Association of Suicide Attempt With Seroprevalence of Toxoplasma gondii in Adolescents.

In this study, we aimed to explore the potential pathophysiological relationship between suicide attempts and Toxoplasma gondii infection. Fifty patients aged between 12 and 18 years who attempted suicide and 50 healthy adolescents were included in this study. All adolescents were evaluated by a child psychiatrist using a semistructured interview and Rosenberg Self-Esteem Scale (RSES), Children's Depression Inventory (CDI), and Inventory of Parent and Peer Attachment. T. gondii IgM and IgG antibodies of patients and control subjects were analyzed from blood samples by enzyme-linked immunosorbent assay. Psychiatric disorders particularly mood disorders were more common in adolescents in the patient group. Adolescents attempting suicide were found to have worse relationships with their parents; their CDI scores were higher, and their RSES scores were lower than their healthy peers. There were no significant differences between the patient and the control groups in terms of Toxoplasma IgG antibody positivity. Although the seropositivity of Toxoplasma IgG antibody was higher in the patient group than that in the control group, the difference between the two groups was not statistically significant.

Reliability and accuracy of smartphones for paediatric infectious disease consultations for children with rash in the paediatric emergency department.

OBJECTIVE: Smartphones and associated messaging applications have become the most common means of communication among health care workers and the general population. The aim of this study was to evaluate the reliability and accuracy of smartphones for the diagnosis of rash in children admitted to emergency departments during the night shift. METHODS: The images of the children who were admitted to the paediatric emergency department with rash were included in this study, and at least two images taken with smartphones by residents or paediatric infectious disease fellows were re-directed to the chief consultant of the Paediatric-Infectious Department via smartphone. Initial diagnosis by the consultant was recorded, and the patient's physical examination was performed by another clinician on the first working day; diagnostic tests were planned by this clinician. The definitive diagnosis was recorded and compared with the initial diagnosis. RESULTS: Among the 194 patients, the most common final diagnoses were chickenpox (varicella-zoster infections) in 33 patients (17.0%) and skin infections (including impetigo, ecthyma, erysipelas and cellulitis) in 33 patients (17.0%). The initial diagnosis, which was performed via WhatsApp on a smartphone, was identical to the final diagnosis in 96.3% of the cases. Incompatible initial diagnoses included 4 measles cases, 1 staphylococcal scalded skin syndrome case, 1 cutaneous leishmaniasis case and 1 petechial rash case. CONCLUSIONS: Our study has shown that the use of a smartphone-based instant messaging application for transmitting images of paediatric rash is accurate and useful for diagnosis. However, physical examination and medical history are still the primary methods. Consultation via smartphones in emergency departments for paediatric rashes during nightshifts would help both clinicians and patients.

Clinical features and laboratory findings in children hospitalized with acute Epstein-Barr virus infection: a crosssectional study in a tertiary care hospital.

Çaglar I, Topal S, Çokboz M, Düzgöl M, Kara A, Bayram SN, Apa H, Devrim I. Clinical features and laboratory findings in children hospitalized with acute Epstein-Barr virus infection: a cross-sectional study in a tertiary care hospital. Turk J Pediatr 2019; 61: 368-373. Epstein-Barr virus (EBV) is widespread all over the world. It causes infectious mononucleosis (IM) mostly in adolescents and adults. Although IM is considered to be rare in younger children and infants, acute EBV infection may have various manifestations in this age group. We aimed to describe the clinical features and laboratory findings of children hospitalized with acute EBV infection. All children hospitalized at Dr. Behçet Uz Children`s Hospital, between January 2010 and January 2017, who tested positive by presence of EBV-specific antibodies and had the diagnosis of acute EBV infection, were included (n=66). Thirty four of the patients (51.5%) were under 6 years of age, and 23 (34.8%) children were below 3 years of age. The most common physical finding was fever (92.4%) followed by cervical lymphadenopathy and tonsillopharyngitis. Leukocytosis (65.1%) and lymphocytosis (42.4%) were the most common laboratory findings. Reactive and atypical lymphocytes were present in 77.2% of the patients. Fifty-three (80.3%) of the patients had a doctor visit before hospitalization, and the ratio of patients using antibiotics was 77.3%. Skin rash was observed in 14 (27.4%) of the patients who used antibiotic treatment and in 2 (13.3%) of the patients who did not (p > 0.05). EBV infection resulting in admission to hospital is common in younger children, even in pre-school period. Serological tests for EBV specific antibody responses and peripheral blood smear evaluation are important diagnostic tools. In addition, rapid streptococcal antigen test and throat culture should be performed in patients presenting with tonsillopharyngitis in order to exclude Group A beta-hemolytic streptococci and reduce unnecessary antibiotic consumption.

