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KEPENEKLİ KADAYİFCİ, EDA

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Tıp Fakültesi

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KEPENEKLİ KADAYİFCİ

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Open Access
Effect of video camera monitoring feedback on hand hygiene compliance in neonatal intensive care unit, an interventional study
(2023-01-02) SİLİ, ULUHAN; MEMİŞOĞLU, ASLI; ÖZEK, EREN; KEPENEKLİ KADAYİFCİ, EDA; Bilgin H., SİLİ U., Pazar N., Kucuker I., Kepenekli E., Yanar M. A., MEMİŞOĞLU A., ÖZEK E., Adhikari N. K., Pinto R., et al.
Background: The purpose of this study was to determine whether use of a video camera surveillance system for hand hygiene (HH) monitoring, video-based education, and feedback could improve the HH compliance in a neonatal intensive care unit (NICU). Methods and materials: This was an interventional before-after trial conducted in a level-III NICU between July 2019 and June 2020. HH compliance was measured using randomly selected video-camera footage in the baseline, intervention, and maintenance periods. After the baseline, an intervention consisting of feedback and education with video scenarios was implemented. The primary outcome was change in HH compliance. The compliance rates were analyzed as an interrupted time series (ITS) with a segmented regression model adjusted for autocorrelation for each study period. Results: We identified a total of 8335 HH indications. There were non significant increases in the total compliance rate (9.0%, 95% CI -2% to 20%) at the time of intervention and in the compliance rate after intervention (0.26%, 95% CI -0.31% to 0.84%) per day. The hand hygiene compliance before patient contact significantly increased (19.8%, 95% CI, 4.8%-34.8%). Incorrect glove use improved non-significantly with the intervention (-3.4%, 95% CI -13.4% to 6.7%). Conclusion: In this study of HH monitoring using video-camera footage combined with an intervention including feedback and education, there were inconsistent improvements in HH compliance. However, these improvements were not sustained in the long term. Frequent feedback and education may be required to sustain high compliance.
Open Access
Healthcare-associated staphylococcus aureus infections in children in Turkey: A six-year retrospective, single-center study
(2023-08-01) İLKİ, ZEYNEP ARZU; KEPENEKLİ KADAYİFCİ, EDA; Yakut N., Ergenç Z., Tuncay S. A., Bayraktar S., Sayın E., İlki Z. A., Kepenekli Kadayifci E.
Objective: To describe clinical and epidemiological characteristics, antimicrobial susceptibility and mortality-associated factors of healthcare-associated infections (HCAIs) caused by Staphylococcus (S.) aureus in children. Methods: We conducted a retrospective, single-centre study of pediatric HCAIs caused by S. aureus from a tertiary care hospital in Turkey between February 2014 and December 2019. The clinical and epidemiological characteristics and antimicrobial susceptibility of the methicillin-susceptible and methicillin-resistant S. aureus (MSSA and MRSA) isolates was evaluated. Results: A total of 310 pediatric patients were examined. Overall, 225 (72.6%) isolates were MSSA and 85 (27.4%) were MRSA. All S. aureus isolates were susceptible to teicoplanin, vancomycin, linezolid, tigecycline, mupirocin, and daptomycin. Penicillin resistance rates were high (89.0%), while fosfomycin, gentamicin, and clindamycin resistance rates were low (1.3%, 1.0%, and 2.3%, respectively). Except susceptibility to fosfomycin, which was significantly lower in 2014 compared to 2018 and 2019, no significant difference was found in the antimicrobial susceptibility of S. aureus isolates between the years. Baseline characteristics and mortality rate were similar comparing MRSA and MSSA causing HCAIs. The mortality rate of HCAIs caused by S. aureus was 6.5% (20 patients). Malignancy was an independent risk factor associated with mortality in the multivariate analysis (OR 5.446, 95% CI 1.573- 18.849). Conclusions: Our findings demonstrate that MSSA remained the most causative agent of HCAIs caused by S. aureus. The mortality rate was 6.5%, the antibiotic resistance rate was quite high for penicillin and diagnosis of malignancy was the main risk factor for increasing mortality in children. These findings could help improve the management of HCAIs caused by S. aureus in children.
