A new model developed through the international Pediatric Emergency Research Network (PERN) creates a predictive tool that will help clinicians decide if a child's pneumonia warrants hospitalization or intensive care, according to new findings in The Lancet Child and Adolescent Health.

Based on outcomes seen in 2,200 children ages 3 months up to 14 years old from 14 countries who sought care at emergency departments (EDs) for community-acquired pneumonia, the study classified which symptoms were predictive of more serious disease progression. 

Overall, 58.1% of participants had mild, 36.5% moderate, and 5.4% severe disease. Runny nose and congestion were negatively associated with moderate to severe illness (adjusted odds ratio [aOR], 0.59; 95% confidence interval [CI], 0.46 to 0.76).

Chest retractions associated with severe disease 

The symptoms most highly associated with severe pneumonia were hypoxemia (oxygen saturation 90% to 92%; aOR, 3.24) and chest retractions (aOR, 2.86). The model suggests that patients showing those signs should be admitted during ED visits, while children with any runny nose or congestion and no signs of respiratory distress can be treated at home. 

While only a small percentage of children with pneumonia will have severe outcomes, it's crucial to identify these patients early.

"While only a small percentage of children with pneumonia will have severe outcomes, it's crucial to identify these patients early so clinicians can act swiftly and aggressively to prevent further deterioration in these children,” said lead author Todd Florin, MD in a press release from the Ann & Robert Lurie Children's Hospital of Chicago. 

A predictive model based on the risk factors of symptoms showed good-to-excellent accuracy when compared to just clinician judgment alone in predicting illness severity.

"Once externally validated, our models will provide evidence-based information for clinicians to consider when evaluating pneumonia in children," said Florin.

A comparative effectiveness study suggests that long-acting lipoglycopeptide (laLGP) antibiotics could be an alternative step-down treatment for serious gram-positive bacterial infections, researchers reported yesterday in JAMA Network Open.

Using a target trial emulation framework, scientists from the University of New South Wales and the University of California-Los Angeles examined outcomes in patients who were hospitalized and discharged for serious bacterial infections—such as bloodstream infections, endocarditis, osteomyelitis, and septic arthritis—from October 2015 through October 2022 and received either laLGPs or standard-of-care (SOC) antibiotics. Although laLGPs (dalbavancin and oritavancin) are approved only for treating skin infections, they have shown promise as an alternative to outpatient parenteral antibiotic therapy (OPAT) for more serious infections, particularly in people who use drugs (PWUD), who may have difficulty adhering to OPAT.

The primary outcome measure was a composite of readmission, emergency department visit, and inpatient death or discharge to hospice within 90 days of the index admission. The outcome was analyzed in PWUD and non-PWUD populations.

Similar outcomes

Among 42,067 patients included in the analysis (median age, 61 years; 58.7% male), 5,047 (12.0%) were classified as PWUD, and laLGPs were prescribed in 825 (2.0%), including 241 PWUD (4.8%) and 584 non-PWUD (1.6%). Dalbavancin was the most common laLGP prescribed.

In the unadjusted analysis, PWUD patients in the laLGP group were less likely than those in the SOC group to meet the composite outcome within 90 days (44.4% vs 51.9%), as were non-PWUD patients in the laLGP group (31.7% vs 41.5%). In the adjusted analysis, there was no statistically significant difference in the composite outcome between the laLGP and SOC groups in both the PWUD (hazard ratio [HR], 1.01; 95% confidence interval [CI], 0.88 to 1.13) and non-PWUD (HR, 0.93; 95% CI, 0.86 to 1.00) participants, with similar findings across individual bacterial infections.

"This is an encouraging finding for the off-label use of laLGPs and adds to the evidence base supporting the effectiveness of laLGPs among PWUD and non-PWUD individuals," the study authors wrote, adding that randomized clinical trials are needed and that future research should compare patient and clinician preferences and cost-effectiveness.

A Harvard University–based team has identified a chemical compound that, when applied to insecticide-treated bed nets, blocks malaria parasite transmission in mosquitoes without contributing to insecticide resistance. 

Yesterday in Nature the researchers said that once-declining malaria death rates have recently stalled, partly due to widespread resistance of Anopheles mosquitoes to the insecticides used in long-lasting insecticide-treated nets (LLINs).

"One way to mitigate insecticide resistance is to directly kill parasites during their mosquito-stage of development by incorporating antiparasitic compounds into LLINs," they wrote. "This strategy can prevent onward parasite transmission even when insecticides lose efficacy."

Mosquitoes essentially disinfected

The researchers screened 81 chemical compounds with activity against the mosquito stages of the Plasmodium falciparum parasite, which causes malaria. Compounds were added to a dimethyl sulfoxide (DMSO)–acetone solution and directly pipetted onto the dorsal thorax of female Anopheles gambiae mosquitoes before infection with P falciparum.

The solution helped disrupt mosquito cuticle and enhance compound membrane permeability. Mosquitoes were then given a P falciparum–containing blood meal 7 days before the scientists counted oocysts (infectious parasite structures) in the digestive tract.