Journal of the Pediatric Infectious Diseases Society最新文献

{"title":"Assessing the Use of Neonatal Sepsis Guidelines and Antibiotic Prescription With Large-Scale Prospective Data From Zimbabwe and Malawi.","authors":"Nushrat Khan, Gwendoline Chimhini, Som Kumar Shrestha, Mario Cortina-Borja, Simbarashe Chimhuya, Gloria Zailani, Hannah Gannon, Marcia Mangiza, Felicity Fitzgerald, Michelle Heys, Msandeni Chiume","doi":"10.1093/jpids/piaf017","DOIUrl":"10.1093/jpids/piaf017","url":null,"abstract":"<p><strong>Background: </strong>Neonatal sepsis is a major cause of mortality in low-resource settings. We assessed how neonatal sepsis guidelines were used in 2 Zimbabwean hospitals and 1 Malawian hospital.</p><p><strong>Methods: </strong>Using routine data collected with the digital health intervention, Neotree, we retrospectively reviewed doctors' and nurses' agreement with national and World Health Organization (WHO) guideline recommendations for antibiotic prescription for sepsis. We compared clinical features and outcomes of neonates who should have received antibiotics as per guideline with those who actually received them and fitted a logistic regression model to identify features associated with prescription.</p><p><strong>Results: </strong>Data were collected between January 2021 and June 2022 from 10 868 neonates: 6045 admitted to Sally Mugabe Central Hospital (SMCH), 1094 to Chinhoyi Provincial Hospital (CPH) and 3729 to Kamuzu Central Hospital (KCH). Complete implementation of national guidelines would increase antibiotics at admission: from 2188 (38%) to 3745 (64%) at SMCH, 472 (44%) to 852 (79%) at CPH, and 1519 (41%) to 3043 (82%) at KCH. Clinical features of sepsis were frequently not acted on, but the case fatality rate was lower in those not prescribed antibiotics despite guideline recommendation. Application of WHO guidelines would increase antibiotic prescription to 91% at SMCH, 88% at CPH, and 77% in KCH. Maternal risk factors for sepsis, male gender, low birth weight, older age at admission, and spontaneous vaginal delivery were associated with higher rate of antibiotic prescription.</p><p><strong>Conclusions: </strong>Guideline-recommended clinical signs for sepsis are inconsistently used, with clinicians using other features for antibiotic decision-making. Work is needed to revise clinical diagnostic algorithms in low-resource settings to ensure they are useful, usable and contextually appropriate.</p>","PeriodicalId":17374,"journal":{"name":"Journal of the Pediatric Infectious Diseases Society","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11976057/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143468382","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":"Healthcare-Associated Gastroenteritis: Outbreak Report and Systematic Review of the Literature.","authors":"Nathan L'Etoile, Morgan A Zalot, Salma Sadaf, Nicole Wittmeyer, Anna Davis, Jordan Mick, Ericka Hayes, Kathleen A Gibbs, Susan E Coffin","doi":"10.1093/jpids/piaf019","DOIUrl":"10.1093/jpids/piaf019","url":null,"abstract":"<p><p>Healthcare-associated gastroenteritis continues to be associated with significant pediatric morbidity and mortality despite the introduction of rotavirus vaccines. Infection prevention (IP) measures are critical in mitigating outbreaks. We describe an outbreak of norovirus and effective IP strategies utilized and calculated the costs associated with the outbreak. To demonstrate the burden of these events, we conducted a systematic review of pediatric healthcare-associated gastroenteritis outbreaks since 1973 to describe changing epidemiologic trends. Twenty-four publications describing 27 outbreaks were included in the final analysis with 293 healthcare-associated cases. Rotavirus (14) and norovirus (7) outbreaks were most commonly described. Limitations include the retrospective nature of included reports, nonuniform data ascertainment and reporting among publications. Norovirus has replaced rotavirus as the most common etiology of healthcare-associated gastroenteritis outbreaks in North America, Europe, and Australia and New Zealand, since the introduction of rotavirus vaccines.