2026 Clinical Practice Guideline Update by the Infectious Diseases Society of America and the Pediatric Infectious Diseases Society on The Management of Community-Acquired Pneumonia in Infants and Children Older than 3 Months of Age: The Use of Pleural Fluid Drainage versus Observation

Clinical Infectious Diseases · 2026-03-13

This paper is part of a larger clinical practice guideline on the diagnosis and management of parapneumonic effusion and empyema in children, developed by the Infectious Diseases Society of America. In this paper, the panel provides recommendations for pleural fluid drainage in children (3 months to 18 years) with parapneumonic effusion and empyema. The panel's recommendations are based upon evidence derived from systematic literature reviews and adhere to a standardized methodology for rating the certainty of evidence and strength of recommendation according to the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) approach.

ONC201 for chemoprevention of colorectal cancer.

Journal of Clinical Oncology · 2026-01-10

TPS246 Background: Dordaviprone (ONC201) is an oral small molecule that antagonizes dopamine receptor D2/3 and agonizes the mitochondrial protease ClpP, leading to activation of the integrated stress response and induction of TNF-related apoptosis-inducing ligand (TRAIL)-mediated apoptosis. In preclinical murine models, ONC201 reduces the burden of colorectal adenomas and modulates inflammatory cytokine signaling, supporting its development as a chemopreventive agent in populations at risk for colorectal cancer (CRC). Despite endoscopic surveillance and non-invasive screening, individuals with familial adenomatous polyposis (FAP) or a history of multiple adenomas remain at elevated risk for CRC, underscoring the need for safe, mechanism-driven preventive strategies. Methods: This first-in-human, multi-center, open-label Phase I prevention study evaluates the safety and tolerability of ONC201 in individuals with FAP or multiple colorectal adenomas of unknown genetic etiology. Eligible participants include adults (≥18 years) at high risk for recurrent colorectal adenomas, defined as either a diagnosis of FAP or findings of >5 small adenomas (<1 cm) or ≥3 adenomas with at least one ≥10 mm on colonoscopy within the past 5 years, excluding those with a history of Lynch syndrome (HNPCC). Participants with ≥2 adenomas ≥5 mm identified during standard-of-care colonoscopy will undergo baseline tissue (adenoma and normal mucosa) sampling, with at least one polyp intentionally retained and accessible by flexible sigmoidoscopy for post-treatment sampling. Subsequently, participants will be assigned to an ONC201 dose level (120 mg, 375 mg, 500 mg) and frequency (weekly versus every 3 weeks) using a “Rolling Six” rule-based design, based on tolerability. Each dose cohort will be comprised of at least 5 participants, with a maximum of 6 participants, who will receive oral ONC201 for approximately 12 weeks. At the end of treatment, participants will undergo flexible sigmoidoscopy (or colonoscopy if clinically indicated), during which time the remaining polyp(s) and additional biopsies of normal colorectal tissue will be collected. The primary endpoint is the proportion of participants with unacceptable toxicity to ONC201. Secondary endpoints are to evaluate the mean changes in TRAIL expression in adenomas and normal mucosa. Exploratory endpoints include serum cytokine and immune profile changes and tissue-based markers of proliferation, apoptosis, stemness, and NK-cell infiltration. Enrollment is ongoing across U.S. academic centers, including Brown University, University of Michigan, Cleveland Clinic Foundation, Ohio State University, and Washington University in St. Louis. Funding is provided by NCI/Division of Cancer Prevention. Clinical trial information: NCT05630794 .

2026 Clinical Practice Guideline Update by the Infectious Diseases Society of America and the Pediatric Infectious Diseases Society on The Management of Community-acquired Pneumonia in Infants and Children Older than 3 Months of Age: The Choice of Chest Tube Size

Clinical Infectious Diseases · 2026-03-13

This paper is part of a larger clinical practice guideline on the diagnosis and management of parapneumonic effusion and empyema in children, developed by the Infectious Diseases Society of America. In this paper, the panel provides recommendations on the appropriate size of thoracostomy tube for drainage. The panel's recommendations are based upon evidence derived from systematic literature reviews and adhere to a standardized methodology for rating the certainty of evidence and strength of recommendation according to the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) approach.

2026 Clinical Practice Guideline Update by the Infectious Diseases Society of America and the Pediatric Infectious Diseases Society on The Management of Community-acquired Pneumonia in Infants and Children Older than 3 Months of Age: The Use of tPa and DNase or tPa Alone for Fibrinolysis

Clinical Infectious Diseases · 2026-03-17

This paper is part of a larger clinical practice guideline on the diagnosis and management of parapneumonic effusion and empyema in children, developed by the Pediatric Infectious Diseases Society and the Infectious Diseases Society of America. In this report, the panel provides recommendations for intrapleural fibrinolysis with tissue plasminogen activator (tPA) alone over tPA and dornase alfa (DNase) in children (3 months to 18 years) with complicated parapneumonic effusion and empyema. The panel's recommendations are based upon evidence derived from systematic literature reviews and adhere to a standardized methodology for rating the certainty of evidence and strength of recommendation according to the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) approach.

