Development of the Anaerobic Microbiome in the Infant Gut.

Ninety-five percent of gut microbiota are anaerobes and vary according to age and diet. Complex carbohydrates in human milk enhance the growth of Bifidobacterium and Bacteroides in the first year. Complex carbohydrates in solid foods enhance the growth of Bacteroides and Clostridium in the second year.

The Role of Faecalibacterium, Roseburia, and Butyrate in Inflammatory Bowel Disease.

Faecalibacterium and Roseburia are major producers of butyrate in the intestine. A reduced abundance of the organisms and a concurrent reduction in butyrate levels are associated with inflammatory bowel disease.

Secretors of HBGA and Susceptibility to Norovirus and Rotavirus Diarrhea.

Histo-blood group antigen contains oligosaccharides that serve as receptors for norovirus (NoV) and rotavirus (RV). The receptors are only present on the surface of intestinal mucosal epithelial cells of secretors; therefore, secretors are susceptible to NoV and RV diarrhea and nonsecretors are resistant. The prevalence of secretors in different countries varies between 50% and 90%.

Review and Commentary on the Importance of Bile Acids in the Life Cycle of Clostridioides difficile in Children and Adults.

Clostridioides difficile, a spore-forming anaerobe, resides in the intestine. The life cycle of C. difficile illustrates an interdependent relationship between bile acids, commensal microbiota, and C.

The Response of the Gut Microbiota to Dietary Changes in the First Two Years of Life.

The infant gut microbiota undergoes significant changes in the first two years of life in response to changes in the diet. The discontinuation of the milk-based diet of the first year and the introduction of solid foods in the second year of life results in a decline in , a shift from infant strains of to adult strains which preferentially metabolize oligosaccharides derived from plants rather than from milk, a surge in short chain fatty acids such as acetic, propionic and butyric acid from newly acquired commensal , and the transformation of primary bile acids into secondary bile acids by a limited number of newly acquired and highly specialized spp. By 3 years of age, diet and gut microbiota closely resemble those of adults.

The milk-based diet of infancy and the gut microbiome.

The composition and the diversity of the gut microbiome play a major role in the health and well-being of humans beginning at birth. The impact of the diet on the structure and the function of the gut microbiome is evident by the changes in the gut microbiome concurrent with the transition from human milk to solid food. Complex oligosaccharides contained in milk are essential nutrients for commensal microbes in the infant gut.

Interactions of bile acids and the gut microbiota: learning from the differences in infection between children and adults.

Bile acids and microbiota differ significantly in the gut of children and adults. In the first 3 yr of life, intestinal bile consists mostly of two primary bile acids, cholic acid (CA) and chenodeoxycholic acid (CDCA); however, in adults, primary bile acids are transformed into the secondary bile acids, deoxycholic acid (DCA) and lithocholic acid. This difference has a major impact on the gut microbiome, especially on anaerobic spore-forming bacteria.

Infections Associated With Streptococcus Constellatus in Children.

Streptococcus constellatus is a viridans Streptococcus belonging to the Anginosus group. It was associated with abscesses in 37 children, 80% of whom had acute appendicitis with perforation and abscess formation in 50%. None of the children was <3 years of age.

The ubiquity of asymptomatic respiratory viral infections in the tonsils and adenoids of children and their impact on airway obstruction.

Background: Airway obstruction due to enlargement of tonsils and adenoids is a common pediatric problem resulting in sleep disordered breathing. The cause for the relatively abnormal growth of tonsils and adenoids is poorly understood.

Methods: Non-acutely ill children undergoing tonsillectomy and adenoidectomy (T&A) for various reasons were enrolled prospectively in a study to determine the frequency of asymptomatic respiratory viral infections in each lymphoid tissue and to relate the number and types of virus to the degree of airway obstruction.

Infections Associated with Streptococcus intermedius in Children.

Streptococcus intermedius is a viridans Streptococcus belonging to the Anginosus group. In the past 7 years, it has been associated with abscesses in 48 children, 40% of whom had complicated and/or life-threatening illness. It was the sole pathogen in 35 cases.

Trimethoprim-Sulfamethoxazole Therapy Reduces Failure and Recurrence in Methicillin-Resistant Staphylococcus aureus Skin Abscesses after Surgical Drainage.

Objective: To determine whether a 3-day vs 10-day course of antibiotics after surgical drainage of skin abscesses is associated with different failure and recurrence rates.

