Journal of the Pediatric Infectious Diseases Society最新文献

{"title":"Heterogeneity in racial and ethnic disparities in COVID-19 severity among pediatric inpatients in a national healthcare database.","authors":"David Watson, Alicen B Spaulding, Laura Norton","doi":"10.1093/jpids/piaf092","DOIUrl":"https://doi.org/10.1093/jpids/piaf092","url":null,"abstract":"<p><strong>Background: </strong>The COVID-19 pandemic magnified longstanding racial and ethnic disparities in pediatric health, but it is unclear which populations experienced the largest disparities. Our objective was to determine if disparities in COVID-19 severity differed with respect to patient factors analyzed as effect modifiers.</p><p><strong>Methods: </strong>Using data from the Premier Healthcare Database, this retrospective cohort study included encounters among inpatients <19 years old from April 2020 through September 2022 in the US with COVID-19 diagnosis. Outcomes of COVID-19 severity were intensive care unit (ICU) admission and ventilator use. Comparisons between Black and White patients and Hispanic and White patients were adjusted for confounders using propensity score weights, reported as risk differences (RDs) in percentage points, and tested for heterogeneity (interaction-p) across subgroups of effect modifiers such as complex chronic conditions (CCCs) and insurance status.</p><p><strong>Results: </strong>Of 8947 pediatric inpatients with primary COVID-19 diagnosis, 3858 were White, 2153 were Black, and 2936 were Hispanic. Among children with a CCC, 14.3% of Black inpatients required a ventilator compared to 9.8% of White inpatients; among children without a CCC, 3.2% of both Black and White inpatients required a ventilator (RDs 4.5 vs. 0.0; interaction-p=.013). Comparisons of Hispanic and White inpatients showed a similar trend in ventilator use, with larger disparities among inpatients with CCCs and no difference among those without CCCs (RDs 2.7 vs. -0.7; interaction-p=.031). Among children with government insurance, 25.9% of Black inpatients were admitted to the ICU compared to 20.8% of White inpatients; among children with private insurance, Black and White inpatients had comparable ICU admission rates of 20.0% and 21.4%, respectively (RDs 5.1 vs. -1.4; interaction-p=.025).</p><p><strong>Conclusions: </strong>Among hospitalized children, racial and ethnic disparities in COVID-19 severity were largest for those with CCCs or government insurance. These results can help identify target populations for interventions to reduce inequity.</p>","PeriodicalId":17374,"journal":{"name":"Journal of the Pediatric Infectious Diseases Society","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145251742","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Off-target impact of clinician feedback reports on antibiotic use in children with medical complexity hospitalized with community-acquired pneumonia.","authors":"Kathleen Chiotos, Lauren Dutcher, Robert W Grundmeier, Julia E Szymczak, Ebbing Lautenbach, Melinda M Neuhauser, Lauri A Hicks, Keith W Hamilton, Yun Li, Brandi M Muller, Didien Meyahnwi, Morgan Congdon, Emily Kane, Jessica Hart, Levon Utidjian, Leigh Cressman, Anne Jaskowiak-Barr, Jeffrey S Gerber","doi":"10.1093/jpids/piaf089","DOIUrl":"https://doi.org/10.1093/jpids/piaf089","url":null,"abstract":"<p><p>In prior work, we demonstrated that clinician audit and feedback reports summarizing adherence to appropriate antibiotic choice and duration metrics in previously healthy children with non-severe community-acquired pneumonia (CAP) were associated with improved antibiotic use in this population. In this exploratory study, we evaluated the off-target impact of these reports on antibiotic choice and duration in a small cohort of medically complex children cared for concurrently by these same clinicians. The feedback report-based intervention was also associated with an increase in adherence to the appropriate antibiotic choice and duration metrics among the medically complex children, despite these children being excluded from the reports. These preliminary, hypothesis generating findings provide proof-of-principle that the impact of clinician feedback reports is broader than the population specifically included in the report, and should inform future studies evaluating the safety and effectiveness of feedback-report based interventions.