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Objective:To investigate the pathogens and drug resistance of bacterial enteritis in children, analyze the clinical characteristics of bacterial enteritis in children, and provide basis for clinical diagnosis and treatment.Methods:The fecal culture strain and drug sensitivity of patients with bacterial enteritis admitted to our hospital from January 2016 to December 2020 were analyzed and summarized, and the clinical characteristics of patients who were infected by Salmonella and Escherichia coli were compared.Results:There were a total of 173 patients, aged from 21 days to 15 years, with a median age of 2.00(1.10, 3.54)years.Bacterial enteritis was most likely to occur in summer and autumn, and the incidence rate was 40.5% and 29.5%, respectively.One hundreds and seventy-three strains of bacteria were cultured in feces, including 148 strains of Salmonella(85.5%), 18 strains of Escherichia coli(10.4%), five strains of Staphylococcus aureus and two strains of Shigella.One hundreds and one of 141 patients who were infected with Salmonella were detected for leukocytes of in feces(71.6%), and four of 16 patients with Escherichia coli were detected for leukocytes(25.0%). The difference was significant( χ2=14.1, P<0.001). Eighty-eight of 113 patients(77.9%) who were infected by Salmonella with increased CRP(CRP>8 mg/L)and the proportion in Escherichia coli infection cases was 6/13(46.2%). There was significant difference( χ2=4.63, P=0.03). The drug sensitivity of Salmonella and Escherichia coli was summarized.There was no carbapenem resistant strain cultured; The sensitivity to piperacillin/tazobactam and cefoperazone/sulbactam was higher than 85%; The sensitivity to cefepime, ceftazidimeand ceftriaxone was higher than 75%; The sensitivity to ampicillin was lower than 30%, and the sensitivity to quinolones was between 20%-40%. Conclusion:Children aged 1-3 years are prone to bacterial enteritis in summer and autumn.The most common pathogens causing bacterial enteritis are Salmonella and Escherichia coli.White blood cells are more easily detected in feces of patients with Salmonella infection, and the increase rate of C-reactive protein in peripheral blood is higher.Patients with bacterial enteritis are recommended to use the third-generation cephalosporins and aforementioned antibiotics and piperacillin/tazobactam for empirical treatment.The sensitivity to quinolones is reduced, and may not be suitable for clinical application.
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Objective:To investigate the distribution and drug resistance of pathogens in urinary tract infection in children.Methods:The clinical data of 108 cases of urinary tract infections with positive urinary culture from January 2018 to December 2018 in our hospital were analyzed retrospectively.The patients were divided into simple urinary tract infection group( n=29) and complex urinary tract infection group( n=79). Antibiotic resistance in each group was compared. Results:Gram-negative bacilli were found in 90 cases(77.59%, 90/116). Gram-positive cocci were found in 26 cases(22.41%, 26/116). Escherichia coli, Klebsiella pneumoniae and Enterococcus faecium were the main pathogens.Gram-negative bacilli had the lowest resistance rate to amikacin, imipenem and piperacillin/tazobactam(about 10%). The resistance rate of Gram-negative bacilli to furantoin and quinolones was about 20%, while 30% to 40% to the third and fourth generation cephalosporins and their enzymatic preparations.No Gram-positive cocci was found to be resistant to vancomycin and linezolid.The resistance rate of Gram-positive bacteria to streptomycin and furantoin was 0-20%.There was no significant difference in resistance rate of Gram-negative bacteria to common antibiotics between simple urinary tract infection group and complex urinary tract infection group( P>0.05). Conclusion:Gram-negative bacteria are the main pathogens of urinary tract infections.With the change of drug resistance of pathogens, it may be necessary to change the empirical treatment of urinary tract infection.Furantor can be used as a recommendation for the empirical treatment of mild infection.In the past, there may be underestimate of drug resistance of simple urinary tract infection, and further research is needed.
