Ibrahim Gokce

Urinary tract pathogens and their antimicrobial resistance patterns in Turkish children

Urinary tract infections (UTIs) are among the most common bacterial diseases in childhood affecting approximately 3–5% of girls and 1% of boys [1]. There is growing concern regarding the resistance of urinary pathogens to commonly used antibiotics because of the increasing number of therapeutic failures after empiric treatment [2]. To ensure appropriate treatment, knowledge of the organisms that cause UTI and their antibiotic susceptibility is mandatory [3]. They need to be constantly reevaluated to achieve maximal clinical response before the antibiotic susceptibility of the isolate is known. The aim of this study was to assess the susceptibility of urinary pathogens to commonly used antibiotics in Turkish children with community-acquired UTI. Children who were admitted with the first episode of UTI to the Pediatric Outpatient Clinic and consulted to the Pediatric Nephrology Department between 2001 and 2003 were included in the study prospectively. UTI was defined as the growth of a single pathogen of greater than 100,000 colony-forming units/ml by a properly collected urine specimen in children with febrile disease or urinary symptoms. Transurethral catheterisation was chosen for children who were not toilet trained (387 children, 75.4% of all cases) and clean midstream specimen collection was preferred for toilet trained children. Antimicrobial susceptibility of the isolates was tested by the automatized identification technique called VITEK (bioMerieux, France). Five hundred thirteen uncomplicated community-acquired UTIs were detected in children aged 0–16 years (mean age 3.0 years); 271 (52.8%) of the children were female. The isolated microorganisms were Escherichia coli in 277 (54.0%), Klebsiella spp. in 88 (17.2%), Proteus spp. in 62 (12.1%), Staphylococci spp. in 31 (6.0%), Pseudomonas spp. in 15 (2.9%), Enterococcus spp. in 15 (2.9%), Enterobacter spp. in 13 (2.5%), and others in 12 (2.4%). Gram-positive cocci were isolated in 48 (9.3%) of UTIs. No vancomycin-resistant Enterococcus spp. were isolated. The antibiotic resistance patterns of different gram-negative pathogens are shown in Table 1. A high proportion of the isolates were resistant to ampicillin (69%), amoxicillin/ clavulanate (44%), cefazolin (39%) and trimethoprim– sulfamethoxazole (TMP-SMX) (32%). The most effective drugs against all the isolates were found to be cefepime (99%), cefixime (99%), ceftriaxone (90%), nitrofurantoin (83%) and cefuroxime (79%). There was no antimicrobial resistance to ciprofloxacin and aminoglycosides except in one case. In our study nearly half of the pathogens were resistant to amoxicillin/clavulanate and one-third of them were resistant to TMP-SMX which shows that empiric treatment with TMP-SMX and amoxicillin/clavulanate is inadequate. The results showing 21% resistance to cefuroxime, 17% resistance to nitrofurantoin and 1% resistance to cefixim led us to recommend these drugs for common treatment of UTI in Turkish children. Parenteral treatment options for treatment are second and third generation cephalosporins and aminoglycosides. Our results showed that resistance rates for these drugs are tolerable. Only 10% of the microorganisms displayed resistance to ceftriaxone and none of them showed resistance to aminoglycosides.

Invasive aspergillosis in a patient with end stage renal disease

Invasive aspergillosis caused by A. Fumigatus, almost occurs in immunocompromised hosts and has a poor prognosis. We report a case of invasive Aspergillosis in a 15-year-old boy with ESRD. He was initially diagnosed as lobar pneumonia and peritonitis. When he complained for lower extremity weakness and had convulsions, a solid mass originated from right lung compresses the spinal cord and intracranial hemorrhagic abscesses were found on MRI. The biopsy specimen showed hypae of aspergillus-spp and he died on 12th day.

