Pediatric Respiratory Infections Research Articles

Biofilm Formations in Pediatric Respiratory Tract Infection : Part 1: Biofilm Structure, Role of Innate Immunity in Protection Against and Response to Biofilm, Methods of Biofilm Detection, Pediatric Respiratory Tract Diseases Associated with Mucosal Biofilm Formation.

Biofilm represents an organized structure of microorganisms within an extracellular matrix attached to a surface. While the importance of biofilm in prosthetic heart valve and catheter-related infections has been known since the 1980s, the role of mucosal biofilm in human disease pathogenesis has only recently been elucidated. It is now clear that mucosal biofilm is present in both healthy and pathologic states. The purpose of this review is to examine the role of mucosal biofilm in pediatric respiratory infections. Mucosal biofilm has been implicated in relationship to several pediatric respiratory infections, including tonsillitis, adenoiditis, otitis media with effusion, chronic rhinosinusitis, persistent endobronchial infection, and bronchiectasis. In these conditions, core pathogens are detected in the biofilm, biofilm organisms are often detected by molecular techniques when conventional cultures are negative, and biofilm presence is more extensive in relation to disease than in healthy tissues. In chronic rhinosinusitis, the presence of polymicrobial biofilm is also a predictor of poorer outcome following sinus surgery. Biofilm in the tonsillar and adenoidal compartments plays a distinct role in contributing to disease in the middle ear and sinuses. Key observations regarding the relevance of biofilm to pediatric respiratory infections include (1) the association between the presence of biofilm and persistent/recurrent and more severe disease in these tissues despite antibiotic treatment, (2) linkage between biofilm core pathogens and acute infections, and (3) interrelationship between biofilm presence in one tissue and persistent or recurrent infection in an adjacent tissue. A greater understanding of the significance of mucosal biofilm will undoubtedly emerge with the development of effective means of eradicating mucosal biofilm.

Biofilm Formations in Pediatric Respiratory Tract Infection Part 2: Mucosal Biofilm Formation by Respiratory Pathogens and Current and Future Therapeutic Strategies to Inhibit Biofilm Formation or Eradicate Established Biofilm.

The purpose of this review is to discuss the unique pathways of biofilm formation utilized by respiratory pathogens and current and future therapeutic strategies to inhibit biofilm formation or eradicate established biofilm in the context of these pathogens. Both nonselective and selective strategies for inhibiting biofilm formation or disrupting established biofilm are discussed. Numerous strategies are being actively pursued to inhibit biofilm formation or eradicate established biofilm in respiratory pathogens. These can be broadly categorized by the stage of biofilm formation (adhesion, extracellular polysaccharide synthesis or structure, EPS, and matrix degradation) that they target and by their selectivity or lack thereof for specific biofilm pathogens. Nonselective inhibitors of adhesion include N-acetylcysteine and artificial surfactants and biosurfactants. Selective inhibitors of adhesion include mannosides that target host-EPS interactions, EPS-targeted antibodies, and other inhibitors of bacterial adhesion. Nonselective inhibitors of EPS synthesis and structure include cyclic di-GMP and cyclic di-AMP-through disruption of glucan-producing exoenzymes. Selective inhibitors of EPS synthesis and structure include antibodies that target proteins essential for biofilm structure (such as DNABII proteins and type IV pilin protein in NTHi) or antibodies that target critical molecules in biofilm formation (such as DNA adenine methyltransferase in Streptococcus pneumoniae). Nonselective agents for EPS or biofilm matrix degradation include peptidoglycan hydrolases that enzymatically degrade bacterial cell wall peptidoglycan and DNase, which degrades extracellular DNA from neutrophils and microorganism-derived DNA. Selective agents for EPS or biofilm matrix degradation include exopolysaccharide-degrading enzymes, such as glycoside hydrolases active against Staphylococcus aureus or exopolysaccharide-degrading enzymes that target Psl and Pel from Pseudomonas aeruginosa. Current strategies toward inhibiting biofilm formation or disrupting established biofilm represent an exciting new approach toward treatment of chronic infectious diseases. Application of these strategies toward treatment of pediatric respiratory tract infections also offers promise of a better understanding of the significance of mucosal biofilm in the pathogenesis of these conditions.

