Carbapenem-resistant multidrug-resistant (MDR) and pandrug-resistant (PDR) Gram-negative infections represent a critical therapeutic challenge in pediatric intensive care units (PICUs), where effective treatment options are extremely limited. This study aimed to describe the real-world clinical outcomes and safety of ceftazidime–avibactam (CZA) in critically ill children with MDR/PDR infections. We conducted a retrospective observational study of pediatric patients aged 1 month to 18 years who received CZA for microbiologically confirmed MDR or PDR Gram-negative infections in a tertiary PICU between February 2021 and January 2025. Twenty-one critically ill children (median age 55 months, IQR 11–126) were included; two-thirds had underlying chronic conditions and 23.8% were immunosuppressed. Klebsiella pneumoniae was the predominant pathogen (85.7%). Microbiological clearance in follow-up cultures was observed in 85.7% of patients with available microbiological data, and clinical improvement was noted in most patients in this critically ill population. Infection-related mortality was 19% and was primarily associated with host-related factors, including younger age and immunosuppression. Resistance emergence during therapy was observed in one patient. Such resistance development during CZA treatment has been reported rarely in the literature and may involve mechanisms such as mutations in carbapenemase enzymes or alterations in bacterial permeability. In our study, resistance was detected during ongoing therapy in a single patient with Klebsiella pneumoniae , highlighting the importance of close microbiological monitoring in critically ill patients receiving prolonged treatment. Conclusion : CZA was used as a salvage treatment in critically ill children with MDR and PDR Gram-negative infections, with favorable clinical and microbiological outcomes observed. These real-world data support its cautious incorporation into pediatric antimicrobial stewardship strategies in PICU settings. What is Known: • Ceftazidime–avibactam is a promising agent against carbapenem-resistant Enterobacterales in adults. • Pediatric data remain limited, especially in critically ill children with MDR or PDR infections. What is New: • Ceftazidime–avibactam was used as salvage therapy for multidrug- and pandrug-resistant Gram-negative infections in critically ill children. • Clinical and microbiological response was achieved in a high-risk PICU population despite prolonged hospitalization and extensive prior antibiotic exposure.

Background: Fungemia caused by non-Candida yeasts is rare but represents an emerging clinical problem that remains less well recognized and studied. These organisms often exhibit intrinsic resistance or reduced susceptibility to commonly used empirical antifungal agents, such as fluconazole and echinocandins. This poses significant challenges for empirical antifungal therapy. Objectives: To describe the clinical characteristics, antifungal treatments, and outcomes of pediatric patients with bloodstream infections due to non-Candida yeasts and to summarize the antifungal susceptibility profiles of available isolates. Methods: This retrospective study reviewed all episodes of fungemia caused by non-Candida yeasts at a tertiary pediatric center between 1 January 2020 and 1 September 2025. Results: Of the 139 yeast-related fungemia episodes identified during the study period, five (3.6%) were caused by non-Candida yeasts: three by Trichosporon spp., one by Rhodotorula mucilaginosa, and one by Magnusiomyces clavatus (formerly Saprochaete clavatus). Two cases occurred as breakthrough infections under ongoing antifungal treatment. Empirical antifungal treatments most often included amphotericin B, fluconazole, or echinocandins. The median time to species-level identification after the first positive culture result was six days (range 4–7), highlighting a considerable delay that may critically affect clinical management. Overall mortality was 40%, while attributable mortality due to non-Candida fungemia was 20%. Conclusions: Non-Candida yeasts, although infrequent, represent clinically important pathogens in pediatric fungemia due to their potential resistance to standard empirical antifungal agents. Early species-level identification and awareness of expected susceptibility patterns are essential to guide appropriate initial therapy and improve outcomes.

Background: Human herpesvirus-6 (HHV-6) is a neurotropic virus that typically remains latent in immunocompetent individuals but may cause severe neurologic complications, including encephalitis, particularly in immunocompromised hosts. Rarely, HHV-6 encephalitis can also occur in immunocompetent children, often presenting with features of acute necrotizing encephalopathy. Cases: We report 2 cases of previously healthy toddlers who presented with fever, seizures and altered mental status. Neuroimaging revealed bilateral thalamic involvement consistent with acute necrotizing encephalopathy. HHV-6 DNA was detected in cerebrospinal fluid via polymerase chain reaction, confirming the diagnosis. Both patients received antiviral therapy with foscarnet, alongside immunomodulatory treatments including intravenous immunoglobulin, corticosteroids, plasmapheresis and, in 1 case, tocilizumab. Clinical outcomes varied, with 1 patient achieving full recovery and the other showing partial neurologic improvement. Conclusions: These cases highlight the potential for HHV-6 to cause severe encephalopathy in immunocompetent children. Early recognition, neuroimaging, and cerebrospinal fluid polymerase chain reaction testing are essential for diagnosis. Combined antiviral and immunomodulatory therapies may improve outcomes by addressing both viral replication and neuroinflammation.