Abstract Objective Over the past few years, no pertussis outbreaks or significant increases in case numbers have been documented in Xiamen, and related academic research remains scarce. To address this knowledge gap, this study conducted a retrospective analysis of the epidemiological characteristics of pediatric pertussis in Xiamen in 2024, as well as the clinical features and risk factors for severe cases, This work aims to provide empirical evidence for optimizing local pertussis prevention and control strategies and clinical case management. Methods Epidemiological characteristics were analyzed by collecting demographic information on all confirmed pertussis cases admitted to Xiamen Children’s Hospital from January to December 2024 through the hospital’s infectious disease reporting system. Clinical data for hospitalized patients were extracted from electronic medical records to identify risk factors associated with severe pertussis. During outbreak periods, nasopharyngeal swab specimens were collected from selected hospitalized patients and their caregivers for real-time polymerase chain reaction (PCR) detection. A subset of these specimens was subjected to Bordetella pertussis culture, and the isolated strains were further subjected to antimicrobial susceptibility. Results A total of 287 confirmed pertussis cases were reported in 2024. The median age of the patients was 5.00 years (interquartile range [IQR]: 0.33–7.00 years), with children aged 6 years and older accounting for 45.30%(130/287). Among all cases, 126 (43.90%) were hospitalized, with a median age of 0.46 years (IQR: 0.17–5.00 years), and 17 (13.49%) of these hospitalized cases were classified as severe, with a median age of 0.08 years (IQR: 0.08–0.21 years). Among the 126 hospitalized cases, 51 (40.48%) had possible household exposure; 89(71.43%) presented with paroxysmal coughing; 31(25.40%) experienced post-tussive emesis and 16 (12.70%) had inspiratory whoop; 68 (53.97%) manifested cyanosis or facial flushing during coughing and 4 (3.17%) had apnea; 28 (22.22%) had fever. A total of 58 cases (46.03%) had no documented pertussis vaccination history. Multivariate logistic regression analysis identified unvaccinated status and elevated white blood cell count (> 20 × 10⁹/L), as independent risk factors for severe pertussis. In vitro drug susceptibility testing of 25 Bordetella pertussis isolates demonstrated high-level resistance to azithromycin but sensitivity to trimethoprim-sulfamethoxazole, levofloxacin, doxycycline, ceftazidime and cefoperazone/sulbactam. Conclusion During the 2024 pertussis epidemic in Xiamen, school-age children aged 6 years and older constituted the most affected population. However, severe pertussis occurred predominantly in unvaccinated infants under 6 months of age. Therefore, timely completion of the primary pertussis vaccination series in infants remains a key strategy for preventing severe pertussis. Additionally, supplementary vaccination for school-age children is necessary to boost waning immunity. Macrolide antibiotics is not advised for empirical treatment of pertussis in China. Clinical trial number Not applicable.

Background:Mucoid sputum is common in pediatric patients with lower respiratory tract infection (LRTI) and can exacerbate cough, contribute to difficulty in expectoration and dyspnea, and even cause suffocation. Although ambroxol hydrochloride and clenbuterol hydrochloride oral solution [AHCHOS (or Yitanjing)] is widely used in pediatric practice, high-quality real-world evidence comparing it with conventional expectorant therapies such as ambroxol hydrochloride injection (AHI) remains limited. This study aimed to investigate the efficacy and safety of AHCHOS in pediatric patients with LRTI complicated with mucoid sputum. Methods:This multicenter, non-randomized observational study included 407 hospitalized pediatric patients with LRTI complicated by mucoid sputum across 30 institutions in China. Patients received AHCHOS (n=254) or AHI (n=153) based on clinical judgment and guardian preference. Inclusion criteria comprised age ≤14 years, confirmed LRTI diagnosis, and clinically significant sputum symptoms. Respiratory symptoms were assessed using a composite symptom score and a visual analog scale (VAS) at baseline and Day 7. Safety was evaluated through routine clinical monitoring, including vital signs, physical examination, and laboratory assessments. Results:The baseline features, including family history of respiratory disease (P<0.001) and type of the episode (P=0.02), differed between groups. The decline in total respiratory symptom score was greater in the AHCHOS group than in the AHI group at D7 (-4.35±2.25 vs. -3.56±1.89; P<0.001), as was the decrease in corresponding percentage (-77%±30% vs. -65%±28%; P<0.001). Regarding subscales, the decrease in cough (P<0.001), sputum amount (P=0.03), and wheezing rale (P=0.008) scores was significantly greater in the AHCHOS group than in the AHI group at D7, but the expectoration difficulty score was not (P=0.90). Meanwhile, the decrease in VAS score for self-reported symptom severity was greater in the AHCHOS group than in the AHI group at D7 (-4.12±2.04 vs. -3.51±1.78; P=0.006). Moreover, no adverse reactions were reported in either group. Conclusions:AHCHOS was associated with improved respiratory symptom outcomes and was well tolerated in pediatric patients with LRTI complicated by mucoid sputum.

