BACKGROUNDRespiratory syncytial virus (RSV) is a major cause of pediatric respiratory tract infections. In Japan, children with specific underlying conditions are eligible to receive palivizumab to prevent severe RSV disease. However, the association between palivizumab eligibility and RSV infection severity remains unclear. This study examined RSV infection severity and hospitalization outcomes in Japanese infants and children according to palivizumab eligibility and identified their associated factors.METHODSUsing insurance claims data from 12 municipalities, we identified RSV cases aged ≤24 months between April 2017 and March 2022. The patients' characteristics and hospitalization status were analyzed according to the presence of palivizumab-indicated underlying conditions. Regression models were used to identify factors associated with hospitalization, length of stay (LOS), and hospital expenditures.RESULTSWe analyzed 1025 first-time RSV cases (860 infants <12 months and 165 children 12-24 months old). There were 777 (90.3%) palivizumab-ineligible infants and 83 (9.7%) palivizumab-eligible infants. Only 13 (15.7%) palivizumab-eligible infants had received palivizumab in the month before RSV infection, and 8 required hospitalization. RSV hospitalization was significantly associated with age (odds ratio: 0.84, 95% confidence interval: 0.79-0.88), palivizumab-indicated underlying conditions (1.82, 1.13-2.89), and non-indicated high-risk conditions (4.87, 2.28-10.99). These factors were also associated with LOS. Hospital expenditures were associated with age, high-risk conditions and LOS.CONCLUSIONSPalivizumab-indicated underlying conditions, high-risk conditions, and younger age are risk factors for RSV hospitalization. Most hospitalized patients did not receive palivizumab in the month before RSV infection despite being eligible, suggesting that some hospitalizations were preventable through appropriate palivizumab use.
{"title":"Factors Associated With Hospitalization, Length of Stay, and Hospital Expenditures for Respiratory Syncytial Virus Infection in Japanese Infants and Children According to Palivizumab-indicated Underlying Conditions: The LIFE Study.","authors":"Masako Inoue,Megumi Maeda,Fumiko Murata,Haruhisa Fukuda","doi":"10.1097/inf.0000000000004543","DOIUrl":"https://doi.org/10.1097/inf.0000000000004543","url":null,"abstract":"BACKGROUNDRespiratory syncytial virus (RSV) is a major cause of pediatric respiratory tract infections. In Japan, children with specific underlying conditions are eligible to receive palivizumab to prevent severe RSV disease. However, the association between palivizumab eligibility and RSV infection severity remains unclear. This study examined RSV infection severity and hospitalization outcomes in Japanese infants and children according to palivizumab eligibility and identified their associated factors.METHODSUsing insurance claims data from 12 municipalities, we identified RSV cases aged ≤24 months between April 2017 and March 2022. The patients' characteristics and hospitalization status were analyzed according to the presence of palivizumab-indicated underlying conditions. Regression models were used to identify factors associated with hospitalization, length of stay (LOS), and hospital expenditures.RESULTSWe analyzed 1025 first-time RSV cases (860 infants <12 months and 165 children 12-24 months old). There were 777 (90.3%) palivizumab-ineligible infants and 83 (9.7%) palivizumab-eligible infants. Only 13 (15.7%) palivizumab-eligible infants had received palivizumab in the month before RSV infection, and 8 required hospitalization. RSV hospitalization was significantly associated with age (odds ratio: 0.84, 95% confidence interval: 0.79-0.88), palivizumab-indicated underlying conditions (1.82, 1.13-2.89), and non-indicated high-risk conditions (4.87, 2.28-10.99). These factors were also associated with LOS. Hospital expenditures were associated with age, high-risk conditions and LOS.CONCLUSIONSPalivizumab-indicated underlying conditions, high-risk conditions, and younger age are risk factors for RSV hospitalization. Most hospitalized patients did not receive palivizumab in the month before RSV infection despite being eligible, suggesting that some hospitalizations were preventable through appropriate palivizumab use.","PeriodicalId":501652,"journal":{"name":"The Pediatric Infectious Disease Journal","volume":"53 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142193796","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
