Juan Garduño-Espinosa1
Fortino Solórzano-Santos2
Guillermo Salinas-Escudero3
Guadalupe Miranda-Novales4
Joaquin F. Mould-Quevedo5
Diana Avila-Montiel1*- 1Division of Research, Hospital Infantil de México Federico Gómez, Mexico City, Mexico
- 2Infectious Diseases Research Department, Hospital Infantil de México Federico, Mexico City, Mexico
- 3Center for Economic and Social Studies in Health, Hospital Infantil de México Federico Gómez, Mexico City, Mexico
- 4Analysis and Synthesis of Evidence Research Unit, XXI Century National Medical Center, Mexican Social Security Institute, Mexico City, Mexico
- 5CSL Seqirus USA Inc., Summit, NJ, United States
Editorial on the Research Topic
Clinical, biological, and economic aspects of pediatric infections in Latin America
In Latin American countries, there is a diversity of infectious diseases that include tropical diseases, diseases related to poverty and malnutrition, and those neglected diseases related to inadequate sanitation, with close contact with infectious vectors and domestic animals. As a consequence, the exaggerated use of antimicrobials has also had an impact on the increase in bacterial resistance (1).
Among the neglected tropical diseases, parasitic diseases, dengue, malaria, and Zika occupy the first places in the Central American region and Mexico, despite a decrease in the frequency of some of these diseases (2). In the group of neglected diseases in children under 5 years of age, the most common disease is malaria, followed by parasitic infections and dengue (3).
Infectious diseases can be life-threatening in children and can also leave lifelong consequences by affecting their growth and neurodevelopment (4).
Addressing infectious diseases in this region is complex due to various determinants such as climate variability, political and security problems, such as violence and organized crime, inequity in the distribution of resources, migration, and food insecurity (5, 6).
The pediatric population is especially vulnerable to these determinants, so it is essential to generate evidence to carry out intervention strategies from a clinical, biological, social, and economic perspective to improve access to health systems and the management of infectious diseases.
This Research Topic consists of four original articles. It compiles evidence and experiences in managing infectious diseases from some Latin American countries, showing data on the pediatric populations of these countries, in which multiple social and cultural aspects are shared.
Below are the topics addressed in the articles contained in this Research Topic.
Bacteremia due to carbapenem-resistant enterobacterales (CRE) is a problem associated with medical care worldwide; in addition, the primary source of infection cannot be identified in most cases, so it is essential to carry out research that explores the different factors that produce it to identify them and be able to carry out infection prevention and control strategies (7–9). The study by Ruvinsky et al. in Argentina identified risk factors for acquiring bacteremia due to CRE in pediatric patients. Among the variables analyzed are demographic, epidemiological, clinical, microbiological, and resource management factors. These results show the importance of establishing comprehensive health programs and policies to improve the appropriate use of antimicrobials. Mortality associated with carbapenem resistance is a challenge worldwide (10).
In pediatric cancer patients, bloodstream infections continue to be a leading cause of morbidity and mortality, especially in low-income patients due to their living conditions and barriers to accessing medical care. Bloodstream infections have also been associated with increased hospitalization time and resource consumption (11–13).
A study in Guatemala by Mukkada et al. found that it is necessary to improve infection control practices and invest in laboratory diagnosis and data recording to identify and document factors contributing to poor outcomes. Modifying negative factors will allow for strategies that will impact the management of healthcare-associated infections, particularly in vulnerable settings. From the prevention approach, the effectiveness of hand hygiene for the prevention of hospital-acquired infections is widely known, and there are standardized protocols; however, adoption and adherence to these protocols continue to be a challenge (14, 15).
The study by Salinas-Escudero et al. in Mexico showed the importance of implementing Automated hand hygiene monitoring (AHHM) to promote hand hygiene and thereby prevent infectious complications. The study demonstrated that it is a profitable strategy since it effectively reduces costs and hospital infections.
Regarding emerging infectious diseases, it is known that COVID-19 represents an economic burden for health systems in the world and is a challenge for health authorities, especially in a country like Mexico, where the health system is fragmented (16, 17).
The study carried out in Mexico City by Reyes-López et al. estimated the direct medical costs associated with the treatment of children with COVID-19 in a tertiary care pediatric hospital. It took into account various factors in the patients to make accurate estimates of the care costs and thus carry out budgetary and input planning for their care.
This Research Topic outlines some of the transcendental factors that influence the care and management of infectious diseases in the pediatric population in a complex and heterogeneous region such as Latin America.
On the other hand, the influence of certain factors on clinical outcomes was explored in statistical models, identifying some that may even modify the outcome.
This Research Topic should be analyzed with the perspective that its content will contain descriptive texts and aspects most applicable to the region.
It is interesting to emphasize the importance of overcoming geographical barriers and inviting scientific collaboration to work to better address pediatric diseases in the region.
Author contributions
JG-E: Conceptualization, Writing – original draft. FS-S: Writing – review & editing. GS-E: Writing – review & editing. GM-N: Writing – review & editing. JM-Q: Writing – review & editing. DA-M: Writing – review & editing.
Funding
The author(s) declare that no financial support was received for the research, authorship, and/or publication of this article.
Acknowledgments
We thank all the contributors to this Research Topic.
Conflict of interest
JM-Q was employed by the CSL Seqirus USA Inc.
The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
Publisher's note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.
