Explore the vast range of titles available.

Background Approximately 100 capsular serotypes of S. pneumonia have been identified according to the composition of their capsular polysaccharides, currently available vaccines do not cover many of these. Pneumococcal vaccination serotype coverage is essential for preventing noninvasive and invasive illnesses as well as asymptomatic carriage. We aimed to determine the serotype distribution and antimicrobial susceptibility pattern of pneumococcal clinical isolates in this study. We also analyzed the serotype coverage rates of PCV13, which is applied in the NIP, and PCV-15 and PCV20, which have been introduced recently. Methods This study is a retrospective surveillance of pneumococcal infections including invasive pneumococcal isolates (IPIs) and non-invasive pneumococcal isolates (non-IPIs). Results A total of 420 isolates from 356 different patients aged 0–89 years were enrolled in the study. A total of 420 pneumococcal isolates were serotyped and 26 different serotypes were detected. Serotype 19 F was the most prevalent serotype ( n  = 96, 22.8%), followed by 6 A/B ( n  = 55, 13.1%), 23 F ( n  = 49, 11.6%), 3 ( n  = 22, 5.2%) and 19 A ( n  = 16, 3.8%). Conclusions Surveillance studies of pneumococcal diseases are critical to investigating current serotype distributions, antibiotic resistance status, and frequency of IPD cases. Considering the increasing antibiotic resistance rates of S. pneumoniae , it is necessary to provide protective immunization by switching to more comprehensive PCV vaccines rather than treatment. Clinical trial number Not applicable.

•The prevalence of pneumococcal carriage 5years after PCV-7 and 2years after PCV-13 childhood vaccination introduction was 6.4%. The 7-valent conjugate pneumococcal vaccine (PCV7) was introduced by the Turkey National Immunization Program in 2008 and replaced by the PCV13 in 2011. We assessed the impact of PCV vaccination on the nasopharyngeal (NP) carriage, serotype distribution and antimicrobial resistance of Streptococcus pneumoniae (SP) among healthy Turkish children. A prospective surveillance study was performed between September 2011 and September 2013 in Istanbul, Turkey. NP swabs, demographic data, and vaccination statuses were obtained from 2165 healthy children aged 0–18years. Pneumococcal carriage was defined by a positive culture; serotyping was performed via multiplex conventional PCR, and the antibiotic susceptibilities of the isolates were determined based on the minimum inhibitory concentration (MIC) values of the Clinical Laboratory Standards Institute (CLSI). The prevalence of pneumococcal carriage was 6.4%. The carriage rates were 8%, 7%, and 5% in the following age groups: 0–24months, 25–60months, and >60months, respectively. The carriage rate was significantly higher in the 0–24month age group than in the >60months age group (p=0.03). Sixty percent of the children were not vaccinated with any PCV; 4%, 2%, and 4% received at least 1, 2 or 3 doses and 30% children received the full schedule (4 doses) of either PCV7 or PCV13. Among the isolated S. pneumoniae strains, 45% were of the non-vaccine type (NVT) and 55% were of the vaccine type (VT). The children who received at least a single PCV dose had significantly lower odds of colonization via VT serotypes than the non-vaccinated children [odds ratio: 0.61 (95% confidence interval=0.41–0.91), p=0.01]. The percentages of the serotypes covered by PCV7 and PCV13 were 51% and 56%, respectively. The most frequently isolated serotypes were 6A/B/C (n=22, 16.5%), 19F (n=18, 13.5%), 23F (n=15, 11.2%), serotype 9V/A (n=10, 7.5%), 12F (n=5, 4.5%), 15A/F (n=7, 4.5%) and 22 A/F (n=6, 4.5%). Using the meningitis criteria and the MIC, 62% of the isolates were resistant to penicillin and 13% were non-sensitive to ceftriaxone. Erythromycin and clindamycin resistance were 43% and 31%, respectively. We shown that following nation-wide PCV vaccination, S. pneumoniae NP carriage was decreased.

