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The aim of this study is to document the clinical characteristics and outcomes of Acinetobacter baumannii infections in pediatric patients in a pediatric intensive care unit (PICU) in TUrkey. The ages ranged from 1 month to 16 years with a mean age of 55.5 months, and the male-to-female ratio was 1:1.5. Ventilator-associated pneumonia (10 patients) was the leading diagnosis, followed by catheter-related blood stream infection (4 patients), and bacteremia and ventilator-associated pneumonia associated with meningitis (1 patient) due to A. baumannii. Mechanical ventilation (93.3%), central venous catheter (73.3%), urinary catheter (93.3%), and broad spectrum antibiotic usage (80%) were the frequently seen risk factors. Neuromuscular (40%) and malignant (26.7%) disorders were the most common underlying diseases. Nosocomial A. baumannii is commonly multidrug-resistant, prolongs the length of stay in the PICU and increases the mortality rates in pediatric critical care. [ABSTRACT FROM AUTHOR]

Background: Stenotrophomonas maltophilia is an important cause of life-threatening nosocomial infection. Aim: To evaluate the clinical features, antibiotic treatment and prognosis of S. maltophilia bacteraemia. Methods: Patients with blood cultures positive for S. maltophilia at the Children's Hospital, Ankara University Medical School between 1995 and 2005 were evaluated retrospectively. The results were compared with those of a case–control group of patients with Pseudomonas aeruginosa bacteraemia (n=33). Antibiotic susceptibilities of S. maltophilia strains were determined by disc diffusion. Susceptibility to ciprofloxacin was also determined by broth dilution. Results: Thirty-six (2.2%) blood cultures were positive for S. maltophilia. Neutropenia was more common in the P. aeruginosa group (p=0.001). Breakthrough bacteraemia developed more commonly during carbapenem treatment in the S. maltophilia group (p=0.02). Ciprofloxacin and trimethoprim–sulfamethoxazole in combination with/without an aminoglycoside were the antibiotics most commonly selected to treat S. maltophilia bacteraemia. Mortality was more common in the P. aeruginosa (13/33) than in the S. maltophilia (2/33) group (p=0.001). According to susceptibility, determination by the disk diffusion method, beta-lactam antibiotics, aminoglycosides and chloramphenicol had little or no effect, whereas trimethoprim–sulfamethoxazole, doxycycline and fluoroquinolones were more active against S. maltophilia strains. However, ciprofloxacin susceptibility results were quite different when determined by disk diffusion (97% isolates susceptible) and broth dilution (49% isolates susceptible). Conclusions: Although S. maltophilia bacteraemia is rare in children, antibiotic resistance to these strains is an important problem. Tetracyclines, trimethoprim–sulfamethoxazole and fluoroquinolones are the most active agents against S. maltophilia strains. [ABSTRACT FROM AUTHOR]

Mechanical ventilation increases the frequency of nosocomial infections. This study describes the frequency of multi-resistant viridans streptococcal colonisation, the clinical course of nosocomial sepsis and ventilator-associated pneumonia in mechanically ventilated neonates in the neonatal intensive care unit of Ankara University Hospital. Seventy-nine ventilated newborns were enrolled. Broncho-alveolar lavage culture and blood cultures were positive in 44 (56%) and 17 (22%) patients, respectively. The most predominant micro-organisms in broncho-alveolar lavage cultures were multi-resistant viridans streptococci (29, 66%). Viridans streptococci were also one of the predominant organisms in blood cultures (5/17, 29%). In 29 patients with broncho-alveolar lavage positive for viridans streptococci, nine (31%) had colonisation, 15 (52%) had ventilator-associated pneumonia and five (17%) had sepsis owing to viridans streptococcus. Ventilator-associated pneumonia was encountered in 52/1000 ventilation days. Mortality was caused by infection in three (10%) of them. Mechanically ventilated neonates in our neonatal intensive care unit had a high rate of both multi-resistant viridans streptococcus airway colonisation and subsequent ventilator-associated pneumonia and sepsis. [ABSTRACT FROM AUTHOR]

