Infections In Pediatric Patients Research Articles

Preparation and Evaluation of Clarithromycin Taste-Masking Dry Suspension Using Hot Melt Extrusion Based on Solid Dispersion Technology.

Clarithromycin (CLA) is the preferred drug for treating respiratory infections in pediatric patients, but it has the drawbacks of extreme bitterness and poor water solubility. The purpose of this study was to improve solubility and mask the extreme bitterness of CLA. We use Hot Melt Extrusion (HME) to convert CLA and Eudragit® E100 into Solid Dispersion (SD). Differential scanning calorimetry (DSC) and Powder X-ray diffraction (PXRD) were used to identify the crystalline form of the prepared SDs, which showed that the crystalline CLA was converted to an amorphous form. At the same time, an increase in dissolution rate was observed, which is one of the properties of SD. The results showed that the prepared SD significantly increased the dissolution rate of crystalline CLA. Subsequently, the SD of CLA was prepared into a dry suspension with excellent suspending properties and a taste-masking effect. The bitterness bubble chart and taste radar chart showed that the SD achieved the bitter taste masking of CLA. Principal components analysis (PCA) of the data generated by the electronic tongue showed that the bitter taste of CLA was significantly suppressed using the polymer Eudragit® E100. Subsequently, a dry suspension was prepared from the SD of CLA. In conclusion, this work illustrated the importance of HME for preparing amorphous SD of CLA, which can solve the problems of bitterness-masking and poor solubility. It is also significant for the development of compliant pediatric formulations.

Cytomegalovirus and Epstein-Barr virus infections in pediatric patients of choledochal cyst

Association of viral infection with obstructive jaundice is well-known however frequency of cholangiotropic virus infection in pediatric choledochal cyst is not known. IgG and IgM antibodies against Cytomegalo virus (CMV) and Epstein Barr virus (EBV) in 48 children with choledochal cysts and 26 controls were analysed using ELISA. We found significantly higher anti-CMV IgG and IgM in patients (95.8% and 77.1%, respectively) compared to controls (73.1% and 42.3%) and a notable prevalence of anti-EBV antibodies among both groups (83.3% versus 65.4% IgG and 77.1% versus 46.1 for IgM in patients and controls respectively). Moreover, 79.2% of patients were positive for both anti-CMV and anti-EBV IgG, and 62.5% for both IgMs. This pilot study suggests that infection with CMV, EBV, or both is frequently seen in pediatric patients with CDC. Molecular screening and follow-up in a larger cohort is therefore required for further validation.

Cytomegalovirus and Epstein-Barr virus infections in pediatric patients of choledochal cyst

Cytomegalovirus and Epstein-Barr virus infections in pediatric patients of choledochal cyst

The impact of the COVID-19 pandemic on Staphylococcus aureus infections in pediatric patients admitted with community acquired pneumonia

The COVID-19 pandemic has significantly transformed the infection spectrum of various pathogens. This study aimed to evaluate the impact of the COVID-19 pandemic on Staphylococcus aureus (S. aureus) infections among pediatric patients with community acquired pneumonia (CAP). We retrospectively reviewed pediatric CAP admissions before (from 2018 to 2019) and during (from 2020 to 2022) the COVID-19 pandemic. The epidemiology and antimicrobial resistance (AMR) profiles of S. aureus isolates were examined to assess the pandemic’s effect. As a result, a total of 399 pediatric CAP patients with S. aureus infections were included. The positivity rate, gender, and age distribution of patients were similar across both periods. There was a marked reduction in respiratory co-infections with Haemophilus influenzae (H. influenzae) during the COVID-19 pandemic, compared to 2019. Additionally, there were significant changes in the resistance profiles of S. aureus isolates to various antibiotics. Resistance to oxacillin and tetracycline increased, whereas resistance to penicillin, gentamicin, and quinolones decreased. Notably, resistance to erythromycin significantly decreased in methicillin-resistant S. aureus (MRSA) strains. The number of S. aureus isolates, the proportion of viral co-infections, and the number of resistant strains typically peaked seasonally, primarily in the first or fourth quarters of 2018, 2019, and 2021. However, shifts in these patterns were noted in the first quarter of 2020 and the fourth quarter of 2022. These findings reveal that the COVID-19 pandemic has significantly altered the infection dynamics of S. aureus among pediatric CAP patients, as evidenced by changes in respiratory co-infections, AMR patterns, and seasonal trends.

