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Abstract Background In adult population with community acquired pneumonia high levels of pro-adrenomedullin (pro-ADM) have been shown to be predictors of worse prognosis. The role of this biomarker in pediatric patients had not been analyzed to date. The objective of this study is to know the levels of pro-ADM in children with community acquired pneumonia (CAP) and analyze the relation between these levels and the patients’ prognosis. Findings Prospective observational study including patients attended in the emergency service (January to October 2009) admitted to hospital with CAP and no complications at admission. The values for pro-ADM were analyzed in relation to: need for oxygen therapy, duration of oxygen therapy, fever and antibiotic therapy, complications, admission to the intensive care unit, and length of hospital stay. Fifty patients were included. Ten presented complications (7 pleural effusion). The median level of pro-ADM was 1.0065 nmol/L (range 0.3715 to 7.2840 nmol/L). The patients presenting complications had higher levels of pro-ADM (2.3190 vs. 1.1758 nmol/L, p = 0.013). Specifically, the presence of pleural effusion was associated with higher levels of pro-ADM (2.9440 vs. 1.1373 nmol/L, p Conclusions In our sample of patients admitted to hospital with CAP, pro-ADM levels are related to the development of complications during hospitalization.

Acute respiratory infections (ARIs) constitute one of the leading causes of antibiotic administration, hospitalization and death among children <5 years old. The upper respiratory tract microbiota has been suggested to explain differential susceptibility to ARIs and modulate ARI severity. The aim of the present study was to investigate the relation of nasopharyngeal microbiota and other microbiological parameters with respiratory health and disease, and to assess nasopharyngeal microbiota diagnostic utility for discriminating between different respiratory health statuses. We conducted a prospective case-control study at Hospital Sant Joan de Deu (Barcelona, Spain) from 2014 to 2018. This study included three groups of children <18 years with gradual decrease of ARI severity: cases with invasive pneumococcal disease (IPD) (representative of lower respiratory tract infections and systemic infections), symptomatic controls with mild viral upper respiratory tract infections (URTI), and healthy/asymptomatic controls according to an approximate case-control ratio 1:2. Nasopharyngeal samples were collected from participants for detection, quantification and serotyping of pneumococcal DNA, viral DNA/RNA detection and 16S rRNA gene sequencing. Microbiological parameters were included on case-control classification models. A total of 140 subjects were recruited (IPD=27, URTI=48, healthy/asymptomatic control=65). Children's nasopharyngeal microbiota composition varied according to respiratory health status and infection severity. The IPD group was characterized by overrepresentation of Streptococcus pneumoniae , higher frequency of invasive pneumococcal serotypes, increased rate of viral infection and underrepresentation of potential protective bacterial species such as Dolosigranulum pigrum and Moraxella lincolnii . Microbiota-based classification models differentiated cases from controls with moderately high accuracy. These results demonstrate the close relationship existing between a child's nasopharyngeal microbiota and respiratory health, and provide initial evidence of the potential of microbiota-based diagnostics for differential diagnosis of severe ARIs using non-invasive samples.

Aim: Escherichia coli (E coli) is a known cause of paediatric bacteraemia. The main objective was to characterise the emergency department (ED) presentations of paediatric E coli bacteraemia and secondarily to identify those related to greater severity., Methods: This was a sub-study of a multicentre cross-sectional prospective registry including all with E coli bacteraemia episodes between 2011 and 2016. We used multiple correspondence and cluster analysis to identify different patterns., Results: We included 291 patients and 43 met criteria for severe disease (14.3%, 95% confidence interval 11.2-19.3). We identified four types of paediatric E coli bacteraemia presentations. Two (178 patients, 61.2%) were related to well-appearing previously healthy infants with associated urinary tract infection (UTI). Well-appearing children older than 12 months old with underlying disease (n = 60, 20.6%) and non-well-appearing children of different ages (n = 53, 18.2%) corresponded to the other two types; these had associated UTI infrequently and higher severity rate (15% and 50.9%, respectively, higher when compared with the two previous types, P < .01), including the two patients who died., Conclusion: There were four different types of ED paediatric E coli bacteraemia presentations with different severity. Febrile young children with associated UTI showed the best outcome., (©2020 Foundation Acta Paediatrica. Published by John Wiley & Sons Ltd.)

