Antibiotic Therapy In Children Research Articles

Twenty-four Month Outcomes of Extended- Versus Standard-course Antibiotic Therapy in Children Hospitalized With Pneumonia in High-Risk Settings: A Randomized Controlled Trial.

Pediatric community-acquired pneumonia (CAP) can lead to long-term respiratory sequelae, including bronchiectasis. We determined if an extended (13-14 days) versus standard (5-6 days) antibiotic course improves long-term outcomes in children hospitalized with CAP from populations at high risk of chronic respiratory disease. We undertook a multicenter, double-blind, superiority, randomized controlled trial involving 7 Australian, New Zealand, and Malaysian hospitals. Children aged 3 months to ≤5 years hospitalized with radiographic-confirmed CAP who received 1-3 days of intravenous antibiotics, then 3 days of oral amoxicillin-clavulanate, were randomized to either extended-course (8-day oral amoxicillin-clavulanate) or standard-course (8-day oral placebo) arms. Children were reviewed at 12 and 24 months. The primary outcome was children with the composite endpoint of chronic respiratory symptoms/signs (chronic cough at 12 and 24 months; ≥1 subsequent hospitalized acute lower respiratory infection by 24 months; or persistent and/or new chest radiographic signs at 12-months) at 24-months postdischarge, analyzed by intention-to-treat, where children with incomplete follow-up were assumed to have chronic respiratory symptoms/signs ("worst-case" scenario). A total of 324 children were randomized [extended-course (n = 163), standard-course (n = 161)]. For our primary outcome, chronic respiratory symptoms/signs occurred in 97/163 (60%) and 94/161 (58%) children in the extended-courses and standard-courses, respectively [relative risk (RR) = 1.02, 95% confidence interval (CI): 0.85-1.22]. Among children where all sub-composite outcomes were known, chronic respiratory symptoms/signs between groups, RR = 1.10, 95% CI: 0.69-1.76 [extended-course = 27/93 (29%) and standard-course = 24/91 (26%)]. Additional sensitivity analyses also revealed no between-group differences. Among children from high-risk populations hospitalized with CAP, 13-14 days of antibiotics (versus 5-6 days), did not improve long-term respiratory outcomes.

Use of Neoflorum probiotic to prevent gastrointestinal tract damage during antibiotic therapy in children

Use of Neoflorum probiotic to prevent gastrointestinal tract damage during antibiotic therapy in children

Shorter versus longer-course of antibiotic therapy for urinary tract infections in pediatric population: an updated meta-analysis.

Urinary tract infections (UTI) affect between 3% to 7.5% of the febrile pediatric population each year, being one of the most common bacterial infections in pediatrics. Nevertheless, there is no consensus in the medical literature regarding the duration of per oral (p.o.) antibiotic therapy for UTI among these patients. Therefore, our meta-analysis aims to assess the most effective therapy length in this scenario. PubMed, Cochrane, and Embase were searched for randomized controlled trials (RCTs) comparing short (≤ 5days) with long-course (≥ 7days) per os (p.o.) antibiotic therapy for children with UTI. Statistical analysis was performed using R Studio version 4.2.1, heterogeneity was assessed with I2 statistics, and the risk of bias was evaluated using the RoB-2 tool. Risk Ratios (RR) with p < 0.05 were considered statistically significant. Seventeen studies involving 1666 pediatric patients were included. Of these, 890 patients (53.4%) were randomized to receive short-course therapy. Patients undergoing short-course therapy showed higher treatment failure rates (RR 1.61; 95% CI 1.15-2.27; p = 0.006). Furthermore, there were no statistically significant differences between groups regarding reinfection (RR 0.73; 95% CI 0.47-1.13; p = 0156) and relapse rates (RR 1.47; 95% CI 0.8-2.71; p = 0.270). Conclusion: In summary, our results suggest that long-course p.o. antibiotic therapy is associated with a lower rate of treatment failure when compared to short-course p.o. antibiotic therapy. There was no statistical difference between both courses regarding reinfection and relapse rates within 15months. PROSPERO identifier: CRD42023456745. What is Known: • Urinary tract infections (UTIs) are common in children, affecting around 7.5% of those under 18. • The optimal duration of antibiotic treatment for pediatric UTIs has been a subject of debate. What is New: • Short-course therapy (5 or fewer days) was associated with a significantly higher failure rate when compared to long-course therapy. • There was no significant difference in reinfection and relapse rates within 15months between short and long-course therapy.

