Search

Objective: Influenza virus is common in children, especially in winter, causing hospitalization, admission to the intensive care unit, or even death. There are few studies on the attitudes or knowledge of influenza diagnosis, treatment, and vaccination among pediatricians. This study was planned to determine pediatric residents' attitudes and behaviors about recognizing the influenza virus, making treatment decisions, prophylaxis, and immunization. Material and Methods: This descriptive cross-sectional study was performed from 31 July-1 December 2019 among pediatric residents working in six different hospitals in the Aegean Region by an online survey. Twenty-seven questions were asked regarding articipant's demographic characteristics, recognition of the influenza symptoms, treatment, prophylaxis, and immunization. Results: Two hundred and four (58.5%) of 349 pediatric residents were included in the study, who answered the questionnaire. Among the participants, 72.5% were females, and their mean age was 27.9 +/- 2.1 years, and 59.3% worked as a pediatric residents for less than two years. When the symptoms of influenza were evaluated, the most known symptoms were fever (94.1%), myalgia (81.9%), tiredness (77.0%), headache (70.1%), and cough (68.6%). When oseltamivir treatment indications were questioned, most pediatric residents (82.2%) answered the questions. It was observed that 21.1% of the pediatric residents had the flu vaccine in the current season. According to the state of having chronic diseases, the rate of vaccination in participants was not statistically significant (p= 0.136). Conclusion: In this study, it was determined that pediatric residents' knowledge about influenza awareness, treatment, and immunization was insufficient. It may be beneficial to train pediatric residents about the influenza virus and vaccine before each influenza season.

Although the underlying disease is associated with a severe course in adults and laboratory abnormalities have been widely reported, there are not sufficient data on the clinical course of coronavirus disease 2019 (COVID‐19) in children with pre‐existing comorbid conditions and on laboratory findings. We aimed to describe the independent risk factors for estimating the severity of the COVID‐19 in children. All children between 1 month and 18 years old who were hospitalized during the period of March 11–December 31, 2020, resulting from COVID‐19 were included in the study. Patients were categorized into mild (group 1) and moderate + severe/critically (group 2) severity based on the criteria. Demographic characteristics, comorbidities, and laboratory variables between the two groups were compared. A total of 292 children confirmed to have COVID‐19 infection were included in the study. The most common associated diseases were obesity (5.1%) and asthma bronchiale (4.1%). We observed that disease progressed more severely in patients with underlying diseases, especially obesity and asthma bronchiale (for patients with obesity odds ratio [OR] 9.1, 95% confidence interval [CI] 1.92–43.28, p = 0.005 and for patients with asthma bronchiale OR 4.1, 95% CI 1.04–16.80, p = 0.044). In group 2 patients, presence of lymphopenia and hypoalbuminemia, and also an elevation in serum levels of C‐reactive protein, procalcitonin, and uric acid were detected and these results were statistically significant (p values; p, Highlights There are not sufficient data on the clinical course of COVID‐19 in children with pre‐existing comorbidities.Obesity, asthma bronchiale, lymphopenia, and uric acid elevation are indicators that COVID‐19 infection may progress more severely.We recommend clinicians must be more aware of deterioration in the children with comorbidities and monitor lymphocyte count, and uric acid levels as predictors for severe infection in terms of deterioration.

Background Studies investigating clinical and imaging findings of coronavirus disease 2019 (COVID‐19) pneumonia and predictors for lung injury mostly focus on adults. In this study, we aimed to evaluate the role of laboratory findings in predicting lung involvement in children with COVID‐19. Methods Children with COVID‐19 confirmed by reverse‐transcription polymerase chain reaction or COVID‐19 IgM and who underwent chest computed tomography (CT) scans were reviewed retrospectively. Admission absolute neutrophil count (ANC), absolute lymphocyte count (ALC), ANC/ALC ratio, platelet count, d‐dimer, fibrinogen, ferritin, procalcitonin, C‐reactive protein (CRP), and lactate dehydrogenase levels were compared in patients with normal and abnormal CT scans. Results A total of 101 children were included. Among the patients, 68 (67.3%) had normal CT scans, and 33 (32.7%) had pulmonary involvement. The median CRP, ferritin, and fibrinogen levels were significantly higher in children with abnormal CT findings. The model of binary logistic regression based on the presence of cough, shortness of breath, fibrinogen, ferritin, and CRP levels showed that the possibility of having abnormal CT was 1.021 times more likely for every one unit increase in fibrinogen levels. Conclusion Fibrinogen might be useful to predict pulmonary involvement of COVID‐19 in children. Restricting radiological imaging to patients with significant symptoms and high fibrinogen levels might be helpful in children with COVID‐19 infections.

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: Invasive Trichosporon infections are rarely seen opportunistic fungal infections in children and mainly affect immunocompromised patients. This multicenter retrospective study has rewieved the characteristics, risk factors, treatment modalities and outcomes of bloodstream infections caused by Trichosporon species in children diagnosed over the past ten years in Turkey. Methods: The study was performed with the participation of 12 of 55 hospitals invited from Turkey. In each center, the patients with bloodstream infections caused by Trichosporon spp. between January 2010 and December 2020 were retrospectively ascertained and the results were reported to the study coordinator by means of a simple case report. Data were collected on patient demographics, underlying condition(s), treatment of.infections caused by Trichosporon spp, and 7 and 30- day mortality rates. Results: A total of 28 cases with fungemia caused by Trichosporon spp. were included in the study. The most common underlying disease was paediatric cancers (39.3%). T. asahii infections were detected in 78.5 % (n=22) of patients. A various spectrum of antifungal treatment regimens were used including intravenous amphotericin B monotherapy in 35.7%, intravenous amphotericin B and voriconazole combination in 32.1% and intravenous voriconazole monotherapy in 28.6% of the patients. The overall mortality rate was 28.5 %. The mortality rates were 12.5% in the voricanozole, 30% in the amphotericin B and 33.3% in combined voriconazole -amphotericin B arms Conclusions: Invasive Trichosporon infections with an important impact of patients quality of life are almost related to underlying diseases with an overall mortality rate of 28.5%. Voriconazole was found to be associated with lower mortality rates when compared with other treatment regimens. (c) 2021 SFMM. Published by Elsevier Masson SAS. All rights reserved.

