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Background. The term ‘pseudo-outbreak’ refers to a condition in which a microorganism is found in cultures at a greater rate than expected due to contamination of materials that would normally be sterile. This situation cannot be clinically correlated with the infection suggested by the culture results. This can be confusing depending on the patient’s clinical condition, especially in intensive care units (ICU). The pseudo-outbreak with Escherichia coli in patients in ICUs will be discussed in this study to emphasize the importance of strict adherence to microbiology policies and procedures. Methods. In September 2022, growths of Escherichia coli were found in the endotracheal aspirate cultures of six children and eighteen adults in the ICU. Results. The identification of the same microbial agent in 24 patients prompted an investigation into a potential outbreak. The infection control committee compiled a comprehensive patient list to facilitate the assessment. Given that the healthcare personnel and infrastructure of each ICU were distinct and functioned independently, the possibility of cross-contamination within these units was deemed unlikely. Consequently, attention was directed toward the microbiology laboratory as a potential source of the outbreak. A thorough review of culture processing steps and laboratory equipment was conducted. This investigation revealed that the saline solution used for the passage of endotracheal aspiration cultures was contaminated, suggesting a laboratory-associated contamination event as the probable cause. Conclusions. By strictly adhering to the latest protocols, the disinfection and sterilization chain can ensure the safe use of both invasive and non-invasive medical equipment. This manuscript aims to raise awareness among pediatricians and pediatric infectious disease specialists regarding the occurrence of pseudo-outbreaks. A pseudo-outbreak is indicative of a disruption in the sterilization chain.

Introduction: The increasing prevalence of Gram-negative bloodstream infections in pediatric patients poses significant treatment challenges, particularly from multi-drug resistant (MDR) strains. Despite advances in medical care, mortality from bloodstream infections remains a concern. Our study aims to understand pediatric patients` demographics, clinical conditions, and microorganisms causing Gram-negative infections, as well as identify factors affecting treatment outcomes and mortality. Methodology: A retrospective, observational study of Gram-negative bacteremia, including all patients < 18 years of age, hospitalized during 2022, with documented bacteremia caused by Enterobacteriaceae or non-fermentative bacteria. Results: In total 123 blood cultures from 102 patients were included study. The median age of patients was 22 months, with 85.3% having an underlying medical condition. Common strains were Klebsiella pneumoniae, Escherichia coli, and Pseudomonas aeruginosa, with 73.2% hospital-acquired infections. Among the isolated species, 28.5% were multidrug-resistant (MDR). The mortality rate was 10.5%. Mortality among patients with antibiotic-resistant isolates was 17.1%. Patients with sepsis had a markedly elevated mortality rate. Additionally, mortality was increased among patients reliant on mechanical ventilation and those with urinary catheters. Furthermore, central venous catheterization was found to be an independent predictor for sepsis (odds ratio: 2.463, 95% confidence interval: 1.095–5.53), while the presence of a urinary catheter was identified as an independent predictor of mortality (odds ratio: 5.681, 95% confidence interval: 1.142–28.249). Conclusions: The study findings highlight a critical need for strategies to reduce MDR Gram-negative infections in children, emphasizing the importance of timely removal of invasive devices and rational antibiotic use to improve patient outcomes.

Introduction: Healthcare-associated infection is an important cause of mortality and morbidity worldwide. Well-regulated infection control and hand hygiene are the most effective methods for preventing healthcare-associated infections. This study evaluated and compared conventional hand hygiene observation and an electronic hand-hygiene recording and reminder system for preventing healthcare-associated infections. Methodology: This pre- and post-intervention study, employed an electronic hand-hygiene recording and reminder system for preventing healthcare-associated infections at a tertiary referral center. Healthcare-associated infection surveillance was recorded in an anesthesia and reanimation intensive care unit from April 2016 to August 2016. Hand-hygiene compliance was observed by conventional observation and an electronic recording and reminder system in two consecutive 2-month periods. healthcare-associated infections were calculated as incidence rate ratios. Results: The rate of healthcare-associated infections in the electronic hand- hygiene recording and reminder system period was significantly decreased compared with that in the conventional hand-hygiene observation period (incidence rate ratio = 0.58; 95% confident interval = 0.33-0.98). Additionally, the rate of central line-associated bloodstream infections and the rate of ventilator-associated pneumonia were lower during the electronic hand hygiene recording and reminder system period (incidence rate ratio= 0.41; 95% confident interval = 0.11-1.30 and incidence rate ratio = 0.67; 95% confident interval = 0.30-1.45, respectively). Conclusions: After implementing the electronic hand hygiene recording and reminder system, we observed a significant decrease in healthcare-associated infections and invasive device-associated infections. These results were encouraging and suggested that electronic hand hygiene reminder and recording systems may reduce some types of healthcare-associated infections in healthcare settings.

