Elif Böncüoğlu

Background: Cefiderocol is a novel siderophore-conjugated cephalosporin with activity against antimicrobial-resistant Gram-negative bacteria. Despite increasing off-label use in critically ill neonates and children, data on its safety and effectiveness remain limited. Methods: We performed a retrospective case series of neonatal and pediatric patients (≤18 years) who received off-label cefiderocol across 3 tertiary-care hospitals in Greece for suspected or documented infections due to multidrug-resistant Gram-negative bacteria. We also conducted a systematic review of pediatric cases published through June 2025. Results: Fifteen patients [median age 65 months (range 4–183)] received 21 cefiderocol courses. The systematic review identified 37 additional treatment courses (32 patients, 6 of them <3 months of age), primarily for bloodstream infections (86%), pneumonia (24.3%) and febrile neutropenia (18.9%). Most patients had received multiple antibiotics before and concomitantly with cefiderocol for extensively resistant Gram-negative bacteria. Clinical response occurred in 16/21 (76.2%) courses in the case series study and 22/28 (78.6%) courses in the systematic review. Microbiologic clearance was observed in 7/9 (78%) courses in the case series. Cefiderocol was well-tolerated without serious adverse events in all cases. Most isolates (14/18, 78%) were susceptible to cefiderocol according to current breakpoints, with a single instance of resistance emergence. Conclusions: This is the largest pediatric cohort to date combining real-world and published cefiderocol cases, suggesting that cefiderocol is a safe, well-tolerated and potentially effective option for severe, difficult-to-treat antimicrobial-resistant Gram-negative infections in neonates and children. These results support cautious off-label use in critically ill patients, while underscoring the urgent need for further pediatric trials.

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.

Background & objectives: Acute lower respiratory tract infections (LRTIs) are a major cause of morbidity and mortality in children under five years of age. Respiratory syncytial virus (RSV) is the leading viral pathogen in infants, yet empirical antibiotics are often prescribed due to difficulty distinguishing bacterial from viral infections. This study aimed to determine clinical, laboratory, and radiologic parameters influencing antibiotic continuation and to evaluate associated costs in RSV-positive infants. Methods: We retrospectively reviewed records of 209 hospitalized infants aged 1–24 months with RSV infection confirmed by multiplex polymerase chain reaction (mPCR) at a tertiary pediatric hospital between April 2017 and April 2021. Patients with co-infections or other exclusion criteria were omitted. Data on demographics, comorbidities, clinical features, laboratory and radiologic findings, treatments, and costs were analyzed. Multivariate logistic regression identified independent predictors of antibiotic continuation. Results: Overall, 69.4% of patients received antibiotics; intravenous β-lactams were most common. Prolonged antibiotic administration showed a significant relationship with elevated C-reactive protein (CRP) values both at the time of admission and at peak measurement (p = 0.003 and p = 0.001, respectively), as well as with the presence of alveolar infiltrates on chest radiographs (p = 0.016). Patients in whom antibiotics were continued had notably longer median hospital stays, extended antibiotic treatment durations, and higher treatment-related costs (all p < 0.01). Conclusions: Antibiotic continuation in RSV-positive infants was primarily driven by elevated CRP and radiologic findings, highlighting the need for evidence-based prescribing to reduce unnecessary antibiotic use and associated costs. Incorporating rapid molecular diagnostics into routine care may improve decision-making and support antimicrobial stewardship.

