Journal of the Pediatric Infectious Diseases Society最新文献

{"title":"Effect of Institutional Guidelines on Equitable Management of Pediatric Osteomyelitis.","authors":"Timothy Schurz, Cheyney C Dobson, Gary L Freed, William E Gillespie, Niko A Kaciroti, Harlan McCaffery, Jason B Weinberg, Elizabeth C Lloyd","doi":"10.1093/jpids/piag103","DOIUrl":"10.1093/jpids/piag103","url":null,"abstract":"<p><strong>Background: </strong>Acute hematogenous osteomyelitis (AHO) in children requires timely diagnosis and multidisciplinary management to optimize outcomes. Clinical practice guidelines aim to standardize care and reduce variation; however, their impact on health equity is not well understood. We evaluated whether implementation of institutional AHO guidelines improved care delivery and reduced disparities in sociodemographic groups.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study of children aged 90 days to 18 years hospitalized with AHO at a tertiary care children's hospital. Patients were stratified into pre- (September 1, 2014-July 31, 2017) and post-guideline implementation (November 1, 2017-December 31, 2023) periods. Care processes included blood culture acquisition, laboratory testing, imaging use and timing, bone biopsy, administration of any antibiotics, administration of appropriate empiric antibiotics, number of inpatient Pediatric Infectious Diseases (PID) consult visits, and Pediatric Orthopedic Surgery involvement. Outcomes were compared across demographic variables including race, ethnicity, preferred language, sex, age, and Area Deprivation Index (ADI).</p><p><strong>Results: </strong>One hundred thirty-one patients were included (35 pre-implementation, 96 post-implementation). Baseline characteristics were similar between groups. Following guideline implementation, rate of appropriate empiric antibiotic administration increased (79.1% vs. 37.1%, P < .001) and median number of inpatient PID consult visits increased (3 vs. 2, P = .039). Across the full cohort, patients from higher-deprivation neighborhoods were less likely to have blood cultures obtained (70.8% high ADI vs. 94.5% low ADI, P = .008). Black children had fewer PID consult visits (median 1 vs. 3 in other race groups, P < .001) as did children from high-ADI neighborhoods (median 2 vs. 3 in other ADI groups, P = .001). These disparities persisted in the post-implementation period.</p><p><strong>Conclusions: </strong>Implementation of an institutional AHO guideline increased appropriate empiric antibiotic use and PID subspecialty involvement but did not eliminate disparities in care delivery. Persistent differences by race and socioeconomic status highlight the need for equity-focused implementation strategies to ensure consistent, high-quality care for all children.</p>","PeriodicalId":17374,"journal":{"name":"Journal of the Pediatric Infectious Diseases Society","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149039711","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":"Variation in Otitis Media Treatment Index by Location and Sociodemographic Groups in Pediatric Urgent Cares.","authors":"Amanda C Nedved, Louis Vernacchio, Brian R Lee, Luis E Sainz, Jonathan Hatoun, Laura B Patane, Matthew P Kronman, Adam L Hersh, Victoria Parente, Rana F Hamdy, Rana E El Feghaly, On Behalf Of The Reducing Differences In Urgent Care Encounters For Antibiotic Choice ReDUCE Antibiotic Choice Quality Improvement Collaborative","doi":"10.1093/jpids/piag100","DOIUrl":"10.1093/jpids/piag100","url":null,"abstract":"<p><strong>Background: </strong>Antibiotic use is often driven by overdiagnosis. Otitis media is the most common diagnosis for which antibiotics are prescribed in pediatrics. Otitis Media Treatment Index (OMTI) measures the proportion of acute respiratory illnesses (ARIs) that have a diagnosis of otitis media (OM) and an antibiotic prescription. We explored variation in OMTI from our national pediatric urgent care (PUC) quality improvement collaborative across sites and by patient characteristics.</p><p><strong>Methods: </strong>This secondary analysis included 24 PUC centers from 6 healthcare organizations representing all 4 regions of the United States. We analyzed encounters of patients aged 6-59 months with diagnoses of ARIs from April 2022 to October 2024. We calculated OMTI defined as the number of ARI encounters with OM diagnosis and antibiotic prescribed divided by all ARI encounters for the collaborative and each PUC center. We examined variability across age, race, and payor type.