Antibiotic prescriptions in 227 patients with acute group A b-hemolytic streptococcal pharyngitis in the emergency department were studied. Antibiotic prescription was inappropriate in 42% of the cases, especially due to errors in the prescription of amoxicillin. Probably the use of low-spectrum penicillins would improve this percentage.

The aim of this study was to study the serotypes and clonal diversity of pneumococci causing invasive pneumococcal disease in Catalonia, Spain, in the era of 13-valent pneumococcal conjugate vaccine (PCV13). In our region, this vaccine is only available in the private market and it is estimated a PCV13 vaccine coverage around 55% in children. A total of 1551 pneumococcal invasive isolates received between 2010 and 2013 in the Molecular Microbiology Department at Hospital Sant Joan de Déu, Barcelona, were included. Fifty-two serotypes and 249 clonal types-defined by MLST-were identified. The most common serotypes were serotype 1 (n = 182; 11.7%), 3 (n = 145; 9.3%), 19A (n = 137; 8.8%) and 7F (n = 122; 7.9%). Serotype 14 was the third most frequent serotype in children < 2 years (15 of 159 isolates). PCV7 serotypes maintained their proportion along the period of study, 16.6% in 2010 to 13.4% in 2013, whereas there was a significant proportional decrease in PCV13 serotypes, 65.3% in 2010 to 48.9% in 2013 (p<0.01). This decrease was mainly attributable to serotypes 19A and 7F. Serotype 12F achieved the third position in 2013 (n = 22, 6.4%). The most frequent clonal types found were ST306 (n = 154, 9.9%), ST191 (n = 111, 7.2%), ST989 (n = 85, 5.5%) and ST180 (n = 80, 5.2%). Despite their decrease, PCV13 serotypes continue to be a major cause of disease in Spain. These results emphasize the need for complete PCV13 vaccination.

Background: Blood cultures (BCs) are commonly performed on children admitted to hospital for skin and soft tissue infections (SSTIs). In recent years, this practice has been questioned in patients with uncomplicated SSTIs because of its low yield. At the same time, however, an increase in community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) infections has been described; its influence on rates of bacteremia in patients with SSTIs is unclear. The aims of the study were to describe the performance and the yield of BC in immunocompetent patients with uncomplicated SSTIs and to determine the prevalence of CA-MRSA as a causative agent in our area., Methods: Retrospective study: immunocompetent patients younger than 18 years evaluated in the emergency department and admitted for uncomplicated SSTIs (cellulitis, abscess, impetigo or erysipelas) from July 1, 2010 to June 31, 2014 were included. Patients referred from other hospitals who were receiving parenteral antibiotics and patients with complicated SSTIs (surgical or traumatic wound infection, need for surgical intervention and infected ulcers or burns) were excluded., Results: We included 445 cases: 348 (78.2%) cellulitis, 78 (17.5%) abscess and 19 (4.3%) impetigo. BCs were performed on 353 (79.3%) patients. Two (0.6%; 95% confidence interval: 0.2-2.0%) were positive and 10 (2.8%; 95% confidence interval: 1.5-5.1%) contaminated. The positive BCs grew S. aureus and Streptococcus pyogenes. Wound cultures were performed on 148 (33.3%) patients; 98 (66.2%) were positive. In 22 (22.4%) patients CA-MRSA grew, accounting for 14.9% of overall wound cultures., Conclusions: BCs are not useful in the management of immunocompetent patients admitted to the hospital with uncomplicated SSTIs. The prevalence of CA-MRSA is low in our area, but continuing careful surveillance is needed.

Aim: The rate of paediatric occult bacteraemia after the introduction of the 13-valent pneumococcal conjugated vaccine is relatively unknown. We determined the rate, and identified isolated pathogens, in children aged three to 36 months who presented to a paediatric emergency department with fever, but otherwise appeared well. We also analysed the yield of laboratory parameters traditionally considered risk factors for occult bacteraemia., Methods: Children aged three to 36 months who were febrile, but otherwise appeared well, were included if they had blood tests in the paediatric emergency department between April 2010 and September 2012., Results: Of the 591 patients, only six (1.0%) had a true bacterial pathogen and three of those were Streptococcus pneumoniae (0.5%). None of the children with pneumococcal bacteraemia had been immunised. The contaminant rate was 2.7%, and an elevated band count was the best predictor of occult bacteraemia, with positive and negative likelihood ratios of 10 and 0.4, respectively. The yield of the other laboratory parameters was very limited., Conclusion: In the era of the 13-valent pneumococcal conjugated vaccine, occult bacteraemia is an uncommon event in febrile children aged three to 36 who otherwise appear well and close follow-up should replace blood analysis in such cases., (©2014 Foundation Acta Paediatrica. Published by John Wiley & Sons Ltd.)