Background:Early manifestations of pediatric Central Nervous System Infection (CNSI) lack specificity and are difficult to distinguish from Febrile Seizures (FS). Previous machine learning research has primarily focused on general infection risk stratification, with few studies on discriminative models for pediatric CNSI using initial clinical data. Objective:To construct an exploratory machine learning-based model for early risk stratification to differentiate pediatric CNSI from FS using single-center retrospective data and to analyze key predictive factors. Methods:Children hospitalized with fever and convulsions between January 2023 and December 2025 were enrolled. Initial clinical features and laboratory test results were used for univariate screening. After multicollinearity handling (Spearman correlation, |r| ≥ 0.70) and feature importance ranking via Random Forest (RF) and Extreme Gradient Boosting (XGBoost) algorithms, a union set of 10 variables was selected for modeling. The performance of multiple algorithms was compared based on the Area Under the Receiver Operating Characteristic Curve (AUC). Model interpretability was assessed using a nomogram and Shapley Additive exPlanations (SHAP). Results:A total of 140 children were included (28 in the CNSI group, 112 in the FS group). 10 core features were selected, including: Calcium (Ca) concentration, Lymphocyte Percentage (L%), Serum Albumin (ALB) level, Red Blood Cell (RBC) count, Oxygen Saturation (SO2), Lactic Acid (LAC), Neutrophil Percentage (N%), Babkinki sign, Headache, and Electroencephalogram (EEG) findings. Among the algorithms, Support Vector Machine (SVM) achieved a relatively high AUC of 0.864 (95% CI: 0.625-1.000) in the internal test set. SHAP analysis indicated that Ca, SO2, and L% contributed significantly to the model. Conclusion:This study developed an exploratory discriminative model for differentiating pediatric CNSI from FS using variables available at initial diagnosis. The model provides preliminary insights for early risk stratification of pediatric CNSI, though its generalizability and clinical utility require further validation through multicenter prospective external studies.

Objective:To analyze the risk factors associated with invasive pneumococcal disease (IPD) complicated by purulent meningitis in children, with the goal of enhancing early diagnosis and treatment, preventing complications, and improving patient outcomes. Methods:The study involved 56 pediatric patients with IPD and admitted to our hospital from January 2016 and December 2024. Patients were stratified into two groups based on the presence or absence of purulent meningitis. Clinical characteristics and laboratory parameters were collected and analyzed using univariate and multivariate methods to identify risk factors. A risk prediction model based on logistic regression was developed, and its performance was assessed via the area under the receiver operating characteristic (ROC) curve. Results:The study cohort comprised 27 males and 29 females, including 13 patients with purulent meningitis and 43 without. Underlying diseases were present in 53.84% (7/13) of the purulent meningitis group compared to 4.65% (2/43) in the non-meningitic group (P < 0.001). Univariate analysis of laboratory indicators revealed significant intergroup differences in eight parameters (NLR, PCT, Alb, Na, Scr, D-Dimer, FDP, TT) (P < 0.05). Further, multivariate analysis identified PCT [odds ratio [OR] = 1.196, 95% confidence interval [CI]: 1.009-1.418, P = 0.039] and NLR (OR = 1.190, 95% CI: 1.014-1.395, P = 0.033) as independent risk factors for IPD complicated by purulent meningitis. The AUC for the model constructed with PCT > 4.215 ng/mL and NLR > 12.94 was 0.885, indicating that its predictive value for combined purulent meningitis is higher than that of the individual indicators, with sensitivity of 84.60% and specificity of 86%. Additionally, drug resistance analysis of 56 Streptococcus pneumoniae isolates revealed penicillin resistance rates of 73.21% (41/56) in meningitic strains vs. 60.71% (34/56) in non-meningitic strains, and ceftriaxone resistance rates of 28.57% (16/56) vs. 10.71% (6/56), respectively. Conclusion:Elevated PCT and NLR levels constitute independent risk factors for IPD complicated by purulent meningitis. The combined predictive model based on PCT > 4.215 ng/mL and NLR > 12.94 demonstrates robust clinical utility.

