Bacteremia due to Acinetobacter ursingii in infants: Reports of two cases

Acinetobacter ursingii is an aerobic, gram-negative, opportunistic microorganism which is rarely isolated among Acinetobacter species. We present two immunocompetent infants who developed bacteremia due to A.ursingii. The first patient is a two -month- old boy who had been hospitalized in pediatric surgery unit for suspected tracheo-esophageal fistula because of recurrent aspiration pneumonia unresponsive to antibiotic therapy. The second patient is a fourteen -month- old boy with prolonged vomiting and diarrhea. A. ursingii was isolated from their blood cultures. They were successfully treated with ampicillin-sulbactam. Although A.ursingii has recently been isolated from a clinical specimen; reports of infection with A.ursingii in children are rare. A.ursingii should be kept in mind as an opportunistic microorganism in children.Pan African Medical Journal 2016; 2

Epstein-Barr Virus Encephalitis in an Immunocompetent Child: A Case Report and Management of Epstein-Barr Virus Encephalitis

Epstein-Barr virus (EBV) usually causes mild, asymptomatic, and self-limited infections in children and adults; however, it may occasionally lead to severe conditions such as neurological diseases, malignant diseases, hepatic failure, and myocarditis. Epstein-Barr virus-related neurological disorders include meningitis, encephalitis, and cranial or peripheral neuritis, which are mostly seen in immunocompromised patients. The therapeutic modalities for EBV-related severe organ damage including central nervous system manifestations are still uncertain. Herein, we describe a seven-year-old boy with EBV encephalitis who presented with prolonged fever, exudative pharyngitis, reduced consciousness, and neck stiffness. Cranial magnetic resonance imaging showed contrast enhancement in the bilateral insular cortex and the right hypothalamus. The diagnosis was made by EBV-DNA amplification in both the blood and cerebrospinal fluid samples. He was discharged with acyclovir therapy without any sequelae

Atypical Presentation of Cat-Scratch Disease in an Immunocompetent Child with Serological and Pathological Evidence

Typical cat-scratch disease (CSD) is characterized by local lymphadenopathy following the scratch or bite from a cat or kitten. An atypical presentation which includes liver and/or spleen lesions is rarely reported in an immunocompetent child. Systemic CSD may mimic more serious disorders like malignancy or tuberculosis. Although a diagnosis is difficult to establish in systemic CSD, an early diagnosis and an appropriate treatment are important to prevent complications. Bartonella henselae is difficult to culture, and culture is not routinely recommended. Clinical, serological, radiological, and pathological findings are used for the diagnosis of CSD. Herein we present a case of systemic CSD presenting with hepatic mass in an immunocompetent child. The differential diagnosis is made by serological and pathological evidence. He was successfully treated with gentamicin (7.5 mg/kg) and rifampin (15 mg/kg) for six weeks

Primary catastrophic antiphospholipid syndrome in an 8 year-old girl

Antiphospholipid syndrome (APS) is a disease characterized by recurrent arterial and venous thromboses. Rapidly progressive multiple thromboses leading to multiorgan failure occur in less than 1% of patients and named as catastrophic antiphospholipid syndrome (CAPS). We, hereby, describe an 8 year-old-girl with erythematous skin lesions progressing into purpura fulminans. The patient developed CAPS with the findings including proteinuria, microangiopathic hemolytic anemia, thrombocytopenia, arterial and venous thromboses demonstrated on skin biopsies. She was admitted to intensive care unit and received empirical antibiotics, anticoagulants, antiaggregants, steroids and intravenous immunoglobulins. The diagnosis of APS was confirmed by positive lupus anticoagulants, elevated anti beta-2 glycoprotein IgG and antiphospholipid IgG titers. Moreover, other than MTHFRA1298C, MTHFR-C677T, factor V H1299R, beta fibrinogen-455 G>A heterozygosity indicating low risk for thrombophilia, no infectious, rheumatological or malignant etiologies were identified. Family history revealed Raynaud’s phenomenon in a sister, interstitial lung disease, proteinuria and hematuria in paternal grandmother in addition to lupus anticoagulant positivity in father and 2 elder sisters. Her treatment included debridement of necrotic skin tissue, grefting and local mesenchymal stem cell application to upper thigh and lower leg region following oral azathioprine administration

Türkiye’deki çocuk yoğun bakım ünitelerinde sağlık hizmeti ilişkili enfeksiyonlar: tek günlük nokta prevalans çalışması

