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目的分析下呼吸道感染儿童肺炎链球菌(SP)对常用抗生素的药敏情况。方法采用回顾性分析方法,收集2005年1月至2009年12月温州医学院附属育英儿童医院住院患儿痰培养SP阳性且临床诊断为下呼吸道感染(包括支气管炎、毛细支气管炎、肺炎等)病例的药敏资料,分析其肺炎链球菌对常用抗生素的耐药。结果共检出643株SP,5年间SP对各种抗生素的不敏感率(中介率+耐药率)较高的前10位的药物依次为:红霉素99.3%、阿奇霉素98.6%、氯林可霉素98.3%、复方磺胺甲口恶唑95.0%、头孢克洛94.6%、头孢呋辛94.1%、四环素93.6%、青霉素93.2%、美罗培南87.4%、头孢噻肟77.9%,无耐万古霉素菌株。青霉素敏感SP组与青霉素不敏感SP组对红霉素、头孢呋辛、头孢噻肟、头孢吡肟、头孢克洛、头孢曲松、阿莫西林/棒酸、阿莫西林、美罗培南的耐药性比较均P<0.05,对氯林可霉素、氨苄青霉素、四环素、复方磺胺甲口恶唑、环丙沙星、壮观霉素、左氧氟沙星和阿奇霉素等抗菌药物均P>0.05。红霉素敏感SP组与红霉素不敏感SP组对氯林可霉素、青霉素、四环素、阿奇霉素的耐药性比较均P<0.05,对头孢菌素、复方磺胺甲口恶唑、环丙...     

2004-2007年温州地区下呼吸道感染患儿肺炎链球菌耐药性分析

目的 检测2004-2007年温州地区下呼吸道感染患儿肺炎链球菌(Sp)对常用抗生素的耐药情况.方法 采集2004年1月-2007年12月温州医学院附属育英儿童医院收治的下呼吸道感染住院患儿的痰标本,经实验室培养、分离、并采用奥普托欣鉴定出339株Sp,检测其对青霉素等10种抗生素的敏感性.结果 Sp 339株中对青霉素的不敏感率达83.18%,耐药率56.34%;Sp菌株对红霉素、克林霉素、四环素、复方磺胺甲噁唑、头孢噻肟、氯霉素、阿莫西林和氧氟沙星的耐药率分别为98.23%、97.52%、84.36%、69.82%、29.0%、24.56%、5.32%和3.01%,未检出对万古霉素耐药的菌株.4 a间Sp对青霉素、氧氟沙星的小敏感率逐年升高(X2=10.193,7.779 Pa<0.05),对复方磺胺甲噁唑的耐药率2007年较2006年降低(X2=36.929 P<0.05),Sp对其余抗生素的耐药率年度间比较羞异均无统计学意义(Pa>0.05).青霉素不敏感Sp(PNSP)对红霉素、四环素、头孢噻肟的耐药率均高于青霉素敏感Sp(PSSP)(Pa<0.05),而对其余几种抗生素耐药率的差异均尤统计学意义(Pa>0.05).耐药模式分析表明多重耐药率达95%以上,PNSP较PSSP更为多见(72.56% vs 22.72%);红霉素耐药Sp较红霉素敏感Sp也更为多见(94.42% vs 0.88%).结论 温州地区下呼吸道感染患儿Sp耐药情况严峻,Sp对克林霉素、红霉素、四环素等多重耐药,对本地区Sp感染儿童的治疗和抗生素的选择具有指导价值.实用儿科临床杂志,2009,24(10):765-767     

