Catheter-related Infections in Pediatric Patients Due to a Rare Pathogen: Herbaspirillum huttiense

BACKGROUND

Herbaspirillum species are nonfermenting, aerobic, helical or curved, Gram-negative bacteria belonging to the class Betaproteobacteria, order Burkholderiales. To date, only a few studies have reported on the epidemiology, clinical symptoms, antibiotic susceptibility profiles, treatment and outcomes of Herbaspirillum huttiense -related infections in pediatric patients.

METHODS

The aim of this study was to present 3 years of H.Huntiense data, antibiotic susceptibility profiles, systemic antibiotics and antibiotic lock therapy (ALT) options and clinical outcomes.

RESULTS

Fourteen episodes of infection in 12 patients were included in this retrospective study. The patients had a male/female ratio of 1:1 and a median age of 160.5 months (range, 3-198 months). Catheter-related bloodstream infection (CRBSI) was detected in 11 patients. Only 1 patient developed catheter-related infective endocarditis. The patient's catheter was removed, and she was successfully treated with systemic antibiotics for 4 weeks. Systemic antibiotics were used in all infections related to H. huttiense . In septic, critically ill patients, the catheter was removed, and systemic antibiotics were started. Port catheters were removed in 5 patients. ALT was performed in clinically stable patients. ALT using amikacin was administered to 6 patients through the port catheter. Two patients had a 2nd attack. After the 2nd ALT treatment, 1 patient cured, and the catheter of the other patient was removed due to persistent microbial growth in cultures. Antimicrobial susceptibility testing of the reported isolates showed susceptibility to meropenem (90%), ceftazidime (87%) and piperacillin/tazobactam (65%), with 92% resistance to colistin.

CONCLUSION

H. huttiense is an emerging pathogen in CRBSI. Piperacillin/tazobactam, ceftazidime and meropenem appear to be good therapeutic options for the treatment of H. huttiense infections. ALT and systemic antibiotics can be used in H. huttiense -CRBSI to sterilize and preserve the central venous catheter.

Twins with meningitis due to Neisseria meningitidis

Introduction

The incidence of invasive meningococcal disease is highest in infants and young children.

Case report

Twin infants diagnosed two days apart with meningitis due to N. meningitidis serogroup B are presented.

Conclusions

There has never been a report of concurrent meningococcal meningitis in twin brothers. We wanted to highlight the high likelihood of meningococcal transmission through household contacts and the importance of antibiotic prophylaxis and meningococcal vaccination recommendations for close contacts of these cases.

Evaluation and follow-up of antibody formation after CoronaVac vaccine

OBJECTIVE

The aim of this study was to monitor the time-dependent change by evaluating the antibody levels at the 4th, 7th, 10th, 13th, and 16th weeks after the second dose of the CoronaVac vaccine.

METHODS

The study group (n=65) were between 21 and 60 years old and received two doses of the CoronaVac vaccine. Blood samples were collected after 4th, 7th, 10th, 13th, and 16th weeks of the second dose of the vaccine administration. There was a coronavirus disease 2019 recovered group (n=29) who were SARS-CoV-2 real-time PCR test result positive before the vaccination period, and no coronavirus disease 2019 history group (n=36). Age, BMI, gender, smoking, comorbidity, coronavirus disease 2019 contact history, and working in the coronavirus disease 2019 service history of the individuals were recorded.

RESULTS

No statistically significant difference was found in the descriptive findings of the individuals according to coronavirus disease 2019 recovered group and no coronavirus disease 2019 history group. It was observed that antibody levels in the coronavirus disease 2019 recovered group were found to be higher for each period of serum collection compared to the no coronavirus disease 2019 history group, which were statistically significant. The distribution curves of the antibody levels according to the timing of blood collection in coronavirus disease 2019 recovered group, no coronavirus disease 2019 history group, and total subjects were extrapolated, and it was observed that the estimated time for the antibodies to reach the threshold value of the test was 214, 145, and 166 days after vaccination.

CONCLUSION

It is important to make booster doses, as the CoronaVac vaccine will lose its effect after the fifth month due to the decrease in Ab levels. In addition, since the antibody levels decrease later in those who have a history of coronavirus disease 2019 infection and are vaccinated, individuals who have no previous history of coronavirus disease 2019 should be given priority for vaccination.

