scholarly journals 698 ENDOLUMINAL VACUUM THERAPY (EVT) AS A TREATMENT FOR ESOPHAGEAL LEAKS; 10-YEARS’ EXPERIENCE FROM A TERTIARY UK ESPHAGOGASTRIC CENTRE

2021 ◽  
Vol 34 (Supplement_1) ◽  
Author(s):  
Zeeshan Afzal ◽  
Stavros Gourgiotis ◽  
Richard Hardwick ◽  
Peter Safranek ◽  
Vijay Sujendran ◽  
...  
Keyword(s):  
Ad Hoc ◽  
Length Of Hospital Stay ◽  
Median Number ◽  
Apache Ii Score ◽  
Vacuum Therapy ◽  
Delayed Presentation ◽  
Median Length ◽  
Vacuum Device ◽  
Successful Resolution ◽  
Management Challenge

Abstract   Esophageal leaks present a significant management challenge, especially in patients with delayed presentation and established sepsis. Endoluminal vacuum therapy (EVT) is an emerging treatment strategy which may reduce morbidity and mortality compared to traditional treatments in this patient group. We report the outcomes for patients with esophageal leaks from a range of different causes that were treated with EVT in a tertiary UK hospital over a 10-year period. Methods Between April 2011 and March 2021, 45 patients with a median age of 67 years (31–92) who had an esophageal leak were treated with EVT. All patients were treated with an ad-hoc endoluminal vacuum device (EVD) constructed using V.A.C GRANUFOAMTM (KCI) and a standard nasogastric (Ryles) tube. The median Apache II score for patients at the time of leak diagnosis was 20 (6–36). The cause of the leak was anastomotic in 16 patients (36%), iatrogenic in 14 patients (31%), spontaneous in 14 patients (31%), and traumatic in 1 patient (2%). Information related to treatment and outcome was recorded prospectively. Results Successful resolution of the leak was achieved in 39 (87%) patients. The median number of EVD changes required to heal the leak was 6 (1–17). There were no complications related to insertion of the EVD. The median length of hospital stay was 49 days (1–108). Six (13%) patients died during treatment. Six (13%) patients had complications during treatment requiring further intervention; 2 (4%) had a significant bleed requiring angiography and aortic stent placement, 1 (2%) had a stroke, 1 (2%) had a pulmonary embolism, 1 (2%) had a myocardial infarction, and 1 (2%) contracted COVID-19. Conclusion EVT is a safe and effective treatment that can be used successfully to treat esophageal leaks from a disparate range of leak causes in selected critically unwell patients. Further studies are required to develop a standardized procedure and management pathway which will enable broader adoption of EVT in this group of patients.

scholarly journals O-EGS08 Endoluminal Vacuum Therapy (EVT) for leaks in the upper gastrointestinal (UGI) tract; 10-years’ experience in a specialist Oesphagogastric centre

2021 ◽  
Vol 108 (Supplement_9) ◽  
Author(s):  
Zeeshan Afzal ◽  
Stavros Gourgiotis ◽  
Richard Hardwick ◽  
Peter Safranek ◽  
Vijayendran Sujendran ◽  
...  
Keyword(s):  
Ad Hoc ◽  
Length Of Hospital Stay ◽  
Median Number ◽  
Apache Ii Score ◽  
Vacuum Therapy ◽  
Delayed Presentation ◽  
Vacuum Device ◽  
Wide Range ◽  
Open Cell Foam ◽  
Successful Resolution

