Evaluation of Viral Agents Detected in Children Admitted to Hospital Due to Lower Respiratory Infection

INTRODUCTION: Background\Aim: Viruses are among the most common causes of acute respiratory tract infections. In this study we aimed to investigate the viral pathogens detected in the nasopharyngeal swab specimens obtained from children in our pediatric ward being followed up due to acute lower respiratory tract infection and to analyse the distribution of the pathogens by age and months. METHODS: Method: This research was carried out between January 2019-January 2020, 289 patients (44.2% female, 55.7% male) admitted for acute respiratory tract infection were included. Patient records were reviewed retrospectively. Viral agents distribution was analysed according to age, sex and months (seasons/seasonall variation). RESULTS: Findings: In 117 (40.5%) of 289 patients viruses were not detected (negative) in the respiratory tract, in 172 (59.5%) they were detected (positive). In 148 (86%) patients a single agent, in 22 (12.8%) patients two agents, in 1 (0.6%) patient three agents, in 1 (0.6%) patient four agents were found. The most common virus detected was rinovirüs (HRV) (23.9%), the second most common was found to be respiratory syncytial virus A (RSVA) (16.3%). The most common agent in ages 0-3 was HRV, after 3 years the most common agent was influenza B virüs (IBV). IBV was the most common during the winter, HRV was the most common in the other seasons. DISCUSSION AND CONCLUSION: Results: In our study 59.5% of admitted children were found to have at least one respiratory virus. Multiplex PCR is a sensitive and specific method which detects viruses that are undetectable by classical methods, gives results in a shorter time compared to classical methods and also a method in which more than one specimen can be processed at the same time. With a faster method diagnosis of viruses, inappropriate use of antibiotics and development of antibiotic resistance can be prevented

Evaluation of Tracheal Aspirate Cultures of Patients Followed with Home Mechanical Ventilators

Purpose: To investigate the underlying diseases, and complaints of patients upon admission, isolated microorganisms from tracheal aspirate (TA) samples and their resistance to antibiotics in patients followed up with a home mechanic ventilator (HMV). Materials and Methods: Between January 1, 2020 and January 1, 2021, TA cultures, identification of bacteria and their antibiotic susceptibilities were evaluated by VITEK 2 (bioMeriux, France) automated identification system. The patients' age, gender, underlying diseases, duration of home ventilator use, complaints, and laboratory data were reviewed. Results: Of the 91 prediagnosed ventilator-associated pneumonia (VAP) patients, 72 (79%) were male and mean age was 91.64 ± 64.07 months. The most common reason for referral was fever and dyspnea and 43.76% of the patients were diagnosed with cerebral palsy/epilepsy and 10.4% with syndromes. Of the samples; 12 (13.3%) were defined as Gram-positive and 79 (86.7%) as Gram-negative. Pseudomonas aeruginosa was detected in 44 (48.4%) samples, Serratia marcescens in 9 (9.9%), Klebsiella spp. in 8 (8.8%) and Staphylococcus aureus was in 12 (13.3%) samples. Carbapenem resistance was 18.75% for Pseudomonas aeruginosa, 16% for Klebsiella spp, 12.5 for Escherichia coli and 12% for Acinetobacter baumannii. Conclusion: TA culture should be taken from patients with HMV who were admitted with signs of infection such as fever and respiratory distress and treatment should be arranged according to the result. It was observed that the TA culture antibiotic resistance rates of the patients with HMV were lower than the TA cultures sent from the patients hospitalized in the intensive care unit in the literature

Presentations of children to emergency departments across Europe and the COVID-19 pandemic: A multinational observational study

