Bacterial Infections In Children Research Articles

The challenge of antimicrobial resistance in the Asia-Pacific: a pediatric perspective.

The densely populated Asia Pacific region is home to 600 million children, and suffers from a significant burden of morbidity and mortality due to infections associated with antimicrobial resistance (AMR). We aimed to identify the drivers, challenges and potential opportunities to alter the burden of AMR within the region. Despite the high AMR burden borne by the Asia Pacific region, there are limited (and geographically imbalanced) published data to delineate the contemporary epidemiology of serious multidrug-resistant bacterial infections in children. Furthermore, the region is impacted by overcrowded and poorly resourced healthcare facilities, insufficient microbiological resources, and widespread community and environmental antibiotic use leading to limited efficacy for frequently prescribed antibiotics. Vaccine coverage is also inadequate and inequitable, further driving the burden of infectious disease (and antibiotic overuse) in children. There are many challenges in implementing antimicrobial stewardship and infection prevention and control programs to reduce the excessive AMR disease burden in children across the Asia Pacific region, yet locally-driven strategies have successfully reduced antibiotic overuse in some settings, and should be replicated. Reducing the AMR disease burden will require improved healthcare resourcing, including better access to microbiological diagnosis, and multidisciplinary approaches to enhance infection prevention and antibiotic prescribing.

P-1163. The Efficacy and Safety of Tosufloxacin in the Treatment of Bacterial Infections in Children: Systematic Review

Abstract Background In recent years, the use of antibiotics in pediatric patients has garnered significant attention due to the rise in drug-resistant bacteria. Tosufloxacin(TFLX) was used in pediatric pneumonia, otitis media, cholera, and anthrax. However, the limited use of TFLX in children is attributed to its adverse effects on bones and muscles. This article retrospectively analyzed the effectiveness and safety of TFLX in treating bacterial infections in children. Methods A comprehensive search was conducted on PubMed, Web of Science, and Embase, up to March 2024. Data regarding the pharmacokinetics, efficacy, and safety of TFLX use in children were included. Results A total of 26 articles were involved, indicating that the pharmacokinetic outcomes of 222 children with infectious diseases were significantly correlated with their body weight following administration of 4 or 6mg/kg of TFLX. The incidence of adverse reactions was associated with AUC and Cmax levels, where higher values of these parameters corresponded to increased adverse reactions. Notably, TFLX exhibited promising efficacy against MRMP, potentially surpassing macrolides, with minocycline showing superior efficacy compared to TFLX. Real-world data revealed a 100% clinical efficacy of TFLX in treating bacterial pneumonia in children. Moreover, a study involving 172 children with otitis media reported 97.7% and 94.1% clinical effectiveness rates for 4mg/kg and 6mg/kg doses of TFLX, respectively. Similar conclusions were drawn across various studies. Children under 2 years old, due to their functional and immune immaturity, benefitted from TFLX treatment for otitis media. The drug also demonstrated efficacy as a secondary option for children with refractory otitis media. Safety assessments highlighted diarrhea as the primary adverse reaction associated with TFLX, with minimal joint-related adverse effects. Some studies indicated a higher incidence of adverse reactions with 6mg/kg compared to 4mg/kg doses, suggesting a dose-dependent relationship. Overall, TFLX exhibited a good safety profile in pediatric infection management. Conclusion The application of TFLX in children with pneumonia and otitis media may be safe and effective, but its efficacy in MRMP is weaker than that of minocycline. Disclosures All Authors: No reported disclosures

P-1575. Trends in antibiotic resistance in community-acquired urinary tract infections among children - a retrospective descriptive nation-wide study

