ABSTRACT
OBJECTIVE: The Italian Society for Pediatric Infectious Diseases created a registry on children with infective endocarditis (IE) hospitalized in Italy. METHODS: A cross-sectional survey was conducted on patients hospitalized due to IE in Italian paediatric wards between January 1, 2000, and June 30, 2015. RESULTS: Over the 15-year study period, 47 IE episodes were observed (19 males; age range, 2-17 years). Viridans Streptococci were the most common pathogens among patients with predisposing cardiac conditions and Staphylococcus aureus among those without (37.9% vs. 5.5%, p = 0.018, and 6.9% vs. 27.8%, p = 0.089, respectively). Six of the 7 (85.7%) S. aureus strains were methicillin-resistant. The majority of patients with and without predisposing cardiac conditions recovered without any complications. CONCLUSION: In Italy, paediatric IE develops without any previous predisposing factors in a number of children, methicillin-resistant S. aureus has emerged as a common causative agent and the therapeutic approach is extremely variable.
Subject(s)
Endocarditis/epidemiology , Endocarditis/microbiology , Adolescent , Child , Child, Preschool , Cross-Sectional Studies , Drug Resistance, Bacterial , Endocarditis/complications , Endocarditis/drug therapy , Female , Heart Diseases/complications , Humans , Italy/epidemiology , Male , Methicillin-Resistant Staphylococcus aureus/isolation & purification , Registries , Risk Factors , Staphylococcal Infections/complications , Staphylococcal Infections/drug therapy , Staphylococcal Infections/epidemiology , Staphylococcal Infections/microbiology , Staphylococcus aureus/drug effects , Staphylococcus aureus/isolation & purification , Streptococcal Infections/complications , Streptococcal Infections/drug therapy , Streptococcal Infections/epidemiology , Streptococcal Infections/microbiology , Viridans Streptococci/drug effects , Viridans Streptococci/isolation & purificationABSTRACT
BACKGROUND: Community acquired-Clostridium difficile infection (CDI) has increased also in children in the last years. AIMS: To determine the incidence of community-acquired CDI and to understand whether Clostridium difficile could be considered a symptom-triggering pathogen in infants. METHODS: A five-year retrospective analysis (January 2007-December 2011) of faecal specimens from 124 children hospitalized in the Niguarda Ca' Granda Hospital for prolonged or muco-haemorrhagic diarrhoea was carried out. Stool samples were evaluated for common infective causes of diarrhoea and for Clostridium difficile toxins. Patients with and without CDI were compared for clinical characteristics and known risk factors for infection. RESULTS: Twenty-two children with CDI were identified in 5 years. An increased incidence of community-acquired CDI was observed, ranging from 0.75 per 1000 hospitalizations in 2007 to 9.8 per 1000 hospitalizations in 2011. Antimicrobial treatment was successful in all 19 children in whom it was administered; 8/22 CDI-positive children were younger than 2 years. No statistically significant differences in clinical presentation were observed between patients with and without CDI, nor in patients with and without risk factors for CDI. CONCLUSIONS: Our study shows that Clostridium difficile infection is increasing and suggests a possible pathogenic role in the first 2 years of life.
Subject(s)
Anti-Infective Agents/therapeutic use , Clostridioides difficile , Clostridium Infections/epidemiology , Community-Acquired Infections/epidemiology , Diarrhea/epidemiology , Adolescent , Age Factors , Child , Child, Preschool , Clostridium Infections/drug therapy , Community-Acquired Infections/drug therapy , Diarrhea/microbiology , Female , Hospitalization , Humans , Incidence , Infant , Male , Retrospective Studies , Risk FactorsABSTRACT
OBJECTIVES: Because of the spread of drug-resistant Gram-positive bacteria, the use of linezolid for treating severe infections is increasing. However, clinical experience in the paediatric population is still limited. We undertook a multicentre study to analyse the use of linezolid in children. METHODS: Hospitalized children treated with linezolid for a suspected or proven Gram-positive or mycobacterial infection were analysed retrospectively. Side effects were investigated, focusing on younger children and long-term treatments. RESULTS: Seventy-five patients (mean age 6.8 years, range 7 days to 17 years) were studied. Meanâ±âSD linezolid treatment duration was 26.13â±â17 days. Clinical cure was achieved in 74.7% of patients. The most frequent adverse events were diarrhoea and vomiting. Two patients had severe anaemia, two neutropenia and one thrombocytopenia. Two cases of grade 3 liver function test elevation and one case of pancreatitis were reported. The overall frequency of adverse events was similar between patients treated for >28 days and those receiving shorter treatments (30.8% versus 28.6%, Pâ=â0.84). Children aged <2 years received linezolid for a shorter duration than older children (21.2 days versus 28.4 days, Pâ=â0.05), whereas the frequency of adverse events was similar in the two age groups. CONCLUSIONS: In our paediatric population, linezolid appeared safe and effective for the treatment of selected Gram-positive and mycobacterial infections. The adverse reactions encountered were reversible and appeared comparable to those reported in paediatric clinical trials. Nevertheless, the potential for haematological toxicity of linezolid in children means that careful monitoring is required during treatment.
