Journal of the Pediatric Infectious Diseases Society最新文献

Background: Less invasive alternatives for nasopharyngeal swab samples are needed for the detection of respiratory pathogens in children.

Methods: Prospective diagnostic study comparing the accuracy and convenience of saliva and mouthwash samples with nasopharyngeal swab samples in detecting respiratory pathogens using a multiplex polymerase chain reaction panel for 19 respiratory viruses or viral subtypes and 4 respiratory bacteria. Acutely ill children aged 2-16 years with a suspected respiratory tract infection provided saliva and mouthwash samples in addition to a nasopharyngeal swab sample.

Results: Altogether, 850 samples were obtained from 302 children, including 300 nasopharyngeal swab, 277 saliva, and 273 mouthwash samples. Among 302 participants (mean age, 9.7 years [SD, 3.0], 151 males [50%]), at least 1 respiratory pathogen was detected in 219 (73%). The most common pathogens in nasopharyngeal swab samples were rhinovirus or enterovirus (86 [29%]), Mycoplasma pneumoniae (46 [15%]), influenza viruses A and B (32 [11%]), adenovirus (15 [5.0%]), and respiratory syncytial virus (14 [4.7%]). The sensitivity of saliva samples was 71% (95% CI, 60%-81%) for rhinovirus or enterovirus, 93% (95% CI, 82%-99%) for M. pneumoniae, 86% (95% CI, 64%-97%) for influenza A virus, and 88% (95% CI, 47%-100%) for influenza B virus. The sensitivity of mouthwash samples was 48% (95% CI, 36-60%) for rhinovirus or enterovirus, 90% (95% CI, 77%-97%) for M. pneumoniae, 73% (95% CI, 50%-89%) for influenza A virus, and 67% (95% CI, 30%-93%) for influenza B virus. In total, 99% (257/260) of the children preferred either saliva or mouthwash samples to nasopharyngeal swab samples.

Conclusions: The sensitivity of saliva and mouthwash samples varied across respiratory pathogens in children. Less invasive saliva samples may serve as an alternative to nasopharyngeal swab samples for detecting certain respiratory pathogens in children.

Despite widespread vaccination, the United States has seen a stark increase in pertussis cases over the past year. Disease profiles vary across age groups, with infants at the greatest risk. The development of next generation pertussis vaccines will involve updated antigenic content, novel adjuvants, and live-attenuated constructs, potentially leveraging controlled human infection models of pertussis.

Introduction: Bronchiolitis, pneumonia, and croup account for a substantial burden of pediatric hospitalizations. We aim to provide an updated, multi-center, multi-pathogen evaluation of viral detections seen with these acute respiratory illness (ARI) syndromes before and after the COVID-19 pandemic.

Methods: We included children <5 years with a diagnosis of bronchiolitis, pneumonia, or croup during 2017-2023 from the New Vaccine Surveillance Network. Respiratory viruses were detected with a research ± clinical respiratory swabs; demographic and clinical data were obtained from caregiver interview and chart review. Virus-specific proportions across all three ARI syndromes were described, including comparisons stratified by age, surveillance year including pre- (2017-2019) and post (2021-2023) COVID-19 onset periods, and underlying medical condition.

Results: Among 14 340 cases of bronchiolitis, 4423 cases of pneumonia, and 2367 cases of croup, >80% had one or more respiratory virus detected. Respiratory syncytial virus (RSV) was the most frequent virus detected in bronchiolitis (41%) and pneumonia (26%), with a similar distribution across the COVID-19 onset periods. Parainfluenza virus (PIV) was the most frequent virus detected in croup (28%), but detections fell in the post-COVID-19 onset period by 8.4%; there was a comparable proportion of SARS-CoV-2 detections (7.6%) that emerged among croup cases. Rhinoviruses/enteroviruses (RV/EV) were the second most frequently detected virus across all three ARI syndromes and were the predominant virus in children <6 months and children with an underlying medical condition diagnosed with croup. Codetections were present in 17%-19% of bronchiolitis, pneumonia, and croup cases.

Discussion: We found a high proportion of respiratory viral detections in children <5 years with bronchiolitis, pneumonia, or croup, particularly with RSV, RV/EV, and PIV. Most viruses were identified in similar proportions before and after the emergence of SARS-CoV-2, except for PIV and influenza virus. In our cohort, there was a high proportion of viral detection across all three ARI syndromes, with RV/EV frequently detected in certain age groups and among children with underlying conditions.

Reduced vaccine coverage has led to a resurgence of vaccine-preventable diseases, threatening decades of public health progress. This perspective explores the rise in measles cases and outlines how the pediatric infectious disease community can rebuild vaccine confidence to reverse this trend.

Nirsevimab reduces respiratory syncytial virus-related hospitalizations and is recommended for infants shortly after birth during RSV season. We compared characteristics of newborns who received nirsevimab to those who received hepatitis B vaccine within one week of life to better identify gaps in coverage and target public health outreach. One year after the introduction of nirsevimab, fewer infants received the recommended birth dose of nirsevimab as compared to hepatitis B vaccine.

Background: The COVID-19 pandemic magnified longstanding racial and ethnic disparities in pediatric health, but it is unclear which populations experienced the largest disparities. Our objective was to determine whether disparities in COVID-19 severity differed with respect to patient factors analyzed as effect modifiers.

