Background. Children diagnosed with preseptal cellulitis frequently require hospitalization, leading to both clinical management challenges and substantial healthcare-related costs. The condition often necessitates intravenous antibiotic therapy, radiological imaging, laboratory tests, consultations, and inpatient care, which collectively contribute to the overall economic burden. However, data on the clinical characteristics and cost distribution among pediatric patients remain limited. This study aimed to evaluate both the clinical and economic burden of preseptal cellulitis in hospitalized children and to identify the clinical factors influencing healthcare costs. Methods. This retrospective study included children aged 1 month to 18 years who were hospitalized with a diagnosis of preseptal cellulitis between January 2019 and December 2024. Patients were grouped according to age and presence of predisposing factors. Length of stay, total hospital costs, and cost components were analyzed based on clinical characteristics. Results. A total of 166 patients were included (mean age: 70.1 ± 46.9 months; 62% male). The most common findings were periorbital swelling (96.4%) and erythema (75.3%). Median length of stay was 5 days, with no significant differences by age, sex, or predisposing factors (p>0.05). However, a strong positive correlation was found between length of stay and total cost (rho=0.775, p

Aim: To determine the rate of antibiotic escalation within the first 72 hours of FN (Febrile neutropenia) episodes in pediatric patients and to evaluate the association of escalation with inflammatory biomarkers and clinical outcomes.Methods: We retrospectively reviewed 84 FN episodes in children with malignancies treated between January 2017 and December 2021. Demographic and clinical data, initial and 72-hour antibiotic regimens, laboratory parameters (CRP, procalcitonin [PCT], interleukin-6 [IL-6], neutrophil-to-lymphocyte ratio [NLR]), blood culture results, length of hospital stay, and 30-day readmission were collected. Escalation was defined as a change to a broader-spectrum antibiotic within 72 hours. Logistic regression and comparative statistical tests were applied.Results: Escalation occurred in 27% (23/84) of FN episodes, most frequently from piperacillin-tazobactam to meropenem. Patients requiring escalation had significantly higher median CRP (115 vs. 62 mg/L, p=0.01), PCT (1.3 vs. 0.5 ng/mL, p=0.02), and IL-6 (120 vs. 65 pg/mL, p=0.04) levels. Blood culture positivity was more common in the escalation group (52% vs. 23%, p=0.01). NLR was higher in escalation cases (8.2 vs. 5.6), with borderline statistical significance (p=0.06). Median length of hospital stay was longer in escalation patients (10 vs. 7 days, p=0.02). Thirty-day readmission did not differ significantly between groups.Conclusions: Approximately one-quarter of FN episodes required antibiotic escalation within 72 hours. Elevated CRP, PCT, IL-6, and blood culture positivity were associated with escalation. These findings underscore the potential role of biomarkers in guiding early escalation decisions and optimizing antibiotic stewardship in pediatric FN.

Central line–associated bloodstream infections (CLABSIs) have been widely studied, but the burden of non-CLABSI hospital-onset bacteremia and candidemia (HOB/HOC) in children outside intensive care units (ICUs) remains poorly understood. We retrospectively analyzed pediatric patients (1 month–18 years) admitted to a tertiary referral hospital in Turkey between January 2021 and January 2025. Eligible cases included the first positive blood culture for a non-commensal organism on or after hospital day 4, without central venous catheters, peripherally inserted central catheters, or ICU stay. Demographic, clinical, microbiological, and outcome data were collected. Of 14,985 blood cultures, 29 episodes of HOB/HOC met inclusion criteria. The median patient age was 38 months (IQR 11.5–78), with 65.5

BACKGROUND:Children with HIV (CWH) remain at increased risk for colonization and invasive disease by Neisseria meningitidis and Streptococcus pneumoniae despite antiretroviral therapy (ART) and vaccination. Data on nasopharyngeal carriage in this group are limited in Türkiye. METHODS:In this multicenter prospective study, nasopharyngeal swabs were obtained from 80 CWH and 180 age-matched healthy controls between July and December 2024 in İstanbul and İzmir. Samples were analyzed by real-time PCR for N. meningitidis and S. pneumoniae , and meningococcal serogroups and pneumococcal serotypes were determined by molecular methods including capsular sequence typing. Demographic, clinical, and vaccination data were collected. Univariate and multivariate analyses assessed factors associated with carriage. RESULTS:Meningococcal carriage was detected in 3 of 80 (3.8%) CWH and 16 of 180 (8.9%) controls ( P  = 0.15). All meningococcal isolates from CWH were nongroupable and were unvaccinated. Pneumococcal carriage occurred in 23 of 80 (28.7%) CWH and 43 of 180 (23.9%) controls ( P  = 0.40). Among CWH isolates, 65.2% were PCV13 serotypes, 26.1% were non-PCV13 serotypes, and 8.7% were nontypeable. Time since the last PCV13 dose was weakly but independently associated with lower pneumococcal carriage [adjusted odds ratio (OR) per month 0.98, 95% confidence interval (CI) 0.97-0.99; P  = 0.011], while having vaccinated siblings showed a borderline protective effect. CONCLUSION:In this contemporary cohort from Türkiye, CWH exhibited low meningococcal carriage dominated by nongroupable strains and pneumococcal carriage comparable to healthy children, with a serotype distribution shaped by vaccination and host immunity. These findings support sustained risk-group vaccination, reinforcement of household-level immunization, and continued molecular surveillance to optimize prevention strategies for CWH.

