脓毒症相关基因多态性与脓毒症易感性

基因多态性在脓毒症病理生理变化中起重要作用,其决定人体对应激打击和感染的易感性与耐受性、临床表现多样性及药物治疗反应差异.基因多态性与脓毒症的易感性、转归等有密切关系.     

C反应蛋白及降钙素原在小儿脓毒症血流感染及其他部位感染性疾病中的诊断价值

目的：评估入住PICU 6 h内血清CRP及PCT水平在脓毒症血流感染及其他部位感染患儿临床诊断中的价值。方法：回顾性分析2010年1月至2012年1月期间,中国医科大学附属盛京医院PICU收治的30名明确诊断SIRS患儿,脓毒症血流感染及脓毒症其他部位感染患儿各15名,收集入住6 h内的血清CRP、PCT及D-二聚体含量资料,进行差异性比较并通过ROC曲线分析其诊断价值。结果：脓毒症血流感染组患儿的血清CRP及PCT水平较脓毒症其他部位感染组显著升高（P0.05）。血清PCT水平较CRP水平在诊断与鉴别脓毒症血流感染与其他部位感染性疾病方面有明显优势,PCT10 ng/mL时诊断脓毒症血流感染具有较高的可信度（阳性预测值：77%）。结论：入院6 h内的血清PCT水平较CRP水平在早期鉴别入住PICU脓毒症血流感染与其他部位感染患儿具有更好的诊断价值;当血清PCT水平>10 ng/mL时,脓毒症血流感染的诊断可能性较大。     

肝素结合蛋白对儿童重症感染诊断价值的前瞻性研究

目的 探讨肝素结合蛋白(heparin-binding protein,HBP)对儿童重症感染的诊断价值.方法 该研究系前瞻性观察研究.收集2019年1月到2020年1月因感染入住儿童重症监护室患儿的临床资料,按照严重脓毒症与脓毒症诊断标准分为严重脓毒症组(49例)、脓毒症组(82例)和非重症感染组(33例),比较3组...     

温州地区汉族儿童脓毒症与Toll样受体基因多态性

目的 研究温州地区汉族脓毒症(sepsis)患儿TLR4(Asp299Gly、Thr399Ile)和TLR2 (Arg753Gln)基因多态性的分布特征及与脓毒症严重程度的相关性.方法 采用病例-对照研究和测序法对2006年1月至2008年6月期间收住温州医学院附属育英儿童医院的59例脓毒症患儿、38例 严重脓毒症患儿(包括脓毒性休克20例)和57例健康对照组儿童进行TLR4(Asp299Gly、Thr399Ile)和TLR2(Arg753Gln)基冈多态性检测,计算多态位点在三组中的分布频率,按Hardy-Weinberg遗传平衡定律检验,比较不同组别之间各等位基因频率和基因型频率差异是否有显著性.结果 59例脓毒症组患儿、38例严重脓毒症组患儿和57例健康对照组儿童中均未发现TLR4突变基因(Asp299Gly、Thr399Ile);在38例严重脓毒症组患儿中发现2例TLR2突变基因(Arg753Gln),且均为金黄色葡萄球菌感染休克死亡病例,而59例脓毒症组患儿和57例健康对照组儿童中均未发现TLR2突变基因(Arg753Gln).结论 TLR4基因(Asp299Giy、Thr399Ile)多态性与温州地区汉族儿童脓毒症易感性无明显相关性;TLR2基因(Arg753Gln)多态性是否与温州地区汉族儿童致命性阳性菌感染有关,尚需积累更多的儿童脓毒症病例进行研究.     

儿童脓毒症发病特点

脓毒症是PICU的常见疾病,至今仍有较高的发病率和病死率.最常见的感染源是呼吸系统感染和菌血症.目前普遍认同的发病机制是炎症反应的紊乱,最终导致免疫抑制、多脏器功能障碍.但针对不同的病因,儿童脓毒症病原学、发病机制、治疗及预后均存在差异.本文探讨不同病因的儿童脓毒症发病特点.     

