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AIM: We aimed to evaluate the microbiological characteristics of bloodstream infections (BSI) in children and the relationship between the time to positivity (TTP) of blood cultures and mortality. BACKGROUND: The early detection of causative microorganisms for BSI helps clinicians to initiate appropriate antimicrobials to reduce mortality. METHODS: A retrospective study was designed to evaluate the TTP of all the blood cultures from children with suspected BSIs for one year at Ege University. Episodes with no growths or contaminations were excluded from the study. RESULTS: A total of 890 BSI were evaluated and 272 episodes in 170 patients were included in the study. The median age of the patients was 2.3 years (min 2 months - 17.5 years) and 60.7% (n=165) were male. The most common underlying disease was solid-hematological malignancy (25%, n=68); followed by solid organ-bone marrow transplantation (19.9%, n=54) and intestinal failure (19.5%, n=53). The isolated microorganisms were gram-positive bacteria in 51.8% (n=141) episodes, gram-negative bacteria in 30.5% (n=83), multiple growths in 9.6% (n=26), and fungi in 8.1% (n=22). The median TTP of all positive blood cultures was 16 (min 5.5- max 103.5) hours. The TTP of Gram-negative strains was significantly shorter than that of Gram-positive strains (13.9 vs 17.5 hours, p0.05). CONCLUSIONS: The TTP in gram-negative agents was found to be shorter than in gram-positive and fungal agents. TTP helps identify the causative microorganisms and initiate appropriate treatment rapidly.

Garre’s osteomyelitis is a rare chronic inflammatory disease with reactive peripheral bone formation due to low-grade local infection. Here, we present a 12-year-old female with chronic osteomyelitis and proliferative periostitis with no definite source of infection, such as caries or periodontitis. The patient had a history of 4-5 hospitalizations with the same symptoms intermittently over the previous two years at the hospital which referred her to our hospital. The patient had undergone a biopsy at the referring hospital, and she was referred to our hospital with a histopathological diagnosis of osteoid osteoma. Physical examination showed a unilateral swelling in the right mandible at admission to our hospital. Since we could not exclude the diagnosis of bacterial osteomyelitis, antibiotics were continued. Periapical radiography, magnetic resonance, computed tomography, and clinical features supported the diagnosis of Garre’s osteomyelitis, so antimicrobial therapy was discontinued. Her biopsy materials were re-examined by the pathologist at our hospital, and Garre’s osteomyelitis was considered. Nonsteroidal anti-inflammatory drugs were started. We added colchicine treatment because she failed to achieve remission, and normal facial symmetrical morphology was not achieved in the two-month follow-up period. However, the symptoms regressed within one year, and the swelling disappeared.

Background: Bone and joint infections are common in children, particularly those under 10 years of age. While antimicrobial therapy can often successfully treat these infections, surgical drainage may also be necessary. It is important to note that prolonged courses of treatment have been associated with adverse events and drug reactions. Among these, drug reactions with eosinophilia and systemic symptoms (DRESS) syndrome is particularly severe and potentially life-threatening. We aimed to evaluate the cases of DRESS syndrome that develop during the treatment of bone and joint infections. Methods: A retrospective study was conducted at a tertiary-level university hospital between 2015 and 2022 to determine the incidence and outcomes of definite DRESS Syndrome in children under 18 years of age with bone and joint infections. Results: Of 73 patients with bone and joint infections, 16 (21.9 %) children developed antimicrobial therapy-induced DRESS syndrome. Eight (50 %) of these children were boys; the mean age of the patients was 9.76 ± 5.5 years. DRESS syndrome occurred in 16 children, including 13 children with osteomyelitis, 1 child with osteomyelitis and septic arthritis, and 2 children with septic arthritis and sacroiliitis. The mean duration of intravenous antibiotic therapy was 40.6 ± 16.6 days; the mean hospital stay was 48.7 ± 23.7 days; the mean time for the development of DRESS syndrome after starting antibiotics was 19.6 ± 7.68 days. New onset fever (68.8 %) and rash (43.8 %) were the most common symptoms of DRESS Syndrome. Cefotaxime and vancomycin were drugs responsible for DRESS syndrome in 8 (50 %) of 16. The causative antibiotics were switched to another class of antibiotic, most commonly preferred was ciprofloxacin (n:5; 31.3 %). For children with persistent symptoms, steroids were used in 5 (31.25) patients. Conclusions: Clinicians should be aware of DRESS syndrome in children who develop fever and rash under long-term antibiotics and should check hematological and biochemical parameters to predict the severity of DRESS syndrome. In patients with persistent symptoms, steroids may be used to control the symptoms.