Abstract Background Endoluminal vacuum therapy (EVT) is an emerging treatment strategy for UGI leaks. When compared to traditional treatments strategies EVT is reported to reduce morbidity and mortality, especially in patients with delayed presentation and established sepsis. We report the outcomes for patients with UGI leaks and perforations treated with EVT using an ad-hoc endoluminal vacuum device (EVD) in a tertiary UK hospital over a 10-year period. Methods Sixty-seven patients with UGI leaks from disparate causes were treated with EVT between April 2011 and July 2021. The ad-hoc EVD was constructed using a piece of open cell foam sutured around the distal end of a nasogastric tube, and placed endoscopically either through the perforation and into the extra-luminal leak cavity OR intraluminally depending on the morphology of the leak cavity. Continuous negative pressure (125mmHg) was applied. Endoscopic re-evaluation of the leak cavity with change of EVD was performed every 48-120 hours depending on the patients clinical condition. Information related to treatment and outcome was recorded prospectively. Results Patients had a median age of 66 years (range 23-92), and median Apache II score of 21 (range 4-36) at presentation. Fifty-two leaks were oesophageal (78%), 12 gastric (18%), 2 duodenal (3%), and 1 pharangeal (1%). The leak cause was anastomotic in 26 (39%), iatrogenic in 20 (30%), spontaneous in 19 (28%), and traumatic in 2 (3%). The median number of EVD changes required to heal the leak was 6 (range 1-27), and median length of hospital stay was 42 days (range 1-182). Successful resolution of the leak was achieved in 59 patients (88%). Eight (12%) patients died during treatment. There were no complications related to insertion of the EVD. Conclusions EVT is an effective treatment for UGI leaks which can be delivered safely in a tertiary oesophagogastric centre, and used to treat a wide range of leak causes in critically unwell patients. Further studies are required to develop a standardized procedure to improve the ease with which EVT can be delivered. This will enable broader adoption of EVT for this group of patients.

Abstract 322: Optimizing Cardiac Catheterization Laboratory Utilization

2013 ◽  
Vol 6 (suppl_1) ◽  
Author(s):  
William E Lawson ◽  
Lisa Wilbert ◽  
Lisa Sokoloff ◽  
Allen Jeremias ◽  
Anil Mani
Keyword(s):  
Length Of Stay ◽  
Limited Resource ◽  
Median Number ◽  
Skewed Distribution ◽  
Median Length ◽  
Case Volume ◽  
Catheterization Laboratory ◽  
Cardiac Catheterization Laboratory ◽  
Cardiac Catheterizations ◽  
Effective Use

Background: Optimizing efficient utilization of the catheterization lab is an important concern. Inefficient use of this limited resource increases costs and can compromise patient care. At times of high hospital and specialty care unit census, cath lab throughput is also limited by the availability of recovery beds which may further compromise efficient throughput. At SBUH the cardiac cath lab is staffed from 0630-2300 daily Monday-Friday with an on-call team to provide 7 x 24 hour coverage for STEMI’s. Lab usage was evaluated to determine if this was an efficient and effective use of this limited resource. Methods: All cardiac catheterizations during the period of 10/1/12-12/31/12 were reviewed. The distribution of daily cases, mean and median hours to catheterization by day of the week and median length of stay (ALOS) were determined. Elective outpatient, inpatient, and emergent cases were included. Results: There were a total of 997 cases during this quarter. Average weekday case volume ranged from 13-17 cases/day with the greatest average number of cases performed on Mondays (24% of the weeks cases). Median hours to the cath lab averaged 4.2 hours with the greatest delay on Mondays (5.4 hrs) and Fridays (5.7 hrs). The median number of hours to the cath lab was 31.3 hours with the greatest delay on Fridays (38.5 hrs) and gradually decreasing times from Monday through Thursday with the lowest time delay being on Thursdays (18.9 hrs). The median length of stay averaged 1.11 days, with Mondays patients averaging the longest stays at 1.26 days. There were 45 emergent STEMI cases (5% of the total) during the reviewed period. Conclusions: The marked disparity in mean and median hours reflects a skewed distribution, with many inpatients delayed in going to the CCL. Both median and mean hours were prolonged on Mondays and Fridays along with median length of stay. Further drill down suggested hand-offs, inter-hospital transfer delays, high bed occupancy, and high patient volume contributed to delays on these days. Operator availability, procedure variance, and case mix also contributed to distortions in scheduling and the effective use of lab time. Mid week, Wednesday, was the most efficient day. Block scheduling has since been implemented to better accomodate operators and procedure types within the current staffing constraints. Also as a result of this analysis fewer outpatients are being scheduled on Mondays, changes have been made in ACS protocols, hand-offs, rounding and transfers, and opening the cath lab on a weekend day for inpatients is planned.