The success rate and complications of midline catheters in pediatric outpatient parenteral antibiotic therapy (OPAT)

The use of outpatient parenteral antimicrobial therapy (OPAT) for children has several advantages, including reduced length of hospital stay and costs. A reliable vascular access is key to delivering safe and effective pediatric OPAT. In recent years, midline catheters (MC) have been increasingly used for short-term intravenous antibiotic therapy in children. However, there are no studies investigating the use of MCs in the OPAT setting. The main aim of this paper was to evaluate the success and complications of using MCs for pediatric OPAT. This was a retrospective cohort study from a tertiary academic pediatric hospital. All MCs inserted at the hospital and used for OPAT were eligible for study inclusion. The primary objective was to describe the percentage of patients able to complete OPAT without the need for additional venous access. Forty-one MCs were included in the study. Patient mean (SD) age was 5.9 (4.9) years. In 31 cases (76%, 95% CI 62–86%), the iv therapy could be successfully completed using only the MC. Imbalances between the groups suggested unfavorable outcome for saphenous vein catheters as well as for shorter and smaller-sized catheters. Fourteen patients (34%) were subjected to a MC-related complication. Pain on injection in the MC was the most frequent complication (n = 10, 24%). Conclusion: Midline catheters could be an alternative to central venous access for pediatric OPAT. Avoiding saphenous vein insertion and using longer and larger-sized catheters could increase MC success rate. No severe MC-related complication was found. Further randomized studies comparing different catheter types are needed.What is Known:• For selected patients, pediatric outpatient parenteral antimicrobial therapy (OPAT) is safe and provides health-economic, psychosocial, and medical advantages compared to in-hospital care.• A reliable venous access is one of the key factors to the success of OPAT, but this can be a challenge in children.What is New:• Using midline catheters, 76% of patients could complete their intended iv therapy without the need for additional venous access. Avoiding saphenous vein insertion and using longer and larger-sized catheters could increase the success rate.• Thirty-four percent of catheters were subject to some kind of complication, the most common being pain on injection in the catheter.

Individualised versus standard duration of antibiotic therapy in children with acute uncomplicated febrile urinary tract infection: a study protocol and statistical analysis plan for a multicentre randomised clinical trial

IntroductionFebrile urinary tract infection is one of the most common bacterial infections in children. Currently, recommended antibiotic duration is 10 days. However, recent evidence suggests that 90%–95% of children with...

Rational choice of antibiotic therapy in children with acute respiratory infections of the upper respiratory tract

Acute respiratory infections are leading in the structure of infectious pathology in children. Despite the high importance of viruses in the etiology of acute respiratory infections, the role of bacterial pathogens remains important. Features of the current course, high frequency of complications, unreasonable prescription of antibacterial drugs and the risk of developing drug-resistant forms of microorganisms require adherence to algorithms for the timely diagnosis of bacterial infections and the rational use of antibacterial drugs. In the article, on the example of the analysis of clinical cases, the main stages of diagnosis and algorithms for choosing the initial antibiotic therapy for acute respiratory infections of the upper respiratory tract in children in an outpatient setting are considered. In the first clinical case, the principles of differential diagnosis of viral and bacterial acute otitis media, the risks of adverse outcome are considered, the main indications for prescribing systemic antibiotic therapy in preschoolers are identified. The second clinical case demonstrates the algorithms for diagnosing bacterial sinusitis, the possible masks of the disease, and the selection of a starting antibacterial drug. The example of the third clinical case shows the etiological diversity of acute tonsillopharyngitis in children, defined indications for systemic antibacterial therapy. It has been noted that only streptococcal tonsillopharyngitis is the primary indication of antibacterial prescription. The features of initial therapy and the duration of the course of antibacterial drugs in children were determined.

Isolation and characterization of enteroaggregative Escherichia coli among the causes of bacterial diarrhea in children