</p><p><strong>Results: </strong>Among 456 748 ARI encounters, the overall OMTI index was 35.8% (n = 163 686), with ranges from 9% to 50% across centers. The West region had the lowest OMTI (28.4%) while the Northeast and Midwest had the highest OMTIs (40.1% and 40.8%). Patient with commercial insurance had a higher OMTI (37.5%) than other payor types. White patients had the highest OMTI (38.7%) compared to other races. OMTI steadily increased between 6 months of age, peaking at 40.9% at 13 months, and then steadily decreased to 33.5% at 59 months.</p><p><strong>Conclusions: </strong>OMTI varied substantially by PUC site and patient subgroups suggesting inconsistent OM diagnosis and antibiotic prescribing practices in PUCs. Using OMTI as a benchmark could identify populations at risk of OM overdiagnosis and antibiotic overuse and may help identify opportunities for diagnostic stewardship interventions and more appropriate antibiotic prescribing in PUC.</p>","PeriodicalId":17374,"journal":{"name":"Journal of the Pediatric Infectious Diseases Society","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148990472","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":"Effectiveness of Nirsevimab Reimmunization against Respiratory Syncytial Virus Hospitalization During the Second Season in High-Risk Children.","authors":"Susana Monge, Olivier Núñez, Roberto Pastor-Barriuso, On Behalf Of The Nirsevimab Effectiveness Study Collaborators","doi":"10.1093/jpids/piag104","DOIUrl":"10.1093/jpids/piag104","url":null,"abstract":"","PeriodicalId":17374,"journal":{"name":"Journal of the Pediatric Infectious Diseases Society","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13662212/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149038867","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":"An Fc Receptor and IgA Functional Signature Identifies TB Disease in Children Living With HIV.","authors":"Ye Jin Kang, Nannan Wang, Amyn A Malik, Pei Lu, Alison Grossman, Irene Njuguna, Elizabeth Maleche-Obimbo, Sylvia M LaCourse, Jennifer Slyker, Dalton Wamalwa, Grace C John-Stewart, Chuangqi Wang, Lisa M Cranmer, Lenette L Lu","doi":"10.1093/jpids/piag101","DOIUrl":"10.1093/jpids/piag101","url":null,"abstract":"<p><strong>Background: </strong>Tuberculosis (TB) is a leading cause of morbidity and mortality among children living with HIV (CLHIV). TB disease is difficult to detect with current clinical microbiological, immunological, and radiographic tools. Serological assays that determine levels of Mycobacterium tuberculosis reactive antibodies inconsistently identify TB, but antibody Fc receptor engagement and effector functions are promising biomarkers of TB disease. The objectives of this study are to identify antigen-specific antibody signatures in CLHIV with TB disease that both (1) respond to treatment and (2) distinguish CLHIV with TB disease from those without TB disease.</p><p><strong>Methods: </strong>This study evaluated serum antibody properties from a well-characterized cohort of Kenyan CLHIV via 2 orthogonal approaches: (1) Longitudinal assessment following individuals over the course of treatment and (2) cross-sectional examination of individuals with and without clinical TB disease. For each individual sample, 13 antibody functional properties against 8 Mtb and 4 non-Mtb microbial antigens were measured and analyzed via univariate and multivariate machine-learning approaches.</p><p><strong>Results: </strong>FcαR/CD89 immune complex formation with antibodies reactive to 4 Mtb antigens including ESAT-6 & CFP-10, FcγRI/CD64 associated with one Mtb antigen, and HIV gp120 IgA1 distinguished CLHIV with from those without TB disease and decreased over the course of treatment.</p><p><strong>Interpretation: </strong>An Mtb and HIV reactive peripheral blood antibody functional signature of FcαR/CD89, FcγRI/CD64, and IgA1 are potential correlates of TB disease in CHLIV.</p>","PeriodicalId":17374,"journal":{"name":"Journal of the Pediatric Infectious Diseases Society","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13652643/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148990520","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":"Impact of delay in the diagnosis of non-cutaneous Lyme disease.","authors":"Lise E Nigrovic, Meagan M Ladell, Laura L Chapman, Fran Balamuth, Rebecca S Green, Desiree N Neville, Anupam B Kharbanda, Stephanie M Hadley, Alexandra T Geanacopoulos, Amy D Thompson","doi":"10.1093/jpids/piag107","DOIUrl":"https://doi.org/10.1093/jpids/piag107","url":null,"abstract":"<p><p>In our prospective cohort of 5,252 children with suspected Lyme disease, lumbar punctures (6.2% vs. 6.9%) were similar, but joint procedures (14.2% vs. 5.5%) and hospitalization (23.4% vs. 18.7%) were more frequent for children with Lyme disease than mimics.