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Objective@#To study the epidemiology and antimicrobial resistance of Gram-negative bacterial bloodstream infections in children, and to guide the choice of antimicrobials and the control of nosocomial infection.@*Method@#Clinical data, bacteriology and antimicrobial susceptibility test results were collected retrospectively in hospitalized children who were diagnosed with gram-negative bacterial bloodstream infections in Yuying Children′s Hospital of Wenzhou Medical University from January, 2010 to December, 2015.@*Result@#A total of 399 cases (253 male and 146 female) were identified. The age ranged from 16 hours to 16 years (median age 10.1 months). The majority of cases were collected from division of neonatology (n=261, 65.4%), followed by 31 cases (7.8%) from pediatric intensive care unit and 29 cases (7.3%) from Gastroenterology Department; 275 cases (68.9%) had underlying diseases, mainly including preterm birth(n=172), neonatal respiratory distress syndrome(n=67) and newborn asphyxia(n=53). Eighty cases had received invasive procedures and 20 had surgical operation; 149 cases (37.3%) were community-acquired and 250 cases (62.7%) were hospital acquired. Fifty cases had complications, among those, 40 cases had septic shock, 32 cases had multiple organ dysfunction syndrome and 7 cases had disseminated intravascular coagulation; 288 cases were cured, 48 improved, 17 gave up treatment and discharged, and 46 died; totally 408 strains were isolated from 399 children, including Enterobacteriaceae (346, 84.8%), non-fermentative Gram-negative bacteria (49, 12.0%) and other gram-negative bacteria (13, 3.2%). The resistance rates of Escherichia coli (n=175) and Klebsiella pneumoniae (n=106) to carbapenems, β-lactams enzyme and its inhibitors, amikacin and cefoxitin were all lower than 10%. Totally 245 multi-drug resistant strains (60.1%) were isolated, including 225 strains of Enterobacteriaceae and 18 strains of non-fermentative Gram-negative bacteria (P<0.01) . Nine strains of Carbapenem-resistant Enterobacteriaceae were isolated, which were all sensitive to amikacin and the sensitive rates to fluoroquinolone reached 88.9%. Five strains which were detected sensitive to tigecycline were all sensitive. The proportion of Klebsiella sp in Gram-negative bacteria between 2013-2015 and 2010-2012 were 32.9% and 21.2%, respectively. The resistance rates of Escherichia coli and Klebsiella pneumoniae to β-lactams and its enzyme inhibitors and carbapenems had no significant change.@*Conclusion@#Gram-negative bacterial bloodstream infections occur more frequently in newborns. Most children had combined underlying diseases. Escherichia coli and Klebsiella pneumoniae are the most common pathogens. β-Lactams and its enzyme inhibitors and carbapenems are the empirical choice of antimicrobial therapy for severe Enterobacteriaceae bloodstream bacterial infections.
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Objective To refine the technique and improve the efficacy of seminal vesiculoscopy in the diagnosis and treatment of seminal vesicle disease.Methods The refined techniques of seminal vesculoscopy,using a patent catheter into the slit-like ejaculatory duct orifice through the verumontanum and another patent catheter introduced into seminal vesicle lumen,were performed in 58 cases,including intractable hematospermia in 42 cases and azoospermia in 16 cases.Results Seminal vesiculoscopy was successfully entered into the seminal vesicular lumen in 46 patients (79％) within 2-3 min.There was no obvious ejaculatory duct orifice in 12 of 16 azoopermia cases,and transurethral resection of verumontanum was performed,then seminal vesiculoscope was directly entered into seminal vesicle lumen.Symptoms of hematospermia were disappeared in 25 cases (60％),improved in 11 cases (26％),and azoospermia were cured in 6 cases (37％),improved in 5 (31％),unchanged in 5 (31％) during the follow-up period of 6-36 months (average 18 months).There were no major or minor complications in this series,and no urine reflux into ejaculatory duct in 19 cases demonstrated by contrast medium.Conclusion Refined seminal vesiculoscopy was technically safe,efficient,simple,and potentially widely used in the cases of hematospermia and ejaculatory duct obstructions.
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Objective To evaluate the method, clinical efficacy and safety of one phase treat-ment of renal calculi associated with pyonephrosis by percutaneous nephrolithotripsy(PCNL) by pneu-matic combined with ultrasonic lithotriptor. Methods Sixty-six cases of renal calculi accompanied with pyonephrosis were treated with PCNL. The renal calyx was punctured under ultrasound gui-dance, then the tract was dilated from F8 to F16 by peel-away vascular access sheathes. After the in-sertion of the flexible sheath, metallic dilator was inserted and the flexible sheath was pulled out. The tract was dilated by metallic sheath to F21 and the operation sheath and nephroseope were placed into working tract. EMS III LithoClast Master was used. Ultrasonic powered lithotriptor probe with suc-tion was used to clear the liquor puris and calculus fragments with low-pressure or no-pressure. The combined pneumatic and ultrasonic powered lithotriptor was used to break and clear the calculi. Re-salts Of the 66 cases, there was no bacteremia or pyaemia intraoperatively and postoperatively. And there was no other severe complication occurred intraoperatively. One phase PCNL was successfully completed in 60 cases. Other 4 cases had residual calculi less than 1.5 em in diameter and received ESWL to break the calculi, 2 cases had bigger residual calculi and accepted second PCNL 1 week after the first intervention. In the follow-up period, the 3 month post-operative serum Cr was 56-203 μmol/L with an average decrease of 40 μmol/L, GFR was 5.0-56.2 ml/min with an average increase of 23.6 ml/min compared with the pre-operative data. At 6 months postoperative serum Cr was 56-158 μmol/L with average decrease of 31 μmol/L, GFR was 5.0-79.2 ml/min with an average in-crease of 30.2 ml/min. Conclusion Application of PCNL in the treatment of patients with renal cal-culi accompanied with pyonephrosis is safe, cost-effective and clinically efficient by pneumatic com-bined with ultrasonic lithotriptor.