Utility of the Neonatal Calf Model for Testing Vaccines and Intervention Strategies for Use against Human RSV Infection.

Respiratory syncytial virus (RSV) is a significant cause of pediatric respiratory tract infections. It is estimated that two-thirds of infants are infected with RSV during the first year of life and it is one of the leading causes of death in this age group worldwide. Similarly, bovine RSV is a primary viral pathogen in cases of pneumonia in young calves and plays a significant role in bovine respiratory disease complex. Importantly, naturally occurring infection of calves with bovine RSV shares many features in common with human RSV infection. Herein, we update our current understanding of RSV infection in cattle, with particular focus on similarities between the calf and human infection, and the recent reports in which the neonatal calf has been employed for the development and testing of vaccines and therapeutics which may be applied to hRSV infection in humans.

Pidotimod in the treatment of pediatric recurrent respiratory tract infection.

Objective:To observe the clinical efficacy of pidotimod in the treatment of recurrent respiratory tract infection in children.Methods:One hundred thirty-two patients with recurrent respiratory tract infection who received treatment in Tianan City Central Hospital were selected and divided into an observation group and a control group using random number table, 66 in each group. Patients in the control group were given conventional treatment, while patients in the observation group were given conventional treatment and pidotimod treatment; the clinical efficacy of the two therapies was compared. The levels of IgG and IgM were measured after treatment.Results:The vital signs and the content of inflammatory mediator and Th1/Th2 in serum before and after treatment were compared, and the clinical efficacy of the two groups was evaluated. The fever, pulmonary rale, cough and antiadoncus of patients in the observation group disappeared earlier than those in the control group (P<0.05). The onset duration of respiratory tract infection and days of antibiotic application of the observation group were shorter than those of the control group after treatment (P<0.05). The times of infection of the observation group were less than that of the control group (P<0.05). Before treatment, the two groups had no significant difference in the content of inflammatory mediators and Th1/Th2 in the serum (P>0.05). The serum content of tumor necrosis factor (TNF)-α and interleukin (IL)-4 of the two groups one week after treatment was lower than that before treatment, and the content of interferon (IFN)-γ and IFN-γ/IL-4 were higher than that before treatment; moreover the observation group had lower serum content of TFN-α and IL-4 and lower content of IFN-γ and IFN-γ/IL-4 compared to the control group (P<0.05). The overall response rate of the observation group was 92.4%, much higher than 81.8% in the control group (P<0.05).Conclusion:Pidotimod has a remarkable efficacy in the treatment of pediatric recurrent respiratory tract infection because it can effectively inhibit the infection and optimize Th1/Th2 immune function.

Drug Prescription Pattern in Paediatric Respiratory Tract Infections

Drug Prescription Pattern in Paediatric Respiratory Tract Infections

Revealing the Culprit behind the Pediatric Respiratory Infections: A Step-up Approach

Revealing the Culprit behind the Pediatric Respiratory Infections: A Step-up Approach

Detection of respiratory syncytial virus & Mycoplasma pneumoniae in paediatric lower respiratory tract infections.

Background & objectives:Respiratory syncytial virus (RSV) and Mycoplasma pneumoniae are considered common cause of lower respiratory tract infections (LRTIs) in children. The present study was conducted to detect M. pneumoniae and RSV in paediatric LRTIs employing serology, polymerase chain reaction (PCR) and reverse transcriptase PCR (RT-PCR) analysis.Methods:Seventy five children aged one month to five years with acute LRTIs were investigated for M. pneumoniae antibodies and RSV antigen using immunochromatographic test, RT-PCR for RSV and M. pneumoniae by PCR on nasopharyngeal aspirates.Results:RSV infection was observed in 33 (44%) and M. pneumoniae was positive in 26 (35%) children. No significant difference in infection was noted between male and female children. Clinical and radiological features among RSV and M. pneumoniae positive and negative cases were similar. Considering RT-PCR for RSV as gold standard, RSV antigen immunochromatography was 90.90 per cent sensitive and 100 per cent specific.Interpretation & conclusions:Our study showed the presence of RSV and M. pneumoniae infection in 44 and 35 per cent children, respectively with community-acquired LRTIs and aged less than five years.