Objectives: Blood culture (BC) is one of the most commonly used microbiological tests in the paediatric emergency department (PED) despite its lack of immediate diagnostic utility. Our objectives were to uncover the reasons for BC in the PED, to review adherence to the current protocol for this technique, and to analyse the diagnostic yield (DY) of BC in localized bacterial infections., Patients and Methods: Retrospective study including patients younger than 18 years with a BC obtained in the PED of a tertiary care hospital in 2011. Patients with bacteraemia risk factors (immunosuppressant condition, long-term vascular catheter, prosthetic valve or ventriculoperitoneal shunt, and hospitalization or aggressive diagnostic or therapeutic procedure in the previous week) were excluded., Results: Two thousand and sixty-two BCs were included. Fever without source (FWS) (34.3%) and pneumonia (10.1%) were the main indications for BC. Twenty-five per cent of BCs did not adhere to protocol: FWS (115 cases), mononucleosic syndrome (83 cases) and acute gastroenteritis (78 cases) represented half of these. The global DY by BC was 2.0%. Streptococcus pneumoniae was the main isolated microorganism (41.4%) and pneumonia was the main associated pathology (22%). All of the BCs with non-adhered-to protocol were negative. All of the BCs obtained for noncomplicated bacterial skin and soft tissue infection were negative., Conclusion: FWS is the main reason for BC in the PED. One-quarter of the BCs were not indicated, with the DY null in these cases. Due to the low DY in certain localized bacterial infections, a strict individualized ordering of BC in these cases should be considered.

Between April 2004 and March 2006 an oropharyngeal swab was obtained from 502 asymptomatic children, aged 6 months to 6 years, at a tertiary children's hospital outpatient department to assess the pneumococcal colonisation rate, risk factors, serotype distribution and antimicrobial susceptibility. Only 126 (25.3%) children had received ≥ 1 dose of PCV7. The pneumococcal carriage rate was 23.5%. Carrier rates were significantly higher in children aged ≥ 24 months and children attending daycare center. Thirty six (31.0%) of the isolates were contained in PCV7, 39 (33.6%) in PCV10 and 62 (53.4%) in PCV13. Forty-four strains (37.9%) were resistant to penicillin. Vaccine serotype (VT) strains were more likely to be penicillin-nonsusceptible S. pneumoniae than non-PCV7 serotype (NVT) strains (66.7% vs. 21.6%; P < 0.001). In our pediatric population, NVT were predominant among pneumococcal carriers whereas antibiotic resistance was significantly associated with VT. PCV13 can substantially increase the serotype coverage of S.pneumoniae in healthy carriers., (Copyright © 2012 Elsevier Inc. All rights reserved.)

We developed a real-time polymerase chain reaction specific for Streptococcus pneumoniae to be applied directly from blood culture bottles without previous DNA extraction step. For the 128 blood culture bottles tested, the assay had 94% and 98.4% sensitivity and specificity, respectively. This assay provides rapid and accurate identification of this pathogen., (2010 Elsevier Inc. All rights reserved.)

Pediatric parapneumonic empyema (PPE) has been increasing in several countries including Spain. Streptococcus pneumoniae is a major PPE pathogen; however, antimicrobial pretreatment before pleural fluid (PF) sampling frequently results in negative diagnostic cultures, thus greatly underestimating the contribution of pneumococci, especially pneumococci susceptible to antimicrobial agents, to PPE. The study aim was to identify the serotypes and genotypes that cause PPE by using molecular diagnostics and relate these data to disease incidence and severity. A total of 208 children with PPE were prospectively enrolled; blood and PF samples were collected. Pneumococci were detected in 79% of culture-positive and 84% of culture-negative samples. All pneumococci were genotyped by multilocus sequence typing. Serotypes were determined for 111 PPE cases; 48% were serotype 1, of 3 major genotypes previously circulating in Spain. Variance in patient complication rates was statistically significant by serotype. The recent PPE increase is principally due to nonvaccine serotypes, especially the highly invasive serotype 1.