This study aimed to evaluate the demographic, clinical, laboratory, microbiological, and radiological characteristics of pediatric brucellosis patients with and without osteoarticular involvement, and to identify associated risk factors and outcomes. A retrospective analysis was conducted on 101 children diagnosed with brucellosis between 2008 and 2022. Data were extracted from patient files and electronic records. Patients were grouped based on the presence or absence of osteoarticular involvement. Of the 101 patients, 52 (51.5%) had osteoarticular involvement. Myalgia (P = .027), low back pain (P < .001), and higher serum standard tube agglutination titers (P = .004) were significantly more common in this group, while abdominal pain was more frequent in patients without joint involvement (P = .007). The time from symptom onset to hospital admission was significantly longer in the osteoarticular group (P = .033). Magnetic resonance imaging confirmed sacroiliitis and hip involvement in 69.2% of relevant cases. In tropical and endemic regions where brucellosis remains a significant public health problem, children presenting with myalgia, back pain, high standard tube agglutination titers, and prolonged symptom duration should be carefully evaluated for osteoarticular brucellosis. Early identification is essential for preventing complications and optimizing treatment.

Invasive pneumococcal disease (IPD) caused by Streptococcus pneumoniae remains a significant cause of pediatric morbidity. This study updates the serotype distribution and antibiotic resistance of pediatric IPD in Türkiye for 2019-2025, about a decade after 13-valent pneumococcal conjugate vaccine (PCV13) was introduced in the National Immunization Program. We conducted a multicenter, hospital-based prospective surveillance between January 2019-April 2025 in children <18 y across 28 tertiary hospitals. S. pneumoniae isolates from sterile sites (blood, cerebrospinal fluid, pleural fluid) were confirmed by standard methods and serotyped using the Quellung reaction. Antimicrobial susceptibility was determined by gradient test as per CLSI criteria. A total of 203 samples were identified from 203 pediatric cases (median age 4 y, 56.2% boys). The clinical presentations were bacteremia/sepsis (57.6%) and meningitis (26.1%). The leading serotypes were 3 (14.3%), 14 (10.3%), 19F (7.9%), 19A (6.4%), 9N (4.4%), 15A (4.4%). PCV13 serotypes accounted for 46.8% isolates, while PCV7 and PCV10 serotypes were detected in 23.2% and 24.6%, respectively. Broader vaccines would increase coverage: PCV15 (46.8%) and PCV20 (56.7%). Antibiotic susceptibility (non-meningitis breakpoint) remained high for beta-lactams; 91.9% of isolates were penicillin-susceptible, with only 0.7% fully resistant, and cefotaxime resistance was rare (2.7%). Conversely, macrolide resistance was high, with 60.2% of isolates resistant to erythromycin. A decade after PCV13 implementation, vaccine serotypes - particularly 3, 14, 19F, and 19A - still cause nearly half of pediatric IPD, though non-vaccine serotypes such as 9N and 15A are rising. Higher-valent PCVs may improve protection, and continued surveillance is critical to guide vaccine policy and treatment strategies.

