Asha C. Bowen

The World Society for Pediatric Infectious Diseases (WSPID) was contemplated in the early 1990s by leaders of the European Society of Paediatric Infectious Diseases (ESPID), Sociedad Latinoamericana de Infectiologia Pediatrica (SLIPE) and Pediatric Infectious Diseases Society (PIDS). It was formally registered in the USA in 1994. A history of the first 30 years of the organisation is conveyed.

Elimination of rheumatic heart disease (RHD) as a public health problem requires a multifaceted approach, including better primordial and primary prevention and early case detection and treatment of rheumatic fever, the autoimmune precursor to RHD. Here, we reflect on progress made in the decade since the 2015 revision of the Jones Criteria for rheumatic fever diagnosis. Advances in understanding rheumatic fever pathophysiology, the identification of potential biomarkers and improved clinical insights are bringing us closer to a diagnostic test for rheumatic fever and to targeted treatments that could prevent progression to RHD.

Lay Summary: The Staphylococcus aureus Network Adaptive Platform trial is a whole-of-life infectious disease trial. Recently, results for the methicillin-susceptible Staphylococcus aureus domain in adults showed cefazolin is non-inferior to (flu)cloxacillin for S. aureus bacteremia. The trial continues in children. Here the investigators outline why.

Background: Vancomycin is first‐line treatment for methicillin‐resistant Staphylococcus aureus (MRSA) infections. However, despite guideline recommendations, there is no evidence that targeting vancomycin trough concentrations of ≥15 mg/L in children confers clinical benefit and is associated with vancomycin‐associated nephrotoxicity (VAN). Aim: This study aimed to evaluate the impact of a vancomycin safety bundle on VAN and vancomycin utilisation in hospitalised paediatric inpatients. Method: A pre–post‐intervention study was conducted in a tertiary paediatric hospital comparing January–December 2018 (pre‐intervention) to May 2019–April 2020 (post‐intervention). Hospitalised children, aged 30 days to Ethical considerations in quality assistance and evaluation activities . Results: A total of 314 vancomycin prescriptions were analysed ( n = 204 pre‐intervention; n = 110 post‐intervention). Post‐intervention, VAN incidence decreased almost twofold from 0.46 to 0.25 episodes per 1000 patient bed days (p ≤ 0.01), and vancomycin prescription days decreased by 19%. Total hospital drug costs for vancomycin decreased by AUD $16 033. Overall, and for paediatric invasive MRSA, no significant difference in clinical outcomes or 30‐day mortality was observed between study periods. Conclusion: This study demonstrated the implementation of a vancomycin safety bundle significantly reduced paediatric VAN and vancomycin utilisation without compromising clinical outcomes. These data support antimicrobial stewardship interventions to improve medication safety for children.

We respond to Bradshaw et al.’s Eczema Bathing Study and its commentary, which report no clinically important difference in eczema symptoms between weekly and daily bathing over 4 weeks. We highlight that translating a ‘preference-led bathing frequency’ message requires caution in settings with high burdens of skin infection, where bathing also serves infection-control goals. We propose future trials and guidance incorporate infection-related endpoints alongside symptom measures to support equity-sensitive implementation.

