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Objective@#To investigate the molecular epidemiology and mechanisms of fosfomycin-resistant Escherichia coli isolates producing extended-spectrum β-lactamases (ESBLs) isolated from urine. @*Methods@#Fosfomycin-resistant phenotypes were screened by drug susceptibility test in ESBLs-producing E.coli stains. The ESBLs gene and fosfomycin resistant gene were amplified by PCR. The molecular typing was analyzed by multiple sequence type (MLST). The transferability of the drug resistant gene was verified by conjugation assays. @*Results@#Among the 308 strains of E.coli isolated from urine, there were 168 (54.54%) ESBLs producing strains and 18 (10.71%, 18/168) fosfomycin resistant strains. In the drug resistant genes, the incidence of bla SHV was about 88.9% (16/18), bla CTX-M was 77.8% (14/18), bla TEM-208 was 5.6% (1/18), bla TEM-1b was 61.1% (11/18) and fosA3 was 83.3% (15/18). The main MLST genotype was ST131. The conjugation test confirmed the transferability of resistance in fosA3 positive strain. @*Conclusion@#The fosfomycin resistant rate of ESBLs producing E.coli in urethral infection was in a low level. The fosA3 gene was the main mechanism of fosomycin resistance and located on the conjugation plasmids, which should be the main node of horizontal gene transmission. We need to pay great attention to this resistant gene.
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Objective To analyze the application of the HR -HPV,TCT combined with digital colposcopy cervical biopsy in diagnosis of CIN and cervical carcinoma.Methods From 2014 to 2016,250 cases diagnosed as ASCUS and above the level of disease were selected in Shanxi Cancer Hospital ,including 148 cases of ASCUS,68 cases of LSIL,27 cases of HSIL and 7 cases of SCC.The HR-HPV copy number was detected by using PCR fluorescence measurement,the Reid colposcopy scores were measured by using digital colposcopy ,and the cervical histopathological diagnosis was regarded as a measurement rule.Results The diagnostic rate of simple use of TCT for the diagnosis of CIN and above lesions was 41.20%(103/250), HR -HPV & TCT in diagnosis of CIN and above lesions was 58.78%(77/131),TCT & digital colposcopy for the diagnosis of CIN and above lesions was 67.42%(89/132), which were significantly increased (χ2=35.87,P=0.00;χ2=59.01,P=0.00).The diagnostic rate of HR-HPV&TCT combined with electronic colposcopy in diagnosis of lesions above CIN was 79.82%( 91/114 ), which was significantly higher than that of HR -HPV & TCT[58.78%(77/131)],and the diagnostic rate of TCT & digital colposcopy was 67.42%(89/132)(χ2=15.54,P=0.01;χ2=8.05,P=0.02).The incidence of CIN and cervical cancer were closely related with HR -HPV infection and the rate of HR-HPV infection showed an increasing trend with the aggravating degree of disease (the HR-HPV infection rate of ASCUS was 39.86%,the HR-HPV infection rate of LSIL was 61.76%,the HR-HPV infection rate of HSIL was 88.89%,while the HR-HPV infection rate of SCC was 100.00%).Conclusion HR-HPV,TCT combined with digital colposcopy can effectively improve the diagnosis rate of CIN and above the level of disease.At the same time,with the deterioration of the disease ,HR-HPV infection rate increases significantly ,which can provide diagnostic information and significance in the clinical diagnosis of CIN and cervical cancer.
