記述言語：英語   掲載種別：研究論文（学術雑誌）  

Echovirus 11 (E11) genotype D5, new lineage 1, has emerged as a cause of severe and often fatal neonatal infection since 2022. Serum detection of E11 has been associated with particularly poor prognosis, yet post-discharge outcomes of survivors, especially regarding cholestasis, remain poorly described. A term male neonate (38 weeks, 3422 g) developed fever on day of life (DOL) 3 with cerebrospinal fluid positive for enterovirus. By DOL 6, he progressed to disseminated intravascular coagulation and acute liver failure, necessitating pediatric intensive care. E11 (genotype D5, new lineage 1) was identified from serum, cerebrospinal fluid, and stool. He survived with multidisciplinary intensive care including blood product transfusions. Following resolution of the acute phase, conjugated hyperbilirubinemia with cholestasis persisted. Obstructive biliary disease and metabolic disorders were excluded. Cholestasis gradually resolved with ursodeoxycholic acid and fat-soluble vitamin supplementation, and all medications were discontinued by 1 year of age. Prolonged cholestasis may occur during recovery from severe neonatal E11-associated acute liver failure, even after successful acute-phase management. Scheduled post-discharge hepatobiliary monitoring including conjugated bilirubin, along with nutritional interventions, should be incorporated into the follow-up plan for survivors.

DOI： 10.1016/j.jiac.2026.103017

PubMed

記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Rapid antimicrobial susceptibility testing (RAST) by direct disk-diffusion (DD) on positive blood cultures can shorten the time to optimize therapy for bloodstream infections. Since 2014, we have implemented an in-house RAST-DD protocol for gram-negative bacilli based on CLSI M100-S23. METHODS: Positive blood cultures processed between April and September 2024 were tested using our in-house RAST-DD method (12-antimicrobial panel including cefmetazole [CMZ]) and compared with broth microdilution interpreted according to CLSI M100-ED29. Categorical agreement (CA) and error rates-very major (VME), major (ME), and minor (mE)-were calculated. We also assessed the effects of applying updated CLSI criteria and rapid species identification, and evaluated the clinical utility of CMZ for extended-spectrum β-lactamase (ESBL)-producing Enterobacterales. RESULTS: Among 234 g-negative isolates (206 Enterobacterales, 28 glucose non-fermenters), most agents showed high CA, but VMEs occurred for cefepime and ceftriaxone, and MEs for cefazolin and tazobactam/piperacillin among Enterobacterales. Applying CLSI M100-ED29 susceptible dose-dependent criteria and rapid identification reduced VMEs and mEs (CA 93.8%, VME 0.1%, ME 5.4%, mE 0.6%). CMZ achieved 100% CA for Enterobacterales excluding chromosomal AmpC producers and supported carbapenem-sparing treatment in several ESBL-producing Escherichia coli bacteremia cases with favorable outcomes. CONCLUSIONS: The in-house RAST-DD method demonstrated reliable performance for gram-negative bacilli. Updating interpretive criteria and incorporating rapid identification reduced interpretive errors. Inclusion of a CMZ disk in the RAST panel may support carbapenem-sparing therapy for ESBL-producing Enterobacterales.

DOI： 10.1016/j.jiac.2026.102927

PubMed

記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Aerococcus urinae is a potential causative pathogen of urinary tract infections in pediatric patients with underlying nephrological or urinary tract disorders. However, the need for targeted antimicrobial therapy remains controversial. Herein, we evaluated pediatric patients in whom A. urinae was identified in urine cultures and compared the clinical outcomes between those who received antimicrobial therapy and those managed with observation alone. METHODS: Urine cultures submitted from 2018 to 2023 were retrospectively reviewed. Cases were included if A. urinae was cultured at ≥ 104 colony-forming units (CFU)/mL in the presence of pyuria. RESULTS: Twenty-six patients met the inclusion criteria; all had preexisting nephrological or urinary tract disorders. A. urinae was isolated as a monoclonal species in only two cases. Thirteen patients (50%) received antimicrobial therapy, most commonly for cystitis, while 13 (50%) were managed conservatively without antimicrobials, achieving spontaneous resolution without relapse. Comparative analysis revealed that myelomeningocele and nitrite positivity were significantly more frequent in the observation group (p = 0.021 and p = 0.009, respectively). Co-infection with other bacterial species was frequently observed in cases where A. urinae was isolated; however, whether these co-isolated organisms were the primary pathogens remains unclear, along with guidance on treatment decisions. CONCLUSIONS: Given that approximately half of the cases involving multiple organisms, including A. urinae, were resolved without antimicrobial intervention, it is crucial to reassess the clinical significance of A. urinae and its potential for contaminating such cultures. Treatment decisions should be individualized by considering anatomical risk factors and the overall clinical context.

DOI： 10.1111/ped.70410

PubMed

記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1111/ped.70371

PubMed

記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: In pediatric sepsis, the source of infection remains unidentified in approximately 16% of cases, and causative microorganisms are not isolated in 35% of cases, potentially due to non-infectious etiologies or false-negative culture results. Although a 7- to 10-day antimicrobial regimen is commonly used for culture-negative sepsis (CNS), robust evidence supporting this practice is limited. METHODS: This prospective cohort study included congenital heart disease patients aged <5 years who were admitted to a pediatric intensive care unit between April 2022 and March 2024, diagnosed with sepsis, and those who exhibited negative culture results, but received antimicrobial therapy for at least 7 days. Descriptive epidemiological analysis was conducted on antimicrobial use in the CNS and instances of antimicrobial re-administration within 1 month. RESULTS: Sixteen cases were analyzed, with a median age of 1 month. Eleven patients (69%) had received prior antimicrobial therapy within 1 week, primarily for surgical prophylaxis. All blood cultures yielded negative results. Bacterial growth was identified in one urine culture and two sputum cultures; however, these were asymptomatic carriers. The most frequently administered empirical regimens were cefepime combined with vancomycin. Antimicrobial re-administration occurred in five cases (31%), with a median duration of 8 days, and were primarily attributed to device-related infections; however, one case was later diagnosed as mediastinitis. Four patients (25%) died within 1 month, with mortality attributed to underlying conditions, but not to infectious diseases. CONCLUSION: A 7-day course of antimicrobials may be sufficient in CNS; however, vigilant monitoring for deep-seated infections is advised.

DOI： 10.1111/ped.70287

PubMed