Clinical Practice Guideline by the Pediatric Infectious Diseases Society (PIDS) and the Infectious Diseases Society of America (IDSA): 2023 Guideline on Diagnosis and Management of Acute Bacterial Arthritis in Pediatrics.

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.

Friends Not Foes: Optimizing Collaboration with Subspecialists.

Pediatric orthopedic patients can be complex to manage. As orthopedists plan for possible surgical interventions, consultation with pediatric subspecialists will be necessary. This article discusses the considerations an orthopedist should make when deciding on the timing and the appropriateness of consultation-both preoperatively and perioperatively. Consultation before surgical intervention will especially be useful if the subspecialist will be collaborating in the management of the condition postoperatively (whether inpatient or outpatient). Clear and early consultation in both written and verbal format will facilitate quality and expedite the patient's care.

Clinical Practice Guideline by the Pediatric Infectious Diseases Society and the Infectious Diseases Society of America: 2021 Guideline on Diagnosis and Management of Acute Hematogenous Osteomyelitis in Pediatrics.

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.

Clinical practice guideline by the pediatric infectious diseases society and the Infectious diseases society of america: 2021 guideline on diagnosis and management of Acute Hematogenous Osteomyelitis in pediatrics

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.

Lemierre's Syndrome Due to the Zoonotic Anaerobe Bacteroides pyogenes: Case Report and Literature Review.

Although Fusobacterium necrophorum is well described as an emerging pathogen of acute mastoiditis in young children, infection with other anaerobes can lead to similar severe sequelae including intracranial and extracranial suppurative thrombophlebitis and sepsis. We describe a patient whose unremarkable exposure history assumed increased significance upon obtaining the results of 16S next generation sequencing from a surgical specimen. The novel pathogen Bacteroides pyogenes is reviewed herein.

Endogenous methicillin-resistant Staphylococcus aureus endophthalmitis after leg trauma.

We present a case of endogenous endophthalmitis in a 13-year-old boy with methicillin-resistant Staphylococcus aureus sepsis. The patient underwent magnetic resonance imaging of the brain after intermittent anisocoria was noted on examination, leading to a diagnosis of endophthalmitis with a chorodial abscess.

Current controversies in childhood vaccination.

As pediatric practitioners, one of the contemporary challenges in providing medical care for children is the increasing proportion of vaccination refusal. This occurs in spite of the demonstrated individual and collective benefit and cost effectiveness of vaccination. Controversies regarding vaccine components and side effects have misled parents to believe that vaccines might be harmful based on inaccurate data from the Internet, celebrities, as well as misinterpreted and frankly bad science. This belief of vaccines being harmful has led to fear and decreased immunization rates in spite of sound scientific evidence supporting the safety of vaccines and their lack of association with autism, developmental disabilities or other medical disorders. Some parents also believe in alternative ways to avoid disease, often adhering to practices that have little foundation in the best of empiric science. It is not a coincidence that recent outbreaks of vaccine-preventable diseases, including measles and pertussis (whooping cough), have occurred in areas where vaccination has declined largely due to exemptors. This article intends to review some of the common vaccine myths and controversies and to serve as a resource to provide accurate information and references for busy practitioners and the families that we serve.

Panton Valentine Leukocidin exotoxin has no effect on the outcome of cancer patients with methicillin-resistant Staphylococcus aureus (MRSA) infections.