Abstract Background Urinary tract infection (UTI) is one of the most common bacterial infections in children. Early antibiotic treatment may prevent complications. Empirical treatment requires up-to-date knowledge of the local epidemiology. This study aims to describe trends in resistance rates in community-acquired UTI`s between 2017-2022, assess whether current recommendations for empirical treatment are valid and identify risk factors for resistance. Methods Data was collected retrospectively from the computerized system of Maccabi Health Services for all children under 18 years-old diagnosed with a UTI in 2017 and 2022 and analyzed using chi-square test and regression models. Results A total of 240,122 urinary samples were included in the study. The most common isolated pathogen was Escherichia coli (78%); there was a slight but significant increase in extended-spectrum beta-lactamases (ESBL) incidence for all Gram-negative Enterobacteriaceae from 6% in 2017 to 8% in 2022, (P-value 0.001). Higher incidence (12%) was detected among Klebsiella isolates compared to E. coli (8%). Aminoglycosides resistance rates increased from 5% to 6% (P-value 0.001). The most impressive increase was in resistance to Fluoroquinolones from 7% to 23% (P-value 0.001). Female gender, younger age, previous antibiotic treatment and urinary tract abnormalities were associated with an increased resistance rate. Conclusion The increased resistance rate observed for most pathogens and antibiotics was statistically significant, nevertheless, due to small absolute changes, the recommendations for empirical antibiotic treatment in Israel are still valid. Fluoroquinolones, which are not recommended as empirical treatment, should be avoided due to high levels of resistance. Disclosures Shirley Shapiro Ben David, MD, GSK: Lecturer|Pfizer: Grant/Research Support|Pfizer: Lecturer

The application of environmental health assessment strategies to detect Streptococcus pyogenes in Kimberley school classrooms.

Children spend almost one-third of their waking hours at school. Streptococcus pyogenes (Strep A) is a common childhood bacterial infection that can progress to causing serious disease. We aimed to detect Strep A in classrooms by using environmental settle plates and swabbing of high-touch surfaces in two remote schools in the Kimberley, Western Australia. Twelve classrooms in two schools participated in 2021 and 2022. Seven horse-blood agar plates containing colistin and nalidixic acid (HBA-CNA) were placed in each occupied classroom at varied heights for 4h, and 20 high-touch items were swabbed and later cultured on HBA-CNA plates. The primary outcome of each sample was presence or absence of Strep A. Identified Strep A isolates were whole genome sequenced (WGS) to assess for similarity between host-derived and environmental strains. During two visits to each participating Kimberley school in June 2021 and September 2022, the point prevalence of Strep A positive throat swab ranged between 3/34 (8.8%) and 5/21 (23.8%); Strep A impetigo was lower at between 0/43 (0%) and 2/23 (8.7%). Strep A was detected from 4/240 (2%) environmental swabs collected across 3/12 (25%) classrooms but not cultured from any of the classroom settle plates. Whole genome sequencing identified environmental emm types to also be those strains in circulation. There was little evidence to support fomite, droplet or airborne Strep A in classrooms as major modes of transmission among children. Further work is required to determine if classrooms play a role in the transmission of Strep A between students.

Sonographic Diagnosis of Urinary Transport Disorders in Childhood.

Urinary transport disorders are among the most common congenital diseases in childhood. Congenital malformations of the urinary tract can cause bacterial urinary tract infections as early as in infancy and early childhood. Urinary tract infections are among the most common bacterial infections in children, and when pyelonephritis is present, the entire urinary tract should always be examined by sonography.

URINARY TRACT INFECTIONS IN CHILDREN: A REVIEW OF CURRENT INTERNATIONAL GUIDELINES

Urinary tract infections (UTIs) are the most common bacterial infections in children, which can lead to renal dysfunction, especially in young children in case of complicated and recurrent course. The aim of this review was to analyze all the latest clinical guidelines on UTIs in children in the world, starting from 2018 to 2024. We analyzed current data on the incidence of UTIs in children depending on age and gender. A classification is presented, the main problems of diagnosis, the most modern approaches to treatment and prevention are discussed. Analysis of these guidelines indicates that UTIs should be diagnosed in all young children with fever over 38 ° C without a focus of infection. Empirical antibacterial therapy should be started within the first 24-48 hours, oral antibiotics have an advantage, third-generation cephalosporins are more often used today, but it is necessary to take into account the data on antibacterial resistance in your region. All modern clinical guidelines emphasize the growth of resistant pathogens and their decreasing sensitivity to protected penicillins. All guidelines recommend identifying a "high-risk recurrence group" that includes children with vesicoureteral reflux (VUR), neurogenic bladder dysfunction, constipation, and "uncircumcised" boys under 1 year of age, and timely conducting imaging diagnostics for such children. According to almost all international guidelines for the diagnosis and treatment of UTIs in children, long-term antibacterial prophylaxis should be carried out only according to strict indications, mainly in children with high VUR and low VUR, taking into account the "risk" factors. In recent years, a large number of modern international clinical guidelines on UTIs in children have appeared. This review, which includes all the latest guidelines on UTIs in children in the world over the past seven years, will allow the use of accumulated modern knowledge in the practical work of pediatricians, pediatric nephrologists, and pediatric urologists in the Russian Federation.