The impact of the COVID-19 pandemic on Staphylococcus aureus infections in pediatric patients admitted with community acquired pneumonia.

The COVID-19 pandemic has significantly transformed the infection spectrum of various pathogens. This study aimed to evaluate the impact of the COVID-19 pandemic on Staphylococcus aureus (S. aureus) infections among pediatric patients with community acquired pneumonia (CAP). We retrospectively reviewed pediatric CAP admissions before (from 2018 to 2019) and during (from 2020 to 2022) the COVID-19 pandemic. The epidemiology and antimicrobial resistance (AMR) profiles of S. aureus isolates were examined to assess the pandemic's effect. As a result, a total of 399 pediatric CAP patients with S. aureus infections were included. The positivity rate, gender, and age distribution of patients were similar across both periods. There was a marked reduction in respiratory co-infections with Haemophilus influenzae (H. influenzae) during the COVID-19 pandemic, compared to 2019. Additionally, there were significant changes in the resistance profiles of S. aureus isolates to various antibiotics. Resistance to oxacillin and tetracycline increased, whereas resistance to penicillin, gentamicin, and quinolones decreased. Notably, resistance to erythromycin significantly decreased in methicillin-resistant S. aureus (MRSA) strains. The number of S. aureus isolates, the proportion of viral co-infections, and the number of resistant strains typically peaked seasonally, primarily in the first or fourth quarters of 2018, 2019, and 2021. However, shifts in these patterns were noted in the first quarter of 2020 and the fourth quarter of 2022. These findings reveal that the COVID-19 pandemic has significantly altered the infection dynamics of S. aureus among pediatric CAP patients, as evidenced by changes in respiratory co-infections, AMR patterns, and seasonal trends.

Serum Angiotensin II Level in Pediatric Patients with COVID-19 and its Correlation with the Disease Severity

Abstract Background Coronavirus disease 2019 (COVID-19) is a newly discovered RNA betacoronavirus infection. It has been caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Angiotensin II (Ang-II) is a mitochondrial toxin that under normal circumstances is rapidly removed by angiotensin converting enzyme 2 (ACE-2). SARS-CoV-2 uses the receptor ACE-2 for host cell entry and viral replication. ACE-2 proteins are occupied and downregulated by SARS-CoV-2. ACE-2 downregulation has been directly linked to toxic over accumulation of Ang-II. Accumulating Ang-II triggers many severe and fatal conditions such as acute respiratory distress syndrome (ARDS). Aim of the Work To assess the serum level of Ang-II and correlate it with the severity of COVID-19 infection in pediatric patients. Patients and Methods This case control study was conducted on 45 positive COVID-19 RT-PCR children who were compared to age and sex matched 45 healthy controls. Clinical examination, laboratory assays and imaging studies were done for the patients group to assess the severity of COVID–19 infection. Serum Ang-II was measured by ELISA for both groups and correlated with clinical (heart rate, blood pressure, respiratory rate and oxygen saturation), laboratory (total leucocytic count, lymphocytes, neutrophils, serum ferritin, ESR and CRP) and radiological (chest x-ray and CORAD score of CT chest ) parameters of the patients. Results The median “IQR” of serum Ang-II was significantly higher in the COVID-19 patients than in the controls (100 (88-137) ng/L) versus 20 (15-25) ng/L) (p-value= 0.001). There were statistically significant positive correlations between serum Ang-II levels and different grades of clinical severity classification (rs = 0.92, p-value=0.001) and CORAD score of CT chest. On the other hand, no statistically significant correlations were found between serum levels of Ang-II and total leucocytic count, lymphocytes, neutrophils, ESR and CRP. Conclusion Serum Ang-II could be used as a biomarker in predicting the severity of COVID-19 infection in pediatrics.

