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Pathogens
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Neonatal and Pediatric Infections and Antimicrobial Stewardship Programs
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Neonatal and Pediatric Infections and Antimicrobial Stewardship Programs

A special issue of Pathogens (ISSN 2076-0817).

Deadline for manuscript submissions: closed (10 February 2022) | Viewed by 12350

Special Issue Editors

Prof. Dr. Carlo Giaquinto

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Guest Editor
Division of Paediatric Infectious Diseases, Department of Women's and Children's Health, University-Hospital of Padua, Via Giustiniani 3, 35128 Padua, Italy
Interests: infectious diseases; clinical research; HIV; antiviral treatment; vaccines
Special Issues, Collections and Topics in MDPI journals
Dr. Daniele Donà

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Guest Editor
Department of Woman’s and Child’s Health, Division of Paediatric Infectious Diseases, University of Padova, 35141 via Giustiniani 3, Padua, Italy
Interests: MDR infections; antimicrobial stewardship programs; antibiotic PK studies
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

During the past two decades, the emergence of resistant pathogens and their global spread has rapidly become a major threat to public health around the world. This is particularly relevant due to the steady reduction in the number of new antimicrobials that are being studied and marketed, particularly for children. Although antimicrobial resistance occurs naturally, antimicrobial misuse promotes the selection of resistant organisms. Antibiotics remain the most commonly used medicines, especially in the pediatric population. The antimicrobial stewardship concept was introduced to tackle this problem. Antimicrobial stewardship programs are defined as a set of coordinated interventions designed to improve antimicrobial use in terms of selecting the appropriate agent, dose, route of administration, and therapy duration, without compromising patient outcomes.

For several years, antimicrobial stewardship efforts were focused on adult populations, and the need for formal antimicrobial stewardship programs in pediatrics was officially recognized only recently, considering the widespread use of antibiotics in children and the different antimicrobial resistance patterns in this population.

This Special Issue is intended to provide a comprehensive discussion of the antimicrobial stewardship in neonates and children in hospital and community settings. The strategies for pediatric antimicrobial stewardship programs and specific stewardship initiatives will be discussed.

The objective is to share experience and information on the impact of pediatric antimicrobial stewardship through relevant contributions to drive improvement in antimicrobial prescriptions in healthcare systems, and, as a result, on patient health as well.

Prof. Dr. Carlo Giaquinto
Dr. Daniele Donà
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Pathogens is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2700 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • antibiotic stewardship
  • antimicrobial stewardship
  • infectious diseases
  • pediatrics
  • neonatal and pediatric infections
  • antimicrobial stewardship programs
  • resistant pathogens
  • antimicrobials
  • antimicrobial resistance
  • antimicrobial misuse
  • antibiotics

Published Papers (5 papers)