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Objective To evaluate the prevalence of cryptococcal antigenemia and explore the related cryptococcal lesions in hospitalized human immunodeficiency virus ( HIV )-infected patients . Methods Medical records of 517 HIV-infected patients ,including patients'age ,sex ,clinical features , previous medical history ,laboratory tests ,chest CT ,treatment and the response to treatment ,in the Second Hospital of the Nanjing between January 2016 and February 2018 were retrospectively analyzed . The serum cryptococcal antigen (sCrAg) was detected by lateral flow immunoassay .The χ2 test or Fisherexact test was used to perform the statistical analysis .Results Among 517 HIV-infected cases ,51 were sCrAg positive ,of whom 96 .1% (49 cases) were men .The cases with CD4+ T lymphocyte count <100 × 106 cells/L accounted for 66 .2% (342 cases) ,while 90 .2% (46 cases) in sCrAg-positive patients showed CD4+ T lymphocyte count < 100 × 106 cells/L with statistical significance (χ2 = 14 .6 , P< 0 .01 ) . Multivariable analysis revealed that CD4+ T lymphocyte count <100 × 106 cells/L was independent risk factor for cryptococcal antigenemia (OR= 4 .7;95% CI:1 .8 -12 .5 , P< 0 .01) .Clinical cryptococcal diseases were found in 76 .4% (39/51 ) of patients with cryptococcal antigenemia , and cryptococcal meningitis (CM) ,pulmonary cyptococcosis (PC) and cryptococcal septicemia were found in 56% (28/50) ,52 .9% (27/51) and 44 .4% (16/36) of the patients ,respectively .Cryptoccal disease was not identified in 21 .6% (11/51 ) of the patients with cryptococcal antigenemia (isolated cryptococcal antigenemia) .The median (range) sCrAg titers of the patients with and without CM were 1:1280 (1:10-1:2560) and 1 :15 (1:2-1:2560) ,respectively (P<0 .01) .The proportion of CM in patients with sCrAg titers ≤1:5 ,1:10 -1:320 and ≥1:640 were 0 (0/10) ,50% (10/20) and 90% (18/20) , respectively .When cryptococcal infection was restricted to the lung ,87 .5% (7/8) of the patients had sCrAg titers ≤1:20 .30% (3/10) of the patients with sCrAg titers ≤1:5 had PC .The median (range) sCrAg titers of the patients with cryptococcal septicemia and with isolated cryptococcal antigenemia were 1:1280 (1:10 -1:2560 ) and 1:5 (1:2 -1:320 ) , respectively . Conclusions T he prevalence of cryptococcal antigenmia is high in hospitalized HIV-infected patients . Most patients with cryptococcal antigenemia have developed cryptococcal diseases .The sCrAg titer in HIV patients may ,in some extend , predicts the condition of cryptococcal infection .sCrAg titers ≥ 1:640 are strongly suggestive of CM . Patients with sCrAg titers ≤1:5 seems unlikely to have CM or cryptococcal septicemia ,however ,clinician should still be alarmed of possible PC .
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The prevalence of invasive pulmonary fungal infections (IPFIs) has increased in children,which becomes a clinical concern in recent years.With the availabilities of new diagnostic tools for fungi and more antifungal agents,children with IPFIs may achieve a much earlier diagnosis and treatment.This article reviewed the development of laboratory tests,diagnostic criteria,treatment strategies and commonly used antifungal agents for IPFIs.
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Objective To study the iodine nutritional status and the thyroid function of pregnant women during different periods,and provide scientific basis for iodine supplementation.Methods Totally 728 pregnant women who visited the obstetric outpatient of Nanjing Drum Tower Hospital for routine prenatal care from December 2014 to August 2016 were recruited in this study,and at the same time 182 non-pregnant women were recruited as control group.The thyroid stimulating hormone (TSH) and free thyroxine (FT4) were measured by Roche 601.The urinary iodine level was measured by SR-I-100 kit.Results The median urinary iodine of 728 pregnant women was 168.24 g/L,and the median urinary iodine of those women in the T1,T2 and T3 period were 186.31,162.65 and 148.76 g/L,respectively.The TSH at T1 period was lower than T2 and T3 period (t=3.429,3.135,P<0.05).The FT4 at T1 period was higher than T2 and T3 period (t=5.251,5.965,P< 0.05).The prevalence rate of thyroid disease in normal urinary iodine group was lower than that in low urinary iodine group and high urinary iodine group (x2 =4.139,4.131,P<0.05).Conclusion There was no iodine deficiency among those pregnant women groups,but only 34.75 % individuals reached the appropriate iodine nutritional level,and the ratio of iodine insufficient increased with the extension of pregnancy.The whole prevalence rate of thyroid disease in abnormal urinary iodine pregnant women was obviously higher than that in normal.It is necessary to improve the pregnant women's knowledge of iodine nutrition,moreover it is suggested that urinary iodine monitoring and thyroid function should be conducted in pregnant women.
