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Objective To study the clinical feature of carbapenem-resistant klebsiella pneumoniae (CRKP) neonatal sepsis.Method From January 2012 to December 2017,clinical data of newborns with klebsiella pneumoniae (Kp) sepsis admitted to the NICU of our hospital were retrospectively analyzed.Clinical manifestations,laboratory examinations,risk factors,treatments and outcomes were compared between newborns with CRKP sepsis and newborns with carbapenem-sensitive klebsiella pneumoniae (CSKP) sepsis.Result A total of 71 strains of Kp were isolated,representing 33.2％ of all isolated pathogens (71/214).Among 71 newborns diagnosed with Kp sepsis,35 were CRKP sepsis and the other 36 were CSKP sepsis.The incidence of dyspnea/apnea in CRKP group was significantly higher than CSKP group (85.7％ vs.55.6％,P=0.005).Newborns in CRKP group had smaller gestational age than CSKP group.The proportions of male gender,the incidences of continuous positive airway pressure treatment,parenteral nutrition and antibiotics exposure (cephalosporins,penicillins or carbapenems) before the onset of sepsis in CRKP group were higher than CSKP group and the hospital stay before sepsis was longer than CSKP group,the differences were statistically significant (P＜0.05).Logistic regression analysis showed that male gender (OR=8.125,95％CI 2.275～29.021),parenteral nutrition (OR=27.730,95％CI 2.948～260.858) and carbapenems exposure before onset (OR=4.849,95％CI 1.091～21.554) were independent risk factors of neonatal CRKP sepsis (P＜0.05).The mortality rate of CRKP group was higher than the CSKP group (22.9％ vs.5.6％,P=0.036).Conclusion Male,parenteral nutrition and carbapenems exposure before onset were independent risk factors of neonatal CRKP sepsis.CRKP sepsis is critical and has a high mortality rate.Clinicians should monitor drug resistance carefully,follow antibiotics stewardship principles and establish enteral nutrition as soon as possible.
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Objective To assess the impact of postnatal exposure to antibiotics on intestinal microbiome in preterm infants with 16S rDNA sequencing technology.Methods This study was conducted on 19 preterm infants admitted to the neonatal intensive care unit (NICU) at Tongji Hospital immediately after birth from September 2015 to February 2016.Two groups were set up according to the duration of antibiotic exposure (＜3 d,n=10;＞7 d,n=9).Fecal samples were collected from each infant within the first day and 2 or 3 weeks after bitrth.High-throughput sequencer (Hiseq 2500) was used for sequencing,from which information on composition and abundance of species,phylogenetic evolution and bacterial community diversity was obtained.Intergroup differences was analyzed with independent samples t-test or Fisher's exact test.Results (1) No statistically significant difference was found in general information about the infants between the two groups.(2) The intestinal flora in preterm infants was mainly composed of Lactococcus,Enterococcus and Bacillus for both groups before antibiotic treatment (36.41％,23.40％ and 14.98％).The proportions of Lactococcus and Bacillus were decreased significantly (1.73％ and 1.25％,P＜0.01) with Enterococcus becoming the predomiant genus (16.73％) after antibiotic treatment,while the relative proportions of Staphylococcus,Clostridium and Bifidobacterium were raised.(3) The Shannon index was decreased after antibiotic exposure [(2.34±0.84) vs (1.06±0.96) in ＜3 d group,and (2.64± 1.04) vs (0.35±0.36) in ＞7 d group,both P＜0.05],and the other three Alpha diversity indexes,including observed species,Chaol and PD whole tree indexes,were also decreased within each group (all P＜0.05).(4) Bacterial assemblages showed high beta diversity in both groups before the usage of antibiotics,but antibiotic therapy reduced the diversity.(5) Anoism analysis showed significant differences in the composition of intestinal flora within each group before and after antibiotic exposure (R=0.555and 0.733,both P=0.001),but no difference was found between the two groups after antibiotic exposure (R=0.060,P=0.138).Conclusions Antibiotic exposure,even short-term (＜3 d) administration,may significantly change the distribution of intestinal microbiota in preterm infants.Prolonged usage of antibiotics could have detrimental influence on intestinal flora.Therefore,for preterm babies,prescription of antibiotics should be cautious,even short-term empirical usage.
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Objective To discuss influence and curative effect observation of sodium hyaluronate on serum matrix metalloproteinase-9,12 and 13 (MMP-9, 12 and 13) levels of patients with knee osteoarthritis (OA). Methods Selected 70 cases of patients with knee OA, and divided into observation group (n=35 cases) and control group (n=35 cases) in accordance at random. The patients in two groups were given oral 75 mg diclofenac sodium enteric capsules , once a day for 5 weeks. The patients in observation group were additionally given 2 mL sodium hyaluronate , injected into in-tra-articular, once a week, for 5 weeks. Excepted for sodium hyaluronate injection fluid, the patients in control group were given the same medical treatment as that in observation group. The changes of serum MMP-9 , 12 and 13 levels between the two groups before and after medical treatment were observed , and the clinical curative effect and untoward effect was compared as well. Results After 5 weeks’ treatment, the serum MMP-9, 12 and 13 levels of patients in two groups were declined more significantly than before with different degrees (P<0.05 or P<0.01), and the declining rate of patients in observation group was much higher than that in control group (P<0.05). The clinical good and excellent rate with in observation group(85.71%) was much higher than that in control group (62.86%)(χ2=4.79,P<0.05). 9 and 11 cases of untoward effect were appeared between control group and observation group respectively with light symp-tom, and after comparing the occurrence rates of untoward effect of patients in two groups, with no statistical differ-ences (χ2=0.28,P>0.05). Conclusion Sodium hyaluronate has favorable curative effect on patients with knee OA, whose mechanism of action has close effect on reducing serum MMP-9 ,12 and 13 levels.