Publications by authors named "Ates Kara"

142 Publications

Usage of Plasma Presepsin, C-Reactive Protein, Procalcitonin and Proadrenomedullin to Predict Bacteremia in Febril Neutropenia of Pediatric Hematological Malignancy Patients.

Lab Med 2021 Apr 14. Epub 2021 Apr 14.

Hacettepe University Faculty of Medicine, Pediatric Hematology Unit, Ankara, Turkey.

Objective: To investigate the value of presepsin and proadrenomedullin (proADM) as new markers for febrile neutropenia, by comparing them with conventional markers.

Methods: Plasma specimens for presepsin, proADM, C-reactive protein (CRP), and procalcitonin (PCT) were collected every 3 days during each episode of febrile neutropenia.

Results: A total of 39 patients experiencing a collective 47 episodes of febrile neutropenia with hematological malignant neoplasms, as well as 40 healthy control patients without infectious disease, were enrolled in this study. Levels of the studied analytes in the presepsin 1 group (with baseline values taken at admission), presepsin 2 group (values recorded on the 3rd day of febrile neutropenia), and presepsin 3 group (values recorded on the 6th day of hospitalization) were all higher in the subgroups with bacteremia. C-reactive protein 1 (baseline value taken at admission), procalcitonin 1 (as recorded at admission), and procalcitonin 2 (recorded on the 3rd day of febrile neutropenia) were higher in the subroups with bacteremia (P =.03, P = .04, and P = .04, respectively). In multivariate logistic regression analysis, presepsin 1 and/or PCT 1/CRP 1 combined analysis was superior in predicting bacteremia.

Conclusion: Presepsin could be used in combination with other biomarkers to detect bacteremia.
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http://dx.doi.org/10.1093/labmed/lmab002DOI Listing
April 2021

Is Posaconazole Really Effective in Adolescent patients as a Prophylactic Agent: Experience of a Tertiary Care Center.

J Pediatr Hematol Oncol 2021 Feb 3. Epub 2021 Feb 3.

Department of Pediatric Infectious Diseases, Izmir Behcet Uz Children's Hospital, Health Sciences University, Izmir Pediatric Hematology Unit Department of Infectious Diseases, Hacettepe University Faculty of Medicine, Ankara Pediatric Infectious Disease Clinic, Gaziantep Cengiz Gökcek Research Hospital, Health Sciences University, Gaziantep, Turkey.

Background: Invasive fungal infections (IFIs) are a leading cause of morbidity and death in immunocompromised patients. Data on efficacy and pharmacokinetics of posaconazole in pediatric patients are rare (1 to 5). Herein, we retrospectively analyzed adolescent patients who had received posaconazole as antifungal prophylaxis.

Methods: We retrospectively analyzed patients who received posaconazole as primary or secondary antifungal prophylaxis.

Results: A total of 34 adolescent patients, 19 men (55.9%) and 15 women (44.1%) with a mean age of 15.8±2.1 years were included. Twenty-five of 34 (73.5%) patients were on primary and nine of 34 (26.5%) patients were on secondary antifungal prophylaxis. Diagnosis of the patients receiving posaconazole as primary antifungal prophylaxis were acute myeloid leukemia (n=12, 48%), hematopoietic stem cell transplantation (n=7, 28%), acute lymphoblastic leukemia (n=5, 20%), and Fanconi aplastic anemia (n=1, 4%). Five patients (55.6%) with hematopoietic stem cell transplantation, 1 patient with acute myeloid leukemia (11.1%), 1 patient with Fanconi aplastic anemia (11.1%), and 2 (22.2%) patients with chronic granulomatous disease received posaconazole as secondary antifungal prophylaxis. Twelve of 25 (48%) patients receiving posaconazole as primary antifungal prophylaxis were complicated by IFI; 4 of them were proven, 6 probable, and 2 with possible IFI. Three of 9 patients (33.3%) receiving posaconazole as secondary antifungal prophylaxis was complicated by IFI (P=0.29), 2 of them were probable and 1 was possible IFI. Five of 25 patients (20%) receiving posaconazole as primary prophylaxis died because of IFI.

Conclusion: Improvement of antifungal prophylaxis in patients with high risk of invasive infections seems clearly necessary, and analyzing serum posaconazole levels and individualizing dosing may be 1 approach to improve outcomes.
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http://dx.doi.org/10.1097/MPH.0000000000002080DOI Listing
February 2021

Outcome predictors of influenza for hospitalization and mortality in children.

J Med Virol 2021 Jan 29. Epub 2021 Jan 29.

Department of Pediatric Infectious Diseases, Hacettepe University Faculty of Medicine, Ankara, Turkey.

Severity of disease caused by influenza virus and the influencing factors that may be different. Moreover, the disease course actually may not be determined specifically in children because of lower seroprotection rates of children. Herein, the results clinic and outcome data of children with influenza from Turkey were reported. We present here the results from 2013 to 2017. Nasopharyngeal swab samples of the children with influenza were investigated via multiplex polymerase chain reaction. A total of 348 children were diagnosed with influenza; 143 (41.1%) were influenza A, 85 (24.4%) were influenza B, and 120 (34.5%) were mixt infection with other respiratory viruses. Fifty-four percent of children admitted to intensive care unit (ICU) were under 2 years of age (p = .001). Having an underlying disease was detected as the main predictor for both hospitalization and ICU stay according to multiple logistic regression analysis (odds ratio [OR], 11.784: 95% confidence interval [CI], 5.212-26.643; p = .001 and OR, 4.972: 95% CI, 2.331-10.605; p = .001, respectively). Neurological symptoms most frequently seen in cases who died (44.4%; p = .02). Lymphopenia was relatively higher (55.6%) and thrombocytopenia was most frequently seen in cases who died (77.8%) with a significant ratio (p = .001). Underlying diseases was found a risk factor for influenza being hospitalized and being admitted to ICU. Children under 2 years of age and with underlying diseases should be vaccinated particularly in countries where the influenza vaccination is still not routinely implemented in the immunization schedule. Highlights Underlying diseases is a risk factor for influenza to be hospitalized and admitted to ICU. Influenza vaccination is of great importance to prevent life-threatening complications of influenza, particularly in children require ICU admission. The possibility to reduce the outpatient visit number by vaccination has a great impact on disease burden in addition to the underestimated crucial social benefits, as well.
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http://dx.doi.org/10.1002/jmv.26833DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8014286PMC
January 2021

Nonmyeloablative hematopoietic stem cell transplantation in a patient with hereditary pulmonary alveolar proteinosis.