BACKGROUNDThis study aimed to determine whether the maximum diameter of ileocecal lymph nodes measured using abdominal ultrasonography is useful for differentiating Yersinia pseudotuberculosis infection from Kawasaki disease in the acute phase. The optimal maximum diameter cutoff of the ileocecal lymph nodes was also explored to optimize differentiation between these 2 diseases.METHODSWe included pediatric patients <15 years old who met the diagnostic criteria for Kawasaki disease. Stool culture testing, loop-mediated isothermal amplification of stool specimens, and serological diagnosis were performed to confirm the presence or absence of Y. pseudotuberculosis infection.RESULTSOf the 122 patients included in the analysis, 17 were confirmed to have Y. pseudotuberculosis infection and 105 were not. The age (in months), white blood cell count, C-reactive protein level, prediction score (risk score) for nonresponse to intravenous immunoglobulin, and number of intravenous immunoglobulin doses did not differ significantly between the Y. pseudotuberculosis-positive and -negative groups. The maximum diameter of ileocecal lymph nodes was 6.0 (5.5-9.5) mm in the Y. pseudotuberculosis-positive group and 3.0 (2.5-3.8) mm in the Y. pseudotuberculosis-negative group (numbers presented as median, interquartile range), with a significantly larger diameter in the Y. pseudotuberculosis-positive group (P < 0.01, Mann-Whitney U test), suggesting potency of ultrasonography.CONCLUSIONIn patients meeting the diagnostic criteria for Kawasaki disease, the possibility of Y. pseudotuberculosis infection is significantly higher if the maximum ileocecal lymph node diameter ≥5.1 mm. Its sensitivity and specificity being 100%, and 89.5%, respectively.
{"title":"Maximum Diameter of Ileocecal Lymph Nodes Measured Using Abdominal Ultrasonography Allows for the Discrimination of Yersinia pseudotuberculosis Infection from Kawasaki Disease.","authors":"Atsushi Kato,Ippei Miyata,Yoshitaka Nakamura,Takaaki Tanaka,Yutaka Koguchi,Tomohiro Oishi,Takashi Nakano,Kazunobu Ouchi","doi":"10.1097/inf.0000000000004531","DOIUrl":"https://doi.org/10.1097/inf.0000000000004531","url":null,"abstract":"BACKGROUNDThis study aimed to determine whether the maximum diameter of ileocecal lymph nodes measured using abdominal ultrasonography is useful for differentiating Yersinia pseudotuberculosis infection from Kawasaki disease in the acute phase. The optimal maximum diameter cutoff of the ileocecal lymph nodes was also explored to optimize differentiation between these 2 diseases.METHODSWe included pediatric patients <15 years old who met the diagnostic criteria for Kawasaki disease. Stool culture testing, loop-mediated isothermal amplification of stool specimens, and serological diagnosis were performed to confirm the presence or absence of Y. pseudotuberculosis infection.RESULTSOf the 122 patients included in the analysis, 17 were confirmed to have Y. pseudotuberculosis infection and 105 were not. The age (in months), white blood cell count, C-reactive protein level, prediction score (risk score) for nonresponse to intravenous immunoglobulin, and number of intravenous immunoglobulin doses did not differ significantly between the Y. pseudotuberculosis-positive and -negative groups. The maximum diameter of ileocecal lymph nodes was 6.0 (5.5-9.5) mm in the Y. pseudotuberculosis-positive group and 3.0 (2.5-3.8) mm in the Y. pseudotuberculosis-negative group (numbers presented as median, interquartile range), with a significantly larger diameter in the Y. pseudotuberculosis-positive group (P < 0.01, Mann-Whitney U test), suggesting potency of ultrasonography.CONCLUSIONIn patients meeting the diagnostic criteria for Kawasaki disease, the possibility of Y. pseudotuberculosis infection is significantly higher if the maximum ileocecal lymph node diameter ≥5.1 mm. Its sensitivity and specificity being 100%, and 89.5%, respectively.","PeriodicalId":501652,"journal":{"name":"The Pediatric Infectious Disease Journal","volume":"69 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142193746","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Probiotics are generally considered safe and used to improve intestinal function. Here, we report a Lacticaseibacillus paracasei bacteremia case in an 8-month-old girl administered probiotics containing L. paracasei after jejunostomy for hypoganglionosis. The patient had persistent bacteremia with L. paracasei and was treated with antimicrobial therapy. The isolate from the blood culture was genetically indistinguishable to the strain contained in probiotics. Bacteremia risk should be considered before probiotic use in patients with underlying compromised immune systems or intestinal integrity.
