Pediatric Infectious Disease Journal最新文献

{"title":"Anticipated Effects of Higher-valency Pneumococcal Conjugate Vaccines on Colonization and Acute Otitis Media.","authors":"Ravinder Kaur, Steven Schulz, Andrew Sherman, Kristin Andrejko, Miwako Kobayashi, Michael Pichichero","doi":"10.1097/INF.0000000000004413","DOIUrl":"10.1097/INF.0000000000004413","url":null,"abstract":"<p><strong>Background: </strong>Bacterial etiologies of acute otitis media (AOM) have shifted from the introduction of pneumococcal conjugate vaccines (PCVs), antibiotic selection and competition among species. We characterized Streptococcus pneumoniae ( Spn ), Haemophilus influenzae ( Hflu ) and Moraxella catarrhalis ( Mcat ) in the nasopharynx during well-child healthy visits and at the onset of AOM, and in middle ear fluid (MEF) of children with AOM to assess anticipated effects of higher-valency PCVs (PCV15 and PCV20).</p><p><strong>Methods: </strong>From September 2021 to September 2023, we conducted a prospective longitudinal cohort study of PCV13 immunized children 6-36 months old. MEF was collected via tympanocentesis. Serotyping and antibiotic susceptibility testing were performed on Spn , Hflu and Mcat isolates.</p><p><strong>Results: </strong>We obtained 825 nasopharyngeal and 216 MEF samples from 301 children. The order of frequency of nasopharyngeal colonization was Mcat , Spn and Hflu ; Hflu was the predominant otopathogen in MEF. Among Spn isolates, non-PCV15, non-PCV20 serotypes predominated in the nasopharynx and in MEF; the most frequent serotype was 35B. Among MEF samples, 30% of Spn isolates were amoxicillin nonsusceptible; 23% of Hflu isolates and 100% of Mcat isolates were β-lactamase-producing.</p><p><strong>Conclusion: </strong>The majority of Spn isolates among young children were non-PCV15, non-PCV20 serotypes, especially serotype 35B; therefore, the impact of higher-valency PCVs in reducing pneumococcal colonization or AOM is expected to be limited. Hflu continues to be the most frequent AOM pathogen. Antibiotic susceptibility data suggest a high dose of amoxicillin/clavulanate or alternative drugs that are effective against contemporary mix of otopathogens could be considered for optimal empiric selection to provide the best efficacy.</p>","PeriodicalId":19858,"journal":{"name":"Pediatric Infectious Disease Journal","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11408086/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141262584","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":"Pneumonia in Children With Complex Chronic Conditions With Tracheostomy: An Emerging Challenge.","authors":"Miguel García-Boyano, Francisco José Climent Alcalá, Aroa Rodríguez Alonso, Marta García Fernández de Villalta, Oihane Zubiaur Alonso, Ignacio Rabanal Retolaza, Inmaculada Quiles Melero, Cristina Calvo, Luis Escosa García","doi":"10.1097/INF.0000000000004395","DOIUrl":"10.1097/INF.0000000000004395","url":null,"abstract":"<p><strong>Background: </strong>Despite respiratory infections being a leading cause of hospitalization in children with tracheostomy tubes, there are no published guidelines for their diagnosis and management. This study aims to outline the clinical, laboratory and microbiological aspects of pneumonia in these children, along with the antibiotics used and outcomes. Additionally, it seeks to determine pneumonia incidence and associated risk factors.</p><p><strong>Methods: </strong>We conducted a retrospective study using the medical records of tracheostomized children at La Paz University Hospital in Madrid from 2010 to 2021.</p><p><strong>Results: </strong>Thirty-three pneumonia cases were observed in 25 tracheostomized children. Pseudomonas aeruginosa was the predominant bacterium (52%), followed by Escherichia coli , Staphylococcus aureus and Serratia marcescens . The same microorganism isolated in the tracheal aspirate culture during pneumonia was previously isolated in 83% of cases that had a similar culture, with some growth obtained within 7-30 days prior. Multiplex respiratory PCR detected respiratory viruses in 73% of cases tested. Antibiotic treatment was administered in all cases except 1, mostly intravenously (81%), with piperacillin/tazobactam and meropenem being commonly used. Only 1 of the described episodes had a fatal outcome.