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Background Levofloxacin prophylaxis (LVXp) is often used for patients with underlying leukemia and severe neutropenia to reduce the risk of fever and bacteremia. This study evaluated trends in viridans group streptococci (VGS) antibiotic susceptibilities over time and clinical outcomes of children with VGS bloodstream infections (BSIs) during institutional adoption of LVXp. Methods VGS blood culture isolates between 1/1/2010 and 12/31/2021 with susceptibility testing reported were included. Available isolates were re-identified to the species level and additional susceptibility testing was performed. Demographic and clinical data were abstracted from medical records. Results A total of 264 VGS BSI isolates were identified in immunocompromised (IC, n = 125) and non-immunocompromised subjects, (non-IC, n = 139). IC subjects had lower rates of VGS isolates susceptible (S) to LVX and higher minimum inhibitory concentration (MICs) to LVX (p = 0.004) and ciprofloxacin (p = 0.0005) compared with non-IC subjects. No other evaluated antibiotic had increased MICs in either group. Fifteen of 19 (74%) LVX not susceptible (NS) isolates occurred in IC subjects, 13 represented breakthrough infections. IC subjects had higher rates of VGS-related shock (p = 0.012), need for pressor support (p = 0.039), and longer duration of hospitalization than non-IC subjects (p < 0.001). Clinical outcomes were comparable between subjects with LVX S and NS VGS BSI isolates. Conclusions VGS with reduced susceptibility to LVX emerged during institutional adoption of LVXp in high-risk children with immunocompromising conditions, but did not result in significant differences in clinical outcomes. Ongoing surveillance and susceptibility testing are critical in weighing the utility of LVXp against emerging antimicrobial resistance in this high-risk population. [ABSTRACT FROM AUTHOR]

Background Few studies have focused on the immune response to more recent influenza vaccine formulations such as cell-cultured inactivated influenza vaccine (ccIIV4) or live-attenuated influenza vaccine (LAIV4) in older children and young adults, or differences in immunoglobulin response using newer antibody landscape technology. Methods Participants ages 4–21 were randomized to receive ccIIV4 (n = 112) or LAIV4 (n = 118). A novel high-throughput multiplex influenza antibody detection assay was used to provide detailed IgG, IgA, and IgM antibody isotypes, along with hemagglutination inhibition levels (HAI), measured pre- and 28 days post-vaccination. Results The HAI and immunoglobulin isotype response to ccIIV4 was greater than LAIV4, with significant increases in IgG but not IgA or IgM. The youngest participants had the highest LAIV4 response. Prior LAIV4 vaccination was associated with a higher response to current season ccIIV4. Cross-reactive A/Delaware/55/2019(H1N1)pdm09 antibodies were present pre-vaccination and increased in response to ccIIV4, but not LAIV4. Immunoglobulin assays strongly correlated with and confirmed the findings of HAI titers to measure immune response. Conclusions Age and prior season vaccination may play a role in the immune response in children and young adults to ccIIV4 and LAIV4. While immunoglobulin isotypes provide high-level antigen-specific information, HAI titers alone can provide a meaningful representation of day 28 post-vaccination response. Clinical Trials No NCT03982069 [ABSTRACT FROM AUTHOR]

Clostridioides difficile infection (CDI) among children remains a concerning cause of morbidity in hospital settings. We present epidemiological and molecular trends in healthcare- and community-associated CDI among children in Canadian inpatient and outpatient settings, including those who experienced recurrent infections. [ABSTRACT FROM AUTHOR]

We surveyed pediatric infectious disease physicians through the Infectious Disease Society of America's Emerging Infections Network regarding the diagnosis and management of encephalitis. We identified practice variations, particularly with the use of new diagnostic modalities and management of autoimmune encephalitides. These findings may inform the creation of updated management guidelines. [ABSTRACT FROM AUTHOR]

