Bacterial Infections In Children Research Articles

Prevalence of Streptococcus agalactiae in Urinary Tract Infections of Pregnant Women

Background: Urinary tract infection is the most common bacterial infection in children and adults, especially females. Among urinary tract infection caused by bacteria, Streptococcus agalactiae can cause periodic, temporary, or persistent infection in women. The aim of this study was to evaluate the prevalence of S. agalactiae isolated from urine samples in pregnant women referred to Qom hospitals, Iran.
 Methods: In this descriptive study, 1264 pregnant women suspected for urinary tract infection were assessed. Midstream urine specimens collected from pregnant individuals in Ali-ibn-AbiTaleb hospital medical laboratory were passaged on blood agar media. Streptococcus agalactiae was detected using phenotype-based tests. Then, antibiotic susceptibility tests were conducted using the disc diffusion method according to CLSI protocols.
 Results: Out of 1264 pregnant patients, 17.64% were diagnosed with beta-hemolytic Streptococcus, and 13.37% were diagnosed with S. agalactiae. The highest rates of antibiotic resistance were found for Clindamycin and Erythromycin. In place, the lowest resistance rate was detected for Nitrofurantoin. The prevalence of resistance to Penicillin was about 33%.
 Conclusion: Regarding the results of this research, it would be better to perform urine culture tests before week 34 of pregnancy and the last weeks of pregnancy. Also, our results showed that Penicillin can be replaced by alternative antibiotics before week 34 of pregnancy to prevent further S. agalactiae antibiotic resistance.

Frequency of microorganisms in children presenting with acute fever at the outpatient department.

Objective: To determine the incidence of blood stream bacterial infection and the frequency of microorganisms involved as evaluated by blood culture in children presenting with acute febrile illness at the outpatient department. Study Design: Cross-sectional study. Setting: Department of Pediatrics and Child Health, Mardan Medical Complex, Mardan, Pakistan. Period: 1st March 2023 to 31st of August 2023. Material & Methods: A total of 252 children from both genders between the ages of 1 month to 15 years presented at outpatients department with fever (≥ 38.0 °C or 100.4 °F) for ˃ two days were included in the study using consecutive sampling technique. The blood cultures of these children were sent to the laboratory for investigations. Bacterial strains were isolated and identified using standard microbiological techniques. The primary outcome was to determine the incidence of blood stream bacterial infection and the frequency of microorganisms involved. Results: The Mean±SD of age is this study was 4.20±3.42 years with an age range of 0.5-14 years. Male gender was 51.59% while female gender was 48.41%. The results of blood culture report showed that bacterial growth was present in 37 (14.68%) of total study patients. Out of these positive blood cultures, Gram-positive Cocci was reported in 16 (43.24%) of the children while Gram-negative bacilli were present in 21 (56.76%). The prevalence of E Coli was highest in these children 10 (27.02%) followed by S Typhi 8 (21.62%), Streptococcus pneumonia 5 (13.51%) and S aureus 4 (10.81%). Conclusion: It was concluded that the Gram-negative bacilli are the common cause of bacterial infection in children presenting with fever at outpatient department of a tertiary care hospital in this region with most frequent presence of E Coli and S Typhi.

Evaluating the Utility of Procalcitonin and C-Reactive Protein to Predict Bacteremia in Children with Musculoskeletal Infections

Background:Musculoskeletal infections (MSKI; osteomyelitis, septic arthritis) are among the most common invasive bacterial infections in children, often associated with complications. Bacteremia precedes these complications; thus, early identification may prevent them. Acute inflammatory markers, C-reactive protein (CRP) and Procalcitonin (PCT) are often elevated in children with acute MSKI. PCT is understudied in children with MSKI. The primary goal of this study was to evaluate the utility of PCT and CRP in distinguishing children with MSKI with bacteremia vs. those without.
 Methods:Patients 6 months to 18 years with strong clinical suspicion of MSKI were prospectively enrolled at Riley Hospital for Children from July 2019 to May 2022 unless clinical evidence suggested an alternative diagnosis or if informed consent was not obtained. CRP was obtained at admission and PCT was collected within 96 hours of presentation to the hospital. Demographic data was recorded from electronic medical records. Two-sided P values of <0.05 were considered statistically significant for univariate analysis and logistic regression.
 Results:Thirty-seven patients were enrolled, the majority being non-Hispanic white males (40.5%), median age of 8 years (IQR, 4-12). Median PCT in children with bacteremia was higher (0.41 ng/mL [IQR 0.14-0.8 ng/mL]) compared to those without (0.10 ng/mL [IQR 0.05-0.31 ng/mL]) (p=0.03). Median CRP in children with bacteremia was higher (13.7 mg/dL [IQR, 9.15-19.9]) compared to those without (4.1 mg/dL, [IQR 0.65-5.8]) (p<0.01). Both PCT and CRP showed good ability to discriminate those with bacteremia from those without, with an area under the ROC of 0.75 (95% CI 0.56, 0.94) and 0.80 (95% CI 0.64, 0.95), respectively.
 Conclusions:Initial PCT and CRP demonstrated utility in detecting bacteremia in patients presenting with MSKIs. This study warrants further exploration into the usage of PCT and CRP as early predictors of bacteremia for more appropriate treatment and potentially fewer complications of these infections in pediatric patients.

