BACKGROUND: The treatment of pediatric patients with latent tuberculosis infection (LTBI) is a crucial TB control strategy. LTBI is not a reportable communicable disease, and data regarding LTBI treatment in pediatric patients in Korea are scarce. This study aimed to investigate the prescription patterns and treatment completion rates among pediatric patients with LTBI in Korea by analyzing National Health reimbursement claims data. METHODS: We retrospectively analyzed outpatient prescription records for pediatric patients aged 18 or younger with LTBI-related diagnostic codes from 2016 to 2020. We compared the frequency of prescriptions for the standard treatment regimen (9 months of isoniazid [9H]) and an alternative treatment regimen (3 months of isoniazid plus rifampicin [3HR]). We also assessed the treatment incompletion rates by age group, treatment regimen, treatment duration, the level of medical facility, physician's specialty, and hospital location. We performed multivariable analysis to identify factors influencing treatment incompletion. RESULTS: Among the 11,362 patients who received LTBI treatment, 6,463 (56.9%) were prescribed the 9H regimen, while 4,899 (43.1%) received the 3HR regimen. Patients in the 3HR group were generally older than those in the 9H group. The proportion of 3HR regimen prescriptions significantly greater in the later period (2018-2020), in primary hospitals, under the management of non-pediatric specialists, and in metropolitan regions. The overall treatment incompletion rate was 39.7% (9H group: 46.9%, 3HR group: 30.3%). In the multivariable analysis, 9H regimen prescription was the strongest factor associated with treatment incompletion (adjusted odds ratio, 2.42; 95% confidence interval, 2.20-2.66; P < 0.001). Additionally, management in a primary hospital, a hospital's location in a non-metropolitan region, and management by a non-pediatric specialist were also significant risk factors for treatment incompletion. CONCLUSION: Our study results suggest that promoting the use of 3HR regimen prescriptions could be an effective strategy to enhance treatment completion. Physicians in primary hospitals, hospitals located in non-metropolitan regions, and physicians without a pediatric specialty require increased attention when administering LTBI treatment to pediatric patients to ensure treatment completion.
Isoniazid , Latent Tuberculosis , Humans , Child , Isoniazid/therapeutic use , Antitubercular Agents/therapeutic use , Retrospective Studies , Latent Tuberculosis/drug therapy , Latent Tuberculosis/diagnosis , Rifampin/therapeutic use , Outpatients , Republic of Korea
Hand, foot, and mouth disease (HFMD) is a pediatric public health concern in Asia. Surveillance data on the circulating serotypes of HFMD suggest that Enterovirus A71 (EV-A71) and coxsackieviruses A6, A10, and A16 (CVA6, CVA10, and CVA16) are the major serotypes causing HFMD. Asian countries, including Korea, are currently developing a multivalent vaccine targeting these serotypes. However, the immunity of children against specific serotypes, indicating past infection, should also be considered while selecting candidate serotypes for vaccine development. Therefore, we aimed to identify the age-stratified serological statuses of Korean children to determine candidate serotypes for HFMD vaccine development. This study included 220 participants, categorized into four age groups, 7 months-2 years, 3-5 years, 6-10 years, and 11-15 years. A neutralization test was performed to quantitate the neutralizing antibodies (NtAbs) in the sera of the participants. Only EV-A71 and CVA6 were found suitable as candidate serotypes for vaccine development, whereas further study is needed for CVA10 and CVA16. The highest seropositivity and NtAb titer ranges were observed for CVA6 in all age groups, suggesting that the participants had been predominantly exposed to CVA6. For EV-A71, seropositivity and NtAb titer ranges steadily increased with age, suggesting that children were currently exposed to EV-A71. For CVA10, the 3-5 years group showed the highest seropositivity rate and higher NtAb titer ranges than the older age groups, indicating that the exposure to CVA10 had mainly occurred in recent years. Future studies will identify whether the exposure to CVA10 was transient or will continue. For CVA16, seropositivity and NtAb titer ranges were generally low, indicating that only a few participants had been exposed to CVA16. We identified discrepancies between the sentinel surveillance data and our findings. This study provides a new perspective for HFMD vaccine development and policy making in Asian countries.
