Infections In Pediatric Patients Research Articles

First-Generation Cephalosporins for Treatment of Acute Hematogenous Osteomyelitis in Children: A Study of Efficacy and Adverse Effects.

Acute hematogenous osteomyelitis (AHO) is a relatively infrequent but significant infection in pediatric patients. As Staphylococcus aureus is the most common cause of AHO, intravenous and oral first-generation cephalosporins are common therapies. Cephalexin is a commonly prescribed oral therapy for pediatric AHO, although it requires frequent dosing that may affect adherence. Cefadroxil is a comparable oral first-generation cephalosporin with a more desirable dosing schedule. We reviewed pediatric patients admitted to Mayo Clinic between March 2002 and September 2020 for management of AHO who received treatment with a first-generation cephalosporin. We reviewed timing of oral therapy transition, therapy-associated adverse effects, and recurrence of disease after completion of therapy. There were 59 patients included in the study. There was similar occurrence of adverse effects in patients receiving cefadroxil and cephalexin, although use of cefadroxil coincided with more gastrointestinal adverse effects and leukopenia and use of cephalexin with more rash and neutropenia. One secondary treatment failure occurred in our study, in a patient receiving cephalexin for treatment of septic arthritis. Cefadroxil may be a reasonable alternative oral therapy for methicillin-susceptible S aureus or culture-negative AHO in pediatric patients, particularly when a less frequent dosing schedule is desired. Future study with a larger sample size is warranted.

388. Evaluating Rates of Co- and Secondary Infections in Pediatric Patients with COVID-19 Infections in Relation to Antibiotic Prescribing: An Observational Study

Abstract Background All ages have been greatly impacted by the Coronavirus disease 2019 (COVID-19) pandemic. While many patients with COVID-19 are prescribed antibiotics, there is often little microbiologic evidence for concurrent or secondary bacterial infection. Such prescribing practices may lead to increased antimicrobial resistance. The purpose of this study is to evaluate the number of microbiologically confirmed bacterial co- and secondary infections in pediatric patients with COVID-19 and characterize associated antimicrobial use at a large academic medical center. Methods An observational, retrospective review of pediatric patients ≤ 18 years admitted to Children’s Medical Center Dallas campus with COVID-19 infections from 5/01/2020 to 9/30/2022 was performed. Basic demographic, epidemiologic, laboratory, and microbiologic data was obtained upon admission and each new antibiotic course. Cultures and microbiologic data were reviewed for relevance. Antibiotic use was characterized based on drug selection, indication, and spectrum. Results Using the International Classification of diseases, tenth revision (ICD-10) code for COVID-19 pneumonia (U07.1) identified 229 patients, of which 164 met inclusion criteria. Within the included patient population, a total of 22 microbiologically-proven infections were found. Both co- and secondary infections were rare (8/164 (5%) and 8/164 (5%), respectively) and consisted of various organisms from differing sites (9 pulmonary, 9 bloodstream, 4 urinary tract, 1 Clostridiodes difficile infection). The most frequently identified organism was Staphylococcus aureus, followed by Escherichia coli and Pseudomonas aeruginosa. 102/164 (63%) children received antibiotics ≤ 48 hours of admission. There were 43 additional instances where antibiotics were started > 48 hours after admission. Conclusion Both co- and secondary bacterial infections are rare in pediatric patients with COVID-19 pneumonia, but many hospitalized patients are given antibiotics. Antibiotics were continued in the absence of microbiologic data potentially increasing antimicrobial resistance. There is clearly a role for antimicrobial stewardship in pediatric patients with COVID-19 pneumonia. Disclosures All Authors: No reported disclosures

1706. Risk factors for infections caused by extended spectrum beta lactamase (ESBL) producing and Carbapenem-resistant Enterobacterales (CRE) in pediatric critical care settings: A case control study

