Resistance In Children Research Articles

Increasing Burden of Antibiotic Resistance in Children Suffering from Septicemia in Tertiary Care Hospitals

Abstract Introduction/Objective Invasion of the bloodstream by microorganisms constitutes one of the most serious situations in infectious disease. Children are the most susceptible groups to contract diseases specifically Blood Stream Infections (BSIs). BSIs have been considered to be the main cause of morbidity and mortality in children. It is associated with a high mortality rate of 20%–50%. The emerging causative agents and resistance to various antimicrobial agents are increasing from time to time. Methods/Case Report The present study was carried out to confirm the causative agents and their antibacterial susceptibility pattern in children with septicemia at Tertiary Care Hospitals, Peshawar, KP, Pakistan. This cross- sectional study involved about 873 pediatric patients (≤ 13 years). BACTEC BD 9050 system was used to identify the causative organism, and sub-cultures were done on MacConkey Agar and Blood Agar. The antibiotic susceptibility test was done using the Kirby Bauer Disk diffusion method as per CLSI guidelines. Results (if a Case Study enter NA) Among 873 study subjects 568 (65.06 %) were males followed by 305 (34.93 %) females. Out of the 873 tested blood samples, blood cultures were positive in 83 (9.51%) followed by 122 (13.98%) skin contaminants, and no growth was observed in 668 (76.51%) cases. The majority 43 (51.80 %) of them were neonates (≤ 28 days). Gram-positive and Gram-negative bacteria constituted 58 (69.87%) and 25 (30.13%), respectively. The most frequent pathogen found was Staphylococcus aureus 54 (65.06 %), followed by Klebsiella spp., E. coli, and Pseudomonas aeruginosa 6 (7.22 %), Salmonella spp. 5 (6.02 %) Enterococcus faecalis 3 (3.61 %), Acinetobacter baumannii 2 (2.40 %) and Staphylococcus epidermidis 1 (1.20 %). In Staphylococcus aureus about 6 (11.11) were MRSA. The majority of bacterial isolates showed high resistance to Ciprofloxacin, Ceftazidime, Cefuroxime, Co-trimoxazole, Cefepime, Cefotaxime, Minocycline, Tobramycin, Cefoxitin and Cephradine that are commonly used in the study area. Conclusion The majority of the isolates were multidrug resistant. These higher percentages of multi-drug resistant emerged isolates urge us to take infection prevention measures and to conduct other large studies for appropriate empiric antibiotic choice.

High Mortality Rates and Antimicrobial Resistance in Children with Invasive Bacterial Infections in a Tertiary Care Facility in West Africa

