Research from the Journal of Infectious Disease

Emergency Medicine Infectious Disease Pediatric Emergency

Prolonged Pediatric Fever: Lots of Labs, Almost No Bacteremia
May 29, 2026May 24, 2026

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In well-appearing children with ≥5 days of fever, bacteremia is exceedingly rare (~0.3%), suggesting routine blood testing and cultures have very low diagnostic yield.

Source
Prevalence and Characteristics of Bacteremia in Children With Prolonged Fever and Well Appearance Attending the Pediatric Emergency Department. Pediatr Infect Dis J. 2026 Apr 6. doi: 10.1097/INF.0000000000005234. Epub ahead of print. PMID: 41937232.

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Critical Care Emergency Medicine Infectious Disease

PRONTO RCT—Procalcitonin + NEWS2 = Lower Mortality?
May 28, 2026May 24, 2026

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Adding procalcitonin to a NEWS2-guided sepsis pathway was associated with lower mortality, although the mechanism by which this benefit occurred remains uncertain.

Source
PRONTO Trial Group. Procalcitonin testing combined with NEWS2 evaluation compared with usual care based on NEWS2 for identification of sepsis and antibiotic initiation in the emergency department in England and Wales (PRONTO): a multicentre, randomised, controlled, open-label, phase 3 trial. Lancet Respir Med. 2026 May;14(5):417-431. doi: 10.1016/S2213-2600(25)00433-3. Epub 2026 Mar 22. Erratum in: Lancet Respir Med. 2026 May;14(5):e31. doi: 10.1016/S2213-2600(26)00115-3. PMID: 41881047; PMCID: PMC13125698.

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Critical Care ED-Hospital-Clinic Operations Emergency Medicine Health Policy Infectious Disease

Timely Fluid and Antibiotics = More Patients Home?
April 16, 2026April 20, 2026

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This multihospital cohort study showed that timely antibiotics and fluid resuscitation were associated with increased discharge to home after community-onset sepsis.

Source
Timely antibiotics and fluid resuscitation are associated with increased discharge to home after sepsis. Chest. 2026 Mar 13:S0012-3692(26)00300-4. doi: 10.1016/j.chest.2026.03.002. Epub ahead of print. PMID: 41833809.

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Emergency Medicine Infectious Disease Pediatric Emergency

Meningococcal Disease: Rare, Rapid, and Ruthless
February 26, 2026March 6, 2026

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Meningococcal disease is a rapidly progressive infection associated with high mortality that often begins with nonspecific symptoms; early recognition, early antibiotics, and aggressive resuscitation are critical to improving outcomes.

Source
High risk and low incidence diseases: Meningococcal disease. Am J Emerg Med. 2026 Jan;99:114-122. doi: 10.1016/j.ajem.2025.09.031. Epub 2025 Sep 18. PMID: 41016083.

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Critical Care Emergency Medicine Infectious Disease Surgery

Necrotizing Soft-Tissue Infections – A Survival Guide
February 20, 2026February 25, 2026

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This evidence-based expert position statement on necrotizing soft tissue infections (NSTIs) provides best practices for assessment, diagnosis, treatment, antimicrobials, adjunctive therapies, and long-term management.

Source
Necrotizing soft-tissue infections survival guide in adult patients: A position statement by the Global Alliance for Infections in Surgery. J Trauma Acute Care Surg. 2026 Feb 1;100(2):320-331. doi: 10.1097/TA.0000000000004833. Epub 2025 Dec 17. PMID: 41417687.

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Emergency Medicine Infectious Disease Pediatric Emergency

Positive Blood Culture ≠ Bacteremia: New Decision Rule
February 3, 2026February 11, 2026

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A simple 4-factor clinical decision rule accurately distinguished true bacteremia from contaminants in children with positive blood cultures, achieving 99% sensitivity while potentially reducing unnecessary hospitalizations.

Source
Derivation and Validation of a Clinical Rule to Detect Bacteremia Versus Contaminants in Positive Pediatric Blood Cultures: A Retrospective Cohort Study. Ann Emerg Med. 2025 Dec;86(6):576-585. doi: 10.1016/j.annemergmed.2025.06.620. Epub 2025 Aug 14. PMID: 40810705.

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Critical Care Emergency Medicine Infectious Disease Medicine/Geriatrics Pulmonary/Allergy

Another Positive Trial for Steroids and Pneumonia
January 21, 2026January 24, 2026

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This RCT demonstrated modest reduction in 30-day mortality for patients with community-acquired pneumonia (CAP) in Kenya who received a 10-day course of glucocorticoids.

Source
A Pragmatic Trial of Glucocorticoids for Community-Acquired Pneumonia. N Engl J Med. 2025 Dec 4;393(22):2187-2197. doi: 10.1056/NEJMoa2507100. Epub 2025 Oct 29. PMID: 41159889; PMCID: PMC12659994.

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Emergency Medicine Infectious Disease Pediatric Emergency

Febrile Neonates Under 28 Days – Is PECARN Rule Safe?
January 14, 2026January 17, 2026

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In a large international cohort of well-appearing febrile infants ≤28 days old, the updated PECARN rule had high sensitivity and negative predictive value for invasive bacterial infection, with no missed cases of bacterial meningitis, supporting selective avoidance of routine lumbar puncture in low-risk neonates.

Don’t miss Dr. Josh Belfer’s interview with lead author Dr. Burstein and senior author Dr. Kuppermann on his blog HipPEMcrates.com.

Source
Prediction of Bacteremia and Bacterial Meningitis Among Febrile Infants Aged 28 Days or Younger. JAMA. 2025 Dec 8:e2521454. doi: 10.1001/jama.2025.21454. Epub ahead of print. PMID: 41359314; PMCID: PMC12687207.

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Emergency Medicine Infectious Disease Pharmacy/Pharmacology

Azelastine Nasal Spray Prevents COVID-19?
October 31, 2025November 1, 2025

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Azelastine nasal spray used three times daily for 56 days significantly reduced PCR-confirmed SARS-CoV-2 infections versus placebo.

Source
Azelastine Nasal Spray for Prevention of SARS-CoV-2 Infections: A Phase 2 Randomized Clinical Trial. JAMA Intern Med. 2025 Sep 2:e254283. doi: 10.1001/jamainternmed.2025.4283. Epub ahead of print. PMID: 40892398; PMCID: PMC12406145.

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Emergency Medicine Infectious Disease Pediatric Emergency

New PECARN Rules for Febrile Infants 61-90 Days
October 24, 2025October 25, 2025

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PECARN derived and internally validated two prediction rules to identify infants 61–90 days at low risk for invasive bacterial infection (IBI): one with urinalysis (UA) + T_max ≤ 38.9°C; another with procalcitonin (PCT) ≤ 0.24 ng/mL + absolute neutrophil count (ANC) ≤ 10,710.

Source
PECARN Registry Working Group. Prediction Rule to Identify Febrile Infants 61-90 Days at Low Risk for Invasive Bacterial Infections. Pediatrics. 2025 Sep 1;156(3):e2025071666. doi: 10.1542/peds.2025-071666. PMID: 40854562; PMCID: PMC12432541.

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