Pediatric Infectious Disease Journal最新文献

Background: Routine surveillance for vancomycin-resistant enterococci (VRE) colonization remains the standard practice in many intensive care units. However, in high-acuity pediatric intensive care units (PICUs), where clinical VRE infections are uncommon, universal screening may impose substantial financial and operational burdens with uncertain clinical benefits. This study evaluates the necessity and value of universal VRE surveillance by describing the clinical characteristics and risk profiles of asymptomatic VRE-colonized patients in a newly established, high-acuity, 54-bed PICU.

Methods: This single-center, retrospective cohort study included all patients with positive admission or weekly rectal VRE screening cultures between October 2023 and October 2024. Demographic, clinical, microbiologic (including species identification) and outcome variables were analyzed.

Results: Among 1270 PICU admissions, 74 patients (5.8%) were colonized with VRE; 42 (56.8%) were positive on admission and 32 (43.2%) acquired colonization during hospitalization. Enterococcus faecium was the predominant species (97.3%). Despite frequent exposure to recognized risk factors, including central venous catheters (79.7%), urinary catheters (77.0%), prolonged PICU stays and carbapenem exposure (62.2%), no patient developed a clinical VRE infection.

Conclusions: In this high-acuity PICU with robust infection prevention infrastructure, VRE colonization, including colonization with high-risk E. faecium strains, did not progress to clinical infection. These findings suggest that in high-acuity PICUs with established infection control excellence, the clinical yield of universal VRE screening may be marginal compared with its operational costs, supporting a transition toward targeted, risk-based surveillance.

Background: Human rhinovirus is one of the leading causes of pediatric respiratory infections worldwide. Its circulation patterns have shown notable changes in recent years. This study aimed to compare the epidemiologic, clinical and laboratory characteristics of rhinovirus infections and coinfections in 2 consecutive periods to identify shifts in age distribution, symptom patterns, healthcare utilization and pathogen codetection among pediatric patients.

Methods: A retrospective analysis was conducted at a tertiary pediatric center and included all children aged 0-18 years with laboratory-confirmed rhinovirus infection between December 2023 and October 2025. Two consecutive 11-month periods were compared: December 2023-October 2024 (Period 1) and December 2024-October 2025 (Period 2). Demographic and laboratory parameters were recorded.

Results: A total of 572 children with rhinovirus-positive samples were evaluated. The number of cases increased 2.9-fold in December 2024-October 2025 (Period 2) (from 141 to 431; 0.42 vs. 1.22 cases/day), while age and sex distributions remained similar. Children under 6 years represented the most detections, and the proportions of 0-2-year-old children were similar in both periods. Fever, cough and rhinorrhea were significantly less frequent in Period 2. Chest X-ray use increased overall (34.8%-49.7%) but remained unchanged among hospitalized patients. Hospitalization rates were comparable, and antibiotic use declined (60.0%-48.9%). Multivariable analysis showed that neither hospitalization nor antibiotic exposure predicted period assignment. Coinfections increased from 3.5% to 10.2%, though severe outcomes remained rare.

Conclusions: Human rhinovirus cases nearly tripled across 2 seasons, yet clinical severity did not increase. Fever, cough and rhinorrhea declined, antibiotic use decreased and hospitalization remained stable. Coinfections became more frequent but did not affect outcomes. These observations suggest that rhinovirus circulation is expanding with a shift toward milder, community-managed illness.

Twice-daily dosing of Dolutegravir is approved for adults with HIV and integrase strand transfer inhibitor resistance, but not for children. Population pharmacokinetic modeling and simulations identified a weight-tiered twice-daily dose for children, predicted to yield dolutegravir exposures within the therapeutic window and provide similar efficacy and safety as seen in adults with HIV-1 and first-generation integrase strand transfer inhibitor resistance.

Background: Congenital toxoplasmosis is both prevalent and severe in Brazil. The Minas Gerais Congenital Toxoplasmosis Control Program (PCTC-MG) used prenatal and neonatal screening to identify neonates at risk for congenital toxoplasmosis. This study aimed to evaluate the clinical and laboratory parameters used to diagnose the disease in this population.

Methods: This retrospective cohort study included children with suspected congenital toxoplasmosis who participated in the PCTC-MG between 2013 and 2020.

Results: A total of 347 children participated in the study; 228 had confirmed toxoplasmosis and 119 were excluded. The majority (314/347; 90.5%) underwent neonatal screening for IgM in filter paper (FP). Among these, 269/314 (85.7%) had positive or indeterminate results, with 186 (69.1%) confirmed infections, while 45/314 (14.3%) had nonreactive results, with 17 confirmed infections. There was an association between treatment during pregnancy (45/227; 19.8%) and a lower number of reagent IgM results in FP ( P = 0.002) and serum ( P = 0.001). A higher gestational age was associated with a higher proportion of IgM in the FP ( P = 0.001) and serum ( P = 0.004). Retinochoroiditis (73.2%; 167/228) and neurologic changes (36.9%; 75/203) were frequent in the infected children. The treatment decision was based on the presence of IgM/IgA (176/226; 77.9%), retinochoroiditis (45/226; 19.9%) or persistence/increase in IgG levels (4/226; 1.8%).

Conclusions: Screening with specific and sensitive serology identified most, but not all, children with congenital toxoplasmosis. Ophthalmologic evaluations and neuroimaging are mandatory in this context. The absence of IgM in the FP did not exclude the diagnosis.