Introduction: The World Health Organization (WHO)'s Research and Development (R&D) Blueprint for Action to Prevent Epidemics, a plan of action, highlighted several infectious diseases as crucial targets for prevention. These infections were selected based on a thorough assessment of factors such as transmissibility, infectivity, severity, and evolutionary potential. In line with this blueprint, the VACCELERATE Site Network approached infectious disease experts to rank the diseases listed in the WHO R&D Blueprint according to their perceived risk of triggering a pandemic. VACCELERATE is an EU-funded collaborative European network of clinical trial sites, established to respond to emerging pandemics and enhance vaccine development capabilities. Methods: Between February and June 2023, a survey was conducted using an online form to collect data from members of the VACCELERATE Site Network and infectious disease experts worldwide. Participants were asked to rank various pathogens based on their perceived risk of causing a pandemic, including those listed in the WHO R&D Blueprint and additional pathogens. Results: A total of 187 responses were obtained from infectious disease experts representing 57 countries, with Germany, Spain, and Italy providing the highest number of replies. Influenza viruses received the highest rankings among the pathogens, with 79 % of participants including them in their top rankings. Disease X, SARS-CoV-2, SARS-CoV, and Ebola virus were also ranked highly. Hantavirus, Lassa virus, Nipah virus, and henipavirus were among the bottom-ranked pathogens in terms of pandemic potential. Conclusion: Influenza, SARS-CoV, SARS-CoV-2, and Ebola virus were found to be the most concerning pathogens with pandemic potential, characterised by transmissibility through respiratory droplets and a reported history of epidemic or pandemic outbreaks.

Varicella is a vaccine-preventable disease, and the incidence of varicella has declined since the introduction of varicella vaccine campaigns. A wild type of varicella zoster virus (VZV) was isolated from a 33-month-old child with varicella in Korea in 1989, a different strain (MAV/06). A live-attenuated varicella vaccine containing strain (MAV/06), Suduvax®, was developed in South Korea in 1994. Turkey introduced the varicella vaccine containing the MAV/06 strain (Varicella Vaccine-GCC, Green Cross, South Korea) in January 2019. Therefore, we aimed to compare the seroconversion rates among MAV/06 vaccine- and vOka-administered children. We prospectively collected blood samples from 98 received vOKA and 98 received MAV/06 children 6 weeks after administration, and seroconversion rates were determined by an indirect fluorescence assay (Anti-VZV IIFT IgG, Euroimmun, Germany). Seroconversion rate was significantly higher in vOka group than MAV/06 group (82.7% vs. 64.3%; p = .004). Of the children vaccinated with vOka strain, 17 children did not develop antibodies, 12 were weakly positive, and the remaining 69 children were strongly positive. Of the children who were administered MAV/06 strain, 35 were negative, 20 were weakly positive, and 43 were strongly positive. In conclusion, this study demonstrated that MAV/06 varicella vaccine had lower seroconversion rates and the strong seropositive cases were less common than vOka-administered children. Larger and prospective studies are needed.

