Pediatric Infections Research Articles

Pediatric Urinary Tract Infection: Evaluation Antibiotic Susceptibility and Biofilm Formation Dynamics

Pediatric Urinary Tract Infection: Evaluation Antibiotic Susceptibility and Biofilm Formation Dynamics

Pediatric Kidney Transplant and BK Viral Infection: A Single-Center Retrospective Analysis of Interventions and Outcomes

Pediatric Kidney Transplant and BK Viral Infection: A Single-Center Retrospective Analysis of Interventions and Outcomes

221 Opportunities for Antibiotic Stewardship for Pediatric Urinary Tract Infection for Outpatient Emergency Department and Urgent Care Encounters

221 Opportunities for Antibiotic Stewardship for Pediatric Urinary Tract Infection for Outpatient Emergency Department and Urgent Care Encounters

Oral Cavity Microbiome Impact on Respiratory Infections Among Children.

The respiratory system, traditionally considered antiseptic, harbors a diverse and dynamic bacterial microbiome. Recent advancements in microbiome research have revealed its significant influence on both innate and adaptive immunity, particularly in the context of respiratory infections in children. This article also provides an overview of the types of bacteria that commonly affect the respiratory system, including Streptococcus pneumoniae, Moraxella catarrhalis and Haemophilus influenzae. These bacteria are prevalent in pediatric populations and significantly contribute to the development and severity of respiratory tract infections (RTIs). This review aims to evaluate the impact of the oral cavity and upper respiratory microbiome on the susceptibility and severity of respiratory infections in pediatric populations. We specifically focus on how early colonization patterns of bacteria such as Moraxella and Streptococcus contribute to the development of respiratory tract infections in children from birth through adolescence. A thorough literature review was performed, focusing on studies publishing between 2004 and 2023. The review included research exploring the role of the upper respiratory microbiome in pediatric populations, with a specific focus on children aged birth to 18 years. Emphasis was placed on microbial characterization, the modulation of immune responses in respiratory tract infections, and the potential therapeutic applications of microbiome-targeted interventions. The findings suggest that the composition and disruption of the upper respiratory microbiome significantly influence clinical outcomes in children with respiratory infections. Notably, dysbiosis in the microbiome has been linked to increased susceptibility to repeated infections, highlighting the importance of maintaining microbial balance for optimal respiratory health. Understanding the impact of oral cavity and upper respiratory microbiome could lead to improved management and prevention strategies for respiratory infections in children. This review underscores the potential of microbiome modulation, including the use of probiotics as a therapeutic approach to enhance clinical outcomes in pediatric respiratory infections.

Molecular Characterization of Human Adenoviruses Associated with Pediatric Respiratory Infections in Omdurman, Sudan

Acute respiratory viral infection (ARVI) is a common cause of morbidity and mortality especially in pediatric patients. Among important respiratory pathogens are adenoviruses, The illnesses can range from the common cold to pneumonia Depending on the type, adenoviruses can cause other illnesses such as gastroenteritis, conjunctivitis, cystitis, and, less commonly, neurological disease. Aim of study: molecular detection of respiratory infection due to adenovirus among children in Khartoum state. Respiratory specimens were collected from children’s patients with RTIs in the emergency department Mohamed Alamin Hamid pediatric hospital Omdurman in Khartoum state during the period of October 2022 to February 2023.the HAdV infection were determined by PCR technique. A total of 50 nasal swap were investigated for HAdV, throughout th PCR technique by using specific primer. The results showed 18 (36.0%) were positive and 32 (64.0%) were negative for HAdVs. The statistical analysis revealed no significant difference between age groups (X2= 0.786 P. value: 0.375). This study summarized the HAdV were the predominant types identified in children less than five years intend to have respiratory tract infection according to clinical symptoms of upper or lower respiratory infections.by using conventional PCR for identify with highly sensitively.

