Management of multidrug-resistant Acinetobacter baumannii (MDRAB) meningitis/ventriculitis is a difficult therapeutic problem owing to the limited penetration of antibiotics into cerebrospinal fluid (CSF). A 2-month-old girl with ventriculitis caused by MDRAB is reported. Despite therapy with intravenous (IV) colistin ventricular fluid, cultures remained positive for MDRAB. Institution of combination therapy with IV and intraventricular colistin resulted in a successful clinical and microbiological outcome. Intraventricular/intrathecal and IV colistin might be the best therapeutic option in the treatment of central nervous system infection caused by MDRAB. Further studies are required to evaluate pharmacokinetic and pharmacodynamic parameters of combined IV and intraventricular/intrathecal colistin administration, especially in children.

Background: Urinary tract infections (UTIs) are a problem frequently encountered by paediatric healthcare providers. Recent data suggest that extended-spectrum β-lactamase (ESBL)-producing bacteria are an emerging cause of UTIs in non-hospitalized patients. We report our experience of ertapenem use in 50 patients with complicated UTIs, mainly pyelonephritis, caused by ESBL-producing organisms. Methods: Fifty patients aged <16 y who had a complicated UTI caused by ESBL-producing organisms and who were treated with ertapenem at our hospital from 1 January 2009 to 31 December 2009, were included in the study. Results: There were 20 (40%) males and 30 (60%) females with a mean ± standard deviation age of 38.6 ± 36.9 months (range 6–156 months). Twenty-eight patients had no urological abnormality. In 40 patients ertapenem was initiated after results of microbiological cultures became available. Ertapenem was initiated empirically for 10 patients known to be colonized with ESBL-producing bacteria. Urine cultures were negative at 3.3 ± 0.7 days (range 2–5 days) after starting ertapenem treatment. The mean duration of ertapenem treatment was 7.8 ± 1.2 days (range 7–14 days). No laboratory or clinical side effects were observed. Conclusions: Ertapenem is promising for the culture-guided treatment of ESBL-producing Gram-negative complicated UTIs. Well-designed prospective studies are needed to define the role of ertapenem in treating complicated paediatric UTIs, especially upper UTIs.

Aim: Multisystem inflammatory syndrome in children (MIS‐C) may cause shock and even death in children. The aim of this study is to describe the clinical features, laboratory characteristics and outcome of children diagnosed with MIS‐C in 25 different hospitals in Turkey.Methods: The retrospective study was conducted between 8 April and 28 October 2020 in 25 different hospitals from 17 cities. Data were collected from patients' medical records using a standardised form. Clinical and laboratory characteristics and outcomes according to different age groups, gender and body mass index percentiles were compared using multivariate logistic regression analysis.Results: The study comprised 101 patients, median age 7 years (interquartile range (IQR) 4.6–9.3); 51 (50.5%) were boys. Reverse‐transcriptase polymerase chain reaction (PCR) assay was positive in 21/100 (21%) patients; 62/83 (74.6%) patients had positive serology for SARS‐CoV‐2. The predominant complaints were fever (100%), fatigue (n = 90, 89.1%), and gastrointestinal symptoms (n = 81, 80.2%). Serum C‐reactive protein (in 101 patients, median 165 mg/L; range 112–228), erythrocyte sedimentation rate (73/84, median 53 mm/s; IQR 30–84) and procalcitonin levels (86/89, median 5 μg/L; IQR 0.58–20.2) were elevated. Thirty‐eight patients (37.6%) required admission to intensive care. Kawasaki disease (KD) was diagnosed in 70 (69.3%) patients, 40 of whom had classical KD. Most patients were treated with intravenous immunoglobulin (n = 92, 91%) and glucocorticoids (n = 59, 58.4%). Seven patients (6.9%) died.Conclusion: The clinical spectrum of MIS‐C is broad, but clinicians should consider MIS‐C in the differential diagnosis when persistent fever, fatigue and gastrointestinal symptoms are prominent. Most patients diagnosed with MIS‐C were previously healthy. Immunomodulatory treatment and supportive intensive care are important in the management of cases with MIS‐C. Glucocorticoids and intravenous immunoglobulins are the most common immunomodulatory treatment options for MIS‐C. Prompt diagnosis and prompt treatment are essential for optimal management.