Open Access
Successful treatment of fasciola hepatica with metronidazole in a child: A case report
(2022-11-01) KEPENEKLİ KADAYİFCİ, EDA; YAPICI, ÖZGE; BATU, UTKU; TUTAR, ENGİN; Ergenç Z., Kepenekli Kadayifci E., Yakut N., Yapıcı Ö., Batu U., Tutar E.
Fasciola hepatica is a zoonotic liver trematode that usually causes infection in cattle and sheep, and is transmitted to humans by consuming water and aquatic plants contaminated with metacercaria. The detection of Fasciola eggs in stools, serological evaluation and radiological evaluation are essential for diagnosis. Triclabendazole is the first-line therapy for fascioliasis. However, as triclabendazole is not an easily accessible drug in countries such as Turkey, it reveals a quest for alternative therapies. In this report, we present a 10-year-old boy with fascioliasis successfully treated with a course of metronidazole 1.5 g/ day for 3 weeks in 2020. During the follow-up, eosinophilia and radiological findings completely recovered. Here we report a case of pediatric fascioliasis that was cured with metronidazole successfully.
Open Access
Healthcare-associated Staphylococcus aureus infections in children in Turkey: A six-year retrospective, single-center study
(2023-08-01) SAYIN, ELVAN; İLKİ, ZEYNEP ARZU; KEPENEKLİ KADAYİFCİ, EDA; Yakut N., Ergenc Z., Aslan Tuncay S., Bayraktar S., Sayin E., Ilki Z. A., Kepenekli Kadayifci E.
Objective: To describe clinical and epidemiological characteristics, antimicrobial susceptibility and mortality-associated factors of healthcare-associated infections (HCAIs) caused by Staphylococcus (S.) aureus in children. Methods: We conducted a retrospective, single-centre study of pediatric HCAIs caused by S. aureus from a tertiary care hospital in Turkey between February 2014 and December 2019. The clinical and epidemiological characteristics and antimicrobial susceptibility of the methicillin-susceptible and methicillin-resistant S. aureus (MSSA and MRSA) isolates was evaluated. Results: A total of 310 pediatric patients were examined. Overall, 225 (72.6%) isolates were MSSA and 85 (27.4%) were MRSA. All S. aureus isolates were susceptible to teicoplanin, vancomycin, linezolid, tigecycline, mupirocin, and daptomycin. Penicillin resistance rates were high (89.0%), while fosfomycin, gentamicin, and clindamycin resistance rates were low (1.3%, 1.0%, and 2.3%, respectively). Except susceptibility to fosfomycin, which was significantly lower in 2014 compared to 2018 and 2019, no significant difference was found in the antimicrobial susceptibility of S. aureus isolates between the years. Baseline characteristics and mortality rate were similar comparing MRSA and MSSA causing HCAIs. The mortality rate of HCAIs caused by S. aureus was 6.5% (20 patients). Malignancy was an independent risk factor associated with mortality in the multivariate analysis (OR 5.446, 95% CI 1.573- 18.849). Conclusions: Our findings demonstrate that MSSA remained the most causative agent of HCAIs caused by S. aureus. The mortality rate was 6.5%, the antibiotic resistance rate was quite high for penicillin and diagnosis of malignancy was the main risk factor for increasing mortality in children. These findings could help improve the management of HCAIs caused by S. aureus in children.
Open Access
Frequency and safety of COVID-19 vaccination in children with multisystem inflammatory syndrome: a telephonic interview-based analysis.
(2022-10-01) KEPENEKLİ KADAYİFCİ, EDA; Aykac K., Ozturk K., Demir O. O., Gumus D. D., Aslan S., Cem E., Celebi M. Y., Karabacak M. D., Alkan G., Aksoy F. D., et al.