Abstract Background Childhood data on infection mortality and antimicrobial resistance in Sub-Saharan Africa are emerging but remain limited. The University of Maryland Center for Vaccine Development (CVD) and CVD-Mali have been conducting a prospective observational study at L’Hopital Gabriel Toure (HGT), a referral hospital in Bamako, Mali, since 2002 to identify causes of invasive bacterial infections (IBI) in children. These data have been used to initiate vaccination programs to decrease the burden of Haemophilus influenzae type b and Streptococcus pneumoniae. Additional demographic and antimicrobial susceptibility data have been collected since 2021, allowing for more detailed resistance and mortality analyses. Methods All children presenting to HGT are screened. Children ages 0-15 years with temperature of at least 39 degrees Celsius and/or suspicion of IBI are eligible. Eligible children have blood cultures collected with additional site-specific cultures when focal infection is suspected. Cultures are performed using the Bactec system; when positive, Gram staining, sub-culturing, and antimicrobial susceptibility testing (by disk diffusion using standard methods) are performed. Organisms thought to be contaminants are excluded. American type culture collection strains are utilized for quality control. Results Between 1/14/2021 and 9/14/2023, 28703 patients were screened. 2156 patients were included. 212 patients (10%) had 235 pathogens isolated. Gram positive organisms were most frequently isolated (N=112), followed by Gram negative Enterobacterales (N=81), non-Enterobacterales Gram negatives (N=36), and yeast (N=6). Staphylococcus aureus was the most frequently isolated Gram positive organism (59 bloodstream isolates, 2 joint isolates, 2 subcutaneous isolates) followed by S.pneumoniae (10 bloodstream isolates, 17 cerebrospinal fluid isolates, 1 joint isolate) and Enterococcus species (16 bloodstream isolates). Klebsiella pneumoniae (28 bloodstream isolates, 2 cerebrospinal fluid isolates) and Escherichia coli (18 bloodstream isolates, 3 cerebrospinal fluid isolates, 2 subcutaneous isolates) were the most frequently isolated Gram negative Enterobacterales, with Pseudomonas species most common among non-Enterobacterales Gram negative organisms (16 bloodstream isolates, 1 cerebrospinal fluid isolate). Mortality rates in both culture-positive and culture-negative patients were high (52% and 28%, respectively), with greater than 50% of deaths occurring within 48 hours in both groups. 88% of Gram negative Enterobacterales were ceftriaxone resistant or intermediate, with 56% ciprofloxacin resistant or intermediate; 55% of isolates were resistant or intermediate to both. 71% of isolates were gentamicin resistant. Imipenem resistance remained low, with 91% of isolates retaining sensitivity. 24% of S. aureus isolates were oxacillin resistant and 34% of isolates were resistant or intermediate to trimethoprim/sulfamethoxazole. 100% of S. aureus isolates tested (14/60) retained sensitivity to clindamycin. Only 54% of pneumococcal isolates had positive oxacillin screens, implying frequent penicillin resistance, and only 60% of enterococcal species were ampicillin sensitive, although 92% retained vancomycin sensitivity. Conclusion We found higher mortality rates in our study than in similar studies; the contribution of issues such as limited access to advanced supportive care and delay in presentation is an area for further study. The high frequency of multidrug-resistant organisms is alarming, suggesting an urgent need to investigate underlying contributing factors, increase access to affordable broad-spectrum antibiotics, and create robust antimicrobial stewardship programs.

The Relationship between Vitamin D, Inflammatory Markers, and Insulin Resistance in Children.

In this study, we investigated 25-hydroxyvitamin D (25(OH)D, vitamin D), inflammatory hematologic ratios such as neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), systemic immune-inflammation index (SII), monocyte/HDL-C ratio (MHR) and plasma atherogenic index (PAI) and possible relationships with insulin resistance (IR) in children. A total of 210 individuals, including 96 children with IR and 114 children without IR, aged 6-18 years, who were admitted to the Pediatric Endocrinology Outpatient Clinic at Medicine Hospital, Istanbul Atlas University were included in our study. Compared to patients without IR, NLR, PLR, SII, and MHR were significantly higher in patients with IR. Fasting insulin, PAI, homeostasis model assessment of insulin resistance (HOMA-IR), and HOMA-β were significantly higher and quantitative insulin sensitivity check index (QUICKI) was considerably lower in patients with IR compared to those without IR. NLR, SII, and MHR were lower in normal vitamin D groups than the others (p < 0.001). PLR was lower in the group with normal vitamin D levels than the groups with insufficient or deficient levels of vitamin D (D < 21). We found that vitamin D deficiency in childhood is related to increased levels of circulating inflammatory markers (NLR, PLR, MHR, PAI), IR, and decreased insulin sensitivity. According to our results, supplementation of vitamin D may be beneficial in averting IR and enhanced systemic inflammation.

Clinical Findings, Bacterial Agents, and Antibiotic Resistance in Children with Spontaneous Peritonitis in Southern Iran: An Academic Tertiary Referral Center's Experience.

