Journal of the Pediatric Infectious Diseases Society最新文献

{"title":"The Role of 1-3-Beta-D-Glucan in Predicting Pneumocystis jirovecii Pneumonia in Immunocompromised Children.","authors":"Markus Keldorfer, Raphael Ulreich, Johann Martensen, Patrick Faudon, Klaus Pfurtscheller, Siegfried Rödl, Robert Krause, Karl Dichtl, Volker Strenger, Stefan Hatzl","doi":"10.1093/jpids/piag085","DOIUrl":"10.1093/jpids/piag085","url":null,"abstract":"<p><p>Serum 1,3-β-D-glucan (BDG) showed high negative predictive value (~99%) for Pneumocystis jirovecii pneumonia (PJP) in 106 non-human immunodeficiency virus immunocompromised children, but modest positive predictive value at low prevalence. These exploratory findings suggest BDG may help exclude PJP, pending prospective validation.</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/PMC13573584/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148857190","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":"Burden and Risk Factors for Severe Respiratory Syncytial Virus Infection among Pediatric Hematopoietic Cell Transplant Recipients.","authors":"Diego R Hijano, Surabhi B Vora, Yilun Sun, Li Tang, Ronald H Dallas, Jose A Ferrolino, Madeline B Johnson, Kim J Allison, Monica Ardura, Emily Ansusinha, Juri Boguniewicz, Janine Dailey Garnes, Kathryn P Goggin, Alexis Gossett, Benjamin Hanisch, Nour Hasan, Sarah M Heston, Jennifer R Jackson, Madam Kumar, Courtney McDonald, Eric McGrath, William J Muller, Anne Rose, Frances Saccoccio, Beth K Thielen, Mary Suzanne Whitworth, Lara Danziger-Isakov, Janet A Englund, Gabriela Maron, Chikara Ogimi","doi":"10.1093/jpids/piag092","DOIUrl":"10.1093/jpids/piag092","url":null,"abstract":"<p><strong>Background: </strong>Respiratory syncytial virus (RSV) causes substantial morbidity in pediatric hematopoietic cell transplant (HCT) recipients; however, risk factors for severe disease remain incompletely characterized.</p><p><strong>Methods: </strong>We conducted a multicenter retrospective cohort study across 16 U.S. transplant centers, evaluating children and adolescents (0-19 years) who underwent HCT and developed a laboratory-confirmed RSV infection between 2010 and 2019. Clinical characteristics, laboratory values, and immunosuppressive and transplant history were analyzed. Outcomes included new or increased supplemental oxygen requirement, RSV-related hospitalization, progression to lower respiratory tract infection (LRTI), invasive mechanical ventilation, and 90-day mortality. Univariate logistic regression was used to screen candidate predictors, followed by the least absolute shrinkage and selection operator for variable selection, and multivariable logistic regression to identify independent predictors associated with clinical outcomes.</p><p><strong>Results: </strong>Among 204 pediatric HCT recipients with RSV infection, 41.7% had RSV-related hospitalization, 21.2% required new or increased supplemental oxygen, and 4% required invasive mechanical ventilation within 28 days after the diagnosis. Mortality within 90 days was 5.4%, with one death attributable to RSV. In multivariable models, female sex, younger age (particularly <5 years), neutropenia (ANC <500/mm3), presence of co-pathogen in the respiratory tract and chronic lung disease were independently associated with this oxygen outcome, while non-peripheral graft sources and T-cell-depleting therapy were associated with RSV-related hospitalization.</p><p><strong>Conclusions: </strong>Severe outcomes are common in pediatric HCT recipients with RSV infection. Younger age, markers of impaired immune recovery, history of chronic lung disease, and T-cell-depleting therapy are major determinants of adverse outcomes. These findings support targeted risk stratification and may inform preventive and treatment strategies in this high-risk population.</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/PMC13641079/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148920517","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":"Drivers of Non-First-Line Antibiotic Prescribing for Acute Respiratory Infections in Urgent Care.","authors":"Nicita Anand, Amanda Nedved, Jennifer McKinsey, Brian Lee, Rana E El Feghaly","doi":"10.1093/jpids/piag086","DOIUrl":"10.1093/jpids/piag086","url":null,"abstract":"<p><strong>Background: </strong>National guidelines provide recommendations for first-line therapy (FLT) for acute respiratory infections (ARIs). Sociodemographic differences in FLT for ARIs have been described. This study identified and categorized reasons for non-FLT for ARIs in pediatric urgent care (PUC) and evaluated whether these reasons differ across sociodemographic groups.