ABSTRACT
Objective To investigate the effect of ultrasound guided percutaneous nephrostomy combined with Mailuoning injection on renal function, TGF- β 1 and α -SMA in patients with obstructive hydronephrosis. Methods 37 cases with obstructive hydronephrosis treated in our hospital from June 2014 to December 2016 were enrolled as the research object, all patients after admission were perfect relevant examination, after exclude contraindications underwent ultrasound-guided percutaneous nephrostomy combined with Mailuoning injection treatment. The operative time, the success rate of first puncture, the amount of bleeding during operation, hospitalization time, incidence of complications, preoperative and postoperative 3 d, 7 d renal function preoperative, postoperative, 7 d urine transforming growth factor β 1 (TGF- β 1) and alpha smooth muscle actin (α -SMA) were observed. Results The operation time was 52~93 minutes in 37 patients, the average operation time was (62.31±8.26) minutes; One puncture was successful in 37 cases, the success rate of one puncture was 100%. The intraoperative blood loss was 51 ~ 102 mL, the average amount of bleeding was (80.27±18.15) mL. The hospitalization time was 3 ~ 9 d, the average time was (6.12±1.97)d.In 37 cases, three cases were blocked by ostomy, the incidence rate was 8.11 %; The fistula was removed in one cases, the incidence rate was 2.70%; seven cases with dermatitis around the fistula, the incidence rate was 18.92%. At 3 d after surgery, BUN and Cr were significantly decreased than before operation (P<0.05). At 7 d after surgery, BUN and Cr were significantly decreased compared with preoperative and postoperative 3 d (P<0.05). The levels of TGF-β1 and α-SMA in patients were significantly lower than those before operation at 7 days after operation (P<0.05). Conclusion Ultrasound guided percutaneous nephrostomy combined with Mailuoning injection in the treatment of obstructive hydronephrosis can timely drainage of urine, improve renal function, avoid ipsilateral renal interstitial fibrosis. The utility model has the advantages of high rate of success and safe operation.
ABSTRACT
Objective To investigate the effect of ultrasound guided percutaneous nephrostomy combined with Mailuoning injection on renal function, TGF- β 1 and α -SMA in patients with obstructive hydronephrosis. Methods 37 cases with obstructive hydronephrosis treated in our hospital from June 2014 to December 2016 were enrolled as the research object, all patients after admission were perfect relevant examination, after exclude contraindications underwent ultrasound-guided percutaneous nephrostomy combined with Mailuoning injection treatment. The operative time, the success rate of first puncture, the amount of bleeding during operation, hospitalization time, incidence of complications, preoperative and postoperative 3 d, 7 d renal function preoperative, postoperative, 7 d urine transforming growth factor β 1 (TGF- β 1) and alpha smooth muscle actin (α -SMA) were observed. Results The operation time was 52~93 minutes in 37 patients, the average operation time was (62.31±8.26) minutes; One puncture was successful in 37 cases, the success rate of one puncture was 100%. The intraoperative blood loss was 51 ~ 102 mL, the average amount of bleeding was (80.27±18.15) mL. The hospitalization time was 3 ~ 9 d, the average time was (6.12±1.97)d.In 37 cases, three cases were blocked by ostomy, the incidence rate was 8.11 %; The fistula was removed in one cases, the incidence rate was 2.70%; seven cases with dermatitis around the fistula, the incidence rate was 18.92%. At 3 d after surgery, BUN and Cr were significantly decreased than before operation (P<0.05). At 7 d after surgery, BUN and Cr were significantly decreased compared with preoperative and postoperative 3 d (P<0.05). The levels of TGF-β1 and α-SMA in patients were significantly lower than those before operation at 7 days after operation (P<0.05). Conclusion Ultrasound guided percutaneous nephrostomy combined with Mailuoning injection in the treatment of obstructive hydronephrosis can timely drainage of urine, improve renal function, avoid ipsilateral renal interstitial fibrosis. The utility model has the advantages of high rate of success and safe operation.
ABSTRACT
<p><b>OBJECTIVE</b>Neonatal purulent meningitis is a severe infection responsible for high mortality and disabling sequelae. Escherichia coli is the main pathogen of neonatal purulent meningitis. This study explored the clinical characteristics and antibiotic resistance of Escherichia coli-induced neonatal meningitis.</p><p><b>METHODS</b>A retrospective chart review was performed. A total of 31 cases of neonatal purulent meningitis caused by Escherichia coli were identified in the neonatal intensive care unit between January 1, 2001 and December 31, 2011. The clinical characteristics and antibiotic sensitivity test results were analyzed.</p><p><b>RESULTS</b>Fever, poor feeding, lethargy and seizure were common clinical signs of neonatal purulent meningitis caused by Escherichia coli. Acute complications mainly included hyponatremia (17 cases), hydrocephalus (8 cases), subdural collection (2 cases), ventriculitis (2 cases) and cerebral infarction (1 case). Thirty neonates (97%) had increased CRP levels. Of the 31 patients, 14 cases were cured and 12 had adverse outcomes (5 patients died during hospitalization). Escherichia coli strains were resistant (>50%) to commonly used penicillins and cephalosporins between 2007 and 2011, presenting significantly higher resistance rates than between 2001 and 2006. The detection rate of extended spectrum β-lactamases (ESBLs)-producing strains between 2007 and 2011 increased significantly compared with between 2001 and 2006 (57% vs 0).</p><p><b>CONCLUSIONS</b>The clinical manifestations of neonatal purulent meningitis caused by Escherichia coli are non specific. The outcome is poor. Monitoring of CRP levels is valuable for the early diagnosis of neonatal purulent meningitis. The antimicrobial resistance rates of Escherichia coli are increasing, especially to cephalosporins. The percentage of ESBLs-producing strains is increasing over the years.</p>