Relation of Total Antioxidant Capacity to Clinical Severity of COVID-19 Infection in Paediatric Patients

Abstract Objectives The pathogenesis of COVID-19 infection is still not well clarified. In this regard oxidative stress and its relation to disease severity is one of the topics that need to be investigated. Aim This study was carried out to investigate the relationship between the oxidant stress and antioxidant system represented by total antioxidant capacity and clinical severity of COVID19 infection in pediatric age group. Methods The current cross-sectional study included 45 patients with COVID 19 PCR-proven infection admitted at the Children’s Hospital, Faculty of Medicine, Ain Shams University compared to 45 healthy age and sex matched control group. Detailed medical history, thorough examination and recording of all infection related laboratory parameters were done for each enrolled case. Measurement of total antioxidant capacity (TAC) in the serum of all studied patients and controls was done by ELISA. Results TAC levels were considerably lower in pediatric patients (median 24u/l, IQR 9-37u/l) compared to healthy individuals (median 90u/l, IQR 77-100u/l, p < 0.001) and the levels were statistically lower in severe cases compared to those with mild disease (p = 0.008). In this regard, 100% of controls showed normal TAC while only 31.1% from cases exhibited normal TAC levels and 68.9% of cases had low TAC levels. There was strong statistical significance between PICU admission and low TAC levels (p = 0.035). Additionally, the TAC showed negative correlation with the initial CRP of patients (r= -0.433, p = 0.003). There was also a significant inverse correlation between TAC and time needed for viral clearance (r=- 0.418, p = 0.004) as well as a significant positive correlation between body mass index z-score and TAC levels (r = 0.423, p value 0.004). Conclusion Total antioxidant capacity could serve as a novel prognostic marker of COVID -19 infection severity in pediatric patients.

Autophagy-related molecular clusters identified as indicators for distinguishing active and latent TB infection in pediatric patients

BackgroundAutophagy is crucial for controlling the manifestation of tuberculosis. This study intends to discover autophagy-related molecular clusters as biomarkers for discriminating between latent tuberculosis (LTBI) and active tuberculosis (ATB) in children through gene expression profile analysis. MethodsThe expression of autophagy modulators was examined in pediatric patients with LTBI and ATB utilizing public datasets from the Gene Expression Omnibus (GEO) collection (GSE39939 and GSE39940).ResultsIn a training dataset (GSE39939), patients with LTBI and ATB exhibited the expression of autophagy-related genes connected with their active immune responses. Two molecular clusters associated with autophagy were identified. Compared to Cluster 1, Cluster 2 was distinguished through decreased adaptive cellular immune response and enhanced inflammatory activation, according to single-sample gene set enrichment analysis (ssGSEA). Per the study of gene set variation, Cluster 2’s differentially expressed genes (DEGs) played a role in synthesizing transfer RNA, DNA repair and recombination, and primary immunodeficiency. The peak variation efficiency, root mean square error, and area under the curve (AUC) (AUC = 0.950) were all lowered in random forest models. Finally, a seven-gene-dependent random forest profile was created utilizing the CD247, MAN1C1, FAM84B, HSZFP36, SLC16A10, DTX3, and SIRT4 genes, which performed well against the validation dataset GSE139940 (AUC = 0.888). The nomogram calibration and decision curves performed well in identifying ATB from LTBI.ConclusionsIn summary, according to the present investigation, autophagy and the immunopathology of TB might be correlated. Furthermore, this investigation established a compelling prediction expression profile for measuring autophagy subtype development risks, which might be employed as possible biomarkers in children to differentiate ATB from LTBI.