Feasibility, Effectiveness, and Safety of Endoscopic Vacuum Therapy for Intrathoracic Anastomotic Leakage Following Transthoracic Esophageal Resection: A Prospective Study

2020 ◽  
Author(s):  
Chengcheng Christine Zhang ◽  
Lukas Liesenfeld ◽  
Rosa Klotz ◽  
Ronald Koschny ◽  
Christian Rupp ◽  
...  
Keyword(s):  
Mortality Rate ◽  
Adverse Events ◽  
Anastomotic Leakage ◽  
Esophageal Resection ◽  
Median Number ◽  
Adverse Event Rate ◽  
Vacuum Therapy ◽  
High Morbidity ◽  
Closure Rate ◽  
Endoscopic Vacuum Therapy

Abstract BackgroundAnastomotic leakage (AL) in the upper gastrointestinal (GI) tract is associated with high morbidity and mortality rates. Especially intrathoracic anastomotic leakage leads to life-threatening adverse events. Endoscopic vacuum therapy (EVT) for anastomotic leakage after transthoracic esophageal resection represents a novel concept. However, sound clinical data are still scarce. This prospective, single-center study aimed to evaluate the feasibility, effectiveness, and safety of EVT for intrathoracic anastomotic leakage following abdomino-thoracic esophageal resection. MethodsFrom March 2014 to September 2019 259 consecutive patients underwent elective transthoracic esophageal resection. 72 patients (27,8 %) suffered from AL. The overall collective in-hospital mortality rate was 3.9% (n=10). Data from those who underwent treatment with EVT were included. ResultsFifty-five patients were treated with EVT. Successful closure was achieved in 89.1% (n=49) by EVT only. The EVT-associated adverse event rate was 5.4% (n=3): bleeding occurred in one patient, while minor sedation-related adverse events were observed in two patients. The median number of EVT procedures per patient was 3. The procedures were performed at intervals of 3-5 days, with a 14-day median duration of therapy. The mortality rate of patients with AL was 7.2% (n=4). Despite successfully terminated EVT, three patients died because of multiple organ failure, acute respiratory distress syndrome, and urosepsis (5.4%). One patient (1.8%) died during EVT due to cardiac arrest. ConclusionsEVT is a safe and effective approach for intrathoracic anastomotic leakages following abdomino-thoracic esophageal resections. It offers a high leakage-closure rate and the potential to lower leakage-related mortalities.

scholarly journals Neurotrauma in the Syrian War: Analysis of 41,143 cases from July 2013-July 2015

2021 ◽  
Author(s):  
Nida Fatima ◽  
Mowafi ◽  
M MD Mahmoud Hariri ◽  
Alnahhas ◽  
F MSc MD Anas Al-Kassem ◽  
...  
Keyword(s):  
Secondary Analysis ◽  
Length Of Hospital Stay ◽  
Neurosurgical Procedures ◽  
Penetrating Injuries ◽  
Median Length ◽  
Factors Associated ◽  
Demographic Group ◽  
Administrative Dataset ◽  
Crush Injuries

Abstract Introduction: Despite nearly a decade of conflict, little is known about trauma and injuries resulting from the Syrian war.Methods: Secondary analysis was conducted of an administrative dataset of patient presentations to a network of 95 war-affected hospitals in Syria from July 2013 - July 2015. Logistic regression was performed to identify factors associated with mortality of neurotrauma patients. Results: Of 193,618 overall trauma presentations, 41,143 were for neurotrauma (37,410 head trauma, 1,407 spinal trauma and 3,133 peripheral nervous system). There were 31,359 males (76.2%) and 9,784 females (23.8%). Males aged 19-30 years (10,113; 24.6%) were the largest single demographic group. Presumed non-combatants including females, elders and children under 13 years (16,214; 39.4%) were the largest group of patients overall. There were 16,881 (41.0%) presentations with blunt injuries (blunt/crush injuries) and 21,307 (51.8%) patients with penetrating injuries (shrapnel, cut, gunshot). A total of 36,589 patients (89.6%) were treated and discharged from the hospital, 2,100 (5.1%) were transferred to another facility, 2,050 patients (5.0%) died in-hospital, 26 remained in the hospital (0.1%), 108 (0.3%) had unknown disposition. The median length of hospital stay was 1 day. There were 4,034 (9.7%) neurosurgical procedures documented. Patients with combined neurotrauma and general trauma suffered 30 times higher mortality than neurotrauma alone (aOR: 30.4; 95%CI: 20.8-44.2, p<0.0001).Conclusion: The Syrian War resulted in large volumes of neurotrauma patients. Presumed non-combatants comprised 39.4% of patients who survived to treatment at a facility. Further study is needed on long-term needs of neurotrauma victims of the Syrian war.

scholarly journals Health-Care Organization For The Management and Surveillance of SARS-CoV-2 Infection in Children During Pandemic in Italy

