Pediatric Infectious Disease Journal最新文献

{"title":"Atypical Presentations of Group A Streptococcal Bacteremia in Two Infants: Isolated Acral Panniculitis and Purpura.","authors":"Meltem Polat, Nursel Atay Ünal, Bengisu Baykara, Tuğba Bedir Demirdağ, Anil Tapisiz","doi":"10.1097/INF.0000000000004874","DOIUrl":"10.1097/INF.0000000000004874","url":null,"abstract":"","PeriodicalId":19858,"journal":{"name":"Pediatric Infectious Disease Journal","volume":" ","pages":"e425"},"PeriodicalIF":2.2,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144182298","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 Characterization of a Rare ESBL E. coli Strain Causing a Necrotizing Enterocolitis Outbreak in Preterm Infants.","authors":"Charlotte Despineux, Florence Crombé, Fiammetta Piersigilli, Bénédicte Van Grambezen, Dimitri Van der Linden, Roberto Tambucci, Alexia Verroken, Olivier Danhaive","doi":"10.1097/INF.0000000000004880","DOIUrl":"10.1097/INF.0000000000004880","url":null,"abstract":"<p><strong>Background: </strong>Necrotizing enterocolitis (NEC), a severe comorbidity of prematurity, is usually sporadic, but occasional outbreaks suggest an infectious cause. Escherichia coli , the most frequent Gram-negative pathogen in preterm infants, historically displays a low inhospital transmissibility.</p><p><strong>Aim: </strong>To report the management of an NEC outbreak in a Belgian neonatal intensive care unit and the molecular characterization of a rare, highly virulent/resistant E. coli strain.</p><p><strong>Methods: </strong>Clinical data were extracted from electronic medical records. Surveillance and clinical isolates characterized using standard methods were secondarily analyzed by bacterial whole-genome sequencing using EnteroBase for phylogenic classification and BioNumerics for resistance and virulence profile determination.</p><p><strong>Findings: </strong>A cluster of 6 infants was colonized by a single extended-spectrum beta-lactamase-producing E. coli strain in a 1-month period. Four infants developed severe NEC, resulting in 1 death and 3 short bowel syndromes. Although the index infant and his twin sibling acquired the strain vertically from their mother, transmission occurred horizontally through caregivers in subsequent cases. Enhanced infection prevention and control measures allowed containment of the outbreak. Molecular typing of the strain revealed a single, previously unregistered O6:H1 serotype of extraintestinal pathogenic E. coli , urinary pathogenic E. coli harboring multiple resistance and virulence genes, including extended-spectrum beta-lactamase-encoding blaCTX-M-15 and fimbriae-encoding papA .</p><p><strong>Conclusion: </strong>The emergence of high-virulence strains in neonatal intensive care units calls for the implementation of enhanced infection prevention and control strategies. Bacterial genomic sequencing techniques, if implemented in multidrug-resistant organism screening, could represent a valuable addition for early characterization of virulence and resistance profiles, and improve prevention and containment of infectious outbreaks.</p>","PeriodicalId":19858,"journal":{"name":"Pediatric Infectious Disease Journal","volume":" ","pages":"1107-1113"},"PeriodicalIF":2.2,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144234774","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":"Suppurative Cervical Infections in Australian Children: A Retrospective Cohort Study Pre- and Post-COVID-19 Pandemic.","authors":"Isabella Taplin, Phoebe C M Williams, Jennifer W Y Lee, Marlene Soma","doi":"10.1097/INF.0000000000004877","DOIUrl":"10.1097/INF.0000000000004877","url":null,"abstract":"<p><strong>Background: </strong>Pediatric cervical infections, including cervical lymphadenitis and deep neck space infections, are potentially life-threatening. Nonpharmaceutical interventions (NPIs) implemented to control the COVID-19 pandemic have altered the epidemiology of many infectious diseases in children. This study aimed to assess the impact of NPIs directed against COVID-19 on the epidemiology of cervical infections in an Australian pediatric population.</p><p><strong>Methodology: </strong>A retrospective cohort study was conducted at the 2 largest pediatric tertiary hospitals in Sydney, New South Wales, Australia. Children (0-16 years inclusive) with a suppurative cervical infection presenting between July 1, 2017 to June 30, 2019 (prepandemic cohort) and July 1, 2021 to June 30, 2023 (postpandemic cohort) were included. Detailed clinical and demographic data were extracted. Descriptive analyses, including statistical tests of comparison, were performed to compare the pre- and postpandemic cohorts.