Pediatr Pulmonol 2021 Feb 24;56(2):341-343. Epub 2020 Nov 24.

Department of Pediatric Hematology, Faculty of Medicine, Hacettepe University, Ankara, Turkey.

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http://dx.doi.org/10.1002/ppul.25174DOI Listing
February 2021

Acquired lung cysts in a premature neonate with congenital cytomegalovirus infection.

Turk Pediatri Ars 2020 23;55(3):309-311. Epub 2020 Sep 23.

Division of Pediatric Infectious Diseases, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey.

We report a preterm newborn diagnosed as having congenital cytomegalovirus infection who developed lung cysts during her clinical follow-up. The lung cysts were shown in chest X-ray, and confirmed by thoracic computed tomography. A few weeks after starting ganciclovir therapy, we observed that the cystic lung changes of the patient were completely improved. No adverse effects of antiviral therapy were observed. Based on this presented patient, it should be kept in mind that congenital cytomegalovirus infection may cause lung cysts.
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http://dx.doi.org/10.14744/TurkPediatriArs.2018.99907DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7536462PMC
September 2020

Stenotrophomonas maltophilia bacteremia in children - A 10-year analysis.

Arch Argent Pediatr 2020 06;118(3):e317-e323

Pediatric Infectious Diseases Unit, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey.

Stenotrophomonas maltophilia is a multidrug-resistant, Gramnegative, and biofilm-forming pathogen. Information is limited concerning S. maltophilia bacteremia in children. Clinical data and microbiological test results collected in a tertiary children's hospital over a ten-year period were reviewed. Children 0-18 years old who had positive clinical specimen, blood and/or catheter cultures were included. We identified 20 S. maltophilia isolates from 12 pediatric patients with confirmed infections. The median age was 28 months (range: 3.1-187.3). The rate of previous use of antimicrobial therapy was 83 %. The median antibiotic number was 3 (range: 0-7) within 30 days prior to onset of S. maltophilia bacteremia. Catheter related infection was the main infectious source (66.6 %). The mortality rate was 33.3 %. The death of two non-survivors was associated with pneumonia. S. maltophilia should be considered a breakthrough agent for bacteremia in children with underlying disease exposed to broad-spectrum antibiotics during long-term hospitalization.
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http://dx.doi.org/10.5546/aap.2020.eng.e317DOI Listing
June 2020

Global surveillance, travel, and trade during a pandemic

Turk J Med Sci 2020 04 21;50(SI-1):527-533. Epub 2020 Apr 21.

Department of Pediatrics, Pediatric Infectious Diseases, Faculty of Medicine, Hacettepe University, Ankara, Turkey

Pandemics have had very important consequences in human history. Lots of people lost their lives and countries have been intensively affected in terms of socioeconomic problems. Unfortunately, avoidance of pandemics and limiting the spread are still currently not always possible. Maybe the most important factor for this is the increasing frequency of traveling. Increasing airline traveling rate also increases the rate of spread. Global organizations like the World Health Organization and United Nations are trying to play a supreme role over the countries. Pandemics do not have borders; therefore, efforts should be given globally, definition of pandemic should be established as soon as possible, and protective measures should be shared with countries. If these are not done, severe health consequences and serious economic problems are inevitable.
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http://dx.doi.org/10.3906/sag-2004-175DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7195981PMC
April 2020

A new use of GG administration in the NICU: colonized vancomycin-resistant enterococcus eradication in the gastrointestinal system.

J Matern Fetal Neonatal Med 2020 Mar 24:1-7. Epub 2020 Mar 24.

Division of Neonatology, Department of Pediatrics, Faculty of Medicine, Hacettepe University, Ankara, Turkey.

Enterococci are microbiota microorganisms that normally have low virulence; however, under some conditions they may cause community-acquired urinary tract and even hospital-acquired serious infections. Vancomycin-resistant enterococci (VRE) can cause aggressive infections in immunosuppressive patients; especially in newborns in intensive care units. Asymptomatic gastrointestinal system carriers are important sources of VRE. Asymptomatic patients colonized by VRE can infect both other patients and the environment. Prevention of gastrointestinal colonization of VRE is an important issue to prevent VRE infection, and for rational use of hospital source. This study was carried out at Hacettepe University, Faculty of Medicine in Newborn Intensive Care Unit between November 2015 and March 2017. The newborn infants who were find as colonized by VRE during weekly surveillance VRE rectal stool culture screening were taken into the study. A single dose of one million colonies of GG (LGG®) was given to the study group daily. The probiotic supplement continued until consecutive three negative cultures were detected or maximum 6 months. Control group received conventional treatment. In the study group, VRE eradication was successful in 21 patients out of 22 within 6 months and 1 patient was still VRE positive at 6 months. In the control group, VRE was eradicated in 12 patients out of 23 and 11 patients continued to be colonized by VRE at 6 months. There was a statistically significant difference between the groups ( <.05). GG use is associated with early clearance of vancomycin-resistant enterococcus in newborn patients.
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http://dx.doi.org/10.1080/14767058.2020.1743671DOI Listing
March 2020

Impact of the mandatory Hepatitis A immunization program: before and after the vaccine in Ankara, Central of Turkey.

