Abstract Background. The effectiveness of piperacillin-tazobactam (PTZ) for the treatment extended-spectrum β-lactamase (ESBL) bacteremia is controversial. We compared 14-day mortality PTZ vs carbapenems as empiric therapy in a cohort patients with ESBL who all received definitive carbapenem. Methods. Patients hospitalized between January 2007 and April 2014 monomicrobial were included. A decrease >3 doubling dilutions minimum inhibitory concentration third-generation cephalosporins...

It is estimated that by 2015 more than half of all HIV-infected individuals in the United States will be 50 years age or older. As this population ages, frequency non-AIDS related comorbidities increases, which includes cardiovascular, metabolic, gastrointestinal, genitourinary and psychiatric disorders. a result, medical management aging HIV can complicated polypharmacy higher pill burden, leading to poorer antiretroviral therapy (ART) adherence. Adherence ART generally better older...

Abstract The role of cefepime for extended-spectrum β-lactamase (ESBL) bacteremia is unclear if susceptible in vitro. In a propensity score-matched study patients with ESBL bacteremia, risk death was 2.87 times higher receiving compared carbapenems (95% confidence interval [CI], .88–9.41). We 14-day mortality empiric versus carbapenem therapy cohort. There trend towards increased the group (hazard ratio, 2.87; 95% CI, .88–9.41), which enhances existing literature suggesting that may be...

Abstract Background National guidelines recommend 10 days of antibiotics for children with community-acquired pneumonia (CAP), acknowledging that the outcomes hospitalized CAP who receive shorter durations therapy have not been evaluated. Methods We conducted a comparative effectiveness study aged ≥6 months at The Johns Hopkins Hospital received short-course (5–7 days) vs prolonged-course (8–14 antibiotic uncomplicated between 2012 and 2018 using an inverse probability treatment weighted...

BACKGROUND: Methicillin-resistant Staphylococcus aureus (MRSA) bacteremia is associated with high rates of treatment failure in adults. The epidemiology, clinical outcomes, and risk factors for MRSA children are poorly understood. METHODS: Multicenter, retrospective cohort study ≤18 years hospitalized across 3 tertiary care children’s hospitals from 2007 to 2014. Treatment was defined as persistent >3 days, recurrence within 30 or attributable 30-day mortality. Potential failure,...

<h3>Importance</h3> National guidelines recommend treating children with pyelonephritis for 7 to 14 days of antibiotic therapy, yet data are lacking suggest a more precise treatment duration. <h3>Objective</h3> To compare the clinical outcomes receiving short-course vs prolonged-course pyelonephritis. <h3>Design, Setting, and Participants</h3> Retrospective observational study using inverse probability weighted propensity score analysis from 5 hospitals in Maryland between July 1, 2016,...

Abstract Stenotrophomonas maltophilia is an important nosocomial pathogen with limited treatment options. Trimethoprim-sulfamethoxazole (TMP-SMX) generally regarded as the preferred therapy; however, failures TMP-SMX have been reported. Herein, we report a case of 5-week-old infant 8 days S. bacteremia while receiving TMP-SMX, despite in vitro susceptibility. Transitioning to cefiderocol monotherapy resulted blood culture clearance within 24 hours, absence any additional interventions. This...

The Infectious Diseases Society of America (IDSA) publishes annual guidance on the treatment antimicrobial-resistant (AMR) gram-negative infections. Within AMR guidance, suggested dosages antibiotics for adults infected with pathogens are provided. This document serves as a companion to IDSA assist pediatric specialists dosing β-lactam agents infections in children. A panel 13 infectious diseases specialists, including 11 pharmacists and two physicians, reviewed existing...

Abstract The treatment of gram-negative bacterial infections exhibiting resistance to all traditional β-lactam and fluoroquinolone agents (i.e., difficult-to-treat [DTR]) poses challenges due the limited numbers active antibiotic agents, in addition data on safety efficacy. Managing DTR becomes even more complex when present central nervous system concerns for insufficient concentrations cerebrospinal fluid brain parenchyma. Several newer with activity against gram-negatives are available...