Yinlai decoction alleviates lipopolysaccharide-induced pneumonia by changing the immune status of juvenile rats: A study based on network pharmacology

Abstract Objective Pediatric pneumonia is a common respiratory disease and Yinlai Decoction (YLD) is a commonly used treatment in China. We explored the anti-inflammatory mechanism of action of this traditional Chinese medicine for pneumonia. Methods We studied, by experimentation, the mechanism of action of YLD in treating pneumonia according to network pharmacology. By comparing YLD with dexamethasone (DXMS), we investigated the efficacy of YLD in treating pneumonia induced by lipopolysaccharide (LPS) in juvenile rats. Results In an aqueous extract of YLD, 22 chemical compounds were identified, among which 10 were related to inflammation, involving 78 target genes and 16 signaling pathways. Among them, 45 core target proteins were related to biologic processes and functions, such as response to stimuli, biologic regulation, cell communication and protein binding. Animal experiments showed that YLD relieved pulmonary inflammation and demonstrated no significant damage to the liver, spleen or kidneys of rats. YLD could regulate expression of inflammatory cytokines in serum and inflammation-related proteins in lung tissues to some extent, but its effect is less significant than that of DXMS. Conclusions YLD protected juvenile rats against LPS-induced pneumonia, and showed fewer side effects in comparison with DXMS. YLD could be efficacious treatment for pediatric respiratory infections and even pneumonia.

Target-independent high-throughput sequencing methods provide evidence that already known human viral pathogens play a main role in respiratory infections with unexplained etiology

ABSTRACT Despite the advanced PCR-based assays available, a fraction of the pediatric respiratory infections remain unexplained every epidemic season, and there is a perception that novel viruses might be present in these specimens. We systematically collected samples from a prospective cohort of pediatric patients with respiratory infections, that returned negative results by validated molecular RT–PCR assays, and studied them with a target-independent, high-throughput sequencing-based approach. We also included a matched cohort of children with no symptoms of respiratory infection, as a contrast study population. More than fifty percent of the specimens from the group of patients with unexplained respiratory infections were resolved. However, the higher rate of detection was not due to the presence of novel viruses, but to the identification of well-known viral respiratory pathogens. Our results show that already known viral pathogens are responsible for the majority of cases that remain unexplained after the epidemic season. High-throughput sequencing approaches that use pathogen-specific probes are easier to standardize because they ensure reproducible library enrichment and sequencing. In consequence, these techniques might be desirable from a regulatory standpoint for diagnostic laboratories seeking to benefit from the many advantages of these sequencing technologies.

The Cost of Acute Respiratory Infections With Cough Among Urban Aboriginal and Torres Strait Islander Children.

Introduction: Acute respiratory infections with cough (ARIwC) contribute considerably to childhood morbidity, yet few studies have examined the cost of these illnesses among Australian children. Moreover, of the few studies that have, none are inclusive of Aboriginal and/or Torres Strait Islander children, despite this population experiencing a greater burden of respiratory illnesses. This study aimed to determine the costs of ARIwC among urban Aboriginal and/or Torres Strait Islander children from the perspective of caretakers, the public healthcare system, and employers.Methods: This cost of illness study used data collected from Aboriginal and/or Torres Strait Islander children aged <5 years enrolled in a 12 month prospective cohort study conducted through an urban primary healthcare clinic in Queensland, Australia. Illness-related resource use was collected for each episode of ARIwC reported, and costed at market rates. Linear regression was used to (a) examine cost per episode by season of illness onset and cough duration and (b) examine cost per month of observation by baseline child and family characteristics.Results: During the study period, a total of 264 episodes of ARIwC were reported among 138 children. The total mean cost was estimated to be $AU252 per non-hospitalized episode (95%CI 169–334). Caretakers, the public healthcare system and employers incurred 44, 39, and 17% of costs per episode, respectively. After accounting for months of completed follow-ups, the total mean cost per child per year was estimated to be $991 (95%CI 514–1468). Winter episodes and episodes resulting in chronic cough were associated with significantly higher costs per episode. A prior history of wheezing, connections to traditional lands and parent/guardian belief that antibiotics should be given until symptoms resolved were associated with significantly higher cost per child month of observation.Conclusion: The cost of ARIwC in this predominantly disadvantaged population is substantial, particularly for caretakers and this needs to be considered in both clinical management and public health initiatives. The importance of cultural factors on health and burden of illness should not be overlooked. Further research into the prevention of chronic cough may play an important role in reducing the economic burden of pediatric respiratory infections.

