Background Urokinase is used as a thrombolytic agent to treat catheter thrombosis. However, since 2022, the supply of urokinase has diminished, and we have been using alteplase as an alternative, although its use for treating catheter thrombosis is off-label in Japan.Methods We performed a single-center, retrospective study on pediatric patients with central venous catheters (CVCs), peripherally inserted central catheters (PICCs), and central venous ports (CVPs) who received alteplase for catheter thrombosis at our facility (May 2023-October 2025). Treatment involved filling the catheter (volume: 1-1.5 mL) with 600,000 U/mL (1 mg/mL) of alteplase solution and leaving it for approximately 40 min. Efficacy was evaluated as follows: (1) success on the first dose, (2) success after two or three doses, or (3) no success. (1) and (2) were defined as effective.Results We evaluated 84 alteplase administrations in 31 patients (CVCs: 47, PICCs: 27, CVPs: 10). Success on the first dose was achieved in 55% of cases and success after two or three doses in 20% of cases, resulting in an overall efficacy rate of 75% (CVCs: 72%, PICCs: 93%, CVPs: 40%). No adverse events were observed.Conclusions Alteplase was generally effective for treating catheter thrombosis. However, results suggest that it is less effective in CVPs than in CVCs and PICCs, and a larger sample size is necessary for confirmation. We recommend that alteplase be approved for treating catheter thrombosis in Japan.
ABSTRACT Objective To characterize the clinical features of pediatric patients with severe respiratory infections associated with rhinovirus/enterovirus (RV/EV) in a pediatric intensive care unit (PICU), compared with those with respiratory syncytial virus (RSV) infections. Design Retrospective cohort study. Setting A single tertiary children's hospital PICU in Japan. Patients Children aged ≤ 15 years admitted to the PICU with respiratory impairment from January 2020 to December 2022 who underwent multiplex PCR testing. Interventions None. Measurements and Main Results Among 181 patients tested, RV/EV was the most frequently detected virus (48.6%, 88/181), followed by RSV (32.0%, 58/181). After excluding cases with multiple‐virus detection, 67 RV/EV‐positive and 38 RSV‐positive patients were analyzed. The RV/EV group was significantly older (36.0 months [interquartile range (IQR) 20.0–54.5] vs. 12.0 months [IQR 3.0–23.8], p < 0.001), had more wheezing (46/67 [69%] vs. 18/38 [47%], p = 0.04), and more history of bronchial asthma (23/67 [34%] vs. 4/38 [11%], p = 0.010). Treatments commonly used for asthma, such as corticosteroids and β‐agonist inhalers, were administered more frequently in the RV/EV group (49/67 [73%] vs. 17/38 [45%], p = 0.006). There were no significant differences in pneumonia on chest X‐ray, invasive mechanical ventilation, or PICU length of stay. Conclusions RV/EV was identified as the most frequently detected virus among children admitted to the PICU due to respiratory impairment and was associated with older age and a higher prevalence of asthma‐related symptoms compared to RSV. These findings underscore the need for further investigation of the pathogenicity and clinical implications of RV/EV in severe pediatric respiratory illnesses.
ABSTRACT Background Urinary tract infection (UTI) is a common cause of postoperative morbidity in children undergoing treatment for urolithiasis. This study evaluated the association of age‐appropriate ureteral stent length and intravesical stent position with urine culture (UC) positivity and symptomatic UTI. Methods Children who underwent endourological treatment for nephrolithiasis or ureterolithiasis between September 2020 and September 2025 were retrospectively analyzed. Demographic characteristics, ureteral stent length, indwelling time, UC results, and symptomatic UTI were recorded. Stent length was categorized as short, appropriate, or long according to the (age + 10) formula. Intravesical position was classified as ipsilateral or cross‐trigonal based on whether the distal stent crossed the bladder midline. Results Ninety‐nine children (57 boys, 42 girls; mean age, 8.8 ± 4.52 years) were included. The mean stent length was 17.69 ± 3.88 cm, and the mean indwelling time was 24.11 ± 5.79 days. Positive UC occurred in 21 patients, and 7 developed symptomatic UTIs. Both UC positivity and symptomatic UTIs were significantly associated with stents that were long for age, (both p < 0.001) and with a cross‐trigonal intravesical position ( p < 0.001 and p = 0.004, respectively). Conclusion Age‐appropriate ureteral stent length and optimal intravesical positioning may reduce postoperative UC positivity and symptomatic UTIs in children undergoing surgical treatment for nephrolithiasis or ureterolithiasis. Careful attention to these modifiable factors may improve postoperative outcomes.
ABSTRACT Background Pyriform sinus fistula (PSF) is a congenital anomaly leading to recurrent cervical abscesses. Data on the clinical characteristics and methods of managing PSF infections in pediatric patients are scarce. Methods This retrospective study analyzed electronic medical records of patients under 15 years old diagnosed with PSF infection at Tokyo Metropolitan Children's Medical Center between March 2010 and August 2024. Diagnosis was based on clinical findings, imaging, hypopharyngeal esophagography, and surgical findings after inflammation resolution. Patients with revised diagnoses or those who declined participation were excluded, and multiple infections in the same patient were recorded as recurrences. Results Nineteen patients met the inclusion criteria; the median age at onset was 4 years (interquartile range [IQR]: 2–6 years), 58% were male, and most of the lesions were left‐sided (17 cases, 89%). The median duration of antimicrobial therapy was 31 days (IQR: 18–49 days), including a median duration of 7 days for intravenous therapy and 23 days for oral therapy. Ampicillin‐sulbactam was the most prescribed intravenous agent while amoxicillin‐clavulanic acid was frequently used for step‐down oral therapy. Drainage occurred in seven patients, including a puncture in five patients and spontaneous rupture in two patients. The most common pathogens were anaerobic bacteria. No treatment failures or recurrences were observed within 30 days after completion of treatment. Conclusions The median duration of antimicrobial therapy of 31 days may be sufficient to resolve acute PSF infections in children, provided that clinically appropriate surgical intervention is performed as required.