Urinary Tract Infection in Children: An Up-To-Date Study.

Urinary tract infections (UTIs) are common bacterial infections in children. UTIs may be limited to the bladder or involve the kidneys with possible irreversible damage. Congenital abnormalities of the kidney and urinary tract (CAKUT) are often associated with UTIs; kidney scars have been considered a consequence of untreated UTIs but may be congenital. The mechanism by which bacteria produce inflammation in the urinary system has been intensively investigated. Diagnostic tools, including invasive imaging procedures, have been advocated in infants and small children with UTIs but are not necessary in most cases. Effective antibiotic drugs are available, and prophylactic treatment has been questioned. Several guidelines on UTIs are available, but a simple one for general practitioners is needed.

The relationship between uropathogens and clinical characteristics of children with urinary tract infection

Urinary tract infections (UTI) are common bacterial infections in children. This study aimed to examine the relationships between different microorganisms and both clinical and laboratory findings in pediatric patients with UTIs. We conducted a retrospective evaluation of children with UTI between 2019 and 2024. Patients were divided into four main groups as normal anatomy, vesicoureteral reflux (VUR), ureteropelvic junction obstruction (UPJO), and neurogenic bladder (NB). Information on clean intermittent catheterization (CIC) and prophylactic antibiotic use was recorded. Laboratory results were compared across these patient groups. The study included 266 patients, with a female predominance (female/male ratio: 7.33). NB was the most common urinary tract condition (43.3%), followed by VUR (10.9%) and UPJO (9%). Prophylactic antibiotics were used by 9% of the patients. Acute phase reactants in patients with CIC were significantly higher (p=0.023 for white blood cell (WBC) and p=0.002 for C-reactive protein (CRP) levels). They were also higher in patients with prophylactic antibiotics compared to those without (p=0.001 for both). The most frequently detected bacteria in urine cultures were E. coli (65%), followed by Klebsiella spp. (18.8%), Pseudomonas spp. (7.5%), and Proteus spp. (4.9%). Klebsiella spp., Enterococcus spp., and Morganella spp. were not isolated from patients receiving prophylaxis (p=0.022). Risk factors for UTIs need to be carefully assessed for every patient, and treatment should be customized according to clinical and laboratory results. Individual patient factors should guide drug selection, and treatment plans should account for potential resistance patterns.

Chromogenic versus Conventional: A Comparative Analysis for Uropathogen Detection in Paediatrics at a Tertiary Centre

Abstract Background: Urinary tract infections (UTIs) are a common bacterial infection in children, often presenting with non-specific symptoms such as undiagnosed fever and gastrointestinal issues. Early detection and treatment are essential to reduce morbidity and mortality. Aims: This study aimed to compare conventional culture media with chromogenic culture methods for detecting uropathogens and to identify the causative pathogens in pediatric patients at a tertiary care hospital. Patients and Methods: The study was conducted over 18 months in the department of microbiology at a tertiary care hospital, involving 400 pediatric patients who met the inclusion and exclusion criteria. Urine samples were collected and promptly processed, then inoculated on various media, including blood agar, MacConkey agar, cysteine lactose electrolyte deficient agar, and UTI chromogenic agar. Bacterial isolates were identified using standard bacteriological techniques, and their antimicrobial susceptibility was determined using the Kirby–Bauer disk diffusion method. Results: Escherichia coli was the most prevalent Gram-negative organism detected on both conventional and UTI chromogenic agar. UTI chromogenic agar showed greater efficiency in isolating and presumptively identifying uropathogens. E. coli isolates demonstrated high susceptibility to key antimicrobial agents. Enterococcus spp. were completely sensitive to vancomycin and linezolid, while nitrofurantoin was effective in 57.14% of cases. Conclusion: UTI chromogenic agar is an effective alternative to conventional media, offering advantages in isolating and presumptively identifying uropathogens. Its enhanced sensitivity, particularly for Gram-positive cocci like Enterococcus spp. in mixed cultures, provides valuable support to clinicians for early UTI diagnosis and treatment decisions.

