Urinary tract infections in children from the Gulf Cooperation Council countries: a literature review (2011-2022).

Urinary tract infections (UTIs) are common healthcare-associated and community-acquired bacterial infections in children. Data on pediatric UTIs in the Gulf Cooperation Council (GCC) region (Bahrain, Kuwait, Oman, Qatar, Saudi Arabia, and the United Arab Emirates) have not been collated. Our aim is to review the published literature on the risk factors, etiology, antimicrobial susceptibility, and treatment of pediatric (aged <18 years) UTIs from healthcare and community settings in the GCC countries.

Frequency of serious bacterial infection among febrile sickle cell disease children in the era of the conjugate vaccine: A retrospective study.

Background: Sickle cell disease (SCD) is a wide prevalence disease worldwide. It has a spectrum of clinical manifestations. However, SCD patients are more susceptible to have a serious bacterial infection (SBI) as compared to other individuals. Objective: The main objective of this study was to investigate the prevalence rate of serious bacterial infection (SBI) in febrile children with sickle cell disease (SCD), whose vaccinations are up to date and are on regular penicillin prophylaxis, presented to the emergency department (ED) to assist in the management approach of such patients. Methods: A retrospective study included febrile SCD children under 12 years of age between 2014 and 2019 at King Saud Medical City (KSMC) in Riyadh, Saudi Arabia. Patients were stratified according to the true culture result of each febrile event. Descriptive statistics were used to report data from the patient's medical records. Results: From 833 febrile events, 40 events were assessed for eligibility with positive culture results. Of these, 10 were excluded due to contamination. The rest, 30 children with confirmed SBI (3.6%, 30/833) (95% CI = 2.4%-5.1%) were recruited. The highest prevalence rate of SBI was for urinary tract infection (UTI) (2.2%, 19/833) (95% CI = 1.4%-3.5%), followed by bacteremia (1.3%, 11/833) (95% CI = 0.7-2.4), osteomyelitis (0.24%, 2/833) (95% CI = 0.03-0.86) and meningitis (0.12%, 1/833) (95% CI = 0.00-0.67). Pneumococcal was the most common isolate among children with bacteremia (46%, 5/11) followed by Salmonella species (36%, 4/11). All the children fully recovered. Conclusion: As the prevalence of SBI, particularly bacteremia, continues to decline with a favorable outcome in our population, ambulatory management practices for well-presented febrile SCD children should be encouraged, for there are no further reasons for admission and the patient can return soon to their hospital if his condition worsens or there is growth in the blood culture. Further effort is needed to determine whether blood culture and empiric antibiotics are necessary for each febrile event in the probable highly active vaccination era.

The challenge of diagnosing and successfully treating anti-NMDA receptor encephalitis in a toddler.

Anti-N-methyl-D-aspartate (anti-NMDA) receptor encephalitis is an immune-mediated syndrome that is still under-recognised, with grave consequences if not treated early. A multidisciplinary team approach is required in the process of diagnosis and management of this potentially treatable and reversible disorder. We report on a 26-month-old Sudanese girl who presented with focal seizures associated with fever (temperature = 38.9°C) and history of trivial head trauma a day before. Viral encephalitis was suspected, and she was started on acyclovir and ceftriaxone. Cranial computed tomography revealed small high density in the right frontal lobe, and magnetic resonance imaging showed the features of cortical haemorrhagic lesion at the right frontoparietal lobe. Polymerase chain reaction for herpes simplex virus 1 and 2 revealed negative results. Her condition worsened over the course of 1 week, with recurrent seizures, insomnia, violent chorea and orofacial dyskinesia. Electroencephalography showed diffuse slow activity and the presence of 'extreme delta brush' pattern, a specific abnormality seen in anti-NMDA receptor (NMDAR) encephalitis. Cerebrospinal fluid was positive for anti-NMDAR antibodies (titre = 1:100). She was treated with intravenous (IV) corticosteroids, IV immune globulin, plasma exchange and rituximab. Her condition improved gradually, with full recovery when last seen 19 months after the onset of the disease.

COVID-19 Disease in Infants Less Than 90 Days: Case Series.

The objective of this study is to describe the clinical presentations, radiological and laboratory findings, and outcomes of COVID-19 disease in infants ≤ 90 days of age at presentation. We conducted a retrospective study of infants in this age group who were found to be SARS-CoV-2 positive. Asymptomatic infants who were identified through routine testing following delivery to COVID-19-positive mothers were excluded. We classified infants according to their presentation: asymptomatic, mildly symptomatic, moderately symptomatic, and severely/critically symptomatic. A total of 36 infants were included. Of them, two were asymptomatic and four had severe/critical presentation. Of the severely symptomatic infants, two were considered as multisystem inflammatory syndrome in children (MIS-C) and there was one death. One infant in the severe symptomatic group presented with cardiac failure, with the possibility of congenital infection. Another infant presented with cardiogenic shock. None of these infants received antiviral medication. The study found that infants ≤ 90 days can present with a severe form of COVID-19 disease. Multisystem inflammatory syndrome in children, although rarely reported in infants, is a possible complication of COVID-19 disease and can be associated with significant morbidity and mortality.