Procalcitonin Levels in Identifying Bacterial Infections in Children with and without COVID-19.

Elevated procalcitonin levels have been associated with bacterial infection in children. Observational studies reported high procalcitonin values in COVID-19. Data on bacterial coinfections in pediatric COVID-19 is sparse; small studies suggest a low coinfection rate. In this study, we aimed to quantify the positive predictive value (PPV) of procalcitonin in identifying bacterial infection in children with and without COVID-19. A retrospective chart review was performed for 215 children <21 years admitted to our tertiary children's hospital between February 1, 2013, and July 15, 2020, who had procalcitonin levels measured within 48 hours of admission. Confirmed bacterial infection was defined as positive blood, urine, or cerebrospinal fluid (CSF) culture, positive endotracheal culture with evidence of leukocytosis on Gram stain, or pneumonia by chest radiograph. Suspected bacterial infection was defined as confirmed bacterial infection or administration of antibiotics for >48 hours. Of the 215 patients, 73 were admitted for COVID-19 (66% multisystem inflammatory syndrome in children [MIS-C], 34% acute COVID-19). The PPV of an elevated procalcitonin level >1.0 ng/mL in identifying suspected bacterial infections for those with MIS-C was 6.3% (95% CI=0-15), in acute COVID-19 was 29% (95% CI=0-62%), and in the non-COVID-19 cohort was 75% (95% CI=62-88%). For identification of confirmed bacterial infection, PPV of an elevated procalcitonin level was 0% in MIS-C, 14% (95% CI=0-40%) in acute COVID-19, and 55% (95% CI=40-69%) in the non-COVID-19 cohort. We found a low PPV of elevated procalcitonin level above 1 ng/mL in identifying either culture-confirmed or presumed bacterial infection in children hospitalized with COVID-19-related illness.

Efficiency of Phenazine Compound Produced by Rhizospheric Pseudomonas fluorescens against Few Pathogenic Bacteria Isolated from Ear Infections

The most typical bacterial infection in children of pediatric age is acute otitis media. Because resistance to these microorganisms grows, management expenses for each pathogen must be specifically adapted to that pathogen. Pseudomonas fluorescens isolated from the rhizosphere rice soil revealed a higher level of antibacterial activity against ear infection pathogenic bacteria than other species of Pseudomonas. Phenazine was extracted P. fluorescens by using organic solvents such as benzene with 3.76 μg/ml then characterized with thin layer chromatography and gave a band with a retardation factor (RF) of 0.64 based on the compound’s mobility on the silica plate. In comparison to the antibacterial activity of crude phenazine, the purified phenazine revealed the highest activity against Staphylococcus aureus at 32 mm, and the lowest activity was recorded on bacteria P. aeruginosa with an 18 mm diameter of inhibition. This leads to the encouragement of the use of phenazine compound for the treatment of the increased ear infections due to multi-resistance by causing pathogens.

Methicillin resistant Staphylococcus aureus infections in children: A prospective study