</p>","PeriodicalId":17374,"journal":{"name":"Journal of the Pediatric Infectious Diseases Society","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12022606/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143557105","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":"Predicting Progression of STEC-HUS: Use of Shiga Toxin Subtype and Routine Laboratory Screening.","authors":"Lydia Maleknia, Zahra Samiezade-Yazd, Xing Luu, Matthew Cranshaw, Miranda Ritterman Weintraub, Tara L Greenhow","doi":"10.1093/jpids/piaf022","DOIUrl":"10.1093/jpids/piaf022","url":null,"abstract":"<p><strong>Background: </strong>Hemolytic uremic syndrome (HUS) is life-threatening sequelae of Shiga toxin-producing Escherichia coli (STEC) enteric infection. To address ambiguity in medical literature, we aimed to identify which STEC toxin profiles and clinical variables were at the highest risk of HUS progression to inform evidence-based screening guidelines.</p><p><strong>Methods: </strong>This was a 5-year retrospective study of children aged <18 years with E. coli O157, Shiga toxin 1 (stx1), or Shiga toxin 2 (stx2)-positive stool. Demographics, clinical symptoms, laboratory studies, and HUS progression were abstracted from the electronic health record. Univariate and multivariable logistic regression identified variables associated with HUS.</p><p><strong>Results: </strong>Of 1071 children with STEC, 55 were hospitalized with HUS (mean age 4.4 years [SD 3.7]). Predictors of HUS were age < 5 years and stool positive for E. coli O157 with stx2, or non-O157 stx2. No children of any age with O157 alone, O157 and stx1, or non-O157 stx1 and stx2 developed HUS. The prevalence of HUS with non-O157 stx1 alone was 0.2%. Vomiting, dehydration, abnormal blood counts, and chemistry were the only clinical variables associated with HUS.</p><p><strong>Conclusion: </strong>We urge care management guidelines based on E. coli serotype and stx. All families of children with STEC should be counseled on the signs and symptoms of HUS and the steps to prevent dehydration; however, serial laboratory monitoring for HUS screening can be reserved for children at the highest risk for HUS. Given the substantial differences in HUS risk with stx2 as the main driver of HUS, we advocate that laboratories provide stx results to better inform anticipatory guidance.</p>","PeriodicalId":17374,"journal":{"name":"Journal of the Pediatric Infectious Diseases Society","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143557107","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":"MRI Findings of La Crosse Virus Encephalitis in the Pediatric Population.","authors":"Farimah Shariati, Shankar Ganapathy, Miraides Brown, Shankar Upadhyayula","doi":"10.1093/jpids/piaf025","DOIUrl":"https://doi.org/10.1093/jpids/piaf025","url":null,"abstract":"<p><p>This retrospective cohort study describes MRI findings in 56 patients with proven or probable La Crosse Virus Encephalitis. Review of the initial MRI images of patients during hospitalization revealed findings such as leptomeningeal enhancement, involvement of the thalamus, and the basal ganglia. Additionally, distinct findings of multiple punctate foci and frequent signal abnormality of the temporal lobe mimicking HSV were noted.</p>","PeriodicalId":17374,"journal":{"name":"Journal of the Pediatric Infectious Diseases Society","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143625054","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":"Molecular analysis of AmpC-producing Escherichia coli isolated from pediatric patients.","authors":"Eiki Ogawa, Masahiro Suzuki, Aki Sakurai, Yohei Doi","doi":"10.1093/jpids/piaf008","DOIUrl":"10.1093/jpids/piaf008","url":null,"abstract":"<p><strong>Background: </strong>AmpC-mediated cephalosporin resistance occurs in 1.0% to 3.3% of Escherichia coli isolates due to the production of either plasmid-mediated AmpC (p-AmpC) or chromosomal AmpC (c-AmpC). Data on the prevalence and molecular characteristics of AmpC-producing E. coli in pediatric patients are limited.</p><p><strong>Methods: </strong>We analyzed E. coli clinical strains with resistance phenotype consistent with AmpC production isolated from patients at a pediatric hospital in Japan between 2015 and 2022. Sequence types, resistance genes, and relevant mutations were identified through whole genome sequencing. Promoter and attenuator regions of the chromosomal ampC gene were examined, and the presence of plasmid-mediated ampC genes was determined.