The Etiologic Organisms, Risk Factors, and Outcomes of Nosocomial Bloodstream Infections in Pediatric Patients

Background Much of the knowledge regarding pediatric healthcare-associated infections is based on studies conducted in adults. Here, we investigated clinical risk factors and etiologic organisms, focusing on antibiotic and antifungal resistance in pediatric patients with nosocomial bloodstream infections (nBSIs) in pediatric intensive care units (PICUs). Methods A retrospective evaluation was conducted on pediatric patients with nBSI in the PICUs of a tertiary referral hospital. Results A total of 69 nBSI episodes in 65 patients were observed during the study period. Of these, a total of 40 (57.97%) were caused by Gram-negative bacteria, 6 (8.7%) by Gram-positive bacteria, and 23 (33.33%) by Candida species. The rankings of Gram-negative bacteria were Klebsiella pneumoniae (37.5%), Acinetobacter baumannii (22.5%), and Serratia marcescens (12.5%). Carbapenem resistance was found to be common among K. pneumoniae (40%) and all Acinetobacter species. Most children (54.41%) had spent >28 days in the PICU at the time of diagnosis of nBSI. The presence of central venous catheters was significantly associated with fungal nBSI (P = 0.047). Conclusions A high rate of antimicrobial resistance was observed among pathogens. A central venous catheter was associated with fungemia in children hospitalized in PICUs. Prolonged hospital stay before the diagnosis of BSI and the use of medical devices were found to be common in fungal infections.

Impact of the COVID-19 pandemic on Haemophilus influenzae infections in pediatric patients hospitalized with community acquired pneumonia

The COVID-19 pandemic has altered the infection landscape for many pathogens. This retrospective study aimed to compare Haemophilus influenzae (H. influenzae) infections in pediatric CAP patients hospitalized before (2018–2019) and during (2020–2022) the COVID-19 pandemic. We analyzed the clinical epidemiology and antimicrobial resistance (AMR) patterns of H. influenzae from a tertiary hospital in southwest China. A total of 986 pediatric CAP patients with H. influenzae-associated infections were included. Compared to 2018, the positivity rate increased in 2019 but dropped significantly in 2020. Although it rose in the following 2 years, the rate in 2022 remained significantly lower than in 2019. Patients’ age during the pandemic was significantly higher than in 2018 and 2019, while gender composition remained similar across both periods. Notably, there were significant changes in co-infections with several respiratory pathogens during the pandemic. Resistance rates of H. influenzae isolates to antibiotics varied, with the highest resistance observed for ampicillin (85.9%) and the lowest for cefotaxime (0.0%). Resistance profiles to various antibiotics underwent dramatic changes during the COVID-19 pandemic. Resistance to amoxicillin-clavulanate, cefaclor, cefuroxime, trimethoprim-sulfamethoxazole, and the proportion of multi-drug resistant (MDR) isolates significantly decreased. Additionally, MDR isolates, alongside isolates resistant to specific drugs, were notably prevalent in ampicillin-resistant and β-lactamase-positive isolates. The number of pediatric CAP patients, H. influenzae infections, and isolates resistant to certain antibiotics exhibited seasonal patterns, peaking in the winter of 2018 and 2019. During the COVID-19 pandemic, sharp decreases were observed in February 2020, and there was no resurgence in December 2022. These findings indicate that the COVID-19 pandemic has significantly altered the infection spectrum of H. influenzae in pediatric CAP patients, as evidenced by shifts in positivity rate, demographic characteristics, respiratory co-infections, AMR patterns, and seasonal trends.

Concomitant Central and Peripheral Nervous System Involvement Associated With Mycoplasma pneumoniae Infection in Pediatric Patients: Two Case Reports and Literature Review.