{"title":"Lacticaseibacillus paracasei Bacteremia Associated With Probiotic Use in a Child With Hypoganglionosis: Case Report and Literature Review.","authors":"Kohei Ukai,Koh Okamoto,Akinori Ichinose,Mariko Yoshida,Yoshimi Higurashi,Ryu Yoneda,Shuta Yamamoto,Takashi Asahara","doi":"10.1097/inf.0000000000004548","DOIUrl":"https://doi.org/10.1097/inf.0000000000004548","url":null,"abstract":"Probiotics are generally considered safe and used to improve intestinal function. Here, we report a Lacticaseibacillus paracasei bacteremia case in an 8-month-old girl administered probiotics containing L. paracasei after jejunostomy for hypoganglionosis. The patient had persistent bacteremia with L. paracasei and was treated with antimicrobial therapy. The isolate from the blood culture was genetically indistinguishable to the strain contained in probiotics. Bacteremia risk should be considered before probiotic use in patients with underlying compromised immune systems or intestinal integrity.","PeriodicalId":501652,"journal":{"name":"The Pediatric Infectious Disease Journal","volume":"153 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142193750","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-06DOI: 10.1097/inf.0000000000004507
Abdullah Zeid Alsuheili,Mohammed Abdullah Alsubaie,Abeer A Alnajjar,Nawaf Al-Dajani
This case report details the fourth documented case of urinary tract infection caused by Kluyvera cryocrescens and the first in a neonate. Including a brief literature review on urinary tract infections associated with this organism, the report highlights the importance of considering uncommon pathogens in neonatal infections and the necessity of a thorough diagnostic approach to initiate appropriate antimicrobial treatment.
{"title":"KLUYVERA CRYOCRESCENS URINARY TRACT INFECTION IN A NEONATE: A CASE REPORT AND LITERATURE REVIEW.","authors":"Abdullah Zeid Alsuheili,Mohammed Abdullah Alsubaie,Abeer A Alnajjar,Nawaf Al-Dajani","doi":"10.1097/inf.0000000000004507","DOIUrl":"https://doi.org/10.1097/inf.0000000000004507","url":null,"abstract":"This case report details the fourth documented case of urinary tract infection caused by Kluyvera cryocrescens and the first in a neonate. Including a brief literature review on urinary tract infections associated with this organism, the report highlights the importance of considering uncommon pathogens in neonatal infections and the necessity of a thorough diagnostic approach to initiate appropriate antimicrobial treatment.","PeriodicalId":501652,"journal":{"name":"The Pediatric Infectious Disease Journal","volume":"16 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142260987","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-06DOI: 10.1097/inf.0000000000004514
Tengfei Long,Xuejiao Hu,Ting Liu,Guanfeng Hu,Jie Fu,Jing Fu
BACKGROUNDHealthcare-associated infections (HAIs) are a common clinical concern associated with adverse prognosis and mortality in burned children. This study aimed to construct a predictive nomogram of the risk of HAIs in burned children.METHODSChildren admitted to the burn unit of Wuhan Third Hospital between 2020 and 2022 were included. The univariate and multivariate logistic regression analyses were adopted to ascertain predictors of HAIs. A nomogram was developed to predict the HAI risk of each patient, with receiver operating characteristic curves and calibration curves being generated to assess its predictive ability. Furthermore, decision and impact curves were used to assess the clinical utility.RESULTSOf 1122 burned children, 61 (5.5%) patients experienced HAIs. The multivariate analysis indicated that total burn surface area, length of stay, surgery, central venous catheter use and urinary catheter use were the independent risk factors of HAIs. Using these variables, we developed a predictive nomogram of the occurrence of HAIs in burned children, and the internal validation results demonstrated good discrimination and calibration of the nomogram. The area under the curve values of the nomogram was 0.926 (95% CI, 0.896-0.957). The calibration curve showed high consistency between the actual and predicted HAIs. The decision and impact curve indicated that the nomogram was of good clinical utility and more credible net clinical benefits in predicting HAIs.CONCLUSIONSThe present study constructed a nomogram for predicting the risk of HAIs in burned children. This nomogram may strengthen the effective screening of patients at high risk of HAIs.
