SUMMARY:The aims of this study were to determine the prevalence, type, and clinical features of nosocomial infections (NIs), their etiological distribution, and the antibiotic resistance patterns of causative organisms in the general pediatric wards of a hospital in Turkey over a 3-year period. The Hospital Infection Control Committee NI surveillance reports were used as a database. NIs were detected in 171 (2.25z) of the 7,594 hospitalized patients. Some of these patients experienced more than 1 episode, and thus, the total NI episodes were 229. Patients' age varied from 1 to 144 months (mean ± standard deviation, 14.5 ± 23.6 months). The NI rate was 3.02z, and the NI density was 3.17/1,000 patient days. The most frequent NIs were lower respiratory system infections, blood stream infections, and urinary tract infections. Gram-negative organisms were the most frequently isolated agents. Of the 171 patients with NIs, 47 (27.5z) died.Nosocomial infections (NIs) are the major causes of prolonged hospital stays, increased costs, the increased resistance of organisms to antimicrobials, and mortality in hospitalized adults and children. NIs in pediatric and adult patients differ with respect to the sites of infection and the types of pathogens. In addition, NIs differ by country, region, hospital, and type of units, such as wards or intensive care units (1). There exist many reports on epidemiology, risk factors, and preventive measures for adult NIs. However, studies that focus on the pediatric population, particularly in developing countries, are limited. For this reason, we investigated the epidemiological, microbiological, and clinical features of NIs in the general wards of a pediatric hospital that does not have a pediatric intensive care unit (PICU) facility.Immunocompetent patients who were aged from 1 month to 18 years and had been admitted for miscellaneous diseases and developed a NI between January 2005 and January 2008 in a hospital in Turkey were retrospectively evaluated. The patients who had positive bacterial culture results or had negative culture results but clinical features of infection were included. A positive blood culture that was taken at least 72 h after the preceding positive blood culture was assessed as a new NI episode. The Hospital Infection Control Committee (HICC) NI surveillance reports were used as the database. NIs were defined on the basis of the Centers for Disease Control and Prevention (CDC) criteria (2). Crude NI rates were calculated with the following formula: NI rate ＝ (infection number/admitted or discharged patient number) × 100, and NI density was caluculated with the following formula: density ＝ (infection number/patient day) × 1,000 for each year and ward. The ventilator-associated pneumonia (VAP) rate was calculated with the following formula: VAP rate ＝ (VAP number/mechanical ventilator day) × 1,000. The NIs of each patient were classified according to the infection sites. Standard methods were used for microbiologic, biochemical, and radiologic investigations. Antib...

Objective: In this study, we aimed to analyze the TURKMI registry to identify the factors associated with delays from symptom onset to treatment that would be the focus of improvement efforts in patients with acute myocardial infarction (AMI) in Turkey. Methods: The TURKMI study is a nation-wide registry that was conducted in 50 centers capable of 24/7 primary percutaneous coronary intervention (PCI). All consecutive patients (n=1930) with AMI admitted to coronary care units within 48 hours of symptom onset were prospectively enrolled during a predefined 2-week period between November 1, 2018, and November 16, 2018. All the patients were examined in detail with regard to the time elapsed at each step from symptom onset to initiation of treatment, including door-to-balloon time (D2B) and total ischemic time (TIT). Results: After excluding patients who suffered an AMI within the hospital (2.6%), the analysis was conducted for 1879 patients. Most of the patients (49.5%) arrived by self-transport, 11.8% by emergency medical service (EMS) ambulance, and 38.6% were transferred from another EMS without PCI capability. The median time delay from symptom-onset to EMS call was 52.5 (15-180) min and from EMS call to EMS arrival 15 (10-20) min. In ST-segment elevation myocardial infarction (STEMI), the median D2B time was 36.5 (25-63) min, and median min. TIT was significantly prolonged from 151 (90-285) min to 250 (165-372) min in patients transferred from non-PCI centers. The major significant factors associated with time delay were patient-related delay and the mode of hospital arrival, both in STEMI and non-STEMI. Conclusion:The baseline evaluation of the TURKMI study revealed that an important proportion of patients presenting with AMI within 48 hours of symptom onset reach the PCI treatment center later than the time proposed in the guidelines, and the use of EMS for admission to hospital is extremely low in Turkey. Patient-related factors and the mode of hospital admission were the major factors associated with the time delay to treatment.

