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This clinical practice guideline for the diagnosis and treatment of acute bacterial arthritis (ABA) in children was developed by a multidisciplinary panel representing the Pediatric Infectious Diseases Society (PIDS) and the Infectious Diseases Society of America (IDSA). This guideline is intended for use by healthcare professionals who care for children with ABA, including specialists in pediatric infectious diseases and orthopedics. The panel’s recommendations for the diagnosis and treatment of ABA are based upon evidence derived from topic-specific systematic literature reviews.Summarized below are the recommendations for the diagnosis and treatment of ABA in children. The panel followed a systematic process used in the development of other IDSA and PIDS clinical practice guidelines, which included a standardized methodology for rating the certainty of the evidence and strength of recommendation using the GRADE approach (Grading of Recommendations Assessment, Development and Evaluation) (see Figure 1). A detailed description of background, methods, evidence summary and rationale that support each recommendation, and knowledge gaps can be found online in the full text.

Acute hematogenous musculoskeletal infections (MSKI) are medical emergencies with the potential for life-altering complications in afflicted children. Leveraging administrative data to study pediatric MSKI is difficult as many infections are chronic, nonhematogenous, or occur in children with significant comorbidities. The objective of this study was to validate a case-finding algorithm to accurately identify children hospitalized with acute hematogenous MSKI using administrative billing codes.This was a multicenter validation study using the Pediatric Health Information System (PHIS) database. Hospital admissions for MSKI were identified from 6 PHIS hospitals using discharge diagnosis codes. A random subset of admissions underwent manual chart review at each site using predefined criteria to categorize each admission as either “acute hematogenous MSKI” (AH-MSKI) or “not acute hematogenous MSKI.” Ten unique coding algorithms were developed using billing data. The sensitivity and specificity of each algorithm to identify AH-MSKI were calculated using chart review categorizations as the reference standard.Of the 492 admissions randomly selected for manual review, 244 (49.6%) were classified as AH-MSKI and 248 (50.4%) as not acute hematogenous MSKI. Individual algorithm performance varied widely (sensitivity 31% to 91%; specificity 52% to 98%). Four algorithms demonstrated potential for future use with receiver operating characteristic area under the curve greater than 80%.Identifying children with acute hematogenous MSKI based on discharge diagnosis alone is challenging as half have chronic or nonhematogenous infections. We validated several case-finding algorithms using administrative billing codes and detail them here for future use in pediatric MSKI outcomes.

Historically, wheat (Triticum aestivumL.) cultivars developed by the cooperative University of Nebraska–USDA‐ARS wheat improvement project were hard red winter wheat. With the expanding hard white wheat market, there is a greater emphasis on developing hard white winter wheat lines adapted to the Great Plains. ‘NW13493’ (tested as NW13493) (Reg. no. CV‐1197, PI 699380) was selected for its white kernels, agronomic performance, relevant disease resistances, and end‐use quality and is adapted to the central Great Plains. NW13493 was licensed to Bay State Milling Company on the basis of its superior agronomic and end‐use quality performance and also the need to ensure hard white wheat growers have a known market for their grain. NW13493 hard white winter wheat was released in February 2021 by the developing institutions and the licensee. NW13493 was a selection in 2013 from the cross ‘SD98W175‐1’/‘NW03666’, which was made in 2007. The pedigree of SD98W175‐1 is ‘KS84273BB‐10’/‘KSSB110‐9’//’KS831374‐141B’/‘YE1110’/3/ ‘KS82W418’/‘Stephens’ and the pedigree of NW03666 is ‘N94S097KS’/‘NE93459’. The F1generation was grown in the greenhouse in 2008, and the F2to F3generations were advanced as bulks at Mead, NE, in 2009–2010. NW13493 was evaluated in replicated trials beginning in 2014. It has excellent winter survival and agronomic performance, acceptable disease reactions to many of the common diseases in its target area, and good end‐use quality for bread making. NW13493 is a new white wheat cultivar adapted to the upper Great Plains.NW13493 has excellent agronomic performance and good disease resistance.The end‐use quality of NW13493 is very good, and it has been licensed to Bay State Milling Company.