Innovative biomarkers TCN2 and LY6E can significantly inhibit respiratory syncytial virus infection

BackgroundRespiratory syncytial virus (RSV) is a prominent etiological agent of lower respiratory tract infections in children, responsible for approximately 80% of cases of pediatric bronchiolitis and 50% of cases of infant pneumonia. Despite notable progress in the diagnosis and management of pediatric RSV infection, the current biomarkers for early-stage detection remain insufficient to meet clinical needs. Therefore, the development of more effective biomarkers for early-stage pediatric respiratory syncytial virus infection (EPR) is imperative.MethodsThe datasets used in this study were derived from the Gene Expression Omnibus (GEO) database. We used GSE188427 dataset as the training set to screen for biomarkers. Biomarkers of EPR were screened by Weighted Gene Co-expression Network Analysis (WGCNA), three machine-learning algorithms (LASSO regression, Random Forest, XGBoost), and other comprehensive bioinformatics analysis techniques. To evaluate the diagnostic value of these biomarkers, multiple external and internal datasets were employed as validation sets. Next, an examination was performed to investigate the relationship between the screened biomarkers and the infiltration of immune cells. Furthermore, an investigation was carried out to identify potential small molecule compounds that interact with selected diagnostic markers. Finally, we confirmed that the expression levels of the selected biomarkers exhibited a significant increase following RSV infection, and they were further identified as having antiviral properties.ResultsThe study found that lymphocyte antigen 6E (LY6E) and Transcobalamin-2 (TCN2) are two biomarkers with diagnostic significance in EPR. Analysis of immune cell infiltration showed that they were associated with activation of multiple immune cells. Furthermore, our analysis demonstrated that small molecules, 3ʹ-azido-3ʹ-deoxythymine, methotrexate, and theophylline, have the potential to bind to TCN2 and exhibit antiviral properties. These compounds may serve as promising therapeutic agents for the management of pediatric RSV infections. Additionally, our data revealed an upregulation of LY6E and TCN2 expression in PBMCs from patients with RSV infection. ROC analysis indicated that LY6E and TCN2 possessed diagnostic value for RSV infection. Finally, we confirmed that LY6E and TCN2 expression increased after RSV infection and further inhibited RSV infection in A549 and BEAS-2B cell lines. Importantly, based on TCN2, our findings revealed the antiviral properties of a potentially efficacious compound, vitamin B12.ConclusionLY6E and TCN2 are potential peripheral blood diagnostic biomarkers for pediatric RSV infection. LY6E and TCN2 inhibit RSV infection, indicating that LY6E and TCN2 are potential therapeutic target for RSV infection.

Incidence of infection rate for shunt implantation: the zero % rate is always a myth

Abstract Introduction Paediatric CSF shunt infection rate remains a well-known complication that is not only responsible of potentially severe sequels for patients but also for economical expenses. In that study, we questioned if it is possible to attain the zero percent rate of infection that should be the goal of every paediatric neurosurgeon. Methods We report our series of patients treated with a CSF device from January the first 2016 to December 31 2018. Results In all 147 patients treated for hydrocephalus, the follow-up was of at least of 2 years from the implantation. Antibiotic-coated tubes were always used with a differential pressure valve system. A total of 172 surgical procedures were performed for 147 patients. In the follow-up time period, 4 patients presented a post-operative infection (2.3%). Two infections appeared early after the surgical procedure one after 24 h and the other after 6 days; the other two infections were diagnosed after 53 days and the other after 66 days. The germs responsible of the infections were a Staphylococcus capitals, an Escherichia coli, a Klebsiella pneumonia, and a Staphylococcus aureus. Conclusions Shunts will always be implanted especially in new-borns and for particular aetiologies of hydrocephalus. To reduce the rate of infection, the best thing to do is to adopt adapted protocols. Our low incidence of infection rate for shunts represent a long history to research preventive factors that helped us to improve our results during the time.

Cold atmospheric plasma therapy as a novel treatment for Berlin Heart EXCOR pediatric cannula infections

Cold atmospheric plasma therapy as a novel treatment for Berlin Heart <scp>EXCOR</scp> pediatric cannula infections

Insights into Hospitalized Children with Urinary Tract Infections: Epidemiology and Antimicrobial Resistance Patterns in Israel-A Single Center Study.