背景医疗相关感染（HAIs）是一种常见的临床问题，与烧伤儿童的不良预后和死亡率相关。本研究旨在构建烧伤儿童 HAIs 风险预测提名图。采用单变量和多变量逻辑回归分析来确定HAIs的预测因素。通过生成接收者操作特征曲线和校准曲线来评估其预测能力。结果 在 1122 名烧伤儿童中，61 名（5.5%）患者出现 HAI。多变量分析表明，烧伤总面积、住院时间、手术、使用中心静脉导管和导尿管是导致 HAIs 的独立风险因素。利用这些变量，我们绘制了烧伤儿童 HAI 发生率的预测提名图，内部验证结果表明提名图具有良好的区分度和校准性。提名图的曲线下面积值为 0.926（95% CI，0.896-0.957）。校准曲线显示实际 HAI 与预测 HAI 高度一致。决策和影响曲线表明，提名图在预测 HAI 方面具有良好的临床实用性和更可信的净临床收益。本研究构建了一个预测烧伤儿童 HAIs 风险的提名图，该提名图可加强对 HAIs 高风险患者的有效筛查。
{"title":"A Nomogram of Predicting Healthcare-Associated Infections in Burned Children.","authors":"Tengfei Long,Xuejiao Hu,Ting Liu,Guanfeng Hu,Jie Fu,Jing Fu","doi":"10.1097/inf.0000000000004514","DOIUrl":"https://doi.org/10.1097/inf.0000000000004514","url":null,"abstract":"BACKGROUNDHealthcare-associated infections (HAIs) are a common clinical concern associated with adverse prognosis and mortality in burned children. This study aimed to construct a predictive nomogram of the risk of HAIs in burned children.METHODSChildren admitted to the burn unit of Wuhan Third Hospital between 2020 and 2022 were included. The univariate and multivariate logistic regression analyses were adopted to ascertain predictors of HAIs. A nomogram was developed to predict the HAI risk of each patient, with receiver operating characteristic curves and calibration curves being generated to assess its predictive ability. Furthermore, decision and impact curves were used to assess the clinical utility.RESULTSOf 1122 burned children, 61 (5.5%) patients experienced HAIs. The multivariate analysis indicated that total burn surface area, length of stay, surgery, central venous catheter use and urinary catheter use were the independent risk factors of HAIs. Using these variables, we developed a predictive nomogram of the occurrence of HAIs in burned children, and the internal validation results demonstrated good discrimination and calibration of the nomogram. The area under the curve values of the nomogram was 0.926 (95% CI, 0.896-0.957). The calibration curve showed high consistency between the actual and predicted HAIs. The decision and impact curve indicated that the nomogram was of good clinical utility and more credible net clinical benefits in predicting HAIs.CONCLUSIONSThe present study constructed a nomogram for predicting the risk of HAIs in burned children. This nomogram may strengthen the effective screening of patients at high risk of HAIs.","PeriodicalId":501652,"journal":{"name":"The Pediatric Infectious Disease Journal","volume":"25 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142193751","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
BACKGROUNDCoagulase-negative staphylococci (CONS) are a major cause of late-onset neonatal sepsis, particularly in preterm infants, with high morbidity and mortality. While vancomycin is the first-line treatment for these infections, the optimal administration in neonates remains uncertain.OBJECTIVEWe aim to compare the outcomes of neonates with CONS bacteremia treated with adjusted continuous infusion (CIV) versus standard intermittent infusion (IIV) of vancomycin.METHODSThis retrospective study included 110 neonates, with 29 in the CIV group and 47 in the IIV group after propensity score matching. The primary outcome was treatment failure defined by the persistence of a positive blood culture for the same organism after at least 48 hours of vancomycin treatment.RESULTSAfter matching, the CIV group exhibited significantly lower treatment failure rates [5/29 (17%) vs. 26/47 (44%); P = 0.014] and a higher rate of achieving therapeutic vancomycin levels after 24 hours [20/29 (69%) vs. 26/47 (44%); P = 0.002] compared to the IIV group. No significant differences were observed in terms of acute kidney failure between the 2 groups.CONCLUSIONAdjusted continuous vancomycin infusion in neonates with CONS bacteremia is associated with a lower treatment failure rate without an increase in renal toxicity compared to standard intermittent infusion. However, due to the observational design, larger prospective studies are needed to validate these results.
