社区获得性耐甲氧西林金黄色葡萄球菌研究现状

一直以来,耐甲氧西林金黄色葡萄球菌(methicillin-resistant Staphylococcus aureus,MRSA)作为医院内感染的重要病原菌,其临床特征及耐药状况一直备受关注.然而自20世纪90年代首次报道社区获得性耐甲氧西林金黄色葡萄球菌(community-acquired methicillin-resistant Staphylococcus aureus,CA-MRSA)后,20年来尤其是近3年来其感染率明显上升,并有超过医院获得性耐甲氧西林金黄色葡萄球菌(hospital-acquired methicillin-resistant Staphylococcus aureus,HA-MRSA)的趋势,成为社区及医院感染的主要致病菌,其临床特征、耐药状况、传播方式和分子生物学特征与HA-MRSA有着较大的差异.     

社区获得性耐甲氧西林金黄色葡萄球菌感染二例

近年来社区获得性耐甲氧西林金黄色葡萄球菌(community acquired methicillin-resistant Staphylococcus aureus,CA-MRSA)感染的病例不断增加.与医院获得性耐甲氧西林金黄色葡萄球菌(hospital acquired methicillin-resistant Staphylococcus aureus,HA-MRSA)感染相比,CA-MRSA感染具有不同的发病机制、遗传学特点和耐药性.我科近期收治了两例CA-MRSA导致严重感染的病例,报道如下.     

关注社区获得性肺炎细菌病原的变化

近些年,引起儿童社区获得性肺炎(Community-acquired pneumonia,CAP)的病原发生了一些变化,如肺炎支原体、肺炎衣原体不仅成为学龄儿童CAP的常见病原,而且3岁以下感染者也屡见报告,重症或难治性肺炎支原体肺炎病例在国内许多城市出现,嗜肺军团菌可能是小儿重症CAP的独立病原或混合病原之一的事实也再次为儿科临床所认识;新型病毒如C型鼻病毒、多瘤病毒等引起的感染在国内也已有文献报道;细菌方面,肺炎链球菌性坏死性肺炎(Necrotizing pneumonia)和脓胸增多,社区相关性耐甲氧西林金黄色葡萄球菌引起的坏死性肺炎并脓毒症病例在国内儿童出现,革兰阴性杆菌引起的婴幼儿CAP增多.     

儿童感染社区获得性耐甲氧西林金黄色葡萄球菌的研究进展

近年来儿童感染社区耐甲氧西林金黄色葡萄球菌（CA-MRSA）日益增多。CA-MRSA是常见的重要病原菌之一,轻则引起浅表性皮肤及软组织感染,重则会引起全身致死性感染。文章就儿童感染CA-MRSA的流行病学、相关危险因素、临床特征、治疗及预防措施作一综述,并总结近十年来我国不同地区儿童感染社区耐甲氧西林金黄色葡萄球菌的相关危险因素,疾病谱及抗生素耐药率。     

儿童耐甲氧西林金黄色葡萄球菌感染的现状与治疗进展

目前,耐甲氧西林金黄色葡萄球菌（methicillin resistant Staphylococcus aureus,MRSA）的感染率逐渐增加,并引起了世界范围内医疗保健机构的重视.本类感染曾经主要是医院获得性相关感染,近年社区获得性耐甲氧西林金黄色葡萄球菌（community associated methicillin resistant Staphylococcus aureus,CA-MRSA）在儿童群体中的培养阳性率也日益增高,其通常引起皮肤及软组织感染[1-2].然而,越来越多的侵袭性感染,特别是肺炎和肌肉、骨组织相关感染也与其有关.本文主要围绕儿科中MRSA相关感染的治疗思路以及目前药物治疗现状进行综合讨论.     

