Pediatric Infectious Disease Journal最新文献

Background: Since March 2024, the European Center for Disease Prevention and Control has reported increased Parvovirus B19 (B19V) infections across 14 European countries. While often self-limiting in healthy children, B19V may cause severe disease in vulnerable populations.

Methods: This multicenter prospective study aimed to characterize the clinical presentation of B19V infection in hospitalized children and identify risk factors for severe outcomes. Data were collected through the INF-ACT pediatric surveillance system, as part of the National Recovery and Resilience Plan. Children hospitalized with confirmed B19V infection were enrolled from January to December 2024 in 10 Italian INF-ACT centers.

Results: A total of 135 children were included (median age 7.6 years, interquartile range 4.4-9.9), with 78.5% of cases occurring between April and July 2024. Acute myocarditis (20.7%) and neurologic complications (17.8%) were the most frequent severe manifestations. Myocarditis was significantly associated with younger age ( P < 0.001), longer hospital stays (median 19.5 vs. 6.5 days; P = 0.0018) and higher intensive care unit (ICU) admission rates (71.4% vs. 20.8%; P < 0.001). Multivariate analysis showed myocardial involvement increased the risk of ICU admission over 20-fold ( P < 0.001).

Conclusions: Although often mild, B19V infection can cause severe complications in children, particularly myocarditis and neurologic involvement. Prompt recognition is essential, even in the absence of classic features like erythema infectiosum, to ensure timely monitoring and management of potentially life-threatening outcomes.

Background: Mycoplasma pneumoniae (MP) is a common cause of lower respiratory tract infections in children. During the COVID-19 pandemic, a marked decline in MP infections was observed, with a delayed resurgence reported in some European countries. This study aimed to assess the epidemiologic trends and clinical features of MP infections in a pediatric tertiary care academic hospital in Italy from 2017 to 2024.

Methods: We conducted a retrospective, single-center study including immunocompetent patients 30 days to 17 years of age, hospitalized with confirmed MP infection. Clinical, laboratory, and radiologic data were analyzed across 3 periods: prepandemic (2017-2019), pandemic (2020-2022) and postpandemic (2023-2024). Statistical analyses were performed to compare incidence and clinical characteristics over time.

Results: Of 303 included patients, 130 were hospitalized prepandemic and 148 postpandemics. The proportion of MP among acute respiratory infection hospitalizations nearly doubled, from 3.2% in 2019 to 6.1% in 2024. Despite the higher incidence, the need for respiratory support remained stable (25.7% overall; P = 0.3), the pediatric intensive care admissions were rare and unchanged (2.0% vs. 2.0%, P = 1.0) and median hospital stay was consistent across both periods (5 days, interquartile range 4-8; P = 0.803).

Conclusions: MP incidence increased significantly postpandemic, and clinical severity remained comparable to prepandemic levels. Ongoing epidemiologic surveillance is essential to better understand infection dynamics and to guide effective clinical management strategies.

Background: Pediatric Clostridioides difficile infection (CDI) is a growing concern, yet nationwide data from Japan are scarce. Current guidelines often discourage CDI testing in infants due to a presumed low incidence of clinical disease. We aimed to characterize the epidemiology and risk factors of pediatric CDI in Japan, focusing on age-specific patterns and community-onset cases.

Methods: We performed a retrospective analysis using the Japan Medical Data Center claims database from 2013 to 2022. CDI cases were defined by the presence of both diagnostic testing and anti-CDI treatment within 7 days. Episodes that relapsed within 8 weeks were excluded. CDI onset setting was classified according to CDC/NHSN criteria. Risk factors were evaluated by age and onset setting.

Results: Of the 4090 CDI cases, 284 were pediatric. The incidence in children 0-2 years old was comparable to that in older children, challenging current assumptions. Risk factor profiles varied by age group and setting, with inflammatory bowel disease being a prominent risk factor in children (28.9% vs. 14.8% in adults/older adults), particularly in adolescents (43.5%). Critically, nearly half of community-onset pediatric CDI cases had no prior antibiotic exposure.

Conclusion: This first large-scale study of pediatric CDI in Japan revealed that CDI can occur in children without prior antibiotic exposure, particularly in community settings. These findings support consideration of revisions to management strategies for pediatric CDI.

Background: Streptococcus pneumoniae remains a major cause of bacterial disease in young children, with increased risk and morbidity in children exposed to HIV but uninfected (CEHU) and children living with HIV (CLWH). This study assessed the persistence of vaccine-specific antibodies, opsonophagocytic activity (OPA) and nasopharyngeal carriage of S. pneumoniae and Haemophilus influenzae in HIV-unexposed children, CEHU and CLWH.

Methods: HIV-unexposed children, CEHU and CLWH who initially received a 10-valent pneumococcal polysaccharide protein D-conjugate vaccine 3-dose primary schedule at 6, 10 and 14 weeks with a booster at 9 months (3 + 1) were followed up at 3, 4 and 5 years to measure serum IgG concentrations, OPA and nasopharyngeal colonization. Geometric mean concentrations (GMCs) and titers, along with the prevalence of colonization, are reported for each group.

