Empirical antimicrobial therapy is usually started in febrile neutropenic patients without having culture results. The aim of this study was to help determine the policies of empirical antibiotic usage in febrile neutropenic children by detecting the antimicrobial susceptibility profile in this group of patients. In this study 811 blood cultures taken from neutropenic children hospitalized at the Department of Oncology of Gaziantep Children Hospital November 2007 and February 2010 were retrospectively evaluated. Blood cultures were routinely collected in aerobic and anaerobic media and incubated using the BACTEC system. Identification and antimicrobial susceptibility testing of the isolates to antimicrobial agents was performed using the Vitek2 Ò system according to the recommendations of the Clinical and Laboratory Standards Institute. Of 811 isolates analyzed, 128 (56.4%) were gram positive cocci, 43 (18.9%) were gram negative bacilli and fungi accounted for 56 (24.7%). The main isolated Gram-positive bacteria from blood were coagulase-negative staphylococcus (56.7%), followed by methicillin-resistant Staphylococcus aureus (14.1%). S. aureus and Streptococcus spp. were all susceptible to linezolid, vancomycin and teicoplanin. S aureus was still susceptible to few other antimicrobial agents such as tetracycline (82.4%), chloramphenicol (55.6%). Seven E. faecium, 7 E. fecalis and 1 E. hirae was isolated from blood cultures. Vancomycin resistance was detected in 6 out of 15 (40%) Enterococcus spp. isolates. Among gram-negative bacteria E. coli (30.2%) was followed by Klebsiella pneumoniae (20.9%) and Proteus spp. (18.6%). Imipenem (89.2%), meropenem (86.6%), chloramphenicol (88.9%), amicasin (82.4%) and fosfomycin (81.3%) showed highest susceptibility in vitro activity against all Gram-negative isolates. To know the antimicrobial susceptibility profile of the pathogens frequently isolated from febrile neutropenic children and to consider this profile before starting an empirical antibiotic therapy would help the clinics which have any role in the treatment of these patients to determine the empirical antibiotic usage policies.

Objectives:To determine effective risk factors on mortality in febrile neutropenic cases with hematologic malignancy. Patients with hematologic diseases are more prone to infections and those are frequent causes of mortality.Methods:This retrospective study was performed using data of 164 febrile neutropenic cases with hematologic malignancies who were followed up in a hematology clinic of a tertiary health care center between 2011-2015. The relationship between descriptive and clinical parameters rates and rates of mortality on the 7th and the 21st days were investigated.Results:Patients with absolute neutrophil count<100/mm3, duration of neutropenia longer than 7 days, pneumonia or gastrointestinal foci of infection, central catheterization (p=0.025), isolation of Gram (-) bacteria in culture, carbapenem resistance, septic shock, and bacterial growth during intravenous administration of antibiotic treatment were under more risk for mortality on both the 7th and the 21st days. The final multivariate logistic regression results showed that pneumonia (p<0.0001), septic shock (p=0.004) and isolation of Gram-negative bacteria (p=0.032) were statistically significant risk factors.Conclusion:Early diagnosis and appropriate treatment of serious infections, which are important causes of morbidity and mortality, are crucial in patients with febrile neutropenia. Thus, each center should closely follow up causes of infection and establish their empirical antibiotherapy protocols to accomplish better results in the management of febrile neutropenia.

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The frequency of invasive fungal infections has increased substantially during the past two decades and it has become a major cause of morbidity and mortality in immunocompromised patients. Aspergillosis, candidiasis, cryptococcosis, and zygomycosis are the main invasive fungal infections observed in these patients (1). Among the fungal pathogens, Candida species are the most common cause of invasive fungal infections (2,3). Candida species rank as the fourth most common cause of nosocomial bloodstream infections and the mortality of these infections varies between 33% and 75%. Despite the widespread use of antifungals for prophylaxis and treatment of invasive fungal infections in immunocompromised patients, candidemia remains the most frequent life-threatening fungal disease and is associated with a prolonged hospital stay that results in a rise in costs (4-6). Although Candida albicans is still the most common cause of Candida infections, fluconazole prophylaxis decreased the incidence of C. albicans infections, but this caused an increase in the incidence of non-albicans Candida species like fluconazole-resistant C. glabrata and C. krusei (1,5,7). Increasing incidence of candidemia caused by C. parapsilosis, C. glabrata, C. tropicalis, C. krusei, C. guilliermondii, and C. lusitaniae was also reported. Approximately half of the reported cases of candidemia are now caused by non-albicans Candida species. This has been attributed to the use of fluconazole prophylaxis (8-12). Rapid identification of Candida species isolated from clinical specimens gives information about antifungal susceptibility as well as shedding light on the choice of empirical treatment. For these reasons, rapid, reliable, and accurate identification of isolates is very important. Identification methods such as germ tube test, morphology on Corn Meal Agar with Tween 80, and assimilationfermentation reactions used for the identification of Candida species in routine laboratory settings are timeconsuming and may lead to ambiguous results, but on the other hand genotype-based methods have become of interest in recent years (12,13). Background/aim: The identification of Candida species isolated from clinical specimens provides information about antifungal susceptibility and sheds light on the choice of empirical treatment. In the present study, restriction enzyme analysis of C. albicans and non-albicans Candida species previously identified by conventional methods was done to evaluate the utility of restriction enzyme analysis for more rapid and reliable identification of Candida species. Materials and methods: A total of 146 Candida strains isolated from various clinical specimens and ATCC strains were included. PCR products were digested with MwoI for all species and with BslI for C. parapsilosis and C. tropicalis strains. Results: The strains were identified by conventional methods as 40 C. albicans, 27 C. parapsilosis, 26 C. tropicalis, 25 C. glabrata, 11 C. kefyr, 10 C. krusei, and 7 C. guilliermondii strains. Restriction digestion with MwoI...