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. Laboratorybased 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.

There is a substantial variability among clinicians' perceptions regarding indications for delay to initiate enteral feeding in critically ill children, especially after the first 6 h of PICU admission. ERTEN, but not EIF, is associated with a significantly lower mortality rate in critically ill children.

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.

Giriş: Optik sinir kılıfı çapı (OSKÇ) kafa içi basınç artışı (KİBA) tanısının koyulması için ölçülür. Bilgisayarlı Tomografi (BT) ve Manyetik Rezonans görüntüleme (MRI) KİBA tespiti için sık kullanılır. Son zamanlarda ultrasonografik (US) yaklaşımla yapılan OSKÇ ölçümleri yatak başında kolayca yapılabilmesi ve sık tekrarlanabilir olması nedeniyle seçenek bir yöntem olarak öne çıkmaktadır. Çalışmamızda US ile yatak başında yapılan OSKÇ ölçümlerinin BT ve MRI ile yapılan ölçümlerle uyumu araştırıldı. Yöntemler: Araştırmamız tek merkezli, ileriye yönelik bir çalışmadır. Herhangi bir sebeple beyin BT/MRI'sı çekilmiş olup US uygulanabilen tüm 1 ay-18 yaş entübe hastalar, aile onamı alınarak çalışmaya dahil edildi. Tek bir nöroradyolog tarafından ölçülen BT/MRI OSKÇ değerleri ile tek bir araştırmacı tarafından saptanan US değerleri karşılaştırıldı. Bulgular: Çalışmamızda toplam 94 ölçüm yapıldı. US ile sağ gözde ortalama OSKÇ 4,56±0,66 cm, sol gözde ise 4,52±0,63 cm idi. BT/ MRI ölçümleri ise sağda 4,65±0,72 cm, solda 4,46±0,67 cm idi. Sağ ve sol taraflı US ve BT/MRI ortalama ölçümleri arasında anlamlı fark yoktu (p=0,4). Sağ OSKÇ için BT ve US ölçümleri arasındaki korelasyon kat sayısı r=0,448 (p=0,002), sol OSKÇ için ise r=0,448 (p=0,001) olup, BT ve US ölçümlerinde korelasyon her iki göz OSKÇ için lineer artış göstermekte ve aralarında orta derecede korelasyon bulunmaktaydı. Santral görüntüleme ile US arasında geçen sürenin 5 saatin altında olduğu 8 olguda BT/MRI ve US ile yapılan OSKÇ ölçümleri arasındaki korelasyonun arttığı (sağ r=0,774, p=0,024: sol r=0,811, p=0,014) görüldü. Introduction: Optic nerve sheath diameter (ONSD) measurements aid in diagnosis of increased intracranial pressure (ICP). Computed tomography (CT) and magnetic resonance imaging (MRI) are commonly used modalities for detecting ICP. Lately, ONSD measurements via ultrasound (US) are getting popular as an alternative method due to the ease of performance at the bedside and repeatability. Our study objective was to investigate whether US measurements correlated with CT/MRI counterparts. Methods: This was a single-center, prospective study. All intubated patients aged 1 month-18 years with a cranial CT/MRI for any indications, who could be scanned ultrasonographically, were included after parental consent. Optic nerve US was performed by a single investigator. CT/MRI ONSDs were measured by a neuro-radiologist. Data obtained from US and CT/MRI scans were compared. Results: A total of 94 different measurements were obtained. The mean ONSD in US and CT was 4.56±0.66 cm and 4.65±0.72cm on the right side, whereas the mean left ONSD was 4.52±0.63 cm and 4.46±0.67 cm, respectively (p=0.4). Correlation coefficient for right ONSD was r=0.448 (p=0.002) while it was r=0.448 (p=0.001) for left ONSD. Both CT and US measurements showed a linear increase, and the correlation between them was moderate. A subgroup of 8 patients who had less than 5 hours between their central imaging and US scan showed strong correlation between measurements for both right and lef...

Anthrax is primarily a disease of herbivores, but it also causes cutaneous, respiratory and gastrointestinal infections in humans. Bacillus anthracis is an uncommon cause of meningitis and generally produces a haemorrhagic meningoencephalitis. We present the CT and MR findings of anthrax meningoencephalitis due to the cutaneous form of anthrax in a 12-year-old boy. They showed focal intracerebral haemorrhage with leptomeningeal enhancement.