Since the earliest times of history, fever has been the symptom that has attracted the most attention of mankind among the many symptoms of disease. Giving their children medications that they believe are beneficial, such as fever reducers, can give parents a sense of control and reduce their anxiety and unnecessary use of health facilities. [...]it is important to safely reduce fever when necessary. According to the results of many clinical studies, normal body temperature is generally accepted to be 37°C.This value was derived by Wunderlich in the 19th century from studies of over 25.000 people. The average normal body temperature in the neonatal period is 37.5°C and the upper limit of normal is 38°C. Exercise, overdressing, hot baths, extremely hot weather, hot food and drinks can raise the body temperature of a healthy child up to 38.0-38.5°C. DEFINITION OF FEVER Fever is defined as an increase in body temperature above the normal daily periodic change, which is centrally regulated by the body against various pathological stimuli.

Meningococcal carriage studies and transmission modeling can predict IMD epidemiology and used to define invasive meningococcal disease (IMD) control strategies. In this multicenter study, we aimed to evaluate the prevalence of nasopharyngeal Neisseria meningitidis (Nm) carriage, serogroup distribution, and related risk factors in Turkey. Nasopharyngeal samples were collected from a total of 1267 children and adolescents and were tested with rt-PCR. Nm carriage was detected in 96 participants (7.5%, 95% CI 6.1–9.0), with the peak age at 13 years (12.5%). Regarding age groups, Nm carriage rate was 7% in the 0–5 age group, was 6.9%in the 6–10 age group, was 7.9% in the 11–14 age group, and was 9.3% in the 15–18 age group. There was no statistically significant difference between the groups (p > 0.05). The serogroup distribution was as follows: 25% MenX, 9.4% MenA, 9.4% MenB, 2.1% MenC, 3.1% MenW, 2.1% for MenY, and 48.9% for non-groupable. The Nm carriage rate was higher in children with previous upper respiratory tract infections and with a high number of household members, whereas it was lower in children with antibiotic use in the last month (p < 0.05 for all). In this study, MenX is the predominant carriage strain. The geographical distribution of Nm strains varies, but serogroup distribution in the same country might change in a matter of years. Adequate surveillance and/or a proper carriage study is paramount for accurate/dynamic serogroup distribution and the impact of the proposed vaccination.

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: 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.

Epstein-Barr virus (EBV) usually causes mild, asymptomatic, and self-limited infections in children and adults; however, it may occasionally lead to severe conditions such as neurological diseases, malignant diseases, hepatic failure, and myocarditis. Epstein-Barr virus-related neurological disorders include meningitis, encephalitis, and cranial or peripheral neuritis, which are mostly seen in immunocompromised patients. The therapeutic modalities for EBV-related severe organ damage including central nervous system manifestations are still uncertain. Herein, we describe a seven-year-old boy with EBV encephalitis who presented with prolonged fever, exudative pharyngitis, reduced consciousness, and neck stiffness. Cranial magnetic resonance imaging showed contrast enhancement in the bilateral insular cortex and the right hypothalamus. The diagnosis was made by EBV-DNA amplification in both the blood and cerebrospinal fluid samples. He was discharged with acyclovir therapy without any sequelae.

Acinetobacter ursingii is an aerobic, gram-negative, opportunistic microorganism which is rarely isolated among Acinetobacter species. We present two immunocompetent infants who developed bacteremia due to A. ursingii. The first patient is a two -month- old boy who had been hospitalized in pediatric surgery unit for suspected tracheo-esophageal fistula because of recurrent aspiration pneumonia unresponsive to antibiotic therapy. The second patient is a fourteen -month- old boy with prolonged vomiting and diarrhea. A. ursingii was isolated from their blood cultures. They were successfully treated with ampicillin-sulbactam. Although A. ursingii has recently been isolated from a clinical specimen; reports of infection with A. ursingii in children are rare. A. ursingii should be kept in mind as an opportunistic microorganism in children.

This multi-center point prevalence study evaluated children who were diagnosed as having coronavirus disease 2019 (COVID-19). On February 2nd, 2022, inpatients and outpatients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) were included in the study from 12 cities and 24 centers in Turkey. Of 8605 patients on February 2nd, 2022, in participating centers, 706 (8.2%) had COVID-19. The median age of the 706 patients was 92.50 months, 53.4% were female, and 76.7% were inpatients. The three most common symptoms of the patients with COVID-19 were fever (56.6%), cough (41.3%), and fatigue (27.5%). The three most common underlying chronic diseases (UCDs) were asthma (3.4%), neurologic disorders (3.3%), and obesity (2.6%). The SARS-CoV-2-related pneumoniae rate was 10.7%. The COVID-19 vaccination rate was 12.5% in all patients. Among patients aged over 12 years with access to the vaccine given by the Republic of Turkey Ministry of Health, the vaccination rate was 38.7%. Patients with UCDs presented with dyspnea and pneumoniae more frequently than those without UCDs ( p  < 0.001 for both). The rates of fever, diarrhea, and pneumoniae were higher in patients without COVID-19 vaccinations ( p  = 0.001, p  = 0.012, and p  = 0.027).   Conclusion : To lessen the effects of the disease, all eligible children should receive the COVID-19 vaccine. The illness may specifically endanger children with UCDs. What is Known: • Children with COVID-19 mainly present with fever and cough, as in adults. • COVID-19 may specifically threaten children with underlying chronic diseases. What is New: • Children with obesity have a higher vaccination rate against COVID-19 than children without obesity. • Among unvaccinated children, fever and pneumoniae might be seen at a higher ratio than among vaccinated children.