Methods: Using data from the Premier Healthcare Database, this retrospective cohort study included encounters among inpatients < 19 years old from April 2020 through September 2022 in the USA with a COVID-19 diagnosis. Outcomes of COVID-19 severity were intensive care unit (ICU) admission and ventilator use. Comparisons between Black and White patients and Hispanic and White patients were adjusted for confounders using propensity score weights, reported as risk differences (RDs) in percentage points, and tested for heterogeneity (interaction P) across subgroups of effect modifiers such as complex chronic conditions (CCCs) and insurance status.

Results: Of 8947 pediatric inpatients with primary COVID-19 diagnosis, 3858 were White, 2153 were Black, and 2936 were Hispanic. Among children with a CCC, 14.3% of Black inpatients required a ventilator compared to 9.8% of White inpatients; among children without a CCC, 3.2% of both Black and White inpatients required a ventilator (RDs 4.5 vs 0.0; interaction P = .013). Comparisons of Hispanic and White inpatients showed a similar trend in ventilator use, with larger disparities among inpatients with CCCs and no difference among those without CCCs (RDs 2.7 vs -0.7; interaction P=.031). Among children with government insurance, 25.9% of Black inpatients were admitted to the ICU compared to 20.8% of White inpatients; among children with private insurance, Black and White inpatients had comparable ICU admission rates of 20.0% and 21.4%, respectively (RDs 5.1 vs -1.4; interaction P = .025).

Conclusions: Among hospitalized children, racial and ethnic disparities in COVID-19 severity were largest for those with CCCs or government insurance. These results can help identify target populations for interventions to reduce inequity.

Background: There are limited data to guide oral antibiotic dosing in neonates and young infants, particularly for intravenous (IV) to oral transition. Cephalexin is a promising oral treatment for neonatal pathogens, including Enterobacterales and methicillin-susceptible Staphylococcus aureus (MSSA). However, maturational changes in gastrointestinal absorption and kidney function during early infancy complicate extrapolation of dosing from older populations. We evaluated cephalexin pharmacokinetics and simulated dosing strategies to achieve pharmacodynamic targets in infants ≤60 days old.

Methods: This prospective, single-center study enrolled infants 0-60 days receiving cephalexin either as part of routine clinical care or as a single 25 mg/kg study dose. Plasma concentrations were analyzed using non-linear mixed-effects modeling. Simulations assessed the probability of target attainment for free time above minimum inhibitory concentration (MIC) (fT > MIC) for ≥ 50% and ≥ 70% of the dosing interval across MICs 1-16 mg/L, assuming 10% protein binding. We also simulated the cumulative fractional response using typical MIC distributions for Enterobacterales and MSSA.

Results: The analysis included 144 samples from 33 infants with median post-natal age 31 days (range 9-56) and median gestational age 37 weeks (range 29-41). A one-compartment model with first-order absorption and lag time best described the data. Weight influenced apparent volume of distribution and apparent clearance. Additionally, we identified a maturational effect on absorption rate using post-natal age and on apparent clearance using post-menstrual age. For Enterobacterales, 25 mg/kg/dose every 6 h achieved >90% cumulative fractional response for a 50% fT > MIC target. For MSSA, 25 mg/kg/dose every 8 h was sufficient. Higher or more frequent dosing was required to meet the more stringent 70% fT > MIC target.

Conclusions: Oral cephalexin can achieve necessary pharmacodynamic targets in infants 7-60 days old. These findings support the use of model-informed dosing strategies to guide safe and effective oral antibiotic use in early infancy, including for IV-to-oral transition.

Background: Critically ill pediatric patients admitted to the pediatric intensive care unit (PICU) are highly vulnerable to infections, including invasive fungal diseases and antifungal agents are frequently prescribed. Little is known about antifungal usage in PICUs across Europe.

Methods: A multinational 3-month weekly point-prevalence study for measuring antifungal drug use was organized. Eigtheen PICUs (16 hospitals) in 10 countries in the European region participated. All patients hospitalized in the participating PICUs and receiving systemic antifungals were included. Information about ward demographics was collected once; weekly ward and patient data were collected prospectively for the 12-week study period and entered in REDCap database.

Results: Among 18 PICUs, 8 (44%) followed prophylactic practices for targeted group of patients, 7/18 (39%) had an antifungal stewardship program and the majority (16/18, 89%) had the capacity of biomarker utilization (16/16 galactomannan, 13/16 beta-D-glucan, and 9/16 pan-fungal PCR). One hundred one courses in equal number of patients were recorded; 14 for patients aged <3 month, 87 for patients ≥3 month. Malignancy was the most common underlying condition among patients aged ≥3 month (29%) followed by surgery/trauma (25%), whereas all patients <3 month had undergone a recent surgery. Indication for antifungal prescribing was prophylaxis in 38% and treatment in 62% [empirical (57%), preemptive (13%), and targeted (30%)]. Fluconazole was the most common agent both for prophylaxis and treatment, whereas liposomal amphotericin B was the most frequent agent for targeted treatment. The majority (63%) of patients on prophylaxis were oncology or transplant patients. Common reasons for empirical and targeted treatment were persistent fever/other signs of infections in high-risk patients (61%) and Candida infections (100%), respectively. For targeted treatment, the most frequent pathogens were Candida albicans (37%) and Candida parapsilosis (32%).

Conclusions: Most antifungal prescriptions across European PICUs were for treatment. Fluconazole was the most frequently prescribed antifungal. These surveillance data can guide antifungal stewardship strategies in PICUs.