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Introduction: Urinary tract infection (UTI) is among the common bacterial infections in pediatric patients. These infections are more common in girls over one year old. This study aimed to investigate the bacterial distribution and drug resistance status in urine cultures of pediatric patients in our center. Materials and Methods: Urine culture results of patients who were presented to the outpatient clinics or were admitted to the Sivas Cumhuriyet University hospital between January 2017 and December 2022 were included in the study. The hospital automation system, patient files, and laboratory information management system were examined retrospectively. Statistical analysis was performed using the SPSS 22.0 software. A P-value of <0.05 was deemed significant. Results: Significant growth was observed in the urine cultures of a total of 1287 pediatric patients, 889 (69.1%) girls and 398 boys (30.9%). The patients included in the study were between the ages of 0-17, and children aged 1-6 (37.6%) were diagnosed with UTI more frequently than other ages. The most common UTI agent in the pediatric age group was Escherichia coli (56.6%). The first agent isolated in girls and boys is E.coli. Additionally, the prevalence of K. pneumoniae, P. mirabilis and K. oxytoca bacteria was higher in boys (p < 0.05). E. coli isolates showed minimal resistance to such as amikacin (0.6%), fosfomycin (1.0%), nitrofurantoin (1.4%), ertapenem (2.4%), imipenem (0.7%) and meropenem (0.9%). Conclusion: In this study, low resistance levels were detected for amikacin, fosfomycin, nitrofurantoin and carbapenem group antibiotics, which are important alternatives in the empirical treatment of UTI. On the other hand, due to the high resistance levels detected, it is thought that more caution should be exercised in the empirical use of amoxicillin-clavulanate, trimethoprimsulfamethoxazole and cefixime. If these antibiotics are to be preferred, waiting for the antibiogram results is an appropriate approach. [ABSTRACT FROM AUTHOR]

Objective: Production of extended-spectrum β-lactamases (ESBLs) is the most important antimicrobial resistance mechanism among Gram-negative pathogens. In this study, ESBL frequency and antimicrobial resistance of Escherichia coli and Klebsiella spp. isolated from community-acquired urinary tract infections (UTIs) are investigated. Methods: In this retrospective cross-sectional study, ESBL rates and the results of antimicrobial susceptibility tests were determined for E. coli and Klebsiella spp. grown in the urine cultures of 520 patients with community-acquired UTI, and the changes in the antimicrobial resistance rates of the isolates were compared in terms of ESBL production. Results: E. coli had grown in 220 samples and Klebsiella spp. in 38 samples. ESBL production frequencies of the isolates were found as 40% and 47.4%, respectively, and the rate of carbapenem resistance was found as 3.1%. Among the isolates, the highest resistance was found for amoxicillin-clavulanate (46%), ciprofloxacin (44.9%), and ceftriaxone (42.2%), while the lowest resistance was found for colistin (0.3%), fosfomycin (1.5%), amikacin (3.1%), and nitrofurantoin (4.2%). In ESBL-producers, significantly higher resistance was found for all antibiotics studied, except colistin, nitrofurantoin and fosfomycin. Conclusions: In this study, it was shown that almost half of the community-acquired isolates were ESBL-producers, and these isolates had acquired resistance against many antimicrobials including the last resorts such as carbapenems and colistin. To reduce the progress of resistance rates in E. coli and Klebsiella spp. which are the most common pathogens in community-acquired UTIs, their therapies should be planned according to the results of susceptibility tests as much as possible. [ABSTRACT FROM AUTHOR]

Objective: Recommended combination for the treatment of serious Stenotrophomonas maltophilia infections is ticarcillinclavulanate and co-trimoxazole (SXT). However, first agent is not available in our country, and the second component may be a matter of antimicrobial resistance or intolerance. Therefore, we aimed to evaluate antimicrobial susceptibility testing results of S. maltophilia and in vitro activity of ceftazidime and moxifloxacin as a potential therapeutic alternative. Methods: S. maltophilia strains isolated from clinical samples in Infectious Diseases and Clinical Microbiology Laboratory between 1 October 2007-23 November 2017 were included in the study. Disk diffusion antimicrobial susceptibility test results of the strains were evaluated retrospectively. The in vitro activity of combination of ceftazidime and moxifloxacin against 24 of these strains was investigated by Etest®. Results: During the study period, 649 S. maltophilia strains were isolated from 649 different patients, and 94%, 93%, 92%, 81%, 60%, 55%, 45%, 41%, 38% of the strains were susceptible to tigecycline, moxifloxacin, SXT, ciprofloxacin, cefoperazonesulbactam, ceftazidime, netilmicin, gentamicin and amikacin, respectively. For the 24 strains included in the combination study, the moxifloxacin minimal inhibitory concentration (MIC)50/MIC90 values were defined as 0.064/0.125 µg/mL (MIC range 0.023-4 µg/mL) and ceftazidime MIC50/MIC90 values were defined as 32/256 µg/mL (MIC range 1.5-256 µg/mL). According to the results of fractional inhibitor concentration (FIC) index; ceftazidime and moxifloxacin combination displayed synergism, additivity and indifference for 1 (4%), 18 (75%) and 5 (21%) strains, respectively and there was no antagonism. The FIC50/ FIC90 value is calculated as 0.75/1.01 (FIC range 0.5-1.01). Conclusions: SXT resistance in S. maltophilia strains is below 10%, but it should be closely monitored because of the limited treatment options. Tigecycline and moxifloxacin can be among the treatment alternatives because of their high sensitivity rates similar to SXT. The combination of moxifloxacin plus ceftazidime demonstrated in vitro synergism or additivity against majority of the strains. So, this combination may be used as an alternative for the treatment of patients with S. maltophilia infections if there is resistance or side effects to the antibiotics used as the first option. [ABSTRACT FROM AUTHOR]