Background Epidemiological data on secondary bacteremia associated with nosocomial urinary tract infections generally include adult patients with urinary catheters. Aim To evaluate the frequency and outcome of secondary bacteremia complicating healthcare-associated urinary tract infections. Material and methods This study was conducted between May 2013 and December 2017 at the Dr. Behcet Uz Children's Hospital and included symptomatic nosocomial urinary tract infections. A total of 117 patients with positive blood cultures were enrolled in the study. Results Six patients had bacteremia associated with nosocomial urinary tract infections yielding an incidence of 5.1%. The pathogens responsible for secondary bacteremia were: Klebsiella pneumonia in two patients, Enterococcus faecium in two patients, Klebsiella oxytoca in one patient, and Pseudomonas aeruginosa in one patient. Conclusion The incidence of bacteremia associated with nosocomial urinary tract infections was not different from bacteremia associated with community-acquired urinary tract infections, and was approximately 5%.

This descriptive study aimed to evaluate the frequency and the types of mucocutaneous manifestations associated with multisystem inflammatory syndrome in children (MIS-C). A cohort of 49 patients was reviewed. There were 6 patients (12.2%) whose mucocutaneous findings were observed by the clinicians on admission, whereas 26 (53%) patients had at least one of the histories of rash or desquamation associated with fever before the admission. Exanthems in our experience demonstrated a variety of morphologies, including morbilliform, urticarial, petechial, and maculopapular forms. Mucosal involvement (conjunctivitis and strawberry tongue) was observed only in 2/6 (34%) patients. In the coronavirus disease 2019 pandemic era, while evaluating the criteria for MIS-C, the history of previous cutaneous findings given by parents/caregivers is also important. There was no pathognomonic rash for MIS-C and a variety of cutaneous findings with a short lifespan can be associated with MIS-C.

Background Acute viral respiratory infections are common causes of febrile episodes in children. There are still limited data about distribution of acute viral respiratory infections in children with cancer. Objective The first aim of this study was to evaluate the viral etiology and seasonality of acute viral respiratory infection in pediatric patients with cancer in a 3-year study. Our second aim was to evaluate the impact of viral infections on delaying the patients' chemotherapy or radiotherapy. Materials and methods This cross-sectional study was conducted from January 2014 to July 2017. Nasopharyngeal aspirates were analyzed in patients younger than 21 years with acute respiratory infections. Patients were treated in the Pediatric Hematology and Oncology Department of Dr. Behcet Uz Children's Hospital with real-time multiplex polymerase chain reaction. Data were analyzed to determine the frequency and seasonality of infections. The χ or the Fisher exact tests were used. Results A total of 219 samples of nasopharyngeal aspirates and blood were analyzed. The mean patient age was 76.8±59.3 months, with 46.3% female and 53.7% male children in a total of 108 patients. Of this total, 55% (60/108 cases) had multiple acute respiratory infections. Acute lymphoblastic leukemia (48.1%) was the most prevalent disease. The 3 most prevalent viruses were human rhinovirus (HRV) (33.1%), parainfluenza (PI) (18.7%), and coronavirus (CoV) (14.8%). In terms of the seasonal distribution of viruses, PI was most common in winter 2014, HRV in spring 2014, HRV in fall 2014, PI in winter 2015 and summer 2015, CoV in spring 2015, HRV in fall 2015, both influenza and HRV in winter 2016, both human metapneumovirus and bocavirus in spring 2016, HRV in summer 2016, both HRV and PI in fall 2016, both respiratory syncytial virus and influenza in winter 2017, HRV in spring 2017, and both HRV and adenovirus in summer 2017. The mean duration of neutropenia for patients with viral respiratory infection was 17.1±13.8 (range: 2 to 90) days. The mean duration of symptoms of viral respiratory infection was 6.8±4.2 (range: 2 to 31) days. A delay in chemotherapy treatment owing to viral respiratory infection was detected in 73 (33.3%) patients. The mean duration of delay in chemotherapy treatment was 9.6±5.4 (range: 3 to 31) days. Conclusions In conclusion, we report our 3-year experience about the frequency and seasonality of respiratory viruses in children with cancer.

Background: The incidence of invasive fungal infections in neonatal intensive care units has increased dramatically over the past few decades, partly due to the increased survival rates of preterm neonates. Currently, there are limited studies concerning the usage of Micafungin in neonates. Therefore, the objective of this study was to review our experience with Micafungin regarding its efficiency and side effects. Methods: In this retrospective analytical study, neonates who recieved micafungin for possible or proven invasive Candida infection between July 2017 and February 2020 were included. The time to achieve negative culture, the 14 days survival of the patients and the the liver and renal functions as well as blood counts were recored. Results: Thirty neonates with a median birth weight of 2125 grams were included . All of them were effectively treated with micafungin. Median serum aspartate aminotransferase, alanine aminotransferase, creatinine levels did not increase during and at the end of micafungin therapy. None of these patients had experienced an anormal kidney or liver function tests due to Micafungin usage with serum aspartate aminotransferase, alanine aminotransferase, creatinine levels before an after micafungin treatment: 28 IU (13-257) vs 37 IU (18-89), p=0.86; 14 IU (6-180) vs 16 IU (6-50), p=0.74; 0.5 mg/dL (0.3-3.4) vs 0.5 mg/dL (0.4-2.1), p=0.42, respectively. Conclusion, Micafungin is a safe and effective treatment choice both in the treatment of neonatal culture proven or probable invasive candida infections in both term and preterm neonates.

Background: Central line-associated bloodstream infection is one of the four primary health-care-associated infections applicable to pediatric intensive care units defined by The Centers for Disease Control and Prevention. According to current guidelines, it is essential to flush vascular access devices before each infusion to assess catheter function and prevent catheter-related complications. Objective: This prospective trial aimed to assess the potential differences between pre-filled and manually prepared saline syringe use during vascular access device management in a pediatric intensive care unit. Methods: Volunteered registered pediatric intensive care unit nurses were asked to implement the flushing solution to an extension line of a central venous catheter in vitro. After the randomization process with opaque sealed envelopes, they have started either with manual preparation or used sterile pre-filled saline syringes. Sterile application steps forms were used for monitoring the manual preparation of saline syringes versus the pre-filled saline syringes phase. Each volunteer repeated the steps for 3, 5, and 10 mL syringe volumes with the manually prepared and pre-filled saline syringes. After completing the procedures, failed steps and durations were transferred into a database to be analyzed by a blinded investigator. Results: A total of 41 nurses volunteered and 123 forms for three attempts per one nurse were filled for each group. In the manual preparation group, the number of at least one failure in the necessary steps was 89 (72.3%) and the same number in the pre-filled syringe group was 6 (4.9%), and significantly lower in the pre-filled saline syringe group ( p Conclusion: Our results demonstrate that the risk for breaking the aseptic no-touch technic was higher in the manual preparation group. We have also demonstrated that the flushing time was shorter with pre-filled syringes compared to manually prepared ones, which may contribute to decreasing the workload of the nurses and may increase the quality of care in the intensive care units. The use of pre-filled saline syringes may decrease the central line-associated bloodstream infections incidence and may increase the quality of care by saving extra time in the pediatric intensive care unit.

