[Show abstract][Hide abstract] ABSTRACT: Objective: Deep neck infections are characterized by infections in the potential spaces of the fascial planes of the neck. The objective of the study was to evaluate the characteristics of patients with deep neck infections who were admitted to pediatric infectious disease clinics. Materials and Methods: The data of patients with deep neck infection was analyzed retrospectively for demographic characteristics, clinical presentation, microbiological and radiological findings, complications, and outcomes between January 2010 and December 2014. Results: During the study period, a total of 18 patients diagnosed with deep neck infection were followed. Of these, 10 patients (55.6%) were male and the mean age was 84±60.5 months (18-192 months). The most common symptoms at presentation were neck mass (72%) and fever (67%). Three patients (16.6%) had peritonsillar, 7 (39%) had parapharyngeal, 7 (39%) had retropharyngeal, and 1 (5.4%) had parapharyngeal-retropharyngeal infection. Cefotaxime+clindamycin or cefotaxime+clindamycin+ gentamicin were the most frequently (78%) used antibiotics. Eleven patients (61%) recovered with only antibiotic treatment. Surgical drainage was performed in 7 patients (39%) who were unresponsive to antibiotic treatment (5 with parapharyngeal, 1 with retropharyngeal, and 1 with peritonsillar abscess). Microorganisms were isolated from 6 (33%) patients’ drainage samples. The median length of hospitalization was 14 (7-21) days. The mean duration of antibiotic treatment was 19.3±4.4 days. Acute glomerulonephritis developed in 1 patient with retropharyngeal abscesses. No recurrence/relapse or mortality was observed. Conclusion: Deep neck infections should be considered in the differential diagnosis of children who present with fever and neck mass. Most patients with deep neck infections can be treated with antibiotics; however, if there is no clinical improvement, surgical drainage must be performed immediately.
[Show abstract][Hide abstract] ABSTRACT: Objective: The purpose of this study is to evaluate the healthcare-associated infections (HCAIs) in the pediatric intensive care unit (PICU) during a 4-year period. Material and Methods: Pediatric patients between the age of 28 days and 18 years were included in the study. The Center for Diseases Control 2008 criteria were used for the diagnosis of HCAI. During the 4-year period (2010–2013), the number of children admitted to PICU was 1884, and the total bed-days were 15,082 days. Results: During the 4-year period, 139 HCAI episodes occurred in 89 children. Of the admitted children, 4.7% had at least one HCAI attack. We found that the HCAI rate and HCAI density were 7.3%, and 9.2 per 1000 patient-days, respectively. Within the two groups, all PICU patients and patients with an HCAI attack, the ages were 75.69±71.24 (median: 48) and 36.85±48.78 (median: 17) months (p<0.001), respectively, and the length of hospital stay was 8.00±16.84 (median: 3) and 109.49±119.98 (median: 75) days (p<0.001), respectively. The percentage of females was 51% (960/1884) and 33% (46/139) (p=0.013) in all children admitted to PICU and those with HCAI attacks, respectively. The duration from admission to HCAI was 61.33±81.51 (median: 36) days. The most common principal accompanying diseases of the patients with HCAI attacks were neurological disease (20.9%; 29/139), solid-tissue malignancy (14.4%; 20/139), heart disease (12.9%; 18/139), chronic pulmonary disease (11.5%; 16/139), and chronic renal disease (8.6%; 12/139). The three most frequent HCAI types were ventilator-associated pneumonia (VAP; 28%), bloodstream infections (22%; with 12% having catheter-related bloodstream infections and 10% having bacteremia), and catheter-related urinary tract infections (15%). There was meaningful culture positivity in 90 of the 139 HCAI episodes (64%). Conclusion: Our PICU-HCAI rates are lower than those in the other studies in Turkey, and they are comparable with other studies conducted in developed countries. Our HCAIs occurred in the patients with an average age of 3 years. The most frequent HCAIs were pneumonia (including VAP), bloodstream, and urinary tract infections, and many of them were related to catheters.