A host immune-related LncRNA and mRNA signature as a discriminant classifier for bacterial from non-bacterial sepsis in children

BackgroundThe variations in non-coding RNA alterations and the host immune response between patients with bacterial and non-bacterial sepsis, along with their clinical characteristics, are largely unknown. MethodsThe landscape of long non-coding RNA (lncRNA) and mRNA in whole blood cells from pediatric patients with bacterial sepsis or non-bacterial sepsis were characterized using an Arraystar human LncRNA microarray. Weighted correlation network analysis (WGCNA) were conducted to identify immune-related LncRNA-mRNA signatures. Least absolute shrinkage and selection operator (Lasso) regression and Ridge regression analysis were employed to develop a specific LncRNA-mRNA signature, serving as a discriminant classifier for bacterial and non-bacterial sepsis in children. ResultsA total of 33 differentially expressed lncRNAs and 52 mRNAs were identified in pediatric patients with either bacterial sepsis or non-bacterial sepsis. Among these, 69 lncRNAs and mRNAs were pinpointed using WGCNA and found to be significantly correlated with clinical parameters. Further intersection analysis identified 12 lncRNAs and 16 mRNAs as immune-related signature for discerning bacterial infections in children with sepsis. Additionaly, the lncRNA-mRNA co-expression network highlighted the key lncRNAs (AC090159.1 and AC080129.2) and mRNAs (S100A8 and TCF7L2) as an infection score model. Lasso regression analysis revealed that this infection score model achieved an area under the received operating curve (AUROC) of 0.96 in the training set and 0.86 in the validation set. Ultimately, the expression levels of these 4 key lncRNAs and mRNAs showed significant correlation with CRP or PCT levels. ConclusionThe machine learning model, developed utilizing key lncRNAs (AC090159.1 and AC080129.2) and mRNAs (S100A8 and TCF7L2), demonstrates robust discrimination and calibration capabilities for distinguishing between bacterial and non-bacterial sepsis in children.

The value of white blood cell count in predicting serious bacterial infections in children presenting to the emergency department: a multicentre observational study

BackgroundWhite blood cell count (WBC) is a widely used marker for the prediction of serious bacterial infection (SBI); however, previous research has shown poor performance. This study aims to assess...

Perfil epidemiológico y microbiológico de la primera infección urinaria en una población pediátrica

Introduction: urinary tract infection (UTI) is the second cause of bacterial infection in children, generates high costs for the health system, may be the first manifestation of urinary tract anomalies and is a risk factor for multiple pathologies. Objective: to characterize the epidemiological and microbiological profile of the first UTI episode in the pediatric population of a referral center in Pereira, Colombia. Methods: a cross-sectional study, conducted during 2016- 2017, including patients aged 2 months to 10 years, with their first UTI episode, based on the American Academy of Pediatrics criteria. Bacterial resistance was defined using current CLSI (Clinical and Laboratory Standards Institute) guidelines. Descriptive statistics and STROBE guidelines were used for reporting this study results. Results: 81 patients were included, 28% were males, most were aged 2 to 12 months (40%), 49% were nitrite-positive, 39% had hematuria and 37% proteinuria, and 87% had a positive Gram stain. Ultrasound imaging revealed urinary tract anomalies in 18%; the most common uropathogens were: Escherichia coli (86%), Proteus mirabilis (5%) and Klebsiella pneumoniae (5%). E. coli showed resistance for trimethoprim-sulfamethoxazole, ampicillin-sulbactam and cephalothin in 51.4%, 32.8% and 17.1%, respectively; 2.8% were extended-spectrum betalactamase/ESBL-positive. The median time of empiric management was 3 days and full treatment was of 10 days. Discussion: high resistance rates were recorded for ampicillin, ampicillin-sulbactam and trimethoprim-sulfamethoxazole, which discourage their use. The sensitivity of E coli to cephalothin and amikacin, reported in this study, favors their use as first empirical therapeutic choices in our setting. Conclusion: ultrasound examination of the urinary tract is recommended in patients experiencing their first febrile UTI episode, due to the high prevalence of urinary anomalies identified.

