Background/AimsBrucellosis patients present various non-specific clinical symptoms, such as fever, fatigue, sweating, joint pain, arthritis, myalgia, and headache. Based on the nonspecifity of its clinical signs and symtoms, we decided to evaluate whether mean platelet volume (MPV) , neutrophil to lymphocyte ratio (NLR), and platelet to lymphocyte ratio (PLR) will contribute to the diagnosis.MethodsIn this retrospective study, we reviewed hospital-records of 60 children with a confirmed diagnosis of brucellosis in Kayseri between January 2013 and January 2016, and compared the hematological parameters; white blood cell (WBC) count, hemoglobin (Hb), neutrophil count, lymphocyte count, platelet count, MPV, NLR, and PLR with 55 healthy age and gender matched children. Also, the well known inf lammation markers; erytrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were compared between the patient and control group.ResultsWe found significant difference among the Hb, platelet count, MPV and NLR values between the patient and control group (p < 0.05). There was no difference between WBC, neutrophil count, lymphocyte count and PLR between the patient and control group (p > 0.05). When the patients were divided into groups as arthritis positive and arthritis negative and compared to the control group; we found that the NLR is more significant in between the arthritis positive and control group (p = 0.013). Also, we found significant difference among the ESR and CRP values between the patient and control group (p < 0.001).ConclusionsThe results of this study indicates that MPV and NLR values can be used as markers of inflammation in childhood brucellosis. Also, NLR is more valuable in children with brucella arthritis.
Objective: The aim of this study was to identify microorganisms causing ventilator-associated pneumonia (VAP) and also study the antibiotic resistance/susceptibility. Materials and Methods:We retrospectively assessed microorganisms isolated from patients diagnosed with VAP in a pediatric intensive care unit between January 1, 2014, and June 30, 2016. Results:We included 44 patients diagnosed with VAP. The prevalence thereof was 8.6 patients per 1,000 ventilator days. Mechanical ventilation was required for 56.5% of patients. Thirty-three patients (75%) died. An underlying chronic disease was detected in 75% of patients (n=33). Fifty microorganisms were isolated from 44 patients. Single microorganisms were isolated from 86.4% (n=38) and two from 13.6% (n=6) of patients. Of all the isolated bacteria, 96% (n=48) were gram-negative; the most common was Pseudomonas aeruginosa (32%), followed by Klebsiella pneumoniae (24%) and Acinetobacter baumannii (22%). The isolates were most susceptible to colistin (92.6%), followed by piperacillin-tazobactam (71.4%), amikacin (65.2%), and gentamicin (52.2%). No enterobacterium or Acinetobacter strain was resistant to colistin; however, 13% of P. aeruginosa isolates were resistant. Conclusion:In VAP, it is essential to catalog antibiotic resistance patterns of bacteria present in the unit to ensure that empirical antibiotic therapy is effective.Keywords: Ventilator-associated pneumonia, pediatric intensive care, microorganism, antibiotic Bulgular: Çalışmaya VİP tanısı alan 44 hasta alındı. VİP hızı 1000 ventilatör gününde 8,6 olarak saptandı. Mekanik ventilatör kullanım oranı %56,5 idi. VİP tanısı alan olguların %75 (n=33)'nin öldüğü saptandı. VİP tanısı alan hastaların %75 (n=33)'inde altta yatan kronik hastalık tespit edildi. VİP tespit edilen 44 olguda 50 mikroorganizma izole edildi. Olguların %86,4'nda (n=38) tek mikroorganizma, %13.6 (n=6)'nda iki mikroorganizma etken olarak izole edildi. İzole edilen suşların %96' sının (n=48) gram negatif bakteri olduğu saptandı. Çalış-mamızda en sık izole edilen gram negatif ajan Pseudomonas Aeruginosa (%32) iken bunu Klebsiella pneumonia (%24) ve Acinetobacter baumannii (%22) izlemekte idi. Genel antibiyotik duyarlılığı incelendiğinde mikroorganizmaların en hassas olduğu antibiyotikler sırasıyla Kolistin (%92,6), Piperasilin-tazobaktam (% 71,4), Amikasin (%65,2) ve Gentamisin (%52,2) olarak saptandı. Enterobacteriaceae ve Acinetobacter suşlarında Kolistin direnci görülmezken P. aeruginosa izolatlarında, kolistin direnci %13 olarak saptandı.Sonuç: Ventilatör ilişkili pnömonidee, etkili ampirik antibiyotik tedavisi için her ünitenin kendi florasının direnç özelliklerini bilmesi gerekmektedir.Anahtar Kelimeler: Ventilatör ilişkili pnömoni, çocuk yoğun bakım, mikroorganizma, antibiyotik Eurasian J Med
Objectives: To determine the serotype distribution of pneumococcus causing invasive pneumococcal disease (meningitidis, bacteremia and empyema) in children in Turkey, and to observe potential changes in this distribution in time to guide effective vaccine strategies. Methods: We surveyed S. pneumoniae with conventional bacteriological techniques and with real-time polymerase chain reaction (RT-PCR) in samples of cerebrospinal fluid (CSF), blood and pleural fluid. S. pneumoniae strains were isolated from 33 different hospitals in Turkey, which are giving health services to approximately 60% of the Turkish population. Results: A total of 167 cases were diagnosed with invasive pneumococcal disease between 2015 and 2018. We diagnosed 52 (31.1%) patients with meningitis, 104 (62.2%) patients with bacteremia, and 11 (6.6%) patients with empyema. Thirty-three percent of them were less than 2 years old and 56% less than 5 years old. Overall PCV13 serotypes accounted for 56.2% (94/167). The most common serotypes were 19 F (11.9%), 1 (10.7%) and 3 (10.1%). Conclusions: Besides the increasing frequency of non-vaccine serotypes, vaccine serotypes continue to be a problem for Turkey despite routine and high-rate vaccination with PCV13 and significant reduction reported for the incidence of IPD in young children. Since new candidate pneumococcal conjugate vaccines with more serotype antigens are being developed, continuing IPD surveillance is a significant source of information for decision-making processes on pneumococcal vaccination.