背景凝固酶阴性葡萄球菌（CONS）是晚发新生儿败血症的主要病因，尤其是在早产儿中，其发病率和死亡率都很高。虽然万古霉素是治疗这些感染的一线药物，但新生儿的最佳用药仍不确定。目的我们旨在比较新生儿 CONS 菌血症患者接受调整后持续输注（CIV）与标准间歇输注（IIV）万古霉素治疗的结果。方法这项回顾性研究纳入了 110 名新生儿，经过倾向评分匹配后，CIV 组 29 人，IIV 组 47 人。结果匹配后，与 IIV 组相比，CIV 组的治疗失败率明显降低 [5/29 (17%) vs. 26/47 (44%); P = 0.014]，24 小时后万古霉素达到治疗水平的比率更高 [20/29 (69%) vs. 26/47 (44%); P = 0.002]。结论与标准间歇输注相比，调整后的万古霉素持续输注在新生儿CONS菌血症中的治疗失败率较低，且不会增加肾毒性。然而，由于该研究采用的是观察性设计，因此需要更大规模的前瞻性研究来验证这些结果。
{"title":"Continuous Versus Intermittent Vancomycin Infusions for Coagulase-negative Staphylococcus Bacteremia in Neonates: A Propensity-matched Cohort Study.","authors":"Rémy Gérard,Emilie Pauquet,Barbara Ros,Philippe Lehours,Laurent Renesme","doi":"10.1097/inf.0000000000004538","DOIUrl":"https://doi.org/10.1097/inf.0000000000004538","url":null,"abstract":"BACKGROUNDCoagulase-negative staphylococci (CONS) are a major cause of late-onset neonatal sepsis, particularly in preterm infants, with high morbidity and mortality. While vancomycin is the first-line treatment for these infections, the optimal administration in neonates remains uncertain.OBJECTIVEWe aim to compare the outcomes of neonates with CONS bacteremia treated with adjusted continuous infusion (CIV) versus standard intermittent infusion (IIV) of vancomycin.METHODSThis retrospective study included 110 neonates, with 29 in the CIV group and 47 in the IIV group after propensity score matching. The primary outcome was treatment failure defined by the persistence of a positive blood culture for the same organism after at least 48 hours of vancomycin treatment.RESULTSAfter matching, the CIV group exhibited significantly lower treatment failure rates [5/29 (17%) vs. 26/47 (44%); P = 0.014] and a higher rate of achieving therapeutic vancomycin levels after 24 hours [20/29 (69%) vs. 26/47 (44%); P = 0.002] compared to the IIV group. No significant differences were observed in terms of acute kidney failure between the 2 groups.CONCLUSIONAdjusted continuous vancomycin infusion in neonates with CONS bacteremia is associated with a lower treatment failure rate without an increase in renal toxicity compared to standard intermittent infusion. However, due to the observational design, larger prospective studies are needed to validate these results.","PeriodicalId":501652,"journal":{"name":"The Pediatric Infectious Disease Journal","volume":"26 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142193753","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-05DOI: 10.1097/inf.0000000000004535
Tahmina A Jahan,Norman A Lapin,Michael T O'Connell,Chanhee Jo,Yuhan Ma,Naureen G Tareen,Lawson A Copley
BACKGROUNDSeverity of illness determination for children with acute hematogenous osteomyelitis should be accomplished during the earliest stages of evaluation to guide treatment and establish prognosis. This study objectively defines an outcome of complicated osteomyelitis and explores an illness severity-based model with an improved ability to predict this outcome as soon and accurately as possible, comparing it to existing models.METHODSChildren with Staphylococcus aureus acute hematogenous osteomyelitis (n = 438) were retrospectively studied to identify adverse events and predictors of severity. The outcome of complicated osteomyelitis was ultimately defined as the occurrence of any major or at least 3 minor adverse events, which occurred in 52 children. Twenty-four clinical and laboratory predictors were evaluated through univariate and stacked multivariable regression analyses of chronologically distinct groups of variables. Receiver operating characteristic curve analyses were conducted to compare models.RESULTSAccelerated Severity of Illness Score included: triage tachycardia [odds ratio: 10.2 (95% confidence interval: 3.48-32.3], triage tachypnea [6.0 (2.4-15.2)], C-reactive proteininitial ≥17.2 mg/dL [4.5 (1.8-11.8)], white blood cell count band percentageinitial >3.8% [4.6 (2.0-11.0)], hemoglobininitial ≤10.4 g/dL [6.0 (2.6-14.7)], methicillin-resistant S. aureus [3.0 (1.2-8.5)], septic arthritis [4.5 (1.8-12.3)] and platelet nadir [7.2 (2.7-20.4)]. The receiver operating characteristic curve of Accelerated Severity of Illness Score [area under the curve = 0.96 (0.941-0.980)] were superior to those of Modified Severity of Illness Score = 0.903 (0.859-0.947), Acute Score for Complications of Osteomyelitis Risk Evaluation = 0.878 (0.830-0.926) and Chronic Score for Complications of Osteomyelitis Risk Evaluation = 0.858 (0.811-0.904). Successive receiver operating characteristic curve analyses established an exponentially increasing risk of complicated osteomyelitis for children with mild (0/285 or 0%), moderate (4/63 or 6.3%), severe (15/50 or 30.0%) and hyper-severe (33/40 or 82.5%) acute hematogenous osteomyelitis (P<0.0001).CONCLUSIONSThis study improves upon previous severity of illness models by identifying early predictors of a rigorously defined outcome of complicated osteomyelitis.