</p>","PeriodicalId":17374,"journal":{"name":"Journal of the Pediatric Infectious Diseases Society","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149111428","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":"Serum Procalcitonin and Outcomes in Severe Pediatric Pneumonia: A Secondary Analysis of An Observational Multicenter Study.","authors":"Judith Ju Ming Wong, Saptadi Yuliarto, Minchaya Rujirojampai, Pei Chuen Lee, Chunfeng Liu, Hongxing Dang, Xuemei Zhu, Jacqueline Soo May Ong, Pustika Efar, Chin Seng Gan, Alvin Wun Fung Hui, Justin Qi Yuee Wang, Phuc Huu Phan, Lijia Fan, Insu Choi, Qalab Abbas, Rujipat Samransamruajkit, Hwa Jin Cho, Suresh Kumar Angurana, Wei Xu, Jan Hau Lee","doi":"10.1093/jpids/piag108","DOIUrl":"https://doi.org/10.1093/jpids/piag108","url":null,"abstract":"<p><strong>Background: </strong>Evidence on procalcitonin's role in the management of severe pediatric pneumonia is limited. This study aims to determine the association between procalcitonin and severity of illness in children with severe pneumonia.</p><p><strong>Methods: </strong>In this secondary analysis of a multi-center study in Asia, peak serum procalcitonin (measured within 5 days) was categorized into four groups (<0.5, 0.5-2.0, 2.0-10.0, >10.0 ng/mL). The primary outcome was mortality and secondary outcomes were acute respiratory distress syndrome (ARDS), septic shock, and multiorgan dysfunction. Area under the receiver operating curve (AUROC) analysis was used to assess the association of peak procalcitonin levels with primary and secondary outcomes.</p><p><strong>Results: </strong>Of 846 patients, 344 had early procalcitonin data. Mortality increased in groups with higher peak procalcitonin levels [8/162 (4.9%), 3/69 (4.4%), 8/55 (14.6%) vs. 11/58 (19.0%); p=0.002]. The proportion of patients with ARDS [23/162 (14.2%), 14/69 (20.3%), 10/55 (18.2%) vs. 25/58 (43.1%); p<0.001], septic shock [8/162 (4.9%), 10/69 (14.5%), 13/55 (23.2%) vs. 32/58 (55.2%); p<0.001], multiorgan failure [19/162 (11.7%), 13/69 (18.8%), 12/55 (21.4%) vs. 23/58 (39.7%); p<0.001] was also higher in groups with higher peak procalcitonin levels. The AUROC for procalcitonin showed moderate discrimination for mortality [0.69 (95%CI 0.58, 0.80)] and good discrimination for septic shock [0.81 (95%CI 0.76, 0.87)].</p><p><strong>Conclusion: </strong>In critically ill children with severe pneumonia, higher serum procalcitonin was associated with mortality, ARDS, septic shock and multi-organ dysfunction. Procalcitonin alone is insufficient for clinical decision-making and should be interpreted alongside clinical assessment.</p>","PeriodicalId":17374,"journal":{"name":"Journal of the Pediatric Infectious Diseases Society","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149111431","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":"Epidemiology of Pediatric Bacterial Meningitis in Japan: A Multicenter Survey, 2022-2024.","authors":"Kentaro Tomita, Munehiro Furuichi, Mizuki Yaginuma, Satoshi Iwata, Satoshi Narumi, Masayoshi Shinjoh","doi":"10.1093/jpids/piag106","DOIUrl":"https://doi.org/10.1093/jpids/piag106","url":null,"abstract":"<p><strong>Background: </strong>Bacterial meningitis remains a life-threatening condition among infants and young children worldwide, even in the era of advanced antimicrobial therapy and widespread vaccination. As part of ongoing multicenter surveillance in Japan, we investigated the recent epidemiology of pediatric bacterial meningitis during 2022-2024.</p><p><strong>Methods: </strong>We conducted a multicenter retrospective study of children aged 0-14 years diagnosed with bacterial meningitis in Japan between January 2022 and December 2024. Data were collected using a standardized survey to characterize current epidemiology, age-specific pathogen and pneumococcal serotype patterns, and predictors of poor outcome. Multivariable logistic regression analysis was performed to identify independent predictors of poor outcome.</p><p><strong>Results: </strong>Of 206 bacterial meningitis cases, 124 (60.2%) were community-acquired and the remaining 82 (39.8%) were healthcare-associated. Eight patients (3.9%) died-four in each group. Streptococcus agalactiae, Escherichia coli, and Streptococcus pneumoniae collectively accounted for 81.5% of community-acquired cases. S. agalactiae predominantly affected neonates and infants up to age 4 months, whereas E. coli was detected from the neonatal period through age 6 months. Among E. coli isolates, 15% (3/20) were extended-spectrum β-lactamase producers. S. pneumoniae was more common after age 4 months; 45.5% (10/22) of isolates were penicillin resistant, and all serotyped isolates were non-PCV13 serotypes. Multivariable analysis identified cerebrospinal fluid glucose level <20 mg/dL as an independent predictor of poor outcome.