Stevens-Johnson syndrome and toxic epidermal necrolysis: a report of six cases.

Kara A, Devrim I, Çaglar I, Bayram N, Kundak S, Apa H, Altan EV. Stevens-Johnson syndrome and toxic epidermal necrolysis: a report of six cases. Turk J Pediatr 2019; 61: 538-543. Stevens-Johnson syndrome and toxic epidermal necrolysis are severe cutaneous adverse reactions commonly caused by exposure to drugs and can end up with significant morbidity and mortality. We reported our experience with six patients who were diagnosed with Stevens-Johnson Syndrome or Toxic Epidermal Necrolysis with a different clinical presentation. In patients, drugs and Mycoplasma pneumoniae infection were implicated as a trigger. Intravenous Immunoglobulin treatment was given to all patients, and intensive treatment was applied for skin and mucosal lesions. The median period of stay in hospital was 13.5 days. The most common long-term complication was ocular involvement. Among six patients, corneal epithelial defects occurred in one patient. Consequently, ophthalmological evaluation should be performed both at the time of diagnosis and before hospital discharge.

Antifungal consumption, indications and selection of antifungal drugs in paediatric tertiary hospitals in Turkey: Results from the first national point prevalence survey.

OBJECTIVES: The aim of this point prevalence survey was to evaluate the consumption, indications and strategies of antifungal therapy in the paediatric population in Turkey. METHODS: A point prevalence study was performed at 25 hospitals. In addition to general data on paediatric units of the institutes, the generic name and indication of antifungal drugs, the presence of fungal isolation and susceptibility patterns, and the presence of galactomannan test and high-resolution computed tomography (HRCT) results were reviewed. RESULTS: A total of 3338 hospitalised patients were evaluated. The number of antifungal drugs prescribed was 314 in 301 patients (9.0%). Antifungal drugs were mostly prescribed in paediatric haematology and oncology (PHO) units (35.2%), followed by neonatal ICUs (NICUs) (19.6%), paediatric services (18.3%), paediatric ICUs (PICUs) (14.6%) and haematopoietic stem cell transplantation (HSCT) units (7.3%). Antifungals were used for prophylaxis in 147 patients (48.8%) and for treatment in 154 patients (50.0%). The antifungal treatment strategy in 154 patients was empirical in 77 (50.0%), diagnostic-driven in 29 (18.8%) and targeted in 48 (31.2%). At the point of decision-making for diagnostic-driven antifungal therapy in 29 patients, HRCT had not been performed in 1 patient (3.4%) and galactomannan test results were not available in 12 patients (41.4%). Thirteen patients (8.4%) were receiving eight different antifungal combination therapies. CONCLUSION: The majority of antifungal drugs for treatment and prophylaxis were prescribed in PHO and HSCT units (42.5%), followed by ICUs. Thus, antifungal stewardship programmes should mainly focus on these patients within the availability of diagnostic tests of each hospital.

Central line bundle for prevention of central line-associated bloodstream infection for totally implantable venous access devices (ports) in pediatric cancer patients.