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.

BACKGROUND Candidemia and Candida-associated catheter-related bloodstream infections (CRBSIs) are the significant cause of mortality and morbidity in patients with malignancy. METHODS A retrospective analysis including all pediatric hematologic/oncologic malignancies patients with CRBSIs treated in Dr. Behcet Uz Children Diseases and Surgery Training and Research Hospital between the period of 2009 and 2020. RESULTS During the study period, 53 children with CRBSIs associated with Candida species were included. The most common malignancy was acute lymphoblastic leukemia (45.3%) and acute myeloid leukemia (15.1%). A total of 56 Candida isolates were present including non-albicans Candida species (80.4%) and Candida albicans (19.6%). The most common isolated Candida species was Candida parapsilosis (42.9%) and followed by C. albicans (19.6%). The ratio of azole prophylaxis was significantly higher in patients with the non-albicans Candida group (P=0.031). Candida-related endocarditis (vegetation) was present in 2 (3.8%) patients, and the overall rate of hepatosplenic candidiasis was 3.8%. Seven days Candida attributable mortality was 7.5% (4 patients) and 30 days Candida attributable mortality was 11.3% (6 patients). The Candida species responsible for the Candida-related deaths were as following: Candida tropicalis (n=3), C. parapsilosis (n=2), and C. lusitanae (n=1). CONCLUSION In pediatric cancer patients with Candida-associated CRBSIs, evaluation of the patient for organ involvement including liver and spleen ultrasonography and cardiac involvement with echocardiography are essential regardless of the patients' clinical picture.

Objectives: To investigate the association between the triggering receptor expressed on myeloid cells-1 (TREM-1) levels and prognosis in septic children. Methods: Patients admitted to pediatric intensive care units (PICU) of three tertiary centers were included in this prospective observational study. Serum samples were taken at admission from patients who were hospitalized with sepsis. Results: Of the 87 patients included, 34 (39.1%) had severe sepsis and 53 (60.9%) had septic shock. The median age was 2 y (2 mo to 16 y). TREM-1 values were found to be significantly higher in septic shock patients 129 pg/ml (min 9.85- max 494.90) compared to severe sepsis 105 pg/ml (min 8.21- max 289.17) (p = 0.048). Despite higher TREM-1 levels been measured in non-survivors compared to survivors, it was not statistically significant [168.98 pg/ml (min 9.85- max 494.90) vs. 110.79 pg/ml (min 8.21- max 408.90), (p = 0.075)]. Conclusions: Admission TREM-1 levels were higher in septic shock compared to severe sepsis patients. There was no association between mortality and TREM-1 levels in sepsis. TREM-1 measurements should be used carefully in pediatric sepsis prognosis. © 2020, Dr. K C Chaudhuri Foundation., Ege Üniversitesi, Scientific Projects Department of Ege University supported this work.

Objective: Acute gastroenteritis due to the rotavirus is one of the common causes of morbidity and mortality in children under five years of age. The objective of this study was to evaluate the epidemiological, clinical, and laboratory data of rotavirus diarrhea in hospitalized children under five years of age. Methods: All children between one month and 60 months old ages who were hospitalized in Health Sciences University Behçet Uz Child Disease and Pediatric Surgery Training and Research Hospital during September 2013 to August 2017 and diagnosed as acute gastroenteritis with rotavirus antigen test positive in feces were included in the current study. Data of the patients were collected retrospectively from medical records. Results: A total of 100 patients were evaluated.The median age of the patients was 13 months (IQR 5-45 months) and 54 patients were male and 46 were female.The highest hospitalization rate was in December, followed by November, and in October. The most common type of G9P (8) serotype was detected in rotavirus serotype analysis by PCR. Breastfeeding infants had milder clinic findings in comparison to the older ones. It was found that clinical findings were milder and Vesicari score was lower in infants who had breast milk. Vesikari score was found to be high in children with severe clinical findings. Conclusion: Rotavirus infection is important for all ages.In case of fever, increased numbers of vomiting and diarrhea, and higher Vesikari system scores may be associated with the severe clinical forms. Determination of rotavirus serotypes and clinical monitoring of genotypic changes are required.

Objective: In this study, we aimed to evaluate the approaches and knowledge levels of pediatric infectious diseases research workers and pediatricians in the diagnosis and treatment of tuberculosis under the guidelines updated by the Ministry of Health in 2019. Method: This survey is a descriptive study applied to pediatric infectious diseases research workers and pediatricians. In the study, a questionnaire form prepared by researchers consisting of questions about sociodemographic features (n: 5), knowledge level about tuberculosis (n: 20), experience and approaches (n: 13) was used. Results: Fifty physicians participated in the study. The average age of participants was 36 years, and 90% of them were women. It was observed that physicians participating in the study had sufficient knowledge of tuberculosis. In terms of their experiences about tuberculosis, it was learned that m. tuberculosis culture (86%), acid-fast-bacilli test (82%), chest radiography (78%) and tuberculosis polymerase chain reaction (66%) were used most frequently for the diagnosis of pulmonary tuberculosis. Most common form of non-pulmonary tuberculosis was lymphadenitis (84%), and the most challenging condition in the treatment of tuberculosis was drug side effect (78%). When drug resistance was questioned, it was seen that 60% of the physicians encountered drug resistance, and the most common drug resistance was against isoniazid (54%). The isolation measures applied to tuberculosis patients were single room admission, and use of a N95 mask in 80%, an ultraviolet protected lamp use in 22%, and negative pressure room monitoring in 32% of the cases. Conclusion: In our country, tuberculosis still retains its importance. For this reason, the information should be updated with in-service training on issues such as diagnosis, treatment, drug resistance and prevention methods

