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Pre-Congress days – 20-21 February
Main Congress days – 22-24 February
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291 Presentations
SOURCE IDENTIFICATION AND INTERVENTION MEASURES TAKEN TO SUCCESSFULLY CONTROL TWO NOSOCOMIAL INFECTION OUTBREAKS AT A NEONATAL INTENSIVE CARE UNIT
Abstract
Background
Neonates in the neonatal intensive care units(NICUs) are vulnerable to nosocomial infections, which in turn are associated with increased infection-related morbidities and mortalities.
Aims
This study aimed to identify the sources of Enterococcus faecium/Staphylococcus capitis outbreak and describe effective infection control measures applied to terminate two nosocomial infection outbreaks.
Methods
Two outbreaks occurred during an 85-day period in two disconnected subunits, that share the same attending physicians. A total of 7 cases of sepsis occurred. Environmental surveillances including Adenosine triphosphate(ATP) bioluminescence assay monitoring and environmental cultures were carried out in parallel to 29 healthcare workers’ hand cultures.
Results
During 4 years prior to the outbreaks, a total of 260 neonatal sepsis occurred. CoNS(n=164,63%), VSE(n=32,12.3%), MRSA(n=21,8.1%), were reported as the most common pathogens. Coincidentally, the causative pathogens of the outbreaks were E. faecium(n=4/7) and S. capitis(n=3/7). In the environmental cultures, both were cultured from both medical and non-medical devices located remotely from the patients. ATP titers were found to be the highest on a keyboard(2706 RLU). Hand cultures were done, and S. capitis was cultured in n=9/29(31%). All S. capitis obtained from the environments as well as hands that had similar antibiotic sensitivity profiles with the pathogen underwent Pulsed-Field Gel Electrophoresis, showing identical genotypes. The following interventions were applied:changing keyboards to sanitizable medical ones, changing methods and frequencies of universal and targeted environmental disinfection. No more infections by the nosocomial pathogens of the outbreak have occurred since, then.
Conclusions
We identified that the colonized pathogens on non-medical devices can be a source of infection.
CLINICAL CHARACTERISTICS AND OUTCOMES OF NEWBORNS FOLLOWING COVID-19 IN PREGNANCY IN MEXICO: A COHORT STUDY.
Abstract
Background
Since the appearance of the coronavirus disease 2019 (COVID-19), clinical characteristics have been described in adults and children, however, there is limited information on the impact of maternal infection on newborns.
Aims
To describe the clinical characteristics and outcomes of newborns following COVID-19 in pregnancy.
Methods
A retrospective, multicenter cohort study from March 11, 2020 to March 1, 2021, comparing clinical characteristics and outcomes of newborns born to mothers with and without COVID-19 during pregnancy, and the SARS-CoV-2-positivity rate of neonates with SARS-CoV-2-positive mother. Data included maternal and neonatal symptoms such as gestational age, birth weight, neonatal and maternal symptoms, antenatal complications, length of hospital stay, neonatal intensive care unit admission, mechanical ventilation, and death. For the comparison of continuous variables and dichotomous variables, the Mann-Whitney U test and Fisher's exact test were used.
Results
Of 177 neonates, 73 were born to SARS-CoV-2-positive mothers. 75.3% of positive pregnant women were asymptomatic, with no severe cases reported. In neonates born to SARS-CoV-2-positive mothers, we found an increased prevalence of prematurity [12 (16.4%) vs 7 (6.7%), p=0.05], neonatal respiratory symptoms [8 (11%) vs 1 (0.9%), p=0.004] and need for mechanical ventilation [7 (9.6%) vs 1 (1%), p=0.009]. No neonatal deaths were reported. SARS-CoV-2-positivity-rate was 6.8% in neonates at 24-hours.
Conclusions
These data suggest that newborns of mothers with COVID-19 are at increased risk of complications in the neonatal period, however, the prognosis appears to be favorable as no deaths were reported. Considering the high prevalence of asymptomatic COVID-19 among pregnant women, it is essential to implement effective screening.
PENICILLIN G MONOTHERAPHY IS EFFECTIVE IN THE TREATMENT OF ODONTOGENIC FACIAL CELLULITIS: RESULTS FROM A PEDIATRIC RETROSPECTIVE COHORT STUDY IN BOGOTÁ, COLOMBIA
Abstract
Background
Odontogenic facial cellulitis (OFC) is a frequent complaint in pediatric emergency and inpatient services worldwide. Successful management requires an appropriate antibiotic regimen and, if indicated, surgery. There are no widespread guidelines regarding antibiotic choice, with prescription relying mainly on local practices, due to the lack of studies evaluating clinical outcomes with different antibiotic regimens.
