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Objective: This study aimed to evaluate the epidemiological, microbiological, clinical characteristics of the patients followed up with different types of underlying hematologic malignancies and solid tumors. Method: This cohort study included patients with pediatric malignancy. Eighty-eight patients who were followed up for two years were included. The number of days from the first diagnosis, recurrent infectious episodes, number of days with fever, presence of neutropenia and nonneutropenic episodes, chemotherapy regimens, antimicrobial agents, blood and urinary tract culture samples were recorded. Results: A total of 149 infectious episodes were observed. The median age was 5.08 years. The mean age was 9.02+-5.17 years in patients who had no infectious episodes during the follow-up and 5.70+-4.60 years in patients with two and more infectious episodes and was significantly lower (p=0.024). In total, 264 microbial cultures were retrieved from different locations during these infectious episodes. Regarding all the cultures, 27% of blood cultures and 9% of urinary tract cultures were positive. The most commonly isolated microorganism were Grampositive bacteria (n=23, 57.5%). Conclusion: Younger children with cancer are at higher risk of infection complications compared to children of older ages. Children with hematologic malignancies are more likely to develop a neutropenic fever during the consolidation and induction periods. Regarding the high rate of FUO in our study, more attempts to increase microbiological diagnosis in this patient population.

Abstract Background Antibiotic-associated diarrhea is one of the most frequent side effects of antimicrobial therapy. We assessed the epidemiological data of antibiotic-associated diarrhea in pediatric patients in our region. Methods The prospective multi-center study included pediatric patients who were initiated an oral antibiotic course in outpatient clinics and followed in a well-established surveillance system. This follow-up system constituded inclusion of patient by the primary physician, supply of family follow-up charts to the family, passing the demographics and clinical information of patient to the Primary Investigator Centre, and a close telephone follow-up of patients for a period of eight weeks by the Primary Investigator Centre. Results A result of 758 cases were recruited in the analysis which had a frequency of 10.4% antibiotic-associated diarrhea. Among the cases treated with amoxicillin-clavulanate 10.4%, and cephalosporins 14.4% presented with antibiotic-associated diarrhea. In the analysis of antibiotic-associated diarrhea occurrence according to different geographical regions of Turkey, antibiotic-associated diarrhea episodes differed significantly (p = 0.014), particularly higher in The Eastern Anatolia and Southeastern Anatolia. Though most commonly encountered with cephalosporin use, antibiotic-associated diarrhea is not a frequent side effect. Conclusion This study on pediatric antibiotic-associated diarrhea displayed epidemiological data and the differences geographically in our region.

Aim:Micafungin is one of three currently available echinocandin for the treatment of candidiasis and candidemia. We aimed to discuss the effectiveness of micafungin and any possible side effects in the treatment of proven candidemia in children.Materials and Methods:In this study, children who were treated with micafungin for proven candidemia between May, 2017 and October, 2019 were included. The time to achieve negative culture, liver and renal functions as well as blood counts were recorded using the hospital data system.Results:Forty-five patients (52.3%) who received micafungin for proven candidemia were included in this study. The median age of the children who received micafungin due to invasive candidiasis (IC) was 4 months (range: 12 days to 216 months). Of these 45 IC patients, 10 (22.2%) were neonates, 19 (42.2%) were infants, 11 (24.4%) were between 1 and 5 years old, and 5 (11.1%) were between 10-18 years old. The median duration of micafungin treatment to culture negativity for C. albicans related candidemia episodes was shorter (6 days, 1-26 days) than non-albicans Candida spp. related candidemia episodes (7 days, 1-35 days) (p=0.10). Culture negativity could not be achieved at the end of the 14th day of micafungin treatment in 15 of the 45 (33.3%) candidemia episodes. The most commonly isolated Candida spp. in patients with treatment failure was C. parapsilosis (n=6), followed by C. albicans (n=5), C. guilliermondii (n=1), C. tropicalis (n=2) and C. tropicalis and C. guilliermondii co-infection (n=1) respectively. None of the patients developed side effects due to micafungin treatment.Conclusion:Micafungin was found to be safe and effective for the treatment of culture proven candidemia in pediatric patients, including neonates.