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Objective To explore the molecular mechanisms of carbapenem-resistant Klebsiella pneumoniae.Methods Carba NP confirmatory test were used to detect carbapenemases.Carbapenemase genes,ESBL genes and plasmid-mediated AmpC genes were amplified by polymerase chain reaction (PCR).The genetic correlation analysis was carried out by using multiple sequence type (MLST).Results 42 out of the 50 carbapenem-resistant Klebsiella pneumoniae strains were KPC-2-positive strains,1 strain was positive for NDM-1,the other 7 strains were not detected for any carbapenemase genes.The percentages of KPC-2-positive Klebsiella pneumoniae with the bla CTX-M,bla SHV,bla TEM,bla DHA were 21.5 %,42.9 %,69.1% and 4.8% respectively.The results of MLST showed that 37 out of 42 KPC-2 positive strains were ST11.Conclusion The production of KPC-2 is the main mechanism of Klebsiella pneumoniae resistance to carbapenem and there is an outbreak of ST11 KPC-2 Klebsiella pneumoniae in this hospital.
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Objective To observe the positive rate of serum anti-cardiac troponin Ⅰ autoantibodies (anti-cTnI) in the patients with coronary atherosclerotic heart disease(CHD) and its clinical significance.Methods A total of 200 CHD patients and 200 healthy controls from the Department of Cardiology,Drum Tower Hospital of Nanjing University Medical School during September 2015 and May 2016 were collected in the case-control study.Serum anti-cTnI was detected with an indirect ELISA method.Meanwhile,the general data,chnical biochemical parameters and coronary vascular lesion from the two groups were analyzed.Results The positive rate of anti-cTnI in CHD patients(21/200,10.5%) was significantly higher than that in healthy controls(4/200,2.0%,P < 0.01).According to the detection results of serum anti-cTnI,the participants were divided into three groups,including anti-cTnI positive group with CHD,anti-cTnd negative group with CHD and anti-cTnI positive group in healthy controls.The median age and serum Glu level in the anti-cTnI positive group with CHD were significantly higher than those in the anti-cTnI positive group in healthy controls (P < 0.05),while the levels of serum HDL-C and apoA I were inverse (P < 0.01).The median age and Gensini score in the anti-cTnⅠ positive group with CHD were significantly higher than those in the anti-cTnI negative group with CHD,while the level of serum HDL-C was inverse (P < 0.05).Conclusion Anti-cTnI may be more likely to occur in old CHD patients with severe coronary artery lesions,and the low levels of serum HDL-C and apoA Ⅰ may correlate to the production of anti-cTnⅠ.
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Objective To investigate the relationship between the systemic lupus erythematosus (SLE)and the SOCS-1 gene methylation status of the peripheral blood DNA,to provide the basis for diagnosis and treatment of systemic lupus erythema-tosus.Methods Blood samples of SLE patients (27 cases)and healthy group (19 cases)in January 2015 to April were col-lected and the DNA were extracted.Using polymerase chain reaction combining DNA agarose gel electrophoresis to detect the SOCS-1 gene methylation status.Results In patients with systemic lupus erythematosus SOCS-1 gene complete methyl-ation accounted for 44% (12/27),incomplete methylation accounted for 56% (15/27).In healthy group SOCS-1 gene com-plete methylation accounted for 74% (14/19)and incomplete methylation accounted for 26% (5/19).The rate of complete methylation of SOCS-1 gene of SLE patients was lower than that of healthy group (χ2=3.88,P=0.049).Conclusion SLE patients may have lower SOCS-1 gene methylation status in the peripheral blood DNA,which is worth for further study.