肺炎链球菌临床分离株耐药性与耐药机制研究

目的 探讨肺炎链球菌(SP)临床分离株的耐药性及对大环内酯类抗生素的耐药机制,为临床用药提供依据.方法 回顾性分析2002年7月至2005年7月年重庆医科大学附属儿童医院964株SP临床分离株的耐药性;采用聚合酶链式反应扩增30株耐药SP基因组DNA,琼脂糖电泳分析SP大环内酯类抗生素耐药基因表达.结果 共分离获得964株SP,对红霉素、阿奇霉素和青霉素(实为苯唑西林)耐药率分别为91.8%、90.0%和61.0%,多重耐药率十分严重,占93.2%,主要是对红霉素、阿奇霉素、复方新诺明、四环素和青霉素(实为苯唑西林)耐药;其中绝大多数SP临床分离株对氧氟沙星、利福平和万古霉素敏感.分析30株对红霉素和阿奇霉素均耐药的SP临床分离株的耐药机制,24株同时具有erm基因和mef基因,4株只有erm基因,1株只有mef基因,1株未检测到erm或mef基因.结论 该研究结果提示重庆地区小儿SP临床分离株对大环内酯类抗生素耐药率较国内其他地区高,耐药模式以红霉素、阿奇霉素、复方新诺明、四环素和青霉素(实为苯唑西林)为主.erm基因介导的靶修饰作用和mef基因介导的外流排出机制的共同作用是重庆地区SP临床分离株时大环内酯类抗生素主要的耐药机制.     

学龄前儿童中耳感染病原菌分布及耐药性分析

目的 研究引起学龄前儿童中耳感染的病原菌分布及耐药特征。方法 选取2012年1月—2015年12月就诊的中耳感染患儿,进行耳分泌物常规病原菌分离培养及药物敏感性试验。结果 分离出病原菌200株,包括革兰阳性球菌156株,占78.0%,主要包括肺炎链球菌、金黄色葡萄球菌等;革兰阴性杆菌38株,占19.0%,主要为铜绿假单胞菌;念珠菌6株,占3%。肺炎链球菌对红霉素、四环素、克林霉素、复方新诺明的耐药率高,对青霉素的耐药率低,金黄色葡萄球菌对青霉素的耐药率高,未见对万古霉素、利奈唑胺、达托霉素耐药的金黄色葡萄球菌。在常规监测的12种抗菌药物中,铜绿假单胞菌总体耐药性低,各抗菌药物的耐药率均32%。结论 学龄前儿童中耳感染的常见病原菌为肺炎链球菌、金黄色葡萄球菌、铜绿假单胞菌,不同细菌对不同抗菌药物的耐药性不同,合理用药是控制感染的关键。     

儿童肺炎链球菌急性下呼吸道感染耐药监测

目的 了解儿童急性下呼吸道感染(ALRI)中肺炎链球菌的发病及耐药情况.方法 对2006年1月-2007年12月临床诊断为急性下呼吸道感染的住院患儿2696例行痰培养,并用纸片扩散法行药敏试验.结果 经痰培养确诊281例肺炎链球菌感染,总检出率为10.42%,以婴幼儿感染多见.冬季检出率14.15%,较其他季节高.检出的肺炎链球菌株对红霉素、青霉素、复方新诺明、克林霉素和四环素的敏感性很低,均低于20%.对红霉素的耐药率达99.28%.100%的菌株对万古霉素敏感.结论 儿童下呼吸道感染肺炎链球菌以婴幼儿感染为主,冬季感染率高.耐药形势严峻,应重视肺炎链球菌的监测,动态了解细菌耐药状况,以指导临床合理使用抗生素.     

新生儿肠球菌败血症的临床特点及耐药性分析

目的了解新生儿肠球菌败血症的临床特点及对抗菌药物的耐药性分析,为临床合理用药提供依据。方法回顾性分析2007—2013年重庆医科大学附属儿童医院750例血培养阳性的败血症新生儿,其中肠球菌败血症患儿的临床资料及其药敏分析结果的差异。结果黄疸和发热是新生儿肠球菌败血症主要的临床表现。屎肠球菌和粪肠球菌对苯唑西林、头孢西丁/头孢唑林、庆大霉素、复方新诺明、红霉素、四环素以及克林霉素均有较高的耐药率(43.3%~100%)。其中屎肠球菌对氨苄青霉素、青霉素、红霉素以及克林霉素的耐药率明显高于粪肠球菌,且两者之间的差异存在统计学意义(P0.05)。屎肠球菌对苯唑西林、庆大霉素及复方新诺明的耐药率有上升的趋势(P0.05)。这两种肠球菌的检出株均对万古霉素、替考拉宁和利奈唑胺100%敏感。结论新生儿肠球菌败血症的临床表现缺乏特异性,屎肠球菌和粪肠球菌败血症的耐药性有所不同,其多重耐药株检出较多,临床应合理使用抗菌药物,尽量减少多重耐药株的出现。     

