Clinical analysis of 26 cases of maternal or neonatal listeriosis / 中华围产医学杂志

Objective To improve clinical management of maternal and neonatal listeriosis through analyzing the clinical characteristics and antibiotic treatment.Methods A retrospective analysis of 26 cases of listeriosis,including their demographic and clinical features,was conducted,involving 16 pregnant women from Civil Aviation General Hospital,Xiamen Humanity Hospital,Tongzhou Maternal and Child Health Hospital of Beijing,Beijing Tiantan Hospital,Tangshan Maternal and Child Health Hospital,the Fourth Hospital of Tianshui City from October,2011 to May,2018,and 10 newborns from the Fourth Hospital of Tianshui City,Tangshan Maternal and Child Health Hospital,Zhengzhou Children's Hospital from February,2016 to April 2018.Descriptive methods were used for data analysis.Results (1) Among the 16 gravidas,one,five and 10 developed the infection in the 1st,2nd and 3rd trimester of pregnancy,respectively,and eight had pregnancy complications.Furthermore,all of them developed fever [(38.9± 0.5) ℃].Symptoms such as cough,nasal congestion,runny nose,sore throat,dizziness,headache and other flu-like symptoms were observed in six cases.Gastrointestinal symptoms and flu-like symptoms were presented in four.Fetal distress,tachycardia and decreased fetal movement occurred in 11 cases.Elevated C-reactive protein and white blood cell count were detected in 16 and 14,respectively.Eight underwent placental pathological examination which shown various degrees of pathological changes,including neutrophil infiltration,acute chorioamnionitis and inflammatory necrosis.The main empirical antibiotic treatment for the 16 patients was cephalosporins and only four covered Listeria monocytogenes.Only two delivered at term,while the others (14/16) ended in miscarriage,premature delivery or stillbirth.(2) Among the 10 newborns with listeriosis,there were eight early-onset infections and two late-onset infections.All of them were febrile [(38.6±0.6)℃].Six had cyanosis,groaning,foaming and three concave sign;five showed shortness of breath;meningitis and skin rash were found in one,respectively.All had elevated white blood cell and C-reactive protein.Six received antibiotics covering Listeria monocytogenes during the initial empirical treatment.Four were treated with cephalosporins alone,one of which died after the treatment was withdrawn.One was cured by initial treatment with meropenem alone,while eight recovered after adjustment of treatment with ampicillin,penicillin,meropenem,vancomycin alone,or meropenem combined with ampicillin or vancomycin.(3) The isolates that were susceptible to penicillin,ampicillin and meropenem accounted for 96.1％ (25/26) all together and 88.5％ (23/26) were susceptible to compound sulfamethoxazole.Conclusions There is no specific clinical manifestations of maternal or neonatal listeriosis.Maternal listeriosis is often characterized by acute onset and high incidence of adverse pregnancy outcomes.

Clinical analysis of 26 cases of maternal or neonatal listeriosis / 中华围产医学杂志

Objective@#To improve clinical management of maternal and neonatal listeriosis through analyzing the clinical characteristics and antibiotic treatment.@*Methods@#A retrospective analysis of 26 cases of listeriosis, including their demographic and clinical features, was conducted, involving 16 pregnant women from Civil Aviation General Hospital, Xiamen Humanity Hospital, Tongzhou Maternal and Child Health Hospital of Beijing, Beijing Tiantan Hospital, Tangshan Maternal and Child Health Hospital, the Fourth Hospital of Tianshui City from October, 2011 to May, 2018, and 10 newborns from the Fourth Hospital of Tianshui City, Tangshan Maternal and Child Health Hospital, Zhengzhou Children's Hospital from February, 2016 to April 2018. Descriptive methods were used for data analysis.@*Results@#(1) Among the 16 gravidas, one, five and 10 developed the infection in the 1st, 2nd and 3rd trimester of pregnancy, respectively, and eight had pregnancy complications. Furthermore, all of them developed fever [(38.9±0.5) ℃]. Symptoms such as cough, nasal congestion, runny nose, sore throat, dizziness, headache and other flu-like symptoms were observed in six cases. Gastrointestinal symptoms and flu-like symptoms were presented in four. Fetal distress, tachycardia and decreased fetal movement occurred in 11 cases. Elevated C-reactive protein and white blood cell count were detected in 16 and 14, respectively. Eight underwent placental pathological examination which shown various degrees of pathological changes, including neutrophil infiltration, acute chorioamnionitis and inflammatory necrosis. The main empirical antibiotic treatment for the 16 patients was cephalosporins and only four covered Listeria monocytogenes. Only two delivered at term, while the others (14/16) ended in miscarriage, premature delivery or stillbirth. (2) Among the 10 newborns with listeriosis, there were eight early-onset infections and two late-onset infections. All of them were febrile [(38.6±0.6)℃]. Six had cyanosis, groaning, foaming and three concave sign; five showed shortness of breath; meningitis and skin rash were found in one, respectively. All had elevated white blood cell and C-reactive protein. Six received antibiotics covering Listeria monocytogenes during the initial empirical treatment. Four were treated with cephalosporins alone, one of which died after the treatment was withdrawn. One was cured by initial treatment with meropenem alone, while eight recovered after adjustment of treatment with ampicillin, penicillin, meropenem, vancomycin alone, or meropenem combined with ampicillin or vancomycin. (3) The isolates that were susceptible to penicillin, ampicillin and meropenem accounted for 96.1% (25/26) all together and 88.5% (23/26) were susceptible to compound sulfamethoxazole.@*Conclusions@#There is no specific clinical manifestations of maternal or neonatal listeriosis. Maternal listeriosis is often characterized by acute onset and high incidence of adverse pregnancy outcomes.