Community acquired MRSA (CA MRSA) can cause invasive diseases posing a challenge to treating physicians. The knowledge about the disease load, clinical pattern, risk factors, outcome and susceptibility pattern in a given geo demographic context contribute crucially to the treatment outcome of MRSA infections in children. To study the profile, clinical pattern, factors affecting the immediate outcome and antimicrobial susceptibility of MRSA infections in children A prospective observational study was conducted in children between 2 months and 12 years admitted with MRSA infections, from January 2016 to December 2017 in the Institute of Maternal and Child Health, Government Medical College Kozhikode, Kerala state, India. Out of 431 children evaluated 83(19.3%) had MRSA infections with 44(53%) CA MRSA and 39(47%) hospital associated MRSA (HA MRSA). Twenty one (53.8%) of HA MRSA infections were hospital onset MRSA (HAHO MRSA) and 18(46.2%) community onset MRSA (HACO MRSA). There were 37 infants, 16 toddlers, 12 preschool children, 18 school children, 48 males and 35 females in the study population. Blood (50.6%), pus (33.7%), and body fluids (15.7%) were the sites of isolation. Skin and soft tissue infections (SSTI)(30.10%), pneumonia (28.90%), empyema (9.64%), meningitis (7.23%), septicaemia (12.05%), bone and joint infections (9.64%), peritonitis (2.41%) and septic shock (18.1%) were the clinical presentation. Mortality occurred in 9.9% and paediatric intensive care requirement in 45.8% patients. Anaemia and thrombocytopenia were identified as the risk factors for PICU admissions (corrected OR; 95% C I, 3.38; 1.02–11.18 and 8.35; 1.35–45.03 respectively). Thrombocytopenia was associated with mortality (corrected OR 43.74, 95% C I 3.86–495.9). Susceptibility to clindamycin, co-trimoxazole, amikacin and rifampicin were 79.5%, 73.5%, 68.7% and 90.4% respectively. MRSA constituted a significant proportion of bacterial infections in children, the majority being community onset. Pneumonia and empyema predominate over SSTI. Thrombocytopenia was associated with mortality and PICU admission. Clindamycin, co-trimoxazole and amikacin can be utilised in the treatment of less severe MRSA infections

Invasive group A streptococcal infections in children and adolescents in Denmark during 2022–23 compared with 2016–17 to 2021–22: a nationwide, multicentre, population-based cohort study

A historic increase in paediatric invasive group A streptococcal (iGAS) infections was reported globally in 2022. iGAS infections can lead to severe manifestations (eg, pleural empyema, necrotising fasciitis, toxic shock syndrome, osteomyelitis, septic arthritis, and meningitis). We aimed to compare the incidence and severity of iGAS infections overall, for distinct clinical phenotypes, and for GAS emm variants in Denmark in 2022-23 with reference to the previous six seasons (ie, 2016-17, 2017-18, 2018-19, 2019-20, 2020-21, and 2021-22). In this nationwide, multicentre, population-based cohort study, we included all children and adolescents in Denmark aged 0-17 years with a positive culture of GAS or GAS confirmed through PCR-based methods from otherwise sterile sites in 2022-23 and the previous six seasons from 2016-17 to 2021-22. For all seven seasons, data were obtained from week 21 to week 20 of the next year. Patients at all 18 paediatric hospital departments in Denmark were identified through the Danish Microbiology Database, in which iGAS isolates from sterile sites are prospectively registered, including emm typing. We obtained electronic medical health records for each patient admitted with a diagnosis of iGAS. We calculated the incidence of iGAS per 1 000 000 inhabitants aged 0-17 years in each season from week 21 to week 20 of the next year and the risk ratios (RRs) for incidence of iGAS, distinct disease manifestations, and emm variants in 2022-23 versus the three pre-COVID-19 seasons in 2016-17, 2017-18, and 2018-19 using Fisher's exact test and Pearson's χ2 test. Among the Danish population of 1 152 000 children and adolescents aged 0-17 years, 174 with iGAS disease were included. 76 children and adolescents with iGAS during 2022-23 were identified; 31 (41%) of 76 were female and 45 (59%) were male. 98 children and adolescents with iGAS during 2016-17 to 2021-22 were identified; 41 (42%) of 98 were female and 57 (58%) were male. There was an increase in incidence of iGAS from mean 22·6 (95% CI 14·7-33·1) per 1 000 000 children and adolescents during 2016-17 to 2018-19 to 66·0 (52·0-82·6) per 1 000 000 during 2023-23 (RR 2·9, 95% CI 1·9-4·6; p<0·0001). During the COVID-19 pandemic in 2019-20, 2020-21, and 2021-22, the mean incidence of iGAS was 6·1 (95% CI 2·4-12·5) per 1 000 000 children and adolescents. In 2022-23, there was a 9·5-fold increase in emm-12 (95% CI 2·2-40·8; p=0·0002) and a 2·7-fold increase in emm-1 (1·3-5·5; p=0·0037). The most common clinical manifestations of iGAS in 2022-23 were soft-tissue infections, which increased by 4·5-fold (1·9-10·9; p=0·0003), and complicated pneumonia with parapneumonic effusion, which increased by 4·0-fold (1·4-11·4; p=0·0059), both compared with the three pre-COVID-19 seasons. Overall, there was no increased severity of iGAS in 2022-23 compared with the previous six seasons as measured by median duration of hospital stay (8 days, IQR 4-14 vs 9 days, 5-15; p=0·39), paediatric intensive care unit (PICU) admission (17 [22%] of 76 vs 17 [17%] of 98; p=0·53), duration of stay in PICU (4 days, IQR 2-10 vs 4 days, 2-11; p=0·84), or mortality (three [4%] of 76 vs three [3%] of 98; p=1·00). In 2022-23, there was a 3·6-fold (95% CI 1·8-7·3; p=0·0001) increase in children with a preceding upper respiratory tract infection and a 4·6-fold (1·5-14·1; p=0·0034) increase in children with a preceding varicella-zoster infection, both compared with the three pre-COVID-19 seasons. In Denmark, the incidence of paediatric iGAS increased in 2022-23 compared with the three pre-COVID-19 seasons of 2016-17, 2017-18, and 2018-19. However, the course of iGAS disease in children and adolescents in 2022-23 was not more severe than in previous seasons. The high morbidity across all seasons highlights iGAS as a major invasive bacterial infection in children and adolescents. Innovation Fund Denmark.