No preview · Article · Jul 2015 · Cocuk Enfeksiyon Dergisi
[Show abstract][Hide abstract] ABSTRACT: Enterococci are one of the major agents of community-acquired and nosocomial infections. In this study we aimed to analyze the clonal relation of the vancomycin-resistant Enterococci outbreak seen at the Neonate Intensive Care Unit (NICU) of Uludag University Hospital. Vancomycin resistance gene was investigated in the Enterococcus faecium strains and pulsed field gel electrophoresis (PFGE) was used to investigate the genetic relation between outbreak strains. Enterococci grown in all patient samples were identified as Enterococcus faecium by BD Phoenix 100 (Becton Dickinson, USA). We found vanA resistance gene in all of the swab samples by Xpert VanA/B test on Cepheid (Cepheid, USA). PFGE band patterns revealed two different strains, of which the majority of them (22/24) had the same clonal origin. The common clonal origin was also isolated from rectal probes. Perianal swab culture positivity was evaluated as colonization but culture growth in two blood cultures, two urine cultures and one wound culture was evaluated as infection and treated with linezolid. All of the patients survived the outbreak. Besides the infection control precautions determining the genetic relation between outbreak strains which can be done in the microbiology laboratory is necessary to control an outbreak. PFGE is a reliable method in the microbiologic analysis of outbreaks. Molecular microbiologic analysis of outbreak strains will contribute to prove the epidemiologic and evolution of outbreaks.
Full-text · Article · Dec 2014 · International Journal of Clinical and Experimental Medicine
[Show abstract][Hide abstract] ABSTRACT: Group A rotaviruses are the most common causative agent of acute gastroenteritis among children less than 5 years of age throughout the world. This sentinel surveillance study was aimed to obtain baseline data on the rotavirus G and P genotypes across Turkey before the introduction of a universal rotavirus vaccination program.
Rotavirus antigen-positive samples were collected from 2102 children less than 5 years of age who attended hospitals participating in the Turkish Rotavirus Surveillance Network. Rotavirus antigen was detected in the laboratories of participating hospitals by commercial serological tests such as latex agglutination, immunochromatographic test or enzyme immunoassay. Rotavirus G and P genotypes were determined by reverse transcription polymerase chain reaction (RT-PCR) using consensus primers detecting the VP7 and VP4 genes, followed by semi-nested type-specific multiplex PCR.
RT-PCR found rotavirus RNA in 1644 (78.2%) of the samples tested. The highest rate of rotavirus positivity (38.7%) was observed among children in the 13 to 24 month age group, followed by children in the age group of 25 to 36 months (28.3%). A total of eight different G types, six different P types, and 42 different G-P combinations were obtained. Four common G types (G1, G2, G3, and G9) and two common P types (P and P) accounted for 95.1% and 98.8% of the strains, respectively. G9P was the most common G/P combination found in 40.5% of the strains followed by G1P (21.6%), G2P (9.3%), G2P (6.5%), G3P (3.5%), and finally, G4P (3.4%). These six common genotypes included 83.7% of the strains tested in this study. The rate of uncommon genotypes was 14%.
The majority of the strains analyzed belonged to the G1-G4 and G9 genotypes, suggesting high coverage of current rotavirus vaccines. This study also demonstrates a dramatic increase in G9 genotype across the country.
[Show abstract][Hide abstract] ABSTRACT: Methicillin resistant Staphylococcus aureus (MRSA) strains lead to severe infections in immunosupressive patients, geriatric population and premature infants. 27 MRSA strains isolated in the Neonatal Intensive Care Unit was considered as an outbreak and it was aimed to investigate the genetic and epidemiologic relation of the MRSA outbreak. MecA gene was investigated in the S. aureus strains and pulsed field gel electrophoresis (PFGE) was used to investigate the genetic relation between outbreak strains. MecA gene was showed in all isolates. PFGE revealed that there were two different strains and most of the isolates (25/27) were owing to same clone. One of the samples were found closely related with the common strain and the other sample was found genetically unrelated. To terminate the outbreak; liquid baby food was gained to the baby food kitchen, no more new patient was imported to the neonatal unit and none of the patients were exported from neonatal unit to other clinics during outbreak, education about infection control precautions was given to all the staff and nursing bottle dishwasher was obtained. To manage and terminate the outbreak, besides the infection control precautions, tests to determine the genetic relation between outbreak strains which are done in the microbiology laboratory are needed. Molecular analysis of outbreak strains will contribute to prove the epidemiologic and evolution of outbreaks.
