Infections In Pediatric Patients Research Articles

Third-Party Virus-Specific T-Cell Infusion for Treatment of Refractory Viral Infections: Interim Results from PBMTC SUP1701

Background Adoptive immunotherapy using banked virus-specific T-lymphocytes (VSTs) derived from partially HLA-matched donors has been successful in restoring antiviral immunity after hematopoietic stem cell transplantation (HSCT), although broad availability of this therapy is currently limited, and best methods for donor-recipient matching remain unclear. Objective To determine the feasibility and efficacy of third-party VSTs for the treatment of immunocompromised pediatric patients with refractory viral infections in a multicenter phase I/II consortium study. Design/Methods There are two arms to this study. Arm A are pediatric subjects who had infections with CMV, EBV, and/or adenovirus after hematopoietic stem cell transplant (HSCT) and had failed antiviral therapy, or who had toxicities related to anti-viral drug-related. Arm B enrolls patients with primary immunodeficiency disorders with refractory viral infection prior to HSCT. A VST bank containing products generated from 40 donors at Children's National was utilized, and antiviral HLA mapping was applied to identify the most suitable product for each patient referred. Patients received a dose of 2 × 10^7 VSTs/m2, with optional additional doses given 28 days after the initial VST infusion. Viral PCRs were monitored for efficacy, and VST persistence and expansion in vivo was measured via IFN-g ELISpot and flow cytometry. Results Twenty-three patients were enrolled from 11 study sites to date. Twenty-two were treated in Arm A (after HSCT), at a median time of 95 days post-HSCT (range 16-476). Fourteen patients were treated for adenovirus and 9 for CMV. Patients received a median of 1 infusion (range 1-3). Infused VSTs were matched at a median of 3/10 HLA alleles (range 2-5), and 22 had confirmation of antiviral activity through at least one shared HLA allele. Of 18 evaluable patients, 14 had antiviral responses at 1-month post-infusion (4/5 with CMV, and 10/13 with adenovirus, Figure 1), including 7 who had complete resolution of viremia. No GVHD was observed after infusion, and 17 of 23 (74%) are virus free up to 15 months post-infusion. Virus-specific T-cell activity was higher by day 45 (mean 177 IFN-g SPW) post-infusion than at baseline (mean 13 IFN-g SPW, p=0.045). VSTs remained detectable for up to 3 months via flow cytometry staining of discordant HLA alleles (Figure 2). Conclusions Third-party VSTs utilized from a single bank can be distributed and administered in a multicenter consortium setting, and are safe and feasible for the treatment of refractory viral infections in pediatric patients. Preliminary efficacy data shows high rates of response and long-term survival. Studies of targeting strategies and characterization of T-cell epitopes are ongoing.

Association of Antibiotic Treatment Duration With Recurrence of Uncomplicated Urinary Tract Infection in Pediatric Patients.

Background: Gaps and inconsistencies in published information about optimal antibiotic treatment duration for uncomplicated urinary tract infection (UTI) in pediatric patients pose a dilemma for antibiotic stewardship. Objective: Evaluate the association of antibiotic treatment duration with recurrence rates in children with new-onset cystitis or pyelonephritis. Methods: Retrospective cohort analysis of patients aged 2 to 17 years with new-onset cystitis or pyelonephritis and without renal/anatomical abnormality was conducted using Truven Health MarketScan Database for 2013-2015. Results: Of 7698 patients, 85.5% had cystitis, 14.3% pyelonephritis. Duration of antibiotic treatment was as follows: 3 to 5 days for cystitis (20.4%) or 7 (33.6%), 10 (44.2%), or 14 (1.8%) days for any UTI. Recurrence occurred in 5.5% of patients. Covariates associated with increased recurrence risk included pretreatment antibiotic exposure (odds ratio [OR] = 1.29; 95% CI = 1.06-1.57), pyelonephritis on diagnosis date (OR = 1.44; 95% CI = 1.03-2.00), follow-up visit during antibiotic treatment (OR = 3.21; 95% CI = 2.20-4.68), parenteral antibiotic (OR = 1.89; 95% CI = 1.33-2.69), and interaction of pyelonephritis diagnosis with nitrofurantoin monotherapy (OR = 3.68; 95% CI = 1.20-11.29). After adjustment for covariates, the association between duration of antibiotic treatment and recurrence was not significant (compared with 7 days: 10 days: OR = 1.07, 95% CI = 0.85-1.33; 14 days: OR = 0.89, 95% CI = 0.45-1.78). Conclusions and Relevance: Antibiotic treatment duration was not significantly associated with recurrence of uncomplicated UTI in a national pediatric cohort. Results provide support for shorter-course treatment, consistent with antimicrobial stewardship efforts.