Historically cultivars developed jointly by the University of Nebraska‐Lincoln and USDA‐ARS wheat (Triticum aestivumL.) improvement project tend to be late and better adapted to the northern Great Plains. LCS ‘Valiant’ (Reg. no. CV‐1196, PI 693223; tested as NE10478‐1) was released based on the merits of its earliness, agronomic performance, relevant disease resistances, and end‐use quality characteristics and its adaptation to the central Great Plains. As such, the line was licensed to Limagrain Cereal Seeds for their ability to market outside of Nebraska. LCS Valiant hard red winter wheat was released in March 2020 by the developing institutions and the licensee. NE10478‐1 was a selection in 2011 for uniformity and grain yield from NE10478, which was derived from the cross NI03418/‘Camelot’. The pedigree of NI03418 is W91‐248/NE95544 (=McVey 78015/NE88521)//‘Thunderbird’. The final cross of NE10478 was made in 2004. The F1generation was grown in Yuma, AZ, in 2005, and the F2to F3generations were advanced as bulks at Mead, NE, in 2006–2007 or sent for Hessian fly resistance screening by the USDA. In 2007, single F3‐derived F4rows were planted for selection. There was no further selection in NE10478 other than to remove off‐types thereafter until 2011 when heads were selected to increase uniformity. LCS Valiant was evaluated in replicated trials thereafter. It has excellent winter survival, acceptable reactions to many of the common diseases in its target area, and good end‐use quality for bread making. Valiant is an early hard red winter wheat adapted to the central Great Plains for dryland production. Valiant has excellent winter survival and stem rust resistance and good Hessian fly resistance. The end‐use quality for bread making of Valiant is very good.

Data on medium-term outcomes in indivduals with myocarditis after mRNA COVID-19 vaccination are scarce. We aimed to assess clinical outcomes and quality of life at least 90 days since onset of myocarditis after mRNA COVID-19 vaccination in adolescents and young adults.

‘Epoch’ (Reg. no. CV‐1195, PI 699379) hard red winter wheat (Triticum aestivumL.) was developed cooperatively by the Nebraska Agricultural Experiment Station and the USDA‐ARS and released in February 2021 by the developing institutions. It was selected from the cross ‘Hitch’/NW03666. The pedigree of NW03666 is N94S097KS/NE93459. The cross was made in 2009. The F1generation was grown in Yuma, AZ, in 2010, and the F2to F3generations were advanced using the bulk breeding method at Mead, NE, in 2010–2011 to 2011–2012. In 2012–2013, single F3‐derived F4rows were planted for selection. From 2015 on, Epoch was tested under rainfed or irrigated conditions in single replicate trials with replicated checks (2015) and in replicated alpha lattice trials (2015–2020). There was no further selection in Epoch other than to remove off‐types thereafter. Epoch was selected using both phenotypic and genomic selection for its ability to survive the winter, short stature with strong straw strength, agronomic performance under irrigation, resistance to diseases, and end‐use quality. Epoch seems to be narrowly adapted to irrigated production fields in Nebraska. The name Epoch was chosen because it marks the transition of leadership in the UNL Wheat breeding project from P. Stephen Baenziger to the new wheat breeder, Katherine A. Frels; hence, it marks the end of one era and the beginning of the next. Epoch is a new hard red winter wheat adapted to irrigated production in the central Great Plains.Epoch is not recommended for rainfed production unless the yield potential is similar to irrigated production.Epoch has superior straw strength, winter survival, and good disease resistance.The overall milling and baking aspects of Epoch should be acceptable to the respective industries.

In the emergency department at a university-associated children's hospital in Nashville, Tenn, investigators recently determined that 60% of all cutaneous Staphylococcus aureus infections treated there in 2003 were caused by [...]

