Bloodstream Infections in Hospitalized Children: Epidemiology and Antimicrobial Susceptibilities.

Background: Bloodstream infection is a major cause of morbidity and mortality. Much of our understanding of the epidemiology and resistance patterns of bloodstream infections comes from studies of hospitalized adults.

Methods: We evaluated the epidemiology and antimicrobial resistance of bloodstream infections occurring during an 11-year period in a large, tertiary care children's hospital in the US.

Daptomycin Use in United States Children's Hospitals.

We described 1035 pediatric hospitalizations with daptomycin use in 794 patients since 2004. Daptomycin use was uncommon but increased over time. A minority of hospitals accounted for the majority of use.

Frontline Clinician Knowledge of Antimicrobial Prescribing in an Academic Tertiary Children's Hospital: A Point Prevalence Study.

Frontline clinicians caring for hospitalized children typically knew the indication for antimicrobial therapy but less often knew the current day or planned duration of therapy or of plans for intravenous to oral conversion. Night shift clinicians were less likely to know day of therapy and duration of therapy than day shift clinicians caring for the same patients.

Antiretroviral treatment in HIV-1 infected pediatric patients: focus on efavirenz.

Efavirenz is a non-nucleoside reverse transcriptase inhibitor (NNRTI), used for the treatment of human immunodeficiency virus (HIV)-1 infection. Approved by the US Food and Drug Administration in 1998, its indication was recently extended to include children as young as 3 months of age. The World Health Organization and many national guidelines consider efavirenz to be the preferred NNRTI for first-line treatment of children over the age of 3 years.

Communicating vaccine science to the public.

Communicating science to the public is not always a straightforward process. In the case of vaccines, fear and lack of knowledge makes it even more challenging. We present some suggestions on how to defend the methods and fruits of scientific investigation to the public: 1) stand up for science, even if it not an easy task, 2) remember that no venue it too small, 3) don't let bad information go unchallenged, 4) don't assume other people are doing it, they are not and 5) remember that scientist have a responsibility to the public.

Cutaneous bacterial infections caused by Staphylococcus aureus and Streptococcus pyogenes in infants and children.

Acute bacterial skin and skin structure infections (SSSIs) are among the most common bacterial infections in children. The medical burden of SSSIs, particularly abscesses, has increased nationwide since the emergence of community-acquired methicillin-resistant Staphylococcus aureus. SSSIs represent a wide spectrum of disease severity.

Candida krusei arthritis in an adolescent with acute myelogenous leukemia.

We report a case of Candida krusei arthritis in an adolescent with secondary acute myelogenous leukemia, who underwent an allogeneic bone marrow transplant complicated by C. krusei fungemia 4 months before her presentation. The infection was successfully treated with voriconazole.

Newer antifungal agents.

Purpose Of Review: In recent years there has been an evolution of a better understanding of the pharmacology and clinical indications of existing antifungal agents and also the development of new broad-spectrum triazoles and a newer class of antifungal agents, the echinocandins. The availability of these agents has broadened the therapeutic options of invasive fungal disease among children and consequently antifungal therapy has become increasingly complex.

Recent Findings: Adoption of adult guidelines' recommendations has been used to guide pediatric treatment as specific pediatric data were often lacking.

Medical treatment failure and complete left pneumonectomy after Legionella pneumophila pneumonia in a bone marrow transplant recipient.

Legionnaire disease (LD) is infrequently considered in the differential diagnoses for hospital- and community-acquired pneumonia in pediatrics. We report a case of Legionnaire disease in a 19-year-old male with aplastic anemia after bone marrow transplant, who was being treated in a children's hospital. Severe, refractory pulmonary disease necessitated pneumonectomy to control the infection.

HIV-infected adolescents: relationship between atazanavir plasma levels and bilirubin concentrations.

The use of atazanavir (ATV) in adolescents infected with human immunodeficiency virus was analyzed in this study. ATV morning plasma concentrations were determined during regular visits to the outpatient department. Results showed that bilirubin levels were higher among patients with higher ATV plasma concentrations (p = .

Comparison of levels of antiretroviral drugs with efficacy in children with HIV infection.

Objective: To determine the prevalence of low and high antiretroviral (ARV) plasma levels and to analyze correlation between ARV concentrations and the appearance of therapeutic failure and toxicity.