Analysis of Eradication, Recurrence and Levels of 25-hydroxyvitamin D3 and Interleukin-1β in paediatric patients with Helicobacter Pylori Infection-related Gastritis.

Objective:To study whether the levels of 25-hydroxyvitamin D3 (25-(OH)D3) and Interleukin-1β (IL-1β) are correlated to the eradication and recurrence of helicobacter pylori (Hp) in paediatric patients with Hp infection-related gastritis.Methods:A total of 142 paediatric patients with Hp infection-related gastritis from November 2017 to March 2018 in Baoding Children’s Hospital were selected as study subjectswere selected as study subjects and were followed up for one year. Paediatric patients were grouped and analyzed according to the effect of follow-up treatment and recurrence.Results:The levels of 25-(OH) D3 in the non-eradication group were lower than those in the eradication group and the control group (F=27.087, P<0.05); the levels of IL-1β were higher than those in the eradication group and the control group (F=16.610, P<0.05). Recurrence during follow-up visits: The levels of 25-(OH) D3 in the recurrence group were lower than those in the non-recurrence group and the control group (F=33.837, P<0.05); the levels of IL-1β in the recurrence group were higher than those in the non-recurrence group and the control group (F=7.896, P<0.05). Correlation analysis showed the levels of 25-(OH) D3 and IL-1β in the eradication group and the non-eradication group were negatively correlated (r=-0.232, P<0.05); the levels of 25-(OH) D3 and IL-1β in the recurrence group and the non-recurrence group were negatively correlated (r=-0.225, P<0.05).Conclusion:Relatively high levels of IL-1β may be correlated to the difficulty in eradicating the Hp infection in paediatric patients. Relatively low levels of 25-(OH) D3 may be correlated to the difficulty in eradicating the Hp infection and recurrence in paediatric patients.

Риск развития Clostridium difficile инфекции, связанный с применением различных групп антибиотиков и их сочетаний, у детей в онкологическом стационаре

Пациенты детского онкологического стационара находятся в группе риска развития Clostridium difficile инфекции. Цель данного исследования состояла в определении степени риска развития Clostridium difficile инфекции в детском онкологическом стационаре при применении различных групп антибиотиков и их сочетаний. В результате было показано, что применение антибактериальных химиотерапевтических препаратов, принадлежащих к группам нитрофуранов (энтерофурил), сульфаниламидов (бисептол), цефалоспоринов и макролидов/азалидов, достоверно повышало риск развития Clostridium difficile инфекции у детей – пациентов стационара. Применение таких антибиотиков, как линезолид, колистин и метронидазол, достоверно снижало риск развития Clostridium difficile инфекции. Применение пенициллинов, аминогликозидов, фторхинолонов, гликопептидов, карбопенемов не было связано с риском развития Clostridium difficile инфекции у детей, находящихся на лечении в онкологическом стационаре. Применение одного или двух антибактериальных химиотерапевтических препаратов, принадлежащих к разным группам, увеличивало риск развития Clostridium difficile инфекции по сравнению с применением препаратов трех групп.