Full-text · Article · Aug 2014 · International Journal of Clinical and Experimental Medicine
[Show abstract][Hide abstract] ABSTRACT: Successful vaccination policies for protection from bacterial meningitis are dependent on determination of the etiology of bacterial meningitis. Cerebrospinal fluid (CSF) samples were obtained prospectively from children from 1 month to ≤ 18 years of age hospitalized with suspected meningitis, in order to determine the etiology of meningitis in Turkey. DNA evidence of Neisseria meningitidis (N. meningitidis), Streptococcus pneumoniae (S. pneumoniae), and Hemophilus influenzae type b (Hib) was detected using multiplex polymerase chain reaction (PCR). In total, 1452 CSF samples were evaluated and bacterial etiology was determined in 645 (44.4%) cases between 2005 and 2012; N. meningitidis was detected in 333 (51.6%), S. pneumoniae in 195 (30.2%), and Hib in 117 (18.1%) of the PCR positive samples. Of the 333 N. meningitidis positive samples 127 (38.1%) were identified as serogroup W-135, 87 (26.1%) serogroup B, 28 (8.4%) serogroup A and 3 (0.9%) serogroup Y; 88 (26.4%) were non-groupable. As vaccines against the most frequent bacterial isolates in this study are available and licensed, these results highlight the need for broad based protection against meningococcal disease in Turkey.
Full-text · Article · Jul 2014 · Human Vaccines and Immunotherapeutics
[Show abstract][Hide abstract] ABSTRACT: Candidemia is the most frequent manifestation observed with invasive candidiasis. The aim of this study was to analyse the trends of candidemia in a large tertiary-care hospital to determine the overall incidence during January 1996-December 2012, as well as to determine the susceptibility of 453 isolates according to the revised Clinical and Laboratory Standards Institute (CLSI) breakpoints. Candidemia episodes in adult and paediatric patients were retrospectively analysed from the laboratory data of Uludağ University Healthcare and Research Hospital. The 17-year period studied was divided into three periods (1996-2001, 2002-2007 and 2008-2012) for better comparison, and candidemia incidence was determined by the ratio of total number of patients with candidemia per 1000 patients admitted to the hospital and per 10 000 patient days in these three periods. Redefined CLSI M27-A3 breakpoints were used for interpretation of antifungal susceptibility results. Candidemia incidence was determined as 2.2, 1.7 and 1.5 per 1000 admitted patients during 1996-2001, 2002-2007 and 2008-2012 respectively. A significantly decreased candidemia incidence was obtained in the third period. C. albicans (43.8%) was the most common candidemia agent, followed by C.parapsilosis (26.5%) in all three periods. According to the revised CLSI breakpoints, there was fluconazole resistance in C. albicans, C.parapsilosis, C.tropicalis and C.glabrata species (1.4%, 18.2%, 2.6% and 14.3% respectively). Almost all Candida species were found susceptible to voriconazole except one C.glabrata (7.1%) isolate. Candidemia is an important health problem. Local epidemiological data are determinative in the choice of appropriate antifungal treatment agents.
[Show abstract][Hide abstract] ABSTRACT: Acute bacterial meningitis (ABM) continues to be associated with high mortality and morbidity, despite advances in antimicrobial therapy. The causative organism varies with age, immune function, immunization status, and geographic region, and empiric therapy for meningitis is based on these factors. Haemophilus influenzae type b (Hib), Streptococcus pneumoniae, and Neisseria meningitidis cause the majority of cases of ABM. Disease epidemiology is changing rapidly due to immunization practices and changing bacterial resistance patterns. Hib was the leading cause of meningitis in children prior to the introduction of an effective vaccination. In those countries where Hib vaccine is a part of the routine infant immunization schedule, Hib has now been virtually eradicated as a cause of childhood meningitis. Vaccines have also been introduced for pneumococcal and meningococcal diseases, which have significantly changed the disease profile. Where routine pneumococcal immunization has been introduced, there has been a reported increase in invasive pneumococcal disease due to non-vaccine serotypes. In those parts of the world that have introduced conjugate meningococcal vaccines, there has been a significant change in the epidemiology of meningococcal meningitis. Antibiotic resistance is an increasing problem, and early diagnosis and prevention of ABM are important. In infants, 60% of cases are caused by serogroup B in the United States and Europe. Asymptomatic colonization of the upper respiratory tract provides the source from which the organism is spread. It has been demonstrated that conjugate meningococcal B vaccine is immunogenic in infants.