</p>","PeriodicalId":17374,"journal":{"name":"Journal of the Pediatric Infectious Diseases Society","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145232838","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fluoroquinolone Susceptibility and Comparative Outcomes of Gram-negative Bloodstream Infection in Pediatric Patients with Hematologic Malignancy.","authors":"Eleana Vasileiadi, Caitlin W Elgarten, Kelly D Getz, Richard Aplenc, Brian T Fisher","doi":"10.1093/jpids/piaf091","DOIUrl":"https://doi.org/10.1093/jpids/piaf091","url":null,"abstract":"<p><strong>Background: </strong>Bacterial bloodstream infections (BSI) cause morbidity and mortality in children with chemotherapy-associated neutropenia. While levofloxacin prophylaxis reduces BSI incidence, breakthrough infections occur in ~20%, often with fluoroquinolone non-susceptible (FQN-NS) gram-negative (GN) pathogens. The impact of FQN-NS on outcomes of GN BSI remains unknown. This study compares outcomes in pediatric patients with hematologic malignancies following FQN-NS vs. fluoroquinolone-susceptible (FQN-S) GN BSI.</p><p><strong>Methods: </strong>A single-center cohort of pediatric patients with hematologic malignancies and neutropenia-associated GN BSI between 2014 and 2023 was retrospectively collected. The exposure was dichotomized as FQN-NS vs. FQN-S. Primary outcomes were ICU admission and 30-day all-cause mortality, assessed from the day before to 30-days after blood culture collection. Modified Poisson regression with inverse probability of treatment weighting (IPTW) was used to balance covariates including age, calendar year of diagnosis, time from malignancy onset, cumulative neutropenia, G-CSF use, international status, relapse/refractory disease, and type of underlying hematologic malignancy. A subgroup analysis assessed effect modification by resistance to empiric therapy. Only five patients contributed multiple events; clustering adjustments were not made.</p><p><strong>Results: </strong>Among 119 GN BSI events, 82 (68.9%) were FQN-S and 37 (31.1%) FQN-NS. In IPTW-adjusted analyses, FQN-NS BSI was associated with higher 30-day all-cause mortality (aRR: 2.62, 95% CI: 0.39-17.64) and sepsis-related mortality (aRR: 2.60, 95% CI: 0.16-41.65), although confidence intervals were wide and not statistically significant. In a subgroup restricted to patients who received effective empiric therapy, estimates further reverted toward the null.</p><p><strong>Conclusions: </strong>FQN-NS GN BSI during neutropenia after chemotherapy was associated with increased 30-day all-cause and sepsis-related mortality in pediatric patients with hematologic malignancies, although not statistically significant. Effect modification by empiric therapy may have contributed to this association, suggesting that FQN-NS itself may not directly drive poor outcomes, but its impact appears mediated through resistance to empiric therapy, which is associated with worse outcomes.</p>","PeriodicalId":17374,"journal":{"name":"Journal of the Pediatric Infectious Diseases Society","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145225653","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Analyzing the Practice of Pediatric Infectious Diseases to Identify the Knowledge Tested on ABP Board Certification Exams.","authors":"Andrew C Dwyer, Alexis M Elward, Walter N Dehority, Mundeep K Kainth, Rebecca S Schein, Gordon E Schutze, Elizabeth H Ristagno","doi":"10.1093/jpids/piaf090","DOIUrl":"https://doi.org/10.1093/jpids/piaf090","url":null,"abstract":"<p><p>To ensure the Pediatric Infectious Diseases (ID) Certifying Examination remains aligned with current clinical practice, the American Board of Pediatrics (ABP) conducted a comprehensive practice analysis to update the exam content outline. A panel of nine pediatric ID physicians identified 34 core tasks across five performance domains to guide revisions to the existing outline. The panel identified relevant, testable knowledge areas aligned with these tasks and organized them into 22 domains and 186 initial subdomains. A nationwide validation survey of board-certified pediatric ID physicians collected relevance ratings, feedback on missing or outdated topics, and suggested exam weights, which was used to guide further revisions. Subsequently, the pediatric ID subboard conducted an item reclassification process, which resulted in additional refinement. The final content outline comprises 22 domains and 196 subdomains, with updated domain weights to better reflect the clinical landscape. Notably, domains such as cardiovascular, bone and joint, and urologic infections increased in weight, while antimicrobial principles decreased. This rigorous, inclusive process strengthens the exam's content validity and supports the ABP's goal of certifying physicians who possess the knowledge needed to deliver safe and effective care.