Judith M Martin

• MD
• Professor (Associate) at Childrens Hospital of Pittsburgh

Background It is recommended that women receive 4 vaccines (influenza, SARS-CoV-2, respiratory syncytial virus (RSV), Tdap) during pregnancy. Among infants with acute respiratory infection (ARI), limited data exist on the burden of viral infections in their mothers. The objective of this study was to describe ARI symptoms and viral infections in th...

Background Despite the success of pediatric pneumococcal conjugate vaccine (PCV) programs in the US, acute respiratory illness, including acute otitis media (AOM) due to Streptococcus pneumoniae (SPN) persists. PCV13 has been recommended for pediatric routine use since 2010. With recent adoption of higher-valency PCVs, there is a continued need to...

Background Although data exists demonstrating widespread antibiotic use across other critically ill neonatal populations, there are limited data regarding the frequency of empiric antibiotic use among neonates with critical congenital heart defects (CCHD). The purpose of this study is to describe prevalence of antibiotic treatment in the first 28 d...

Background The Centers for Disease Control and Prevention (CDC) recommends oseltamivir phosphate for children <2 years old with confirmed or suspected influenza as they are at high risk for complications. We analyzed infant characteristics associated with nonprescription of oseltamivir over 9 years. Methods We conducted a retrospective electronic...

Background Varicella‐zoster virus (VZV) pretransplant immunization rates, exposures, and posttransplant disease are poorly characterized among pediatric solid organ transplant (SOT) recipients in the two‐dose varicella vaccine era. Methods A retrospective analysis of the electronic health records among children <18 years old who received SOT from...

Background: Hospitalization rates for childhood pneumonia vary widely. Risk-based clinical decision support (CDS) interventions may reduce unwarranted variation. Methods: We conducted a pragmatic randomized trial in two US pediatric emergency departments (EDs) comparing electronic health record (EHR)-integrated prognostic CDS versus usual care f...

Objective: To support a pragmatic, electronic health record (EHR)-based randomized controlled trial, we applied user-centered design (UCD) principles, evidence-based risk communication strategies, and interoperable software architecture to design, test, and deploy a prognostic tool for children in emergency departments (EDs) with pneumonia. Metho...

Importance Influenza virus infection during pregnancy is associated with severe maternal disease and may be associated with adverse birth outcomes. Inactivated influenza vaccine during pregnancy is safe and effective and can protect young infants, but recent evidence, particularly after the 2009 novel influenza A (H1N1) pandemic, is limited. Objec...

Background Children < 6 months of age are not eligible for influenza vaccine but are at high risk of influenza and its complications. Maternal influenza immunization (MII) in pregnancy or during lactation are two ways to provide infants vaccine specific influenza antibodies that could confer protection. Limited data delineate the individual and com...

Background The two-dose varicella-zoster virus (VZV) immunization schedule significantly decreased VZV infections in the US. Yet, among pediatric solid organ transplant recipients (SOT), the characterization of pre-transplant VZV immunity, VZV exposure with progression to disease, and disease outcomes remain poorly described. Methods We performed...

Background While vaccines have established utility against COVID-19, phase 3 efficacy studies have generally not comprehensively evaluated protection provided by previous infection or hybrid immunity (previous infection plus vaccination). Individual patient data from US government-supported harmonized vaccine trials provide an unprecedented sample...

Acute otitis media (AOM) is the most common childhood bacterial infectious disease requiring antimicrobial therapy. Most cases of AOM are caused by translocation of Streptococcus pneumoniae or Haemophilus influenzae from the nasopharynx to the middle ear during an upper respiratory tract infection (URI). Ongoing genomic surveillance of these pathog...

Background Cell-based quadrivalent-inactivated influenza vaccine has been shown to have higher vaccine effectiveness than traditional egg-based quadrivalent-inactivated influenza vaccine. This is observed despite similar levels of serum hemagglutinin antibodies induced by each vaccine. Methods In this study, we examine peripheral immune activation...

Importance: The large overlap between symptoms of acute sinusitis and viral upper respiratory tract infection suggests that certain subgroups of children being diagnosed with acute sinusitis, and subsequently treated with antibiotics, derive little benefit from antibiotic use. Objective: To assess if antibiotic therapy could be appropriately wit...

