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Bacterial infection is the main cause of infectious diseases in children. Antibacterials play an important role in anti infection treatment of children. At present, the treatment of antimicrobial drugs in children is facing a severe situation of bacterial resistance. In January 2020, a children′s specialized hospital carried out the practice of precise management of antibiotics in combination with key performance indicators. Through the multi sectoral linkage of management and technology, eight key performance indicators and assessment methods were set up from three levels of antibiotic use, bacterial resistance and hospital infection, to standardize the clinical application of antibiotics and continue to promote the rational use of antibiotics. This practice had improved the performance indicators of antibacterial management. Among them, the use intensity of antibacterial drugs for inpatients decreased from 40.07 DDD in 2019 to 29.00 DDD in 2021, the use rate of antibacterial drugs for inpatients decreased from 81.32% to 64.40%, the percentage of antibacterial drug expenses in total drug expenses decreased from 35.41% to 26.82%, the use proportion of non restricted antibacterial drugs in antibacterial drugs increased from 71.30% to 82.21%, and the drug resistance rate of Salmonella to β-Lactam/enzyme inhibitors decreased from 4.84% to 0.03%, and the incidence of hospital infection decreased from 1.16% to 0.96%. The precise management of antibiotics in combination with key performance indicators improved the level of rational use of antibiotics, effectively curbed bacterial resistance, achieved phased results, so as to provide a reference for the scientific management of antibiotics in children′s hospitals.
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Objective:To investigate the clinical features and etiology of 176 children with liver dysfunction, and to provide reference for the diagnosis and treatment of children with liver dysfunction.Methods:From April 2017 to February 2019, 176 children with liver function abnormalities from 2 months to 13 years old who were admitted to Hangzhou Children's Hospital were selected inthe study.The pathogens of the children's secretions were detected by fluorescence quantitative method.The blood was tested for hepatitis B virus, hepatitis C antibody and hepatitis A antibody, and blood culture method was used to detect and identify bacteria, and blood genetic metabolism and coagulation function were also screened.According to the age of the children, they were divided into infant group, toddlergroup, preschool group and school age group.Results:Among the 176 children, the infants had the most abnormal liver function, 93 cases(52.84%), followed by 43 children (24.43%) in the toddler group.Causes of the disease: 138 cases (78.41%) of the original diseases, 8 cases (4.55%) of non-infectious diseases, 30 cases (17.04%) of the undetected pathogens.Among the 138 cases with liver function abnormality due to infectious diseases, 123 cases (89.13%) were infected with virus, 8 cases (5.80%) were infected with bacteria, 6 cases (4.35%) were infected with mycoplasma, and 1 case (0.72%) was infected with Toxoplasma gondii.Among the 123 cases of liver dysfunction caused by viral infection, cytomegalovirus was detected in 62 cases (50.41%), followed by EB virus in 38 cases (30.89%), rotavirus in 10 cases (8.13%), and EV71 virus in 5 cases (4.07%), 4 cases of common enterovirus (3.25%), 2 cases of respiratory syncytial virus (1.63%), 1 case of herpes simplex virus and Coxsackie A16 virus (0.81%). Pre-school and above were mainly infected with EB virus; the age>1 year-old liver function abnormality was 37.10% (23/62) due to cytomegalovirus, and the proportion of EB virus infection was 92.11% (35/38). Compared with 62.90% and 7.89% of age 2 months to 1 year, the difference was statistically significant (χ 2=29.27, P=0.00). Eightcases of liver infection caused by bacterial infection: 3 cases of Staphylococcus aureus, 2 cases of Streptococcus pneumoniae, 2 cases of Escherichia coli, and 1 case of Pseudomonas aeruginosa.There were 3 cases of genetic metabolic diseases, including 2 cases of hepatolenticular degeneration and 1 case of glycogen accumulation.Characteristics of liver function abnormalities in children: the main clinical manifestations of children were jaundice, splenomegaly and hepatomegaly, cough, diarrhea, etc.Outcome: 98 cases (55.68%) were healed, 60 cases (34.09%) were improved, and 17 cases (9.66%) were aggravated, 1 case of death (0.57%). Conclusion:The abnormal liver function of infants was mainly caused by virus infection, especially cytomegalovirus.Infants and young children have no obvious symptoms in the early stage of the disease, severe cases can be manifested as jaundice and hepatosplenomegaly, mainly mild, with a good prognosis.