Case-control study of the epidemiological and clinical features of human adenovirus 55 and human adenovirus 7 infection in children with acute lower respiratory tract infections in Beijing, China, 2008\u20132013

BackgroundIn adults, the emerging human adenovirus (HAdV) type 55 (HAdV-55) has been reported to cause more severe cases of adenovirus induced acute lower respiratory tract infections (ALRTIs) compared to other HAdV serotypes (HAdV-3, HAdV-7, HAdV-14). However, there is a dearth of comparative studies in children that address differences in the clinical epidemiological features between HAdV-55 and other HAdV serotypes that can also induce severe infection (such as HAdV-7).MethodsWe conducted a retrospective review of pediatric patients hospitalized at Beijing Children’s Hospital with ALRTI from April 2008 to December 2013 who had adenovirus detected from nasopharyngeal or throat samples by PCR. We further compared pediatric patients infected with HAdV-55 to those infected with HAdV-7 using a case-control methodology by matching each subject with HAdV-55 infection to 4 patients with HAdV-7 infection within 2 months of each HAdV-55 infection. Demographic, clinical, and etiological data were collected and analyzed.ResultsOver the five-year period, HAdV was detected in 194 children. Of these, 8 were HAdV-55 positive. Epidemiological results showed that HAdV-55 infection was observed only in 4% of adenovirus infected children whereas HAdV-7 infection proportioned 53%. Most cases of HAdV-55 infection were identified during March and April, whereas HAdV-7 infection occurred throughout the year. Wheezing was significantly less frequent in the HAdV-55 group. No patients infected with HAdV-55 presented with vomiting or had any underlying disease. Coinfections with other respiratory tract pathogens were frequent among children infected with either HAdV-55 or HAdV-7.ConclusionsHAdV-55 circulated in Beijing during spring and appeared to cause pediatric respiratory infections that were as severe as HAdV-7 infections. Broader surveillance studies are needed.

The Qualitative Evaluation Of Antibiotics Used In Pediatric Respiratory Tract Infection Treatments At A Primary Hospital In Surabaya

Respiratory Tract Infections (RTIs) commonly occur as an infection in children. A considerable amount of antibiotics consumption is used to treat RTIs in many hospitals. Unwise antibiotic treatments in RTIs will increase bacterial resistance and treatment cost. This study aimed to investigate the quality or appropriateness of antibiotics use in RTI treatments in pediatric inpatients. A retrospective analysis of antibiotics consumption data was conducted through inpatient medical records for three months in 2017 at a primary hospital in Surabaya, Indonesia. The qualitative assessment was performed using a modified Gyssens algorithm based on the National Guideline and other relevant international standards of antibiotics applications in RTI treatment. The medical records of a total of 87 pediatric inpatients aged 0-14 y.o. were included in this study. The most common diagnosis was tonsillopharyngitis (32.18%), and the average length of hospital stay was 4.84 days. Antibiotics used in the treatments were from the class of -lactams and cephalosporins, all of which were applied in empirical therapy. According to the analysis, the antibiotic treatments were not appropriate. The most inappropriate use of antibiotics was in the form of wrong choice of drug choice (95.40%), followed by the sub-optimal duration of antibiotics (4.60%). The RTI treatment in pediatrics has to avoid any inappropriate uses of antibiotics, which can be achieved through the evaluation of institutional policy against the local guideline, antibiogram, or any relevant international guidelines.

