This study demonstrates the high mortality of hospital-acquired MDRGN bacteremia in children. International networks focusing on clinical management and outcomes of MDRGN in children are required. Study of novel antibiotics active against Gram-negative bacteria should include children early in the clinical trial development programs.

objectives. To describe trends in the epidemiology of healthcare-associated Infections (HAIs) in pediatric/neonatal intensive care units (ICUs) and to evaluate risk factors and impact of multidrug resistance in children admitted to ICUs.design. Multicenter, retrospective, cohort study with a nested case-control study conducted from January 1, 2010, through December 31, 2014.setting. Three tertiary care pediatric hospitals in Italy and Brazil with a total of 103 ICU beds.patients. Inclusion criteria were admission to ICU during the study period, age at onset less than 18 years, and microbiologically confirmed HAI.results. A total of 538 HAIs in 454 children were included; 93.3% of patients had comorbidities. Bloodstream infections were the leading pattern (45.4%). The cumulative incidence of HAI was 3.6/100 ICU admissions and the crude 30-day fatality rate was 5.7/1,000 admissions. The most frequently isolated pathogens were Enterobacteriaceae, followed by Pseudomonas aeruginosa and Staphylococcus aureus. Forty-four percent of isolates were multidrug-resistant (MDR). Two multivariate logistic regressions were performed. Factors independently associated with an MDR-HAI were country, previous antibiotics, transplantation, major surgery, and colonization by an MDR strain. Factors independently associated with 30-day case fatality were country, previous transplantation, fungal infection, bloodstream infection, lower respiratory tract infection, and infection caused by MDR strains.conclusions. Infection control and prevention can limit the spread of MDR strains and improve outcomes. Targeted surveillance programs collecting neonatal and pediatric HAI/bloodstream infection data and outcomes would allow global benchmarking. The next step is to identify methods to monitor key HAIs and integrate these into affordable intervention programs. 2016;37:1302-1309 Healthcare-associated infections (HAIs) are one of the most frequent adverse events affecting children admitted to intensive care units (ICUs). Infect Control Hosp Epidemiol1,2 Exposure to invasive devices and procedures, immune suppression, and underlying conditions are considered as main determinants of patients' increased susceptibility.3,4 The impact of multidrug-resistant (MDR) organisms in pediatrics is increasing globally. [5][6][7] It is assumed that infections caused by MDR bacteria will have a worse prognosis because of the delay in the administration of appropriate therapy. However, it is difficult to estimate the clinical impact of MDR-HAI in children.Previous literature has shown conflicting results about the impact of different underlying risk factors on the clinical outcome of patients with HAI admitted to ICUs. There is no clear independent correlation between antimicrobial resistance and patients' mortality. [8][9][10][11] Clarifying the relationship between patient risk factors and pediatric HAI mortality could allow improved targeting of interventions on the patients most at risk of adverse outcome. The aims of this study were to describe trends i...

We evaluated severe acute respiratory syndrome coronavirus 2 RNA clearance in 22 children. The estimation of positivity at day 14 was 52% for nasopharyngeal swab and 31% for stool samples. These data underline the significance of nasopharyngeal and stoolsample for detecting infected children. Additional studies are needed for transmissibility.

Background Lately, one of the major clinical and public health issues has been represented by Coronavirus disease of 2019 (COVID-19) during pregnancy and the risk of transmission of the infection from mother to child. Debate on perinatal management and postnatal care is still ongoing, principally questioning the option of the joint management of mother and child after birth and the safety of breastfeeding. According to the available reports, neonatal COVID-19 appears to have a horizontal transmission and seems to be paucisymptomatic or asymptomatic, compared to older age groups. The aim of this work is to describe a cluster of neonatal COVID-19 and discuss our experience, with reference to current evidence on postnatal care and perinatal management. Methods This is a retrospective observational case series of five mother-child dyads, who attended the Labor and Delivery Unit of a first-level hospital in Italy, in March 2020. Descriptive statistics for continuous variables consisted of number of observations, mean and the range of the minimum and maximum values. Results Five women and four neonates tested positive for Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). In one case, the mother-child dyad was separated and the neonate remained negative on two consecutive tests. Two positive neonates developed symptoms, with a predominant involvement of the gastrointestinal tract. Blood tests were unremarkable, except for a single patient who developed mild neutropenia. No complications occurred. Conclusions We agree that the decision on whether or not to separate a positive/suspected mother from her child should be made on an individual basis, taking into account the parent’s will, clinical condition, hospital logistics and the local epidemiological situation. In conformity with literature, in our study, affected neonates were asymptomatic or paucisymptomatic. Despite these reassuring findings, a few cases of severe presentation in the neonatal population have been reported. Therefore, we agree on encouraging clinicians to monitor the neonates with a suspected or confirmed infection.