ÖZETAnahtar Kelimeler: Nokta Prevalans, Çocuk Yoğun Bakım Üniteleri, ÇYBÜ, Sağlık Hizmeti İlişkili Enfeksiyon, SHİE, TürkiyeAmaç: Çocuk yoğun bakım ünitelerinde morbidite ve mortalitenin önde gelen sebeplerinden biri olan sağlık hizmeti ilişkili enfeksiyonların (SHİE) prevalansını belirlemek.Metod: Yirmi yedi Eylül, 2012 tarihinde gerçekleştirilen nokta prevalans çalışmamıza 50 çocuk yoğun bakım ünitesi dahil edildi. Demografik özellikler, enfeksiyon tipleri, mikrobiyolojik bulgular, tıbbi gereç kullanımı ve hastalık sonucun içeren veriler değerlendirildi.Sonuçlar: Elli çocuk yoğun bakım ünitesinden 327 hasta dahil edildi. Ortalama yaş 48 ± 57 (bir-216 ay) idi. Yüzyirmiiki (%37) hastada bir veya birden fazla sağlık hizmeti ilişkili enfeksiyon mevcuttu. En sık enfeksiyon tipleri alt solunum yolu enfeksiyonları (n=77, %23,5), kan akımı enfeksiyonları (n=38, %11,6) ve idrar yolu enfeksiyonları (n=10, %3) idi. En sık saptanan patojenler Pseudomonas aeruginosa (30 enfeksiyon, %42), Acinetobacter türleri (18 enfeksiyon, %25) ve Candida türleri (9 enfeksiyon, %12) idi. Hastane tipi, santral venöz kateter, idrar sondası, ortalama idrar kateter süresi, endotrakeal tüp, mekanik ventilasyon, total parenteral nütrisyon, ortalama total parenteral nütrisyon süresi, nazogastrik sonda, antibiyotik tedavisi, ortalama antibiyotik kullanım süresi, antifungal tedavi, ortalama antifungal kullanım süresi ve çocuk yoğun bakım ünitesi uzmanı varlığı SHİE için risk faktörü olarak saptandı. En sık kullanılan antibiyotik türleri üçüncü kuşak sefalosporinler (%19) karbapenemler (%14) ve glikopeptidler (%9) idi. Dört haftalık izlem sonrası 43 (%13) hasta eksitus oldu ve bunların 28’i (%8) SHİE ilişkili olarak bildirildi. Erkek cinsiyet, santral venöz kateter, idrar sondası, ortalama idrar sondası kullanım günü,endotrakeal tüp, mekanik ventilasyon, total parenteral nütrisyon, nazogastrik sonda, steroid kullanımı, hepatik yetmezlik, antifungal kullanımı ve SHİE varlığı mortalite ile ilişkili risk faktörleri olarak belirlendi.Sonuç: Ulusal çok merkezli nokta prevalans çalışmamızda ülkemiz çocuk yoğun bakım ünitelerinde SHİE prevalansının yüksek olduğu belirlendi. Bu enfeksiyonların önlenmesinin ulusal bir önceliğimiz haline gelmesi gerekmektedir.ABSTRACTKeywords: Point Prevalance, Pediatric Intensive Care Units, PICU, Healthcare-Associated Infections, HCAI, TurkeyObjective: To determine the prevalance of healthcare-associated infections, a major cause of morbidity and mortality in pediatric intensive care unit patients.Methods: Pediatric Intensive Care Units (n=50) participated in a pointprevalance survey on September 27, 2012. Data collected for all pediatric intensive care unit inpatients included demographics, infections, microbiological findings, therapeutic interventions and outcomes.Results: There were 327 patients in 50 PICUs. The median age was 48 ± 57 months (range 1-216 months). One hundred twenty two patients had 1 or more healthcare-associated infections corresponding to a prevalance of %37. The most frequently reported sites were lower respiratory tract (n=77, 23,5% ), blood-stream (n=38, 11,6%) and urinary tract (n=10, 3%). The most frequent pathogens were Pseudomonas aeruginosa (in 30 infections, 42%), Acinetobacter spp. (in 18 infections,25% ) and Candida spp. (in 9 infections, 12%). Hospital type (research and education or university hospital), central venous catheters, urinary catheters, mean urinary catheter duration, endotracheal tube, mechanical ventilation, total parenteral nutrition, mean total parenteral nutrition duration, nasogastric feeding, antibiotic therapy, mean antibiotic therapy duration, antifungal therapy, mean antifunga therapy duration and pediatric intensive care specialist existence were found to be risk factors. Most frequently administered antimicrobials were third generation cephalosporins (19%), carbapenems (14%) and glycopeptides (9%). According to a4-weeks follow up, 43 (13%) patients died, 28 (8%) of whom died from healthcareassociated infections. Male gender, central venous catheter, urinary catheter, mean urinary catheter duration, endotracheal tube, mechanical ventilation, total parenteral nutrition, nasogastric feeding, steroids, hepatic failure, antifungals and healthcare associated infections were risk factors for death.Conclusion: This national multicenter study documented the high prevalenceof healthcare associated infections. Preventing these infections should be a nationalpriority

Epidemiologic and microbiologic evaluation of nosocomial infections associated with Candida spp in children: A multicenter study from Istanbul, Turkey

