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Objective: Vancomycin-resistant enterococci (VRE) are responsible for a considerable amount of healthcare-associated infections. In this study, we investigated the ability of three probiotic organisms to eliminate VRE colonization or protect against gastrointestinal (GI) epithelium-induced injury in a rat model.

Background: The study aimed to evaluate the distribution of circulating respiratory viral pathogens other than severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) during the first year of the coronavirus disease-2019 (COVID-19) pandemic with especially focusing on the effects of the national-based mitigation strategies. Methods: This single-center study was conducted between March 11, 2020-March 11, 2021. All children who were tested by polymerase chain reaction on nasopharyngeal swabs for SARS-CoV-2 and other common respiratory viral pathogens were included in the study. Results: A total of 995 children with suspected COVID-19 admitted to the study center. Of these, 513 patients who were tested by polymerase chain reaction for both SARS-CoV-2 and common respiratory viral pathogens were included in the final analysis. Two hundred ninety-five patients were (57.5%) male. The median age was 3 years of age (27 days-17 years). A total of 321 viral pathogens identified in 310 (n: 310/513, 60.4%) patients, and 11 of them (n: 11/310, 3.5%) had co-detection with more than 1 virus. The most common detected virus was rhinovirus (n: 156/513, 30.4%), and SARS-CoV-2 (n: 122/513, 23.8%) followed by respiratory syncytial virus (n: 18/513, 3.5%). The influenza virus was detected in 2 patients (0.4%). A total of 193 patients were negative for both SARS-CoV-2 and other pathogens. Conclusions: There is a decline in the frequency of all viral pathogens like SARS-CoV-2 in correlation with the national-based mitigation strategies against COVID-19 during the pandemic. (c) 2021 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

Objective: Needlestick injuries are important for healthcare workers due to their morbidity and mortality. The aim of this study was to determine the risk group of needlestick injuries (NSIs) among healthcare workers, and possible risk groups, actions, and prevention practices of the healthcare workers. Material and Methods: This cross-sectional study included 249 healthcare workers(doctors, nursing staff, laboratory technicians and the cleaning personnel) in a tertiary care pediatric hospital in Turkey. Results: Among the 249 healthcare workers, there were 35 physicians, 124 nursing staff, 11 laboratory technicians and 79 cleaning personnel. Seventy (28.1%) were males, 179 (71.9%) were females. The most common equipment associated with needlestick injury were syringe needles ( 54.6 %), followed by intravenous cannula (peripheral catheter) (17.2%). In 103 (41.2%) cases, the injury occurred during use of the needle, with the greater part of injuries (24%) while establishing a venous access. Most healthcare workers experienced hand injuries (%82.7). Conclusion: This study revealed that the high risk group for needlestick injury was nurses followed by the cleaning personnel. Healthcare workers did not take the necessary measures for themselves. Needlestick injuries could be prevented easily by increasing the use of needles when needed, increasing awareness for using devices with safety features, promoting education and safe work practices for needles and related systems.

BACKGROUND The increasing prevalence of methicillin-resistant Staphylococcus aureus (MRSA) and its resistance to multiple antibiotics has become a serious challenge since the early 2000s. Especially, community-acquired MRSA (CA-MRSA) infections that appear mainly as skin and soft tissue infections (SSTIs) tend to increase worldwide. The objective of this cross-sectional study was to evaluate the trends in the frequency of SSTIs due to community-acquired S. aureus among children. METHODS All children with SSTIs caused by culture positive community-acquired S. aureus during the period from 2013 to 2018 were included in this study. Data of the outpatients were collected from medical records. Annual alteration in frequencies of CA-MRSA and community-acquired methicillin-sensitive S. aureus (CAMSSA) were evaluated. RESULTS A total of 112 cases was evaluated. Of these, 35 (31.25%) were CA-MRSA. The rates of CA-MRSA had emerged from an increasing annual frequency of 9.5 cases per 10,000 SSTIs as of 2014 to 96.8 cases per 10,000 SSTIs in 2018. The ratio of cases with CA-MRSA to cases with CA-MSSA was 0 - 0.09 in two years of the study period and increased to a maximum ratio of 0.6 - 0.72 in the last two years. Consequently, the frequency of S. aureus in cases with SSTIs was significantly higher in 2016 - 2018 compared to the initial study period within the years of 2013-2015 [p < 0.001, relative risk increase: 7 (2.6-28.7) for CA-MRSA and p=0.002, relative risk increase: 2.1 (1.2-3.5)]. Cases with CA-MRSA increased approximately eight-fold during the six-year-study period. CONCLUSIONS The rates of CA-MRSA in SSTIs among children increased significantly compared to CA-MSSA. The clinical impact of this increase should be evaluated, especially in patients with SSTI who are unresponsive to empirical treatment.

