ABSTRACT
Objective:To study the distribution and antibiotics resistance of the main pathogens of neonatal purulent meningitis in different regions of China.Methods:A retrospective descriptive clinical epidemiological study was conducted in children with neonatal purulent meningitis which admitted to 18 tertiary hospitals in different regions of China between January 2015 to December 2019. The test results of blood and cerebrospinal fluid, and drug sensitivity test results of the main pathogens were collected. The distributions of pathogenic bacteria in children with neonatal purulent meningitis in preterm and term infants, early and late onset infants, in Zhejiang Province and other regions outside Zhejiang Province, and in Wenzhou region and other regions of Zhejiang Province were analyzed. The chi-square test was used for statistical analysis.Results:A total of 210 neonatal purulent meningitis cases were collected. The common pathogens were Escherichia coli ( E. coli)(41.4%(87/210)) and Streptococcus agalactiae ( S. agalactiae)(27.1%(57/210)). The proportion of Gram-negative bacteria in preterm infants (77.6%(45/58)) with neonatal purulent meningitis was higher than that in term infants (47.4%(72/152)), and the difference was statistically significant ( χ2=15.54, P=0.001). There were no significant differences in the constituent ratios of E. coli (36.5%(31/85) vs 44.8%(56/125)) and S. agalactiae (24.7%(21/85) vs 28.8%(36/125)) between early onset and late onset cases (both P>0.05). The most common pathogen was E. coli in different regions, with 46.7%(64/137) in Zhejiang Province and 31.5%(23/73) in other regions outside Zhejiang Province. In Zhejiang Province, S. agalactiae was detected in 49 out of 137 cases (35.8%), which was significantly higher than other regions outside Zhejiang Province (11.0%(8/73)). The proportions of Klebsiella pneumoniae, and coagulase-negative Staphylococcus in other regions outside Zhejiang Province (17.8%(13/73) and 16.4%(12/73)) were both higher than those in Zhejiang Province (2.9%(4/137) and 5.1%(7/137)). The differences were all statistically significant ( χ2=14.82, 12.26 and 7.43, respectively, all P<0.05). The proportion of Gram-positive bacteria in Wenzhou City (60.8%(31/51)) was higher than that in other regions in Zhejiang Province (38.4%(33/86)), and the difference was statistically significant ( χ2=6.46, P=0.011). E. coli was sensitive to meropenem (0/45), and 74.4%(32/43) of them were resistant to ampicillin. E. coli had different degrees of resistance to other common cephalosporins, among which, cefotaxime had the highest resistance rate of 41.8%(23/55), followed by ceftriaxone (32.4%(23/71)). S. agalactiae was sensitive to penicillin, vancomycin and linezolid. Conclusions:The composition ratios of pathogenic bacteria of neonatal purulent meningitis are different in different regions of China. The most common pathogen is E. coli, which is sensitive to meropenem, while it has different degrees of resistance to other common cephalosporins, especially to cefotaxime.
ABSTRACT
Objective To investigate the clinical effects and safety of terbutaline combined with budesonide atomized inhalation in the treatment of children with bronchiolitis obliterans .Methods 140 cases of children with bronchiolitis obliterans from June 2015 to June 2017 were selected as research subjects , and they were randomly divided into control group and observation group according to the digital table ,with 70 cases in each group .The control group was given budesonide atomized inhalation alone ,and the observation group was given terbutaline combined with budesonide atomized inhalation .The clinical effects ,disappeared time of symptoms ,levels of IL-4 and INF-γbefore and after treatment and incidence rate of adverse effects in the two groups were compared .Results The excellent effective rate and total effective rate of the control group were 28.57％,78.57％,respectively,which were significantly lower than those of the observation group (44.29％,95.71％) (χ2 =9.73,8.60,all P<0.05).The disappeared time of symptoms of the observation group was significantly shorter than those of the control group ( t=2.67,3.15,2.20, 2.36,all P<0.05).The levels of IL-4 and INF-γafter treatment of the observation group were significantly higher than those of the control group and before treatment (t=2.44,2.71,3.07,3.66,2.94,3.26,all P<0.05).The incidence rates of adverse effects of the control group and the observation group were 8.57％,11.43％,respectively, there was no statistically significant difference between the two groups (χ2 =1.49,P>0.05).Conclusion Terbutaline combined with budesonide atomized inhalation in the treatment of children with bronchiolitis obliterans can efficiently control the disease progression ,shorten the clinical disease course ,regulate the levels of IL -4 and IFN-γand not aggravate the adverse drug reactions .