Background: The escalating resistance of uropathogens in pediatric febrile urinary tract infection (F-UTI) is a global concern. This study examined changing trends in F-UTI epidemiology and resistance patterns among Israeli pediatric inpatients over a decade. Methods: Demographic, clinical, and laboratory data for children between 3 months and 18 years old with febrile UTI from 2010 to 2021 were retrieved from electronic medical records. Results: A total of 761 cases of F-UTI were identified (702 females, mean age 43 months). Escherichia coli was the most common pathogen (85.9%), followed by Pseudomonas aeruginosa (3.5%) and Klebsiella pneumoniae (3.4%). Compared with the non-complicated UTI group, the complicated UTI group had significantly higher rates of Pseudomonas aeruginosa (5.3% vs. 1.0%, p = 0.002) and Klebsiella pneumoniae (4.6% vs. 1.6%, p = 0.03). Antibiotic resistance analysis revealed significant differences between the groups: resistance to cephalexin was higher in the complicated UTI group (19.3%) compared with the non-complicated UTI group (13.4%, p = 0.03). Notably, relatively low resistance rates were observed for ceftriaxone (4.4%) and gentamicin (6.0%). Over time, a significant decreasing trend in resistance to ampicillin was observed (slope = -0.0193, p = 0.011). No significant trends were found for trimethoprim-sulfamethoxazole, cephalexin, amoxicillin-clavulanic acid, ceftriaxone, and cefuroxime. Conclusions: Significant differences in pathogen distribution and resistance patterns between complicated UTI and non-complicated UTI groups highlight the need for continuous resistance monitoring and adherence to local guidelines. For the treatment of severe community F-UTI, ceftriaxone could be a reasonable option for first-onset F-UTI. Further studies are needed to implement antibiotic stewardship and optimize usage.

Improving treatment plan and mental health in children with abdominal infection for broad-spectrum bacterial infections

BACKGROUND Pediatric abdominal infection is a common but serious disease that requires timely and effective treatment. In surgical treatment, accurate diagnosis and rational application of antibiotics are the keys to improving treatment effects. AIM To investigate the effect of broad-spectrum bacterial detection on postoperative antibiotic therapy. METHODS A total of 100 children with abdominal infection who received surgical treatment in our hospital from September 2020 to July 2021 were grouped. The observation group collected blood samples upon admission and sent them for broad-spectrum bacterial infection nucleic acid testing, and collected pus or exudate during the operation for bacterial culture and drug sensitivity testing; the control group only sent bacterial culture and drug sensitivity testing during the operation. RESULTS White blood cell count, C-reactive protein, procalcitonin, 3 days after surgery, showed better postoperative index than the control group (P &lt; 0.05). The hospital stay in the observation group was significantly shorter than that in the control group. The hospitalization cost in the observation group was significantly lower than that in the control group, and the difference between the two groups was statistically significant (P &lt; 0.05). CONCLUSION Early detection of broad-spectrum bacterial infection nucleic acids in pediatric abdominal infections can help identify pathogens sooner and guide the appropriate use of antibiotics, improving treatment outcomes and reducing medical costs to some extent.

Investigating urinary characteristics and optimal urine white blood cell threshold in paediatric urinary tract infection: A prospective observational study.

While the definitive diagnosis of urinary tract infection (UTI) requires a positive urine culture, the likelihood of UTI can be determined by urinalysis that includes white blood cell (WBC) count. We aimed to determine the optimal urine WBC threshold in urinalysis to predict UTIs in children presenting at the emergency department (ED). We performed a prospective observational study in the ED at KK Women's and Children's Hospital for children below 18 years old who underwent both urine microscopy and urine cultures, between 10 January and 7 November 2022. We assessed the various urine WBC thresholds associated with culture-proven UTIs using sensitivity, specificity, positive and negative predictive values, positive and negative likelihood ratios, and area under receiver operating characteristic curve. We found a culture-proven UTI rate of 460/1188 (38.7%) among all patients analysed, and 278/998 (27.9%) among those with nitrite-negative urine samples. Among all patients, a urinalysis WBC threshold of 100/μL had a sensitivity of 82.2% (95% confidence interval [CI] 78.4-85.5) and negative predictive value of 86.2% (95% CI 83.6-88.4). Among those who were nitrite-negative, a WBC threshold of ≥100/μL resulted in a potential missed rate of 48/278 (17.3%). By lowering the WBC threshold to ≥10/μL, the potential missed cases reduced to 6/278 (2.2%), with an estimated increase in 419 urine cultures annually. A urine microscopy WBC threshold of ≥100/μL results in a clinically significant number of missed UTIs. Implementation of various thresholds should consider both the potential missed UTI rate and the required resource utilisation.