Objetivo. Determinar el perfil etiológico de la infección de vías respiratorias bajas (IVRB) en los neonatos durante la temporada de virus sincicial respiratorio (VSR) y definir las características de esta y otras infecciones. Métodos. Estudio retrospectivo con neonatos hospitalizados por IVRB durante dos temporadas de VSR, con reacción múltiple en cadena de la polimerasa en tiempo real. Se revisaron los datos relevantes y se compararon las características de la infección por VSR con las de otros microorganismos. Resultados. Entre 224 pacientes, 160 (71 %) fueron positivos para, al menos, un agente causal potencial. Entre ellos, el 65 % tenía VSR y el 15 %, más de un agente (coinfección). En el grupo con VSR, hubo más dificultad respiratoria (p < 0,01), radiografías de tórax anormales (p < 0,01), requerimiento de atención en terapia intensiva (p < 0,01) y más días de oxigenoterapia (p < 0,01). No obstante, hubo menos casos de fiebre al ingreso y menos días de antibioticoterapia (en ambos, p < 0,01), y la duración de la hospitalización no fue más prolongada. Los pacientes con coinfección requirieron atención en terapia intensiva en mayor medida que los demás (25 % contra 6,5 %, p < 0,01). Conclusión. Este estudio demostró que el VSR fue más frecuente en los neonatos hospitalizados por IVRB durante la temporada y condujo a una evolución más grave que otros microorganismos patógenos detectados. Posiblemente la gravedad de la infección por VSR se viera aumentada por la presencia de una coinfección y radiografía de tórax anormal. Aim: To determine the etiological profiles of lower respiratory tract infection (LRI) in neonates during respiratory syncytial virus(RSV) season, and to define the clinical features of RSV-related infection and others. Methods: The retrospective study included newborn infants who were hospitalized for LRI during the two consecutive RSV seasons, and then tested for possible etiological agent by multiplex real-time polymerase chain reaction. All relevant data were reviewed, and the clinical characteristics of RSV-related infection were compared to those of others. Results: Of 224 patients, 160 (71 %) were positive for at least one potentially causative agent. Of them, 65 % had RSV, and 15 % had more than on ecausative agent (co-infection). The RSV group had more the findings of respiratory distress (p< 0.01), abnormal chest radiography (p< 0.01), need for intensive care (p< 0.01), and duration of oxygen requirement (p< 0.01) but less fever on admission and duration of antibiotic use (for both, p< 0.01), and no longer hospital stay. Need of intensive care nursery was more common in patients with co-infection than others (25 % vs. 6.5 %, p< 0.01). Conclusion: This study highlighted that RSV was the most frequent agent in neonates hospitalized for LRI during the season, with a more severe clinical course than other detected pathogens. The disease severity of RSV infection may have seemed to be increased by the presence of coinfection and abnormal chest radiography.

Antifungal-lock therapy (AfLT) has arrived as an investigational approach for preventing catheter removal with limited clinical evidence of its efficiency. The principle of AfLT consists of catheter lumen replenishment by a selected antimicrobial agent and then locking it for an alternative treatment to eradicate the microbes embedded in endoluminal biofilms. Herein, we report a pediatric hematology-oncology patient with Candida parapsilosis-related central venous access device infection in which catheter removal was performed despite the systemic and intraluminal caspofungin treatment. For now, we recommend higher doses of caspofungin for AfLT especially in Candida parapsilosis-related catheter infections.