</p><p><strong>Conclusions: </strong>This multicenter survey highlights the continued predominance of S. agalactiae, E. coli, and S. pneumoniae as the major causative pathogens of pediatric bacterial meningitis in Japan. Ongoing challenges-including antimicrobial resistance, serotype replacement, and healthcare-associated meningitis-underscore the need for continued surveillance.</p>","PeriodicalId":17374,"journal":{"name":"Journal of the Pediatric Infectious Diseases Society","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149111448","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":"Congenital Infections as Risk Factor for Adverse Birth Outcomes among HIV-Exposed Neonates in Uganda.","authors":"Patience Atuhaire, Mark J Giganti, Flynn McMorrow, Maxensia Owor, Philippa Musoke, Mary Glenn Fowler, For Promise Bf Team","doi":"10.1093/jpids/piag090","DOIUrl":"10.1093/jpids/piag090","url":null,"abstract":"<p><strong>Background: </strong>Prematurity and low birth weight (LBW) are leading risk factors for morbidity among HIV-exposed uninfected (HEU) neonates. The IMPAACT PROMISE 1077BF trial found high rates of adverse pregnancy outcomes among women living with HIV (WLHIV) randomized to triple antiretroviral treatment compared to zidovudine alone. We sought to elucidate the possible association of select congenital infections with preterm delivery (PTD) and low birth weight (LBW) among Women Living with HIV (WLHIV) on ART.</p><p><strong>Methods: </strong>This study was designed as 1:2 nested case-control study of Ugandan mother/infant pairs enrolled in the IMPAACT 1077BF trial. All eligible mother/infant pairs with a PTD (< 37 weeks) or LBW (<2500 gm) HIV Exposed Uninfected (HEU) infants were selected as cases. For every case, up to two control maternal-infant pairs of similar maternal age, parity, and infant specimen availability were selected.PCR testing for cytomegalovirus (CMV) and syphilis testing (RPR and Treponema test if RPR positive) were done for all maternal samples at delivery. Infant testing was performed if the maternal sample was positive. Weighted estimates of prevalence were calculated for each congenital infection. Multivariable weighted modified Poisson models were fit to assess the association between maternal congenital infections and adverse pregnancy outcomes.</p><p><strong>Results: </strong>Among 158 women, the estimated prevalence (95% CI) of syphilis or CMV was 49% (39%, 58%). Prevalence estimates for maternal CMV and syphilis were 44% and 7%, respectively. Infant prevalence estimates were 7% for CMV and 2% for syphilis. CMV was associated with a significantly increased risk of PTD and/or LBW; Risk Ratio (95% CI): 2.2 (1.2, 4.1).</p><p><strong>Conclusion: </strong>This study found a high burden of congenital infections among women with HIV, and maternal CMV was associated with increased risk of PTD and/or LBW. Further evidence is needed on feasibility and clinical benefit of CMV screening for HEU infants in high-burden settings.</p>","PeriodicalId":17374,"journal":{"name":"Journal of the Pediatric Infectious Diseases Society","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13641073/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148920464","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":"Metabolic Changes in Pediatric HIV Patients on Contemporary Antiretroviral Therapy: Implications for Research and Interventions.","authors":"Caroline M Carlson, Sahera Dirajlal-Fargo","doi":"10.1093/jpids/piag097","DOIUrl":"10.1093/jpids/piag097","url":null,"abstract":"","PeriodicalId":17374,"journal":{"name":"Journal of the Pediatric Infectious Diseases Society","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148956264","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":"Pharmacokinetics of Clofazimine Tablet Formulation in Children with Rifampicin-Resistant Tuberculosis in CATALYST, a Multi-Site International Trial.","authors":"Yuanxi Zou, Megan Palmer, Melchor V G Frias, Dessa J O Casalme, Aarti A Kinikar, Mandar Paradkar, Vandana Kulkarni, Pragathi Kamath, Ingrid Courtney, Heather Draper, Lubbe Wiesner, Mats O Karlsson, Paolo Denti, Louvina van der Laan, Anthony J Garcia-Prats, Anneke C Hesseling, Elin M Svensson","doi":"10.1093/jpids/piag089","DOIUrl":"10.1093/jpids/piag089","url":null,"abstract":"<p><p>We evaluated the pharmacokinetics of a novel child-friendly 50 mg clofazimine tablet formulation that disperses quickly in water, compared to traditional gel capsules, in 36 children routinely treated for rifampicin-resistant tuberculosis. No substantial pharmacokinetic difference was observed between tablets and gel capsules, supporting the tablet formulation use for paediatric dosing.</p>","PeriodicalId":17374,"journal":{"name":"Journal of the Pediatric Infectious Diseases Society","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13623529/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148912718","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}