Objective: To evaluate associations between database-recorded bronchoalveolar lavage fluid (BALF) microbiology labels and prolonged hospitalization among children with lower respiratory tract infections (LRTIs) who underwent clinically indicated bronchoalveolar lavage (BAL). Methods: This single-center retrospective data-reconstruction study screened 3,480 hospitalization episodes from March 2023 to March 2025. The cohort was reconstructed from original deidentified hospital and microbiology exports, mixed-flora records were retained, and evaluable protocol eligibility criteria were re-executed. Hospital and microbiology records were matched to the indexed admission and BALF specimen using patient and encounter identifiers, BAL and specimen dates, and specimen type. The final analysis included 1,695 episodes from 1,628 children. Specific microbiology labels could coexist. The primary outcome was hospital stay >14 days. Logistic generalized estimating equations (GEE) clustered by child were used; an extended attenuation model and a length-of-stay sensitivity analysis were also performed. Results: Prolonged hospitalization occurred in 262 episodes (15.5%); median length of stay was 9 days (interquartile range, 7–12). Mixed-flora-only records were present in 1,281 episodes, and 414 had at least one specific label. In the primary GEE model, infancy, clinician-recorded severe pneumonia, major underlying conditions, malnutrition, and several microbiology labels were associated with prolonged stay. After complication, ventilatory-support, and pediatric intensive care unit proxies were added, several estimates attenuated, including Acinetobacter baumannii from 6.35 to 3.61 and Haemophilus influenzae from 1.66 to 1.18. Conclusion: Database-recorded BALF microbiology labels and administrative severity proxies were associated with prolonged hospitalization. Because recorded labels were not adjudicated as causative pathogens, prior antibiotic exposure was unavailable, and assay methods and quantitative interpretation criteria were heterogeneous, the findings are exploratory and do not support pathogen-specific or causal interpretation.
Objective: Acinetobacter lwoffii is an environmental organism and skin commensal with low intrinsic virulence. We describe the clinical, laboratory, and microbiological features of pediatric A. lwoffii bacteremia. Methods: We retrospectively reviewed 50 pediatric patients aged 2 months to 18 years whose blood cultures grew A. lwoffii at a tertiary pediatric center between January 2015 and December 2023. Inclusion were concurrent growth in paired culture sets and specialist confirmation that the clinical findings were compatible with infection. Community- and hospital-acquired infections were compared with Mann-Whitney U and Fisher exact tests. Exact 95% confidence intervals were calculated for susceptibility estimates. Results: The laboratory processed 88,258 pediatric blood cultures and recovered 2,023 Acinetobacter isolates; A. lwoffii accounted for 2.5%. Median age was 28 months (IQR 7.0–60.5), and 34 infections (68%) were community acquired. Hospital admission occurred in 88%, intensive care was required in 18%, and empirical treatment was successful in 94%; no deaths occurred. Community- and hospital-acquired infections did not differ significantly in any measured characteristic. Susceptibility exceeded 90% for meropenem, imipenem, and gentamicin but was 70% for trimethoprim-sulfamethoxazole (95% CI 56.2–80.9). All isolates were reported susceptible to colistin and tigecycline, although colistin was not tested by reference broth microdilution and tigecycline lacked Acinetobacter-specific breakpoints. Conclusion: A. lwoffii bacteremia generally had a mild course with favorable outcomes. We did not detect significant differences between community- and hospital-acquired infections, although the small subgroup sizes limit statistical power. Retrospective data cannot establish that every positive culture represented invasive disease. Prospective studies with standardized adjudication and molecular species confirmation are needed.