</p><p><strong>Methods: </strong>We conducted a retrospective chart review of PUC encounters for patients ages 6 months to 19 years diagnosed with acute otitis media, pharyngitis, community-acquired pneumonia, or acute bacterial rhinosinusitis between April 2023 and March 2024 who received an oral antibiotic. We categorized reasons for non-FLT using predefined groups: penicillin allergy label (PAL), treatment failure, new adverse effect of FLT, recent antibiotic exposure, other clinical rationale such as additional diagnoses or concern for atypical infections, family request, or no documented reason. Sociodemographic characteristics were compared across categories.</p><p><strong>Results: </strong>Among 18 507 ARI encounters, 1506 (8.1%) received non-FLT. PALs accounted for 58.8% (n = 886) of non-FLT prescribing. Recent antibiotic exposure was the second most common reason (n = 265, 17.6%); however, only 9.8% of therapy escalations were guideline-concordant. Family requests accounted for 4.3% of non-FLT use. Non-FLT were more common in White children, those on Commercial insurance, and children who speak English as their primary language compared to their socioeconomic counterparts. No differences in reasons for non-FLT were observed by race, insurance type, or preferred language. Hispanic patients had a higher proportion of PAL-related non-FLT (71.4%) compared with non-Hispanic patients (58.3%).</p><p><strong>Conclusion: </strong>PALs and escalation of therapy were the predominant drivers of non-FLT prescribing in PUC. Family requests played a minimal role. Although we observed differences of non-FLT by race, language, and insurance as described previously, we did not observe differences in reasons for non-FLT between the different socioeconomic groups. Interventions aimed at improving PAL accuracy and guideline-concordant escalation practices may enhance appropriate FLT use.</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":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148874425","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":"Correction: Factors Associated With Newborn Nirsevimab Administration in Los Angeles County During the 2024 Respiratory Syncytial Virus Season.","authors":"","doi":"10.1093/jpids/piag096","DOIUrl":"10.1093/jpids/piag096","url":null,"abstract":"","PeriodicalId":17374,"journal":{"name":"Journal of the Pediatric Infectious Diseases Society","volume":"15 9","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13617159/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149069754","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":"Incidence of Invasive Pneumococcal Disease in US Children by Risk Group, 1998-2023.","authors":"Salini Mohanty, Nicolae Done, Yan Song, Travis Wang, Abigail Zion, Emily Reichert, Tayler Li, Meghan White, Kelsie Cassell, Yi-Ling Huang, Jessica P Weaver, Kelly D Johnson, Natalie Banniettis, Kristen A Feemster","doi":"10.1093/jpids/piag084","DOIUrl":"10.1093/jpids/piag084","url":null,"abstract":"<p><strong>Background: </strong>Children with risk conditions are vulnerable to invasive pneumococcal disease (IPD) and are targeted for routine and supplemental pneumococcal vaccination. This study aimed to quantify the incidence of IPD in US children by risk group since pneumococcal conjugate vaccine introduction.</p><p><strong>Methods: </strong>Invasive pneumococcal disease episodes were identified in the Merative™ MarketScan® Commercial Database (1998-2023) and Multi-State Medicaid Database (2001-2023) using inpatient and outpatient claims. Annual IPD incidence rates (IRs) were calculated as episodes per 100 000 person-years (PY) for children <18 years of age, overall and by insurance type, age, and risk group. Incidence rate ratios (IRRs) were calculated to compare IR for children with chronic medical conditions (CMC) and immunocompromising conditions (IC) with those with no CMC/IC.