Objective Ambroxol hydrochloride and clenbuterol hydrochloride oral solution (AHCHOS) is an agent with mucolytic and bronchodilator functions, but its clinical application in child patients with lower respiratory tract infections (LRTI) and symptoms of mucoid sputum needs more investigation. This study aimed to investigate efficacy of AHCHOS, its influencing factors, and effect on quality of life in these patients. Methods This study enrolled 254 hospitalized child patients with LRTI and symptoms of mucoid sputum receiving AHCHOS. Results Total cough of respiratory symptom (QS) score and QS scores of each subscale (cough, amount of sputum, difficulty in expectoration, and wheeling rale) on the 7th day (D7) were decreased than those at baseline (all P < 0.001). After multivariate logistic regression analysis, non parental guardian status (OR = 25.641, P = 0.020), respiratory rate (OR = 1.075, P = 0.019), and neutrophil percentage (OR = 1.034, P = 0.026) were independently related to higher possibility of absolute value of change of total QS score>5. Quality of life visual analog scale score on D7 was reduced than that at baseline (P < 0.001). Medication compliance was 98.00% on the 4th day, 92.68% on D7, 76.00% on the 14th day, and 75.95% on the 28th day. No adverse event occurred. Conclusion AHCHOS alleviates respiratory symptoms and improves quality of life with good safety in child patients with LRTI and symptoms of mucoid sputum, which is more beneficial for those with elevated respiratory rate, higher neutrophil percentage, and nonparental guardians.

Candidemia is life-threatening in children. Limited epidemiological and antifungal resistance data for children necessitate national surveillance. This multicenter retrospective study (2016-2024) analyzed 527 pediatric candidemia cases from 13 children's hospitals via the Infectious Disease Surveillance of Pediatrics (ISPED) network. Candida species caused 96.0% (527/549) of fungemia cases. Neonates and infants comprised 51.6% of cases (24.5% neonates and 27.1% infants). Non-albicans Candida species (NACs) dominated (74.0%), with the prevalence of Candida parapsilosis increasing from 21.2% in 2019 to 51.9% in 2024 (Z = 3.11, P = 0.002), while the prevalence of C. albicans decreased from 38.9% to 15.6% during the same period (Z = -2.25, P = 0.024). Azole susceptibility of NACs decreased significantly: C. parapsilosis fluconazole susceptibility decreased from 93.5% (2016-2018) to 63.6% (2022-2024) (P < 0.001), whereas voriconazole (79.5%-93.3%, P = 0.078) and itraconazole (80.0%-97.4%, P = 0.369) susceptibility remained high. Candida tropicalis showed low azole susceptibility, with significant decreases in susceptibility to fluconazole (61.5% in 2016-2018 to 35.0% in 2022-2024) and voriconazole (61.5% in 2016-2018 to 20.0% in 2022-2024; P < 0.001 for all). The susceptibility of wild-type Candida guilliermondii decreased toward fluconazole (100.0% in 2016-2018 and 2019-2021 to 38.9% in 2022-2024), voriconazole (100.0% in 2016-2018 and 2019-2021 to 27.8% in 2022-2024), and itraconazole (100.0% in 2016-2018 and 2019-2021 to 22.2% in 2022-2024) (P < 0.001 for all). All Candida species showed high susceptibility to amphotericin B and echinocandins (99.0% and 95.9%, respectively). Overall, there was a notable shift toward NACs, especially C. parapsilosis, C. tropicalis, and C. guilliermondii, accompanied by declining susceptibility to azoles (particularly in C. tropicalis and C. guilliermondii), which underscores the urgent need for enhanced antifungal stewardship and continuous resistance monitoring.

