Future Directions And Molecular Basis Of Ventilator Associated Pneumonia

Mechanical ventilation is a lifesaving treatment and has complications such as ventilator associated pneumonia (VAP) that lead to high morbidity and mortality. Moreover VAP is the second most common hospital-acquired infection in pediatric intensive care units. Although it is still not well understood, understanding molecular pathogenesis is essential for preventing and treating pneumonia. A lot of microbes are detected as a causative agent of VAP. The most common isolated VAP pathogens in pediatric patients are Staphylococcus aureus, Pseudomonas aeruginosa, and other gram negative bacteria. All of the bacteria have different pathogenesis due to their different virulence factors and host reactions. This review article focused on mechanisms of VAP with molecular pathogenesis of the causative bacteria one by one from the literature. We hope that we know more about molecular pathogenesis of VAP and we can investigate and focus on the management of the disease in near future.PubMedWoSScopu

Clinic Features, Follow-Up And Treatment Options Of Acute Paronychia In Children: Hacettepe University Experience

Objective: Paronychia, the inflammation of proximal and lateral nail folds and, is the most commonly encountered hand infection. In this study, it was aimed to evaluate the clinical features and treatment options of paronychia in our center. Material and Methods: Patients diagnosed with acute paronychia from June 2014 to December 2016 in the Pediatric Infectious Disease Department of Hacettepe University ihsan Dogramaci Children Hospital were included into the study. Patients' age, gender, underlying disease, physical examination findings, laboratory parameters, hospitalization status, treatment choices (surgery/antibiotic treatment) and durations, and complications were evaluated. Results: Seventy-five patients (37 male, 49.3%) with a median age of 8 years (0-18) were enrolled into the study. The patients were divided into two groups as immunocompetent (62, 82.7%) and immunocompromised (primary or secondary immunodeficiency, 13, 17.3%). Two of the immuncompromised patients (14.3%) and eight of immunocompetent patients underwent surgery drainage because of abscess formation. Five patients were hospitalized, three of whom (21.4%) were immunocompromised and two of whom (3.3%) were immunocompetent (p=0.01). Conclusion: Immune response of the patients diagnosed with paronychia is the main guide for treatment and follow plan.Wo

Perianal Abscess In Children: A Pediatric Infectious Disease Perspective

Introduction: There are limited data on the aetiology and management of perianal abscesses (PAs). The aim of this retrospective study was to define the characteristics of children with PAs; describe our experience with PA from the perspective of paediatric infectious medicine and determine the factors that influence clinical outcomes. Methods: We performed a retrospective review of cases of PA in children with no underlying disease managed in a tertiary referral hospital between January 2005 and July 2015. We collected data on demographic characteristics, symptoms, abscess size and location, abscess recurrences, laboratory and microbiological findings, treatment modalities, diagnosis of systemic illness at the end of the diagnostic workup and clinical outcomes. Results: We included a total of 47 patients in the study, with a predominance of male patients (93.6 vs 6.4%, P<.001). The median age was 7.7 months (IQR 1.8-13.7 months), and 40 children (85.1%) were younger than 2 years of age. Four PAs drained spontaneously and 7 healed without need of drainage (23.4%). Drainage by simple incision was applied to 36 patients (76.5%) and six PAs required fistulotomy (12.7%). Recurrent abscesses were found in 25 patients (53.1%). Three patients with recurrent PA were diagnosed with inflammatory bowel disease at the end of the diagnostic evaluation. Conclusions: Based on the findings of our study, measurement of white blood cell counts and serum levels of acute phase reactants may be useful in the initial evaluation of children with PA. In light of the high relapse rates observed in surgically managed patients, it seems reasonable to use a conservative approach in patients aged less than 2 years. (C) 2017 Asociacion Espanola de Pediatria. Published by Elsevier Espana, S.L.U.WoSScopu