2020 ◽  
Author(s):  
Francesco Nunziata ◽  
Eugenia Bruzzese ◽  
Marco Poeta ◽  
Luca Pierri ◽  
Andrea Catzola ◽  
...  
Keyword(s):  
Medical Decision Making ◽  
Health Care Organization ◽  
Length Of Hospital Stay ◽  
Medical Decision ◽  
Admission Criteria ◽  
Global Evaluation ◽  
Care Organization ◽  
Risk Of Infection ◽  
Median Length ◽  
Hub And Spoke

Abstract Background: In comparison with adults, severe acute respiratory syndrome (SARS-CoV-2) infection in children has a milder course. The management of children with suspected or confirmed coronavirus disease (COVID-19) needs to be appropriately targeted. Methods: We designed a hub-and-spoke system involving a Hub Centre to provide relevant healthcare information, based on the use of telemedicine and stringent admission criteria. Result: Between March and April 2020, the Hub Centre managed a total of 119 children (62 males, 52%; median age, 5.5 years; interquartile range [IQR], 2; 10) with suspected or confirmed COVID-19. Of the 119 children, 90 were managed in cooperation with family paediatricians and 29 with hospital-based physicians. In total, 8 (6.7%) children were hospitalised, with a median length of hospital stay of 10 days (IQR, 8.5 days; range, 4–22 days). Conclusion: case-by-case management allows a global evaluation in which the clinical condition is one determinant in medical decision-making along with the use of isolation to prevent the spread of COVID-19 among family members and cohabitants, and biocontainment measures. Large centres could coordinate paediatric COVID-19 cases through telemedicine, taking advantage of the generally milder presentation in children but also considering their dependence on adults and risk of infection spreading.

scholarly journals Pheochromocytoma Masquerading as Weight Loss - a Diagnostic and Management Challenge

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A148-A149
Author(s):  
Gurunanthan Palani ◽  
Tyler C Drake ◽  
Shalamar Dionne Sibley
Keyword(s):  
Weight Loss ◽  
Reference Range ◽  
High Dose ◽  
Delayed Presentation ◽  
Presenting Symptoms ◽  
Risk Of Death ◽  
Alpha Blockade ◽  
History Of ◽  
Plasma Metanephrines ◽  
Management Challenge

Abstract Introduction: Classic pheochromocytoma symptoms include headache, diaphoresis, palpitations and symptomatic pheochromocytomas are on average around 5cm. They respond to preoperative alpha blockade followed by surgery. We present a case of a giant 15.9cm pheochromocytoma with delayed presentation and diagnosis complicated by atypical symptoms of nausea, weight loss; preoperative preparation included a modified preparation of high-dose phenoxybenzamine but she underwent successful surgery. Case Description: A 62-year-old female with a history of hypertension and diabetes presented with nausea and 80 lbs weight loss over 18 months. CT scan revealed large centrally necrotic mass overlying the left kidney, measuring 15.9 x 12.7 x 14.7cm. Abdominal MRI showed claw sign; she was admitted to the urology service for tube feeding prior to resection of suspected renal cell carcinoma. Given the location of the mass and history of hypertension, plasma metanephrines, included in preoperative workup, were notable for: total metanephrines &gt;40000 pg/ml (reference range &lt;=205), normetanephrines &gt;20000 pg/ml (reference range &lt;=148), metanephrines 57 pg/ml (reference range &lt;=57). Endocrine was consulted and she was started on phenoxybenzamine; she underwent volume replacement with fluids and salt tablets. Due to nausea and vomiting she was unable to reliably tolerate oral medication; BP management was challenging. Oral pill dosing was minimized. Metoprolol was converted to metoprolol SA and a phenoxybenzamine suspension that could be delivered through the feeding tube with good absorption was made. On the day prior to surgery, BP was 117/76 mmHg, supine HR 92 bpm, on a total daily dose of phenoxybenzamine 240mg, metoprolol SA 200mg and amlodipine 10mg. She underwent a radical left nephrectomy and adrenalectomy. Plasma metanephrines six weeks later were normal: total metanephrines 84 pg/ml, normetanephrines 84 pg/ml, metanephrines &lt;25 pg/ml. Pathology showed benign pheochromocytoma. Conclusion: Giant pheochromocytomas present significant challenges for clinicians who must be aware of the potential for nonspecific symptoms which can delay diagnosis. Paroxysmal hypertension happens in only about 50% of pheochromocytoma patients; primary hypertension is often diagnosed, as had been the case with our patient. Additionally, initial imaging related to atypical presenting symptoms may not lead to the specific diagnosis, as in our patient; metanephrine screening revealed the correct diagnosis. Regarding management, preoperative alpha blockade dosage and delivery should be tailored to individual patient needs, with adjustment as needed and alternative preparations considered to optimally control BP and reduce risk of death and other perioperative complications. Our case highlights the diagnostic and management challenge of patients presenting with giant pheochromocytomas.