Introduction Health care workers (HCWs) are disproportionately exposed to infectious diseases and play a role in nosocomial transmission, making them a key demographic for vaccination. HCW vaccination rates are not optimal in many countries; hence, compulsory vaccination policies have been implemented in some countries. Although these policies are effective and necessary under certain conditions, resolving HCWs’ hesitancies and misconceptions about vaccines is crucial. HCWs have the advantage of direct contact with patients; hence, they can respond to safety concerns, explain the benefits of vaccination, and counter antivaccine campaigns that escalate during pandemics, as has been observed with COVID-19. Method A short survey was carried out in May–June 2020 on the vaccination status of HCWs working with pediatric patients with COVID-19. The survey inquired about their vaccination status (mumps/measles/rubella [MMR], varicella, influenza, and diphtheria/tetanus [dT]) and willingness to receive hypothetical future COVID-19 vaccines. The respondents were grouped according to gender, age, occupation, and region. Results In total, 4927 HCWs responded to the survey. Most were young, healthy adults. The overall vaccination rates were 57.8% for dT in the past 10 years, 44.5% for MMR, 33.2% for varicella, and 13.5% for influenza. Vaccination rates were the highest among physicians. The majority of HCWs (81%) stated that they would be willing to receive COVID-19 vaccines. Conclusion Although vaccination rates for well-established vaccines were low, a majority of HCWs were willing to receive COVID-19 vaccines when available. Education and administrative trust should be enhanced to increase vaccination rates among HCWs.

Objectives: The aim of this study is to identify the epidemiological, clinical, and laboratory features of coronavirus disease 2019 (COVID-19) in children.Methods: A retrospective study was conducted by pediatric infectious disease specialists from 32 different hospitals from all over Turkey by case record forms. Pediatric cases who were diagnosed as COVID-19 between March 16, 2020, and June 15, 2020 were included. Case characteristics including age, sex, dates of disease onset and diagnosis, family, and contact information were recorded. Clinical data, including the duration and severity of symptoms, were also collected. Laboratory parameters like biochemical tests and complete blood count, chest X-ray, and chest computed tomography (CT) were determined.Results: There were 1,156 confirmed pediatric COVID-19 cases. In total, male cases constituted 50.3% (n = 582) and females constituted 49.7% (n = 574). The median age of the confirmed cases was 10.75 years (4.5–14.6). Of the total cases, 90 were younger than 1 year of age (7.8%), 108 were 1–3 years of age (9.3%), 148 were 3–6 years of age (12.8%), 298 were 6–12 years of age (25.8%), 233 were 12–15 years of age (20.2%), and 268 cases were older than 15 years of age (23.2%). The most common symptom of the patients at the first visit was fever (50.4%) (n = 583) for a median of 2 days (IQR: 1–3 days). Fever was median at 38.4°C (38.0–38.7°C). The second most common symptom was cough (n = 543, 46.9%). The other common symptoms were sore throat (n = 143, 12.4%), myalgia (n = 141, 12.2%), dyspnea (n = 118, 10.2%), diarrhea (n = 112, 9.7%), stomachache (n = 71, 6.1%), and nasal discharge (n = 63, 5.4%). When patients were classified according to disease severity, 263 (22.7%) patients were asymptomatic, 668 (57.7%) patients had mild disease, 209 (18.1%) had moderate disease, and 16 (1.5%) cases had severe disease. One hundred and forty-nine (12.9%) cases had underlying diseases among the total cases; 56% of the patients who had severe disease had an underlying condition (p < 0.01). The need for hospitalization did not differ between patients who had an underlying condition and those who do not have (p = 0.38), but the need for intensive care was higher in patients who had an underlying condition (p < 0.01). Forty-seven (31.5%) of the cases having underlying conditions had asthma or lung disease (38 of them had asthma).Conclusions: To the best of our knowledge, this is one of the largest pediatric data about confirmed COVID-19 cases. Children from all ages appear to be susceptible to COVID-19, and there is a significant difference in symptomatology and laboratory findings by means of age distribution.

Objectives: Invasive aspergillosis (IA) is an important cause of mortality and morbidity in children with hematological malignancies. The monitoring of serum galactomannan (GM) antigen is considered useful in the diagnosis of IA . The aim of this study was to determine the utility of serum GM monitoring in the early diagnosis of IA and the role of positive antigenemia in the management of children with acute lymphoblastic leukemia (ALL). Methods: The cases of 141 children who were being treated for ALL in the Division of Pediatric Hematology of the Medical School of Ege University between January 2006 and February 2015 were reviewed retrospectively. Cases of proven and probable IA were defined according to the European Organization for the Research and Treatment of Cancer/Mycoses Study Group (EORTC/MSG) criteria. Results: The incidence of proven and probable IA was 3.5% (5/141). The incidence of positive GM antigenemia among 3264 serum samples was 5.5% (n = 179). Of the cases detected, 21.7% were true-positive, 52.1% were false-positive, and the remaining 26.1% were classified as ‘undetermined.’ An increase in the incidence of true-positive tests and induction of antifungal therapy was determined through multiple consecutive positive tests. Conclusions: GM may be detected in the serum before the clinical signs of IA appear, but its sensitivity and specificity are variable. False-positivity is a significant disadvantage, and consecutive positive GM must be taken into account in the case of clinical and imaging findings that are relevant to IA.