Objective: SARS-CoV-2, emerged in December 2019 in the city of Wuhan in the People’s Republic of China affects children as well as all age groups. The aim of the study was to evaluate the clinical features and outcomes of pediatric cases with COVID-19 in the first month of the epidemic in Turkey. Method: This single center cross-sectional study was conducted in University of Health Sciences Dr Behçet Uz Child Diseases and Pediatric Surgery Training and Research Hospital during the period of March 11 – April 20, 2020. Demographic, epidemiological and clinical data were collected from medical records. All patients were confirmed by real time reverse transcription- polymerase chain reaction. Chidren were classified as asymptomatic, mild, moderate, severe, and critically ill patients. Results: In this study, we reported the clinical characteristics of a case series involving 30 chilren with COVID-19 aged from 23 days to 16 years. Twenty-nine (96.7%) patients had confirmed contact with family members for COVİD-19. The majority of patients were asymptomatic (50%) or had mild symptoms (26.7%). Fever (46.6%) and cough (33.3%) were the most common symptoms. Conclusion: Our study indicated that COVID 19 in children exhibited less severe symptoms and had better outcomes

Objective: Infections are an important cause of morbidity and mortality for patients with congenital neutropenia. In the present study, we report on the incidence, type, localization of documented infections, as well as the clinical features and long-term outcome in patients with congenital neutropenia in our clinic. Method: We performed a retrospective chart review of children with neutropenia seen at our hospital from 2000-2018. The data of 15 patients with congenital neutropenia were included in this study. Clinical and laboratory data were analyzed retrospectively using patients’ files and an electronic data system. Results: The median age at diagnosis was 34 months (range, four months- 150 months) and the median follow-up time was 48 months (range, 13-179 months). The leading causes of hospital admission before the establishment of the diagnosis were upper respiratory tract infection in six, pneumonia in four, gingival stomatitis in three and soft tissue infection in two patients. We reached the documented 74 hospitalization episodes and the most common reasons for hospitalization were pneumonia (35%), fever (21%), stomatitis (16%), cutaneous and deep soft tissue infections (12%). Conclusion: The management of infectious complications in children with congenital neutropenia is crucial. Early diagnosis is essential to prevent infections and permanent organ damage. Congenital neutropenia should be suspected in patients with a history of frequent upper respiratory tract infection, and necessary investigations should be performed accordingly. However, it should be kept in mind that the clinical findings of the patients may vary despite having the same mutation.

Background:. In January 2020 a modification is applied for pediatric ventilator associated events (Ped-VAE) surveillance by Center for Disease Control and Prevention. In this study we investigate the potential impact of this newly criteria and determine whether the adult ventilator-associated conditions (VAC), infection-related ventilator-associated complications (IVAC) and possible ventilator-associated pneumonia (PVAP) criteria could be applied pediatric patients with ped-VAE Methods:. We analyzed data between January 2014 and December 2019 using the new ped-VAE criteria. We compared two different criteria for identifying VAE: the 2013 adult VAE criteria, and the newly ped-VAE criteria. Result: The data of 91 VAE patients were evaluated, 42.8 % were not categorized as ped-VAE and 57.2% patients were compatible with the ped-VAE , 19.2% were categorized as adult VAC, 21.1% were categorized as IVAC, and 59.6% patients were categorized as PVAP. There was no significant difference between mortality and the diagnostic ventilator surveillance types. Conclusions: Pediatric ventilator-associated event algorithm is a better tool for children than the VAE algorithm defined for adults and the new pediatric criteria are more effective in detecting ventilator assosiated complications in children. We think further studies will be needed for evaluate ped VAE criteria.

BACKGROUND The aim of this study is to provide a basis for the development of appropriate screening strategies and evaluate the indications of the interferon-gamma release assay (IGRA) in Bacillus Calmette-Guerin (BCG)-vaccinated children. METHODS Children who were examined with both IGRA (QuantiFERON®-TB Gold Plus) and tuberculin skin test (TST) for tuberculosis infection were included in the study. Underlying medical conditions of the patients were recorded. Cohen's κ was run to determine if there was an agreement between TST and IGRA. RESULTS A total of 220 patients with a mean age of 11.05 ± 4.43 years (2.5-18 years) were analyzed. Ninety-nine patients were immunocompromised and 121 patients were immunocompetent. TSTs and IGRA showed none to the slight agreement in both of the immunocompromised and immunocompetent patients. In the immunocompromised group, 43/99 (43.4%) and the immunocompetent group 35/121 (28.9%) of the tests did not show any correlation. CONCLUSION In a high-risk setting where the BCG vaccine is mandatory, it may be beneficial to use IGRA primarily in immunocompetent patients. In immunocompromised patients, the use of both the TST and IGRA could increase the efficacy of screening for latent tuberculosis infection.

Objectives: To determine the serotype distribution of pneumococcus causing invasive pneumococcal disease (meningitidis, bacteremia and empyema) in children in Turkey, and to observe potential changes in this distribution in time to guide effective vaccine strategies. Methods: We surveyed S. pneumoniae with conventional bacteriological techniques and with real-time polymerase chain reaction (RT-PCR) in samples of cerebrospinal fluid (CSF), blood and pleural fluid. S. pneumoniae strains were isolated from 33 different hospitals in Turkey, which are giving health services to approximately 60% of the Turkish population. Results: A total of 167 cases were diagnosed with invasive pneumococcal disease between 2015 and 2018. We diagnosed 52 (31.1%) patients with meningitis, 104 (62.2%) patients with bacteremia, and 11 (6.6%) patients with empyema. Thirty-three percent of them were less than 2 years old and 56% less than 5 years old. Overall PCV13 serotypes accounted for 56.2% (94/167). The most common serotypes were 19 F (11.9%), 1 (10.7%) and 3 (10.1%). Conclusions: Besides the increasing frequency of non-vaccine serotypes, vaccine serotypes continue to be a problem for Turkey despite routine and high-rate vaccination with PCV13 and significant reduction reported for the incidence of IPD in young children. Since new candidate pneumococcal conjugate vaccines with more serotype antigens are being developed, continuing IPD surveillance is a significant source of information for decision-making processes on pneumococcal vaccination. © 2020 The Author(s). Published with license by Taylor & Francis Group, LLC., Pfizer, The study was supported by Pfizer.