Turk J Pediatr 2019 ;61(5):677-685

Division of Pediatric Infectious Diseases, Department of Pediatrics, Ankara University Faculty of Medicine.

Kanık Yüksek S, Tezer H, Özkaya Parlakay A, Gülhan B, Kara A, Çiftçi E, Tapısız A, Çelik M, Özdemir H, Aykaç K, Demirdağ TB, Tural Kara T, Hayran G, İnce E. Impact of the mandatory Hepatitis A immunization program: before and after the vaccine in Ankara, Central of Turkey. Turk J Pediatr 2019; 61: 677-685. In Turkey Hepatitis A virus (HAV) infection is considered to be moderateendemic. Hepatitis A vaccine was included in the mandatory vaccination schedule of Turkey on November 2012. We aimed to evaluate the cases of HAV infection followed in Ankara, which is located in the center of Central Anatolia, retrospectively according to the date of the administration of the mandatory hepatitis A vaccine. A total of 272 children followed-up between January 2008 and December 2015 for HAV infection in five separate hospitals were enrolled to the study. There were 200 (68.2%) cases in the pre-vaccination group, 72 (31.74%) cases in the post-vaccination group, and 55.1% were male in total. The immunization status were as follow; 89.7% (n = 244) unvaccinated, 0.4% (n = 1) vaccinated and 9.9% (n = 27) with unknown immune status. There was a statistically significant difference between the groups in hospitalization rates, but no statistically significant differences in hospitalization indications, length of hospital stay, complication types and proportions, and normalization period of transaminases. The national hepatitis A immunization program in Turkey has had a significant impact when the targeted population is considered, with suggestive herd protection effects.
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http://dx.doi.org/10.24953/turkjped.2019.05.006DOI Listing
July 2020

Etiology of vaginal discharge in sexually inactive adolescents.

Turk J Pediatr 2019 ;61(2):305-306

Divisions of Adolescent Medicine, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey.

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http://dx.doi.org/10.24953/turkjped.2019.02.027DOI Listing
January 2019

The impact of meningococcal conjugate vaccine (MenACWY-TT) on meningococcal carriage in Hajj Pilgrims returning to Turkey.

Hum Vaccin Immunother 2020 06 12;16(6):1268-1271. Epub 2019 Dec 12.

İhsan Doğramacı Children's Hospital, Pediatric Infectious Department, Hacettepe University Faculty of Medicine , Ankara, Turkey.

Meningococcal conjugate vaccine was administered for the first time to pilgrims in 2018 in Turkey prior to their departure to the Hajj. This study aimed to determine the effect of vaccination on the prevalence of carriage among the pilgrims returning to Turkey. This prospective paired (departing and arriving) cohort study included pilgrims aged 10-80 years and compared carriage before and after pilgrimage. Oropharyngeal samples were collected from 229 pilgrims before departing for Mecca, Kingdom of Saudi Arabia (KSA) and after their return to Turkey. Meningococcal carriage was detected in 3.9% (n = 9) at the time of departure; all positive samples were serogroup B. Upon returning to Turkey,1 (0.4%) pilgrim, who was not a carrier before pilgrimage, was positive for serogroup B. This study is the first to examine meningococcal carriage following the administration of conjugate vaccine to Hajj pilgrims from Turkey.
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http://dx.doi.org/10.1080/21645515.2019.1680084DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7482844PMC
June 2020

Perinatal outcomes of twenty-five human immunodeficiency virus-infected pregnant women: Hacettepe University experience

J Turk Ger Gynecol Assoc 2020 09 30;21(3):180-186. Epub 2019 Sep 30.

Department of Obstetrics and Gynecology, Division of Perinatology, Hacettepe University Faculty of Medicine, Ankara, Turkey

Objective: To evaluate perinatal outcomes in human immunodeficiency virus (HIV) infected pregnant women in Turkey.

Material And Methods: Maternal characteristics, pregnancy complications, laboratory findings including HIV load, CD4 cell count, CD4/CD8 ratio, neonatal features and final HIV status of the baby were retrospectively analyzed.

Results: The sample included 26 singleton pregnancies, from 25 HIV-infected women. The ethnicities were Turkish (n=18), East European (n=4), Asian (n=2) and African (n=2). The majority (76.9%) was aware of their HIV status before becoming pregnant. Four cases (15.3%) were diagnosed during pregnancy and two (7.8%) at the onset of labor. The results for median HIV viral load, CD4 count, and CD4/CD8 ratio at birth were 20 copies/mL (0-34 587), 577/mm (115-977), and 0.7 (0.1-1.9), respectively. The HIV viral load rate was 5.5% in eighteen women taking anti-retroviral treatment. The rates of gestational diabetes mellitus, gestational hypertension, intrauterine growth restriction, and preterm delivery were 3.8%, 3.8%, 7.6%, and 8% (numbers are 1;1;2;2), respectively. The mean gestational week at birth was 38 weeks and mean birthweight is 2972±329 g. Two babies were congenitally infected with HIV (infection rate of 8.3%). There was one needle-related accident during surgery.

Conclusion: Timely diagnosis of HIV infection during pregnancy is important for preventing mother to child transmission. HIV infected women may give birth to HIV negative babies with the help of a multidisciplinary team, composed of perinatology, infectious diseases, and pediatrics specialists.
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http://dx.doi.org/10.4274/jtgga.galenos.2019.2019.0033DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7495123PMC
September 2020

Prevalence of Protective Measles Virus Antibody Levels in Umbilical Cord Blood Samples and Sera of Mothers and Transplacental Transport Ratio in Turkey.

Jpn J Infect Dis 2019 May 31;72(3):185-192. Epub 2019 Jan 31.