Mycoplasma pneumoniae (M. pneumoniae) is a common pathogen for community-acquired pneumonia and is also implicated in a broad array of extra-pulmonary manifestations. M. pneumoniae infection is rarely associated with concurrent central nervous system (CNS) and peripheral nervous system (PNS) involvement in children. We report 2 patients who presented with acute encephalitis and polyradiculitis due to M. pneumoniae infection and review the literature to discuss the pathogenesis and treatment of concomitant CNS and PNS involvement associated with M. pneumoniae infection. We report two 6-year-old boys with M. pneumoniae antecedent infection who presented initially with impaired consciousness followed by limb weakness, limb pain and urinary retention, and responded well to immunotherapy. We described 2 patients who presented symptomatic combined CNS and PNS involvement with persistent urinary retention associated with M. pneumoniae infection. We found autoimmunity plays an important role and recommend that antibiotics and immunomodulators should be administered with concurrent CNS and PNS involvement associated with M. pneumoniae.

Profile and Outcomes of COVID-19 Infection in Pediatric Patients with and without Cancer: A Case–Control Study

Abstract Objectives Pediatric patients with cancer are considered a vulnerable population to the ill effects of coronavirus disease 2019 (COVID-19). We hereby studied the difference between clinical characteristics, lab parameters, and outcomes of COVID-19 among children suffering from cancer and those without cancer. We also analyzed risk factors for the occurrence of moderate-to-severe COVID-19 disease in pediatric cancer patients. Materials and Methods This retrospective case–control study was carried out using the medical record review method over 6 months in a tertiary-care center in India. All patients below 18 years of age, with reverse-transcriptase polymerase chain reaction (RTPCR) confirmed COVID-19, were screened for enrolment. Patients were split into two groups: Group A comprised of patients with cancer, while group B consisted of patients without any underlying comorbidity. Patients with other comorbidity except cancer and inadequately recorded case sheets were excluded. Details regarding demography, clinical features, investigations, treatment, and outcomes were recorded. Statistical Analysis Microsoft Excel and Statistical Package for the Social Sciences (SPSS) software, version 25 was used for data analysis. A p-value less than 0.05 was considered significant. Results Two-hundred-five pediatric inpatients with RTPCR-established COVID-19 infection were screened and final analyses were performed on 97 patients, of which 31 children were classified into group A and 66 into group B. Median age of enrolled children was 5 years with 58.8% males. The prevalence of cancer as a comorbidity in pediatric inpatients with COVID-19 was 15%. Fifty-five percent of cancer patients had hematological malignancies, while 45% had solid tumors. Fever (p = 0.001) and gastrointestinal manifestations (p = 0.0001) were significantly less common among pediatric cancer patients. Children with cancer had significantly more leukopenia (p = 0.003), neutropenia (p = 0.003), and lymphopenia (p = 0.005). The case fatality rate was higher in children with cancer (3.2%) as compared to noncancer patients (1.5%, p = 1.0). Few risk factors for moderate-to-severe COVID-19 among children with cancer included age less than 2 years (p = 0.06), undernutrition (p = 0.33), advanced stage of cancer (p = 0.49), and presence of coinfection (p = 0.35) Conclusion Cancer is a significant comorbidity among pediatric COVID-19 patients. While children with cancer have less severe COVID-19, their case fatality rate is higher than those without cancer. Younger age, undernutrition, advanced stage of cancer, and presence of coinfections may predispose to the development of moderate-to-severe COVID-19 among pediatric cancer patients.

The clinical Spectrum of Viridans Group Streptococci infections in paediatric patients at a tertiary hospital.

