Bacterial etiology and antibiotic resistance pattern of pediatric bloodstream infections: A multicenter based study in Tehran, Iran.

BACKGROUND: Due to the diverse nature of bloodstream infections etiology and to the antibiotic resistance patterns in periodic intervals, rational and accurate use of antibiotics requires an understanding of common causative agents of septicemia and their susceptibility patterns. The present study aimed to determine the bacterial etiology of the neonate and pediatric septicemia, and their antibiotic resistance pattern in Tehran, North of Iran. MATERIAL AND METHODS: This retrospective cross-sectional study was conducted along two years, from October 2014 to November 2016 among children with suspected bloodstream infection. Blood specimens were collected aseptically in BACTECTM blood bottles, and standard microbiological methods were applied for the isolation and identification of the bacteria. Antimicrobial susceptibility tests were performed using the disk diffusion method according to Clinical and Laboratory Standards Institute recommendations. RESULTS: Overall, 433 (21.1%) blood cultures showed a significant bacterial growth. Gram-negative bacteria with a proportion of 55.4% were the predominant isolates. The most frequently isolated Gram-negative bacteria were Pseudomonas spp. (26.8%), followed by Klebsiella spp. (8.8%), and Acinetobacter spp. (7.9%). Ciprofloxacin, amikacin, and piperacillin/tazobactam had the highest antibacterial effect on non-fermenting Gram-negative bacilli. Regarding the recovered Enterobacteriaceae, aminoglycosides and carbapenems showed a promising effect for tested isolates. The prevalence of methicillin-resistant S. aureus and coagulase-negative staphylococci were 52.6%, and 78.6%, respectively. The rate of vancomycin-resistant enterococci was estimated 68.8%. Meanwhile, the overall prevalence of multiple-drug resistant isolates was 83.4. CONCLUSION: Regarding results, Multiple Drug Resistant isolates had a significant role in the occurrence of bloodstream infections. Hopefully, several locally available antibiotics still have promising effects on these isolates.

Impact of helmets on injuries to riders of all-terrain vehicles.

BACKGROUND: Although helmet use has been shown to be effective in reducing traumatic brain injuries (TBIs) due to motorcycle and bicycle crashes, it is unknown whether helmet use is associated with different injury patterns and severity for users of all-terrain vehicles (ATVs). OBJECTIVES: To compare likelihood of injury and death between helmeted and unhelmeted riders of ATVs. METHODS: The National Trauma Data Bank for years 2002-2006 was used to examine the records of 11 589 patients hospitalized for injuries resulting from ATV use. The likelihood of receiving a TBI diagnosis or a significant injury to other body regions and differences in injury severity and in-hospital mortality between helmeted and unhelmeted ATV riders were compared. RESULTS: After multivariable adjustment, compared with helmeted riders, unhelmeted riders were significantly more likely to sustain any TBI (OR 1.62, 95% CI 1.49 to 1.76, p<0.001) and major/severe TBI (OR 3.19, 95% CI 2.39 to 4.25, p<0.001). Unhelmeted riders were significantly more likely to die while in hospital than were helmeted riders (OR 2.58, 95% CI 1.79 to 3.71, p<0.001). Significant injuries to the neck and face regions were also significantly more likely in unhelmeted riders (OR 3.53, 95% CI 1.28 to 9.71, p = 0.015, and OR 1.94, 95% CI 1.32 to 2.84, p = 0.001, respectively). CONCLUSIONS: ATV riders who do not wear helmets are more likely to receive significant injuries to the head, face, and neck. Prevention strategies and enforceable policy interventions to increase helmet use among ATV riders appear warranted.