Spontaneous bacterial peritonitis (SBP) is a fatal complication of ascites fluid infection. The causes of SBP in children differ from those in adults, and these bacteria are frequently resistant to antibiotics. Therefore, this study investigated the clinical findings, bacterial etiology, and antimicrobial resistance in children with SBP. This study was conducted on all new pediatric ascites patients, who were admitted to the Department of Pediatric Gastroenterology, Namazi Hospital, affiliated with Shiraz University of Medical Sciences (Shiraz, Iran) from 2021 to 2022. Required data such as demographic information, and clinical information such as complete blood count (CBC), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), Gram staining, blood culture by Automated Blood Culture System (BACTEC), and antibiogram of ascites fluids by disc diffusion method were all collected. Finally, the data were statistically analyzed using SPSS Software (version 26). Besides, the t test, Fisher's exact, Mann-Whitney, and Chi square tests were used for data analysis. In all tests, P≤0.05 was considered statistically significant. The present study examined 62 children with ascites of which 18 (29%) had SBP. The median (IQR) age was 2.5 (8.1) years. Thirty-four (54.8%) of the participants were girls. Abdominal pain was the most common clinical manifestation in patients (54%), and there was a significant association between abdominal pain and SBP (P=0.02). In 12 positive ascites fluid cultures, coagulase-negative staphylococci had the highest frequency (25%), followed by Escherichia coli (16.7%). Third-generation cephalosporins had a 25% sensitivity in the total positive cultures. This sensitivity was 33.3% for Gram-negative cultures and 16.6% for Gram-positive cultures. Although third-generation cephalosporins are recommended as the primary antibiotic for the empirical treatment of SBP, the present study found high bacterial resistance. Finally, empirical therapy should be tailored to each region's bacterial resistance features.

Aerobic Microbiological Spectrum and Antibiotic Resistance in Children Operated for Anorectal Abscesses.

(1) Background: Anorectal abscesses are a relatively rare pathology in childhood. Most often, male children under 1 year of age are affected. The importance of microbiological examination for the diagnosis and treatment of such patients remains debatable among surgeons, resulting in scarce data being available in the literature. We aimed to identify the aerobic microbiological spectrum and antibiotic resistance of isolates in children undergoing operation to treat anorectal abscesses. (2) Methods: We performed a case series of 102 children diagnosed and operated for anorectal abscesses over a period of 10 years (2010-2019). Purulent wound exudate was used for microbiological evaluation, which was subsequently cultured on 5% sheep-blood agar and eosin-methylene blue agar. For microbiological identification, conventional biochemical tests and semi-automated (API 20, bioMerieux, Marcy-l'Étoile, France) tests were used, as well as automated systems (Vitek-2 Compact, bioMerieux, France). Antimicrobial susceptibility testing was performed by the disk diffusion method of Bauer-Kirby and by determining the minimal inhibitory concentrations for glycopeptides. The results were interpreted according to the EUCAST standard for the corresponding year. (3) Results: Microbiological testing in children operated for anorectal abscesses mainly identified the gut commensals that normally reside in the rectal mucosa. Monocultures were found in just over half of the cases. Escherichia coli, Klebsiella pneumoniae complex, and Proteus mirabilis were the most frequently isolated. In addition, Staphylococcus aureus was found in 7% of patients. In Gram-negative bacteria, antibiotic resistance was most often observed in penicillins, cephalosporins, sulfonamides, and fluoroquinolones. (4) Conclusions: The increasing rates of antimicrobial resistance impose the need for the local monitoring of circulating commensal bacteria associated with anorectal abscesses in children to guide antibiotic therapy when indicated.

Longitudinal Trends in HIV-1 Subtypes and Drug Resistance in Children from Argentina over a 15-Year Period (2006-2021).

Human immunodeficiency virus (HIV) drug resistance is a major cause of treatment failure in children and adolescents infected with the virus. The objectives of the study are to investigate HIV drug resistance (HIVDR) in patients who attended a referral care center in Argentina over a 15-year period and to compare mutational patterns between HIV-1 polsequences characterized as B or BF recombinants. Individual resistance-associated mutations (RAMs) (to protease and reverse transcriptase inhibitors) were identified according to IAS-USA guidelines in 374 HIV-1-infected children and adolescents. HIV-1 subtype was characterized by phylogenetic and recombination analysis using MEGA5.1 and Simplot. Poisson linear regression was used to model the dynamics of the RAMs over time. The prevalence of RAMs to protease inhibitors (R2 = 0.52, p = 0.0012) and nucleoside reverse transcriptase inhibitors (R2 = 0.30, p = 0.0225) decreased over time. HIVDR to non-nucleoside reverse transcriptase inhibitors remained moderate to high, ranging between 33% and 76%. BF recombinants showed a higher frequency of thymidine analog mutation 1 RAMs profile and I54V mutation. In Argentina, HIVDR observed in children and adolescents has decreased over the past 15 years, regardless of the viral subtype. (REV INVEST CLIN. 2024;76(1):29-36).