Viridans Group Streptococci (VGS) are often considered organisms of low virulence; however, infection can result in clinically significant sepsis and life-threatening complications in paediatric patients. This study aimed to describe the spectrum of clinical presentation of VGS bacteraemia in paediatric patients, to analyse risk factors, and to describe the antibiotics resistance patterns of VGS. Cultures of VGS in paediatric patients admitted to Chris Hani Baragwanath Academic Hospital in 2019 were identified through National Health Laboratory Service. Data were extracted from archived clinical records and analysed. Sepsis scores were calculated at the time of bacteraemia. A total of 133 cultures were identified; 64 (48.1%) polymicrobial cultures and no records 4 (0.03%) were excluded; 65 (48.9%) were analysed. The median age was 1.5 months (range 0.03 to 168, interquartile range [IQR]: 0.3-13.25), 27/65 (42%) were neonates. The median duration of hospitalisation was 7 days (IQR: 3-21). The commonest diagnoses were neonatal sepsis 30.8% (n = 20) and pneumonia 28% (n = 18). The systemic inflammatory response syndrome (SIRS) score was ≥ 2 in 57% (16/28) patients; paediatric sequential organ failure assessment (pSOFA) score was > 2 in 10/24 (42%). Fifty-seven (88%) patients were discharged; three (5%) required ICU admission and 8/65 (12.3%) died. Malnutrition was present in 50% of patients who died. Cephalosporins and penicillin had sensitivity of 89% and 55%, respectively. Viridans Group Streptococci bacteraemia was common in neonates, and pneumonia was a common presentation in this cohort. The VGS bacteraemia was associated with morbidity and deaths in this cohort. The VGS should be considered a significant organism when cultured from sterile sites and routine antibiotic susceptibility testing should be performed. Prospective studies are recommended.

Helicobacter pylori infection in pediatric patients with celiac disease: A single-center experience

Aim: There are numerous studies investigating the relationship between celiac disease (CD) and Helicobacter pylori (H. pylori). In this study, we aimed to compare the prevalence of coexisting H. pylori infection and CD in pediatric patients diagnosed with celiac disease at our clinic versus an age-matched control group. Materials and Methods: A total of 198 patients with celiac disease and 131 sex and age -matched controls undergoing upper gastrointestinal endoscopy due to dyspeptic complaints were included in this study. The prevalence of H. pylori was compared between the groups. Results: Of the 198 patients with CD included in the study, 66 (33.3%) were male and 132 (66.7%) were female, while in the control group, 36 (27.5%) were male, and 95 (72.5%) were female. 89 (44%) of the patients with CD and 70 (53.4%) of the controls were H. pylori-positive. There was no statistically significant difference in the distribution of Marsh scores between the H. pylori-negative and -positive groups. Conclusion: The association between celiac disease and H. pylori remains controversial. Thus, multicenter studies are warranted to evaluate the role of H. pylori in the pathogenesis of celiac disease.

Efficiency of an algorithm for the prevention of sternal infection after cardiac surgery in children under 1 year of age: A single-center retrospective study

BackgroundSternal infection is one of the most challenging complications to manage after heart surgery. The aim of our study is to evaluate the effectiveness of a developed algorithm for preventing sternal infection in pediatric patients after surgery for congenital heart disease (CHD). MethodsWe conducted a single-center study examining the treatment of 478 children with CHD. Patients were divided into 2 groups, taking into account the application of a developed management algorithm. A multivariate logistic regression analysis was used to identify the factors influencing the development of sternal infection following heart surgery using median sternotomy. ResultsA developed algorithm was applied in 308 children. In total, there were 16 cases of sternal infection (3.34 %) across both groups. Deep wound infection developed in 6 patients (1.26 %). Sternal infection developed in 2 children (0.65 %) in the first group (in which the algorithm was applied) and 14 children (8.2 %) in the second group. Deep sternal infection developed in 1 patient in the first group (0.33 %) and in 5 patients in the second group (2.94 %). As a result, perioperative risk factors as postoperative resternotomy (OR 23.315; p < 0.001), delayed sternal closure (OR 9.087; p = 0.003), development of acute renal failure (OR 5.322; p = 0.018) were associated with increased risk of infection and application of the developed algorithm resulted in a significant reduction in risk (OR 0.032; p < 0.001). ConclusionThe suggested method for the prevention of sternal infection has significantly reduced the incidence of sternal infection after cardiac surgery in children less than 1 year of age. In patients with moderate to high risk for surgical site infection, surgeons can enhance wound healing and prevent wound infections with simple, inexpensive, and readily available tools and techniques. Surgical aspects, topical use of antibiotics, prevention of peripheral vasoconstriction, maintenance of normal oxygen delivery rates, and an individual approach to intensive care are essential.

