Screening tools for bacteraemia in a selected population of febrile children

<p><b>INTRODUCTION</b>This is a prospective, observational study. The aims of the study were to determine the rate of bacteraemia in febrile children in Turkey, and to evaluate the usefulness of white blood cell (WBC) count and manual differential counts of peripheral blood smears and a RISK score in predicting bacteraemia among these children.</p><p><b>MATERIALS AND METHODS</b>A total of 377 febrile children aged 3 to 36 months were included in the study. Complete blood cell (CBC) count, manual differential counts and blood cultures were performed in all patients. The main outcome measures used to evaluate the usefulness of the RISK score were sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), odds ratio (OR), posterior probability, areas under receiver operator characteristic curves (AUC) and miss-to-diagnosis ratio (MDR).</p><p><b>RESULTS</b>Among the patients, 4.4% had bacteraemia and the predominant pathogen was Streptococcus pneumoniae. The Yale Observation Scale scores, percentages of neutrophil and bands, band-neutrophil ratio, absolute neutrophil count and absolute band count were found to be statistically significant predictors of bacteraemia. When the RISK score was 2 or higher, sensitivity was 93.8%, false positive ratio 35.8%, PPV 10.6%, NPV 99.5%, OR 26.2 (95% CI, 3.4 to 200.8), MDR 0.066 and posterior probability value 10%.</p><p><b>CONCLUSIONS</b>We conclude that determination of the RISK score will significantly decrease unnecessary blood culture sampling, antibiotherapy and hospitalisation among febrile patients aged 3 to 36 months without an identifiable focus of infection.</p>

Reference ranges of lymphocyte subsets of healthy adults in Turkey

The aim of this study was to determine the reference ranges of lymphocyte subsets in serologically HIV-negative healthy adults in Turkey. Materials and Blood samples from 220 healthy adults, 105 female and 115 male, collected into tubes containing EDTA were investigated for lymphocyte subsets using flow cytometry. The age range was 18-80 years [44.80 +/- 16.69]. The mean percentage and absolute values of the lymphocyte subsets were as follows: CD3: 72.70 +/- 8.44%, 1,680 +/- 528 cells/micro l; CD4: 47.37 +/- 9.10%, 1,095 +/- 391 cells/micro l; CD8: 28.99 +/- 5.99%, 669 +/- 239 cells/micro l; CD19: 10.96 +/- 4.44%, 254 +/- 122 cells/micro l and CD56: 7.03 +/- 3.26%, 161 +/- 92 cells/micro l, respectively. The ratio of CD4/CD8 was 1.68 +/- 0.43. There was no statistically significant difference in the percentages and absolute values of lymphocyte subsets between the genders [p > 0.05]. Immunophenotyping has been used to establish reference values of lymphocyte subsets in normal healthy adults in Turkey

Investigation of the antibiotic susceptibility patterns of pathogens causing nosocomial infections

The aim of this study is to determine the resistance patterns of bacteria causing nosocomial infections. The outcome of this resistance was followed for 3 years. This study was carried out during 2000 to 2002 at a university hospital in Turkey. The resistance patterns of 570 bacteria [390 Gram-negative, 180 Gram-positive] against meropenem, imipenem, ceftazidime, cefotaxime, cefepime, piperacillin/tazobactam, ciprofloxacin and tobramycin were investigated using the E-test. Extended-spectrum beta-lactamase [ESBL] production was determined using ceftazidime and ceftazidime/clavulanic acid E-test strips. Meropenem was the most effective antibiotic against Gram-negative organisms [89.0%]; this was followed by imipenem [87.2%] and piperacillin/tazobactam [66.4%]. The most active antibiotic against Gram-positive bacteria was imipenem [87.2%] and this was followed by piperacillin/tazobactam [81.7%] and meropenem [77.8%]. The rates of production of ESBL by Escherichia coli were 20.9%, Klebsiella pneumoniae 50% and Serratia marcescens were 46.7%. Extended-spectrum beta-lactamase production increased each year [21.7%, 22.1% and 45.5%]. All of the ESBL producing isolates were sensitive to meropenem and 98.5% sensitive to imipenem. AmpC beta-lactamase was produced by 20.9% of the Enterobacter species spp, Citrobacter spp. and Serratia marcescens. All of these were sensitive to meropenem and 77.8% to imipenem and ciprofloxacin. Multi-drug resistance rates in Acinetobacter spp were 45.4% and 37.7% in Pseudomonas aeruginosa isolates. As in the entire world, resistance to antibiotics is a serious problem in our country. Solving of this problem depends primarily on prevention of the development of resistance