Journal of the Pediatric Infectious Diseases Society最新文献

Mycoplasma pneumoniae is a common respiratory pathogen of increasing clinical interest due to a recent rise in cases in the United States and worldwide following a period of reduced activity during the COVID-19 pandemic. While most cases are mild, M pneumoniae can cause severe community-acquired pneumonia (CAP), and cannot be reliably distinguished from other common causes of CAP based solely on features of clinical presentation or imaging. However, testing to confirm a diagnosis of M pneumoniae, when it is suspected, can be logistically challenging in some clinical settings. It also remains unclear which patients with M pneumoniae CAP benefit from antibiotic treatment, which raises the question of whether treatment should be offered, particularly when the diagnosis is not confirmed. This pro/con discussion explores the available data to support or refute routine testing and empiric antibiotic treatment for M pneumoniae.

In a 6-year observational study of 45 children with suspected septic arthritis and no pathogen identified, early antibiotic discontinuation based on strict clinical and biological criteria was not associated with relapse during the 6-month period following hospitalization, supporting this approach may be safe and reduce unnecessary antibiotic exposure.

Background: Respiratory syncytial virus (RSV) illness poses a significant burden in children yet is understudied in those >2 years old.

Methods: We identified patients aged ≤17 years hospitalized with RSV between July 2010 and March 2023 using Ontario's administrative healthcare data. RSV-specific hospitalizations were defined by ICD-10-CA codes (B97.4, J12.1, J20.5, J21.0) and included overnight stays. Key outcomes included hospitalization frequency, intensive care unit (ICU) use, mechanical ventilation, supplemental oxygen, length of stay, mortality, and costs. Risk conditions included chronic respiratory diseases, congenital malformations, and cystic fibrosis.

Results: There were 23 930 RSV hospitalizations; annual counts ranged from 1356 (2010-2011) to 4298 (2022-2023). Children <2 years accounted for 84% of hospitalizations, though risk conditions were more common in those aged 2-17 years (35% vs. 7%). In 2022-2023, hospitalizations were ~2-fold, ~3-fold, and ~5-fold higher than previous years (2010-2021) for those <12 months, 12-<24 months, and 2-17 years, respectively. Median length of stay was 69 h. Annual median cost per hospitalization was $5070 (IQR: $4486-6742). ICU admission occurred in 12% of cases, with median costs over twice that of non-ICU stays ($12 042 vs. $5070). ICU use ranged from 7% to 16% in <2 years and 10%-35% in 2-17 years. In-hospital mortality was 0.12%, higher among those with risk conditions (<2 years: 0.61%; 2-17 years: 1.02%).

Conclusions: This study highlighted the burden associated with RSV hospitalizations for people aged ≤17 years and those who may be more impacted by RSV illness.

Background: Staphylococcus aureus is the leading cause of infectious-related deaths. Vaccine development has been hampered by the recall of nonprotective immune responses from prior exposure, suggesting an effective vaccine may need to be given early in life. The goal of this pilot study was to correlate the maternal serologic response against S. aureus to an infant's risk for skin and soft tissue infection (SSTI) and colonization in the first year of life.

Methods: Pregnant women were enrolled and maternal-infant dyads followed for 12 months. Maternal third trimester and cord blood were obtained to determine the anti-S. aureus IgG and anti-α-toxin (Hla) neutralizing antibody (NAb) titers. Serial surveys and skin swabs were obtained from mothers at enrollment and from infants longitudinally to ascertain S. aureus colonization status and the incidence of SSTI.

Results: Sixty-three pregnant women were enrolled, 54% with history of SSTI or asymptomatic S. aureus colonization at enrollment. Within 48-h of delivery, 23% of infants had S. aureus colonization and 43% at 1-month. Maternal S. aureus colonization resulted in 7.4 increased odds of infant colonization at delivery. Higher cord blood anti-Hla Nab titer was associated with significantly lower risk for infant SSTI in the first year of life.

Conclusions: S. aureus colonization occurs early in life, with over 40% of infants colonized by 1-month. These results are the first to demonstrate an association between higher transplacental anti-Hla NAb and protection against infant SSTI in the first year of life. Overall, these findings support Hla as a promising vaccine target.

We examined 51 monomicrobial Rothia spp. blood cultures from 2015 to 2024. Seventy-one percent occurred in cancer/hematopoietic cell transplantation patients, of which 97% were treated as true bloodstream infections and 78% followed recent broad-spectrum antibiotics. Prolonged (>4 day) fever was common. Routine Rothia spp. susceptibility testing is warranted to gauge antibiotic-driven breakthrough infection.