</p>","PeriodicalId":17374,"journal":{"name":"Journal of the Pediatric Infectious Diseases Society","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145213013","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Childhood Pneumonia-Related Mortality Trends in the United States, 1999-2023.","authors":"Mark I Neuman, Chris A Rees","doi":"10.1093/jpids/piaf085","DOIUrl":"10.1093/jpids/piaf085","url":null,"abstract":"","PeriodicalId":17374,"journal":{"name":"Journal of the Pediatric Infectious Diseases Society","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12494196/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145091942","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Antifungal Prescribing in European Pediatric Intensive Care Units: Results of a Multinational 3-Month Weekly Point-Prevalence Survey†.","authors":"Elisavet Chorafa, Elias Iosifidis, Aisha Abdalla Alkhaaldi, Ana Arias, Benhur Sirvan Cetin, Maia De Luca, Marieke Emonts, Laura Ferreras-Antolin, Elisabetta Ghimenton-Walters, Carlos D Grasa, Andreas H Groll, Laura Herrera-Castillo, Thomas Lehrnbecher, Angela Manzanares, Katja Masjosthusmann, Susana Melendo, Natalia Mendoza-Palomar, Stéphane Paulus, Elena Rincón-López, Lorenza Romani, Maria Sdougka, Galina Solopova, Volker Strenger, Kara Tedford, Christina Tzika, Adilia Warris, Borbala Zsigmond, Emmanuel Roilides","doi":"10.1093/jpids/piaf081","DOIUrl":"10.1093/jpids/piaf081","url":null,"abstract":"<p><strong>Background: </strong>Critically ill pediatric patients admitted to the pediatric intensive care unit (PICU) are highly vulnerable to infections, including invasive fungal diseases and antifungal agents are frequently prescribed. Little is known about antifungal usage in PICUs across Europe.</p><p><strong>Methods: </strong>A multinational 3-month weekly point-prevalence study for measuring antifungal drug use was organized. Eigtheen PICUs (16 hospitals) in 10 countries in the European region participated. All patients hospitalized in the participating PICUs and receiving systemic antifungals were included. Information about ward demographics was collected once; weekly ward and patient data were collected prospectively for the 12-week study period and entered in REDCap database.</p><p><strong>Results: </strong>Among 18 PICUs, 8 (44%) followed prophylactic practices for targeted group of patients, 7/18 (39%) had an antifungal stewardship program and the majority (16/18, 89%) had the capacity of biomarker utilization (16/16 galactomannan, 13/16 beta-D-glucan, and 9/16 pan-fungal PCR). One hundred one courses in equal number of patients were recorded; 14 for patients aged <3 month, 87 for patients ≥3 month. Malignancy was the most common underlying condition among patients aged ≥3 month (29%) followed by surgery/trauma (25%), whereas all patients <3 month had undergone a recent surgery. Indication for antifungal prescribing was prophylaxis in 38% and treatment in 62% [empirical (57%), preemptive (13%), and targeted (30%)]. Fluconazole was the most common agent both for prophylaxis and treatment, whereas liposomal amphotericin B was the most frequent agent for targeted treatment. The majority (63%) of patients on prophylaxis were oncology or transplant patients. Common reasons for empirical and targeted treatment were persistent fever/other signs of infections in high-risk patients (61%) and Candida infections (100%), respectively. For targeted treatment, the most frequent pathogens were Candida albicans (37%) and Candida parapsilosis (32%).</p><p><strong>Conclusions: </strong>Most antifungal prescriptions across European PICUs were for treatment. Fluconazole was the most frequently prescribed antifungal. These surveillance data can guide antifungal stewardship strategies in PICUs.