Diarrhea is a public health problem and an important cause of morbidity and mortality, enteroaggregative Escherichia coli (EAEC) have been recognized increasingly as agents of diarrhea in developing and in industrial countries. So the aim of this study is to study the prevalence of EAEC, its virulence factors and study it´s resistance to antibiotics. Results showed that E. coli represent 86 (32.9%) of the isolated bacteria. the high percentage 60% were EAEC, plasmid-encoded toxin (pet) was the marker most prevalent detected 14/30(28%) than EAST1(for EaggEC heat-stable enterotoxin 1)which detected in 9/30(18%) of EAEC and two virulence genes (pet+ and EAST1+) were found in7/30(14 %) of EAEC. 10% of isolates were contained capsule but only 3.3%isolates of E. coli have Type Ι pili while all the isolates possess Type ΙΙΙ pili. The results in the present study indicated that all E. coli were negative to Congo red dye agar test in contrast high percent of E. coli isolates were able to produce biofilm (86.7%) with different degree of thickness, while 20%isolates were urease positive after 24- 48 hrs, and 10% isolates were able to produce amylase. All isolates of E. coli were unable to produce Lecithinase, nuclease and hemolysin. While, 93.3% of E. coli isolates produced β-lactamase. The frequency of Sorbitol E. coli fermenter was 66.7%. In this study EAEC isolates were resistance (100%) to Penicillin and Ampicillin, High resistance(96.7%) was observed to each of Ceftriaxone, Cefotaxime and Trimethoprim. and Tetracycline (76.7%), resistance percentage of Both Amikacin and Rifampicin were (40%) and (33.3%) respectively. Higher sensitivity was reported to Gentamicin (63.3%), Ciprofloxacin(60%) then Nitrofurantoin (56.7%). The data from this study draw attention to the importance of notifying diarrheal disease. The high level of antimicrobial resistance observed in our study raises a broader discussion about the indiscriminate use or misuse of antibiotics and the risks of empirical antibiotic therapy in children of a very young age.

Oral Zinc as an Adjunct in the Treatment of Enteric Fever: A Randomised Double-blinded Controlled Trial

Introduction: Enteric fever is an important tropical disease which takes an average of five days for defervescence even with effective antibiotic therapy. Zinc has been successfully used as an adjuvant in diarrhoeal disease. If addition of oral zinc can lead to reduction in time to defervescence, it will be a useful adjuvant in the therapy of enteric fever. Aim: To determine the effect of oral zinc supplementation, along with standard antibiotic therapy, for early defervescence among children with enteric fever. Materials and Methods: This double-blinded, randomised controlled trial was conducted at the Department of Paediatrics, ESICMC and PGIMSR, Chennai, Tamil Nadu, India from November 2014 to August 2016. A total of 58 children aged &lt;12 years with enteric fever were included and were randomised to receive 40 mg elemental zinc per day (n=29) or placebo (n=29) for one week. All children received intravenous ceftriaxone (75 mg/ kg every 12 hours) until five days after defervescence. The main outcome measures studied were time taken for defervescence of fever and resolution of toxaemia. Kaplan-Meier survival analysis was used to compare differences in the time to resolution of toxaemia and defervescence of fever between the two groups and the log-rank test was used to test for significance. Results: The mean age of the children of the two groups was 6.48±3.15 years and 7.55±2.59 years, respectively. The mean time for fever defervescence was shorter among the zinc supplemented children than among the children in the control group (2 vs 3 days, p-value=0.043). Resolution of toxaemia was noted earlier in the zinc group than in the control group (75% vs 43%, p-value=0.054). Conclusion: Zinc when used as an adjunct along with standard antibiotic therapy in children with enteric fever, resulted in earlier defervescence of fever.

THE PROFILE OF ANTIBIOTIC PRESCRIPTIONS IN PEDIATRIC OUTPATIENTS: A RETROSPECTIVE OBSERVATIONAL STUDY

Background. Antimicrobial therapy is a common practice in pediatrics.&#x0D; Aim. The main objective was to determine and characterize the profile of antibiotic prescriptions in pediatric outpatients.&#x0D; Methods. This was a retrospective observational study performed in two pharmacies in Lviv (October 2021). 113 written doctor’s prescriptions for outpatient children were collected.&#x0D; Results. Antibiotics were administered for 44.2% (95%CI 34.9%–53.9%) of patients. The main reasons for antibiotic prescriptions were acute tonsillitis (30.0%) and acute upper respiratory tract infections (26.0%). Macrolides, cephalosporins, penicillins, and sulfonamides with trimethoprim presented 40.0%, 36.0%, 20.0%, and 4.0% of antibiotic prescriptions, respectively. Antimicrobials from the Access group accounted for 26.0% of antibiotic prescriptions (instead of at least 60.0%, WHO) and antibiotics from the Watch group constituted 74.0% (instead of a maximum of 40.0%, WHO). Antibiotics were prescribed to 61.9% of outpatients with acute upper respiratory tract infections, 93.7% of patients with acute tonsillitis, and 45.5% – with otitis media instead of recommended 0-20% (ESAC-Net). The first-line antibiotics were used in 23.1% of cases of acute upper respiratory infections, 26.7% of cases of acute tonsillitis, and 40.0% of otitis media, which is below the acceptable range (80–100%, ESAC-Net). In total, 22 antibiotic-associated drug-related problems (DRPs) were found in 34.0% of written doctor’s prescriptions with antimicrobials. The most common were: (1) excessive length of therapy (36.4%) and (2) potential drug-drug interactions (31.8%).&#x0D; Conclusions. The rate of antibiotic prescriptions for children is high and associated with different DRPs. The majority of antibiotic prescription quality indicators are outside the recommended ranges. Thus, effective interventions and campaigns to improve antibiotic therapy in children are needed.