Results: Compared with HIV-unexposed children, CLWH had similar antibody concentrations for all serotypes at each timepoint except at 4 years where GMCs were lower for 6B and at 5 years where GMCs were lower for 6A. OPA titers were lower for 6B at 3 years and lower for 4B at 4 and 5 years in CLWH compared with HIV-unexposed children. Comparing CEHU to HIV-unexposed children, both study groups had similar GMCs and OPA titers for all serotypes during the study period. Prevalence of nasopharyngeal colonization of S. pneumoniae and H. influenzae was similar amongst the 3 study groups.

Conclusions: There was no association between HIV exposure or infection and antibody persistence or colonization at 3, 4 and 5 years of age.

Background: A comprehensive analysis of the respiratory syncytial virus (RSV) burden in England is required. We estimated respiratory-related healthcare resource utilization (HCRU) and costs for infants experiencing RSV episodes.

Methods: A birth cohort of all infants born between March 01, 2015, and February 28, 2017 (n = 449,591) was established using Clinical Practice Research Datalink-Hospital Episode Statistics. Case cohorts included infants with an episode of (1) RSV, (2) bronchiolitis, (3) any respiratory tract infection at <24 months and (4) RSV-predicted at <12 months. Treatments, procedures, clinical outcomes, respiratory-related HCRU and associated costs, and the patient pathway during the month before and 24 months following the index episode were described in case and comparative cohorts.

Results: Among the 4813 infants in the RSV-coded case cohort (vs. comparative cohort), the mean number of respiratory-related healthcare visits was 5.1 (vs. 1.5), with the highest burden occurring in November and December, mostly in infants up to 12 months of age. Noninvasive and invasive ventilations were performed in 17% (vs. 0.47%) and 9% (vs.0.28%), respectively, 48% (vs. 38%) were prescribed antibiotics, and 0.44% (vs. 0.09%) died. Before and after the index episode, ~30% and ~75%, respectively, had another respiratory-related healthcare visit, with a mean cost of £4060 (vs. £242) per infant. Notably, minimal differences were observed across all outcomes between infants born before and during the RSV season.

Conclusions: This study quantifies the significant impact of RSV infections in infants on the healthcare system. It highlights the need for effective preventive strategies for infants entering their first season.

Background: Vancomycin therapeutic drug monitoring (TDM) is essential for optimizing efficacy and minimizing toxicity, particularly in acute kidney injury (AKI). However, recent guidelines favor area under the curve (AUC)-guided dosing over traditional trough monitoring to improve dosing. This study aimed to compare vancomycin TDM strategies in pediatric patients, examine the agreement between 1-point and 2-point sampling methods for AUC estimation, and explore the association between vancomycin exposure and clinical outcomes.

Methods: This retrospective cohort study included pediatric patients (2 months to 18 years of age) who underwent vancomycin TDM between 2017 and 2019 (trough-based dosing) and 2020 and 2022 (AUC-based dosing). The pharmacokinetic parameters were estimated using Bayesian software. AKI was defined according to the Kidney Disease: Improving Global Outcomes criteria. Receiver operating characteristic curve analysis was performed to identify the threshold values of AUC and trough concentrations for predicting AKI.

Results: A total of 288 patients were included in the study: 164 were from 2017 to 2019 and 124 were from 2020 to 2022, respectively. A comparison of the 1-point and 2-point sampling methods for estimating the AUC showed no significant differences. The incidence of AKI was slightly lower in the 2020-2022 cohort (2.4%) than in the 2017-2019 cohort (6.7%), though the difference was not statistically significant. The AUC threshold for predicting AKI was similar between 1-point and 2-point sampling methods (588-621 mg h/L).

Conclusions: AUC-based vancomycin dosing was associated with a reduced incidence of AKI in pediatric patients, without compromising efficacy. Further studies are warranted to refine the exposure targets for bacteremia resolution.

Background: Pneumonia is a leading cause of antibiotic use for children. This study aimed to assess nationwide antibiotic prescribing patterns for pediatric pneumonia in South Korea between 2016 and 2023, a period encompassing both epidemic and nonepidemic periods of Mycoplasma pneumoniae pneumonia (MPP).

Methods: Using national claims data from the Health Insurance Review and Assessment Service, we analyzed antibiotic prescriptions for patients under 18 years diagnosed with bacterial pneumonia (International Classification of Diseases, 10th Revision codes; viral pneumonia was excluded). Antibiotic use was measured in days of therapy per 1000 patient-days (inpatients) or per 1000 patients (outpatients).

Results: Among 8.7 million inpatient days and 3.5 million outpatient visits, the 2-4 years group accounted for the highest burden (497.1 inpatient days and 161.6 outpatient visits per 1000 population). Macrolides were the most prescribed class in both inpatients [805.1 days of therapy (DOT)/1000 patient-days] and outpatients (4898.0 DOT/1000 patients), except in infants, where third-generation cephalosporins predominated. Use of third-generation cephalosporins increased sharply from 2022 and became the most prescribed class in 2023. Tertiary hospitals had higher use of tetracyclines (26.8 DOT/1000 patient-days) and quinolones but lower use of beta-lactams than other facility types. Antibiotic prescribing peaked in the fourth quarter of each year.

Conclusion: Among children in South Korea diagnosed with bacterial pneumonia, macrolides were most frequently prescribed, and prescriptions for third-generation cephalosporins showed an increasing trend. These findings underscore challenges in antimicrobial stewardship and need for strengthened nationwide antimicrobial stewardship policies for pediatric pneumonia tailored to age, setting, and seasonal trends.