Objective: Ventilator-associated pneumonia (VAP) is a life-threatening complication for children who are treated in a paediatric intensive care unit. Tigecycline treatment of children with VAP has not been well studied. This study aimed to describe tigecycline use in children with VAP in a tertiary care hospital. Methods: We conducted a retrospective chart review in a tertiary hospital from May 1, 2012 to May 1, 2017. Results: Twenty-four children (20 girls) with median age of 8 months (range, 27 days to 6 years and 9 months) were treated with tigecycline. In-hospital mortality was 41.7% (10/24). The primary diagnosis was congenital heart disease (15/24). A total of 70.8% (17/24) of patients received a loading dose (1.5 mg/kg), followed by 1 mg/kg every 12 hours. The median duration of tigecycline therapy was 10.75 days (range, 3–21.5 days). Sulperazone was the most frequently used concomitant antibiotic. Eighteen pathogens were isolated in 16 cases. Tigecycline therapy failed in 41.6% (10/24) of patients and 20.8% (5/24) died. The pathogen was eradicated in 37.5% (6/16) of patients. No serious adverse effects were detected. Conclusion: Tigecycline combined with other agents as salvage therapy in children with VAP is well tolerated. Our preliminary results show a positive clinical response.

Purpose Chromobacterium violaceum(C. violaceum) is a gram-negative bacterium that rarely infects humans, especially children. However, the mortality rate is high and there are no clear guidelines for treatment. The aim of this paper is to increase clinicians’ awareness of diseases caused by C. violaceum infections in children, to diagnose and treat them in a timely manner, to improve patient survival and to reduce mortality. Results We analysed the latest paediatric-related English language literature over the last 10 years and summarised the latest mechanisms of injury, susceptibility factors, adverse prognostic and mortality predictors, mortality rates, methods to reduce mortality, clinical manifestations, new diagnostic methods, therapeutic agents and directions for future drug development for C. violaceum. Conclusions Based on the available data, we conclude that the possibility of C. violaceum infection should be considered and diagnosed when cellulitis, septicaemia and visceral abscesses develop in children with a history of skin injury and exposure to stagnant water or soil. When clinicians strongly suspect that a child is infected with this bacterium, the recommended medication is ciprofloxacin if the child presents with severe illness. If the child has a non-severe condition, medications with relatively fewer side effects for children can be chosen, such as gentamicin, trimethoprim/ sulfamethoxazole, imipenem, and other drugs. The physician can then adjust the antimicrobial regimen based on the antimicrobial spectrum after obtaining the drug sensitivity results.

Objective: To assess the validity of the Broselow tape in estimating the weight of Chinese children in pediatric emergency.Methods: A cross-sectional study was conducted in the emergency department of the Children's Hospital of Zhejiang University School of Medicine (Hangzhou, Zhejiang Province, China) in March 2022. Broselow tape was used to estimate weight and its validity was compared with the advanced child life support (APLS) method.Results: The study included 442 children (mean age: 48 months; male-to-female ratio: 1.13:1). The < 10, 10–19 and > 19-kg groups included 44, 257, and 141 children, respectively. The color concordance rates of the Broselow tape-estimated weight in the three groups were 56.8, 57.2, and 68.1%, respectively. The percentage of weight estimations within 10% of actual weight were 65.8% (59.1, 65.8, and 68.1% for the 19-kg groups, respectively) and 44.8% (40.9, 50.6, and 35.5% for the < 10, 10–19 and > 19-kg groups, respectively) using the Broselow tape and the APLS method, respectively. The correlation between the Broselow tape estimated weight and actual weight was r = 0.931 (P < 0.0001, 95% CI: 0.918–0.943), while the correlation between actual weight and the APLS method calculated weight was r = 0.883 (P < 0.0001, 95% CI: 0.861–0.902). The mean percentage error using the Broselow tape was 1.0 ± 12.0% (P < 0.001 vs. −7.2 ± 17.2% of the APLS method).Conclusion: The Broselow tape may be an available method for predicting the weights of Chinese children in pediatric emergency.

Background: Multidrug-resistant Gram-negative bacteria (MDR-GNB) are becoming increasingly common around the world, with carbapenems frequently serving as a last resort but being threatened by the growing incidence of carbapenemase-producing bacteria. Ceftazidime-avibactam (CAZ/AVI) is a potential agent against MDR-GNB but with limited clinical experience, particularly in critically ill immunosuppressed children. Methods: This study analyzed the use of CAZ/AVI as salvage treatment in severely infected immunosuppressed children from September 2019 to July 2022. Patients with confirmed GNB infection who received CAZ/AVI were matched with patients who received other antibiotics. Results: Twenty-five critically ill immunosuppressed children treated with CAZ/AVI were included. The majority had hematologic diseases. All patients presented with sepsis in all 30 courses. Septic shock presented in 36.7% of these courses. The primary sites of infection included bloodstream infection (20.0%), skin and skin structure infection (20.0%), intra-abdominal infection (13.3%) and hospital-acquired pneumonia (10.0%). Twelve of the 25 (48.0%) patients had positive microbiological cultures, mainly Pseudomonas aeruginosa and Klebsiella pneumoniae, including 5 carbapenem-resistant GNB-infected cases. Fifteen (50.0%) courses presented clinical improvement. For the initial course of each patient, the clinical response rate of the GNB recovered group was significantly higher than that of the group without GNB recovery (66.7% vs 23.1%, P = 0.047). The 14-day and 30-day mortality rates were 24.0% and 28.0%, respectively, which were significantly correlated with the absence of GNB recovery (P = 0.004 and 0.024, respectively) and hospital-acquired pneumonia as the primary site of infection (P = 0.001 and 0.006, respectively). There was no significant difference in major outcomes between patients who received CAZ/AVI and matched patients who received other antibiotics. Conclusion: CAZ/AVI could be considered a salvage strategy for immunosuppressed children with confirmed GNB infection. Caution should be taken when CAZ/AVI is applied to these patients in the absence of GNB recovery.