Background Suppurative intracranial complications of sinusitis are rare events in children and can lead to harmful neurologic sequelae and significant morbidity. We sought to review the presentation and management of patients admitted at our hospital with these conditions. Methods This was a retrospective study of pediatric patients admitted to a quaternary children's hospital from 2007 to 2019 for operative management of sinusitis with intracranial extension. Clinical characteristics, including surgical and microbiological data, were collected and analyzed. Results Fifty-four patients were included; the median age was 11.0 years, and there was a male predominance. Eighty-nine percent of patients had prior healthcare visits for the current episode of sinusitis; 46% of patients had an abnormal neurologic exam on admission. Epidural abscess and subdural empyema were the most common complications, and subdural empyema was associated with repeat surgical intervention. The dominant pathogens were Streptococcus anginosus group organisms (74%). The majority of patients completed treatment parenterally, with a median duration of therapy of 35 days. Neurological sequelae, including epilepsy or ongoing focal deficits, occurred in 22% of patients. History of seizure or an abnormal neurological exam at admission were associated with neurological sequelae. Conclusions Clinicians should consider intracranial complications of sinusitis in patients with symptoms of sinusitis for >1 week. Patients should undergo urgent neuroimaging, as neurosurgical intervention is essential for these patients. Subdural empyema was associated with repeat neurosurgical intervention. Neurological sequelae occurred in 22% of patients, and new onset seizure or an abnormal neurological exam at admission were associated with neurological sequelae. [ABSTRACT FROM AUTHOR]

Background Rhinovirus (RV) is one of the most common viral etiologies of acute respiratory infection (ARI)—the leading infectious cause of mortality in young children. Multiple respiratory viruses may be detected with RV in children with ARI, but the clinical significance of viral co-detection is unclear. We aimed to compare the clinical characteristics and outcomes of children with ARI associated with RV-only detection or RV co-detection. Method We conducted a prospective viral surveillance study (11/2015–7/2016) in Nashville, Tennessee. Children <18 years old who presented to the emergency department (ED) or were hospitalized with fever and/or respiratory symptoms of <14 days duration were eligible if they resided in one of nine selected counties in Middle Tennessee. Demographics and clinical characteristics were collected by parental interviews and medical chart abstractions. Nasal and/or throat specimens were collected and tested for RV, RSV, metapneumovirus, adenovirus, parainfluenza 1–4, and influenza A–C using real-time reverse transcriptase polymerase chain reaction assays. We compared clinical characteristics and outcomes of children with RV-only detection or RV co-detection using Pearson's χ2 test for categorical variables and linear regression with robust standard errors for continuous variables. Results Of 1,250 children who were enrolled, 904 (72.3%) were positive for at least one virus. RV was detected in 406 virus-positive children (44.9%), of whom 117 (28.8%) had RV co-detection. The most common RV co-detection pair was RV/RSV (n=36). The mean age of children with RV co-detection was lower than those with RV-only detection (2.6 ± 2.7 years vs. 4.3 ± 4.4 years; p<0.001). The signs and symptoms of children with RV-only detection and those with RV co-detection are compared in Table 1. A total of 283 children with RV were discharged from the ED (69.7%), of whom 89 (31.4%) had RV co-detection. Children with RV co-detection who were discharged from the ED were less likely to have a diagnosis of asthma/reactive airway disease (RAD) than those with RV-only detection (10.1% vs. 21.6%; p=0.019) but more likely to be diagnosed with bronchiolitis (18.0% vs. 1.5%; p<0.001). Of the 123 hospitalized children with RV, 28 (22.8%) had RV co-detection. Hospitalized children with RV co-detection were less likely to have an admission diagnosis of asthma/RAD than those with RV-only detection (7.1% vs. 43.2%; p<0.001) but more likely to be diagnosed with bronchiolitis (32.1% vs. 14.7%; p=0.038) and pneumonia (32.1% vs. 8.4%; p<0.001). We did not identify differences in hospitalization, intensive care unit admission, supplemental oxygen use, or length of stay between children with RV-only detection and RV co-detection. Conclusion We did not find evidence that RV co-detection was associated with worse outcomes in children with ARI. However, the clinical presentation of children with RV co-detection differs from that of children with RV-only detection. These distinctions warrant consideration in the diagnostic evaluation and management of RV-positive children. Further studies are needed to describe the distinct clinical presentations of RV/non-RV pairs and RV species. [ABSTRACT FROM AUTHOR]