</p><p><strong>Results: </strong>Three hundred twenty-nine patients with cervical infections were included: 150 in the prepandemic cohort and 179 in the postpandemic cohort. There was a significant increase in the number of retropharyngeal/parapharyngeal infections in the postpandemic cohort. Additionally, infections were more severe, with patients presenting earlier to hospital with larger abscesses. Management was also more aggressive, with greater administration of corticosteroids and longer hospital stays. These changes post-COVID-19 were most pronounced in infections caused by Streptococcus pyogenes.</p><p><strong>Conclusion: </strong>The relaxation of NPIs directed against COVID-19 appears to correlate with an increased incidence and severity of suppurative cervical infections in Australian. This concurs with the changing epidemiology of infectious diseases in pediatric populations following the pandemic, both within Australia and globally.</p>","PeriodicalId":19858,"journal":{"name":"Pediatric Infectious Disease Journal","volume":" ","pages":"1030-1037"},"PeriodicalIF":2.2,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144234777","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":"Detection and Density of S. pneumoniae , Cytokine/Chemokine Levels and Mucosal Antibody Levels to Pneumococcus in Nasopharyngeal Samples During SARS-CoV-2 Respiratory Infection in Children.","authors":"Ravinder Kaur, Eduardo Gonzalez, Jill Mangiafesto, Robert Parody, Michael Pichichero","doi":"10.1097/INF.0000000000004939","DOIUrl":"10.1097/INF.0000000000004939","url":null,"abstract":"<p><strong>Background: </strong>Streptococcus pneumoniae ( Spn ) and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are important pathogens. We evaluated the frequency and density of Spn in nasopharyngeal samples, frequency of multiple respiratory virus detection, mucosal cytokine/chemokine levels, and mucosal antibody levels to Spn proteins and capsular polysaccharides during SARS-CoV-2 respiratory infections in children.</p><p><strong>Methods: </strong>This retrospective study evaluated 222 nasopharyngeal samples collected from children (age 0-18 years) who were tested for SARS-CoV-2 between May 2020 and October 2021. In 111 SARS-CoV-2 positive (+) and 111 SARS-CoV-2 negative (-) samples, we tested for Spn presence and density, 6 viruses (influenza, parainfluenza, respiratory syncytial virus, human rhinovirus, enterovirus and adenoviruses), 9 mucosal cytokine and chemokine levels, mucosal immunoglobulin G (IgG) and IgA antibody levels to Spn PhtD and PcpA proteins and 7 capsular polysaccharides.</p><p><strong>Results: </strong>Fourteen percent had Spn concurrently present in SARS-CoV-2+ versus 10.6% for SARS-CoV-2-, (not significant). Concurrent SARS-CoV-2 and human rhinovirus detection occurred. Nasopharyngeal cytokine levels in SARS-CoV-2+ samples were not different compared to SARS-CoV-2- samples, except for monocyte chemoattractant protein-1 (higher in SARS-CoV-2+), and not impacted by presence/density of Spn . Nasopharyngeal IgG antibody levels to PhtD and PcpA, and capsular polysaccharide serotypes during SARS-CoV-2+ infections were not different compared to SARS-CoV-2-.</p><p><strong>Conclusion: </strong>Nasopharyngeal Spn detection and density were not different between SARS-CoV-2+ and SARS-CoV-2- samples in children. Concurrent respiratory virus infection was not common. Nasopharyngeal monocyte chemoattractant protein-1 was higher in SARS-CoV-2+ children. Nasopharyngeal IgG antibody levels to 2 Spn proteins and 7 polysaccharide capsule types did not differ between SARS-CoV-2+ and SARS-CoV-2- samples.