Pediatric Infectious Disease Journal最新文献

Objectives: The current study aimed to explore the prevalence, predictors and outcomes of infections in pediatric acute liver failure (PALF).

Methods: Data were retrieved from a prospectively maintained database of patients admitted with PALF between January 2012 and June 2024. "Sepsis" was defined as the presence of systemic inflammatory response syndrome with suspected or proven infection. Patients with positive bacterial and/or fungal cultures were labeled as "culture-positive sepsis." Outcome variables included native liver survival (NLS) and overall survival (OS) at day 28.

Results: A total of 422 patients of PALF were included in the study of whom 195 (46.21%) fulfilled the criteria of sepsis and 71 (16.8%) had culture-positive sepsis. Bronchoalveolar fluid (37/81, 45.7%) was the commonest site of culture positivity followed by blood (29, 35.8%). More than 80% of cultures grew Gram-negative organisms with a high prevalence of carbapenem (77.1%) and multidrug (60%) resistance. These organisms were sensitive to colistin and newer beta-lactam combinations. Intensive care unit (ICU) stay, mechanical ventilation, grade 3-4 hepatic encephalopathy and use of extracorporeal liver support systems were associated with culture-positive sepsis. Patients with culture-negative sepsis had lower NLS and OS, whereas patients with culture-positive sepsis had outcomes comparable with patients without sepsis. However, culture-positive severe sepsis patients had significantly lowered NLS (33.3%) and OS (42.9%) at day 28.

Conclusion: There is a high prevalence of carbapenem and multidrug-resistant sepsis in PALF. ICU stay and use of extracorporeal support are factors independently associated with sepsis. While culture-positive sepsis did not significantly affect survival, patients with severe sepsis had lower NLS and OS.

Background: Surveillance of neonate microbiota carriage, particularly multidrug-resistant organisms (MDROs) and Bacillus cereus, could help prevent infection. We evaluated the presence of these in the stools of hospitalized infants, duration of isolation and risk of infection in infants with digestive carriage of MDROs or B. cereus.

Methods: In a population-based retrospective study, we analyzed the results of weekly stool cultures performed from birth to discharge, in all hospitalized newborns from January 2018 to September 2020, in a single tertiary unit. Information regarding infections was collected.

Results: In total, 1409 infants were included; 220 (15.6%) were carriers of MDROs and/or B. cereus: 74.1% (163/220) carried MDROs only, 20.5% (45/220) carried B. cereus only and 5.5% (12/220) were cocarriers. Eighteen MDROs were identified; Enterobacter cloacae (43.6%, 82/188) was the most frequent. There was no B. cereus infection in infants with B. cereus in the stool; 7.4% (13/175) of infants with MDROs were infected.

Conclusions: MDROs and B. cereus were commonly found in stools in a large population of hospitalized neonates. Identification of carriage and duration of this according to the germ can help to adapt the isolation protocol duration to limit constraints for parents and caregivers and to guide antibiotic therapy.

We describe the characteristics of children hospitalized for coronavirus disease 2019 in France with a focus on the post-BA.1 Omicron period (February 2022-December 2023). We identified 3 main groups of children: those ≤90 days old (44.8%), older children with comorbidities (22.1%) and children with multisystem inflammatory syndrome (5.2%). Low vaccination coverage in these groups suggests that this burden could be alleviated with immunization.

Background: Treating patients for tuberculosis (TB) infection prevents future cases and transmission. Long treatment regimens have been associated with low completion rates. We describe a 1-decade experience with treating children and adolescents for TB infection (TBI) with 3 months of once-weekly doses of isoniazid and rifapentine (3HP).

Methods: This was a retrospective review (2014-2024) of 2 to <21 year olds who received 3HP under directly observed therapy for TBI. We abstracted demographic data, testing methods and treatment course information. Our primary outcome was treatment completion; our secondary outcome was adverse events (AEs).

Results: Eight hundred two patients met inclusion criteria; 94.1% completed therapy. Completion rates were not associated with demographic data or testing methods. The most common reasons for not completing 3HP were AEs (23/802, 3%), moving out of the area (11, 1.4%) and pill burden (7, 0.9%). AEs resulting in failure to complete 3HP were rare. These included vomiting (15; 2 with elevated aspartate aminotransferase/alanine aminotransferase), abdominal pain (7, all with normal aspartate aminotransferase/alanine aminotransferase), rash (6), angioedema (4) and myalgias (2); 16/23 had >1 AE. Of the 23 with AEs, 20 began alternative regimens [rifampin (12), levofloxacin (5) and isoniazid (3)], and 17/20 (85%) completed TBI therapy.

Conclusions: Over 94% of children as young as 2 years of age completed 3HP for TBI, which is remarkable considering the large pill burden and lack of child-friendly formulations available in the United States. The only factor associated with treatment completion was the presence of an AE.

Background: Septic pulmonary embolism (SPE), resulting from infections such as osteomyelitis and endocarditis, is rare and lacks specific diagnostic guidelines. This report reviews the clinical manifestations, radiographic abnormalities and antibiotic therapy in children with SPE.

Methods: Patients aged 1 to 18 years with confirmed SPE were identified from a database using the International Classification of Diseases-9/10 codes from 2000 to 2020. After excluding duplicates and those with neoplastic disease, 8 patients were included out of 16 encounters.

Results: Patients predominantly presented with shortness of breath, fever and chest pain. Half had identifiable extrapulmonary infection sources. Leukocytosis was present in 50% and leukopenia in 12.5%. Anemia was noted in 87.5% of patients, possibly linked to patients' acute illness. Contrasted chest computed tomography showed bilateral emboli in most patients. Echocardiograms were normal. Methicillin-resistant Staphylococcus aureus was identified in 62.5% of cases and oxacillin-sensitive staphylococcus aureus in 37.5%. While osteomyelitis was the most common infection source, our series uniquely included cavernous sinus thrombosis in children and reported for the first time. Most patients were empirically treated with vancomycin.

Conclusion: This case series highlights cavernous sinus thrombosis as a new clinical entity associated with pediatric SPE. It emphasizes the significance of prompt, targeted antibiotic therapy for improved outcomes in children with SPE.