[Show abstract][Hide abstract] ABSTRACT: Objective: The aim of the study was to compare C-reactive protein (CRP), procalcitonin (PCT) and serum amyloid A (SAA) levels in children with bacterial infection. Material and Methods: In this prospective study, 120 pediatric patients who were hospitalized with bacterial infection in the Uludag University Medical Faculty Pediatric Clinic between June 2009 and June 2011 were included. Patients were evaluated in 5 groups as sepsis, pneumonia, meningitis, pyelonephritis and other infection groups. Before initiating the antimicrobial therapy, blood samples for whole blood count, blood culture, CRP, PCT and SAA were obtained from children with bacterial infection. This procedure was repeated three times at 48 h, 7 and 10 days. Whole blood count was performed using an automated counter, Cell Dyn 3700 (Abbott Diagnostics Division, Santa Clara, CA, USA). CRP and SAA were determined by an immunonephelometric method using BN II device (Dade Behring Marburg GMBH, Marburg, Germany). PCT was measured by Enzyme- Linked Fluorescent Assay (VIDAS PCT; Brahm Diagnostica GMBH, Lyon, France). Results: Of the patients, 66 (55%) were male and 54 (45%) were female. The median age was 37.5 months (1-209). PCT levels of the sepsis group was significantly higher than those of the pneumonia and other infection groups (respectively, p=0.001, p=0.003). SAA levels were higher in the meningitis group than those of the pneumonia group (p=0.007). When patients were divided into two groups as invasive bacterial infection group and localised bacterial infection group; PCT levels were found significantly higher in the invasive bacterial infection group than those of the localised bacterial infection group. Also, percentage change of PCT at the 48th hour, 7 and 10 days was determined as significantly higher in the invasive bacterial infection group than that of the localised bacterial infection group. Conclusion: In this study, PCT seems to be a more valuable parameter in diagnosing invasive bacterial infections.
[Show abstract][Hide abstract] ABSTRACT: Respiratory syncytial virus (RSV) is the most frequent agent of acute lower respiratory diseases and creates a significant burden of disease in children under 5 years all over the world. RSV causes severe lower respiratory tract infections (LRTI) that require hospitalization, especially in children ≤2 years. The aim of this study was to determine the incidence of RSV in children ≤2 years of age hospitalized for LRTI. Children ≤2 years of age hospitalized for one year for LRTI in the three largest hospitals of Bursa City Center, Turkey were evaluated. These three hospitals comprise 67.5% of all child beds in central Bursa, so this study allows us to evaluate the total disease burden and hospitalization incidence in central Bursa. Nasal swabs of the children were evaluated with RSV Respi- Strip (Coris Bioconcept Organization). A total of 671 children were hospitalized for LRTI, and 254 (37.9%) had at least one hospitalization that was positive for RSV. Of all patients with LRTI, 54.8% (368/671) were hospitalized for acute bronchiolitis, while 45.2% (303/671) were hospitalized for pneumonia. Of patients with acute bronchiolitis or pneumonia, 41% (151/368) and 34% (103/303) were RSV+, respectively. Of RSV+ hospitalized children, 59.5% (151/254) were diagnosed as acute bronchiolitis and 40.5% (103/254) as pneumonia. The annual incidences of hospitalization due to LRTI, acute bronchiolitis and pneumonia were 20.5/1000, 11.2/1000 and 9.3/1000, respectively, in children ≤2 years of age. The annual incidences of hospitalization due to RSV+ LRTI, acute bronchiolitis and pneumonia were found as 7.8/1000, 4.6/1000 and 3.2/1000, respectively, in children ≤2 years of age. More than one-third of all children hospitalized with LRTI (38.3%, n=257) were in the 0-3 months age group. Compared to other age groups, RSV positivity was highest in that age group for acute bronchiolitis (57%), pneumonia (39.5%) and also total children with LRTI (47.9%). RSV is a very important cause of lower respiratory infections in children ≤2 years of age and occurred most frequently in those 0-3 months of age in our study. Since there is no other study assessing the annual hospitalization incidence of RSV+LRTIs in one city in Turkey, our study has unique importance for providing valuable statistical data about RSV+LRTIs.