</p>","PeriodicalId":19858,"journal":{"name":"Pediatric Infectious Disease Journal","volume":" ","pages":"1094-1100"},"PeriodicalIF":2.2,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144883459","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":"The Effects on the Growth of HIV-exposed Uninfected Infants of Initiating Dolutegravir-based Versus Efavirenz-based cART in Late Pregnancy (DolPHIN-2).","authors":"Lisa Hagens, Lisanne A H Bevers, Thokozile R Malaba, Sylvia Cornelia Nassiwa, Megan Mrubata, Helene Theunissen, Helen Reynolds, Nengjie He, Jim Read, David M Burger, Mohammed Lamorde, Landon Myer, Duolao Wang, Saye Khoo, Catriona Waitt, Angela Colbers","doi":"10.1097/INF.0000000000004902","DOIUrl":"10.1097/INF.0000000000004902","url":null,"abstract":"<p><strong>Background: </strong>In 2019, the World Health Organization (WHO) changed its recommendations for pregnant women living with HIV from efavirenz-based to dolutegravir-based therapy due to its superior efficacy, tolerability and resistance profile. Perinatal exposure to antiretrovirals may influence infant growth, but limited data exist on the effects of specific regimens over time.</p><p><strong>Aim: </strong>This study aimed to compare growth trajectories over the first 72 weeks of life among infants exposed to dolutegravir-based versus efavirenz-based therapy during late pregnancy.</p><p><strong>Methods: </strong>The DolPHIN-2 trial was a randomized, open-label trial conducted in South Africa and Uganda, researching the efficacy of dolutegravir-based versus efavirenz-based therapy in pregnant women living with HIV, initiating treatment in the third trimester. In this secondary analysis, we compared growth trajectories until 72 weeks postpartum between HIV-exposed uninfected infants perinatally exposed to dolutegravir-based versus efavirenz-based therapy. Measures of infant weight, length and head circumference were converted to WHO-defined weight-for-age, weight-for-length, length-for-age and head circumference-for-age Z-scores. Subsequently, Z-scores were compared across treatment arms, using linear mixed-effect models.</p><p><strong>Results: </strong>After exclusions, 232 infants remained (dolutegravir: n = 116; efavirenz: n = 116). In both crude models and models adjusted for study site and maternal height, length-for-age Z-scores were 0.277 units higher in the dolutegravir arm. No statistically significant impact of treatment was observed for other outcomes. In both study arms, a decline in mean length-for-age Z-scores occurred over the first 72 weeks, while mean weight-for-age Z-scores declined between weeks 48 and 72.</p><p><strong>Conclusion: </strong>Our data support the WHO in recommending dolutegravir-based therapy over efavirenz-based therapy in pregnant women living with HIV.</p>","PeriodicalId":19858,"journal":{"name":"Pediatric Infectious Disease Journal","volume":" ","pages":"1066-1071"},"PeriodicalIF":2.2,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12506683/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144659807","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":"Late-onset Carbapenem-resistant Enterobacteriaceae Sepsis Among Very Preterm Infants: A Multicenter Study in China.","authors":"Shujuan Li, Weiyin Yu, Jinglin Chen, Long Li, Xiuying Tian, Shoo K Lee, Yun Cao, Yongyan Shi, Siyuan Jiang","doi":"10.1097/INF.0000000000004891","DOIUrl":"10.1097/INF.0000000000004891","url":null,"abstract":"<p><strong>Background: </strong>Carbapenem-resistant Enterobacteriaceae (CRE) infections are emerging as a crisis in developing countries. We aim to investigate the epidemiologic characteristics and antibiotic treatment strategies of CRE sepsis in very preterm infants (VPIs).</p><p><strong>Method: </strong>This cross-sectional study included all infants born at 24-31 weeks of gestation or birth weight <1500 g who developed late-onset sepsis caused by Enterobacteriaceae , as recorded in the 2022 Chinese Neonatal Network database. Late-onset sepsis was defined as sepsis occurring after 72 hours of birth.</p><p><strong>Results: </strong>Of 11,447 VPIs admitted, 205 infants had 207 episodes of Enterobacteriaceae -related late-onset sepsis, of which 27 (13.0%) were caused by CRE. The most common CRE pathogens were Klebsiella spp. (66.7%, 18/27). Multivariate analysis identified prior carbapenem exposure as an independent risk factor for CRE sepsis (adjusted odds ratio: 2.33; 95% confidence interval: 1.02-5.49). In the CRE group, mortality due to Enterobacteriaceae sepsis (22.2% vs. 10.1%, P = 0.07) and all-cause mortality during hospitalization (29.6% vs. 13.5%, P = 0.04) were both higher than that in the non-CRE group. For empirical antibiotic therapy, of the 27 CRE cases, 21 (77.8%) were treated with meropenem alone and 6 (28.6%) of these infants died from CRE sepsis. For definitive therapy, 17/22 (77.3%) received monotherapy, of which 12 (70.6%) were treated with meropenem, while 5 (22.7%) received combination therapy.