Abstract Background Infections due to Gram negative resistant bacterial pathogens are a major concern in intensive care units. The purpose of this study is to determine the risk factors for developing ESBL-producing and CRE infections in pediatric patients in critical care settings (PICU and NICU). Methods A retrospective case control study of infections due to ESBL-producing and CRE during a 5-year period (2016-2021) at Children’s Hospital of Michigan, Detroit. All patients had positive cultures during their PICU/NICU stay. Control cases were matched for age, infection site and year of infection but their cultures grew Enterobacterales that were non-ESBL or carbapenemase producers. Results A total of 58 patients with ESBL/Carbapenemase-producing Enterobacterales (cases) and 59 control patients were included. Majority of organisms were E. coli and Klebsiella species recovered from respiratory tract. There was no difference in both groups in regards to age, gender, race or length of hospital stay (p >0.3). There was no difference in prior hospital admission, PICU or NICU stay during the previous 6 months, indwelling devices, comorbid conditions, or surgery in the last 6 months (p >0.3). However, the presence of gastrostomy tube was more frequent in the cases group (29.3%) than the control group (15.3%) (p=0.078). Risk factors by univariate analysis included history of antibiotic use in last 6 months (93% in cases vs 73% in controls; p=0.006), cephalosporins use > 14 days (67% vs 31.2%; p=0.006),Trimethoprim/Sulfamethoxazole treatment duration > 14 days (11.1% vs 0%; p=0.012), carbapenem treatment duration > 14 days (14% vs 1.9%; p=0.027), and vancomycin use > 14 days (43.6% vs 21.6%; p=0.053). However, multivariate logistic regression analysis showed that antibiotic usage in the last 6 months was the single best predictor for cases with odds ratio of 5.02-fold (95% CI 1.56-16.13) (p=0.007). Conclusion Prior broad spectrum antibiotic usage was significantly associated with acquisition of ESBL and carbapenemase producing Enterobacterales. The study further underscores the need for optimizing antimicrobial stewardship practices to limit unnecessary and prolonged use of antibiotics to prevent the emergence of resistant pathogens. Disclosures All Authors: No reported disclosures

2781. The Use of Aminoglycosides for Treatment of Urinary Tract Infections in Pediatric Patients, a Carbapenem-Sparing Approach

Abstract Background Urinary tract infections (UTIs) caused by antimicrobial-resistant pathogens have been increasingly reported. Aminoglycosides are known to be effective therapy for UTIs, however their use is not common due to a fear of nephrotoxicity. Overuse of broad-spectrum antimicrobial agents, particularly carbapenems can lead to colonization with carbapenem-resistant pathogens resulting in more difficult-to-treat infections. We aim to evaluate the use of aminoglycosides for UTI therapy in pediatric patients to assess the clinical outcome. Methods A retrospective chart review was performed to evaluate all orders of aminoglycosides for the indication of UTI from 2020-2022 at Children’s Hospital Los Angeles. Demographic data, bacterial pathogen, kidney function before and during treatment, and clinical outcomes were collected and analyzed. We also evaluated the resistance patterns of bacterial pathogens, and whether they met our institutional criteria of a multi-drug resistant organism (MDRO). Patients were excluded if they received ≤ 48hrs of treatment with an aminoglycoside or if they did not have a gram-negative pathogen identified on urine culture. Results A total of 61 patient encounters included an aminoglycoside order for treatment of UTI during the review period. 45 out of 61 encounters had a positive urinary culture that met our institutional criteria for an MDRO. Among patients receiving aminoglycosides, we observed 4 cases of elevated sCr that met our definition of AKI. The 2 cases with the greatest creatine increase (3-4 x baseline), were also currently receiving empiric vancomycin treatment. No patients had a documented treatment failure requiring change or escalation in therapy, or lack of resolution of fever. Four cases had a recurrence within 30 days after discharge. Three out of the four patients with recurrence had pre-existing anatomical abnormalities of the urinary tract that put them at increased risk for recurrent infection. Conclusion Overall, extended interval aminoglycoside therapy was effective and well-tolerated for the treatment of urinary tract infections in our pediatric patient population. For cases of multi-drug resistant urinary pathogens, aminoglycosides represent a reasonable alternative to broader spectrum options such as carbapenems. Disclosures All Authors: No reported disclosures

2790. Activity of Cefiderocol and Comparator Agents Against Pediatric Isolates of Enterobacterales, Pseudomonas aeruginosa, Acinetobacter baumannii-calcoaceticus species complex, and Stenotrophomonas maltophilia from the SENTRY Surveillance Program (2020-2022)