Vitamin d receptor gene polymorphisms in children with kidney stone disease

Subaşı B, Gökçe İ, Delil K, Alpay H. Vitamin D receptor gene polymorphisms in children with kidney stone disease. Turk J Pediatr 2017; 59: 404-409. Kidney stone disease has a multifactorial etiology involving the interaction of genetic and environmental factors. There is an increased risk of stone formation in the relatives of idiopathic stone patients, which can be explained up to 60% by genetic factors. This study was conducted to explore the association of vitamin D receptor (VDR) gene polymorphisms with the risk of urolithiasis (UL) in Turkish children. We investigated the VDR gene polymorphisms: ApaI, BsmI, TagI, Cdx2, FokI, in 52 children (26 boys, 26 girls) with UL and in 51 healthy children (22 boys, 29 girls) without UL. Apa I, BsmI, TagI, Cdx2, FokI genotypes were analyzed by Apa I, BsmI, TagI, Cdx2, FokI restriction enzyme digestion, respectively. The resulting alleles are designated as ABTCF (ApaI, BsmI, TagI, Cdx2, and FokI restriction site is absent), or abtcf (ApaI, BsmI, TagI, Cdx2, FokI restriction site is present), respectively. Genotype and allele frequencies were calculated, and the association with UL, hypercalciuria and hypocitraturia was investigated. Our data provide no statistically significant evidence for an association between UL and VDR ApaI, BsmI, TagI, Cdx2, and FokI genotype and allele frequencies. Patients with hypocitraturia and hypercalciuria were compared with the control group and no statistically significant difference was detected in terms of VDR gene ApaI, BsmI, TagI, Cdx2, and FokI polymorphisms and allele frequencies. Our data suggest that the VDR ApaI, BsmI, TagI, Cdx2, and FokI polymorphisms do not indicate a significant risk for UL.

The Clinical and Mutational Spectrum of Turkish Patients with Cystinosis

BACKGROUND AND OBJECTIVES Infantile nephropathic cystinosis is a severe disease that occurs due to mutations in the cystinosis gene, and it is characterized by progressive dysfunction of multiple organs; >100 cystinosis gene mutations have been identified in multiple populations. Our study aimed to identify the clinical characteristics and spectrum of cystinosis gene mutations in Turkish pediatric patients with cystinosis. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS We identified the clinical characteristics and spectrum of cystinosis gene mutations in Turkish patients with cystinosis in a multicenter registry that was established for data collection. The data were extracted from this registry and analyzed. RESULTS In total, 136 patients (75 men and 61 women) were enrolled in the study. The most common clinical findings were growth retardation, polyuria, and loss of appetite. None of the patients had the 57-kb deletion, but seven novel mutations were identified. The most common mutations identified were c.681G>A (p.Glu227Glu; 31%), c.1015G>A (p.Gly339Arg; 22%), and c.18_21 del (p.Thr7Phefs*7; 14%). These mutations were associated with earlier age of disease onset than the other mutations. To understand the effects of these allelic variants on clinical progression, the mutations were categorized into two major groups (missense versus deletion/duplication/splice site). Although patients with missense mutations had a better eGFR at the last follow-up visit, the difference was not significant. Patients in whom treatment began at age <2 years old had later onset of ESRD (P=0.02). Time to ESRD did not differ between the patients with group 1 and group 2 mutations. CONCLUSIONS The most common cystinosis gene mutations identified in Turkey were c.681G>A (p.Glu227Glu), c.1015G>A (p.Gly339Arg), and c.18_21 del (p.Thr7Phefs*7). Patients with less severe cystinosis gene mutations tend to have better kidney outcome.

Renal Artery Stenosis and Aneurysm in a Child Presenting with Hypokalemia, Metabolic Alkalosis and Hypertension

Renovascular hypertension is one of the important causes of secondary hypertension in children and can be caused by many different diseases, with the most common being fibromuscular dysplasia (FMD) and Takayasu arteritis (TA). The differential diagnosis between TA and FMD seems to be difficult and much less certain than is generally assumed in many cases. Here we present a case report of an 11-yearold girl with FMD presenting with hypokalemia, metabolic alkalosis and hypertension secondary to renal artery stenosis and hyperreninemic hyperaldosteronism.

