Please take a moment to read about some exciting upgrades (CME, Amal Mattu, new website!!) and pricing changes with JournalFeed. I don't want anyone to be caught off guard. I also don't want anyone to let cost be a barrier. So, please read it when you can. ~Clay Smith

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Procalcitonin (PCT) is suppressed in young febrile infants in the presence of confirmed viral infection (CVI), which lowers its sensitivity to detect bacterial infection (BI). Infants meeting the AAP cutoff of 0.5 ng/mL, even in the presence of CVI, should undergo full diagnostic workup for BI.

Source
Effect of Viral Illness on Procalcitonin as a Predictor of Bacterial Infection in Febrile Infants. Hosp Pediatr. 2023 Nov 1;13(11):961-966. doi: 10.1542/hpeds.2022-007070.

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This article provides a review of hemolytic-uremic syndrome (HUS) associated with Shiga toxin-producing Escherichia coli (STEC) infection. This condition, which disproportionately impacts children under five, is defined by thrombocytopenia, non-immune hemolytic anemia, and azotemia caused by thrombotic microangiopathy.

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Contact precaution (CP) for patients with MRSA infection or colonization is listed as an "essential practice" for all U.S. hospitals, but should it be?

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In this randomized control trial of patients receiving cefepime or piperacillin-tazobactam, there was no difference in risk of acute kidney injury between the two groups. However, those who received cefepime were more likely to have neurologic side effects.

Source
Cefepime vs Piperacillin-Tazobactam in Adults Hospitalized With Acute Infection: The ACORN Randomized Clinical Trial. JAMA. 2023 Oct 14:e2320583. doi: 10.1001/jama.2023.20583. Online ahead of print.

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Encephalitis can be cryptic – here are the latest updates for diagnosis and treatment.

Source
State of the Art: Acute Encephalitis. Clin Infect Dis. 2023 Sep 11;77(5):e14-e33. doi: 10.1093/cid/ciad306.

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A new cutoff of 10,000 colony-forming units per milliliter (CFU/mL) on urine culture to diagnose urinary tract infection (UTI) from catheterized specimens in infants and children <3 years improved sensitivity and specificity.

Source
Support for the Use of a New Cutoff to Define a Positive Urine Culture in Young Children. Pediatrics. 2023 Oct 1;152(4):e2023061931. doi: 10.1542/peds.2023-061931.

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Don’t hang your hat on lactate clearance to assess therapeutic response to resuscitation in sepsis; there are too many confounders, and initial clearance does not necessarily project clinical course.

Source
Initial Lactate Clearance Is Confounded Highly by Comorbidities and Poorly Predicts Subsequent Lactate Trajectory. Chest. 2023 Sep;164(3):667-669. doi: 10.1016/j.chest.2023.04.023. Epub 2023 Apr 20.

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For pediatric patients with acute sinusitis, amoxicillin-clavulanate does not offer treatment benefit over amoxicillin alone and is more likely to be associated with gastrointestinal (GI) side effects and yeast infections than amoxicillin.

Source
Treatment Failure and Adverse Events After Amoxicillin-Clavulanate vs Amoxicillin for Pediatric Acute Sinusitis. JAMA. 2023 Sep 19;330(11):1064-1073. doi: 10.1001/jama.2023.15503.

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There was a strong association with lower mortality and hospitalization in high-risk patients with COVID-19 who were treated with either nirmatrelvir/ritonavir or molnupiravir.

Source
Nirmatrelvir or Molnupiravir Use and Severe Outcomes From Omicron Infections. JAMA Netw Open. 2023 Sep 5;6(9):e2335077. doi: 10.1001/jamanetworkopen.2023.35077.

We're trying something new! Watch quick videos, with my personal take on the articles we cover each week and more! Here's the JournalFeed YouTube channel link. ~Clay

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Modified dose nirmaltrevir-ritonavir is well-tolerated in patients with CKD as therapy for mild COVID-19 and effectively suppresses viral load.

Source
Safety Profile and Clinical and Virological Outcomes of Nirmatrelvir-Ritonavir Treatment in Patients With Advanced Chronic Kidney Disease and Coronavirus Disease 2019 (COVID-19). Clin Infect Dis. 2023 Aug 2:ciad371. doi: 10.1093/cid/ciad371. Epub ahead of print.