血清降钙素原判断儿童脓毒症病原学的作用

目的 了解细菌、病毒及支原体感染引起脓毒症血清降钙素原（procalcitonin,PCT）的水平,明确血清PCT判断引起儿童脓毒症常见病原的作用.方法 回顾性分析2011年2月1日至2012年9月1日入住湖南省儿童医院PICU确诊细菌、病毒、支原体感染引起脓毒症患儿330例,检测其入院时及治疗3d后的PCT水平,分析不同血清PCT水平下细菌、病毒及支原体感染引起的脓毒症的分布差异.分析细菌、病毒及支原体感染引起脓毒症的血清PCT水平在入院时与治疗3d时的差异.结果 细菌感染引起的脓毒症血清PCT水平明显升高,病毒及支原体感染引起的血清PCT水平升高不明显,分别为0.71 （8.14） ng/ml、0.15 （1.68） ng/ml、0.28 （1.89） ng/ml.按PCT水平分为0.05～ ng/ml、0.5～ ng/ml、2～ng/ml、10 ～ 300 ng/ml组,四组中细菌、病毒及支原体感染引起的脓毒症的分布不同,差异有统计学意义（x2=84.50,P＜0.01）.细菌感染引起的脓毒症抗炎治疗3d后,PCT水平较入院时明显下降[0.32（5.68） ng/ml vs 0.71 （8.14） ng/ml],差异有统计学意义（U=19.34,P＜0.05）.结论 PCT判断儿童脓毒症病原学有一定作用.PCT明显升高及抗炎治疗后PCT明显降低提示细菌感染可能性大,PCT升高不明显以病毒及支原体感染为主,不能完全排除细菌感染.     

小儿脓毒症血流感染致各种并发症的诊治分析

目的：对小儿脓毒症血流感染致各种并发症的临床资料进行总结,为临床治疗提供经验。方法对2013年1月至2015年3月收入 PICU,出院诊断脓毒症血流感染及有并发症的患儿进行回顾性分析。结果11例确诊患儿,均起病不典型,入院病程长短不一,并发症种类多,发现时间各有差异。全部患儿均并发有迁徙性病灶,发生部位有肺、脑、皮肤、关节、眼、心内膜等。3例并发感染性休克和弥散性血管性凝血。少见并发症4例,分别是溶血尿毒综合征、川崎病、海绵窦栓塞、出血坏死性肠炎。先后给予多学科治疗及血液净化治疗等。全部患儿死亡2例,失明1例,右眼睑疤痕1例。结论对于小儿脓毒症血流感染致各种并发症我们需力求做到及时发现,合理治疗,有效沟通,才能最大限度改善预后,规避医疗风险。     

儿童细菌性脓毒症的抗生素应用

脓毒症是与感染相关的全身炎症反应综合征,早期应用有效抗生素和积极复苏是救治关键,其中早期及正确的静脉抗生素应用是严重脓毒症/脓毒性休克患者生存的独立预测因素.儿童的年龄及免疫状态对病原菌谱有较强的提示作用,初始经验治疗应选用能覆盖所有可能病原的抗生素,并且在可疑感染源部位有较高的渗透浓度,在得到病原学结果后尽快降为目标治疗.     

