Effect of the COVID-19 pandemic on the pediatric infectious disease landscape.

This narrative review aims to present an overview of the COVID-19 pandemic's effects on the landscape of pediatric infectious diseases. While COVID-19 generally results in mild symptoms and a favorable prognosis in children, the pandemic brought forth significant consequences. These included persistent symptoms among infected children ("long COVID"), a profound transformation in healthcare utilization (notably through the widespread adoption of telemedicine), and the implementation of optimization strategies within healthcare settings. Furthermore, the pandemic resulted in alterations in the circulation patterns of respiratory pathogens, including influenza, RSV, and Streptococcus pneumoniae. The possible reasons for those changes are discussed in this review. COVID-19 effect was not limited to respiratory infectious diseases, as other diseases, including urinary tract and gastrointestinal infections, have displayed decreased transmission rates, likely attributable to heightened hygiene measures and shifts in care-seeking behaviors. Finally, the disruption of routine childhood vaccination programs has resulted in reduced immunization coverage and an upsurge in vaccine hesitancy. In addition, the pandemic was associated with issues of antibiotic misuse and over-prescription.     Conclusion: In conclusion, the COVID-19 pandemic has left a profound and multifaceted impact on the landscape of pediatric infectious diseases, ranging from the emergence of "long COVID" in children to significant changes in healthcare delivery, altered circulation patterns of various pathogens, and concerning disruptions in vaccination programs and antibiotic usage. What is Known: • COVID-19 usually presents with mild symptoms in children, although severe and late manifestations are possible. • The pandemic resulted in a dramatically increased use of health care services, as well as alterations in the circulation patterns of respiratory pathogens, decreased rates of other, non-respiratory, infections, disruption of routine childhood vaccination programs, and antibiotic misuse. What is New: • Possible strategies to tackle future outbreaks are presented, including changes in health care services utilization, implementation of updated vaccine programs and antibiotic stewardship protocols. • The decline in RSV and influenza circulation during COVID-19 was probably not primarily related to NPI measures, and rather related to other, non-NPI measures implementation, including specific pathogen-host interactions on the level of the biological niche (the nasopharynx).

Catheter-obtained, Enterococcus and Proteus positive urine cultures may represent mostly contamination or asymptomatic bacteriuria in infants <90 days.

BACKGROUND: Urinary tract infection (UTI) diagnosis in infants is often made by a positive urine culture result, regardless of urine dipstick findings. AIM: To assess parameters that may affect positive urine culture results interpretation in infants, including dipstick performance, obtainment method, bacteria type, age and laboratory results. METHODS: A retrospective, cohort study. Infants <90 days with urine dipstick and culture obtained through subrapubic aspiration (SPA) or catheter, 2015-2016, were included. RESULTS: Overall, 19% (129/678) of cultures were positive. The dipstick sensitivity was 51% for all cultures; 66%, 47%, 15% and 10% for Escherichia coli (n= 71), Klebsiella (n= 19), Enterococcus (n= 34) and Proteus (n= 10), respectively (p<.001). Sensitivity was higher in SPA vs. catheter for all cultures (67% vs. 43%); E. coli (78% vs. 59%); and Klebsiella (88% vs. 18%). For Enterococcus, dipstick sensitivity was low in both SPA and catheter (0-16%). All Proteus episodes were catheter obtained. Positive culture with negative dipstick and Enterococcus episodes had lower C-reactive protein levels, and higher proportion of mixed infection compared with positive dipstick and E. coli episodes. CONCLUSIONS: Urine cultures in infants should be obtained by SPA, since catheter-obtained, Enterococcus and Proteus positive cultures may represent contamination or asymptomatic bacteriuria, rather than true UTI.

Urine dipstick low sensitivity for UTI diagnosis in febrile infants *.

Background: Urine cultures are usually obtained from 0- to 2-month-old febrile infants, while in older children they are obtained more selectively. In 3- to 23-month-old children, urinary tract infection (UTI) diagnosis requires both positive culture and dipstick, but data are scarce regarding 0- to 2-month-old infants. We assessed dipstick performance for UTI diagnosis in 0-2 vs. 3- to 23-month-old children. Methods: A case-control study, conducted between 2015 and 2016, in southern Israel. Sensitivity and specificity of urine dipstick for diagnosing UTI were assessed. We compared dipstick false-negative (FN) and true-positive (TP) groups; high FN rate indicates low sensitivity. Results: Overall, 434 positive and 571 sterile urine culture episodes were included. Dipstick sensitivity was 63% in 0-2 month old children; 93% for supra-pubic aspiration (SPA), and ∼50% for non-SPA sampling method. However, sensitivity was >90% for 3-5 and 6- to 23-month-old children. In univariate analysis, younger age, hospitalization, lower temperature, short fever duration, lower leukocyte blood levels, neutrophils, stabs and C-reactive protein, and absent future UTI within <1 year were associated with FN compared with TP. In multivariate analysis, among positive culture episodes, age 0-2 months (odds ratio, OR = 6.60) and non-SPA sampling method (OR = 8.39) were associated with FN episodes. Conclusions: Dipstick lower sensitivity for diagnosing UTI in febrile infants 0-2 months old vs. their older counterparts, was associated with non-SPA sampling method, lower inflammatory markers, lower temperature and low risk for future UTI. This suggests that positive culture in negative dipstick episodes may not reflect a true UTI.