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Prolonged positive polymerase chain reaction (PCR) results, irrespective of the transmission risk, can lead to prolonged restrictions on daily activities and infection precaution interventions. Studies evaluating the duration of PCR positivity for multiple pathogens in a single patient cohort are scarce. This study aimed to evaluate and compare the durations of PCR positivity for multiple respiratory viruses among children and adolescents. This retrospective study was conducted between April 2018 and March 2024 using a multiplex PCR respiratory panel for symptomatic children and adolescents who had at least two tests within 90 days of study period, with the first PCR test positive. The rate and likelihood of persistent PCR positivity were evaluated for multiple respiratory viruses. For 1325 positive results, repeat tests were conducted within 90 days. The persistent PCR positivity rate at repeat testing decreased over time (60.6%, Days 1–15 and 21.7%, Days 76–90, after the first test). In multivariate logistic regression analysis, an increased likelihood of persistent PCR positivity was observed for rhinovirus/enterovirus and adenovirus, whereas decreased likelihood of persistent positivity was seen in influenza and seasonal coronaviruses, compared with parainfluenza viruses. Persistent PCR positivity is common for multiple respiratory viruses in symptomatic children. [ABSTRACT FROM AUTHOR]

Background: Solid‐organ transplant recipients are at increased risk of developing human papillomavirus‐related diseases. Methods: To evaluate the immunogenicity of a quadrivalent vaccine, a prospective observational study included females aged 12–19 years who had received kidney or liver transplants, or were otherwise healthy volunteers. With the three‐dose vaccination, serum antibodies were measured. Results: The study included 17 transplant recipients (seven kidney and 10 liver) and 16 healthy participants. Six of seven kidney transplant recipients were on three immunosuppressive medications, whereas 9 of the 10 liver transplant recipients were on one. For the serology within 6 months from the last vaccine dose, the geometric mean titers of human papillomavirus types 6, 11, 16, and 18 were 26.7, 8.6, 35.7, and 42.4 (kidney transplant); 579.2, 569.3, 3097.3, and 835.7 (liver transplant); and 860.5, 638.8, 4391.6, and 902.6 milli‐Merck Units/ml (healthy). The seropositivity rates of kidney transplant recipients for the four serotypes ranged from 50% to 75%, while all liver transplant recipients and healthy participants had 100% seropositivity rates for all four types. While there were no statistical differences of titers between liver transplant recipients and healthy participants, the titers of kidney transplant recipients were lower than those of healthy participants for type 6 (p =.034), type 11 (p =.032), and type 16 (p =.032). Conclusions: The results support the recommendation of human papillomavirus vaccination in pediatric transplant recipients given the significant risk of human papillomavirus‐related diseases in this population, though immunogenicity was lower in kidney transplant recipients on multiple immunosuppressive medications. [ABSTRACT FROM AUTHOR]

Congenital cytomegalovirus infection is the most common congenital infection. Using a decision tree model, cost‐effectiveness of maternal screening with subsequent prenatal valacyclovir treatment and newborn screening with neonatal valganciclovir treatment was evaluated. The incremental cost‐effectiveness ratio (ICER) was calculated for (1) universal maternal antibody screening with prenatal valacyclovir treatment compared to targeted newborn screening, and (2) universal newborn screening with postnatal valganciclovir treatment compared to targeted newborn screening. We performed a one‐way sensitivity analysis. Compared to targeted newborn screening, the ICERs for universal newborn screening and maternal screening were 2 966 296 Japanese Yen (JPY) (21 188 USD) and 1 026 984 JPY (7336 USD), respectively. In all scenarios in the one‐way sensitivity analysis, the ICERs of the maternal screening and the universal newborn screening strategies were less than three gross domestic product per capita compared with the targeted newborn screening strategy. Both maternal and universal newborn screening strategies may be cost‐effective than a targeted newborn screening program. The potential utility of the maternal screening with valacyclovir treatment strategy, while potentially cost effective in regions with lower baseline seroprevalence rates, requires further study as the modeling was based on limited evidence. [ABSTRACT FROM AUTHOR]

Background: Solid organ transplant (SOT) recipients are at increased risk of severe outcomes associated with antimicrobial resistance (AMR). Antimicrobial stewardship programs (ASPs) play a vital role in mitigating the negative impacts of AMR. Pediatric evidence regarding ASP for SOT recipients is scarce, although many pediatric SOT centers have implemented different forms of ASP. Methods: This article summarized the available evidence relating to AMR among pediatric SOT recipients and discussed key strategies for the successful implementation of ASP among this population. The focus is primarily on antibacterial and secondarily on antifungal management. Results: The development of multidisciplinary antimicrobial stewardship teams for pediatric SOT recipients is essential for successful stewardship implementation. Key stakeholders may include but are not limited to SOT recipients and their caregivers, primary SOT teams (transplant physicians, transplant pharmacists, transplant unit nurses, and transplant outpatient care team), transplant surgery teams, transplant infectious diseases teams, hospital AST, microbiology teams, infection prevention teams, quality improvement teams, and information technology teams. Conclusion: As the evidence for optimal ASP in pediatric SOT is still evolving, it is important to measure the impact of implemented interventions. [ABSTRACT FROM AUTHOR]

