The characteristics and changes of bacterial infection and drug resistance in pediatric intensive care unit from 2016 to 2020 / 中国小儿急救医学

Objective:To investigate the characteristics and changes of bacterial infection and drug resistance in PICU at Children′s Hospital of Fudan University from 2016 to 2020.Methods:All the strains were collected at Children′s Hospital of Fudan University from January 1 st, 2016 to December 31 st, 2020.Antimicrobial susceptibility test was carried out according to a unified protocol using Kirby-Bauer method or automated systems.Results were analyzed according to CLSI 2020 breakpoints. Results:(1)Bacterial distribution: 2 551 bacteria were monitored from 2016 to 2020 in our center.The top 3 bacteria were all gram-negative bacteria.Among them, Burkholderia cepacian showed a tortuous downward trend(13.45% to 1.18%), and Klebsiella pneumoniae showed an upward trend(6.05% to 10.61%).The most common infected site was respiratory tract, although the strains in the respiratory tract decreased year by year.Baumanii was the most common bacteria in respiratory infections.Staphylococcus epidermidis was the most common bacteria from 2016 to 2017 in blood infections, but Achromobacter xylosoxidans were became the most common bacteria from 2018 to 2020.Enterococcus faecium was the most common bacteria in urinary infections.(2) Drug resistance: Baumanii had a high drug resistance rate to amikacin, gentamicin, cefepime, and cefitadine, with no obvious changes over the years, which had a gradually decreasing drus resistance rate to cefoperazone sulbactam, showing a tortuous upward trend to imipenem and meropenem.Baumanii and Pseudomonas aeruginosa had a low drug resistance to levofloxacin over the years, but with high resistance rates in 2020.Escherichia coliand and Klebsiella pneumoniae still had high resistance rates to beta-lactam antibiotics, and their resistance rates to levofloxacin were decreasing.Escherichia coli and Klebsiella pneumoniae showed decreasing resistance rates to imipenem and increased resistance rates to meropenem.The resistance rate of Enterococcus faecium to levofloxacin decreased and always showed a high susceptibility rate to polypeptide antibiotics.Neither Staphylococcus epidermidis nor Staphylococcus aureus were currently resistant to tetracycline antibiotics, and the resistance rates of aminoglycoside antibiotics, such as gentamicin, was also declining.Conclusion:The bacterial infection in PICU shows as the main characteristics of respiratory infection and gram-negative bacteria infection.Carbapenem-resistant Enterobacteriaceae bacteria, Enterococci and Staphylococcus species are becoming increasingly more resistant.

Epidemiological and clinical features of SARS-CoV-2 Infection in children during the outbreak of Omicron Variant in Shanghai, March 7-March 31, 2022

ObjectivesTo understand the epidemiological and clinical characteristics of pediatric SARS-CoV-2 infection during the early stage of Omicron variant outbreak in Shanghai. MethodsThis study included local COVID-19 cases <18 years in Shanghai referred to the exclusively designated hospital by the end of March 2022 since emergence of Omicron epidemic. Clinical data, epidemiological exposure and COVID-19 vaccination status were collected. Relative risks (RR) were calculated to assess the effect of vaccination on symptomatic infection and febrile disease. ResultsA total of 376 pediatric cases of COVID-19 (median age:6.0{+/-}4.2 years) were referred to the designated hospital during the period of March 7-31, including 257 (68.4%) symptomatic cases and 119 (31.6%) asymptomatic cases. Of the 307 (81.6%) children;3 years eligible for COVID-19 vaccination, 110 (40.4%) received 2-dose vaccines and 16 (4.0%) received 1-dose vaccine. The median interval between 2-dose vaccination and infection was 3.5 (IQR: 3, 4.5) months (16 days-7 months). Two-dose COVID-19 vaccination reduced the risks of symptomatic infection and febrile disease by 35% (RR 0.65, 95% CI:0.53-0.79) and 33% (RR 0.64, 95% CI: 0.51-0.81). Two hundred and sixteen (83.4%) symptomatic cases had fever (mean duration: 1.7{+/-}1.0.8 days), 104 (40.2%) had cough, 16.4% had transient leukopenia; 307 (81.6%) had an epidemiological exposure in household (69.1%), school (21.8%) and residential area (8.8%). ConclusionThe surge of pediatric COVID-19 cases and multiple transmission model reflect wide dissemination of Omicron variant in the community. Asymptomatic infection is common among Omicron-infected children. COVID-19 vaccination can offer protection against symptomatic infection and febrile disease.

Adverse reaction of antibacterial drugs and evaluation of vital organ injuries / 中国小儿急救医学

Infectious diseases are clinically very common, among which bacterial infections are the most common ones.Therefore, antibiotics have become ones of the most widely used drugs in clinical practice.While saving lives of many infected patients, antibiotics can also lead to adverse reactions, which can cause damage to organs function in severe cases and even life-threatening.Common adverse reactions include allergic reactions and various organs damage.In this review, we aimed to focus on the evaluation of common adverse reactions and organs damage caused by antibiotics, in order to improve the prevention and treatment of adverse reactions and promote rational use of antibiotics.

Effect of thrombelastography in the diagnosis of disseminated intravascular coagulation in children / 中华儿科杂志

<p><b>OBJECTIVE</b>To study the effect of thrombelastography (TEM) in the diagnosis of disseminated intravascular coagulation (DIC) in children.</p><p><b>METHOD</b>The data of 117 children suffering from DIC in the pediatric intensive care unit (PICU) and Cardiologic ICU (CICU) in the authors' hospital from January 2010 to June 2012 were collected. Ninety-four children without DIC were enrolled into the control group. The platelet count, prothrombin time (PT), activated partial thromboplastin time (APTT), fibrinogen (FIB), D-dimers and TEM were determined. The sensitivity and specificity of TEM were measured and the relevance of TEM and DIC was investigated to evaluate the effect of TEM and the conventional tests of the coagulation system in the diagnosis of DIC in children.</p><p><b>RESULT</b>The average R reaction time in the DIC group was significantly longer than that in the control group[(13.3 ± 3.3)s vs. (4.5 ± 2.6)s, P = 0.000 5], and the average α-angle in the DIC group was smaller than that in the control group significantly (37.2° ± 1.4° vs. 55.6° ± 3.8°, P = 0.001 0). There was significant decrease in the maximal amplitude (MA) and amplitude (A) in the DIC group, compared with the control group. The OR value (95%CI) of the R reaction time,α-angle and MA was 3.538 (1.298-5.389), 2.472 (1.820-2.224) and 0.256 (0.263-0.831) respectively, which suggests good correlation with the existence of DIC (all P < 0.01). The specificity of R reaction time, α-angle and MA was higher than that of PT, APTT and D-dimers (85.7%, 73.5% and 72.9% vs. 27.0%, 42.1% and 68.2%) . The average R reaction time of children suffering from hemorrhage of severe liver disease(n = 36) was significantly longer than that of 40 healthy children [(9.2 ± 2.7) vs. (2.3 ± 1.8)s, P = 0.001 0], while the α-angle (42.8° ± 7.6° vs. 59.2° ± 10.8°, P = 0.040 0) and the MA value [(33.9 ± 5.1) vs.(56.0 ± 8.1) mm, P = 0.020 0] were significantly smaller. The average R reaction time of children suffering from congenital coagulopathy was significantly longer than that of healthy children [(6.8 ± 3.1) vs. (2.3 ± 1.8)s, P = 0.003 0], too.</p><p><b>CONCLUSION</b>TEM, which has high specificity, is beneficial to the diagnosis of DIC in children.</p>