Intact FGF23 and Markers of Iron Homeostasis, Inflammation, and Bone Mineral Metabolism in Acute Pediatric Infections.

We intend to evaluate the association of intact Fibroblast Growth Factor 23 (i-FGF23), a phosphaturic hormone that contributes to anemia of inflammation, with markers of iron homeostasis, inflammation, and bone mineral metabolism in acute pediatric infections. Seventy-nine children, aged 1 month-13 years, out of which forty-two were males and thirty-seven females, participated in this study. Children with diseases and nutrient deficiencies causing anemia were excluded. Twenty-six patients had bacterial infections, twenty-six had viral infections, and twenty-seven children served as healthy controls. Complete blood count, markers of inflammation, iron and mineral metabolism, serum hepcidin, and i-FGF23 were compared between the groups. Thirty-nine percent of patients with bacterial infection and twelve percent of patients with viral infection presented characteristics of anemia of inflammation (p < 0.001). Ninety-two percent of patients with bacterial infection and eighty-one percent of patients with viral infection had functional iron deficiency (p < 0.001). Hepcidin was significantly positively correlated with the duration of fever, markers of inflammation, and negatively with iron, mineral metabolism parameters, and i-FGF23. i-FGF23 was positively correlated with iron metabolism parameters and negatively with the duration of fever, markers of inflammation, and hepcidin. Hepcidin levels increase, whereas i-FGF23 levels decrease in acute pediatric infections. Further research is required to understand the role of FGF23 in the hepcidin-ferroportin axis and for hepcidin in the diagnosis of bacterial infections and mineral metabolism.

Trends in orbital cellulitis severity and management: 2016 through 2022

ABSTRACT Purpose To characterize trends in orbital cellulitis (OC) severity and management from 2016 through 2022, including assessment of effects from the COVID-19 pandemic. Methods A retrospective chart review was conducted at a tertiary care center using an electronic medical record search of OC from January 1 2016 to January 1 2023. Radiography was used to categorize patients into three cohorts – OC without abscess, OC with subperiosteal abscess (SPA), and OC with orbital abscess (OA). Infection cohort and age group [pediatric (<9 years old), adolescent (9–18 years), adult (>18 years)] were compared across years. Subgroup analysis was performed in the SPA cohort. Comparisons were made between the time periods prior to and after the start of the COVID-19 pandemic. Results From 2016–2022, there were 247 (67.3%) cases of OC, 103 (28.1%) SPA, and 17 (4.6%) OA. The year 2022 incurred higher rates of SPA and OA (p = 0.035), pediatric infections (p = 0.008), and co-morbid sinusitis (p = 0.005) compared to all preceding years. Rates were similar from 2016 through 2021. Within the SPA cohort, rates of surgical intervention and outcomes were similar across all years. Rate of abscess formation was significantly higher during the COVID-19 pandemic compared to the pre-pandemic era (p = 0.033). Conclusion The severity of OC leading up to the COVID-19 pandemic appeared steady. After pandemic onset, a delayed increase in abscess formation, predominantly affecting pediatric patients and correlating with a greater rate of sinusitis, was observed in 2022.

Factors Associated With Hospitalization, Length of Stay, and Hospital Expenditures for Respiratory Syncytial Virus Infection in Japanese Infants and Children According to Palivizumab-indicated Underlying Conditions: The LIFE Study.