Abstract Background Cefiderocol (CFDC) is a siderophore cephalosporin with broad activity against Gram-negative bacteria including multi-drug resistant isolates. The in vitro activity of CFDC and comparator agents was evaluated against pediatric (0-17 years old) isolates collected in 2020–2022 as part of the SENTRY Antimicrobial Surveillance Program. In vitro Activity of Cefiderocol and Comparator Agents Against Pediatric Isolates Methods 2,249 Enterobacterales (ENT), 707 P. aeruginosa, 194 Acinetobacter baumannii-calcoaceticus complex (ABC) and 220 S. maltophilia from the USA and Europe were tested for susceptibility (%S) by broth microdilution with cation-adjusted Mueller-Hinton broth (CAMHB). Iron-depleted CAMHB was applied for CFDC. Comparators included newer β-lactam/β-lactamase inhibitor (BL/BLI) combinations ceftazidime-avibactam (CZA), ceftolozane-tazobactam (C/T), imipenem-relebactam (I-R) and meropenem-vaborbactam (MVB) as well as ampicillin/sulbactam (SAM) meropenem (MEM) and colistin (CST). %S was interpreted according to 2023 CLSI & EUCAST breakpoints. Carbapenem non-susceptible (CarbNS) was defined as non-susceptibility to imipenem and MEM. Results All agents displayed >96 %S for ENT while CFDC (MIC50/90, 2/4 mg/L; 91.7 %S) was the most active agent against CarbNS ENT. P. aeruginosa susceptibilities to CFDC and BL/BLI combinations were >97.0%. CFDC was the most potent agent against CarbNS P. aeruginosa with MIC50/90 values of 0.12/0.25 mg/L and 100 %S & 98.5 %S per CLSI & EUCAST breakpoints, respectively. ABC susceptibility to CFDC was >97% per CLSI & EUCAST while the susceptibility for MEM was 87.1% (CLSI & EUCAST) and SAM was 80.9% (CLSI). CFDC (MIC50/90, 0.25/1 mg/L; 95.7 %S) displayed better in vitro potency in CarbNS ABC as compared to SAM (MIC50/90, 32/ >64 mg/L; 17.4 %S CLSI) and CST (MIC50/90, 0.5/ >8 mg/L; 78.3%S EUCAST). Among pediatric S. maltophilia, CFDC was the most active agent with MIC50/90, 0.06/0.25 and 100 %S per CLSI & EUCAST breakpoints. Conclusion CFDC was a highly active β-lactam against contemporary pediatric isolates of Enterobacterales, P. aeruginosa, ABC, and S. maltophilia, including CarbNS subsets for which treatment options are limited. These data suggest CFDC may be a valuable treatment for serious Gram-negative infections in pediatric patients. Disclosures Sean T. Nguyen, PharmD, Shionogi: Employee|Shionogi, Inc: Employee Boudewijn L. DeJonge, PhD, Shionogi Inc.: Employee Jason J. Bryowsky, PharmD, MS, Shionogi Inc.: Employee Anne Henriksen, PhD, Shionogi: Employee Christopher M. Longshaw, PhD, Shionogi BV: Employee Joshua Maher, PhD, AbbVie: Grant/Research Support|Affinity Biosensors: Grant/Research Support|AimMax Therapeutics, Inc: Grant/Research Support|Alterity Therapeutics: Grant/Research Support|Amicrobe, Inc: Grant/Research Support|Arietis Pharma: Grant/Research Support|Armata Pharmaceuticals, Inc: Grant/Research Support|Astrellas Pharma, Inc.: Grant/Research Support|Basilea Pharmaceutica AG: Grant/Research Support|Becton Dickinson And Company: Grant/Research Support|bioMerieux, Inc: Grant/Research Support|Boost Biomes: Grant/Research Support|Diamond V: Grant/Research Support|Fedora Pharmaceuticals, Inc: Grant/Research Support|Iterum Therapeutics plc: Grant/Research Support|Johnson & Johnson: Grant/Research Support|Kaleido Biosciences, Inc.: Grant/Research Support|Meiji Seika Pharma Co. Ltd.: Grant/Research Support|National Institutes of Health: Grant/Research Support|Pfizer Inc.: Grant/Research Support|Roche Holding AG: Grant/Research Support|Shionogi Inc.: Grant/Research Support|Summmit Therapeutics, Inc.: Grant/Research Support|Zoetis Inc: Grant/Research Support Rodrigo E. Mendes, PhD, AbbVie: Grant/Research Support|Basilea: Grant/Research Support|Cipla: Grant/Research Support|Entasis: Grant/Research Support|GSK: Grant/Research Support|Paratek: Grant/Research Support|Pfizer: Grant/Research Support|Shionogi: Grant/Research Support Miki Takemura, n/a, Shionogi & Co., Ltd.: Stocks/Bonds Yoshinori Yamano, PhD, Shionogi HQ: Employee

1675. Community Acquired Serious Bacterial Infections in Pediatric Patients Before and After COVID: Could Masks Save Lives?