No preview · Article · Nov 2013 · The Turkish journal of pediatrics
[Show abstract][Hide abstract] ABSTRACT: The aim of this study was to determine the causative agents in early-, late- and very late-onset sepsis in preterm infants. The demographic features, risk factors, clinical and laboratory findings in sepsis types were also defined.
A total of 151 preterm infants with culture-proven neonatal sepsis were enrolled in this prospective study. The infants were classified into three groups with regard to the onset of sepsis: early onset sepsis (EOS), late onset sepsis (LOS) and very late onset sepsis (VLOS). A sepsis screen including whole blood count, blood smear, infection markers and cultures was performed before initiating antibiotic therapy.
EOS, LOS and VLOS groups consisted of 23, 86 and 42 infants, respectively. Coagulase-negative staphylococci (CONS) was the most common organism in all sepsis groups. The main factors associated with EOS included presence of premature rupture of membranes, antibiotic use in pregnancy and choriamnionitis. Previous antibiotic use was the main factor associated with LOS, while low birth weight was the main factor in infants with VLOS. Although mortality rate due to Gram negative bacteria and fungi was higher, CONS was an important cause of mortality in infants with LOS and VLOS.
CONS was found to be the most common causative organism in three sepsis types in preterm neonates. Although mortality rate due to CONS was lower in EOS, it was an important cause of mortality in LOS and VLOS. CONS seems to be the main pathogen in neonatal sepsis in developing countries, as in those developed.
Full-text · Article · Sep 2013 · Pediatrics International
[Show abstract][Hide abstract] ABSTRACT: Streptococcus pneumoniae is the most common etiological cause of complicated pneumonia, including empyema. In this study, we investigated the serotypes of S. pneumoniae causing empyema in children. During 2010-2012, 156 children with a diagnosis of pneumonia complicated with empyema from 13 hospitals in seven geographic regions of Turkey were included in this study. Pleural fluid samples were collected by thoracentesis and tested for 14 serotypes/serogoups using a Bio-Plex multiplex antigen detection assay. Serotypes of S. pneumoniae were specified in 33 of 156 samples. The median age of the 33 patients was 6.17 ± 3.54 years (range, 0.6-15 years). All children were unvaccinated according to the vaccination reports. Eighteen of the children were male and 15 were female. The serotypes of the non-7-valent pneumococcal conjugated vaccine (PCV) serotype-1, serotype-5 and serotype-3 were detected in eight (14.5%), seven (12.7%), and five (9.1%) of the samples, respectively. Serotypes 1 and 5 were co-detected in two samples. The remaining non-PCV-7 serotypes were 8 (n = 3), 18 (n = 1), 19A (n = 1), and 7F/A (n = 1). PCV-7 serotypes 6B, 9V, 14, 19F, and 23F were detected in nine (16.3%) of the samples. The potential serotype coverage of PCV-7, PCV-10, and PCV-13 were 16.3%, 45.4%, and 60%, respectively. Pediatric parapneumonic empyema continues to be an important health problem despite the introduction of conjugated pneumococcal vaccines. Active surveillance studies are needed to monitor the change in S. pneumoniae serotypes causing empyema in order to have a better selection of pneumococcal vaccines.
Full-text · Article · May 2013 · Clinical and vaccine Immunology: CVI
[Show abstract][Hide abstract] ABSTRACT: Catheter-associated bloodstream infections (CABSIs) are common complications encountered with cancer treatment. The aims of this study were to analyze the factors associated with recurrent infection and catheter removal in pediatric hematology-oncology patients. All cases of CABSIs in patients attending the Department of Pediatric Hematology-Oncology between January 2008 and December 2010 were reviewed. A total of 44 episodes of CABSIs, including multiple episodes involving the same catheter, were identified in 31 children with cancer. The overall CABSIs rate was 7.4 infections per 1000 central venous catheter (CVC) days. The most frequent organism isolated was coagulase-negative Staphylococcus (CONS). The CVC was removed in nine (20.4%) episodes. We found that hypotension, persistent bacteremia, Candida infection, exit-side infection, neutropenia, and prolonged duration of neutropenia were the factors for catheter removal. There were 23 (52.2%) episodes of recurrence or reinfection. Mortality rate was found to be 9.6% in children with CABSIs. In this study, we found that CABSIs rate was 7.4 infections per 1000 catheter-days. CABSIs rates in our hematology-oncology patients are comparable to prior reports. Because CONS is the most common isolated microorganism in CABSIs, vancomycin can be considered part of the initial empirical regimen.
