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.

Pathogenesis and therapy in sepsis-induced cardiomyopathy / 国际儿科学杂志

Sepsis-induced cardiomyopathy(SICM)is a reversible cardiac insufficiency in the early stage of sepsis, and mainly manifests as left ventricular dilation, decreased ejection fraction, and recovery within 7~10 days.Although it is reversible, the incidence and mortality in sepsis are high.The specific mechanism is still unclear.Inflammatory reaction, mitochondrial dysfunction, apoptosis and other pathophysiological processes play an important role.Its process is complex and involves the interaction between organism and pathogen.The management of SICM is still based on the etiologic treatment of septic shock guided by hemodynamic monitoring and tissue perfusion, with cardio-protective therapy and specific measures.This review summarizes the literatures on the mechanisms and treatments of SICM.

Application of the positive end expiratory pressure titration technique in acute respiratory distress syndrome with mechanical ventilation / 中国小儿急救医学

For patients with acute respiratory distress syndrome, the use of lung protective ventilation strategy is currently recognized, and the setting of positive end expiratory pressure(PEEP)is an important part of lung protective ventilation.PEEP titration techniques are diverse, but the selection of the best PEEP is still difficult in clinical work.

Risk factors of septic shock with acute kidney injury in 89 children / 中国小儿急救医学

Objective We analyzed the clinical data of 89 septic shock in children retrospectively to provide evidence of early diagnosis,treatments and improving prognosis for children who had septic shock and acute kidney injury(AKI). Methods Eighty-nine children were selected from June 2013 to December 2018 in the PICU of Children′s Hospital Affiliated to the Capital Institute of Pediatrics. According to whether accompanied by AKI or not,they were divided into two groups:56 cases of patients with septic shock accom-panied by AKI in the research group,and 33 cases of patients without AKI in the control group. Then we used SPSS25. 0 software to analyze the clinical data with univariate and multivariate analysis. Results The mor-tality of research group and control group were 46. 4%(26/56) and 39. 4% (13/33),respectively. There were obvious differences between two groups in pediatric critical illness score(PCIS),the number of organ failure,nervous failure,hepatic failure,circulatory failure,lactic acid,γ-glutamyltransferase,creatinine,urea, total bilirubin,direct bilirubin(P<0. 05). Logistic regression showed that hepatic failure( OR 0. 099,95%CI 0. 018~0. 549),PCIS<80(OR 0. 223,95%CI 0. 064~0. 774),lactic acid>4. 1 mmol/L( OR 0. 221,95%CI 0. 055~0. 885) were independent risk factors for septic shock with AKI. Conclusion The mortality of septic shock with AKI is high. Hepatic failure,PCIS<80,lactic acid>4. 1 mmol/L are independent risk fac-tors. Septic shock is a systemic inflammation which can influence all organs. In order to reduce the incidence of AKI,it′s necessary to pay early attention to the changes of microcirculation such as lactic acid.

Risk factors of septic shock with acute kidney injury in 89 children / 中国小儿急救医学

Objective@#We analyzed the clinical data of 89 septic shock in children retrospectively to provide evidence of early diagnosis, treatments and improving prognosis for children who had septic shock and acute kidney injury(AKI).@*Methods@#Eighty-nine children were selected from June 2013 to December 2018 in the PICU of Children′s Hospital Affiliated to the Capital Institute of Pediatrics.According to whether accompanied by AKI or not, they were divided into two groups: 56 cases of patients with septic shock accompanied by AKI in the research group, and 33 cases of patients without AKI in the control group.Then we used SPSS25.0 software to analyze the clinical data with univariate and multivariate analysis.@*Results@#The mortality of research group and control group were 46.4%(26/56) and 39.4% (13/33), respectively.There were obvious differences between two groups in pediatric critical illness score(PCIS), the number of organ failure, nervous failure, hepatic failure, circulatory failure, lactic acid, γ-glutamyltransferase, creatinine, urea, total bilirubin, direct bilirubin(P<0.05). Logistic regression showed that hepatic failure(OR 0.099, 95%CI 0.018~0.549), PCIS<80(OR 0.223, 95%CI 0.064~0.774), lactic acid>4.1 mmol/L(OR 0.221, 95%CI 0.055~0.885) were independent risk factors for septic shock with AKI.@*Conclusion@#The mortality of septic shock with AKI is high.Hepatic failure, PCIS<80, lactic acid>4.1 mmol/L are independent risk factors.Septic shock is a systemic inflammation which can influence all organs.In order to reduce the incidence of AKI, it′s necessary to pay early attention to the changes of microcirculation such as lactic acid.