Diagnosis and management of community-acquired urinary tract infection in infants and children: Clinical guidelines endorsed by the Saudi Pediatric Infectious Diseases Society (SPIDS).

Urinary tract infection (UTI) is the most common bacterial disease in childhood worldwide and may have significant adverse consequences, particularly for young children. In this guideline, we provide the most up-to-date information for the diagnosis and management of community-acquired UTI in infants and children aged over 90 days up to 14 years. The current recommendations given by the American Academy of Pediatrics Practice guidelines, Canadian Pediatric Society guideline, and other international guidelines are considered as well as regional variations in susceptibility patterns and resources. This guideline covers the diagnosis, therapeutic options, and prophylaxis for the management of community-acquired UTI in children guided by our local antimicrobial resistance pattern of the most frequent urinary pathogens. Neonates, infants younger than three months, immunocompromised patients, children recurrent UTIs, or renal abnormalities should be managed individually because these patients may require more extensive investigation and more aggressive therapy and follow up, so it is considered out of the scope of these guidelines. Establishment of children-specific guidelines for the diagnosis and management of community-acquired UTI can reduce morbidity and mortality. We present a clinical statement from the Saudi Pediatric Infectious Diseases Society (SPIDS), which concerns the diagnosis and management of community-acquired UTI in children.

Fetal case of diphtheria reported to CDC emergency operations.

Unreported cases of diphtheria are still present in developing countries. A 9-year-old incompletely vaccinated girl was admitted with pharyngotonsillitis caused by diphtheria. On day 9 of her illness, renal and cardiac failure occurred. Unfortunately, she died within hours of admission to intensive care with cardiogenic shock despite the vigorous supportive care delivered to her and the administration of antibiotics and diphtheria antitoxin. The suboptimal dose of antitoxin administered initially upon admission to hospital was likely to have contributed to the unfavorable outcome.

A matched case-control study to assess the carbapenem-resistant Enterobacteriaceae infections among hospitalized children at King Fahad Medical City, Riyadh, Saudi Arabia.

OBJECTIVES: To identify risk factors associated with carbapenem-resistant Enterobacteriaceae (CRE) infections among hospitalized children at King Fahad Medical City, Riyadh, Saudi Arabia. METHODS: A retrospective matched case-control study was conducted in pediatric patients with CRE infection at King Fahad Medical City, Riyadh, Saudi Arabia between January 2016-2017. RESULTS: During the study period, 19 CRE cases and 37 controls were identified for analysis. Children  ≤17 years (mean age±SD for cases was 43.9±46 months and controls was 29.2±52.2 months) were included in the study. Several factors associated with CRE infections were identified, which included, central venous catheter (CVC) line placement (p=0.023; confidence interval [CI]: 0.97-85.77), recent surgical procedures (p=0.006; CI: 1.30-9.28), invasive procedures (p greater than 0.001; CI: 1.98-21.18), use of prior antibiotics (p=0.008; CI: 1.38-24.62), and carbapenem exposure in the past 3 months (p=0.004; CI: 1.09-12.20). Among the cases, Klebsiella pneumonia was the most commonly identified (47%) followed by Escherichia coli (31%). Carbapenem-resistant Enterobacteriaceae was associated with increased comorbidities and prolonged hospitalization however, no mortalities were reported. CONCLUSION: This study identified prior antibiotic exposure, recent surgery and the use of invasive procedures as significant risk factors for colonization or infection with CRE. Also, the need for public awareness, continuing education for healthcare professionals, optimum use of invasive devices, enhanced surveillance, and antimicrobial stewardship are highlighted here which can limit CRE transmission in healthcare facilities.

Invasive community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) infection in children: case series and literature review.

The majority of CA-MRSA infections present as skin and soft tissue infections such as abscesses or cellulitis. However, CA-MRSA can cause invasive infections such as joint infections, necrotizing pneumonia or septicemia. Here we describe five cases with CA-MRSA bacteremia complicated with osteoarticular infection, necrotizing pneumonia, and infective endocarditis. We report these case series to outline the spectrum of invasive CA-MRSA diseases and to demonstrate clinical outcome. Early proper intervention with regular revisiting the empirical treatment based on local susceptibility data is crucial. More data on the risk factors for acquiring and spread of CA-MRSA in children are required.