</p><p><strong>Conclusions: </strong>It is advisable to include coverage for P. aeruginosa , E. coli , S. aureus , and S. marcescens in the empirical antibiotic treatment for pneumonia in tracheostomized children, along with the microorganisms identified in tracheal cultures obtained within 7-30 days prior, if available. A positive PCR for respiratory viruses is often discovered in bacterial pneumonia in tracheostomized children.</p>","PeriodicalId":19858,"journal":{"name":"Pediatric Infectious Disease Journal","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140958494","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":"One- and Two-year Multidisciplinary Follow-Up of MIS-C at a Tertiary Hospital: A Retrospective Cohort Study.","authors":"Sarah May Johnson, Justin Penner, Richard Issitt, Laura Kmentt, Karlie Grant, Ashwin Pandey, Dimitrios Champsas, Omar Abdel-Mannan, Sue Maillard, Kim McKenzie, Emily Golding, Filip Kucera, Yael Hacohen, Karyn Moshal","doi":"10.1097/INF.0000000000004430","DOIUrl":"10.1097/INF.0000000000004430","url":null,"abstract":"<p><strong>Background: </strong>Although 6-month follow-up of patients with multisystem inflammatory syndrome in children (MIS-C) was reassuring, there is scant data on long-term sequelae, including whether changing variants affect clinical severity and outcomes.</p><p><strong>Methods: </strong>Children (<18 years of age) admitted to Great Ormond Street Hospital between April 4, 2020, and January 2023, meeting diagnostic criteria for MIS-C were included. Admission and follow-up data were categorized by the predominant SARS-CoV-2 circulating variant in the United Kingdom.</p><p><strong>Results: </strong>One hundred and sixty children [median age, 10.1 (interquartile range, 7.9-12.6) years] were included. There was no difference in the time of symptom onset to diagnosis between waves ( P =0.23) or hospitalization days across all waves ( P =0.32). Inflammatory markers were normal for up to 2 years in all patients except one. Eleven patients (6.9%) remain in follow-up: cardiology (n=5), gastroenterology (n=5) and nephrology (n=1). The main self-reported symptoms at 2 years were abdominal pain (n=5) and myalgia (n=2). Fatigue was present in approximately a quarter of patients at admission; this reduced to 14 (9%), (2%) and 1 (2%) at 6-month, 1-year and 2-year follow-ups, respectively. Chronic fatigue or long-COVID symptomatology was rare (n=1) even with high rates of concurrent Epstein-Barr virus positivity (49/134). All patients had sustained neurological recovery with no new neurological pathology observed.</p><p><strong>Conclusions: </strong>Patients with MIS-C have a sustained recovery, which is reassuring for positive long-term outcomes. Across waves, time from symptom onset to diagnosis and treatment, symptomatology and length of stay were similar. Sustained recovery is reassuring for clinicians and parents alike. Differentiating long-COVID symptomatology from that of MIS-C is important in formulating an individualized treatment plan.</p>","PeriodicalId":19858,"journal":{"name":"Pediatric Infectious Disease Journal","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141427318","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":"Postdiscontinuation Antibiotic Exposure in Hospitalized Infants at Risk for Late-onset Sepsis in the Neonatal Intensive Care Unit.","authors":"Kelly C Wade, Rachel G Greenberg, Daniel K Benjamin, Lydia Li-Hui Chen, Brandon Vo, Berwyn Liselle Ang, Angelique Boutzoukas, Kanecia Zimmerman, Reese H Clark, Michael Cohen-Wolkowiez, Jennifer Le","doi":"10.1097/INF.0000000000004426","DOIUrl":"10.1097/INF.0000000000004426","url":null,"abstract":"<p><strong>Background: </strong>In the neonatal intensive care unit, infants are at risk for late-onset sepsis. When blood cultures are negative, antibiotic stewardship efforts encourage stopping antibiotics, yet the duration of therapeutic exposure after the last dose is unknown.