Background: Some regions of Spain are withdrawing their pregnancy screening program for congenital toxoplasmosis (CT). The Spanish Research Network of Congenital Toxoplasmosis (REIV-TOXO) was created to describe the current status of CT in Spain. The aims of this study were to describe the epidemiological and clinical characteristics of CT and to evaluate the effect of prenatal treatment on clinical outcomes to inform decision-making policies. Methods: Ambispective observational study including CT cases recorded in the REIV-TOXO database that includes 122 hospitals (2015–2022). Inclusion criteria were one or more of the following: positive PCR in maternal amniotic fluid; positive Toxoplasma gondii-specific IgM or IgA antibodies at birth; positive PCR in the placenta, newborn blood, urine or CSF; increase of specific IgG levels during infant follow-up; or specific IgG persistence beyond age 12 months. Findings: Fifty-six newborns (54 pregnancies) were included. Prenatal screening allowed 92.8% of cases to be identified. The time of maternal infection was well documented in 90.7% of cases, with 61.1% occurring in the third trimester. A total of 66.6% (36/54) pregnant women received antiparasitic treatment: 24/36 spiramycin, 8/36 pyrimethamine, sulfadiazine, and folinic acid, and 4/36 both treatments sequentially. Most cases were asymptomatic at birth (62.5%, 35/56), and 84% (47/56) newborns completed one year of treatment. Median follow-up was 24 months (IQR = 3–72): 14.2% children exhibited new complications, mainly ocular. Newborns born to mothers treated prenatally had four-fold lower risk of CT clinical features at birth (p = 0.03) and six-fold lower risk of further complications during follow-up (p = 0.04) with no treatment-related differences during pregnancy. Conclusions: While diagnosis based only on neonatal assessment misses a significant number of CT cases, prenatal screening allows treatment to be started during pregnancy, with better clinical outcomes at birth and during follow-up. REIV-TOXO provides valuable information about CT in Spain, highlighting the need for universal maternal screening.

In Spain, many programs have been introduced in recent years to optimize antimicrobial stewardship in pediatric care (known as pediatric PROA). However, information on the current situation of these programs is scarce. The present study assesses current antimicrobial use in pediatric care in the hospitals of Catalonia affiliated with the VINCat pediatric PROA group. Between December 2020 and January 2021, an electronic survey related to the design and use of PROA was administered to members of PROA teams in our hospital network. The survey was conducted at 26 hospitals. Twelve percent of the hospitals had pediatric PROA in operation, 42% were included in adult PROA, and 46% carried out pediatric PROA activities but not as part of an established program. At 81%, the pediatric PROA team included a pediatrician, in 58% a pharmacist, and in 54% a microbiologist. The main activities were monitoring the use of antimicrobials and bacterial resistance. Twenty-seven percent measured indicators regularly. The VINCat Pediatric PROA group’s hospitals have implemented measures for optimizing antimicrobial stewardship, but few have a pediatric PROA program in place. Specific measures and indicators must be defined, and the resources available should be increased. The development of pediatric PROA should be monitored in the coming years.

Recent data on toxoplasmosis seroprevalence in Spain is limited, and pregnancy-screening programs are being discontinued. This study aimed to describe seroprevalence in pregnant women in Catalonia using newborn dried blood samples (DBS) from the Catalonian Newborn Screening (NBS) Program; as well as to assess detection of Toxoplasma gondii antibodies in DBS (Anti- Toxoplasma gondii ELISA (IgG/IgM), Euroimmun Lubeck, Germany) as a NBS tool and for retrospective diagnosis of congenital toxoplasmosis (CT) in cases from the Spanish Research Network of Congenital Toxoplasmosis (REIV-TOXO). A total of 3,231 DBS samples from NBS program (September 2022–August 2023) were randomly selected and analyzed, alongside with 30 DBS from CT confirmed cases. The overall seroprevalence of T. gondii IgG in pregnant women was 15.5% (95%CI: 14.33-16.85), higher in foreign women 22.6%, particularly Latin American (30.3%). Analysis of DBS from CT cases showed concordance in IgG detection but only 3.3% (1/30) were IgM positive despite 37% (10/27) having positive serum IgM at birth. In conclusion, IgG analysis in newborn DBS provides valuable information on pregnant seroprevalence. However, its value for identifying CT cases in retrospective diagnosis or as neonatal screening is poor given the low IgM detection. Thus, prenatal screening remains the most effective approach to identify children at risk.

Background: Streptococcus pyogenes (group A Streptococcus , GAS) is a common pediatric pathogen causing a wide range of diseases with significant morbidity and mortality. GAS infections exhibit strong seasonal patterns, and the invasive forms (iGAS) have historically been associated with influenza. Since September 2022, a global outbreak of both iGAS and noninvasive GAS infections has been reported. Methods: This is a retrospective observational multicentric study of children (<15 years) with iGAS in Catalonia (Spain) from week 40 of 2022 to week 24 of 2023. We collected clinical, epidemiologic and microbiologic data on iGAS, scarlet fever and acute respiratory infection diagnoses between 2013 and the study period. Seasonal comparisons were assessed using Kruskal–Wallis and Wilcoxon tests, and correlations between weekly time series were evaluated using Spearman coefficients. Results: Among 135 pediatric iGAS cases, the median age was 3.7 years (interquartile range, 1.6–5.9), mostly healthy. Fever was the most common symptom (92.6%), and pneumonia was the most prevalent diagnosis (40.7%). Viral coinfection occurred in 59.3% of the cases, with influenza A/B being the most prevalent. One-third (35.6%) required intensive care; the case fatality rate was 3.0%. We found a significant correlation between pediatric iGAS infections and influenza A/B circulation (ρ = 0.85) in the context of significantly higher scarlet fever incidence compared with pandemic and pre-pandemic seasons. Weaker correlations were identified between iGAS infections and the other acute viral infections studied. Conclusions: Pediatric iGAS during the 2022–2023 outbreak was strongly associated with influenza activity, suggesting that influenza might contribute to the epidemiology of pediatric iGAS in a context of increased GAS circulation.