Objective: There is currently no drug that is effective against the coronavirus disease-2019 (COVID-19) and no consensus was present regarding the treatment. In this cross-sectional study, we aimed to evaluate the progress of the treatment process of patients with COVID-19 since the first day of pandemic in our country and the changes in the process. Method: This single-center cross-sectional study was conducted from March 11 through November 30, 2020, in University of Health Sciences Turkey, Dr. Behçet Uz Pediatric Diseases and Surgery Training and Research Hospital, a 400-bed tertiary care hospital in İzmir, Turkey. Treatment options in all hospitalized children with COVID-19 were evaluated. Results: Evaluation of our clinical treatment algorithm from March to December, it was seen that the majority of the patients did not need any specific treatment and recovered only with supportive treatment. Because of the recommendations of the COVID-19 guidelines, no efficacy has been detected during the oseltamivir treatment and there was a significant decrease in use of azithromycin and hydroxychloroquine. Favipiravir is still the first choice of drug for patients with COVID-19. Conclusion: World Health Organization, the Infectious Diseases Society of America, and Surviving Sepsis guidelines indicate that their investigational treatments should only be used in certain clinical trial setting. Supportive care is still the main therapeutic option in COVID-19.

Abstract Background For children with the multisystem inflammatory syndrome(MIS-C), intravenous immunoglobulins (IVIG) with or without methylprednisolone are the most effective treatment. In this study, IVIG combined with methylprednisolone was compared to IVIG used alone in children with MIS-C. Methods This retrospective cohort study was carried out between April 1, 2020, and November 1, 2021. This study covered all children with MIS-C. According to whether they received IVIG alone or IVIG with methylprednisolone as an initial treatment for MIS-C, the patients were split into two groups. The IVIG dosage for the patients in group I was 2 gr/kg, whereas the IVIG dosage for the patients in group II was 2 gr/kg + 2 mg/kg/day of methylprednisolone. These two groups were contrasted in terms of the frequency of fever, length of hospital stay, and admission to the pediatric intensive care unit. Results The study comprised 91 patients who were diagnosed with MIS-C and were under the age of 18. 42 (46.2%) of these patients were in the IVIG alone group (group I), and 49 (53.8%) were in the IVIG + methylprednisolone group (group II). Patients in group II had a severe MIS-C ratio of 36.7%, which was substantially greater than the rate of severe MIS-C patients in group I (9.5%) (p 0.01). When compared to group I (9.5%), the rate of hypotension was considerably higher in group II (30.6%) (p = 0.014). Additionally, patients in group II had considerably higher mean serum levels of C-reactive protein. The incidence of fever recurrence was 26.5% in group II and 33.3% in group I, however the difference was not statistically significant (p > 0.05). Conclusions The choice of treatment for patients with MIS-C should be based on an individual evaluation. In MIS-C children with hypotension and/or with an indication for a pediatric intensive care unit, a combination of IVIG and methylprednisolone may be administered. For the treatment modalities of children with MIS-C, however, randomized double-blind studies are necessary.

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: Central venous catheters (CVC) provides great convenience in pediatric intensive care units (PICUs). In this study, we aimed to prospectively examine patients who underwent CVC in the PICU in terms of catheter types and infections Methods: We conducted our monocentric, prospective, and cohort study by including patients between January 2019 and December 2020, involving all central catheters temporarily inserted, except port-line catheters, PICCs, indwelling catheters (cuffed and uncuffed tunnel catheters), and arterial catheters. The main issue we focus on is the rate of catheter-associated bloodstream infection (CLABSI). We analyzed the relationship between infection and risk factors using binary logistic regression analysis. Results: We included 26 CLABSIs with 196 CVCs. The incidence rate was 6.2/1000 catheter days. We found that the incidence of CLABSI increased in femoral catheters (OR: 0.04 p: 0.035, 95% CI: 0.49-3.49). Moreover, the incidence was increased in catheters with 3 lumens (OR: 0.06, p: 0.031, 95% CI: 0.34-1.69). The prolongation of the catheter also increases the risk of infection (OR: 0.06, p: 0.028, 95% CI: 0.56-2.36). Also, we found that the frequency of CLABSI increased in patients with underlying immunodeficiency (OR: 0.19, p: 0.007, 95% CI: 0.85-1.39) and in patients who were given total parenteral nutrition (OR: 0.02, p: 0.041, 95% CI: 0.063-2.38). Conclusion: The number of studies that directly compare catheter types in pediatric patients and their relationship with CLABSI is limited. Moreover, the comparison of unrelated studies is difficult because of heterogeneity in study populations. Multicenter pediatric prospective studies focused on identifying catheter-associated infections are needed.