Antibiotic Resistance in Children with Urinary Tract Infection at Al-Mahmodyiah General Hospital: Descriptive Study

Antibiotic Resistance in Children with Urinary Tract Infection at Al-Mahmodyiah General Hospital: Descriptive Study

Mediation Analysis of Waist Circumference in the Association of Gut Microbiota with Insulin Resistance in Children.

Persistent gut microbiota (GM) imbalance has been associated with metabolic disease development. This study evaluated the mediating role of waist circumference in the association between GM and insulin resistance (IR) in children. This cross-sectional study included 533 children aged between 6 and 12. The anthropometry, metabolic markers, and relative abundance (RA) of five intestinal bacterial species were measured. Path coefficients were estimated using path analysis to assess direct, indirect (mediated by waist circumference), and total effects on the association between GM and IR. The results indicated a positive association mediated by waist circumference between the medium and high RA of S. aureus with homeostatic model assessments for insulin resistance (HOMA-IR) and for insulin resistance adiponectin-corrected (HOMA-AD). We found a negative association mediated by waist circumference between the low and medium RA of A. muciniphila and HOMA-IR and HOMA-AD. Finally, when we evaluated the joint effect of S. aureus, L. casei, and A. muciniphila, we found a waist circumference-mediated negative association with HOMA-IR and HOMA-AD. Waist circumference is a crucial mediator in the association between S. aureus and A. muciniphila RA and changes in HOMA-IR and HOMA-AD scores in children.

Associations Among Physical Activity, Adiposity, and Insulin Resistance in Children Exposed In Utero to Maternal Obesity With and Without Gestational Diabetes.

Investigate whether obesity risk and current weight status are independently associated with physical activity (PA) and whether PA is associated with adiposity and insulin resistance (homeostatic model assessment of insulin resistance) among children with high versus low obesity risk based on in utero exposure to maternal overweight/obesity with gestational diabetes mellitus (GDM; high risk) or without GDM (overweight/obesity; high risk) or maternal normal weight without GDM (low risk). Secondary analysis of data from children born to women with overweight/obesity and GDM, overweight/obesity without GDM, or normal weight without GDM. PA was assessed with accelerometry, percentage of body fat derived from anthropometrics, and homeostatic model assessment of insulin resistance calculated from glucose and insulin. Among 4- to 10-year-old children (N = 163), analyses of covariance showed that children with a current BMI ≥85th percentile had less vigorous PA than those with BMI <85th percentile, but in utero exposure was not an independent predictor of PA. In linear regression modeling, moderate to vigorous PA was inversely associated with percentage of body fat and homeostatic model assessment of insulin resistance independent of age, Tanner stage, and accelerometer wear time, with stronger associations in high-risk groups. Children's PA is related to current weight status but not underlying risk for obesity but may be especially important to reduce obesity and insulin resistance in high-risk children.

Association between Serum Adiponectin and Insulin Resistance in Children and Adolescents with Type 1 Diabetes: A Cross-Sectional, Single Center Study from Egypt

Association between Serum Adiponectin and Insulin Resistance in Children and Adolescents with Type 1 Diabetes: A Cross-Sectional, Single Center Study from Egypt

Factors Associated With Viral Suppression and Drug Resistance in Children and Adolescents Living With HIV in Care and Treatment Programs in Southern Tanzania.