Host biomarkers and combinatorial scores for the detection of serious and invasive bacterial infection in pediatric patients with fever without source.

Improved tools are required to detect bacterial infection in children with fever without source (FWS), especially when younger than 3 years old. The aim of the present study was to investigate the diagnostic accuracy of a host signature combining for the first time two viral-induced biomarkers, tumor necrosis factor-related apoptosis-inducing ligand (TRAIL) and interferon γ-induced protein-10 (IP-10), with a bacterial-induced one, C-reactive protein (CRP), to reliably predict bacterial infection in children with fever without source (FWS) and to compare its performance to routine individual biomarkers (CRP, procalcitonin (PCT), white blood cell and absolute neutrophil counts, TRAIL, and IP-10) and to the Labscore. This was a prospective diagnostic accuracy study conducted in a single tertiary center in children aged less than 3 years old presenting with FWS. Reference standard etiology (bacterial or viral) was assigned by a panel of three independent experts. Diagnostic accuracy (AUC, sensitivity, specificity) of host individual biomarkers and combinatorial scores was evaluated in comparison to reference standard outcomes (expert panel adjudication and microbiological diagnosis). 241 patients were included. 68 of them (28%) were diagnosed with a bacterial infection and 5 (2%) with invasive bacterial infection (IBI). Labscore, ImmunoXpert, and CRP attained the highest AUC values for the detection of bacterial infection, respectively 0.854 (0.804-0.905), 0.827 (0.764-0.890), and 0.807 (0.744-0.869). Labscore and ImmunoXpert outperformed the other single biomarkers with higher sensitivity and/or specificity and showed comparable performance to one another although slightly reduced sensitivity in children < 90 days of age. Labscore and ImmunoXpert demonstrate high diagnostic accuracy for safely discriminating bacterial infection in children with FWS aged under and over 90 days, supporting their adoption in the assessment of febrile patients.

Challenges of Antibiotic Formulations and Administration in the Treatment of Bloodstream Infections in Children Under Five Admitted to Kisantu Hospital, Democratic Republic of Congo.

Severe bacterial infections in children need prompt, appropriate antibiotic treatment. We report challenges observed within a prospective, cohort study on antibiotic efficacy in non-typhi Salmonella bloodstream infection (NCT04850677) in Kisantu district hospital (Democratic Republic of Congo). Children (aged >28 days to <5 years) admitted with suspected bloodstream infection (August 1, 2021 through July 31, 2022) were enrolled and followed until day 3 or discharge for non-typhi Salmonella patients. Antibiotics were administered to 98.4% (1,838/1,867) of children, accounting for 2,296 antibiotic regimens (95.7% intravenous, 4.3% oral). Only 78.3% and 61.8% of children were, respectively, prescribed and administered antibiotics on the admission day. At least one dose was not administered in 3.6% of children, mostly because of mismatch of the four times daily cefotaxime schedule with the twice-daily administration rounds. Inappropriate intravenous administration practices included multidose use, air-venting, and direct injection instead of perfusion. There was inaccurate aliquoting in 18.0% (32/178) of intravenous ciprofloxacin regimens, and thus administered doses were >16% below the intended dose. Dosing accuracy of oral suspensions was impaired by lack of instructions for reconstitution, volume indicators, and/or dosing devices. Adult-dose tablets were split without/beyond scoring lines in 84.4% (27/32) of tablets. Poor availability and affordability of age-appropriate oral formulations contributed to low proportions of intravenous-to-oral switch (33.3% (79/237) of non-typhi Salmonella patients). Other quality issues included poor packaging, nonhomogeneous suspensions, and unsafe water for reconstitution. In conclusion, poor antibiotic products (no age-appropriate formulations, poor quality and access), processes (delayed prescription/administration, missed doses), and practices (inaccurate doses, [bio]safety risks) must be urgently addressed to improve pediatric antibiotic treatment.

