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Havan M, Kendirli T, Parlar ÖT, Özcan S, Yahşi A, Erat T, Öcal D, Guriz H, Özdemir H, Karahan ZC, Çiftci E, İnce E. Clinical Management of a Pandrug-Resistant OXA-48 Klebsiella pneumoniae Infection in the Pediatric Intensive Care Unit. Microb Drug Resist 2023. [PMID: 36912811 DOI: 10.1089/mdr.2022.0247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2023] Open
Abstract
Background: Carbapenem-resistant Klebsiella pneumoniae (CRKP) is one of the serious forms of health care-associated infection. Pan-drug resistant (PDR) CRKP infections can cause severe infections. Mortality and treatment costs in the pediatric intensive care unit (PICU) are high. This study aims to share our experience regarding the treatment of oxacillinase (OXA)-48-positive PDR-CRKP infection in our 20-bed tertiary PICU with isolated rooms and 1 nurse for every 2-3 patients. Methods: Patient demographic characteristics, underlying diseases, previous infections, source of infection PDR-CRKP, treatment modalities, measures used, and outcomes were recorded. Findings: Eleven patients (eight men and three women) were found to have PDR OXA-48-positive CRKP. Because of the simultaneous detection of PDR-CRKP in three patients and the rapid spread of the disease, it was classified as a clinical outbreak, and strict infection control measures were taken. Combination therapy with double carbapenemase (meropenem and imipenem), amikacin, colistin, and tigecycline was used for treatment. The mean duration of treatment and isolation was 15.7 and 65.4 days, respectively. No treatment-related complication was observed, only one patient died, and the mortality rate was 9%. Conclusions: This severe clinical outbreak can be successfully treated with effective treatment with combined antibiotics and strict adherence to infection control measures. ClinicalTrial.gov ID: 28/01/2022 - 1/5.
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Affiliation(s)
- Merve Havan
- Division of Pediatric Critical Care Medicine, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Tanıl Kendirli
- Division of Pediatric Critical Care Medicine, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Özgün Tutku Parlar
- Division of Pediatric Critical Care Medicine, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Serhan Özcan
- Division of Pediatric Critical Care Medicine, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Aysun Yahşi
- Department of Pediatric Infectious Diseases, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Tuğba Erat
- Department of Pediatric Infectious Diseases, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Duygu Öcal
- Department of Microbiology, Ankara University School of Medicine, Ankara, Turkey
| | - Haluk Guriz
- Department of Microbiology, Ankara University School of Medicine, Ankara, Turkey
| | - Halil Özdemir
- Department of Pediatric Infectious Diseases, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Zeynep Ceren Karahan
- Department of Microbiology, Ankara University School of Medicine, Ankara, Turkey
| | - Ergin Çiftci
- Department of Pediatric Infectious Diseases, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Erdal İnce
- Department of Pediatric Infectious Diseases, Ankara University Faculty of Medicine, Ankara, Turkey
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Büyükcam A, Kara A, Bedir T, Gülhan B, Özdemir H, Sütçü M, Düzgöl M, Arslan A, Tekin T, Çelebi S, Kukul MG, Bayhan Gİ, Köşker M, Karbuz A, Çelik M, Kocabay Sütçü Z, Metin Ö, Karakaşlılar S, Dağlı A, Kara SS, Albayrak E, Kanık S, Tezer H, Parlakay A, Çiftci E, Somer A, Devrim İ, Kurugöl Z, Dinleyici EÇ, Atla P. Pediatricians' attitudes in management of acute otitis media and ear pain in Turkey. Int J Pediatr Otorhinolaryngol 2018; 107:14-20. [PMID: 29501295 DOI: 10.1016/j.ijporl.2018.01.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Revised: 01/15/2018] [Accepted: 01/17/2018] [Indexed: 10/18/2022]
Abstract
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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Affiliation(s)
- Ayşe Büyükcam
- Hacettepe University, Pediatric Infection Department, Ankara, Turkey.
| | - Ateş Kara
- Hacettepe University, Pediatric Infection Department, Ankara, Turkey
| | - Tuğba Bedir
- Gazi University, Pediatric Infection Department, Ankara, Turkey
| | - Belgin Gülhan
- Ankara Hematology Oncology Children's Training and Research Hospital, Pediatric Infection Department, Ankara, Turkey
| | - Halil Özdemir
- Ankara University, Pediatric Infection Department, Ankara, Turkey
| | - Murat Sütçü
- İstanbul University, Pediatric Infection Department, İstanbul, Turkey
| | - Mine Düzgöl
- Behçet Uz Training and Research Hospital, Pediatric Infection Department, İzmir, Turkey
| | - Aslı Arslan
- Ege University, Department of Pediatrics, İzmir, Turkey
| | - Tuna Tekin
- Eskişehir University, Department of Pediatrics, Eskişehir, Turkey
| | - Solmaz Çelebi
- Uludağ University, Pediatric Infection Department, Bursa, Turkey
| | - Musa Gürel Kukul
- Hacettepe University, Pediatric Infection Department, Ankara, Turkey
| | | | - Muhammet Köşker
- Diyarbakır Children Hospital, Pediatric Infection Department Diyarbakır, Turkey
| | - Adem Karbuz
- Okmeydanı Training and Research Hospital, Pediatric Infection Department, İstanbul, Turkey
| | - Melda Çelik
- Keçiöğren Training and Research Hospital, Pediatric Infection Department, Ankara, Turkey
| | - Zümrüt Kocabay Sütçü
- Süleymaniye Maternity and Children Hospital, Department of Pediatrics, İstanbul, Turkey
| | - Özge Metin
- Konya Training and Research Hospital, Pediatric Infection Department, Konya, Turkey
| | | | | | - Soner Sertan Kara
- Erzurum Training and Research Hospital, Pediatric Infection Department, Erzurum, Turkey
| | - Eda Albayrak
- Recep Tayip Erdoğan University, Department of Pediatrics, Rize, Turkey
| | - Saliha Kanık
- Ankara Hematology Oncology Children's Training and Research Hospital, Pediatric Infection Department, Ankara, Turkey
| | - Hasan Tezer
- Gazi University, Pediatric Infection Department, Ankara, Turkey
| | - Aslınur Parlakay
- Ankara Hematology Oncology Children's Training and Research Hospital, Pediatric Infection Department, Ankara, Turkey
| | - Ergin Çiftci
- Ankara University, Pediatric Infection Department, Ankara, Turkey
| | - Ayper Somer
- İstanbul University, Pediatric Infection Department, İstanbul, Turkey
| | - İlker Devrim
- Behçet Uz Training and Research Hospital, Pediatric Infection Department, İzmir, Turkey
| | - Zafer Kurugöl
- Ege University, Department of Pediatrics, İzmir, Turkey
| | | | - Pınar Atla
- Kırklareli State Hospital, Department of Pediatrics, Kırklareli, Turkey
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