Detecting imipenem resistance in Acinetobacter baumannii by automated systems (BD Phoenix, Microscan WalkAway, Vitek 2); high error rates with Microscan WalkAway

<p>Abstract</p> <p>Background</p> <p>Increasing reports of carbapenem resistant <it>Acinetobacter baumannii </it>infections are of serious concern. Reliable susceptibility testing results remains a critical issue for the clinical outcome. Automated systems are increasingly used for species identification and susceptibility testing. This study was organized to evaluate the accuracies of three widely used automated susceptibility testing methods for testing the imipenem susceptibilities of <it>A. baumannii </it>isolates, by comparing to the validated test methods.</p> <p>Methods</p> <p>Selected 112 clinical isolates of <it>A. baumanii </it>collected between January 2003 and May 2006 were tested to confirm imipenem susceptibility results. Strains were tested against imipenem by the reference broth microdilution (BMD), disk diffusion (DD), Etest, BD Phoenix, MicroScan WalkAway and Vitek 2 automated systems. Data were analysed by comparing the results from each test method to those produced by the reference BMD test.</p> <p>Results</p> <p>MicroScan performed true identification of all <it>A. baumannii </it>strains while Vitek 2 unidentified one strain, Phoenix unidentified two strains and misidentified two strains. Eighty seven of the strains (78%) were resistant to imipenem by BMD. Etest, Vitek 2 and BD Phoenix produced acceptable error rates when tested against imipenem. Etest showed the best performance with only two minor errors (1.8%). Vitek 2 produced eight minor errors(7.2%). BD Phoenix produced three major errors (2.8%). DD produced two very major errors (1.8%) (slightly higher (0.3%) than the acceptable limit) and three major errors (2.7%). MicroScan showed the worst performance in susceptibility testing with unacceptable error rates; 28 very major (25%) and 50 minor errors (44.6%).</p> <p>Conclusion</p> <p>Reporting errors for <it>A. baumannii </it>against imipenem do exist in susceptibility testing systems. We suggest clinical laboratories using MicroScan system for routine use should consider using a second, independent antimicrobial susceptibility testing method to validate imipenem susceptibility. Etest, whereever available, may be used as an easy method to confirm imipenem susceptibility.</p

Deep Neck Infections in Childhood

Objective: Deep neck infections (DNI) are infections that occur in potential cavities surrounded by the cervical fascia located on the neck. DNI is rarerly seen in childhood but carries a risk of serious morbidity and mortality. In treatment modalities, antibiotics can be used with or without surgery. In this study, we aimed to investigate children and adolescent cases with DNI and to compare patients who underwent surgery with those who did not

Investigating the risk factors for antibiotic lock therapy failure in pediatric cancer: a single center retrospective analysis

Background. Catheter-related bloodstream infection (CRBSI) is one of the most common complications of central lines. Data concerning the effectiveness and safety of antibiotic lock therapy (ALT), especially in pediatric hematology and oncology patients, have not yet reached sufficient levels of evidence. We aimed to share our center's experience on ALT in pediatric cancer and to investigate the causes of ALT failure

Complications of Acute Bacterial Rhinosinusitis in Children: A Single Tertiary Care Center

Objective: Acute bacterial rhinosinusitis (ABRS) can lead to serious complications, especially when treated inadequately. In this study, we evaluated pediatric patients treated for sinusitis complications by the Pediatric Infectious Diseases Department at Dokuz Eylul University Fa-culty of Medicine.Material and Methods: Patients who were consulted with a preliminary diagnosis of sinusitis complication and hospitalized between January 2014 and March 2021 were retrospectively analyzed. Patients who de-veloped complications due to causes other than ABRS were excluded. Those with isolated orbital complications and those with intracranial complications were compared.Results: Seventeen patients who were hospitalized for ABRS were inclu-ded in the study. Median age was 13 (min 3-max 17) years, the majority were (14, 82.4%) males. There were isolated orbital complications in 11 (64.7%), intracranial complications in 4 (23.5%), and both orbital and int-racranial complications in two (11.8%) patients. S. pneumoniae, Strepto-coccus spp. and S. constellatus grew in cultures obtained intraoperatively from three patients. Age (median 16 and 12, p= 0.048), number of surge-ries (median 2 and 0, p= 0.027), length of stay (median 44 and 8, p< 0.001), total follow-up time (median 110 and 30, p= 0.015), absolute neutrophil count (median 16700/mm3 and 7000/mm3, p= 0.020) and C-reactive pro-tein (229.0 +/- 62.9 and 65.7 +/- 57.4, p< 0.001) were found to be higher in patients with intracranial complications. Endoscopic sinus surgery was performed in one patient. Three patients were operated by neurosurgery, and one patient by the ophthalmology department. A sequela of drop foot was observed in a patient with subdural empyema and meningitis. Only one patient died after discharge due to her underlying disease.Conclusion: Age, length of hospital stay, and surgical requirement in patients with intracranial complications are higher than those with only orbital complications. There may be sequelae in patients whose surgical needs are not met. However, there are cases in whom only conservati-ve medical therapies were adequate. Randomized studies with larger numbers of patients are needed to obtain definitive data on optimal treatment methods and surgical indications for sinusitis complications in children

[A Case of Congenital Syphilis and Prozone Phenomenon].