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Objective To investigate the incidence of Acinetobacter baumannii induced paediatric bacterial meningitis and to explore the characteristics,treatment,and prognosis of Acinetobacter baumannii menin-gitis. Methods The cerebrospinal fluid specimens and the clinical data about patients who acquired intracranial infection of Acinetobacter baumannii were collected from 10 children′s hospital,and analysed by WHONET. Results A total of 318 positive cerebrospinal fluid specimens from 10 hospitals were collected,and 16(5%) of Acinetobacter baumannii were detected. Acinetobacter baumannii was completely resistant to Aztreonam (100%),Cefotetan(100%) and Cefazolin(100%),and the resistance rates of Acinetobacter baumannii to Ceftriaxone and Ciprofloxacin were above 80%,and the resistance rates of Acinetobacter baumannii to Cefta-zidime and Cefepime were all 68. 8%,and the resistance rates of Acinetobacter baumannii to Meropenem, Imipenem,Cefoperazone/Sulbactam were 69. 2%,68. 8% and 53. 3%,respectively. In 16 cases of intracrani-al infection caused by Acinetobacter baumannii,11 cases(68. 8%) had underlying diseases such as intracrani-al tumor,hydrocephalus,craniocerebral injury and intracranial hemorrhage,and all 11 cases underwent surgi-cal intervention,such as surgical resection and hydrocephalus drainage. Among 16 cases,14 cases(87. 5%) were admitted to SICU,PICU or NICU and other intensive care units,and the lengths of stay were all ＞20 d. Under the combined treatment of multiple antibiotics,16 cases of intracranial infection caused by Acinetobact-er baumannii,6 cases died,with a mortality of 37. 5%. Conclusion Acinetobacter baumannii meningitis is becoming an increasingly common clinical entity recently. Because of the resistance to antibiotics,the therapy for Acinetobacter baumannii infection encounters arduous challenge. Insisting on multi-center monitoring and using antibiotics reasonably and effectively appears to be particularly important.
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Objective To explore the optimal storage standard of fresh human milk, and to observe the influence of different cold storage condition (time-temperature) on macronutrients (fat, protein, carbohydrates, TS and energy), immune sub-stances (sIgA, lactoferrin, IL-6, 8, 10 and TNF-α) and bacteria indicators of fresh human milk.Methods Fresh milk samples (n=30) were divided and stored at three temperature and nine time points, which are 4℃ (24 h, 48 h, 72 h), -18℃(72 h, 7 d, 14 d, 4 w, 8 w, 12 w), and -80℃ (12 w, 24 w). At each time point, the macronutrients , immune substance, and bacteria colony counts of each milk sample were measured and compared with fresh milk. Results Compared with fresh milk, all indicators with the exception of lactoferrin in stored human milk showed signiifcant difference (P<0.05). Under 4℃ refrigeration condition, fat, IL-6, and TNF-α decreased, bacteria colony counts and Gram-positive colony counts increased over 72 h storage (P<0.05). Under-18℃ freezing condition, fat, protein, TS, energy and IL-6 decreased from 72 h to 12 w storage (P<0.05); carbohydrates and sIgA also decreased from 4 w and 8 w storage, respectively (P<0.05). Under -80℃ freezing condition, fat, protein, TS, energy and IL-6 decreased over 24 W storage (P<0.05).Conclusions The macronutrients, immune substance, and bacteria indicators of human milk were affected obviously by cold storage. Refrigerated at 4℃ should not be longer than 72 h, -80℃ freezing condition should be chosen for more than two months storage.
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Objective To investigate the treatment method of osteoporotic refracture after vertebroplasty.Methods One hundred and twenty patients (140 vertebraes) with osteoporotic fractures from January 2010 to January 2011 were selected,12 months after operation,15 cases of refracture (20vertebraes) patients as the research object,11 cases were given bone cement to strengthen treatment,postoperative anti-infection,recovery given a positive rehabilitation exercise instruction ;4 cases were given anti-osteoporosis treatment.Follow-up of 10 months,whether leakage of bone cement and the recovery of anti-osteoporosis treatment were observed.Results Eleven patients with refracture in the process of bone cement injection had no prevertebral venous leakage and disc leakage,none of the patients had bone cement leakage after operation;including 3 cases occurred back pain after injection,the main consideration was surgery influenced the local nerve functions and given analgesic treatment,then pain significantly reduced; 4cases with anti-osteoporosis therapy and recoverd better,no pain and other unsuitable symptom occurred.Postoperative 3 d all of the patients could get out of bed,were discharged on 1 week after operation.All patients were not appear the adverse host reaction of fillers,with no occurrence of refracture.Through visual analog pain scale(VAS) score,VAS score in the 3 d after treatment and end-stage follow-up were significantly lower than before treatment [(3.05 ± 0.55),(0.05 ± 0.15) scores vs.(6.95 ± 0.65) scores],and VAS score at the time of end-stage follow-up was lower than 3 d after treatment,there was significant difference (P ＜0.05).Conclusion Bone cement to strengthen with anti-infection and rehabilitation exercise instruction and anti-osteoporosis in the treatment of osteoporotic refracture after vertebroplasty curative effect,safe and reliable effect,worthy of clinical popularization and application.