Brevibacterium spp. are catalase-positive, non-spore-forming, non motile, aerobic Gram-positive rods that were considered apathogenic until a few reports of infections in immunocompromised patients had been published. To the best of our knowledge, this is the first report of B. casei catheter-related bloodstream infection in a child with acute leukemia. We aim to enhance the awareness of pediatric hematology and infectious disease specialists about this pathogen and review of the literature. Keywords: Brevibacterium casei, Bloodstream infection, Child, Leukemia

Abstract The prognosis of tuberculous meningitis, a rare form of extrapulmonary tuberculosis, depends on the stage of treatment initiation. We report a fatal case of tuberculous meningitis. The patient had received successive tumor necrosis factor (TNF) antagonists and abatacept to treat juvenile idiopathic arthritis, with negative results for polymerase chain reaction and acid-fast bacilli on smear, had normal cerebrospinal fluid (CSF) adenosine deaminase and glucose levels. Six weeks post-admission, the CSF culture demonstrated Mycobacterium tuberculosis. The altered immunological responses caused by anti-TNF treatment made the diagnosis challenging. Clinicians should bear this in mind and, if suspected, treatment should be initiated immediately.

The most prevalent malignancy that complicates both adult and pediatric solid organ transplantation is post‐transplant lymphoproliferative disorder (PTLD). This study aimed to analyze the clinical and pathological characteristics, treatments, and outcomes of Epstein‐Barr virus (EBV) DNAemia and PTLD in pediatric liver transplant recipients. A retrospective chart review was performed on 112 patients less than 18 years of age who underwent isolated orthotopic liver transplantation (OLT) between 2010 and 2022 at Ege University Children's Hospital. Data gathered for 1‐year post‐OLT included age at OLT, EBV, immunoglobulin (Ig)M/IgG status of the donor and recipient, indication for OLT, induction regimen, all immunosuppression levels, date and result of EBV polymerase chain reaction testing, rejection episodes documented by liver biopsy, and the development of PTLD. Forty‐nine patients (43.75%) developed EBV DNAemia (median interval from surgery: 2 months, min–max: 2–36), of which 43 (87.8%) grafts came from living donors, and 6 (12.2%) came from deceased donors. Nine (18.4%) patients died during follow‐up, and eight (16.3%) developed PTLD. Of these 8 patients; five patients developed EBV‐related disease, one child developed hemophagocytic lymphohistiocytosis, one developed aplastic anemia, and one child developed B cell lymphoma. When PTLD patients and without‐PTLD patients were compared, pediatric intensive care unit hospitalization, abnormal bone marrow biopsy findings, lymphadenopathy, age at diagnosis of EBV DNAemia, EBV viral load, tacrolimus (FK 506) pre‐infection, were higher and tacrolimus 1‐month levels were lower in patients with PTLD (p < 0.05). In logistic regression analysis, we showed that the age at diagnosis of EBV DNAemia was significantly higher in children with PTLD (p = 0.045; OR: 1.389; 95% CI: 1.007–1.914). PTLD is a rare but severe complication associated with EBV after OLT. This study demonstrated that PTLD is associated with older age, higher tacrolimus blood levels before EBV DNAemia, and higher peak EBV viral load at 1 month of EBV DNAemia. [ABSTRACT FROM AUTHOR]

Aim: The children of healthcare workers (HCWs) constitute a group highly vulnerable to anxiety disorders during the coronavirus disease-2019 (COVID-19) pandemic. This study aimed to compare the prevalence and severity of anxiety between the children of HCWs and non-HCWs while identifying factors contributing to this anxiety. Materials and Methods: A cross-sectional study was conducted involving 334 children aged between 6 and 17 years to assess their anxiety levels. The risk factors related to anxiety were determined using binary logistic regression analysis. Results: Significant risk factors for anxiety included having parents who were HCWs, having parents with psychiatric disorders, changes in household members, and following news updates (p=0.045, 0.022, 0.021, and 0.024, respectively). Children of HCWs working in COVID-19 clinics exhibited a higher prevalence of moderate to severe anxiety than the other groups (p=0.036). Additionally, prolonged screen time and changes in sleep duration were more common in children with moderate to severe anxiety. Conclusion: The results suggest that the children of HCWs may be more prone to anxiety symptoms than the children of parents in other professions.