痰肝素结合蛋白在脓毒症合并急性呼吸窘迫综合征患儿中的临床价值

目的探讨痰肝素结合蛋白(HBP)对脓毒症合并急性呼吸窘迫综合征(ARDS)患儿病情的预测价值。方法本研究为前瞻性病例对照研究, 纳入2020年1月至2021年11月入住湖南省儿童医院PICU的134例脓毒症患儿, 其中完善纤维支气管镜检查患儿63例, 根据是否出现ARDS及其严重程度分为脓毒症非ARDS组、脓毒症并轻度ARDS组和脓毒症并中重度ARDS组;所有脓毒症患儿入院时采集痰液并检测HBP, 入院72 h内完善纤维支气管镜检查的63例患儿留取肺泡灌洗液并检测HBP、白细胞介素(IL)-6、肿瘤坏死因子(TNF)-α水平, 收集72 h内血生化、肺部影像学、小儿危重病例评分等资料。结果 (1)63例患儿中, 脓毒症非ARDS组患儿29例, 脓毒症并轻度ARDS组患儿18例, 脓毒症并中重度ARDS组患儿16例, 3组患儿入院时小儿危重病例评分、原发感染灶部位差异均无统计学意义。原发感染灶为呼吸系统感染患儿36例, 痰HBP水平为(42.1±9.8) ng/mL, 其他系统感染患儿27例, 痰HBP水平为(37.8±10.8) ng/mL, 两组间差异无统计学意义(t=1.65, P...     

小儿先天性心脏病术后脓毒症发生的危险因素

目的：探讨小儿先天性心脏病（先心病）术后脓毒症发生的危险因素,以利于疾病早期认识和诊断,改善临床转归。方法回顾性分析我院胸外科重症监护室2012年1月至2015年4月间发生的52例先心病术后合并脓毒症患儿和1∶2配对的104例非脓毒症患儿的临床资料。对患儿年龄、性别、术前感染、延迟关胸、膈肌麻痹、二次开胸、长时间体外循环、留置多个有创导管方面进行Logistic回归分析,分析脓毒症发生的危险因素,计算OR值及其95％CI。结果先心病术后合并脓毒症患儿休克发生率高、功能受累脏器数目多,住院及ICU滞留天数长,病死率高,较非脓毒症患儿差异有统计学意义[25.32％vs.6.73％,（3.5±1.1）个vs.（1.1±0.7）个,（35.1±11.2）d vs.（11.3±3.1）d,（21.3±7.1）d vs.（7.1±2.3） d,19.23％ vs.4.81％,P＜0.05]。 Logistic回归分析显示术前合并感染、延迟关胸、二次开胸、留置多个有创导管,膈肌麻痹是小儿先天性心脏病术后脓毒症发生的危险因素, OR值（95％CI）分别为10.53（1.73,64.22）、26.66（2.69,263.83）、19.47（1.87,203.02）、4.99（1.361,8.31）、8.32（0.12,16.46）（P＜0.05）。结论小儿先心病术后脓毒症发生的危险因素有术前合并感染、延迟关胸、二次开胸、留置多个有创导管及膈肌麻痹。脓毒症患儿较非脓毒症患儿临床转归差。     

Incidence and causes of sepsis in glucose-6-phosphate dehydrogenase-deficient newborn infants

To determine the susceptibility to sepsis in newborn infants deficient in glucose-6-phosphate dehydrogenase (G6PD), we screened 33,943 Saudi Arab infants. Deficiency of G6PD was found in 18%. Sepsis was determined by the presence of clinical signs of sepsis and confirmed by positive blood cultures. Sepsis was documented in 75 infants (2.2/1000). The incidence of sepsis was significantly higher in 6138 G6PD-deficient infants (3.4/1000) than in the 27,805 with normal G6PD activity (1.9/1000; p less than 0.02). The incidence of catalase-positive organism sepsis was higher in G6PD-deficient infants (2.9/1000) compared with those with normal G6PD activity (1/1000; p less than 0.0002), whereas the incidence of catalase-negative organism sepsis did not differ (p less than 0.2). Deficiency of G6PD was more common in infants with late sepsis (46%) than in those with early sepsis (21%) and in all infants screened (18%) (p less than 0.03 and p less than 0.001, respectively). We conclude that neonates with G6PD deficiency are more susceptible to late sepsis and to infection with catalase-positive organisms. The exact mechanism for the increased susceptibility is not clear, but a partial explanation could be lack of leukocyte bactericidal activity associated with G6PD deficiency, and an increased susceptibility to infection caused by hyperferremia resulting from lysis of G6PD-deficient erythrocytes.     