夫西地酸对金黄色葡萄球菌儿童感染株的体外抗菌活性研究

目的 了解夫西地酸对引起儿童感染的金黄色葡萄球菌(金葡菌)的体外抗菌活性,并与其他抗菌药物比较,为临床合理用药提供依据.方法 采用血浆凝固酶、金葡菌单克隆抗体及Vitek-32型仪进行菌株鉴定,纸片琼脂扩散法(K-B法)进行药物敏感性试验,头孢西丁纸片法检测耐甲氧西林金葡菌(MRSA),并用D-试验检测红霉素诱导克林霉素的耐药表型.结果 68株金葡菌中共检测到MRSA 7株,占10.29%,红霉素耐药而克林霉素敏感菌珠5株,诱导试验阳性2株,红霉素诱导克林霉素耐药的菌株占40.00%.全部菌株均对夫西地酸和万古霉素敏感;对青霉素、红霉素、克林霉素、庆大霉素、利福平、复方新诺明和头孢西丁的耐药率分别为98.52%、70.59%、63.24%、20.59%、14.71%、11.76%和10.29%;对头孢唑啉、头孢呋辛及左氧氟沙星的耐药率均为1.47%.结论 夫西地酸对引起儿童感染的金葡菌有很强的体外抗菌活性.     

儿童呼吸道感染肺炎链球菌耐药性及pbp2B与TEM基因的研究

目的：了解广州地区儿童呼吸道感染肺炎链球菌(Streptococcus pneumoniae,SP)的耐药情况以及SP中青霉素耐药相关基因TEM与pbp2B的流行分布及突变情况。方法：采用E-test和K-B纸片法对44株SP分离株进行药敏试验;PCR扩增SP中的TEM基因及pbp2B,并对pbp2B基因进行测序,结果与SP青霉素敏感株R6进行序列比对分析。结果：①44株SP对青霉素的敏感率仅为11.4％,不敏感率高达88.6％。对红霉素耐药率已达100％,对克林霉素、复方新诺明的耐药性也在90％以上。但对头孢曲松、阿莫西林、亚胺培南仍敏感,耐药率分别为0,2.6%和3.9%。未发现对氧氟沙星、万古霉素耐药菌株。②44株SP的pbp2B基因扩增序列与R6敏感株相比较,5株青霉素敏感株99%以上的核苷酸序列相同,未发生氨基酸的替换。39株青霉素不敏感株均发生核苷酸序列的改变,核苷酸序列突变率为13.2％～23.1%,约6.5％～10.9%的氨基酸发生了替换。根据氨基酸在Ser391-Thr492片段之间的突变情况,可将39株青霉素不敏感株分为四型,其中Ⅰ型突变30株,Ⅱ型突变7株,Ⅲ型和Ⅳ型各1株。44株SP均未检出TEM型β-内酰胺酶耐药基因。结论：广州地区儿童呼吸道感染SP多重耐药情况较严重,青霉素、红霉素已不适宜作为SP感染的临床一线用药,阿莫西林及第三代头孢菌素可作为SP感染的经验用药。pbp2B基因突变是广州地区儿童SP对青霉素耐药的主要机制之一。［中国当代儿科杂志,2009,11（8）：623-626］     