2026 Clinical Practice Guideline Update by the Infectious Diseases Society of America and the Pediatric Infectious Diseases Society on The Management of Community-Acquired Pneumonia in Infants and Children Older than 3 Months of Age: The Use of Chest Ultrasound in Children with Parapneumonic Effusion

Clinical Infectious Diseases · 2026-03-13

This paper is part of a larger clinical practice guideline on the diagnosis and management of parapneumonic effusion and empyema in children, developed by the Pediatric Infectious Diseases Society and the Infectious Diseases Society of America. In this paper, the panel provides recommendations for the role of chest ultrasound to evaluate parapneumonic effusion and empyema. The panel's recommendations are based upon evidence derived from systematic literature reviews and adhere to a standardized methodology for rating the certainty of evidence and strength of recommendation according to the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) approach.

Grounded by design

Journal of Hospital Medicine · 2026-04-22

Clinical Practice Guideline by the Infectious Diseases Society of America and the Pediatric Infectious Diseases Society: 2026 Guideline Update on The Management of Community-Acquired Pneumonia in Infants and Children Older than 3 Months of Age

Clinical Infectious Diseases · 2026-03-13

As the first part of an update to the clinical practice guideline on the management of community-acquired pneumonia in infants and children older than 3 months of age, we present six updated recommendations. The updated recommendations span the characterization and management of pneumonia with parapneumonic effusion. The panel's recommendations are based on evidence derived from systematic literature reviews and adhere to a standardized methodology for rating the certainty of evidence and strength of recommendation according to the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) approach.

2026 Clinical Practice Guideline Update by the Infectious Diseases Society of America and the Pediatric Infectious Diseases Society on The Management of Community-Acquired Pneumonia in Infants and Children Older than 3 Months of Age: The Use of Pleural fluid drainage compared to Surgical Debridement

Clinical Infectious Diseases · 2026-03-13

This paper is part of a larger clinical practice guideline on the diagnosis and management of parapneumonic effusion and empyema in children, developed by the Infectious Diseases Society of America. In this paper, the panel provides recommendations on the choice of pleural fluid drainage by chest tube with fibrinolysis versus mechanical debridement. The panel's recommendations are based upon evidence derived from systematic literature reviews and adhere to a standardized methodology for rating the certainty of evidence and strength of recommendation according to the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) approach.

Phlebotomy‐free days in children hospitalized with common infections and their association with clinical outcomes

UNC Libraries · 2026-04-17

BACKGROUND: Phlebotomy for hospitalized children has consequences (e.g., pain, iatrogenic anemia), and unnecessary testing is a modifiable source of waste in healthcare. Days without blood draws or phlebotomy-free days (PFDs) has the potential to serve as a hospital quality measure. OBJECTIVE: To describe: (1) the frequency of PFDs in children hospitalized with common infections and (2) the association of PFDs with clinical outcomes. DESIGN, SETTINGS AND PARTICIPANTS: We performed a cross-sectional study of children hospitalized 2018-2019 with common infections at 38 hospitals using the Pediatric Health Information System database. We included infectious All Patients Refined Diagnosis Related Groups with a median length of stay (LOS) >2 days. We excluded patients with medical complexity, interhospital transfers, those receiving intensive care, and in-hospital mortality. MAIN OUTCOME AND MEASURES: We defined PFDs as hospital days (midnight to midnight) without laboratory blood testing and measured the proportion of PFDs divided by total hospital LOS (PFD ratio) for each condition and hospital. Higher PFD ratios signify more days without phlebotomy. Hospitals were grouped into low, moderate, and high average PFD ratios. Adjusted outcomes (LOS, costs, and readmissions) were compared across groups. RESULTS: We identified 126,135 encounters. Bronchiolitis (0.78) and pneumonia (0.54) had the highest PFD ratios (most PFDs), while osteoarticular infections (0.28) and gastroenteritis (0.30) had the lowest PFD ratios. There were no differences in adjusted clinical outcomes across PFD ratio groups. Among children hospitalized with common infections, PFD ratios varied across conditions and hospitals, with no association with outcomes. Our data suggest overuse of phlebotomy and opportunities to improve the care of hospitalized children.

Family-Reported Posthospitalization Outcomes for Children With Complex Chronic Disease

PEDIATRICS · 2025-12-04

BACKGROUND AND OBJECTIVE: Children with complex chronic disease (CCD) are at high risk for poor hospital-to-home transition and unplanned urgent health care use. Existing measures of transition effectiveness have rarely included families of children with CCD in their development and validation. We sought to identify patient- and family-reported outcomes (PROs) of transition effectiveness that matter most to families of children with CCD and to assess the feasibility, acceptability, and variation in each family-identified PRO among recently discharged families. METHODS: We recruited family members of children with CCD to participate in design sessions to review existing and develop new PRO measures. We then conducted a prospective cohort study of hospitalized children with CCD, collecting transition measures 7 days after discharge. These measures were compared with 30-day unplanned readmission rates using Somers' D test of ordinal correlation. RESULTS: Families endorsed existing transition effectiveness measures and co-created a Return to Baseline measure assessing progress toward prehospital baseline. In a prospective cohort of 102 children with CCD, families rated transition measures highly, although children often were not at baseline health by 7 (64.7%) or 30 days (62.4%). Return to baseline at 7 days with regards to child health, child routine, work schedule, and sleep was moderately correlated with unplanned 30-day readmission. CONCLUSIONS: Families of children with CCD endorsed several transition measures as family-centered. Many reported their child's health had not returned to baseline 7 and even 30 days after hospitalization. Future trials of hospital-to-home transition interventions in this population should include PROs and health utilization outcomes.