Solmaz Celebi

A prospective study of etiology of childhood acute bacterial meningitis, Turkey.

Vaccines to prevent bacterial meningitis in this region must provide reliable protection against serogroup W-135.

Necrotizing pneumonia in children.

Aim: Clinical features and outcome of 36 patients with necrotizing pneumonia (NP) as well as 36 children with parapneumonic effusions (PPE) and 36 with severe control pneumonia (CP) were investigated. The mean age of the patients in the NP, PPE and CP groups were similar (3.8 ± 3.3 (mean ± SD), 4.2 ± 3.0 and 4.2 ± 3.0 y, respectively (p < 0.05)). The duration of symptoms at presentation were 11.9 ± 8.5, 9.2 ± 7.2 and 6 ± 3.6 d, respectively (p > 0.01). The diagnosis of NP was established by computerized tomography. The mean (mean ± SD) laboratory results in patients with NP revealed a white blood cell (WBC) count of 19 300 ± 8 700/mm3, erythrocyte sedimentation rate (ESR) of 71 ± 22mm/h, C‐reactive protein (CRP) of 13.6 ± 11.7 mg/dl and aspartate aminotransferase (AST) of 66 ± 132 U/L. The values of WBC, ESR, CRP and AST in the NP group were significantly higher than those of the other groups (p > 0.001). The duration of hospitalization in the NP, PPE and CP groups was 26 ± 9, 16 ± 6 and 10 ± 5d, respectively (p > 0.001). The number of febrile days was 8 ± 4, 4 ± 3 and 3 ± 3 (p > 0.001), and the duration of normalization of CRP was 14 ± 4, 11 ± 4 and 7 ± 3 d (p > 0.001), respectively. The average cost of treatment was US 3 476, 1 646 and 844, respectively (p > 0.001). Conclusion: All NP patients except two (94%) were complicated with PPE. The effusion in patients with NP and PPE was complicated with bronchopleural fistula (55% and 0%, respectively, p > 0.001). Surgical treatment was required in 66%, 8% and 0% in patients with NP, PPE and CP, respectively (p > 0.001). The mortality rate was 5.5%, 2.7% and 0% (p < 0.05).

Management of thoracic empyema in children

Abstract The effectiveness of fibrinolytic treatment has been shown in cases of thoracic empyema in adults. In pediatric patients experience is, however, very limited. The aim of this study was to determine the success and complication rates of fibrinolytic treatment in thoracic empyema in children. A series of 25 consecutive children who had loculated pleural empyemas that did not respond to tube thoracostomy and antibiotics is presented. Their ages ranged from 1 to 12 years (mean 4.2). There were 19 boys and 6 girls, and all epyemas were postpneumonic. The fibrinolytic agent used was urokinase in 17 and streptokinase in 8. The mean duration of fibrinolytic treatment was 4.3 days (range 2 to 8) and the mean duration of chest-tube drainage was 8.9 days (range 7 to 13). In 20 patients the fluid output from the chest tube increased significantly after instillation of the fibrinolytic agent, and these patients showed almost complete resolution of the effusion on chest radiograph and ultrasound examinations (80%). Only 5 patients developed complications: bronchopleural fistula and pleural thickening in 3, and recurrent effusion, multiloculation, and pleural thickening in other 2 which were managed by surgical intervention (20%). Our study suggests that intrapleural fibrinolytic treatment is an effective and safe adjunctive therapy in children with thoracic empyema and can obviate a thoracotomy in most cases.

Nosocomial candidaemia in children: results of a 9‐year study

The aim of this study was to determine changes in the incidence of nosocomial candidaemia and to evaluate the risk factors, demographic features, treatment and clinical outcome associated with candidaemia in a Turkish tertiary care paediatric unit within a 9‐year period. The data of children who were diagnosed as nosocomial candidaemia, were examined in this study. Between January 1997 and December 2005, a total of 102 nosocomial candidaemia episodes were identified in 102 patients. The rate of nosocomial candidaemia in our clinic increased from 3.2 cases per 1000 admissions in 1997–1999, to 5.5 per 1000 admissions in 2000–2002 and to 6.9 per 1000 admissions in 2003–2005 (P = 0.003). The species most frequently causing candidaemia were Candida albicans (39.2%), Candida parapsilosis (21.6%) and Candida tropicalis (15.7%). The mortality of C. albicans (37.5%), was significantly higher than the mortality of non‐albicans species (17.7%) (P = 0.04). Independent risk factors associated with candidaemia‐related deaths by logistic regression analysis were disseminated candidiasis (odds ratio, 5.7; P = 0.01), paediatric intensive care unit stay (odds ratio, 8.1; P = 0.001), prolonged antibiotics therapy (odds ratio, 5.2; P = 0.014), use of total parenteral nutrition (odds ratio, 4.4; P = 0.038) and mechanical ventilation (odds ratio, 4.9; P = 0.01). The rate of nosocomial candidaemia in our clinic increased >2‐fold during the study period.