A multi-platform approach to identify a blood-based host protein signature for distinguishing between bacterial and viral infections in febrile children (PERFORM): a multi-cohort machine learning study

Differentiating between self-resolving viral infections and bacterial infections in children who are febrile is a common challenge, causing difficulties in identifying which individuals require antibiotics. Studying the host response to infection can provide useful insights and can lead to the identification of biomarkers of infection with diagnostic potential. This study aimed to identify host protein biomarkers for future development into an accurate, rapid point-of-care test that can distinguish between bacterial and viral infections, by recruiting children presenting to health-care settings with fever or a history of fever in the previous 72 h. In this multi-cohort machine learning study, patient data were taken from EUCLIDS, the Swiss Pediatric Sepsis study, the GENDRES study, and the PERFORM study, which were all based in Europe. We generated three high-dimensional proteomic datasets (SomaScan and two via liquid chromatography tandem mass spectrometry, referred to as MS-A and MS-B) using targeted and untargeted platforms (SomaScan and liquid chromatography mass spectrometry). Protein biomarkers were then shortlisted using differential abundance analysis, feature selection using forward selection-partial least squares (FS-PLS; 100 iterations), along with a literature search. Identified proteins were tested with Luminex and ELISA and iterative FS-PLS was done again (25 iterations) on the Luminex results alone, and the Luminex and ELISA results together. A sparse protein signature for distinguishing between bacterial and viral infections was identified from the selected proteins. The performance of this signature was finally tested using Luminex assays and by calculating disease risk scores. 376 children provided serum or plasma samples for use in the discovery of protein biomarkers. 79 serum samples were collected for the generation of the SomaScan dataset, 147 plasma samples for the MS-A dataset, and 150 plasma samples for the MS-B dataset. Differential abundance analysis, and the first round of feature selection using FS-PLS identified 35 protein biomarker candidates, of which 13 had commercial ELISA or Luminex tests available. 16 proteins with ELISA or Luminex tests available were identified by literature review. Further evaluation via Luminex and ELISA and the second round of feature selection using FS-PLS revealed a six-protein signature: three of the included proteins are elevated in bacterial infections (SELE, NGAL, and IFN-γ), and three are elevated in viral infections (IL18, NCAM1, and LG3BP). Performance testing of the signature using Luminex assays revealed area under the receiver operating characteristic curve values between 89·4% and 93·6%. This study has led to the identification of a protein signature that could be ultimately developed into a blood-based point-of-care diagnostic test for rapidly diagnosing bacterial and viral infections in febrile children. Such a test has the potential to greatly improve care of children who are febrile, ensuring that the correct individuals receive antibiotics. European Union's Horizon 2020 research and innovation programme, the European Union's Seventh Framework Programme (EUCLIDS), Imperial Biomedical Research Centre of the National Institute for Health Research, the Wellcome Trust and Medical Research Foundation, Instituto de Salud Carlos III, Consorcio Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, Grupos de Refeencia Competitiva, Swiss State Secretariat for Education, Research and Innovation.

Diagnostic value of serum CRP, PCT and IL-6 in children with nephrotic syndrome complicated by infection: a single center retrospective study.