IMPORTANCE: Childhood community-acquired pneumonia (CAP) is usually treated with 10 days of antibiotics. Shorter courses may be effective with fewer adverse effects and decreased potential for antibiotic resistance. OBJECTIVE: To compare a short (5-day) vs standard (10-day) antibiotic treatment strategy for CAP in young children. DESIGN, SETTING, AND PARTICIPANTS: Randomized double-blind placebo-controlled clinical trial in outpatient clinic, urgent care, or emergency settings in 8 US cities. A total of 380 healthy children aged 6 to 71 months with nonsevere CAP demonstrating early clinical improvement were enrolled from December 2, 2016, to December 16, 2019. Data were analyzed from January to September 2020. INTERVENTION: On day 6 of their originally prescribed therapy, participants were randomized 1:1 to receive 5 days of matching placebo or 5 additional days of the same antibiotic. MAIN OUTCOMES AND MEASURES: The primary end point was the end-of-treatment response adjusted for duration of antibiotic risk (RADAR), a composite end point that ranks each child’s clinical response, resolution of symptoms, and antibiotic-associated adverse effects in an ordinal desirability of outcome ranking (DOOR). Within each DOOR rank, participants were further ranked by the number of antibiotic days, assuming that shorter antibiotic durations were more desirable. Using RADAR, the probability of a more desirable outcome was estimated for the short- vs standard-course strategy. In a subset of children, throat swabs were collected between study days 19 and 25 to quantify antibiotic resistance genes in oropharyngeal flora. RESULTS: A total of 380 children (189 randomized to short course and 191 randomized to standard course) made up the study population. The mean (SD) age was 35.7 (17.2) months, and 194 participants (51%) were male. Of the included children, 8 were Asian, 99 were Black or African American, 234 were White, 32 were multiracial, and 7 were of unknown or unreported race; 33 were Hispanic or Latino, 344 were not Hispanic or Latino, and 3 were of unknown or unreported ethnicity. There were no differences between strategies in the DOOR or its individual components. Fewer than 10% of children in either strategy had an inadequate clinical response. The short-course strategy had a 69% (95% CI, 63-75) probability of a more desirable RADAR outcome compared with the standard-course strategy. A total of 171 children were included in the resistome analysis. The median (range) number of antibiotic resistance genes per prokaryotic cell (RGPC) was significantly lower in the short-course strategy compared with the standard-course strategy for total RGPC (1.17 [0.35-2.43] vs 1.33 [0.46-11.08]; P = .01) and β-lactamase RGPC (0.55 [0.18-1.24] vs 0.60 [0.21-2.45]; P = .03). CONCLUSIONS AND RELEVANCE: In this study, among children responding to initial treatment for outpatient CAP, a 5-day antibiotic strategy was superior to a 10-day strategy. The shortened approach resulted in similar clinical response and antibiotic-associated adverse effects, while reducing antibiotic exposure and resistance. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02891915.

This clinical practice guideline for the diagnosis and treatment of acute hematogenous osteomyelitis (AHO) in children was developed by a multidisciplinary panel representing Pediatric Infectious Diseases Society (PIDS) and the Infectious Diseases Society of America (IDSA). This guideline is intended for use by healthcare professionals who care for children with AHO, including specialists in pediatric infectious diseases, orthopedics, emergency care physicians, hospitalists, and any clinicians and healthcare providers caring for these patients. The panel’s recommendations for the diagnosis and treatment of AHO are based upon evidence derived from topic-specific systematic literature reviews. Summarized below are the recommendations for the diagnosis and treatment of AHO in children. The panel followed a systematic process used in the development of other IDSA and PIDS clinical practice guidelines, which included a standardized methodology for rating the certainty of the evidence and strength of recommendation using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach. A detailed description of background, methods, evidence summary and rationale that support each recommendation, and knowledge gaps can be found online in the full text.

Data from 1174 infants enrolled in a previous rotavirus vaccine study were analyzed to determine the effect of antibiotic exposure (from 14 days before to 7 days after vaccination) on rotavirus serum immunoglobulin A (IgA) responses. Serum IgA responses 1 month after the completion of vaccination were similar among antibiotic-exposed and nonexposed infants.

Staphylococcus aureus is among the most commonly identified causes of invasive bacterial infection in children; however, reliable results from cultures of sterile-site samples often cannot be obtained, which necessitates prescription of a broad empiric antimicrobial agent(s). Children with invasive S aureus infection rapidly generate high antibody titers to the cytotoxin LukAB; therefore, the aim of this study was to assess the diagnostic utility of an anti-LukAB antibody assay for children with musculoskeletal infection (MSKI).

We conducted a survey of pediatric infectious diseases providers in the Emerging Infections Network regarding the workup and treatment of children with Staphylococcus aureus bacteremia (SAB). We found significant practice variation in the management of children with SAB. These findings emphasize the need for further research to guide best practices.