肺炎链球菌100株耐药性分析

目的　了解杭州地区小儿肺炎链球菌致病株的耐药特征。方法　用Kirby -Bauer法对浙江大学儿童医院 2 0 0 1年 7月至 2 0 0 2年 1月鉴定的 10 0株肺炎链球菌进行耐药性分析 ,同时用E -test法测定青霉素、氨苄西林、头孢噻肟和红霉素的最低抑菌浓度。结果　青霉素不敏感株 6 1株占 6 1% ,其中中介株占 46 % ,耐药株占15 % ,其最低抑菌浓度范围为 0 0 16～ 3 0 0 0mg/L ,平均 0 5 2 3mg/L。 92 %的菌株对红霉素耐药 ,对四环素、复方新诺明的耐药率也分别高达 85 %和 5 6 % ,氯霉素的耐药率为 16 %。多重耐药率为 6 3 % ,其中多数对红霉素、四环素和复方新诺明联合耐药。 99%的菌株对利福平敏感。未发现氨苄西林耐药株 ,但中介株达 43 %。所有的菌株都对头孢噻肟、万古霉素和氧氟沙星敏感。结论　杭州地区肺炎链球菌耐药现象比较严重 ,第三代头孢菌素是临床治疗耐青霉素肺炎链球菌感染的理想药物。     

北京地区儿童鼻咽部肺炎链球菌对大环内酯类抗生素耐药的检测

目的 研究北京地区儿童携带肺炎链球菌(SP)对大环内酯类抗生素的耐药特点。方法 对2002～2003年上呼吸道感染儿童鼻咽部200株SP分离株对4种大环内酯类抗生素、青霉素和克林霉素的最低抑菌浓度进行检测;耐药诱导试验分析部分耐药菌株大环内酯类耐药表型;PCR检测红霉素耐药基因ermB和mefA。结果 200株SP中179株对红霉素耐药。红霉素和青霉素的药敏结果无明显关连性。耐红霉素的147株SP中,阿奇霉素、克拉霉素、乙酰螺旋霉素和克林霉素的耐药率分别是100％,100％,95．2％,95．9％。耐药表型以结构型大环内酯类、林可酰胺类和链阳性菌素B耐药表型(cMLS)为主,占红霉素耐药株的95．9％。耐药基因检测中,仅携带ermB基因的菌株为79．6％,同时携带ermB和mefA基因菌株为17．7％,仅携带mefA基因的菌株为2．7％。结论 2002～2003年北京上呼吸道感染患儿携带的SP对红霉素耐药率达89．5％,分离株在对红霉素耐药同时也对其他大环内酯类药物和克林霉素耐药。耐大环内酯SP表型以cMLS为主,基因型以ermB为主。     

Allergic factors associated with the development of asthma and the influence of cetirizine in a double-blind, randomised, placebo-controlled trial: First results of ETA®

There is a common progression known as the allergic march from atopic dermatitis to allergic asthma. Cetirizine has several antiallergic properties that suggest a potential effect on the development of airway inflammation and asthma in infants with atopic dermatitis. Methods. Over a two year period, 817 infants aged one to two years who suffered from atopic dermatitis and with a history of atopic disease in a parent or sibling were included in the ETAC^® (Early Treatment of the Atopic Child) trial, a multi-country, double-blind, randomised, placebo-controlled trial. The infants were treated for 18 months with either cetirizine (0.25mg/ kg b.i.d.) or placebo. The number of infants who developed asthma was compared between the two groups. Clinical and biological assessments including analysis of total and specific IgE antibodies were performed. Results. In the placebo group, the relative risk (RR) for developing asthma was elevated in patients with a raised level of total IgE (≥ 30 kU/I) or specific IgE (≥ 0.35 kUA/I) for grass pollen, house dust mite or cat dander (RR between 1.4 and 1.7). Compared to placebo, cetirizine significantly reduced the incidence of asthma for patients sensitised to grass pollen (RR = 0.5) or to house dust mite (RR = 0.6). However, in the population that included all infants with normal and elevated total or specific IgE (intention-to-treat - ITT), there was no difference between the numbers of infants developing asthma while receiving cetirizine or placebo. The adverse events profile was similar in the two treatment groups. Discussion. Raised total IgE level and raised specific IgE levels to grass pollen, house dust mite or cat dander were predictive of subsequent asthma. Cetirizine halved the number of patients developing asthma in the subgroups sensitised to grass pollen or house dust mite (i.e. 20% of the study population). In view of the proven safety of the drug, we propose this treatment as a primary pharmacological intervention strategy to prevent the development of asthma in specifically sensitised infants with atopic dermatitis.     