Relationship between group BStreptococcus colonization in late pregnancies and neonatal infection / 中华围产医学杂志

ObjectiveTo study the effects of group BStreptococcus (GBS) colonization in late pregnancies on neonatal GBS infection.MethodsA total of 17 019 pregnant women who received antenatal care and delivered in Xiamen Maternal and Child Care Hospital from June 1, 2014 to May 31, 2015 were enrolled in this study. Secretions from the lower third of the vagina in the pregnant women at 35-37 weeks of gestation or having premature baby(regardless of gestational age) were obtained to test GBS by standard bacterial culture, and 1 472 cases underwent GBS DNA test by real-time fluorescent quantitative-polymerase chain reaction (PCR) meanwhile. The pregnant women colonized with GBS (GBS culture and/or PCR DNA test positive) were given intrapartum antibiotic prophylaxis (IAP) during parturition or rupture of fetal membranes. Detection rate of the two methods was compared, and the effects of GBS colonization and IAP on neonatal GBS infection were analyzed to identify the risk factors of neonatal early-onset GBS disease (GBS-EOD). Two independent samplest-test,Chi-square test and Logistic regression analysis were used for statistical analysis. ResultsThe detection rate of GBS culture and PCR DNA test was 14.43% (2 456/17 019) and 14.13%(288/1 472), respectively. The total colonization rate was 14.52%(2 472/17 019). Based on the culture results as golden criteria, the sensitivity, specificity, positive predictive value and negative predictive value of PCR assay were 95.05%, 98.74%, 92.31% and 99.21%, respectively. There were 17 332 deliveries from the 17 019 pregnant women, of which 31 cases had GBS-EOD. The incidence of neonatal GBS-EOD in maternal GBS colonization [1.05%(26/2 472)] was 31 times higher than in pregnant women without GBS colonization [0.34‰(5/14 547)]. Among the 31 infants with GBS-EOD, 24 had pneumonia, five had sepsis, and two had meningitis. The case fatality rate was 6.45%(2/31). Logistic regression analysis found that chorioamnionitis was an independent risk factor of neonatal GBS-EOD (OR=40.425, 95%CI: 7.514-379.782,P=0.000). Compared with the non-IAP group,IAP group had a lower incidence of GBS-EOD among the pregnant women colonized with GBS [0.94%(23/2 443) vs 10.34%(3/29),χ2=24.350,P<0.01].ConclusionsGBS colonization in late pregnant women has adverse effects. Therefore, routine maternal rectovaginal culture of GBS may be necessary and IAP should be applied in those with GBS colonization.

Analysis on detection and drug resistance of Ureaplasma urealyticum in 3 249 cases of cervical samples in Southern Fujian / 国际检验医学杂志

Objective To investigate the infection status of Ureaplasma urealyticum (Uu) and its situation of drug resistance . Methods The separation ,identification and drug resistance test plate was used for Uu detection in 3 249 cases of cervical samples . Results The total infection rate of Uu was 47 .18% (1 533/3 249) .The patients with Uu infection mainly distributed in >20-40 years ,with the constituent ratio accounted to 90 .8% .The sensitive rates of Uu to josamycin and doxycycline were both higher than 95 .00% ,however ,the resistant rate of Uu to azithromycin and ofloxacin were both higher than 50 .00% .Conclusion The drug re‐sistant strains of Uu were common .The clinic should choose the sensitive antibiotics for the treatment according to the results of drug sensitivity test .