References
1. Morel CM. Significance of a neglected tropical disease: lessons from a paradigmatic case of ‘success in translation'. Mem Inst Oswaldo Cruz. (2022) 117:e200277. doi: 10.1590/0074-02760200277
2. Hotez PJ, Odom John AR, LaBeaud AD. Pediatric tropical medicine: the neglected diseases of children. PLoS Negl Trop Dis. (2019) 13:e0007008. doi: 10.1371/journal.pntd.0007008
3. Hotez PJ, Damania A, Bottazzi ME. Central Latin America: two decades of challenges in neglected tropical disease control. PLoS Negl Trop Dis. (2020) 14:e0007962. doi: 10.1371/journal.pntd.0007962
4. Khalil IA, Troeger C, Rao PC, Blacker BF, Brown A, Brewer TG, et al. Morbidity, mortality, and long-term consequences associated with diarrhoea from Cryptosporidium infection in children younger than 5 years: a meta-analyses study. The Lancet Global Health. (2018) 6:e758–68. doi: 10.1016/S2214-109X(18)30283-3
5. The World Bank. Population, Total. The World Bank. Available online at: http://data.worldbank.org/country/Mexico?view=chart (accessed March 15, 2024).
6. United Nations High Commissioner for Refugees (UNHCR). Protection and Solutions Strategy for the Northern Triangle of Central America 2016–2018. Geneva: UNHCR (2018).
7. Osei Sekyere J, Reta MA, Bernard Fourie P. Risk factors for, and molecular epidemiology and clinical outcomes of, carbapenem- and polymyxin-resistant gram-negative bacterial infections in pregnant women, infants, and toddlers: a systematic review and meta-analyses. Ann N Y Acad Sci. (2021) 1502:54–71. doi: 10.1111/nyas.14650
8. Tumbarello M, Spanu T, Sanguinetti M, Citton R, Montuori E, Leone F, et al. Bloodstream infections caused by extended-spectrum- b-lactamase- producing Klebsiella pneumoniae: risk factors, molecular epidemiology, and clinical outcome. Antimicrob Agents Chemother. (2006) 50:498–504. doi: 10.1128/AAC.50.2.498-504.2006
9. Meatherall BL, Gregson D, Ross T, Pitout JDD, Laupland KB. Incidence, risk factors, and outcomes of Klebsiella pneumoniae bacteremia. Am J Med. (2009) 122:866–73. doi: 10.1016/j.amjmed.2009.03.034
10. Paniagua-García M, Bravo-Ferrer JM, Pérez-Galera S, Kostyanev T, de Kraker MEA, Feifel J, et al. mortality of infections caused by carbapenem-resistant Enterobacterales: results from a prospective, multinational case-control-control matched cohorts study (EURECA). Clin Microbiol Infect. (2024) 30:223–30. doi: 10.1016/j.cmi.2023.11.008
11. Caniza MA, Odio C, Mukkada S, Gonzalez M, Ceppi F, Chaisavaneeyakorn S, et al. Infectious complications in children with acute lymphoblastic leukemia treated in low-middle-income countries. Expert Rev Hematol. (2015) 8:627–45. doi: 10.1586/17474086.2015.1071186
12. Leung KKY, Ho PL, Wong SCY, Chan WYK, Hon KLE. Prevalence and outcomes of infections in critically-ill paediatric oncology patients: a retrospective observation study. Curr Pediatr Rev. (2024) 24:4248. doi: 10.2174/0115733963264717231208114248
13. Aviles-Robles M, Ojha RP, Gonzalez M, Ojeda-Diezbarroso K, Dorantes-Acosta E, Jackson BE, et al. Bloodstream infections and inpatient length of stay among pediatric cancer patients with febrile neutropenia in Mexico City. Am J Infect Control. (2014) 42:1235–7. doi: 10.1016/j.ajic.2014.07.021
14. Larson E. A causal link between handwashing and risk of infection? Examination of the evidence. Infect Cont. (1988) 9:28–36. doi: 10.1086/645729
15. Boyce JM, Pittet D. Recommendations of the healthcare infection control practices advisory committee and the HICPAC/SHEA/APIC/IDSA hand hygiene task force. Society for healthcare epidemiology of America/association for professionals in infection control/infectious diseases society of America. MMWR Recomm Rep. (2002) 51:1–45. doi: 10.1086/503164
16. Jin H, Wang H, Li X, Zheng W, Ye S, Zhang S, et al. Economic burden of COVID-19, China, January–march, 2020: a cost-of-illness study. Bull World Health Organ. (2021) 99:112–24. doi: 10.2471/BLT.20.267112
17. Llanos Guerrero A, Méndez Méndez JS. Interrupción de los Servicios de Salud por COVID-19: Implicaciones en el Gasto de Bolsillo. Newsletter del Centro de Investigación Económica y Presupuestaria A.C. (2021). Available online at: https://ciep.mx/wp-content/uploads/2021/08/interrupcion_servicios_ENIGH-1.pdf (accessed August 23, 2021).
Keywords: infectious diseases, children, pediatric, health economics, Latin America
Citation: Garduño-Espinosa J, Solórzano-Santos F, Salinas-Escudero G, Miranda-Novales G, Mould-Quevedo JF and Avila-Montiel D (2024) Editorial: Clinical, biological, and economic aspects of pediatric infections in Latin America. Front. Public Health 12:1398071. doi: 10.3389/fpubh.2024.1398071
Received: 08 March 2024; Accepted: 13 March 2024;
Published: 22 March 2024.
Edited and reviewed by: Chiara de Waure, University of Perugia, Italy
Copyright © 2024 Garduño-Espinosa, Solórzano-Santos, Salinas-Escudero, Miranda-Novales, Mould-Quevedo and Avila-Montiel. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: Diana Avila-Montiel, diana.avmo@gmail.com