The purpose was to look into the diagnostic value of serum CRP, PCT and IL-6 in children with nephrotic syndrome co-infection. One hundred and forty-nine children with nephrotic syndrome who met the inclusion and exclusion criteria were included in this study. The children were divided into three groups: bacterial infection group, non-bacterial infection group, and non-infection group. The diagnostic value was analyzed and compared using the ROC curve. There was no statistically significant difference in the Leukocyte counts among three groups. The mean results of serum CRP, PCT and IL-6 were significantly higher in the bacterial infection group compared to those in the non-infection group (p < 0.05). AUC of CRP, PCT, IL-6 in bacterial infection were 0.791, 0.859, 0.783. The following combinations CRP + PCT + IL-6, IL-6 + PCT, CRP + PCT significantly increased the efficiency of bacterial infection diagnosis, the AUCs were 0.881, 0.884, and 0.884, respectively. AUC of PCT in non-bacterial infection was 0.663. The combinations of these three clinical indicators performed no better than PCT in ROC analysis. Normal CRP or IL-6 levels do not rule out the diagnosis of bacterial infection in children on long-term glucocorticoid therapy. The appropriate combination of two or three indicators can improve the diagnostic value. This study evaluated the diagnostic value of the serum concentrations of CRP, PCT and IL-6 and assessed whether the value of their combined application is better than when used alone for diagnosing primary nephrotic syndrome complicated by infection. The elevation in leukocyte count cannot be used to diagnose children with nephrotic syndromes on long-term glucocorticoid treatment who have bacterial infections. Normal CRP or IL-6 levels do not rule out the diagnosis of bacterial infection in children on long-term glucocorticoid therapy. The appropriate combination of two or three indicators can improve diagnostic value, sensitivity, and specificity.

Invasive Bacterial Infections in Children With Sickle Cell Disease: 2014-2019.

Children with sickle cell disease (SCD) are at a high risk of invasive bacterial infections (IBI). Universal penicillin prophylaxis and vaccination, especially against Streptococcus pneumoniae, have deeply changed its epidemiology. Analysis of IBI in children with SCD in a post-13-valent pneumococcal vaccine era is limited. Twenty-eight pediatric hospitals from 5 European countries retrospectively collected IBI episodes in SCD children aged 1 month to 18 years between 2014 and 2019. IBI was defined as a positive bacterial culture or polymerase chain reaction from a normally sterile fluid: blood, cerebrospinal, joint, or pleural fluid and deep surgical specimen. We recorded 169 IBI episodes. Salmonella spp. was the main isolated bacteria (n = 44, 26%), followed by Streptococcus pneumonia (Sp; n = 31, 18%) and Staphylococcus aureus (n = 20, 12%). Salmonella prevailed in osteoarticular infections and in primary bacteremia (45% and 23% of episodes, respectively) and Sp in meningitis and acute chest syndrome (88% and 50%, respectively). All Sp IBI occurred in children ≤10 years old, including 35% in children 5 to 10 years old. Twenty-seven (17%) children had complications of infection and 3 died: 2 because of Sp, and 1 because of Salmonella. The main risk factors for a severe IBI were a previous IBI and pneumococcal infection (17 Sp/51 cases). In a post-13-valent pneumococcal vaccine era, Salmonella was the leading cause of bacteremia in IBI in children with SCD in Europe. Sp came second, was isolated in children ≤10 years old, and was more likely to cause severe and fatal cases.

Urinary Tract Infections in Children: Clinical and Antibiotic Susceptibility Data from a Tertiary Care Hospital

Aim: Urinary tract infections (UTIs) are among the most common bacterial infections in children.&#x0D; Empirical antibiotic treatment is recommended until the antibiogram reports of urine culture are&#x0D; available. It is essential to initiate local UTI agents and their antimicrobial susceptibility patterns in&#x0D; specific geographical regions to choose the best empirical antibiotics. The current study aimed to&#x0D; determine causative microorganisms and antibiotic resistance patterns in children diagnosed with UTI.&#x0D; Material and Methods: The study was carried out retrospectively with 216 children diagnosed with&#x0D; UTIs for the first time. The patients were categorized into two groups according to age (≤1 year and &gt;1&#x0D; year). Demographic data, presenting symptoms, imaging findings, and urine and culture analysis results&#x0D; were collected and compared between these two groups.&#x0D; Results: Cefazolin and nitrofurantoin use may be preferred in the empirical treatment of UTIs caused&#x0D; by Escherichia coli and Enterococcus spp. Additionally, amoxicillin/clavulanate was recommended in&#x0D; the empirical therapy of UTIs caused by Enterococcus spp., Klebsiella spp., and Proteus spp. The&#x0D; trimethoprim-sulfamethoxazole and nitrofurantoin resistance of E. coli was found to be statistically&#x0D; significantly higher in the ≤1 year group (p=0.03 and p=0.01, respectively), while the nitrofurantoin&#x0D; resistance of Klebsiella was statistically significantly higher in the &gt;1 year group (p=0.01). The gentamicin&#x0D; resistance of Klebsiella spp. was statistically significantly higher in the ≤1 year group (p=0.03).&#x0D; Conclusion: It is important to detect regional antibiotic resistance patterns to manage UTIs and minimize&#x0D; related complications. Antibiotic susceptibility studies are necessary to reduce improper antibiotic use&#x0D; and resistance rates of antibiotics.