The risk of developing a Clostridium difficile infection from the administration of different classes of antibiotics and their combinations to children in an oncological hospital

Patients in pediatric oncological hospitals are at risk of developing a Clostridium difficile infection. The purpose of this study was to determine the risk of developing a Clostridium difficile infection in patients who are treated with antibiotics of different classes and their combinations by way of a retrospective analysis of 122 patient records. It was shown that the administration of antibacterial chemotherapeutic drugs that belong to the classes of nitrofurans (enterofuryl), sulfonamides (biseptol), cephalosporins, and macrolides/azalides significantly increased the risk of developing a Clostridium difficile infection in pediatric patients. On the contrary, treatment with antibiotics of different classes, such as linezolid, colistin, and metronidazole, significantly reduced the risk of developing a Clostridium difficile infection. The use of penicillins, aminoglycosides, fluoroquinolones, glycopeptides, and carbapenems was not associated with the risk of developing a Clostridium difficile infection in pediatric patients. The administration of one or two antimicrobial drugs of different classes increased the risk of developing a Clostridium difficile infection while a combination of three different types of antimicrobial drugs lowered the rate of this infection in pediatric patients.

Differences among Severe Cases of Sars-CoV-2, Influenza, and Other Respiratory Viral Infections in Pediatric Patients: Symptoms, Outcomes and Preexisting Comorbidities

OBJECTIVES:Previous studies focusing on pediatric patients hospitalized with severe coronavirus disease 2019 (COVID-19) have been limited to small case series. We aimed to evaluate the characteristics of a large population of pediatric patients with severe COVID-19 and compare them with patients with severe cases of influenza and other respiratory viruses (ORV).METHODS:We performed a cross-sectional study of Brazilian data from the National Epidemiological Surveillance Information System, gathered from January 1st to July 14th, 2020. The sample included 4,784 patients (2,570 with confirmed COVID-19, 659 with influenza, 1,555 with ORV). Outcome measures included clinical features, preexisting comorbidities, pediatric intensive care unit admissions, need for ventilatory support, and death.RESULTS:Compared with the influenza and ORV groups, the COVID-19 group had a higher proportion of newborns and adolescents, as well as lower frequencies of fever, cough, dyspnea, respiratory distress, and desaturation. Although use of invasive ventilatory support was similar among groups, death rate was highest for COVID-19 (15.2% vs. 4.5% vs. 3.2%, p<0.001), with death risk more than three times the other groups (adjusted OR=3.7 [95% CI 2.5-5.6]). The presence of two or more comorbidities further increased this risk (OR=4.8 [95% CI 3.5-6.6]). Preexisting comorbidities were reported in 986 patients with severe COVID-19 (38%). Mortality rate among COVID-19 patients was significantly higher for almost all comorbidities reported.CONCLUSION:Severe COVID-19 had a higher mortality rate than other viral respiratory illnesses, despite the lower frequency of fever, cough, dyspnea, respiratory distress, and desaturation. Death risk was strongly associated with preexisting comorbidities.

Urinary Tract Infection in Pediatric Patients on Clean Intermittent Catheterization via a Mitrofanoff port with Reused Catheters - Any Association with Catheter Sterility?

Objective:The objective of this study is to find out whether the reused catheters for clean intermittent catheterization (CIC) are colonized before insertion and its association with urinary tract infection (UTI).Materials and Methods:This is a study conducted on 28 pediatric surgery patients who are on CIC via a Mitrofanoff port and who were reusing catheters, in a tertiary care private medical college hospital for 6-month period. Catheters to be used for the next catheterization were sent for culture along with urine culture. A questionnaire was utilized to assess CIC practice and UTI.Results:Diseases of patients were: neurogenic bladder and exstrophy–epispadias and posterior urethral valve. Twenty-one of them had an augmented bladder. Hydronephrosis was present in ten and vesicoureteral reflux (VUR) in five. Their mean duration of CIC was 5.3 years. Of 28 catheter tip samples, 16 catheters were colonized with organism. Of the 28 urine culture samples, 17 cultures were positive and all were asymptomatic except one. Of the 16 positive catheter samples, only 9 had positive urine culture; four of them had grown different organisms and five of them had the same organism, and even in these five, single organism was seen only in three. Urine culture grew Gram-negative organism in 85%, but catheter grew Gram-positive organism in 46%. No difference was found in the variables between both groups such as hydronephrosis, VUR, and augmented bladder.Conclusion:Reused catheters were colonized in 57% of the study patients, but reused catheter may not be the cause of culture positivity or UTI in the study population.