Клинико-патогенетические аспекты лечения и профилактики пиелонефрита у детей

Treatment of pyelonephritis in children should be combined, long-term and individual-based. The success of the therapy in children largely depends on the prompt appointment and the correct choice of antimicrobial therapy.To evaluate the efficiency of the dietary supplement "Cystenium II" in a group of children aged 7 to 14 years with a diagnosis of acute and chronic recurrent pyelonephritis in the acute phase.A total of 60 children aged 7 to 14 years with a diagnosis of acute or chronic recurrent pyelonephritis in the acute stage were included in the study. The clinical group consisted of 30 patients (mean age 12.1+/-1.8 years), while the control group included 30 patients of mean age 11.2+/-1.7 years. In the control group patients received only standard antibiotic therapy, while in the clinical group it was combined with a dietary supplement "Cystenium II" 1 tablet 2 times a day with meals for 14 days. After the course of antibacterial treatment, the children in the clinical group continued to take the studied dietary supplement for another 14 days in order to prevent the recurrence of pyelonephritis. The results of treatment (patient's condition, presence of pain, dysuria, fever) were assessed on the 3rd, 7th, 14th day, 1 and 6 months after the start of treatment. A urinalysis was performed at the baseline, on the 7th and 14th days, as well as after 1 and 6 months. Urine culture was performed before and after antibiotic therapy at the baseline, on the 14th day, 1 and 6 months after the start of treatment.The main indicators of urinalysis (leukocytes, red blood cells, protein) returned to normal values in 26 (86.7%) patients of the clinical group and in 23 (76.7%) patients of the control group on the 7th day after the start of treatment. At the completion of the basic therapy (after 14 days) normal clinical parameters (absence of leukocyturia, microhematuria, proteinuria) were observed in all patients of the clinical group and in 28 (93.3%) patients of the control group. After a month of follow-up, the disturbances in urinalysis (leukocytes, red blood cells, protein) in the control group were again seen in 3 (10%) patients, as well as after 6 months. However, in the clinical group all patients had normal urinalysis (absence of leukocyturia, microhematuria, proteinuria) after 1 month and only in 1 (3.3%) case leukocyturia, as well as an increase in the number of red blood cells and protein was detected by 6 months.According to our results, the use of dietary supplements "Cystenium II" (manufactured by Akvion, Russia), due to the constituents of D-mannose (450 mg), cranberry fruit extract with a standardized activity of 500 mg (36 mg of proanthocyanidins) and vitamin C (60 mg), may cause anti-inflammatory and anti-adhesive effects (resolving of leukocyturia and bacteriuria). This allows to use the dietary supplement Cystenium II in children from 7 years of age in the combination therapy of acute pyelonephritis, as well as exacerbation of chronic pyelonephritis. The obtained results showed a high overall therapeutic efficacy of combination therapy using Cystenium II after 6 months from the start of treatment (relapse in 1 patient), in contrast to the control group (relapse in 6 patients).the use of dietary supplement "Cystenium II" allowed to reduce the number of repeated courses of antibiotic therapy in children during 6 months of follow-up and, most likely, reduced the frequency of development of chronic pyelonephritis after an acute inflammation. Therefore, the wide clinical use of dietary supplements "Cystenium II" for the combined treatment of acute and exacerbation of chronic pyelonephritis in children older than 7 years seems to be very reasonable.