Purpose:To evaluate the association of ambroxol hydrochloride and clenbuterol hydrochloride oral solution (AHCHOS) with respiratory symptom improvement and safety in Chinese children with pneumonia using real-world data. Methods:A propensity score-matched (PSM) cohort study was conducted. Children patients (≤14 years) with a diagnosis of pneumonia between May, 2018 and July, 2019 were considered as the study population. The main outcome of interest was the overall rate of improvement of respiratory symptoms in treatment groups with or without AHCHOS at day 7 using respiratory symptom scores (QS) and Visual Analog Scale (VAS) score of severity of respiratory signs. Secondary end points include medication adherence assessment and safety assessment. Results:A total of 3103 children with a diagnosis of pneumonia were included. After propensity score matching, a sample of 1428 patients was analyzed. AHCHOS use was associated with greater improvement in cough score (p=0.01) and day 7 clinical sign improvement rate (p=0.03) compared with no AHCHOS use. Exploratory subgroup analyses suggested larger differences in children aged 3-6 years and in selected severity strata. Medication adherence assessmentdid not differ significantly between groups at days 4, 7, 14, and 28. Adverse events were similar between groups. Conclusion:In this real-world propensity score-matched analysis, AHCHOS use was associated with improved respiratory symptom outcomes in children with pneumonia and appeared to have an acceptable safety profile. These findings should be interpreted as observational and hypothesis-generating. Trial Registration Number:The study was registered at Chinese Clinical Trial Registry (https://www.chictr.org.cn/, ChiCTR1800015818).

Objective Salmonella and its increasing antimicrobial resistance (AMR) threaten public health. This study analyzed the epidemiology and AMR profiles of pediatric Salmonella in China to support rational antibiotic use. Method A multicenter retrospective study included 17540 Salmonella isolates from ISPED (2017–2024). Antimicrobial susceptibility was tested by disk diffusion and MIC, and analyzed with WHONET. Results Most isolates were from feces, peaking in children aged 1–3 years and during June–October. S. typhimurium and S. enteritidis were predominant. High resistance was observed to ampicillin (77.8%), ampicillin/sulbactam (39.3%), and trimethoprim/sulfamethoxazole (39.3%), while levofloxacin remained highly effective. Resistance differed by serotype, sample type and region, with S. enteritidis showing rising resistance to fluoroquinolones and cephalosporins. Conclusion Treatment should be individualized according to Salmonella serotype, regional epidemiological characteristics and antimicrobial susceptibility. Continuous national antimicrobial resistance surveillance is vital to improve antibiotic stewardship and public health interventions. Based on the multicenter ISPED program, this study clarified the epidemiological features and antimicrobial resistance of Salmonella isolates among Chinese children from 2017 to 2024. The findings support targeted public health planning, rational antibiotic use in pediatrics, strengthened Salmonella surveillance, and policy development for food safety and childhood infectious disease prevention.

BackgroundWe aimed to investigate the clinical characteristics and influencing factors of severe influenza A virus pneumonia complicated by gram-negative bacterial infection in children.MethodsWe retrospectively analysed data from 43 paediatric patients with severe influenza A virus pneumonia who had been treated at our hospital. The patients were divided into observation (28 patients) and control (15 patients) groups based on whether they had a coinfection with gram-negative bacteria. The clinical data of the two groups were compared, and multivariate regression analysis was performed.ResultsThe mean age in the observation group was 2.5 ± 1.53 years; 26 (92.86%) patients were aged ≤5 years, and 11 (39.3%) had underlying diseases. The mean age in the control group was 4.07 ± 2.11 years; 10 (66.67%) patients were aged ≤5 years, and 2 (13.33%) had underlying diseases. The differences in age and the proportion of children with underlying diseases were statistically significant (P < 0.05). The observation group had a longer duration of fever, higher number of patients with fever lasting ≥7 days and higher incidence of gasping, with statistically significant differences (P < 0.05). The C-reactive protein level, procalcitonin level, platelet count and monocyte count in the observation group were significantly higher than those in the control group (P < 0.05). Among the gram-negative bacterial coinfections in the observation group, coinfections with Haemophilus influenzae (21 cases, 75%) and Moraxella catarrhalis (7 cases, 25%) were predominant. The observation group had a higher proportion of paediatric intensive care unit admissions and longer hospital stays than the control group. Additionally, significantly fewer patients in the observation group received neuraminidase inhibitor antiviral therapy within 48 h (P < 0.05). In the observation group, all H. influenzae isolates were sensitive to ceftriaxone, cefotaxime and meropenem, while resistance rates to ampicillin, trimethoprim-sulfamethoxazole, cefuroxime and ampicillin/sulbactam were 60.4%, 75%, 27.8% and 6.2%, respectively. All M. catarrhalis isolates were sensitive to ampicillin/sulbactam, amoxicillin/sulbactam and ciprofloxacin, whereas resistance rates to ampicillin and trimethoprim-sulfamethoxazole were 67.9% and 10.7%, respectively.ConclusionSevere influenza A virus pneumonia complicated by gram-negative bacterial infection is more common in children aged <5 years. Younger age and the presence of underlying diseases increase the likelihood of gram-negative bacterial coinfection. Persistent fever, wheezing and significant elevations in C-reactive protein level, procalcitonin level, platelet count and monocyte count are important early warning signs for the clinical identification of gram-negative bacterial infection.