</p><p><strong>Results: </strong>A total of 3538 commercially-insured and 3268 Medicaid-insured children with ≥1 IPD episode were identified among 128.9 million (121.9 million PYs) and 71.2 million eligible children (65.4 million PYs), respectively. Across age and risk groups, IPD IRs decreased over time, regardless of insurance type. Commercially-insured children with CMC and IC had 3.1-8.6 and 19.1-74.5 times higher IPD IRs, respectively, than those without CMC/IC, with similar patterns in the Medicaid database. Invasive pneumococcal disease IRs were the highest among children <2 years, while risk-group disparities were greater among older children. Incidence rate ratios comparing CMC and IC vs. no CMC/IC increased over time, indicating widening disparities.</p><p><strong>Conclusions: </strong>Invasive pneumococcal disease IRs among children with CMC/IC remain substantially higher than those without CMC/IC, and IRRs for children with risk conditions have increased over time. The risk-group disparities were more pronounced in older children. Better prevention strategies are needed to prevent IPD in children with risk conditions.</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/PMC13573585/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148857173","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":"Outcomes after Modified Pediatric Emergency Care Applied Research Network Procalcitonin Rule Implementation in Febrile Infant Care Process Model.","authors":"Jared Olson, Frank Cipriano, Amani Jridi, Roni D Lane, Per H Gesteland, Adam L Hersh, Carolyn Reynolds, Marilyn Valentine, R Neil Davis, Jeff Schunk, Emily A Thorell","doi":"10.1093/jpids/piag087","DOIUrl":"10.1093/jpids/piag087","url":null,"abstract":"<p><strong>Background: </strong>Stratification of well-appearing febrile infants into a low-risk category for invasive bacterial infections (IBI) is critical to optimizing patient care. Procalcitonin (PCT), a biomarker associated with bacterial infection, was included in the 2019 Pediatric Emergency Care Applied Research Network (PECARN) clinical prediction rule to identify febrile infants 60 days and younger at low risk for serious bacterial infection. That same year, we incorporated a modified PECARN febrile infant prediction rule into our existing febrile infant algorithm. The primary objective of the study was to evaluate the effect of the modified PECARN prediction rule on rate of lumbar puncture (LP), hospital admissions, and 30-day readmissions.</p><p><strong>Methods: </strong>We identified febrile infants 3 to 90 days evaluated in our emergency department from November 2017 through April 2022. The pre-implementation period was from November 2017 to June 2019. The modified PECARN rule was incorporated into the clinical care process model between July 2019 and August 2019. The post-implementation period was September 2019 through April 2022. The primary outcomes were LP rate and hospital admissions. The primary process metric was PCT obtainment. The balancing metric was 30-day readmissions. Between group comparisons were performed with Chi square tests.</p><p><strong>Results: </strong>A total of 1520 febrile infants were included in the analysis, 662 in the pre-implementation period, and 858 in the post-implementation period. Lumbar puncture rate and hospital admissions decreased from 45.8% to 31.0% (P < .001) and from 54.1% to 43.2% (P < .001), respectively. The percentage of infants with a PCT increased from 3.9% to 94.1% post-implementation (P < .001). The 30-day readmission rate was 3.5% in the pre-implementation and 4.8% in the post-implementation period (P = .26).</p><p><strong>Conclusion: </strong>Incorporation of the modified PECARN prediction rule to an existing febrile infant care process model resulted in decreased lumbar punctures and hospital admissions without significantly increasing 30-day readmissions.</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":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148874376","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":"Early Discontinuation of Antibiotics in Pediatric Patients with Low- and High-Risk Febrile Neutropenia: A Single-Center Experience.","authors":"Cristina Cámara Costa, Ares Benavent Puiggené, Nuria Mas Malagarriga, María Antonia Ruiz-Cobo, Irene Martínez-de-Albeniz, Julià Gotzens Bersch, Antoni Noguera-Julian, Silvia Simó Nebot","doi":"10.1093/jpids/piag094","DOIUrl":"10.1093/jpids/piag094","url":null,"abstract":"<p><strong>Background: </strong>Maintaining broad-spectrum antibiotics until resolution of fever and recovery of absolute neutrophil count (ANC) has traditionally been the standard approach for pediatric patients with cancer and for hematopoietic stem-cell transplantation (HSCT) recipients who present with febrile neutropenia (FN). Recent studies in adults support the safety of discontinuing empiric antibiotic treatment (EAT) prior to ANC recovery. However, data in children remain limited.