Methods: The authors present here a study evaluating antiretroviral plasma concentrations in HIV infected children on nonnucleoside reverse transcriptase inhibitors and protease inhibitors based therapy. The authors carried out a multicentre, cross-sectional study, including HIV-infected children from five large Hospitals in Madrid, Spain.

Association between lipodystrophy and leptin in human immunodeficiency virus-1-infected children receiving lopinavir/ritonavir-based therapy.

Highly active antiretroviral therapy might lead to the development of dyslipidemia and lipodystrophy (LD) syndrome. We carried out a multicenter prospective study of 22 human immunodeficiency virus (HIV)-1-infected children treated during 48 months with lopinavir/ritonavir-based highly active antiretroviral therapy to evaluate the trend of serum lipids and adipokines. Increase in plasma leptin levels and leptin/adiponectin ratio was associated with LD.

[Plasma antiretroviral levels in children with human immunodeficiency virus infection. Influence of sex and age].

Introduction: Pharmacologic studies have shown a relationship between plasma antiretroviral levels and toxicity/viral activity. Nevertheless, pharmacokinetic and pharmacodynamic data are inconsistent and limited in HIV-infected children. An analysis was performed of plasma antiretroviral concentrations in clinical practice and their influence on therapy efficacy in HIV-infected children.

Pathology in children of HIV women.

Objective: To assess the frequency of perinatal pathology in children exposed to antiretrovirals in perinatal period.

Design: Retrospective observational cohort study.

Methods: Retrospective observational cohort study.

Malaria in infants below six months of age: retrospective surveillance of hospital admission records in Blantyre, Malawi.

Background: Information on the burden of malaria in early infancy is scarce. Young infants are relatively protected against clinical malaria during the first six months of life due to the presence of maternal antibodies and foetal haemoglobin, and have received relatively little attention with respect to research and treatment guidelines. The World Health Organization provides treatment guidelines for children from six months onwards, without specific treatment guidelines for the younger infants.

Immunological recovery and metabolic disorders in severe immunodeficiency HIV type 1-infected children on highly active antiretroviral therapy.

Little is known about immunologic reconstitution in children on highly active antiretroviral treatment (HAART) during very long-term periods. A retrospective study was carried out to assess the effectiveness and development of metabolic disorders after very long-term periods on HAART in HIV-infected children with severe immunodeficiency. We included 55 children who were stratified into three groups according to %CD4(+) pre-HAART and rate of immunologic recovery: (1) S1-Rec: CD4(+) < or =5% at baseline and slow immunologic recovery; (2) S2-Rec: CD4(+) 5-15% at baseline and slow immunologic recovery; (3) R-Rec: CD4(+) < or =15% at baseline and rapid immunologic recovery (reference group).

[Evolution of HIV and HCV coinfected children receiving long-term lopinavir/ritonavir-based antiretroviral therapy].

Introduction: There are few studies investigating the effect of HCV coinfection on HIV-related disease among children.

Methods: We studied 5 HIV/HCV coinfected children receiving an LPV/r-containing HAART regimen. Their evolution was compared with a control group of 72 HIV-infected children.

Long-term response to highly active antiretroviral therapy with lopinavir/ritonavir in pre-treated vertically HIV-infected children.

Background: Immune recovery after prolonged highly active antiretroviral therapy (HAART) with lopinavir/ritonavir has been reported in adults but not in children. Our study aimed at evaluating the long-term use of lopinavir/ritonavir among children in a clinical setting.

Methods: We carried out a retrospective study on 69 protease inhibitor (PI)-experienced vertically HIV-infected children on HAART containing lopinavir/ritonavir.

Predictive factors of virological success to salvage regimens containing protease inhibitors in HIV-1 infected children.

Background: The impact of HIV drug resistance mutations in salvage therapy has been widely investigated in adults. By contrast, data available of predictive value of resistance mutations in pediatric population is scarce.

Methods: A multicenter, retrospective, observational study was conducted in children who received rescue salvage antiretroviral therapy after virologic failure.

Effects of highly active antiretroviral therapy with nelfinavir in vertically HIV-1 infected children: 3 years of follow-up. Long-term response to nelfinavir in children.

Background: Antiretroviral treatment (ART) in children has special features and consequently, results obtained from clinical trials with antiretroviral drugs in adults may not be representative of children. Nelfinavir (NFV) is an HIV-1 Protease Inhibitor (PI) which has become as one of the first choices of PI for ART in children. We studied during a 3-year follow-up period the effects of highly active antiretroviral therapy with nelfinavir in vertically HIV-1 infected children.