1309. Adherence to Short-Term Antibiotic Therapy in Children – a Blinded, Prospective, Electronically-Monitored Study

Abstract Background Non-adherence to short-term antibiotic treatment in children can lead to treatment failure and development of drug resistance. To develop effective interventional programs reliable adherence data is needed, but previous studies are scarce and have mostly used parental self-reports. We aimed to determine true adherence rates of pediatric patients treated for acute infections with antibiotic suspensions. Secondary goals were to evaluate patient and treatment characteristics influencing adherence rates and whether the prescriber can predict adherence rates of patients. Methods A prospective, blinded, electronically monitored, observational study. Patients aged 2 months to 5 years diagnosed with an acute bacterial infection requiring short (5-10 days) oral antibiotic monotherapy were enrolled. Parents were told they received a new "childproof" cap for evaluation, but unknowingly were provided with an electronically monitored medication bottle recording every manipulation of the cap. At the end of treatment study purpose was disclosed and, if approved, cap data and patient and treatment information collected. Results 100 infants (49 boys, mean [range] age 1.87 years [0.2-5.1]) were included in the final analysis. Only 11 participants received all the recommended doses. Overall adherence (defined as administration of &amp;gt;75% of prescribed doses) was 62%, while timing adherence (administration of &amp;gt;75% of doses within ±20% of the prescribed interval) was only 21%. After applying a logistic regression model, the only factor significantly associated with non-adherence was being a single parent [OR=5.7 95%CI (1.07-30.3)]. Prescribers overestimated adherence, defining 49/62 (77.7%) participants as likely adherent. Patient/parent pairs that were predicted to be adherent were not more likely to be overall or timing adherent than those predicted to be non-adherent (31/47 vs. 6/16, p=0.77). Conclusion Adherence of children to short-term antimicrobial treatment for an acute infection is suboptimal, with only 62% showing good adherence and 21% with good adherence at proper timing intervals. Providers were unable to predict patient adherence. This data is important when considering recommended treatment durations and developing interventional programs to increase adherence. Disclosures All Authors: No reported disclosures.

488. Association between the Respiratory Microbiota and Response to Antibiotic Therapy in Children with Macrolide-resistant Mycoplasma pneumoniae Pneumonia

Abstract Background Along with the overuse of macrolides as the empirical treatment for M. pneumoniae infection, macrolide-resistant M. pneumoniae (MRMP) emerged up to 90 prevalence rate in Asian countries. We investigated whether respiratory microbiota at the beginning of hospitalization was associated with disease severity and response to antibiotic treatment in children with MRMP pneumonia. Methods Prospectively enrolled children aged &amp;lt; 18 years with community-acquired pneumonia caused by MRMP from 2017/4-2020/3 at Linkou Chang Gung Memorial Hospital. Oropharyngeal samplings were collected within 48 hours after admission. Total 66 children were included: 23 had not received macrolide or gave response to macrolide (defined as without effective treatment group); 43 needed doxycycline treatment (defined as doxycycline treatment group). Compared the oropharyngeal microbiota between groups using the 16S-rRNA-based sequencing. Patients who were administered antibiotics other than augmentin or Azithromax were excluded. The difference in microbial composition will be examined using microbial community analysis. Statistically significant species for each group were evaluated by the linear discriminant analysis of effect size analysis to identify differentially abundant biomarkers, comparing disease severity scores, CRP and febrile days lasting. Scheme of sample collection and analyses Augmentin with or without Azithromax was the most common antimicrobial agent used. If fever persisted under the impression of suspected MRMP infection, doxycycline was used following three days of Azithromax usage. Scheme of sample collection and analyses Correlation between microbiome and clinical feature. Results Doxycycline treatment group had longer duration of total febrile days (p&amp;lt; 0.001) and total hospitalization days (p=0.002). Without effective treatment group had higher microbial richness, different overall community composition (p&amp;lt; 0.01). The lowest respiratory alpha diversity had prolonged febrile days (p=0.032). Without effective treatment group had more abundant spices or genera. Classification of samples to detect patients with effective treatment or not based on these selected microbiota genera features achieved the ROC curve of 0.86. From the list of most relatively abundant species in MRMP patient without doxycycline, Fusobacterium periodonticum most negatively correlated with total febrile days and severity score. Clinical characteristics of patients enrolled in this study Data were shown as n (%) or mean ± standard deviation. N/A, not applicable. Taxonomic assignment of the all throat swab samples. Fraction of predominant microbiota with a relative abundance of at least 2% at the order level (A) and genus level (B) in all sample. Higher respiratory microbial diversity is associated with MRMP patients without effective treatment than MRMP patients who needed doxycycline treatment Microbial richness base on the different alpha-diversity index in MRMP patients without effective treatment (blue); MRMP patients with doxycycline treatment (red). (A)(B)The box represented the interquartile range (IQR, and the midline represented the median. Tukey’s honest significance test of ANOVA, p&amp;lt;0.05.) (C)Kaplan-Meier (KM) plot of febrile time by respiratory diversity. (D)Principal coordinates analysis (PCoA) for MRMP patients without effective treatment (blue), MRMP patients with doxycycline treatment (red) by Unweighted UniFrac distance. Significant differences were observed between MRMP patients without effective treatment and MRMP patients with doxycycline treatment. A PERMANOVA (α=0.05) with 999 random permutations, p = 0.001. Conclusion Respiratory dysbiosis was associated with persistent fever and disease severity in MRMP pneumonia. In our study, F. periodoticum negatively related to fever duration and disease severity. Compositional differences in the respiratory microbiome are associated with MRMP patients without effective treatment than MRMP patients who needed doxycycline treatment by LEfSE analysis LDA scores revealed differentially abundant bacteria in the respiratory microbiome of without effective treatment (blue) and doxycycline treatment (red) groups at genus level (A) and species level (B).The mean relative abundance of genera at right side. The mean relative abundance of genera at right side. (C) Receiver operating characteristic (ROC) curves of ASVs to predict MRMP patients without effective treatment or who needed doxycycline treatment. Pairwise Spearman rank correlation heat map of significantly different taxa in throat swabs at initial sampling and clinical severity score in MRMP patients without effective treatment/with doxycycline treatment The genus (A) and species (B) level. Genus and species were in rows; the correlation was indicated by color gradient. Disclosures All Authors: No reported disclosures.