Population-based paediatric respiratory infection surveillance: a prospective inception feasibility cohort study

BackgroundThere is a need to reduce unnecessary general practitioner (GP) consultations and improve antibiotic stewardship in primary care. Respiratory tract infections (RTIs) in children are the most common reason for consulting and prescribing. Most RTI research is conducted at the point of consultation, leaving a knowledge gap regarding the population burden of RTIs.MethodsCommunity-based, online prospective inception cohort study with nested qualitative study, to evaluate the feasibility and acceptability of collecting RTI symptom and microbiological data from children recruited prior to RTI onset.ResultsParents of 10,310 children were invited. Three hundred thirty-one parents of 485 (4.7%) children responded and completed baseline data. Respondents were less socioeconomically deprived (p < 0.001) with younger (median ages 4 vs. 6 years, p < 0.001) children than non-respondents. The same parents reported 346 RTI episodes in 259 children, and 305 RTIs (in 225 children) were retained to parent-reported symptom resolution. Restricting analyses to the first RTI episode per family (to account for clustering effects), parents fully completed symptom diaries for 180 (87%) of 192 first illness episodes. Research nurses conducted home visits for 199 RTI episodes, collecting complete (symptomatic) swab sets in 195 (98%). Parents collected 194 (98% of 199 possible) symptomatic (during the nurse visit) and 282 (92% of 305 possible) asymptomatic swab sets (on symptom resolution, no nurse present). Interviews with 30 mothers and 11 children indicated study acceptability.ConclusionsInvitation response rates were in the expected range. The high retention and qualitative evidence suggest that community-based paediatric syndromic and microbiological surveillance research is feasible.

738. Role of Respiratory Syncytial Virus and Mycoplasma pneumoniae in Pediatric Community-Acquired Lower Respiratory Tract Infections

BackgroundRespiratory syncytial virus (RSV) infection is a major cause of serious lower respiratory disease in infancy and early childhood and Mycoplasma pneumoniae (M. pneumoniae) is a common cause of respiratory tract infections in all age groups. This study was conducted to determine the role of RSV and M. pneumoniae and in pediatric lower respiratory tract infections employing serological tests, polymerase chain reaction (PCR) and reverse transcriptase PCR analysis.MethodsIn this prospective study, 75 children aged 1 month to 5 years with acute lower respiratory tract infections (LRTIs) were investigated. Paired serum samples were obtained on admission and after 4–6 weeks to assay for M. pneumonia antibodies. Nasopharyngeal aspirates were obtained for the detection of RSV antigen by using the immunochromatographic test, reverse transcriptase-polymerase chain reaction (RT-PCR) for RSV and M. pneumoniae by PCR.ResultsRSV infection was positive in 20(60.60%) children aged <1 year and 13 (39.40%) aged 2–5 years, the difference being statistically insignificant (P = 0.360). M. pneumoniae infection was documented in a 15(57.6%) children aged <1 year age and 11(42.4%) in age 2–5 years which was statistically significant(P = 0.026). Clinical and radiological features among RSV and M. pnemoniae positive and negative cases were comparable. Thirty (40%) children were positive for RSV antigen and by RT-PCR and 3(12%) only by RT-PCR. Serological evidence of M pneumoniae infection was documented in 24(32%) children. M. pnemoniae PCR was positive in 8 (10.66%) patients. Together, serology and PCR detected M. pneumoniae in 26(34.66%) children. Considering RT-PCR as a diagnostic standard, the sensitivity of RSV antigen by immunochromatography was 90.90%, specificity 100%, positive predictive value 100% and a negative predictive value of 93.3%.The sensitivity of M. pneumoniae serology was 75%, specificity 73.3%, positive predictive value 25% and a negative predictive value of 96% considering PCR as a diagnostic standard,.ConclusionOur data underline the role of RSV and M. pneumoniae as the major cause of community-acquired lower respiratory tract infections in children aged <5 years.Disclosures All authors: No reported disclosures.

