Objective: Stenotrophomonas maltophilia is an emerging multi-drug resistant, opportunistic pathogen in the neonatal intensive care unit (NICU). In this study, we aimed to assess the incidence, clinical features, antibiotic susceptibility, and treatment options of S. maltophilia infection among the healthcare-associated infections (HAIs) in the neonatal unit. Methods: In this study , the patients who were hospitalized in the NICU between January 2020 and December 2021 with S. maltophilia isolated from clinical samples were included. Demographic, clinic features, and microbiological findings of the patients were retrospectively evaluated by using the medical records. The samples (lower respiratory tract, urine, peritoneal fluid) were first examined microscopically by gram preparation and cultured. Antibiotic susceptibility tests were performed according to the recommendations of The European Committee on Antimicrobial Susceptibility Testing (EUCAST) for TMP-SMX. Results: S. maltophilia was isolated in 38 clinical samples of the 20 patients who were hospitalized at the NICU between January 2020 and December 2021. A total of 40 % (n = 8) of samples from different patients were accepted as colonization. Ventilator-associated pneumonia was determined in 55 % (n = 11), and urinary tract infection in 5 % (n = 1). S. maltophilia -associated bacteremia was not detected in any of the cases. The TMP-SMX susceptibilities of the strains were as it follows: 3 (15 %) were resistant (R), 7 (28 %) were susceptible (S), and 10 (47 %) were susceptible-increased exposure (I). Three of these patients were given dual antibiotics therapy (levofloxacin plus TMP-SMX) and nine of them were given only TMP-SMX. The most common hospital-acquired infectious agents are Gram negative microorganisms (51 %), followed by coagulase negative staphylococci (CNS), Staphylococcus aureus (24 %) and S. maltophilia (24 %). Conclusion: Increasing TMP-SMX resistance and specific drug and dosage-related problems in the neonatal unit are important problems in treatment management.

Aim. This study aimed to describe barriers and facilitators of the adherence of children with human immunodeficiency virus (HIV) to antiretroviral therapy (ART) from the perspectives of their caregivers. Methods. In-depth interviews were held with the caregivers of 15 children. The collected data were analyzed using thematic analysis procedures. The Consolidated Criteria for Reporting Qualitative Research (COREQ) were followed in the study. Results. The perspectives of caregivers were categorized under four themes and subthemes. Barriers and facilitators of the adherence of children with HIV to ART were categorized into 4 main themes: (1) medication-related, (2) child-related, (3) caregiver-related, and (4) health system-related. The results indicated that understanding the factors that influence pediatric ART adherence is critical to the development of adequate strategies. In addition, disclosure of HIV status to the child is also an important factor affecting drug administration in the social environment. Conclusions. To ensure adherence to lifelong ART, targeted caregiver support through continuous supervision, clear guidance on drug preparation, and strategies for effective administration should be integrated into context-specific interventions that address the combined influence of factors related to the child, medication, healthcare, and of the sociocultural environment.

Although COVID-19 (Coronavirus disease-2019) is observed to be milder in children, it has been observed that the symptoms continue for a long time in many people after the acute period of the disease, especially the multisystemic inflammatory syndrome (MISC) that developed after COVID-19 with the progression of the pandemic. Although it was first defined by different names such as long COVID and post COVID in adults, it has been observed in studies that similar complaints such as cough, fatigue and difficulty in concentrating continue for a long time in children, just as in adults. In our study, we aimed to evaluate the status of long COVID in childhood. Our study included patients aged from one month to 18 years with moderate and severe symptoms who were hospitalized and discharged for SARS-CoV-2 infection in İstanbul University Faculty of Medicine between November 1, 2020 and November 1, 2021. A questionnaire form was created to learn about the complaints of the patients and their ongoing complaints. The patients/parents were called by phone and their complaints were recorded in the questionnaire. The patients were classified according to the definitions in the guidelines published by NICE, RCGP and SIGN. In total, 116 patients were included; 57.8% (n= 64) male, 42.5% (n= 49) female; 53.4% (n= 62) 0-9, 46.6% (n= 54) 10-18 years old. Comorbid conditions were found in 64 (55.2%) patients. The mean follow-up period was 5.90 ± 3.61 [min-max (1-12)] months; longest symptom durations: decrease in effort loss/fatigue 19.25 ± 74.56 (0-365) days, concentration difficulties 11.12 ± 49.75 (0-365) days, fatigue 9.61 ± 34.96 (0-365) days and cough were 8.34 ± 35.37 (0-365) days. The percentage of the patients who met the definition of subacute/ongoing symptomatic COVID-19 was 37.9% (n= 44). The most common symptoms were the decrease of effort capacity/fatigue 12.1% (n= 14) and the concentration difficulties 10.3% (n= 12) in subacute symptomatic patients. The percentage of patients matching the definition of chronic/post COVID-19 was 11.2% (n= 13). In the first year of the disease, ongoing complaints such as fatigue and concentration difficulties were observed in eight patients. The rate of concentration difficulties in the 10-18 age group was statistically significantly higher than the 0-9 age group (p= 0.037). In terms of other symptoms, no significant difference was found according to age, gender and concomitant disease status. Out of these, one patient was diagnosed with Type 2 diabetes mellitus during the acute illness, and two patients were diagnosed with allergic rhinitis after COVID-19. A statistically significant difference was found in the rates of concentration disorders according to age groups with subacute/ongoing symptoms. Although only the hospitalized patients were included, fatigue and difficulty in concentration were among the most common ongoing symptoms in our study, similar to the literature, and they were seen to be more common in older children. It is important both for early diagnosis and awareness to follow up children with COVID-19 in terms of symptoms, not only in terms of prolonged symptoms but also in terms of new diseases.