Elizabethkingia meningoseptica is a widespread gram-negative bacillus in the environment, but a rarely reported human pathogen presenting mostly as nosocomial infections. Advances in neonatal intensive care facilities and usage of sophisticated medical devices strengthen the invasive infectious potential of the microorganism. Clinical manifestations usually include primary bacteremia, meningitis, nosocomial pneumoniae, intravascular catheter-related bacteremia and gastrointestinal and biliary tract infections. Lack of improved diagnostic systems in resource constrained settings, might be a cause of underreporting of such infections. Discrimination between colonization and infection is quite difficult, and it has an unusual antibiotic susceptibility pattern. Therefore clinicians should pay special attention to accurate diagnosis in order to prevent mistreatment. Here we report three newborn cases with the diagnosis of E. meningoseptica infection and colopnization, with the aim of drawing attention to the diagnosis and management of this rare but lethal bacteria that is already present in the intensive care unit environment.Elizabethkingia meningoseptica es un bacilo gramnegativo ampliamente distribuido en la naturaleza pero poco frecuente en humanos que se presenta en infecciones intrahospitalarias. Los avances en las instalaciones de cuidados intensivos neonatales y el uso de dispositivos médicos sofisticados fortalecen la capacidad infecciosa invasiva del microorganismo. Las manifestaciones clínicas suelen incluir bacteriemia primaria, meningitis, neumonía intrahospitalaria, bacteriemia relacionada con el uso de catéteres intravasculares e infecciones gastrointestinales y de las vías biliares. Es posible que, en entornos con recursos limitados, la falta de sistemas de diagnóstico mejorados sea una de las causas por las que no se notifican todas esas infecciones. Resulta bastante difícil distinguir entre colonización e infección, y el patrón de sensibilidad a los antibióticos es diferente. Por consiguiente, los médicos deben realizar el diagnóstico preciso para así evitar el tratamiento incorrecto. En este artículo, describimos tres casos de recién nacidos con diagnóstico de infección y colonización por E. meningoseptica con el objetivo de destacar la importancia del diagnóstico y el tratamiento oportunos de esta bacteria poco frecuente pero letal que ya está presente en las unidades de cuidados intensivos.

To determine the etiological profiles of lower respiratory tract infection (LRI) in neonates during respiratory syncytial virus(RSV) season, and to define the clinical features of RSV-related infection and others.The retrospective study included newborn infants who were hospitalized for LRI during the two consecutive RSV seasons, and then tested for possible etiological agent by multiplex real-time polymerase chain reaction. All relevant data were reviewed, and the clinical characteristics of RSV-related infection were compared to those of others.Of 224 patients, 160 (71 %) were positive for at least one potentially causative agent. Of them, 65 % had RSV, and 15 % had more than on ecausative agent (co-infection). The RSV group had more the findings of respiratory distress (p0.01), abnormal chest radiography (p0.01), need for intensive care (p0.01), and duration of oxygen requirement (p0.01) but less fever on admission and duration of antibiotic use (for both, p0.01), and no longer hospital stay. Need of intensive care nursery was more common in patients with co-infection than others (25 % vs. 6.5 %, p0.01).This study highlighted that RSV was the most frequent agent in neonates hospitalized for LRI during the season, with a more severe clinical course than other detected pathogens. The disease severity of RSV infection may have seemed to be increased by the presence of coinfection and abnormal chest radiography.Objetivo. Determinar el perfil etiológico de la infección de vías respiratorias bajas (IVRB) en los neonatos durante la temporada de virus sincicial respiratorio (VSR) y definir las características de esta y otras infecciones. Métodos. Estudio retrospectivo con neonatos hospitalizados por IVRB durante dos temporadas de VSR, con reacción múltiple en cadena de la polimerasa en tiempo real. Se revisaron los datos relevantes y se compararon las características de la infección por VSR con las de otros microorganismos. Resultados. Entre 224 pacientes, 160 (71 %) fueron positivos para, al menos, un agente causal potencial. Entre ellos, el 65 % tenía VSR y el 15 %, más de un agente (coinfección). En el grupo con VSR, hubo más dificultad respiratoria (p0,01), radiografías de tórax anormales (p0,01), requerimiento de atención en terapia intensiva (p0,01) y más días de oxigenoterapia (p0,01). No obstante, hubo menos casos de fiebre al ingreso y menos días de antibioticoterapia (en ambos, p0,01), y la duración de la hospitalización no fue más prolongada. Los pacientes con coinfección requirieron atención en terapia intensiva en mayor medida que los demás (25 % contra 6,5 %, p0,01). Conclusión. Este estudio demostró que el VSR fue más frecuente en los neonatos hospitalizados por IVRB durante la temporada y condujo a una evolución más grave que otros microorganismos patógenos detectados. Posiblemente la gravedad de la infección por VSR se viera aumentada por la presencia de una coinfección y radiografía de tórax anormal.

