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??Objective To analyse the pathogen distribution and drug resistance status in 268 cases of neonatal sepsis. Methods Totally 268 cases of neonatal sepsis were chosen who had been hospitalized between 2010 and 2015 with blood culture being positive. They were divided into early-onset and late-onset sepsis groups and their clinical characteristics??pathogen distribution and drug resistance were explored. Results The gram-negative bacteria were the major pathogens early-onset sepsis group??58.3%????in which escherichia coli was 31.2% and klebsiella pneumoniae was 23.9%. Gram-positive bacteria were the major pathogen in late-onset sepsis group??65.1%????in which coagulase negative staphylococcus was 46.5% and excrement enterococcus was 11.6%. Gram-positive bacteria were sensitive to vancomycin with durg resistance rate ??90% to penicillin????80% to erythromycin????60% to clindamycin??ampicillin and cefazolin . Gram-negative bacteria were sensitive to meropenem. Gram-negative bacteria showed high resistance to ampicillin??piperacillin and cefotaxime??but low resistance to ceftazidime and cefoperazone. Conclusion The common pathogens and clinical characteristics are different in the early-onset and late-onset sepsis groups. It is important to choose reasonable antibiotic drugs and strengthen drug resistance surveillance.     

Quantitation and properties of fecal and upper small intestinal aerobic microflora in infants and young children with persistent diarrhea

The duodenal juice and fecal aerobic microflora was investigated in 54 patients with persistent diarrhea (age less than or equal to 2 years). The duodenal aspirates yielded increased aerobic bacteria (greater than 10(5) organisms/ml) in 28 (51.9%) of the patients. Established enteric pathogens were isolated from the duodenal aspirates of 12 (22.2%) of the 54 patients, viz., enteroadherent Escherichia coli (EAEC) (5), enterotoxigenic E. coli (ETEC) (3), enteropathogenic E. coli (EPEC) (1), nontyphoidal Salmonella (1), and Giardia lamblia (2). The total aerobic bacterial count was greater than 10(5) in all 12 patients positive for specific pathogens apart from one case in whom E. coli showing diffuse adherence to HEp-2 cells were identified. Among the remaining 42 specific pathogen-negative patients, 19 (45.2%) also had greater than 10(5) aerobic organisms/ml in the small bowel. Eight strains of Klebsiella from four of the patients were negative for enterotoxin production in a rabbit ileal loop assay and for adherence to HEp-2 cells. In contrast, 28/54 (51.9%) of the same patients had known enteric pathogens in their stools, viz., nontyphoidal Salmonella (8 or 14.8%), Shigella (2 or 3.7%), Campylobacter (1 or 1.9%), ETEC (4 or 7.4%), EPEC (2 or 3.7%), EAEC (7 or 13.0%), and G. lamblia and Entameba histolytica (3 or 5.6%). Further search for potential virulence factors among aerobic bacteria colonizing the upper small intestine in persistent diarrhea is warranted.     

Rotavirus disease in young children from Hanoi, Vietnam

BACKGROUND: Pathogen prevalences and antimicrobial susceptibilities are essential for the rational development of preventive strategies for diarrheal diseases, but little recent information from Vietnam is available. We prospectively studied the prevalence of enteric pathogens in children less than 5 years of age with acute diarrhea and in nondiarrhea controls in a city hospital in Hanoi, Vietnam for 1 year. METHODS: Enteric bacteria and viruses were detected by standard culture methods, and enzyme immunoassay in 291 cases and 291 controls. RESULTS: Detection rates of viral pathogens among cases and controls were 31% and 3% for rotavirus, 12% and 1% for astrovirus and 4% and 1% for adenovirus. For bacterial pathogens, Aeromonas, Shigella, Salmonella, Campylobacter and enterotoxigenic E. coli were isolated from cases and controls in 15% and 8%, 9% and 1%, 7% and 1%, 4% and 0%, and 3% and 0%, respectively. The isolation of bacterial and viral pathogens except for adenovirus was significantly lower in controls than cases. Fluoroquinolones were effective against most bacterial enteropathogens, but resistance was observed in 27% of Campylobacter isolates. CONCLUSIONS: Viral etiologic agents especially rotavirus were the most important cause of acute diarrhea in children less than 5 years of age in Hanoi. The burden of rotavirus in young children in Hanoi warrants consideration of using the recently released rotavirus vaccine.     

