The etiology of bacterial meningitis in Turkey changed after the implementation of conjugated vaccines against Streptococcus pneumoniae and Haemophilus influenzae type b (Hib) in the Turkish National Immunization Program (NIP). Administration of Hib vaccine and PCV-7 (7-valent pneumococcal conjugate vaccine) was implemented in NIP in 2006 and 2009, respectively. In 2011, PCV-7 was replaced with PCV-13. Meningococcal vaccines have not yet been included in Turkish NIP. This prospective study comprised 27 hospitals located in seven regions of Turkey and represented 45% of the population. Children aged between 1 month and 18 years who were hospitalized with suspected meningitis were included. Cerebrospinal fluid (CSF) samples were collected, and bacterial identification was made according to the multiplex PCR assay results. During the study period, 994 children were hospitalized for suspected meningitis, and Hib (n = 3, 2.4%), S. pneumoniae (n = 33, 26.4%), and Neisseria meningitidis (n = 89, 71%) were detected in 125 samples. The most common meningococcal serogroup was MenB. Serogroup W comprised 13.9% (n = 5) and 7.5% (n = 4) of the meningococci in 2015 to 2016 and 2017 to 2018, respectively. Serogroup C was not detected. There were four deaths in the study; one was a pneumococcus case, and the others were serogroup B meningococcus cases. The epidemiology of meningococcal diseases has varied over time in Turkey. Differing from the previous surveillance periods, MenB was the most common serogroup in the 2015-to-2018 period. Meningococcal epidemiology is so dynamic that, for vaccination policies, close monitoring is crucial. IMPORTANCE Acute bacterial meningitis (ABM) is one of the most common life-threatening infections in children. The incidence and prevalence of ABM vary both geographically and temporally; therefore, surveillance systems are necessary to determine the accurate burden of ABM. The Turkish Meningitis Surveillance Group has been performing a hospital-based meningitis surveillance study since 2005 across several regions in Turkey. Meningococcus was the major ABM-causing agent during the 2015-to-2018 period, during which MenB was the dominant serogroup.

Santral venöz kateterler, çocuk yoğun bakım ünitelerinde damar içi ilaç uygulamaları ve hemodinamik takip için sıklıkla kullanılmaktadır. Sağladıkları faydaların yanı sıra, başta kateter ilişkili kan dolaşımı enfeksiyonu (KİKDE) gibi pek çok komplikasyona yol açabilirler. KİKDE'nin önlenmesinde en önemli basamaklardan biri hemşirelik bakımıdır. Biz burada üçüncü basamak çocuk yoğun bakım ünitemizde standart bakım örtüsü ve klorheksidin glukonat içeren bakım örtüsü ile kateter pansumanı uyguladığımız hastalarımızın kateter ilişkili kan akımı enfeksiyonu oranlarını karşılaştırdık. Yöntemler: Çocuk yoğun bakım ünitemizde 18 aylık süreçte, santral venöz kateter ve hemodiyaliz kateteri yerleştirilen toplam 144 hasta çalışmaya alındı. Bir gruba standart bakım örtüsü ile, ikinci gruba klorheksidin glukonat içeren şeffaf bakım örtüsü ile pansuman yapıldı. KİKDE ve kolonizasyon tanısı Hastalık Kontrol ve Önleme Tanı Merkezi'nin tanı ölçütleri kullanılarak konuldu. Bulgular: Çalışma sürecinde çocuk yoğun bakım ünitemizde santral kateter kullanımının 3749 kateter günü olduğu saptandı. KİKDE hızımız 4,53/1000 santral venöz kateter günü idi. Tüm grupta KİKDE %10,4, kolonizasyon oranı %11,8 idi. Standart bakım örtüsü ile bakım yapılan grupta KİKDE 13 hastada (%12,3), klorheksidin glukonat emdirilmiş bakım örtüsü ile bakım yapılan grupta KİKDE 2 hastada (%5,1) saptandı ve gruplar arasında istatistiksel anlamlı farklılık yoktu (p=0,356). İki grup arasında kateter kolonizasyonları açısından anlamlı fark saptanmadı (p=0,616). Grupların kateter kullanım süresi ve yoğun bakım kalış süresi arasında istatistiksel anlamlı farklılık saptanmadı. Sonuç: Klorheksidin glukonat emdirilmiş bakım örtüsü ile pansuman yapılan grupta KİKDE ve kolonizasyon oranları, istatistiksel olarak Introduction: Central venous catheters are frequently used for intravenous applications and hemodynamic monitoring in pediatric intensive care units. In addition to the benefits of the catheters, they can lead to many complications such as catheter-related bloodstream infection (CRBI). One of the most important steps in the prevention of CRBI is nursing care. Here, we compared CRBI rates between standard dressing and chlorhexidine gluconate-impregnated dressing in our pediatric intensive care unit. Methods: A total of 144 patients, who underwent central venous catheter and hemodialysis catheter placement, were included in the study. The patients were divided into two groups as standard dressing and chlorhexidine gluconate-impregnated dressing. The diagnosis of CRBI and colonization was made using the diagnostic criteria of the Center for Disease Control and Prevention. Results: The total number of central catheter days was 3749 in our pediatric intensive care unit during the study period. The CRBI rate was 4.53/1000 central venous catheter days. In the whole group, the CRBI rate was 10.4% and colonization rate was 11.8%. CRBI was detected in 13 patients (12.3%) with standard dressing and 2 patients (5.1%) in the chlorhexidine gluconate-impregnated dressing group. T...