Aims
To describe the effectiveness of penicillin G in the treatment of OFC in a pediatric population from Bogotá, Colombia.
Methods
Retrospective cohort study conducted in a pediatric hospital in Bogotá, Colombia. Patients with OFC were identified from the Stewardship Program and Antibiotic Control program database. Clinical and laboratory data were extracted from the medical records after approval from the Institutional Review Board. Statistical analysis was performed in R environment.
Results
201 patients with OFC, admitted to the hospital from December 2019 to February 2021, were included in the study. 176 (87.5%) patients were treated with penicillin G as first-line treatment; 170 (96.5%) were considered to have a satisfactory response to treatment. Further, 9 (4.5%) patients were treated with similar spectrum amoxicillin; all of them were considered to have a satisfactory response to treatment. There was no need to stop treatment because of adverse events.
Conclusions
Our study is, perhaps, the biggest case series using Penicillin G as monotherapy in the treatment of OFC. The results obtained suggest that Penicillin G is safe and effective when used for this infection. New research (randomized clinical trials) must be conducted in order to evaluate other outcomes (including cost), and avoid possible bias.
PERFORMANCE OF AUTOMATED VERSUS MANUAL RESPIRATORY RATE MEASUREMENT IN CHILDREN UNDER FIVE ADMITTED WITH SUSPICION OF BLOODSTREAM INFECTION TO KISANTU HOSPITAL, DR CONGO
Abstract
Background
To improve early recognition of danger signs in children with sepsis in low resource settings, WHO promotes automated respiratory rate (RR) counting.
Aims
Prospective performance evaluation of an automated plethysmography-based RR counter in a hospital setting in sub-Saharan Africa.
Methods
RR was simultaneously measured manually (comparative method) and with Rad G pulse oximeter (Masimo, Irvine, US) (Figure 1) by a trained study nurse in children (>28 days - <5 years) admitted to Kisantu hospital with suspicion of bloodstream infection upon inclusion in the DeNTS study (NCT04473768). Rapid breathing was defined according to WHO criteria.
Results
Paired RR measurements were correctly and successfully obtained in 206 (80.3%) eligible children, from whom 44.2% (91/206) had rapid breathing based on manual counting (Figure 2). Automated counting frequently underestimated the RR (median difference of -1 breath/ minute ; p2.5 – p97.5 limits of agreement: -34.5 – 4), particularly at higher RR (Figure 3). This resulted in failure to detect rapid breathing in nearly a quarter (21/91, 23%) of rapidly breathing children (positive percent agreement: 76.9%), while children with normal RR were mostly correctly classified (negative percent agreement: 97.3% ; kappa-statistic: 0.76). Logistic regression revealed that low hemoglobin levels were associated with failure to automatically detect rapid breathing.
Conclusions
In the present setting, the automated RR counter performed insufficiently in terms of limits of agreement and positive percent agreement.
COMPARISON OF CLINICAL FEATURES AND OUTCOME OF DENGUE FEVER AND MIS-C IN CHILDREN
Abstract
Background
MIS-C is an inflammatory condition following severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).
Aims
To identify clinical and laboratory features that differentiate dengue fever patients from MIS-C patients and determine their outcomes
Methods
This comparative cross-sectional study was
done at tertiary care teaching institute. We enrolled all hospitalized children aged 1 month - 18 years and diagnosed with either MIS-C and/or dengue fever according to WHO criteria between June and December, 2020. Clinical and laboratory features and outcomes were recorded on a structured proforma.
Results
During study 34 cases of MIS-C and 83 cases of Dengue fever were
enrolled. Mean age of MIS-C cases (male, 86.3%) was 7.89 (4.61) years. Of 34 cases, MIS-C with shock was seen in 15 (44%), MIS-C without shock, 17 (50%) and Kawasaki disease-like presentation in 2 cases (6%). Patients of MIS-C were younger as compared to dengue fever (P=0.002). Conjunctival injection and swelling of hand and feet were more commonly seen in MIS-C.