Treatment of invasive infections caused by Stenotothromhomas maltophilia is difficult as the bacterium is frequently resistant to a wide range of commonly used antimicrobials. The aim of this retrospective study was to evaluate effectiveness of treatment with ciprofloxacin monotherapy compared to trimethoprim-sulfamethoxazole monotherapy in patients with S. maltophilia infections. We evaluated 50 patients with S. maltophilia bloodstream infections who had received monotherapy with trimethoprim-sulfamethoxazole or ciprofloxacin. Twenty-five patients (50%) received trimethoprim-sulfamethoxazole, and 25 patients (50%) received ciprofloxacin. Thirty-six (72%) patients were in the intensive care unit. All of the patients had at least one indwelling devices and approximately 25% patients had immunosuppression. Ciprofloxacin had the same clinical outcome and mortality as trimethoprim-sulfamethoxazole for the treatment of S. maltophilia bacteremia. In our study; side-effects ratio were not statistically different between ciprofloxacin and trimethoprim-sulfamethoxazole group. Ciprofloxacin could be an alternative drug of choice for treating S. maltophilia infections especially in premature infans in stead of trimethoprim-sulfamethoxazole.

WOS: 000439064100006 PubMed ID: 30150887 Non-typhoidal Salmonella (NTS) is an important pathogen that causes gastroenteritis, bacteraemia, and focal infections. Herein, we present our experience with bloodstream infections caused by Salmonella in paediatric leukaemia patients, which has been reported for the first time in both Europe and the US. According to our research, NTS might be a cause of serious infections in paediatric haematology-oncology patients. Following a low bacterial diet and increasing the hygiene of both the children and their surroundings would be beneficial in preventing these infections.

Introduction: Fungal endocarditis is reported less frequently than bacterial endocarditis, with an incidence of 0-12% of the total pediatric infective endocarditis. Objective: In this study, the incidence of infective endocarditis in Candida bloodstream infections in a tertiary hospital during the periods of 2007 and 2016 was reviewed. Methods: Patients with positive blood or catheter cultures in terms of Candida spp. during the study period of January 2007 and January 2016 were analyzed in terms of Candida infective endocarditis. Infective endocarditis was defined according to the modified Duke criteria. The outcome, possible associated predisposing factors for Candida endocarditis were determined. Results: 221 patients and 256 attacks with positive blood or catheter cultures in terms of Candida were included in the study. The most common Candida species was Candida parapsilosis, isolated in 157 (61.3%) attacks, followed by Candida albicans in 70 (27.3%). Neurological diseases (23%), hemato-oncological diseases (12.1%), previously known heart diseases (8.2%), inborn errors of metabolism (9%) were common comorbidities. Twelve (5.4%) patients had a previous history of cardiac surgery. Among the 221 patients, Candida endocarditis was present in only two (0.9%) of them. Conclusion: Although Candida infective endocarditis is an uncommon but frequently fatal infection in pediatrics, echocardiography should be performed routinely for patients with positive blood or catheter cultures in terms of Candida. Prompt and effective antimicrobial therapy might prevent cardiac surgery in selected cases, however this could not be a general rule for all patients.

Background/aim: It is recommended that a central venous catheter (CVC) be removed if central line-associated bloodstream infection (CLABSI) has been diagnosed. The objective of this retrospective study was to evaluate the risk factors for recurrent CLABSI in reinserted catheters in a pediatric intensive care unit. Materials and methods: Patients with recurrent and nonrecurrent CLABSI were compared in terms of the catheter exchange interval, the interval between negative blood culture and reinsertion of the CVC, and the pre-/reinsertion treatment duration. Results: Thirty-one patients with initial CLABSI had reinserted CVCs, and 12 (38.7%) of these patients were diagnosed with recurrent CLABSI. In the recurrent group, the catheter exchange interval, the interval between negative blood culture and reinsertion of the second CVC, and pre-/reinsertion treatment duration were found to be shorter. Logistic regression analysis revealed that if the interval between negative blood culture and reinsertion of the second CVC was shorter than 4 days, recurrent CLABSI risk increased by 1.7-fold (P = 0.021). Sterile gauze-dressed patients had shorter cumulative catheter surveys than the polyurethane-dressed patients (P = 0.005). Conclusion: Using transparent polyurethane dressings instead of sterile gauze for maintaining the CVC and delaying the reinsertion procedure for at least 4 days after the negative culture might be helpful in preventing recurrent CLABSI.