Differences in hepatitis A seroprevalence among geographical regions in Turkey: a need for regional vaccination recommendations

Summary.  Hepatitis A is a worldwide vaccine‐preventable infection. Recommendation of vaccination depends on the endemicity of the disease. The World Health Organization recommends universal hepatitis A vaccination in intermediate areas; however, there is no need of mass vaccination in high and low endemicity regions. Therefore, most of the countries are using a vaccination policy according to the endemicity characteristic representing the whole of the country. The endemicity of this infection varies due to sanitary and hygiene conditions and socioeconomic differences among the countries and in various regions of the same country. A sample of 1173 persons between the age of 0 and 91 years from nine randomly selected medical centres from five different geographical centres of Turkey were tested for the level of anti‐hepatitis A virus (anti‐HAV) immunoglobulin‐G antibodies using an enzyme‐linked immunosorbent assay. The overall prevalence of anti‐HAV antibodies was 64.4% (1142/1173). While the rate of sero‐positivity was over 80% in the 5–9 age group and more than 90% after 14 years of age in south‐eastern and eastern regions, it was lower than 50% at the age of 5–9 years in central and western regions and remains under 80% in those areas. We conclude that the differences observed in HAV sero‐positivity among various geographical regions in Turkey support a universal HAV immunization policy for children currently living in regions of intermediate endemicity.

The progression of maternal RSV antibodies in the offspring

The concentrations of maternal anti-RSV IgG antibodies were followed in 49 healthy newborns over the first six months of life. At birth, 41 mothers (83%) tested positive for anti-RSV IgG and all of their babies carried maternal anti-RSV IgG. Anti-RSV IgG positivity dropped to 73% at 1 month, 6% at 3 months, and 2% at 6 months. Between 3 and 6 months, 8% did acquire RSV infection, half of them as acute bronchiolitis and half as non-specific respiratory infection. All of the patients who acquired clinical RSV disease had an antibody concentration of <20 RU/ml which may be the cut off value for protection.

Culture-proven neonatal sepsis in preterm infants in a neonatal intensive care unit over a 7 year period: coagulase-negative Staphylococcus as the predominant pathogen.

The aim of this study was to determine the causative agents in early, late‐ and very late‐onset sepsis in preterm infants. The demographic features, risk factors, clinical and laboratory findings in sepsis types were also defined.

Meropenem in neonatal severe infections due to multiresistant gram-negative bacteria.

Recently, new broad spectrum carbapenem has been investigated on a world-wide scale for the treatment of moderate to severe infections. In the neonatal intensive care units the extensive use of third generation cephalosporins for therapy of neonatal sepsis may lead to rapid emergence of multiresistant gram-negative organisms. We report the use of meropenem in 35 infants with severe infections due toAcinetobacter baumanii andKlebsiella pneumoniae. All gram negative bacteria were resistant to ampicillin, amoxicillin, ticarcilin, cefazoline, cefotaxime, ceftazidime, ceftriaxone and aminoglycosides. Eighty two percent of the cases (29/35) were born prematurely. Assisted ventilation was needed in 85.7 % (30/35). All infants deteriorated during their conventional treatment and were changed to meropenem monotherapy. Six percent (2/35) died. The incidence of drug-related adverse events (mostly a slight increase in liver enzymes) was 8.5 %. No adverse effects such as diarrhea, vomiting, rash, glossitis, oral or diaper area moniliasis, thrombocytosis, thrombocytopenia, eosinophilia and seizures were observed. At the end of therapy, overall satisfactory clinical and bacterial response was obtained in 33/35 (94.3%) of the newboms treated with meropenem. Clinical and bacterial response rates for meropenem were 100% for sepsis and 87.5% for nosocomial pneumonia. This report suggests that meropenem may be a useful antimicrobial agent in neonatal infections caused by multiresistant gram negative bacilli. Further studies are needed to confirm these results : Meropenem, newborn, sepsis and nosocomial infection.

Colistimethate sodium therapy for multidrug‐resistant isolates in pediatric patients

Aim:  The aim of the present study was to assess the efficacy and safety of colistimethate sodium therapy in multidrug‐resistant nosocomial infections caused by Pseudomonas aeruginosa or Acinetobacter baumannii in neonates and children.

Meningitis caused by Neisseria Meningitidis, Hemophilus Influenzae Type B and Streptococcus Pneumoniae during 2005–2012 in Turkey: A multicenter prospective surveillance study

Successful vaccination policies for protection from bacterial meningitis are dependent on determination of the etiology of bacterial meningitis. Cerebrospinal fluid (CSF) samples were obtained prospectively from children from 1 month to ≤ 18 years of age hospitalized with suspected meningitis, in order to determine the etiology of meningitis in Turkey. DNA evidence of Neisseria meningitidis (N. meningitidis), Streptococcus pneumoniae (S. pneumoniae), and Hemophilus influenzae type b (Hib) was detected using multiplex polymerase chain reaction (PCR). In total, 1452 CSF samples were evaluated and bacterial etiology was determined in 645 (44.4%) cases between 2005 and 2012; N. meningitidis was detected in 333 (51.6%), S. pneumoniae in 195 (30.2%), and Hib in 117 (18.1%) of the PCR positive samples. Of the 333 N. meningitidis positive samples 127 (38.1%) were identified as serogroup W-135, 87 (26.1%) serogroup B, 28 (8.4%) serogroup A and 3 (0.9%) serogroup Y; 88 (26.4%) were non-groupable. As vaccines against the most frequent bacterial isolates in this study are available and licensed, these results highlight the need for broad based protection against meningococcal disease in Turkey.