Infecção por SARS-CoV-2 em pacientes pediátricos portadores de doenças renais hospitalizados

OBJECTIVES: This study aims to present the confirmed cases of SARS-CoV-2 infection in pediatric patients with chronic and acute kidney diseases admitted to a tertiary pediatric hospital. METHODS: Descriptive and retrospective observational study with all children hospitalized between March and June 2020 who had, simultaneously, SARS-CoV-2 infection and renal pathologies. Of this total of patients, those who had another underlying disease besides the renal disease were excluded. RESULTS: During the period, nine children with kidney disease were admitted to the hospital and had infection confirmed by the new coronavirus through positive RT-PCR. Regarding the underlying disease, seven had only kidney disease, three of whom had stage 5 chronic kidney disease; one, with stage 1 chronic kidney disease; one, with cortic-sensitive nephrotic syndrome; and two, with acute kidney injury. Two patients in this study had already undergone kidney transplantation, used immunosuppressants and had their doses reduced due to the infectious condition. Only one required oxygen therapy and transfer to the intensive care unit, but was not intubated and returned to the ward within 24 hours. CONCLUSIONS: According to the cases described, the pediatric population with kidney disease, including those using immunosuppressants due to acute transplant rejection, seems to evolve without severe COVID-19, therefore there is no great divergence in relation to the population of the same healthy age group.

Characteristics of human parainfluenza virus type 4 infection in hospitalized children in Korea.

BackgroundThe characteristics of human parainfluenza virus type 4 (hPIV4) infection are not thoroughly understood. We therefore clarified the characteristics of hPIV4 in Korea.MethodFrom January 2013 to December 2017, children admitted with respiratory tract infection at the Department of Pediatrics in Chung‐Ang University Hospital were enrolled in the study. Nasopharyngeal aspirate specimens were obtained from patients and tested for hPIV types by multiplex reverse transcription polymerase chain reaction. We retrospectively reviewed subject medical records, focusing on epidemiological and clinical characteristics.ResultsOf the 12 423 NPA specimens, 8,406 were positive by multiplex reverse transcription polymerase chain reaction for nine respiratory viruses, and 1,018 were positive for one of the four types of hPIV: 1,018 specimens led to the detection of 1,029 hPIVs; 3ss (31.3%) were positive for hPIV1, 120 (11.7%) were positive for hPIV2, 356 (34.6%) were positive for hPIV3, and 231 (22.4%) were positive for hPIV4. Of the hPIV‐positive patients, the mean age was 2.3 years (range, 0.1–12.7 years), 225 (97.4%) had no underlying disease, and 178 (77.1%) had a fever with a duration of 4.1 ± 2.3 days and a peak temperature of 39.0 ± 0.7 ℃. The most common diagnosis in hPIV4 infection was pneumonia (44.2%), followed by bronchiolitis (26.0%) and upper respiratory tract infection (24.3%). Only 2.2% of patients were diagnosed with croup. Although the most prevalent overall type of hPIV was hPIV3, hPIV4 generally caused acute respiratory tract infection in summer and early fall in an irregular annual pattern.ConclusionsHuman parainfluenza virus type 4 is an important common pathogen of respiratory tract infections in pediatric patients in Korea.

Characteristics of Pseudomonas Aeruginosa Infection in Pediatric Patients Treated in Sanglah General Hospital Denpasar During Period February 2017 - May 2019