As part of a multicenter study evaluating homologous and heterologous COVID-19 booster vaccines, we assessed the magnitude, breadth, and short-term durability of binding and pseudovirus-neutralizing antibody (PsVNA) responses following a single booster dose of NVX-CoV2373 in adults primed with either Ad26.COV2.S, mRNA-1273, or BNT162b2 vaccines. NV...

Importance: There is a paucity of pediatric-specific comparative data to guide duration of therapy recommendations in children with urinary tract infection (UTI). Objective: To compare the efficacy of standard-course and short-course therapy for children with UTI. Design, setting, participants: The Short Course Therapy for Urinary Tract Infect...

Maternal COVID-19 vaccination could protect infants who are ineligible for vaccine through antibody transfer during pregnancy and lactation. We measured the quantity and durability of SARS-CoV-2 antibodies in human milk and infant blood before and after maternal booster vaccination. Prospective cohort of lactating women immunized with primary and b...

Background: Few studies have focused on the immune response to more recent influenza vaccine formulations such as cell-cultured inactivated influenza vaccine (ccIIV4) or live attenuated influenza vaccine (LAIV4) in older children and young adults, or differences in immunoglobulin response using newer antibody landscape technology. Methods: Parti...

Background: Young children with acute otitis media (AOM) frequently exhibit nasopharyngeal colonization with either Streptococcus pneumoniae, Haemophilus influenzae or both pathogens. We aimed to determine if antibiotics could be spared or shortened in those without nasopharyngeal colonization with either pathogen. Methods: In 2 separate randomi...

Objective: To determine test characteristics of categorical risk stratification for early onset sepsis (EOS) using maternal criteria for suspected intraamniotic infection (IAI) and/or newborn exam and compare them to the EOS calculator. Study Design: Retrospective 1:3 case-control study of late preterm/term infants with bacterial culture growth obt...

Background: Electronic health record-based clinical decision support (CDS) is a promising antibiotic stewardship strategy. Few studies have evaluated the effectiveness of antibiotic CDS in the pediatric emergency department (ED). Objective: To compare the effectiveness of antibiotic CDS vs. usual care for promoting guideline-concordant antibioti...

Background: Pregnant and recently pregnant people have lower vaccination rates against SARS-CoV-2 than the general population, despite increased risk of adverse outcomes from infection. Little is known about vaccine hesitancy in this population. Research aim: To characterize SARS-CoV-2 and other vaccine attitudes of lactating people who accepted...

This cross-sectional study examines prescribed and filled antibiotics for outpatient COVID-19 treatment among children, adolescents, and adults with commercial insurance.

Objective: Chest radiographs are frequently used to diagnose community-acquired pneumonia (CAP) for children in the acute care setting. Natural language processing (NLP)-based tools may be incorporated into the electronic health record and combined with other clinical data to develop meaningful clinical decision support tools for this common pedia...

Importance The COVID-19 pandemic has caused millions of infections and deaths and resulted in unprecedented international public health social and economic crises. As SARS-CoV-2 spread across the globe and its impact became evident, the development of safe and effective vaccines became a priority. Outlining the processes used to establish and suppo...

Background Transplacental and milk antibodies following maternal SARS-CoV-2 vaccination could offer infants protection against SARS-CoV-2 infection as there are no approved vaccines for this age-group. Our objective was to assess maternal and infant factors to determine if they are protective against infant SARS-CoV-2 infection. Methods Prospectiv...

Antibody responses to influenza vaccines may vary by many factors. Participants ages 4-21 were randomized to receive cultured inactivated influenza vaccine (ccIIV4; n =112) or live attenuated influenza vaccine (LAIV4; n=118). Hemagglutinin inhibition (HAI) reported in geometric mean titers (GMTs) and mean fold rise in titers (MFR) and IgG, IgA, and...

SARS-CoV-2 vaccines BNT162b2, mRNA-1273, and Ad26.COV2.S received emergency use authorization by the U.S. Food and Drug Administration in 2020/2021. Individuals being vaccinated were invited to participate in a prospective longitudinal comparative study of immune responses elicited by the three vaccines. In this observational cohort study, immune r...

The Omicron variant of SARS-CoV-2 exhibits reduced susceptibility to vaccine-induced neutralizing antibodies, requiring a boost to generate protective immunity. We assess the magnitude and short-term durability of neutralizing antibodies after homologous and heterologous boosting with mRNA and Ad26.COV2.S vaccines. All prime-boost combinations subs...