170. Characterization of Appropriate Antibiotic Prescribing for Pediatric Respiratory Tract Infections: Setting the Stage for Stewardship

BackgroundInappropriate antibiotic use includes prescribing for antibiotic inappropriate diagnoses and use of broad-spectrum instead of narrow-spectrum therapies and contributes to adverse events and antibiotic resistance. To guide the design and implementation of antibiotic stewardship interventions in a network of pediatric clinics, we sought to characterize appropriate antibiotic prescribing for children diagnosed with uncomplicated respiratory infections.MethodsRetrospective cohort study of visits by children to one of 31 primary care or six urgent care clinics in a university healthcare system between January 1, 2016 and December 31, 2017. Two outcomes were used to characterize antibiotic prescribing: (1) percentage of antibiotic inappropriate diagnoses (bronchitis, bronchiolitis, upper respiratory infection) that were prescribed an antibiotic; (2) percentage of visits with a diagnosis for acute otitis media (AOM), sinusitis, or pharyngitis prescribed first-line recommended antibiotics (amoxicillin or penicillin). Children with a documented penicillin allergy or antibiotic prescriptions in the previous 30 days were excluded. Chi-square tests were used to compare prescribing between settings.ResultsAmong 117,279 total visits examined, 16,760 (14%) were for antibiotic inappropriate diagnoses, 5,912 (5%) for AOM, 844 (1%) for sinusitis and 4,912 (4%) for pharyngitis. Only 3% (95% CI: 2.9–3.4) of antibiotic inappropriate diagnoses were prescribed antibiotics. The percent of visits for AOM, sinusitis, and pharyngitis prescribed first-line antibiotics ranged from 27% (95% CI: 21–33) for sinusitis in urgent care to 91% (95% CI: 90–92) for pharyngitis in urgent care (figure). Differences in appropriate prescribing by setting were observed for AOM (P < 0.01) and sinusitis (P < 0.01).ConclusionIn this network of pediatric practices, we found minimal evidence of unnecessary antibiotic use for respiratory infections but substantial underuse of first-line therapy for sinusitis, especially in urgent care settings. Stewardship interventions designed to reinforce existing practices for antibiotic-inappropriate conditions and promote greater use of appropriate first-line therapies are planned for this setting. Disclosures All authors: No reported disclosures.

2359. Validation of a Novel Scoring Criteria for Assessing the Severity of Viral Respiratory Infections in Children

BackgroundNovel investigative tools (e.g., whole-genome sequencing) help characterize host and viral genetic contributions to disease severity in pediatric viral respiratory infection. However, a validated scoring system for quantifying illness severity is needed to properly contextualize results. Existing scoring systems are outdated, unvalidated and underpowered. We thus developed a scoring system to address these concerns.MethodsChildren hospitalized with viral respiratory infections were prospectively enrolled over 2 years, with 51 clinical variables abstracted from the medical record. 7 variables felt to be most predictive of disease severity and significantly correlated with each other (Spearman correlation coefficient P < 0.001) were included in the scoring system (duration of hospital and ICU stay, oxygen and high flow nasal cannula (HFNC) use and intubation; maximum nasal cannula and HFNC support), and combined into a disease severity index by converting each into an ordinal score and summing over the variables, with each variable sub-divided into 7 levels of exposure (based on equal interval length cutpoints). For a validation comparison, sampling algorithms utilizing a linear model selected a subset of 96 patients whose disease severity would be randomly assessed by 8 pediatricians in blocks of 12, using D-optimality and space filling criteria to protect against non-linearity (severity scored 1 to 10; 80% power for detection of correlation >0.28, two-sided α = 0.05). Mixed model regression analyses compared clinician-scored disease severity with the scoring system. Akaike Information criteria (AIC) and coefficients of determination (R2) ranked severity indices.Results445 subjects (56.2% male, median age 1.2 years) were enrolled. Clinician scores of disease severity averaged 6.2 (SD = 2.2, range 1–10). A scoring system using 7 variables with 7 levels of exposure per variable produced the lowest AIC (0.00, R2 = 0.70 for predicting clinician-scored disease severity after adjustment for rater effects) (Figure 1).ConclusionA 7-variable scoring system quantifying disease severity in pediatric viral respiratory infections correlates well with clinician assessment, and may advance the study of such infections.Figure 1: Fitted model: Association of Clinician Score and Severity Scoring System.Disclosures All authors: No reported disclosures.