Background Central line bundle programs were found to be effective in decreasing central line-associated bloodstream infection rates in pediatric cancer patients with ports. However, cost-effectiveness studies of central line bundle programs in pediatric cancer patients are limited, and most available data are from intensive care unit or adult studies. Methods In this cross-sectional study spanning 6 years, comprehensive assessment of total health care costs attributable to CLABSI’s associated with ports between two periods. Results This cross-sectional study was carried out in the pediatric hematology-oncology ward of Dr. Behçet Uz Children’s Hospital from 1 August November 2011 to 31 July 2017. The CLABSI rates decreased significantly from 8.31 CLABSIs to 3.04 per 1000 central line days (p Conclusion Our study shows that central line bundles decreases not only the CLABSI rate but also decreases attributable costs due to CLABSI. Expenses spent for bundle elements, were covered by savings by preventing CLABSI with higher costs.

Yilmazer MM, Ozdemir R, Mese T, Kucuk M, Oner T, Devrim I, Bayram N, Guven B, Tavli V. Kawasaki disease in Turkish children: a single center experience with emphasis on intravenous immunoglobulin resistance and giant coronary aneurysms. Turk J Pediatr 2019; 61: 648-656. Prompt diagnosis and the administration of intravenous immunoglobulin (IVIG) has reduced the incidence of coronary artery abnormalities (CAA) in Kawasaki Disease (KD). The resistance to treatment and development of the coronary sequelae remain the most important problems in KD. We aimed to determine the predicting factors of nonresponse to initial IVIG therapy and to analyze the cases who had giant coronary aneurysms. A total of 120 KD cases, including 61 children fulfilling the criteria for KD and 59 with incomplete KD were enrolled into this study. Demographic, laboratory, clinical, echocardiographic characteristics, and treatment regimens were reviewed, retrospectively. The median age of the patients was 33.5 months (range: 3-168 months). Coronary artery aneurysms were detected in 35 patients (29%) at the time of diagnosis. Twenty-eight patients had coronary aneurysms small or medium in size, one had a large, and seven had giant coronary aneurysms. CAA persisted in 8 cases in the follow-up, all of which were large or giant aneurysms. A ten month-old girl with a giant coronary aneurysm was referred to coronary bypass surgery in the subacute phase of follow-up, due to myocardial ischemia. Eighteen patients were unresponsive to the initial IVIG therapy (%15), of whom 10 were diagnosed as cKD and 8 were iKD. Patients who did not respond to initial IVIG therapy, had higher white blood cell (WBC) count, higher C-reactive protein (CRP) and lower albumin levels than those who did (P < 0.05). In univarite analysis; CRP, WBC and albumin were found to be significant predictors of nonresponse to initial IVIG therapy, while a stepwise multiple linear regression analysis showed that WBC count and albumin levels were significantly correlated with nonresponse to initial treatment with IVIG. Our study showed that WBC count and albumin levels might be used as predictors of nonresponse to the IVIG therapy in Turkish children with KD.

Background The influenza virus is a significant cause of acute lower respiratory tract infections (LRTI) requiring hospitalization in childhood and leads to severe morbidity and mortality, especially in certain risk groups. Objectives The study aims to evaluate acute LRTI due to influenza in a tertiary care hospital and the risk factors for hospitalization among Turkish children. Study Design Children between 1 month and 18 years of age who were hospitalized at Dr. Behcet Uz Children's Hospital between January 2016 and March 2018 with lower respiratory tract infection that tested positive for influenza by PCR were included. Children with viral coinfections were excluded. Patient files were retrospectively scanned from the hospital computerized system in terms of age, underlying diseases, whether antiviral therapy was used, and length of hospital stay. Statistical analysis was performed using SPSS statistical software. Results The study included 131 patients with a median age of 2 years (1 month-15 years). Sixty-seven (51,1%) patients were younger than two years. Influenza A was isolated in 129 patients and B in 2 patients. Fifty-two patients (39,7%) had underlying medical conditions, and the most common one was malignancies (12/52, 23%). This was followed by neurodevelopmental diseases (9/52, 17,3%), prematurity (9/52 patients, 17,3%), primary immunodeficiency (8/52, 15,4%), asthma (7/52, 13,4%), Down syndrome (4/52, 7,7%), chronic renal disease (2/52, 3,8%) and congenital heart diseases (1/52, 1,9%). The mean length of stay (LOS) was 12,3 ± 9,5 days (2-60 days). The LOS was found to be statistically longer (15,2 ± 12,1 days, 3-60 days) in patients with an underlying disease compared to previously healthy patients (10,4 ± 6,7 days, 2-35 days) (p = 0.01). Conclusions Hospitalization due to influenza-related acute LRTI is not an issue only for patients with an underlying medical condition. Vaccination should be considered not only for those with underlying medical conditions but also for healthy children.

The etiology of bacterial meningitis in Turkey changed after the implementation of conjugated vaccines against Streptococcus pneumoniae and Haemophilus influenzae type b (Hib) in the Turkish National Immunization Program (NIP). Administration of Hib vaccine and PCV-7 (7-valent pneumococcal conjugate vaccine) was implemented in NIP in 2006 and 2009, respectively. in 2011, PCV-7 was replaced with PCV-13. Meningococcal vaccines have not yet been included in Turkish NIP. This prospective study comprised 27 hospitals located in seven regions of Turkey and represented 45% of the population. Children aged between 1 month and 18 years who were hospitalized with suspected meningitis were included. Cerebrospinal fluid (CSF) samples were collected, and bacterial identification was made according to the multiplex PCR assay results. During the study period, 994 children were hospitalized for suspected meningitis, and Hib (n = 3, 2.4%), S. pneumoniae (n = 33, 26.4%), and Neisseria meningitidis (n = 89, 71%) were detected in 125 samples. The most common meningococcal serogroup was MenB. Serogroup W comprised 13.9% (n = 5) and 7.5% (n = 4) of the meningococci in 2015 to 2016 and 2017 to 2018, respectively. Serogroup C was not detected. There were four deaths in the study; one was a pneumococcus case, and the others were serogroup B meningococcus cases. The epidemiology of meningococcal diseases has varied over time in Turkey. Differing from the previous surveillance periods, MenB was the most common serogroup in the 2015-to-2018 period. Meningococcal epidemiology is so dynamic that, for vaccination policies, close monitoring is crucial. IMPORTANCE Acute bacterial meningitis (ABM) is one of the most common life-threatening infections in children. The incidence and prevalence of ABM vary both geographically and temporally; therefore, surveillance systems are necessary to determine the accurate burden of ABM. The Turkish Meningitis Surveillance Group has been performing a hospital-based meningitis surveillance study since 2005 across several regions in Turkey. Meningococcus was the major ABM-causing agent during the 2015-to-2018 period, during which MenB was the dominant serogroup., GlaxoSmithKlineGlaxoSmithKline, Funding for this study was provided by GlaxoSmithKline.