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Aim To explore the influence of metformin(a first-line drug for type 2 diabetes) on ATP-induced inflammasome activation and the release of interleukin-1β(IL-1β) by LPS-activated peritoneal macrophages, a commonly-used inflammatory cell model.Methods Peritoneal macrophages were elicited by intraperitoneal injection of 30 g·L-1 thioglycollate into C57BL/6 mice.Inflammasome was activated and cell pyroptosis was induced by LPS plus ATP treatment, and the pyroptotic cells were calculated after propidium iodide(PI) staining.The protein levels of IL-1β and caspase-1 expressed in the cells and released from them into the supernatant were evaluated by Western blot.Immunofluorescent microscopy was recruited to detect the subcellular distribution and fluorescent intensity of the purinergic P2X7 receptor(P2X7R).Results Metformin per se did not induce pyroptosis in LPS-activated peritoneal macrophages, but it significantly and dose-dependently increased cell pyroptosis induced by ATP treatment.At protein levels, maturated IL-1β(17 ku) could not be released from the cells upon single LPS or LPS plus metformin stimulation;but after ATP was added, maturated IL-1β was released into the supernatants of the cells.Moreover, metformin dose-dependently increased the protein levels of both maturated IL-1β and active caspase-1 released by the LPS-activated peritoneal macrophages upon ATP stimulation.Conclusion Metformin intensifies the activation of inflammasome and increases the release of active caspase-1 and maturated IL-1β upon ATP stimulation in the LPS-activated peritoneal macrophages, which should promote inflammatory responses.
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Objective To identify the pathogen distribution and antibiotics resistance of blood stream infection(BSI) in the pediatric surgery intensive care unit(PSICU).Methods The clinical data of 138 pediatric patients diagnosed with BSI from January 2011 to December 2015 were collected in PSICU,and the distribution of pathogens and drug resistance were retrospectively analyzed.Results The incidence of BSI was 3.88‰(138/35.524)in the five years,the majority of the BSI cases occurred under one year old,and the mortality was 13.77%(19/138).A total of 179 strains were isolated from blood samples of 138 patients,of which gram-positive bacteria,gram-negative bacteria and fungi accounted for 60.89%(109/179),22.91%(41/179)and 16.20%(29/179)respectively.The most common gram-positive bacteria was coagulase-negative staphylococcus (84/179,46.93%).The predominant gram-negative bacteria were Acinetobacter baumannii(15/179,8.38%),Klebsiella pneumonia(12/179,6.70%) and Escherichia coli(6/179,3.35%).The rate of carbapenems-resistant Acinetobacter baumannii increased continuously in the study period.Non-albicans Candida was the most common fungi (14/179,7.82%).The resistance rate of multi-drug resistant strains to carbapenems significantly increased.Conclusion The incidence of BSI in PSICU increases,and the mortality in children younger than one year is high.Better understanding of distribution of BSI pathogen could provide more effective antibiotic prescription.
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Objective To analyze the epidemiology and clinical characteristics of the children with measles. Methods Retro-spectively analyzed methods were applied to analyze the timing, and season of the break, age distribution, clinical manifestations and major complications of 3431 children with measles (<12 years) in the Second Hospital of Nanjing from 2008 to 2015. Results It found that there was a peak incidence of measles in children each in 2009, 2013, and 2015 , peaking in March to May. Onset age of measles mainly within the first year of life, and incidence increased with age within the first 8 months. Typical clinical manifestations are mainly fever, rash, cough, and catarrhal symptoms. The main complications of measles were pneumonia, laryngitis and heart failure. Conclusions Early diagnosis and effective treatment of the children with measles needs to be strengthened.
