Streptococcus mitis/oralis Causing Blood Stream Infections in Pediatric Patients.

Viridans streptococci are still under investigation concerning epidemiology, pathogenesis and clinical presentations. We aimed to investigate the clinical presentations and outcomes of pediatric patients infected with Streptococcus mitis/oralis. Based on the accumulation of bloodstream infections (BSI) caused by S. mitis/oralis in 4 patients in our Hematology and Bone Marrow Transplantation Department at a particular time, a review of the medical and microbiological records of pediatric patients with positive blood cultures for S. mitis/oralis in the entire hospital was performed. In addition, a retrospective case-control study was conducted. Pulsed-field gel electrophoresis of S. mitis/oralis in 4 patients displayed unrelatedness of the strains. A total of 53 BSI (42 BSI and 11 catheter-related BSI) were analyzed. Thirty-four percent of patients with BSI caused by S. mitis/oralis had febrile neutropenia. Clinical and microbiological outcomes were favorable and infection-related mortality was not observed. Although not significant, previous antibiotic use and trimethoprim-sulfamethoxazole prophylaxis were more common in the case group. S. mitis/oralis seems likely an important agent in bacteremic children who are particularly neutropenic because of the underlying hematologic and oncologic diseases. Prompt management of infections with appropriate antimicrobials, regarding antibiotic susceptibilities of organisms, may facilitate favorable outcomes.

Knowledge and awareness of optimal use of reporting guidelines in paediatricians: A cross-sectional study.

Aim: The aim of this study was to investigate pediatricians' ideas and awareness of reporting guidelines of scientific researches, as well as the use of these guidelines in routine practice. Material and Methods: This cross-sectional survey was conducted among pediatricians working at two of the largest pediatric hospitals in Ankara. The pediatricians were asked to complete a 13-item questionnaire in Turkish about reporting guidelines and the Enhancing the Quality and Transparency of Health Research internet network, and their level of knowledge, awareness, and use of these guidelines were investigated. Results: A total of 224 physicians from both centers agreed to participate in the study (56.4% of the target population). The average age of the participants was 34±9.24 years, their median age was 31 (min-max: 24-63) years, and 71.4% were female physicians. The participants' median duration in their careers was 6 (min-max: 1-39) years and 63.8% had participated in a scientific study as a researcher. Forty-five (20%) of the participants had known about the reporting guidelines before and reported that they had most frequently heard about them via journals, congresses, and seminars. Twenty (26.6%) of these physicians had used the guidelines. Sixty-five (29%) of the participants had served as a reviewer for a scientific article, but only three (4.6%) stated that they had made use of the guidelines while reviewing the articles. Some 83.5% of the participants reported that they would like to be informed about reporting guidelines. Both centers had similar knowledge levels about the use of the guidelines. Conclusion: The awareness and use of reporting guidelines of scientific researches by pediatricians is insufficient.

Poor outcomes among elderly patients hospitalized for influenza-like illness.

BACKGROUND AND OBJECTIVE: Global Influenza Hospital Surveillance Network is a worldwide initiative that aims to document the burden of influenza infections among acute admissions and vaccine effectiveness in particular countries. As a partner of this platform, we aimed to determine the frequency of influenza infections among acute admissions with influenza-like illness and the outcomes of enrolled patients during the 2015-2016 influenza season in selected hospitals in Turkey. PATIENTS AND METHODS: The investigators screened the hospital admission registries, chart review or available records, and screened all patients hospitalized in the previous 24-48 hours or overnight in the predefined wards or emergency room. A total of 1351 patients were screened for enrollment in five tertiary care referral hospitals in Ankara and 774 patients (57.3% of the initial screened population) were eligible for swabbing. All of the eligible patients who consented were swabbed and tested for influenza with real-time polymerase chain reaction (PCR) based methods. RESULTS: Overall, influenza positivity was detected in 142 patients (18.4%). The predominant influenza strain was A H1N1pdm09. Outcomes were worse among elderly patients, regardless of the presence of the influenza virus. Half of the patients over 65 years of age were admitted to the intensive care unit, while one third required any mode of mechanical ventilation and one fourth died in the hospital in that particular episode. CONCLUSION: These findings can guide hospitals to plan and prepare for the influenza season. Effective influenza vaccination strategies, particularly aimed at the elderly and adults with chronic diseases, can provide an opportunity for prevention of deaths due to influenza-like illness.

Bloodstream infections in children caused by carbapenem-resistant versus carbapenem-susceptible gram-negative microorganisms: Risk factors and outcome.

Carbapenems are often considered the last resort agents reserved for treatment of infections due to highly antimicrobial resistant organisms such as A. baumannii and P. aeruginosa. However, carbapenem-resistant Gram-negative (CRGN) pathogens have become much more prevalent in the last decade. The objective of this study was to determine risk factors for and outcome of bacteremia caused by Gram-negative microorganisms in a pediatric tertiary-care hospital. Among 97 patients with hospital-acquired Gram-negative bacteremia, 66 patients with carbapenem-susceptible Gram-negative pathogens (CSGN) were compared with the remaining 31 with CRGN isolates. The overall clinical response and microbiological response rates were 83.3% and 43.9% in CSGN group, and 54.8% and 32.3% in CRGN group, respectively (P=0.002 and P=0.004, respectively). The treatment failure and relapse rates were 18.2% and 6.1% in CSGN group, and 38.7% and 6.5% in CRGN group, respectively (P=0.03 in each). The infection-related mortality rates were 10.8% in the CSGN group and 32.3% in the CRGN group (P=0.01). The total length of stay in hospital before infection was longer in patients with CRGN bacteremia than that of the CSGN bacteremia (P=0.002). The extended spectrum antibiotic usage prior to infection was significantly different between the groups (P=0.008). Infections due to CRGN are generally associated with poorer patient outcomes. Longer hospital stay and extended spectrum antibiotic usage prior to infection are the most important risk factors for CRGN bacteremia in our cohort.