The screening for syphilis during pregnancy is important to prevent intrauterine transmission and complications. Prozone phenomenon may cause a false negative result in non-treponemal syphilis tests, which complicates an accurate diagnosis. In this case report a newborn syphilis case was presented to emphasize the importance of reverse algorithm in diagnosis and the prozone phenomenon which can cause problems in rapid plasma reagin (RPR) test. The 2920 g infant patient was born from a 24-year-old mother with no known diseases, at the 35th week of gestation by cesarean section due to premature rupture of membranes. The initial physical examination of the newborn revealed erythema and exfoliation of the bilateral hands and feet. Laboratory results revealed CRP: 90 mg/L, WBC: 19.2 x 10(3)/mu l, hemoglobin: 9.5 g/dl, platelet count: 214 x 10(3)/mu l, HIV-Ag/Ab: non-reactive, anti-Toxoplasma gondii IgM and IgG: negative, anti-cytomegalovirus IgM: negative, anti-cytomegalovirus IgG: positive (128.7 AU/ml), anti-Rubella IgM: negative, anti-Rubella IgG: positive (26 IU/ml), anti-Treponema pallidum (anti-T.pallidum) antibody [IgM and IgG by the chemiluminescence microparticle enzyme immunoassay (Architect Syphilis TP; Abbott Japan Co, Japan)]: positive (Signal Cut Off value (S/CO): 28.35), and RPR (Omega Diagnostics, UK): negative. All of the above ELISA tests were performed by using Architect (Abbott Diagnostics, Wiesbaden, Germany) kits. When the RPR test was repeated with serial dilutions of the serum in order to detect prozone phenomenon, positive reaction was detected starting from 1:2 and ending at 1:64 dilution. It was determined that the mother was not tested for syphilis during her pregnancy. When both the mother and the father were tested for syphilis, the mother's anti-T.pallidum total antibody test result was reactive (S/CO: 30.52) and the RPR was positive at 1:32 dilution, while the father's anti-T.pallidum total antibody test result was reactive (S/CO: 16.05) and the RPR was negative. A four-fold difference between the maternal and infant RPR dilutions is required by the guidelines for a laboratory diagnosis of congenital syphilis. Although this criterion was not met in the newborn, the case was accepted as congenital syphilis due to clinical findings. Congenital syphilis must be considered in the differential diagnosis in the presence of skin manifestations at the birth and early neonatal period. Accurate and early diagnosis of the disease is important to start appropriate treatment and prevent complications. As described in the presented case, the use of reverse syphilis test algorithm will enable to reach the correct diagnosis of the infection. If the result of the treponemal test is positive and the RPR test is negative, prozone phenomenon should be considered and the RPR test should be repeated with serial serum dilutions

[Evaluation of SARS-CoV-2 PCR Positive Cases in the Pediatric Emergency Department].

In December 2019, a previously unknown type of coronavirus was detected in China and named as "severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2)". The World Health Organization has named the SARS-CoV-2 related as coronavirus disease-2019 (COVID-19) and declared it as a pandemic. There is a limited data about the COVID-19 disease for the pediatric patients. In this study, it was aimed to evaluate the epidemiological, clinical, laboratory and radiologic findings, treatment and clinical outcomes of patients admitted to the pediatric emergency department with the suspicion of COVID-19. Between March 11 and dune 16, 2020, patients aged between 1 month-18 years admitted to the pediatric emergency department and who have an indication for sampling for the polymerase chain reaction (PCR) method with the suspicion of COVID-19 according to the current guidelines published by the Ministry of Health were included in the study. The demographic characteristics, symptoms, durations and the history of contact with the suspected/definite COVID-19 cases were questioned in the patients with positive results. Physical examination, laboratory and imaging data of the patients were recorded. According to clinical severity, patients were divided into five groups. Treatment methods, ward/intensive care unit admission, length of stay at hospital, and prognosis were recorded. Of the 237 patients included in the study, 45 (18.9%) of the samples were positive and 192 (81.1%) were negative. There was a history of contact with COVID-19 positive case in 38 (85.6%) of COVID-19 PCR positive patients. The mean time for onset of symptoms after contact was 3.5 +/- 1.7 days. Twenty-one of the patients (46.6%) were asymptomatic and the most common symptom was fever (34.1%) and cough (27.3%). Of the patients whose laboratory tests were requested, lymphopenia wasdetected in 50% and 52.3% of procalcitonin, 23.5% of C-reactive protein and 64.7% of D-dimer values were found to be high. Chest radiography was obtained from 45.4% of the patients; 90.0% were evaluated as normal, bronchovascular change, pleural effusion and consolidation were detected in one of each (5.0%) patient. Thorax computed tomography (CT) was obtained from 4 (9.0%) patients. One patient had normal CT findings, two patients had consolidation, one patient had peripheral ground-glass appearance and one patient had pleural effusion. Antibiotics were started in 38.6% of the patients and the most commonly used antibiotic was azithromycin (34.1%). Oseltamivir was started in one (2.3%) patient, and 10 (24.7%) patients were treated with hydroxychloroquine. There were no serious and critical cases according to the clinical severity. Pediatric patients constitute a small part of COVID-19 individuals in the community, and a significant part of them are asymptomatic, and patients who are symptomatic present with a mild clinic. In our study, most of the patients had a history of contact with COVID-19 positive cases, therefore, it should be questioned when evaluating a pediatric patient. There were no specific findings for COVID-19 positive patients in terms of laboratory and radiology

Evaluation of Attitudes and Knowledge of Influenza Diagnosis, Treatment and Vaccination Among Pediatric Residents

Objective: Influenza virus is common in children, especially in winter, causing hospitalization, admission to the intensive care unit, or even death. There are few studies on the attitudes or knowledge of influenza diagnosis, treatment, and vaccination among pediatricians. This study was planned to determine pediatric residents' attitudes and behaviors about recognizing the influenza virus, making treatment decisions, prophylaxis, and immunization