Aim: This work was designed to investigate the relationship between cardiac outcomes and Naples Prognostic Score (NPS) among heart failure (HF) patients. Materials & methods: This retrospective observational study enrolled 298 consecutive individuals hospitalized for New York Heart Association class 3–4 HF. The primary outcome was all-cause mortality. Secondary outcomes were rehospitalization and in-hospital death. Results: The high NPS group had a statistically greater rate of all-cause mortality (p < 0.001). In Cox regression analysis, integrating NPS considerably improved the performance of the full model over the baseline model (adjusted hazard ratio = 2.28; p = 0.004). Based on time-dependent receiver operating characteristic curve analysis, the NPS model outperformed the baseline and CONUT score models in discriminatory power in predicting the probability of survival. Conclusion: NPS was associated with short- and midterm mortality as well as rehospitalization.

ÖZAmaç: Kawasaki hastalığı (KH) çocukluk çağında edinilmiş kalp hastalıklarının en sık nedenlerindendir. Ülkemizdeki insidansı bilinmeyen hastalık multisistemik vaskülitik bir sendrom olup, pek çok organı ve sistemi etkilemektedir. Yöntem: Erzurum Bölge Eğitim ve Araştırma Hastanesinde KH tanısı konulan hastaların klinik ve laboratuvar bulguları retrospektif olarak incelendi. Bulgular: Hastaların yaş ortalaması 4,1±2,4 yıldı, 8'i (%66,6) erkek, 4'ü (%33,3) kızdı. Hastaların başvuruda ortalamaları 8,5±3,5 gündü, semptomları mevcuttu. On (%83,3) hastaya akut, 2 (%16,6) hastaya subakut KH (12 ve 17 gün) tanısı konuldu. Hastaneye en sık başvuru üçer olguyla 4. ve 9. aylarda oldu. Tüm hastaların en az 5 günden beri süren ateşi ve oral mukoza değişiklikleri mevcuttu. Diğer sık bulgular, on birer (%91,7) hastada konjunktivit ve polimorfik ekzantemdi. On (%83,3) hastanın komplet, 2 (%16,6) hastanın inkomplet KH vardı. İkişer (%16,6) hastada safra kesesi hidropsu ve BCG aşısı reaktivasyonu saptandı. Çalışmada, beyaz küre sayısı, C-reaktif protein ve eritrosit sedimentasyon hızı ortalama değerleri normal sınırların üzerindeydi. Trombositoz 4 (%33,3), hiponatremi 8 (%66,6), hipoalbüminemi 3 (%25) ve steril piyüri 3 (%25) hastada gözlendi. Dört (%33,3) hastada ekokardiyografide bulgu (2'sinde sol koroner arterde dilatasyon, 2'sindeyse intravenöz immünglobulin [IVIG] tedavisiyle gerilemiş olan hafif mitral yetmezlik ve sol ventrikül fonksiyonlarında azalma) saptandı. Tüm hastalara tanı anında IVIG, hastaların 9'una yüksek doz, 3'üne düşük doz asetil salisilat başlandı. Bir (%8,3) hastaya ikinci doz IVIG verildi. Koroner dilatasyonu bulgularının 3. ve 6. aydaki kontrollerde gerilese de devam ettiği görülerek asetil salisilat tedavilerine devam edildi. Sonuç: Nadir görülen ancak yüksek morbidite riskine sahip KH ülkemizde Doğu Anadolu bölgesinde de görülmektedir. Hızlı tedaviyle komplikasyonlar önlenebileceği için hastalığın hakkında farkındalığın artması önemlidir. Anahtar kelimeler: Asetil salisilat, intravenöz immünglobulin, Kawasaki hastalığı ABSTRACTObjective: Kawasaki disease (KD) is a frequently seen acquired childhood heart disease. This multisystemic vasculitic syndrome involves most organs and systems. The incidence in Turkey is unknown. Methods: Patients with KD at the Erzurum Regional Training and Research Hospital were retrospectively evaluated. Results: Patients' mean age was 4.1±2.4 years; eight (66.6%) patients were male and four (33.3%) female. Symptoms persisted for a mean 8.5±3.5 days. Ten (83.3%) patients were diagnosed with acute KD and two (16.6%) with subacute KD. Admission was most common in the 4 th and 9 th months with three cases each. All patients had fever for at least five days and oral mucosa changes. Other findings were conjunctivitis and polymorphic exanthems in 11 (91.7%) patients. Ten (83.3%) patients had complete KD and two 2 (16.6%) incomplete KD. Two (16.6%) patients had gallbladder hydrops and two (16.6%) had BCG vaccine reactivation. White blood cell count, CRP, and ESR were above norma...

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