Publications by authors named "Andrea Lo Vecchio"

Unlabelled: An increase in severe and invasive infections has been reported since the COVID-19 pandemic. However, most evidence comes from monocentric studies without nationwide representativeness. This multicenter, nationwide, retrospective study, conducted within the network of the Italian Society of Pediatric Infectious Diseases (SITIP), aimed to compare the severity of empyema at presentation in children (aged 1 month to 18 years) admitted to 19 Italian hospitals before, during, and after the pandemic.

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The development of artificial intelligence systems is revolutionizing many fields of medicine, but specific studies are still missing in pediatrics. In our study, we showed that an untrained free-to-use large language model provided reliable responses regarding antibiotic prescription for 13 primary-care scenarios of pediatric infections.

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Background: According to estimates, globally more than 200,000 pregnant women develop tuberculosis (TB) annually. Despite this, data on perinatal TB remain scarce. This study aimed to describe perinatal TB, comprising congenital (cTB) and postnatal (pTB) TB, in a European setting.

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A previous study settled in the Campania Region (Southern Italy) has proven the effectiveness of a multifaceted antimicrobial stewardship program in reducing prescription rates and use of broad-spectrum molecules in the Primary Care setting. Since autumn 2022, the amoxicillin shortage has been reported at a national level, and respiratory pathogens resurged in children after the easing of COVID-19 pandemic restrictions. We aimed to assess the impact of amoxicillin shortage on antimicrobial prescription patterns and quality indexes in the same setting as the past AMS campaign.

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Sinusitis is an inflammation of the mucous membrane of the paranasal sinuses. Bacterial sinusitis usually occurs as a complication of viral infections of the upper respiratory tract and is a frequent cause of medical consultation. The clinical presentation of acute bacterial sinusitis can vary.

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In a subset of children and adolescents, SARS-CoV-2 infection induces a severe acute hyperinflammatory shock termed multisystem inflammatory syndrome in children (MIS-C) at four to eight weeks after infection. MIS-C is characterized by a specific T cell expansion and systemic hyperinflammation. The pathogenesis of MIS-C remains largely unknown.

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Antimicrobial stewardship programs (ASPs) and diagnostic stewardship programs (DSPs) are essential strategies for effectively managing infectious diseases and tackling antimicrobial resistance (AMR). These programs can have a complementary impact, i.e.

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Acute Otitis Media (AOM) typically affects previously healthy children and can be recurrent. This inter-society consensus aims to provide evidence-based recommendations for the antibiotic therapy of mild, severe and recurrent otitis media in previously healthy children in Italy.A systematic literature review was conducted to identify the most recent/relevant evidence.

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Background: Fever is a common symptom in children, but despite existing guidelines, pediatricians may not fully apply recommendations. Fever of Unknown Origin (FUO) is generally referred to as an unexplained prolonged fever. However, a standardized FUO definition and management is missing.

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Sore throat represents one of the main causes of antibiotic overprescription in children. Its management is still a matter of debate, with countries considering streptococcal pharyngotonsillitis a benign and self-limiting condition and others advocating for its antibiotic treatment to prevent suppurative complications and acute rheumatic fever. Italian paediatricians frequently prescribe antibiotics on a clinical basis regardless of microbiological results.

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Community-acquired pneumonia (CAP) is an acute infection of the lung parenchyma acquired outside the hospital or other healthcare settings, typically affecting previously healthy individuals. This intersociety consensus aims to provide evidence-based recommendations for the antibiotic treatment of mild to moderate CAP in previously healthy children in Italy.A systematic review was conducted to identify the most recent and relevant evidence.

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Article Synopsis
  • The study looked at how serious Human Adenovirus (HAdV) infections are compared to other viral illnesses in kids with breathing problems in Italy.
  • They found that kids with HAdV showed more inflammation but didn't have worse breathing issues than those with other viruses.
  • The research highlights the need to identify HAdV early to avoid giving unnecessary antibiotics, since many kids might get treated for bacterial infections when they really have a virus.
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Clinical manifestations of congenital syphilis (CS) include liver disease with/without impaired liver function, identified as syphilitic hepatitis. Hepatic involvement may be dramatic; therefore, early diagnosis is crucial to provide treatment and prevent fatal outcomes. A new resurgence of CS cases has been described in recent years worldwide.