{"title":"Accelerated Severity of Illness Score Enhances Prediction of Complicated Acute Hematogenous Osteomyelitis in Children.","authors":"Tahmina A Jahan,Norman A Lapin,Michael T O'Connell,Chanhee Jo,Yuhan Ma,Naureen G Tareen,Lawson A Copley","doi":"10.1097/inf.0000000000004535","DOIUrl":"https://doi.org/10.1097/inf.0000000000004535","url":null,"abstract":"BACKGROUNDSeverity of illness determination for children with acute hematogenous osteomyelitis should be accomplished during the earliest stages of evaluation to guide treatment and establish prognosis. This study objectively defines an outcome of complicated osteomyelitis and explores an illness severity-based model with an improved ability to predict this outcome as soon and accurately as possible, comparing it to existing models.METHODSChildren with Staphylococcus aureus acute hematogenous osteomyelitis (n = 438) were retrospectively studied to identify adverse events and predictors of severity. The outcome of complicated osteomyelitis was ultimately defined as the occurrence of any major or at least 3 minor adverse events, which occurred in 52 children. Twenty-four clinical and laboratory predictors were evaluated through univariate and stacked multivariable regression analyses of chronologically distinct groups of variables. Receiver operating characteristic curve analyses were conducted to compare models.RESULTSAccelerated Severity of Illness Score included: triage tachycardia [odds ratio: 10.2 (95% confidence interval: 3.48-32.3], triage tachypnea [6.0 (2.4-15.2)], C-reactive proteininitial ≥17.2 mg/dL [4.5 (1.8-11.8)], white blood cell count band percentageinitial >3.8% [4.6 (2.0-11.0)], hemoglobininitial ≤10.4 g/dL [6.0 (2.6-14.7)], methicillin-resistant S. aureus [3.0 (1.2-8.5)], septic arthritis [4.5 (1.8-12.3)] and platelet nadir [7.2 (2.7-20.4)]. The receiver operating characteristic curve of Accelerated Severity of Illness Score [area under the curve = 0.96 (0.941-0.980)] were superior to those of Modified Severity of Illness Score = 0.903 (0.859-0.947), Acute Score for Complications of Osteomyelitis Risk Evaluation = 0.878 (0.830-0.926) and Chronic Score for Complications of Osteomyelitis Risk Evaluation = 0.858 (0.811-0.904). Successive receiver operating characteristic curve analyses established an exponentially increasing risk of complicated osteomyelitis for children with mild (0/285 or 0%), moderate (4/63 or 6.3%), severe (15/50 or 30.0%) and hyper-severe (33/40 or 82.5%) acute hematogenous osteomyelitis (P<0.0001).CONCLUSIONSThis study improves upon previous severity of illness models by identifying early predictors of a rigorously defined outcome of complicated osteomyelitis.","PeriodicalId":501652,"journal":{"name":"The Pediatric Infectious Disease Journal","volume":"79 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142193754","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-24DOI: 10.1097/INF.0000000000004364
Mulatu Gashaw, Solomon Ali, M. Berhane, Getnet Tesfaw, Beza Eshetu, N. Workneh, Thomas Seeholzer, G. Froeschl, Arne Kroidl, Andreas Wieser, E. K. Gudina
BACKGROUND The burden of multidrug-resistant bacterial infections in low-income countries is alarming. This study aimed to identify the bacterial etiologies and antibiotic resistance patterns among neonates in Jimma, Ethiopia. METHODS An observational longitudinal study was conducted among 238 presumptive neonatal sepsis cases tested with blood and/or cerebrospinal fluid culture. The bacterial etiologies were confirmed using matrix-assisted laser desorption ionization-time of flight mass spectrometry. The antibiotic resistance patterns were determined using the automated disc diffusion method (Bio-Rad) and the results were interpreted based on the European Committee on Antimicrobial Susceptibility Testing 2021 breakpoints. Extended-spectrum β-lactamases were detected using a double disc synergy test and confirmed by Mast discs (Mast Diagnostica GmbH). RESULTS A total of 152 pathogens were identified. Of these, Staphylococcus aureus (18.4%) was the predominant isolate followed by Klebsiella pneumoniae (15.1%) and Escherichia coli (10.5%). All the isolates exhibited a high rate of resistance to first- and second-line antibiotics ranging from 73.3% for gentamicin to 93.3% for ampicillin. Furthermore, 74.4% of the Gram-negative isolates were extended-spectrum β-lactamase producers and 57.1% of S. aureus strains were methicillin resistant. The case fatality rate was 10.1% and 66.7% of the deaths were attributable to infections by multidrug-resistant pathogens. CONCLUSIONS The study revealed a high rate of infections with multidrug-resistant pathogens. This poses a significant challenge to the current global and national target to reduce neonatal mortality rates. To address these challenges, it is important to employ robust infection prevention practices and continuous antibiotic resistance testing to allow targeted therapy.
