During the study period, 511 pediatric patients including 296 male (56.9%) and 315 (43.1%) female cases were evaluate The median age of the patients was 2.2 years (min:1 month-max:18 years). Indications for hospitalization were as follows: lower respiratory tract infection in 110 (21.2%), gastrointestinal system diseases in 52 (10.2%), congenital heart diseases, shunt replacement scheduled for surgery in 50 (10.2%), chronic diseases in 46 (9%), neurological diseases in 102 (20%) and malignancies in 97 (19%) patients. A total of 145 patients (28.4%) did not have any underlying disease.
Intravascular catheter was used in 215 (42.1%), surgical intervention was performed in 88 (17.2%), and ventriculoperitoneal shunt was used in 19 (3.7%). patients The median duration of catheteization was 19 days (min:1-max:168). The median length of hospital stay of the patients was 14 days (min:1 max:168 days) (Table 1).
The highest rate of blood cultures was obtained in 312 (61.1%) patients due to febrile episodes, followed by indications of hospitalization in 97 (19%), increased acute phase reactants in 38 (7.4%), worsening of clinical conditions in 26 (5.1%) patients.
Growth of following isolates was detected in culture media of indicated number of patients: S. epidermidis (n: 299 ;58.5%), S. hominis ( n:206;40.3% ) S. haemolyticus (n:71; 13.9%), and S. capitis (n:31; %6,1) (Table 2). Among all CoNS species, antibacterial resistance was detected against ciprofloxacin (43.2% :200/463), clindamycin (57.6% :204/495), gentamicin (40.8%; (160/392), linezolid (2%; 7/353), teicoplanin (4.5%;8/178), vancomycin (1.1% ;5/469), erythromycin (81.7%;405/496), and methicillin (36.8%; 188/511) at indicated rates. Resistance against methicillin treatment was detected in patients where S. epidermidis (37.8% ;n:113/511), S. hominis (35.4% n:73), S. haemolyticus (49.3%:n:35) were grown in culture media (figüre 1). Growth of CoNS in culture media was due to contamination in 420 (82.2%), blood stream infection in 55 (10.8%), catheter- related blood stream infection in 36 (7%) patients. When the demographic, laboratory and other clinical conditions of the patients with catheter-related bloodstream infection (CRBSI) and bloodstream infection (BSI) and those considered as contamination were compared, the mean age of the patients with CRBSI/ BSI was 1.6 years, while it was 2.4 years in the group of patients considered as having contamination in their cultures(p = 0.16). Regarding gender, there was no statistically significant difference between the two groups. Febrile episodes were seen at a significantly higher rate in the CRBSI/BSI group than in the contamination group (72.5% vs. 59%; p = 0.017). There was no statistically significant difference between the two groups in terms of the underlying diseases. When the presence of antibiotherapy before bacterial growth in the cultures of the patients was evaluated, statistically significantly higher number of patients received antibiotherapy in the CRBSI/BSI group (100% vs. 81.2%, respectively; p < 0.001). There was no statistically significant difference in CRP and white blood cell counts between the two groups (p = 0.64 and p = 0.48, respectively) (Table 3).
Intravascular catheters were used significantly more frequently in the CRBSI/BSI group (76.9% vs. 34.5%; p < 0.001). Intravascular catheters removed due to bacterial growth in statistically significantly higher number of patients in the CRBSI/BSI group (37.4% vs. 1%; p:<0.001). Greater number of patients in the CRBSI/BSI group were receiving total parenteral nutrition compared to the contaminated group (8.8% vs. 1.4%; p:0.001). There was no statistically significant difference between the two groups in terms of the presence of ventriculoperitoneal shunt, CT shunt, pacemaker and prosthetic joint. However, patients with hemodialysis-peritoneal dialysis catheters were more numerous in the CRBSI/BSI group (4.4% vs. 1%, respectively). The duration of hospitalization was longer in the CRBSI/BSI group (median: 23 days vs. 12 days, respectively; p < 0.001). Antibiotherapy changed at significantly higher rate based on antimicrobial susceptibility test results in the CRBSI/BSI group (52.7% vs. 0.5%; p < 0.005). There was no statistically significant difference in mortality rates between the two groups (p > 0.99). (Table 3)
In our study, when the CoNS species in the CRBSI/BSI group and the patients considered as having contamination were compared, S. epidermidis which was isolated most frequently in the CRBSI/BSI group (69.2% vs. 56.2%; p:0.002). S. haemolyticus was the third most frequent isolate in our cultures and was more frequently identified in the CRBSI/BSI group (27.5% vs. 11%; p < 0.001. S. cohnii grew at a higher rate in the CRBSI/BSI group (3.3% vs. 0.5%; p = 0.042). There was no statistically significant difference between the groups in terms of bacterial growth rates of other species (Table 5).