</p><p><strong>Methods: </strong>This retrospective cohort study of simulated antibiotic exposures used published population pharmacokinetic models within drug-specific neonatal intensive care unit cohorts of preterm and term infants, postnatal age 7-60 days and exposed to cefepime, piperacillin-tazobactam or tobramycin. Monte Carlo simulations (NONMEM 7.3) were used to predict steady-state exposures after a 72-hour antibiotic course per Neofax dosing. Exposure was assessed relative to drug-specific minimum inhibitory concentration (MIC) targets between 1 and 16 mcg/mL for Pseudomonas and Enterobacteriaceae species. Postdiscontinuation antibiotic exposure (PDAE) was defined as the time from the last dose to when antibiotic concentration decreased below a specific MIC.</p><p><strong>Results: </strong>Piperacillin-tazobactam, cefepime and tobramycin cohorts included infants with median gestation age 29, 32 and 32 weeks and postnatal age 17, 19 and 15 days, respectively. The mean PDAE was 19-68 hours, depending on the specific antibiotic/MIC combination. PDAE was longer for infants <28 days old and preterm (vs. term) infants. Cefepime exhibited the longest mean PDAE of 68 hours for Enterobacteriaceae MIC 1. Piperacillin mean PDAE was 25 hours for Enterobacteriaceae MIC 8. Tobramycin had a short mean PDAE of 19 hours.</p><p><strong>Conclusions: </strong>Piperacillin and cefepime exposures remained therapeutic long after the expected 8- to 12-hour dosing interval. PDAE is an important consideration for antibiotic stewardship among hospitalized infants, particularly premature infants and those within 1 month postbirth.</p>","PeriodicalId":19858,"journal":{"name":"Pediatric Infectious Disease Journal","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11408093/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141427321","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":"Abnormal T Cells Function Associated With Intraspinal Cold Abscess Caused by Macrolide-resistant Mycoplasma pneumoniae in a Patient With X-linked Agammaglobulinemia.","authors":"Ying-Ying Jin, Jing Wu, Fei Ding, Hua Huang, Xue-Mei Xu, Qi-Min Chen, Min-Zhi Yin, Yu-Min Zhong, Yan-Liang Jin","doi":"10.1097/INF.0000000000004569","DOIUrl":"https://doi.org/10.1097/INF.0000000000004569","url":null,"abstract":"<p><p>Intraspinal cold abscesses caused by macrolide-resistant Mycoplasma pneumoniae in patients with X-linked agammaglobulinemia have not yet been described to our knowledge. Here we describe a patient with X-linked agammaglobulinemia who developed an intraspinal cold abscess caused by macrolide-resistant M. pneumoniae . Genetic analysis revealed a hemizygous c.1566 + 1G > C (IVS15 + 1G > C) mutation in BTK gene. The patient showed relatively naive T cells and a significant proliferative defect.</p>","PeriodicalId":19858,"journal":{"name":"Pediatric Infectious Disease Journal","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142351670","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":"Racial and Ethnic Disparities in Neonatal Sepsis.","authors":"Vanishree Nandakumar, Shady Hazzaa, Firas Saker, Hany Aly, Mohamed A Mohamed","doi":"10.1097/INF.0000000000004572","DOIUrl":"https://doi.org/10.1097/INF.0000000000004572","url":null,"abstract":"<p><strong>Background: </strong>Sepsis is a significant health burden in the neonatal population. Although disparities in neonatal care have been reported, there are no data on racial/ethnic disparities in the context of sepsis. Therefore, we aimed to assess racial/ethnic disparities in the prevalence and outcomes of neonatal sepsis.</p><p><strong>Methods: </strong>The national inpatient Kids' Inpatient Database produced by the Healthcare Cost and Utilization Project was used for the year 2019. The International Classification of Diseases, 10th revision codes were used to identify the primary outcome of the neonates diagnosed with sepsis. The χ2 and Fisher tests were used to calculate odds ratios for categorical variables, and logistic regression was performed to calculate adjusted odds ratio (aOR) to account for confounders in neonatal sepsis.