BACKGROUND:Candidemia is a life-threatening infection, and uncommon Candida species (UCS) are increasingly reported in pediatric patients. We aimed to evaluate the demographic and clinical characteristics of UCS candidemia in children. MATERIALS AND METHODS:This multicenter retrospective study included pediatric patients with UCS candidemia (species other than Candida albicans , Candida parapsilosis , Candida glabrata , Candida tropicalis and Candida krusei ) from 14 tertiary hospitals in Turkey between January 2013 and December 2023. RESULTS:A total of 221 episodes in 204 patients were analyzed. The median age was 29 months (interquartile range [IQR]: 7.8-78.5), and 58.8% were male. The most common UCS were Candida lusitaniae (n = 44, 19.9%), Candida kefyr (n = 40, 18.1%) and Candida guilliermondii (n = 31, 14%). Hematologic malignancy was the most frequent underlying condition (n = 50, 22.6%). Central venous catheters (CVC) were present in 76% (n = 168) of patients and were removed in 67.9% (n = 114) of episodes. Immunosuppressive therapy and recent surgery were documented in 53.8% (n = 119) and 53.4% (n = 118) of episodes, respectively, while total parenteral nutrition was used in 44.3% (n = 98). Recent antibiotic exposure was observed in 95.5% (n = 211) of episodes, and concomitant bacteremia occurred in 27.1% (n = 60). Neutropenia and thrombocytopenia were present in 59.7% (n = 132) and 48% (n = 106) of episodes, respectively. Antifungal prophylaxis was recorded in 23.5% (n = 52) of episodes, predominantly with fluconazole (76.9%). Susceptibility rates were 89.2% (116/130) for fluconazole, 90.4% (113/125) for caspofungin and 85.7% (102/119) for amphotericin B. Pediatric intensive care unit admission was required in 25.8% (n = 57) of episodes. The 7-day and 30-day mortality rates were 7.2% (n = 16) and 14.5% (n = 32), respectively. Female sex and longer hospital stay before infection were associated with increased mortality (7-day: P = 0.04 and P = 0.047; 30-day: P = 0.02 and P = 0.023). Mechanical ventilation, urinary catheterization and total parenteral nutrition were more frequent among nonsurvivors in both mortality periods (7-day: P < 0.001, P = 0.03, P < 0.001; 30-day: P < 0.001, P < 0.001, P = 0.03). The CVC removal rate was lower in mortality groups than in survivors (7-day: P = 0.005 and 30-day: P = 0.006).Thrombocytopenia was associated with both 7-day and 30-day mortality ( P < 0.001 and P = 0.001), while elevated C-reactive protein levels were associated with 7-day mortality ( P = 0.046). CONCLUSIONS:UCS candidemia in children most commonly occurred in patients with solid-hematologic malignancy, central venous catheters and recent antibiotic exposure within 1 week. Female sex, prolonged pre-infection hospitalization, intensive care-related interventions, thrombocytopenia, lower CVC removal rate and elevated C-reactive protein were associated with increased short-term mortality.

BACKGROUND:The primary risk factor determining the progression of tuberculosis (TB) infection is the host's immune status. However, reports of TB cases in children diagnosed with primary immunodeficiency (PID), also referred to as inborn errors of immunity (IEI), remain scarce. In this study, we describe the impact of PID/IEI on childhood TB disease. METHODS:In this retrospective cohort study, data of patients aged 1 month to 18 years who were diagnosed with TB between January 2012 and January 2025 were collected. TB patients were compared according to PID status. Additionally, radiological, histopathological, and microbiological diagnostic findings, as well as clinical features and treatments of TB patients with PID, were evaluated. RESULTS:A total of 217 TB patients were included, with a median age of 118 months (IQR: 42-169.5). PID was detected in 5.5% (n = 12) of the patients. In 6 (50%) of the PID patients, the immunodeficiency was not known before the TB diagnosis. The median age of patients with PID was 17 months (IQR: 10.3-58.5), which was significantly lower compared to other patients (p = 0.001). The diagnosis of extrapulmonary TB was significantly more common among PID patients (p = 0.049). Treatment durations in patients with PID ranged from 6 to 24 months, and no mortality was observed. CONCLUSION:Investigating PID in children diagnosed with TB may be a critical step in enabling early diagnosis and treatment before the development of potentially fatal complications. We also believe that expanding immunological investigations will contribute to a better understanding of childhood TB pathogenesis.

Objective: Outpatient parenteral antimicrobial therapy (OPAT) has been developed as an alternative approach to hospital stay for the effective treatment of infections requiring long-term therapy. The aim of this study is to evaluate the clinical outcomes and hospital readmission rates of pediatric patients receiving OPAT. Method: Pediatric patients aged between 1 month and 18 years who received antimicrobial treatment under the OPAT program were included in this retrospective study. The duration of OPAT, the antimicrobial treatments used, bed-days saved by OPAT, OPAT-related complications, and readmission rates were examined. Results: A total of 21 patients were included in the study, and the median age of these patients was 85 months. The most common diagnosis was leishmaniasis, observed in 33.3% of cases. OPAT shortened hospital stays for a median of 6 days (interquartile range: 2-12.5) per case. However, 14.3% (n=3) of the patients required readmissions to the hospital. No infusion-related side effects were observed in any patients receiving OPAT. Conclusion: Our data suggest that OPAT could be a good option for selected pediatric patients. However, further research and increased awareness are needed to promote the widespread use of OPAT for pediatric patients.