2568. Variability in Pediatric Antibiotic Prescribing for Upper Respiratory Illnesses by Provider Specialty

BackgroundAntibiotic prescribing varies among providers, contributing to antibiotic resistance and adverse drug reactions. Objective. To evaluate variation in antibiotic prescribing between pediatric and nonpediatric providers for common upper respiratory illnesses.MethodsPatient encounters for children aged <18 years from a regional healthcare system were identified. Electronic medical records from 2011 to 2016 were extracted for diagnoses of upper respiratory infection (URI), pharyngitis, acute otitis media (AOM), and sinusitis. Encounters with competing medical diagnoses, recent hospitalization, and antibiotic prescriptions within 30 days were excluded. Adherence to antibiotic guidelines was assessed by provider training (pediatric, nonpediatric physicians, and advance practice providers [APP]). Additional factors assessed included clinic or urgent care setting, calendar year, and patient’s age, gender, insurance status, and number of sick visits in the prior year.ResultsAcross 6 years, 141,361 visits were examined: 43,914 for URI, 43,701 for pharyngitis, 43,925 for AOM, and 9,821 for sinusitis. Pediatricians were more likely than APPs and nonpediatric providers to have guideline-concordant prescribing for pharyngitis (pediatricians 66.7 (54.5, 77.0)%, nonpediatricians 49.1 (36.3, 62.0)%, APPs 52.2(39.4, 64.7)%, P < 0.0001) and sinusitis (pediatricians 70.8(53.8, 83.4)%, nonpediatricians 63.3(46.8, 77.2)%, APPs 62.1(45.1, 76.5)%, P = 0.48) and to withhold antibiotics for URI than APPs and nonpediatric providers (pediatricians 86.6(81.2, 90.6)%, nonpediatricians 80.8(73.0, 86.8)%, APPs 76.8(68.4, 83.5)%, P < 0.0001). Pediatricians were less likely to prescribe antibiotics for pharyngitis without a positive Group A Streptococcus test than APPs and nonpediatric providers (pediatricians 15.1(10.4, 21.6)%, nonpediatricians 29.4(20.8, 39.6)%, APPs 27.2(19.3, 36.9)%, P < 0.0001). First-line antibiotic prescribing for pharyngitis and AOM did not differ between provider specialties. A trend toward more guideline-concordant prescribing was seen for pharyngitis and sinusitis over the study period.ConclusionPediatricians were more likely to adhere to guidelines for pediatric acute respiratory infections. Pediatric antibiotic stewardship efforts should also target non-pediatricians.Disclosures All authors: No reported disclosures.

Variability in Antibiotic Prescribing for Upper Respiratory Illnesses by Provider Specialty