Background Umbilical vein catheters (UVC) are one of the most common types of vascular access device in the neonatal intensive care units. Central line-associated bloodstream infections were reported to be in the first place of healthcare-associated infections in preterm infants. In this study, we aimed to evaluate the effectiveness of the bundle applications in the prevention of umbilical vein catheter-associated bloodstream infections in neonates including premature infants. Methods This 40 months cross-sectional study included two periods, including pre-bundle period (from August 1, 2015 to March 31, 2017) and bundle period (April 1, 2017 to November 30, 2018). The umbilical vein catheter-related bloodstream infections, catheter line days, number of the patients were recorded and compared between the prebundle and bundle periods. Bundle steps were defined as education-training-assignment, evaluation of daily catheter indications, hand hygiene and aseptic technique while insertion, maximal sterile barrier precautions, closure of the catheter area with transparent semi-permeable membrane, using needless connectors in stead of 3-way stop-cocks, and single-use prefilled saline syringes for flushing. Results During the whole study period total umbilical vein catheter days were 2,228 days. During the prebundle period there was 10 and in the bundle period there was 2 umbilical vein catheter-related bloodstream infections (Table 1). While umbilical vein-associated bloodstream infection rate was 8.9 per 1,000 catheter days in the pre-bundle period, and significantly decreased to 1.79 in the bundle period (P < 0.05). After the introduction of bundle applications, it was observed that the rate of infection decreased by 68% (P < 0.05) Conclusion Our study showed that implementation of central line bundle including needless connectors and single-use prefilled syringes for umbilical vein-related bloodstream infections was effective for the prevention of catheter-related bloodstream infections in neonatal intensive care units. Disclosures All authors: No reported disclosures.

Candidemia is an important cause of morbidity and mortality in cancer patients. The incidence of candidemia has been reported to have shifted toward nonalbicans species. The aim of this study was to determine the distribution of Candida species resulting in bloodstream infections or catheter-related blood stream infections (CRBSIs) in pediatric hematology-oncology (PHO) patients over a 7-year-period. Medical and computerized microbiology laboratory records of all positive blood fungal cultures during the study period were analyzed retrospectively. The ratio of non-albicans Candida species (81.4%) was nearly four times higher than that of C. albicans candidemia (18.5%). Overall, C. parapsilosis caused the majority (61.4%) of candidemia episodes, followed by C. tropicalis (14.8%), C. famata (2.9%), C. ciferrii (1.4%) and C. glabrata (0.7%). The rate of CRBSIs was significantly higher in C. Parapsilosis candidemia. The overall rate of 30-day mortality in 135 candidemia episodes was 4.44%. Nearly half of the C. parapsilosis candidemia was associated with CRBSIs, suggesting its importance in PHO, in which several types of central venous catheters have been used.

VRE species are an increasingly important and universal problem in intensive care units and hematology-oncology departments due to the spread of glycopeptide resistance. Rapid and accurate identification of VRE is therefore crucial. The intent of this study was to compare the diagnostic performance of a real-time PCR test, the BD GeneOhm VanR assay (GeneXpert vanA/ vanB, Cepheid, USA), with conventional cultures for screening hospitalized immunocompromised hematology-oncology patients for VRE. Three hundred and six duplicate rectal swab specimens were obtained from 120 pediatric hematology-oncology patients. PCR and conventional culture-based studies were performed. One hundred and twenty patients, 46 female and 74 male, participated in the study. The mean age of the patients was 7.5±4.7 years. A total of 51 specimens from 306 samples were found to be positive for vanA or vanB. Mean turnaround time for PCR was 0.5±0.2 days. Compared to the culture method, the RT-PCR assay had an overall sensitivity of 91.8% (34/37) and a specificity of 93.6%. The positive predictive value and negative predictive value were 66.6% and 98.8%, respectively. This study demonstrates that RT-PCR is a suitable alternative to culture-based procedures for rapid and accurate identification of VRE in hematology-oncology patients, as the overall performance of PCR is comparable to that of a chromogenic agar-based culture method for VRE screening, especially for detection of VRE-negative patients.

