The Evaluation of Nosocomial Candidemia in Pediatric Intensive Care: A Single-center Study

Objective: Patients in pediatric intensive care units are more likely to develop serious nosocomial infections due to comorbidities, longer and more invasive procedural treatments, and the development of immunosuppression. We described Candida infections, management, morbidity and mortality in critically ill pediatric patients. Materials and Methods: A retrospective single-center study includes patients aged 1 month-18 years treated against candidemia from January to December 2021. This included those who had blood cultures of Candida species growth. We excluded patients with infection Candida in endotracheal aspiration and/or urinary specimens, etc. The demographic characteristics, medical histories, comorbidities, length of stay, need for mechanical ventilation supports, laboratories, relationship use of catheters and total parenteral nutrition, treatment periods, antifungal response/resistance, duration of treatment and adverse effects, morbidities/mortalities. Results: In this study, the total mortality rate was 40.7%, and the mortality rate due to candidemia was detected at 44.4%, but the correlation between candidemia and mortality was not significant (p=0.975). However, 18.5% of them are caused by nosocomial. The mortality risk did not change for subtypes (p=0.975). No significant correlation was found when mortality (p=0.07) and central venous catheter infection (p=0.563) were compared using total parenteral nutrition. Conclusion: In our study, in which 27 patients were followed up for nosocomial candidemia, the rate of candidemia was found to be higher in patients with comorbidity, long-term mechanical ventilation support, central venous catheter use, long hospital stay, parenteral nutritional support, and high Pediatric Risk of Mortality III score. C. parapsilosis was detected most frequently in our Candida subtype unit with a rate of 59.3%. The fluconazole 8 (29.6%), amphotericin B 18 (66.7%) and voriconazole 1 (3.7%) patients were initiated. At this treatment time, only 4 (14.8%) patients developed organ failure. In our study, we detected a total mortality rate of 40.7%. However, 18.5% of them were caused by nosocomial candidemia. Considering all these reasons, we believe that our risk factors, diagnosis, treatment, follow-up, and management process will contribute to the literature

The Impact of Multiple Viral Infection in Children with Severe Lower Respiratory Tract Infections

Aim:We aimed to compare the clinical features and outcomes between single and multiple viral pathogens in children with severe lower respiratory tract infections (LRTIs) in a pediatric intensive care unit (PICU).Materials and Methods:This study was conducted retrospectively in patients who were admitted to a PICU between March, 2018 and March, 2020. The subjects were divided into two groups, single viral infection and multiple viral infection. The epidemiologic characteristics, clinical features, disease severity and outcomes were compared between these single and multiple viral infection groups.Results:During this study period, positive polymerase chain reaction (PCR) tests were carried out on 136 (29%) children among the 468 children admitted to the PICU with the diagnosis of LRTI. Rhinovirus and Respiratory Syncytial Virus (RSV) were the most commonly identified viruses (44.1% and 35.2%, respectively). Two viruses were detected in thirty-nine (28.6%) of samples via PCR tests. Rhinovirus and RSV co-infection was the most common combination (10/39, 25.6%) in our cohort. The multiple viral infection group had higher PRISM scores than the single virus infection group (10 vs. 7, respectively, p=0.009). In the multiple viral infection group, the invasive ventilatory support rate (56.4% vs 36.1%, p=0.030) and the non-invasive ventilatory (NIV) support rate (43.5% vs 6.1%, p=0.018) were significantly higher than in the single viral infection group.Conclusion:Lower respiratory multi-viral infections are associated with increased invasive and NIV support requirements. Close monitoring in a unit where support can be provided is essential for those infants with multi-viral LRTIs

Çocuk yoğun bakım ünitesinde dirençli gram negatif bakteriyel enfeksiyonların tedavisinde Levofloksasin kullanılması güvenli midir?