OBJECTIVE: The clinical impact of central line bundle programs for central line-associated bloodstream infections has been well demonstrated in intensive care units. However, the experience of central line bundle programs in totally implantable venous access devices (ports) in pediatric-hematology patients was limited. METHODS: A retrospective study was designed to compare and evaluate the clinical impact of implementing a central line bundle for a 2-year 5-month period, including 10 months of prebundle period, 11 months of central line bundle (that includes needleless split-septum devices), and finally 8 months of central line bundle period in which single-use prefilled flushing devices were added to the previous central line bundle. RESULTS: During the prebundle period, the rate of 14.5 central line-associated bloodstream infections per 1000 CL-days had decreased to 5.49 CLABSIs per 1000 CL-days in the first bundle period. The incidence rate ratio with these two groups was 0.379, indicating a relative risk reduction of 62% ( p = 0.005). By the addition of single-use prefilled flushing devices to the first bundle program, the central line-associated bloodstream infection rate decreased to 2.63 per 1000 CL-days. Port removal rate due to central line-associated bloodstream infections was 0.46 per 1000 catheter days in the bundle period, which was significantly lower than in the prebundle period in which port removal rate was 4.5 per 1000 catheter days ( p < 0.001). CONCLUSION: Central line bundle programs were found to be effective in decreasing central line-associated bloodstream infection rates, improving patients' quality of life by preventing ports removal due in pediatric cancer patients.

The Frequency of Infective Endocarditis in Candida Bloodstream Infections: a Retrospective Study in a Child Hospital.

INTRODUCTION: Fungal endocarditis is reported less frequently than bacterial endocarditis, with an incidence of 0-12% of the total pediatric infective endocarditis. OBJECTIVE: In this study, the incidence of infective endocarditis in Candida bloodstream infections in a tertiary hospital during the periods of 2007 and 2016 was reviewed. METHODS: Patients with positive blood or catheter cultures in terms of Candida spp. during the study period of January 2007 and January 2016 were analyzed in terms of Candida infective endocarditis. Infective endocarditis was defined according to the modified Duke criteria. The outcome, possible associated predisposing factors for Candida endocarditis were determined. RESULTS: 221 patients and 256 attacks with positive blood or catheter cultures in terms of Candida were included in the study. The most common Candida species was Candida parapsilosis, isolated in 157 (61.3%) attacks, followed by Candida albicans in 70 (27.3%). Neurological diseases (23%), hemato-oncological diseases (12.1%), previously known heart diseases (8.2%), inborn errors of metabolism (9%) were common comorbidities. Twelve (5.4%) patients had a previous history of cardiac surgery. Among the 221 patients, Candida endocarditis was present in only two (0.9%) of them. CONCLUSION: Although Candida infective endocarditis is an uncommon but frequently fatal infection in pediatrics, echocardiography should be performed routinely for patients with positive blood or catheter cultures in terms of Candida. Prompt and effective antimicrobial therapy might prevent cardiac surgery in selected cases, however this could not be a general rule for all patients.

Hospital cost analysis of children with preseptal cellulitis.

OBJECTIVE: Hospitalization of the children with preseptal cellulitis creates a burden on healthcare costs. This study aimed to analyze the hospital costs for preseptal cellulitis and determine the factors contributing. METHODS: Children, between 1 and 18 years old, who were admitted to hospital for preseptal cellulitis from May 2013 to December 2016 were included in the study. Patients were divided into groups by age (under or equal to five years and older than five years) and by the presence of sinusitis. Demographics, length of stay and total and categorical hospital costs were evaluated retrospectively. RESULTS: The study included 54 patients with a mean age of 5 years. Thirty one of the patients were under five years of age. The most common symptoms were swelling (94.4%) and redness (83.3%) around eye. Among the predisposing factors, sinusitis was the most common one (37%). The average length of stay was 4.5 days. Total hospital cost of all patients was $11,841. Antibiotic costs (37%) and inpatient floor costs (36%) were the greatest expenditures. Between age groups, length of stay was longer, and inpatient floor and antibiotic costs were significantly higher in the group of >5 years (p = 0.007, p = 0.004 and p = 0.001, respectively). In the group with sinusitis, length of stay was longer, and all hospital costs were significantly higher compared to the group without sinusitis (p < 0.001). There was a strong, positive correlation between length of stay and hospital costs (r = 0.854, n = 53, p < 0.001). Sinusitis was a significant factor (p < 0.001) for longer length of stay, but age was not (p = 0.841). CONCLUSION: Sinusitis was found to be an important factor contributing to longer length of stay and higher hospital costs for preseptal cellulitis. Oral or ambulatory intravenous antimicrobial treatment strategies might decrease the hospital expenditure in these patients; however care should be taken in the presence of sinusitis.