Multicenter Hospital-Based Prospective Surveillance Study of Bacterial Agents Causing Meningitis and Seroprevalence of Different Serogroups of Neisseria meningitidis, Haemophilus influenzae Type b, and Streptococcus pneumoniae during 2015 to 2018 in Turkey

Emiroglu, Melike/0000-0003-1307-0246; Basaranoglu, Sevgen Tanir/0000-0002-9416-1512; Sutcu, Murat/0000-0002-2078-9796; Duman, Murat/0000-0001-6767-5748WOS: 000551068100003PubMed: 32213620The 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.GlaxoSmithKlineGlaxoSmithKlineFunding for this study was provided by GlaxoSmithKline

Respiratory Viral Infections In Infants With Possible Sepsis

Background Knowledge of infections leading to sepsis is needed to develop comprehensive infection prevention and sepsis, as well as early recognition and treatment strategies.The aim of this study was to investigate the etiology of sepsis and evaluate the proportion of respiratory viral pathogens in infants under two years of age with possible sepsis. Methods The prospective study was performed in two years. Multiplex reverse transcriptase polymerase chain reaction (RT-PCR) was performed to detect viral pathogens. All patients who were included in this study had sepsis symptoms as defined by the Surviving Sepsis Campaign. Results We compared 90 patients with sepsis into three groups as patients (n = 33) who had only viral positivity in nasopharyngeal swab, patients (17) had proven bacterial infection with or without viral infection, and patients (40) without the pathogen detection. Human rhinovirus (16.7%) and influenza (7.8%) were the most commonly seen viruses. A cough was more common in the viral infection group than other groups (P = 0.02) and median thrombocyte count was lower in the bacterial infection group than the others (P = 0.01). Patients having bacterial sepsis had the longest duration of hospitalization than the other groups (P = 0.04). During winter and spring seaons, patients with sepsis had more viral infection; however, in summer and autumn period, patients were mostly in a state that we could not prove infection agents (P = 0.02). Conclusions Our results suggest that respiratory tract viruses may play an important role in patients with sepsis and they should be kept in mind, especially during winter and spring seasons. In overall infection, viral respiratory viruses as a single pathogen with a detection rate of 36.6% in sepsis etiology.WoSScopu

Surveillance of penicillin resistance of Neisseria meningitidis strains from invasive infections between 2013 and 2018 in Turkey

Basaranoglu, Sevgen Tanir/0000-0002-9416-1512; Emiroglu, Melike/0000-0003-1307-0246WOS: 000513186600001PubMed: 32028863Neisseria meningitidis (N. meningitidis) is regarded as the leading cause of bacterial meningitis in many regions of the world. the empiric antimicrobial treatment is mainly based on antimicrobial resistance and patient characteristics. We aimed to analyze susceptibility patterns of N. meningitidis strains isolated in Turkey. Invasive meningococci collected in a multicenter, hospital-based, epidemiological surveillance study of pediatric (0-18 years of age) bacterial meningitis cases between 2013 and 2018 were studied. Five isolates (8.7%) displayed resistance to penicillin-G, while 13 isolates (22.8%) had intermediate susceptibility. All isolates were cefotaxime and rifampin susceptible. the data shows appropriateness of third-generation cephalosporins in empirical use for meningococcal infections in children. Since Turkey is located in a transition zone geographically, surveillance reports are very crucial

Invasive Pneumococcal Disease: From a Tertiary Care Hospital in the Post-Vaccine Era

A breakthrough infection occurring with 13-valent pneumococcal conjugate vaccine (PCV13) in Turkey are previously described. A breakthrough infection is defined as IPD in a child who had received 1 PCV-7 or PCV-13 and for which the pneumococcal isolate was a vaccine serotype. During one year period, among 6 patients with invasive pneumococcal infection, 2 patients were considered to have a vaccine failure with serotype 19F. Antibiotic resistance results were remarkable; macrolide resistance were observed in all strains except one, and high and intermediate penicillin resistance were determined in 2 strains.WoSScopu