Amaç: Günümüzde hastane ilişkili ve dirençli enfeksiyonlar artmaktadır. Bunların eradikasyonu, artmış antibiyotik direnci ve dar tedavi seçenekleri nedeniyle zordur. Bu nedenle çocuk yoğun bakımlarda farklı antibiyotiklerin kullanımı artmıştır. Florokinolonlar, geniş spektrumlu bir antimikrobiyal türüdür. Çocuklarda klinik olarak kullanımlarına ilişkin bildirilen belirli bir komplikasyon yoktur. Çalışmamız tek merkezli retrospektif olup levofloksasin tedavisinin etkileri, sonuçları ve güvenliği açısından değerlendirilmesini amaçlanmıştır. Gereç ve Yöntemler: Üçüncü basamak olan hastanemizde Temmuz-Aralık 2021 tarihleri arasında çocuk yoğun bakımda levofloksasin ile tedavi edilen 22 hastanın dahil edildiği retrospektif tek merkezli bir çalışma yapıldı. Hastaların demografik özellikleri, tıbbi öyküleri, komorbiditeleri, yatış süreleri, mekanik ventilasyon ihtiyacı, laboratuvar tetkikleri, enfeksiyon/mikroorganizma tipi ve tedavi süresi, tedaviye yanıtı ve yan etkileri, morbidite ve mortaliteleri incelendi. Bulgular: Levofloksasin kullanılan hastalarda Stenotrophomonas maltophilia 13 (%59,1) ve Pseudomonas aeruginosa 9 (%40,9) hastada saptandı. Bu hastalarından 20 (%90,9)’sinin enfeksiyonları eradike edilmişti. Çalışmanın mortalite oranı %13,6 olup 19 hasta (%86,4) başarılı şekilde tedavi edildi. Bu tedavi süresince levofloksasine bağlı herhangi bir komplikasyona rastlamadık. Eradike olan hastalarda levofloksasin 14-27 (21) gün, eradike edilemeyenlerde tedavi 10-14(12) gün verilmişti. Bu tedavi süresi istatistiksel olarak anlamlı bulunmuştur (p=0.007). Sonuç: Enfeksiyonların eradikasyonunun zorluğu ve artan antibiyotik direnci nedeniyle, genellikle pediatrik grupta kullanılmayan antibiyotiklerin veya yeni ilaç kategorilerinin geliştirilmesi gereklidir. Bu nedenle levofloksasin de dahil, yeni antibiyotik gruplarının gram negatif bakterilerin tedavisindeki etkinliğini değerlendirecek çok merkezli, randomize kontrollü ve uzun süreli gözlemsel çalışmalara ihtiyaç vardır

Measles-rubella-mumps vaccination in cases with egg allergy: Is skin prick test necessary? Can vaccination be done safely?