Background/Objectives: Patients with rheumatic diseases have an increased burden of infection owing to biological disease-modifying antirheumatic drug (bDMARD) therapy. Therefore, vaccination is crucial for the prevention of infection in these patients. In this case–control study, we aimed to evaluate vaccine response to hepatitis B, pneumococcus, and measles using antibody titers in patients undergoing biological therapy. Methods: This study included 16 patients aged 5–18 years of age who received bDMARD treatment and 20 healthy controls. Serum samples of the patients were collected at baseline and subsequently on the 3rd and 6th months after bDMARD therapy, and IgG antibodies against pneumococcal capsular polysaccharide antigen (PCP), measles, and hepatitis B were measured. Results: There were no statistically significant differences in mean anti-HBsAg, anti-PCP, and anti-measles antibody titers between the study and control groups. The percentages of patients with anti-HbsAg, anti-PCP, and anti-measles protective antibodies were 68.8% (n = 11/16), 100% (n = 16/16), and 56.25% (n = 9/16), respectively. There were no statistically significant differences in the mean antibody titers at baseline and 3rd month. Only the anti-measles IgG titer level decreased below 200 (mIU/mL) in one patient in the 3rd month and in two patients in the 6th month. Conclusions: Patients with low or declining hepatitis B and measles antibody titers before or during bDMARD treatment may require close monitoring to ensure adequate protection against vaccine-preventable diseases. Regular screening and follow-up are essential in this patient population.

Objective Although coronavirus disease 2019 (COVID-19) is mainly a respiratory system disease, many hematological abnormalities have been reported. Due to the application of primary immunization in infancy, our study aimed to examine the relationship between lymphopenia frequency and duration of lymphopenia in infants with COVID-19. Methods The files of infants hospitalized with the diagnosis of COVID-19 in the Pediatric Pandemic Service of Istanbul Medical Faculty between January 2020 and October 2022 were evaluated retrospectively. Demographic characteristics, leukocyte, lymphocyte count, comorbidity, hospitalization, and lymphopenia recovery time were recorded. Results In this study, 93 infants with COVID-19 were included. Lymphopenia was detected in 62 of these patients (n = 62/93, 66.7%). The 47.3% of the patients were female (n = 44) and the mean age was 6 ± 3.42 months. Comorbidities were detected in the 33% of the patients. Lymphopenia resolved in an average of 11 days. While the mean hospitalization period of patients with lymphopenia was 3.6 ± 2.9 (minimum: 1 and maximum: 15) days, the mean hospitalization period of patients without lymphopenia was 2.5 days. Leukopenia (p: 0.014) and lymphopenia (p: 0.005) were more common in infants with chronic disease. Similarly, the duration of hospitalization and recovery from lymphopenia were statistically significantly longer (p: 0.016). A statistically significant correlation was found between the duration of lymphopenia recovery and the duration of hospitalization (p: 0.001). Conclusion Although we found lymphopenia as a common finding in infancy in our study, it was not observed frequently enough to require the postponement of the vaccination program due to its short duration. Vaccination should not be delayed due to lymphopenia in infants with COVID-19 to avoid a missed opportunity for vaccination.

Purpose: The COVID-19 pandemic has had a significant impact on solid organ transplantation (SOT), creating challenges in clinical management and contributing to substantial morbidity and mortality. By presenting our experience with immunosuppressive therapy management during COVID-19 infection in liver and kidney transplant recipients followed at our center, we want to raise awareness among transplant physicians about the effects of COVID-19 and discuss their management.Methods: The files of patients who were followed up with a diagnosis of COVID-19 at the Istanbul Faculty of Medicine Pediatric Pandemic Service and outpatient clinic between January 2020 and January 2023 were retrospectively evaluated. Demographic characteristics, transplantation characteristics, immunosuppression treatments, COVID-19 severity, and laboratory parameters were evaluated.Results: Thirty children diagnosed with COVID-19, with a history of liver and kidney transplantation, were included in the study. Twenty-one of these patients (n = 21, 70%) were liver transplant recipients and 9 (n = 9, 30%) were kidney transplant recipients. A total of 53.3% of the patients were male (n = 16) and the mean age was 10.1±4,85 years. Mild-to-moderate disease was observed in 93.3% patients. The rate of comorbidities, such as hypertension, obesity, and chronic lung disease, was 16.7%, and the hospitalization rate was significantly higher in these patients (p = 0.014). Of the nine patients whose immunosuppressive treatment was discontinued, three were kidney transplant recipients and six were liver transplant recipients; there was no statistically significant difference between them in terms of treatment discontinuation (p = 1,000). Patients in whom immunosuppressive treatment was discontinued had a significantly higher rate of severe disease (p = 0.049). Myocarditis was detected in one kidney transplant patient. No mortality was observed in any patient. The COVID-19 vaccination rate among patients was 13% (n = 4/30).Conclusions: Pediatric liver and kidney transplant recipients generally experienced mild COVID-19 courses without mortality. Comorbidities were associated with hospitalization. Severe disease was linked to immunosuppressive discontinuation, particularly mycophenolate mofetil. Our findings highlight the importance of individualized immunosuppression management during COVID-19 in pediatric transplant recipients.