Abstract Background Association of serious bacterial infections (SBI) and preceding respiratory viral illness (RVI) has been described. Social distancing, (masking and lockdowns), in response to pandemic resulted in > 95% decrease in RVI, specifically influenza (Flu). Invasive Streptococcus pneumoniae (iSpneumo) and Streptococcus pyogenes (iGABHS) have substantial morbidity and mortality. Decrease in culture (Cx) proven iSpneumo during COVID has been reported. We used PCR in empyema fluid for enhanced SBI microbiologic diagnosis. Here, we evaluate Cx/PCR diagnosed community acquired SBI (CA-SBI) in children and relationship with Flu burden and social distancing. Methods Data from surveillance of bacteremia and CA-empyema (Cx and PCR) at our institution was used to identify CA-SBI cases in children 3 months – < 18 years. Spinal fluid Cxs were reviewed to identify meningitis cases. We used data from the Orange County Health Care Agency for detection of countywide Flu trends. We normalized yearly CA-SBI cases per 10,000 discharges, grouped them into before COVID (BC) (7/1/2017 – 12/31/19) and after covid (AC) (1/1/2020 – 6/30/2022), and compared to countywide Flu cases 7/1/2017 – 6/30/2022. Results We identified 361 CA-SBIs. S aureus (95; 26.3%) and E coli (65, 18%) were most common overall (Fig 1) and per cohort (BC 45; 25.7% and 25; 14.3% / AC 50; 26.9% and 40; 21.5%) respectively (Fig 2); 35.7% and 12.9% of iSpneumo and iGABHS respectively were identified by PCR only. Both decreased during COVID (iSpneumo BC 40; 22.9% to AC 16; 8.6% and iGABHS BC 24; 13.7% to AC 7; 3.8%). iSpneumo and iGABHS mortality was 3.6% and 12.9% respectively. There were no iSpneumo (5/2020 – 10/2021) or iGABHS 12/2020 – 11/2021) cases or deaths when Flu was not circulating. Conclusion iSpneumo and iGABHS cases decreased during social distancing, which included mandatory masking. No cases or deaths occurred when Flu was not circulating supporting association with Flu. Decrease in iSpneumo by routine pediatric vaccination has limitations due to differential protection by serotype and serotype replacement. Seasonal masking should be evaluated to decrease CA-SBI associated pediatric morbidity and mortality due to iSpneumo and iGABHS, further Flu vaccine development is needed. Disclosures Antonio C. Arrieta, MD, FIDSA, FPIDS, Astellas Pharma Global Development, Inc.: Advisor/Consultant|Astellas Pharma Global Development, Inc.: Grant/Research Support|Astellas Pharma Global Development, Inc.: Honoraria|Cumberland Pharmaceutical: Grant/Research Support|IDbyDNA: Advisor/Consultant|IDbyDNA: Grant/Research Support|Melinta: Grant/Research Support|Merck: Advisor/Consultant|Merck: Grant/Research Support|Nabriva: Grant/Research Support|Paratek Pharmaceuticals: Grant/Research Support|Pfizer, Inc: Advisor/Consultant|Pfizer, Inc: Grant/Research Support|Roche/Genentech: Grant/Research Support|The Medicine Company: Grant/Research Support Delma Nieves, MD, Merck: Grant/Research Support|Summit Therapeutics: Grant/Research Support Negar Ashouri, MD, Merck: Grant/Research Support

876. Real-world impact of a novel host response test for distinguishing between bacterial and viral infections in pediatric patients at ten Urgent Care Centers

Abstract Background Antibiotic misuse is a major driver of antimicrobial resistance and is prevalent in the urgent care setting. A leading cause of misuse is uncertainty regarding infection etiology. MeMed BV® (MMBV) is an FDA-cleared test designed to aid physicians in differentiating between bacterial and viral infections based on computational integration of the blood levels of three host proteins into a score. Here we examined the real-world impact of integrating MMBV in the urgent care workflow on clinical decision-making. Methods A retrospective cohort study. MMBV test was ordered as part of the routine care for clinically appropriate pediatric patients at ten Maccabi Healthcare Services outpatient urgent care centers in Israel. MMBV results were interpreted based on manufacturer’s instructions as viral or bacterial infection or equivocal. As part of MMBV evaluation, physicians who ordered the test were immediately and automatically asked to complete a short questionnaire reporting their initial etiological diagnosis and likelihood to prescribe antibiotics. Upon discharge, physicians completed a second questionnaire to report if MMBV impacted their decision-making process. The physician’s intent, MMBV results and final antibiotic prescription practice were compared to evaluate the impact of MMBV on antibiotic misuse. Results Between 04-12/2022, 2,265 patients were enrolled and 1,759 had fully filled out questionnaires (Figure 1, Table 1). In 1,566 cases, a bacterial or viral MMBV result was received. Among the 449 cases for whom physicians initially intended to prescribe antibiotics, 320 (71.7%) had viral MMBV results and in 198 cases (61.9%) the physician did not prescribe antibiotics. Conversely, among the 805 cases for whom physicians did not initially intend to prescribe antibiotics, 153 (19%) had bacterial MMBV results and the physician prescribed antibiotics in 93 (60.8%) cases. Physicians reported uncertainty with regard to antibiotic prescription in 312 (19.9%) cases and acted in accordance with MMBV results in 236 (75.6%). Overall, physicians reported that MMBV aided in their patient management for 82.4% of cases. Conclusion Physicians incorporate MMBV into their real-world decision-making in the urgent care center setting and report that it aids in patient management. Disclosures All Authors: No reported disclosures