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Research

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11 pages, 272 KiB  
Article
High Fecal Carriage of Multidrug Resistant Bacteria in the Community among Children in Northwestern Tanzania
by Delfina R. Msanga, Vitus Silago, Tulla Massoza, Benson R. Kidenya, Emmanuel Balandya, Mariam M. Mirambo, Bruno Sunguya, Blandina Theophil Mmbaga, Eligius Lyamuya, John Bartlet and Stephen E. Mshana
Pathogens 2022, 11(3), 379; https://doi.org/10.3390/pathogens11030379 - 21 Mar 2022
Cited by 4 | Viewed by 2202
Abstract
Colonization of multidrug resistant (MDR) bacteria is associated with subsequent invasive infections in children with comorbidities. This study aimed to determine the resistance profile and factors associated with MDR pathogen colonization among HIV−and HIV+ children below five years of age in Mwanza, Tanzania. [...] Read more.
Colonization of multidrug resistant (MDR) bacteria is associated with subsequent invasive infections in children with comorbidities. This study aimed to determine the resistance profile and factors associated with MDR pathogen colonization among HIV−and HIV+ children below five years of age in Mwanza, Tanzania. A total of 399 (HIV− 255 and HIV+ 144) children were enrolled and investigated for the presence of MDR bacteria. The median [IQR] age of children was 19 (10–36) months. Out of 27 Staphylococcus aureus colonizing the nasal cavity, 16 (59.5%) were methicillin resistant while 132/278 (47.2%) of Enterobacteriaceae from rectal swabs were resistant to third generation cephalosporins, with 69.7% (92/132) exhibiting extended spectrum beta lactamase (ESBL) phenotypes. The proportion of resistance to gentamicin, amoxicillin/clavulanic acid and meropenem were significantly higher among HIV+ than HIV− children. A history of antibiotic use in the last month OR 2.62 [1.1, 6.9] (p = 0.04) and history of a relative admitted from the same household in the past three months OR 3.73 [1.1, 13.2] (p = 0.03) independently predicted ESBL rectal colonization. HIV+ children had significantly more fecal carriage of isolates resistant to uncommonly used antibiotics. There is a need to strengthen antimicrobial stewardship and Infection Prevention and Control (IPC) programs to prevent the emergence and spread of MDR pathogens in children. Full article
(This article belongs to the Special Issue Neonatal and Pediatric Infections and Antimicrobial Stewardship Programs)
27 pages, 3927 KiB  
Article
Impact of Annual Albendazole versus Four-Monthly Test-and-Treat Approach of Intestinal Parasites on Children Growth—A Longitudinal Four-Arm Randomized Parallel Trial during Two Years of a Community Follow-Up in Bengo, Angola
by Carolina Gasparinho, Aguinaldo Kanjungo, Félix Zage, Isabel Clemente, Ana Santos-Reis, Miguel Brito, José Carlos Sousa-Figueiredo, Filomeno Fortes and Luzia Gonçalves
Pathogens 2021, 10(3), 309; https://doi.org/10.3390/pathogens10030309 - 07 Mar 2021
Cited by 2 | Viewed by 2111
Abstract
Malnutrition and intestinal parasites continue to have serious impacts on growth and cognitive development of children in Angola. A longitudinal four-arm randomized parallel trial was conducted to investigate if deworming with a single annual dose of albendazole (annual-ALB) or a four-monthly test-and-treat (4TT) [...] Read more.
Malnutrition and intestinal parasites continue to have serious impacts on growth and cognitive development of children in Angola. A longitudinal four-arm randomized parallel trial was conducted to investigate if deworming with a single annual dose of albendazole (annual-ALB) or a four-monthly test-and-treat (4TT) intestinal parasites approach at individual or household levels improve nutritional outcomes of pre-school children in Bengo province. Children with intestinal parasites (n = 121) were randomly assigned (1:1:1:1) to arm A1: annual-ALB*individual level; A2: annual-ALB*household level; A3: 4TT*individual; and A4: 4TT*household level. At baseline, 4, 8, 12, 16, 20, and 24 months of follow-up, growth was assessed by height, weight, height-for-age, weight-for-height, weight-for-age, and mid-upper arm circumference. Intention-to-treat analysis was done using non-parametric approach, mixed effect models, and generalized estimating equations (GEE). Initially, 57% and 26% of the children were infected by Giardia lamblia and Ascaris lumbricoides, respectively. This study did not show that a 4TT intestinal parasites approach results on better growth outcomes of children (height, weight, HAZ, WAZ, WHZ and MUACZ) when compared with annual ALB, with exception of height and WHZ using GEE model at 5% level. Positive temporal effects on most nutrition outcomes were observed. Implementing a longitudinal study in a poor setting is challenging and larger sample sizes and ‘pure and clean’ data are difficult to obtain. Nevertheless, learned lessons from this intensive study may contribute to future scientific research and to tailor multidisciplinary approaches to minimize malnutrition and infections in resource-poor countries. Full article
(This article belongs to the Special Issue Neonatal and Pediatric Infections and Antimicrobial Stewardship Programs)
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9 pages, 784 KiB  
Article
Effectiveness and Sustainability of an Antimicrobial Stewardship Program for Perioperative Prophylaxis in Pediatric Surgery
by Daniele Donà, Dora Luise, Elisa Barbieri, Nicola Masiero, Sonia Maita, Luca Antoniello, Theoklis Zaoutis, Carlo Giaquinto and Piergiorgio Gamba
Pathogens 2020, 9(6), 490; https://doi.org/10.3390/pathogens9060490 - 19 Jun 2020
Cited by 14 | Viewed by 2401
Abstract
Background—Appropriate perioperative antibiotic prophylaxis (PAP) is essential to prevent surgical site infections (SSIs) and to avoid antibiotics misuse. Aim—The aim of this study is to determine the effectiveness and long-term sustainability of an antimicrobial stewardship program (ASP), based on a clinical pathway (CP) [...] Read more.
Background—Appropriate perioperative antibiotic prophylaxis (PAP) is essential to prevent surgical site infections (SSIs) and to avoid antibiotics misuse. Aim—The aim of this study is to determine the effectiveness and long-term sustainability of an antimicrobial stewardship program (ASP), based on a clinical pathway (CP) and periodic education, to improve adherence to the guidelines for PAP in a tertiary care pediatric surgery center. Methods—We assessed the changes in PAP correctness and its effect on SSIs between the six months before and the 24 months after the implementation of ASP in the Pediatric Surgery Unit of the Department of Women’s and Children’s Health of Padova. The ASP was addressed to all surgeons and anesthesiologists of the Pediatric Surgery Unit. The primary outcome was appropriateness of PAP (agent, timing of the first dose, and duration). SSI rate was the secondary outcome. Results—1771 patients were included in the study and 676 received PAP. The overall correctness of the PAP, in terms of agent, timing, and duration, increased significantly after the CP implementation. What changed most was the PAP discontinuation within 24 h (p < 0.001). Cefazolin was the most used antibiotic, with a significant increase in the post-intervention period (p < 0.001) and with a reduction in the use of other broad-spectrum antibiotics. No variations in the incidence of SSIs were reported in the five periods (p = 0.958). Conclusion—The implementation of an ASP based on CP and education is an effective and sustainable antimicrobial stewardship tool for improving the correct use of PAP. Full article
(This article belongs to the Special Issue Neonatal and Pediatric Infections and Antimicrobial Stewardship Programs)
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Review