</p><p><strong>Results: </strong>Among 2081 E. coli strains, 80 (3.8%) from 27 patients demonstrated the AmpC phenotype. The median patient age was 55 months, with 92.6% having underlying diseases, mainly renal and urinary tract abnormalities. Of the 27 strains, p-AmpC was found in 9 strains including 6 strains belonging to ST131, while c-AmpC was identified in 18 strains including 9 ST73 strains and 4 ST12 strains.ST131 and ST73 were the major AmpC-E. coli lineages isolated from children with underlying diseases.</p><p><strong>Conclusions: </strong>Most ST131 strains harbored p-ampC, while all ST73 strains acquired cephalosporin resistance by c-AmpC production through promoter and attenuator mutations, suggesting the presence of both AmpC mechanisms in a lineage-specific manner in E. coli identified among hospitalized children.</p>","PeriodicalId":17374,"journal":{"name":"Journal of the Pediatric Infectious Diseases Society","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11949381/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143189267","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":"Receipt of Fluoroquinolone Prophylaxis is not Associated With Development of Vancomycin-Resistant Enterococcus Colonization During Pediatric Hematopoietic Cell Transplantation.","authors":"Catherine R Murphy, Chunyan Liu, Joshua Courter, Cameron Griffin, Felicia Scaggs Huang, Hilary Miller-Handley, Michael S Grimley, Lara Danziger-Isakov, William R Otto","doi":"10.1093/jpids/piaf010","DOIUrl":"10.1093/jpids/piaf010","url":null,"abstract":"<p><p>Fluoroquinolones are used to prevent bloodstream infections in pediatric hematopoietic cell transplant (HCT) recipients. We performed a retrospective cohort study in 799 pediatric HCT patients to evaluate the association between fluoroquinolone prophylaxis and VRE colonization. Propensity score analyses were performed. Fluoroquinolone prophylaxis was not associated with VRE colonization.</p>","PeriodicalId":17374,"journal":{"name":"Journal of the Pediatric Infectious Diseases Society","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143189271","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":"Impact of Pneumococcal Conjugate Vaccines on Otitis Media among American Indian/Alaska Native Children in the Southwest United States.","authors":"Victoria M Sergent, Catherine G Sutcliffe, Del Yazzie, George Brasinikas, Laura B Brown, Loretta Christensen, Demetria Clichee, Shawnell Damon, Sheri L Dixon, Lindsay R Grant, Marcella Harker-Jones, James B McAuley, Pierrette Montanez, Dennie Parker Riley, Alisa Reasonover, Amy Rice, Eugene Romancito, Charis Salabye, Brenna Simons-Petrusa, Valerie L Tenequer, Polly Thompson, Minnie Tsingine, Carol Tso, Robert C Weatherholtz, Laura L Hammitt","doi":"10.1093/jpids/piaf013","DOIUrl":"10.1093/jpids/piaf013","url":null,"abstract":"<p><p>We assessed the impact of pneumococcal conjugate vaccines on pneumococcal otitis media (OM) among children living in Navajo and White Mountain Apache Tribal lands. During the PCV7 era (2000-2009), the proportion of vaccine-type OM declined. However, vaccine-type OM (predominantly 3, 19A, and 19F) persisted in the PCV13 era (2010-2019).</p>","PeriodicalId":17374,"journal":{"name":"Journal of the Pediatric Infectious Diseases Society","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143433053","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":"Utility and Safety of Bronchoalveolar Lavage for Diagnosis and Management of Respiratory Illnesses in Immunocompromised Children.","authors":"Afreen Abraham, Amanda Green, Jose Ferrolino, Tim Flerlage, Ashleigh Gowen, Kim J Allison, Ali Y Suliman, Nickhill Bhakta, Jennifer McArthur, Saumini Srinivasan, Randall T Hayden, Diego R Hijano","doi":"10.1093/jpids/piaf015","DOIUrl":"10.1093/jpids/piaf015","url":null,"abstract":"<p><strong>Background: </strong>Acute respiratory illnesses (ARIs) in immunocompromised children have diverse causes, which can obscure accurate diagnosis and lead to unnecessary antimicrobial use. The risk-benefit ratio of bronchoalveolar lavage (BAL) in these patients is debated. This study aimed to evaluate the safety, yield, and utility of BAL in managing ARIs in immunocompromised children.</p><p><strong>Methods: </strong>This retrospective review examined BALs performed on immunocompromised children with ARI at St. Jude Children's Research Hospital between 2016 and 2021. Microbiological and molecular test results were reviewed from BAL, respiratory tract, and blood within 7 days of the BAL. The final ARI diagnosis was determined by the primary team, changes in antimicrobial management and adverse events were assessed.