We aimed to evaluate the risk factors for VRE colonization in neonatal intensive care units. In December 2007, we identified a neonate with VRE infection (urinary tract infection and we performed blood and stool cultures for VRE until the last colonized patient was discharged from our clinic. All the neonates hospitalized in NICU during December 2007 to January 2008. Active surveillance cultures for VRE fecal carriage was carried out in neonatal intensive care unit. Resistance to vancomycin was detected by the E-test method. Epidemiological data was recorded for all patients included in the study and was used for the risk factors. Totally 54 infants in NICU were screened for VRE colonization. Totally 11 infants (20%) were colonized with vancomycin-resistant enterococci. The average duration of all antimicrobial therapy was significantly longer in colonized patients. The infants who were hospitalized for more than 10 days were found to be significantly more colonized with VRE when compared to the infants with shorter hospital stay (p 0.05). The premature infants and the mature infants were under risk of VRE colonization. Longer duration of hospitalization and antimicrobial usage were the prominent risk factors. Since infants in neonatal intensive care units were under risk of infections, periodic active surveillance cultures should be combined with logical antimicrobial therapy.

Background: Vancomycin-resistant enterococci colonization has been reported to increase the risk of developing infections, including bloodstream infections. Aim: In this study, we aimed to share our experience with the vancomycin-resistant enterococci bloodstream infections following gastrointestinal vancomycin-resistant enterococci colonization in pediatric population during a period of 18 months. Method: A retrospective cohort of children admitted to a 400-bed tertiary teaching hospital in Izmir, Turkey whose vancomycin-resistant enterococci colonization was newly detected during routine surveillances for gastrointestinal vancomycin-resistant enterococci colonization during the period of January 2009 and December 2012 were included in this study. All vancomycin-resistant enterococci isolates found within 18 months after initial detection were evaluated for evidence of infection. Findings: Two hundred and sixteen patients with vancomycin-resistant enterococci were included in the study. Vancomycin-resistant enterococci colonization was detected in 136 patients (62.3%) while they were hospitalized at intensive care units; while the remaining majority (33.0%) were hospitalized at hematology-oncology department. Vancomycin-resistant enterococci bacteremia was present only in three (1.55%) patients. All these patients were immunosuppressed due to human immunodeficiency virus (one patient) and intensive chemotherapy (two patients). Conclusion: In conclusion, our study found that 1.55% of vancomycin-resistant enterococci-colonized children had developed vancomycin-resistant enterococci bloodstream infection among the pediatric intensive care unit and hematology/oncology patients; according to our findings, we suggest that immunosupression is the key point for developing vancomycin-resistant enterococci bloodstream infections. Keywords: Bloodstream infections, Colonization, Immunosupression, Vancomycin-resistant enterococcus

Acute rheumatic fever (ARF) carditis is treated with steroids, which can cause changes in the cellular immune response, especially decreased CD3 (+) T cells. Nosocomial infections due to steroid use for treatment of ARF carditis or secondary to the changes in the cellular immune response have not been reported in the literature. Sphingomonas paucimobilis is a Gram-negative bacillus causing community- and hospital-acquired infections. It has been reported as causing bacteraemia/sepsis, pneumonia or peritonitis in patients with malignancies, immunosuppression or diabetes. We present a case with S. paucimobilis bacteraemia/sepsis and shock after administration of steroids for treatment of ARF carditis. We suggest early identification of the causative agent and appropriate adjustments of the treatment plan to avoid shock and possible mortality. This is the first reported case of S. paucimobilis bacteraemia/sepsis in the setting of steroid use for ARF carditis.