Etiology of diarrhea in pediatric outpatient settings

BACKGROUND: The frequency with which bacteria cause diarrhea evaluated in ambulatory settings is often unknown. We attempted to determine the microbiologic etiology of diarrhea in a private pediatric practice (site A) and a clinic serving largely immigrant children (site B) and to establish guidelines for bacterial culture. METHODS: Children with diarrhea were prospectively enrolled, and their stools were examined for diarrheagenic bacteria, viruses and parasites. RESULTS: A total of 123 and 103 children were enrolled at sites A and B, respectively. Stools from all (100%), 126 (55.8%), 104 (46.0%) and 75 (33.2%) were tested for bacterial enteric pathogens, parasites, Clostridium difficile toxin and viruses, respectively. Of the 75 patients whose stool underwent complete testing, 36 (48%) contained at least 1 definitive or plausible pathogen. Twelve stools (5.3%) tested positive for bacteria [Campylobacter jejuni (n = 7), Yersinia enterocolitica, Shigella flexneri, Shigella sonnei, Salmonella serogroup D and Salmonella Braenderup (n = 1 each)]. One contained Blastocystis hominis, 8 contained C. difficile toxin and 16 contained viruses (9 rotavirus, 5 adenovirus and 2 astrovirus). Visible fecal blood (P = 0.029), increased stool frequency (P = 0.035), abdominal tenderness (P = 0.011) and fecal white (P < 0.001) or red blood cells (P = 0.002) were associated with bacterial infection. All children with stool yielding diarrheagenic bacteria or C. difficile toxin had at least 1 of these factors, but so did 75% of children without these agents (positive predictive value, 11%; negative predictive value, 100%; sensitivity, 100%; specificity, 25%). CONCLUSIONS: The bacterial diarrhea prevalence is similar to that in other ambulatory studies, although the spectrum differs. Exclusion criteria for stool testing in diarrhea remain elusive. Studies to determine the etiology of unexplained diarrhea and cost-effective algorithms for diarrhea diagnosis, are needed.     

Enteroaggregative Escherichia coli and Salmonella associated with nondysenteric persistent diarrhea

A hospital-based case-control study including 92 children with diarrhea for longer than 14 days and 92 controls without gastrointestinal symptoms was performed to describe the association between the excretion of enteric pathogens and persistent diarrhea. In patients the most frequently isolated stool pathogens were enteroaggregative Escherichia coli (19.6%), nontyphoidal Salmonella spp. (17.4%), E. coli with diffuse adherence pattern (7.6%), G. lamblia (7.6%) and enterotoxigenic E. coli (5.4%). The excretion rates in patients were significantly greater than in controls only for nontyphoidal Salmonella spp. (P = 0.0006) and enteroaggregative E. coli (P = 0.016).     

Studies on the etiologic agents of infantile diarrhea in Riyadh

Rectal swabs from children, aged from 1 month to 5 yr with diarrhea brought to the outpatient clinic of the Children Hospital, Riyadh, Kingdom of Saudi Arabia were examined for the presence of common enteric pathogens both bacterial and viral. Important diarrheal pathogens were isolated from 30·6 per cent of the children. Rotavirus was detected from 16·7 per cent of the patients followed by EPEC 5·5 per cent, ETEC 4·6 per cent and Shigella sp. 3·7 per cent. No organism of Salmonella group was found in this group of children. Rotavirus was predominant in age groups between 1 month to 2 yr. Antibiotic resistance were less common in pathogenic bacteria but more prominent in the non pathogenic Esch. coli isolated from the stool. Fifty four of the Esch coli were resistant to 4–6 commonly used antibiotics such as tetracycline, ampicillin, chloramphenicol, kanamycin, streptomycin and cotrimoxazole. This high incidence of multiple resistance in the population may be attributed to indiscriminate use of antibiotics.     

Prospective study of enteropathogens in children with diarrhea in Houston and Mexico.

During a 22-month period, 595 children with diarrhea and 210 age-matched controls attending clinics in Houston (367 children) and Mexico (438) were prospectively evaluated for enteric pathogens. Enteropathogens associated with disease were Shigella (18%), rotavirus (14%), Salmonella (9%), toxigenic Escherichia coli (6%), and others (12%), including 14 Proteus isolates that caused rounding of adrenal cells. Enteropathogens were isolated from a greater (P less than 0.001) number of children with diarrhea (59%) than from asymptomatic controls (6%). Paired sera tested for antibody to heat-labile toxin of E. coli rarely demonstrated a fourfold rise during episodes of diarrhea. This study demonstrates: (1) more striking illness in children from Mexico; (2) more common occurrence of Shigella in Houston, and of rotavirus and Salmonella in Mexico; (3) lack of seasonal occurrence of rotavirus isolation in either population and a summertime occurrence of Shigella in Houston; (4) lack of toxigenic E. coli isolation in endemic diarrhea of either population; and (5) a significant (P less than 0.001) age-related acquisition of E. coli LT antibodies.     