Background. Although the use of inflammatory markers in diagnosing Brucella-related complications has been the subject of research, studies on osteoarticular disease are insufficient, especially in children. This study aimed to compare inflammatory markers in children diagnosed with brucellosis, distinguishing between those with and without osteoarticular involvement (OI). Methods. In this retrospective study, patients diagnosed with brucellosis from 1 month to 18 years of age were evaluated. Data collected included age, gender, OI, treatment duration, complete blood count, inflammatory markers including neutrophil-monocyte ratio (NMR), monocyte-lymphocyte ratio, neutrophil-lymphocyte ratio, platelet-lymphocyte ratio, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR) and Brucella serum agglutination test (SAT) results. OI was confirmed by MRI in symptomatic patients. The results of patients with and without OI were compared. Results. The study included 38 patients, 23.7% having OI (8 with sacroiliitis and 1 with spondylitis). The median age of patients with OI was significantly higher than those without (p=0.037). All patients with OI (n = 9, 100%) had an SAT titer ≥ 1/640. Among patients without OI, 62% (n = 18) had an SAT titer ≥1/640. This difference was statistically significant (p = 0.028). Patients with OI had higher CRP levels (p=0.038) but similar ESR levels compared to those without. WBC levels were significantly lower in the group with OI (p=0.015). NMR was significantly higher in those with OI (p=0.012). Conclusions. Lower WBC counts and higher CRP and NMR levels can predict OI in children with brucellosis at the time of admission. However, our findings should be validated through prospective studies involving larger patient groups.

Challenges in Interpreting Cerebrospinal Fluid Viral Polymerase Chain Reaction Results: Understanding the Results Related to HHV-6, HHV-7, and Enterovirus - Journal of Dr. Behcet Uz Children's Hospital

Background: The severe acute respiratory syndrome coronavirus 2 is now part of our lives. Many children still experience post‐COVID respiratory conditions and require evaluation and follow‐up. Methods: Children referred to the Pediatric Pulmonology Department between 2021 and 2022, due to a history of COVID‐19 pneumonia with/without comorbid disease and respiratory complaints after COVID‐19, were prospectively followed up with pulmonary function tests at 3, 6, and 12 months. Results: The median age of 138 children was 14 years (1–18), 42 (30.4%) had comorbid conditions, and 40 (28.9%) had a history of COVID‐19 pneumonia. Respiratory symptoms after infection persisted in approximately 62% of children, and 28% of children who had no symptoms before infection were diagnosed with asthma ( N = 18, 13%), allergic rhinitis ( N = 5), anxiety and tic disorder ( N = 4), and other diseases ( N = 4). At admission, pulmonary function abnormalities were detected in 12% (N = 4 obstructive ventilatory pattern, N = 6 restrictive, and N = 2 mixed). Pulmonary functions were similar in children with and without persistent respiratory complaints (PRCs). At the 12‐month follow‐up, there were three children (2.1%) with PRC, and pulmonary function anomalies persisted in five children. A significant increase in pulmonary function was observed in both children with and without PRC. FEF _25‐75 , the indicator of small airways, was lower in children with PRC. Conclusions: This study suggested that COVID‐19 may have affected pulmonary function in children independently of respiratory symptoms and that this effect may be more severe in children with PRC. It is necessary to follow up and research examination and early intervention methods for post‐COVID conditions.

Urinary tract infections (UTI) are common bacterial infections in children. This study aimed to examine the relationships between different microorganisms and both clinical and laboratory findings in pediatric patients with UTIs. We conducted a retrospective evaluation of children with UTI between 2019 and 2024. Patients were divided into four main groups as normal anatomy, vesicoureteral reflux (VUR), ureteropelvic junction obstruction (UPJO), and neurogenic bladder (NB). Information on clean intermittent catheterization (CIC) and prophylactic antibiotic use was recorded. Laboratory results were compared across these patient groups. The study included 266 patients, with a female predominance (female/male ratio: 7.33). NB was the most common urinary tract condition (43.3%), followed by VUR (10.9%) and UPJO (9%). Prophylactic antibiotics were used by 9% of the patients. Acute phase reactants in patients with CIC were significantly higher (p=0.023 for white blood cell (WBC) and p=0.002 for C-reactive protein (CRP) levels). They were also higher in patients with prophylactic antibiotics compared to those without (p=0.001 for both). The most frequently detected bacteria in urine cultures were E. coli (65%), followed by Klebsiella spp. (18.8%), Pseudomonas spp. (7.5%), and Proteus spp. (4.9%). Klebsiella spp., Enterococcus spp., and Morganella spp. were not isolated from patients receiving prophylaxis (p=0.022). Risk factors for UTIs need to be carefully assessed for every patient, and treatment should be customized according to clinical and laboratory results. Individual patient factors should guide drug selection, and treatment plans should account for potential resistance patterns.