Aim: In this study, it was aimed to retrospectively assess the frequency and antibiotic resistance of microorganisms isolated from blood cultures of patients in a pediatric intensive care unit. Material and Methods: The study was conducted on blood culture tests obtained from patients in a pediatric intensive care unit and sent to a microbiology laboratory between 2013 and 2016. The species and antibiotic susceptibilities were assessed in microorganisms isolated from the blood cultures. Results: Overall, 4239 blood cultures were obtained. Growth was detected in 324 blood cultures (7.6%). Of the microorganisms isolated, 195 (60.2%) were Gram-positive bacteria, and 107 (33.0%) were Gram-negative bacteria; 22 (6.8%) were fungi. The most commonly isolated microorganisms were Coagulase-negative staphylococci (45.1%), followed by Klebsiella pneumonia (14.5%), and Enterococcus faecalis (6.5%). Among the fungi, the most common was Candida albicans (59.1%), followed by Candida parapsilosis. The resistance rate against methicillin was 89.9% in coagulase-negative staphylococci, and 66% in S. aureus strains. The resistance rate against vancomycin was 3.6% in Enterococci spp. There was no resistance against linezolid in Gram-positive microorganisms. The rate of extended-spectrum beta lactamase positivity was found as 34% in Klebsiella spp. and 100% in Escherichia coli. The resistance rate against carbapenem was 44.9% in Gram-negative bacteriae. The resistance rate against carbapenem was 100% in Acinetobacter baumanii. In Candida albicans, resistance to amphotericine B was 61.5%, and resistance to voriconazole was 7.7%. Conclusions: To plan effective empiric antibiotic therapy against nosocomial infections in intensive care units, all units should have information about the characteristics of their own flora.
Diagnosis of COVID19 is based on reverse transcription-polymerase chain reaction (RT-PCR) testing of nasopharyngeal swab (NPS) samples. As NPS sampling is a discomforting invasive procedure, studies were conducted to investigate the performance of saliva and mouthwash (MW) samples in RT-PCR. There is limited data about MW samples. We have developed a new method for concentrating gargle and mouthwash (GMW) samples to be used in RT-PCR. In our study, we aimed to investigate the performance of concentration of GMW samples in detection of SARS-CoV-2. A paired sample of NPS and GMW samples were collected from patients in 11 centers in Turkey. MW samples were concentrated using MyMagiCon-RW100® (Bio-T, Istanbul, Turkey). NPS, GMW and concentrated GMW samples were tested by RT-PCR for the presence of SARS-CoV2 and the results were compared. The viral RNA was detected in 47.5% of NPS samples, in 28.8% of GMW before concentration and in 37.5% GMW samples after concentration. Concentration of samples increased the number of samples in which SARS-CoV2 RNA was detected by 16.6%. The RT-PCR of concentrated GMW samples yielded better results than the RT-PCR of NPS samples in two centers. Concentrated GMW sampling can be an alternative method to NPS sampling in rapid and accurate diagnosis of COVID-19.
Purpose This was a prospective randomized controlled study to evaluate the time-dependent incidence of contamination of K-wires and wounds in patients who underwent osteosynthesis and the effect of covering the K-wires on this incidence rate of infection. Methods The study sample included 90 patients who underwent open reduction and internal fixation between 2018 and 2019. Patients were randomized to two groups: use of covered K-wires during surgery (using a sterile towel) and use of uncovered K-wires. Bacterial samples were obtained from the K-wires and wound at the following time points: 0 (just after opening of the K-wire packages) and at 15, 30, 60, 90, and 120 min after. Samples with bacterial growth at 48 h were considered contaminated. Microscopic, staining, and biochemical properties were used for bacterial typing. Results Bacterial growth was detected at the 30- and 60-min time points for the uncovered and covered groups, respectively. Wound contamination was identified within 15 min for the uncovered group. Wound and K-wire contamination progressed as a function of time, being consistently more significant in the uncovered group (p<0.005). Conclusions Time-dependent K-wire and wound contamination rates may be decreased by covering the K-wires (and other instruments) with a sterile towel. Frequent wound irrigation during surgery and postoperative prophylactic antibiotics targeting the bacteria we identified might further be useful in lowering the incidence rate of infection.
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