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.

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: 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.

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.

Aim:The ratio of monocytes to lymphocytes (ML) could reflect an immunity to Mycobacterium tuberculosis (TB). The objective of this study was to evaluate the relationship between the ratio of ML and the clinical status of patients with active TB.Materials and Methods:This was a retrospective review of data collected from the clinical database of the Behcet Uz Children’s Research Hospital. One hundred thirty-eight patients were diagnosed with pulmonary and extra-pulmonary TB from January 2006 to January 2015. White blood cell count, absolute monocyte and absolute lymphocyte counts, the ML ratio, erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were compared between extra-pulmonary and pulmonary TB cases. Pre-treatment and after treatment values of the parameters were also compared in both of the groups.Results:A total of 138 patients were diagnosed as having pulmonary or extra-pulmonary TB during the study period. No significant difference between pulmonary and extra-pulmonary TB was present regarding white blood cell count, absolute ML, ESR and CRP (p>0.05). In patients with pulmonary TB and extra-pulmonary TB, a significant decrease in white blood cell count, absolute monocyte count, ESR and CRP values after treatment compared to pretreatment was observed (p0.05) while a significant difference was present between the pre- and post-treatment groups in pulmonary TB (p=0.000).Conclusion:The hematological markers including the ML ratio were found to be more useful for monitoring the response of TB therapy, rather than as a differential diagnosis of pulmonary TB from extra-pulmonary TB.

Abstract 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

INTRODUCTION: There are limited data focusing on cytomegalovirus (CMV) incidence and manifestations in children with acute lymphoblastic leukemia (ALL) apart from bone marrow transplant recipients. In this study, we review our experience of the manifestations, treatment, and outcome of cytomegalovirus infection in pediatric ALL patients. METHODS: We retrospectively reviewed the clinical characteristics of patients with ALL that were diagnosed with CMV disease while they are on standard chemotherapy. RESULTS: Fourteen patients were included. Fever was the most common symptom (64%). Eyes, lungs and liver were the most commonly involved organs in CMV disease. Lymphopenia was found in most of the patients. At the time of diagnosis, 50% of the patients were on maintenance phase of chemotherapy. All patients were treated with intravenous ganciclovir; two patients died because of concomitant infections, two children with retinitis had permanent visual sequelae and others had a complete recovery. DISCUSSION AND CONCLUSION: In children with ALL, CMV is an important pathogen with serious consequences including retinitis which may be asymptomatic and result in complete visual loss. Not only during intense chemotherapy but also in maintenance phase CMV disease may occur. Especially when prolonged (>7 days) febrile neutropenia and lymphopenia is present, CMV must be kept in mind for differential diagnosis.

INTRODUCTION: This cross-sectional descriptive study aimed to evaluate the distribution of the diseases which were reported to the mandatory disease system and the characteristics of the patients in 2018. METHODS: Between January 2018 – December 2018, all patients who were notified according to the 'Ministry of Health, Standard Diagnosis, Surveillance and Laboratory Guidelines of the Communicating Diseases and Notification System' in Dr. Behçet Uz Children's Hospital except rabies risk-contact cases were included in the current study. Data of the patients was collected from medical records. RESULTS: During the study period 392 communicable diseases were notified. Of these, 41 cases were excluded due to recurrence of notified diseases. As a result a total of 351 patients included in the final evaluation. The most frequently reported diseases were varicella diseases (176 cases, 50%), pertussis (35 cases, 10%), and influenza (25 cases, 7.1%). The most frequent notification was made by the emergency department (129 cases, 36.8%). DISCUSSION AND CONCLUSION: There are very few studies on the notification of the communicable disease reports in Turkey, especially in childhood. Evaluation of the notifications of communicable diseases is accurate for the proper epidemiological surveillance,

