Ahmet Derya Aysev

Drug Resistance of Shigella Strains Isolated in Ankara, Turkey, 1993-1996

289 Shigella strains were isolated from children at the paediatrics department of Ankara University. 75% of the isolates were S. sonnei and 24.8% were S. flexneri. Each strain was tested for resistance to 9 antimicrobial agents. 79% of the isolates were resistant to streptomycin (S), 56% to tetracycline (T), 55.7% to trimethoprim-sulfamethoxazole (SXT), 27.7% to ampicillin (Am) and 19.7% to chloramphenicol (C). None of the isolates was resistant to ciprofloxacin, nalidixic acid, cephalothin, ampicillin-sulbactam and ceftriaxone. 56% of the isolates were resistant to 3 or more antimicrobial agents. The most frequent pattern of resistance of S. sonnei and S. flexneri strains was SXT, T, S (39.6%) and Am, SXT, T, S, C (48.6%), respectively (p < 0.0001). These results demonstrate that trimethoprim-sulfamethoxazole should not be used in the treatment of shigellosis.

The use of colistin in critically ill children in a pediatric intensive care unit.

Background: Colistin is active against most multidrug-resistant, aerobic Gram-negative bacteria. Because of the reported nephrotoxicity during the first years of use of colistin, there were concerns of its use in pediatrics where there was limited experience The aim of this study is to document the clinical characteristics and outcomes of use of colistin in pediatric patients at a pediatric intensive care unit in Turkey. Methods: We reviewed the medical and laboratory records of 29 critically ill children who were treated with colistin for 38 courses between January 2011 and December 2011 at the Department of Pediatric Intensive Care Unit in Ankara University Medical School, Turkey. Results: The median age was 17 months (range 3–217 months). Male-to-female ratio was 1:1.37. Ventilator-associated pneumonia (21 courses) was the leading diagnosis followed by catheter-related blood stream infection (6 courses), bacteremia (4 courses), ventriculoperitoneal shunt infection, peritonitis and pneumonia (1 course). The most commonly isolated microorganisms were Acinetobacter baumanni, Pseudomonas aeruginosa, Klebsiella pneumoniae, Serratia marcescens, Stenotrophomonas maltophilia, and Enterobacter cloacae. Two colistin formulations were used. Colimycin (Kocak Farma) was used in 21 colistin treatment episodes. The median dosage of colistin in this group was 5.0 mg/kg/d (2.3–5.6 mg/kg/d). Colomycin (Forest Laboratories) was used in 17 colistin treatment episodes. The median dosage of colistin in the second group was 75,000 International Unit/kg/d (50,000–80,000 International Unit/kg/d). Thirty colistin treatment episodes (79%) had a good or partial clinical response and 8 (21%) had a poor clinical response. Of the 8 colistin treatment episodes with poor clinical response, 3 were in the Colimycin group and 5 were in the Colomycin group. Ten patients died. There was no evidence of neurotoxicity in this study. Nephrotoxicity was observed in 1 patient but was not attributed to colistin because the patient had multiorgan failure at the same time. Conclusions: This study in a small cohort of patients suggests that the use of colistin in severe nosocomial infections caused by multidrug-resistant Gram-negative bacteria is well-tolerated and efficacious.

Drug resistance of Salmonella strains isolated from community infections in Ankara, Turkey, 1993-99.

160 Salmonella strains were isolated from children at the paediatrics department of Ankara University. 48.1% of the isolates were Salmonella enteritidis, 41.9% Salmonella typhimurium and 10% other serotypes. For the analysis of data, the study period was divided into 2 periods: 1993-95 and 1996-99. A decline in the isolation rate of S. typhimurium (from 63.1% to 30.1%) and rapid rise in S. enteritidis (from 31.6% to 57.3) was observed during the review period. However, for S. typhimurium isolates, the 5-drug (ampicillin, chloramphenicol, streptomycin, tetracycline and sulfonamides) pattern of resistance was increased from 13.5% to 38.7% in the second period. Since S. enteritidis and 5-drug-resistant S. typhimurium have also increased in other countries, their pandemic spread in humans indicates the continuing importation and exportation of these pathogens.160 Salmonella strains were isolated from children at the paediatrics department of Ankara University. 48.1% of the isolates were Salmonella enteritidis, 41.9% Salmonella typhimurium and 10% other serotypes. For the analysis of data, the study period was divided into 2 periods: 1993?95 and 1996?99. A decline in the isolation rate of S. typhimurium (from 63.1% to 30.1%) and rapid rise in S. enteritidis (from 31.6% to 57.3) was observed during the review period. However, for S. typhimurium isolates, the 5-drug (ampicillin, chloramphenicol, streptomycin, tetracycline and sulfonamides) pattern of resistance was increased from 13.5% to 38.7% in the second period. Since S. enteritidis and 5-drug-resistant S. typhimurium have also increased in other countries, their pandemic spread in humans indicates the continuing importation and exportation of these pathogens.