Comparison of Clinical, Etiological and Antibiotic Sensitivity Patterns of UTI in CAKUT and Non CAKUT Children

Background: Urinary tract infections (UTIs) are one of the most common bacterial infections in children. Congenital anomalies of the kidney and urinary tract (CAKUT) are a major cause of UTIs in this population. Objective: To compare clinical, etiological and antibiotic sensitivity patterns of UTIs in CAKUT and non-CAKUT children. Study Design: Prospective comparative study. Place and Duration: The study was conducted at the department of Pediatric Nephrology, The Children's Hospital Lahore from August 2023 to January 2024. Methods: 68 children with and without CAKUT having UTI were evaluated. Data regarding demographics, clinical presentation and antibiotic sensitivity pattern was collected. Susceptibility testing was done according to CLSI recommendations. Results: 34 patients with UTI in CAKUT group (Group A) had male predominance (73.5%) while children without CAKUT (Group B) were predominantly females (55.9%). Mean age in Group A (38.9 months) was less than that in Group B (53.9 months). The common presentations in both the groups were pyelonephritis and cystitis. Vesico-ureteric reflux (32.4%) and posterior urethral valves (29.4%) were the most common CAKUT findings. Majority of patients with CAKUT had Pseudomonas UTI (32.4%) while E. coli (35.3%) was common in children without CAKUT. Fosfomycin, Colistin, Linezolid and Polymyxin B had low resistance amongst both groups. The association between CAKUT and atypical uropathogens was not found to be statistically significant (p = 0.287). Conclusion: Differences exist in clinical presentation, etiology and antibiotic sensitivity patterns specific to UTI in CAKUT and non-CAKUT children. A high resistance pattern was found amongst common antibiotics.

Plasma and Urinary Neutrophil Gelatinase-Associated Lipocalin as Predictors of Renal Parenchymal Involvement in Children with Febrile Urinary Tract Infection: A Pilot Study.

Urinary tract infections (UTIs) are very common bacterial infections in children. Early detection of renal parenchymal involvement in this setting can help clinicians make more effective treatment choices. The aim of this pilot study was to assess the ability of plasma and urinary neutrophil gelatinase-associated lipocalin (pNGAL and uNGAL) levels, measured using an automated system, to accurately predict renal parenchymal involvement in children with febrile UTIs. This prospective single-center study included 28 children aged ≥ 4 years with a first episode of febrile UTIs. All patients underwent magnetic resonance imaging. pNGAL, uNGAL, procalcitonin, C-reactive protein (CRP), and white blood cells were measured before antibiotic therapy. The receiver operating characteristic (ROC) area under the curve for predicting acute pyelonephritis was 0.6 for pNGAL, 0.8 for CRP, 0.4 for PCT, and 0.4 for uNGAL. The ROC analyses showed an optimal cutoff of 141.0 ng/mL for pNGAL (sensitivity, 54.2%; specificity, 75.0%; positive predictive value, 92.9%; and negative predictive value, 21.4%). pNGAL and uNGAL did not effectively aid the early prediction of renal parenchymal involvement in children ≥ 4 years with febrile UTIs. The novelties of this study were the use of MRI as the gold standard and an automated biochemical method to measure NGAL.

The Susceptibility of Escherichia Coli to Antibiotic Treatment for Pediatric Patients With Febrile Urinary Tract Infections in the Bratislava Region.

Urinary tract infections are one of the most common types of bacterial infections in childhood. Normally, empiric antibiotic therapy is given based on local antimicrobial susceptibility. We performed a retrospective study to evaluate bacterial resistance and clinical responses to antibiotics in childhood febrile urinary tract infections (fUTIs) in the Bratislava region of Slovakia. A total of 182 children with a fUTI were enrolled in our retrospective study. 84,07% of these fUTIs were caused by pathogenic Escherichia coli (E. coli). According to microbial antibiotic susceptibility tests, the most effective antibiotic agents were third-generation cephalosporins (susceptibility was observed in 92,16% (n=141) of the cases), followed by aminopenicillins with betalactamase inhibitor (susceptibility was observed in 84,97% (n=130) of the cases) and trimethoprim-sulfamethoxazole (susceptibility was observed in 79,74% (n=122) of the cases). In contrast, E. coli was susceptible to second-generation cephalosporins in just 3,92% (n=6). Patients treated with third-generation cephalosporins achieved a clinical response to therapy almost in all of the cases (95,7% (n=66)), whereas second-generation cephalosporins were associated with a clinical response to therapy in only 55,9% (n=33) of the cases. Third-generation cephalosporins and aminopenicillins with a betalactamase inhibitor appear to be the most suitable initial antibiotic therapies in pediatric patients with fUTIs. Following current guidelines alongside the regular assessment of regional microbial antibiotic susceptibilities should provide the best treatment management for children with fUTIs.