Catheter-related Infections in Pediatric Patients Due to a Rare Pathogen: Herbaspirillum huttiense.

Herbaspirillum species are nonfermenting, aerobic, helical or curved, Gram-negative bacteria belonging to the class Betaproteobacteria, order Burkholderiales. To date, only a few studies have reported on the epidemiology, clinical symptoms, antibiotic susceptibility profiles, treatment and outcomes of Herbaspirillum huttiense -related infections in pediatric patients. The aim of this study was to present 3 years of H.huntiense data, antibiotic susceptibility profiles, systemic antibiotics and antibiotic lock therapy (ALT) options and clinical outcomes. Fourteen episodes of infection in 12 patients were included in this retrospective study. The patients had a male/female ratio of 1:1 and a median age of 160.5 months (range, 3-198 months). Catheter-related bloodstream infection (CRBSI) was detected in 11 patients. Only 1 patient developed catheter-related infective endocarditis. The patient's catheter was removed, and she was successfully treated with systemic antibiotics for 4 weeks. Systemic antibiotics were used in all infections related to H. huttiense . In septic, critically ill patients, the catheter was removed, and systemic antibiotics were started. Port catheters were removed in 5 patients. ALT was performed in clinically stable patients. ALT using amikacin was administered to 6 patients through the port catheter. Two patients had a 2nd attack. After the 2nd ALT treatment, 1 patient cured, and the catheter of the other patient was removed due to persistent microbial growth in cultures. Antimicrobial susceptibility testing of the reported isolates showed susceptibility to meropenem (90%), ceftazidime (87%) and piperacillin/tazobactam (65%), with 92% resistance to colistin. H. huttiense is an emerging pathogen in CRBSI. Piperacillin/tazobactam, ceftazidime and meropenem appear to be good therapeutic options for the treatment of H. huttiense infections. ALT and systemic antibiotics can be used in H. huttiense -CRBSI to sterilize and preserve the central venous catheter.

Multidrug-Resistant Bacterial Infections in Pediatric Patients Hospitalized at King Abdulaziz University Hospital, Jeddah, Western Saudi Arabia.

Multidrug-resistant bacterial infections (MDRIs) constitute a major global threat due to increased patient morbidity/mortality and hospital stay/healthcare costs. A few studies from KSA, including our locality, addressed antimicrobial resistance in pediatric patients. This study was performed to recognize the incidence and clinical/microbiologic features of MDRIs in hospitalized pediatric patients. A retrospective cross-sectional study included pediatric patients < 18 years, admitted to King Abdulaziz University Hospital, between October 2021 and November 2022, with confirmed positive cultures of bacteria isolated from blood/body fluids. Patients' medical files provided the required data. MDR organisms (MDROs) were identified in 12.8% of the total cultures. The incidence of MDRIs was relatively high, as it was detected in 42% of patients and in 54.3% of positive bacterial cultures especially among critically ill patients admitted to the NICU and PICU. Pneumonia/ventilator-associated pneumonia was the main type of infection in 37.8% of patients with MDROs. Klebsiella pneumoniae was the most common significantly isolated MDRO in 39.5% of MDR cultures. Interestingly, a low weight for (no need for their as terminology weight for age is standard and well-known) was the only significant risk factor associated with MDROs (p = 0.02). Mortality was significantly higher (p = 0.001) in patients with MDROs (32.4%) than in patients without MDROs (3.9%). Patients who died including 85.7% of patients with MDROs had significantly longer durations of admission, more cultures, and utilized a larger number of antibiotics than the surviving patients (p = 0.02, p = 0.01, p = 0.04, respectively). This study provided a comprehensive update on the seriously alarming problem of MDROs, and its impacts on pediatric patients. The detected findings are crucial and are a helpful guide to decid for implementing effective strategies to mitigate MDROs.