Clinical characteristics of severe influenza virus-associated pneumonia complicated with bacterial infection in children: a retrospective analysis

BackgroundWe aimed to investigate the clinical characteristics of severe influenza virus-associated pneumonia complicated with bacterial infection in children.MethodsWe retrospectively analysed data concerning 64 paediatric patients with severe influenza virus-associated pneumonia who had been treated at our hospital. The patients were divided into observation (44 patients) and control (20 patients) groups, based on the presence or absence of concomitant bacterial infection, and clinical data were compared between the groups.ResultsThe mean age in the observation group was 2.71 ± 1.44 years, 42 (95.45%) were aged ≤ 5 years, and 18 (40.9%) had underlying diseases. The mean age in the control group was 4.05 ± 2.21 years, 13 (65%) were aged ≤ 5 years, and 3 (15%) had underlying diseases. There was a statistically significant difference in patient age and the proportion of patients with underlying diseases (P < 0.05). The observation group had higher duration of fever values, a higher number of patients with duration of fever ≥ 7 days, a higher incidence of gasping, and a higher incidence of seizures/consciousness disturbance, and the differences were statistically significant (P < 0.05). Secondary bacterial infections in the observation group were mainly due to gram-negative bacteria, with Haemophilus influenzae and Moraxella catarrhalis being the most common pathogens. The observation group had a higher proportion of patients treated in the paediatric intensive care unit and a longer hospital stay, and the differences were statistically significant (P < 0.05).ConclusionSevere influenza virus-associated pneumonia complicated with bacterial infection was more common in children aged ≤ 5 years. Younger patients with underlying diseases were more susceptible to bacterial infection (mainly due to gram-negative bacteria). The timely administration of neuraminidase inhibitors and antibiotics against susceptible bacteria is likely to help improve cure rates.

Comparison of Enhanced and Manual Urinalysis for Detecting Urinary Tract Infections in Children

Background: Urinary tract infections (UTIs) are among the most common bacterial infections in children. Urinalysis (UA) is a beneficial test for the preliminary diagnosis of UTIs. The presence of bacteriuria in UA can be determined by either an enhanced (using uncentrifuged Gram-stained specimens) or manual (using centrifuged specimens) technique. However, the diagnostic performance of enhanced UA is not well-established in childhood UTIs. Objectives: To assess the ability of enhanced and automated urinalysis to detect UTIs in children. Methods: This cross-sectional study was conducted on 191 children with the symptoms of UTI referred to Dr. Sheikh Hospital, Mashhad, Iran, from 2018 to 2019. Standard urinalysis, enhanced urinalysis, and quantitative urine culture were performed on specimens. A positive enhanced UA test was defined as ≥ 10 white blood cells per mL of urine and the presence of any bacteria per 10 high-power microscopic fields of a Gram-stained smear. A positive manual UA test was defined as ≥ 5 white blood cells per high-power field. The results of standard and enhanced UA were compared with urine culture findings to determine the accuracy of these two methods in detecting UTIs. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were determined for each test. Results: The results showed that the prevalence of UTI was 23%. Enhanced UA retrieved a sensitivity of 97.7%, specificity of 93.1%, PPV of 81.1%, and NPV of 99.3% for detecting UTIs. In standard UA, sensitivity, specificity, PPV, and NPV were 90.9%, 80.7%, 57.1%, and 96.6% for pyuria, 56.8%, 98.6%, 92.5%, and 88.4% for the nitrite test, 72.7%, 94.5%, 80%, and 92% for the leukocyte esterase test, respectively. Conclusions: Enhanced UA had higher sensitivity, specificity, PPV, and NPV than standard UA.

Severe Acute Bacterial Infections in Children With Sickle Cell Disease in Togo.