1680. Characterization of Ethanol Lock Use and Line Infections in Pediatric Patients with Intestinal Failure Requiring Central Venous Access

Abstract Background Pediatric patients with intestinal failure often require central venous line access for administration of parenteral nutrition and/or fluids, which leads to increased risk for central line associated-bloodstream infections (CLABSI). Ethanol lock therapy (ELT) has been used to reduce the risk of CLABSI in this patient population, but recent significant increases in the price of ethanol have prompted healthcare systems to explore cost-saving measures such as decreasing ELT frequency from daily to thrice weekly (TIW) or using antibiotic lock therapy as an alternative to ELT. The objective of this study was to compare the incidence and microbiology of CLABSI in pediatric patients with intestinal failure who received different lock therapies. Methods This was a single-center, retrospective, descriptive study that included pediatric patients who were followed by the Michigan Medicine Children’s Intestinal Rehabilitation Program between July 1, 2020 and June 30, 2022. Data were collected via the electronic health record. Incidence of CLABSI and microbiology were compared based on the type of lock therapy patients received (daily ELT, TIW ELT, or no ELT). Results A total of 46 patients were analyzed in this study, including 13 on daily ELT, 23 on TIW ELT, and 10 on no ELT. During the study period, 69% (9/13) of patients on daily ELT, 35% (8/23) of patients on TIW ELT, and 60% (6/10) of patients on no ELT had at least one CLABSI (for comparison between daily and TIW ELT, p = 0.0819). Of 75 episodes of CLABSI identified during the study period, the most commonly isolated pathogens were Staphylococcus epidermidis (n = 33), S. aureus (n = 19), S. hominis (n = 17), and Escherichia coli (n = 8). Almost half (44%, 33/75) of CLABSI reported were polymicrobial (see Table 1 for comparison of microbiology by type of lock therapy).Table 1:Number of monomicrobial vs. polymicrobial CLABSI by Gram stain results and type of lock therapy. Conclusion There was no statistically significant difference in the incidence of CLABSI between pediatric patients with intestinal failure who received TIW ELT and those who received either daily ELT or no ELT. TIW ELT appears to be an effective and cost-efficient option compared to daily ELT in this patient population. Disclosures All Authors: No reported disclosures

Recommendations based on clinical practice guidelines on diagnosis, treatment and follow-up of urinary tract infection in pediatric patients in Colombia

Antecedentes: La infección del tracto urinario (ITU) es una enfermedad frecuente en la niñez y una de las causas más comunes de consulta en el servicio de urgencias pediátricas. Su incidencia está entre el 5 y 10 % en menores de 2 años. Objetivo: Generar recomendaciones sobre el diagnóstico, tratamiento y seguimiento de ITU en pacientes pediátricos en Colombia. Métodos: Se formularon 15 preguntas de interés clínico en el diagnóstico, tratamiento y seguimiento de ITU en pacientes pediátricos. Se realizó una revisión sistemática de la literatura para identificar las guías de práctica clínica (GPC) disponibles en ITU, con el fin de usar esta evidencia para responder las preguntas planteadas y articular las recomendaciones. Para seleccionar y evaluar las GCP se usaron herramientas locales e internacionales. Se extrajo la información de las guías seleccionadas, se compilaron las recomendaciones preliminares, y se aprobaron las recomendaciones finales mediante consenso de expertos. Finalmente, se evaluó la fuerza y la dirección de cada recomendación. Resultados: Se seleccionaron 4 GCP: American Academy of Pediatrics, Ministerio de Salud de España, McTaggart y National Institute for Health and Care Excellence. En este artículo se presentan las recomendaciones finales para el diagnóstico, tratamiento y seguimiento de ITU. Conclusiones: Estas recomendaciones permitirán orientar a los equipos en la toma de decisiones clínicas respecto a la atención de pacientes pediátricos con ITU en Colombia. Esto contribuirá a mejorar el cuidado y a generar políticas para que haya diagnóstico, tratamiento y seguimiento oportunos en estos pacientes.