ABSTRACT Pediatric community-acquired pneumonia (CAP) is often treated with 10 days of antibiotics. Shorter treatment strategies may be effective and lead to less resistance. The impact of duration of treatment on the respiratory microbiome is unknown. Data are from children (n = 171), ages 6 to 71 months, enrolled in the SCOUT-CAP trial (NCT028919...

Antibiotic-associated diarrhea (AAD) is a common side effect of antibiotics. We examined the gastrointestinal microbiota in children treated with beta-lactams for community-acquired pneumonia. Data were from 66 children (n=198 samples), ages 6-71 months, enrolled in the SCOUT-CAP trial (NCT02891915). AAD was defined as ≥1 day of diarrhea. Stool sam...

Background: Although the three vaccines against coronavirus disease 2019 (Covid-19) that have received emergency use authorization in the United States are highly effective, breakthrough infections are occurring. Data are needed on the serial use of homologous boosters (same as the primary vaccine) and heterologous boosters (different from the pri...

Importance Childhood community-acquired pneumonia (CAP) is usually treated with 10 days of antibiotics. Shorter courses may be effective with fewer adverse effects and decreased potential for antibiotic resistance. Objective To compare a short (5-day) vs standard (10-day) antibiotic treatment strategy for CAP in young children. Design, Setting, a...

As part of an ongoing study assessing homologous and heterologous booster vaccines, following primary EUA series, we assessed neutralization of D614G and Omicron variants prior to and 28 days after boost. Subset analysis was done in six combinations (N = 10/group): four homologous primary-booster combinations included mRNA-1273 two-dose priming fol...

Objective: Children with no pathogenic bacteria in the nasopharynx are unlikely to have acute bacterial sinusitis. We evaluated whether information on clinical presentation, viral co-detection, and mucosal cytokine levels could be used to predict presence of bacteria in the nasopharynx. Method: We obtained nasopharyngeal (NP) swabs from children di...

Background The Centers for Disease Control and Prevention (CDC) recommends oseltamivir be given to children < 2 years old with confirmed or suspected influenza as they are at high risk for complications. We sought to analyze oseltamivir prescribing patterns and to describe factors associated with adherence and non-adherence to CDC guidelines. Meth...

Background Immune responses to influenza vaccines (IV) are influenced by pre-existing antibodies to vaccine components. Immune responses to vaccines were evaluated following vaccination with quadrivalent egg-based live-attenuated influenza vaccine (LAIV4) and cell-culture inactivated influenza vaccine (ccIIV4). Methods Racially diverse (48.0% non-...

Background Influenza in infancy can cause significant morbidity and mortality. This study aimed to characterize influenza outcomes in infants < ορ = 12 months and identify risk factors for severe infection. Methods A retrospective cohort of infants ≤ 12 months born between 2011-2019 who received longitudinal ambulatory and inpatient care within a...

Background Hemagglutination inhibition (HAI) titers to the live-attenuated influenza vaccine (LAIV4) are typically lower than its counterpart egg-based inactivated influenza vaccines (IIV). Similar comparisons have not been made between LAIV4 and the 4-strain, cell-culture inactivated influenza vaccine (ccIIV4). We compared healthy children’s and y...

BACKGROUND Acute otitis media (AOM) is the most frequent reason for children to be prescribed antimicrobial treatment. Surfactants are naturally occurring substances that may restore the eustachian tube’s function and potentially enhance resolution of AOM. METHODS This was a phase 2a, single-center, double-blind, randomized, placebo-controlled, pa...

BACKGROUND At interim analysis in a phase 3, observer-blinded, placebo-controlled clinical trial, the mRNA-1273 vaccine showed 94.1% efficacy in preventing coronavirus disease 2019 (Covid-19). After emergency use of the vaccine was authorized, the protocol was amended to include an open-label phase. Final analyses of efficacy and safety data from t...

Background While Coronavirus disease 2019 (Covid-19) vaccines are highly effective, breakthrough infections are occurring. Booster vaccinations have recently received emergency use authorization (EUA) for certain populations but are restricted to homologous mRNA vaccines. We evaluated homologous and heterologous booster vaccination in persons who h...