Objective: It is known that coronavirus disease-2019 (COVID-19) showed a clinical course with milder symptoms in children than in adults. However, a multisystem inflammatory syndrome in children (MIS-C), which developed 2-4 weeks after COVID-19 infection, emerged in April 2021. Other respiratory viruses such as influenza, respiratory syncytial virus, and parainfluenza spread worldwide after loosening pandemic restrictions. Pediatricians were challenged to distinguish COVID-19, MIS-C, and other viral infections from each other. Herein, we have aimed to determine basic, simple hematological parameters that can predict the prognosis and outcomes of the patients with COVID-19 and MIS-C. Method: In this study, 300 pediatric inpatients including those with MIS-C, COVID-19, and other respiratory virus infections admitted to Ege University Faculty of Medicine between January 2018 and September 2021, were retrospectively evaluated. Results: The neutrophil-to-lymphocyte ratio (NLR), neutrophil-to-monocyte ratio (NMR), derived NLR, and the systemic inflammatory index were higher in the MIS-C patients compared to others. The lymphocyte-to-monocyte ratio (LMR) and platelet-to-lymphocyte ratio (PLR) were lower in children with COVID-19 disease than those with MIS-C (p

Neisseria meningitidis is a rare and significant bacterial infection that can lead to severe morbidity and mortality if not promptly diagnosed and treated. While disseminated meningococcal infections often result in a high mortality rate due to sepsis, septic shock, and multi-organ failure, they can also cause other life-threatening complications, albeit rarely, such as pericarditis. This article presents a case study of reactive pericarditis following disseminated meningococcal infection. The patient underwent an echocardiogram due to suspicion of cardiac tamponade, which revealed the presence of pericardial effusion. Microbiology and pathology laboratories evaluated the effusion sample obtained through pericardiocentesis, leading to the diagnosis of reactive pericarditis. This case is quite remarkable in the literature due to its unique aspects, including the patient being the youngest reported case of meningitidis infection and the development of reactive pericarditis caused by the B serotype within a shorter timeframe than typically expected.

OBJECTIVES: Coronavirus disease 2019 (COVID-19) that causes a respiratory illness, continues to be a global pandemic. In this study, we purpose to identify the features of children with COVID-19 and the factors affecting disease severity. METHODS: This is a retrospective, observational study was conducted on patients who presented with suspicion of COVID-19 from April 1, 2020, to March 31, 2021, at a tertiary care medical center in Turkey. The characteristics of 640 children who were confirmed to have COVID-19 by real-time reverse transcription-polymerase chain reaction were retrieved from medical records. RESULTS: The mean age of the cases was 10 ± 6 years, and 56% of them were male. Seasonal difference did not affect the number of cases. The majority of the cases (n = 501, 78%) were infected by family members. Fever (67%) and cough (38%) were common complaints. The mean duration of fever was 1.9 ± 1.1 days. One-fourth of the cases were asymptomatic, 462 (72%) had mild upper respiratory tract infections, and 18 (3%) had pneumonia. Patients with pneumonia were more likely to have comorbidities and had a longer fever duration (both P < 0.001). Fever, cough, and respiratory distress were more common in patients with pneumonia (P = 0.010, P = 0.023, and P < 0.001, respectively). The mean C-reactive protein (CRP) value of the patients with pneumonia was significantly higher than that of the others (P < 0.001). A total of 70 (11%) complicated patients were hospitalized, 5 of them requiring intensive care admission. All hospitalized patients were discharged with recovery. CONCLUSIONS: Although pediatric COVID-19 patients tended to have a mild disease, some children with comorbidities can still develop a severe illness. CRP value is a useful indicator in the diagnosis of COVID-19 pneumonia. Furthermore, the prevalence rate of COVID-19 did not decrease with hot seasons.