Background: The purpose of this study was to establish species distribution of Candida isolates from pediatric patients in Istanbul, Turkey, and to determine risk factors associated with nosocomial Candida infections. Methods: This study was conducted between June 2013 and June 2014 by participation of 7 medical centers in Istanbul. Candida spp strains isolated from the clinical specimens of pediatric patients were included. Clinical features were recorded on a standardized data collection sheet. Results: A total of 134 systemic Candida infections were identified in 134 patients. The patients were admitted in pediatric and neonatal intensive care units (41.8% and 9.7%, respectively) and in pediatric wards (48.5%). Candida albicans was the most prevalent species (47%), followed by Candida parapsilosis (13.4%), Candida tropicalis (8.2%), Candida glabrata (4.5%), Candida lusitaniae (3.7%), Candida kefyr (2.2%), Candida guilliermondii (1.5%), Candida dubliniensis (0.7%), and Candida krusei (0.7%). Types of Candida infections were candidemia (50.7%), urinary tract infection (33.6%), surgical site infection (4.5%), central nervous system infection (3.7%), catheter infection (3.7%), and intra-abdominal infection (3.7%). In multivariate analysis, younger age (1-24 months) and detection of non-albicans Candida spp was found to be risk factors associated with candidemia (P = 0.040; odds ratio [OR], 4.1; 95% confidence interval [CI], 1.06-15.86; and P = 0.02; OR, 2.4; 95% CI, 1.10-5.53, respectively). Conclusions: This study provides an update for the epidemiology of nosocomial Candida infections in Istanbul, which is important for the management of patients and implementation of appropriate infection control measures. (C) 2016 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved

Antifungal consumption, indications and selection of antifungal drugs in paediatric tertiary hospitals in Turkey: Results from the first national point prevalence survey

Objectives: The aim of this point prevalence survey was to evaluate the consumption, indications and strategies of antifungal therapy in the paediatric population in Turkey. Methods: A point prevalence study was performed at 25 hospitals. In addition to general data on paediatric units of the institutes, the generic name and indication of antifungal drugs, the presence of fungal isolation and susceptibility patterns, and the presence of galactomannan test and high-resolution computed tomography (HRCT) results were reviewed. Results: A total of 3338 hospitalised patients were evaluated. The number of antifungal drugs prescribed was 314 in 301 patients (9.0%). Antifungal drugs were mostly prescribed in paediatric haematology and oncology (PHO) units (35.2%), followed by neonatal ICUs (NICUs) (19.6%), paediatric services (18.3%), paediatric ICUs (PICUs) (14.6%) and haematopoietic stem cell transplantation (HSCT) units (7.3%). Antifungals were used for prophylaxis in 147 patients (48.8%) and for treatment in 154 patients (50.0%). The antifungal treatment strategy in 154 patients was empirical in 77 (50.0%), diagnostic-driven in 29 (18.8%) and targeted in 48 (31.2%). At the point of decision-making for diagnostic-driven antifungal therapy in 29 patients, HRCT had not been performed in 1 patient (3.4%) and galactomannan test results were not available in 12 patients (41.4%). Thirteen patients (8.4%) were receiving eight different antifungal combination therapies. Conclusion: The majority of antifungal drugs for treatment and prophylaxis were prescribed in PHO and HSCT units (42.5%), followed by ICUs. Thus, antifungal stewardship programmes should mainly focus on these patients within the availability of diagnostic tests of each hospital. © 2018 International Society for Chemotherapy of Infection and Cance

Combined treatment with chlorhexidine and 0.9% saline in a newborn infant with an infected surgical wound

Newborns are more susceptible to infection; this makes proper wound care extremely important in them. Unfortunately, in spite of successful surgery, patients can die as a result of wound area infections. Herein, we report a case in which a combined therapy of chlorhexidine (a disinfectant) and saline (a cleansing agent used in wound care) was used effectively to treat the wound in a newborn infant with an antibiotic-resistant, Gram-negative, bacteria-related surgical site infection

Antifungal susceptibility, species distribution and risk factors associated with mortality of invasive candidiasis in children in Turkey: A six-year retrospective, single-centre study

Invasive candidiasis (IC) is a life-threatening fungal infection with high morbidity and mortality. In this study, we aimed to investigate the Candida species distribution and antifungal drug susceptibility and to identify the risk factors associated with IC mortality in children. We conducted a retrospective, single-centre study of paediatric IC in patients from a tertiary care hospital in Turkey between January 2013 and February 2019. A total of 56 Candida isolates underwent antifungal susceptibility testing performed by Sensititre YeastOne YO10 panel, and the demographic and clinical data of 65 patients were examined during the study period. The most commonly isolated species was Candida albicans in 30 patients (46%), followed by C. parapsilosis in 25 patients (38%) and C. tropicalis in three patients (5%). According to the antifungal drug susceptibility testing, C. albicans was fully susceptible to fluconazole and the other antifungal agents (100%). None of the isolates displayed resistance to anidulafungin, micafungin, flucytosine, posaconazole, voriconazole or itraconazole. There were low rates of resistance to fluconazole (1.8%), caspofungin (1.8%) and micafungin (1.8%). In addition, 5.3% of the Candida isolates were susceptible in a dose-dependent manner to itraconazole, 3.6% were susceptible to voriconazole and fluconazole and 1.8% were susceptible to anidulafungin. The mortality rate of IC was 15.4%. Thrombocytopenia after IC treatment was significantly associated with mortality in the multivariate analysis. These results, which help determine the species distribution, antifungal susceptibility patterns and risk factors for mortality, could make a significant contribution to the management of these challenging infections, including choosing appropriate empirical antifungal therapy. (C) 2020 Elsevier Masson SAS. All rights reserved