To investigate the clinical characteristics and epidemiology of human adenovirus (HAdV) infection in the respiratory tract of children,, and to provide evidence for the diagnosis, treatment, prevention and control of HAdV infection in this area. Retrospective analysis was conducted on data from 91 children with HAdV infection admitted to the Department of Infection at Xiamen Children's Hospital between June 1, 2023, and May 31, 2024. The study analyzed the clinical characteristics, epidemiology, laboratory examination results, and co-infections among these children. Among a total of 772 cases of respiratory tract infections examined, HAdV infection was detected in 91 cases with a detection rate of 11.8

Background:In the spring and summer of 2024, an unexpected large outbreak of pertussis hit China, with the annual incidence of pertussis (34.03/100,000) more than 12-fold higher than that of 2023 (2.71/100,000). We aimed to assess clinical and molecular epidemiological patterns and unravel the reasons behind the 2024 pertussis outbreak. Methods:PCR-confirmed pertussis cases were enrolled from five sentinel hospitals in Shanghai, Anhui, Hainan, Fujian, and Inner Mongolia between 1 January and 30 September 2024. The epidemiological data of PCR-confirmed cases, as well as the clinical data and vaccination history of hospitalized cases were collected. Nasopharyngeal swab samples were collected from partial pertussis cases and their household contacts for Bordetella pertussis culture during the local peak months. Antimicrobial susceptibility testing and whole genome sequencing were performed on all 394 isolates to evaluate six antibiotic susceptibility and characterize the antigenic, virulent, and phylogenetic characteristics of the circulating isolates. Findings:A total of 14,874 cases of pertussis were PCR-confirmed in the 5 sentinel hospitals, peaking in April to July. Infants represented 9.6% of cases and children aged 4-10 years represented 74.3% of cases in the five hospitals. Of the 7238 (48.7%) cases with vaccination data, 6563 (90.7%) were fully vaccinated. Breakthrough pertussis cases were mainly observed in fully vaccinated children since the age of 7 months. Among the 828 (5.6%) cases hospitalized for pertussis, 71.7% (594/828) cases had complications (pneumonia 69.7%, 577/828), 5.7% (47/828) were admitted to intensive care unit and 0.24% (2/828) cases died. Sixty-four per cent (403/630) of families had both the patient and at least one family member PCR-positive for B. pertussis. In total, 394 B. pertussis isolates were recovered from the 1921 nasopharyngeal swab samples. Ninety-nine point seven per cent (393/394) of isolates displayed high-level resistance to azithromycin (MIC range, 16-256 μg/ml), and 48.0% (189/394) isolates were susceptible to trimethoprim-sulfamethoxazole (MIC range, <0.008/0.152-0.5/9.5 μg/ml). All the isolates were susceptible to levofloxacin, doxycycline, ceftazidime, and cefoperazone/sulbactam. All the isolates were assigned to ST-2 and 99.5% (392/394) belonged to the MT28-Shanghai clone by SNP-based analysis, carrying ptxP3 AgST4, 23S rRNA-13 (with erythromycin resistance), and prn150. 23.4% (92/394) of isolates were predicted to be PRN-deficient. Interpretation:The waning vaccine-derived protection and the prevailing macrolide-resistant MT28 clone harboring non-vaccine type ptxP3 are responsible for the 2024 large outbreak of pertussis in China. Our findings highlight the urgent need for revising national pertussis vaccination strategies and traditional first-line antibiotic therapy. Booster vaccination for children aged 4-6 years is urgent to control the pertussis outbreak. Funding:This work is supported by Shanghai Municipal Sixth Round Three-Year Action Plan for Strengthening the Construction of the Public Health System (GWVI-11.1-07, GWVI-2.1.2) and National Natural Science Foundation of China (82272381).