</p><p><strong>Results: </strong>Of the total 3,512,817 patients, 202,103 patients with neonatal sepsis were identified across all racial and ethnic groups. Overall prevalence was statistically significant in Black [aOR, 1.13 (95% confidence interval [CI], 1.10-1.17)], Hispanic [aOR, 1.19 (95% CI, 1.15-1.22)], Asian/Pacific Islander [aOR, 1.10 (95% CI, 1.05-1.16)] and Native Americans [aOR, 1.17 (95% CI, 1.04-1.31)] compared with Whites. In Black infants, the OR for the overall mortality was 1.35 (95% CI, 1.28-1.42), and sepsis-related mortality was 1.20 (95% CI, 1.06-1.35) compared to Whites.</p><p><strong>Conclusions: </strong>Although the prevalence of sepsis is marginally higher in Hispanic infants compared with Whites, the overall and sepsis-related mortalities are the highest in Black infants compared with all races and ethnic groups.</p>","PeriodicalId":19858,"journal":{"name":"Pediatric Infectious Disease Journal","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142351581","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":"Outpatient Laboratory Monitoring for Antibiotic-related Adverse Events in Children With Acute Hematogenous Osteomyelitis.","authors":"Felicia O Rosiji, Marritta Joseph, Lauren M Sommer, Sheldon L Kaplan, Jesus G Vallejo, J Chase McNeil","doi":"10.1097/INF.0000000000004576","DOIUrl":"https://doi.org/10.1097/INF.0000000000004576","url":null,"abstract":"<p><p>Monitoring for antibiotic-related lab abnormalities (ARLA), including hematologic, renal, and/or hepatic toxicity, in pediatric osteomyelitis is common. In 240 cases of osteomyelitis with outpatient laboratory monitoring, ARLA occurred in 13.3% with the most common finding being neutropenia. ARLA impacted antibiotic therapy in <1% of subjects, however, raising questions about the value of such monitoring being performed routinely.</p>","PeriodicalId":19858,"journal":{"name":"Pediatric Infectious Disease Journal","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142351580","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 Prognosis in Children With Pneumonia of Respiratory Syncytial Virus Co-detection With Airway Dominant Flora.","authors":"Lu Li, Ximing Xu, Enmei Liu, Yu Deng","doi":"10.1097/INF.0000000000004550","DOIUrl":"10.1097/INF.0000000000004550","url":null,"abstract":"<p><strong>Background: </strong>Airway bacterial microbiota influences the prognosis in children with respiratory syncytial virus infection. The study aimed to investigate the effect of the airway-dominant bacterial microbiota on disease severity in children with pneumonia of respiratory syncytial virus infection.</p><p><strong>Methods: </strong>A retrospective study was conducted in the Children's Hospital of Chongqing Medical University, which involved a cohort of patients with respiratory syncytial virus (RSV)-infected pneumonia from January 2012 to December 2021. Patients were assigned to a normal flora group or to a dominant flora group (with the top 5 individual bacteria) based on the nasopharyngeal aspirates culture and matched using propensity-score matching. Univariate analysis and multivariate analysis were performed to estimate the risk factors of poor prognosis in dominant flora.</p><p><strong>Results: </strong>Five thousand five hundred and twelve patients in the normal flora and 4556 in the dominant flora were included ( Escherichia coli 514, Streptococcus pneumoniae 1516, Staphylococcus aureus 506, Moraxella catarrhalis 509 and Haemophilus influenzae 1516, respectively). The dominant flora had more patients developing severe pneumonia, needing mechanical ventilation/tracheal intubation (up to 15.8% in the S. aureus ) and admission to the intensive care unit (up to 4.5% in the E. coli ) than in the normal flora (28.5% vs. 25.9%; P = 0.001; 9.8% vs. 5.4%; P < 0.001; 2.0% vs. 1.2%; P <0.001). And the hospitalization was longer in the dominant flora than in the normal flora [8 (6-9) vs. 8 (7-9) days; P < 0.001], the E. coli and S. aureus had the longest hospitalization [8 (7-10) days]. Several factors were associated with critical illness in Dominant flora according to multivariate analysis ( P < 0.001), including age (OR: 0.965; CI: 0.954-0.976; P < 0.001), anhelation (OR: 0.530; CI: 0.446-0.631; P < 0.001), disorders of consciousness (OR: 0.055; CI: 0.016-0.185; P < 0.001) as well as assisted respiration (OR: 0.115; CI: 0.097-0.138; P < 0.001), C-reactive protein >10 mg/L (OR: 0.686; CI: 0.560-0.839; P < 0.001), SpO 2 <90% (OR: 0.366; CI: 0.214-0.628; P < 0.001), pulmonary consolidation (OR: 0.511; CI: 0.364-0.717; P < 0.001) and pulmonary atelectasis (OR: 0.362; CI: 0.236-0.555; P < 0.001).