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Objective To investigate the molecular characteristic,the virulence factors and antimicrobial resistance of Methicillin-resistant Staphylococcus aureus (MRSA) isolated from pediatric patients.Methods Ninety-eight non-duplicate strains of and 49 non-duplicate strains of Methicillinsusceptible Staphylococcus aureus (MSSA) isolated from the three children's hospitals in Shanghai in 2008 were investigated.Panton-valentine leukocidin (PVL) gene was detected by polymerase chain reaction (PCR).The genotypes of staphylococcal cassette chromosome mec (SCCmec) of the MRSA isolates were confirmed by multiplex PCR.The sequence type (ST) of each strain was determined by multilocus sequence typing (MLST),and the algorithm eBURST was used to identify groups of clonal complex (CC).The minimal inhibitory concentrations (MIC) of fourteen antibiotics for all isolates were determined by agar dilution method.Results Among 98 isolates of MRSA,the positive rate of PVL genes was 6.1％ (6/98).In contrast,the positive rate of PVL genes was 4.1％ (2/48) of the MSSA strains.Among 98 isolates of MRSA,4.1％ (4/98),23.5％ (23/98),53.0％ (52/98) and 15.3％ (15/98) of the strains harboured SCCmec types Ⅱ,Ⅲ,Ⅳ and Ⅴ,respectively. The remaining four isolates (4.1 ％) presented a unique SCCmec pattern that could not be classified to any known types by the employed typing assays.Combining the ST and SCCmec type,the predominant clones were ST59-SCCmec Ⅳ (30 strains) and ST239-SCCmec Ⅲ (23 strains),followed by ST5-SCCmecⅣ and ST1-SCCmecⅣ (8 strains for each clone),ST239-SCCmec Ⅴ (6 strains),ST88-SCCmecⅤ (5 strains),ST5 SCCmecⅡ (4 strains),ST59-SCCmec Ⅴ (3 strains),ST8-SCCmecⅣ and ST88-SCCmecⅣ (2 strains for each clone),ST22-SCCmecⅣ,ST910-SCCmecⅣ and S45-SCCmec Ⅴ (1 strain for each clone),eBURST analysis distributed the MRSA isolates into several CC.ST8 and ST239 belonged to ST8 CC,ST1 belonged to ST15 CC,ST910 belonged to ST 30 CC,ST59,ST5,ST88,ST45,ST22,ST9 and ST7 were the origin of their own CC.The results of MIC showed that the 67 strains of MRSA harboring SCCmec type Ⅳ or SCCmec type Ⅴ were more susceptible to various non-β-lactam antibiotics than 27 strains of MRSA harboring SCCmec type Ⅱ or SCCmec type Ⅲ,and no vancomycin-resistant strain was found.Conclusions In three children's hospitals in Shanghai,the PVL gene-positive rate of MRSA isolates is relatively low,SCCmec type Ⅳ and SCCmec type Ⅴ could spread among hospitals to cause a small scale epidemic and have a variety of ST.
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OBJECTIVE To investigate the bacterial resistance of clinical isolates from pediatric hospital for the guidance of rational use of antibiotics.METHODS Disc diffusion test(Kirby-Bauer method) was used to study the antimicrobial resistance(fastidious bacteria were detected by E test).WHONET5 was applied for analysis.(RESULTS) In the period of study from 2002 to 2003,2 303 strains which were the first isolated from each patient were collected.Of 2 303 clinical isolates,Gram positive organisms accounted for 29.7%,Gram negative ones for 70.3%.Escherichia coli,Klebsiella spp,Staphylococcus aureus,coagulase-negative staphylococci and Pseudomonas aeruginosa were the most common strains among the isolates.Meticillin-resistant S.aureus(MRSA) and meticillin-resistant coagulase(-negative) staphylococci(MRCNS) accounted for 9.7% and 67.6% of S.aureus and coagulase-negative(staphylococci),respectively.Resistant rates of MRSA and MRCNS were higher than that of meticillin-susceptible S.aureus(MSSA) and meticillin-susceptible coagulase-negative staphylococci(MSCNS) to antimicrobial agents commonly used in clinic.No vancomycin resistant strains of staphylococci were found. 4.1% of Enterococcus spp were vancomycin resistant strains.Resistant rate of Streptococcus pneumoniae was 11.9% to penicillin. Most of isolates of Enterobacteriaceae were susceptible to imipenem.The incidences of E.coli and Klebsiella spp producing extended spectrum beta-lactamases(ESBLs) isolates were 49.7% and 63.1%,respectively.The resistance rates of(ESBLs) producing strains to antimicrobial agents(except carbapenems) were higher than those of ESBLs nonproducing ones.CONCLUSIONS Bacterial resistance is still or even a more serious clinical problem than before.The(surveillance) of antimicrobial susceptibility in pediatric hospital is of great significance.It is also very important to promote the rational use of antimicrobial agents so that resistance is minimized and take effective strategy for the control of the problem.