Pediatric Infectious Disease Journal最新文献

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.

Background: This study aims to assess whether Swiss guidelines for pneumococcal vaccination in children with cochlear implants are followed and whether they elicit adequate pneumococcal vaccine immunity.

Methods: We performed a retrospective analysis at the Western Switzerland University Cochlear Implants Center, reviewing data between January 2009 and December 2023. Vaccination records and serotype-specific pneumococcal IgG concentrations were extracted from computerized medical records.

Results: Fifty children were included, with a median implantation age of 1.5 years. In children <2 years old, 82% (27/33) were up to date with routine pneumococcal vaccination (3 doses of the 13-valent pneumococcal conjugate vaccine administered at 2, 4 and 12 months), yet only 56% (15/27) achieved protective pneumococcal seroprotection. In contrast, among children ≥2 years of age, 24% (4/17) received both the age-appropriate routine schedule and the additional recommended dose of 13-valent pneumococcal conjugate before implantation, and all of these (100%) showed protective seroprotection. An overall decline in seroprotection was observed within 5 years postvaccination, particularly around 5 years of age. Vaccine-induced immunity differed by serotype; serotypes 6B, 14 and 19 elicited higher antibody levels, whereas serotypes 4, 9V and 18C produced lower responses. Notably, children 2-5 years of age tended to exhibit lower overall pneumococcal immunity.

Conclusions: Our findings support the proactive administration of an additional pneumococcal vaccine dose at the time of planning cochlear implant surgery for children ≥2 years old. In addition, periodic monitoring of serotype-specific pneumococcal antibody levels (every 5 years) is recommended to determine the need for booster vaccinations.

The study analyzed pregnancy outcomes among 498 women living with HIV in East Asia. We found 15% had pregnancies postdiagnosis, with 57% resulting in live births. Older age at antiretroviral therapy initiation and higher pre-antiretroviral therapy viral loads were negatively associated with pregnancy. High rates of unplanned pregnancies (61%) and terminations (26%) highlight the need for improved reproductive counseling.

Background and aims: This study aimed to analyze liver fibrosis using transient elastography (TE) and serum biomarkers [aspartate transaminase-to-platelet ratio index (APRI) and the fibrosis-4 index (FIB-4)] in children with chronic hepatitis C before antiviral treatment and to compare the results of these noninvasive methods.

Methods: All consecutive patients 3-17 years old treated with direct-acting antivirals for hepatitis C virus infection between August 2019 and July 2024 were included. Evaluation of liver stiffness measurement (LSM) was performed before starting treatment with TE. Liver fibrosis was considered significant if the median LSM was >7 kPa, corresponding to a METAVIR F score of ≥2 points. Simultaneously, TE, APRI and FIB-4 evaluations were performed, and their accuracy in the detection of significant fibrosis and cirrhosis was determined by calculating areas under the receiver operating characteristic curve (AUROC) using the LSM results as a reference.

Results: One hundred fifty patients with a median age of 11 years were included. TE evaluation revealed that 139/150 (92.7%) of the participants presented with normal LSMs (≤7.0 kPa), whereas in the remaining 11/150 (7.3%) participants, significant fibrosis was confirmed, correlating to a score of F2 on the METAVIR scale in 6 (4%), F3 in 2 (1.3%) and F4 in 3 (2%). Among the independent predictors of significant fibrosis were age >10 years and duration of infection >10 years. The median APRI and FIB-4 values were significantly greater in children with significant liver fibrosis on TE evaluation. For detecting significant fibrosis, the AUROC was 0.706 for the APRI and 0.802 for the FIB-4, with cutoff values >0.53 for the APRI and >0.24 for the FIB-4. When the accuracies of the APRI and the FIB-4 for detecting cirrhosis were analyzed, the AUROCs were greater: 0.879 for the APRI, with a cutoff >0.53, and 0.96 for the FIB-4, with a cutoff >0.40.

Conclusion: There is some agreement between the results of biomarker (APRI and FIB-4) and TE evaluation, but with the assumption of lower cutoff thresholds indicating significant fibrosis/cirrhosis than previously validated in adults.

Background: Diagnosing extrapulmonary tuberculosis (EPTB) in children is challenging due to nonspecific presentations and poor diagnostic yield from conventional microbiologic tests. Host gene expression signatures offer a non-sputum-based diagnostic alternative. This systematic review evaluates their diagnostic performance in pediatric EPTB.

Methods: We systematically reviewed host-based gene expression diagnostics for pediatric EPTB. PubMed, Embase and Cochrane Library (January 1965-May 2025) were searched for studies in children (0-18 years) with EPTB. Exclusions were adult-only studies, mixed data on pulmonary TB and EPTB without disaggregation, pulmonary TB-only studies, reviews and abstracts. Two reviewers screened data, resolving disagreements by discussion.

Results: Of 830 records, 2 studies met the inclusion criteria: Pan et al. (2017) and Olbrich et al. (2024), both in low and middle-income countries, enrolling a total of 891 children under 15 years. Olbrich et al.'s 3-gene MTB-HR prototype showed 59.8% sensitivity against a strict culture-confirmed reference standard and 50.0% in isolated EPTB with a low risk of bias. Using a microbiologic, clinical and radiologic composite standard, Pan et al.'s miRNA-29a assay achieved 67.2% sensitivity, 88.5% specificity in peripheral blood mononuclear cells; 81.1% sensitivity, 90.0% specificity in cerebrospinal fluid; 84.4% sensitivity, 95.4% specificity in combined peripheral blood mononuclear cell/cerebrospinal fluid with a high risk of bias.

Conclusions: Evidence for host gene expression diagnostics in pediatric EPTB is limited by few studies, small sample sizes, bias and lack of disaggregated data, with accuracy falling short of the World Health Organization targets.