BackgroundThe etiology of bacterial meningitis in Turkey has been changed after the implementation of conjugated vaccines against Streptococcus pneumonia and Haemophilus influenzae type b (Hib) in Turkish national immunization schedule. Methods. This prospective study was conducted in 25 hospitals located seven regions of Turkey (representing 30% of Turkey population) and children aged between 1 month and 18 years with suspected meningitis and hospitalized were included. Cerebrospinal fluid samples were collected and bacterial identification was made according to the multiplex PCR assay results. Results. During the study period, 927 children were hospitalized for suspected meningitis and Hib (n:1), S. pneumonia (n:17) and Neisseria meningitidis (n:59) were detected in 77 samples (Figure 1, Table 1). During 2015–2016, N. meningitidis serogroup W, B, A, Y, X frequencies were as 5 (13.9%), 16 (44.4%), 1 (2.8%), 1 (2.8%), 1 (2.8%), respectively. There were 12 nongroupable N. meningitidis samples and serogroup C was not detected. In 2017, of meningococcal meningitis serogroup B, W, A, Y and X were identified in two (8.7%), 15 (65.2%), two (8.7%), 1 (4.3%) and 1 (4.3%) cases, respectively (Figure 2). There were four deaths in this study period, all of them were caused by N. meningitidis serogroup B and three of them were under 1 year old. Conclusion. The epidemiology of meningococcal diseases has been varied in time with or without any apparent reasons. Hajj is a well-known cause for serogroup W epidemics and serogorup W was the most common cause of meningitis in Turkey during 2009–2014 as in other Middle East countries. After the impact of serogroup W epidemics related to Hajj seen in 2010’s was diminished, serogroup B has been leading cause of childhood meningitis since 2015. In countries affected from Hajj like Turkey, vaccination of children with serogroup B meningococcal vaccine as well as quadrivalentconjugated vaccine seems to be very important. It should be kept in mind that meningococcal epidemiology is dynamic and needed to be closely monitored to detect changes in yearsFigure 1.Distribution of causative agents of bacterial meningitis in Turkey during 2005–2017.Figure 2.Distribution of meningococcal serogroups of meningococcal meningitis in Turkey during 2015–2017 and comparison with results belonging to previous years.Disclosures All authors: No reported disclosures.

Background Candida urinary tract infections (UTIs) are common nosocomial infections among critically ill patients hospitalized in pediatric intensive care Units (PICU). We aimed to report outcomes of critically ill pediatric patients who received micafungin for hospital acquired Candida UTIs. We analyzed treatment success rates and success rates among different Candida species. Methods This retrospective cohort study included patients who received micafungin for Candida UTI as first choice in our PICU between January 2017 and July 2018. Data, including demographic and clinical features, were retrospectively collected from medical files of the patients. Treatment efficacy was defined as resolution of clinical symptoms and a negative culture for Candida at day 14 after initiation of micafungin treatment. Results Twenty‐four pediatric patients (median age 5.72 years, range, 2 months–16 years) were included in the present study. Fourteen (58.3%) patients had urinary catheters at the time of Candida isolation. Resolution of symptoms and a negative culture at day 3 of micafungin treatment were achieved in 17 (70.8%) and 14 (58.3%) patients, respectively. Moreover, 19 (79.2%) patients had a normal urine analysis and negative culture 14 days after initiation of micafungin treatment. Treatment responses did not statistically differ between Candida species. Conclusions Micafungin is safe and efficacious in critically ill pediatric patients with Candida UTIs. Its efficacy in our pediatric population was as comparable to that observed in adult studies, therefore, it should be considered as an effective therapeutic option in Candida UTIs of critically ill pediatric patients.

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