Introduction: Congenital cytomegalovirus (cCMV) is a common infection at birth with the potential to cause significant and permanent morbidity, most commonly hearing loss. Targeted cCMV testing programmes use hearing loss as an indicator of an infant being at high risk of the infection and thereby can ‘target’ or focus testing on those at greatest risk. Australian and International guidelines recommend that high-risk infants be offered cCMV testing, yet across Australia, a formal testing system does not exist. This paper presents the results of a Western Australian (WA) targeted testing study, detailing its methodology, strengths and challenges to evaluate the feasibility of a targeted cCMV testing programme in WA. Methods: A 2-year statewide observational study was conducted in WA from 2020 to 2022. The study used the established universal infant hearing-screening programme to identify infants at high risk of cCMV. Infants who failed their newborn hearing test were recruited to the study and underwent saliva PCR testing. Confirmatory testing was via urine PCR for CMV. This study examines the first 12 months of data. Data collected included the timeliness of testing and results, both integral to effective cCMV diagnosis and treatment. The reasons for high-risk infants being ineligible for testing were explored, and for cCMV-positive infants, the timeliness of reviews and investigations was evaluated. Results: During the study period, 212 infants at high risk of cCMV were identified. Of these, 134 (63%) met inclusion criteria and 103 (77%) consented to participate. The study achieved complete and timely cCMV testing, along with timely review and investigation of cCMV-positive infants. Barriers to testing eligibility among high-risk infants (n=78) were assessed to inform strategies to improve testing access. Conclusions: WA currently lacks a structured, targeted cCMV testing programme, resulting in missed diagnosis and early intervention opportunities for high-risk infants. The study findings indicate that a structured, targeted cCMV testing programme is feasible and would ensure affected children receive care that aligns with national and international standards.

Background: Staphylococcus aureus bacteremia (SAB) is the most common cause of childhood sepsis contributing to pediatric intensive care unit admission. The cost of adult SAB hospitalization is well described globally, but limited costing information is available for children. To bridge this knowledge gap, we investigated the cost of hospitalization in children with SAB in Australia. Methods: An economic analysis of hospitalization costs involving children aged ≤18 years with SAB admitted to Perth Children’s Hospital (PCH) between January 2017 and December 2018 was completed. Children were identified from the Invasive Staphylococcus aureus Infections and Hospitalisations (ISAIAH) cohort, a prospective multicenter study of pediatric SAB in Australia and New Zealand. The primary measure was mean hospitalization cost of community-onset SAB, overall and stratified by key variables, with 95% CIs calculated by bootstrapping. Results: There were 61 patients with SAB admitted to PCH. Fifty-six patients had community-onset SAB. The mean hospitalization cost per patient with community-onset SAB was A$53 037 [95% CI $44 623-$61 452]. The annual total cost was A$1 485 058. Hospital-onset SAB costs were significantly higher than community-onset SAB costs, and there was no difference in hospitalization costs by antibiotic susceptibility profile for community-onset SAB. The total cost of pediatric hospitalization for community-onset SAB within the ISAIAH cohort was estimated to be over A$9 million. Conclusion: This study provides the first in-depth analysis of the cost of hospitalization for SAB in children. This study suggests that the economic burden of SAB in children is substantial, and prevention and treatment strategies should remain focused on S. aureus as a whole.

The prevalence of impetigo and pharyngitis – which are both superficial group A streptococcus (GAS) infections that precede acute rheumatic fever – is poorly defined. Guidelines recommend the early diagnosis of both infections to prevent ARF; however, screening to enable the concurrent detection of these infections in high-risk populations has rarely been performed. In this observational cohort study, children attending one of two schools in the remote Kimberley region of Western Australia were assessed for signs and symptoms of impetigo and pharyngitis at repeated screening visits (conducted up to three times per year), and weekly assessments were performed in response to self-reported symptoms. Throat and skin swabs and dried blood spots were collected at screens. Swabs underwent standard microbiological culture and whole genome sequencing was conducted on confirmed GAS isolates. Dried blood spots were assessed for anti-streptococcal antibody titres. A higher-than-anticipated rate of pharyngitis (29.5%), GAS-positive pharyngitis (6.3%) and GAS carriage (9%) was detected, but GAS-positive impetigo was lower (2.6%) compared with previous studies in the Kimberley. Aboriginal and Torres Strait Islander children experienced more GAS infections than did children of other ethnicities, whereas anti-streptococcal antibody titres did not differ according to ethnicity. This study provides evidence to support the need for increased investment and resourcing of ARF primary prevention in the Kimberley, due to high rates of GAS infection.