Abstract Background Antibiotic-associated adverse events (AEs) in hospitalized children have not been comprehensively characterized. Methods We conducted a retrospective observational study of at The Johns Hopkins Hospital receiving ≥24 hours systemic antibiotics. Consensus regarding antibiotic-associated AE definitions was established by 5 infectious diseases specialists prior to data collection. Two physicians reviewed potential AEs and determined whether they were more likely than related...

<h3>Importance</h3> Definitive combination antibiotic therapy with a β-lactam and an aminoglycoside for the treatment of gram-negative bacteremia is commonly prescribed in pediatric patients; however, its efficacy toxicity relative to monotherapy are unknown. <h3>Objective</h3> To determine whether definitive affects mortality nephrotoxicity patients bacteremia. <h3>Design, Setting, Participants</h3> Retrospective cohort study including (aged ≤18 years) hospitalized at Johns Hopkins...

ABSTRACT We report our clinical experience treating a 2-month-old infant with congenital diaphragmatic hernia who experienced prolonged bacteremia Burkholderia cepacia complex (Bcc) despite conventional antibiotic therapy and appropriate source control measures. The infection resolved after initiation of ceftazidime-avibactam. Whole-genome sequencing revealed that the isolate most closely resembled B. contaminans identified mechanism resistance likely contributed to cure this agent....

Abstract Invasive fungal disease (IFD) remains a significant cause of morbidity and mortality in children undergoing transplantation. There is growing armamentarium novel antifungal agents recently approved for use or late stages clinical development. The overarching goal this review to discuss the mechanisms action, spectrum activity, stage development, pediatric-specific data following agents: encochleated amphotericin B deoxycholate, fosmanogepix, ibrexafungerp, isavuconazole, olorofim,...

Study Objective To determine whether human immunodeficiency virus ( HIV )‐positive patients who received intravenous midazolam during an inpatient bronchoscopy procedure were more likely to experience severe prolonged sedation if they taking antiretroviral therapy that included a protease inhibitor versus those not any therapy. Design Retrospective cohort study. Setting Tertiary care academic medical center. Patients Two hundred forty‐one ‐positive adults while undergoing between January 1,...

Establishing the diagnosis of invasive mold infections (IMI) in immunocompromised children is challenging due to nonspecific clinical presentations and limited sensitivity traditional culture-based methods. Rapid non-culture-based diagnostics such as 1,3-beta-d-glucan galactomannan assays have emerged promising adjuncts conventional diagnostic tests adults. Available data suggest that has accuracy pediatric population not recommended be used for IMI children. On other hand, performance serum...

The utility of methicillin-resistant Staphylococcus aureus (MRSA) nasal surveillance swabs has not been well-described in children. This retrospective, cohort study yielded a negative predictive value 99.4% for an initial MRSA swab 165 hospitalized children with suspected infection and clinical cultures obtained from likely site infection.

Background. The Clinical and Laboratory Standards Institute (CLSI) recently elected to adjust the previous piperacillin susceptibility breakpoint of ≤64 µg/mL against Pseudomonas aeruginosa ≤16 µg/mL, based largely on pharmacokinetic–pharmacodynamic (PK–PD) modeling studies. Data whether PK–PD correlates with clinical outcomes in children are needed before resorting broader classes antibiotics treat P. aeruginosa.

Abstract Objective National guidelines recommend oral vancomycin over metronidazole as first-line treatment for nonsevere Clostridioides difficile infection (CDI) in adults. Guidelines children with CDI, emphasizing that comparative effectiveness studies comparing the relative efficacy of and are lacking children. Method We conducted an observational study hospitalized CDI treated versus using inverse probability treatment-weighted propensity-score analysis. All following criteria had to be...

In a multicenter retrospective study, we sought to determine the optimal vancomycin trough concentration that would impact duration of methicillin-resistant Staphylococcus aureus bacteremia in children. We found median <10 µg/mL within first 72 hours may be associated with longer compared ≥10 µg/mL.