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Article Synopsis
  • Acute infectious diarrhea (AID) is a common illness in children worldwide, and probiotics are considered a promising treatment due to their effects on gut health and immune response.* -
  • The effectiveness of probiotics varies by strain and dosage, and guidelines recommend using specific strains with proven safety and efficacy for AID treatment.* -
  • While probiotics have strong support for treating AID in children, their role in preventing diarrhea in healthy individuals is uncertain, though they may help at-risk groups and in preventing hospital-acquired diarrhea.*
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Since January 2024, Italy experiences a pertussis outbreak, primarily affecting neonates and unvaccinated infants at high risk of severe complications and mortality; 11 major paediatric centres noted 108 hospitalisations and three deaths by 10 May. The outbreak reflects increased circulation of and non-adherence to immunisation recommendations during pregnancy. Public health interventions, including maternal immunisation, vaccination of infants as early as possible and post-exposure prophylaxis, are critical for reducing the burden of pertussis and preventing further mortality.

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Acute Bacterial Skin and Skin Structure Infections (ABSSSI) are marked by substantial morbidity, frequent need for hospitalization, and long courses of intravenous antibiotic therapy. Herein, we report four cases of pediatric patients admitted for ABSSSI and managed with a combination antibiotic regimen incorporating dalbavancin: a second-generation lipoglycopeptide active against Gram-positive bacteria, including methicillin-resistant . In our experience, particularly in a setting with a high methicillin-resistance rate, dalbavancin demonstrated safety and efficacy, simplifying ABSSSI management in childhood.

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Background: In high-resource settings, the survival of children with immunocompromise (IC) has increased and immunosuppressive therapies are increasingly being used. This study aimed to determine the clinical characteristics, performance of diagnostic tools, and outcome of IC children with tuberculosis (TB) in Europe.

Methods: Multicenter, matched case-control study within the Pediatric Tuberculosis Network European Trials Group, capturing TB cases <18 years diagnosed 2000-2020.

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Background: COVID-19 is generally milder in children than in adults, however severe infection has been described in some patients. Few data are available on use of Remdesivir (RDV) in children, as most clinical trials focused on adult patients. We report a multicenter study conducted in 10 Italian Hospitals to investigate the safety of RDV in children affected by COVID-19.

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Article Synopsis
  • The study aimed to explore the impact of SARS-CoV-2 on heart injury markers in infants with COVID-19, involving 152 hospitalized infants, 79 with other infections, and 71 healthy controls from March 2020 to March 2022.* -
  • Results showed that infants with COVID-19 had significantly higher levels of cardiac troponin (hs-cTn), indicating myocardial injury, particularly in those under three months old, compared to both control groups.* -
  • Despite the initial elevation of hs-cTn indicating some heart stress, levels returned to normal over time without any severe symptoms or long-term heart damage observed during up to one year of follow-up, though future monitoring is advised due to
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Aim: Prolonged diarrhoea (ProD) refers to acute-onset diarrhoea that persists for longer than 1 week. As the aetiology, risk factors and management are poorly defined, we prospectively enrolled children hospitalised in a high-income setting to assess these outcomes and investigate the potential role of gut microbiota.

Methods: All children aged 30 days to 14 years admitted for acute-onset diarrhoea lasting 7-14 days were included.

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Introduction: In Italy Rotavirus vaccination (RVV) is provided free of charge from 2018, however, the coverage is scattered and suboptimal. The narrow time frame to complete the schedule is a barrier to uptake, and co-administration with other vaccines may potentially increase the coverage. Although the co-administration of RV vaccine and Meningococcal Group B vaccine (MenB) is not included in the product labels, we aimed at studying its impact on RVV coverage.

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Objective: The objective of this study was to assess the clinical impact and outcome of the SARS-CoV-2 infection on children with cancer or those who received a hematopoietic stem cell transplantation.

Methods: AIEOP (Italian Association of Pediatric Hematology and Oncology) performed a nationwide multicenter observational cohort study, including consecutive patients between April 2020 and November 2022.

Results: Twenty-five Italian centers participated and 455 patients were enrolled.

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The Spike protein of SARS-CoV-2 acts as an enterotoxin able to induce chloride secretion and production of reactive oxygen species (ROS), involved in diarrhea pathogenesis. (LGG) is recommended in pediatric acute gastroenteritis guidelines as a therapy independent of infectious etiology. We tested a postbiotic preparation of LGG (mLGG) in an in vitro model of COVID-associated diarrhea.

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Article Synopsis
  • * Three main management strategies emerged: one endorsing antibiotics to prevent acute rheumatic fever, another viewing pharyngitis as self-limiting, and a third adjusting treatment based on individual risk for rheumatic fever.
  • * The findings highlight inconsistencies across international guidelines, suggesting the need for a unified global approach and further research on cost-effectiveness and local GABHS epidemiology.
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