To investigate the risk factors for new renal scarring (NRS) in children with vesicoureteral reflux (VUR) receiving continuous antibiotic prophylaxis (CAP). This was a single-center cohort study. The clinical data of 140 children with grade I–V VUR receiving CAP were analyzed. In this study, exposure variables were sex, younger age at the initial diagnosis of UTI ≤ 12 months, the occurrence of breakthrough urinary tract infection (BT-UTI), high-grade VUR, bilateral VUR, etiology, presence of renal scarring at the initial diagnosis and ultrasound abnormalities. The outcome was NRS. A total of 140 children were included in the risk factor analysis of NRS, 73 of whom experienced NRS, an incidence rate of 52.14%. Multivariate Cox regression suggested that the presence of renal function impairment after the initial diagnosis of UTI (OR 3.411, 95% CI 1.5751–6.646) and the occurrence of BT-UTI while receiving CAP (OR 1.995, 95% CI 1.089–2.958) were independent risk factors for NRS. Multivariate Cox regression showed that high-grade VUR had no significant effects on NRS (OR 0.940, 95% CI 0.462–1.912, P = 0.864). No significant difference was identified in multivariate Cox regression analysis in the IV–V group (vs I–III group) (OR 0.960, 95% CI 0.565–1.633, P = 0.960). Renal function impairment after the initial diagnosis of UTI and the occurrence of BT-UTI while receiving CAP were independent risk factors for NRS. Neither univariate analysis nor multivariate analysis found a correlation between VUR grade and NRS.

Background: We investigated two brothers who presented with repeated lung infections after 6 months of age. Lymphocytes and neutrophils were significantly decreased, and both had bronchiectasis and emphysema.Objective: We sought to characterize the complete picture of lung injury in some types of primary immunodefficiency disease, followed by verification and analysis.Methods: We performed immune function determination, a complete examination of the respiratory system, genetic analysis, and literature research.Results: The levels of lymphocytes, neutrophils, monocytes, and natural killer cells in the brothers were significantly decreased. The IgM and IgG levels of the older brother were decreased, while the IgM and IgA levels of the younger brother were decreased. Both brothers had bronchial wall erosion with a worm-eaten appearance and decreased lung function. Genetic testing revealed a hemizygous missense mutation (c.511C > T:p.R171W) in exon 5 of the MSN gene, which was inherited from the mother. A literature review showed that the primary immunodeficiency caused by MSN gene mutations is an X-linked recessive genetic disease with four known gene mutation sites, including nonsense and missense mutations. Nonsense mutations result in a higher incidence of autoimmune diseases and a lower degree of immune function impairment. Nonsense mutations closer to the front of the MSN gene may cause more severe disease. Neonatal disease screening can improve the early diagnosis rate, but hematopoietic stem cell transplantation (HSCT) treatment is controversial.Conclusion: The primary immunodeficiency disease caused by MSN gene mutation is an X-linked recessive genetic disease that involves structural and functional damage to the respiratory system, and the worm-eaten appearance of the bronchial wall under endoscopy may be a relatively specific sign. The general manifestations of this disease are recurrent infections from 1 month to 6 months after birth, significantly reduced counts of lymphocytes and neutrophils, and decreased cellular and humoral immune function. Different types of MSN gene mutations and nonsense mutations at different sites have different clinical phenotypes. This study enriches the known spectrum of this disease.

Purpose:To investigate human coronavirus (HCoV) infection with acute respiratory tract infection in children in the Xiamen area, China, and to analyze the clinical features of HCoV infection in children. Methods: A total of 15 283 children with acute respiratory tract infection were hospitalized in Xiamen City Children's Hospital from January 2021 to June 2023. Nasopharyngeal swabs from these children were assessed for the presence 13 respiratory tract-associated viruses, namely, Influenza A virus, adenovirus, bocavirus, rhinovirus, human coronavirus, influenza A virus H1N1, parainfluenza virus, chlamydia, metapneumovirus, influenza B virus, Mycoplasma pneumoniae, respiratory syncytial virus (RSV), and seasonal H3N2 virus using real-time fluorescence quantitative PCR. The clinical symptoms and signs of HCoV-positive children were analyzed and compared with those of RSV-infected children hospitalized during the same period. Results:(1) Of the 15 283 children with acute respiratory infections, 8624 were positive for HCoV.(2) The HCoV detection rate was 0.87% (54/6230) during 2021, 0.82% (53/6439) during 2022, and 1.53% (40/2612) during 2023. The HCoV detection rates (%) for January to December were 0.98, 0.86, 0.83, 0.96, 0.67, 0.57, 0.66, 0.98, 1.02, 1.66, 1.89 and 1.23, respectively.(3) Eighty cases of acute respiratory tract infection with HCoV alone were hospitalized, including 33 cases of bronchopneumonia, 23 cases of acute bronchitis, 10 of acute tonsillitis, 10 of acute tonsillitis, and 4 of acute laryngitis.(4) The common clinical manifestations of HCoV-only infection were cough (72 cases), fever (64 cases), and wheezing (23 cases).(5) The proportion of wheezing in the RSV group was significantly higher than that in the HCoV group (P<0.05), but there were no significant differences observed in other clinical manifestations, the incidence of complications, and proportion of cases requiring mechanical ventilation between HCoV group and 103 RSV infected children (P>0.05). Conclusion: Between January 2021 and June 2023, the detection rate of HCoV in Xiamen was 0.96%. The clinical manifestations and severity of acute respiratory tract infections due to HCoV were similar to those with respiratory syncytial virus infection.

