Vancomycin-resistant enterococcus colonization and infection in children: six-year follow-up.

Vancomycin-resistant enterococci (VRE) have become a major concern in medical practice. Asymptomatic VRE colonization of the gastrointestinal tract may lead to infection. In this study, which included patients who stayed in our hospital between 2006 and 2011, we looked at the cases of 342 patients with VRE colonization and 19 patients with VRE infection. Vancomycin and carbapenem exposure and intestinal disorders were significantly more common in patients with VRE infection than in those with VRE colonization (p=0.02/0.04/0.04 respectively). Secondary immune deficiency was significantly more common in VRE-colonized patients than in VRE-infected patients (p=0.03). VRE colonization time was significantly related with young age, presence of intravenous catheter, presence of mechanical ventilation, length of hospital stay, length of hospitalization before and after VRE isolation, length of ICU stay before and after VRE isolation, total ICU stay, antibiotic exposure within 3 months, hospitalization (in our hospital) within 3 months, and having a site of infection other than VRE (p=0.01/ 0.01/ 0.04/ <0.001/0.02/ <0.001/ 0.002/ 0.006/ 0.002/ 0.004/ 0.01/ 0.002, respectively). Overall mortality and sepsis was more common in the VRE-infected group than in the VRE-colonized group. Taking into consideration limiting antibiotic usage in potential cases and screening for patients at risk could be beneficial in terms of limiting VRE infection and colonization.

Oseltamivir use in infants under one year of age: are there still unanswered questions?

The influenza A (H1N1) virus responsible for the 2009 pandemic follows a more severe course in children, thus increasing the need for hospitalization. On the other hand, during the first weeks of the pandemic, use of oseltamivir (Tamiflu) in children was restricted, and it was not yet approved for use in children younger than one year of age because of the lack of adequate safety and efficacy data and because of concerns regarding central nervous system (CNS) toxicity in newborn rats. However, citing a state of emergency, conditional approval was granted first in the United States, then Europe and finally in Turkey. The main aim of this study was to share our experience with oseltamivir in 35 patients less than one year of age during the 2009 H1N1 pandemic. A total of 35 infants (21 boys, 14 girls; mean age: 160 days [24-335]) were treated during the study period. Six patients required hospitalization, five of whom (14.2%) had an underlying chronic disorder. During the pandemic, we diagnosed H1N1 infection based on clinical symptoms. Nasal swabs were positive for H1N1 in 88.5% of cases. Mild elevations in liver enzymes were present in 39.1% of patients with available blood workup at presentation, and no changes in liver enzymes were observed with oseltamivir treatment. None of the patients developed any neurological, dermatological or gastrointestinal side effects in association with oseltamivir treatment. No complaints of drowsiness, lethargy or sleep disturbance were reported by the parents. Although our case number is very limited, our study results suggest that oseltamivir is well tolerated in young infants, and we can conclude that oseltamivir could be used in the treatment of influenza A in this age group. Nevertheless, further studies are needed to evaluate using oseltamivir in more cases among infancy age groups.

A Chryseobacterium meningosepticum outbreak observed in 3 clusters involving both neonatal and non-neonatal pediatric patients.

Three clusters of Chryseobacterium meningosepticum infections in a tertiary health center in July 2006 and January 2007 involving 8 newborns and 5 older children were investigated. The index patient was from the neonatal intensive care unit, and the older patients were from other pediatric wards. Cultures were obtained from the environment and from health care workers' hands as part of an outbreak investigation. C meningosepticum was isolated from hand cultures obtained from a senior resident and from environmental cultures obtained from powdered infant formula, an electrical button, a computer keyboard, phone, a doorknob, and an Ambu bag. Antibiogram typing and enterobacterial repetitive intergenic consensus sequence polymerase chain reaction indicated that all of the isolates were epidemiologically related. Nine patients improved on antimicrobial treatment, and 4 premature infants died after the infection. C meningosepticum is a well-known etiologic agent for nosocomial infections involving newborns and immunocompromised patients. Wet and dry environmental surfaces and equipment may act as a source or play a role in disseminating the microorganism. Outbreaks may be controlled with strong emphasis on infection control measures.

A prospective comparative study of the relationship between different types of ring and microbial hand colonization among pediatric intensive care unit nurses.

OBJECTIVES: The aim of the study is to assess the effect of ring wearing and ring types on hand contamination and efficacy of alcohol-based hand disinfection among nurses working in intensive care settings. METHODS: Hand cultures were obtained from 84 nurses providing direct patient care in intensive care units of a pediatric hospital. Colony counts were compared depending on ring wearing and the type of ring worn. Twenty-eight nurses were asked to a wear plain wedding ring, 28 to wear rings with stones and 28 not to wear any rings, starting 15 days before and continuing throughout the study. Cultures were obtained by using sterile gloves containing phosphate-buffered-saline solution (PBS) after an alcohol-based hand disinfectant was used and bacteria were identified with standard laboratory tests. RESULTS: The nurses wearing rings had more Gram-positive, Gram-negative and total bacterial colonization on their hands than the nurses without rings despite using an alcohol-based rub (p=0.001). When comparing the two groups with rings (plain wedding rings and rings with stones), colony counts of Gram-positive, Gram-negative and total bacteria did not differ (p>0.05). CONCLUSIONS: Ring wearing increases the bacterial colonization of hands and alcohol-based hand disinfection might not significantly reduce contamination of the ring-wearing hands. The type of ring did not cause any significant difference on the bacterial load. Wearing rings could increase the frequency of transmission of potential nosocomial pathogens.