INTRODUCTION: Aim of the study was to evaluate rabies-suspected animal contact (RSAC) cases admitted to our center and determine the high-risk groups and the high-risk periods during the year. METHODS: This retrospective study was carried out at Dr. Behçet Uz Children's Hospital between December 2017 and December 2018. All children who were admited to the emergency service due to RSAC were reviewed. RESULTS: A total of 224 cases were analyzed. Of these, 140 (62.5%) were male and 84 (37.5%) were female. The mean age of the patients was 7.4+-4.7 years, and 50.9% of the patients were older than seven years. During the study period, 97.7% of the RSAC originated from domestic animals (Dogs and cats constituted 45.9% and 35.2%, respectively). Most of the admissions due to contacts were in April (32 cases, 14.3%) and in June (28 cases, 12.5%). DISCUSSION AND CONCLUSION: According to World Health Organization data, RSAC cases are seen more frequently under 15 years of age. While in developed countries, wild animal rabies are more common; in developing countries such as Turkey domestic animal rabies (especially caused by dogs) is seen more frequently. Rabies is still a public health problem in endemic areas such as our country. For this reason, we consider that is important to determine the risky periods and groups of contact and to take the necessary precautions.

Abstract Objective Smartphones and associated messaging applications have become the most common means of communication among health care workers and the general population. The aim of this study was to evaluate the reliability and accuracy of smartphones for the diagnosis of rash in children admitted to emergency departments during the night shift. Methods The images of the children who were admitted to the paediatric emergency department with rash were included in this study, and at least two images taken with smartphones by residents or paediatric infectious disease fellows were re-directed to the chief consultant of the Paediatric-Infectious Department via smartphone. Initial diagnosis by the consultant was recorded, and the patient’s physical examination was performed by another clinician on the first working day; diagnostic tests were planned by this clinician. The definitive diagnosis was recorded and compared with the initial diagnosis. Results Among the 194 patients, the most common final diagnoses were chickenpox (varicella-zoster infections) in 33 patients (17.0%) and skin infections (including impetigo, ecthyma, erysipelas and cellulitis) in 33 patients (17.0%). The initial diagnosis, which was performed via WhatsApp on a smartphone, was identical to the final diagnosis in 96.3% of the cases. Incompatible initial diagnoses included 4 measles cases, 1 staphylococcal scalded skin syndrome case, 1 cutaneous leishmaniasis case and 1 petechial rash case. Conclusions Our study has shown that the use of a smartphone-based instant messaging application for transmitting images of paediatric rash is accurate and useful for diagnosis. However, physical examination and medical history are still the primary methods. Consultation via smartphones in emergency departments for paediatric rashes during nightshifts would help both clinicians and patients.

ABSTRACT 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.

Mastitis and breast abscess do not occur frequently during neonatal period. The most common pathogen is Staphylococcus aureus. Gram negative species are rarely the cause. Treatment of breast abscess is mainly surgical drainage of the abscess, and with the use of proper antibiotics complete resolution is attainable. If not treated properly, severe suppurative complications may develop. A 40 days old infant was hospitalized with a 15 days of history of redness, swelling and warmth on the left breast, despite she had been treated with breast abscess diagnosis in another health care center.Breast abcsess was shown on ultrasound; surgical drainage was performed. Pseudomonas aeruginosa was isolated from pus sample; and appropriate antibiotics were used according to the culture antibiogram results for treatment. In this article, a case of breast abscess which is remarkable for occurring in neoanatal period and having a rare cause as Pseudomonas aeruginosa was reported with a review of recent literature.

Septic arthritis is an inflammation of the synovial membrane and synovial fluid in the joints caused by bacterial, viral or fungal agents. Since it has high morbidity rate, requires urgent intervention. The synovial membrane is a highly vascular structure, but because it is not a protective basement membrane, the microorganisms that come through the bloodstream can easily settle here. For this reason, it should be kept in mind that an infection such as septic arthritis may develop in a hematogenous way in patients exposed to many invasive procedures, and having long-term catheter in pediatric intensive care unit. Serratia species are a gram-negative facultative anaerobic population of the Enterobacteriaceae group and have become more common in recent years as a cause of hospital-acquired bacteremia, pneumonia and urinary tract infections in intensive care units. However, primary joint infections secondary to infection with Serratia marcescens are extremely rare. Almost all cases were seen in trauma patients, immunocompromised patients, in those with central catheters and intensive care patients. When septic arthritis due to Serratia marcescens is not treated urgently, septicemia and mortality risk is high and may cause permanent destruction of the joint. Here, we present a rare case of septic arthritis caused by Serratia marrascens after a bacteremia in a patient with Escobar variant of Multiple Pterygium syndrome who had a central vascular access device and was hospitalized in the pediatric intensive care unit.

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.

An amendment to this paper has been published and can be accessed via the original article.

