Our analyses revealed common findings between adult and pediatric invasive aspergillosis. However, one key difference is diagnostic radiologic findings. Unlike adults, children frequently do not manifest cavitation or the air crescent or halo signs, and this can significantly impact diagnosis. Immune reconstitution, rather than specific antifungal therapy, was found to be the best predictor of survival.

Since the introduction of the PCV7, the number of invasive pneumococcal infections caused by vaccine-serogroup isolates among 8 US children's hospitals has decreased >75% among children < or =24 months old. In addition, penicillin resistance decreased in 2002 for the first time since our surveillance began in 1993-1994. However, we have noted that replacement may be developing with serogroups 15 and 33. Furthermore, penicillin resistance seems to be increasing among nonvaccine serogroups. Surveillance must be continued to detect the emergence of changes in the distribution of serotypes as well as antibiotic susceptibility.

Adenoviral (ADV) infections are increasingly recognized as a cause of morbidity and mortality in pediatric hematopoietic stem cell transplantation (HSCT). We reviewed our experience with ADV infections in HSCT patients hospitalized for transplantation at Childrens Hospital Los Angeles January 1998 through December 1998. ADV was detected in 47% of patients, with recipients of HSCT from alternative donors (matched unrelated, unrelated cord, and mismatched related donors) being more frequently culture positive than recipients of HSCT from matched siblings (62% versus 27%, P = .04). Detection of ADV from 2 or more sites was associated with organ injury, eg, hemorrhagic cystitis, enteritis, and hepatitis. Because of the high incidence of ADV culture-positive patients and the lack of effective anti-ADV therapy, we initiated a prospective trial to evaluate cidofovir (CDV) in the treatment of ADV infections in HSCT recipients. Eight patients were enrolled on a dosage schedule of 1 mg/kg 3 times weekly. AD of these patients eventually achieved long-term viral suppression and clinical improvement, although 6 patients needed prolonged CDV therapy for up to 8 months before CDV could be stopped without ADV recurrence. We did not observe dose-limiting nephrotoxicity, and the discontinuation of the drug was not required in any patients. Prospective controlled trials to further define the role of CDV in the treatment of ADV infections in HSCT patients are warranted.

Background Voriconazole pharmacokinetic (PK) and pharmacodynamic (PD) data are lacking in children. Methods Records at the Childrens Hospital Los Angeles were reviewed for children with ≥1 serum voriconazole concentration obtained between May 1, 2006 and June 1, 2007. Demographics, dosing histories, serum concentrations, toxicity/survival data and outcomes were obtained. Analysis was with R 2.9.1 and the non-parametric modeling and simulation MM-USCPACK software. Results There were 207 voriconazole concentrations obtained from 46 patients (0.8 – 20.5 years). A 2-compartment Michaelis-Menten PK model fit the data best, but only explained 80% of the observed variability. Crude mortality was 13 (28%), and each trough serum voriconazole concentration <1,000 ng/mL was associated with a 2.6-fold increased odds of death (95% CI 1.6 – 4.8, P=0.002). Serum voriconazole concentrations were not associated with hepatotoxicity. Simulations predicted an intravenous dose of 7 mg/kg or oral dose of 200 mg twice daily would achieve a trough >1,000 ng/mL in the majority of patients, but with a very wide range of possible concentrations. Conclusions We found a PD association between a voriconazole trough >1,000 ng/mL and survival, and marked PK variability, particularly after enteral dosing, justifying measurement of serum concentrations.