[Effect of breastfeeding on the development of infection-related diseases during hospitalization in late preterm infants in 25 hospitals in Beijing, China].

OBJECTIVE: To investigate the incidence rate of infectious diseases during hospitalization in late preterm infants in Beijing, China, as well as the risk factors for infectious diseases and the effect of breastfeeding on the development of infectious diseases. METHODS: Related data were collected from the late preterm infants who were hospitalized in the neonatal wards of 25 hospitals in Beijing, China, from October 23, 2015 to October 30, 2017. According to the feeding pattern, they were divided into a breastfeeding group and a formula feeding group. The two groups were compared in terms of general status and incidence rate of infectious diseases. A multivariate logistic regression analysis was used to investigate the risk factors for infectious diseases. RESULTS: A total of 1 576 late preterm infants were enrolled, with 153 infants in the breastfeeding group and 1 423 in the formula feeding group. Of all infants, 484 (30.71%) experienced infectious diseases. The breastfeeding group had a significantly lower incidence rate of infectious diseases than the formula feeding group (22.88% vs 31.55%, P=0.033). The multivariate logistic regression analysis showed that breastfeeding was an independent protective factor against infectious diseases (OR=0.534, P=0.004), while male sex, premature rupture of membranes, gestational diabetes mellitus, and asphyxia were risk factors for infectious diseases (OR=1.328, 5.386, 1.535, and 2.353 respectively, P < 0.05). CONCLUSIONS: Breastfeeding can significantly reduce the incidence of infectious diseases and is a protective factor against infectious diseases in late preterm infants. Breastfeeding should therefore be actively promoted for late preterm infants during hospitalization.

Mycoplasma pneumoniae Macrolide Resistance and MLVA Typing in Children in Beijing, China, in 2016: Is It Relevant?

OBJECTIVE: The aim of this study is to investigate the macrolide resistance rate and molecular type with multiple-locus variable-number tandem-repeat analysis (MLVA) of Mycoplasma pneumoniae of Beijing in 2016 in pediatric patients. METHODS: Real-time quantitative polymerase chain reaction (PCR) was used to identify M. pneumoniae, and MLVA was performed. The domain V of the 23S rRNA was sequenced to detect macrolide-resistant point mutations. We also investigated the activities of antibiotics against M. pneumoniae isolates in vitro. RESULTS: The PCR detection rate of M. pneumoniae in children in Beijing was 40%, and the macrolide resistance rate was 66%. The A2063G mutation in the 23S rRNA V region is the dominant mutation (137/146, 93.84%), whereas the A2064G mutation is rare (9/146, 6.16%). Seventy-three samples were typed successfully by MLVA typing, including 86.3% (63/73) were MLVA type 4-5-7-2, and 13.7% (10/73) were MLVA type 3-5-6-2. No other types were found. No strains were resistant to levofloxacin or tetracycline. CONCLUSION: In 2016, a specific decrease in the macrolide resistance rate occurred in Beijing. The detection rate and macrolide resistance rate of outpatients are lower than those of inpatients. The A2063G mutants M. pneumoniae have high levels of resistance to erythromycin and azithromycin. The primary MLVA type is 4-5-7-2, followed by 3-5-6-2. No other MLVA types were detected. No strains resistant to tetracycline or levofloxacin were found in vitro.

Epidemiology and mechanism of drug resistance of Mycoplasma pneumoniae in Beijing, China: A multicenter study.

Mycoplasma pneumoniae (M. pneumoniae) is one of the most common causes of community-acquired respiratory tract infections (RTIs). We aimed to investigate the prevalence of M. pneumoniae infection, antibiotic resistance and genetic diversity of M. pneumoniae isolates across multiple centers in Beijing, China. P1 protein was detected by Nested PCR to analyze the occurrence of M. pneumoniae in pediatric patients with RTI. M. pneumoniae isolates were cultured and analyzed by Nested-PCR to determine their genotypes. Broth microdilution method was used to determine the minimum inhibitory concentration (MIC) of antibiotics. Out of 822 children with RTI admitted to 11 hospitals in Beijing, 341 (41.48%) were positive for M. pneumoniae by Nested PCR and 236 (69.21%) samples had mutations in 23S rRNA domain V. The highest proportion of M. pneumoniae positive samples was observed in school-age children (118/190; 62.11%) and in pediatric patients with pneumonia (220/389; 56.56%). Out of 341 M. pneumoniae positive samples, 99 (12.04%) isolates were successfully cultured and the MIC values were determined for 65 M. pneumoniae strains. Out of these, 57 (87.69%) strains were resistant to macrolides, and all 65 strains were sensitive to tetracyclines or quinolones. M. pneumoniae P1 type I and P1 type II strains were found in 57/65 (87.69%) and 8/65 (12.31%) of cultured isolates, respectively. Overall, we demonstrated a high prevalence of M. pneumoniae infection and high macrolide resistance of M. pneumoniae strains in Beijing. School-age children were more susceptible to M. pneumoniae, particularly the children with pneumonia. Thus, establishment of a systematic surveillance program to fully understand the epidemiology of M. pneumoniae is critical for the standardized use of antibiotics in China.