scholarly journals Evaluation of predictors of mortality in patients of ruptured liver abscess: a prospective study

2021 ◽  
Vol 8 (12) ◽  
pp. 3639
Author(s):  
Syed A. Faridi ◽  
Syed H. Harris ◽  
Yasir Alvi
Keyword(s):  
Prognostic Factors ◽  
Prospective Study ◽  
Liver Abscess ◽  
Laboratory Data ◽  
Left Lobe ◽  
Apache Ii ◽  
Apache Ii Score ◽  
Delayed Presentation ◽  
Predictors Of Mortality ◽  
A Prospective Study

Background: Ruptured liver abscess is a rare condition which is associated with high mortality. Ruptured liver abscess should be assessed carefully especially in patients with poor prognostic factors, which highlight the need for early diagnosis to further improve our results of management. The aim of the present study was to evaluate the predictors of mortality in patients of ruptured liver abscess.Methods: This was a prospective study, performed at Jawaharlal Nehru medical college, AMU, Aligarh between October 2015 to October 2017. For each case-patient, we reviewed demographic data, underlying medical conditions, clinical features, laboratory data, imaging and microbial findings and treatment. The prognostic factors independently related to mortality were then identified using univariate and multivariate analysis considering significance at p<0.05.Results: The overall in-hospital mortality was 27% (11 out of 40). On multivariate regression analysis, the factors that independently predicted mortality were shock at presentation, time of presentation (>48 hours), left lobe abscess and APACHE II score on admission more than 15.Conclusions: The independent predictors of mortality in ruptured liver abscess are shock at presentation, delayed presentation, higher APACHE II score on admission and left lobe abscess.

scholarly journals P-EGS19 Complete oesophageal transection during thyroidectomy; Successful management of anastomotic leak using endoluminal vacuum therapy (EVT) following failed primary repair

2021 ◽  
Vol 108 (Supplement_9) ◽  
Author(s):  
Zeeshan Afzal ◽  
Stavros Gourgiotis ◽  
Richard Hardwick ◽  
Peter Safranek ◽  
Vijayendran Sujendran ◽  
...  
Keyword(s):  
Total Thyroidectomy ◽  
Anastomotic Leak ◽  
Ad Hoc ◽  
Primary Repair ◽  
Organ Support ◽  
Vacuum Therapy ◽  
Team Approach ◽  
Cervical Oesophagus ◽  
Complete Transection ◽  
Wide Range

Abstract Background Perforation of the cervical oesophagus is an extremely rare but recognised complication of thyroidectomy. As with all oesophageal perforations management depends on timing of diagnosis in relation to the timing of injury, the size of the oesophageal wall defect, extent of extraluminal contamination, and how unwell the patient is with respect to sepsis. We report a case of complete transection of the cervical oesophagus during total thyroidectomy and its subsequent management. Methods A previously well 32-year-old female had a complete cervical oesophageal transection during total thyroidectomy and neck dissection for papillary carcinoma of thyroid. This was recognised by her ENT surgeon who repaired the oesophagus primarily. Subsequently, she developed sepsis with cellulitis of her anterior chest wall. Cross-sectional imaging demonstrated a leak at the site of the cervical oesophageal repair. Gastroscopy confirmed a 50% dehiscence of the oesophageal anastomosis. Control and management of her oesophageal leak was achieved with EVT delivered using an ad-hoc endoluminal vacuum device (EVD) constructed from open cell foam sutured around the distal end of a nasogastric tube. Results The patient was managed in the intensive care unit (ICU) with appropriate organ support and antimicrobial cover. A surgical jejunostomy was placed to facilitate enteral feeding. EVT was delivered using the ad-hoc EVD which was placed endoscopically and situated intraluminally across the anastomotic leak site. Continuous negative pressure (125 mmHg) was applied. Six EVD changes were required to heal the leak. Her total length of stay was 41 days, of which 38 days were in ICU. There were no periprocedural complications related to using the EVD or EVT, although the patient subsequently developed an oesophageal stricture which required endoscopic dilatation. Conclusions Accidental complete transection of the cervical oesophagus is extremely rare. This case highlights the importance of a multidisciplinary team approach for managing such cases. EVT is an emerging treatment option for upper gastrointestinal (UGI) leaks and is reported to be safe and effective for leaks from a wide range of causes throughout the UGI tract.  Successful resolution of the oesophageal leak in this unusual case demonstrates the utility of EVT in difficult clinical situations which may otherwise pose a formidable management challenge using traditional treatment strategies.

