Journal of the Pediatric Infectious Diseases Society最新文献

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.

We described the microbiology of 216 pilonidal abscess episodes among 154 children over a 10-year period at a tertiary pediatric center and assessed patient characteristics associated with recurrence. Anaerobes and Streptococcus anginosus group were the most common organisms isolated from surgical cultures. No risk factors for recurrence were identified.

A pediatric Rocky Mountain spotted fever (RMSF) outbreak exhibiting high pediatric mortality in Nuevo León, Mexico. The classic triad was present (fever, rash, and tick bite). Geographic Information Systems (GIS) analysis identified urban clusters in marginalized areas, emphasizing social determinants' impact. Early diagnosis and targeted interventions are critical.

We queried pediatric infectious diseases physicians via the Emerging Infections Network regarding management preferences for Clostridioides difficile infection (CDI). We explored use of vancomycin, fidaxomicin, bezlotoxumab, and fecal microbiota transplantation and found that physicians are increasingly considering newer and adjunctive therapies for pediatric CDI, highlighting the need for updated guidelines.

This study analyzed US emergency department (ED) visits for antibiotic adverse drug events (ADEs) in children. Antibiotics were implicated in over one-third of pediatric ADE visits during 2019-2023, an estimated average of 47 628 ED visits annually and 73 095 in 2023. Antibiotics remain a high yield target for pediatric ADE prevention.

We describe the epidemiology of invasive fungal disease (IFD) in pediatric heart transplant recipients. Eight patients (4%) suffered IFD. Prolonged central access, delayed chest closure, broad-spectrum antibiotics, and extracorporeal membrane oxygenation (ECMO) were associated with early post-transplant IFD. Delayed chest closure and ECMO were associated with administration of systemic antifungals.

Background: Coccidioidomycosis is a fungal infection endemic to the southwestern United States. Central nervous system (CNS) coccidioidomycosis is a severe manifestation that requires lifelong antifungal therapy. While fluconazole is currently recommended as the initial therapy in pediatric patients, a rise in reports of fluconazole failure has led to use of alternative treatment approaches. In this paper, we evaluated our institutional preference to use intravenous (IV) liposomal amphotericin B (L-AmB) as part of the initial therapy for pediatric CNS coccidioidomycosis.

Methods: We conducted a retrospective case series of pediatric patients diagnosed with CNS coccidioidomycosis between 2010 and 2024. Clinical presentation, diagnostics, treatment strategies, and outcomes were analyzed.

Results: Among 10 patients, 6 had mild initial symptoms of fevers and/or headaches, while 4 had more severe initial presentations, including focal deficits, seizures, or altered mental status. All severe cases received immediate IV L-AmB and fluconazole (+IV L-AmB); 75% were discharged with improvement. The 2 mild cases that received early +IV L-AmB had uncomplicated courses, while 2 of the 4 mild cases initially treated with fluconazole alone progressed to severe disease. Over an average follow-up of 4.5 years, 5 patients were fully functional without neurologic deficits, 2 had mild residual deficits, and 3 died. Relapse occurred in all but 1 patient. Patients receiving early +IV L-AmB trended toward shorter hospitalizations, lower disease progression rates, and delayed disease relapse.

Conclusions: Our institutional experience with IV L-AmB in combination with fluconazole for the initial management of pediatric CNS coccidioidomycosis suggests that +IV L-AmB may help reduce disease progression and improve symptom resolution with mild and transient side effects, although the findings of this case series should be interpreted cautiously due to the small cohort size, limited generalizability, and potential confounding factors.

Background: Cystic fibrosis (CF) leads to chronic airway obstruction, inflammation, and infection, resulting in pulmonary exacerbations (PEx) that negatively impact lung function, quality of life, and mortality. The introduction of highly effective CFTR modulator therapy (HEMT) has improved outcomes in people with CF (pwCF), reducing the frequency of PEx and antibiotics. Using data from a single-center retrospective review and the Pediatric Health Information System (PHIS) database, this study evaluates the impact of HEMT on antibiotic utilization in pwCF.

Methods: A single-center, retrospective analysis was conducted comparing antibiotic use in the pre-ETI (2017-2019) and post-ETI (2020-2022) periods. Inclusion criteria were pwCF receiving care at for at least 1 year in both periods. Data on antibiotic agent, duration, and route of administration were collected. Additionally, a multicenter, retrospective study using the PHIS database was performed between January 2015 through June 2023, analyzing antibiotic utilization in hospitalized pwCF across multiple pediatric hospitals. Metrics included days of therapy (DOT) per 1000 patient days and length of stay.

Results: In the single-center analysis, there was a 36.2% decrease in IV and 19.5% decrease in PO antibiotic use in the post-ETI period, with no change in treatment duration. In the PHIS analysis, antibiotic utilization decreased from the pre-ETI to post-ETI period, with reductions in anti-PsA and anti-MRSA agents and a decrease in length of stay. The median DOT per 1000 patient days decreased from 2257 (IQR: 1950, 2417) to 1710 (IQRL: 1371, 1909) (P < .001).

Conclusions: The introduction of HEMT has led to reduction in antibiotic utilization for PEx among pwCF, at a single center and across multiple institutions. This decrease in antibiotic use highlights the potential for antibiotic stewardship programs to reassess and optimize antibiotic management in pwCF. Additional research is needed to determine the optimal duration and choice of antibiotics in the context of HEMT, with the goal of minimizing antibiotic exposure and associated risks.

Objective: To investigate the follow-up and outcomes of HIV-exposed infants in a setting of low HIV prevalence.

Study design: This was a multicenter, retrospective study of live-born infants of women known to be living with HIV, at 9 tertiary pediatric centers in Australia and New Zealand from 2009-2025. Antenatal, perinatal, and postnatal data, and outcomes at clinic visits to 18 months of age were collected, including co-morbidities, development, and HIV results.

Results: Six hundred sixty-eight infants were born from 657 pregnancies to 530 women living with HIV. Two (0.3%) infants were HIV-infected. Regarding preventative interventions, 612/616 (99.4%) pregnant women received combination antiretroviral (ARV) therapy, 660/661 (99.8%) infants received ARV prophylaxis, and 543/568 (96%) exclusively formula fed. A total of 94/588 (16%) born <37 weeks, 106/600 (18%) had birth weight <2500 g, and 26/642 (4%) had congenital abnormalities. HIV polymerase chain reaction (PCR) testing was done for 621/668 (93%) within 2 weeks, 598/664 (90%) at 6 weeks, 582/657 (89%) after 3 months, with a combined total of 643/657 (98%) infants having at least one post 6-week HIV PCR result. At 18-month follow-up, 24/426 (6%) had developmental delay and 47/426 (11%) had at least 1 comorbidity. A total of 577/668 (86%) infants were confirmed as HIV-negative by either negative antibody or 2 negative PCR tests over the age of 6 weeks.

Conclusions: The perinatal transmission rate of 0.3% was extremely low. While the majority of infants were followed up well, the proportion of infants with developmental delay and co-morbidities highlights the need for improved engagement, even in a low-prevalence setting.