Study of Urinary Tract Infection and Bacteriuria in Neonatal Sepsis

Objective  

To determine magnitude of Urinary tract infection (UTI) in neonatal sepsis and to evaluate bacteriuria as indicator of neonatal urinary tract infection for use in resource limited settings.     

Community-acquired disseminated methicillin-resistant Staphylococcus aureus infection: case report and clinical implications

A 6-year-old girl with community-acquired disseminated infection caused by methicillin-resistant Staphylococcus aureus (MRSA) is described. She had sepsis, meningo-encephalitis, pyomyositis, osteomyelitis, pericarditis and pulmonary embolisation caused by a multi-resistant strain of MRSA. Vancomycin is not routinely recommended as the first-line antimicrobial agent for suspected Staphylococcus aureus infection; however, it should be considered pending susceptibility results in patients presenting with severe sepsis in areas where the prevalence of MRSA is high.     

Streptococcus pneumoniae sepsis in the newborn

Background: Streptococcus pneumoniae (SP) is an uncommon cause of neonatal sepsis. Aims: To report on the spectrum of morbidity associated with SP infections in the neonatal period. Methods: A case series of SP infection in the neonatal period was studied. Maternal and neonatal outcomes were noted. Results: Four cases of neonatal SP infection are reported, one of which was due to a strain with reduced susceptibility to penicillin. All four cases had very early onset of severe clinical disease with bacteremia and pneumonia. In one case a retrospective diagnosis of meningitis was made as well. Maternal illness was a feature in one of these infants. Conclusions: Although less common now than in the pre‐antibiotic era, Streptococcus pneumoniae remains a rare but important cause of neonatal sepsis and can mimic early onset Group B streptococcal sepsis. It is unclear whether current infant or adult pneumococcal immunisation programs might influence its incidence in the neonatal period. The potential for strains with reduced susceptibility to β‐lactam antibiotics to cause neonatal infection needs to be considered in relevant settings.     

Concomitant aseptic meningitis and bacterial urinary tract infection in young febrile infants.

We evaluated the incidence and implications of coexistent bacterial urinary tract infection and aseptic meningitis in 1629 young febrile infants (age 1 to 60 days) who underwent sepsis work-up. Urinary tract infection was diagnosed in 13.2% and aseptic meningitis in 8.8%. Eleven patients (0.7%) had both infections. In view of possible coinfection initial laboratory results may be insufficient for decision-making regarding treatment in young febrile infants.     

Urinary tract infection caused by Kluyvera ascorbata in a child: case report and review of the kluyvera infections in children

Kluyvera species are described infrequently in association with clinically significant infections, and infections caused by these gram negative rods are rare in children. The spectrum of disease due to Kluyvera infection in children includes urinary tract infections, enteritis, soft tissue infections, sepsis, central venous catheter infections and peritonitis. The authors report a case of Kluyvera ascorbata urinary tract infection in a 3-month-old female baby, and they review the literature on Kluyvera infections in children.     

小儿泌尿系感染277例临床分析

目的探讨小儿泌尿系感染的临床特点及致病菌的分布和耐药情况,为临床诊断治疗提供依据。方法对1998—2006年首都医科研究所附属儿童医院肾脏病房收治的277例泌尿系感染患儿的临床特点、实验室检查、治疗及转归进行回顾性分析。结果145例尿培养前未应用过药物的患儿其尿培养阳性率为62.07%,132例培养前应用过药物的患儿其阳性率为20.45%,两者差异有统计学意义(P<0.05)。尿培养结果中大肠埃希菌有94例,对丁胺卡那霉素和头孢西丁的敏感率均在90%以上。结论抗生素的应用会大大降低尿培养的阳性率。大肠埃希菌为泌尿系感染的常见致病菌,头孢西丁可作为小儿泌尿系感染的首选用药。对首次发病的泌尿系感染患儿进行相应的影像学检查以排除一些潜在的病因是十分必要的。     

Comparison of urinary lactic dehydrogenase with antibody-coated bacteria in the urine sediment as means of localizing the site of urinary tract infection.