Achieving viral suppression (VS) for persons living with HIV is key to reaching epidemic control. We assessed the prevalence of VS and the frequency of HIV drug resistance mutations (HIVDRM) among children and adolescents living with HIV (CALHIV) in the Southern Highland zone of Tanzania. From 2019 to 2021, we enrolled CALHIV aged 1-19 years on ART for >6 months in a cross-sectional study. Participants had viral load (VL) testing; those with VL ≥ 1000 copies/mL underwent HIVDRM testing. VS (<1000 copies/mL) prevalence estimates were calculated and robust Poisson regression was used to estimate prevalence ratios (PRs) and 95% confidence intervals (CIs) for associations with potential predictors of VS. Of 707 participants, 595 had VS (PR: 0.84, 95% CI: 0.81-0.87). Use of an integrase strand transfer inhibitor-containing regimen (aPR 1.15, 95% CI: 0.99-1.34), age 5-9 years (aPR 1.16, 95% CI: 1.07-1.26), and seeking care at a referral center (aPR 1.12, 95% CI: 1.04-1.21) were associated with VS. Factors inversely associated with VS included having one (aPR 0.82, 95% CI: 0.72-0.92) or two or more (aPR 0.79, 95% CI: 0.66-0.94) referrals for adherence counselling, and self-reporting missing one to two (aPR 0.88, 95% CI: 0.78-0.99) or three or more (aPR 0.77, 95% CI: 0.63-0.92) doses of ART in the past month. Of 74 participants with PRRT and INT sequencing done, 60 (81.1%) had HIVDRMs at the following frequencies: 71.6%, 67.6%, 1.4%, and 4.1% for major NNRTI, NRTI, PI, and INSTI respectively. Higher rates of VS were observed in this cohort, and HIVDRMs were common in those without VS. This evidence supports ART optimization using dolutegravir-based regimens. However, better strategies to improve adherence are needed.

Evaluation of the Correlation Between Vitamin D Level and Insulin Resistance in Children with Overweight and Obesity

Aim: This study aimed to evaluate the relationship between vitamin D levels and insulin resistance parameters in children with overweight and obesity. Material and Methods: A total of 174 children, 64.4% (n=112) female, and 35.6% (n=62) male, aged between 6-17 years were included in the study. The participants were divided into three groups as normal (29.9%, n=52), overweight (23.6%, n=41), and obesity (46.5%, n=81) based on the criteria of the World Health Organization body mass index (BMI) classification. The insulin resistance status of the participants was evaluated by homeostatic model assessment of insulin resistance (HOMA-IR), fasting glucose to insulin ratio (FGIR), and quantitative insulin sensitivity check index (QUICKI). Results: HOMA-IR was found higher in the obesity group (3.2±2.1) compared to the overweight (2.2±1.0) and the normal weight (1.5±1.0) groups (p&amp;lt;0.001). It was observed that QUICKI values of the overweight (0.34±0.03) and the obesity (0.33±0.03) groups were lower than the normal weight (0.37±0.03) group (p&amp;lt;0.001). FGIR was noticed as higher in the normal weight (16.8±10.4) group compared to the overweight (10.6±6.0) and the obesity (8.5±5.5) groups (p&amp;lt;0.001). The mean serum 25-hydroxyvitamin D [25(OH)D] levels of the children and adolescents were 19.6±10.7 ng/mL, and no statistically significant difference was found between the groups (p=0.153). A significant weak negative correlation between serum 25(OH)D and HOMA-IR values was found (r=-0.170, p=0.025). Additionally, a weak positive statistically significant correlation was found between serum 25(OH)D level and QUICKI and FGIR values (r=0.173, p=0.022, and r=0.173, p=0.023, respectively). Conclusion: Vitamin D levels can affect insulin resistance parameters.