WOS: 000418200900008Amaç: İçerisinde yumurta proteini bulunan kızamık-kızamıkçık-kabakulak aşısının (KKK) yumurta alerjisi olan hastalarda doğrudan uygulanması önerilmesine karşın literatürde aşı uygulaması sırasında anaflaksi gözlenen olguların bulunması nedeniyle bu konu hem hekim hem de ailelerde sıkıntılara neden olmaktadır. Bu çalışmada, kliniğimizde yumurta alerjisi nedeniyle izlenen, KKK aşı uygulanmış hastalarda aşı sonrası reaksiyon sıklığının ve aşı uygulaması öncesi aşı ile deri prick test uygulamasının gerekliliğinin değerlendirilmesi amaçlanmıştır.Yöntem: Retrospektif kesitsel çalışmamızda Eylül 2013-Mayıs 2015 tarihleri arasında yumurta alerjisi tanısı ile izlenip, KKK aşısı uygulanmış olan 82 hasta değerlendirildi. Bulgular: Tanı anında yaş ortalaması 8,34±7,1ay olan 82 hastanın %37,8'i (n=31) kız idi. Tanısal dağılımına göre hastalar değerlendirildiğinde, %68,3'ü (n=56) atopik dermatit, %8,5'i (n=7) ürtiker/anjioödem, %18,3'ü (n=15) reaktif havayolu hastalığı, %4,9'u (n=4) anafilaksi olarak değerlendirilmişti. KKK aşı uygulaması öncesi %21'ine (n=17) aşı ile deri prick test uygulanmıştı. Anafilaksi tanısı ile izlenen 2 olgu dışında aşı tam doz yapılmış olup, olguların hiçbirinde KKK aşısı uygulaması sonrasında reaksiyon gözlenmemişti. Sonuç: Yumurta alerjili hastalarda KKK aşısı sonrası herhangi bir reaksiyon gözlenmemiştir. Bu hastalarda diğer sağlıklı çocuklardan farklı reaksiyonlar gözlemediğimiz için KKK aşısının diğer aşıların yapıldığı merkezlerde, aşı ile teste ve bölünmüş dozlara gerek kalmadan uygulanmasında sakınca olmadığını düşünüyoruz.Objective: Measles-mumps-rubella vaccine which contains egg protein is considered as a potential allergen in children with egg allergy and although administration of the vaccine without any evaluation in egg allergic patients is suggested, due to the presence of reported cases of anaphylaxis during vaccination in the literature this issue causes distress to both families and doctors. In this study the frequency of reactions observed after MMR vaccination and the necessity of skin prick test in the patients followed up with egg allergy in our clinic were evaluated. Methods: In our study, 82 patients followed up with the diagnosis of egg allergy diagnosis and administered MMR vaccine between September 2013 and May 2015 were included in retrospective cross-sectional study. Results: The average age was 8.34 +/- 7.1 months, and 37.8% (n=31) of the cases were female. According to their diagnostic distribution, the patients had atopic dermatitis (n=56; 68.3%) had, urticaria/angioedema (n=7; 8.5%), reactive airway disease (n=15; 18.3%), and anaphylaxis (n=9; 4.9%). Skin prick test was administered to 17 (21%) patients before MMR vaccination. A whole dose of vaccine was administered to all cases except in two cases with the diagnosis of anaphylaxis. There was no reaction observed after MMR vaccination in any of the cases. Conclusion: Any reaction was not observed in any of egg allergy cases after MMR vaccination. Since we didn't observe any reaction in these patients different from that seen in other healthy children, we think that there is no containdication for administering MMR vaccines at the centers in which the other vaccines were done, without any need to administer MMR vaccine with prick test or in divided doses

Influenza Virus Associated Pediatric Acute Respiratory Distress Syndrome: Clinical Characteristics and Outcomes.

Background and Objective: The aim of this multicenter retrospective study was to determine the clinical characteristics, treatment approaches and the course of pediatric acute respiratory distress syndrome (PARDS) which developed associated with the influenza virus in the 2019-20 season

Mortality risk factors among critically ill children with MIS-C in PICUs: a multicenter study

Background: This study evaluated of clinical characteristics, outcomes, and mortality risk factors of a severe multisystem inflammatory syndrome in children admitted to a the pediatric intensive care unit. Methods: A retrospective multicenter cohort study was conducted between March 2020 and April 2021 at 41 PICUs in Turkey. The study population comprised 322 children diagnosed with multisystem inflammatory syndrome. Results: The organ systems most commonly involved were the cardiovascular and hematological systems. Intravenous immunoglobulin was used in 294 (91.3%) patients and corticosteroids in 266 (82.6%). Seventy-five (23.3%) children received therapeutic plasma exchange treatment. Patients with a longer duration of the PICU stay had more frequent respiratory, hematological, or renal involvement, and also had higher D-dimer, CK-MB, and procalcitonin levels. A total of 16 patients died, with mortality higher in patients with renal, respiratory, or neurological involvement, with severe cardiac impairment or shock. The non-surviving group also had higher leukocyte counts, lactate and ferritin levels, and a need for mechanical ventilation. Conclusions: In cases of MIS-C, high levels of D-dimer and CK-MB are associated with a longer duration of PICU stay. Non-survival correlates with elevated leukocyte counts and lactate and ferritin levels. We were unable to show any positive effect of therapeutic plasma exchange therapy on mortality. Impact: MIS-C is a life-threatening condition.Patients need to be followed up in the intensive care unit.Early detection of factors associated with mortality can improve outcomes.Determining the factors associated with mortality and length of stay will help clinicians in patient management.High D-dimer and CK-MB levels were associated with longer PICU stay, and higher leukocyte counts, ferritin and lactate levels, and mechanical ventilation were associated with mortality in MIS-C patients.We were unable to show any positive effect of therapeutic plasma exchange therapy on mortality