Study Design: Patients age 3 months to 17 years seeking care at a pediatric emergency department with an uncomplicated skin abscess that required surgical drainage were randomized to receive 3 or 10 days of oral trimethoprim-sulfamethoxazole therapy. Patients were evaluated 10-14 days later to assess clinical outcome.

Trends in Oral Antibiotic, Proton Pump Inhibitor, and Histamine 2 Receptor Blocker Prescription Patterns for Children Compared With Adults: Implications for Clostridium difficile Infection in the Community.

The use of antibiotics, proton pump inhibitor (PPI), and histamine 2 receptor blocker (H2B) was compared between children and adults in the community from 2005 through 2011. Antibiotic prescription rates remained stable for children, but increased significantly for adults, P = .03.

Importance of asymptomatic shedding of Clostridium difficile in environmental contamination of a neonatal intensive care unit.

A survey of C. difficle in a neonatal intensive care unit (NICU) was conducted. Approximately 25% of infants in the NICU were colonized with Clostridium difficle.

Neurologic complications of 2009 influenza-a H1N1 infection in children.

Little is known about the neurologic complications of the 2009 Influenza-A H1N1 epidemic in children. We present a retrospective analysis of children evaluated at a tertiary children's hospital who tested positive for H1N1 with neurologic complications. A total of 164 children tested positive for H1N1.

Impact of management and bacterial genomics on outcomes of Staphylococcus aureus bacteremia in children.

Children with Staphylococcus aureus bacteremia (SAB) generally presented with nonsevere signs and symptoms in sharp contrast to reports of adults with SAB. Despite incomplete adherence to current management guidelines, children with SAB did not experience mortality or relapse. Molecular characteristics of strains responsible for SAB in children were not significantly different than those described in adults.

Azithromycin-induced agitation and choreoathetosis.

We report a child who developed agitation and choreoathetoid movements with azithromycin therapy on 2 separate occasions. In both instances, the symptoms resolved when the antibiotic was discontinued. By means of the Naranjo adverse drug reaction probability scale, we classified this event as a probable adverse drug reaction (score of 6 points).

Genomic comparisons of USA300 Staphylococcus aureus colonizating the nose and rectum of children with skin abscesses.

USA300 Staphylococcus aureus is responsible for the current outbreak of skin abscesses in the United States. Unlike other USA types, USA300 colonizes the rectum at rates higher than the nose. The reason for the difference in colonization site preference may be related to specific adherence or attachment factors contained in the genome of these strains.

Pseudo-outbreak of adenovirus infection in a neonatal intensive care unit due to a false-positive antigen detection test.

Twenty-eight of 56 infants in a neonatal intensive care unit had stools positive for adenovirus by the Sure-Vue adenovirus test. Virus cultures of conventionally processed and chloroform-extracted stool samples, as well as conventional and real-time PCR tests, were negative for adenovirus. The cause for the 50% false-positive rate with the antigen test was not determined.

Comparison of midturbinate flocked-swab specimens with nasopharyngeal aspirates for detection of respiratory viruses in children by the direct fluorescent antibody technique.

Paired nasopharyngeal aspirate (NPA) and midturbinate flocked-swab specimens from 153 children with respiratory symptoms were examined by the direct fluorescent antibody (DFA) technique. Seventy-four infants (49%) had a viral infection documented by DFA. The flocked-swab specimens had 93% sensitivity and 96.

Importance of colonization site in the current epidemic of staphylococcal skin abscesses.

Objective: The goal was to compare rectal and nasal Staphylococcus aureus colonization rates and S aureus pulsed-field types (PFTs) for children with S aureus skin and soft-tissue abscesses and normal control subjects.

Methods: Sixty consecutive children with S aureus skin and soft-tissue abscesses that required surgical drainage and 90 control subjects were enrolled. Cultures of the nares and rectum were taken in both groups.

Increasing incidence of community-associated atypical Clostridium difficile disease in children.

Forty-one children with a variety of gastrointestinal complaints were diagnosed with Clostridium difficile infections as part of a routine screen over 3 years. The infection had not been suspected prior to the screen. Each child responded to treatment with metronidazole with resolution of their symptoms.

The high rate of adverse drug events in children receiving prolonged outpatient parenteral antibiotic therapy for osteomyelitis.

Forty-five children treated with 82 courses of 15 different antibiotics over 344 weeks during outpatient parenteral antibiotic therapy were evaluated for adverse drug events (ADE). Fifty-one percent of the courses had an associated ADE and 32.5% of the antibiotic courses were discontinued because of ADE.