Pocapavir exhibits antiviral activity against both polio and nonpolio enteroviruses. There is limited experience of the use of this investigational drug in young children with enteroviral infection. We describe the successful clearance of prolonged immunodeficiency-associated vaccine-derived type 3 poliovirus infection by pocapavir in an infant with underlying X-linked agammaglobulinemia.

Background Self-harm in adolescents is of growing concern internationally but limited evidence exists on the prevalence of self-harm in those living with HIV, who may be at higher risk of poor mental health outcomes. Therefore our aim was to determine the prevalence and predictors of self-harm among young people with perinatally-acquired HIV (PHIV) and HIV negative (with sibling or mother living with HIV) young people living in England. Methods 303 PHIV and 100 HIV negative young people (aged 12–23 years) participating in the Adolescents and Adults Living with Perinatal HIV cohort study completed an anonymous self-harm questionnaire, as well as a number of standardised mental-health assessments. Logistic regression investigated predictors of self-harm. Results The median age was 16.7 years in both groups, and 40.9% of the PHIV and 31.0% of the HIV negative groups were male. In total 13.9% (56/403) reported having ever self-harmed, with no difference by HIV status ( p = 0.089). Multivariable predictors of self-harm were female sex (adjusted odds ratio (AOR) 5.3, (95% confidence interval 1.9, 14.1), p = 0.001), lower self-esteem (AOR 0.9 (0.8, 0.9) per 1 point increase, p < 0.001) and having ever used alcohol (AOR 3.8 (1.8, 7.8), p < 0.001). Self-esteem z-scores for both PHIV and HIV negative participants were 1.9 standard deviations below the mean for population norms. Conclusions Self-harm is common among PHIV and HIV negative adolescents in England. Reassuringly however, they do not appear to be at an increased risk compared to the general adolescent population (15–19% lifetime prevalence). The low level of self-esteem (compared to available normative data) in both groups is worrying and warrants further attention.

Carbapenem-resistant Enterobacterales (CRE) is a global threat to human health. [1,2] The main mechanism of resistance is production of carbapenemases, which hydrolyse most beta-lactam antibiotics. Clinical management is compounded by resistance conferred by plasmid-encoded genes to other classes of antibiotics, such as aminoglycosides, fluoroquinolones and colistin. [1,2] The newer beta-lactam-inhibitor combination (BLIC) antibiotics, such as ceftazidime-avibactam (CA), for serious CRE infections, are now available in South Africa (SA). However, these are not easily accessible and decisions regarding their appropriate use are complex. Furthermore, to ensure sustained effectiveness of these antibiotics, it is imperative that health systems guard against unnecessary use and recommit to infection prevention and control measures to prevent the spread of these organisms in hospitals. We describe a child with persistent carbapenem-resistant Serratia marcescens bacteraemia, who was successfully treated with CA. We also highlight some of the challenges faced using a new unregistered antibiotic (Table 1) and call for the development of antimicrobial stewardship (AMS)-guided 'best practices' for their use. Case presentationA 17-month-old previously well child was referred to our tertiary centre with extensive hot-water burns (46% total body surface area). After resuscitation she was admitted for wound debridement and dressings. During the first 2 weeks of admission, she was treated empirically for presumed sepsis multiple times. Four blood cultures, one catheter tip and two tracheal aspirate cultures did not yield growth of a bacterial pathogen. Antimicrobials used during this period included amoxicillin-clavulanic acid, clindamycin, piperacillintazobactam, amikacin, meropenem, vancomycin and fluconazole. Additional risk factors for CRE infection included placement of central venous pressure (CVP) catheters and mechanical ventilation during periods of clinical instability. [3] On day 21 of admission, she developed a low-grade fever. Clinically, no source of infection was found, but procalcitonin increased from 0.3 µg/L to 3 µg/L over 72 hours. The child's CVP catheter was replaced and she was commenced empirically on meropenem, vancomycin and fluconazole. Culture from the CVP catheter tip and burn wound pus swab subsequently cultured CRE S. marcescens, and an extended-spectrum beta-lactamase (ESBL) producing S. marcescens, respectively. To reduce transmission of the CRE organism in the hospital, the patient was isolated and strict contact precautions were implemented. The ETEST (bioMérieux, France) determined CRE S. marcescens minimum inhibitory concentrations (MICs) of >32 µg/mL for ertapenem, imipenem and meropenem. The presence of an oxacillinase-48 (OXA-48) carbapenemase was phenotypically confirmed using the RESIST-4 OKNV kit (Coris Bioconcept, Belgium). As S. marcescens is inherently resistant to colistin, combination therapy with meropenem (40 mg/kg/dose 8-hourly) and amikacin was initiated, and after completion of...