Autoinmunidad en pacientes pediátricos de una región de Colombia, tras un pico de SARS-CoV-2

IntroductionWith the onset of the 2019 coronavirus pandemic, there was an increase in the number of reported cases of autoimmune manifestations in the midst of the disease and new cases of autoimmunity after infection. ObjectiveTo correlate the rate of positive tests of SARS-CoV-2 with the rate of new diagnoses of autoimmune disease in paediatric patients of the department of Huila (Colombia), between March 2020 and September 2021. MethodsThe socio-demographic characterization of the subjects diagnosed with autoimmune disease and of the cases of SARS-CoV-2 was performed; an analysis of the monthly trend of events was performed and a correlation model was applied between the rate of SARS-CoV-2 diagnosis and the rate of autoimmune diseases during the study period. ResultsA total of 94 cases of autoimmune disease were diagnosed, with an average age of 8.3years, most were girls and belonged to the urban area and the subsidized regimen, and immune thrombocytopenic purpura was the most common diagnosis. In addition, 4,303 cases of SARS-CoV-2 were detected, mostly adolescents, from urban areas and the contributory system. Finally, it was evidenced that the highest rate of autoimmune disease was reported just after the highest peak of SARS-CoV-2. ConclusionsThis study did not show a statistical correlation between the rate of SARS-CoV-2 and the rate of diagnoses of autoimmune disease; however, it showed an enormous peak of autoimmunity after the highest peak of infection in paediatric patients of the department during the first eighteen months of the pandemic.

Impact of Intravenous Fat Emulsion Choice on Candida Biofilm, Hyphal Growth, and Catheter-Related Bloodstream Infections in Pediatric Patients.

Use of mixed-oil (MO) intravenous fat emulsion (IFE) was shown to inhibit Candida albicans biofilm formation and overall rate of catheter-related bloodstream infections (CR-BSIs) compared with soybean-oil (SO) IFE). We aimed to delineate this inhibitory mechanism and impact of IFE choice on distribution of fungal CR-BSIs. Transcriptional profiling was conducted on C. albicans grown in SO-IFE, MO-IFE, or SO-IFE with capric acid. Overexpression strains of shared down-regulated genes were constructed using a tetracycline-off system to assess hypha and biofilm formation in IFEs. A 5-year retrospective multicenter cohort study was performed to assess differences in CR-BSIs caused by Candida species based on the IFE formulation received in pediatric patients. Genes significantly down-regulated in MO-IFE and SO-IFE with capric acid included CDC11, HGC1, and UME6. Overexpression of HGC1 or UME6 enabled filamentation in capric acid and MO-IFE. Interestingly, only overexpression of UME6 was sufficient to rescue biofilm growth in MO-IFE. MO-IFE administration was associated with a higher proportion of non-albicans Candida versus C. albicans CR-BSIs (42% vs 33%; odds ratio, 1.22 [95% confidence interval, .46-3.26]). MO-IFE affects C. albicans biofilm formation and hyphal growth via a UME6-dependent mechanism. A numerical but not statistically significant difference in distribution of Candida spp. among CR-BSIs was observed.

Characteristics of Hospital-Acquired Respiratory Syncytial Virus (RSV) Infection in Young Children Prior to the COVID-19 Outbreak

Background: Respiratory syncytial virus (RSV) causes healthcare-associated respiratory infections in pediatric patients. Previous studies in developed countries have identified risk factors associated with hospital-acquired RSV (HA-RSV) infection as a higher mortality rate than community-acquired RSV (CA-RSV) infection. Objective: To investigate risk factors, clinical characteristics, and outcomes of RSV infection in young children within hospitals. Materials and Methods: Data from Siriraj Hospital’s surveillance system (2014-2018) included children under 5 with laboratory-confirmed HA-RSV infection. Two control groups were formed: CA-RSV infection and non-RSV hospital-acquired infections (non-RSV HAI), time-matched with the study group (1:2 ratio). Results: Fifty-one HA-RSV cases were identified, with the highest infection rate during the rainy season (July to December). HA-RSV patients had higher rates of underlying neuromuscular disease and malignancy. Fever was common in HA-RSV, while upper respiratory and gastrointestinal symptoms were less frequent than CA-RSV. Antibiotic and oseltamivir treatment did not differ significantly. HA-RSV patients had longer stays in the intensive care unit and hospital, but transfer rates and mortality did not differ significantly among the groups. Conclusion: HA-RSV coincides with community outbreaks, being more severe and affecting vulnerable patients. Targeted surveillance during high RSV seasons is crucial for prevention in hospitals. Keywords: RSV; Respiratory syncytial virus; Hospital-acquired infection; Healthcare-associated infection

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

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

Invasive lactobacillus infection in pediatric patients in a tertiary center in Taiwan – 16 years’ experience and literature review