Etiology of bloodstream infections among pediatric patients in Bauchi metropolis, north-east Nigeria

Background: The prevalence of bacterial infections in children is increasing by the day, this gives a cause for concern regarding the high rate of bloodstream infection (BSI) and associated mortality in developing countries. Physical signs and symptoms may be useful but have limited specificity which would be addressed with bacteriologic blood culture. This study was aimed at determining the etiologic agents of bacteremia and the prevalence in pediatric patients aged 0-5years. Methods: Two hundred and sixty- two (262) blood samples were analyzed from children aged 0-5years, attending hospitals within Bauchi metropolis with features suggestive of septicemia. Samples were collected under aseptic conditions and automated blood culture was done on BacT/ALERT 3D Biomerieux, Germany. Positive blood culture was sub-cultured on blood agar and MacConkey agar and identified on Vitek2 (bioMѐrieux, France) automated system after gram staining. Changes in pathogen distribution according to age and gender were determined by the chi-square test and statistical significance confirmed if a two-tailed p-value was not more than 0.01. Results: Bacteria was isolated in 119 (45.4) of samples with highest rate among neonates 54(45.3). Staphylococcus aureus 21 (17.6) was the most predominant organism isolated across all age groups with a higher occurrence in patients<1year old. A chi-square test of independence for culture positivity and age/gender at p<.01 was not significant Conclusion: In this study both Gram-positive and Gram-negative bacteria are implicated in pediatric bloodstream infections. Staphylococcus aureus was the most predominant organism followed by members of the Enterobacterales (Enterobacter spp, Klebsiella spp and Escherichia coli).

Biomarker for infection in children with decompensated chronic liver disease: Neutrophilic CD64 or procalcitonin?

ObjectiveBiomarkers with high accuracy for identification of infection in decompensated chronic liver disease (DCLD) are urgently needed. We compared the accuracy of neutrophilic cluster of differentiation 64 (nCD64) with procalcitonin for diagnosis of bacterial infection in children with DCLD. MethodsConsecutive children admitted with DCLD were enrolled prospectively. nCD64 was assessed by flow cytometry and expressed in percentage. nCD64, procalcitonin and hemogram were measured at admission and 7-14 days after treatment in those with infection. Complete work-up for infection was done. Presence, site and severity of infection was classified as per guidelines. Results107 children [64 boys, age 97(18-168) months] were enrolled. 78(72.9%) had infection, 26(24%) had severe sepsis and 60(56%) had systemic inflammatory response syndrome. The commonest site of infection was ascitic fluid (n=37), followed by pneumonia (n=24), urinary tract (n=15), bacteraemia (n=10), cholangitis (n=8) and cellulitis (n=3). nCD64 (cut-off-51%, AUC-0.82) had a higher sensitivity (79.5%) and specificity (82.8%) than procalcitonin (cut-off ≥0.58ng/mL, AUC-0.74, sensitivity-76.9% and specificity-62.1%) for diagnosis of infection. nCD64 and procalcitonin correlated with infection severity, being highest in children with severe sepsis [88(71-97) %and 1.98(0.83-10.36) ng/mL], than in infection alone [72(45-84) % and 1.09(0.45-2.07) ng/mL], and no-infection [36(20.2-48) % and 0.42(0.19-1.08) ng/mL]. There was no difference in diagnostic utility of procalcitonin or nCD64 with different sites of infection. Elevation of all 3 parameters (nCD64, PCT and total leukocyte count) was uncommon but highly specific for presence of infection. ConclusionnCD64 identifies infection better than procalcitonin and correlates well with infection severity in children with DCLD.

Optimal Teicoplanin Trough Concentration With Therapeutic Drug Monitoring in Children: A Systematic Review and Meta-analysis.