Coronavirus disease (COVID-19) is an infectious disease caused by a newly discovered coronavirus strain (SARS-CoV-2). COVID-19 is an acute respiratory infection that occurs with a wide range of symptoms. The best way to prevent and slow down infection is based on the assumption that we know the characteristics of the SARS-CoV-2 virus, the disease it causes, and the way it spreads. This review has been prepared by the Pediatric Infectious Diseases Unit of the Behçet Uz Children’s Education and Research Hospital in order to share the preparations and strategies to combat the SARS-CoV-2 virus together with other hospitals. What has been prepared in the clinic (physical arrangements, disinfection, regulations for the protection of employees from occupational infections, regulations for patients and companions) is explained under subheadings. The COVID-19 epidemic, which has affected the entire world and caused many people to die, requires the establishment of many new regulations in health services, including new ones to existing patient safety and infection control measures. The treatment and care for children and their families continued without interruption, with various arrangements made in the clinic in cooperation with the team, based on the guidelines updated frequently by the Ministry of Health, international literature, and experiences. Nurses who managed to communicate with children by wearing clothes that looked “like robots” (in the words of the children) used their existing knowledge and equipment in this process and gained new knowledge. It is thought that this review will be useful in guiding future developments of new information emerging during the COVID-19 outbreak.

Summary Introduction Imaging of the urinary tract by ultrasonography (USG) or computerized tomography scanning is recommended for detecting structural abnormalities, hydronephrosis, abscesses, emphysematous pyelonephritis, or fungus ball formation. Limited studies on the epidemiology and the imaging results of candiduria were present in the children. Aim This study aimed to evaluate the results of renal ultrasonography imaging in hospitalized pediatric patients with candiduria. Study design In this descriptive study, we reviewed our ultrasonography findings with hospitalized children and infants who with candiduria. The study included the period between January 2012 and December 2019. Demographic data, the previous medical history, the clinical features of the patients, ultrasonographic findings of the urinary tract system, presence of an indwelling urinary catheter, type of urinary samplings, type of candida species were retrospectively recorded. The study was approved by Institutional Review Board with the registration number 2019/366. Results During the study period, 220 children with nosocomial candiduria were evaluated. The most common isolated candida species was Candida albicans (68.2%) and followed by C. tropicalis (9.1%). Among all patients, 2 (0.9%) had renal fungal balls associated with C. Albicans. Twenty-five patients (11.4%) had findings including internal echogenicity in the bladder (n = 12), uroepithelial thickening of the kidney (n = 10), and sediments in the renal pelvis (n = 3). Discussion Candida albicans was the most prominent candida isolated from the patients. The fungal ball is an uncommon infection especially in children and predominantly caused by Candida species. Fungal ball in the kidney was reported as case reports especially in neonates, in immunosupressed patients, and in patients who had undergone surgical procedures. In our study, none of the patients with the fungal ball were in the neonatal period, however, the patients with fungus ball had underlying disease or condition. Our study has several limitations including a retrospective study, and the USG were not performed by a single radiologist. Besides these limitations, our findings are important to give information about the place of USG for diagnosis of the renal fungal ball in children adding valuable information to a topic in which data came from mainly case reports. Conclusions Despite the low incidence of fungal balls reported, considering the high consequences of missing a fungal ball and elimination of it, a non-invasive method such as the renal bladder USG is still necessary for detection of fungal ball especially. More prospective studies are required for high risk groups to establish the diagnostic value of renal USG.

Background Infections are the leading cause of morbidity and mortality in patients with burns in burn units. Bloodstream infections (BSIs) in patients with burns may result from burn wound infection, use of invasive devices such as central venous catheters, and translocation of the gastrointestinal flora. Objective In this study, we investigated the distribution and antimicrobial drug resistance of causative pathogens in children with burns and the durational changes of microorganisms in the distribution of BSIs in children. Methods This study was conducted at the Pediatric Burn Unit (PBU) of Dr. Behcet Uz Children Research and Training Hospital during the period of November 2008–April 2015. The study subjects were all the patients admitted to the PBU, in whom microorganisms were isolated at least from one of the cultures, including blood and catheter cultures. Results Gram-positive bacteria were the most common causative agents of BSI in patients with burns (66.4%), followed by gram-negative bacteria (22.1%) and fungi (11.5%). The median duration of development of BSIs caused by gram-positive bacteria from the time of burn was 5 days (ranging from 2 to 54 days of burn), which was significantly shorter than that of BSIs caused by gram-negative bacteria (12 days) and fungal pathogens (13 days). Conclusion The etiologic agents of BSIs in children may differ from those in adults. Gram-negative drug-resistant bacteria such as multidrug-resistant Pseudomonas aeruginosa and Acinetobacter baumannii were important agents of BSI in patients with burns, especially in the long term; however, gram-positive bacteria should also be considered while deciding the antimicrobial therapy, especially in the early periods of burn.