Correlation between ARID5B Gene SNP and MTX Resistance in Children with ALL

To investigate the correlation between single-nucleotide polymorphism (SNP) of ARID5B gene and resistance to methotrexate (MTX) in children with acute lymphoblastic leukemia (ALL). A total of 144 children with ALL who were treated in General Hospital of Ningxia Medical University from January 2015 to November 2021 were enrolled and divided into MTX resistant group and non-MTX resistant group, with 72 cases in each group. Matrix-assisted laser desorption/ionization time of flight mass spectrometry (MALDI-TOF MS) technology was used to measure the SNP of ARID5B gene in all children and analyze its correlation with MTX resistant. There were no significant differences in the genotype and gene frequency of rs7923074, rs10821936, rs6479778, and rs2893881 between MTX resistant group and non-MTX resistant group (P>0.05). The frequency of C/C genotype in the MTX resistant group was significantly higher than that in the non-MTX resistant group, while the frequency of T/T genotype was opposite (P<0.05). The frequency of C allele in the MTX resistant group was significantly higher than that in the non-MTX resistant group, while the frequency of T allele was opposite (P<0.05). Multivariate logistic regression analysis showed that ARID5B gene rs4948488 TT genotype and T allele frequency were risk factors for MTX resistant in ALL children (P<0.05). The SNP of ARID5B gene is associated with MTX resistant in ALL children.

Insulin Resistance in Children and the role of Endocrine-Disrupting Chemicals: Taking Stock of the Situation

The prevalence of non-communicable diseases, of which insulin resistance is a major constituent, among the pediatric population is exponentially increasing worldwide; this is causing a significant health burden, making understanding the basis of this phenomenon an issue of primary importance. During the last decades, we also observed that exposure to endocrine-disrupting chemicals is becoming more and more common; this has led researchers to investigate the mechanism of action and define the role of those substances in interfering with human metabolism and hormonal balance, especially at a young age. We reviewed the literature on prospective, epidemiological, and cross-sectional studies that have shown a link between exposure to pesticides, polychlorinated biphenyls, bisphenol A, phthalates, aromatic polycyclic hydrocarbons, or dioxins and insulin resistance; the strength of the associations varies between the substances and human biomonitoring studies have helped in defining the role of these chemicals. The number of prospective studies in children and even in adults is still low and heterogenous, still, evidence that Endocrine disruptors might be involved in the development of insulin resistance and related diseases is accumulating. This review aims to analyze the latest findings linking exposure to endocrine-disrupting chemicals with insulin resistance in children with the perspective of taking a cue for conducting new studies and identifying the most concerning Endocrine disruptors exposures, in order to guide future risk assessment and policy action aimed to limit the negative consequences of endocrine disrupting chemical exposure.

Trends in Bacterial Blood Culture Isolates and Resistance in Children in Two Microbiologic Eras from a Tertiary Health Facility in North East Nigeria

Trends in Bacterial Blood Culture Isolates and Resistance in Children in Two Microbiologic Eras from a Tertiary Health Facility in North East Nigeria

Handgrip Strength Is Associated with Metabolic Syndrome and Insulin Resistance in Children and Adolescents: Analysis of Korea National Health and Nutrition Examination Survey 2014-2018.

Reduced handgrip strength (HGS) is associated with adverse cardiometabolic health outcomes. We examined HGS, metabolic syndrome (MetS), and insulin resistance (IR) in children and adolescents. The following population-based data from 2,797 participants (aged 10-18 years) of the Korea National Health and Nutrition Examination Survey 2014-2018 were analyzed: complete anthropometric measures, HGS, MetS, and IR (subgroup with fasting insulin, n=555). HGS was analyzed as the combined HGS (CHGS) and the normalized CHGS (nCHGS=CHGS divided by body weight). At a mean age of 14.4 years, 276 participants (9.9%) had abdominal obesity, 56 (2.0%) had MetS, and 118 (20.9%) had IR. Individual components of MetS and IR were inversely associated with the nCHGS. The odds ratios (ORs) for MetS and IR decreased significantly with higher nCHGS after adjustment for sex, age, physical activity, and sedentary times. The optimal cut-off values that predicted MetS were 0.80 kg/kg (males) and 0.71 kg/kg (females), with significant associations with MetS (OR: 7.4 in males; 5.7 in females) and IR (OR: 3.3 in males; 3.2 in females) observed when nCHGS values were lower than those cut-offs. HGS is associated with MetS and IR and might be a useful indicator of cardiometabolic risk factors in children and adolescents.