Background: Understanding SARS-CoV-2 seroprevalence among health care personnel is important to explore risk factors for transmission, develop elimination strategies and form a view on the necessity and frequency of surveillance in the future. Methods: We enrolled 4927 health care personnel working in pediatric units at 32 hospitals from 7 different regions of Turkey in a study to determine SARS Co-V-2 seroprevalence after the first peak of the COVID-19 pandemic. A point of care serologic lateral flow rapid test kit for immunoglobulin (Ig)M/IgG was used. Seroprevalence and its association with demographic characteristics and possible risk factors were analyzed. Results: SARS-CoV-2 seropositivity prevalence in health care personnel tested was 6.1%. Seropositivity was more common among those who did not universally wear protective masks (10.6% vs 6.1%). Having a COVID-19-positive co-worker increased the likelihood of infection. The least and the most experienced personnel were more likely to be infected. Most of the seropositive health care personnel (68.0%) did not suspect that they had previously had COVID-19. Conclusions: Health surveillance for health care personnel involving routine point-of-care nucleic acid testing and monitoring personal protective equipment adherence are suggested as important strategies to protect health care personnel from COVID-19 and reduce nosocomial SARS-CoV-2 transmission.

Aim:Bloodstream infections are serious conditions that can cause significant morbidity and mortality. Early recognition of the bacteria and targeted early treatment play an important role in prognosis. The Verigene Gram-negative blood culture nucleic acid test (BC-GN; Nanosphere, USA) is a new method that can accurately identify both Gram-negative bacteria and resistance genes within 2 hours. In this study, we aimed to determine the accuracy of this assay for the rapid identification of certain Gram-negative microorganisms in children with bloodstream infections and to compare with the conventional culture method.Materials and Methods:A total of 30 patients (

In early December, pneumonia cases of unknown origin started to appear and, on the 7th of January 2020, these cases were declared to be caused by a novel beta-coronavirus according to viral genome sequencing on the 11th of February, 2020. Coronaviruses are enveloped, single strand RNA viruses that have been known to have the ability to mutate rapidly, alter tissue tropism and adjust to different epidemiological situations. As of the end of April 2020, 122,392 laboratory-confirmed cases of COVID-19 had been detected in Turkey, of whom 3,258 died. From the beginning of the COVID-19 epidemic, children seem to be less affected than adults. Therefore, there are limited data regarding the clinical features of COVID-19 in children. The majority of children with confirmed COVID-19 had a history of household contact. The most common symptoms were fever and cough. Previous data suggest that nearly half of patients are afebrile at the onset of the disease. Hospitalization and PICU admission rates for children were lower than for adults. However, PICU admission can be necessitated in children with severe disease. Infants, particularly under the age of 12 months, were more likely to develop severe disease. In children, milder and asymptomatic cases can be challenging and can play a role in transmission. In particular, clinicians should test those children who have a history of family cluster even though they are asymptomatic or present with mild symptoms.

Aim:Infections and sepsis are the leading causes of death in non-cardiac intensive care units (ICUs) and account for 40 percent of all ICU expenditures. Data regarding bloodstream infections (BSIs) due to a carbapenem-resistant gram negative (CRGN) microorganisms in pediatric ICUs still remain limited.Materials and Methods:This study was conducted retrospectively in patients who were admitted to two pediatric critical care units between January 2011 and December 2017. Patients were assigned to two groups. Patients with BSI caused by a CRGN microorganism and infections were assigned to the BSI group and those other than BSI were assigned to the non-BSI group.Results:This study included 89 critically ill children with a mean age of 52.1 (±65.1) months. The requirements for invasive procedures including tracheostomy, Foley catheter and central venous catheter were not statistically different among the groups, p values were 0.159, 0.291 and 0.803, respectively. The majority of the patients admitted to pediatric intensive care unit were due to sepsis/septic shock in the BSI group (n=18, 58%) and in the non-BSI group, this figure was 37.9% (n=24). Prior third/fourth generation cephalosporin exposure was significantly more common in the BSI group (51.6% vs 15.5%, p