The frequency of infective endocarditis in candida bloodstream infections: a retrospective study in a child hospital

Abstract Introduction: Fungal endocarditis is reported less frequently than bacterial endocarditis, with an incidence of 0-12% of the total pediatric infective endocarditis. Objective: In this study, the incidence of infective endocarditis in Candida bloodstream infections in a tertiary hospital during the periods of 2007 and 2016 was reviewed. Methods: Patients with positive blood or catheter cultures in terms of Candida spp. during the study period of January 2007 and January 2016 were analyzed in terms of Candida infective endocarditis. Infective endocarditis was defined according to the modified Duke criteria. The outcome, possible associated predisposing factors for Candida endocarditis were determined. Results: 221 patients and 256 attacks with positive blood or catheter cultures in terms of Candida were included in the study. The most common Candida species was Candida parapsilosis, isolated in 157 (61.3%) attacks, followed by Candida albicans in 70 (27.3%). Neurological diseases (23%), hemato-oncological diseases (12.1%), previously known heart diseases (8.2%), inborn errors of metabolism (9%) were common comorbidities. Twelve (5.4%) patients had a previous history of cardiac surgery. Among the 221 patients, Candida endocarditis was present in only two (0.9%) of them. Conclusion: Although Candida infective endocarditis is an uncommon but frequently fatal infection in pediatrics, echocardiography should be performed routinely for patients with positive blood or catheter cultures in terms of Candida. Prompt and effective antimicrobial therapy might prevent cardiac surgery in selected cases, however this could not be a general rule for all patients.

Risk factors for recurrent central line-associated bloodstream infections in a pediatric intensive care unit

Background/aim: It is recommended that a central venous catheter (CVC) be removed if central line-associated bloodstream infection (CLABSI) has been diagnosed. The objective of this retrospective study was to evaluate the risk factors for recurrent CLABSI in reinserted catheters in a pediatric intensive care unit. Materials and methods: Patients with recurrent and nonrecurrent CLABSI were compared in terms of the catheter exchange interval, the interval between negative blood culture and reinsertion of the CVC, and the pre-/reinsertion treatment duration. Results: Thirty-one patients with initial CLABSI had reinserted CVCs, and 12 (38.7%) of these patients were diagnosed with recurrent CLABSI. In the recurrent group, the catheter exchange interval, the interval between negative blood culture and reinsertion of the second CVC, and pre-/reinsertion treatment duration were found to be shorter. Logistic regression analysis revealed that if the interval between negative blood culture and reinsertion of the second CVC was shorter than 4 days, recurrent CLABSI risk increased by 1.7-fold (P = 0.021). Sterile gauze-dressed patients had shorter cumulative catheter surveys than the polyurethane-dressed patients (P = 0.005). Conclusion: Using transparent polyurethane dressings instead of sterile gauze for maintaining the CVC and delaying the reinsertion procedure for at least 4 days after the negative culture might be helpful in preventing recurrent CLABSI.