</p><p><strong>Conclusions: </strong>In Chinese neonatal intensive care units, 13.0% of late-onset Enterobacteriaceae sepsis in VPIs was caused by CRE, which was associated with a significant mortality rate. Meropenem-based regimens remain the primary treatment for CRE sepsis, though with a high treatment failure rate.</p>","PeriodicalId":19858,"journal":{"name":"Pediatric Infectious Disease Journal","volume":" ","pages":"e394-e399"},"PeriodicalIF":2.2,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144234773","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":"Postoperative Mediastinitis in Pediatric Cardiac Surgery: Clinical Characteristics, Management and Risk Factors for Mortality.","authors":"Ségolène Bernheim, Sophia Chikhi, India Foufa, Perrine Parize, Emmanuelle Bille, Margaux Pontailler, Ayman Haydar, Gilles Orliaguet, Damien Bonnet, Olivier Raisky","doi":"10.1097/INF.0000000000004882","DOIUrl":"10.1097/INF.0000000000004882","url":null,"abstract":"<p><strong>Objectives: </strong>The aim is to describe the clinical features, management and outcomes of postoperative mediastinitis in children following cardiac surgery and to identify risk factors for mortality.</p><p><strong>Methods: </strong>We retrospectively reviewed all cases of mediastinitis in children following congenital heart surgery over a 10-year period (2013-2023) at Necker Hospital, a tertiary care center.</p><p><strong>Results: </strong>Cumulative incidence of mediastinitis was 0.74% [95% confidence interval (CI): 0.56-0.96] with 57 cases of 7665 interventions. Median age at surgery was 12 days (6-146), with 58% of patients younger than 1 month. Thirty-four patients (60%) had delayed sternal closure. The most frequent germs were Staphylococcus spp. (45%), Gram-negative bacteria (36%) and fungi (9%). All patients had surgical debridement: 46 (81%) in the operating room and 11 (19%) in the intensive care unit (ICU). Median length of stay was 21 days (13-30) in the ICU and 35 days (28-48) until hospital discharge. The mortality rate was 27%, with 12 of 15 deaths occurring in the ICU. In univariate analysis, mortality risk factors were surgical revision in the ICU compared with the operating room [odds ratio (OR): 4.9; 95% CI: 1.3-19.9], delayed sternal closure superior to 3 days (OR: 5.0; 95% CI: 1.3-16.5) and fungal mediastinitis (OR: 14.9; 95% CI: 2.0-185.4). In the multivariate analysis, only fungal infection remained a significant risk factor for mortality (OR: 25.4; 95% CI: 2.7-608).</p><p><strong>Conclusion: </strong>Mediastinitis is a rare complication of neonatal cardiac surgery, with a low incidence (0.74%) in this tertiary referral center. However, mortality from this condition remains high, with fungal infections identified as the main mortality risk factor.</p>","PeriodicalId":19858,"journal":{"name":"Pediatric Infectious Disease Journal","volume":" ","pages":"1025-1029"},"PeriodicalIF":2.2,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144234775","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":"Management of Non-neutropenic Fever in Children with Cancer.","authors":"Konrad Bochennek, Andreas H Groll, Thomas Lehrnbecher","doi":"10.1097/INF.0000000000004944","DOIUrl":"10.1097/INF.0000000000004944","url":null,"abstract":"","PeriodicalId":19858,"journal":{"name":"Pediatric Infectious Disease Journal","volume":" ","pages":"e410-e413"},"PeriodicalIF":2.2,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144883418","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":"Evaluating the Clinical Impact of the BCID2 Panel and Antimicrobial Stewardship in Pediatric Bloodstream Infections: A Pragmatic Trial in Guatemala.","authors":"Kelly E Graff, Nancy Galvez, Molly M Lamb, Rosa Cortes, Edie A Sanchez Villeda, Diva M Calvimontes, Mario A Melgar, Daniel Olson, Edwin J Asturias, Samuel R Dominguez","doi":"10.1097/INF.0000000000004937","DOIUrl":"10.1097/INF.0000000000004937","url":null,"abstract":"<p><strong>Background: </strong>Multiplex polymerase chain reaction panels improve outcomes for bloodstream infections in high-income countries, but little is known in low- and middle-income countries, where there are high rates of antimicrobial resistance and mortality.