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Objective:To investigate the magnetic resonance imaging (MRI) features of Cryptococcus infection in central nervous system patients with acquired immune deficiency syndrome (AIDS).Methods:The retrospective study on magnetic resonance imaging (MRI) and clinical data of cryptococcal meningitis (CM) was carried out between July 2011 and March 2017.These patients had not received anti-retroviral treatment.Patients with other specific or suspicious diseases in the central nervous system were not included in the analysis.Results:A total of 39 patients were included in the analysis,with CD4 cell counts of 13.0×106/L [(0-205)×106/L],and 94.9% (37/39) of patients with CD4 cell count <100×106/L.Of the 39 patients,26 patients showed abnormal MRI signals in the brain,which were most frequently involved in the basal ganglia (20/26,76.9%).The basal ganglia lesions showed dilated VirchowRobin space (VRS)/gelatinous spseudocysts (18/20,90%).Postcontrast T 1-weighted MRI revealed no significant enhancement (3/5,60%) and mild enhancement (2/5,40%).The incidence of cerebral cryptococcal granuloma were 35% (7/20).Nineteen of 26 patients with lesions outside the basal ganglia,of which 13 patients also complicated with basal ganglia lesions.Postcontrast T1-weighted MRI revealed no significant enhancement.The incidence of cryptococcal granuloma and meningeal thickening were 15.7% (3/19) and 26.3% (5/19),respectively.Postcontrast T1-weighted MRI meningeal thickening revealed enhancement (5/5,100%).Conclusion:The incidence of brain MRI abnormality in AIDS complicated with central nervous system Cryptococcus infection may not be low,and the lesions are mostly located in the basal ganglia.It most frequently displays the dilated VRS/gelatinous spseudocysts.It can also be showed cryptococcal granuloma.Postcontrast T1-weighted MRI often reveals no enhancement or mild enhancement.
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Invasive fungal disease(IFD) is one of the causes leading to death in intensive care unit,and now more likely to occur in non-neutropenic critically ill patients.Early diagnosis and appropriate selection of patients at high risk of IFD to receive prophylactic antifungal therapy are of great concern.Risk factors related to IFD were established by multivariable analysis and then risk evaluation models were developed.Candida score could accurately select patients who would benefit from early antifungal treatment.Evaluation and validation of risk models for non-neutropenic critically ill patients at high risk of IFD were reviewed in this article.
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Objective To investigate the clinical value of urinaryα1-acid glycoprotein (AAG)in the early diagnosis of diabetic nephropathy(DN).Methods 266 cases of diabetic patients in Drum Tower Hospital Affiliated to Medical School of Nanjing University from May 2013 to October 2014 were recruited,and patients were divided into four groups based on the urine al-bumin/creatinine (ACR)levels,as follows:non-diabetic nephropathy group (Non-DN)152 cases,low urinary albumin/cre-atinine group (LUA)49 cases,high urinary albumin/creatinine group (HUA)32 cases,and very high urinary albumin/cre-atinine group (VHUA)33 cases.63 cases of healthy subjects (NC group)and 66 cases of fracture patients (stress group) were recruited as control group.The urinary AAG and other biochemical indicators were measured for all subjects.Results The level of urinary AAG in DN group was significantly higher than that in stress group,Non-DN group and NC group (t=7.951,7.985,8.021,P <0.05),and gradually increased from LUA,HUA to VHUA group (P <0.05).The urinary AAG level was positively correlated with UA,Cr,CRP and ACR (r=0.169,0.286,0.373,0.606,P <0.01).Stepwise logistic re-gression analysis showed that the urinary AAG was the independent risk factor of DN (P <0.05).Conclusion The level of urinary AAG has good application value in the early diagnosis and monitoring progression of DN.
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Objective To discuss the efficacy of ulinastatin in treatment of children with severe pneumonia.Methods One hundred children with severe pneumonia were analyzed retrospectively.They were divided into two groups.One was treatment group with 48 cases of patients and another was control group with 52 cases of patients.The two groups both accepted routine treatments,while the treatment group was given ulinastatin[(20 kU/(kg·d),5 d in total] additionally.The clinical improvement of both groups was observed.Changes of clinical syndromes including temperature and lung rale were observed.The effect of treatment in following aspects were evaluated:time of oxygen therapy,the length of stay in PICU and total hospitalization day.Recovery times of infectious indicators were monitored including peripheral WBC count,C-reactive protein (CRP) and procalcitonin (PCT).Meanwhile,the clinical adverse effect of the drug was observed.Results After treatment,recovery time of temperature in treatment group was (5.81±1.26) d,while in control group was(8.04±1.38) d.There was an obvious difference between two groups(t=-8.42,P<0.01).Compared to control group,the recovery times of infectious indicators including WBC count,CRP,and PCT were shorter[(5.35±1.39) d vs.(6.65±1.79) d,t=-4.03,P<0.01;(6.98±1.66) d vs.(8.17±1.64) d,t=-3.60,P<0.01;(6.13±1.72)d vs.(7.52±1.78)d,t=-3.96,P<0.01].In the treatment group,the length of stay in PICU was (8.44±2.47) d,which was shorter than that in control group [(10.62±3.13)d,t=-3.84,P<0.05].But there was no significant difference in both groups of time of lung rale disappearing,oxygen therapy and the total hospitalization days.No side effect was found in treatment group.Conclusion For the children with severe pneumonia,besides the treatments of anti-infection,breathing and nutrition support,the use of ulinastatin can improve the condition of patients and the index of inflammatory reaction.It also can shorten the length of stay in PICU.Since the curative effect of ulinastatin is specific and it has less adverse reactions,ulinastatin can be used as one of the effective measure in treatment of severe pneumonia in children.