Introduction: Tuberculosis (TB) remains a major global health problem affecting millions of people annually. Tuberculosis in children has unique features different from adults which makes the diagnosis to be more difficult. The spectrum of the symptoms of TB in children could vary from non-specific symptoms to severe clinical presentations. In this study, we reviewed our experience at pediatric patients with active TB admitted in a tertiary hospital and aimed to compare the epide­miological, clinical and microbiological features of children with the extra-pulmonary tuberculosis(EPTB) and pulmonary tuberculosis(PTB).Material and methods: Patients under 14 years of age diagnosed with active TB in our unit between December 2008 and September 2013 were included in the study. Data including demographic characteristics, clinical history, microbiology, imaging studies, medications and outcomes of the patients were collected from medical records.Results: A total of 129 cases of active TB were identified. Ninety-two (78.6%) of the cases had Pulmonary Tuberculosis and 25 (21.4%) of the cases had Extra-pulmonary tuberculosis. The most common signs and symptoms on admission were fever in 40 cases (34.2%) and cough in 81 cases (69.2%). The number of patients without symptoms including fever, cough, malaise and weight loss were significantly higher in EXPTB (72.0%) group when compared with patients in PTB group (13.0%) (p 0.05). The detection rate of source in PTB group (42.4%) was significantly higher than the rate in EPTB group (20.0%)( p=0.04). In the drug-resistant group, no source of infection could be established in 5 of 9 patients (55.5%).Conclusions: Extra-pulmonary tuberculosis diagnosis is more difficult than Pulmonary tuberculosis in children due to the various problems such as absence of associated pulmonary involvement, lack of constitutional symptoms and negative tuberculosis exposure history compared to Pulmonary Tuberculosis. New strategies are required for improving the diagnosis of Extra-pulmonary tuberculosis in children

Seven clusters of hospital infection due to Salmonella enterica serovar typhimurium were documented in the neonatology clinic of a children's hospital between April 2002 and March 2004. Eighty-one neonates were infected. Three cases were asymptomatic, 73 cases had gastroenteritis as the only clinical condition, and 5 cases had bacteremia associated with gastroenteritis. All isolates from stool and blood samples (n=86) were identified as Salmonella enterica serovar typhimurium. Extended-spectrum beta-lactamase (ESBL) production was determined by clavulanate disk potentiation assay in all isolates. Enterobacterial Repetitive Intergenic Consensus polymerase chain reaction (ERIC-PCR) was performed in 26 selected isolates, which were chosen as being representative of different clusters, to determine the clonal relationship. PCR, isoelectric focusing and sequence analysis revealed the production of CTX-M-3, TEM-1 and SHV-12 by these isolates in 23%, 76.9% and 100%, respectively. None of the isolates had PER beta-lactamase production. Standard infection control measures such as handwashing and disinfection procedures were implemented in initial clusters. During the two-year period, the infection control policy of the hospital was improved with appropriate actions such as assignment of an infection control nurse and increasing the number of staff of the clinic, and finally, with the establishment of an active surveillance program, the clusters were stopped.

Leech infestation can cause many different clinical symptoms such as epistaxis, haemoptysis, haematemesis, and vaginal bleeding. Therefore leech infestation should be considered as a cause of unexplained severe anemia in rural areas where aquatic leeches are common. In this paper we report a case of pharyngeal leech infestation (Limnatis nilotica) presenting with haemoptysis, and epistaxis which resulted in difficulty in making a diagnosis.