</p><p><strong>Methods: </strong>We conducted a pragmatic clinical trial in children at a public hospital in Guatemala comparing the impact of a multiplex polymerase chain reaction panel to conventional microbiologic methods. The BioFire Blood Culture Identification (BCID2) panel was performed with antimicrobial stewardship advice on positive blood cultures from midnight to 1 pm on weekdays as the intervention. Children with positive cultures outside these times served as the control group. Time-to-optimal antimicrobial therapy was the primary outcome measure. All-cause mortality was a secondary outcome.</p><p><strong>Results: </strong>A total of 246 children were enrolled from April 2022 to October 2022: 135 in the BCID2 and 111 in the control group. The most common pathogens were coagulase-negative Staphylococcus (54%) and Klebsiella pneumoniae (11%). There was a significant reduction in median time-to-optimal antimicrobial therapy from 97·9 (0-252.3) hours to 31·5 (0-157.1) hours ( P = 0.03) in the control versus BCID2 groups. There was a trend for reduction in overall mortality from 18% (20 deaths) in the control to 10% (14 deaths) in the BCID2 group ( P =0.08). Subanalysis of children with Gram-negative sepsis revealed a 62% reduction in mortality with 14 (25%) deaths in the control group compared with 4 (9·5%) deaths in the BCID2 group ( P = 0.05).</p><p><strong>Conclusions: </strong>Use of BCID2 with antimicrobial stewardship significantly reduces time-to-optimal antimicrobial therapy in low- and middle-income countries like Guatemala, with a significant reduction in mortality due to Gram-negative bacteremia.</p>","PeriodicalId":19858,"journal":{"name":"Pediatric Infectious Disease Journal","volume":" ","pages":"1051-1058"},"PeriodicalIF":2.2,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144964327","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":"A Peer-Mother Counseling Intervention Improves Early Infant HIV Testing in Rural Uganda.","authors":"Jane Kabami, Stella Kabageni, Catherine A Koss, Jaffer Okiring, Joanita Nangendo, Emmanuel Ruhamyankaka, Peter Ssebutinde, Elizabeth Arinitwe, Michael Ayebare, Agnes Napyo, Valence Mfitumukiza, Munezero Tamu, Elijah Kakande, Anne R Katahoire, Philippa Musoke, Moses R Kamya, Laura B Balzer","doi":"10.1097/INF.0000000000004884","DOIUrl":"10.1097/INF.0000000000004884","url":null,"abstract":"<p><strong>Background: </strong>Peer-led counseling interventions could improve early infant diagnosis of HIV by empowering mothers with knowledge and information on their role in preventing perinatal transmission. We hypothesized that a peer-led intervention would increase completion rates of infant HIV testing in rural Uganda.</p><p><strong>Methods: </strong>From September 2019 to October 2021, we conducted the Enhanced viral load counseling with Standardized Peer-Support (ENHANCED-SPS) trial, which randomized 14 public health facilities to the intervention: peer-led counseling on HIV viral load and perinatal transmission, support for status disclosure and treatment adherence, and point-of-care viral load testing; or control: HIV care per national guidelines (NCT04122144). We retrospectively reviewed medical records of all infants born to ENHANCED-SPS participants during the 1-year follow-up and compared the proportions completing final testing (antibody rapid test at 18 months) between arms with targeted minimum loss-based estimation. Secondary outcomes included completion of earlier steps in the testing algorithm for the HIV-exposed infants.</p><p><strong>Results: </strong>Among 464 children (intervention = 234 and control = 230) born to trial participants, the proportions completing final testing were 94.5% (95% CI: 91.6-97.5%) in the intervention and 83.3% (95% CI: 78.4-88.3%) in the control: a difference of 11.2% (CI: 5.4-17.0%; P < 0.001). There were no differences in the proportions completing the 1st test (at 4-6 weeks) or the 2nd test (at 9 months), but completion of the 3rd test (6 weeks after breastfeeding cessation) was 14.8% (95% CI: 7.9-21.8%; P < 0.001) higher in the intervention.</p><p><strong>Conclusions: </strong>Peer-led counseling on the mother's role in ensuring a healthy baby reduced drop-offs in infant HIV testing, which is progress toward improved infant diagnosis and prompt linkage to care.</p>","PeriodicalId":19858,"journal":{"name":"Pediatric Infectious Disease Journal","volume":" ","pages":"1059-1065"},"PeriodicalIF":2.2,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12313110/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144732679","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}