Abdominal pain and erythematous rash were more common in dengue fever. Of the inflammatory markers, mean C reactive protein was higher in MIS-C patients, than dengue fever patients [100.2 (85.1) vs 16.9 (29.3) mg/dL (P<0.001). In contrast, serum ferritin levels were higher in dengue fever patients (P=0.03). Need for mechanical ventilation was significantly more in MIS-C cases. Mean
hospital stay was longer in MIS- C patients days compared to dengue fever (8.6 vs 6.5 days; P=0.014)
Conclusions
Clinical and laboratory features can give important clues to differentiate dengue fever and MIS-C and help initiate specific treatment.
MICROBIOLOGICALLY APPROPRIATE AND INAPPROPRIATE EMPIRIC ANTIBIOTIC THERAPY IN PEDIATRIC FEBRILE ESCHERICHIA COLI URINARY TRACT INFECTIONS: A RETROSPECTIVE STUDY COMPARING IN VIVO AND IN VITRO EFFICACY
Abstract
Background
Urinary tract infections (UTIs) are among the most common bacterial infections in children and E.coli is the main responsible pathogen. Given the current increasing rates of antibiotic resistance worldwide, the choice of empiric therapy (ET) often results inappropriate.
Aims
To compare clinical efficacy of ET in pediatric patients with UTIs caused by an E.coli strain that turned out to be resistant to the ET in vitro (inappropriate ET, IET), to that of patients treated with an appropriate ET (AET), according to the antimicrobial susceptibility testing (AST) results.
Methods
We conducted a retrospective study on pediatric patients admitted to our Pediatric ward for an E.coli febrile UTI, over the period 2016-2020. The clinical efficacy of ET was assessed as time to defervescence, improvement of inflammatory blood markers, length of hospitalization (LOH), need of antibiotic prophylaxis and short and long-term complications.
Results
We enrolled 106 patients (median [IQR] age: 6.0 [3.0-14.3] months). Twenty-one (19.8%) patients underwent an IET. The comparison between IET and AET groups did not show any statically significant difference in terms of clinical efficacy. Within the IET group we compared patients who underwent a switch of the therapy, according to AST results, to those who did not. Within these 2 subgroups, 8/13 (61.5%) and 8/8 (100%) patients, respectively had defervescence before AST results. No differences were found in terms of clinical efficacy, except for the LOH as expected.
Conclusions
According to our findings, in vitro resistance of E.coli to ET did not affect the clinical outcome of pediatric patients with febrile UTIs who underwent an IET.
INCOMPLETE PNEUMOCOCCAL CONJUGATE VACCINE (PCV) VACCINATION SERIES IN CHILDREN GLOBALLY
Abstract
Background
In countries with pediatric pneumococcal conjugate vaccine (PCV) national immunization programs (NIPs), some children remain unvaccinated or partially vaccinated with PCV. Incompletely vaccinated children may be at an increased risk of pneumococcal disease compared with children fully vaccinated with the recommended three or four dose PCV schedule.
Aims
Estimate the number of children born in countries with PCV NIPs who are unvaccinated or partially vaccinated.
Methods
Adherence to PCV recommended schedules were obtained from the latest year of the World Health Organization’s complete first (PCV1), second (PCV2), and final (PCV3) dose data by country. The calculated percentages of children who received no, one, or two PCV dose(s) in the series were multiplied by each country’s 2019 birth cohort. The number of children receiving no, one, or two PCV dose(s) by country was summed to estimate the global percentage of unvaccinated or partially vaccinated children.
Results
Globally, an estimated 14.9%, 4.0%, and 6.8% of children born in countries with PCV NIPs complete no, one, or two doses of the PCV series, respectively (Table 1). This equates to approximately 15.0 million unvaccinated children and 10.9 million partially vaccinated children across PCV-eligible countries in 2019. Overall, countries in Asia, Africa, the Middle East, and Latin America with larger birth cohorts had a higher number of incompletely vaccinated children (Table 2).
Conclusions
Of children born in countries with PCV NIPs, nearly 26% are unvaccinated or partially vaccinated with PCVs. Country-specific tactics should be explored to increase PCV vaccination rates and subsequent vaccine impact.
