Pediatrics International最新文献

Background: Patients discharged from the intensive care unit (ICU) often experience high morbidity rates. The aim of the present study was to estimate the incidence of functional capacity impairment in pediatric patients who were discharged from the ICU in a middle-income country and to identify associated factors, considering the socioeconomic context.

Methods: This was a multicenter cohort study of 357 patients aged <18 years admitted to three ICUs in the interior cities of São Paulo State. The Functional Status Scale was used to assess the patients at admission, ICU discharge, and hospital discharge. New morbidity was defined as a change in any domain of the scale equal to or greater than two, or a change in the total score equal to or greater than three. A multiple logistic regression model was used to identify independent associations with new morbidity.

Results: New morbidity occurred in 14.6% and 12.3% of patients at ICU and hospital discharge, respectively, compared with those at admission. The feeding (p < 0.001) and respiratory (p = 0.036) functional domains were the most affected at ICU discharge. The risk factors associated with new morbidity at hospital discharge were heart disease, older age, longer ICU stay, and higher PELOD2 severity score.

Conclusions: To reduce the risk of new functional morbidity, healthcare teams should be attentive to the critically ill pediatric population, particularly those who are older and have chronic clinical conditions, especially heart disease.

Background: Moraxella species are commensal organisms of the upper respiratory tract that only occasionally cause invasive infection. Pediatric Moraxella bacteremia is extremely rare, and its clinical features and optimal management remain poorly defined.

Methods: We conducted a single-center, retrospective observational study at Tokyo Metropolitan Children's Medical Center. Patients with blood cultures yielding Moraxella spp. between April 2010 and March 2024 were identified. Clinical and microbiological data were extracted from electronic medical records. The primary outcome was all-cause 28-day mortality.

Results: Among 24 patients (28 episodes) with blood cultures positive for M. catarrhalis or M. osloensis, 13 episodes were excluded as contamination. Eleven patients (15 episodes) with confirmed bacteremia were analyzed: 8 episodes were due to M. osloensis and 7 to M. catarrhalis. Two patients had recurrent episodes (one patient with congenital nephrotic syndrome had four episodes of M. catarrhalis bacteremia). Overall, 10 of 11 patients (91%) had underlying immunodeficiency. Central venous catheters were present in 6 of 8 M. osloensis episodes, which were classified as catheter-associated bacteremia. In the M. catarrhalis group, pneumonia was the most likely focus in 2 of 7 episodes. Antimicrobial therapy commonly included cefepime or ampicillin-sulbactam for M. osloensis and cefotaxime or ampicillin-sulbactam for M. catarrhalis. The median duration of antimicrobial therapy was 14 days in both groups. No patients required pediatric intensive care unit (PICU) care and no 28-day mortality occurred.

Conclusion: The patients with bacteremia due to M. osloensis or M. catarrhalis had favorable clinical outcomes.

Background: The implementation of the antimicrobial stewardship program (ASP) has become a standard practice aimed at optimizing antimicrobial prescriptions to prevent further development of drug-resistant organisms. However, the challenges faced in long-term care facilities (LTCFs) often present a scarcity of human resources crucial for the effective implementation of ASP initiatives. Our study was to evaluate the impact of feasible ASP in the LTCF.

Methods: A quasi-experimental study was conducted at the Tokyo Metropolitan Fuchu Medical Center for the Disabled serving as a LTCF in Japan. The pre- and post-intervention periods were from April 2013 to March 2018 and from April 2018 to March 2019, respectively. Multidisciplinary ASP, including periodic educational interventions, utilization of internal treatment manuals, pre-authorization, and prospective audit and feedback on prescribing practices, was administered by the infectious diseases team from the Tokyo Metropolitan Children's Medical Center. We compared days of antimicrobial therapy (DOT) and resistance rates between the pre- and post-intervention phases.

Results: Following the intervention, there was a noteworthy decline in the use of oral broad-spectrum antimicrobials (macrolides, fluoroquinolones, and third-generation cephalosporins), demonstrating a statistically significant level of change (p < 0.05). Throughout the study period, resistance rates of Escherichia coli and Pseudomonas aeruginosa to meropenem and levofloxacin remained largely stable, with no notable changes observed.

Conclusion: In this study, extending the expertise of antimicrobial stewardship from an adjoining acute-care facility to a LTCF was associated with a 42% reduction in the use of oral broad-spectrum antimicrobials.