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15 pages, 668 KiB  
Review
Vancomycin Use in Children and Neonates across Three Decades: A Bibliometric Analysis of the Top-Cited Articles
by Chiara Minotti, Elisa Barbieri, Carlo Giaquinto and Daniele Donà
Pathogens 2021, 10(10), 1343; https://doi.org/10.3390/pathogens10101343 - 18 Oct 2021
Cited by 3 | Viewed by 2183
Abstract
Vancomycin is frequently prescribed in pediatrics, especially in intensive care unit settings, to treat Gram-positive bacterial infections. This work aims to collect the top-cited articles of pediatric and infectious diseases areas to gather the current evidence and gaps of knowledge on the use [...] Read more.
Vancomycin is frequently prescribed in pediatrics, especially in intensive care unit settings, to treat Gram-positive bacterial infections. This work aims to collect the top-cited articles of pediatric and infectious diseases areas to gather the current evidence and gaps of knowledge on the use of vancomycin in these populations. The most relevant journals reported in the “pediatrics” and “infectious diseases” categories of the 2019 edition of Journal Citation Reports were browsed. Articles with more than 30 citations and published over the last three decades were collected. A bibliometric analysis was performed and 115 articles were retrieved. They were published in 21 journals, with a median impact factor of 4.6 (IQR 2.9–5.4). Sixty-eight of them (59.1%) belonged to “infectious diseases” journals. The most relevant topic was “bloodstream/complicated/invasive infections”, followed by “antibiotic resistance/MRSA treatment”. As for population distribution, 27 articles were on children only and 27 on neonates, most of which were from intensive care unit (ICU) settings. The current literature mainly deals with vancomycin as a treatment for severe infections and antibiotic resistance, especially in neonatal ICU settings. Lately, attention to new dosing strategies in the neonatal and pediatric population has become a sensible topic. Full article
(This article belongs to the Special Issue Neonatal and Pediatric Infections and Antimicrobial Stewardship Programs)
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12 pages, 245 KiB  
Review
Non-Tuberculous Mycobacterial Diseases in Children
by Aniello Meoli, Michela Deolmi, Rosanna Iannarella and Susanna Esposito
Pathogens 2020, 9(7), 553; https://doi.org/10.3390/pathogens9070553 - 09 Jul 2020
Cited by 9 | Viewed by 2611
Abstract
Non-tuberculous mycobacteria (NTMs) are ubiquitous and opportunistic emerging bacteria with the potential to colonize and eventually infect either immunocompromised or immunocompetent individuals. In the last three decades, the prevalence of disease caused by NTMs has increased in several countries. The increased prevalence of [...] Read more.
Non-tuberculous mycobacteria (NTMs) are ubiquitous and opportunistic emerging bacteria with the potential to colonize and eventually infect either immunocompromised or immunocompetent individuals. In the last three decades, the prevalence of disease caused by NTMs has increased in several countries. The increased prevalence of NTM infection can be explained by an ageing population with rising comorbidities, HIV infection, the common use of immunosuppressive drugs, and improved diagnostic methods. The aim of this review is to demonstrate the clinical relevance of NTMs in children, describing their features and manifestations, diagnostic tools, and therapeutic approaches. We collected data from the literature about NTM infections in young patients over the past five years (2014–2019) using the keywords “non-tuberculous”, “mycobacteria”, “paediatric”, “NTM”, “cystic fibrosis”, and “children”. Recent literature points out that NTMs are ubiquitous, with several species including both those that are pathogens for humans and those that are not. This means that, if a mycobacterium is isolated from a patient’s specimen, we have to distinguish between a simple colonization and an NTM-related disease. The start of treatment depends on many factors that are necessary to consider, such as clinical and imaging features, patient comorbidity and immunocompetence, drug adverse effects, and compliance with a very long therapy that can last many months. Due to the increasing prevalence and clinical relevance of NTMs, guidelines for their optimal management, especially in the presence of chronic underlying disease, are urgently needed. Full article
(This article belongs to the Special Issue Neonatal and Pediatric Infections and Antimicrobial Stewardship Programs)
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