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.

Neonatal syphilis: clinical and laboratory assessments and postnatal treatments for infants born to infected mothers

PURPOSE

This study aims to assess congenital syphilis incidence, main clinical presentations and the relation to maternal treatment during pregnancy, with the goal of raising awareness of this emerging public health issue and offering local epidemiological data.

METHODS

Infants born to mothers diagnosed with syphilis at Etlik City Hospital between June 1, 2023 and June 1, 2024 were included to the study. Patient records were reviewed retrospectively.

RESULTS

During the study period, 12,892 live births were recorded, with congenital syphilis detected in 0.12% of cases, corresponding to a rate of 116 cases per 100,000 live births. Fifteen neonates born to mothers with syphilis were evaluated. Penicillin treatment was administered to 93.3% of the neonates, including 73.3% classified as highly probable or probable cases. Bone abnormalities such as periostitis and osteitis were detected in two patients. Only 46.7% of mothers received adequate prenatal treatment, and 40% lacked prenatal care altogether. Co-infections with hepatitis C virus, human papillomavirus, and herpes simplex virus type 2 were noted in 26% of mothers, though none had HIV. Substance addiction was reported in 26.7% of mothers.

CONCLUSION

This study highlights a significant burden of congenital syphilis, with many cases stemming from untreated or inadequately managed maternal infections. Some neonates were infected despite maternal treatment, underscoring gaps in prevention. The limited data from our center, despite high case rates, likely underestimates the regional burden and risks missed diagnoses. These findings emphasize the urgent need for enhanced prenatal screening, timely treatment, and comprehensive care to mitigate congenital syphilis rates.

Intravenous fosfomycin indications and treatment outcomes in pediatric usage: analysis from a single center in Turkey

Current data on fosfomycin usage in children are limited. We present data on the clinical use of intravenous (IV) fosfomycin in children. Hospitalized patients who received ≥3 days of IV fosfomycin between April 2021 and March 2023 were analyzed retrospectively. Forty-three episodes of infection in 39 patients were evaluated. The mean age of the patients was 5.35 (10 days to 17.5 years) years, and 54% were male. Infections were hospital-acquired in 79% of the episodes. Indications for fosfomycin were urinary tract infection (35%), bacteremia (32.6%), catheter-related bloodstream infection (16.3%), soft tissue infection (4.7%), sepsis (4.7%), surgical site infection (2.3%), burn infection (2.3%), and pneumonia (2.3%). Klebsiella pneumoniae was identified in 46.5% of the episodes, and a pan-drug or extensive drug resistance was detected in 75% of them. Carbapenem was used before fosfomycin at significantly higher rates in K. pneumoniae episodes (P = .006). Most (88.5%) patients received fosfomycin as a combination therapy. Culture negativity was achieved in 80% of episodes within a median treatment period of 3 (2-22) days, which was significantly shorter in K. pneumoniae episodes (P < .001). Treatment-related side effects were seen in 9.3% of the episodes. Side effects were significant after 3 weeks of treatment (P = .013). The unresponsivity rate to fosfomycin was 23.3%. Nine (21%) of the patients who were followed up in the intensive care units mainly died because of sepsis (56%). IV fosfomycin is an effective agent in treating severe pediatric infections caused by resistant microorganisms. Fosfomycin can be used in various indications and is generally safe for children.

Evaluation of the Relationship between Serum 25(OH) Vitamin D Levels and Cardiac Functions in Adolescent Athletes

BACKGROUND

Vitamin D is a prohormone necessary for the optimal functioning of the locomotor and circulatory systems in humans. As a caveat, vitamin D metabolism is crucial for maintaining musculoskeletal and cardiovascular health for overexercising people, like athletes. Our study intended to explore the relationship between serum 25-hydroxy vitamin D (25(OH) D) levels and left ventricle/right ventricle (LV/RV) systolic and diastolic function in adolescent athletes using 2D Doppler studies.

METHODS

In our cross-sectional study, 100 adolescent athletes were divided into two groups: vitamin D insufficiency (25(OH)D<20 ng/mL) and vitamin D sufficiency (25(OH)D>20 ng/mL) with 30 males and 20 females in both groups. A detailed physical examination and basic biochemical tests were performed; serum 25(OH)D levels were determined, and an echocardiographic evaluation was performed.

RESULTS

We found that decreased serum 25(OH)D levels were associated with impairment in many indicators of cardiac function, such as left ventricular-right ventricular-interventricular septum peak systolic velocity (Sm) and Tei index, inflow peak early diastolic velocity and inflow peak late diastolic velocity ratio (E/A), annulus early diastolic myocardial peak velocity (E'), and E/E' ratio.

CONCLUSIONS

To protect cardiac functions in adolescent athletes, we suggest screening serum 25(OH) D levels during certain periods, such as fall and winter, and vitamin D supplementation if necessary.