AbstractThis study aimed to establish a registry database of different treatment modalities for lower respiratory tract infections (LRTIs) in Chinese children, thereby filling gaps in knowledge on clinical characteristics, treatment modalities, and rational drug use in relation to LRTIs in Chinese children, and providing large amounts of continuous, complete, scientific, and objective clinical data, and an information exchange platform. Multicenter data from these children's clinical visits were collected, pooled, and analyzed using medical informatics and statistical techniques to explore their potential value. The database was preliminarily established and a real‐world study cohort was constructed based on a total of 4805 patients registered in this database. Pneumonia was identified as the most common type of LRTIs (72.44%), followed by acute bronchitis (20.71%). The mean age of the enrolled children with LRTIs was 3.26 ± 2.84 years, and boys accounted for 59.21% of the samples. Among the enrolled children, pneumonia and acute bronchitis had the highest incidence in children aged 1–3 years (27.44%) and those aged 3–6 years (34.16%), respectively. In this national, multicenter, observational database of LRTIs in children, the real‐world characteristics and treatment modalities for LRTIs in Chinese children are elucidated. This database will help improve the research efficiency of clinicians and facilitate the exploration of underlying clinical patterns in real‐world medical big data.

This study investigated the roles of P-selectin and Clara cell secretory protein 16 (CC16) levels in the pathogenesis of severe adenovirus (ADV) pneumonia in children and evaluated their ability to predict disease. Fifty-one children (age, 1-5 years) with ADV pneumonia who were admitted to Xiamen Children's Hospital were included in this study and divided into the mild group (24 patients) and severe group (27 patients). A control group comprising healthy children of the same age who underwent routine physical examinations during the same period (30 patients) was also included. The univariate analysis demonstrated that the levels of the white blood cell count and C-reactive protein, procalcitonin, d-dimer, and P-selectin were increased in a severe group compared with a mild group, while CC16 levels were significantly decreased (p < 0.05). The logistic regression analysis revealed that P-selectin and CC16 levels were independent risk factors for severe ADV pneumonia in children. The areas under the ROC curves suggested that P-selectin and CC16 exhibited high predictive value for severe ADV pneumonia. P-selectin values more than 898.58 pg/mL and CC16 values less than 11.355 ng/mL predicted severe ADV pneumonia. P-selectin and CC16 levels are correlated with the severity of ADV pneumonia in children.

Background: The risk factors for mucus plug in children with adenovirus(ADV) pneumonia. Methods and materials：A retrospective analysis wasconducted of children diagnosed ADV pneumonia and underwentbronchoscopy. The patients were divided into a mucus plug group (39cases) and a non-mucus plug group (53 cases). The children’s dataincluding sex, age, clinical presentation, laboratory test parameters,imaging and bronchoscopic data were collected. The risk factors for thedevelopment of airway mucus plug were analysed by multifactoriallogistic regression. Results: There were no statistically significantdifferences in sex, age, fever, hospitalization days, mixed infection,WBC count, neutrophil proportion, CRP, and D-dimer (allP>0.05); Thermal range, calcineurin (PCT), lactatedehydrogenase (LDH), Pleural effusion and associated decreased breathsounds was significantly higher in mucus plug group than in non-mucusplug group; multifactorial logistic regression analysis showed that theduration of fever, PCT, and LDH were independent risk factors for theformation of mucus plugs. The critical values of ROC curves werepyroprocedure ≥6.5 d, PCT ≥0.705 ng/ml and LDH ≥478.5 U/L. Conclusion:Duration of fever, PCT and LDH levels were the independent risk factorsfor the formation of an airway mucus plug in children with ADVpneumonia.