Bacterial infections are considered a major cause of morbidity and mortality in patients, especially children, with sickle cell disease. This study aims at determining, a year after the introduction of the 13-valent pneumococcal conjugate vaccine the distribution of severe acute bacterial infections and germs in children with sickle cell disease. Records of children 0 to 15 years of age and admitted from January 1, 2015 to December 31, 2019 (5 y), were examined retrospectively in the four sickle cell monitoring units in Lomé. The main infections found were pleuropulmonary (46.1%), urinary tract (32.8%), and osteoarticular (9.3%). A germ was isolated in 139 of the 265 cases (52.4%). 65.5% of the microorganisms isolated were Gram-negative organisms, with mostly Escherichia coli (31.6%) , and Klebsiella pneumoniae (18%) being the main germs. They were mainly responsible of urinary tract and osteoarticular infections. The majority of these Enterobacteriaceae was Extended-Spectrum Beta-Lactamase-Producing (41.1%, n = 37). Gram-positive cocci were represented by Staphylococcus sp (25.9%), Streptococcus sp (4.3%), Streptococcus pneumoniae (2.9%), and Enterococcus (1.4%). Staphylococcus aureus was the most common germ in pleuropulmonary (40%), osteoarticular (47.3%), and sepsis (28.6%) infections. Even if the infections found remained classic, there is a redistribution of germs with a decline in Salmonella and increase of Escherichia coli , Klebsiella pneumoniae , and Staphylococcus aureus .

Urine soluble TLR4 levels may contribute to predict urinary tract infection in children: the UTILISE Study.

One of the most common bacterial infections in childhood is urinary tract infection (UTI). Toll-like receptors (TLRs) contribute to immune response against UTI recognizing specific pathogenic agents. Our aim was to determine whether soluble TLR4 (sTLR4), soluble TLR5 (sTLR5) and interleukin 8 (IL-8) can be used as biomarkers to diagnose UTI. We also aimed to reveal the relationship between urine Heat Shock Protein 70 (uHSP70) and those biomarkers investigated in this study. A total of 802 children from 37 centers participated in the study. The participants (n = 282) who did not meet the inclusion criteria were excluded from the study. The remaining 520 children, including 191 patients with UTI, 178 patients with non-UTI infections, 50 children with contaminated urine samples, 26 participants with asymptomatic bacteriuria and 75 healthy controls were included in the study. Urine and serum levels of sTLR4, sTLR5 and IL-8 were measured at presentation in all patients and after antibiotic treatment in patients with UTI. Urine sTLR4 was higher in the UTI group than in the other groups. UTI may be predicted using 1.28ng/mL as cut-off for urine sTLR4 with 68% sensitivity and 65% specificity (AUC = 0.682). In the UTI group, urine sTLR4 levels were significantly higher in pyelonephritis than in cystitis (p < 0.0001). Post-treatment urine sTLR4 levels in the UTI group were significantly lower than pre-treatment values (p < 0.0001). Urine sTLR4 may be used as a useful biomarker in predicting UTI and subsequent pyelonephritis in children with UTI. A higher resolution version of the Graphical abstract is available as Supplementary information.

Urinary tract infections in children from the Gulf Cooperation Council countries: a literature review (2011-2022).

Urinary tract infections (UTIs) are common healthcare-associated and community-acquired bacterial infections in children. Data on pediatric UTIs in the Gulf Cooperation Council (GCC) region (Bahrain, Kuwait, Oman, Qatar, Saudi Arabia, and the United Arab Emirates) have not been collated. Our aim is to review the published literature on the risk factors, etiology, antimicrobial susceptibility, and treatment of pediatric (aged <18 years) UTIs from healthcare and community settings in the GCC countries.

Bacterium detected by gram stain and drug sensitivity in Chinese children with acute sinusitis

BackgroundAcute rhinosinusitis (ARS) is one of the common diseases of upper respiratory tract infection in children. Bacterial infection is a significant aggravating factor in pediatric ARS. In this research, our goal was to detected the bacterial flora and antibiotic sensitivity of ARS in Chinese children.MethodsWe recruited 133 children with ARS between January 2020 and January 2022 from our hospital. Sinus secretion were collected and cultured for Gram stain as well as antimicrobial susceptibility tests.ResultsMoraxella catarrhalis, Staphylococcus aureus, Haemophilus influenzae, Streptococcus pneumoniae and Pseudomonas aeruginosa were detected in order in children with ARS, of which 25% were negative for bacterial culture and 10% were positive for two strains. Amoxicillin and clavulanate potassium were useful for Haemophilus influenzae, Streptococcus pneumoniae and Moraxella catarrhalis. Quinolones are useful for Staphylococcus aureus, Haemophilus influenzae, Streptococcus pneumoniae and Pseudomonas aeruginosa.ConclusionsThis research updates the proportion of ARS bacterial infection in children in southern China and the antibiotic sensitivity.

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...