Sore throat in children: diagnosis, treatment, prevention

Introduction. Sore throat often accompanies acute pharyngitis and tonsillitis in both children and adults. Inflammation of the posterior pharyngeal wall, acute pharyngitis, almost never occurs in isolated form in children and is often accompanied by symptoms of acute adenoiditis and / or tonsillitis.Aim. To study the effectiveness of the treatment of exacerbation of chronic non-streptococcal tonsillitis with an antiseptic herbal product in childhood.Materials and methods. We examined 58 children diagnosed with exacerbation of chronic tonsillitis for the period from June 2018 to December 2019. The age of the children ranged from 6 years 4 months up to 14 years old, the average age was 8.3 + 2.4 years, the group included 32 boys (55%) and 26 girls (45%). The duration of the disease ranged from 1 to 5.5 years. The exacerbations of chronic tonsillitis occured 3-4 times a year. The patients included in the study received the antiseptic herbal product in the form of drops at a dose of 15 drops five times/day for 7 days, and then 15 drops three times/day for another 7 days. The course of therapy was 14 days.Results. The provided course of therapy resulted in the significant positive changes overtime: reduced intensity of complaints already at the second visit, significant reduction of complaints at the third visit and actual relief of complaints by the fourth visit in the patients receiving the monotherapy with antiseptic herbal product.Conclusions. Preservation of the normal microbiome of the upper respiratory tract in children maintains effective functioning of MALT and thereby reduces the risk of the development and chronification of inflammation in the oropharynx. The antiseptic herbal medicinal product may be regarded as the alternative to antibiotic therapy in children with exacerbation of chronic tonsillitis, as it has a multifunctional effect on the mucous membranes lining upper respiratory tract, stimulates innate and adaptive immunity, and increases the resistance of mucous membranes to the pathogens.

Intravenous Antibiotic Duration for Nontyphoidal Salmonella Bacteremia in Children.

The optimal duration of intravenous (IV) antibiotic therapy for children with nontyphoidal Salmonella bacteremia (NTSB) is unknown. The objective of the authors of this study is to evaluate differences in outcomes among children with NTSB who received a short (≤3 days; short-duration group [SDG]) versus long (>3 days; long-duration group [LDG]) course of IV antibiotics. This is a retrospective study of children 3 months to 18 years old with NTSB admitted to a tertiary pediatric health care system in the southeastern United States between 2008 and 2018. Among 57 patients with NTSB without focal infection, 24 (42%) were in the SDG and received IV antibiotics for a median of 3.0 days and 33 (58%) were in the LDG and received IV antibiotics for a median of 5.0 days. Demographic and clinical characteristics were similar between the SDG and LDG. The median total duration of antibiotics was 11.5 days in the SDG and 13.0 in the LDG (P = .068). The median length of stay was 3.0 days in the SDG and 4.0 in the LDG (P ≤ .001). Two children in the SDG (8%) and 1 child in the LDG (3%) returned to the emergency department for care unrelated to the duration of their IV antibiotic therapy (P = .567). None of the children were readmitted for sequelae related to salmonellosis. The duration of IV antibiotics varied for NTSB, but the outcomes were excellent regardless of the initial IV antibiotic duration. Earlier transitions to oral antibiotics can be considered for NTSB.