Management outcome of a COVID-19 Positive Child with Multiple Contacts admitted in a General Intensive Care Unit-A Case Report

COVID-19 infection in paediatric patients is relatively low in Nigeria. The low index of suspicion made healthcare providers to be at risk of contracting the disease from this age group making prevention and contact tracing difficult. We report the management of a 9-month- old male child who had palatoplasty following a prior negative polymerase chain reaction (PCR) screening. The patient underwent palatoplasty for isolated cleft palate under general anaesthesia and endotracheal intubation. The patient was found to be desaturating significantly on admission to the recovery room and was subsequently taken back to the theatre with multiple attempts at intubation. A repeat PCR done was positive and subsequently, he was admitted into the ICU for ventilatory support. A chest radiograph taken on admission revealed features of severe bronchopneumonia and COVID-19 pneumonic changes. He was ventilated for 14 days and thereafter, was discharged home on a tracheostomy in good clinical condition. The mother of the child and 20 members of staff (23.5%) out of the 85 personnel who had close contact with the child in the course of treatment tested PCR positive. Contact tracing was difficult among those infected. They all recovered from the disease without complications. The treatment outcome in this COVID-19-positive child was good and contact tracing was effective in reducing the transmission of SARS-CoV-2 and limiting the impact of the outbreak. We hereby recommend preventive measures against the infection, vaccination and establishment of dedicated paediatric ICU for infectious diseases.

Randomised multicentre effectiveness trial of rapid syndromic testing by panel assay in children presenting to European emergency departments with acute respiratory infections—trial protocol for the ADEQUATE Paediatric trial

IntroductionSyndromic panel assays, that is, using one test to simultaneously target multiple pathogens with overlapping signs and symptoms, have been integrated into routine paediatric care over the past decade, mainly...

Pediatric Maxillofacial Infections During COVID-19: What Have We Learned?

BackgroundThe COVID-19 pandemic significantly affected healthcare systems worldwide, and the field of dentistry is no exception. Odontogenic infections in pediatric patients pose unique challenges to treatment and diagnosis. PurposeThe purpose of this study was to evaluate the incidence, characteristics, and treatment of pediatric maxillofacial odontogenic infections during COVID-19 compared to pre-COVID-19. Study design, setting, and sampleThis retrospective cohort study included all pediatric patients (0-18 years) who visited the emergency department (ED) at Tzafon Medical Center, Israel, between March 2020 and February 2021 (COVID-19), or between March 2018 and February 2020 (Pre-COVID-19), and were diagnosed with maxillofacial odontogenic infections. Patients with missing demographic data and patients who did not complete the medical examination were excluded. Predictor/exposure/independent variableThe exposure variable was the date of presentation, categorized as COVID-19 or pre-COVID-19. Main outcome variable(s)The main outcome variables were the proportion of patients diagnosed with odontogenic infections, hospitalization rate, treatment methods, and length of hospital stay (LOS). CovariatesCovariates included patient demographics, involved dentition and associated spaces, and the administration of antibiotics before ED arrival. AnalysesFisher exact test and Pearson's chi-squared test were applied to assess differences in categorical variables. Wilcoxon rank-sum test was used for independent variables. A logistic regression model was used to predict outcome variables. P-values were two-tailed and statistical significance was defined as p<0.05. ResultsThe study sample comprised 471 patients: 357 (76%) in the pre-COVID-19 period and 114 (24%) during COVID-19. The relative-risk of visits to the ED out of total oral and maxillofacial ED visits was lower during COVID-19 (RR=0.65, p=0.0001). The hospitalization rate increased from 72% (257 patients) pre-COVID-19 to 86.8% (99 patients) during the COVID-19 period (p=0.001). LOS during Covid-19 was significantly shorter than pre-COVID-19 (p<0.001). ConclusionsThe findings of this study reveal a significant reduction in odontogenic infection incidents referred to the ED during the pandemic. This implies that many of these incidents can be successfully treated in community healthcare settings, without referral to the ED.