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Aim: This was a prospective randomized controlled study to evaluate the time-dependent incidence of contamination of K-wires and wounds in patients who underwent osteosynthesis and the effect of covering the K-wires on this incidence rate of infection. Materials and Methods: The study sample included 90 patients who underwent open reduction and internal fixation between 2018 and 2019. Patients were randomized to two groups: use of covered K-wires during surgery (using a sterile towel) and use of uncovered K-wires. Bacterial samples were obtained from the K-wires and wound at the following time points: 0 (just after opening of the K-wire packages) and at 15, 30, 60, 90, and 120 min after. Samples with bacterial growth at 48 h were considered contaminated. Microscopic, staining, and biochemical properties were used for bacterial typing. Results: Bacterial growth was detected at the 30- and 60-min time points for the uncovered and covered groups, respectively. Wound contamination was identified within 15 min for the uncovered group. Wound and K-wire contamination progressed as a function of time, being consistently more significant in the uncovered group (p<0.005). Conclusion: Time-dependent K-wire and wound contamination rates may be decreased by covering the K-wires (and other instruments) with a sterile towel. Frequent wound irrigation during surgery and postoperative prophylactic antibiotics targeting the bacteria we identified might further be useful in lowering the incidence rate of infection. [ABSTRACT FROM AUTHOR]

The combination of Mannan antigen and anti-mannan antibody (Ag / Ab) test is a specific diagnostic test for the diagnosis of invasive Candida (IC) infections. In this study, it was purposed to determine the roles of Ag and Ab in the diagnosis of IC in pediatric intensive care unit patients. Nineteen patients with candidiasis treated for various reasons in the pediatric intensive care unit, 25 patients colonized with Candida spp without candidemia, and 15 patients with neither candidemia nor colonized with a total number of 59, were included in the study. In colonized patients to consider colonization; cervical, nasal, throat, axillary, perineal and rectal swab cultures and urine culture were obtained every week throughout admission and Candida colonization index (CI) was calculated. Blood samples were stored at -80°C after seperated to serum form till the tests performed. Candida mannan and anti-mannan (Ab) tests were performed in duplicate in a total of 59 serum samples. Serum was assayed with Candida mannan antigen (Ag) and anti-mannan antibody (Ab) with Platelia ™ Candida Ag Plus and Platelia ™ Candida Ab Plus (Bio-Rad, Marnes las Coquette, France). The Ag and Ab values of the candidemia and colonized group were higher than the non infected and non-colonized group (p <0.001). The antigens were evaluated for threshold values of 125, 250 and 500 pg / ml while 10 IU /ml was the cut off value for antibody. Although the rate of Ag positive patients (48%) in the colonized group was significantly higher than the group with candidemia (21%) for threshold 125, this difference was not statistically significant. When the threshold value Ag > 125 was accepted, antigen positivity for C. albicans (12/22) was found to be higher than that of C.parapsilosis strains (1/4) (p> 0.05). The most compatible combination to detect IC was the combination of Ag 500 and Ab usage with a sensitivity of 57.8% and specificity of 80%. On the era of this combination, PPV was 42.8 and NPV was 80. The use of Candida mannan Ag and Ab together in children increases the diagnostic value in showing invasive candidiasis. Although concomitant use increases the diagnostic value, they need to provide higher NPV in order to exclude invasive candidiasis. [ABSTRACT FROM AUTHOR]

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Invasive candidiasis is an important cause of morbidity and mortality, which primarily occurs in intensive care units. The Candida colonization index is an accepted score as an early warning tool for invasive candidiasis. This study was performed in a medical PICU with patients prone to contracting invasive candidiasis, to determine the usefulness of the Candida colonization index in forecasting invasive candidiasis in children. This prospective study including 87 patients (children 1 month to 16 years old with several illnesses and requiring ICU care) was conducted in a 22-bed medical PICU, Health Science University of Kayseri Training and Research Hospital, between January 2015 and September 2016. Those patients not on antifungal therapy, who were expected to stay more than seven days in PICU and had no history of a PICU stay within the previous two months were included in the study. In all patients, rectal, cervical, throat, axillary, perineal and nasal swab cultures, urine culture and blood culture tests were performed at admission and every week throughout their stay. Overall, 2639 swab and urine cultures (mean: 30.3) and 325 blood cultures (mean: 3.73) were obtained from 87 patients and a total of 576 grew Candida spp. In patients' swab and urine cultures C. albicans was detected in 64.5%, C. parapsilosis in 12.1%, C. glabrata in 7.5%, Saccharomyces spp in 3.0 %, C. tropicalis in 2.4%, C. krusei in 2.1% and C. kefyr in 1.2%. Three patients had C. albicans and one had C. parapsilosis growth in blood culture. Sensitivity, specificity, positive predictive value and negative predictive value for CI were found to be 33.73%, 100%, 6.7%, and 100%, respectively. Patients are at risk of fungal infection in paediatric intensive care units. Specificity and the negative predictive value of 100 % indicate that CI is a useful score to rule out the presence of invasive fungal disease. On the other hand, the low rate of sensitivity (33.3 %) and positive predictive value (6,7%) make this score less reliable in forecasting invasive candidiasis in children.