Predictor of Early Administration of Antibiotics and a Volume Resuscitation for Young Infants with Septic Shock

(1) Background: It is critical to administer antibiotics and fluid bolus within 1 h of recognizing sepsis in pediatric patients. This study aimed to identify the predictor of the successful completion of a 1-h sepsis bundle for infants with suspected sepsis. (2) Methods: This is an observational study using a prospective registry including febrile young infants (aged < 90 days) who visited a pediatric emergency department with a core body temperature of 38.0 °C or higher and 36.0 °C or lower. Univariate and logistic regression analyses were conducted to determine the predictor (s) of successful sepsis bundle completion. (3) Results: Of the 323 registered patients, 118 patients with suspected sepsis were analyzed, and 38 patients (32.2%) received a bundle-compliant treatment. Among potential variables, such as age, sex, and vital sign parameters, the logistic regression analysis showed that heart rate (odds ratio: OR 1.02; 95% confidence interval: 1.00–1.04) is a significant predictor of the completion of a 1-h sepsis bundle. (4) Conclusions: We found that tachycardia facilitated the sepsis recognition and promoted the successful completion of a 1-h sepsis bundle for young infants with suspected septic shock and a possible indicator for improving the quality of the team-based sepsis management

Limited Utility of SIRS Criteria for Identifying Serious Infections in Febrile Young Infants

(1) Background: Young infants have a high risk of serious infection. The Systematic Inflammatory Response Syndrome (SIRS) criteria can be useful to identify both serious bacterial and viral infections. The aims of this study were to evaluate the diagnostic performance of the SIRS criteria for identifying serious infections in febrile young infants and to identify potential clinical predictors of such infections. (2) Methods: We conducted this prospective cohort study including febrile young infants (aged < 90 days) seen at the emergency department with a body temperature of 38.0 °C or higher. We calculated the diagnostic performance parameters and conducted the logistic regression analysis to identify the predictors of serious infection. (3) Results: Of 311 enrolled patients, 36.7% (n = 114) met the SIRS criteria and 28.6% (n = 89) had a serious infection. The sensitivity, specificity, positive predictive value, and positive likelihood ratio of the SIRS criteria for serious infection was 45.9%, 69.4%, 43.5%, 71.4%, 1.5, and 0.8, respectively. Logistic regression showed that male gender, body temperature ≥ 38.5 °C, heart rate ≥ 178 bpm, and age ≤ 50 days were significant predictors. (4) Conclusions: The performance of the SIRS criteria for predicting serious infections among febrile young infants was poor

Sustained pediatric antimicrobial stewardship program with consultation to infectious diseases reduced carbapenem resistance and infection-related mortality

Objective: The impact of pediatric antimicrobial stewardship programs (ASP) on antimicrobial resistance (AMR) remains largely unknown. This study aimed to evaluate the AMR for carbapenem of Gram-negative bacilli (GNB) and carbapenem use with infectious diseases consultation after the implementation of an ASP. Methods: This quasi-experimental study was conducted at Tokyo Metropolitan Childrenâs Medical Center in Japan. The pre- and post-intervention periods were April 2010 to September 2011 and October 2011 to March 2017, respectively. The pre-intervention phase consisted of consultations with the infectious diseases service alone. The ASP was implemented during the post-intervention phase. The carbapenem resistance rates of GNB were calculated. The correlation between carbapenem resistance rates and carbapenem day of therapy (DOT) was examined. The outcome metrics were compared by average length of hospitalization, all-cause mortality, and infection-related mortality. Results: A positive correlation was observed between the carbapenem resistance rate in Pseudomonas aeruginosa and DOT (0.76, p = 0.04). The carbapenem resistance rate in P. aeruginosa (p < 0.01) and DOT (p < 0.01) decreased significantly in the post-intervention period. The length of hospitalization (p < 0.01) and infection-related mortality (p = 0.05) decreased in the post-intervention period. Conclusions: A sustained ASP with additional consultation with the infectious disease service reduced carbapenem use and resistance in P. aeruginosa, leading to favorable outcomes in terms of length of hospitalization and infection-related mortality. Keywords: Antimicrobial stewardship program, Antimicrobial resistance, Children, Pseudomonas aeruginosa, Carbapenem, Day of therap

Chronic otitis media caused by Mycobacterium abscessus spp. massiliense treated with tigecycline in a 10-year-old child

Mycobacterium abscessus is one of the most pathogenic and chemotherapy-resistant rapidly growing mycobacteria. This Mycobacterium should always be considered as a possible cause of chronic otitis media in children, and treatment might be challenging because of its resistance to multiple antibiotics. There are no reports describing the therapeutic use of tigecycline for the treatment of chronic otitis media caused by M. abscessus. A 10-year-old boy was referred to Tokyo Metropolitan Children’s Medical Center with a 7-year history of recurrent otitis media despite treatment with antibiotics and ventilation tubes. Cultures of the otorrhea yielded Mycobacterium abscessus spp. massiliense, and it showed multiple and high-level resistance. The boy required surgery and underwent initial treatment with clarithromycin, amikacin, and tigecycline for 4 weeks. He experienced emesis as a side-effect of tigecycline, which was well controlled with ondansetron. He was treated successfully with 3 months of subsequent oral clarithromycin and linezolid. This is the first pediatric case of chronic otitis media caused by M. abscessus treated with a tigecycline-containing regimen. Although the therapeutic use of tigecycline remains controversial, especially in the pediatric population, it can be an acceptable option in the treatment of chronic otitis media caused by M. abscessus. Keywords: Mycobacterium abscessus, Chronic otitis media, Tigecyclin

Comparison of USA300 with non-USA300 methicillin-resistant Staphylococcus aureus in a neonatal intensive care unit

Objectives: Reports of USA300 methicillin-resistant Staphylococcus aureus (MRSA) strain were still scarce in neonatal intensive care units (NICUs) and the relationship of USA300 MRSA to clinical infections is still controversial. The primary outcome was the incidence of MRSA infections caused by the USA300 and non-USA300 strains at a NICU in Japan. Methods: This retrospective cohort study was conducted between November 2011 and October 2016 at Tokyo Metropolitan Children’s Medical Center in Japan. All MRSA isolated after 48 h of hospitalization were included for analysis by pulsed-field gel electrophoresis (PFGE) using the standard USA300 strain. Genes were tested for Panton-Valentine leukocidin (PVL) and arginine catabolic mobile element (ACME). A whole genome sequence was performed for representative isolates of USA300. Results: In total, 109 MRSA isolates were included for analysis. PFGE classified 34 and 75 isolates of USA300 and non-USA300 MRSA, respectively. Both PVL and ACME genes were detected in USA300 and non-USA300 strains at rate of 100% (34/34) and 5.3% (4/75), respectively (P < 0.05). There was no statistically significant difference in the proportion of clinical diseases between USA- 300 and non-USA 300 strains. Conclusions: Infants with USA300 MRSA infection did not differ significantly from those with non-USA300 MRSA infection. Keywords: Methicillin-resistant Staphylococcus aureus, Neonatal intensive care unit, USA300, Panton-Valentine leukocidin, Arginine catabolic mobile elemen