Clinical and etiological characteristics of the ventilator-associated pneumonia in newborns / 中国综合临床

Objective To investigate the clinical and etiologic characteristics and drug-resistance features of ventilator-associated pneumonia(VAP)in neonatal intensive care unit.Methods A retrospective study was conducted in 712 newborns with VAP who were admitted to the NICU from January 2007 to December 2010 and had received mechanical ventilation.The pathogenic bacteria spectrum of hospital infection were statistically analyzed.Results VAP was occurred in 69 out of 712 newborns with mechanical ventilation (incidence rate of 9.7％).The top four pathogens were saccharomyces albicans(39.2％),stenotrophomonas maltophilia(20.3％),staphylococcus epidermidis(13.5％)and klebsiella pneumoniae(9.5％),respectively.Conclusion Implementing strict measures to control the nosocomial infection can significantly reduce the incidence of VAP.Saccharomyces albicans,stenotrophomonas maltophilia,staphylococcus epidermidis and klebsiella pneumoniae were the pathogens most commonly involved.

Analysis of Drug Resistance in 112 Strains of Streptococcus Agalactiae Isolated from Genitourinary Tract of Pregnant Women / 医学研究杂志

Objective To emphasize the hazardness due to streptococcus agalactiae infecting genitourinary tract of the pregnant women,and to analyze the drug resistance to 7 kinds of antibiotics in streptococcus agalactiaes in order to guide the clinical drug usage.Methods 112 isolates of streptococcus agalactiaes were identified by API 20 STREP.The susceptibility to 7 kinds of antibiotics were performed by K-B method.Results All of the 112 strains were susceptible to penicillin,cefazolin,ceftriaxone,vancomycin.The susceptibility to erythromycin,clindamycin and levofloxacin were 39.3%,56.2%,74.1% respectively.The resistance ratio to erythromycin was 49.1% followed by clindamycin(41.1%).Conclusions Penicillin and ampicillin were the first recommended antibiotics in treating and preventing streptococcus agalactiae infection.Erythromycin and clindamycin could be selected according to antibiotic susceptibility results in case of the patient with severe penicillin allergy.It is important to detect streptococcus agalactiae in preventing its infection among pregnant women.The results of the antibiotic susceptibility test can guide the rational drug usage in clinical treatment of streptococcus agalactiae infection.

Distribution Characteristic and Drug Reisitance Analysis of 207 Children Infected Klebsiella Pneumoniae / 医学研究杂志

Objective Analysis of K.pneumoniae infection in the Pediatrics and the Neonatology clinical characteristics of the resistance,that can guide and use medicine clinically rationally.Methods The sensitiveness test and ESBL detection to the 20 kinds of antibiotics were examined by Automatic Instrument bacterial identification and susceptibility testing ;ESBL positive strains with the standards disk diffusion method phenotypic confirmatory test.Results The 207 strains of K.pneumoniae from fecal specimens were 77.3% and from respiratory specimens were 18.8%.Imipenem and meropenem sensitivity 100%,followed by compound piperacillin,ciprofloxacin,compound amoxicillin and cefoxitin,that sensitive rates were 98%,97%,96% and 96%,;ceftazidime,cefepime,cefotaxime lower sensitivity were 75%,75%,78%.50 ESBL-producing strains,accounting for 24.2%.Conclusions K.pneumoniae have different levels of the drug resistance expcept Imipenem and meropenem,and the multi-drug resistant strains ratio and the positive rate are high.The sensitiveness of penicillin compound containing enzyme inhibitor is second only to the two described above,and they are economy and effective.Considering by medicine economics,the kinds of medicine is preferred on according to the drug sensitivity.

The Assessment of Human Gait Function Based on Wavelet Entropy / 航天医学与医学工程

Objective To seek a useful index for assessing the change of human gait function based on the application of wavelet entropy in the gait data analysis.Methods The ground reaction force(GRF)gait data of 2 groups(10 young and 10 elderly subjects)were acquired with Bertec 3 dimensional force measured system(a strain gauge force platform)during normal walking.The orthogonal discrete wavelet transform was used for decomposing the collected gait data.The relative wavelet energy and wavelet entropy were defined and calculated respectively.They were statistically analyzed with t-test technique respectively to evaluate the change of human gait function.Results There was significant difference between the relative wavelet energy from GRF gait data of the two subject groups.The average values of wavelet entropy from the GRF gait data of elderly subject group were obviously less than those from the GRF gait data of young subject group.With the value of significance level of t-test P