Influenza is a generally self-limited infection agent that only rarely causes severe complications. To increase awareness about its serious complications, we report three cases of influenza A (H1N1) infection complicated with hemolytic uremic syndrome, myocarditis and acute necrotizing encephalopathy. In all three cases, nasopharyngeal samples confirmed influenza A (H1N1) infection by antigen test and multiplex PCR detection. The first case, a 3-year-old girl, had respiratory distress, anemia, thrombocytopenia and renal failure at admission, and was diagnosed with hemolytic uremic syndrome. Supportive treatment and oseltamivir did not prevent the development of chronic renal failure. The second case, a 5-year-old girl admitted with lethargia and flu-like symtoms and was diagnosed with myocarditis and cardiogenic shock. Oseltamivir and supportive treatment including extra-corporeal membrane oxygenation (ECMO) failed. She died on the 3rd day of admission. The third case, a 21-month-old boy, presented with decreased level of consciousness and was diagnosed with acute necrotizing encephalopathy with the aid of cranial magnetic resonance imagining (MRI). He was discharged without any neurological sequelae three weeks after admission. It should be kept in mind that influenza virus does not always cause a self-limited flu. Multidisciplinary management, early diagnosis and antiviral treatment are critical for the disease and to prevent its life-threatening complications.

Introduction: Healthcare-associated infections (HAIs) are a significant cause of morbidity and mortality, particularly among critical pediatric surgical patients. This study aimed to evaluate the incidence, distribution, types, and pathogens involved in HAIs, in a newly established pediatric surgery intensive care unit (PSICU). Methodology: The Infection Control Team of Marmara University Pendik Training and Research Hospital identified and documented HAI cases according to the Centers for Disease Control and Prevention criteria over a four-year period following the unit's opening. Prospective, laboratory-based surveillance of HAIs was conducted within the PSICU from 1 January 2011 to 30 November 2014. Continuous monitoring and early detection of HAIs are crucial for implementing timely and effective infection control measures. Results: A total of 599 patients were admitted to the PSICU, and 90 HAI cases were identified, resulting in an overall HAI rate of 15%. The incidence density was 14.7 per 1,000 patient-days. The most prevalent types were bloodstream infections (40%), pneumonia (23.4%), and urinary tract infections (17.8%). The primary pathogens were Klebsiella spp. (27.8%), Acinetobacter baumannii (13.9%), Staphylococcus spp. (13.9%), and Candida spp. (13.9%). Conclusions: There is limited data on HAI rates in PSICUs, and this study showed that infection rates in the PSICU were not higher than in pediatric intensive care units and neonatal intensive care units. The incidence of HAIs in this study was not higher than reports from other PSICUs in developing countries like Mexico, Brazil, and Egypt; but was higher compared to the rates reported in developed countries such as the US.

There is rising concern that patients who recover from COVID-19 may be at risk of recurrence. Increased rates of infection and recurrence in healthcare workers could cause the healthcare system collapse and a further worsening of the COVID-19 pandemic. Herein, we reported the clinically symptomatic recurrent COVID-19 cases in the two healthcare workers who treated and recovered from symptomatic and laboratory confirmed COVID-19. We discuss important questions in the COVID-19 pandemic waiting to be answered, such as the protection period of the acquired immunity, the severity of recurrence and how long after the first infection occurs. We aimed to emphasize that healthcare workers should continue to pay maximum attention to the measures without compromising.

Streptococcus pneumoniae colonization is a precursor to pneumococcal disease. Although children with a tracheostomy have an increased risk of pneumococcal pneumonia, the pneumococci colonizing their lower airways remain largely uncharacterized. We sought to compare lower respiratory tract isolates colonizing tracheostomy patients and a convenience sample of isolates from individuals intubated for acute conditions. We collected pneumococcal isolates from the lower respiratory tract of 27 patients with a tracheostomy and 42 patients intubated for acute conditions. We compared the penicillin susceptibility, rates of co-colonization, genetic background, and serotype of isolates colonizing these patient populations. Isolates from both groups showed high genetic diversity. Forty multi-locus sequence types and 20 serotypes were identified. There was no significant difference in serotype distribution, co-colonization rates, vaccine coverage, or non-susceptibility to penicillin among pneumococcal isolates from the two groups. Colonization of the lower airways with non-vaccine serotypes 15B/C, 23B and 35B was noted for the first time in patients with tracheostomies and supports recently observed increases in nasopharyngeal colonization and disease due to these serotypes.