Respiratory syncytial virus (RSV) is a major cause of pediatric respiratory tract infections. In Japan, children with specific underlying conditions are eligible to receive palivizumab to prevent severe RSV disease. However, the association between palivizumab eligibility and RSV infection severity remains unclear. This study examined RSV infection severity and hospitalization outcomes in Japanese infants and children according to palivizumab eligibility and identified their associated factors. Using insurance claims data from 12 municipalities, we identified RSV cases aged ≤24 months between April 2017 and March 2022. The patients' characteristics and hospitalization status were analyzed according to the presence of palivizumab-indicated underlying conditions. Regression models were used to identify factors associated with hospitalization, length of stay (LOS), and hospital expenditures. We analyzed 1025 first-time RSV cases (860 infants <12 months and 165 children 12-24 months old). There were 777 (90.3%) palivizumab-ineligible infants and 83 (9.7%) palivizumab-eligible infants. Only 13 (15.7%) palivizumab-eligible infants had received palivizumab in the month before RSV infection, and 8 required hospitalization. RSV hospitalization was significantly associated with age (odds ratio: 0.84, 95% confidence interval: 0.79-0.88), palivizumab-indicated underlying conditions (1.82, 1.13-2.89), and non-indicated high-risk conditions (4.87, 2.28-10.99). These factors were also associated with LOS. Hospital expenditures were associated with age, high-risk conditions and LOS. Palivizumab-indicated underlying conditions, high-risk conditions, and younger age are risk factors for RSV hospitalization. Most hospitalized patients did not receive palivizumab in the month before RSV infection despite being eligible, suggesting that some hospitalizations were preventable through appropriate palivizumab use.

Distribution and antimicrobial susceptibility of pathogenic micro-organisms in pediatric urinary tract infections

Distribution and antimicrobial susceptibility of pathogenic micro-organisms in pediatric urinary tract infections

Pediatric Clinical Outcomes of Nasal Methicillin-resistant Staphylococcus aureus Polymerase Chain Reaction Utilization.

Methicillin-resistant Staphylococcus aureus (MRSA) is a clinical challenge in selecting empiric antimicrobials for pediatric infections. We implemented nasal MRSA polymerase chain reaction (nMRSA PCR) screening as a diagnostic tool and evaluated its impact on empiric antibiotic use and clinical outcomes. A retrospective single-center study of patients hospitalized with infections who were empirically prescribed anti-MRSA antibiotics was conducted prior to and following the initiation of nMRSA PCR screening. Electronic medical records, pharmacy data and bacterial cultures results were reviewed. Predictive values of nMRSA PCR testing were calculated and the duration of anti-MRSA empiric therapy and clinical outcomes preimplementation and postimplementation were compared. During the preimplementation period, there were 382 distinct episodes (294 unique patients) that met the inclusion criteria and during post-nMRSA PCR implementation, 394 episodes (360 unique patients) were identified. The median time to discontinuation of anti-MRSA antibiotics and proportion of patients prescribed anti-MRSA antibiotics at discharge were significantly lower in postimplementation compared with preimplementation period; 48 versus 56 hours, P < 0.001 and 20.1% versus 40.3%, P < 0.001, respectively. The negative and positive predictive values of nMRSA PCR compared to clinical culture results were 95.6% and 51.2%, respectively. Predefined adverse outcomes were documented in 11 patients who had early anti-MRSA discontinuation with negative nMRSA PCR results but only 3 were restarted on anti-MRSA treatment and none grew MRSA in clinical cultures. Shortened anti-MRSA antibiotic duration, high negative predictive value and low adverse events provide promising evidence that nMRSA PCR is an effective, rapid antimicrobial stewardship tool for hospitalized children.

ID Consultant: Laboratory monitoring during long-term use of oral antimicrobials in pediatric patients.

Oral antimicrobials remain the mainstay of long-term treatment for many infections. Meanwhile, the use of oral agents is becoming commonplace for treatment of several pediatric infections once managed exclusively with parenteral therapies. Unfortunately, antimicrobials are associated with several laboratory toxicities, particularly when high doses or combination therapies are used, but there is a paucity of data on optimal laboratory monitoring strategies. In this ID Consultant piece, we offer a summary of the three most common lab-based toxicities seen with long-term use of oral antimicrobials - drug-induced kidney injury, liver injury, and hematological toxicities - and we provide our recommended approach to monitoring.