Enterovirus A, Human , Enterovirus , Hand, Foot and Mouth Disease , Vaccines , Aged , Antibodies, Neutralizing , Child , China/epidemiology , Humans , Seroepidemiologic Studies , Serogroup
PURPOSE: Enterococci are a common cause of bacteremia in immunocompromised patients. Although the increase of vancomycin-resistant enterococci (VRE) makes appropriate antibiotic therapy difficult, clinical characteristics of enterococcal bacteremia and the impact of VRE infection on outcomes have rarely been reported in immunocompromised children. METHODS: We enrolled children and adolescents (< 19 years of age) with underlying malignancies who were diagnosed with enterococcal bacteremia during febrile neutropenia between 2010 and 2017. Medical records of the enrolled children were retrospectively reviewed to evaluate the clinical characteristics of enterococcal bacteremia and impact of VRE infection on outcomes. RESULTS: Thirty-six episodes of enterococcal bacteremia were identified in 30 patients. VRE infection was identified in 11 episodes (30.6%); the 7- and 30-day mortalities were 27.8% and 44.4%, respectively. Acute lymphoblastic leukemia (50.0%) and acute myeloid leukemia (30.6%) were the most common underlying disorders. Three (8.3%) of the patients were in complete remission, and palliative and reinduction chemotherapies were administered in 47.2% and 36.1% of episodes, respectively. Empirical antibiotic therapy was appropriate in 64.0% of patients with vancomycin-susceptible enterococcal infection and in none of the VRE-infected patients (p = 0.001). However, the 30-day mortality was not significantly different between the two patient groups (44.0% vs. 45.5%, p = 1.000). CONCLUSIONS: Most episodes of enterococcal bacteremia occurred in advanced stages of underlying malignancies, and still showed high mortality. The prognosis seemed to be related to the underlying disease condition rather than vancomycin resistance of the isolated enterococci, although the number of enrolled patients was small.
Anti-Bacterial Agents/therapeutic use , Bacteremia/drug therapy , Gram-Positive Bacterial Infections/drug therapy , Neutropenia/drug therapy , Vancomycin-Resistant Enterococci/drug effects , Adolescent , Bacteremia/diagnosis , Bacteremia/microbiology , Child , Child, Preschool , Female , Gram-Positive Bacterial Infections/diagnosis , Gram-Positive Bacterial Infections/microbiology , Humans , Infant , Infant, Newborn , Male , Neoplasms/etiology , Neutropenia/diagnosis , Prognosis , Republic of Korea , Retrospective Studies
BACKGROUND: Although Escherichia coli is a common cause of bacterial enteritis in Korea, reports on community-acquired E. coli enteritis in Korean children are scarce. This study aimed to determine the clinical characteristics and pathotype distribution of community-acquired E. coli enteritis diagnosed by a multiplex polymerase chain reaction (PCR) assay in Korean children. MATERIALS AND METHODS: The medical records of children aged 18 years or less who were diagnosed with acute gastroenteritis by the attending physician between 2013 and 2016 were retrospectively reviewed. The clinical characteristics of children diagnosed with E. coli enteritis were investigated and compared with those diagnosed with Salmonella enteritis. E. coli and Salmonella infections were diagnosed by a stool PCR assay. RESULTS: Among 279 children, in whom PCR assays for E. coli and Salmonella spp. were performed, Salmonella enteritis and E. coli enteritis were diagnosed in 43 (15.4%) and 39 (14.0%) children, respectively. Among the 39 children with E. coli enteritis, enteropathogenic E. coli (n=21, 53.8%) and enteroaggregative E. coli (n=15, 38.4%) were the most common causative agents. Empirical antibiotics were administered to 33 (84.6%) children. A total of 31 (79.5%) children developed fever, and 25 (80.6%) of them had the fever for 3 days or less, which resolved a median of 1 day (range 0-3 days) after hospitalization. The most frequent gastrointestinal symptom was diarrhea (n=36, 92.3%). Significantly more children with E. coli enteritis were aged 2 years or less as compared with those with Salmonella enteritis (41.0% vs. 21.9%, P = 0.021). Children with Salmonella enteritis more frequently complained of fever (97.7% vs. 79.5%, P = 0.012), abdominal pain (90.7% vs. 64.1%, P = 0.004), and hematochezia (46.5% vs. 10.3%, P <0.001) than those with E. coli enteritis. Erythrocyte sedimentation rate and C-reactive protein levels were significantly higher in children with Salmonella enteritis than those with E. coli enteritis (P <0.001). CONCLUSION: Enteropathogenic E. coli was the most frequent pathotype in Korean children with E. coli enteritis that caused mild clinical symptoms. A stool PCR assay for E. coli may be useful for epidemiological purpose and for an early diagnosis of E. coli enteritis.