The presence of Panton-Valentine leukocidin (PVL) gene in methicillin-resistant Staphylococcus aureus (MRSA) infections has been associated with high severity and mortality rates. In this study we evaluated the effect of PVL on outcome in cancer patients with MRSA infections.We retrospectively reviewed the records of 173 cancer patients diagnosed with MRSA pneumonia (n = 47), skin and soft tissue infections (n = 77), and bacteremia (n = 49) between September 2003 and September 2007 at M. D. Anderson Cancer Center. We obtained demographic and clinical data and tested isolates for the presence of PVL. The data were compared between patients with PVL (+) and those with PVL (-) strains. Statistical methods for comparison included Cochran-Mantel-Haenszel tests, 2-way nonparametric analysis of variance, chi-square or Fisher exact tests, and Wilcoxon rank sum tests. All tests were 2-sided with a significance level of 0.05.Seventy patients with PVL (+) strains and 103 patients with PVL (-) strains were included in our study. Fewer PVL (+) patients had pneumonia than did PVL (-) patients (14% vs. 36%, p = 0.002). PVL (-) patients were more likely to have concomitant infections (35% vs. 17%, p = 0.012). The 2 groups were similar in terms of fever, sepsis, vasopressor use, mechanical ventilation, antibiotics response, infection relapse, death, and death due to MRSA. In a skin and soft tissue subset analysis, PVL (+) patients were more likely to have solid tumors (73% vs. 47%, p = 0.02) and less likely to have fever (20% vs. 44%, p = 0.02) and sepsis (12% vs. 36%, p = 0.013). There were no differences in outcome between patients with pneumonia and bacteremia; however, most patients with pneumonia were PVL (-) (79% vs. 21%). Among the 73 patients who received vancomycin and the 20 who received linezolid, there was no difference in response to treatment, regardless of PVL status or neutropenia. In conclusion, the presence of the PVL gene had no negative effect on cancer patients with health care-associated MRSA.

Staphylococcus aureus pneumonia in children in the era of community-acquired methicillin-resistance at Texas Children's Hospital.

BACKGROUND: Community-acquired Staphylococcus aureus (SA) pneumonia has increased in children, yet few studies have focused on this infection. METHODS: Patients with SA pneumonia (not ventilator-associated) were identified from our surveillance database. Medical records were reviewed; isolates were genotyped by PFGE and Panton-Valentine leukocidin genes detected by polymerase chain reaction. RESULTS: From August 2001 to April 2009, 117 patients had SA pneumonia. The rate of SA pneumonia per 10,000 admissions increased from 4.81 hospitalizations in year 1 to 9.75 in year 7 (P = 0.04). Methicillin-resistant SA (MRSA) caused 74% and methicillin-susceptible SA (MSSA) caused 26% of the infections. USA300 represented 75/82 (92%) of the MRSA and 14/28 (50%) of the MSSA isolates (P < 0.01). Patients with MRSA were younger (median [range], 0.8 years [0.1-16.9 years]) than patients with MSSA infections (2.5 years [0.2-20.9 years]) (P = 0.008). Clinical presentation was pneumonia with or without effusion in 30, empyema in 72, or lung abscess in 15 cases. Viral coinfections in 18/68 patients tested were associated with respiratory failure (72% vs. 24% [P < 0.001]). Thirty-five children were intubated and 68 had intensive care unit care; 89, 25, and 3 had video-assisted thoracoscopy (VATS), thoracentesis, and lobectomy, respectively. VATS was used more for USA300 than non-USA300 infections (80% vs. 57% [P = 0.03]). In all, 88 children received clindamycin. Improvement or cure occurred in 103 patients (88%), unscheduled visit or readmission related to the same problem in 6, respiratory sequelae in 7, and death in 1 patient. CONCLUSIONS: SA pneumonia increased in frequency over the study years and most were caused by community-acquired MRSA and USA300 isolates. Viral coinfection in 15% of the cases was associated with respiratory failure. Clindamycin is an effective treatment for susceptible-SA pneumonia; VATS was more common in patients with USA300 infections.

Staphylococcus aureus sinus infections in children.