Health-care-associated infections is one of the causes of high mortality among inpatient children. Globally, prevalence nosocomial infection are 8.7%. In Indonesia, prevalence of nosocomial infection at 2014 are 148.703 cases. One of the Gram negative pathogen that has been known can cause nosocomial infection is <i>Pseudomonas aeruginosa</i>. This study aims to know patient characteristic with <i>P. aeruginosa</i> infection at Sanglah Hospital. This research is descriptive study with a cross-sectional approach conducted in Sanglah Hospital, Denpasar. The study used secondary data from medical records of pediatric patients who were proven to have <i>P. aeruginosa</i> infection through microbiological examination while undergoing treatment at Sanglah hospital in the period of Februari 2017- Mei 2019. Incomplete medical record data were excluded from the study. There were 30 children with positive blood culture <i>P. aeruginosa</i>. Most of them were male (17/30), with underlying disease pneumonia (13/30), length of stay before infection 16,8 days, total length of stay 28,5 day. Most patients died (19/30). 7 patients had history positive blood culture before <i>P. aeruginosa</i> infection. 29 patients using peripheral intravenous line (mean 22.5 day). Most patients were sensitive to Cefepime (80%) and resistant to Ampicilin Sulbactam (80%). Characteristic patients with Pseudomonas aeruginosa infection mostly were male, with underlying disease pneumonia, using medical device peripheral line, and died. Most of them were sensitive to Cefepime and resistant to Ampicilin Sulbactam.

Relationship Between Ventriculoperitoneal Shunt Obstruction and Infection in Pediatric Patients with Hydrocephalus

Relationship Between Ventriculoperitoneal Shunt Obstruction and Infection in Pediatric Patients with Hydrocephalus

Preoperative and operation-related risk factors for postoperative nosocomial infections in pediatric patients: A retrospective cohort study.

Pediatric patients undergoing invasive operations bear extra risk of developing nosocomial infections (NIs). However, epidemiological evidence of the underlying risk factors, which is needed for early prevention, remains limited. Using data from the electronic medical records and the NI reporting system of a tertiary pediatric hospital, we conducted a retrospective analysis to identify preoperative and operation-related risk factors for postoperative NIs. Multivariable accelerated failure time models were fitted to select independent risk factors. The performance of these factors in risk stratification was examined by comparing the empirical risks between the model-defined low- and high-risk groups. A total of 18,314 children undergoing invasive operations were included for analysis. After a follow-up period of 154,700 patient-days, 847 postoperative NIs were diagnosed. The highest postoperative NI rate was observed for operations on hemic and lymphatic system. Surgical site infections were the NI type showing the highest overall risk; however, patients were more likely to develop urinary tract infections in the first postoperative week. Older age, higher weight-for-height z-score, longer preoperative ICU stay, preoperative enteral nutrition, same-day antibiotic prophylaxis, and higher hemoglobin level were associated with delayed occurrence of postoperative NIs, while longer preoperative hospitalization, longer operative duration, and higher American Society of Anesthesiologists score showed acceleration effects. Risk stratification based on these factors in an independent patient population was moderate, resulting in a high-risk group in which 72% of the postoperative NIs were included. Our findings suggest that pediatric patients undergoing invasive operations and at high risk of developing postoperative NIs are likely to be identified using basic preoperative and operation-related risk factors, which together might lead to moderately accurate risk stratification but still provide valuable information to guide early and judicious prevention.

Invasive Scedosporium spp. and Lomentospora prolificans infections in pediatric patients: Analysis of 55 cases from FungiScope® and the literature

ObjectivesCurrent knowledge on infections caused by Scedosporium spp. and Lomentospora prolificans in children is scarce. We therefore aim to provide an overview of risk groups, clinical manifestation and treatment strategies of these infections. MethodsPediatric patients (age ≤18 years) with proven/probable Scedosporium spp. or L. prolificans infection were identified in PubMed and the FungiScope® registry. Data on diagnosis, treatment and outcome were collected. ResultsFifty-five children (median age 9 years [IQR: 5–14]) with invasive Scedosporium spp. (n = 33) or L. prolificans (n = 22) infection were identified between 1990 and 2019. Malignancy, trauma and near drowning were the most common risk factors. Infections were frequently disseminated. Most patients received systemic antifungal therapy, mainly voriconazole and amphotericin B, plus surgical treatment.Overall, day 42 mortality was 31%, higher for L. prolificans (50%) compared to Scedosporium spp. (18%). L. prolificans infection was associated with a shorter median survival time compared to Scedosporium spp. (6 days [IQR: 3–28] versus 61 days [IQR: 16–148]). Treatment for malignancy and severe disseminated infection were associated with particularly poor outcome (HR 8.33 [95% CI 1.35–51.40] and HR 6.12 [95% CI 1.52–24.66], respectively). Voriconazole use at any time and surgery for antifungal treatment were associated with improved clinical outcome (HR 0.33 [95% CI 0.11–0.99] and HR 0.09 [95% CI 0.02–0.40], respectively). ConclusionsScedosporium spp. and L. prolificans infections in children are associated with high mortality despite comprehensive antifungal therapy. Voriconazole usage and surgical intervention are associated with successful outcome.

