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    Evaluation of Gram-negative hospital-acquired infections and antibiotic resistance in the pediatric intensive care unit
    (J Infection Developing Countries, 2025) Oezmen, Berfin oezgoekce; Senguel, Merve Tuerkeguen; Ozdem, Suna; Aldan, Sefika; Katlan, Banu
    Introduction: We retrospectively analyzed the frequency of healthcare-associated infections (HAIs), infection sites, Gram-negative microorganisms in the cultures, and antibiotic resistance patterns; recorded in the pediatric intensive care unit (PICU); between 2017 and 2023; based on the records in our hospital's infection control surveillance system. Our aim was to determine the state of infections over the years and the status of antibiotic resistance. Methodology: Medical records of PICU patients, between 1 January 2017 and 31 July 2023, whose cultures were identified to have Gramnegative bacterial growth, were evaluated retrospectively. Results: A total of 125 nosocomial infections were recorded. Pseudomonas aeruginosa and Klebsiella pneumoniae were the most frequently identified and had equal growth rates in blood culture. K. pneumoniae were most frequently identified in the central venous catheter (CVC). Mortality was significantly higher for patients with fungal growth, congenital diseases, and males (p < 0.05); except in patients with CVC. Patients with congenital diseases had a shorter median survival time (65 days) compared to chronic disease patients (151 days; p < 0.005). Cox regression analysis indicated that comorbidity was a significant risk factor for survival time. The risk of mortality was 3.074 times higher in patients with congenital disease compared with chronic disease patients (HR = 3.074; 95% CI: 1.577-5.995). Gender had a significant relationship with mortality; however, survival times did not differ between genders (p > 0.05). Conclusions: Gram-negative bacterial infections are becoming more prevalent in intensive care units, and effective control and prevention policies are needed for these infections.
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    Healthcare-associated Candida infections in neonates: A clinical perspective on risk and outcome
    (Sage Publications Inc, 2025) Ozmen, Berfin Ozgokce; Sengul, Merve Turkegun; Ozdem, Suna; Aldas, Sefika; Akcali, Mustafa; Simsek, Huseyin
    Objective: Healthcare-associated infections (HAIs) remain a major cause of morbidity and mortality in neonatal intensive care units (NICUs), particularly in preterm and low birth weight infants. Candida species are among the most frequently isolated fungal pathogens in this vulnerable population. Study Design: This retrospective study was conducted in a tertiary NICU in Turkey between January 1, 2015, and December 31, 2023. Daily active surveillance was used to detect HAIs. Neonates with Candida-positive blood cultures were identified. Demographic characteristics, clinical risk factors, laboratory findings, and treatment outcomes were analyzed. Results: Among 9065 neonates admitted to the NICU during the 9-year study period, 26 (0.28%) developed Candida bloodstream infections. The majority of affected infants were premature (84.6%) and had a birth weight <= 2500 g (80%), with 30.8% weighing <1000 g. Predisposing risk factors included: central venous catheter use (92.3%), total parenteral nutrition (96.2%), and exposure to broad-spectrum antibiotics (88.4%). The most frequently isolated species were Candida parapsilosis (46.2%) and Candida albicans (42.3%), while fluconazole resistance was detected in 15.4% of isolates. The overall mortality rate was 38.5%. The median hospital stay was 14.5 days. Conclusions: Candida bloodstream infections are a serious complication in NICUs, particularly among extremely low birth weight and premature infants. Invasive procedures and parenteral nutrition remain major risk factors. The observed high mortality rate and resistance patterns underscore the need for enhanced infection control measures and antifungal stewardship programs in NICUs.
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    Predictive value of systemic immune inflammation index for infections caused by healthcare in pediatric patients hospitalized to the burn unit
    (Nature Portfolio, 2025) Ozmen, Berfin Ozgokce; Senguel, Merve Turkegun; Aldas, Sefika; Ozdem, Suna; Ersoy, Murat
    The Systemic Immune-Inflammation Index is a measurement of the systemic immune-inflammatory response (SII), which is used as both a diagnostic and predictive index for many diseases. Burns are a major public health problem among children. Infection caused by burns is the most important cause of mortality in children. In this study aims to investigate the predictive and diagnostic performance of SII for infection for pediatrics at the burn center and the causes of burns and responsible microorganisms and possible risk factors on infection. Data were collected retrospectively from 42 pediatric patients between 2013 and 2023 and analyzed in the burn center. Infected and uninfected burn patients were compared. Scalds were the most common cause of burns in both groups, (91.3%; 87%, respectively). The most frequently isolated microorganism was Pseudomonas aeruginosa (52,6%). Central venous catheter use was the biggest risk factor for infection (OR = 8,077; 95% CI 1,523 to 42,834). The AUC value demonstrated an acceptable diagnostic performance (AUC = 0,605; 95% CI 0,450 to 0,746) Similarly, the odds ratio suggested a potential relationship between SII and infection (OR = 2,057; 95% CI 0,489 to 8,657), but both failed to reach statistical significance. The results of this investigation indicate limited predictive and diagnostic utility for SII. CRP performed better diagnostically than SII (AUC = 0,877; 95% CI 0,747 to 0,955), suggesting that traditional inflammatory markers may still be a better way to predict infection in pediatric burns. Moreover, substantial disparities in hemoglobin levels, lymphocyte counts, CRP, and procalcitonin between infected and uninfected groups indicate that a multi marker strategy may prove more efficacious than dependence on a solitary index. While the SII showed a tendency to predict infection in pediatric burn patients, it did not achieve statistical significance in our research. These findings highlight the need for larger-scale studies to clarify the role of SII in infection prediction among pediatric burn patients. Further research with larger cohorts or multicenter studies could help determine whether SII has clinical utility in this population. Also, accurate identification of infectious agents, development of effective treatment strategies, avoidance of prophylactic antibiotic use, and strict adherence to isolation precautions will significantly reduce the risk of infection in centers where burn patients are followed up.