BackgroundLactobacilli are common microorganisms in the human body. Some species were used as probiotics supplement for many purposes such as preventing necrotizing enterocolitis, or improving allergic diseases or diarrhea. Previously, Lactobacillus infection was thought of as contamination due to its low pathogenicity. However, there have been reports of invasive Lactobacillus infection in immunocompromised patients or patients with comorbidities. The purpose of this study was to analyze the clinical characteristics, antibiotic treatment and outcomes of pediatric patients with invasive Lactobacillus infection. MethodsWe retrospectively reviewed pediatric patients diagnosed with invasive Lactobacillus infection between 2004 and 2020. Invasive Lactobacillus infection was diagnosed if sterile sites yielded Lactobacillus spp. Clinical manifestations, chronic diseases, potential predisposing factors, medical treatments, antimicrobial susceptibility tests and outcomes were recorded. ResultsFifteen pediatric patients were diagnosed with invasive Lactobacillus infection, accounting for 2.4% of total invasive Lactobacillus infections during the 16-year period. Eleven infections were bacteremia, two were intra-abdominal infections, and two were biliary tract infections. Fever was the most common symptom. Potential predisposing factors were immunocompromised status, central venous device, prolonged antibiotics use and receiving supplemented probiotics for at least one week. All patients survived with favorable outcomes. Most pathogens were identified as Lactobacillus spp, and two were Lactobacillus rhamnosus, which were related to supplemented probiotics. The antimicrobial susceptibility tests showed that Lactobacilli were all sensitive to ampicillin but resistant to glycopeptides. ConclusionInvasive Lactobacillus infections in pediatric patients were rare. Despite its low pathogenicity, Lactobacillus could cause invasive infection in those immunocompromised patients.

Ultrasonographic Findings of Catheter-Related Bloodstream Infection in Pediatric Patients.

Catheter removal is essential for treating catheter-related bloodstream infection (CRBSI); however, clinicians are sometimes hesitant to remove catheters in pediatric patients due to the difficulty of securing vascular access. Confirming the diagnosis of CRBSI is important to justify catheter removal. The purpose of this study was to describe the sonographic findings of CRBSI. We included patients with a central venous catheter (CVC) or peripherally inserted central catheter (PICC) who had a positive blood culture and underwent ultrasound. The patients were classified as with or without CRBSI. Sonographic findings, such as the presence/absence of thrombus, venous wall thickening, hyperechogenicity, and fluid collection around the vein were compared using Fisher's exact test. Of the 58 patients, 38 (66%) were diagnosed with CRBSI. The presence of thrombus (19/38 vs 3/20, P = .011); and hyperechogenicity around the vein (14/38 vs 2/20, P = .035) differed significantly, but There was no significant difference in the presence of venous wall thickening (10/38 vs 1/20, P = .077), and fluid collection around the vein (5/38 vs 0/20, P = .153), did not differ significantly in patients with and without CRBSI, respectively. One-third of patients with CRBSI, including 11 (42.3%) patients with CVC, and 2 (16.7%) patients with PICC, did not have abnormal sonographic findings. Ultrasound findings are useful for diagnosing CRBSI. However, the sensitivity of sonographic findings is low and abnormal sonographic findings are sometimes absent in children with CRBSI; therefore, physicians should not rule out CRBSI based on normal sonographic findings, especially in patients a CVC and a positive blood culture.

Analysis of respiratory virus detection in hospitalized children with acute respiratory infection during the COVID-19 pandemic

ObjectiveIt is now understood that the Coronavirus disease 2019 (COVID-19) pandemic and its associated containment measures have influenced the epidemiology of other respiratory viruses. This study aimed to characterize respiratory virus infections in pediatric patients hospitalized for acute respiratory infections (ARIs) in East China both prior to and during the COVID-19 pandemic.MethodsWe collected nasal secretions from 9782 pediatric ARI patients admitted to Shaoxing Maternal and Child Health Care Hospital between January 2018 and December 2022. We analyzed and compared changes in viral detection rates, epidemiological features, and clinical characteristics.ResultsA total of 1633 strains from 7 common respiratory viruses were identified, with an overall positive rate of 16.35% (n = 821/5021) in 2018–2019 and 17.06% (n = 812/4761) in 2020–2022. Compared to 2018–2019, the positive rate for RSV significantly increased in 2020–2022, while detection rates for ADV, PIV-2, PIV-3, and flu-B showed reductions (P < 0.05). The RSV-positive rate experienced a more significant increase in winter compared to other seasons both before and during COVID-19 (P < 0.05), whereas PIV-3 predominantly circulated in spring and summer before COVID-19.ConclusionDuring the COVID-19 pandemic, marked variations in age distribution and seasonality of respiratory virus infections were observed among hospitalized children with ARIs in East China. Non-pharmaceutical interventions (NPIs) implemented during the pandemic yielded a limited impact on common respiratory viruses.