{"title":"Neonatal Sepsis Due to Multidrug-resistant Bacteria at a Tertiary Teaching Hospital in Ethiopia.","authors":"Mulatu Gashaw, Solomon Ali, M. Berhane, Getnet Tesfaw, Beza Eshetu, N. Workneh, Thomas Seeholzer, G. Froeschl, Arne Kroidl, Andreas Wieser, E. K. Gudina","doi":"10.1097/INF.0000000000004364","DOIUrl":"https://doi.org/10.1097/INF.0000000000004364","url":null,"abstract":"BACKGROUND\u0000The burden of multidrug-resistant bacterial infections in low-income countries is alarming. This study aimed to identify the bacterial etiologies and antibiotic resistance patterns among neonates in Jimma, Ethiopia.\u0000\u0000\u0000METHODS\u0000An observational longitudinal study was conducted among 238 presumptive neonatal sepsis cases tested with blood and/or cerebrospinal fluid culture. The bacterial etiologies were confirmed using matrix-assisted laser desorption ionization-time of flight mass spectrometry. The antibiotic resistance patterns were determined using the automated disc diffusion method (Bio-Rad) and the results were interpreted based on the European Committee on Antimicrobial Susceptibility Testing 2021 breakpoints. Extended-spectrum β-lactamases were detected using a double disc synergy test and confirmed by Mast discs (Mast Diagnostica GmbH).\u0000\u0000\u0000RESULTS\u0000A total of 152 pathogens were identified. Of these, Staphylococcus aureus (18.4%) was the predominant isolate followed by Klebsiella pneumoniae (15.1%) and Escherichia coli (10.5%). All the isolates exhibited a high rate of resistance to first- and second-line antibiotics ranging from 73.3% for gentamicin to 93.3% for ampicillin. Furthermore, 74.4% of the Gram-negative isolates were extended-spectrum β-lactamase producers and 57.1% of S. aureus strains were methicillin resistant. The case fatality rate was 10.1% and 66.7% of the deaths were attributable to infections by multidrug-resistant pathogens.\u0000\u0000\u0000CONCLUSIONS\u0000The study revealed a high rate of infections with multidrug-resistant pathogens. This poses a significant challenge to the current global and national target to reduce neonatal mortality rates. To address these challenges, it is important to employ robust infection prevention practices and continuous antibiotic resistance testing to allow targeted therapy.","PeriodicalId":501652,"journal":{"name":"The Pediatric Infectious Disease Journal","volume":"42 7","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140662557","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-24DOI: 10.1097/INF.0000000000004377
Nursel Atay Ünal, Nursel Kara Ulu, Elif Güdeloğlu, Tuğba Bedir Demirdağ, Meltem Polat, Hasan Tezer, A. Tapısız
{"title":"A Case of Late Congenital Syphilis.","authors":"Nursel Atay Ünal, Nursel Kara Ulu, Elif Güdeloğlu, Tuğba Bedir Demirdağ, Meltem Polat, Hasan Tezer, A. Tapısız","doi":"10.1097/INF.0000000000004377","DOIUrl":"https://doi.org/10.1097/INF.0000000000004377","url":null,"abstract":"","PeriodicalId":501652,"journal":{"name":"The Pediatric Infectious Disease Journal","volume":"26 11","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140659714","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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