Efectos adversos relacionados con la linezolida en la práctica clínica pediátrica / Linezolid-related adverse effects in clinical practice in children

Introducción. La linezolida puede causar efectos adversos, como trombocitopenia, que, según lo observado, se relacionan con la administración de linezolida durante más de 2 semanas. Se ha realizado una cantidad limitada de estudios sobre la seguridad y el momento de aparición de los efectos adversos relacionados con la linezolida en los niños. El objetivo de este estudio fue evaluar la incidencia de los efectos adversos asociados con la linezolida, especialmente en relación con el momento de su aparición. Población y métodos. Se incluyeron a todos los niños (< 18 años de edad) que recibieron tratamiento con linezolida durante > 3 días. Se evaluaron los efectos adversos atribuidos a la linezolida y el momento de aparición de los efectos secundarios. Resultados. En total, se incluyeron 179 niños. La mediana de edad de los pacientes fue 4 años (entre 6 días y 17 años). Durante el tratamiento con linezolida, 36 (20,1%) pacientes tuvieron efectos adversos. El efecto adverso más frecuente fue la trombocitopenia, detectada en 26 (14,5%) pacientes. Los demás efectos adversos fueron: elevación de las enzimas hepáticas en 4 pacientes, leucopenia y anemia en 2 pacientes, disfunción renal en 1 y reacciones cutáneas graves en 3 pacientes. Los efectos adversos se detectaron dentro de una mediana de 7,5 días de tratamiento (intervalo: de 4 a 18 días). Entre los 36 pacientes, 26 (72,2%) presentaron un efecto adverso en los primeros 10 días de tratamiento. Conclusiones. Se detectaron efectos adversos transitorios en el 20,1% de los pacientes durante el tratamiento con linezolida. Estos efectos adversos podrían detectarse antes de los 10 días de tratamiento. La linezolida debe recetarse de manera segura a los niños siempre que se vigilen los efectos adversos, en especial el recuento de trombocitos y el nivel de enzimas hepáticas.

Introduction: Linezolid may cause adverse effects such as thrombocytopenia, which were found to be dependent on receiving linezolid for longer than 2 weeks. There are limited studies concerning the safety and timing of linezolid-related adverse effects in children. Objective of this study was to evaluate the incidence of adverse effects associated with linezolid, with especially focusing on the time of occurrence. Population and Methods: All children (<18 years of age) who received >3 days of linezolid therapy were included in this study. Adverse effects attributed to linezolid and time of occurrence of side effects was evaluated. Results: A total of 179 children were enrolled to the study. The patients' median age was 4 years (6 days to 17 years). During linezolid treatment, 36 (20.1%) patients experienced adverse effects. The most common adverse effect was thrombocytopenia that was detected in 26 patients (14.5%). Other adverse effects were as following; elevated liver enzymes in 4 patients, leucopenia and anemia in 2 patients, renal function impairment in one patient, and serious skin reactions in 3 patients. Adverse effects were detected within median 7.5 days of therapy (ranging from 4 to 18 days). Among 36 patients, 26 (72.2%) patients had adverse effect on the first 10 days of therapy. Conclusions: Transient adverse effects were detected in 20.1% of the patients during linezolid therapy. These adverse effects may be detected earlier than ten days of treatment. Linezolid should be prescribed safely in children with monitoring adverse effects especially platelet count and level of liver enzymes.

Linezolid-related adverse effects in clinical practice in children. / Efectos adversos relacionados con la linezolida en la práctica clínica pediátrica.

INTRODUCTION: Linezolid may cause adverse effects such as thrombocytopenia, which were found to be dependent on receiving linezolid for longer than 2 weeks. There are limited studies concerning the safety and timing of linezolid-related adverse effects in children. Objective of this study was to evaluate the incidence of adverse effects associated with linezolid, with especially focusing on the time of occurrence. POPULATION AND METHODS: All children (<18 years of age) who received >3 days of linezolid therapy were included in this study. Adverse effects attributed to linezolid and time of occurrence of side effects was evaluated. RESULTS: A total of 179 children were enrolled to the study. The patients' median age was 4 years (6 days to 17 years). During linezolid treatment, 36 (20.1%) patients experienced adverse effects. The most common adverse effect was thrombocytopenia that was detected in 26 patients (14.5%). Other adverse effects were as following; elevated liver enzymes in 4 patients, leucopenia and anemia in 2 patients, renal function impairment in one patient, and serious skin reactions in 3 patients. Adverse effects were detected within median 7.5 days of therapy (ranging from 4 to 18 days). Among 36 patients, 26 (72.2%) patients had adverse effect on the first 10 days of therapy. CONCLUSION: Transient adverse effects were detected in 20.1% of the patients during linezolid therapy. These adverse effects may be detected earlier than ten days of treatment. Linezolid should be prescribed safely in children with monitoring adverse effects especially platelet count and level of liver enzymes.