The challenge of evaluating of SARS-CoV-2 antibody responses among vaccinated transplant patients Keywords: Antibody; COVID-19; Immunogenicity; SARS-CoV-2; Solid organ transplant EN Antibody COVID-19 Immunogenicity SARS-CoV-2 Solid organ transplant 1 3 3 08/16/22 20220901 NES 220901 Abbreviations COVID-19 coronavirus disease 2019 SARS-CoV-2 severe acute respiratory syndrome coronavirus 2 SOT solid organ transplant INTRODUCTION Data on the immunogenicity of the COVID-19 vaccines among SOT recipients are required to formalize COVID-19 vaccine recommendations for this immunocompromised population. Nucleocapsid antibody testing is recommended to evaluate the evidence of prior infection among vaccinated populations.7 Current vaccines only produce spike protein antibody responses, while both spike protein and nucleocapsid antibody responses are seen during SARS-CoV-2 infection. [Extracted from the article]

SOT recipients are more vulnerable to infections with antimicrobial‐resistant organisms, and therefore, it may be useful for transplant centers to create transplant‐specific antibiograms to direct empirical antimicrobial regimens and monitor trends in antimicrobial resistance. SOT‐specific antibiograms were created using antimicrobial susceptibility data on isolates from 2012 to 2018 at The Hospital for Sick Children, Toronto, Ontario, Canada. The CLSI guidelines were followed to generate the antibiograms except that results from 2 years of data were pooled on a rolling basis to achieve larger sample sizes. The 3 most frequent organisms in one analysis period of the SOT antibiogram were Escherichia coli (average sample size ±standard deviation; n = 28.7 ± 3.8), Staphylococcus aureus (n = 27.8 ± 5.0), and Pseudomonas aeruginosa (non‐CF) (n = 19.8 ± 8.8). For E.coli, susceptibilities in the SOT antibiogram were significantly lower than those in the hospital‐wide antibiogram in 2017–2018 for ampicillin (27% vs 47%; p =.014), piperacillin/tazobactam (55% vs 88%; p <.001), cefotaxime (59% vs 89%; p <.001), ciprofloxacin (71% vs 88%; p =.007), and trimethoprim‐sulfamethoxazole (41% vs 69%; p =.001), but not significantly different for aminoglycosides and meropenem. In the SOT antibiogram of E. coli, decreased susceptibility trend was confirmed in some antibiotics, including piperacillin/tazobactam (83% in 2012–2013 vs 55% in 2017–2018). At our center, the solid organ transplant–specific antibiogram revealed important differences in E. coli susceptibilities and trends in antimicrobial resistance. Developing a SOT antibiogram will assist in revising and improving empiric treatment guidelines as well as monitoring antimicrobial resistance in this population. [ABSTRACT FROM AUTHOR]

Emerging evidence has shown that the risk of developing COVID-19 in SOT recipients following non-lung transplantation from SARS-CoV-2 positive donors appears to be low in adults, with the transmission of SARS-CoV-2 from positive donors having only been reported in lung transplant recipients. Conclusions regarding the broad use of organs from SARS-CoV-2-positive donors remain limited, and a careful case-by-case evaluation of the donor and recipient with individualized risk stratification is still needed in the pediatric population. Abbreviations COVID-19 coronavirus disease 2019 C t cycle threshold OPTN Organ Procurement and Transplantation Network PCR polymerase chain reaction SARS-CoV-2 severe acute respiratory syndrome coronavirus 2 SOT solid organ transplantation COVID-19 has had an undeniable impact on the transplant population, including with regards to organ allocation. [Extracted from the article]

Background: C‐reactive protein (CRP) has limited placental transportability. Relying on CRP level in umbilical cord blood alone is an inaccurate way to predict early onset neonatal sepsis, and we retrospectively reviewed the clinical courses of neonates with elevated CRP in umbilical cord blood. Methods: This study was a retrospective case review of neonates with elevated CRP in umbilical cord blood (>0.5 mg/dL) in the Nara Prefecture General Medical Center, Nara, Japan between February 2013 and August 2017. We investigated the association of maternal and neonatal factors with neonatal clinical course. Then, we compared the cases of neonates with and without elevated CRP in umbilical cord blood. Results: The subjects consisted of a total of 22 neonates with elevated CRP in umbilical cord blood and 344 neonates without elevated CRP in umbilical cord blood. Of the 22 neonates with elevated CRP, 18 had some symptoms of sepsis at birth, but the symptoms of 85% of the symptomatic patients resolved ≤24 h after birth. Two neonates with elevated CRP in umbilical cord blood had bacteremia, and they had poor prognoses. Elevated CRP in umbilical cord blood was associated with length of antimicrobials (P = 0.021), immature/total neutrophil ratio (P = 0.017), and pathological chorioamnionitis (CAM; P = 0.028) on multivariable logistic regression analysis. Conclusion: Elevated CRP in umbilical cord blood was associated with pathological CAM. Most symptoms of sepsis resolved <24 h after birth. [ABSTRACT FROM AUTHOR]