Background: Three SARS-CoV-2 vaccines, two based on mRNA, BNT162b2 and mRNA-1273, and one based on an adenovirus platform, Ad26.COV2.S, received emergency use authorization by the U.S. Food and Drug Administration in 2020/2021. These vaccines displayed clinical efficacy in initial studies against confirmed COVID-19 of 95.0%, 94.1%, and 66.9%, respe...

Background At interim analysis in a phase 3, observer-blinded, placebo-controlled clinical trial, the mRNA-1273 vaccine showed 94.1% efficacy in preventing coronavirus disease 2019 (Covid-19). After emergency use of the vaccine was authorized, the protocol was amended to include an open-label phase. Final analyses of efficacy and safety data from t...

Background: Hemagglutination inhibition (HAI) titers to the live-attenuated influenza vaccine (LAIV4) are typically lower than its counterpart egg-based inactivated influenza vaccines (IIV). Similar comparisons have not been made between LAIV4 and the 4-strain, cell-culture inactivated influenza vaccine (ccIIV4). We compared healthy children and yo...

Background Official recommendations differ regarding tympanostomy-tube placement for children with recurrent acute otitis media. Methods Download a PDF of the Research Summary. We randomly assigned children 6 to 35 months of age who had had at least three episodes of acute otitis media within 6 months, or at least four episodes within 12 months wi...

Objective Regulatory and payment changes associated with COVID-19 facilitated wide-spread use of telehealth within pediatric primary care starting in March 2020. Given prior quality concerns about antibiotic management for children during telemedicine visits outside of primary care, we sought to examine acute respiratory tract infection (ARTI) visi...

Background The AAP recommends 7 to 14-days of antimicrobials for the treatment of urinary tract infections (UTIs), one of the most common bacterial infections of childhood. However, most physicians routinely prescribe at least 10 days of therapy. Prior observational studies suggest that courses shorter than 10 days might be effective. Methods The...

Background Community-acquired pneumonia (CAP) in children is usually treated with 10 days of antibiotics. Shorter antibiotic courses may be beneficial if proven effective, with potentially fewer antibiotic adverse effects and decreased antibiotic exposure. Methods This randomized, double-blind, placebo-controlled superiority trial (NCT02891915) co...

Background Background: Antibiotic resistance is a major public health concern. A modifiable intervention is outpatient antibiotic stewardship. The goal of this study was to review the electronic health records (EHR) of children diagnosed with community acquired pneumonia (CAP) to compare patients who received non-guideline concordant therapy with t...

Background To evaluate the efficacy of adjuvant systemic corticosteroids in reducing kidney scarring. A previous study suggested that use of adjuvant systemic corticosteroids reduces kidney scarring in children radiologically confirmed to have extensive pyelonephritis. Efficacy of corticosteroids for children with febrile urinary tract infection (U...

Background Current influenza vaccine effectiveness (VE) improvement efforts focus on minimizing egg adaptation mutations during manufacture. This study compared immune response of two FDA-approved quadrivalent inactivated influenza vaccines in an unblinded randomized controlled trial. Methods Participants were 144 community dwelling, healthy child...

The human immune response to inactivated influenza vaccine is dynamic and impacted by age and preexisting immunity. Our goal was to identify postvaccination transcriptomic changes in peripheral blood mononuclear cells from children. Blood samples were obtained before and at 3 or 7 days postvaccination with 2016–2017 quadrivalent inactivated influen...

Background: Among children with pharyngitis who test positive for group A Streptococcus (GAS), 10%-25% are GAS carriers. Current laboratory methods cannot distinguish acute infection from colonization. Methods: We examined 2 separate longitudinal studies of children with symptomatic pharyngitis associated with a positive GAS throat culture (illn...

Background: Pharyngitis due to group A Streptococcus (GAS) represents a major cause of outpatient visits and antibiotic use in the United States. A leading vaccine candidate targets 30 of the >200 emm types of GAS. We aimed to assess natural protection conferred by GAS against respiratory symptoms. Methods: In a 5-year study among school-aged ch...

Background: Influenza vaccine is the most effective means to prevent influenza for the high-risk population of child care attendees. This national survey assessed child care center directors' reports of seasonal influenza vaccine requirements for children and adult caregivers. Methods: This was a 2016 telephone-based survey of child care center...