INTRODUCCIÒN: La linezolida puede causar efectos adversos, como trombocitopenia, que, según lo observado, se relacionan con la administración de linezolida durante más de 2 semanas. Se ha realizado una cantidad limitada de estudios sobre la seguridad y el momento de aparición de los efectos adversos relacionados con la linezolida en los niños. El objetivo de este estudio fue evaluar la incidencia de los efectos adversos asociados con la linezolida, especialmente en relación con el momento de su aparición. POBLACIÓN Y MÉTODOS: Se incluyeron a todos los niños (< 18 años de edad) que recibieron tratamiento con linezolida durante > 3 días. Se evaluaron los efectos adversos atribuidos a la linezolida y el momento de aparición de los efectos secundarios. RESULTADOS: En total, se incluyeron 179 niños. La mediana de edad de los pacientes fue 4 años (entre 6 días y 17 años). Durante el tratamiento con linezolida, 36 (20,1%) pacientes tuvieron efectos adversos. El efecto adverso más frecuente fue la trombocitopenia, detectada en 26 (14,5%) pacientes. Los demás efectos adversos fueron: elevación de las enzimas hepáticas en 4 pacientes, leucopenia y anemia en 2 pacientes, disfunción renal en 1 y reacciones cutáneas graves en 3 pacientes. Los efectos adversos se detectaron dentro de una mediana de 7,5 días de tratamiento (intervalo: de 4 a 18 días). Entre los 36 pacientes, 26 (72,2%) presentaron un efecto adverso en los primeros 10 días de tratamiento. CONCLUSIONES: Se detectaron efectos adversos transitorios en el 20,1% de los pacientes durante el tratamiento con linezolida. Estos efectos adversos podrían detectarse antes de los 10 días de tratamiento. La linezolida debe recetarse de manera segura a los niños siempre que se vigilen los efectos adversos, en especial el recuento de trombocitos y el nivel de enzimas hepáticas.

Burn-associated bloodstream infections in pediatric burn patients: Time distribution of etiologic agents.

BACKGROUND: Infections are the leading cause of morbidity and mortality in patients with burns in burn units. Bloodstream infections (BSIs) in patients with burns may result from burn wound infection, use of invasive devices such as central venous catheters, and translocation of the gastrointestinal flora. OBJECTIVE: In this study, we investigated the distribution and antimicrobial drug resistance of causative pathogens in children with burns and the durational changes of microorganisms in the distribution of BSIs in children. METHODS: This study was conducted at the Pediatric Burn Unit (PBU) of Dr. Behçet Uz Children Research and Training Hospital during the period of November 2008-April 2015. The study subjects were all the patients admitted to the PBU, in whom microorganisms were isolated at least from one of the cultures, including blood and catheter cultures. RESULTS: Gram-positive bacteria were the most common causative agents of BSI in patients with burns (66.4%), followed by gram-negative bacteria (22.1%) and fungi (11.5%). The median duration of development of BSIs caused by gram-positive bacteria from the time of burn was 5 days (ranging from 2 to 54 days of burn), which was significantly shorter than that of BSIs caused by gram-negative bacteria (12 days) and fungal pathogens (13 days). CONCLUSION: The etiologic agents of BSIs in children may differ from those in adults. Gram-negative drug-resistant bacteria such as multidrug-resistant Pseudomonas aeruginosa and Acinetobacter baumannii were important agents of BSI in patients with burns, especially in the long term; however, gram-positive bacteria should also be considered while deciding the antimicrobial therapy, especially in the early periods of burn.

Varicella-Zoster Virus Infections in Pediatric Malignancy Patients: A Seven-Year Analysis.