Background:Febrile neutropenia (FN) remains a frequent and potentially life-threatening complication in pediatric oncology, where prompt recognition of bacteremia is critical for risk-adapted therapy and antimicrobial stewardship. Traditional biomarkers such as C-reactive protein (CRP) and procalcitonin (PCT) are widely used, yet their early predictive value is inconsistent across studies. Cellular activation markers measured by flow cytometry, particularly CD48, have been scarcely investigated in this setting. This study aimed to evaluate conventional, metabolic, and immune biomarkers for predicting bacteremia in children with FN and to assess the incremental diagnostic value of CD48. Methods:This prospective single-center cohort enrolled 38 pediatric oncology patients presenting with 46 FN episodes over 9 months. Clinical data, blood cultures, and serial measurements of CRP, PCT, lactate, interleukin-6, interleukin-8, MCP-1, sTREM-1, CD48, and CD64 were obtained at 0, 24, 48, and 72 hours. Bacteremia was defined by positive culture for a recognized pathogen. Receiver operating characteristic (ROC) analyses were performed to determine the area under the curve (AUC), sensitivity, and specificity. A multivariable logistic regression model evaluated the combined performance of biomarkers. Results:Bacteremia occurred in 12 (26.1%) FN episodes. Sepsis, tachycardia, and elevated lactate were more common among bacteremic patients. CRP showed limited early discrimination (AUC 0.62 on day 2) but improved by day 4 (AUC 0.74). PCT was consistently higher in bacteremia (AUC 0.89 at day 4), and lactate demonstrated strong early predictive value (AUC 0.81). CD48 was significantly elevated from 0-24 h (AUC 0.78), outperforming CD64 (AUC 0.60) and preceding the rise in CRP. In combined modeling, PCT + CD48 + lactate achieved the highest discrimination (AUC 0.92; sensitivity 92%, specificity 85%). Post-hoc power analysis showed 82% power to detect AUC differences ≥0.15. Conclusion:Integration of CD4 with PCT and Lactate markedly improved diagnostic accuracy in this cohort; however, given the limited number of bacteremic episodes, these findings should be considered exploratory and require external validation in larger, multicenter studies before clinical implementation.

BACKGROUND:Postexposure prophylaxis (PEP) is critical in preventing HIV acquisition after risky exposures, particularly in pediatric sexual assault victims. Despite its importance, adherence and follow-up remain significant challenges. OBJECTIVES:This study evaluates PEP and follow-up adherence and efficacy among pediatric sexual assault victims treated at a tertiary care hospital in Turkey. METHODS:A retrospective analysis was conducted on 119 pediatric patients 1 month to 18 years of age, treated between September 2017 and September 2022. Data were collected on demographics, PEP initiation and completion, follow-up rates and serologic testing for HIV. PEP compliance, follow-up adherence and outcomes were analyzed. RESULTS:PEP was initiated in 97% of the eligible 119 patients, with 70% completing the regimen. Compliance showed no significant differences by sex or age. Follow-up adherence decreased progressively, from 55% at the first month to 30% by the sixth month. Nausea and vomiting occurred in one case, indicating a low incidence of side effects. None of the patients seroconverted to HIV. CONCLUSION:A structured care system involving multidisciplinary collaboration, pioneered by pediatric infectious diseases, can lead to high PEP initiation and completion rates in children. Single-pill PEP regimens may enhance adherence. However, the decline in follow-up rates underscores the need for improved follow-up mechanisms and future interventions.

This consensus report presents current expert opinions on the clinical use of the BioFire (R) FilmArray (R) Pneumonia Plus (PNplus) rapid molecular test in patients with pneumonia. A group of eight physicians with clinical experience in pneumonia identified common questions encountered in clinical practice regarding the use of PNplus for lower respiratory tract infections and developed consensus-based answers. Based on this process, a list of recommendations was compiled for the use of the PNplus rapid syndromic molecular test, which detects the most common bacteria, viruses, and resistance genes. These recommendations were supported by case examples based on fictional clinical scenarios, along with a proposed diagnostic algorithm for the management of pneumonia.