Invasive fungal infections in pediatric patients with central nervous system tumors: novel insights for prophylactic treatments?

Invasive fungal disease (IFD) poses significant morbidity and mortality risks, especially in pediatric patients with neoplastic diseases. However, there is a notable lack of data concerning patients with central nervous system (CNS) tumors. Considering vulnerability factors to infections such as neutropenia, corticosteroids, chemotherapy, surgical interventions, and others, this study aims to evaluate the incidence of IFD in pediatric patients with CNS tumors and determine appropriate indications for prophylactic measures. This is a single-center, retrospective study conducted between 2011 and 2022 at the Pediatric Institute of Oncology (IOP-GRAACC-UNIFESP). A total of 38 cases of IFD were diagnosed in 818 children with CNS malignancies (4,6%). The mean age was 3.5 years (0.4-28y), with 22 (57.9%) male patients. Embryonal tumors (18/38, 47.3%) were the most prevalent CNS tumors, followed by low-grade gliomas (13/38, 34.2%). All episodes met the EORTC IFD criteria, and 36/38 (94.7%) were proven. Invasive yeast infections (33/36, 91.6%), predominantly Candida (30/33, 90.9%), were the most common diagnosis. In total, 25 patients (25/38, 65.8%) were receiving chemotherapy, with 13 of them having embryonal tumors. A total of 11 infants were in the Head Start scheme, resulting in a high prevalence of IFD in these group of patients (11/58, 18.9%). In total, 13 (13/38, 34.2%) patients underwent neurosurgery, mostly ventricular-peritoneal shunts revisions (10/13, 76.9%). Nine (9/38, 23.7%) were with prolonged use of corticosteroids, eight of them associated with neurosurgery. Routine systemic antifungal prophylaxis based solely on diagnosis is not recommended for low-risk cases. Evaluating patient- and treatment-specific risk factors is crucial in infants undergoing high-dose chemotherapy with expected neutropenia and in patients requiring prolonged corticosteroid therapy alongside neurosurgical procedures.

Clinical Outcomes of SARS-CoV-2 Infection in Pediatric Patients on Ventricular Assist Device Support: An ACTION Registry Analysis.

Adult patients on left ventricular assist device (LVAD) support have increased morbidity and mortality after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. There are no reported clinical data describing outcomes among pediatric patients on ventricular assist device (VAD) support infected with SARS-CoV-2. We conducted a retrospective study using the Advanced Cardiac Therapies Improving Outcomes Network (ACTION) registry to evaluate patient characteristics and clinical outcomes after SARS-CoV-2 infection. A total of 22 children on VAD support (median age at infection 10.6 years) from 16 centers tested positive for SARS-CoV-2. Cardiomyopathy (59.1%) and congenital heart disease (40.9%) were the most common primary diagnoses. The type of support included LVAD in 19 (86.4%), biventricular assist device (BIVAD) in one (4.5%), and single ventricle VAD in two (9%) patients. At the time of infection, 50% were outpatients, 23% were inpatients on a general cardiology floor, and 27% were in the cardiac intensive care unit (CICU). Most patients (82%) were symptomatic at time of diagnosis, but only 13% required escalation of respiratory support, and 31% received SARS-CoV-2 therapies. Notably, no mortality occurred, and significant morbidity was rare after SARS-CoV-2 infection in pediatric patients on VAD support.

Prevalence of neuropsychiatric disorders related to long-term COVID-19 syndrome following acute SARS CoV-2 infection in pediatric patients

Prevalence of neuropsychiatric disorders related to long-term COVID-19 syndrome following acute SARS CoV-2 infection in pediatric patients

Assessment of the Prevalence of Infections in Pediatric Patients With Acute Lymphoblastic Leukemia.

Infections cause notable treatment-related morbidity during pediatric acute lymphoblastic leukemia/lymphoma (ALL/LLy) therapy. Infections are the most critical cause of morbidity and mortality in children undergoing treatment for acute lymphoblastic leukemia (ALL). Children with ALL, who are frequently underweight, are at increased risk of community-acquired pathogens, nosocomial multidrug-resistant pathogens, and opportunistic microorganisms. A weakened immune system from ALL itself and chemotherapy's side effects further worsen the prognosis. PubMed and Google Scholar articles were curated in a Google document with shared access. Discussion and development of the paper were achieved over Zoom meetings. This narrative review aims to analyze and summarize various pathogens responsible for infections in children receiving treatment for ALL and their treatment regimen and prophylaxis. The incidence of viral infection is higher in ALL patients, followed by bacterial and fungal infections. Prevention via prophylaxis and timely initiation of treatment is essential for positive outcomes.