Early Short-Term Use of Different Doses of Corticosteroid in Hospitalized Pediatric Patients with Coronavirus Disease 2019 Pneumonia

Objective Encouraged by reports of favorable outcomes following the use of corticosteroids in patients with moderate-to-severe coronavirus 2019 (COVID-19) pneumonia, we aimed to present our experience with early short-term corticosteroid use at our center in pediatric patients with COVID-19 pneumonia.

Methods One hundred and twenty-nine pediatric patients were included in the study. Patients were divided into four groups according to the type and dose of corticosteroids given: Group 1 (those receiving dexamethasone 0.15 mg/kg/d); Group 2 (those receiving methylprednisolone 1 mg/kg/d); Group 3 (those receiving methylprednisolone 2 mg/kg/d); and Group 4 (those receiving pulse methylprednisolone 10–30 mg/kg/d).

Results Of 129 patients, 19 (14.7%) patients were assigned to Group 1, 30 (23.3%) patients to Group 2, 30 (23.3%) patients to Group 3, and 50 (38.8%) patients to Group 4. Thirty-two (24.8%) patients were followed in the pediatric intensive care unit (PICU), of whom 13 (10%) required mechanical ventilation, and 7 (%5.4) died. In Group 4, the hospitalization length was significantly longer than in other groups (p < 0.001, p < 0.001). No significant difference was found among the groups in terms of mortality (p = 0.15). The most common comorbidity was obesity (33%). A significant association was found between the presence of comorbidity and mortality (p < 0.001). All patients who died had an underlying disease. Cerebral palsy was the most common underlying disease among the patients who died. Worsening of lymphopenia was significant in patients with severe COVID-19 pneumonia at the time of transfer to the PICU (p = 0.011).

Conclusion Although children usually have a milder course of COVID-19 than adults, underlying diseases and obesity increase the severity of disease manifestations also in children. Further studies are needed to define the exact role of corticosteroids in COVID-19 patients.

Comparison of clinical outcomes of antibiotics used for Staphylococcus aureus bacteremia in pediatric patients

BACKGROUND

This study aims to evaluate the risk factors, clinical features, and clinical outcomes among pediatric hospitalized patients receiving treatment for Staphylococcus aureus bacteremia and compare the effects of antibiotics used in the treatment on clinical outcomes.

RESEARCH DESIGN AND METHODS

This single-center retrospective study included patients aged between 1 month and 18 years who received treatment for Staphylococcus aureus bacteremia (SAB) betweenSeptember 2019 and September 2022.

RESULTS

SAB was detected in 95 pediatric patients. In MRSA bacteremias, no difference in clinical outcomes was found between patients receiving vancomycin or teicoplanin. In MSSA bacteremias, the recurrence rate of SAB was 0% in the penicillin group and 23.5% in the cephalosporin group. The median duration of bacteremia-related hospital stay (10 vs. 14 days), and the median duration of bacteremia (2 vs. 3 days) were shorter in the ampicillin-sulbactam group than in the piperacillin-tazobactam group (p = 0.016, and p = 0.050, respectively).

CONCLUSIONS

Teicoplanin was found to have similar clinical outcomes to vancomycin in treating MRSA bacteremia. In addition, ampicillin sulbactam was found to have better clinical outcomes than other antibiotics in treating MSSA bacteremia. Teicoplanin and ampicillin sulbactam may be considered as a choice in the treatment of pediatric SAB.

A Survey on Parents' Health Literacy on Childhood Human Papilloma Virus Vaccination

Objective The aim of this study is to determine parents' knowledge levels and attitudes about childhood human papillomavirus (HPV) vaccination and reveal the differences between parents who are health care workers and nonhealth care workers. The HPV vaccine can potentially prevent initial HPV infection and HPV-related genital and anal precancerous disorders and cancers.

Methods Questions and attitudes toward childhood HPV vaccination were asked to 564 parents who agreed to participate in the study.

Results In our study, the rate of health care worker parents considering having their children vaccinated against HPV (63.1%) was higher than that of nonhealth care worker parents (11.4%). Only 5% of parents had their children previously vaccinated against HPV; however, there was no difference between parents who were health care workers and those who were not. In addition, this rate was relatively low compared to other paid vaccines (49.8, 35.3, and 18.8%, respectively). Parents who had not previously vaccinated their children against HPV were considering getting their children vaccinated, especially if a pediatrician recommended it.

Conclusion The parents' high level of health literacy may not be effective in deciding to vaccinate their children against HPV. Therefore, adequate information and awareness should be provided to all parents about HPV vaccination as early as possible for all children of appropriate age. Pediatricians should be given important roles in raising the awareness of parents about childhood HPV vaccination by health authorities.