Objective: This study aimed to assess the outcomes including morbidity and mortality of carbapenem-resistant gram-negative (CRGN) infections in pediatric critical care setting. The second aim was to investigate the impact of aminoglycosides on colistin-containing regimen in CRGN-infected pediatric critical care patients. Materials and Methods: We retrospectively evaluated medical records of 82 patients who had received colistin in combination with an aminoglycoside (CA group) or another antibiotic (CO group) at two reference pediatric intensive care units (PICUs) between February 2011 and February 2016. Results: We enrolled 82 CRGN-infected patients who were admitted to PICUs of two hospitals. The median age of the patients was 24 (25th–75th percentile; 8–78.75) months, and the median duration of hospital stay was 30 days (25th–75th percentile; 16.7–57.7). No statistical difference was observed in the variables, including microbiological response, attributable mortality, crude mortality, and the duration of achieving first negative culture (p>0.05). Clinical response was significantly more observed in the CA group (85.5% vs. 63.2; p=0.048), and attributable mortality was higher in the CO group (12.7% vs. 31.6%; p=0.055). Nephrotoxicity did not show statistical difference between groups (p=0.357), and neurotoxicity was not observed. Conclusion: Colistin-containing regimen in combination with an aminoglycoside may be an effective and safe antimicrobial agent without a significant increase in side effects.

Aim:Despite improvements in diagnosis and treatment, infections are still major cause of morbidity and mortality in children with febrile neutropenia (FN). In these patients, due to inadequate inflammatory response and subtle clinical symptoms, to determine the source of infection can be challenging. Therefore, it is important to distinguish infections from other non-infectious causes, for both to choose appropriate antibiotic and to reduce the redundant antibiotic use.Materials and Methods:In this retrospective study, we aim to evaluate serial procalcitonin (PCT) levels for predicting bacteremia particularly caused by Gram-negative microorganism.Results:Among FN episodes caused by Gram-negative microorganism, the median level of second PCT sample obtained between 48 and 72 hours PCT 2 was found to be significantly higher when compared to infections caused by Coagulase-negative Staphylococcus or culture-negative confirmed infections, p value was 0.003; however, fever onset PCT 1 and C-reactive protein (CRP) 1 values showed no significant difference (p>0.05). The area under curve values demonstrated by receiver operating characteristic (ROC) analysis for CRP 1, CRP 2, PCT 1, PCT 2 were 0.664, 0.748, 0.504 and 0.842, respectively.Conclusion:This study showed that initial PCT levels were not significantly correlate with culture-confirmed bacterial infection. Therefore, initial PCT values do not help the clinicians in terms of administering or postponing empirical antibiotics at the time of fever onset. However, third day PCT levels present as a good diagnostic marker due to a higher sensitivity and specificity when comparing them to the initial values. Determination of serial PCT may enhance the diagnostic value of PCT diagnostic marker in FN episodes caused by Gram-negative bacteria with a high sensitivity (87.5%). This study also demonstrated that PCT could be used to rule out bacterial infections particularly caused by Gram-negative bacteria.

Congenital syphilis is preventable with proper antenatal follow-up and treatment of the pregnant woman infected with Treponema pallidum, and the rapid evaluation and early treatment of the newborns. Here we report a newborn with early congenital syphilis presenting with maculopapular rash and positive treponemal test born to an inadequately treated syphilitic mother.

Despite improvements in diagnosis and treatment, infections are still a major cause of morbidity and mortality in children with febrile neutropenia. In the majority of febrile episodes, the source of infection cannot be defined. In this study, we aimed to identify the earlier predictors of bacteremia/fungemia and a useful cytokine to identify the source of infection and to discriminate the patients with culture-confirmed bacterial/fungal infection. The most sensitive cytokine was interleukin (IL)-10 and the most specific was IL-8 in predicting culture-confirmed cases. IL-8 had greater sensitivity and specificity in determination of gram-negative bacterial infections with a higher negative predictive value; therefore, IL-8 can be used particularly to rule out gram-negative bacterial infections. IL-6, IL- 8, and IL-10 circulating levels were shown to be higher in cases of infection. Further studies are needed to recommend a routine practice for predicting culture-confirmed bacterial infections.