Risk Factors and Outcomes Associated With Antibiotic Therapy in Children Hospitalized With Asthma Exacerbation.

Despite lack of benefit, antibiotics are overused in management of asthma exacerbation in children. In this study, data from a single children's hospital were analyzed to identify factors and outcomes associated with antibiotic use in children hospitalized with asthma. The study population was identified by using administrative data from 2012 to 2015, with subsequent verification of asthma. We analyzed factors associated with antibiotic use (demographic, seasonal, clinical) and outcome (length of stay [LOS]) with respect to: 1) disposition to pediatric floor (PF) or pediatric intensive care unit (PICU); and 2) evidence of coexisting bacterial infection and/or fever. Statistical analysis included univariate and controlled regression models. Data are presented as median and IQR for continuous variables and OR and regression coefficient (β) with 95% CIs for regression analyses. Of 600 patients, 28.8% were admitted to PICU, 14.8% had verified bacterial infection, and 53.8% received antibiotic, mainly azithromycin. Nearly all PICU patients were treated with antibiotic, irrespective of coexisting bacterial infection or fever. Among PF patients, nearly 30% without bacterial infection or fever and 40% with fever alone received antimicrobials. Overall risk for antibiotic treatment was associated with older age, female sex, desaturation events, oxygen supplementation, and PICU admission. Additionally, antibiotic treatment was associated with 13- to 19-hour increased LOS for PF patients without bacterial infection and/or fever. Almost half of pediatric patients admitted with asthma exacerbation received antibiotic therapy with no clear indication, which was associated with prolonged LOS.

Effect of Antibiotic Therapy in Children with Pyelouretheral Segment Obstruction

The present retrospective study, which was conducted from 2013 to 2018 years, includes data of 131 children with antenatally diagnosed grade III and IV hydronephrosis (SFU). All patients underwent surgical treatment at the age from 3 months to 3 years and did not receive antibiotic prophylaxis. Urinary tract infection was diagnosed in the presence of WBC in urine sample (&gt; 10 WBC/field of view), positive bacterial growth (≥105 CFU/ml) and fever (≥38.5 ° C). Children with duplex system, obstructive megaureter, vesicoureteral reflux, posterior urethral valve, and neurogenic bladder were excluded from this study. Grade III hydronephrosis was detected in 113 children and grade IV in 18 patients. The total incidence of urinary tract infection was 9.2% (12 patients), while in the group of children with grade IV hydronephrosis it was higher (in 3 of 18 - 16.7%) than in children with grade III (in 9 out of 113 - 7.9%) (P &lt;0.05). The incidence of urinary tract infections did not differ significantly depending on the sex or age of the patients. In 7 (58.3%) patients, urinary tract infection was noted before the age of 6 months, with an average age of 2.7 months. A bacteriological study revealed that in eight (66.7%) patients, E. Coli was the causative agent of urinary tract infection. Children with antenatal diagnosed and postnatal confirmed ureteropelvic junction obstruction do not need antibiotic prophylaxis because of the low incidence of urinary tract infection. However, patients with grade IV hydronephrosis under the age of 6 months should be closely follow-up by physicians for the early diagnosis and treatment of urinary tract infection.

Impact of Cell-Free Next-Generation Sequencing on Management of Pediatric Complicated Pneumonia.

Community-acquired pneumonia (CAP) is common in pediatrics. More severe complicated CAP (cCAP) requires broad-spectrum empirical therapy. Cell-free plasma next-generation sequencing (cfNGS), a DNA-based diagnostic tool, could be used to guide therapy. We retrospectively compared the pathogen identification rate of cfNGS to that of standard culture methods and assessed the impact of cfNGS on antibiotic therapy in children hospitalized for cCAP. We conducted a retrospective review of children aged 3 months to 18 years hospitalized for cCAP with cfNGS results from January 24, 2018, to December 31, 2020. We compared the positivity rate of conventional microbiologic diagnostic testing with that of cfNGS and the impact on clinical management, including changes in antibiotic therapy. We identified 46 hospitalized children with cCAP with cfNGS results. Of these children, 34 also had blood cultures (1 positive for pathogen; 3%) and 37 had pleural fluid cultures (10 positive for pathogen; 27%). Of the 46 children, positive cfNGS testing results were positive for pathogen in 45 (98%), with the causative pathogen identified in 41 (89%). cfNGS was the only method for pathogen identification in 32 children (70%). cfNGS results changed management in 36 (78%) of 46 children, with the antibiotic spectrum narrowed in 29 (81%). cfNGS provided a higher diagnostic yield in our pediatric cCAP cohort compared with conventional diagnostic testing and affected management in 78% of children. Prospective studies are needed to better characterize the clinical outcome, cost-effectiveness, and antimicrobial stewardship benefits of cfNGS in pediatric cCAP.

