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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.

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.

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

Point-Prevalence Study Related to Antimicrobial Usage in a Children’s Diseases and Surgery Training and Research Hospital: Comparison with 2008 and 2012 Data

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.

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

Objective: We aimed to determine the patterns of antimicrobial drug usage and appropriateness of antibiotic indications ratios in patients hospitalized in a children’s diseases and surgery training and research hospital. Material and Methods: This retrospective and observational study included 130 patients who were under antimicrobial therapy in pediatric and surgical wards at Dr. Behçet Uz Children’s Diseases and Surgery Training and Research Hospital on July 1, 2015. A standard form was prepared, and the demographic features such as age, gender, specifications of ward, diagnosis of infection, antimicrobial drug indications for antimicrobial selection, microbiological results, appropriateness of the dosage and dosing intervals of the antimicrobial drugs, and presence of pediatric infectious disease consultations were recorded in this form and evaluated by two pediatric infectious disease specialists simultaneously. The results were compared with the data of the previous point-prevalance studies conducted at the same hospital in 2008 and 2012. Results: In this study, 130 (49.6%) of 262 patients had been under antimicrobial therapy. The inappropriate antimicrobial usage rate was 19.6% in pediatric wards, while it was 57.1% in surgical wards; the rate was significantly higher in surgical wards (p<0.001). The ratio of inappropriate antibiotic therapy was 23.2% in empirical therapy, whereas it was 76.5% in prophylaxis (p<0.001). In patients who had been consulted by pediatric infectious disease specialists, the provision of appropriate treatment was significantly higher (p<0.001). Conclusion: Rational antimicrobial use is the most important strategy for decreasing the development of antimicrobial resistance and lowering the cost of health care. In particular, increasing the rates of consultations with an infectious disease specialist will be a factor for decreasing the inappropriate usage of antimicrobials. (J Pediatr Inf 2016; 10: 44-8)