The purpose of this study was to determine if a decolonization regimen reduces the frequency of methicillin-resistant Staphylococcus aureus (MRSA) infections and if colonization isolates are genetically related to subsequent infectious strains. Trauma patients admitted to the intensive care unit with positive MRSA nasal swabs were randomized to either daily chlorhexidine gluconate (CHG) baths and mupirocin (MUP) ointment to the nares or soap and water baths and placebo ointment for five days. Nasal swabs performed at the end of treatment and invasive MRSA infections during the remaining hospitalization were compared with the original nasal isolate via polymerase chain reaction for genetic relatedness as well as CHG and MUP resistance genes. Six hundred and seventy-eight intensive care unit admissions were screened, and 92 (13.6%) had positive (+) MRSA nasal swabs over a 22-month period ending in 3/2014. After the five day treatment period, there were 13 (59.1%) +MRSA second nasal swabs for CHG + MUP and 9 (90%) for soap and water baths and placebo, P = 0.114. No isolates tested positive for the MUP or CHG resistance genes mupA and qacA/B but 7 of 20 (35%) contained smr. There were seven (31.8%) MRSA infections in the CHG group and six (60%) for soap, P = 0.244. All 13 patients with MRSA infections had the same MRSA isolate present in the original nasal swab. There was no difference in all-cause Gram-negative or positive infections for CHG versus soap, 12 (54.5%) versus 7 (70%), P = 0.467. CHG + MUP are ineffective in eradicating MRSA from the anterior nares but may reduce the incidence of infection. Subsequent invasive MRSA infections are typically caused by the endogenous colonization strain.

Chronic granulomatous disease (CGD), a disease characterized by inadequate neutrophil killing of microbial pathogens, affects 4 to 5 per million live births. For many decades following its description, CGD was a fatal disease in childhood. With the development of effective preventive therapies and the early recognition of infectious complications, 90% of children with CGD now survive into adulthood. The management of CGD in adults includes unique challenges and potential disease manifestations. In this article, the authors discuss the current approach to the management of CGD in both children and adults. This includes a focus on the importance of a comprehensive multidisciplinary approach in the care of CGD and its potential complications. In addition, a novel approach to improving education about CGD, and subsequently improving adherence to preventive therapies, is discussed.

ObjectiveThe characteristics of staphylococcal skin and soft tissue infections (SSTIs) are poorly understood in northern South America and the Caribbean. The objectives of this study were to determine the frequency of methicillin resistance among Staphylococcus aureusisolates in an emergency department (ED) in Guyana and to identify specific molecular characteristics of these methicillin-resistant Staphylococcus aureus(MRSA) strains.MethodsThis was a cross-sectional study conducted at the main teaching hospital in Georgetown, Guyana. Eligible subjects included patients of all ages with SSTIs with obtainable purulent material. Purulent material was cultured, and S. aureusisolates were evaluated for antibiotic susceptibilities by disc diffusion. Molecular characterisation of MRSA isolates included identification of SCCmectype, assignment of genetic relatedness by rep-PCR and determination of the presence of two exotoxins, Panton-Valentine Leukocidin (PVL) and LukAB.ResultsEighty-five samples were collected; of these, 47 grew S. aureus.24 of the 47 S. aureussamples were MRSA (51%; 95% CI 37% to 65%), representing 28% of all samples. All MRSA isolates were SCCmectype IV, PVL positive, LukAB positive and were highly related to the current epidemic clone in the USA, USA300.ConclusionsHere, we demonstrate a clinically significant proportion of methicillin resistance in SSTI-associated staphylococcal isolates. Guyanese isolates were highly related to the most common community-associated strain seen in the USA, USA300. These results have important implications for empiric antibiotic therapy and infection control policies in Guyana and similar settings.

ABSTRACTThe adjuvant AS03 is stockpiled for future formulations with new and existing vaccines for the control of pandemic influenza virus. We previously reported the immunogenicity of an A/H5N1 vaccine extemporaneously mixed with the AS03 adjuvant for 42 days following vaccination. This report extends those findings to 1 year after vaccination.