背景 中国儿童细菌耐药监测组(ISPED)每年对纳入的 12 家成员单位的儿童耐药监测数据进行汇总和分析,了解儿童感染性病原学变化和耐药现状.目的 分析 2022 年我国儿童细菌感染和耐药现状,旨在指导儿童抗菌药物合理应用.设计 横断面调查.方法 菌株来源于 2022 年 1 月 1 日至 12 月 31 日ISPED成员单位细菌室,抗菌药物敏感试验采用自动化细菌鉴定及药敏分析仪或扩散纸片法,肺炎链球菌青霉素药物敏感性试验采用E-test法,结果判断采用美国临床实验室标准化委员会(CLSI)2022 年标准.主要结局指标 儿童人群菌群分布特征及主要分离株对抗菌药物耐药性变化,多重耐药菌(MDROs)的检出情况.结果 2022 年ISPED单位共分离到 50 399 株临床菌株,革兰阳性菌和阴性菌的比例分别为 38.8%和 61.2%.前 10 位分离株分别是:大肠埃希菌(14.3%)、流感嗜血杆菌(11.8%)、金黄色葡萄球菌(11.4%)、肺炎链球菌(11.3%)、卡他莫拉菌(7.3%)、凝固酶阴性葡萄球菌(6.8%)、肺炎克雷伯菌(5.3%)、铜绿假单胞菌(4.4%)、鲍曼不动杆菌(2.3%)及粪肠球菌(2.1%).大肠埃希菌是新生儿、学龄期和青春期儿童主要分离菌,流感嗜血杆菌是婴儿主要分离菌,肺炎链球菌是幼儿和学龄前期儿童主要分离菌.青霉素不敏感菌株(PNSP)在脑脊液和非脑脊液来源肺炎链球菌中的比例分别为 88.9%和 6.6%.甲氧西林耐药金黄色葡萄球菌(MRSA)、碳青霉烯类耐药的肠杆菌目细菌(CRE)、铜绿假单胞菌(CR-PA)和鲍曼不动杆菌(CR-AB)检出率分别为 32.8%、4.5%、7.6%和 24.3%.MRSA、CRE 和CR-PA在新生儿组检出率分别为 33.2%、6.4%和 11.3%,高于非新生儿组的 32.6%、4.2%和 7.5%;CR-AB在新生儿组的检出率为 10.9%,低于非新生儿组的 26.3%.结论 2022 年MDROs检出率较往年呈现下降趋势,应高度警惕和防范MRSA、CRE和CR-PA在新生儿中的定植、感染与传播.

Background This study aimed to analyze the clinical characteristics of severe pediatric adenoviral pneumonia combined with invasive pulmonary aspergillosis. Methods We retrospectively analyzed the clinical data of five children clinically diagnosed with severe adenoviral pneumonia combined with invasive pulmonary aspergillosis at Xiamen Children’s Hospital. Results These five children included one boy and four girls, with ages of onset ranging from 8 months and 15 days to 2 years and 2 months. All of them had fever with a mean duration of 11–35 days and cough. Pulmonary imaging was performed, which revealed solid pulmonary opacification in all five children, pleural effusion in two children, and emphysema and multiple small cavity formations in one child. Multiple microbiological tests were performed on the 5 children, and adenovirus was positive in the alveolar lavage fluid for the first time, and aspergillus culture was positive in the second test. On tracheoscopy, the bronchial mucosa was seen to be congested and edematous or pale and eroded; white moss-like material was seen adhering to the tracheal wall or even blocking the airway. The five children were treated with a combination of two or more broad-spectrum antimicrobials, glucocorticoids, and gamma globulins and underwent bronchoscopy. Voriconazole was added in the treatment regimen after the diagnosis of aspergillosis (28–34 days of treatment). Four of the children were discharged in good condition with a mean total length of hospital stay of 17–47 days. The other child leave against medical advice. Follow-up 3–5 months after discharge showed that one child had been cured; two children had developed obliterative bronchiolitis; one child had developed bronchiectasis; and the remaining child who had been discharged spontaneously was not contactable via telephone. Conclusions Immune disorders and antibiotic and steroid treatments for adenovirus infection are high-risk factors for secondary invasive pulmonary aspergillosis in children. Prolonged fever and cough are the main manifestations, but which lack specificity, and bronchoscopic mucosal-specific injury evaluation and alveolar lavage fluid culture are helpful in the diagnosis of aspergillosis. The long-term prognosis of severe pediatric adenoviral pneumonia combined with invasive pulmonary aspergillosis maybe poor.