Ureteropelvic Junction Obstruction Mimicking an Intraabdominal Mass in a Child

Giant hydronephrosis is a rare entity that may mimic benign and progressive intraabdominal cystic masses. It is defined as the presence of more than 1 liter of fluid in the collecting system of the kidney. Despite the increase in the use of antenatal ultrasound, giant hydronephrosis may still be seen in the pediatric population. Here, we report a case of giant hydronephrosis due to ureteropelvic junction obstruction mimicking an intraabdominal mass in an 11-year-old male who presented with abdominal pain and other gastrointestinal symptoms.

Clinical and histopathological features of asymptomaticpersistent microscopic hematuria in children

BACKGROUND/AIM We analyzed the clinical and pathological features and prognosis of 106 children with persistent asymptomatic microscopic hematuria (PAMH) with or without mild proteinuria. MATERIALS AND METHODS This was a retrospective study of 106 children who were referred to our clinics from 2000 to 2013 for evaluation of PAMH. RESULTS Among the 106 patients, 69 (65%) were female and 37 (35%) were male. The patients were divided into two groups: 101 patients with isolated microscopic hematuria (IMH) and 5 patients with asymptomatic microscopic hematuria and mild proteinuria (AMHP). Renal biopsy was performed in all 5 children with AHMP: 2 patients had hereditary nephropathy and 2 patients had focal segmental glomerulosclerosis (FSGS). One biopsy specimen revealed nonspecific findings. Renal biopsy was performed in 9 children with IMH: 4 patients had hereditary nephropathy and 5 patients had nonspecific findings. None of the patients received any specific treatment prior to renal biopsy. During the follow-up period, none of the patients developed impaired renal function. Among all the children, only one patient with AMHP developed hypertension and 2 patients with IMH developed proteinuria. CONCLUSION Long-term follow-up must be done carefully for isolated microscopic hematuria and renal biopsy should be performed in selected cases.

Çocuklarda sünnetin idrar yolu enfeksiyonu sıklığı üzerine etkisi Özgün Araştırma

Ozet Amac: Cocuklarda yenidogan donemi sonrasi yapilan sunnetin idrar yolu enfeksiyonu sikligi uzerine etkisini degerlendirmektir nbsp; Gerec ve Yontem: Idrar yolu enfeksiyonu geciren yaslari 1 70 ay ortanca 5 ay arasinda 56 erkek cocuk calismaya alindi Tum hastalara bobrek ultrasonografisi ve dimerkaptosuksinik asit sintigrafisi basvuruda uygulandi ldquo;Iseme sistouretrografisi rdquo; secilmis hastalara yapildi Otuz uc hastada vezikoureteral reflu tespit edilmedi 23 hastada 1 3 dereceli vezikoureteral reflu vardi Hastalardan duzenli araliklarla idrar kulturleri alindi idrar yolu enfeksiyonu idrar kulturunde gt;105 cfu ml tek bir organizmanin uremesi olarak tanimlandi Idrar ornegi basina sayi ve takip suresi ay boyunca gecirilen idrar yolu enfeksiyonu sikligi sunnet oncesi ve sonrasi degerlendirilerek karsilastirildi nbsp; Bulgular: Idrar yolu enfeksiyonu sikligi kultur basina sunnet oncesi ortanca 0 33 IR; 0 21 ve sunnet sonrasi 0 0 IR; 0 50 bulundu Takip suresi boyunca gecirilen idrar yolu enfeksiyonu sikligi sunnet oncesi ortanca 0 37 IR; 0 51 ve sunnet sonrasi 0 0 rsquo;di IR; 0 0 Vezikoureteral reflusu olmayanlar ve dusuk dereceli reflusu olanlar icin ayri ayri analiz yapildiginda benzer sekilde sunnet sonrasi idrar yolu enfeksiyonu sikliginin her iki grupta azaldigi goruldu Cikarimlar: Bu calismada yenidogan donemi sonrasi yapilan sunnetin vezikoureteral reflusu olan ve olmayan hastalarda idrar yolu enfeksiyonu sikligini azalttigi gosterilmistir Turk Ped Ars 2010; 45: 137 40 Anahtar sozcukler: Cocuk idrar yolu enfeksiyonu sunnet