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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.
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Objective To investigate the clinical effect of ibuprofen on preventing intracranial hemorrhage in premature infants and its influence on the levels of NT-proBNP and ET-1.Methods From January 2016 to December 2017,112 premature infants in Taizhou Hospital were selected as study objects after screening by inclusion and exclusion criteria.The infants were randomly divided into observation group and control group according to the digital table,with 56 cases in each group.The control group was treated with routine therapy,and the observation group was given ibuprofen prophylaxis.The incidence of intracranial hemorrhage,clinical index and serum NT-proBNP,ET-1 levels were compared between the two groups.Results There was significant difference in the incidence rate of intracranial hemorrhage between the observation group (17.86％) and the control group (30.36％)(x2 =12.472,P ＜0.05).The serum levels of NT-proBNP and ET-1 in the observation group were significantly lower than those in the control group(all P ＜ 0.05).There were no statistically significant differences in liver function,renal function,coagulation abnormality and oliguria between the two groups (all P ＞ 0.05).There were no statistically significant differences in feeding intolerance and gastric hemorrhage between the two groups (all P ＞ 0.05).Conclusion The application of ibuprofen suspension can effectively prevent intracranial hemorrhage in premature infants,which is worthy of clinical use.
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Objective@#To improve the understanding of clinical characteristics of streptococcal toxic shock syndrome (STSS) caused by Streptococcus pyogenes (S. pyogenes) in children.@*Methods@#A retrospective study was conducted to analyze the clinical data of STSS caused by S. pyogenes (culture-confirmed) in 7 tertiary hospitals during 2010—2017 in China. Clinical and laboratory data were collected by reviewing the medical records.@*Results@#Fifteen cases of STSS, including 9 males, were confirmed and the ages of the patients ranged from 6 months to 15 years, with median age of 3 years. All cases had the positive blood culture for S. pyogenes and only 3 cases had short course of β-lactam treatment before blood culture. Medical evaluation was initiated within (5.1±4.6) days after symptom onset. All patients had fever, and 13 patients had multiple organ dysfunction and 10 patients had disseminated intravascular coagulationl (DIC). Twelve cases had severe pneumonia with or without skin and (or) soft tissue infections. Underlying conditions included giant hemangioma of the skin in 2 patients and varicella in 1 patient. All isolated strains in 14 cases were sensitive to penicillin G, ceftriaxone/cefotaxime, vancomycin, but 12 and 13 isolates were resistant to clindamycin and erythromycin, respectively. Eight patients died, and 5 of them died within 24 hours after admission. One patient was lost to follow-up after intended discharge against medical advice.@*Conclusion@#STSS caused by S. pyogenes in children is a severe syndrome with rapid clinical progression and high mortality rate, and thus the pediatricians should be aware of STSS and immediately initiate aggressive treatment for the suspected cases.
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Objective To observe the effect of intermittent and continuous blue light therapy for pathological neonatal jaundice,and to evaluate the prognosis of newborns.Methods 214 patients with pathologic neonatal jaundice who treated with blue light irradiation were slected,they were randomly divided into two groups according to the admission number combined with single and double numbers,107 patients in each group.Group A received continuous blue light irradiation treatment.Group B received intermittent blue light irradiation.The clinical efficacy and prognosis of children,blue light exposure time,serum total bilirubin (TBiL) recovery time,the hospitalization time and the adverse reactions during the treatment were observed.The levels of serum TBiLwere measured before and after light exposure 3,5 days.Results The total effective rate of group B was 97.18％ (104/107),which was higher than that of group A [90.65 ％ (97/107)],the difference was statistically significant (x2 =10.30,P ＜ 0.05).The time of blue light irradiation and hospital stay time of group B were (71.59 ± 7.05) d and (11.51 ± 1.23) d,respectively,which were significantly shorter than those of group A [(79.54 ± 6.82) d and (13.64 ± 1.18) d],the differences were statistically significant (u =11.42,9.87,all P ＜ 0.05).The level of TBiL of group B was (96.28 ± 10.25) μmol/L,which was significantly lower than (104.52 ± 10.31) μmol/L of group A (u =8.94,P ＜ 0.05).The incidence rate of adverse reactions in group B was 2.55％ (4/157),which was lower than that in group A [7.01％ (11/157)],the difference was statistically significant (x2 =9.66,P ＜ 0.05).The prognosis of neonatal in the two groups was good.Conclusion The intermittent and continuous blue light in the treatment of pathological neonatal jaundice has good clinical effect and the neonatal prognosis is good.The clinical efficacy of intermittent blue light irradiation is better,which can significantly shorten the treatment time and has higher safety.