PEDIATRIC NASAL EPITHELIAL CELLS ARE LESS PERMISSIVE TO SARS-COV-2 REPLICATION COMPARED TO ADULT CELLS
Abstract
Background
Children typically experience more mild symptoms of COVID-19 when compared to adults. There is a strong body of evidence that children are also be less susceptible to SARS-CoV-2 infection with the original Wuhan isolate. The reasons for reduced SARS-CoV-2 symptoms and infection in children remain unclear and may be influenced by a multitude of factors, including differences in target cell susceptibility and innate immune responses.
Aims
To investigate differential infection kinetics and antiviral responses to SARS-CoV-2 infection in children and adults.
Methods
We used primary nasal epithelial cells from children and adults, differentiated at an air-liquid interface, to investigate differential infection kinetics and antiviral responses to SARS-CoV-2 infection. Viral replication was quantified by plaque assay. ACE2 protein expression were quantified by Western Blot and immunofluorescence. The cellular transcriptome of infected and uninfected cells was assessed by RNA-sequencing.
Results
Our results show that SARS-CoV-2 (both the Wuhan isolate and the more recent Alpha variant) replicates to significantly lower titers in the nasal epithelial cells of children compared to those of adults. This was associated with a heightened antiviral response to SARS-CoV-2 in the nasal epithelial cells of children. Importantly, influenza virus, a virus whose transmission is frequently associated with pediatric infections, replicated in both adult and pediatric nasal epithelial cells to comparable titres.
Conclusions
We report significantly higher SARS-CoV-2 replication in adult compared to pediatric nasal epithelial cells. Taken together, our data suggest that the nasal epithelium of children supports lower infection and replication of SARS-CoV-2 than the adult nasal epithelium.
SEROPREVALENCE OF SARS-COV-2 IN CHILDREN IN DELHI, INDIA: A POPULATION BASED SEROEPIDEMIOLOGICAL STUDY
Abstract
Background
Globally, children and adolescents in absence of chronic underlying illnesses have been observed to experience less severe manifestations of the Covid-19 disease and low mortality hypothesized from multiple differential physiological mechanisms. However, there are growing public health concerns in India related to the extent of susceptibility in this hitherto unvaccinated and potentially vulnerable cohort.
Aims
To determine the seroprevalence of SARS-CoV-2 infection in children and adolescents and ascertain their predictors
Methods
This cross-sectional serosurvey included 4290 children aged 5-17 years and 23807 adults, and was conducted from January 11-22’ 2021. The participants were selected through a multi-stage sampling technique from all the 280 wards of the state of Delhi, India. Anti SARS CoV-2 IgG antibodies were detected by using the VITROS assay (90% Sn, 100% Sp).
Results
The seroprevalence of IgG SARS-CoV-2 in children was 52.8% (95% C.I. 51.3, 54.3) which was higher compared to adults (50.3%, 95% CI 49.7, 50.9). The assay adjusted seroprevalence in children was 53.5% (95% C.I. 51.7, 55.4). On adjusted analysis, older (15-17 years) aged compared to the younger children had significantly higher odds of infection (aOR 1.16 (0.97, 1.39)). However, child gender, presence of overcrowding, and the household income levels did not show statistically significant association with seropositivity. Among the participants with past history of laboratory diagnosed Covid-19 disease (n=102), 77 (75.5%) were also currently seropositive.
Conclusions
SARS-CoV-2 seropositivity was observed in more than one in two children. Comparable seroprevalence with adults indicates greater protection and discounts the possibility of children being disproportionately impacted during any future Covid-19 pandemic wave.
INCIDENCE OF FIRST-CHOICE ANTIRETROVIRAL TREATMENT FAILURE AMONG CHILDREN IN MOZAMBIQUE, 2019
Abstract
Background
Though access to antiretroviral therapy (ART) has increased in recent years, there is limited information about the incidence of treatment failure (TF) among children in Mozambique.
Aims
We aimed to estimate the incidence of TF, the mean time to TF (MTTF), and to identify regimens associated with higher TF among children on ART, in 2019.
Methods
Data from children on ART were obtained from the national ART registry and those with TF from the national ART Committee database. The total TF incidence was calculated by dividing the number of children with TF by the total number of children on ART, in 2019. Regimen-specific incidences were obtained by multiplying the total incidence of TF by the proportion of children with TF in each regimen. The 1000-sample bootstrap was used to calculate 95% CIs.