Питання своєчасної діагностики кишкових ускладнень антибіотикотерапії у дітей

Метою дослідження було вдосконалення своєчасної діагностики кишкових ускладнень антибіотикотерапії, обумовлених Clostridium difficile-інфекцією у дітей. Обстежили дітей віком від 6 місяців до 18 років (n = 131), які отримували антибактеріальні препарати з приводу мікробно-запальних захворювань. У 116 з них були бактеріально-запальні захворювання, які потребували лікування антибіотиками в умовах стаціонару або поліклініки; контрольну групу становили 15 клінічно здорових дітей. Використали загальноклінічні та імуноферментні методи. Установлено, що в дітей iз соматичними захворюваннями, які отримували лікування антибіотиками у стаціонарi, найбільш поширеним кишковим ускладненням є гостра діарея, і доведено, що діарея обумовлена в більшості випадків інфекцією Clostridium difficile. Визначено частоту та особливості клінічного перебігу кишкових ускладнень антибіотикотерапії у дітей. Виявлено існування субклінічної форми кишечного клостридіозу. Доведено, що рецидивуючий діарейний синдром у дітей, які отримували повторні курси антибактеріальних препаратів в амбулаторних умовах, також обумовлений Clostridium difficile-інфекцією.

Влияние инфекции дыхательных путей на стоимость терапии при муковисцидозе

Cystic fibrosis (CF) is a severe progressive disease in which the control of respiratory infection determines the disease prognosis. Objective. To assess the impact of different respiratory tract infections on the costs of antibiotic therapy in children with CF, depending on their age. Patients and methods. Patients were divided into three groups (0–3 years, 4–10 years, and 11–18 years) for the costeffectiveness analysis; mean body weight was calculated for each group. Current regulatory documents were used to evaluate antibacterial therapy. The State Register of Medicines was used to calculate the costs of each drug. Results. We found that the highest costs were associated with inhaled antibiotics used for the eradication therapy in patients with P. aeruginosa and Achromobacter spp. infections (up to 1,152,000 RUB per year), chronic P. aeruginosa and Achromobacter spp. infections (up to 2,304,000 RUB per year), and infections caused by Burkholderia cepacia complex (up to 750,178 RUB per year). In case of intravenous antibiotics, the highest costs were associated with the treatment of infections caused by Burkholderia cepacia complex (up to 790,236 RUB per year). Conclusion. Patients with CF require regular microbiological monitoring to ensure timely detection of pathogenic microorganisms and respiratory tract infections. Early initiation of adequate antibacterial therapy in accordance with clinical guidelines is necessary to prevent chronic infections. Key words: antibacterial drugs, children, cystic fibrosis, therapy cost

Outpatient Antibiotic Prescription Rates and Mastoiditis in Children and Adolescents, Saarland, 2014-2019

Infections of the respiratory tract are the main indication for outpatient antibiotic therapy in children and adolescents. In recent years the antibiotic prescription rate (APR) in the pediatric population has decreased significantly. The aim of the retrospective mastoiditis audit in the PaedineSaar network is to investigate the incidence of inpatient acute mastoiditis (AM) in Saarland (2014-2019) regarding to the decreasing APRs in children, as well as to gather data of the clinical course of AM. All inpatient AM cases 2014-2019 were analyzed retrospectively from 6 hospitals for pediatrics and/or otorhinolaryngology in Saarland and Trier. Children and adolescents aged 0-17 years and residing in Saarland were included in the study. 2014-2019 53 inpatient treated AM cases have been recorded. During the study period there was no significant increase of AM incidence (mean incidence 2014-2019: 6.1/100,000). 34% (18/53) of the patients received prehospital antibiotic treatment (main indication: acute otitis media (AOM) 15/18, 83%). At least one complication occurred in 30% of the patients (16/53). There was a slight trend to more complications in children without oral antibiotic treatment before admission (14/35 (40%) vs. 2/18 (11%) p=0.056). The incidence of AM leading to inpatient treatment in children in Saarland did not increase 2014-2019 despite a significant and sustained decline in the outpatient APRs. The results of this audit should be used for the development of a more standardized approach concerning the diagnostics and treatment of children with AM.