Multi-center Study of Enteral Feeding Practices in Hospitalized Late Preterm Infants in China.

OBJECTIVE: To investigate the current enteral feeding practices in hospitalized late preterm infants in the Beijing area of China. METHODS: A multi-center, cross-sectional study was conducted. Infants born after 34 weeks and before 37 weeks of gestation were enrolled from 25 hospitals in the Beijing area of China from October 2015 to October 2017. Data on enteral feeding practices were collected and analyzed. RESULTS: A total of 1,463 late preterm infants were enrolled, with a mean gestational age (GA) of 35.6 (34.9, 36.1) weeks. The percentage of exclusive breastfeeding was 4.5% at the initiation of enteral feeding but increased to 14.4% at discharge. When human milk was not available, most infants (46.1%) were fed with preterm infant formula. The rate of exclusive human milk feeding in infants born at 34 weeks gestation was higher than at discharge (21.1% of infants born at 34 weeks' GA versus 12.1% of infants born at 35 weeks' GA versus 12.3% of infants born at 36 weeks' GA, P < 0.001). Only 28.4% of late preterm infants achieved full enteral feeding at discharge, and only 19.2% achieved 120 kcal/(kg•d) by enteral feeding at discharge. Importantly, 40.5% of infants did not regain the birth weight at discharge. CONCLUSION: Enteral feeding support of late preterm infants has not been standardized to achieve optimal growth. Moreover, the human milk feeding rate was low, and many late preterm infants did not achieve the goal of enteral feeding and failed to regain birth weight at the time of discharge. More aggressive enteral feedings protocols are needed to promote human milk feeding and optimize growth for late preterm infants.

[The clinical characteristics, treatment and outcome of macrolide-resistant Mycoplasma pneumoniae pneumonia in children].

OBJECTIVE: To investigate the drug resistance of Mycoplasma pneumoniae among children with community-acquired pneumonia (CAP), and to explore the clinical and radiological characteristics of and the role of azithromycin in the treatment of of macrolide-resistant (MR) Mycoplasma pneumoniae pneumonia. METHODS: Cases of CAP in children (n = 179) were prospectively enrolled in the Pediatric ward of Beijing Chaoyang Hospital from 1st September, 2010 to 31st August 2011. Pharyngeal swabs were collected for detection of Mycoplasma pneumoniae DNA. Mycoplasma pneumoniae culture and in vitro susceptibility testing were also performed. RESULTS: Eighty-three cases met the diagnostic criteria of mycoplasma pneumonia, accounting for 46% of the CAP patients. Mycoplasma pneumoniae culture was positive in 45 cases, including 44 highly resistant to macrolides (MR) in vitro, and 1 sensitive. The 44 cases caused by MR pathogen presented with fever for (8 ± 3) d and cough for (17 ± 5) d, with higher fever (39.5 ± 0.7) °C and more irritating dry cough. In most of the children, peripheral blood leukocytes (8 ± 4)×10(9)/L were normal, with normal or elevated (0.60 ± 0.94) neutrophils, normal or slightly elevated erythrocyte sedimentation rate [(24 ± 14) mm/1 h] and CRP (12.8 mg/L). Chest X-ray showed lobar consolidation in 10 cases (23%, 10/44), among them 3 in the lower left lung, 2 in the left lung, 3 in the right lower lung, 2 in the right upper lung. Pleural effusion (small amount), combined with right lower lung consolidation, was found in 1 case. Patchy shadows were found in 27 cases, and interstitial lung infiltrate in 7 cases. Of the 44 cases caused by MR Mycoplasma pneumoniae, 19 had lung computed tomography (CT) scanning, among them 13 had lobar or segmental consolidation. Azithromycin therapy started in an average of 4.0 days after onset of illness, with duration of therapy averaging (9 ± 4) d. Cephalosporin or penicillin (n = 1) was the initial antibiotic choice in 12 of them, while combination therapy with azithromycin and cephalosporin or penicillin antibiotics was given in 41 of them. The duration of fever averaged (6 ± 3) d after treatment of azithromycin and duration of cough averaged (17 ± 5) d after treatment. Among patients with MR Mycoplasma pneumonia, those with lobar consolidation had longer duration of fever after treatment with azithromycin, compared with those without consolidation (P < 0.05). CONCLUSIONS: The macrolide resistance rate was 98% (44/45) in our patients. Fever and duration of therapy with azithromycin in MR infection was longer in patients with lobar consolidation. The 44 children with MR Mycoplasma pneumonia recovered with no serious complications.