OBJECTIVE: Staphylococcus aureus can cause sinusitis in children. The predominant MRSA clone in the United States, USA300, has been associated with skin and soft tissue as well as invasive diseases. USA300 has increased among CA methicillin-susceptible S. aureus (CA-MSSA) isolates. We describe the clinical characteristics of pediatric patients with S. aureus cultured from sinus specimens, treated at Texas Children's Hospital (TCH), and characterized their isolates by molecular methods. METHODS: This was a retrospective study of children with endoscopic sinus surgery (ESS) cultures positive for S. aureus between 01/2005 and 12/2008 at TCH. Medical records were reviewed and associated S. aureus isolates were characterized by pulsed field gel electrophoresis (PFGE). Data were analyzed by Mann-Whitney U, Chi-square, Fisher's exact test, and Chi-square for trend. RESULTS: We identified 56 patients with S. aureus sinus infections; 12 (21%) were MRSA. Seven of 12 (58%) MRSA vs. 5/44 (11%) MSSA were USA300 (p<0.01). All MRSA isolates were non-susceptible to erythromycin compared to 30% of MSSA (p<0.01); 75% of the USA300 strains were non-susceptible to erythromycin compared to 36% of the non-USA300 strains (p<0.04). Co-pathogens were isolated from 77% (43/56) of the patient specimens. Both MRSA and USA300 isolates were associated with Haemophilus influenzae co-isolation (p<0.05). Patients with USA300 strains were significantly younger (p=0.02) and more likely to experience snoring as a symptom associated with their sinusitis (p=0.03) than those infected with non-USA300 strains. Children with MRSA (4/12) tended to have a greater recurrence rate than children with MSSA isolates (5/44) (p=0.09). No significant differences were observed between groups for fever or complications such as neck cellulitis, nasal abscess, meningitis, subdural empyema, and orbital cellulitis. CONCLUSION: MSSA was more commonly isolated than MRSA from sinus cultures of children who underwent ESS at TCH. The majority of ESS cultures positive for S. aureus, were mixed with other respiratory pathogens, principally H. influenzae. USA300 was the major clone among the MRSA sinusitis isolates, but was not associated with more complications than other S. aureus isolates.

Clinical and molecular epidemiology of Staphylococcus aureus catheter-related bacteremia in children.

BACKGROUND: Staphylococcus aureus (SA) is an important cause of catheter-related bacteremia (CRB). The USA300 clone increasingly causes healthcare associated infections. We compared children with SA-CRB due to USA300 versus non-USA300 isolates and identified risk factors for complications. METHODS: Children at Texas Children's Hospital (TCH) with SA-CRB were identified from a prospective S. aureus surveillance study. S. aureus isolates were characterized by methicillin susceptibility and pulsed field gel electrophoresis. RESULTS: From August 2001 to October 2007, 112 children with a first episode of SA-CRB and corresponding isolates were identified. USA300 accounted for 21 isolates. Metastatic infection complicated 10.7% of cases and was associated with methicillin resistance. Other complications were recurrence (n = 16), death (n = 13), thrombosis (n = 9), and intravascular "cast" (n = 6). Four patients with non-USA300 SA-CRB had endocarditis. Prolonged bacteremia was more common in methicillin-resistant SA (12/29) than in methicillin-susceptible SA SA-CRB (14/83) (P = 0.007). Complications were more common in patients with bacteremia > or =4 days (16/26 [61.5%]) versus patients with bacteremia <4 days (25/86 [29%]) (P = 0.003). The complication rate was lower in patients who had the catheter removed <4 days (22.5%) versus patients whose catheter was removed > or =4 days after infection or not removed (44.4%) (P = 0.02). Children with USA300 versus non-USA300 isolates did not differ with respect to frequency or type of complications. CONCLUSIONS: At Texas Children's Hospital, the USA300 clone caused 19% of initial SA-CRB episodes and was associated with methicillin resistance. Complications occurred in 36.6% of the patients and were associated with prolonged bacteremia and catheter removal > or =4 days after infection or failure to remove the catheter.

Hospital-acquired Staphylococcus aureus infections at Texas Children's Hospital, 2001-2007.

