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OBJECTIVE@#To study the clinical characteristics, drug sensitivity of isolated strains, and risk factors of drug resistance in children with invasive pneumococcal disease (IPD).@*METHODS@#The clinical characteristics and drug sensitivity of the isolated strains of 246 hospitalized children with IPD in nine grade A tertiary children's hospitals from January 2016 to June 2018 were analyzed.@*RESULTS@#Of the 246 children with IPD, there were 122 males and 124 females. Their ages ranged from 1 day to 14 years, and among them, 68 (27.6%) patients were less than 1 year old, 54 (22.0%) patients were 1 to 2 years old, 97 (39.4%) patients were 2 to 5 years old, and 27 (11.0%) patients were 5 to 14 years old. Pneumonia with sepsis was the most common infection type (58.5%, 144/246), followed by bloodstream infection without focus (19.9%, 49/246) and meningitis (15.0%, 37/246). Forty-nine (19.9%) patients had underlying diseases, and 160 (65.0%) had various risk factors for drug resistance. The isolated Streptococcus pneumoniae strains were 100% sensitive to vancomycin, linezolid, moxifloxacin, and levofloxacin, 90% sensitive to ertapenem, ofloxacin, and ceftriaxone, but had a low sensitivity to erythromycin (4.2%), clindamycin (7.9%), and tetracycline (6.3%).@*CONCLUSIONS@#IPD is more common in children under 5 years old, especially in those under 2 years old. Some children with IPD have underlying diseases, and most of the patients have various risk factors for drug resistance. Pneumonia with sepsis is the most common infection type. The isolated Streptococcus pneumoniae strains are highly sensitive to vancomycin, linezolid, moxifloxacin, levofloxacin, ertapenem, and ceftriaxone in children with IPD.
Subject(s)
Child , Child, Preschool , Female , Humans , Infant , Male , Anti-Bacterial Agents , Ceftriaxone , Drug Resistance , Microbial Sensitivity Tests , Pneumococcal Infections , Streptococcus pneumoniaeABSTRACT
Objective To evaluate the effect of carbapenem exposure on isolation rate of multidrug resistant organisms(MDROs) and prognosis of elderly patients with severe pneumonia.Methods Elderly patients with severe pneumonia and admitted to the intensive care unit in a hospital between February 2014 and February 2016 were investigated retrospectively.According to whether there was carbapenem exposure,patients were divided into group A(carbapenem exposure group) and group B(carbapenem non exposure group).Patients in group A were subdivided into two subgroups according to exposure time of carbapenems,group A1 received carbapenems for＞7 days,group A2 received carbapenems for ≤7 days.The isolation rates of MDROs,mechanical ventilation days,length of stay in ICU,and 28 day mortality among groups were compared and analyzed.Results A total of 86 patients were enrolled in the investigation,57 were males and 29 were females;the average age was (80.12 + 10.45) years (range:65-92 years).There were 40 cases in group A,46 in group B;24 cases in group A1,and 16 in group A2.The isolation rates of MDROs in group A and group B were 65.00％ and 36.96％ respectively,difference was sta tistically significant(P＜0.05);Comparison between two groups of patients revealed that mechanical ventilation days,length of stay in ICU,and 28 day mortality in group A were all higher than group B,difference was statistically significant(all P＜0.05);the isolation rates of MDROs in group A1 was higher than group A2 (75.00％ vs 43.75％,P＜0.05)；mechanical ventilation days of group A1 was higher than group A2 ([7.69 ± 2.22]d vs [6.34±-1.56]d,P＜0.05);28-day mortality and length of stay in ICU between group A1 and A2 were not significantly different(both P＞0.05).Conclusion Carbapenem exposure can increase the occurrence of MDRO infection,especially the non-fermentative bacterial colonization or infection,and prolong the mechanical ventilation days and length of stay in ICU,thus affect the prognosis of patients.
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<p><b>OBJECTIVE</b>To study the status of Th1/Th2 immune response and the value of the detection of cytokines in bronchoalveolar lavage fluids (BALF) by examining the levels of IFN-γ and IL-4 in BALF and serum in children with severe Mycoplasma pneumonia (MPP).</p><p><b>METHODS</b>The levels of IFN-γ and IL-4 in BALF and serum were measured using ELISA in 25 children with severe MPP, 25 children with mild MPP and 25 children with foreign body in bronchus.</p><p><b>RESULTS</b>The levels of IL-4 and IFN-γ and the IL-4/IFN-γ ratio in BALF in children with severe MPP were significantly higher than those in children with foreign body in bronchus (P<0.01 or P<0.05). The serum levels of IL-4 and the IL-4/IFN-γ ratio in children with severe MPP were significantly higher than those in children with foreign body in bronchus (P<0.01) or with mild MPP (P<0.05). The levels of IL-4 and the IL-4/IFN-γ ratio in BALF were significantly higher than in serum (P<0.05).</p><p><b>CONCLUSIONS</b>The data suggest that the imbalance of Th1/Th2 exists in children with severe MPP and it seems to represent a predominant Th2-like cytokine response. The detection of cytokines in BALF appears to be more sensitive than in serum and may be of value in the diagnosis and therapy of MPP.</p>