Staphylococcus aureusinfections pose a significant health burden. The emergence of community-associated methicillin-resistant S aureushas resulted in an epidemic of skin and soft tissue infections (SSTI), and many patients experience recurrent SSTI. As S aureuscolonization is associated with subsequent infection, decolonization is recommended for patients with recurrent SSTI or in settings of ongoing transmission. S aureusinfections often cluster within households, and asymptomatic carriers serve as reservoirs for transmission; therefore, a household approach to decolonization is more effective than measures performed by individuals alone. Novel strategies for the prevention of recurrent SSTI are needed.

Clostridium difficile, a common cause of antibiotic-associated diarrhea, has been reported to recur in high rates in adults. The rates and risk factors for recurrent C difficileinfection (rCDI) in children have not been well established.

As the influenza A H1N1 pandemic emerged in 2009, children were found to experience high morbidity and mortality and were prioritized for vaccination. This multicenter, randomized, double-blind, age-stratified trial assessed the safety and immunogenicity of inactivated influenza A(H1N1)pdm09 vaccine in healthy children aged 6 months to 17 years.

Malaria results in over 650 000 deaths each year; thus, there is an urgent need for an effective vaccine. Pre-clinical studies and recently reported human trials suggest that pre-erythrocytic stage vaccines can provide protection against infection. A Phase 1, randomized, placebo-controlled, dose-escalation study was conducted with a vaccine composed of a replication-deficient adenovirus-35 backbone with P. falciparumcircumsporozoite (CS) surface antigen (Ad35.CS.01). Healthy adult subjects received three doses of 108, 109, 1010, or 1011vp/mL Ad35.CS.01 vaccine or saline placebo intramuscularly at 0, 1, and 6-mo intervals. Adverse events were assessed and anti-CS antibody responses were determined by ELISA. Seventy-two individuals were enrolled, with age, gender, and ethnicity similar across each study arm. While the vaccine was generally well tolerated, adverse events were more frequent in the highest dose groups (1010and 1011vp/mL). More robust humoral responses were also noted at the highest doses, with 73% developing a positive ELISA response after the three dose series of 1011vp/mL. The Ad35.CS.01 vaccine was most immunogenic at the highest dosages (1010and 1011vp/mL). Reactogenicity findings were more common after the 1011vp/mL dose, although most were mild or moderate in nature and resolved without therapy.

ABSTRACTDespite the importance of Staphylococcus aureusas a common invasive bacterial pathogen, the humoral response to infection remains inadequately defined, particularly in children. The purpose of this study was to assess the humoral response to extracellular staphylococcal virulence factors, including the bicomponent leukotoxins, which are critical for the cytotoxicity of S. aureustoward human neutrophils. Children with culture-proven S. aureusinfection were prospectively enrolled and stratified by disease type. Fifty-three children were enrolled in the study, of which 90% had invasive disease. Serum samples were obtained during the acute (within 48 h) and convalescent (4 to 6 weeks postinfection) phases, at which point both IgG titers against S. aureusexotoxins were determined, and the functionality of the generated antibodies was evaluated. Molecular characterization of clinical isolates was also performed. We observed a marked rise in antibody titer from acute-phase to convalescent-phase sera for LukAB, the most recently described S. aureusbicomponent leukotoxin. LukAB production by the isolates was strongly correlated with cytotoxicity in vitro, and sera containing anti-LukAB antibodies potently neutralized cytotoxicity. Antibodies to S. aureusantigens were detectable in healthy pediatric controls but at much lower titers than in sera from infected subjects. The discovery of a high-titer, neutralizing antibody response to LukAB during invasive infections suggests that this toxin is produced in vivoand that it elicits a functional humoral response.

To define the molecular epidemiology of colonization and disease-associated isolates of community-associated methicillin-resistant Staphylococcus aureus(CA-MRSA).

OBJECTIVE To determine the frequency and clinical importance of methicillin-resistant Staphylococcus aureus (MRSA) colonization in student athletes. DESIGN Prospective observational cohort study. SETTING A major university in the southeastern United States. PARTICIPANTS Student athletes participating in the men's football and women's lacrosse programs (N = 126). MAIN EXPOSURE Monthly assessment of S aureus nasal colonization. MAIN OUTCOME MEASURES Trends in S aureus colonization over time and the occurrence of skin and soft tissue infections. RESULTS Methicillin-resistant S aureus nasal colonization varied significantly through the athletic season (4%-23%), peaking during times of highest athletic activity. This increase in colonization was not associated with the development of an outbreak of skin and soft tissue infections, and no single MRSA clone emerged as a dominant isolate. CONCLUSIONS During the athletic season, there is a considerable burden of MRSA colonization in student athletes; however, colonization alone appears to be insufficient to trigger an outbreak of staphylococcal infections. A combination of distinct molecular characteristics in the organism and specific host factors may govern the development of staphylococcal disease.Arch Pediatr Adolesc Med. 2010;164(7):615-620--