Subject(s)
Female , Humans , Infant, Newborn , Male , C-Reactive Protein , Drug Resistance, Bacterial , Meningitis, Escherichia coli , Drug Therapy , Pathology , Microbial Sensitivity Tests , Retrospective Studies , Suppuration , Drug TherapyABSTRACT
<p><b>OBJECTIVE</b>To study the clinical characteristics of neonatal sepsis caused by Klebsiella pneumoniae and the antibiotic sensitivity pattern of Klebsiella pneumoniae strains.</p><p><b>METHODS</b>The clinical data of 42 cases of neonatal sepsis caused by Klebsiella pneumoniae from January, 2000 to August, 2009 were retrospectively studied.</p><p><b>RESULTS</b>The clinical presentations were non-specific, including fever or hypothermia, tachypnea, apnea and feeding intolerance. C-reactive protein (CRP) level increased in 95% of the cases. The mortality was 21%. In neonates with early onset sepsis, Klebsiella pneumoniae strains were sensitive to amoxicillin/clavulanic-acid, piperacillin/tazobactam, cefoxitin, imipenem, cefoperazone/and sulbactam. In neonates with late onset sepsis, the sensitive antibiotics of Klebsiella pneumoniae strains were less, including cefoxitin, piperacillin/tazobactam and imipenem. Klebsiella pneumoniae strains were not sensitive to penicillins and cephalosporins in either neonates with early onset sepsis or late onset sepsis. The extended spectrum β-lactamases (ESBLs)-producing strains were found in 92% of the cases. The neonates with late onset sepsis presented a higher prevalence of ESBLs-producing strains than those with early onset sepsis (100% vs 70%; P<0.05).</p><p><b>CONCLUSIONS</b>The clinical manifestations of neonatal sepsis caused by Klebsiella pneumoniae are usually non-specific. CRP detection is valuable for early diagnosis of sepsis. There are differences in the antibiotic sensitivity of strains between the neonates with early onset and late onset Klebsiella pneumoniae sepsis.</p>
Subject(s)
Female , Humans , Infant, Newborn , Male , Anti-Bacterial Agents , Pharmacology , Bacteremia , Diagnosis , Drug Therapy , C-Reactive Protein , Klebsiella pneumoniaeABSTRACT
<p><b>OBJECTIVE</b>Late onset neonatal septicemia (systemic infection after 72 hours of life) remains a major cause of neonatal morbidity and mortality. Early treatment with appropriate antibiotics is critical since infected infants can deteriorate rapidly. The aim of this study was to review the pathogens responsible for late onset neonatal septicemia (LONS) and their antimicrobial susceptibilities in order to guide the initial selection of appropriate antibiotics for infants with suspected LONS.</p><p><b>METHODS</b>A retrospective chart review of all cases with LONS seen in the neonatal intensive care unit (NICU) of Yuying Children's Hospital of Wenzhou Medical College from January 1, 2002 to December 31, 2005 was conducted. All cases were selected based on the clinical presentation and at least one positive result of blood culture. The basic clinical characteristics and the results of blood culture and antimicrobial susceptibilities were analyzed.</p><p><b>RESULTS</b>A total of 102 cases with LONS were identified. Among those 102 cases, 80 were community acquired (infants admitted from home and the blood culture was done on admission) and 22 were hospital acquired (infants became sick while in the NICU and the blood culture was done prior to use of antibiotics). The clinical presentations were non-specific. Compared to the infants with community acquired LONS, infants with hospital acquired LONS were usually born more prematurely (mean gestational age 33 +/- 3 vs 39 +/- 2 wks, t = 2.255, P < 0.01), with lower weight (mean weight 1.79 +/- 0.70 vs 3.23 +/- 0.67 kg, t = 8.818, P < 0.01) and with younger age (mean age 12 +/- 6 vs 16 +/- 7 days, t = 7.581, P < 0.05). Of the 102 cases, a total of 103 strains of bacteria were isolated. Among the pathogenic bacteria isolated, the most common were coagulase-negative Staphylococcus (CoNS) (50/103, 48.5%), followed by Klebsiella pneumoniae (16/103, 15.5%). The main pathogens for community acquired LONS were Staphylococcus species and Escherichia coli. The most important pathogen responsible for hospital acquired LONS was Klebsiella pneumoniae. Most (> 80%) of the Staphylococcus especially CoNS were resistant to common antibiotics such as penicillin, erythromycin and cefazolin. Significant numbers (6/9) of Staphylococcus aureus isolated were methicillin-resistant Staphylococcus aureus (MRSA). However, all of the Staphyloccus isolates were sensitive to vancomycin. Almost all (15/16) of the Klebsiella pneumoniae isolated were multi-drug resistant due to production of extended-spectrum beta-lactamases (ESBLs). They were sensitive only to a few antibiotics such as carbapenems, aminoglycosides and quinolones. There was also one strain of vancomycin-resistant Enterococcus (VRE). Furthermore, there was no a single case of late onset neonatal sepsis due to infection with group B Streptococcus (GBS).</p><p><b>CONCLUSIONS</b>The clinical manifestations of late onset neonatal sepsis are usually non-specific. GBS is not a significant pathogen responsible for community acquired LONS in the Wenzhou area. There are increasing numbers of multi-drug resistant bacterial species isolated from the newborn infants with late onset neonatal septicemia, which is most likely due the non-restricted use of antibiotics in the hospitals as well as in the communities. A routine blood culture should be taken from any newborn infant who is suspected of LONS and empirical use of appropriate antibiotics should be initiated as soon as the blood specimen for culture has been drawn. To reduce the occurrence of multi-drug resistant bacteria, the use of antibiotics especially the third generation cephalosporins in neonates should be restricted as much as possible.</p>