Primary varicella-zoster virus (VZV) infection is a benign self-limited disease. In this study, we review our experience in focusing on the outcome and treatment of VZV infection in pediatric malignancy patients. During the study period, a total of 41 patients with pediatric malignancy had been hospitalized with the diagnosis of VZV infection. All the patients were treated with intravenous acyclovir for a median of 7 days (ranging from 5 to 21 days). The calculated attributable delay of chemotherapy due to VZV infections was 8 days (ranging from 2 to 60 days). VZV-related complications were observed in 3 of 41 patients (7%) who suffered from acute respiratory distress syndrome, and one of them with hemophagocytic lymphohistiocytosis died due to respiratory failure despite acyclovir and broad-spectrum antimicrobial treatment plus supportive treatment. VZV infections are still important contagious diseases in pediatric cancer patients, because they cause not only significant mortality but also a delay in chemotherapy.

Outcome of Candida Parapsilosis Complex Infections Treated with Caspofungin in Children.

BACKGROUND: We aimed to evaluate the correlation of caspofungin E-tests with the prognosis and response to caspofungin therapy of Candida parapsilosis complex bloodstream infections in children hospitalized in a pediatric intensive care unit. METHODS: All children who had C. parapsilosis complex bloodstream infections and who were treated with caspofungin were included in this retrospective study. For each patient, the following parameters, including all consecutive blood and central venous catheter (CVC) cultures, the duration between diagnosis and CVC removal, mortality rate, relapses of the C. parapsilosis complex infections as well as the demographic features, were recorded. RESULTS: The central venous catheter survival rate was 33.3% under caspofungin treatment. In 92.4 % of the patients, the negative culture was achieved within a median duration of 12.5 days. The rate of relapses was 18.9%. The overall mortality rate was 37.7% (20 of 53 patients), and the 30-days mortality rate was 7.5% (4 of 53 patients). There was no statistically significant difference between the groups with MIC<2 mg/l and MIC =2 mg/l using CVC survival rate; rate and duration of achieving negative blood culture for C. parapsilosis complex; duration of hospital stay; rate and duration of relapses; overall mortality and 30-days mortality. CONCLUSIONS: The beneficial effects of Caspofungin on biofilms has been shown in vivo, while its impact in children for maintenance of CVC was limited in our study but should not be underestimated in children who strongly need the presence of CVCs. The clinicians should weigh their priority for their patients and choose the optimal antifungal therapy for C. parapsilosis complex infections in children.

Bacterial agents causing meningitis during 2013-2014 in Turkey: A multi-center hospital-based prospective surveillance study.

This is an observational epidemiological study to describe causes of bacterial meningitis among persons between 1 month and 18 y of age who are hospitalized with suspected bacterial meningitis in 7 Turkish regions. covering 32% of the entire population of Turkey. We present here the results from 2013 and 2014. A clinical case with meningitis was defined according to followings: any sign of meningitis including fever, vomiting, headache, and meningeal irritation in children above one year of age and fever without any documented source, impaired consciousness, prostration and seizures in those < 1 y of age. Single tube multiplex PCR assay was performed for the simultaneous identification of bacterial agents. The specific gene targets were ctrA, bex, and ply for N. meningitidis, Hib, and S. pneumoniae, respectively. PCR positive samples were recorded as laboratory-confirmed acute bacterial meningitis. A total of 665 children were hospitalized for suspected acute meningitis. The annual incidences of acute laboratory-confirmed bacterial meningitis were 0.3 cases / 100,000 population in 2013 and 0.9 cases/100,000 in 2014. Of the 94 diagnosed cases of bacterial meningitis by PCR, 85 (90.4%) were meningococcal and 9 (9.6%) were pneumococcal. Hib was not detected in any of the patients. Among meningococcal meningitis, cases of serogroup Y, A, B and W-135 were 2.4% (n = 2), 3.5% (n = 3), 32.9% (n = 28), and 42.4% (n = 36). No serogroup C was detected among meningococcal cases. Successful vaccination policies for protection from bacterial meningitis are dependent on accurate determination of the etiology of bacterial meningitis. Additionally, the epidemiology of meningococcal disease is dynamic and close monitoring of serogroup distribution is comprehensively needed to assess the benefit of adding meningococcal vaccines to the routine immunization program.