Mupirocin vs terbinafine in impetigo

Objevtive: Terbinafine is an antifungal drug known to have also antibacterial activity against certain Gram-positive and Gram-negative bacteria. It seems that antibacterial and antifungal activity of terbinafine may have an advantage in the treatment of mixed fungal and bacterial superficial skin infections. Nevertheless, clinical relevance of the antibacterial part of its action has not been investigated efficiently. To compare the efficacy and safety of terbinafine with those of mupirocin, which has already proven antibacterial action, in the treatment of impetigo.Methods: Children clinically diagnosed as having impetigo were treated with topical mupirocin or topical terbinafine in a randomized fashion. Patients’ lesions were examined clinically on days 0,4, 7,10 and bacteriologic cultures were obtained on days 0 and 10.Results: A total of 62 patients were included in the study. Forty-eight of these patients were eligible for the efficacy and safety analysis. Twenty-five and 23 patients were treated with mupirocin and terbinafine, respectively. The clinical cure rates were 100% for the mupirocin group and 70% for the terbinafine group (p< 0.05). The bacteriological eradication rate for mupirocin-treated children was 100% and that for terbinafine-treated children was 78%(p< 0.05). Presence of bullous lesions appeared to be a factor for poor clinical outcome in the terbinafine group. Mild local adverse effects were noted in a small percentage of patients in each group.Conclusion : Antibacterial activity of terbinafine is not strong enough to be an alternative in the treatment of impertigo. It is advisable that terbinafine could be used in combination with an antibacterial drug for superficial skin enfections caused by both fungi and bacteria.

Salmonella bacteraemia in Turkish children: 37 cases seen in a university hospital between 1993 and 2002.

Abstract The aim of the study was to evaluate the clinical pattern of Salmonella bacteraemia in Turkish children. From 1993 to 2002, all children with a blood culture positive for Salmonella were retrospectively evaluated in the Division of Paediatric Infectious Diseases in Ankara University School of Medicine. All Salmonella isolates were serotyped and investigated for antimicrobial susceptibility. During the 10-year study period, 40 patients with Salmonella bacteraemia were identified. Of 37 eligible children, eight had enteric fever and 29 had non-typhoidal salmonellosis. Salmonella typhimurium was the most common serotype in the group with non-typhoidal salmonellosis. No significant differences were found between the enteric fever and non-typhoidal salmonellosis groups with regard to clinical features, laboratory findings and outcome, except in mean platelet counts and mean serum alanine aminotransferase (ALT) levels. In vitro resistance rates of Salmonella strains were low. Outcome was excellent in all but one child with hydrocephalus and gross neurological sequelae owing to meningitis. Salmonella bacteraemia is relatively uncommon in Turkish children. Differentiating between enteric fever and non-typhoidal Salmonella bacteraemia on clinical grounds is difficult.

P268 Bloodstream infections in paediatric immunocompromised patients, responsible pathogens, antibiotic susceptibility patterns and treatment outcomes: experience of single centre in turkey

Background and aims Bloodstream infections are the major cause of morbidity, increased cost, prolonged hospitalisation and mortality in paediatric haematology and oncology patients. We aimed to identify causative microorganisms and their antimicrobial susceptibilities in paediatric immunocompromised patients. Methods Patients with haematological and/or oncological diseases who admitted to our hospital with fever between January 2010 and November 2015 were included in this study. Patients’ demografic and clinical findings were collected from hospital information systems and microbiology laboratory records retrospectively. Results Totally 71 paediatric patients who had 111 bloodstream infection episodes were included in this study. The median age of patients was 90 (3-247) months. The most underlying disease was acute lymphoblastic leukaemia. While 31 patients had only peripheral blood culture positivity, 80 patients had catheter related blood stream infections. Of 80.2% blood stream infections occurred in neutropenic period. Responsible pathogens were detected as follows: 35.1% gram-positive microorganisms, 60.5% gram-negative bacteria and 4.4% fungi. The most causative gram negative pathogen was Escherichia coli and the most isolated gram positive microorganism was meticillin resistant coagulase negative Staphylococci. Extended spectrum beta lactamase was produced by 60% of Klebsiella spp. and 42.1% of E. coli. In addition carbapenemase producing E. coli and Klebsiella spp. were 15.8% and 26.7% respectively. Enterococcus spp. had 88.9% ampicillin resistance and%33.3 vancomycin resistance. Bloodstream infection related mortality rate was 2.7%. Conclusion Gram negative microorganisms were predominant pathogens in bloodstream infections. Extended spectrum beta lactamase and carbapenem resistance were increasingly important and they limited treatment options. The choice of empiric antimicrobial drug in immunosuppressed patients is life-saving. For all these reasons, the choice of empirical antibiotics should be made according to the clinical condition of the patient and the prevalent microorganisms in the current clinic, as favourable antimicrobial therapy will be able to achieve positive clinical outcomes.