Microbiology of Osteoarticular Infections in Patients with Sickle Hemoglobinopathies at Texas Children's Hospital, 2000-2018.

The association between Salmonella spp. and osteoarticular infections in pediatric patients with major sickle hemoglobinopathies has been well established. However, the contemporary microbiology of these infections in such patients is unknown. We conducted a retrospective review of medical records at Texas Children's Hospital in Houston from 2000 to 2018 to investigate this question. Fifty cases were identified. In 23 (46%) cases, a pathogen was identified. Salmonella was the most common pathogen isolated, accounting for 61% of culture-positive cases followed by Staphylococcus aureus (21.7%).

Treatment of pediatric extra-axial sinogenic infection: case series and literature review.

Analyze the clinical presentation, microbiology, outcomes, and medical and surgical treatment strategies of intracranial extension of sinogenic infection in pediatric patients. A retrospective, single-center study of patients < 18 years of age, presenting with intracranial extension of bacterial sinogenic infections requiring surgical intervention over a 5-year period, was conducted. Electronic medical records were reviewed for age, sex, primary symptoms, duration of symptoms, presence of sinusitis at initial presentation, microorganisms isolated, mode of surgery, timing of surgery, length of stay, and neurologic sequelae. Seventeen patients were identified; mean age was 10 years with 82.3% male predominance. Average duration of illness prior to presentation was 9.8 days, with 64.7% of patients displaying disease progression while on oral antibiotics prior to presentation. Sinusitis and intracranial extension were present in all patients upon admission. Simultaneous endoscopic endonasal drainage and craniotomy were performed on 70.5% of the patients, with the remaining 29.5% undergoing endonasal drainage only. Of the patients who underwent simultaneous endoscopic endonasal drainage and craniotomy, 17.6% required repeat craniotomy and 5.8% required repeat sinus surgery. The most commonly isolated organisms were S. intermedius (52.9%), S. anginosus (23.5%), and S. pyogenes (17.6%). All patients were treated postoperatively antibiotic on average 4-6 weeks. Frequently occurring long-lasting complications included seizures (29.4%) and focal motor deficits (17.6%); learning disability, anxiety disorders, impaired cognition, and sensory deficits occurred less frequently. In the case of intracranial extension of bacterial sinogenic infection, early identification and surgical treatment are crucial to avoid neurological sequelae.

Etiology and Outcome of Candidemia in Neonates and Children in Europe: An 11-year Multinational Retrospective Study.

Background:Data on Candida bloodstream infections in pediatric patients in Europe are limited. We performed a retrospective multicenter European study of the epidemiology and outcome of neonatal and pediatric candidemia.Material and Methods:All first positive blood cultures from patients ≤ 18 years of age with candidemia were registered. Patients’ demographic and clinical characteristics and causative Candida species were collected and analyzed. Regression analysis was used to identify factors independently associated with mortality.Results:One thousand three hundred ninety-five episodes of candidemia (57.8% male) were reported from 23 hospitals in 10 European countries. Of the 1395 episodes, 36.4% occurred in neonates (≤ 44 weeks postmenstrual age), 13.8% in infants (> 44 weeks postmenstrual age to 1 year) and 49.8% in children and adolescents. Candida albicans (52.5%) and Candida parapsilosis (28%) were the predominant species. A higher proportion of candidemia caused by C. albicans was observed among neonatal patients (60.2%) with highest rates of C. parapsilosis seen among infants (42%). Children admitted to hematology-oncology wards presented the highest rates of non-albicans Candida species. Candidemia because of C. albicans was more frequent than non-albicans Candida in Northern versus Southern Europe (odds ratio, 2.3; 95% confidence interval, 1.8–2.9; P < 0.001). The all-cause mortality at 30 days was 14.4%. All-cause mortality was higher among patients admitted to the neonatal or pediatric intensive care units than other wards. Over time, no significant changes in species distribution were observed.Conclusions:This first multicenter European study shows unique characteristics of the epidemiology of pediatric candidemia. The insights obtained from this study will be useful to guide clinical management and antifungal stewardship.