Objective: Routine laboratory test requesting is not recommended for every child presenting with a tick bite; however, the factors influencing laboratory test requesting in daily pediatric practice remain poorly understood. This study aimed to evaluate the clinical management of pediatric tick bites and to identify demographic and temporal factors associated with laboratory test requesting. Methods: This retrospective, single-centre, cross-sectional study included children aged 0–18 years presenting with tick bites to a tertiary referral hospital between January 2022 and December 2024. Demographic characteristics, management, laboratory investigations, and clinical outcomes were analyzed. Independent factors associated with laboratory test requesting were evaluated using multivariable logistic regression including variables available before the laboratory test requesting decision. Consistent with the predefined study objective, the analysis focused on demographic and temporal factors associated with laboratory test requesting; clinical variables, including presenting symptoms and physical examination findings, were not included in the analysis. Results: A total of 631 patients were included (mean age, 7.87±4.92 years; 52.1% female). Laboratory investigations were performed in 262 patients (41.5%), whereas 369 (58.5%) were managed without laboratory testing. Hospitalization was required in 1.1% of cases, there were no CCHF diagnoses, and no mortality. Younger age (odds ratio [OR] = 0.951, 95% confidence interval [CI]: 0.918–0.985; p = 0.006), presentation in 2024 versus 2022 (OR = 1.833, 95% CI: 1.232–2.726; p = 0.003), and presentation during spring versus summer (OR = 2.264, 95% CI: 1.429–3.587; p < 0.001) were independently associated with laboratory test ordering, whereas winter presentation was associated with lower odds of testing (OR = 0.051, 95% CI: 0.007 – 0.381; p = 0.004). Sex was not independently associated with laboratory test ordering. Conclusion: In this cohort, most children were managed without laboratory testing or hospital admission, and no documented CCHF diagnosis or death was identified in the available institutional records.
Background: Tracheostomized pediatric patients are at increased risk for ventilator-associated pneumonia (VAP), and distinguishing true infection from airway colonization remains challenging. Therefore, reliable diagnostic tools are needed to support timely identification and avoid unnecessary antibiotic use. This study aimed to evaluate the diagnostic performance of CPIS, CPIS–Procalcitonin (CPIS-PCT), and the Phoenix Sepsis Score (PSS) in identifying VAP in critically ill tracheostomized children. Methods: This single-center, retrospective observational study included critically ill tracheostomized children treated in a pediatric intensive care unit between January 2019 and December 2024. Patients receiving mechanical ventilation for ≥48 hours with clinical suspicion of VAP were evaluated. Results: Eighty tracheostomized pediatric patients were included; 43 (53.7%) developed VAP. Mortality was significantly higher in the VAP group (14.0% vs. 0%, p=0.018). CPIS (AUC 0.976) and CPIS-PCT (AUC 0.973) demonstrated excellent diagnostic discrimination, while PSS showed good performance (AUC 0.865). Optimal cutoff values were ≥3 for CPIS, ≥4 for CPIS-PCT, and ≥2 for PSS. Purulent sputum or change in sputum characteristics and increased oxygen/ventilator support were identified as clinical features associated with VAP diagnosis. Conclusion: CPIS shows potential diagnostic utility for identifying VAP in tracheostomized pediatric patients. Although procalcitonin levels were elevated in the VAP group, combining procalcitonin with CPIS did not provide significant additional diagnostic benefit. These findings suggest that CPIS, in conjunction with close monitoring of clinical features, may support timely diagnosis and management; however, given the exploratory nature of this study and potential limitations regarding bias, these findings require further validation.
Objective: This study aimed to analyze the research evolution process, hotspots, and trends of hand, foot, and mouth disease (HFMD) over the past 20 years and try to explore future development directions. Methods: Publications related to HFMD were extracted from the Web of Science Core Collection (WoSCC). Based on bibliometric analysis, the keywords toward the publications, countries, institutions, authors, journals and references in the field of HFMD were quantitatively and visually analyzed using VOSviewer and CiteSpace. Results: A total of 4,279 publications related to HFMD were published in 880 journals by 49,435 authors from 3,312 institutions in 93 countries/regions, with the number of publications on HFMD increasing over the past 20 years. The most productive and influential countries were China and the United States (USA). The Chinese Academy of Sciences (CAS) was the most prolific institution, and Shih SR was the most productive author. The most common keywords were enterovirus A71 (EV-A71), HFMD, enterovirus, myocarditis, coxsackievirus B3 (CV-B3), coxsackievirus, vaccines, coxsackievirus A16 (CV-A16), antivirals, and inflammation. Moreover, research hotspots and trends shifted mainly from clinical symptoms, pathogenesis and epidemiology of HFMD to vaccine development, antiviral research, surveillance, and early warning. Conclusion: HFMD is a growing global public health concern. Our findings provide a systematic bibliometric mapping of the research landscape of HFMD over the past two decades, which may shed light on future development directions for researchers.