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Objective To summarize theskill practice as the coremethods and training effect in tumor specialist nurse training , and to explore the suitable effective methods and pattern of China′s national conditions of specialist nurse training in China, for providing a reference for conducting cancer specialist nurse training. Methods Reviewed and analyzed tumor specialist nurse training method to make clear the training effect from 2012 to 2013, 100 students was investigated by using questionnaires , which contain 15 aspects, before and after the training respectively. designskill practice as the coreof the training content (160 hours) and theoretical classes (80 hours), established training evaluation criteria and the organization management system. Results All 100 students had grasped maintenance technology, observation of the complications of treatment, infusion port of the maintenance, the use of chemotherapy drugs, health education for patients with PICC catheter, and the use of effective order, the grasp rate was 100%. Complications rate was decreased significantly after using PICC catheter, (the rate of catheter related blood stream infections and the rate of thrombosis was reduced from the top 35%and 12%before training to 4%and 1%after training respectively (P<0.05). Conclusions In order to train more practical clinical nurse specialists, reduce the complications, raise the overall level of nursing profession, and improve the quality of nursing after using PICC catheter. Skill practice as the core methods in tumor specialist nurse training should be advocated.
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Objective To analyze the epidemiological characteristics of Epstein Barr virus (EBV)or cytomegalovirus (CMV) infection in systemic lupus erythematosus (SLE)patients in order to provide reference for clinic.Methods The clinical data of 202 female cases in-patients diagnosed with SLE (SLE group)from January 2012 to May 2015 in Nanjing Drum Tower Hospital were analyzed retrospectively.Meanwhile,203 cases including female renal transplant donors,obstetrics and gyne-cology in-patients selected randomly were enrolled as control group.The infection rate between SLE and control groups was analyzed and compared based on the results of EBV-DNA and CMV-DNA in peripheral blood quantified by real time PCR. Results The positive rate of EBV-DNA in SLE group was 11.39% (23/202),with significantly statistical difference when comparing with the control group [3.45% (6/174)](χ2 = 8.28,P < 0.01).The positive rate of CMV-DNA [7.92% (16/202)]was significantly higher than that in control group [1.97% (4/203)](χ2 =7.64,P <0.05).In addition,the positive rate of EBV-DNA and CMV-DNA was also greatly higher in reproductive-age (20~45 years old)of SLE patients than those in control group,10.94%(14/128)vs 3.45%(4/116)(χ2 =4.99,P <0.05)and 7.75%(10/129)vs 2.22%(3/135)(χ2 =4.31,P <0.05),respectively.Conclusion SLE patients were more inclined to be accompanying infected by EBV or CMV, indicating the possible correlation between SLE and EBV or CMV infection;and physicians should pay more attention to the viral infection of SLE in clinical treatment.