Children Hospital of Hacettepe University.

In Turkey, the Measles Elimination Program has been implemented since 2002. The aim of this study was to evaluate the measles-specific antibody levels of mothers admitted to a hospital for birth and their infants, to determine the factors influencing the antibody levels of both, and to evaluate the transplacental transport ratio. We selected healthy women who came to the hospital for birth and their healthy newborns. We collected blood samples from 1,547 mothers and 1,529 infants. The protective prevalence of measles antibody levels of mothers was 80% (95% confidence interval [CI]: 78-82%) and that of newborns was 85% (95% CI: 83-86%). The antibody levels of mothers and newborns were positively linearly correlated (R: 0.922, p < 0.001) and were associated with parity (p < 0.001). The ratio of neonatal to maternal antibody levels increased with gestational age. The protective levels were 1.6 times higher (95% CI: 1.1-2.4) in mothers ≥ 32 years of age and 2.1 times higher (95% CI: 1.4-3.3) in naturally immune mothers. Two factors affecting the antibody levels of newborns were the mothers' antibody levels and their immunization status. The antibody level of mother was the most significant factor that influenced the infant's antibody level. Vaccination of women before pregnancy could enhance passive antibody protection by increasing the level of transplacental transmission.
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http://dx.doi.org/10.7883/yoken.JJID.2018.387DOI Listing
May 2019

A case of Raoultella ornithinolytica urinary tract infection in a pediatric patient.

J Infect Chemother 2019 Jun 22;25(6):467-469. Epub 2019 Jan 22.

Department of Medical Microbiology, Hacettepe University Faculty of Medicine, Ankara, Turkey. Electronic address:

Raoultella ornithinolytica is a Gram-negative, non-motile, encapsulated, biofilm producing, facultative aerobic bacillus and is found in natural environment. Human infections with R.ornithinolytica is rare in children with only five cases having been reported previously. The present case report describes an urinary tract infection caused by R. ornithinolytica that was identified by MALDI-TOF MS and successfully treated with antibiotic therapy in a 6.5-year-old female child.
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http://dx.doi.org/10.1016/j.jiac.2018.12.011DOI Listing
June 2019

The Effect of National Pneumococcal Vaccination Program on Incidence of Postmeningitis Sensorineural Hearing Loss and Current Treatment Modalities.

J Int Adv Otol 2018 Dec;14(3):443-446

Department of Otolaryngology, Hacettepe University School of Medicine, Ankara, Turkey.

Objectives: The aim of the present study was to investigate the effect of the national pneumococcal vaccination program on postmeningitis sensorineural hearing loss (SNHL).

Materials And Methods: Overall, 2751 patients (2615 cochlear implantation and 136 auditory brainstem implantation) who underwent cochlear implantation (CI) and auditory brainstem implantation (ABI) at a tertiary referral hospital otolaryngology clinic were retrospectively analyzed. One hundred sixteen patients with a history of meningitis were included in the study. Patients were evaluated for their age at the time of surgery, gender, computerized tomography (CT) and magnetic resonance imaging (MRI) findings, implant type, side, and incidence before and after the vaccination program.

Results: When patients with cochlear implants or ABI were examined, the incidence of meningitis-induced hearing loss was 6.2% in the pre-vaccination period and 0.6% in the post-vaccination period. There is a significant difference between them when compared by chi-square test (p<0.001).

Conclusion: The most important finding of the present study is the dramatic decrease in the number of CI and ABI surgeries performed in patients with SNHL due to meningitis. This shows the effectivity of pneumococcal vaccination in this special group of patients. If total ossification is detected on CT of patients with postmeningitis, ABI should be preferred to CI.
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http://dx.doi.org/10.5152/iao.2018.6169DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6354544PMC
December 2018

Respiratory viral infections in infants with possible sepsis.

J Med Virol 2019 02 24;91(2):171-178. Epub 2018 Sep 24.

Pediatric Infection Department, Hacettepe University Medicine Faculty Hospital, Ankara, Turkey.

Background: Knowledge of infections leading to sepsis is needed to develop comprehensive infection prevention and sepsis, as well as early recognition and treatment strategies.The aim of this study was to investigate the etiology of sepsis and evaluate the proportion of respiratory viral pathogens in infants under two years of age with possible sepsis.

Methods: The prospective study was performed in two years. Multiplex reverse transcriptase polymerase chain reaction (RT-PCR) was performed to detect viral pathogens. All patients who were included in this study had sepsis symptoms as defined by the Surviving Sepsis Campaign.

Results: We compared 90 patients with sepsis into three groups as patients (n = 33) who had only viral positivity in nasopharyngeal swab, patients (17) had proven bacterial infection with or without viral infection, and patients (40) without the pathogen detection. Human rhinovirus (16.7%) and influenza (7.8%) were the most commonly seen viruses. A cough was more common in the viral infection group than other groups ( P = 0.02) and median thrombocyte count was lower in the bacterial infection group than the others ( P = 0.01). Patients having bacterial sepsis had the longest duration of hospitalization than the other groups ( P = 0.04). During winter and spring seaons, patients with sepsis had more viral infection; however, in summer and autumn period, patients were mostly in a state that we could not prove infection agents ( P = 0.02).

Conclusions: Our results suggest that respiratory tract viruses may play an important role in patients with sepsis and they should be kept in mind, especially during winter and spring seasons. In overall infection, viral respiratory viruses as a single pathogen with a detection rate of 36.6% in sepsis etiology.
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http://dx.doi.org/10.1002/jmv.25309DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7166951PMC
February 2019

Streptococcus mitis/oralis Causing Blood Stream Infections in Pediatric Patients.

Jpn J Infect Dis 2019 Jan 31;72(1):1-6. Epub 2018 Aug 31.