Staphylococcus aureusis an important pathogen, contributing to both pediatric and adult infections in the USA. In recent years, methicillin-resistant Staphylococcus aureus(MRSA) has become a source of public fear and outcry. In this article, we review facts and fiction of sinonasal MRSA.

Multisystem inflammatory syndrome in children (MIS-C) is a hyperinflammatory condition associated with antecedent SARS-CoV-2 infection. In the USA, reporting of MIS-C after vaccination is required under COVID-19 vaccine emergency use authorisations. We aimed to investigate reports of individuals aged 12–20 years with MIS-C after COVID-19 vaccination reported to passive surveillance systems or through clinician outreach to the US Centers for Disease Control and Prevention (CDC).

Pediatric cases of fulminant community-associated methicillin-resistant Staphylococcus aureus(MRSA) infections requiring extracorporeal life support (ECLS) have been reported, but the frequency of ECLS use for severe presentations of staphylococcal disease is unknown.

With the emergence of combinatorial chemistry, whether based on parallel, mixture, solution, or solid phase chemistry, it is now possible to generate large numbers of diverse or focused compound libraries. In this paper we aim to demonstrate that it is possible to design targeted libraries by applying nonparametric statistical methods, recursive partitioning in particular, to large data sets containing thousands of compounds and their associated biological data. Moreover, when applied to an experimental high-throughput screening (HTS) data set, our data strongly suggest that this method can improve the hit rate of our primary screens (about 4- to 5-fold) while increasing screening efficiency:  less than one-fifth of the complete selection needs to be screened in order to identify about 75% of all actives present.

We collected all Staphylococcus aureusisolates from the National Children’s Hospital in Costa Rica to evaluate the prevalence and molecular epidemiology of methicillin-resistant Staphylococcus aureus(MRSA). Of 299 S. aureusisolates, 61 were MRSA. Most MRSA isolates (94.5) carried SCCmecIV, and 45.6 carried Panton-Valentine leukocidin-encoding genes. The high prevalence of MRSA in this population highlights the need for improvement of antibiotic prescription and infection control measures.

We describe a patient who presented at 9 years of age with oral ulcers and cutaneous lesions, meeting diagnostic criteria for Behçet disease. At 11 years of age, she developed infectious complications and was proven to have chronic granulomatous disease, with characterization of the specific genetic mutation. We review available literature regarding overlap of these symptom complexes leading to delay in securing this important diagnosis. This is the second reported case of chronic granulomatous disease mimicking Behçet disease, and the first report to include identification of the specific genetic mutation of the nicotinamide adenine dinucleotide phosphate oxidase complex.

This study examined the frequency and types of complications with peripherally inserted central catheters (PICCs) placed in immunocompetent pediatric patients for parenteral antimicrobial therapy. It also sought to determine risk factors associated with those complications. Complications occurred at a frequency of 19.31000 PICC days, and greater than 30 of PICCs developed at least one complication. Risk factors for complication include double-lumen PICCs, PICCs placed in the femoral vein, younger age, and greater number of daily doses.

This study examined the characteristics of culture-negative osteoarticular infections (OAIs) during the emergence of methicillin-resistant Staphylococcus aureus. Culture-negative OAIs were mild compared with culture-positive infections, especially those caused by methicillin-resistant Staphylococcus aureus. Despite no increase in severity during the study period, the duration of parenteral antibiotics for children with culture-negative OAIs more than tripled in 2004–2008 compared with 2002–2003.

The pursuit of an effective staphylococcal vaccine has never been more critical, as community-associated MRSA has become the most common bacterial infection in the US. In this commentary, we will highlight new discoveries in the host response to colonization and infection with S. aureus, discuss potential antigens that might be used as vaccines, and make recommendations as to how the field can move forward towards discovering the "holy grail" of an effective staphylococcal vaccine.

