Pediatric Infectious Disease Journal最新文献

Background: Human Adenovirus (HAdV) is a significant pathogen associated with severe acute respiratory infections, especially in children under 5. Despite its global impact, its epidemiological and clinical burden in Jordan, particularly post-COVID-19, is limited.

Methods: We conducted a multicenter cross-sectional study across 4 hospitals in Jordan from November 2022 to April 2023. Nasopharyngeal swabs were collected from children <5 years old hospitalized with respiratory symptoms. HAdV positivity was determined using real-time polymerase chain reaction. Demographic, clinical and laboratory data were analyzed to identify predictors of HAdV positivity and complications.

Results: Among 1000 enrolled participants (median age 9.68 months, 59% male), the HAdV positivity rate was 10.9%, highest in children 49-60 months of age. HAdV-positive cases had higher rates and longer duration of sore throat compared with HAdV-negative cases. Coinfections with respiratory syncytial viruses or influenza were present in 34.9% of HAdV-positive cases and were associated with increased rates of cough, wheezing and respiratory crackles. Logistic regression revealed lower odds of HAdV positivity in children under six months [odds ratio (OR) 0.31, P < 0.001], while invasive ventilation was associated with higher odds of positivity (OR 5.01, P < 0.001). HAdV infection without coinfection was associated with reduced odds of complications (OR 0.06, P < 0.001).

Conclusions: This is the first comprehensive study in Jordan to document the epidemiologic and clinical burden of HAdV in children post-COVID-19. HAdV remains a major cause of respiratory morbidity, with significant coinfection rates. Further research is needed to explore the nonrespiratory manifestations, identify HAdV common local serotypes and genetic characteristics.

Background: Prophylactic antimicrobials for pediatric patients requiring extracorporeal membrane oxygenation (ECMO) support are not well delineated; there are no consistent guidelines nationally or internationally. We analyzed antimicrobial use before and after implementing a narrow-spectra ECMO antimicrobial prophylaxis protocol intended to standardize prophylaxis by risk related to ECMO type and configuration.

Methods: This retrospective, single-center study included children under 18 years old requiring ECMO between May 2018 and December 2021. Medical and cardiac surgical patients requiring open-chested (central) or peripheral veno-venous or veno-arterial ECMO were included. We evaluated the impact of an ECMO antimicrobial prophylaxis protocol by comparing the appropriateness of antimicrobial use as well as nosocomial infections in the pre versus post protocol.

Results: Our study included 55 children with 58 individual ECMO episodes. More than 50% of the patients were open-chested during ECMO support, and the majority of ECMO support was veno-arterial. In the post protocol period, patients were 4 times as likely to have appropriate antimicrobial prescribing (Odds ratio 4.4; 95% confidence interval: 1.1-19; P = 0.036), including both prophylactic (per protocol) and therapeutic (chart documentation of an infection with appropriate therapeutic antimicrobials, including drug and duration). There was no difference in the odds of nosocomial infection occurring during ECMO pre protocol versus post protocol (pre vs. post protocol, P = 0.71 for invasive infections, P = 0.73 for all infections including potential colonization).

Conclusions: After implementation of a standardized narrow-spectra ECMO antimicrobial prophylaxis protocol, we observed an increase in appropriate and standardized antimicrobial prescribing without concomitant increase in nosocomial infections.

After the lifting of the nonpharmaceutical interventions introduced during the COVID-19 pandemic. Enterovirus reappeared 16 months after COVID-19 onset; bronchiolitis, 33 months; group A Streptococcus infections, 36 months; pneumonia, 45 months and pertussis, 51 months. These differences across pathogens shed light on differences in herd immunity durability and pathogen-specific vulnerability.

Background: Early initiation of antiretroviral therapy (ART) can reduce HIV-related morbidity and mortality. We described treatment outcomes of children living with HIV identified through the early infant diagnosis (EID) program and linked to the Thai National AIDS Program (NAP).

Methods: We used the Thai NAP database to conduct a cohort analysis of infants identified through the EID program who initiated ART from August 2014 to July 2018, with data cutoff on 31 December 2023. The Thai NAP is a national database linked to public hospitals in Thailand and a vital status registry. First-line ART was a lopinavir/ritonavir-based regimen; pediatric dolutegravir became available in May 2023. Attrition outcomes included death and loss-to-follow-up (LTFU). Virologic suppression was defined as plasma HIV RNA <200 copies/mL. The overall 7-year survival rate was estimated using the Kaplan-Meier estimate.

Results: The median [interquartile range (IQR)] age at ART initiation was 3.3 (2.2-6) months for the 230 infants included. Twenty children [8.7%, 95% confidence interval (CI): 5.4-13.1] died at a median (IQR) age of 1.1 (0.6-3.0) years. LTFU was 44 (19.1%, 95% CI: 14.3-24.8) at the median (IQR) age of 3.6 (2.0-5.6) years. Overall, the 7-year survival rate was 90.7% (95% CI: 85.6-94.1). Among 166 children retained on ART, the median (IQR) age at the last visit was 7.7 (6.7-8.7) years. Of these, 107 (64.5%) children transitioned to dolutegravir-based regimens. Overall, virologic suppression was achieved in 144 children at the last visit, representing 62.6% of children who initiated ART and 86.7% of children who remained in care.

Conclusions: Children diagnosed with HIV through EID and linked to the Thai NAP had promising 7-year survival rates but substantial LTFU. Strategies to improve retention and re-engagement in care and are essential for better outcomes.

Background: Orthopedic device-related infection (ODRI) is a major postoperative complication encompassing a broad spectrum of clinical situations depending on the anatomical site, type of implanted material, and patient-specific factors. Despite their clinical significance, data on ODRIs in children are scarce and standardized management guidelines are lacking. Our aim was to characterize the clinical presentation, laboratory findings, microbiological characteristics, therapeutic management and outcomes of ODRIs in children.

Methods: We conducted a retrospective, observational study at Montpellier University Hospital from January 2015 to June 2023. All children under 16 years with an ODRI diagnosis, defined as the presence of clinical signs requiring surgical revision, were included.

Results: Sixty-nine ODRI cases were analyzed. Initial surgical indications were: 25 fractures, 16 cases of nonidiopathic scoliosis (NIS), 12 of idiopathic scoliosis (IS) and 16 other orthopedic anomalies. Infections were polymicrobial in 35% of cases. Staphylococcus aureus (SA) was isolated in 39/69 cases, Gram-negative bacteria (GNB) in 13/69 cases and anaerobic bacteria in 9/69 cases (none on fracture cases). SA was involved in 72% of fracture-related ODRI. 50% of NIS were affected by GNB and 58% of IS by anaerobic bacteria. Empirical antibiotic treatment was mainly piperacillin/tazobactam and vancomycin (n = 38). Median duration of intravenously antibiotic therapy was 15 days [interquartile range (IQR) 10-18.5]. Median duration of total antibiotic therapy was 60 days (IQR 44.5-92), 46.5 days (IQR 42-61.75) with implant removal and 63.5 days (IQR 42.25-96.5) with implant retention. The cure rate in our cohort was 85%.

Conclusions: SA is the first cause of ODRIs in children. GNB predominates in the case of NIS and anaerobic bacteria in the case of IS. Surgical indications and comorbidities are essential to determine antibiotic prophylaxis, antibiotic therapy and optimize their duration.