Area Deprivation as a Risk Factor for Methicillin-resistant Staphylococcus aureus Infection in Pediatric Cystic Fibrosis.

In US cystic fibrosis (CF) patients, methicillin-resistant Staphylococcus aureus (MRSA) rates have tripled in the past 2 decades. Known clinical risk factors include exposure to a healthcare setting, Pseudomonas aeruginosa and CF-related diabetes. Area-level socio-environmental exposures have not been evaluated. We explored the association of area-level deprivation with MRSA prevalence in a pediatric CF Center in the Southeastern United States. Patients' residential addresses were geocoded and linked to a composite Area Deprivation Index and Rural-Urban Commuting Area scores. The association of MRSA with Area Deprivation Index and Rural-Urban Commuting Area scores was evaluated using logistic regression with robust standard errors adjusted for sociodemographic covariates (age, sex, race, mother's and father's education and household income), clinical risk factors (P. aeruginosa, CF-related diabetes, hospitalizations and number of clinic visits) and clustering. The study included all pediatric patients (N = 231; mean age 12) at a single CF Center. MRSA was present in 44% of subjects. Higher area-level deprivation was correlated with rural residence, lack of parental college education and lower household income (P < 0.001 for each). In a multiple regression model fully adjusted for patient-level sociodemographic covariates, clinical risk factors and clustering, neighborhood deprivation was associated with more than 2-fold increase in the odds of having MRSA [OR 2.26 (1.14-4.45), P < 0.05]. Neighborhood deprivation is a risk factor for MRSA in pediatric CF, doubling the odds of infection. Community-level socioeconomic risk factors should be considered when developing prevention strategies and treatment plans for MRSA infection in pediatric patients with CF.

Viral Etiology of Acute Respiratory Infections in Pediatric Patients in Lebanon.

BackgroundAcute respiratory infections (ARI) are the leading cause of death worldwide, especially among children. The majority of these infections in children are of viral etiology. In this study, we evaluated the incidence of viral ARI among children in Lebanon.Patients and MethodsChildren presenting with symptoms of ARI were prospectively recruited between September 2009 to February 2012. Nasopharyngeal aspirates were obtained from patients and screened for 11 respiratory viruses using a multiplex Luminex-based PCR assay.ResultsTwo hundred twenty-one patients were recruited with a median age of 1 year (IQR: 0 – 5). Out of 221 patients, 116 (52.5%) were positive for at least one virus, the majority (103/116; 88.8%) of which were in children under 6-year of age. Overall, 188 viruses were detected. Rhinovirus (RhV) was the most common virus detected in 81 (69.8%) patients followed by coxsackie virus and echovirus (CVEV) which were detected as one target in the panel in 45 (38.8%), and parainfluenza viruses (PIV types: 1, 2, 3, 4) in 24 (20.7%) patients. Coinfection with more than one virus was detected in 49 (42.9%) patients. RhV and CVEV were the most common viruses associated with co-infections and higher risk of rhinorrhea.ConclusionsViral pathogens account for at least half of the ARIs in Lebanon, with a high frequency of co-infections being detected.