</p><p><strong>Methods: </strong>Retrospective study that included patients under 18 years of age with cancer and/or undergoing HSCT admitted with FN between June 2022 and August 2023, in whom EAT was discontinued prior to ANC ≥500/mm3. Patients already receiving antibiotics for a documented or suspected source of bacterial infection, sepsis, or admitted to pediatric intensive care unit (PICU) were excluded. We report the characteristics and clinical outcomes (readmission, new fever onset, and new infection) within 7 days of the discontinuation of EAT, as well as the 30-day PICU admission, infection-related mortality, and all-cause mortality rates.</p><p><strong>Findings: </strong>We included 97 episodes (65 patients) of FN, 47 (48.4%) occurred in children with hematologic disease (malignant or non-malignant), including patients who had received an HSCT (n = 8) and/or a chimeric antigen receptors T-cell therapy (n = 6). Fever lasted less than 24 h in 75.3% of episodes. Median EAT duration was 3 days (interquartile range [IQR]: 3-5). Absolute neutrophil count recovery occurred at a median of 4 days (IQR 2-12) after EAT discontinuation. Fever recurred in 11 episodes (11.3%) within 7 days from EAT discontinuation. An infectious cause was identified in 3/11 episodes (mild bacterial folliculitis, probable primary Cytomegalovirus infection, and invasive fungal infection, n = 1 each). No admissions to PICU or 30-day infection-related mortality were observed. Two patients died because of non-infectious causes.</p><p><strong>Conclusion: </strong>Early EAT discontinuation before ANC recovery in selected pediatric patients with FN, including high-risk patients, may reduce hospitalization and antibiotic exposure.</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":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148920467","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":"Environmental Contamination of Pediatric Offices by Clostridioides difficile.","authors":"Ayden Magence, Tovah Magence, Jennifer L Cadnum, Jennifer M Hailes, Curtis J Donskey, Philip Toltzis","doi":"10.1093/jpids/piag093","DOIUrl":"10.1093/jpids/piag093","url":null,"abstract":"<p><p>We explored whether infant colonization by Clostridioides difficile potentially originates in the pediatrician's office. Three hundred surface cultures were obtained from 3 practices. C. difficile was detected in all 3. Twelve cultures (4.0%) yielded C. difficile; 7 were toxigenic. The organism was recovered from 7 of 60 (11.7%) examination rooms.</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":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148920543","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":"When Vaccination Meets Infection Prevention: National Practices for Inpatient Administration of Measles-Mumps-Rubella, Varicella, and Rotavirus Vaccines.","authors":"Maria S Rueda, Celia Hutto, Delphene Hobby-Noland, Xiaoyan Song","doi":"10.1093/jpids/piag091","DOIUrl":"10.1093/jpids/piag091","url":null,"abstract":"<p><p>Among pediatric institutions surveyed, administration of MMR, VAR, and RV was frequently allowed, though infection-prevention practices varied, particularly for VAR. Most institutions used standard precautions and reported no vaccine-derived transmission. Despite ongoing safety concerns and limited formal policies, most respondents believed benefits outweighed risks.</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":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148919557","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":"Frequency of Asymptomatic Bordetella pertussis Colonization in Healthy Children and Family Members.","authors":"Dakota Musgrave, Luke Keffer, Sandra M Yoder, Nicole Soper, C Buddy Creech","doi":"10.1093/jpids/piag095","DOIUrl":"10.1093/jpids/piag095","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":"148920501","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}