Department of Pediatric Infectious Diseases, Hacettepe University Faculty of Medicine.

Viridans streptococci are still under investigation concerning epidemiology, pathogenesis and clinical presentations. We aimed to investigate the clinical presentations and outcomes of pediatric patients infected with Streptococcus mitis/oralis. Based on the accumulation of bloodstream infections (BSI) caused by S. mitis/oralis in 4 patients in our Hematology and Bone Marrow Transplantation Department at a particular time, a review of the medical and microbiological records of pediatric patients with positive blood cultures for S. mitis/oralis in the entire hospital was performed. In addition, a retrospective case-control study was conducted. Pulsed-field gel electrophoresis of S. mitis/oralis in 4 patients displayed unrelatedness of the strains. A total of 53 BSI (42 BSI and 11 catheter-related BSI) were analyzed. Thirty-four percent of patients with BSI caused by S. mitis/oralis had febrile neutropenia. Clinical and microbiological outcomes were favorable and infection-related mortality was not observed. Although not significant, previous antibiotic use and trimethoprim-sulfamethoxazole prophylaxis were more common in the case group. S. mitis/oralis seems likely an important agent in bacteremic children who are particularly neutropenic because of the underlying hematologic and oncologic diseases. Prompt management of infections with appropriate antimicrobials, regarding antibiotic susceptibilities of organisms, may facilitate favorable outcomes.
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http://dx.doi.org/10.7883/yoken.JJID.2018.074DOI Listing
January 2019

Antifungal consumption, indications and selection of antifungal drugs in paediatric tertiary hospitals in Turkey: Results from the first national point prevalence survey.

J Glob Antimicrob Resist 2018 12 16;15:232-238. Epub 2018 Aug 16.

Çukurova University, Faculty of Medicine, Department of Pediatric Infectious Diseases, Adana, Turkey.

Objectives: The aim of this point prevalence survey was to evaluate the consumption, indications and strategies of antifungal therapy in the paediatric population in Turkey.

Methods: A point prevalence study was performed at 25 hospitals. In addition to general data on paediatric units of the institutes, the generic name and indication of antifungal drugs, the presence of fungal isolation and susceptibility patterns, and the presence of galactomannan test and high-resolution computed tomography (HRCT) results were reviewed.

Results: A total of 3338 hospitalised patients were evaluated. The number of antifungal drugs prescribed was 314 in 301 patients (9.0%). Antifungal drugs were mostly prescribed in paediatric haematology and oncology (PHO) units (35.2%), followed by neonatal ICUs (NICUs) (19.6%), paediatric services (18.3%), paediatric ICUs (PICUs) (14.6%) and haematopoietic stem cell transplantation (HSCT) units (7.3%). Antifungals were used for prophylaxis in 147 patients (48.8%) and for treatment in 154 patients (50.0%). The antifungal treatment strategy in 154 patients was empirical in 77 (50.0%), diagnostic-driven in 29 (18.8%) and targeted in 48 (31.2%). At the point of decision-making for diagnostic-driven antifungal therapy in 29 patients, HRCT had not been performed in 1 patient (3.4%) and galactomannan test results were not available in 12 patients (41.4%). Thirteen patients (8.4%) were receiving eight different antifungal combination therapies.

Conclusion: The majority of antifungal drugs for treatment and prophylaxis were prescribed in PHO and HSCT units (42.5%), followed by ICUs. Thus, antifungal stewardship programmes should mainly focus on these patients within the availability of diagnostic tests of each hospital.
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http://dx.doi.org/10.1016/j.jgar.2018.08.007DOI Listing
December 2018

Economic evaluation of micafungin versus liposomal amphotericin B (LAmB) for treating patients with candidaemia and invasive candidiasis (IC) in Turkey.

Eur J Clin Microbiol Infect Dis 2018 Sep 30;37(9):1777-1784. Epub 2018 Jun 30.

Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, 381 Royal Parade, Parkville, Victoria, 3052, Australia.

Micafungin was reported to be non-inferior to liposomal amphotericin B (LAmB) in treating patients with candidaemia and invasive candidiasis (IC). The current study aimed to evaluate the economic impact of using micafungin versus LAmB for treatment of candidaemia and IC in Turkey. A decision analytic model, which depicted economic consequences upon administration of micafungin or LAmB for treating patients with candidaemia and IC in the Turkish hospitals, was constructed. Patients were switched to an alternative antifungal agent if initial treatment failed due to mycological persistence. All patients were followed up until treatment success or death. Outcome probabilities were obtained from published literature and cost inputs were derived from the latest Turkish resources. Expert panels were used to estimate data that were not available in the literature. Cost per patient treated for each intervention was then calculated. Sensitivity analyses including Monte Carlo simulation were performed. For treatment of candidaemia and IC, micafungin (€4809) was associated with higher total cost than LAmB (€4467), with an additional cost of €341 per treated patient. Cost of initial antifungal treatment was the major cost driver for both comparators. The model outcome was robust over a wide variation in input variables except for drug acquisition cost and duration of initial antifungal treatment with micafungin or LAmB. LAmB is cost-saving relative to micafungin for the treatment of candidaemia and IC from the Turkish hospital perspective, with variation in drug acquisition cost of the critical factor affecting the model outcome.
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http://dx.doi.org/10.1007/s10096-018-3312-9DOI Listing
September 2018

Time Series Analysis of the Microbiota of Children Suffering From Acute Infectious Diarrhea and Their Recovery After Treatment.

Front Microbiol 2018 12;9:1230. Epub 2018 Jun 12.

Institute for Integrative Systems Biology, Catedrático José Beltrán, Valencia, Spain.