2122. Isavuconazonium for Invasive Fungal Therapy: Single-Center Pediatric Experience

BackgroundIsavuconazole (ISZ), dosed as the pre-drug isavuconazonium (ISM), is active against a wide variety of clinically important fungal pathogens. ISM is approved for the treatment of invasive aspergillosis and mucormycosis in adults ≥18 years of age. We present our experience with ISM to treat proven or to prevent fungal infection in pediatric patients.MethodsIn a retrospective review of patients who received ISM at our institution between April 2016 and April 2019, we abstracted demographic information, primary diagnosis, indication for ISM therapy, ISZ serum concentrations if available, and outcomes.ResultsOf 16 patients who received ISM, 12 were < 18 years of age (range 6–17 years). Underlying conditions included leukemia (n = 8), lymphoma (n = 1), post BMT (n = 1), diabetes (n = 1), and cardiac transplant (n = 1). Nine (75%) had proven invasive fungal infection with aspergillosis (n = 2), zygomycosis (n = 3), mixed aspergillosis and zygomycosis (n = 2), mixed Rhizopus and Scedosporium (n = 1), and pathology only (n = 1). Five of these 9 patients received combination ISM and liposomal amphotericin initially, followed by monotherapy with ISM in 4 patients after a mean of 26 days (range 6–63), and continued dual therapy in the fifth. The other 4 received liposomal amphotericin with or without other azoles prior to changing to ISM monotherapy. ISM dosing was 10 mg/kg q8h on days 1 and 2, followed by q24 thereafter, up to a maximum of 372 mg/dose. There were 19 measured ISZ serum concentrations obtained from 8 patients after >1 week of verified inpatient dosing, ranging from 1.0 to 7.5 mg/L, above the MIC in all cases when known. Five (42%) patients died of underlying non-mycological causes, 1 (8%) died of progressive scedosporiosis, and 6 (50%) improved. The two patients receiving ISM prophylaxis did not suffer a breakthrough fungal infection. ISM was well tolerated with no dose-limiting, drug-related toxicities noted.ConclusionISM is a well-tolerated therapeutic option in pediatric patients at risk for or with invasive mycosis. Only 1 of our 12 patients died from progressive fungal disease.Disclosures All authors: No reported disclosures.

2854. Enterovirus D68 Infections in Pediatric Patients in Central Ohio: Clinical Characteristics of a New Outbreak in 2018

BackgroundMany aspects of EV-D68 pathogenesis in children are not fully understood. In 2014, we experienced an outbreak of EV-D68-associated acute respiratory illness affecting mostly asthmatic children with no cases of acute flaccid myelitis identified. Late in 2018, a new outbreak occurred. The objective of this study was to describe the differences in clinical presentation in children diagnosed with EV-D68 infection during the 2018 outbreak.MethodsThis is a single-center, observational study. Nasopharyngeal (NP) samples from patients <21 years of age that tested positive for rhinovirus/enterovirus (RV/EV) by the FilmArray respiratory panel v1.7 were prospectively collected. EV-D68 was confirmed using a laboratory-developed RT-PCR. Demographic, clinical characteristics, and semiquantitative EV-D68 loads were analyzed according to the clinical presentation.ResultsFrom May to October 2018, 1,987/3,633 (55%) samples were RV/EV positive. Of those 399/1,028 (39%) tested positive for EV-D68 (121 outpatients; 278 inpatients). Inpatients were older (3.1 vs. 1.8 year olds; P < 0.01) with no differences in sex or EV-D68 loads (P > 0.05). Within the inpatient cohort, 67 (1.4 year olds) children were previously healthy, 146 (4.1 year olds) had underlying asthma and 65 (2.5 year olds) had chronic medical conditions (24% vs. 53% vs. 23%, respectively). Most patients presented with respiratory symptoms (>95%), followed by fever (51%) or gastrointestinal symptoms (28%). Eleven children (4%) presented with neurologic manifestations including: acute flaccid myelitis in two children, opsoclonus myoclonus syndrome in one child, and seizures in the remaining eight. Rates of viral co-detection were low (8%) and none of the children with neurologic manifestations had another respiratory virus identified. Patients with neurologic findings had lower EV-D68 loads than those who did not (29 vs. 25 Ct values; P = 0.03).ConclusionEV-D68 infection was associated with significant morbidity, affecting children with underlying asthma at greater rates. It was associated with severe neurologic manifestations despite these children having lower EV-D68 loads. Active surveillance for EV-D68 should be routine to allow a better understanding of the epidemiology and severity of disease.Disclosures All Authors: No reported Disclosures.