Background Micafungin is one of three currently available echinocandin for treatment of candidiasis and candidemia. Methods Children who were treated for micafungin for possible or proven invasive Candidia infection between May 2017 and October 2019 were included. Results In this cross-sectional study, totally 78 children with a median age of 3 months (8 days -17 years), 50 (64.1%, F/M: 0.56) male were included. Thirty four (43.6%) patients were neonate, 26 (76 %) of them were premature. Thirty seven patients (47.4%) received micafungin for candidemia and 41 (52.6%) patients received micafungin empirically for IC. Twelve (32.4%) Candida spp cultured were C. albicans, the rest twenty five (67.6%) Candida spp were non-albicans Candida spp. The most commonly cultured Candida spp was Candida parapsilosis (C. parapsilosis) (n=13) followed by C. albicans (n=12), C. glabrata (n=3), C. tropicalis (n=3), C. guilliermondii (n=3), C. krusei (n=2) respectively. Resistance rate of C. parapsilosis (n=13) isolates to fluconazole, voriconazole, amphotericin B, caspofungin, micafungin were as follows respectively; 66.7%, 100%, 69.2%, 90.9%, 37.5% respectively. Resistance rate of C. albicans (n=11) isolates to fluconazole, voriconazole, amphotericin B, caspofungin, micafungin were as follows respectively; 50%, 50%, 12.5%, 42.9%, 0% respectively. None of the C. tropicalis, C. guilliermondii and C. krusei isolates were resistant to micafungin. Culture negativity could not be achieved at the end of 14th day of micafungin treatment in the 15 (16.9%) candidemia episodes. The most commonly isolated Candida spp in patients with treatment failure was C. parapsilosis (n=7), the other species were; C. albicans (n=5), C. guilliermondii (n=1), C. tropicalis (n=1) and C. tropicalis and C. guilliermondii coinfection (n=1) respectively. Median serum AST, ALT and creatinin levels didn’t increase during and at the end of micafungin therapy. None of these patients had experienced an anormal kidney or liver function tests due to micafungin usage. Characteristics of patients who received micafungin.and cultured Candida spp Antifungal resistance patterns of Candida spp. Laboratory change before and after micafungin treatment Conclusion Increase in fluconazole resistant Candida spp makes micafungin a reasonable and effective choice for suspected or proven invasive candidiasis Disclosures All Authors: No reported disclosures

Background: Little is known about the long-term safety of canakinumab about tuberculosis (TB) risk in paediatric rheumatologic diseases. Objectives: To determine the incidence of latent tuberculosis infection and evaluate the follow-up protocol of the patients treated with canakinumab in a single pediatric rheumatology center from a TB-medium burden country. Methods: The hospital charts of patients treated with canakinumab between 2012 and 2019 were retrospectively reviewed. The patients were screened for TB using tuberculin skin test (TST) and/or QuantiFERON-TB Gold (QFT-G) test. They had no history of active TB prior to screening and no signs or symptoms of active TB. None of the patients had recent close contact with a person diagnosed as active TB. At initial evaluation, in patients who had never been given immunosuppressive therapy, TST ≥15 mm (if BCG vaccinated) and TST ≥10 mm (if BCG unvaccinated) were considered as positive. In the case of prior immunosuppressive drug use TST cut-off limit was accepted as 5 mm. Patients with either a positive TST or QFT-G result, in whom active TB ruled out, were to receive appropriate treatment for latent TB one month prior to the first dose of canakinumab and continue throughout 9 months. Chest radiographs were performed prior to therapy and every 6 months. In case TST was anergic, both chest X-ray and TST were repeated after 3 months. Patients were evaluated for signs and symptoms of active TB by an infectious disease specialist every 3 months while on canakinumab therapy according to the “guidelines of Ministry of Health for use of biologic agents”. The TST conversion was considered as a variation ≥5 mm between the two TSTs performed within an interval at least 3 months. If TB was suspected during the study, repeat TB testing (TST, QFT-G, and chest radiograph) was recommended. Results: 29 Familial Mediterranean fever, 6 systemic juvenile idiopathic arthritis, 1 TRAPS and 1 hyper Ig D syndrome patients were evaluated. The mean age at canakinumab onset was 12.4 ± 4.3 years (min: 2, max: 17 years). The average duration of canakinumab use was 2.3±1.4years (min: 1 max: 6.5 years). Among 37 patients, 5 patients had positive TST and one had positive QFT-G with normal chest X-ray prior to therapy. They were given isoniasid prophylaxis for latent TB. QFT-G was checked in 6 patients prior to canakinumab, 5 were negative. Seven patients had TST conversion during follow-up. Their chest X-rays were normal. None of them had active TB symptoms, such as; cough, fever, night sweats and weight loss. The mycobacterial cultures, mycobacterium tuberculosis PCR of induced sputum (via hypertonic saline nebulization) or morning gastric aspirates were negative in these patients. QFT-G was checked in 10 patients during follow-up and all were negative. None of the patients experienced active TB during follow-up. Conclusion: To the best of our knowledge, this is the first study investigating the frequency of latent tuberculosis infection among patients treated with canakinumab. The results of this study suggest that although frequency of latent TB infection in children treated with canakinumab may not be low in a TB-medium burden country, canakinumab seems to be a safe treatment option in terms of active tuberculosis risk. Close follow-up of children on canakinumab treatment with respect to TB by the pediatric infectious disease department is important to prevent possible complications. Reference: [1] T.C Saglik Bakanligi Turkiye Halk Sagligi Kurumu AntiTNF Kullanan Hastalarda Tuberkuloz Rehberi. Available at: http://www.mhsm.gov.tr/images/diger_haberler/anti_tnf_kullanan_hasta_tb_rehber.pdf. Disclosure of Interests: Balahan Makay Speakers bureau: Enzyvant, Novartis, Roche, Abbvie, ozge altug gucenmez Speakers bureau: Novartis, Abbvie, Ilknur Caglar: None declared, Suleyman Nuri Bayram: None declared, Nesrin Gulez: None declared, Ilker Devrim: None declared

Purpose: The optimal scrubbing time for the disinfection of the surface of needleless connectors has not been determined. The evidence for successful needleless connector decontamination with 70% isopropyl alcohol ranges from 5 to 60 s. The aim of this prospective study was to identify colonization on the external surface of needleless connectors on central venous catheters and measure the efficiency of 15 s of scrubbing with 70% alcohol. Method: A total of 31 patients were included. Samples were collected adhering to aseptic no-touch technique policies. Two samples were collected from the injectable surface of the needleless connector with sterile sodium chloride 0.9% moistened and a dry swab from the same site. Then the surface was scrubbed with alcohol 70% for 15 s for disinfection and second couples of samples for the cultures were taken after disinfection. Findings: A total of 420 swabs were obtained. The number of colonization (equal or higher than 15 CFU/plate) was present on 21 of the needleless connectors (20.0%). Coagulase-negative staphylococci was responsible for all the colonization. After disinfection for 15 s, no isolation exceeding 1 CFU/plate was present. Conclusion: Scrubbing for 15 s with 70% alcohol was found to be successful at elimination of colonization of the surface of needleless connector even in high microorganism counts.