Background The specificity of the leukocyte esterase test (87%) is suboptimal. The objective of this study was to identify more specific screening tests that could reduce the number of children who unnecessarily receive antimicrobials to treat a presumed urinary tract infection (UTI). Methods Prospective cross-sectional study to compare inflammato...

To develop a method to perform multiple tests on a single nasopharyngeal (NP) swab. We collected a NP swab on children aged 2–12 years with acute sinusitis and processed it for bacterial culture, viruses, cytokine expression, and 16S ribosomal RNA gene sequencing analysis. During the course of the study, we expand the scope of evaluation to include...

Objective: To determine whether treatment for urinary tract infections in children could be individualized using biomarkers for acute pyelonephritis. Study design: We enrolled 61 children with febrile urinary tract infections, collected blood and urine samples, and performed a renal scan within 2 weeks of diagnosis to identify those with pyelone...

Background Among symptomatic children who test positive for Group A Streptococcus (GAS) by throat swab, approximately 20–25% are GAS carriers. Current laboratory methods cannot distinguish acute infection from the carrier state at time of diagnosis. Methods We examined findings from two longitudinal studies of children 5 to 15 years of age who had...

Background ABS is one of the most common infections in childhood leading to antibiotic prescriptions, but remains a clinical diagnosis. Laboratory testing does not aid diagnosis and there are no predictors to identify those who will respond to therapy or develop complications. Thus, the tools to diagnose and manage ABS remain limited. Initial viral...

Background Antibiotics are the most common prescription drugs given to children, yet inappropriate usage is common. This study compared antibiotic prescribing practices for community-acquired pneumonia (CAP) in the Children’s Hospital of Pittsburgh (CHP) Emergency Department (ED) vs. outpatient practices at sites affiliated with CHP. Methods We re...

Background The reasons for differences in vaccine effectiveness between live attenuated influenza vaccine (LAIV) and inactivated influenza vaccine (IIV) are not clear. Methods Blood samples were obtained before and at days 7 and 21 post vaccination with 2015-2016 quadrivalent IIV or LAIV. Serologic response to the vaccine was measured by hemagglut...

Paired nasopharynx and midturbinate swabs were obtained from 96 children (mean age: 2.45 years) with upper respiratory tract symptoms. Of these, 38.5% were colonized with Streptococcus pneumoniae only, 16.7% with Haemophilus influenzae only and 9.4% with both bacteria. Bacterial cultures from paired nasopharynx and midturbinate swabs demonstrated a...

Background In children with acute otitis media (AOM) a decrease in nasopharyngeal (NP) colonization with vaccine serotypes of Streptococcus pneumoniae has been noted since the introduction of pneumococcal conjugate vaccines (PCV). The purpose of this study is to describe corresponding changes in colonization with Haemophilus influenzae. Methods In...

Background: In recent influenza seasons, the live attenuated influenza vaccine (LAIV) has not demonstrated the same level of vaccine effectiveness as that observed among children who received the inactivated influenza vaccine (IIV). To better understand this difference, this study compared the mRNA sequencing transcription profile (RNA seq) in chi...

Background In recent influenza seasons, the live attenuated influenza vaccine (LAIV) has not demonstrated the same level of vaccine effectiveness as that observed among children who received the inactivated influenza vaccine (IIV). To better understand this difference, this study compared the mRNA sequencing transcription profile (RNA seq) in child...

Amoxicillin/clavulanate (A/C), is currently the most effective oral antimicrobial in treating children with acute otitis media (AOM), but standard dosage of 90/6.4 mg/kg/day commonly causes diarrhea. We examined whether an A/C formulation containing lower concentrations of clavulanate would result in less diarrhea, while maintaining plasma levels o...

Objective: To assess whether antimicrobial therapy in young children with acute otitis media reduces time to resolution of symptoms, overall symptom burden, and persistence of otoscopic evidence of infection. We used a cost-utility model to evaluate whether immediate antimicrobial treatment seems to be worthwhile, and if so, which antimicrobial ag...

Background: Children in child care centers represent an important population to consider in attempts to mitigate the spread of an influenza pandemic. This national survey, conducted in 2008 and 2016, assessed directors' reports of their child care centers' pandemic influenza preparation before and after the 2009 H1N1 novel influenza pandemic. Met...