Abstract: Background: Admission to the neonatal intensive care unit (NICU) due to respiratory distress is determined according to subjective clinician judgement. We investigated prenatal factors predictive of NICU admission in neonates with respiratory distress. Methods: This case–control study was conducted at Nara Prefecture General Medical Center, Nara, Japan, from February 2013 to April 2017 and included neonates with birthweight ≥2,000 g, ≥36 weeks of gestational age, who required oxygen due to respiratory distress at birth. The cases consisted of neonates admitted to the NICU, and the control group consisted of neonates who did not require NICU admission. Perinatal factors between the groups were compared, and multivariate logistic regression analysis carried out to evaluate predictive factors. Results: The NICU group consisted of 94 neonates, and the control group, 417 neonates during the period reviewed. On multivariate analysis, maternal anemia (OR, 2.97; 95%CI: 1.42–6.21), infertility treatment (OR, 2.79; 95%CI: 1.36–5.71), threatened preterm labor (OR, 2.16; 95%CI: 1.10–4.23), premature rupture of membranes (OR, 5.30, 95%CI: 2.52–11.17), fibroids (OR, 6.06; 95%CI: 1.57–23.41), history of uterine surgery (OR, 3.53, 95%CI: 1.13–11.06), abruptio placentae (OR, 10.21; 95%CI: 1.83–57.17), intrauterine growth restriction (OR, 6.69; 95%CI: 1.96–22.85), and having twins (OR, 0.23; 95%CI: 0.09–0.58) were significant prenatal predictors of NICU admission. Conclusion: Factors that potentially predict NICU admission were identified. Clinicians may wish to consider these factors when treating neonates with respiratory distress. [ABSTRACT FROM AUTHOR]

Abstract: Background: Routine catheter tip cultures are not recommended because some cases of colonization, such as with Staphylococcus aureus, can lead to subsequent bacteremia. To evaluate the safety of colonization without antimicrobial treatment, as well as the effectiveness of routine catheter tip cultures in the neonatal intensive care unit (NICU), we performed a retrospective data analysis in a Japanese community hospital. Methods: We reviewed all peripherally inserted central venous catheter tip culture results from the NICU ward between April 2012 and June 2017 and noted outcome (i.e. antimicrobial treatment or subsequent infection). We then performed a cost analysis for routine catheter tip culturing on patients who were symptom free during the study period. Results: Of the 93 positive cases in 80 patients from 1,051 catheter tip cultures, seven patients had suspected infection and were treated with antimicrobials. The other 73 symptom‐free, positive patients had no subsequent or exacerbated symptoms indicative of an infection, and did not have antimicrobial treatment. The total cost for catheter tip culturing during the study period was ¥548 731. After excluding patients with symptoms of infection at the time of culture, the efficacy of routine catheter tip cultures on symptom‐free patients was estimated to be zero. Conclusion: Symptom‐free colonization did not affect clinician management in this study, and all colonized patients without suspected infection were safely managed without antimicrobials. Furthermore, routine catheter tip culturing was not cost‐effective; therefore, this practice may be no longer recommended in the NICU. [ABSTRACT FROM AUTHOR]

Abstract: Background: Although the mumps vaccine has not been included in the national immunization program (NIP) in Japan, it has been shown that a two‐dose routine vaccine program would be highly cost‐effective. In this study, we carried outa questionnaire‐based study to investigate how many Japanese parents want the mumps vaccine to be included in the NIP with proper information. Methods: The questionnaire was given to parents who visited the Pediatrics or neonatal intensive care unit of Nara Prefecture General Medical Center, Nara City, Japan, between 1 March 2017 and 31 August 2017. The questionnaire consisted of information about mumps and six questions, for example (i) do parents know that mumps can be prevented by vaccine; (ii) do they know that they need to pay for mumps vaccines; and (iii) do they hope that the government will resume routine mumps vaccination. Results: In total, 1,224 parents answered the questionnaire. A total of 81% and 75.4% of parents knew that mumps can be prevented by vaccination and that mumps vaccine is not included in the NIP, respectively, before reading the information. After reading the information, 95.0% of parents thought that mumps vaccine should be included in the NIP. While 61.7% of parents answered that they would choose two‐dose vaccination without governmental financial support, 92.1% of them would choose two‐dose vaccination with governmental financial support (P < 0.0001). Conclusion: Japanese parents want the mumps vaccine to be included in the NIP. Japan is able to start routine use of the mumps vaccine now. [ABSTRACT FROM AUTHOR]