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孤独症谱系障碍(autistic-spectrum disorders,ASDs)近年来患病率逐年攀升至1%左右,其症状往往伴随终生,成为严重威胁儿童健康和发展的神经发育性疾患;注意缺陷多动障碍(attention deficit hyperactivity disorder,ADHD)是儿童期最常见的精神障碍,国内报道患病率为4.13%～5.83%,其症状可延续至青少年期,甚至到成年期[1]。这两类精神障碍在成年期的临床表现、共患病、治疗策略和预后与儿童期有哪些不同呢?本文通过回顾相     

EXCITING NEW TREATMENT APPROACHES FOR PATHYPHYSIOLOGIC MECHANISMS OF SICKLE CELL DISEASE

During the past several decades, our understanding of the complex pathophysiology of vasoocclusion associated with sickle cell disease has improved greatly. Interaction of genes, hemoglobin molecules, red cell membrane and metabolic changes, cell-cell interactions and cell-plasma interactions, red cell adhesion to vascular endothelium, activation of coagulation, and vascular reactivity play a role in vaso occlusion. Penicillin prophylaxis of pneumococcal infections and appropriate use of blood transfusions and other supportive measures improved survival of sickle cell patients. Hydroxyurea made a major impact on sickle cell therapy when it was shown to decrease acute painful episodes, acute chest syndrome, and the need for blood transfusion in adults. Significant experience in the use of hydroxyurea has been accumulated in older children. The benefits and risks of hydroxyurea for younger children and long-term risks in all patients will be evaluated in future investigations. Other promising therapies include butyrate compounds, clotrimazole, magnesium supplementation, poloxamer 188, antiadhesion agents, anticoagulant approaches, and nitric oxide. Hemopoietic transplantation remains the only curative therapy. However, several transgenic mouse models are available for studies of gene therapy or other treatment approaches on biochemical, cellular, and pathologic effects of mutant genes.     

Infiltrations of Epstein-Barr virus-carrying cells in granular lymphocyte-proliferative disorders corresponding to chronic active Epstein-Barr virus infection

A 21-year-old man with granular lymphocyte-proliferative disorders (GLPD) associated with chronic active Epstein-Barr virus (EBV) infection is described. Chromosomal analyses revealed several clonal abnormalities and two of them were mainly repetitious. High copy numbers of monoclonal EBV genome were also detected in the proliferative large granular lymphocytes (LGLs), indicating the monoclonal expansion of EBV-infected LGLs. The patient had an indolent course for several years, and there was no evidence of infiltrations of his bone marrow until the end stage. At autopsy, microscopic studies revealed marked infiltrations of LGL in the liver and spleen, and the infiltrating cells were NK-cell immunophenotype. The infiltrated LGLs showed latency I.     

LUTEINIZING HORMONE RECEPTOR MUTATIONS IN DISORDERS OF SEXUAL DEVELOPMENT AND CANCER

Human male sexual development is regulated by chorionic gonadotropin (CG) and luteinizing hormone (LH). Aberrant sexual development caused by both activating and inactivating mutations of the human luteinizing hormone receptor (LHR) have been described. All known activating mutations of the LHR are missense mutations caused by single base substitution. The most common activating mutation is the replacement of Asp-578 by Gly due to the substitution of A by G at nucleotide position 1733. All activating mutations are present in exon 11 which encodes the transmembrane domain of the receptor. Constitutive activity of the LHR causes LH releasing hormone-independent precocious puberty in boys and the autosomal dominant disorder familial male-limited precocious puberty (FMPP). Both germline and somatic activating mutations of the LHR have been found in patients with testicular tumors. Activating mutations have no effect on females. The molecular genetics of the inactivating mutations of the LHR are more variable and include single base substitution, partial gene deletion, and insertion. These mutations are not localized and are present in both the extracellular and transmembrane domain of the receptor. Inactivation of the LHR gives rise to the autosomal recessive disorder Leydig cell hypoplasia (LCH) and male hypogonadism or male pseudohermaphroditism. Severity of the clinical phenotype in LCH patients correlates with the amount of residual activity of the mutated receptor. Females are less affected by inactivating mutation of the LHR. Symptoms caused by homozygous inactivating mutation of the LHR include polycystic ovaries and primary amenorrhea.     

