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•Baseline numbers of certain immune cells predicted influenza vaccine immunogenicity in pediatric HCT recipients.•Immune reconstitution profiles could inform optimal influenza vaccination timing after pediatric HCT.

During 662 pediatric candidemia episodes, abdominal imaging occurred in 74%, ophthalmologic examination in 68%, echocardiogram in 64%, neuroimaging in 24%, and lumbar puncture in 11%. Each study was reported positive infrequently (3%–6% of evaluated episodes) and predominantly in immunocompromised participants.

Monoclonal antibody therapies currently available under Emergency Use Authorization for the treatment of COVID-19 are suggested for adolescents with the highest risk of severe COVID-19 and could be considered with shared decision-making for those at moderate risk of severe COVID-19.

Reducing avoidable antimicrobial exposure to pediatric patients with cancer is achievable and necessary to promote optimal short- and long-term outcomes. Multiple evidence-based practices are already well established but should be more consistently implemented. Important opportunities exist to further improve the evidence to guide selective antimicrobial use in pediatric oncology.This commentary provides guidance to clinicians on specific opportunities and strategies to promote judicious antimicrobial use in pediatric oncology patients. Current best practices and research gaps are addressed from both infectious disease specialist and oncologist perspectives.

In this multinational prospective, observational cohort study of children and adolescents with invasive candidiasis, initial directed echinocandin antifungal therapy was associated with an adjusted risk reduction of 7.1 points compared with triazole or amphotericin B formulation antifungals.

Although monoclonal antibody therapies for coronavirus disease 2019 have received emergency use authorization for treatment of adolescents in specified high-risk categories, there is currently insufficient evidence for necessity, safety, or efficacy to recommend routine use, even in those with specified conditions.

Although coronavirus disease 2019 (COVID-19) is a mild infection in most children, a small proportion develop severe or critical illness. Data describing agents with potential antiviral activity continue to expand such that updated guidance is needed regarding use of these agents in children.

Despite increasing neonatal antibiotic stewardship efforts, understanding of interhospital variation in neonatal antibiotic use is limited.

Although coronavirus disease 2019 (COVID-19) is mild in nearly all children, a small proportion of pediatric patients develop severe or critical illness. Guidance is therefore needed regarding use of agents with potential activity against severe acute respiratory syndrome coronavirus 2 in pediatrics.

The coronavirus disease 2019 (COVID-19) pandemic has created many challenges for pediatric solid organ transplant (SOT) recipients and their families. As the pandemic persists, patients and their families struggle to identify the best and safest practices for resuming activities as areas reopen. Notably, decisions about returning to school remain difficult. We assembled a team of pediatric infectious diseases (ID), transplant ID, public health, transplant psychology, and infection prevention and control specialists to address the primary concerns about school reentry for pediatric SOT recipients in the United States. Based on available literature and guidance from national organizations, we generated consensus statements pertaining to school reentry specific to pediatric SOT recipients. Although data are limited and the COVID-19 pandemic is highly dynamic, our goal was to create a framework from which providers and caregivers can identify the most important considerations for each pediatric SOT recipient to promote a safe return to school.

A guideline identifying when inpatients with penicillin or cephalosporin antibiotic allergy labels (PCAAL) can receive β-lactam antibiotics increased β-lactam receipt at a large northeastern US health care system.

OBJECTIVETo evaluate interventions to reduce avoidable antibiotic use on pediatric oncology and hematopoietic stem cell transplantation (HSCT) services.DESIGNInterrupted time series.SETTINGAcademic pediatric hospital with separate oncology and HSCT services.PARTICIPANTSChildren admitted to the services during baseline (October 2011–August 2013) and 2 intervention periods, September 2013–June 2015 and July 2015–June 2016, including 1,525 oncology hospitalizations and 301 HSCT hospitalizations.INTERVENTIONIn phase 1, we completed an update of the institutional febrile neutropenia (FN) guideline for the pediatric oncology service, recommending first-line β-lactam monotherapy rather than routine use of 2 gram-negative agents. Phase 2 included updating the HSCT service FN guideline and engagement with a new pediatric antimicrobial stewardship program. The use of target antibiotics (tobramycin and ciprofloxacin) was measured in days of therapy per 1,000 patient days collected from administrative data. Intervention effects were evaluated using interrupted time series with segmented regression.RESULTSPhase 1 had mixed effects–long-term reduction in tobramycin use (97% below projected at 18 months) but rebound with increasing slope in ciprofloxacin use (+18% per month). Following phase 2, tobramycin and ciprofloxacin use on the oncology service were both 99% below projected levels at 12 months. On the HSCT service, tobramycin use was 99% below the projected level and ciprofloxacin use was 96% below the projected level at 12 months.CONCLUSIONSLocally adapted guidelines can facilitate practice changes in oncology and HSCT settings. More comprehensive and ongoing interventions, including follow-up education, feedback, and engagement of companion services may be needed to sustain changes.Infect Control Hosp Epidemiol2017;38:1039–1047

Background Invasive mold infections (IMIs) are a leading cause of mortality in immunocompromised children, yet there has never been an international epidemiologic investigation of pediatric IMIs. Methods This international, prospective cohort study was performed to characterize the epidemiology, antifungal therapy, and outcomes of pediatric IMIs. Children (≤18 years) with proven or probable IMIs were enrolled between August 2007 and May 2011 at 22 sites. Risk factors, underlying diagnoses, and treatments were recorded. Outcomes were assessed at 12 weeks after diagnosis using European Organization for Research and Treatment of Cancer/Mycoses Study Group response criteria. Results One hundred thirty-one pediatric patients with IMIs were enrolled; the most common IMI was invasive aspergillosis ([IA] 75%). Children with IA and those with other types of IMIs had similar underlying risk factors, except that children with IMIs caused by non-Aspergillus species were more likely to have received mold-active antifungal agents preceding diagnosis. The most commonly used antifungal classes after diagnosis were triazoles (82%) and polyenes (63%). Combination therapy was used in 53% of patients. Use of combination therapy was associated with an increased risk of adverse events (risk ratio, 1.98; 95% confidence interval, 1.06–3.68; P = .031), although there was no detectable difference in outcome. Conclusions Although risk factors for IMIs are similar across specific subtypes, preceding antifungal therapy may be an important modifier. Combination antifungal therapy requires further study to determine its true risks and benefits.