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Background and aims
Most children attending the ED suffer from self-limiting respiratory tract infections. However, inappropriate antibiotic prescribing often occurs, which contributes to antimicrobial resistance. We aimed to assess the impact of rapid viral testing at the ED on antibiotic prescription rate.

Methods
This study is part of the MOFICHE/PERFORM study on febrile children (0-18 years) attending 12 European EDs. In children with respiratory symptoms, we performed multivariate regression analysis regarding antibiotic prescription adjusted for patient characteristics, disease severity, focus of infection and hospital. We evaluated the influence of: (1) availability of rapid viral testing at the EDs (N=20,707), (2) performing versus not performing a rapid viral test (N=12,524), (3) positive versus negative test results (N=1213) on antibiotic use.

Results
Patients in 6 EDs equipped with a rapid viral test more often received antibiotics compared to patients in 6 EDs without a rapid viral test (aOR 1.8, 95%CI 1.2-2.7). Antibiotic prescription rate was comparable in patients in whom a test was performed versus patients who were not tested (aOR 1.0, 95%CI 0.9-1.2). Children testing positive less often received antibiotics than children testing negative (31% versus 38%, p<0.001). CRP level was elevated (>60 mg/L) in 19% of the positive tested children receiving antibiotics.

Conclusion
Our data show an overall higher antibiotic prescription rate in EDs equipped with a rapid viral test and a comparable antibiotic prescription rate in patients with versus without test performed. Although antibiotic prescription was lower in children testing positive, one third of these children still received antibiotics.

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Background and aims: Infections are the leading cause of mortality in children worldwide and are exacerbated by increasing levels of antimicrobial resistance (AMR), a consequence of poor antibiotic governance, particularly in developing nations. The aim of the Childhood Infections and Pollution Consortium is to reduce the burden of childhood infections and AMR through the co-production of integrated, low-cost behavioural and slum-upgrading interventions using a One Health and technology-enabled Citizen Science approach.

Methods: Between September-December 2019, we undertook transect walks, social mapping and 1:1 interview with mothers and key informants in slum areas in Jaipur, Jakarta and Antofagasta. We utilised a geo-tagged action camera in walks to observe potential infection pathways as well as social-cultural aspects of each community and co-produced a detailed map of slum-level variables with the residents. The interviews explored the dwellers’ understanding of infections and their pathways and gave us insight into the feasibility of collecting biological and non-biological samples in the future.

Results: A conceptual map of One Health factors associated with infections and AMR in U5s living in slums was created from the data collected (Fig 1). It summarises the complex relationships we are investigating, and it serves as a roadmap to identifying research questions and designing interventions.

Conclusion: Infection pathways involve a complex network of One Health factors and AMR. Our fieldwork allowed us to observe environmental and living conditions, potential human-livestock interactions, pathways to infections for children, and to explore the feasibility of sampling procedures that would be acceptable to the individual communities.

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Background and aims:

Systemic lupus erythematosus (SLE) is an autoimmune inflammatory disease which mainly affects adult population, however 10-20% of cases are diagnosed during childhood. About a 50-75% of patients with pediatric systemic lupus erythematosus (pSLE) have lupus nephritis (LN) at onset and more than a 90% develop it during the first 2 years of illness.

In this study we aim to analyze systemic manifestations of 13 patients with SLE at diagnosis.

Methods:

Retrospective, descriptive study of patients with LN followed in a level-III pediatric hospital between 2013 and 2019.

Results:

At onset, the most common findings were LN (46,1%), followed by musculoskeletal (38,4%), hematologic (38,4%) and mucocutaneous (30,7%) manifestations. Only one patient (7,7%) showed neuropsychiatric symptoms and two patients (15,3%) constitutional symptoms.

Regarding LN, kidney failure was present in two patients, one of them associated with nephrotic syndrome . Isolated proteinuria was seen in two other patients, one patient showed episodic hematuria (firstly diagnosed as IgA nephropathy) and microscopic hematuria was the only initial symptom in one last patient.

Renal biopsy was undertaken in twelve patients, class III and IV LN were the most frequent findings (INS/RPS 2003 classification).

During follow up, 38,5% of patients had more than 3 systems affected (maximum of 7). No patients required renal replacement therapy and there was no mortality.

Conclusions:

pSLE has many systemic presentations, with LN being of the most frequently found. This may prove helpful, as early diagnosis might allow early treatment, improve prognosis and survival.