Introduction: Healthcare-associated infections (HAIs) are important causes of morbidity and mortality, especially in critically ill patients in intensive care units. The aim of this study was to assess the rate and distribution of HAIs, pathogens, and antimicrobial susceptibility patterns in a newly opened pediatric intensive care unit (PICU). Methodology: The infection control team detected and recorded HAI cases according to the Centers for Disease Control and Prevention’s criteria in the PICU of Marmara University Pendik Training and Research Hospital over a four-year period following its opening. Laboratory-based HAIs surveillance was performed prospectively from 1 January 2011 to 30 November 2014. Results: During the study period, 1,007 patients hospitalized in the PICU and 224 HAIs were identified. The overall HAI rate was 22.24%, and the incidence density was 20.71 per 1,000 patient-days. The most commonly observed HAIs were bloodstream infection (35.7%), pneumonia (21.4%), and urinary tract infection (20.5%), and the three most common HAI pathogens were Klebsiella spp. (19.4%), Pseudomonas aeruginosa (13.8%), and Acinetobacter baumanii (12%). Methicillin resistance was detected in 78% of coagulase-negative Staphylococcus. Presence of extended-spectrum beta-lactamases was determined in 45% and 54% of Klebsiella spp. strains and Escherichia coli isolates, respectively. Conclusions: Our rate of HAIs is higher than the mean rates reported in PICU studies from developed countries. Active surveillance studies of HAIs is an essential component of infection control, which may contribute to improving preventive strategies in developing countries.

Lactococcus lactis is a gram-positive, facultative anaerobic coccus that is occasionally isolated from human mucocutaneous surfaces such as the intestines. It is used in the dairy industry for milk acidification and is mostly nonpathogenic in immunocompetent humans, however a number of cases of infection with L. lactis have been reported in recent years. In this article, we describe two cases of infection due to L. lactis in patients with chronic diarrhea. The first case is a five-month-old boy who was operated on for volvulus on his first day of life and had ileostomy with subsequent diagnosis of chronic diarrhea and bacteremia due to L. Lactis. The second case is a six-month-old girl with the diagnosis of chronic diarrhea that developed after a catheter-related bloodstream infection. Both of the infections due to L. Lactis spp lactis were successfully treated with intravenous vancomycin therapy. Although Lactococcus species is mostly known as nonpathogenic, it should be kept in mind as a potential pathogen, especially in patients with gastrointestinal disorders.

Introduction: The human nasopharynx is the main reservoir of Neisseria meningitidis, and asymptomatic carriage is common. N. meningitidis one of the common causes of bacterial meningitis in Turkey, especially after the implementation of the national immunization program that includes conjugated pneumococcal and Haemophilus influenzae type b vaccines. The purpose of this study was to evaluate the prevalence of meningococcal carriage and determine the leading serogroup, which may help authorities to adapt appropriate meningococal vaccine into the national immunization programme. Methodology: The prevalence of oropharyngeal carriage of N. meningitidis in 1,000 healthy subjects, 0–79 years of age, was investigated. Oropharyngeal swabs were collected during an 18-month period. Samples obtained were inoculated onto Thayer-Martin agar. The API-NH test and VITEK-MS system were used for identification of colonies. Multiplex real-time polymerase chain reaction assay was used to determine serogroups with serogroup-specific genes. Results: N. meningitidis was isolated from 6 of 1,000 subjects (0.6%). Meningoccocal carriers were between 21 and 40 years of age. All isolates were serogrouped as B, except one that did not survive on subculture. N. lactamica was isolated from 13 of 1,000 subjects (1.3%). Conclusions: Carriage rate of meningococci in our study was relatively low. However, we detected that serogroup B was the leading strain in meningococcal carriage in Istanbul; choosing an appropriate meningococcal vaccine containing serogroup B should therefore be considered. High absolute humidity throughout the year in Istanbul may explain the low prevalence of carriage in our study. This should be verified with a multicenter national survey.

Background. The objective of this study was to assess the compliance of hand hygiene (HH) of healthcare workers (HCWs) in the neonatal and pediatric intensive care unit in a tertiary university hospital in Istanbul. Methods. An observational study was conducted on the compliance of HH for the five World Health Organization (WHO) indications. HCWs were observed during routine patient care in day shift. The authors also measured the technique of HH through hand washing or hand hygiene with alcohol-based disinfectant. Results. A total of 704 HH opportunities were identified during the observation period. Overall compliance was 37.0% (261/704). Compliance differed by role: nurses (41.4%) and doctors (31.9%) [P=0.02, OR: 1.504, CI 95%: 1.058–2.137]. HCWs were more likely to use soap and water (63.6%) compared to waterless-alcohol-based hand hygiene (36.3%) [P<0.05]. Conclusion. Adherence to hand hygiene practice and use of alcohol-based disinfectant was found to be very low. Effective education programs that improve adherence to hand hygiene and use of disinfectants may be helpful to increase compliance.