P269 Responsible pathogens of paediatric implantable long term catheter related blood stream infections and effectiveness of antibiotic lock therapy

Background Catheter related blood stream infections (CRBSIs) are important problem in paediatric haematology, oncology and immunology patients with central venous catheter. This study aimed to determine incidence of CRBSIs, responsible pathogens and outcomes of antibiotic lock treatment (ALT) in paediatric patients. Methods Between January 2010 and November 2015 all hospitalised paediatric haematology, oncology and immunology patients who were diagnosed as CRBSIs, were retrospectively included in this study. Causative microorganisms and their antibiotic susceptibility, success rate of ALT, treatment failure, recurrence, catheter removal, complications and mortality are analysed. Results Seventy eight CRBSIs episodes were detected in 60 paediatric patients. The median age was 106.4±66.6 (86, 3–240) months. Male/female ratio was 1.9/1. The incidence of CRBSIs was 4.20/1000 catheter days. Most frequently detected pathogen was methicillin-resistant coagulase-negative Staphylococcus. Antibiotic lock therapy was administered in 42 patients. Success rate of ALT was 81% (34/42). Catheter was removed without ALT in 36 episodes. Common reasons for catheter removal were sepsis and causative microorganisms which had high probability of biofilm formation. Relapse was observed in 1 (1.3%) episodes and mortality was detected in 3 (3.8%) episodes. Conclusion Catheter related blood stream infections are important cause of morbidity and mortality in paediatric patients. However, incidence may be decreased with antiseptic procedures and hand hygiene. Antibiotic lock therapy is safe and effective. It is possible to obtain satisfactory results when ALT is used with intravenous systemic antibiotics for CRBSIs except in some cases catheter removal must be necessary. Antibiotic lock therapy helps to prevent unnecessary catheter removing in paediatric immunocompromised patients.

Sağlıklı çocuklarda antistreptolizin O ve anti deoksiribonükleaz B düzeyleri Orijinal Araştırma

Antistreptolizin O ASO ve anti deoksiribonukleaz B anti DNAse B duzeyleri toplumdan topluma farkli yas gruplarina ve kullanilan olcum yontemine gore farklilik gosterir Ayni toplumda streptokok enfeksiyonun epidemiolojisindeki degisime bagli olarak zaman icinde bu degerlerde degisiklik olabilir Her toplum kendi normal degerlerini farkli yas gruplarina farkli olcum yontemlerine gore belirlemeli ve bu degerler belli zaman araliklari ile yeniden degerlendirilmelidir Bu calismada saglikli Turk cocuklarinda normal ASO ve anti DNAse B titrelerin olculmesi yas gruplarina gore pratik uygulamada kullanilabilecek ortalama ve normalin ust sinir degerlerinin hesaplanmasi amaclandi Calisma grubunu son 4 ay icinde gecirilmis bogaz ve deri enfeksiyonu oykusu ve klinik bulgusu olmayan 6 ay 16 yas arasindaki 230 saglikli cocuk olusturdu Calisma grubunu olusturan olgulardan ASO ve anti DNAse B duzeyleri ve es zamanli bogaz kulturleri alindi Ornek toplama islemi Agustos 1999 Agustos 2000 tarihleri arasinda 1 yil surduruldu Bogaz kulturlerinde ureme olmayan 230 cocugun ASO titreleri Nefelometrik yontemle anti DNAse B titreleri DNA’nin enzimatik bolunmesi yontemiyle olculdu ASO ortalamalari aritmetik ortalama anti DNAse B ortalamalari geometrik ortalama kullanilarak hesaplandi Calisma grubunu olusturan cocuklar ikili yas gruplarina ayrildi ve sonuclar yedi grupta incelendi Hem ASO hemde anti DNAse B titrelerin ortalamasinin 12 yasa kadar arttigi ve 12 yastan sonra hafif bir dusus gosterdigi goruldu En yuksek duzeyler 10 12 yas grubunda saptandi Tum yas gruplari birlikte degerlendirildiginde; ASO ortalamasi 86 Todd unitesi normalin ust sinir degeri 131 Todd unitesi anti DNAse B geometrik ortalamasi 72 unite normalin ust sinir degeri 200 unite bulundu Anahtar Kelimeler: A grubu beta hemolitik streptokok antistreptolizin O anti deoksiribonukleaz B streptokok antikorlari normalin ust limiti