The multidrug-resistant bacterial infections cause high mortality in immunocompromised patients because of the limited antibacterial choices. Tigecycline, first member of the glycylcyclines, has in vitro activity against a wide variety of organisms, including multidrug-resistant pathogens; however, it has not yet been approved for use in children. Herein, we report a nine-year-old girl with acute myeloid leukemia who was treated successfully with tigecycline due to multidrug-resistant Escherichia coli bacteremia. [ABSTRACT FROM AUTHOR]

Abstract: Our aim was to evaluate diagnostic accuracy of rapid immunochromatographic stool antigen test (Rapid HpSA; LİNEAR Chemical, Barcelona, Spain) and a practical low-dose 14C urea breath test (UBT) (Heliprobe™) test before and after eradication therapy. One hundred nine children with abdominal symptoms (age range, 5–17 years; mean, 12.1) underwent endoscopy, 14C-UBT, and Rapid HpSA. Patients were defined as Hp infected when histology was positive for Hp. Forty children (36.6%) were Hp infected. The sensitivity of Rapid HpSA and 14C-UBT was 65% and 92.5% (P = 0.0003), respectively; the specificity of Rapid HpSA and 14C-UBT was 92.3% and 85.5% (P = 0.180), respectively. After eradication therapy endoscopy, 14C-UBT and Rapid HpSA were repeated. The eradication rate was 70.5%. After eradication, the sensitivity of Rapid HpSA and 14C-UBT was 60% and 100%, respectively; the specificity of Rapid HpSA and 14C-UBT was 100%. 14C-UBT was more reliable than the Rapid HpSA test for the diagnosis and for confirming eradication of Hp infection. [Copyright &y& Elsevier]

Introduction: The aim of this prospective single-center study was to determine the changings in incidence of invasive pneumococcal disease (IPD), serotype distribution and the antimicrobial resistance patterns of S. pneumoniae in children with IPD after the period (1 to 7 years) of vaccination with PCV7 (2008) and PCV13 (2011)., Population and Methods: The study was conducted on 39 Turkish children with IPD between ages 1 month and 18 years in Ankara, Turkey. Streptococcus pneumoniae was identified using standard laboratory procedures from blood, cerebrospinal fluid (CSF), pleural fluid, and other sterile body fluids and tissues. S. pneumoniae isolates were tested for resistance to penicilin and ceftriaxone using the E-test methodology. Serotypes of the isolates were determined by Quellung reaction., Results: The overall annual incidence rate of IPD decreased significantly from 7.71 (95% CI, 1.99-13.4) to 1.58 (95% CI, 0.6-3.77; RRR=-79.5; p=0.006) per 100 000 population among ≤5 years of age without underlying disease. During the overall study period, the PCV7-serotypes and PCV13-serotypes represented 27.8% and 63.8% of isolates, respectively. PCV13-serotypes made up 81.8% of cases of IPD in the pre-PCV13 era and decreased to 56% in the 4 years after PCV13. The penicillin and ceftriaxone (for meningitis) resistance rates were 48.5% and 9.1%, respectively., Conclusions: This is the first study about the changing pattern of the incidence of IPD in Turkish children after the implementation of the PCV7 and PCV13 in Turkish national vaccine schedule and a prominent decrease in incidence of IPD has seen after the implementation of PCV13., (Sociedad Argentina de Pediatría)

The aims of the study were to examine the distribution of Candida spp. isolated from sterile body sites, the antifungal susceptibility of the isolates to amphotericin B, fluconazole, voriconazole, and caspofungin, and factors affecting mortality with invasive Candida infections in children. Thirty-five children with invasive candidiasis between January 2004 and January 2008 were evaluated retrospectively. The antifungal susceptibility of isolated Candida species was studied by Etest. Of the invasive Candida infections, 65.7% were due to C. albicans. The second most common isolated species was C. parapsilosis (11.4%). The rates of resistance to fluconazole, amphotericin B and voriconazole were 8.5%, 2.8% and 5.7%, respectively. Caspofungin was the most effective antifungal agent. 22.8% of the patients died in the first 30 days. In univariate analyses, increased mortality was associated with stay in the intensive care unit, the presence of central venous catheter (CVC), failure to remove CVC, and mechanical ventilation.