Full-text · Article · Mar 2013 · Pediatric Hematology and Oncology
[Show abstract][Hide abstract] ABSTRACT: Objective: Rotavirus (RV) infections constitute a substantial burden in Turkey, particularly in children under 5 years of age. RV vaccines are administered to infants by payment only,and no reimbursement is available. The first aim of this study is to evaluate the cost effectiveness of implementing a national basis monovalent or pentavalent RV vaccination program in target populations. Material and Methods: A decision tree model was employed using demographic and epidemiological input obtained from study sources conducted before in our region and international literature. Monovalent or pentavalent vaccination was assumed to protect in 83.7% or 90% of severe RV acute gastroenteritis (RVAGE) in children respectively. Costs inputs were obtained from a provincial study conducted in 2007. Univariate sensitivity analyses and Monte-Carlo simulations were performed. Results: The vaccination program was cost effective and cost saving compared to no vaccination with 85% coverage. Monovalent and pentavalent RV vaccination led to a mean of 2,316 (95% CI: 2.240-2.392) and 2.972 (95% CI: 2.677-3.267) life-years gained (LYG) with 83.7% and 90% efficacy level respectively. Monovalent and pentavalent RV vaccinations avoided 551.820 (95% CI: 539.032; 564.609) and 683,529 (95% CI: 638.906-728.158) individuals with clinical acute gastroenteritis (AGE) cases requiring hospital visits respectively. In the simulation for monovalent and pentavalent vaccines, the cost of RVAGE was 116.1 million TL (€59.2 million) in the non-vaccinated cohort and 35 and 22.5 million TL (€17.8 and 11.5 million) in the vaccinated cohort respectively. The cost of the vaccination program was estimated to be approximately 65.6 and 83.4 million TL (€33.5 and 42.5 million) and the incremental cost was approximately-15.4 million TL (-€7.9 million) and - 15.3 million TL(-€. 9.6 million) respectively. Conclusion: This analysis suggests that both monovalent and pentavalent RV vaccinations of children are very cost effective and also cost saving. Therefore, RV vaccination is associated with a positive return on investment from a public payers' perspective and supports the continued recommendation of RV vaccines as well as their full funding in Turkey.
[Show abstract][Hide abstract] ABSTRACT: The objective of this study was to compare the effectiveness of piperacillin-tazobactam (PIP/TAZO) plus amikacin (AMK) (PIP/TAZO+AMK) versus cefoperazone-sulbactam (CS) plus AMK (CS+AMK) for the treatment of febrile neutropenia (FN) in children with cancer. The study was designed prospectively and randomized in 0- to 18-year-old children with lymphoma or solid tumor who were hospitalized with FN diagnosis. Consecutively randomized patients received either PIP/TAZO 360 mg/kg/day in 4 doses plus AMK 15 mg/kg/day in 3 doses or CS 100 mg/kg/day in 3 doses plus AMK 15 mg/kg/day in 3 doses intravenously. Treatment modification was defined as any change in the initial empirical antibiotic therapy. A total of 116 FN episodes were managed in 46 patients (26 boys and 20 girls) with a median age of 6.5 years (range .8-17.0) during the study period. Success rates without modification of therapy were 47.5% and 52.6% in PIP/TAZO+AMK group and CS+AMK group, respectively (P >.05). No statistical difference was found between treatment groups in terms of durations of neutropenia, fever, and hospitalization. The overall success rate in all groups was 97.4%. No major side effect was observed in either group during the course of the study. Our study is the first to compare the effectiveness of PIP/TAZO+AMK and CS+AMK therapies. Both combinations were effective and safe as empirical therapy for febrile neutropenic patients.
No preview · Article · Jan 2013 · Pediatric Hematology and Oncology