Background: The developments in neonatal intensive care units (NICUs) have led to an increase in the survival rate of newborns. However, there is also an increase in nosocomial infections (NE). In this study, we aimed to investigate the predisposing factors in the neonatal sepsis due to Klebsiella strains in the NICU, clinical and laboratory features, mortality rates and antibiotic resistance of these cases. Material and Methods: The patients hospitalized in the neonatal intensive care unit were within 2015-2017 years. They were proven sepsis cases due to Klebsiella pneumoniae and retrospectively analyzed. Demographic, laboratory and clinical features and microbiological results of the patients were recorded. Results: Of the 59 blood culture samples with K. pneumoniae sepsis, 55 (93.2%) had late-onset neonatal sepsis (LNS) and 4 (6.8%) had early-onset neonatal sepsis (ENS). 47 (79.7%) of the cases were preterm. The primary diagnoses of the patients were preterm and respiratory distress syndrome (n: 47, 79.7%), common pathologies include preterm + necrotizing enterocolitis (n: 9, 15.3%), intracranial hemorrhage + hydrocephalus (n: 5, 8.5%), onfalocele or gastroschisis (n: 7, 11.9%), intesttinal atresia (n: 4, 6.8%), severe congenital heart disease (n: 1, 1.7%). More than two invasive procedures were performed in 53 (89.8%) cases before bacteremia developed. The most effective antibiotics against K. pneumoniae strains were colistin (87.3%), meropenem (51.7%) and ciprofloxacin (49.1%). The mortality rate of K. pneumoniae infection was found to be 30%. Resistance rates were 86% against piperacillin, 85% against ceftazidime, 91% against ceftriaxone and 95% against cefaperozone. The percentages of Klebsiella strains resistant to gentamycin, were 67.8% and 68% to both amikacin and trimethoprim-sulfamethoxazole. Conclusion: Klebsiella infections associated with health care are mainly caused by K. pneumoniae. Low birth weight, birth at early gestational weeks, invasive procedures and underlying serious diseases predispose to Klebsiella infections in the newborn. Today, multidrug resistance is a major problem. Mortality is associated with sepsis and underlying primary disease. [ABSTRACT FROM AUTHOR]

Aim: Orbital tissue infections are common infections of childhood that can lead to severe complications. Herein, we aimed to evaluate the etiologic factors, diagnosis, follow-up, and treatment procedures in pediatric patients with orbital infections. Material and Methods: This study was performed retrospectively between January 2014 and December 2015 in Cerrahpasa Medical Faculty Pediatric Infectious Disease Unit. Patients were studied for age, ophthalmologic examination features, laboratory and radiology results, treatment modalities, and the response to these treatments. Results: Thirty-six patients (21 males, 15 females) with an average age of 71.43±42.24 months (5-168 months) participated in the study in the two-year period. Thirty-two patients (88.9%) had preseptal cellulitis, and four (11.9%) had orbital cellulitis. All patients had eyelid hyperemia, edema, and ocular pain, with chemosis in seven and proptosis in four cases. Twenty-five patients were admitted with fever. All cases were unilateral and 44.4% occurred secondary to paranasal sinusitis. All cases were treated with intravenous cefazolin-amikacin. The mean of duration of hospitalization was 12.02±8.75 days (range, 3-28 days) and the duration of parental antibiotics was 12.83±8.18 days (range, 7-21 days). All patients recovered without any vision loss, only one patient experienced subdural empyema complicating preseptal cellulitis. Conclusions: Most orbital tissue infections occur secondary to paranasal sinusitis in childhood. Orbital tissue infections can be complicated by brain abscess, cavernous sinus thrombophlebitis, and vision loss. Early diagnosis and proper antibiotic treatment are essential to prevent these life-threatening complications. [ABSTRACT FROM AUTHOR]

Objective: Urinary Tract Infections (UTI) are most common causes of bacterial infections in humans. Escherichia coli (E.coli) is the most frequently isolated microorganism in cases of uncomplicated UTI. In this study, we aimed to determine antimicrobial resistance patterns of E.coli strains isolated from patients with UTI. Materials and Methods: E.coli strains isolated from urine cultures of patients admitted to the Hospital of the Medical Faculty of Bezmialem Vakif University were retrospectively evaluated between the dates of January 2013 and December 2013. The bacterial identification and rates of antibiotic resistance were determined using VITEK-2 automatized system. Results: E.coli isolates were found to have low resistance rates to fosfomycin (0.6%), nitrofurantoin (5.3%) and amikacin (8%). Among the other antibiotics, the lowest susceptibility rates were detected to ampicillin (64%), trimetoprim/sulfomethoxazole (43.2%), amoxicillin/clavulonic acid (32.8%). Conclusion: Fosfomisin, nitrofurantoin and amikacin are thought to be suitable antimicrobial agens in the empiric treatment treatment of uncomplicated UTI. [ABSTRACT FROM AUTHOR]