Resurgence of measles in Singapore: profile of hospital cases

OBJECTIVE: To ascertain the profile of cases of measles seen at a general hospital during a recent outbreak that occurred despite a measles vaccination program. METHODOLOGY: A retrospective study from January 1991 to March 1998. All patients with measles (ICD code 055. 9) seen at the emergency unit or as inpatients were included. RESULTS: There were 87 cases identified. The diagnosis was clinical in all and proven serologically in 71%. Eighty-five per cent of the cases occurred between January 1997 and March 1998. There was a bi-modal age distribution with peaks in the very young (相似文献   

Personality profiles and heart rate variability (vagal tone) in children with recurrent abdominal pain

The aim of the study was to explore psychological factors and autonomic activity in children with recurrent abdominal pain and to compare them with those in a control group of healthy children. The Personality Inventory for Children was used for assessment of developmental, emotional and psychosocial factors in 25 children with recurrent abdominal pain (age, 7-15 y). Parasympathetic and sympathetic functions in these children and in 23 healthy control subjects (age, 7-13 y) were also investigated, non-invasively using a computerized polygraph. Vagal tone (parasympathetic function) was indexed by calculation of respiratory sinus arrhythmia in beats/min. Skin conductance (sympathetic function) was recorded by the constant current method. On the Personality Inventory for Children, 16 patients had high scores on somatic concern. Several patients had scores in the clinical range for depression, withdrawal and anxiety, but the mean scores for these personality profile scales were well within the normal range of healthy children. Interestingly, there was a spike on the L (Lie)-scale for most of the patients and 15 patients had scores above or close to the clinical cut-off value. As compared with the scores in healthy children, vagal tone and sympathetic tone were normal. Conclusion: Many children with recurrent abdominal pain have scores in the clinical range for depression, withdrawal, anxiety and L-scale indicating coping problems, denial and a trend towards somatic concern that may contribute to the evolution of abdominal pain. Autonomic nerve activity was not disturbed in these children.     

Overcoming surfactant inhibition with polymers

Inhibition of the function of pulmonary surfactant in the alveolar space is an important element of the pathophysiology of many lung diseases, including meconium aspiration syndrome, pneumonia and acute respiratory distress syndrome. The known mechanisms by which surfactant dysfunction occurs are (a) competitive inhibition of phospholipid entry into the surface monolayer (e.g. by plasma proteins), and (b) infiltration and destabilization of the surface film by extraneous lipids (e.g. meconium-derived free fatty acids). Recent data suggest that addition of non-ionic polymers such as dextran and polyethylene glycol to surfactant mixtures may significantly improve resistance to inhibition. Polymers have been found to neutralize the effects of several different inhibitors, and can produce near-complete restoration of surfactant function. The anti-inhibitory properties of polymers, and their possible role as an adjunct to surfactant therapy, deserve further exploration.     

Understanding infant formula

The World Health organisation recommends breast feeding infants for the first six months of life. When this breast feeding does not occur either through parental choice or medical need, infant formulas will be required. There is a bewildering array of formulas on the UK market for many different requirements. When faced with an unsettled infant many parents (and healthcare professionals) will experiment with the infant formula available and then attend the paediatric clinic looking for help and advice. It is therefore essential that paediatricians understand what milks are available and what the key differences between different products are. This review attempts to provide a simple guide through many of the formulations currently available in the UK; and offers advice for the dietary management of the child with extra calorie requirements, infants with cow's milk protein allergy, gastro oesophageal reflux disease, apparent unresolved hunger and infantile colic. Whatever the underlying condition, there is likely to be an infant formula that is suitable in this generation of ever expanding formulations.