Two noninvasive methods of localizing the site of urinary tract infection, urinary lactic dehydrogenase (LDH) isoenzymes and antibody coating of bacteria in the urinary sediment, have been prospectively compared with the bladder washout technique in a series of children with urinary tract infection. Fifteen children had infection localized in the upper tract. Urinary LDH isoenzymes correctly localized the infection in 14 children; however, the infection was correctly localized by the antibody coating of bacteria in only eight patients (P less than .02). Fourteen children had lower tract infection by the bladder washout technique. Urinary LDH isoenzymes localized the infection in all 14 children, whereas the antibody coating correctly localized the infection in ten children (P less than .05). This study shows the urinary LDH isoenzyme pattern to be a more accurate technique than the detection of antibody-coated bacteria for localizing the site of urinary tract infection.     

Aetiology of neonatal sepsis in Blantyre, Malawi: 1996-2001

AIM: The aim of this retrospective study was to report causes, antibiotic resistance and outcome of neonatal sepsis (often fatal in developing countries) in Malawi. METHODS: All blood and cerebrospinal fluid isolates collected between January 1996 and December 2001 from inpatients aged 0-30 days with suspected sepsis at Queen Elizabeth Central Hospital, Blantyre, Malawi were reviewed. In vitro resistance to antibiotics commonly used in Malawi was assessed. Case fatality rate was analysed with respect to age, bacterial pathogen and infection site. RESULTS: A total of 801 bacteria were isolated from 784 neonates over 6 years-599 isolates from blood and 202 from cerebrospinal fluid. Overall, 54% of bacteria were gram-positive and 46% gram-negative. The commonest causes of neonatal sepsis were group B Streptococcus (17%) and non-typhoidal Salmonella (14%). In vitro antibiotic susceptibility to the first-line antibiotic combination of penicillin and gentamicin was 78% for all isolates, but in vitro sensitivities to gentamicin for Klebsiella spp and non-typhoidal Salmonella were only 33% and 53%, respectively. In-hospital case fatality rate was known for only 301 cases and was high at 48%. Group B Streptococcus was associated with the best outcome. Mortality was significantly higher if presentation was in the 1st week of life or if sepsis was caused by gram-negative bacteria. The causes of neonatal sepsis in this population show a different pattern from other studies in developing countries.     

Patterns of fungal colonization in preterm infants weighing less than 1000 grams at birth

BACKGROUND: Colonization with Candida spp. is an important risk factor for systemic infection in very low birth weight (VLBW; <1500 g) and extremely low birth weight (ELBW, <1000 g) infants. ELBW infants are at a higher risk than VLBW infants for fungal sepsis and its associated mortality, but few studies have examined fungal colonization exclusively in ELBW infants. METHODS: Fungal colonization data were analyzed retrospectively in 50 high risk ELBW infants. Weekly surveillance fungal cultures of the skin, gastrointestinal tract, respiratory tract and umbilicus had been performed from birth through the first 6 weeks of life. Colonization was analyzed for time of initial colonization, site, species and spread of Candida from one site to another. RESULTS: Candida was isolated from surveillance cultures in 31 of 50 (62%) infants. Colonization was inversely proportional to gestational age. Initial week of both the fungal colonization of the skin [1 (0-6) week, median (range)] and gastrointestinal tract [2 (0-6)] preceded colonization of the respiratory tract [3 (1-6)] (P = 0.0001). Among infants colonized by only 1 of the species, colonization at 2 or more sites occurred similarly with Candida albicans (77%) and Candida parapsilosis (85%), whereas colonization at 3 or more sites occurred more frequently with C. albicans (69%) compared with C. parapsilosis (23%) (P = 0.047). CONCLUSIONS: Fungal colonization occurs on the skin and gastrointestinal tract before the respiratory tract. In addition, C. albicans is more likely than C. parapsilosis to colonize multiple sites.