BackgroundExtensively drug-resistant Pseudomonas aeruginosa (XDR-PA) isolates are susceptible to only one or two classes of antibiotics. In 2011–2012, we investigated an outbreak of XDR-PA affecting children with onco-hematological diseases.MethodsOutbreak investigation included ascertainment of cases, tracing of intestinal carriers and environmental surveillance. Contact precautions were adopted for patients with infection or colonization. Isolates were tested for antimicrobial susceptibility; phenotypic confirmation of carbapenemase production was performed, and carbapenemase genes were tested by multiplex polymerase-chain-reaction (PCR). Genotypes were determined by pulsed-field gel electrophoresis (PFGE).ResultsXDR-PA was isolated from 27 patients; 12 had bacteremia, 6 other infections and 9 were colonized. Severe neutropenia was significantly associated with bacteremia. Bloodstream-infection mortality rate was 67%. All isolates were resistant to carbapenems, cephalosporins and penicillins + β-lactamase inhibitors. Isolates were susceptible only to colistin in 22 patients, to colistin and amikacin in 4, and to ciprofloxacin and colistin in 1. PFGE results identified 6 subtypes of a single genotype, associated with clusters of cases, and 4 sporadic genotypes. Two sporadic isolates were metallo-β-lactamase producers, negative to PCR. All other isolates were metallo-β-lactamase producers due to the presence of a VIM carbapenemase. Incidence of XDR-PA infections decreased from 0.72 cases/1,000 inpatient-days in March 2011-March 2012, to 0.34/1,000 in April-December 2012, after implementation of active finding of intestinal carriers on all onco-hematological inpatients.ConclusionsControl measures targeting intestinal carriers are crucial in limiting in-hospital transmission of XDR-PA polyclonal strains, protecting more vulnerable patients, such as severely neutropenic children, from developing clinical infections.Electronic supplementary materialThe online version of this article (doi:10.1186/1471-2334-14-494) contains supplementary material, which is available to authorized users.

No abstract

SummaryAcinetobacter baumannii is a Gram-negative coccobacillus causing serious nosocomial infections. The recent emergence of strains of bacteria, which are resistant to common antibiotics, has made the treatment of these infections increasingly complex. We report the case of a young patient affected by AIDS, who suffered brain toxoplasmosis and sepsis due to multidrug-resistant A baumannii . This bacterial infection was successfully treated with colistin and tigecycline. In addition, we review recent literature on this topic, from the year 2000 to date. showed a left pleural effusion. Epstein-Barr virus and cytomegalovirus infection was ruled out on the basis of a molecular test (PCR). BMJ Case ReportsBrain CT documented coarse, hypodense and inhomogeneous area, probably due to toxoplasmosis, localised in the left basal ganglia. Other hypodense areas of variable size were diffused bilaterally in all brain parenchyma. Electroencephalogram showed diffuse depressed brain activity, without epileptiform abnormalities.After the onset of suprapubic pain, an abdominal ultrasound scan was performed, which visualised fl uid collection (37×34×66 mm) of probable infectious origin above the bladder located in the point of insertion of the ventricular-peritoneal shunt.The most likely cause of the clinical status of the patient was a meningitis secondary to neurosurgery, which was complicated by the contamination of the shunt with consequent formation of a peritoneal abscess and sepsis. Indeed, ventriculo-peritoneal catheter culture, cerebrospinal fl uid (CSF) examination and peritoneal swab culture revealed the presence of multidrug-resistant (MDR) A baumannii . The bacteria were identifi ed by morphology, Gram stain and reactions with automated instrument Vitek 2 (BioMerieux, Inc.100 Rodolphe Street, Durham, NC 27712).Full in vitro antibiotic susceptibility was exclusively present for colistin (minimum inhibitor concentration (MIC) 1.5 mg/l) and tigecycline (MIC 0.5 mg/l) with a partial susceptibility to amikacin, tobramycin and levofl oxacin. TREATMENTAt the beginning, antibiotic treatment with meropenem and piperacillin/tazobactam was started.Successively, vancomycin was added to the treatment, following the discovery of the fl uid collection above the bladder.Since culture results detected the presence of MDR A baumannii , the patient was treated with a combined therapy based on the association of colistin (150 000 UI/kg/ day divided in three doses) and tigecycline (3 mg/kg/day divided in two doses) for 4 weeks and then continued with tigecycline alone for another 4 weeks. Therapy was well tolerated. At the same time, highly active antiretroviral therapy treatment led an increase of CD4 cells (126 cells/ ml -5.1%). OUTCOME AND FOLLOW-UPThe patient's general clinical conditions rapidly improved and there was a reduction of the infl ammation markers, with a complete disappearance of fever after 1 week of therapy. After 2 weeks of therapy, CSF testing gave a negative result. Successive chest x-ray showed gradual improvemen...

We investigated the clonal relatedness of seven multi-drug-resistant (MDR) Klebsiella pneumoniae isolates, as well as three susceptible K. pneumoniae isolates collected during hospital outbreaks and outbreak-related microbiological surveillance, respectively. The relatedness among K. pneumoniae isolates was assessed by pulsed field gel electrophoresis (PFGE) and automated repetitive-sequencebased PCR (rep-PCR) genotyping and the results were compared to a proteomic phenotyping performed by matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS). All typing methods agreed on the generation of three different clusters of K. pneumoniae isogenetic/ related MDR strains. After strengthening hospital infection control measures, no other spreading events involving MDR-K. pneumoniae were reported until the end of the observation period. This preliminary investigation suggests that, in a hierarchical approach to bacterial typing, MALDI-TOF MS proteome profiling might offer a fast and valuable preliminary screening tool able to support microbiologists during nosocomial outbreak surveys.