Methicillin-resistant Staphylococcus aureusisolates with vancomycin minimal inhibitory concentrations (MICs) ≥1.5 g/mL have been associated with poorer clinical outcomes and treatment failures in adults. We evaluated vancomycin MICs in 71 invasive pediatric community-acquired MRSA isolates from 2004 to 2008, using the E-test micromethod and the E-test macro-method. The modal MIC by micromethod was 1.5 g/mL, and median vancomycin MICs did not increase over time.

There are currently no clear consensus recommendations for the treatment and prevention of community-associated methicillin-resistant Staphylococcus aureusskin and soft tissue infections in pediatric patients. We surveyed over 100 Pediatric Infectious Diseases consultants and found considerable variability in both the treatment of skin and soft tissue infections and the strategies used for the management of children with recurrent MRSA disease.

ABSTRACTThe pathogenesis of Staphylococcus aureusis mediated by an array of important virulence factors, including the two-component leukocidin family of toxins. LukAB (also known as LukGH), the most recently discovered leukocidin, is potently lethal to phagocytes, produced during invasive human disease, and present in all known clinical isolates of S. aureus. Intravenous immunoglobulin (IVIg) is often used clinically in severe S. aureusinfections. The primary aim of this study was to assess the binding and neutralization potential of IVIg against LukAB. A secondary aim was to examine the lot-to-lot variability of IVIg in the binding and neutralization of LukAB. We studied 24 distinct lots of IVIg and compared them to serum from children with invasive S. aureusinfection (in the acute and convalescent phases) and from healthy, uninfected controls. We found that all lots of IVIg contained functional antibodies targeting LukAB. After adjusting for total antibody content per sample, we found that the amount of anti-LukAB antibody in IVIg was similar to that seen with healthy controls and less than that seen with patients with invasive S. aureusinfection. IVIg samples had lower neutralization capacity than samples from healthy controls and children with invasive infection. IVIg had remarkably little lot-to-lot variation in LukAB binding but had significantly more variation in toxin neutralization. These results represent the first report of functional antibodies against the important S. aureusleukocidin LukAB in IVIg. Given the frequent clinical use of IVIg for severe S. aureusinfections, improving our understanding of functional antibody properties exhibited by this therapeutic is essential.

Background Staphylococcus aureus is the leading cause of skin and soft tissue infections in the United States, and S. aureus colonization increases the risk of infection. Although athletes have a higher risk of infection with S. aureus than the general population, most studies in athletes have not assessed colonization. Methods We conducted a prospective cohort study of Vanderbilt University varsity athletes from August 2008 to April 2010. We assessed nasal and oropharyngeal colonization with methicillin-susceptible S. aureus (MSSA) and methicillin-resistant S. aureus (MRSA) strains by obtaining swabs at enrollment and monthly thereafter until the end of the study. The athletes were also monitored for skin and soft tissue infections. Results We enrolled 377 athletes and trainers (224 in contact sports and 153 in noncontact sports). The total S. aureus colonization prevalence ranged from 34% to 62%, and for MRSA it ranged from 8% to 29%. The colonization rate in the summer was significantly higher than that in the winter (odds ratio for MRSA [ORMRSA], 1.70 [95% confidence interval (CI), 1.23–2.35]; ORMSSA, 1.38 [95% CI, 1.05–1.82]). Of 603 MRSA isolates, 75% carried the staphylococcal cassette chromosome mec (SCCmec) type IV, and 5% carried the genes encoding Panton-Valentine leukocidin. Nine symptomatic S. aureus infections occurred, 7 of which were between July and September. Conclusions The S. aureus colonization rate is higher than previously reported and fluctuated over time in this prospective cohort of athletes. The higher colonization prevalence during summer might explain the infectious outbreak during the summer months and may represent a key intervention time for preventing S. aureus disease in athletes.

Therapeutics blocking the activity of tumor necrosis factor (anti-TNF) are a risk factor for invasive fungal infections; however, infectious risks to infants born to mothers receiving anti-TNF therapy are not well defined. We report a case of vertical transmission of disseminated histoplasmosis in a mother-infant pair exposed to anti-TNF therapy.

The article presents the poem "June 22, 1969 June 27, 1969," by C. Cleo Creech. First Line: A partial Filmography: Last Line: We will never go back.