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Objective To investigate the influence of high-fat diet on liver function and intestinal bacte-rial community through building rat models. Methods 20 rats of 21 days old were divided into two groups ran-domly as normal diet group fed with standard chow diet and high-fat group fed with high-fat diet. After 6 weeks, feces of rats in both groups were obtained for 16S rRNA high-through sequencing of the intestinal bacterial com-munity. Results After 6 weeks high-fat diet, total protein (TP) (55. 79±3. 75, P=0. 002), globin (GLB) ( 34. 9±2. 53, P<0. 001), albumin (ALB) /GLB (. 60±0. 02, P<0. 001), alkaline phosphatase (ALP) (373. 80±63. 05, P<0. 001), total cholesterol (TC) (1. 94±0. 23, P<0. 001), low density lipoprotein (LDL) (0. 76±0. 93, P<0. 001), LDL/high density lipoprotein (HDL) (1. 43±0. 22, P<0. 001), and tri-glyceride (TG) (1. 48±0. 50, P=0. 015) increased compared with the normal diet group. Additionally, intes-tinal bacterial diversity and evenness decreased significantly. The dominant bacteria were Bacteroidetes, Firmi-cutes, and Proteobacteria, with averaged relative abundances as 56. 36%, 35. 31%, and 6. 61%, respectively. The relative abundances of Bacteroidetes deceased (P=0. 007), those of Firmicutes increased (P=0. 020), and those of Proteobacteria were kept stable (P=0. 928) after a 6-week high-fat diet. Furthermore, the intesti-nal bacterial community structure changed distinctly between the two groups by 16s rRNA high-through sequen-cing. Conclusion High-fat diet can lead to change of intestinal bacterial community structure and further result in liver function damnification as well as obesity.
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Objective@#To observe the intestinal viral shedding time in patients with hand, food and mouth disease (HFMD) induced by coxsackievirus A6 (CA6).@*Method@#Throat swab specimens and stool specimens of HFMD children were collected from those admitted to Hangzhou Children′s Hospital between May and October 2015, while fluorescence quantitative PCR was used to detect the viral load.Eeighteen cases of HFMD children were followed up, who were confirmed as CA6 infection via laboratory tests.Stool specimen was collected every 4-7 days, and fluorescence PCR was used for virus nucleic acid detection until the stool viral nucleic acids of infected children turned to be negative.The intestinal virus shedding time of CA6-infected HFMD was compared with the intestinal virus shedding time of 65 children with enterovirus 71 (EV71) infection and 44 children with coxsackievirus A16 (CA16) infection of the previous studies (from May to September 2012).@*Result@#The median stool viral load was 25×105 copies/ml (55×104 copies/mL, 9×106 copies/ml) in CA6-infected children.The numbers of stool virus nucleic acid turning negative were 0 case, 4 cases, 9 cases, 3 cases and 2 cases in 18 children at 1st, 2nd, 3rd, 4th, 5th weeks. At 5th week, the stool virus nucleic acid of children in CA6 group all turned to be negative.The positive rates of stool virus nucleic acid in EV71 group and CA16 group at the 5th week, however, were 31% and 27% respectively.There were statistically significant differences in distribution of positive rate of stool virus nucleic acid between CA6 infected children with EV71 and CA16 infected children (χ2=13.894, 10.698, P<0.05).@*Conclusion@#The longest intestinal virus shedding time for CA6-infected HFMD children was 5 weeks, which is obviously shorter than that of EV71- infected children and CA16-infected children.
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Objective To investigate the role of heme oxygenase-1 ( HO-1 ) and carbon monoxide ( CO) in children with mycoplasma pneumoniae infection. Methods A total of 198 cases with mycoplasma pneumoniae infection under 3 years were enrolled in this study. According to whether with wheezing,all cases were divided into wheezing group( n=58 ) and no wheezing group ( n=140 ) . According to having hypox-emia,wheezing group was divided into mild wheezing group(n=34) and severe wheezing group(n=24). And no wheezing group was set as control group. The serum COHb levels were measured by dual-wavelength spectrophotometry. The serum HO-1 were measured by ELISA. Results The levels of serum HO-1 and COHb% in severe wheezing group were ( 2 734. 10 ± 707. 59 ) ng/L, ( 3. 88 ± 0. 83 )%, and ( 1 130. 03 ± 671. 02) ng/L,(1. 16 ± 0. 63)% in mild wheezing group,and(931. 32 ± 451. 67) ng/L,(1. 04 ± 0. 37)% in no wheezing group,respectively. There were significant differences in serum HO-1 and COHb% between se-vere wheezing group and mild wheezing group(P0. 05,respec-tively). There was significant positive correlation between serum HO-1 and COHb%(r=0. 875,P<0. 01). Conclusion With mycoplasma pneumoniae infection,the expression of HO-1 and COHb% increase by the wheezing disease progression. HO-1 and CO may participate in the development process of infantile wheezing diseases.