We appreciate the study performed and described by Devrim et al, who practice at Dr. Behçet Uz Children's Diseases and Surgery Training and Research Hospital in Izmir, Turkey. This study aimed to compare the colonization rates of short-term PIVC tips between patients' catheters flushed with manually prepared saline syringes and single-use prefilled saline syringes. The practice of manually preparing saline syringes for use in flushing intravenous catheters is uncommon in many health care organizations. While many health care organizations have permanently exchanged manual flush syringe preparation for prefilled single-use saline syringes, we are respectful of professionals and organizations who serve in areas where practice is different. As noted, we appreciate Devrim et al's study and described findings. The conclusion of this study affirms and further substantiates the INS Infusion Therapy Standards of Practice described in Standard 38. Flushing and Locking. Practice Recommendation - A. Use single-dose systems (eg, single-dose vials and syringes or prefilled labeled syringes) for all VAD flushing and locking. Additional recommendations are listed in A.2. and A.3. Use commercially manufactured prefilled flush syringes (when available) to reduce the risk of catheter-associated bloodstream infection (CABSI) and device failure, save time for syringe preparation, and aid optimal flushing technique and objectives. 3. Do not use IV solution containers (eg, bags or bottles) as a source for obtaining flush solutions (see Standard 56, Compounding and Preparation of Parenteral Solutions and Medications).

Background. Isolating microorganisms from blood cultures is the gold standard for identifying the cause of sepsis. However, contamination of the blood culture is a significant barrier to the blood culture’s utility. In this study, we aimed to evaluate the impact of blood culture bundles on the incidence of contamination in the neonatal intensive care unit (NICU). Methods. A prospective research to compare pre-bundle and bundle periods was created. During the bundle period, a bundle for blood culture sampling was implemented. The numbers of unnecessary antibiotic days and hospital stay following a false positive blood culture were used to calculate costs. Results. A total of 320 neonatal blood culture procedures were included. The rate of blood culture contamination was 3.8% in the bundle and 12.5% in the pre-bundle period, this was significantly higher in the pre-bundle period (p

Objective: We have aimed to evaluate our experience in interpreting polymerase chain reaction (PCR) test results of cerebrospinal fluid (CSF) samples for human herpesvirus (HHV)-6, HHV-7, and enterovirus in children with suspected viral meningoencephalitis. Method: Children aged 1 month to 5 years underwent PCR analyses. Samples were collected via lumbar puncture and assessed using real-time PCR for the identification of enterovirus, HHV-6, and HHV-7. Results: Most (79.8%) of 109 CSF samples analyzed did not show the presence of any viral particles. Among the positive samples, 8.3% were positive only for HHV-6, 6.4% for HHV-7, and 1.9% for enterovirus. Two samples showed positivity for both HHV-6 and HHV-7; one sample for HHV-7 and enterovirus; and another sample for HHV-6, HHV-7, and enterovirus. Among the PCR-positive patients, fever (77%) and seizures (59%) were the most prevalent presenting symptoms. A statistically significantly higher incidence of seizures was observed in patients with HHV-7 positivity compared to those in whom no virus was detected (p=0.003). At discharge, three patients received alternative diagnoses. Conclusion: The most frequently detected virus was HHV-6, followed by HHV-7. Enterovirus was detected at a lower frequency than expected, most probably due to the rapid clearance of enterovirus from the CSF and coronavirus disease 2019 mitigation. Considering the possible latency or chromosomal integration (for HHV-6), clinical presentations, CSF findings, and patient-specific additional diagnostic work-up were influential on the decision-making process for diagnosis. In the absence of advanced molecular techniques, it is crucial to recognize that HHV-6 and HHV-7 may be bystanders, and other potential pathogens and diagnoses should be considered.

OBJECTIVE:Totally implantable venous access devices (TIVADs) are essential in pediatric oncology but pose a risk of catheter-related infections. This study assesses the impact of 70% isopropyl alcohol-impregnated disinfecting caps on microbial colonization of needleless connectors (NCs) and extension set lumens. DESIGN:This is a single-center, open-label, prospective study. PARTICIPANTS:The study included 23 pediatric patients (50 treatment episodes) with acute lymphoblastic leukemia using TIVADs. METHODS:From April to July 2024, patients with double-lumen extension sets and needleless connectors (NCs) were included. One NC remained uncovered, while the other was capped with a 70% alcohol-impregnated disinfecting cap. Surface cultures were obtained from the uncovered NC on days 2, 3, and 4, and from the capped NC on day 4. RESULTS:Microbial colonization was significantly higher in uncovered NCs (63.3%) than in capped NCs (2%) (P < .001). Coagulase-negative staphylococci were the predominant isolates (88.4%). Intraluminal colonization was also higher in uncovered NCs (76% vs. 6%; P < .001). CONCLUSION:Alcohol-impregnated disinfecting caps significantly reduce microbial colonization of NCs and extension set lumens in pediatric oncology patients, suggesting their effectiveness in infection prevention.