Gut microbiota is closely related to acute infectious diarrhea, one of the leading causes of mortality and morbidity in children worldwide. Understanding the dynamics of the recovery from this disease is of clinical interest. This work aims to correlate the dynamics of gut microbiota with the evolution of children who were suffering from acute infectious diarrhea caused by a rotavirus, and their recovery after the administration of a probiotic, CNCM I-745. The experiment involved 10 children with acute infectious diarrhea caused by a rotavirus, and six healthy children, all aged between 3 and 4 years. The children who suffered the rotavirus infection received CNCM I-745 twice daily for the first 5 days of the experiment. Fecal samples were collected from each participant at 0, 3, 5, 10, and 30 days after probiotic administration. Microbial composition was characterized by 16S rRNA gene sequencing. Alpha and beta diversity were calculated, along with dynamical analysis based on Taylor's law to assess the temporal stability of the microbiota. All children infected with the rotavirus stopped having diarrhea at day 3 after the intervention. We observed low alpha diversities in the first 5 days (-value < 0.05, Wilcoxon test), larger at 10 and 30 days after probiotic treatment. Canonical correspondence analysis (CCA) showed differences in the gut microbiota of healthy children and of those who suffered from acute diarrhea in the first days (-value < 0.05, ADONIS test), but not in the last days of the experiment. Temporal variability was larger in children infected with the rotavirus than in healthy ones. In particular, class was found to be abundant in children with acute diarrhea. We identified the microbiota transition from a diseased state to a healthy one with time, whose characterization may lead to relevant clinical data. This work highlights the importance of using time series for the study of dysbiosis related to diarrhea.
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http://dx.doi.org/10.3389/fmicb.2018.01230DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6005867PMC
June 2018

[Perianal abscess in children: A pediatric infectious disease perspective].

An Pediatr (Barc) 2019 Jun 5;90(6):370-375. Epub 2018 Jun 5.

Department of Pediatric Infectious Diseases, Faculty of Medicine, Hacettepe University, Ankara, Turquía.

Introduction: There are limited data on the aetiology and management of perianal abscesses (PAs). The aim of this retrospective study was to define the characteristics of children with PAs; describe our experience with PA from the perspective of paediatric infectious medicine and determine the factors that influence clinical outcomes.

Methods: We performed a retrospective review of cases of PA in children with no underlying disease managed in a tertiary referral hospital between January 2005 and July 2015. We collected data on demographic characteristics, symptoms, abscess size and location, abscess recurrences, laboratory and microbiological findings, treatment modalities, diagnosis of systemic illness at the end of the diagnostic workup and clinical outcomes.

Results: We included a total of 47 patients in the study, with a predominance of male patients (93.6 vs 6.4%, P<.001). The median age was 7.7 months (IQR 1.8-13.7 months), and 40 children (85.1%) were younger than 2 years of age. Four PAs drained spontaneously and 7 healed without need of drainage (23.4%). Drainage by simple incision was applied to 36 patients (76.5%) and six PAs required fistulotomy (12.7%). Recurrent abscesses were found in 25 patients (53.1%). Three patients with recurrent PA were diagnosed with inflammatory bowel disease at the end of the diagnostic evaluation.

Conclusions: Based on the findings of our study, measurement of white blood cell counts and serum levels of acute phase reactants may be useful in the initial evaluation of children with PA. In light of the high relapse rates observed in surgically managed patients, it seems reasonable to use a conservative approach in patients aged less than 2 years.
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http://dx.doi.org/10.1016/j.anpedi.2018.03.020DOI Listing
June 2019

Myocarditis associated with influenza infection in five children.

J Infect Public Health 2018 Sep - Oct;11(5):698-701. Epub 2018 May 28.

Department of Pediatric Infectious Diseases, Hacettepe University Faculty of Medicine, Ankara, Turkey.

Background: Myocarditis is an inflammatory condition located mainly in the myocardium. It is caused by a variety of bacterial and viral infections. Influenza is one of the most common relevant viruses that cause myocarditis.

Objectives: We attempted to share our experiences about clinical and laboratory findings, cardiac evaluation, and treatment of children with influenza myocarditis.

Methods: This retrospective study was performed by the Department of Pediatric Infectious Diseases at the Faculty of Medicine, Hacettepe University in Turkey. The medical records of patients diagnosed with myocarditis associated with an influenza infection between January 2014 and January 2017 were systematically reviewed.

Results: Vaccination seems likely to be an important protection strategy for both influenza infections and complications.
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http://dx.doi.org/10.1016/j.jiph.2018.05.003DOI Listing
November 2018

Presepsin: A new marker of catheter related blood stream infections in pediatric patients: Reply to Rivera-Moran Javier et al.

J Infect Chemother 2018 08 5;24(8):687. Epub 2018 May 5.

Hacettepe University, Ihsan Dogramacı Children Hospital, Pediatric Infectious Disease Department, Ankara, Turkey.

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http://dx.doi.org/10.1016/j.jiac.2018.04.008DOI Listing
August 2018

Pediatricians' attitudes in management of acute otitis media and ear pain in Turkey.

Int J Pediatr Otorhinolaryngol 2018 Apr 31;107:14-20. Epub 2018 Jan 31.

Kırklareli State Hospital, Department of Pediatrics, Kırklareli, Turkey.

Objectives: Acute otitis media (AOM) is predominantly a disease of childhood and one of the common reasons for prescribing antibiotics. Ear pain is the main symptom of AOM, with the result that parents frequently seek immediate medical assistance for their children. Antibiotic therapy for AOM does not provide symptomatic relief in the first 24 hours, and analgesics are commonly recommended for relieving the pain associated with AOM. The aims of the present study were to assess pediatricians' attitudes toward AOM and ear pain management in Turkey.

Methods: This multicenter descriptive questionnaire study was conducted in 20 centers from different geographic locations in Turkey, with 977 pediatricians, between June 2015 and December 2016. The questionnaire comprised 20 questions focusing on the pediatricians' sociodemographic variables, experiences, and treatment related to AOM and ear pain.