Results
The incidence of TF was 246.0 (95% CI: 101.2-390.8) cases per 10,000 children per year. Regimens with higher incidence of TF included AZT+3TC+NVP, TDF+3TC+EFV, and ABC+3TC+NVP with 231.5 (95% CI: 96.6-366.4), 4.9 (95% CI: 2.6-7.2), and 2.2 (95% CI: 1.1-3.3) TF cases in 10,000 children per year, respectively. The MTTF was 5.4 years (95% CI: 5.2-5.6), and d4T+3TC+NVP, TDF+3TC+NVP, and AZT+3TC+LPV/r had longer MTTF of 9.5 (95% CI: 3.3-12.7), 8.3 (95% CI: 2.0-10.5), and 7.9 (95% CI: 6.2-11.8), respectively.
Conclusions
The incidence of TF among children on ART was found to be of public health concern. There is need to consider regimens containing protease inhibitors and DTG as first-choice ART among children to achieve sustained viral suppression.
BROADER SOCIETAL IMPACT OF OTITIS MEDIA PREVENTION FOLLOWING PNEUMOCOCCAL CONJUGATE VACCINE USE IN THE UNITED STATES
Abstract
Background
Otitis media (OM) is a common childhood infection and a reason for antibiotic prescriptions. Pneumococcal conjugate vaccines (PCVs) prevent initial OM episodes, thereby reducing both short- and long-term clinical, economic, humanistic, and societal consequences (Figure 1). These broader societal impacts associated with OM prevention are rarely quantified or included in cost-effectiveness analyses (CEAs) of PCVs.
Aims
Estimate the broader impact of preventing OM in children less than 5 years old following PCV use in the United States (US).
Methods
A literature review was conducted on the long-term broader implications of OM. Data were then used from US studies to retrospectively estimate the societal burden of OM avoided due to pediatric PCV use.
Results
PCV use has been estimated to avert more than 97 million cases of OM over 20 years in the US. Extrapolating from this estimation, 5,235 deaths and 542,086 cases of hearing loss have been avoided. Twenty-year nationwide societal returns were realized, with over 131.8 million parental workdays gained and over 59.6 million absent daycare days avoided. Health system benefits include over 1.3 and 1.4 million days saved in clinic wait and physician consultation time, respectively, as well as over 83.6 million avoided antibiotic prescriptions (Figure 2).
Conclusions
PCVs’ role in preventing OM has led to substantial broader value beyond averted cases in the US population. PCVs in development may further reduce OM cases and increase broader benefits. Future CEAs of PCVs should include broader benefits of OM prevention for communicating the full value to diverse US stakeholders and improving implementation.
ZIKACTION PAEDIATRIC REGISTRY: MATERNAL CHARACTERISTICS AND CLINICAL, RADIOLOGICAL, AND FOLLOW-UP FEATURES OF CHILDREN BORN WITH CONGENITAL ZIKA INFECTION IN BRAZIL
Abstract
Background
In 2015, Brazil experienced an unexpected increase in newborns with microcephaly. Subsequently, the association between microcephaly and Congenital Zika Infection (CZI) was confirmed.
Aims
This study, part of the ZIKAction Paediatric Registry, intends to describe clinical, radiological, neurodevelopmental, and laboratory features and follow-up of children with CZI in Bahia, Brazil.
Methods
This observational study had following inclusion criteria: intrauterine exposure to ZIKV, laboratory-confirmed CZI, or meeting the definition of suspected CZI, based on clinical and radiological features.
Results
Of 129 participants, 57% were female. Most mothers (75%) had symptoms suggestive of Zika infection during pregnancy. Median gestational age at delivery was 38 weeks, with 19% delivered preterm. Median birth length and weight were 46cm and 2690g, respectively. Most infants (118, 91.5%) had microcephaly (median head circumference Z-score -3.51, IQR -4.69,-2.73), and 17 (13.2%) have arthrogryposis. During follow-up, 96% and 92% of children had hearing and ophthalmological assessments, with 21% and 57% having abnormalities respectively. Brain image was abnormal in all cases, with ventriculomegaly (70.1%), cerebral parenchyma calcifications (62.1%), and cortical atrophy (48.6%) were main findings. Median age at last follow-up was 5 years; to date, 54 (42%) participants needed hospitalization, 44 (35%) needed care in the emergency department, and two (1.5%) died.
Conclusions
CZI is an emerging disease shown to have a varied spectrum. Registry children were biased towards those with more severe disease, with several abnormalities and complications observed. Continued long-term follow-up is essential to understand the prognosis and clinical spectrum as these children reach school-age.