Role of Prenatal Nutrition in the Development of Insulin Resistance in Children.

Nutrition during the prenatal period is crucial for the development of insulin resistance (IR) and its consequences in children. The relationship between intrauterine environment, fetal nutrition and the onset of IR, type 2 diabetes (T2D), obesity and metabolic syndrome later in life has been confirmed in many studies. The intake of carbohydrates, protein, fat and micronutrients during pregnancy seems to damage fetal metabolism programming; indeed, epigenetic mechanisms change glucose-insulin metabolism. Intrauterine growth restriction (IUGR) induced by unbalanced nutrient intake during prenatal life cause fetal adipose tissue and pancreatic beta-cell dysfunction. In this review we have summarized and discussed the role of maternal nutrition in preventing insulin resistance in youth.

The Effect of Healthy Lifestyle Strategies on the Management of Insulin Resistance in Children and Adolescents with Obesity: A Narrative Review.

Childhood obesity is characterized by an increased risk of several metabolic derangements including insulin resistance (IR). The strongest recommendations to prevent obesity and related complications are a balanced and adequate diet and practicing physical activity from early childhood. In this review, we propose to present the effects of healthy lifestyle strategies, including physical exercise and dietary approaches, on the management of IR and related metabolic derangements. All types of exercise (aerobic, resistance and combined training) effectively reduce IR in pediatric patients with obesity; it seems that aerobic and combined training stimulate greater improvements in IR compared to resistance training. Balanced normocaloric or hypocaloric dietary approaches are also valid strategies to address IR; it is not possible to assess the long-term impact of varying macronutrients on cardiometabolic risk. The glycemic index/load evaluation is a useful dietary approach to glucose metabolism control. Similarly, they should adopt the principle of the Mediterranean diet. Randomized studies with longer monitoring are needed to define the benefits of nutritional supplementation on IR. Considering that healthy style acquisition could track to later ages, programs of healthy lifestyle starting with children offer a better preventive strategy to preserve metabolic control and children's health.

Anthropometric and Metabolic Parameters to Detect Insulin Resistance in Children

Anthropometric and Metabolic Parameters to Detect Insulin Resistance in Children

High-Concentration Intravenous Immunoglobulin May Influence the Course of Fever and Rate of Reported Treatment Resistance in Children With Kawasaki Disease: A Single-Center Retrospective Analysis.

BackgroundIntravenous immunoglobulin (IVIG) resistance in patients with Kawasaki disease (KD) is defined as persistent or recrudescent fever ≥36 hours after IVIG infusion. We have experienced an increase in IVIG resistance in patients with KD since the substitution of 10% IVIG for 5% IVIG. This study aimed to determine the independent association between increased IVIG resistance and 10% IVIG therapy.MethodsMedical records of pediatric patients with KD were retrospectively reviewed. Clinical and laboratory characteristics were compared between patients receiving 5% IVIG therapy and those receiving 10% IVIG therapy. Between IVIG-responsive and IVIG-resistant patients, a multivariate analysis was performed to determine the independent factors for IVIG resistance.ResultsA total of 119 patients were included in this study: 81 (68.1%) and 38 (31.9%) patients received 5% and 10% IVIG therapy, respectively. IVIG resistance was identified in 34 (28.6%) patients: 44.7% of patients receiving 10% IVIG therapy and 21.0% of patients receiving 5% IVIG therapy (p = 0.008). The clinical manifestations and outcomes were comparable between patients who received 5% IVIG therapy and those who received 10% IVIG therapy. IVIG resistance was significantly associated with fewer fever days at IVIG administration (p = 0.032), a higher percentage of neutrophils (p = 0.013), and 10% IVIG treatment (p = 0.004) in the multivariate analysis.Conclusion10% IVIG therapy was significantly associated with increased reporting of IVIG resistance. However, the increase in patients with fever patterns consistent with IVIG resistance seemed to represent adverse febrile reactions resulting from using high-concentration IVIG rather than increased severity of KD.Supplementary InformationThe online version contains supplementary material available at 10.1007/s40272-022-00537-8.