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.

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.

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

Tularemia, a zoonotic disease caused by Francisella tularensis, is found throughout most of the Northern Hemisphere. It is not well known and is often misdiagnosed in children. Our aim with this study was to evaluate the diagnosis, treatment, and prognosis for 100 children with tularemia in Turkey. The mean patient age was 10.1 ± 3.5 years (range 3–18 years), and most (63%) patients were male. The most common physical signs and laboratory findings were cervical lymphadenopathy (92%) and elevated erythrocyte sedimentation rate (89%). Treatment response was higher and rate of relapse lower for children 5–10 years of age than for those in other age groups. Associated with treatment failure were female sex, treatment delay of ≥16 days, and use of doxycycline. Tularemia is endemic to Turkey, and the number of cases has been increasing among children as well as adults.

Background: We aimed to evaluate the correlation of caspofungin E-tests with the prognosis and response to caspofungin therapy of Candida parapsilosis complex bloodstream infections in children hospitalized in pediatric intensive care unit. Methods: All children who had C.parapsilosis complex bloodstream infections and who were treated with caspofungin were included in this retrospective study. For each patient, the following parameters, including all consecutive blood and central venous catheter (CVC) cultures, duration between diagnosis and CVC removal, mortality rate, relapses of the C.parapsilosis complex infections as well as the demographic features, were recorded. Results: The study covered 53 patients with a median age of 11 months. The median duration of C.parapsilosis complex isolation was 31 days. The CVC rescue rate was 33.3% under caspofungin treatment. In 92.4% of the patients, the negative culture was achieved within a median duration of 14 days. The rate of relapses was 18.9%. The overall mortality rate was %37.7 (20 patients) and 30-days mortality rate was 7.5% (4 patients). Conclusions: Caspofungin is an attractive option due to its effects on biofilms in vivo, while the reflection of its affect on C.parapsilosis complex was limited in our study, but it should not be underestimated in children who strongly need the presence of central venous catheters. Moreover, in vivo susceptibility might not always guarantee good clinical response in clinical practice. The clinicians should weigh their priority for their patients and choose the optimal antifungal therapy for C.parapsilosis complex infections in children.

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

Background: The newer antifungal drugs were related to have fewer side effects such as infusion related problems and nephrotoxicity. However hepatotoxicity due to antifungal drugs had been more increasingly reported with a wide spectrum changing from asymptomatic abnormalities in liver function test results to potentially fatal fulminant hepatic failure Methods: This study was designed and conducted as a retrospective study of immunocompromised pediatric patients to whom voriconazole was administered for proven or probable invasive fungal infections, between January 2008-December 2011. The alanine aminotransferase (ALT), total bilirubin levels and hemogram with absolute neutrophil count were recorded. Results: A total of 60 patients with 90 probable and possible invasive aspergillus infection were enrolled in this study. Among the 90 episodes of voriconazole therapy; six patients (6,6%) had increased ALT levels (116 to 416 u/L). Rest of them had normal levels of ALT during the 21 day period. The mean duration of the day that the ALT increased was 9th ± 5,0 day (ranging from 3th days to 15th days). The median duration of the hepatotoxicity was 6 days, ranging from 6 to 22 days. Only one patient had increased direct bilirubin levels. Conclusion: Hepatotoxicity due to 7 mg/kg/dose twice a day of voriconazole treatment is very low even with the long duration of exposure; and discontinuation of the drug in children may not be required in case of invasive aspergillus infections.

Background: Tuberculosis(TB) remains a major global health problem. The childhood tuberculosis has some unique features different which makes the diagnosis more complicated. We described the epidemiologic, clinical and microbiologic features of children with extrapulmonary and pulmonary TB. Methods: The data of the patients 10 years. PTB was present in 75.0% of the cases and EXPTB was present in 25% of cases. There was no significant difference between the EXPTB and PTB by means of distribution of age groups(p=0,201). The rate of patients free of constitutional symptoms were significantly higher in EXPTB compared to PTB(p=0.000). There was no significant difference between EXPTB and PTB by means of sources detection(p=0.069). Conclusion : TB is still a major public health problem. EXPTB has an insidious and silent onset without any constitutional symptoms and microbiological confirmation plus the adult source could not be found mostly. Thus detection of the adult source is mandatory for controlling the TB disease in children

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.

Abstract 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.