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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.

Although physiologic and neurologic consequences of micronutrient deficiencies have been addressed extensively, less is known about their impact on developing gut microbiota. Vitamin B12 deficiency is a common micronutrient deficiency in infants. We aimed to analyze the gut microbial composition of exclusively breastfed infants aged between 4 and 6 months with and without vitamin B12 deficiency by 16S rRNA gene sequencing. In a subgroup of infants with vitamin B12 deficiency, stool samples are recollected and reanalyzed after vitamin B12 supplementation. A total of 88 infants’ stool samples (median age 4 months [IQR 4–5], 50% males) were analyzed, of which 28 (31.8%) were vitamin B12 sufficient and 60 (68.2%) were vitamin B12 insufficient. Comparisons between vitamin B12-sufficient and vitamin B12-insufficient infants revealed no evidence of differences in the microbiota. Proteobacteria, Firmicutes, Actinobacteria, and Bacteroidetes were the most abundant phyla in all groups. There was no difference between the pre- and post-treatment composition of gut microbiota.Conclusion: Vitamin B12-deficient infants have similar gut microbial composition as vitamin B12-sufficient infants. Since the samples were collected at an early period of life and the exposure to deficiency was relatively short, it may be possible that the effects were not fully established.What is Known: • Vitamin B12 is an essential vitamin for humans and also a crucial compound for human gut microbiota. • Vitamin B12 deficiency is common in exclusively breastfed infants. • In contrast to the adult gut microbiota, infant gut microbiota has been shown to have decreased capacity for de novo synthesis of vitamin B12 and depend on dietary source of vitamin B12.What is New: • There is no difference in the gut microbial composition of vitamin B12-deficient and vitamin B12-sufficient infants.

Background. This study aims to assess Turkish pediatricians’ knowledge and attitudes regarding respiratory syncytial virus (RSV) infection and its current immunization strategies. Methods. From May 10 to June 4, 2024, we invited 1603 pediatricians who subscribed to the website of The Turkish Pediatrics Atelier via e-mail to respond to an online questionnaire. A total of 401 pediatricians responded. Results. Of pediatricians, 11% stated that they routinely use chest X-ray (CXR) for diagnosing RSV illness. When managing RSV-positive patients, while 44.4% of pediatricians indicated that they need a CXR if there are lung auscultation findings, the rate of routine CXR usage was 22.7%. While most pediatricians (74.8%) stated that they prefer nebulized salbutamol and/or corticosteroid; 43.4% used hypertonic saline; and 22.7% used nebulized epinephrine as a treatment option. While 60.3% of pediatricians had no information about the maternal RSV vaccine; 58.1% stated that they would recommend it to only willing women; 16% stated that they would not recommend it; and 25.9% indicated that they would recommend it to every pregnant individual. While most pediatricians (79.8%) had knowledge about nirsevimab; 14% indicated that it was not approved in children worldwide; 49.1% stated that it is more effective than palivizumab; and 37.9% indicated that they would start administrating it immediately after its approval and availability in Türkiye. Conclusions. The use of CXR and administration of non-evidence-based therapies in diagnosing and managing RSV illness were relatively high. Additionally, there is a notable gap in knowledge and awareness regarding the maternal RSV vaccine and nirsevimab.

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.

Introduction: Intravenous immunoglobulin (IVIG) is an alternative for post-exposure prophylaxis if a vaccine is contraindicated and intramuscular immunoglobulin is unavailable. We retrospectively examined the effect of IVIG administration time on measles development in measles-contact infants younger than 6 months of age. Methodology: Contact tracing of measles cases was performed by the Istanbul Public Health Directorate (IPHD) between August 24, 2012, and June 16, 2013. The mothers of 187 infants younger than 6 months were found to have negative IgG for measles. Under IPHD supervision, IVIG (0.4 g/kg) was administered to these infants within the first 6-10 days following exposure. These infants were monitored for rash and fever by IPHD for up to 28 days after IVIG prophylaxis. The study was conducted retrospectively, infants were divided into two groups, those who received IVIG at 6 days and later. These groups were compared according to the development of measles. Results: Only 2 out of 187 infants developed measles after IVIG prophylaxis. No significant difference in measles frequency was observed between infants who received IVIG within the first 6 days after exposure and those who received IVIG after 6 days. Nine infants received IVIG in the first 3 days, and none of them developed measles. The risk of developing measles was higher in infants who had experienced contact at home (p = 0.002). Conclusion: IVIG administration may provide stronger protection in the first 3 days and may be given until 10 days after exposure.

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.

Background The frequency of influenza virus infections and group A beta-hemolytic streptococcus (GAS) pharyngitis varies according to populations. We aimed to investigate the frequency of influenza virus and streptococcal pharyngitis infections in a pediatric outpatient cohort with many pediatric admissions in Istanbul. Materials and methods Children with upper respiratory tract infection (URTI) symptoms between 2011 and 2018 who underwent rapid diagnostic tests for influenza virus or streptococcal infection were evaluated retrospectively. Results The total number of pediatric cases admitted between 2011 and 2018 was 185,228, of which 119,928 were under five years old and 66,300 were children over five years old. The mean frequency of the influenza virus was 1,283 per 100,000 children, and the mean frequency of streptococcal pharyngitis was 1,764 per 100,000 children. The frequency of influenza has increased over the years. The frequency of streptococcal infection is higher in children over five years of age, and its frequency has decreased in this group. Conclusions The frequency of influenza virus infection and GAS pharyngitis varies according to years and seasons. Winter and spring were the seasons with the most frequent positive influenza virus and GAS pharyngitis. Although influenza frequency increased annually, this phenomenon was not observed in the frequency of GAS pharyngitis.

•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.

Cat scratch disease (CSD) typically presents as a self‐limiting lymphadenopathy associated with a cat bite or scratch and commonly affects children and young adults. Atypical manifestations, involving the eyes, nervous system, heart, liver, spleen, skin, and musculoskeletal system, could be severe and difficult to diagnose, and they could occur in 5%–20% of the cases. Herein, we report an unusual case of CSD with multifocal osteomyelitis. A 15‐year‐old girl presented with right axillary lymphadenopathy. Since she had a history of cat scratch, azithromycin was started for CSD. Two days later, she was readmitted to our hospital with severe back pain which required differential diagnosis. Lumbar spinal magnetic resonance imaging (MRI) revealed multifocal vertebral osteomyelitis. The patient was hospitalized, and then teicoplanin and cefotaxime were added to the azithromycin therapy. After excluding the possible other causes, the definitive diagnosis of osteomyelitis secondary to CSD was made upon the combination of the MRI scan findings of the vertebrae, histopathological investigation of excisional right axillary biopsy, positron‐emission tomography/computed tomography (PET/CT), and Bartonella henselae serologies. Atypical manifestations of CSD are widely variable; therefore, it should be kept in mind in the differential diagnosis of severe musculoskeletal pain and osteomyelitis.

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.