Prognostic value of neutrophile-to-lymphocyte ratio (NLR) and lactate dehydrogenase (LDH) levels for geriatric patients with COVID-19

Aim

In this study it was aimed to evaluate the prognostic factors for the geriatric patients with confirmed COVID-19 in a tertiary-care hospital at Kastamonu region of Turkey.

Method

Patients (≥65-year-old) who had PCR positivity for COVID-19 between March 2020 and April 2020 in our center were recorded retrospectively. A p value less than 0.05 was considered significant. Ethical committee approval was given from the Bolu University with decision number 2020/176.

Results

There were a total of 100 patients (44% female). In-hospital mortality was recorded as 7%. In univariate analysis for 1 month mortality, diabetes mellitus (p = 0.038), leucocyte count (p = 0.005), neutrophile count (p = 0.02), neutrophile-to-lymphocyte ratio (NLR) (p < 0.001), thrombocyte-to-lymphocyte ratio (TLR) (p = 0.001), C-reactive protein (CRP) (p = 0.002), lactate dehydrogenase (LDH) (p = 0.001), sequential organ failure assessment (SOFA) score (p = 0.001) and qSOFA score (p = 0.002) were found as independent risk factors. On admission, one point increase of NLR (p = 0.014, odds ratio (OR) = 1.371, 95% CI = 1.067–1.761) and one point increase of LDH (p = 0.047, OR = 1.011, 95% CI = 1.001–1.023) were associated with mortality on day 30 according to logistic regression analysis. The cut-off values were found as > 7.8 for NLR (83.33% sensitivity, 97.7% specificity) and > 300 U/L for LDH (100% sensitivity, 79.31% specificity) regarding the prediction of 30-day mortality.

Conclusion

In order to improve clinical management and identify the geriatric patients with COVID-19 who have high risk for mortality, NLR and LDH levels on admission might be useful prognostic tools.

Evaluation of 86 Patients Whom Death While Being Followed up with Pre-Diagnosis of Covid-19

The Coronavirus-19 pandemic continues at full speed, and the number of patients who die from Covıd-19 is increasing. It was aimed to evaluate the demographic information and laboratory findings of 86 patients who died while being followed up in our hospital with a pre-diagnosis of Covıd-19. Identifying these characteristics of deceased patients will be essential to guide clinicians in identifying critically ill patients. Data on demographic information, comorbidities, time from hospitalization to death, molecular test results, thorax CT findings, biochemical findings, culture, antibiotic susceptibility, and the given treatments of the cases were collected from the electronic system Kastamonu Training and Research Hospital. While the RT-PCR test of 21 of the cases was positive, in 9 of the cases, control PCR tests were negative after a while. The CT results of 18 of the 21 initially RT-PCR positive cases were compatible with Covid-19, and the CT result of 3 could not be reached. When the blood test results of the cases were examined, neutrophil increase, white blood cell increase, lymphocyte reduction, and inflammatory markers increase were determined. A total of 43 bacterial growths were found in 21 cases. It has been observed that deaths in patients who were followed up with the pre-diagnosis of Covıd-19 generally occur in older people, males, and those with underlying diseases. It was thought that the cause of death could be underlying diseases, pathologies caused by inflammation, and secondary bacterial infections in addition to viral infection. Clinicians should be more careful about elderly patients, patients with secondary bacterial infections, or patients with neutrophilia, lymphopenia.

[National Antimicrobial Resistance Surveillance System (NAMRSS) external quality assessment studies: 2011-2016]