We assessed the impact of maternally derived pertussis antibodies on infant responses to a 2 + 1 vaccine schedule (6 weeks, 12 weeks, and 12 months). Infants with baseline antibodies showed lower IgG responses following the primary vaccination series, but this did not impair booster responses at 4 years of age. Clinical Trials: The study is registered on the Australian New Zealand Clinical Trials Registry - www.anzctr.org.au (Part 1: ACTRN12615000898550, Part 2: ACTRN12622001216707).

Background: The cell culture-based inactivated influenza vaccine (ccIIV) was first approved for use in children aged 4-17 years in 2016 in the United States. The approved age indication for ccIIV was expanded to include children 6 months and older beginning the 2022-2023 season. There is limited real-world data on ccIIV effectiveness in children. We assessed ccIIV effectiveness using the test-negative design during the 2023-2024 season.

Methods: Patients aged 6 months to 64 years who sought outpatient or telehealth care for acute respiratory illness were actively recruited between October 2023 and May 2024. Symptom eligibility criteria included cough, with an illness duration of ≤ 7 days. Respiratory samples were tested by reverse transcription polymerase chain reaction to identify influenza cases. Vaccination dates and products were determined by immunization records. Analyses were restricted to ccIIV recipients and unvaccinated participants. Cell culture-based inactivated influenza vaccine effectiveness was estimated as [100% × (1 - odds ratio)] for vaccination in cases versus test-negative controls, with adjustment for age and calendar time.

Results: Among 1850 participants, 12% were age 6 months to 3 years, 32% were age 4-17 years, and 56% were age 18-64 years. Influenza was detected in 505 (27%) participants; 267 had influenza A/H1N1pdm09; 149 had influenza B; 56 had influenza A/H3N2; and 33 had influenza A with unknown subtype. A total of 470 (25%) received ccIIV. Among children (age 6 months to 17 years), ccIIV effectiveness was 64% [95% confidence interval (CI), 37%-81%] against influenza A/H1N1pdm09, 75% (95% CI, 43%-91%) against influenza B, and 76% (95% CI, 4%-97%) against influenza A/H3N2. Among adults (age 18-64 years), ccIIV effectiveness was 56% (95% CI, 31%-73%) against influenza A/H1N1pdm09, 62% (95% CI, 13%-86%) against influenza B, and 33% (95% CI, -62% to 76%) against influenza A/H3N2. Young children aged 6 months to 3 years had the highest point estimates (88%-98%).

Conclusion: Cell culture-based inactivated influenza vaccine generated substantial real-world effectiveness against medically attended, laboratory-confirmed influenza in children and adults during a season when influenza A/H1N1pdm09 viruses predominated and influenza B and influenza A/H3N2 co-circulated at lower levels.

Untargeted molecular tests are increasingly available for the diagnosis of infectious diseases. In this national survey, plasma metagenomic next-generation sequencing had widespread use (89.8%), but disparate frequency from a few times ever (18.4%) to > weekly (9.6%). Respondents offered thoughtful insights into stewardship and future research needs.

Background: Asynchronous electronic consults, or eConsults, are a novel way for pediatric infectious disease (PID) physicians to provide non-urgent specialty advice to other clinicians. We sought to evaluate the first 5 years of a PID eConsult program with a specific focus on the utility, acceptability, and sustainability of the program.

Methods: Data were abstracted from the electronic medical records for eConsults completed from March 2018 through October 2023 including patient and referring provider characteristics and consultation information. Recommendations were analyzed for content. Referring providers were surveyed to assess their experience and satisfaction with the eConsult service.

Results: In the first 5 years of the program, 727 eConsults were completed. In 461 consultations (64.8%), the PID clinician suggested a change to the plan (new or additional diagnosis, diagnostic study, and/or therapeutic intervention) with 81.8% including counseling for the referring provider or patient. Of referring provider survey responders, 98.3% were satisfied/very satisfied with the eConsult program. Only 3.4% of respondents were dissatisfied with the turnaround time although 22% still found traditional "curbside" telephone calls to be more valuable than eConsults. Both the number of individual referring providers and the number of referring practices increased steadily over 5 years.

Conclusions: Asynchronous eConsults present a novel platform for PID specialists to formally provide recommendations. A majority of recommendations changed the diagnostic plan and treatment while providing education to both patients and referring providers. Our program demonstrated acceptance of this consulting format from referring providers and sustainability over the first 5 years of the program.