OBJECTIVE: To document the introduction of the methicillin-resistant Staphylococcus aureus (MRSA) USA300 clone into a children's hospital. Current molecular epidemiology of infections due to the USA300 strain of MRSA in the pediatric healthcare setting remains obscure. DESIGN: Retrospective study of patients with hospital-acquired S. aureus infection during the period from August 1, 2001, through July 31, 2007, at Texas Children's Hospital in Houston. METHODS: Patients with hospital-acquired S. aureus infection from whom an isolate was available for molecular analysis were included. Clinical information was obtained from patient medical records and the electronic hospital information system. S. aureus isolates underwent antimicrobial susceptibility testing, pulsed-field gel electrophoresis, and polymerase chain reaction testing for staphylococcal cassette chromosome (SCC) mec, agr, the diamine N-acetyltransferase gene, and the Panton-Valentine leukocidin genes (pvl). RESULTS: Of 242 patients with hospital-acquired S. aureus infection, 147 (61%) had methicillin-susceptible S. aureus infection. Of the 95 MRSA isolates causing hospital-acquired infection, 69 (73%) were USA300 isolates, and that rate did not increase over time. Skin and soft tissue infection (P < .001), onset of infection less than 10 days after admission (P = .007), and lack of comorbidities (P < .001) were associated with hospital-acquired MRSA infection caused by the USA300 strain, compared with other isolates (hereafter referred to as non-USA300 isolates). Nine of 10 patients with a S. aureus infection at the time of death were infected with a non-USA300 strain. USA300 carried SCCmec IV, agr I, the diamine N-acetyl transferase gene, and pvl. USA300 isolates were more susceptible to clindamycin, gentamicin, and trimethoprim-sulfamethoxazole than were other non-USA300 isolates (P < .01). CONCLUSIONS: In our patient population, the annual numbers of observed cases of hospital-acquired S. aureus infection have remained constant. USA300 was the most common clone and, compared with other non-USA300 MRSA isolates, was associated with skin and soft tissue infection, early onset of infection after admission, and greater susceptibility to antimicrobial agents.

USA300 is the predominant genotype causing Staphylococcus aureus septic arthritis in children.

BACKGROUND: Staphylococcus aureus is the most common cause of septic arthritis (SA) in children. USA300 is the predominant community methicillin-resistant (MRSA) clone. Panton-Valentine leukocidin genes (pvl) have been associated with severe disease. METHODS: Patients with S. aureus SA were identified from the Texas Children's Hospital surveillance study. Pulsed field gel electrophoresis and pvl polymerase chain reaction were performed on isolates. RESULTS: Forty-five patients with S. aureus SA were identified between August 2001 and October 2008. Median age was 5.5 years (0.3-17.9 years); 69% were previously healthy. The most common joints affected were hip (40%) followed by knee (36%). Associated infection sites were osteomyelitis (n = 14), pyomyositis/myositis (n = 13), and cellulitis (n = 9). Bacteremia for 1 to 5 days occurred in 31% of the patients. Patients with associated osteomyelitis were more likely to be bacteremic (P = 0.001), have fever >2 days (P = 0.03), and to have C-reactive protein (CRP) > or = 10 mg/dL (P = 0.01). Of 44 available isolates, 16 were MRSA; 13 of 16 were USA300 and 14 of 16 were pvl+. Twenty-eight isolates were MSSA; 8 of 28 were USA300 and 13 of 28 were pvl+. Infections caused by USA300 isolates were associated with longer duration of fever than non-USA300 isolates (median, [range]: 4 [0-15] days vs 1 [0-8] days) (P = 0.03). Overall, 61% of the isolates were pvl+. CRP > or = 10 mg/dL was more likely in pvl+ infections than in pvl- infections (P = 0.05). CONCLUSIONS: S. aureus SA caused by USA300 isolates is associated with longer duration of fever. Empirical treatment of SA should include MRSA. CRP levels > or = 10 mg/dL, fever >2 days, and bacteremia should raise suspicion for associated osteomyelitis.