Oxidant and Antioxidant Balance in Children with Community-Acquired Pneumonia

Objective The balance between oxidant and antioxidant defense mechanisms is crucial. In this article, we aimed to evaluate the role of this balance in community-acquired pneumonia (CAP) in children. Methods We analyzed serum oxidant and antioxidant stress parameters according to the clinical and demographic data of children with CAP and compared them with healthy controls. Serum total antioxidant status (TAS) and total oxidant status (TOS) were evaluated and compared between the groups, along with levels of ischemia-modified albumin (IMA), antioxidant enzymes, nonenzymatic antioxidant factors, and plasma thiol. Results Of 160 children evaluated, 106 had CAP (54 outpatients and 52 inpatients), and the other 54 were healthy (control group). Total thiol and native thiol levels were significantly lower in the inpatient group compared with the outpatient group (p = 0.004 and p = 0.005, respectively). Serum IMA differed significantly among the groups (p = 0.001), with inpatients showing the highest level. A positive correlation was found between serum IMA and C-reactive protein levels in patients with pneumonia (r = 0.351; p = 0.001). Conclusion Parameters that provide information about antioxidant capacity may be useful in the diagnosis and prognosis of pneumonia. Our results suggest that plasma thiol levels and IMA may be good candidate biomarkers to predict hospitalization for CAP in children

Streptococcus Mitis/Oralis Causing Blood Stream Infections In Pediatric Patients

Viridans streptococci are still under investigation concerning epidemiology, pathogenesis and clinical presentations. We aimed to investigate the clinical presentations and outcomes of pediatric patients infected with Streptococcus mitis/oralis. Based on the accumulation of bloodstream infections (BSI) caused by S. mitis/oralis in 4 patients in our Hematology and Bone Marrow Transplantation Department at a particular time, a review of the medical and microbiological records of pediatric patients with positive blood cultures for S. mitis/oralis in the entire hospital was performed. In addition, a retrospective case-control study was conducted. Pulsed-field gel electrophoresis of S. mitisloralis in 4 patients displayed unrelatedness of the strains. A total of 53 BSI (42 BSI and 11 catheter-related BSI) were analyzed. Thirty-four percent of patients with BSI caused by S. mitis/oralis had febrile neutropenia. Clinical and microbiological outcomes were favorable and infection-related mortality was not observed. Although not significant, previous antibiotic use and trimethoprim-sulfamethoxazole prophylaxis were more common in the case group. S. mitis/oralis seems likely an important agent in bacteremic children who are particularly neutropenic because of the underlying hematologic and oncologic diseases. Prompt management of infections with appropriate antimicrobials, regarding antibiotic susceptibilities of organisms, may facilitate favorable outcomes.WoSScopu

Prevalence and Seasonal Distribution of Viral Etiology of Respiratory Tract Infections in Inpatients and Outpatients of the Pediatric Population: 10 Year Follow-Up

The aim of this study was to investigate the prevalence and seasonal distribution of respiratory viruses in pediatric patients. Nasopharyngeal swab specimens, demographic and clinical information were collected from 1240 pediatric patients aged <18 years between 2006 and 2015 in Hacettepe University Children's Hospital. Multiplex RT-PCR (multiplex reverse transcriptase polymerase chain reaction) was performed to detect viral pathogens. A total of 1240 pediatric outpatients and inpatients who had been admitted to the hospital with symptoms of upper and lower respiratory tract infections (RTIs) were enrolled. Viruses were identified in 339 (27.3%) of cases, with the leading three viruses being respiratory syncytial virus (RSV, 74/339; 21.8%), human rhinovirus (62/339; 18.3%), and multiple viruses (56/339; 16.5%). Most of the patients were diagnosed with lower RTI (264/339; 77.8%) and antibiotics were administered to three quarters of positive patients (254/339; 74.9%). With an overall viral agent detection rate of 27.3%, the findings of the present study suggest that other respiratory pathogens, whether viral or bacterial, may also lead to hospital visits due to respiratory tract symptoms in children.WoSScopu