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The epidemiology of Staphylococcus aureus infection in children is dynamic. We conducted a retrospective observational study on pediatric clinical cultures, performed between 2005 and 2017, that grew S aureus to determine temporal trends in antibiotic resistance. Although methicillin resistance declined, clindamycin and trimethoprim-sulfamethoxazole resistance increased significantly, especially among community-onset isolates.

Understanding the role that children play in the clinical burden and propagation of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) responsible for novel coronavirus (COVID-19) infections is emerging. While the severe manifestations and acute clinical burden of COVID-19 has largely spared children compared to adults, understanding the epidemiology, clinical presentation, diagnostics, management, and prevention opportunities as well as the social and behavioral impacts on child health is vital. Foremost is clarifying the contribution of asymptomatic and mild infections to transmission within the household and community and the clinical and epidemiologic significance of uncommon severe post-infectious complications. Herein we summarize the current knowledge, identify useful resources, and outline research opportunities. Pediatric infectious disease clinicians have a unique opportunity to advocate for the inclusion of children in epidemiological, clinical, treatment and prevention studies to optimize their care, as well as to represent children in the development of guidance and policy during pandemic response.

IMPORTANCE Escherichia coli is a leading cause of serious infection among term and preterm newborn infants. Surveillance of antibiotic susceptibility patterns of E coli among infants admitted to neonatal intensive care units should inform empirical antibiotic administration.OBJECTIVE To assess the epidemiologic characteristics and antibiotic susceptibility patterns of E coli in infants admitted to neonatal intensive care units in the US over time.

Compliance-linked incentives are an important intervention for improving the coverage and timeliness of immunizations in young children in resource-poor settings.

bRat bite fever is a rare infection usually caused by Streptobacillus moniliformis. A case of septic arthritis and possible osteomyelitis as sequelae of rat bite fever in a pediatric patient is described. CASE REPORTA 22-month-old male presented during the summer of 2011 to the emergency department of the Alfred I. duPont Hospital for Children with 2 days of upper respiratory tract symptoms followed by 5 days of fever, malaise, and a gradually worsening rash on his upper and lower extremities, including his palms and soles. The rash began to blister, and the toddler became irritable, prompting evaluation. Given his prodrome and rash, the patient was initially thought to have a viral syndrome, such as coxsackievirus. He was admitted for intravenous hydration and pain control. Initial vital signs included mild hypertension, tachycardia, and a fever to 38.0°C.Physical examination revealed a toddler in moderate distress with a tender, erythematous, pustular rash scattered on his feet (Fig. 1), ankles, and hands. No joint swelling or tenderness was initially noted; however, due to patient anxiety, examination was difficult. Initial laboratory results were unremarkable, including a white blood cell (WBC) count of 10,200/l, a hemoglobin concentration of 10.9 g/dl, and a platelet count of 217,000/l, with normal differential values, electrolytes, and urinalysis results. Blood and left-foot pustule fluid were sent for cultures. Over the next few days, his fevers persisted in the setting of a worsening rash and pain. The patient had reportedly been walking less prior to admission, which was attributed to the painful lesions on his feet, but on day 5, he refused to bear any weight and on exam was noted to have pain when his right-hip range of motion was examined. Repeat blood work revealed a WBC count of 18,100/l, a hemoglobin concentration of 10.0 g/dl, a platelet count of 523,000/l, and a neutrophilic predominance. Inflammatory markers revealed a C-reactive protein concentration of 5.4 mg/dl and an erythrocyte sedimentation rate of 94 mm/h. A repeat blood culture was drawn, a lumbar puncture was performed, and an infectious disease specialist was consulted for further evaluation. An ultrasound of the right hip was performed, which found a joint effusion, and the child was started on vancomycin and ceftriaxone for empirical bacterial coverage. Caretakers rereviewed the patient's initial history, and a physical and further discussion revealed that the family had two pet rats. Rat bite fever (RBF) quickly entered the differential.The patient was taken emergently to the operating room due to concern for septic joint, where right-hip joint aspiration revealed a cloudy, green fluid, which was sent for a cell count and culture. Given the clinical scenario and appearance of the fluid, formal open irrigation and debridement of the joint were performed. After 6 liters of irrigation, a sterile Jamshidi needle was used to aspirate the proximal metaphysis of the right femur, and the bone sample was sent for culture. The Gram stain of ...

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