Results: Of the pediatricians, 58.2% were residents, 36.5% were specialists, and 4.3% were lecturers. Most participants were working in a university hospital (54.8%) or education and research hospital (32.2%). In general daily practice, the AOM diagnosis rates were between 6% and 20% in outpatient clinics, and 52.3% of the participants stated the patients complained about ear pain in pediatric clinics. The watchful waiting (WW) rate, as opposed to immediate antibiotic treatment, was 39.8% for all the pediatricians. The pediatric residents used the WW strategy less than the specialists and lecturers did (p = 0.004). The rates of the WW strategy were higher in outpatient clinics where AOM was commonly diagnosed (p < 0.001). The most common antibiotic prescribed for AOM was amoxicillin clavulanate (76.7%). The mean recommended treatment period for AOM was 9.3 ± 2.2 days. The choices for systemic ear pain treatment were acetaminophen (26.8%), ibuprofen (29.4%), and alternating between ibuprofen and acetaminophen (43.9%). Moreover, 34.6% of the participants recommended topical agents for otalgia. Topical agents were more commonly recommended by the pediatric residents than specialists or lecturers (p < 0.001). Finally, 58.3% of pediatricians had experiences of the parents' usage of a variety of herbal and folk remedies, such as breast milk or olive oil, for their children's ear pain.

Conclusion: Amoxicillin clavulanate was the most frequently prescribed antibiotic for AOM. WW was approved by the pediatricians, and having more AOM patients was a significant factor in the physicians' choice of WW; nevertheless, the WW rate was poor. Implementation of educational intervention strategies will help pediatricians in improving their compliance with evidence-based guidelines for AOM treatment. Otalgia is taken seriously by parents and pediatricians, and otalgia treatment seems to be well accepted in Turkey for providing symptomatic relief and enhancing the patients' quality of life.
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http://dx.doi.org/10.1016/j.ijporl.2018.01.011DOI Listing
April 2018

Prevalence and seasonal distribution of viral etiology of respiratory tract infections in inpatients and outpatients of the pediatric population: 10 year follow-up.

Turk J Pediatr 2018 ;60(6):642-652

Division of Pediatric Infectious Diseases, Hacettepe University Faculty of Medicine, Ankara, Turkey.

Aykaç K, Karadağ-Öncel E, Bayhan C, Tanır-Başaranoğlu S, Akın MŞ, Özsürekci Y, Alp A, Cengiz AB, Kara A, Ceyhan M. Prevalence and seasonal distribution of viral etiology of respiratory tract infections in inpatients and outpatients of the pediatric population: 10 year follow-up. Turk J Pediatr 2018; 60: 642-652. The aim of this study was to investigate the prevalence and seasonal distribution of respiratory viruses in pediatric patients. Nasopharyngeal swab specimens, demographic and clinical information were collected from 1240 pediatric patients aged < 18 years between 2006 and 2015 in Hacettepe University Children`s Hospital. Multiplex RT-PCR (multiplex reverse transcriptase polymerase chain reaction) was performed to detect viral pathogens. A total of 1240 pediatric outpatients and inpatients who had been admitted to the hospital with symptoms of upper and lower respiratory tract infections (RTIs) were enrolled. Viruses were identified in 339 (27.3%) of cases, with the leading three viruses being respiratory syncytial virus (RSV, 74/339; 21.8%), human rhinovirus (62/339; 18.3%), and multiple viruses (56/339; 16.5%). Most of the patients were diagnosed with lower RTI (264/339; 77.8%) and antibiotics were administered to three quarters of positive patients (254/339; 74.9%). With an overall viral agent detection rate of 27.3%, the findings of the present study suggest that other respiratory pathogens, whether viral or bacterial, may also lead to hospital visits due to respiratory tract symptoms in children.
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http://dx.doi.org/10.24953/turkjped.2018.06.004DOI Listing
January 2018

Clinical Strains of Chryseobacterium and Elizabethkingia spp. Isolated from Pediatric Patients in a University Hospital: Performance of MALDI-TOF MS-Based Identification, Antimicrobial Susceptibilities, and Baseline Patient Characteristics.

Microb Drug Resist 2018 Jul/Aug;24(6):816-821. Epub 2017 Dec 11.

2 Department of Medical Microbiology, Hacettepe University Faculty of Medicine , Ankara, Turkey .

Our objective was to evaluate the performance of matrix-assisted laser desorption ionization time-of-flight mass spectrometry (MALDI-TOF MS) for identification of the Chryseobacterium and Elizabethkingia spp. isolated from pediatric patients at Hacettepe University Hospital using 16S rRNA gene sequencing as the gold standard and to determine the antimicrobial susceptibility patterns of the isolates and baseline characteristics of patients. All stored Chryseobacterium and Elizabethkingia spp. isolated from various clinical specimens (sputum, blood, and urine) of pediatric patients at Hacettepe University Hospital between 2012 and 2016 were included in this study. Minimum inhibitory concentrations of 10 antimicrobial agents were determined by Etest for all isolates. To determine the baseline characteristics of patients, medical records of all patients were retrospectively reviewed. In total, 18 isolates of Chryseobacterium spp. (16 C. indologenes, 2 C. gleum) and 5 isolates of Elizabethkingia spp. (3 E. meningoseptica, 2 E. anophelis) were identified by 16S rRNA sequencing. MALDI-TOF MS correctly identified 19 (82.6%) isolates to the species level. The quinolones (ciprofloxacin and levofloxacin), trimethoprim/sulfamethoxazole and piperacillin/tazobactam showed the highest spectrum of activity against the overall collection of isolates. Cystic fibrosis (CF) was the underlying disease in 81.8% of patients. To our knowledge, this study includes the largest number of Chryseobacterium spp. isolated from clinical specimens of pediatric patients in Turkey. In this study, we also report the first clinical isolate of E. anophelis in Turkey. Since, the majority of strains were isolated from patients with CF; larger, prospective clinical studies are needed to establish whether chryseobacteria could be considered as an emerging opportunistic pathogen in patients with CF.
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http://dx.doi.org/10.1089/mdr.2017.0206DOI Listing
October 2018

Presepsin: A new marker of catheter related blood stream infections in pediatric patients.