Background: Vitamin D is an immunomodulating hormone which has been associated with susceptibility to infectious diseases. Methods: Serum vitamin D levels in 135 children ages 3-17?years were measured at baseline and hemagglutinin influenza antibody titers were measured pre- and 21?days post influenza vaccination with live attenuated influenza v...

Background Limiting the duration of antimicrobial treatment constitutes a potential strategy to reduce the risk of antimicrobial resistance among children with acute otitis media. Methods We assigned 520 children, 6 to 23 months of age, with acute otitis media to receive amoxicillin–clavulanate either for a standard duration of 10 days or for a re...

Background: Data on safety and efficacy of voriconazole for invasive aspergillosis (IA) and invasive candidiasis/esophageal candidiasis (IC/EC) in pediatric patients are limited. Methods: Patients aged 2-<18 years with IA and IC/EC were enrolled in two prospective open-label, non-comparative studies of voriconazole. Patients followed dosing regi...

Human influenza A(H3N2) viruses that predominated during the moderately severe 2014-15 influenza season differed antigenically from the vaccine component, resulting in reduced vaccine effectiveness (VE). To examine antibody responses to 2014-2015 inactivated influenza vaccine (IIV) and live-attenuated influenza vaccine (LAIV) among children and ado...

Background Emergence of drifted influenza A(H3N2) viruses resulted in reduced vaccine effectiveness in all age groups during the 2014-15 influenza season. In children, inactivated influenza vaccine (IIV) elicited neutralizing antibodies (Abs) against drifted strains at significantly lower levels than against vaccine strain. Little is known about cr...

Objective: We sought to determine factors associated with the absence of pyuria in symptomatic children whose urine culture was positive for a known uropathogen. Methods: We obtained data on children evaluated at the Children's Hospital of Pittsburgh emergency department between 2007 and 2013 with symptoms of urinary tract infection (UTI) who ha...

Lemierre's syndrome is a complex infection involving oropharyngeal sources leading to septic jugular thrombophlebitis. Otogenic variants may arise from complicated ear disease and involved cranial venous sinuses. We describe a case of a 9 year boy with chronic suppurative otitis media leading to mastoiditis, cranial venous sinus and jugular vein th...

In this review of 200 charts, piperacillin-tazobactam usage was analyzed at a pediatric tertiary hospital, with an assessment of the indications for initiation, and continuation at day 3 of usage. Significant cost savings could be obtained with antibiotic stewardship audit on day 3 of antibiotic administration.

Streptococcal pharyngitis is common in children between 5 and 15 years of age. While there is a “classic” presentation, few patients have all of the characteristic signs and symptoms. Therefore, for those children who present with a sore throat in the absence of other respiratory symptoms such as nasal congestion and cough, the best method of deter...

Background: Since the introduction of pneumococcal conjugate vaccines (PCV), a decrease in nasopharyngeal (NP) colonization with vaccine serotypes of Streptococcus pneumoniae (Spn) has been noted in children with acute otitis media (AOM). However, neither the overall prevalence of S. pneumoniae, nor the proportion of resistant strains has changed....

We conducted a prospective pilot study to evaluate the potential role of combined systemic antifungal and liposomal amphotericin B lock therapy in children with intestinal insufficiency with fungal catheter-related bloodstream infections whose central venous catheters had not been removed. Our results provide supportive evidence for the conduct of...

Background: Surveillance of children with acute otitis media (AOM) for nasopharyngeal colonization with Streptococcus pneumoniae before, during and after the introduction of 7-valent pneumococcal conjugate vaccine (PCV7) indicated the near-complete elimination of PCV7 strains and the emergence of pneumococcal serotype 19A. Methods: To determine...

The guideline is intended for use by healthcare providers who care for adult and pediatric patients with group A streptococcal pharyngitis. The guideline updates the 2002 Infectious Diseases Society of America guideline and discusses diagnosis and management, and recommendations are provided regarding antibiotic choices and dosing. Penicillin or am...

The guideline is intended for use by healthcare providers who care for adult and pediatric patients with group A streptococcal pharyngitis. The guideline updates the 2002 Infectious Diseases Society of America guideline and discusses diagnosis and management, and recommendations are provided regarding antibiotic choices and dosing. Penicillin or am...