expected cost and effectiveness of each approach was measured. Effectiveness was measured as missed school days avoided, missed workdays avoided, and COVID-19 tests taken, and calculated as ratios of differences over differences in costs. The analysis was performed using a decision analytic simulation model with probabilistic sensitivity analysis.

Results: ITM + HN yielded most missed school days avoided (8290 vs. 1840) and COVID-19 tests taken (9468 vs. 1876) but was costlier than UC ($34 vs. $11 per family). The costs for ITM + HN compared to UC were $30/COVID-19 test taken, and $21/missed workday avoided. ITM alone did not yield improved outcomes relative to UC or ITM + HN.

Conclusions: Inclusion of a health navigator substantially enhances the benefits of bidirectional text messaging compared to UC but is costlier. This study quantifies these extra costs to inform decision makers as to the optimal screening and communication strategy for a school population during a pandemic.

We evaluated a decade-long pediatric antimicrobial stewardship intervention targeting meropenem at a public hospital in Colombia. Structured preauthorization, prospective audit, and strengthened infection-control practices reduced meropenem use by >80% without compensatory increases in other broad-spectrum agents. Microbiologic trends remained stable, supporting the program's sustainability in a middle-income setting.

Background: Staphylococcus aureus bacteremia (SAB) is the most common cause of childhood sepsis contributing to pediatric intensive care unit admission. The cost of adult SAB hospitalization is well described globally, but limited costing information is available for children. To bridge this knowledge gap, we investigated the cost of hospitalization in children with SAB in Australia.

Methods: An economic analysis of hospitalization costs involving children aged ≤18 years with SAB admitted to Perth Children's Hospital (PCH) between January 2017 and December 2018 was completed. Children were identified from the Invasive Staphylococcus aureus Infections and Hospitalisations (ISAIAH) cohort, a prospective multicenter study of pediatric SAB in Australia and New Zealand. The primary measure was mean hospitalization cost of community-onset SAB, overall and stratified by key variables, with 95% CIs calculated by bootstrapping.

Results: There were 61 patients with SAB admitted to PCH. Fifty-six patients had community-onset SAB. The mean hospitalization cost per patient with community-onset SAB was A$53 037 [95% CI $44 623-$61 452]. The annual total cost was A$1 485 058. Hospital-onset SAB costs were significantly higher than community-onset SAB costs, and there was no difference in hospitalization costs by antibiotic susceptibility profile for community-onset SAB. The total cost of pediatric hospitalization for community-onset SAB within the ISAIAH cohort was estimated to be over A$9 million.

Conclusion: This study provides the first in-depth analysis of the cost of hospitalization for SAB in children. This study suggests that the economic burden of SAB in children is substantial, and prevention and treatment strategies should remain focused on S. aureus as a whole.

This single-center retrospective cohort study of children with orbital cellulitis over a 16-year time period found that clinical characteristics including duration of symptoms prior to presentation did not differ between those with versus without an abscess. Streptococcus intermedius was the most common pathogen identified, followed by Staphylococcus aureus.