Hastane infeksiyonları, yatan tüm hastalar için sorun olmakla birlikte maliyn hastalarda çok ağır seyretmekte ve tedavi başarısını, prognozu etkileyen en önemli faktörlerin başında gelmektedir. Burada maliyniteli çocuklarda gelişen hastane infeksiyonları, risk faktörleri, etken mikroorganizmalar ve antibiyotik duyarlılıklarının belirlenmesi amaçlandı. Bu çalışmada 01.01.2003-31.12.2003 tarihleri arasında hastanemiz Onkoloji servisinde yatan 0-17 yaş çocuk hastaların hastane infeksiyon atakları incelendi. Kliniğimizde bir yıllık takip süresi içerisinde toplam 92 hastane enfeksiyon atağı görüldü, net hastane enfeksiyonu hızımız % 3.3 olarak hesaplandı. İnfeksiyon ataklarının, 411 (% 44.6) Akut Lenfoblastik Lösemi, 16'sı (%17.4) Akut Myelositer Lösemi, 15'i (%16.3) Non Hodgkin Lenfoma, 20'si ise (% 21,8) solid tümörlü hastalarda idi. 58 infeksiyon atağında (%63) nötropeni mevcuttu. Fizik incelemede 66 atakta (% 71.7) infeksiyon odağı saptanırken, 26'sında (%28.3) odak saptanamadı ve bakteriyemi olarak değerlendirildi. Ataklar sırasında alınan kültürlerde (kan, idrar, deri sürüntüsü, sekresyon) 28 atakta (%33.2) etken mikroorganizma izolasyonu yapılabildi. Mikrobiyolojik olarak dökümante edilebilen 14 atakta gr (-) barsak patojenleri, 10 atakta gr (+) etkenler ve 4 atakta mantar türleri saptanmıştır. Hastane infeksiyonu olarak izlediğimiz 92 ataktan 16'sında (%17.4) olgular kaybedildi. Kaybedilen hastaların tamamı relaps gelişen veya terminal dönemdeki hastalardı. Hastane infeksiyonlarının çoğunun dirençli ve tedavisi zor olan mikroorganizmalarla meydana geldiği, mortalitelerinin yüksek olduğu bilinmelidir. Ayrıca her hastane kendi mikroorganizma profillerini çıkararak tedavilerinde ampirik uygulamaların yerine duyarlı antibiyotiklerin optimal doz ve sürede kullanımını sağlamalıdır. Because of immunologic impairment and altered cutaneous barriers play important role in the vulnerability of patients with malignancy to nosocomial infections, we conducted a prospective study in our clinic to describe the incidence rate, risk factors, focuses of infections, causative organisms and their antibiotic susceptibility. Data were collected prospectively from children with cancer aged between 0-17 years in Dr. Behcet Uz Children's Hospital Hematology-Oncology Clinics from January 01 to December 31, 2003, observed 92 attacks of nosocomial infections (41 attacks in acute lymphoblastic leukemia, 20 attacks in solid tumors, 16 attacks in acute myeloblasts leukemia and 15 attacks in Non-Hodgkin Lymphoma patients) and rates of infections in our department have been 3.3 % of patients. In 58 attacks (63%), neutropenia accompanied with nosocomial infection. In physicial examinations, while infectious focus was detected in 66 attacks (71.7%), no focuses was found in 26 (28.3%) and accepted as bacteraemia. Cultures of blood, urine, body secretions revealed micro organisms in 28 attacks (33.2%). Patients died in 16 attacks and mortality rate was 17.4%. In microbiologically documented infections, gram (-) enteric pathogens were causative agents in 14 attacks, gram (+) pathogens in 10 attacks and fungi in 4 attacks. All the children who died were terminally ill or relapsed patients. Most of nosocomial infections are due to antibiotic resistant microorganisms and have high mortality rate. All hospitals supply self microorganisms profile and judicious use of antimicrobial agents, with an emphasis on targeted (narrow spectrum) rather than broad-spectrum antibiotics and appropriate indications (proven or suspected bacterial infections).

Sphingomonas paucimobilis is a causative agent of infection in immunocompromised patients, and healthcare-associated infections. Although the infections associated with S.paucimobilis occurs rarely, it has been encountered with increasing frequency in clinical settings. In the current study we noted the risk factors and clinical features of the children with S.paucimobilis infections, and the antimicrobial susceptibilities of the isolated strains among the patients. This study was conducted in Dr. Behçet Uz Children’s Hospital, Turkey, during the period of January 2005 and December 2012. The medical records of pediatric patients with positive cultures for S.paucimobilis were reviewed. Sphingomonas paucimobilis isolates were recovered from 24 pediatric patients. The median age was 4 years (ranging from 3 days infant to 15 years) and 58,3% were male. Eight (33,3%) of the patients were under 1 months of age. Among the patients; 13 (54,2%) infections were community related however 11(45.8%) infections were nosocomial infection. The median duration of hospital stay was 7 days (ranging from 4 to 22 days). The most effective antibiotics were fluoroquinolones, carbapenems, and trimethoprim/sulfamethoxazole. This is the first largest study in children to evaluate the clinical features of S. paucimobilis infections. Sphingomonas paucimobilis may cause infections in both previously healthy and immunocompromised children. Although variable antimicrobial regimens were achieved to the patients, there was no attributable fatality due to S.paucimobilis infections due to the low virulence of the bacteria.