</p>","PeriodicalId":17374,"journal":{"name":"Journal of the Pediatric Infectious Diseases Society","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145030098","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk of Highly Pathogenic Avian Influenza A/H5N1 Virus in Pediatrics.","authors":"C Mary Healy","doi":"10.1093/jpids/piaf035","DOIUrl":"10.1093/jpids/piaf035","url":null,"abstract":"<p><p>Although the current risk of avian influenza A/H5N1 Virus infection in humans is low, children represent a high-risk group for severe disease as virus evolves. A/H5N1 vaccine development, clinical trials, and implementation strategies for infants and children should be prioritized. Highly pathogenic avian influenza A/H5N1 Virus has been found in multiple US states since 2024. While human infection risk is currently low, children are a high-risk group for severe infection as the virus evolves. Preventive efforts should prioritize children in vaccine and therapeutic clinical trials and vaccine implementation strategies.</p>","PeriodicalId":17374,"journal":{"name":"Journal of the Pediatric Infectious Diseases Society","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143999378","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Incidence and Predictors of HBsAg Loss in Treatment-Naïve Children With Immune-Tolerant Chronic Hepatitis B After Antiviral Therapy.","authors":"Yi Xu, ShuangJie Li, Yingping Gu, Meng Yang, Sisi Li, Ling Ye, Songxu Peng","doi":"10.1093/jpids/piaf083","DOIUrl":"10.1093/jpids/piaf083","url":null,"abstract":"<p><strong>Background: </strong>There are no established recommendations for the most suitable treatment of children with immune-tolerant chronic hepatitis B (CHB).To evaluate the clinical outcome of combination therapy among treatment-naïve children with immune-tolerant CHB, we conducted this study.</p><p><strong>Methods: </strong>We retrospectively identified pediatric patients who were diagnosed with immune-tolerant CHB and who received combination therapy with interferon-alpha or peginterferon-alpha-2a plus entecavir at Hunan Children's Hospital between August 2014 and April 2023. A total of 106 patients were ultimately enrolled in the study. Complete clinical data were collected for all the enrolled patients. The associations between baseline characteristics and HBsAg loss were assessed using Cox proportional hazards regression. Restricted cubic spline (RCS) plots were constructed to portray the association between HBsAg loss and patient age.</p><p><strong>Results: </strong>After a median follow-up of 87 weeks, 23.5% (25/106) of the participants achieved sustained HBsAg loss, with a cumulative incidence of 44.9%. Proportional hazard regression indicated a significant association between achieving HBsAg loss and age, HBsAg level, and HBsAb level at baseline. The RCS plots suggested that, for pediatric patients, initiating antiviral therapy for immune-tolerant CHB might be most beneficial when they are less than 5 years old. Seventy-five (70.8%) patients experienced adverse events (AEs) following interferon therapy, with no severe AEs leading to treatment discontinuation.</p><p><strong>Conclusions: </strong>The combination therapy led to favorable clinical outcomes for children with immune-tolerant CHB. Moreover, young age and low HBsAg and high HBsAb levels at baseline are predictors of a clinical cure.</p>","PeriodicalId":17374,"journal":{"name":"Journal of the Pediatric Infectious Diseases Society","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145091978","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Advancing Antimicrobial Stewardship in a Challenging Era.","authors":"Sameer J Patel, Jason G Newland","doi":"10.1093/jpids/piaf082","DOIUrl":"10.1093/jpids/piaf082","url":null,"abstract":"","PeriodicalId":17374,"journal":{"name":"Journal of the Pediatric Infectious Diseases Society","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145091983","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Stewardship of Broad-Range Polymerase Chain Reaction Testing.","authors":"Caitlin Naureckas Li, Cecilia Thompson, Neil Jordan, Molly Schnieders, Kayla Moore, Ravi Jhaveri","doi":"10.1093/jpids/piaf086","DOIUrl":"https://doi.org/10.1093/jpids/piaf086","url":null,"abstract":"","PeriodicalId":17374,"journal":{"name":"Journal of the Pediatric Infectious Diseases Society","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145176224","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}