A 7-year study of the distribution of nosocomial candidemia in children with cancer.

Candidemia is an important cause of morbidity and mortality in cancer patients. The incidence of candidemia has been reported to have shifted toward nonalbicans species. The aim of this study was to determine the distribution of Candida species resulting in bloodstream infections or catheter-related blood stream infections (CRBSIs) in pediatric hematology-oncology (PHO) patients over a 7-year-period. Medical and computerized microbiology laboratory records of all positive blood fungal cultures during the study period were analyzed retrospectively. The ratio of non-albicans Candida species (81.4%) was nearly four times higher than that of C. albicans candidemia (18.5%). Overall, C. parapsilosis caused the majority (61.4%) of candidemia episodes, followed by C. tropicalis (14.8%), C. famata (2.9%), C. ciferrii (1.4%) and C. glabrata (0.7%). The rate of CRBSIs was significantly higher in C. Parapsilosis candidemia. The overall rate of 30-day mortality in 135 candidemia episodes was 4.44%. Nearly half of the C. parapsilosis candidemia was associated with CRBSIs, suggesting its importance in PHO, in which several types of central venous catheters have been used.

Risk of vancomycin-resistant enterococci bloodstream infection among patients colonized with vancomycin-resistant enterococci

Background: Vancomycin-resistant enterococci colonization has been reported to increase the risk of developing infections, including bloodstream infections. Aim: In this study, we aimed to share our experience with the vancomycin-resistant enterococci bloodstream infections following gastrointestinal vancomycin-resistant enterococci colonization in pediatric population during a period of 18 months. Method: A retrospective cohort of children admitted to a 400-bed tertiary teaching hospital in Izmir, Turkey whose vancomycin-resistant enterococci colonization was newly detected during routine surveillances for gastrointestinal vancomycin-resistant enterococci colonization during the period of January 2009 and December 2012 were included in this study. All vancomycin-resistant enterococci isolates found within 18 months after initial detection were evaluated for evidence of infection. Findings: Two hundred and sixteen patients with vancomycin-resistant enterococci were included in the study. Vancomycin-resistant enterococci colonization was detected in 136 patients (62.3%) while they were hospitalized at intensive care units; while the remaining majority (33.0%) were hospitalized at hematology-oncology department. Vancomycinresistant enterococci bacteremia was present only in three (1.55%) patients. All these patients were immunosuppressed due to human immunodeficiency virus (one patient) and intensive chemotherapy (two patients). Conclusion: In conclusion, our study found that 1.55% of vancomycin-resistant enterococcicolonized children had developed vancomycin-resistant enterococci bloodstream infection among the pediatric intensive care unit and hematology/oncology patients; according to our findings, we suggest that immunosupression is the key point for developing vancomycinresistant enterococci bloodstream infections. .

The prevalence of migraine and tension-type headache among schoolchildren in Kayseri, Turkey: an evaluation of sensitivity and specificity using multivariate analysis.

This study aimed to determine the prevalence as well as psychosocial and demographic features of migraine and tension-type headache among school children between the ages of 7 and 17, and using the International Classification of Headache Disorders II. The study was conducted during the questionnaire phase and the interview phase. The prevalence of recurrent headache was 47.5%, whereas that of primary recurrent headache was 21%. The estimated prevalence rates of migraine and tension-type headache were 7.2% and 7.8%, respectively. Unilateral headache, throbbing-type headache, severe headache, and the severity of the headache with physical activity were specific for migraine. Headache was significantly higher in first-degree relatives of the children with migraine compared to the children with tension-type headache (P < .0001). We determined the prevalence rates of migraine and tension-type headache and revealed the characteristics as well as the psychosocial and demographic features of migraine and tension-type headache. Sensitivity, specificity, and multivariate analysis were also evaluated.