The epidemic characteristics of Mycoplasma pneumoniae infection among children in Anhui, China, 2015-2023.

The number of pediatric respiratory tract infection cases in China has significantly increased this year, and Mycoplasma pneumoniae is one of the main pathogens. This study aimed to investigate the epidemiological characteristics of M. pneumoniae in children in the Anhui region and provide evidence for the prevention and control strategies of M. pneumoniae in children in this region.

Whole-Genome Sequencing Reveals Temporal Trends in Antibiotic Resistance Genes in Escherichia coli Causing Pediatric Urinary Tract Infections in Central Vietnam.

(1) Background: Pediatric urinary tract infections (UTIs) pose significant challenges due to drug-resistant Escherichia coli (E. coli) strains. This study utilizes whole-genome sequencing to analyze temporal trends in antibiotic resistance genes (ARGs) in clinical E. coli isolates from pediatric UTI cases in central Vietnam. (2) Methods: We conducted whole-genome sequencing on 71 E. coli isolates collected from pediatric UTI patients between 2018 and 2020. ARGs were identified, and their prevalence over time was analyzed. Statistical tests were used to correlate ARG presence with antibiotic resistance. (3) Results: Of the 47 E. coli isolates with complete data, 40 distinct ARGs were identified, with a median of 10 resistance genes per isolate. A significant increase in the total number of ARGs per isolate was observed over time, from an average of 8.88 before June 2019 to 11.63 after. Notably, the prevalence of the aadA2 gene (aminoglycoside resistance) rose from 0% to 26.7%, and that of the blaNDM-5 gene (beta-lactam and carbapenem resistance) increased from 0% to 23.3%. Key correlations include blaEC with cephalosporin resistance, blaNDM-5 with carbapenem resistance, and sul2 with sulfamethoxazole/trimethoprim resistance. (4) Conclusions: Whole-genome sequencing reveals complex and evolving antibiotic resistance patterns in pediatric E. coli UTIs in central Vietnam, with a marked increase in ARG prevalence over time. Continuous surveillance and targeted treatments are essential to address these trends. Understanding genetic foundations is crucial for effective intervention strategies.

A penicillin allergy stewardship team to address unconfirmed pediatric penicillin allergies in Houston, Texas

BackgroundPenicillin (PCN) allergy labels are the most common drug allergy label and limit use of first-line antibiotics for many pediatric bacterial infections. Improving access to PCN allergy evaluations is a priority for allergy and immunology (A&I) and infectious diseases (ID) programs. ObjectiveTo increase the number of completed PCN allergy evaluations from 6 to 24 per month from January 2022 to December 2023. MethodsA collaborative PCN allergy stewardship team was established in the A&I and ID divisions at Texas Children's Hospital. Telemedicine evaluations and, when clinically indicated, in-person PCN allergy evaluations were conducted from January 2022 to December 2023. Plan-do-study-act cycles were conducted to increase awareness about the clinics. The primary outcome measure was the average number of monthly completed PCN allergy evaluations. ResultsThe average number of completed PCN allergy evaluations increased from 6 to 19 per month. Children were seen rapidly in the ID telemedicine clinic (20 vs 62 days, P < .001), and 428 of 627 (68%) children who required in-person challenge were scheduled for their in-person evaluation. Among the 211 children delabeled, 71 (33.6%) were subsequently diagnosed with a bacterial infection requiring PCN during the study period. ConclusionA collaborative PCN allergy stewardship team consisting of ID and A&I specialists increased the number of completed PCN allergy evaluations 3-fold. ID telemedicine services allowed prompt access to care, and most children were delabeled and subsequently able to receive PCN antibiotics for bacterial respiratory tract infections. Future work should explore ways to minimize barriers to PCN allergy evaluations and further expand testing services in other settings.