scholarly journals Surgical Site Infection In Laparotomy

2018 ◽  
Vol 4 (1) ◽  
pp. 22-25
Author(s):  
Pashupati N. Bhatta ◽  
Umesh Kumar Yadav ◽  
Gorakh Nath Mishra ◽  
Randhir Jha ◽  
Kumar Shrestha
Keyword(s):  
Risk Factor ◽  
Surgical Site Infection ◽  
Hospital Stay ◽  
Length Of Hospital Stay ◽  
Site Infection ◽  
Median Length ◽  
National Medical College ◽  
Medical College ◽  
National Medical ◽  
Duration Of Surgery

INTRODUCTION: Surgical site infection (ssi) is one of the most common surgical complications which increases the rate of morbidity and mortality and increases the health care cost by prolonging the hospital stay.  AIMS AND OBJECTIVES: The main objective of the study was to find out the incidence of ssi in emergency laparotomy in general surgery and to find out the associated risk factor for ssi.MATERIAL & METHODS: Study was carried out in national medical college, Birgunj from January 2011 to June 2012 after getting ethical clearance from Institutional Review Committee National Medical College. Total 200 cases were included in study and follow up done up to 30 days postoperatively. RESULTS: Out of 200 patients, 76 patients developed ssi. The total incidence of ssi was 38%.The rate ssi in clean-contaminated, contaminated and dirty wound were 18.2%, 33.3% & 45.5% respectively. Age, type of surgical operation and prolonged duration of surgery were the significant risk factor for ssi while sex, BMI were not statistically significant. The median length of hospital stay with ssi was 16 days while the median length of hospital stay without ssi was 10 days.CONCLUSION: The rate of ssi was found to be higher in our study in comparison to western study but neariy same when comparing to study of Asian countries. so, we emphasize for the need of  evidence based infection control and recommend for better surveillance program me for control of ssi in each hospital.Journal of Universal College of Medical Sciences (2016) Vol.04 No.01 Issue 13, Page: 22-25

scholarly journals Etiology, Clinical Presentation and Incidence of Infectious Meningitis and Encephalitis in Polish Children

2020 ◽  
Vol 9 (8) ◽  
pp. 2324
Author(s):  
Kacper Toczylowski ◽  
Ewa Bojkiewicz ◽  
Marta Barszcz ◽  
Marta Wozinska-Klepadlo ◽  
Paulina Potocka ◽  
...  
Keyword(s):  
Clinical Presentation ◽  
Length Of Hospital Stay ◽  
Incidence Rates ◽  
Diagnostic Methods ◽  
Molecular Diagnostic ◽  
Central Nervous System Infections ◽  
Median Length ◽  
North East ◽  
The North ◽  
Enteroviral Meningitis

Little is known about the causes and the frequency of meningitis and encephalitis in Poland. We did a retrospective single-center cohort study of children under 18 years old hospitalized with infectious meningitis or encephalitis. Incidence rates were calculated using collected data from patients from the North-East Poland only. A total of 374 children hospitalized between 1 January 2015 and 31 December 2019 were included in the study. A total of 332 (89%) children had meningitis, and 42 (11%) had encephalitis. The etiology of the infection was established in 331 (89%) cases. Enteroviruses accounted for 224 (60%) of all patients. A total of 68 (18%) cases were tick-borne infections. Bacterial pathogens were detected in 26 (7%) children. The median length of hospital stay for children with enteroviral meningitis was 7 days (IQR 7–9), increasing to 11 days (8–13) in those treated with antibiotics. The incidence of meningitis was estimated to be 32.22 (95% CI, 25.33–40.98) per 100,000 and that of encephalitis to be 4.08 (95% CI, 2.07–8.02) per 100,000. By the broad use of molecular diagnostic methods, we managed to identify etiology of the infection in the majority of children. Our data suggest that thorough diagnostics of central nervous system infections are needed to rationalize treatment.

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