Yeliz Oruç

Secondary bacteremia in rotavirus gastroenteritis.

The aim of the study was to determine the frequency of secondary bacteremia in children with rotavirus gastroenteritis and persistence or reemergence of fever. We identified 376 children with a mean of age of 14.2 ± 10.1 months. A significant pathogen was isolated from blood cultures in 5 patients [Enterococcus faecium (n = 1), Klebsiella spp (n = 1), Staphylococcus aureus (n = 1), Raoultella planticola (n = 1), Candida albicans (n = 1); 1.3%]. The frequency of secondary bacteremia in children with rotavirus gastroenteritis is low, but it should be considered when there is fever lasting >48 hours or reemergence of fever.

Epidemic Adenoviral Keratoconjunctivitis Possibly Related to Ophthalmological Procedures in a Neonatal Intensive Care Unit: Lessons from an Outbreak

Purpose: Epidemic adenoviral keratoconjunctivitis can spread rapidly among preterm infants who frequently undergo ophthalmological examination. Here we present our experience on a nosocomial outbreak that affected 8 nursery staff members and 26 premature infants. We focus on the presentation and progress of the outbreak, the diagnosis of the disease and the measures taken for its control. Methods: Data were collected from patients’ files and records of the infection control team. Conjunctival swabs were collected to perform direct fluorescent assay (DFA) and viral culture. Diagnosis was made according to clinical evidence and/or detection of the virus. Statistical analysis was performed using SPSS 15.0 statistical software. Results: Infection was introduced to our unit after a laser photocoagulation procedure of a 28-week gestational infant and circulated rapidly within the unit due to direct transmission through contaminated medical equipment, fomites and hands of nursery staff members. Neither the patients, nor the nursery staff members developed systemic symptoms. While DFA tests were positive in seven infants, culture positivity could be demonstrated in only three infants. Contact and droplet precautions were implemented with the recommendation of the infection control team. No recurrence occurred after definition of the last case on the 32nd day. Conclusion: Ophthalmologic procedures continue to be a potential source of adenovirus outbreaks. However, negligence of contact measures during routine daily nursing care seems to be a more important contributing factor for rapid spread. Strict adherence to appropriate aseptic procedures is required to prevent this potentially hazardous infection in preterm infants.

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. Vancomycin-resistant 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 enterococci-colonized 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 vancomycin-resistant enterococci bloodstream infections.

Clinical impact and cost-effectiveness of a central line bundle including split-septum and single-use prefilled flushing devices on central line–associated bloodstream infection rates in a pediatric intensive care unit

BACKGROUND Central line-associated bloodstream infections (CLABSIs) are among the most frequent health care-associated infections. Central line bundle (CLB) programs are useful for reducing CLABSIs. METHODS A retrospective study was designed to compare 2 periods: the prebundle and bundle periods. We evaluated the impact of a CLB including implementation of split-septum (SS) devices and single-use prefilled flushing (SUF) devices in critically ill children. RESULTS During the prebundle period, the overall rate was 24.5 CLABSIs per 1,000 central line (CL) days, whereas after the initiation of the CLB, the CLABSIs per 1,000 CL days dropped to 14.29. In the prebundle period, the daily cost per patient with CL and CLABSI were

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

232.13 and

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

254.83 consecutively. In the bundle period, the daily cost per patient with CL and CLABSI were

Comparison of the BD GeneOhm VanR assay and a chromogenic agar-based culture method in screening for vancomycin-resistant enterococci in rectal specimens of pediatric hematology-oncology patients

226.62 and

THE EMERGING RESISTANCE IN NOSOCOMIAL URINARY TRACT INFECTIONS: FROM THE PEDIATRICS PERSPECTIVE.

194.28 consecutively. Compared with the period with no CLB, the CLB period, which included SUF and SS devices, resulted in more costs saving by lowering the daily total costs of patients and indirectly lowering total drug costs by decreasing antibacterial and more significantly antifungal drugs. CONCLUSIONS CLB programs including SS and SUF devices were found to be effective in decreasing the CLABSI rate and decreasing the daily hospital costs and antimicrobial drug expenditures in children.

Comparison of Healthcare-related Infection Rates Based on the National Nosocomial Infections Surveillance System of Turkey Diagnostic Criteria Reported in 2010 and Centers for Disease Control and Prevention Reported in 2014 in A Tertiary Hospital

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.

Point-Prevalence Study Relating to Antibiotic Usage in Dr. Behçet Uz Children Hospital; Comparison of 2008 and 2012 Data

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)