</p><p><strong>Conclusions: </strong>The airway-dominant bacterial microbiota influenced disease severity and comorbidities in children with RSV-infected pneumonia. Clinicians should pay attention to the nasopharyngeal aspirate culture, especially after detecting S. aureus and E. coli in RSV-infected children with pneumonia, closely observe the disease progression and take timely measures to avoid adverse outcomes.</p>","PeriodicalId":19858,"journal":{"name":"Pediatric Infectious Disease Journal","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142292990","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":"CITROBACTER KOSERI SKIN AND SOFT TISSUE INFECTION COMPLICATED BY ABSCESS FORMATION: A CASE REPORT AND A REVIEW OF LITERATURE.","authors":"Dima Khreis, Samar Dalle, Samir Akel, Rima Hanna-Wakim","doi":"10.1097/INF.0000000000004573","DOIUrl":"https://doi.org/10.1097/INF.0000000000004573","url":null,"abstract":"<p><p>Citrobacter koseri (C. koseri) can lead to severe infections in the neonates, elderly and immunocompromised patients. We describe the first reported case of an axillary abscess due to C. koseri in a healthy adolescent, and review the clinical aspects and associated risk factors of this rare condition.</p>","PeriodicalId":19858,"journal":{"name":"Pediatric Infectious Disease Journal","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142351572","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 Bone Ischemia in Pediatric Acute Hematogenous Osteomyelitis and its Association With Progression to Chronic Osteomyelitis: New Insights From Gadolinium-enhanced Subtraction MRI.","authors":"Ahmed Al-Alawi, Sameer Raniga, Ian C Michelow, Laila Al-Yazidi, Zaid Alhinai","doi":"10.1097/INF.0000000000004552","DOIUrl":"https://doi.org/10.1097/INF.0000000000004552","url":null,"abstract":"<p><strong>Background: </strong>Acute hematogenous osteomyelitis (AHO), the most common osteoarticular infection in children, carries a significant risk for chronic complications. Predicting chronic complications early in the course of disease is challenging. The underlying pathogenesis of complications is not fully understood.</p><p><strong>Methods: </strong>Children who presented to Sultan Qaboos University Hospital, Muscat, Oman between January 2015 and April 2022 for AHO were identified by a search of magnetic resonance imaging (MRI) records. Children between 1 month and 18 years of age who did not meet exclusion criteria, and whose MRI also included gadolinium-enhanced subtraction (GES) sequences were included in the analysis. Outcomes were compared between patients who showed early evidence of bone ischemia and those who did not.</p><p><strong>Results: </strong>The analysis included 11 children who had GES MRI sequences from among 18 AHO cases in total. Median age was 5 years (IQR, 4-9), and 82% were males. Median duration of symptoms at presentation was 5 days (IQR, 3-7). GES sequences showed early bone ischemia in 6 of 11 (55%) patients. Patients with early bone ischemia were treated with significantly longer durations of IV antibiotics (median 23 vs. 10 days, P = 0.017) and oral antibiotics (median 134 vs. 29 days, P = 0.004), and required more surgical debridements (median 3 vs. 0 debridements, P = 0.017). Chronic osteomyelitis only developed among patients with early bone ischemia (5/6 vs. 0/5, P = 0.015).</p><p><strong>Conclusions: </strong>In pediatric AHO, GES MRI sequences revealed early bone ischemia in a significant proportion of patients. Early bone ischemia was strongly associated with progression to chronic osteomyelitis.</p>","PeriodicalId":19858,"journal":{"name":"Pediatric Infectious Disease Journal","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142351576","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}