Establishment of sustainable and evidence-based surveillance systems are recommended for prevention of microbial resistance by the World Health Organization (WHO). As a necessity of these surveillance systems, participants are recommended to implement an external quality assessment (EQA) program. In this scope, National Antimicrobial Resistance Surveillance System (NARSS) has been established within the Public Health Institute of Turkey (PHIT) in our country since 2011. In the scope of this surveillance, NARSS EQA program has been implemented in a cycle per year and four isolates were sent to participants per cycle every year since 2011. In this study, it was aimed to evaluate the six years results of the EQA programs being implemented on NARSS participants between 2011 and 2016. The surveillance system consisted of 118 laboratories. Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, Staphylococcus aureus, Streptococcus pneumoniae, Enterococcus faecium/faecalis and Acinetobacter baumannii bacteria included in scope of the surveillance were sent to participants. Identification of bacteria to the species level, verification of the antibiotic susceptibility test results and existence of specified resistance of the isolates performed with valid test methods required from the participants. Identified isolates were cultured with routine microbiological methods and sent to participants in ambient temperature in triple carrying pouches inside suitable carrying media via PTT Cargo. The results were entered by means of passwords prepared by PHIT and sent to the web based system. The analysis of results were made with SPSS program. A total of twenty-three isolates were sent to participants between 2011 and 2016. It was determined that participants commonly preferred automated systems for bacterial identification and antibiotic sensitivity test results. The use of MALDI TOF MS system was determined to be raised up to 15.65% in 2016. It has been determined that usually little mistakes were done in bacterial identification but the error rate was high especially in antimicrobial susceptibility test results with close clinical threshold values. Although not required for antibiotic susceptibility test results, it was determined that phenotypic tests have been used more widely in determining the specific resistance mechanisms that are important for epidemiological data. It was determined that 80% of participants have used EUCAST standards in 2016. As a result of this research, we have observed that EQA studies of NARSS EQA are a good performance tool for sustainable and evidence based surveillance studies, that the national antimicrobial resistance data quality is sufficiently good and that the data can be shared on international platforms. In addition, the regular maintenance of national surveillance studies shown that laboratories have positive reflections on self improvement in achieving up to date and accurate results.

Low pertussis antibody levels in maternal and umbilical cord blood samples in Turkey

Pertussis continues to cause significant mortality and morbidity in many countries despite high vaccine coverage, especially among young infants. The aim of the study was to determine pertussis antibody levels in paired maternal and cord blood samples, to evaluate the placental transfer of these antibodies, and to assess whether newborn infants have adequate antibody levels against pertussis. Antibody titers to pertussis toxin (anti-PT) and filamentous hemagglutinin (anti-FHA) were measured by in-house enzyme linked immunosorbent assay (ELISA) in 251 paired maternal delivery and cord blood samples. Geometric mean concentrations (GMCs) of pertussis antibodies and cord:maternal GMC ratios were calculated. GMCs of maternal anti-PT and anti-FHA antibodies at delivery were 4.12 and 9.89 EU/ml, respectively. Cord GMCs were 133% and 131% of maternal delivery values for PT and FHA, respectively; demonstrating effective placental transfer. However, cord pertussis antibodies were at a low concentration; 5.49 EU/ml for PT and 12.73 EU/ml for FHA. Only 34.6% of infants had protective anti-PT levels (≥10 EU/ml) at birth. Anti-pertussis antibody concentrations were extremely low in pregnant women in Turkey where childhood pertussis vaccination coverage has been high for a long time. Despite effective placental antibody transfer, umbilical cord pertussis antibody concentrations are similarly low. A majority of young infants are vulnerable to pertussis infection until the onset of primary vaccinations. These data support the need for pertussis vaccination during pregnancy to prevent infant infection in Turkey.

Pertussis serosurveillance study in Izmir, Turkey

Pertussis is a life-threatening, vaccine-preventable infection. Adults who can be asymptomatic may infect infants. The aim of this study is to determine the IgG antibody levels against pertussis toxin (PT) and filamentous hemagglutinin from 6 months to ≥60 years in Izmir, Turkey. A cluster sample design developed by Expanded Programme on Immunization of the World Health Organization was carried out for the selection of the study population, which consisted of 399 healthy subjects. In-house ELISA was studied in Turkish Public Health Institution. Antibody levels of <10 EU/ml, ≥10 EU/ml and ≥100 EU/ml were accepted as non-immune, immune and possible acute/recent infection, respectively. Anti-PT antibody levels were 8.5% <10 EU/ml, 68.2% 10-100 EU/ml and 23.3% ≥100 EU/ml; the latter was correlated with possible acute/recent infection. Results showed that pertussis is endemic, particularly among adolescents and adults, which is a threat for infants who have not completed their primary immunization.