bioMérieux.

A high proportion of hospitalized children received prophylactic BSAs. This represents a clear target for quality improvement. Collectively speaking, it is critical to reduce total prophylactic prescribing, BSA use, and prolonged prescription.

No abstract

These infections were associated with longer hospital stay and higher mortality rate. Conducting further studies with larger sample size and investigating more effective prophylactic measures should be considered in future studies.

Point Prevalence Surveys (PPSs) provide useful data on the patterns of in-hospital antimicrobial prescription. Aiming to identify targets for quality improvement, we evaluated prescribing patterns of antimicrobials in the pediatric and neonatal wards of two tertiary referral centers in Iran. Materials and Methods: Two PPSs on antimicrobial use in children and neonates hospitalized in the Nemazee teaching hospital in Shiraz (south of Iran) and Besat teaching hospital in Sanandaj (west of Iran) were performed for two consecutive years. We used a validated and standardized method based on the Antibiotic Resistance and Prescribing in European Children project. Results: Out of a total of 266 and 129 admissions in pediatric and neonatal wards, respectively, 61% of pediatric inpatients and 71% of neonates received at least one antimicrobial. The most frequently prescribed antibiotics in pediatric wards were ceftriaxone (29.2%) and vancomycin (15%), and in neonatal wards, ampicillin (34.7%) and cefotaxime (14.7%). Antimicrobial combination therapies and the parenteral route of administration in pediatric wards were 40% and 91.3%, and in neonatal wards, 63% and 100%, respectively. Empirical antibiotic therapies in pediatric and neonatal wards were 93.6% and 96%, respectively. Conclusion: The high percentage of antimicrobial use, combination therapies, and empirical therapies could be the targets for quality improvement in our hospitals.

Liver transplantation (LT) is a potentially curative treatment for terminal stage hepatic diseases. Bacterial infections are the main causes of mortality and morbidity in the early period after LT. Identifying the risk factors could help in minimizing their development. We prospectively investigated the incidence, characteristics, and risk factors of bacterial infections among the recipients during hospitalization after LT and assigned a predictive score. All 389 consecutive adults who underwent LT at the main referral hospital of LT in Iran during 1 year were enrolled prospectively in a cohort study. Infection group consisted of 143 recipients (36.8%). Urinary tract and surgical site infections were the most frequent ones. Gram-negative bacteria were more prevalent than Gram-positive ones. Independent risk factors were female sex (relative risks = 2.13), age ≤ 43.5 years (3.70), hospital stay ≥ 9.5 days (5.22), abdominal reoperation (3.03), vancomycin-resistant Enterococci colonization (5.52), hospitalization 3 months prior to LT (3.25), mechanical ventilation ≥48 hr (4.93), and renal replacement therapies (13.40). We developed a risk score for the prediction of bacterial infections with an area under the receiver operating characteristic curve of 0.85 (95% CI, 0.81-0.89) with sensitivity of 88% and specificity of 64%. In the infection group, mortality was higher than in controls (18.9% vs. 2.0%) with longer hospitalization (16 vs. 10 days; P < 0.001). We detected a high rate of bacterial infections leading to longer hospital stay and higher mortality rate. The formulated risk score can help predict bacterial infections; however, it requires clinical validation in further studies. K E Y W O R D S bacterial infections, Iran, liver transplantation, risk factors, scoring systems ---Abbreviations: AUC, area under the curve; CRRT, continuous renal replacement therapy; LT, liver transplantation; MDR, multidrug resistance; MELD, model for end-stage liver disease; ROC curve, receiver operating characteristic curve. | RESULTSDuring the study period, 399 LTs were performed on 389 adult patients. Ten (2.6%) patients received two transplants each: seven for post-transplant complications, two 408 | JAFARPOUR ET AL.

Disseminated Bacillus Calmette-Guérin (BCG) disease is one of the most serious complications of BCG vaccination, mainly among immunocompromised children with high morbidity and mortality.Currently, there is no any consensus with regard to the standard regimen of antituberculosis (anti-TB) agents and duration of treatment in healthy or immunocompromised host in children. The aim of this study is to investigate the effect of various combination treatment strategies for disseminated BCG disease in children.In this cross-sectional study, the outcome of 3 different combination protocols was investigated in 59 patients.All patients were younger than 6 years old. Both possible immunocompetent and proven immunodeficient children were included in a period of 25 years (1991-2014) in a Nemazee referral teaching hospital.The minimum age was 1 month and the maximum was 60 months. The average age of patients was 8 months (8.26 ± 9.73). Out of 59 cases, 32 (54.2%) were female and 27 (45.8%) were male. Based on the primary work up, 52.5% of cases were classified as definite immunodeficient and 47.5% were classified as possible immunocompetent. Overall mortality rate was 50.8%. Mortality rate of disseminated BCG disease in immunocompetent and immunodeficient children was 28.6% and 71%, respectively. The mortality rate was not statistically different between patients treated with different treatment protocols. These results were not affected by immune status and the type of immunodeficiency.More than 2 anti-TB drugs combination will not change outcome of patient with disseminated BCG disease.

Gastrointestinal basidiobolomycosis (GIB) is a rare, life-threatening fungal infection affecting immunocompetent individuals in tropical and subtropical regions. A diverse presentation of GIB has been reported, but no report has yet been published on intussusception. We describe a 23-month-old immunocompetent boy from a subtropical area in Iran who presented with intussusception. Prolonged fever, an abdominal mass, hepatomegaly, high erythrocyte sedimentation rate, and peripheral eosinophilia strongly suggested GIB. Accordingly, GIB was diagnosed based on the characteristic histopathology (the Splendore-Hoeppli phenomenon) detected in a liver sample taken via biopsy. Exploratory laparotomy showed several organs, including the colon, gall bladder, liver, and abdominal wall, were involved. Antifungal therapy with trimethoprim/sulfamethoxazole, liposomal amphotericin B, a saturated solution of potassium iodide, and surgical resection of involved tissues were used with improved outcome. The presence of non-septate fungal hyphal elements in the colonic mucosa led to the thickening of the bowel wall, leading to secondary intussusception.