Teicoplanin is used to treat serious Gram-positive bacterial infections. However, the optimal trough concentrations for pediatric patients remain unclear owing to the lack of monitoring guidelines. This study aimed to determine the optimal teicoplanin trough concentration for treating Gram-positive bacterial infections in children. A systematic review was conducted using 4 databases. Stepwise cutoffs within the range of 10-30 mcg/mL were used for efficacy and safety. Studies were included if they reported treatment success rates and/or all-cause mortality, nephrotoxicity, hepatotoxicity, and thrombocytopenia according to the trough concentration. The meta-analysis included 12 studies involving 830 pediatric patients. Teicoplanin cutoff values of 10, 15, 20, and 30 mcg/mL were reported in 9, 8, 9, and 2 studies, respectively. Trough concentrations <10 mcg/mL significantly reduced the treatment success rate, with an odds ratio of 0.07 and a 95% confidence interval ranging from 0.01 to 0.40. The overall treatment success rate was 50.0% versus 95.7% observed at concentrations ≥10 mcg/mL. However, no significant difference was observed at the 15-, 20-, and 30-mcg/mL cutoffs, when compared with lower concentrations. Trough concentrations <20 mcg/mL were associated with a decreased risk of nephrotoxicity (odds ratio = 0.21; 95% confidence interval, 0.08-0.55). However, hepatotoxicity and thrombocytopenia showed no significant associations with trough concentration ranges between 10 and 30 mcg/mL. Although further prospective studies are required for validation, the authors' findings suggest that 10- to 20-mcg/mL teicoplanin is the optimal trough concentration for enhanced clinical success and reduced toxicity in pediatric patients.

Pediatric Urinary Tract Infections at a Tertiary Care Center: Microbial Diversity and Antibiotic Resistance Patterns

Abstract Introduction: Urinary tract infection (UTI) remains a prevalent bacterial infection among the pediatric age group, ranking as the third-most common bacterial infection in children in developing countries, following gastrointestinal and respiratory tract infections. It continues to pose a significant health challenge. Materials and Methods: The urine samples underwent gross examination, wet mount, and Gram stain. Semiquantitative cultures were conducted on conventional media (MacConkey agar, blood agar, and CLED agar) and UTI chromogenic media. Uropathogen identification employed standard microbiological techniques. Antibiotic susceptibility was determined using the Kirby–Bauer disk diffusion method, with interpretation based on CLSI guidelines. Plates were incubated overnight, and clear zone diameters around antibiotic discs were measured for sensitivity or resistance determination. Results: The study comprised 64.75% male children and 35.25% female children. Analyzing the age distribution, the majority of participants fell within the age range of 1–5 years (35%), followed by those &lt;1 year (33.75%), and the age group of 5–12 years, accounting for 31.25% of the total 400 participants. The findings from our investigation revealed a UTI prevalence of 17.25%, with Escherichia coli and Klebsiella emerging as the predominant uropathogens. Notably, these pathogens exhibited a significant susceptibility to carbapenems, nitrofurantoin, and amikacin. Conclusion: Our study identified a male predominance and various age distributions among UTI patients. Antibiotic susceptibility patterns revealed E. coli and Klebsiella pneumoniae’s high sensitivity to key antibiotics, whereas Enterococcus spp. exhibited significant high-level aminoglycoside resistance. This study underscores the importance of tailored antibiotic strategies based on local resistance profiles to combat UTIs effectively.

Lactobacillus rhamnosus PL1 and Lactobacillus plantarum PM1 versus Placebo as Prophylaxis for Recurrence of Urinary Tract Infections in Children.

Urinary tract infections (UTIs) rank among the most prevalent bacterial infections in children. Probiotics appear to reduce the risk of recurrence of UTIs. This study aimed to evaluate whether probiotics containing Lactobacillus rhamnosus PL1 and Lactobacillus plantarum PM1 therapy prevent UTIs in the pediatric population compared to a placebo. A superiority, double-blind, randomized, controlled trial was conducted. In total, 54 children aged 3-18 years with recurrent UTIs or ≥one acute pyelonephritis and ≥one risk factor of recurrence of UTIs were randomly assigned (27 patients in each arm) to a 90-day probiotic or placebo arm. The age, sex, diagnosis, renal function, risk factors, and etiology of UTIs did not vary between the groups. During the intervention, 26% of children taking the probiotic had episodes of UTI, and it was not significantly less than in the placebo group. The number of UTI episodes during the intervention and the follow-up period decreased significantly in both groups, but the difference between them was insignificant. We observed a decrease in UTIs during the study of almost 50% in the probiotic group compared to the placebo group. Probiotics can be used as natural, safe prophylaxis for children with risk factors for UTIs in whom antibiotic prevention is not indicated.