Coronavirus disease 2019 (COVID-19) vaccines are currently approved or authorized to prevent serious outcomes, such as severe disease, hospitalization, and death. The Pfizer- BioNTech vaccine is recommended for everyone aged five and older in the United States (US) to prevent severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection [1, 2]. However, it is unclear whether children with a history of multisystem, inflammatory syndrome in children (MIS-C) may be at risk for a MIS-like response following COVID-19 vaccination or SARS-CoV-2 reinfection [2]. Therefore, physicians remain uncertain about vaccinating children with a history of MIS-C. This study investigates the occurrence of severe, systemic side effects of COVID-19 vaccines and the recurrence of the MIS-C symptoms in children with a history of MIS-C to overcome vaccine hesitancy. We recruited children with a history of MIS-C diagnosed between April 2020 and December 2021 in seven hospitals in different regions of Turkey. Our study included three groups of children: (1) those with a history of MIS-C who met the US Center for Disease Control (CDC) or World Health Organization definitions for MIS-C [3, 4]; (2) those with a history of severe/critical COVID-19 [5]; (3) and those visiting hospitals for another reason and had no history of severe/ critical COVID-19 or MIS-C (controls). Children were called by phone and were asked to complete a questionnaire. We checked their vaccination status in the mobile application developed by the Republic of Turkey Ministry of Health to inform and guide citizens about COVID-19. Turkey authorized the Pfizer-BioNTech (mRNA) and Sinovac (inactivated virus) vaccines only for children aged 12 years or older. We developed a questionnaire including questions adopted from previous studies and new questions related to vaccine side effects reported by the CDC [6, 7]. Children with a MIS-C and severe/critical COVID-19 diagnosis and children without a MIS-C or severe/critical COVID-19 history were called by phone and were asked a standard set of questions that included their age, gender, and COVID-19 vaccination status. If the child had received a COVID-19 vaccination, we asked about the date of vaccination, the brand of the vaccine given, doses, side effects experienced (including their date and duration), polyclinic visit, and hospitalization. Children were asked about local and systemic reactions. Parents were asked questions about factors affecting their vaccination decision, including infection or reinfection anxiety in their family, information disseminated via social media, and advice from schools, friends, doctors, and the healthcare ministry.
Open Access
Investigation of oral and fecal colonization with candida species and associated factors in human immunodeficiency virus-infected children in Turkey
(2023-03-01) KEPENEKLİ KADAYİFCİ, EDA; Bilgi E. A., Genc G. E., Kara M., KEPENEKLİ KADAYİFCİ E., Torun S. H., BAYDEMİR C., Somer A., Agacfidan A., Erturan Z.
Objective The risk of endogenous infections in human immunodeficiency virus (HIV)-infected individuals increases with Candida species colonized in mouth and intestinal areas. The predisposing factors for colonization and the prevalence of different Candida spp. in HIV-infected Turkish children remain unknown. This study aimed to determine the colonization frequency and risk factors of colonization with Candida species in oral and fecal samples of HIV-infected pediatric patients in relation to a control group.Methods Oral and feces samples of 22 HIV-infected and 52 healthy children were plated onto CHROMagar and CHROM-Pal-agar. Yeasts were identified by conventional methods, and strains with insufficient identification were identified by molecular techniques.Results Candida spp. were detected in oral/fecal samples of 50%/68.2% HIV-infected and 36.5%/73.1% healthy children. The most common species was Candida albicans in oral and fecal samples of HIV-infected (31.8 and 31.8%) and healthy (26.9 and 48.1%) children. The most frequently non-albicans species in oral samples was Candida dubliniensis (18.2%) in HIV-infected children and Candida parapsilosis (3.8%) in healthy children. In feces samples, C. parapsilosis , Candida glabrata , and Candida krusei were most frequent (13.6%, each) in HIV-infected patients, and Candida kefyr (11.5%) was most frequent in controls. There was a significant association between oral C. dubliniensis colonization and HIV infection ( p = 0.006). Yeast carriage was not associated with gender and viral load in HIV-infected patients.Conclusion The isolation of C. dubliniensis from oral and fecal samples of pediatric HIV patients was done for the first time in Turkey in the present study. Additional studies are needed to clarify the factors associated with oral and fecal Candida colonization in these children.
Open Access
Multisystem inflammatory syndrome in children associated with covid-19 in 101 cases from Turkey (Turk-MISC study)
(2022-06-01) KEPENEKLİ KADAYİFCİ, EDA; YAKUT, NURHAYAT; Yilmaz Ciftdogan D., Ekemen Keles Y., Karbuz A., ÇETİN B. Ş., Elmas Bozdemir S., KEPENEKLİ KADAYİFCİ E., Metin Akcan O., Ozer A., Erat T., Sutcu M., et al.
