{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,19]],"date-time":"2026-05-19T06:08:54Z","timestamp":1779170934755,"version":"3.51.4"},"reference-count":35,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,5,19]],"date-time":"2026-05-19T00:00:00Z","timestamp":1779148800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100003196","name":"Italian Ministry of Health","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100003196","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Tuberculosis (TB) remains a leading cause of pediatric morbidity and mortality worldwide, with diagnostic and therapeutic challenges continuing to affect outcomes, including in high-income settings. The TBSure study investigated current practices in pediatric TB diagnosis and management across multiple countries, aiming to identify variations, strengths, and gaps in real-world care and to inform evidence-based recommendations.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a cross-sectional, structured survey distributed to healthcare professionals involved in pediatric TB care through a professional network. The questionnaire assessed diagnostic approaches, specimen selection, use of microbiological and molecular tests, treatment regimens for active and latent TB, monitoring practices, and adherence to international (WHO 2022, ERS\/ECDC 2017 and IJTLD 2023) guidelines. Descriptive analyses were performed to summarize practices and identify variability across settings.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 60 participants from 17 countries responded, predominantly from Europe. In children unable to expectorate, early-morning gastric aspirates were used by 47% of respondents, induced sputum or gastric aspirate depending on age by 29%, and induced sputum alone by 18%. Smear microscopy and culture were systematically performed by 86 and 63% of respondents, respectively. Rapid molecular testing was routinely performed by 80%. Culture was systematically requested following negative nucleic acid amplification test results in 88% of cases. Molecular drug-resistance testing on initial samples was commonly requested, most frequently for rifampicin resistance alone (47%) or combined rifampicin and isoniazid resistance (41%). Treatment practices for presumed drug-susceptible tuberculosis were uniform across respondents, with universal use of the standard 6-month regimen. However, implementation of the 4-month regimen for non-severe disease was inconsistent, being reported by only 47% of respondents. Fluoroquinolones were used as first-line therapy in cases of suspected isoniazid resistance by 49% of respondents and in tuberculous meningitis by 33%. Baseline blood testing (92%), toxicity monitoring (67%), HIV testing (86%), and post-discharge directly observed therapy (83%) were widely implemented.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Pediatric TB practices are generally aligned with guidelines, with widespread use of rapid molecular testing and standardized treatment regimens, but substantial heterogeneity persists for diagnostic approaches and isolation measures. Strengthening implementation of evolving international recommendations may improve early diagnosis, treatment consistency, and outcomes for children affected by tuberculosis.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpubh.2026.1829612","type":"journal-article","created":{"date-parts":[[2026,5,19]],"date-time":"2026-05-19T05:43:19Z","timestamp":1779169399000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["TBSure: an ESGMYC survey of pediatric TB management practices in high-income countries"],"prefix":"10.3389","volume":"14","author":[{"given":"Anita","family":"Uka","sequence":"first","affiliation":[{"name":"Service of Pediatrics, Department of Women\u2013Mother\u2013Child, Lausanne University Hospital","place":["Lausanne, Switzerland"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fr\u00e9d\u00e9ric","family":"M\u00e9cha\u00ef","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, Avicenne Hospital, H\u00f4pitaux Universitaires Paris Seine-Saint-Denis","place":["Bobigny, France"]},{"name":"IAME, INSERM UMR 1137, INSERM, Universit\u00e9 Paris Cit\u00e9","place":["Paris, France"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daniela Maria","family":"Cirillo","sequence":"additional","affiliation":[{"name":"Division of Immunology, Transplant and Infectious Diseases, IRCCS San Raffaele Scientific Institute","place":["Milan, Italy"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lorenzo","family":"Guglielmetti","sequence":"additional","affiliation":[{"name":"Department of Infectious, Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella","place":["Verona, Italy"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yousra","family":"Kherabi","sequence":"additional","affiliation":[{"name":"Infectious and Tropical Diseases Department, Bichat-Claude Bernard Hospital, Assistance Publique\u2013H\u00f4pitaux de Paris","place":["Paris, France"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daria","family":"Podlekareva","sequence":"additional","affiliation":[{"name":"International Reference Laboratory of Mycobacteriology (IRLM), Statens Serum Institut","place":["Copenhagen, Denmark"]},{"name":"Department of Respiratory Medicine and Infectious Diseases, Copenhagen University Hospital \u2013 Bispebjerg","place":["Copenhagen, Denmark"]},{"name":"Faculty of Medical Science, University of Copenhagen","place":["Copenhagen, Denmark"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pierre Alex","family":"Crisinel","sequence":"additional","affiliation":[{"name":"Unit of Pediatric Infectious Diseases and Vaccinology, Service of Pediatrics, Department Women\u2013Mother\u2013Child, Lausanne University Hospital and University of Lausanne","place":["Lausanne, Switzerland"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Onya","family":"Opota","sequence":"additional","affiliation":[{"name":"Institute of Microbiology, University of Lausanne University Hospital","place":["Lausanne, Switzerland"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"name":"on behalf of the ESGMYC group","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2026,5,19]]},"reference":[{"key":"ref1","volume-title":"Tuberculosis Surveillance and Monitoring in Europe 2025\u20132023 data","year":"2025"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"e1002152","DOI":"10.1371\/journal.pmed.1002152","article-title":"The global burden of latent tuberculosis infection: a re-estimation using mathematical modelling","volume":"13","author":"Houben","year":"2016","journal-title":"PLoS Med"},{"key":"ref3","volume-title":"Monitoring Tuberculosis in the WHO European Region","year":"2025"},{"key":"ref4","volume-title":"Tuberculosis Action Plan for the WHO European Region 2023\u20132030","year":"2023"},{"key":"ref5","volume-title":"WHO Consolidated Guidelines on Tuberculosis. 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