</p><p><strong>Results: </strong>BAL identified a potential pathogen in 84/137 (61.3%) of ARI episodes. BAL results contributed to changes in antimicrobial management in 120 (87.6%) cases and contributed to the ARI diagnosis in 106 (77.3%) cases. In 81 (59.1%) cases, ARI diagnosis was established solely from BAL results (infectious [33.3%], noninfectious [63%], multifactorial [3.7%]). BAL results usually agreed with the ARI diagnosis, but 31/137 (22.6%) were not concordant. Post-BAL, only 5 (3.6%) had increased supplemental oxygen > 24 hours, and 3 (3.4%) required new, persistent intubation. Consolidative or nodular pulmonary lesions and post-hematopoietic cell transplant had the highest BAL yields, with no significant differences based on the diffuseness of lesions.</p><p><strong>Conclusions: </strong>BAL is a safe, high-yield diagnostic procedure in immunocompromised children, with results leading to changes in clinical management of ARI. Prospective studies are needed to generate BAL guidelines for ARI in this population.</p>","PeriodicalId":17374,"journal":{"name":"Journal of the Pediatric Infectious Diseases Society","volume":"14 3","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11932144/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143700737","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":"Retrospective Investigation of Pediatric Histoplasmosis Diagnosed at a Tertiary Children's Hospital in an Endemic Area Over 11 Years.","authors":"Lina Al-Tahhan, Christopher J Harrison, Brian R Lee, Rana E El Feghaly","doi":"10.1093/jpids/piaf007","DOIUrl":"10.1093/jpids/piaf007","url":null,"abstract":"<p><strong>Background: </strong>Most histoplasmosis data are from adults. We describe pediatric histoplasmosis diagnosed at a tertiary pediatric care center in an endemic area.</p><p><strong>Methods: </strong>We performed a retrospective chart review of patients birth-18 years seen in our institution (January 1, 2010 to August 15, 2022) with histoplasmosis identified by International Classification of Disease codes. We performed descriptive and univariate analyses of demographic, historical, clinical, laboratory, and treatment data.</p><p><strong>Results: </strong>Of 122 patients, 26 had disseminated histoplasmosis (DH), 71 pulmonary/thoracic (P/T) disease, 21 had histoplasmosis as an incidental finding, and 4 were classified as other. Median age was 14 years (range 0.3-18.7 years); most were non-Hispanic White (70.5%) and city dwellers (77.1%). We noted neither seasonality nor disease category differences for age, race and ethnicity, residence, or environmental factors. Compared to P/T, DH more frequently had complex chronic conditions (73.1% vs 12.7%, P < .001), fever (88.5% vs 52.1%, P < .001), fatigue (76.9% vs 46.5%, P = .01), vomiting (53.8% vs 25.3%, P = .01), anemia (hemoglobin median 10.05 vs 12.5 g/dL, P < .001), elevated sedimentation rate values (median 31 vs 29 mm/h, P = .02), blood and urine Histoplasma antigen detection (63.6/84.6% vs 20.0/14.8%, P < .001), and antifungal treatment (100% vs 70.4%, P < .001). Patients with DH had longer antifungal treatment courses (399 vs 84 days, P < .001). Exposures were rarely recorded, but the most common was chickens. Chest radiographs were less likely to show adenopathy in DH compared to P/T (8.7% vs 55%, P < .001).</p><p><strong>Conclusions: </strong>Presentations, risk factors, diagnostics use/results, and therapy for pediatric histoplasmosis most often parallel those in adults.</p>","PeriodicalId":17374,"journal":{"name":"Journal of the Pediatric Infectious Diseases Society","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143408957","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":"Utility of Bronchoalveolar Lavage in Immunocompromised Children: Is the Bronch Result in the Eye of the Beholder or Is It a Wash?","authors":"Joshua Wolf, Monica I Ardura","doi":"10.1093/jpids/piaf018","DOIUrl":"https://doi.org/10.1093/jpids/piaf018","url":null,"abstract":"","PeriodicalId":17374,"journal":{"name":"Journal of the Pediatric Infectious Diseases Society","volume":"14 3","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143700740","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}