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 mu g/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.
Open Access
Cost and length of hospital stay for healthcare facility-onset clostridioides difficile infection in pediatric wards: a prospective cohort analysis
(2021-11-01) KEPENEKLİ KADAYİFCİ, EDA; Demir S. O., KEPENEKLİ KADAYİFCİ E., Akkoc G., Yakut N., Soysal A.
Background. Clostridioides difficile (C. difficile) is a well-known causative agent of healthcare associated infection, it increases medical cost besides increasing morbidity and mortality. This study was conducted to determine the incidence, and economic burden of healthcare facility-onset C. difficile infection (HO-CDI) in children. Methods. Data was acquired with a prospective cohort study conducted in pediatric wards of a tertiary university hospital between August 2015 to August 2016. The HO-CDI was defined as diarrhea that began after 48 hours of admission with a positive cytotoxic stool assay for the presence of toxin A and/or B of C. difficile. Results. In the 3172 admissions in one year, 212 (7%) healthcare associated diarrhea (HAD) episodes were observed, in 25 (12%) of them C. difficile was identified in which 6 (25%) cases <2-year-old. The incidence of HOCDI was estimated as 8.8/10,000 patient-days. Cases with HO-CDI (n=19) were compared with cases with nonCDI-HAD (n=102); the presence of one of the risk factors for CDI increased the risk for HO-CDI (5,05; 95% Cl: 1.10-23.05; P 0,037), the median length of stay (LOS) attributable HO-CDI was 7 days (IQR,5-10) per admission, whereas for non-CDI-HAD was 2 days (IQR,0-4) (p=0.036). General hospitalization costs in the two groups were similar, specifically estimated costs attributable to HO-CDI and non-CID-HAD were $294.0 and $137.0 per Conclusion. Although in children the incidence of HO-CDI is increasing, its clinical manifestation is still milder and effective infection control measures with antibiotic stewardship can limit related morbidly, mortality, LOS, and cost.
Open Access
Single-center experience in vaccination of children in special risk groups: A multidisciplinary institutional consensus protocol
(2023-09-01) BARIŞ, HATİCE EZGİ; KEPENEKLİ KADAYİFCİ, EDA; ÜTÜK, BURAK; ŞAHİN, PINAR; TOKUÇ, AYŞE GÜLNUR; KOÇ, AHMET; AYDINER, ELİF; BORAN, PERRAN; BARIŞ H. E., Kepenekli E., Sakar F. İ. A., ÜTÜK B., ŞAHİN P., Ergenç Z., TOKUÇ A. G., KOÇ A., Karakoç-Aydıner E., BORAN P.
Objective: Despite marked improvements in the accessibility of childhood vaccines, knowledge gaps remain about the vaccination of children in special risk groups (SRG). This study aimed to analyze the clinical data of children vaccinated in SRG in a single-center unit to contribute to the clinical evidence for the specific planning of immunization of children in SRG. The secondary aim is to present institutional consensus on the vaccination of children in SRG. Materials and Methods: This retrospective study was conducted at a single-center pediatric vaccination clinic. Patient charts between 2018 and 2021 were retrospectively reviewed, and clinical and laboratory data were extracted. Serial joint meetings with multiple healthcare pro-fessionals were performed to develop an institutional protocol for vaccination. Results: There were 479 children vaccinated between 2018 and 2021 for reasons such as post-chemotherapy, after hematopoietic stem cell transplantation, before/after solid organ trans-plantation, allergies, and chronic diseases. Of these, 298 (62.2%) children vaccinated in the unit due to a history of food or vaccine allergies were excluded. One hundred eighty-one children were vaccinated at a median age of 11 [7-15] years. Most children were vaccinated after treatment for malignancies. Solid tumors were the most frequent malignancy (67%), followed by acute lymphoblastic leukemia (29.0%) and acute myeloid leukemia (4.0%). Institutional vaccination protocols for cancer survivors, hematopoietic stem cells, and solid organ recipient children were developed and presented. Conclusion: There is a need to prepare national guidelines for vaccinating children with altered immunocompetence. Sharing vaccination practices by multidisciplinary vaccination units might increase and provide knowledge to develop national policies.