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Objective To explore how to establish and safeguard the peripherally inserted central catheters(PICC) maintenance network for the management and practical activity of PICC,so as to provide continuous high-quality PICC maintenance for discharged patients with PICC. Methods 40 nurses each year from 10 cities and 100 country hospitals affiliated with Shanxi Quality Control Center to train in the 1st and 2nd affiliated hospital of Xi`an Jiaotong University were choosen as 214 PICC maintainers. These maintainers were taken into the inner-net of 1st affiliated hospital of Xi`an Jiaotong University management system complete the PICC maintenance net of Shanxi province. Results After the establishment of maintenance network, the number of patients with PICC increased (from 610 cases in 2008 to 1 434 cases in 2014);A large number of PICC management had been down by the qualified nurses in primary hospitals; Duration of PICC in patients days was prolonged; The PICC related complications including thrombophlebitis, catheter infection,occlusion or dislodgment and unplanned extubate were significantly decreased (P < 0.05 respectively). Conclusions Establishment of PICC maintenance network can provide patients with standardized and convenient PICC maintenance service,decrease the incidence of catheter which related complications and ensure patient safety. The application of PICC maintenance network should be used more and more.
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Objective To investigate the trough and peak vancomycin plasma concentrations in steady-state following regular dosage and to improve dosing regimen based on pharmacokinetic modeling, providing reference for clinical practice in children.Methods we retrospectively analyzed pharmacokinetics of vancomycin in 50 cases admitted in our PICU who had been confirmed or suspected with gram-positive bacterial infections following regular dosage[40 mg /(kg?d)].Then we tried to optimize dosing regimens with Monte Carlo simulation to evaluate different dosing regimens of vancomycin in children.Results with regular dosage of vancomycin,mean trough concentrations of vancomycin were (1 1.02 ±4.44 )mg /L, trough concentrations higher than 15 mg /L accounted for only 12%.In the actual program,the extension of a single intravenous infusion to 3 hours after administration would result in 26% of trough concentrations dis-tributing in the range above 15 mg /L.If we increased daily dose to 50 mg /kg and 60 mg /kg with simulation, the trough concentration distribution frequency above 15 mg /L would increase from 12% to 32% and 40%. If minimum inhibitory concentration of vancomycin to pathogenic bacteria (Staphylococcus aureus )was 1 mg/L,the probabilities of target attainment for pharmacokinetic/pharmacodynamic evaluation were 51.73%, 76.54% and 87.5% for three dosages [40 mg/(kg?d),50 mg/(kg?d)and 60 mg/(kg?d)]of vancomycin, respectively.we suspected that dosage of 60 mg/(kg?d)was a good choice.with this dosage regimen,we could achieve a substantial increase in the probability of target attainment.Conclusion Following regular dosages, trough concentration distribution frequency from 15 to 20 mg /kg is low.The extension of a single intravenous infusion time can not achieve a good result.According to the result of pathogenic bacteria and anti-microbial susceptibility tests,increasing daily dosage of vancomycin to 60 mg /(kg?d)will help to improve the trough concentration and get more clinic achievements.
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Objective To improve theu nderstanding of the characteristci s of death in hospitail zed hc ildren and provide clinical cautionary information to professional healthcarep rovdie rs.Methods A retro-spective analysis was undertaken on thed ata of all children aged 1 month to 11 years who died at the Xinhua H ospital between 2007 and 2014.Demographic details,main causes of deaths,and chronic underyl ingd iseases were reviewed.Results Case fatality rate was 0.58%( 451/77 838 ) .Overall, the most common causes fo deathni hospitalized childer n were pneumo nia 38.80%(175/451),tumor 13.75%(62/451),sepsis 11.97%(54/451),central nerve system infection 8.00%(36/451) and accident 7.32%(33/451).Infectious disea-ses were the maoj r causes of deathi n children younger than 5ye ars of age(66.86%,230/344).In oc ntrast, noninfectious diseases accuo tn ed for mo re deathsni children more than 5 years old(52.34%,56/107).There were 343d eath cases comp licated wiht chronic undelr ying diseases.Congentia la bnormality was the most fre-quent chronic underlying disease observed in infants(59.90%,115/192) and tumor was the main chronic nu -derlying dsi easei not ddlers and elder children(34.36%,89/259).Conclusion Infectious diseasse were the major causes of deta hs,and teh mortality in the study popual tion decreased with age.Tumors and accidents accounted for more deaths in elder children.Chronic underlying diseases were found in most deaths of children.Efficient evaluation and effective intervention of these vulnerable children might save more lives.