To evaluate variation in antibiotic prescribing between pediatric and nonpediatric providers for common upper respiratory illnesses. Patient encounters for children aged <18 years from a regional health care system were identified. Electronic medical records from 2011 to 2016 were extracted for diagnoses of upper respiratory infection, pharyngitis, acute otitis media, and sinusitis. Encounters with competing medical diagnoses, recent hospitalization, and antibiotic prescriptions within 30 days were excluded. Adherence to antibiotic guidelines was assessed by provider training (pediatric, nonpediatric physicians, and advance practice providers). Additional factors assessed were calendar year, and patient's age, sex, insurance status, and number of sick visits in the prior year. Across 6 years, 141 361 visits were examined: 43 914 for upper respiratory infection, 43 701 for pharyngitis, 43 925 for acute otitis media, and 9821 for sinusitis. Pediatricians were more likely than Advanced practice providers (APP) and nonpediatric providers to have guideline-concordant prescribing for pharyngitis (pediatricians, 66.7% [95% CI, 54.5-77.0]; nonpediatricians, 49.1% [95% CI, 36.3-62.0], APPs, 52.2% [95% CI, 39.4-64.7]; P < .0001) and sinusitis (pediatricians, 70.8% [95% CI, 53.8-83.4], nonpediatricians, 63.3% [95% CI, 46.8-77.2], APPs, 62.1% [95% CI, 45.1-76.5]; P = .48) and to withhold antibiotics for upper respiratory infection than APPs and nonpediatric providers (pediatricians, 86.6% [95% CI, 81.2-90.6], nonpediatricians, 80.8% [95% CI, 73.0-86.8], APPs, 76.8% [95% CI, 68.4-83.5]; P < .0001). Pediatricians were less likely to prescribe antibiotics for pharyngitis without a positive test for group A Streptococcus than APPs and nonpediatric providers (pediatricians, 15.1% [95% CI, 10.4-21.6], nonpediatricians, 29.4% [95% CI, 20.8-39.6], APPs, 27.2% [95% CI, 19.3-36.9]; P < .0001). First-line antibiotic prescribing for acute otitis media did not differ between provider specialties. A trend toward more guideline-concordant prescribing was seen for pharyngitis and sinusitis over the study period. Pediatricians were more likely to adhere to guidelines for management of pediatric acute respiratory infections. Pediatric antibiotic stewardship efforts should also target nonpediatricians.

Preventing Pediatric Respiratory Syncytial Virus Infection.

Respiratory syncytial virus (RSV) infection in infants is a major cause of morbidity and mortality worldwide. Despite intense research efforts, safe and effective vaccines have remained elusive. Risk factors for the development of severe disease are well known, and those infants at highest risk are identified to receive RSV prophylaxis in the form of anti-RSV monoclonal antibody. Still, many other infant groups remain at risk and could benefit from an effective RSV prevention program. An explosion of clinic research activity is bringing unprecedented progress. Several of the most promising approaches currently being evaluated in clinical trials are reviewed. [Pediatr Ann. 2018;47(9):e371-e376.].

Clinical efficacy of Golden Lotus granules combined with ribavirin in the treatment of pediatric acute upper respiratory tract infection and its effect on serum inflammatory markers

目的 探讨金莲花颗粒联合利巴韦林治疗小儿急性上呼吸道感染的疗效及其对血清炎症标记物的影响。 方法 选取2014年1月至2016年12月安吉县中医医院急性上呼吸道感染的患儿116例，采用随机数字表法分为观察组和对照组，每组58例。两组患儿均给予支持治疗，对照组给予利巴韦林颗粒，观察组在对照组的基础上给予金莲花颗粒。两组疗程均为1周。比较两组治疗疗效，临床症状积分，血清C反应蛋白(CRP)和肿瘤坏死因子因子α(TNF-α)水平的变化，并建立ROC曲线，分析CRP和TNF-α的曲线下面积(AUC)，敏感性和特异性。 结果 观察组的临床总有效率为94.8%，显著高于对照组的77.5%，差异有统计学意义(χ2＝9.854，P<0.05)；治疗后观察组咳嗽、发热和咽喉肿痛积分均显著低于对照组，差异均有统计学意义(t＝－30.698、－29.786、－33.377，均P<0.01)，其血清CRP和TNF-α水平均均显著低于对照组，差异有统计学意义(t＝－11.3528、－17.4182，均P<0.01)；ROC曲线分析可知TNF-α的AUC、敏感度和特异度最高，分别为0.820、85.8%和80.0%。 结论 金莲花颗粒联合利巴韦林治疗小儿急性上呼吸道感染的临床疗效明确，其作用机制可能与下调CRP和TNF-α的水平有关，其中TNF-α对小儿支气管肺炎具有较高的诊断价值。