Lyme disease is an illness caused by species of Borrelia spirochetes. Early diagnosis of lyme disease depends on the recognition of skin findings, which are seen in almost 80% of all cases. Erythema migrans is the most common skin lesion. Serologic tests can be used to support the clinical diagnosis. In this article, we report a six-year-old girl who was diagnosed as having early localized lyme disease, who presented with a rash on her right shoulder. The lesion was found consistent with erythema migrans. She had a history of tick bite seven days before the onset of the rash. Serologic test results were also consistent with lyme disease. Her skin lesion disappeared with cefuroxime treatment, and no additional symptoms or pathologic findings were observed on follow-up. Recognizing early signs is important for prompt diagnosis and treatment to prevent long-term complications because the diagnosis and treatment of late-stage lyme disease can be challenging.

SummaryPurpose Our aim is to determine whether the presence of soluble triggering receptor expressed on myeloid cells-1 (s-TREM-1) of bronchoalveolar lavage fluid (BALF), serum procalcitonin levels (PCT), and Clinical Pulmonary Infection Score (CPIS) have diagnostic value in children with VAP. Methods All children followed in pediatric intensive care unit (PICU) who were mechanically ventilated at least for 48 hr between January 2014 and December 2015 were enrolled into our study. BALF sample was obtained via non-bronchoscopic method from the children with VAP suspicion (case group) and s-TREM-1 levels were measured. Furthermore we calculated CPIS and measured serum PCT levels. Same procedures were applied to the control group who were admitted to PICU without infectious problems and who were not under antimicrobial therapy. First we compared the case group with the control group and then we compared the quantitative culture confirmed and non-confirmed VAP cases among themselves. Results Case group (n:58) had significant higher PCT and s-TREM-1 levels compared to control group (n:58). The VAP confirmed cases had higher s-TREM-1, PCT ve CPIS levels compared to non-confirmed VAP cases. s-TREM-1, PCT ve CPIS variables were found to be independent risk factors for VAP. The cutoff values for s-TREM-1, CPIS, and PCT, are 281 pg/ml, 6, and 1.9 ng/ml, respectively. The patients whose s-TREM-1, CPIS, and PCT values above the cutoff levels were found to have higher cumulative VAP rate. Conclusions s-TREM-1 of BALF, serum PCT levels, and CPIS are useful predictors for ventilator-associated pneumonia diagnosis in children. Pediatr Pulmonol. 2017;52:119–128. © 2016 Wiley Periodicals, Inc.

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.

Primary varicella-zoster virus (VZV) infection is a benign self-limited disease. In this study, we review our experience in focusing on the outcome and treatment of VZV infection in pediatric malignancy patients. During the study period, a total of 41 patients with pediatric malignancy had been hospitalized with the diagnosis of VZV infection. All the patients were treated with intravenous acyclovir for a median of 7 days (ranging from 5 to 21 days). The calculated attributable delay of chemotherapy due to VZV infections was 8 days (ranging from 2 to 60 days). VZV-related complications were observed in 3 of 41 patients (7%) who suffered from acute respiratory distress syndrome, and one of them with hemophagocytic lymphohistiocytosis died due to respiratory failure despite acyclovir and broad-spectrum antimicrobial treatment plus supportive treatment. VZV infections are still important contagious diseases in pediatric cancer patients, because they cause not only significant mortality but also a delay in chemotherapy.Primer varisella zoster virüs (VZV) enfeksiyonu benign, kendi kendini sınırlayan bir hastalıktır. Bu çalışmada pediatrik malignitesi olan hastalarda VZV enfeksiyonu ve tedavisine odaklı tecrübelerimizi gözden geçirmeyi amaçladık. Çalışma süresi boyunca; VZV enfeksiyonu tanısı alan pediatrik maligniteli toplam 41 hasta hastaneye yatırıldı. Tüm hastalar ortalama 7 gün (5 ila 21 gün arasında değişen) intravenöz asiklovir ile tedavi edildi. VZV enfeksiyonlarına bağlı olarak hesaplanan atfedilebilir kemoterapi gecikmesi ortalama 8 gündü (2 ile 60 gün arasında değişen). VZV enfeksiyonuna bağlı komplikasyonlar 41 hastadan 3’ünde (%7) akut solunum distres sendromu olarak görüldü ve bu hastalardan hemofagositik lenfohistiyositozu olan bir tanesi asiklovir, geniş spektrumlu antibiyotik ve destekleyici tedaviye rağmen solunum yetmezliği nedeniyle kaybedildi. VZV enfeksiyonları, pediatrik malignite hastalarında hala önemli bulaşıcı hastalıklardan biridir, çünkü sadece ciddi mortaliteye sebep olmakla kalmayıp kemoterapi başlangıcını da geciktirmektedir.

Background: Healthcare–associated infections results increased healthcare costs and mortality. There are limited studies concerning the distribution of the etiologic agents and the resistance patterns of the microorganisms causing healthcare–associated urinary tract infections (HA-UTI) in pediatric settings.Objectives: The aim of this study was to evaluate the distribution and antibiotic susceptibility patterns of pathogens causing HA-UTI in children.Material and Methods: Isolates from 138 children with UTI who were hospitalized in pediatric, neonatal and pediatric surgery intensive care units were reviewed.Results: Most common isolated organism was Kleibsella pneumoniae (34.1%) and Escherichia coli (26.8%). Among the Pseudomonas aeruginosa, Meropenem and imipenem resistance rates were 46.2% and 38.5%. Extended spectrum beta-lactamase (ESBL) production was present in 48 Klebsiella species (82.75%). Among ESBL positive Klebsiella species, the rate of meropenem and imipenem resistance was 18.8% and ertapenem resistance was 45.9%. Extended spectrum beta-lactamase production was present in 27 (72.9%) Escherichia coli species. Among ESBL positive E.coli, the rate of meropenem and imipenem resistance was 7.4% and ertapenem resistance was 14.8%Conclusions: Emerging meropenem resistance in P. aeruginosa, higher rates of ertapenem resistance in ESBL positive ones in E.coli and Klebsiella species in pediatric nosocomial UTI are important notifying signs for superbug infections.