During the initial phase of the Coronavirus Disease 2019 (COVID-19) pandemic, reduced numbers of acutely ill or injured children presented to emergency departments (EDs). Concerns were raised about the potential for delayed and more severe presentations and an increase in diagnoses such as diabetic ketoacidosis and mental health issues. This multinational observational study aimed to study the number of children presenting to EDs across Europe during the early COVID-19 pandemic and factors influencing this and to investigate changes in severity of illness and diagnoses. Routine health data were extracted retrospectively from electronic patient records of children aged 18 years and under, presenting to 38 EDs in 16 European countries for the period January 2018 to May 2020, using predefined and standardized data domains. Observed and predicted numbers of ED attendances were calculated for the period February 2020 to May 2020. Poisson models and incidence rate ratios (IRRs), using predicted counts for each site as offset to adjust for case-mix differences, were used to compare age groups, diagnoses, and outcomes. Reductions in pediatric ED attendances, hospital admissions, and high triage urgencies were seen in all participating sites. ED attendances were relatively higher in countries with lower SARS-CoV-2 prevalence (IRR 2·26, 95% CI 1·90 to 2·70, p < 0.001) and in children aged <12 months (12 to <24 months IRR 0·86, 95% CI 0·84 to 0·89; 2 to <5 years IRR 0·80, 95% CI 0·78 to 0·82; 5 to <12 years IRR 0·68, 95% CI 0·67 to 0·70; 12 to 18 years IRR 0·72, 95% CI 0·70 to 0·74; versus age <12 months as reference group, p < 0.001). The lowering of pediatric intensive care admissions was not as great as that of general admissions (IRR 1·30, 95% CI 1·16 to 1·45, p < 0.001). Lower triage urgencies were reduced more than higher triage urgencies (urgent triage IRR 1·10, 95% CI 1·08 to 1·12; emergent and very urgent triage IRR 1·53, 95% CI 1·49 to 1·57; versus nonurgent triage category, p < 0.001). Reductions were highest and sustained throughout the study period for children with communicable infectious diseases. The main limitation was the retrospective nature of the study, using routine clinical data from a wide range of European hospitals and health systems. Reductions in ED attendances were seen across Europe during the first COVID-19 lockdown period. More severely ill children continued to attend hospital more frequently compared to those with minor injuries and illnesses, although absolute numbers fell. ISRCTN91495258 https://www.isrctn.com/ISRCTN91495258

Evaluation of Rapid Antigen Test Results and Real-time Reverse Transcription Polymerase Chain Reaction for the Laboratory Diagnosis of SARS-CoV-2

Introduction: Real-time reverse transcription-polymerase chain reaction (RT-PCR) is the gold standard method for the diagnosis of Severe acute respiratory syndrome-Coronavirus-2 (SARS-CoV-2) infection. However, real-time RT-PCR is time-consuming, expensive, and requires special laboratory conditions and experienced personnel. Thus, the diagnostic importance of faster and easier-to-perform antigen-detecting rapid diagnostic tests (Ag-RDTs) has increased. With on-site application and fast turnaround time, Ag-RDTs provide quick isolation, minimizing the risk of transmission. We aimed to compare the results of the Mö-Screen Corona Antigen Test (MöLab, Langenfeld, Germany) and real-time RT-PCR. Materials and Methods: Nasopharyngeal swabs from 863 patients from January 2022 to March 2022 were included in the study. The SARS-CoV-2 antigen was assessed for using the Mö-Screen Corona Antigen Test. The SARS-CoV-2 real-time RT-PCR results were obtained within two days in 417 patients. Results: The agreeability of the real-time RT-PCR and Ag-RDT results was 96.2%. The sensitivity and specificity of Ag-RDT were 84.8% and 100%, respectively. The test sensitivity increased to 92% in specimens with Ct value <25. Conclusion: The Mö-Screen Corona Antigen Test (MöLab, Langenfeld, Germany), an Ag-RDT test with a high specificity and sensitivity, may be an alternative to real-time RT-PCR for the diagnosis of SARS-CoV-2

Respective roles of non-pharmaceutical interventions in bronchiolitis outbreaks: an interrupted time-series analysis based on a multinational surveillance system

Background Bronchiolitis is a major source of morbimortality among young children worldwide. Non-pharmaceutical interventions (NPIs) implemented to reduce the spread of severe acute respiratory syndrome coronavirus 2 may have had an important impact on bronchiolitis outbreaks, as well as major societal consequences. Discriminating between their respective impacts would help define optimal public health strategies against bronchiolitis. We aimed to assess the respective impact of each NPI on bronchiolitis outbreaks in 14 European countries. Methods We conducted a quasi-experimental interrupted time-series analysis based on a multicentre international study. All children diagnosed with bronchiolitis presenting to the paediatric emergency department of one of 27 centres from January 2018 to March 2021 were included. We assessed the association between each NPI and change in the bronchiolitis trend over time by seasonally adjusted multivariable quasi-Poisson regression modelling. Results In total, 42 916 children were included. We observed an overall cumulative 78% (95% CI −100–−54%; p<0.0001) reduction in bronchiolitis cases following NPI implementation. The decrease varied between countries from −97% (95% CI −100– −47%; p=0.0005) to −36% (95% CI −79–7%; p=0.105). Full lockdown (incidence rate ratio (IRR) 0.21 (95% CI 0.14–0.30); p<0.001), secondary school closure (IRR 0.33 (95% CI 0.20–0.52); p<0.0001), wearing a mask indoors (IRR 0.49 (95% CI 0.25–0.94); p=0.034) and teleworking (IRR 0.55 (95% CI 0.31–0.97); p=0.038) were independently associated with reducing bronchiolitis. Conclusions Several NPIs were associated with a reduction of bronchiolitis outbreaks, including full lockdown, school closure, teleworking and facial masking. Some of these public health interventions may be considered to further reduce the global burden of bronchiolitis