Enteric pathogens,intestinal permeability and nitric oxide production in acute gastroenteritis

BACKGROUND: Aboriginal children hospitalized with diarrheal disease in northern Australia have high rates of acidosis, hypokalemia and osmotic diarrhea, as well as abnormal small bowel permeability and elevated nitric oxide (NO) production. METHODS: In a study of 291 diarrheal admissions and 84 controls, we examined the relationship of diarrheal severity outcomes with specific enteric pathogens. NO production was measured by urine nitrate plus nitrite excretion on a low nitrate diet, small bowel permeability by the lactulose:rhamnose ratio on a timed blood specimen and stool pathogens by standard microbiologic investigations and PCR. RESULTS: The addition of diagnostic tests for diarrheagenic Escherichia coli to standard stool microbiologic testing increased the rate of specific diagnoses from 53% to 75%, but with multiple pathogens isolated from 34%. The most frequently isolated pathogens from diarrheal patients were enteroaggregative E. coli (28.9%), rotavirus (26.5%), enteropathogenic E. coli (17.2%), Salmonella spp. (10.7%), Cryptosporidium parvum (7.2%) and Strongyloides stercoralis (7.2%). High geometric mean permeability ratios (95% confidence intervals) occurred with rotavirus (19.6; 15.3 to 25.1), enteroaggregative E. coli (21.2; 15.3 to 29.3) and Cryptosporidium (23.0; 15.1 to 35.1) compared with 9.4 (6.8 to 13.1) for no pathogens. NO production was highest for Cryptosporidium (3.7; 2.3 to 6.1) compared with 0.6 (0.4 to 1.1) for no pathogens. Multiple regression analysis revealed significant associations (P < 0.001) for rotavirus with acidosis and osmotic diarrhea, for Strongyloides with wasting and hypokalemia and for Cryptospoidium with severe and prolonged diarrhea. CONCLUSIONS: Cryptosporidium, Strongyloides, rotavirus and enteroaggregative E. coli are important contributors to the severe manifestations of acute gastroenteritis in Australian Aboriginal children.     

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??Objective??To study the variation tendency of pediatric gastroenteric disease spectrum in order to provide scientific evidence for prophylaxis??treatment of disease?? preventive health care and rational allocation of medical resources. Methods??A retrospective analysis was perfomed about the disease species??constitute ratio??gender?? age and area distribution of 16??127 children admitted to Department of Pediatric Gastroenterology?? Shengjing Hospital?? from January 2007 to December 2015??to analyze the spectrum trend and epidemiological characteristics. Results??Boys were significantly more than girls??the ratio being 1.52??1. The patients ranged from 1 month to 16 years old??the ratios of infants and toddlers being 39.39% and 26.25% respectively?? who accounted for most part of total patients. Patients from the city of Shenyang accounted for almost half of total number??49.7%????with 42.6% from other cities and 7.7% from other provinces. Top five diseases were diarrhea??34.05%???? Henoch Schonlein purpura??11.56%???? jaundice??11.12%????infection-associated hepatitis??10.87%?? and EB virus infection??7.19%??. Functional gastrointestinal diseases were more commnon in girls. Conclusion??During the 9 years??the patients’ number is increasing??the species and composition of the diseases have changed. Diarrhea is the top disease in hospitalized children??which shows a growing trend. The species difference in different age groups is significant??and infants and young children are at higher risk of diarrhea. The incidence of infection associated hepatitis??inflammatory bowel disease and cow’s protein allergy shows a rising trend.     

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目的了解冬春季呼吸道感染住院患儿中7种常见呼吸道病毒的感染状况。方法采集2006年11月至2007年5月及2007年11月至2008年5月于新疆维吾尔自治区人民医院儿科住院的共479例呼吸道感染患儿的鼻咽分泌物,用直接免疫荧光方法,检测呼吸道合胞病毒(RSV)、腺病毒(ADV)、甲型流感病毒(IfuA)、乙型流感病毒及副流感病毒Ⅰ、Ⅱ、Ⅲ(ParaⅠ、Ⅱ、Ⅲ)型7种常见呼吸道病毒抗原。结果 2006—2007年冬春季7种病毒阳性检出率为24.3%,2007—2008年冬春季阳性检出率为41.8%。2年冬春季7种病毒中RSV检出率均占首位,分别为20.1%及32.3%。结论 RSV感染是新疆维吾尔自治区人民医院冬春季呼吸道感染住院患儿的最主要呼吸道病毒病原。ADV及ParaⅢ型感染位居第二、三位,而其他4种病毒感染少见。