J Infect Chemother 2018 Jan 14;24(1):25-30. Epub 2017 Sep 14.

Hacettepe University, Ihsan Dogramacı Children Hospital, Pediatric Infectious Disease Department, Ankara, Turkey.

Background: Catheter related blood stream infections (CRBSI) are mostly preventable hospital-acquired conditions. We aimed to investigate the value of presepsin in detection of CRBSI in hospitalized children.

Methods: Hospitalized pediatric patients who had clinical suspicion of CRBSI were followed. Results of peripheral blood cultures and blood cultures from central venous catheters, procalcitonin (PCT), C-reactive protein (CRP), total white blood cell (WBC) counts were recorded. Serum samples for presepsin were studied at the same time with the samples of healthy controls. The patients with positive blood cultures were defined as proven CRBSI and with negative cultures as suspected CRBSI.

Results: Fifty-eight patients and 80 healthy controls were included in the study. Proven CRBSI group consisted of 36 patients (62%) with positive blood cultures and compared with the suspected CRBSI group (n = 22, 36%) with negative culture results. There was no difference between proven and suspected CRBSI groups concerning WBC, PCT, CRP and presepsin. Presepsin was significantly higher in patient groups when compared with healthy controls. The receiver operating characteristic curve area under the curve was 0.98 (%95 CI: 0.97-1) and best cut-off value was 990 pg/ml.

Conclusion: In hospitalized pediatric patients with CRBSI, presepsin may be a helpful rapid marker in early diagnosis.
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http://dx.doi.org/10.1016/j.jiac.2017.08.012DOI Listing
January 2018

Poor outcomes among elderly patients hospitalized for influenza-like illness.

Curr Med Res Opin 2018 07 16;34(7):1201-1207. Epub 2017 Oct 16.

h Hacettepe University Faculty of Medicine , Department of Infectious Diseases and Clinical Microbiology , Ankara , Turkey.

Background And Objective: Global Influenza Hospital Surveillance Network is a worldwide initiative that aims to document the burden of influenza infections among acute admissions and vaccine effectiveness in particular countries. As a partner of this platform, we aimed to determine the frequency of influenza infections among acute admissions with influenza-like illness and the outcomes of enrolled patients during the 2015-2016 influenza season in selected hospitals in Turkey.

Patients And Methods: The investigators screened the hospital admission registries, chart review or available records, and screened all patients hospitalized in the previous 24-48 hours or overnight in the predefined wards or emergency room. A total of 1351 patients were screened for enrollment in five tertiary care referral hospitals in Ankara and 774 patients (57.3% of the initial screened population) were eligible for swabbing. All of the eligible patients who consented were swabbed and tested for influenza with real-time polymerase chain reaction (PCR) based methods.

Results: Overall, influenza positivity was detected in 142 patients (18.4%). The predominant influenza strain was A H1N1pdm09. Outcomes were worse among elderly patients, regardless of the presence of the influenza virus. Half of the patients over 65 years of age were admitted to the intensive care unit, while one third required any mode of mechanical ventilation and one fourth died in the hospital in that particular episode.

Conclusion: These findings can guide hospitals to plan and prepare for the influenza season. Effective influenza vaccination strategies, particularly aimed at the elderly and adults with chronic diseases, can provide an opportunity for prevention of deaths due to influenza-like illness.
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http://dx.doi.org/10.1080/03007995.2017.1381078DOI Listing
July 2018

A comparison of blood stream infections with extended spectrum beta-lactamase-producing and non-producing Klebsiella pneumoniae in pediatric patients.

Ital J Pediatr 2017 Sep 12;43(1):79. Epub 2017 Sep 12.

Department of Pediatric Infectious Diseases, Hacettepe University Faculty of Medicine, Sıhhıye, Ankara, Turkey.

Background: Rapid development and global spread of multidrug resistant Klebsiella pneumonia (K. pneumoniae) as a major cause of nosocomial infections is really remarkable. The aim of this study was to explore risk factors for health care associated blood stream infections (BSI) caused by ESBL-producing K. pneumoniae in children and analyze clinical outcomes.

Methods: A retrospective review of patients younger than 18 years-old with blood stream infection caused by K. pneumoniae was performed. Patients with ESBL-producing K. pneumoniae isolates were compared with ESBL-non-producing isolates in terms of risk factors, outcome and mortality.

Results: Among 111 K. pneumoniae isolates 62% (n = 69) were ESBL -producing K. pneumoniae. The median total length of hospitalization and median length of stay in hospital before infection was significantly higher in patients with ESBL-producing isolates than ESBL-non-producing. Use of combined antimicrobial treatment was significantly different between ESBL-producing and ESBL-non-producing groups, 75.4% and 24.6%, respectively (p = 0.001). Previous aminoglycoside use was higher in cases with ESBL -producing isolates (p = 0.001). Logistic regression analysis showed a significant correlation between mortality and use of combined antibiotics (OR 4.22; p = 0.01).

Conclusion: ESBL production in K. pneumoniae isolates has a significant impact on clinical course of BSIs. Total length of hospitalization, length of hospital stay before infection, prior combined antibiotic use and use of aminoglycosides were significant risk factors for development of ESBL-producing K. pneumoniae related BSI.
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http://dx.doi.org/10.1186/s13052-017-0398-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5596860PMC
September 2017