Pediatric Infectious Disease Journal最新文献

Background: Multiple epidemiologic surveys of acute encephalitis/encephalopathy have been conducted in Japan; however, information on incidence rates and related infectious diseases/pathogens remains limited.

Objective: To clarify the epidemiological characteristics of acute encephalitis/encephalopathy in Fukushima Prefecture, we investigated the number of cases and the associated infectious diseases/pathogens using polymerase chain reaction (PCR) in addition to conventional diagnostic methods.

Methods: We collected data on acute encephalitis/encephalopathy cases from 16 medical institutions in Fukushima Prefecture that provided pediatric inpatient care between 2014 and 2024. At Fukushima Medical University Hospital, PCR testing was used in addition to conventional diagnostic methods to identify the related pathogens.

Results: Over the 11-year study period, 106 cases of acute encephalitis/encephalopathy associated with infectious disease were reported, with an average of 9.6 cases per year and an annual incidence rate of 15.2 per 100,000 children aged under 5 years. Associated infectious diseases/pathogens were identified in 59.4% of cases: exanthema subitum/human herpes virus-6,7 in 22.6%, influenza/influenza virus in 18.9% and other in 17.9%. Among 50 cases admitted to Fukushima Medical University Hospital, the pathogen identification rate was 76.0%: human herpes virus-6,7 in 24.0%, influenza virus in 22.0% and other pathogens in 30.0%.

Conclusion: Based on the prospective active survey of acute encephalitis/encephalopathy in Fukushima Prefecture, the annual incidence rate is estimated to be 15.2 cases per 100,000 children under the age of 5 in Japan. Since PCR testing is effective for detecting pathogens, comprehensive PCR analysis may further improve pathogen identification in acute encephalitis/encephalopathy.

Background: The prevalence of pediatric urinary tract infections (UTIs) caused by extended-spectrum β-lactamases (ESBL)-producing bacteria is increasing worldwide and is difficult to predict. As these infections require special antibiotic treatment, which is often not started empirically, they are associated with higher rates of intensive care unit admission, morbidity and prolonged hospitalization. We aimed to develop machine learning-based tools to aid pediatricians in predicting ESBL-positive UTIs and initiate appropriate empiric antibiotics.

Methods: The electronic medical records of a large Health Maintenance Organization were searched for all children one month to 18 years of age with confirmed UTIs during January 1, 2010, to August 31, 2020. Data on demographics, clinical and laboratory information were retrieved, and following univariate analysis, machine learning-based tools were used to develop models to predict a UTI caused by an ESBL-producing bacterium.

Results: A total of 35,830 pediatric UTI events comprised the study group. Age, sex, socioeconomic status, site of infection (community or hospital), prior antibiotic use, previous ESBL-positive UTI and the specific uropathogen were significantly associated with the rates of ESBL-positive infection. Using patients' data available on presentation, the 5 models developed had a very high negative predictive value of ~0.98, indicating strong rule-out performance for ESBL-positive UTIs.

Conclusions: Our study indicates that machine learning models based on data available at UTI presentation may support clinicians in estimating the likelihood of ESBL-producing bacteria UTIs. Prospective studies are required to improve the models' performance and determine their actual impact on clinical outcomes.

Background: Sisunatovir is an investigational respiratory syncytial virus (RSV) antiviral that was effective in an adult human viral challenge study.

Methods: In 2 multicenter studies, safety and pharmacokinetics of sisunatovir were evaluated in hospitalized individuals 1 month to 36 months of age (Study 1) and outpatient and hospitalized individuals 1 day to 60 months of age (Study 2) with RSV lower respiratory tract infection (RSV-LRTI). In Study 1 Part A, participants received single sisunatovir doses; in Part B, participants received placebo or multiple ascending sisunatovir doses every 12 hours for 5 days. In Study 2, participants received weight-based sisunatovir dosing or placebo every 12 hours for 5 days.

Results: In Study 1 Part A, 19 participants received sisunatovir; 31 in Part B received sisunatovir (n = 22) or placebo (n = 9). Adverse events (AEs) were reported by 11 (57.9%) and 12 (38.7%) participants in Parts A and B, respectively. In Study 2, 10 participants received sisunatovir (n = 6) or placebo (n = 4). No treatment-related serious AEs were reported; all AEs were mild or moderate. In Study 1 Part A 12 hours post-dose, mean sisunatovir concentrations were within safety margins. In Part B, at the highest dose assessed for each group, steady-state trough concentrations surpassed those effective in the adult challenge study.

Conclusions: In children with RSV-LRTI, sisunatovir was safe and well tolerated. The pediatric multiple-dose regimen achieved plasma concentrations effective at reducing viral load and symptoms in an adult challenge study; however, further studies are needed to identify doses providing comparable exposure across pediatric populations.

Clinicaltrialsgov registration number: NCT04225897 (registered December 11, 2019); NCT06102174 (registered October 6, 2023).

Background: Human metapneumovirus (hMPV) is a significant respiratory pathogen in infants and young children. Although most infections present as nonsevere cases in outpatient settings, severe courses can lead to hospitalization. Few potential risk factors for hospitalization have already been identified, but studies comparing the clinical presentation of children with hMPV in inpatient versus outpatient settings are lacking.

Methods: This retrospective analysis used data from the Pediatric Airway Pathogen Incidence study, a multicenter surveillance study of lower respiratory tract infections, conducted in Germany during winter seasons 2021/22 and 2022/23 (weeks 40-17 each season). We compared 102 hospitalized and 114 outpatient pediatric cases with laboratory-confirmed hMPV infection after excluding coinfections with respiratory syncytial virus. Detailed clinical and demographic data were collected.

Results: Hospitalized patients were significantly younger (median age 9 vs. 14 months, P = 0.003) than outpatients. Prematurity was notably higher in severe cases (25% vs. 6.2%, P < 0.001), and extreme prematurity (gestational age <28 weeks) was present only in hospitalized patients. Hospitalized cases were independently associated with a history of recurrent wheezing, but not with neonatal invasive and noninvasive respiratory support, inhalative steroids and bronchopulmonary dysplasia. On clinical examination, hospitalized children more often exhibited wheezing, crackles, tachypnea, hypoxemia and reduced fluid intake. Hypoxemia in hMPV was independently associated with gestational age at birth, but not with age at diagnosis.

Conclusion: The clinical presentation of hMPV in hospitalized young children differed from that observed in outpatient settings. We identified multiple factors that were independently associated with hMPV-related hospitalization.

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.