儿童社区获得性耐甲氧西林金黄色葡萄球菌感染及防治

耐甲氧西林金黄色葡萄球菌(MRSA)为院内感染的重要病原菌。由于儿童免疫力差,更易被其感染,MRSA感染现已成为儿科抗感染中的防治重点。20世纪80年代后期Craven等报道了首例儿童社区获得性MRSA(CA-MRSA)感染病例。1999年美国CDC又报道了4例儿童患者死于CA-MRSA引起的感染,由此引     

儿童呼吸道感染常见革兰阳性致病菌耐药性研究

目的 研究儿科患者呼吸道感染常见致病菌(肺炎链球菌、金黄色葡萄球菌及A族乙型溶血性链球菌)的耐药情况.方法 对2004年1月至2006年12月首都医科大学附属北京友谊医院儿科呼吸道感染患儿鼻咽分泌物分离的55株金黄色葡萄球菌、49株肺炎链球菌、15株A族乙型溶血性链球菌采用K-B纸片法进行抗生素敏感性检测.结果 49株肺炎链球菌对红霉索的耐药率高达90%,青霉素不敏感株5株,占10%,多重耐药率高达90%;55株金黄色葡萄球菌对氨苄西林耐药率为86%,对青霉素耐药率为82%,对苯唑西林耐药率为9%,且多重耐药问题很严重;15株A族乙型溶血性链球菌对红霉素的耐药率为80%,对青霉素和氨苄西林敏感.结论 儿童呼吸道感染常见致病菌的耐药情况不容乐观.肺炎链球菌及A族乙型溶血性链球菌对红霉素的耐药性很高;发现了耐甲氧西林的金黄色葡萄球菌,且多重耐药问题很严重.儿童呼吸道细菌感染时,应尽量避免使用非β-内酰胺类抗生素.     

社区获得性耐甲氧西林金黄色葡萄球菌肺炎1例诊治经验北大核心CSCD

近年来,耐甲氧西林金黄色葡萄球菌（MRSA）引起的感染呈急剧增加趋势。值得关注的是,在无医院或医疗机构接触的健康人群中发生MRSA感染的现象有所增多。本文对河北省儿童医院呼吸三科2015年3月收治的1例儿童社区获得性MRSA（CA-MRSA）肺炎患儿的临床及诊治过程进行分析,探讨CA-MRSA肺炎早期临床特点及诊治要点。     

金黄色葡萄球菌儿童急性呼吸道感染的分布及耐药

<正>金黄色葡萄球菌(简称金葡菌)是呼吸道感染重要致病菌,特别是近年来耐甲氧西林的金黄色葡萄球菌(MRSA)在世界各地流行,成为医院感染的重要病原菌和治疗难题。调查金葡菌在儿童呼吸道感染的临床分布及耐药,为临床合理应用抗生素提     

社区获得性耐甲氧西林金黄色葡萄球菌肺炎1例诊治经验

<正>近年来,耐甲氧西林金黄色葡萄球菌(MRSA)引起的感染呈急剧增加趋势。值得关注的是,在无医院或医疗机构接触的健康人群中发生MRSA感染的现象有所增多。本文对河北省儿童医院呼吸三科2015年3月收治的1例儿童社区获得性MRSA(CAMRSA)肺炎患儿的临床及诊治过程进行分析,探讨CA-MRSA肺炎早期临床特点及诊治要点。1临床资料患儿,女,10岁,因发热、咳嗽3 d入院。既往     

2011至2014年上海单中心下呼吸道感染住院患儿常见病原体流行病学研究

目的 分析近3年上海一家医院下呼吸道感染(LRTI)住院患儿中呼吸道合胞病毒（RSV）、腺病毒（ADV）、副流感病毒（PIV）、流感病毒（FLU）、人偏肺病毒（MV）、沙眼衣原体（CT）和肺炎支原体（MP）7种常见病原体的流行病学特征,为上海地区儿童LRTI的预防与诊治提供数据支持。 方法 收集2011年10月至2014年9月于复旦大学附属儿科医院就诊的LRTI住院患儿,取其鼻咽部抽吸物,使用直接免疫荧光法或实时荧光定量PCR技术检测上述7种呼吸道病原体,并对其流行病学特征行描述性分析。 结果 3年的呼吸道病原体总检出率为44.0%(6 301/14 334),MP的检出率最高（17.5%）,其次为RSV(13.9%）和PIV(5.6%）。男、女呼吸道病原体的总检出率差异无统计学意义（χ2=0.68,P=0.408）。0~6月龄患儿以RSV检出率最高,>2岁患儿以MP检出率最高。RSV和CT随着年龄的增长检出率显著降低,MP的检出率随着年龄增长而显著升高。RSV的检出率高峰出现在冬季,夏季少见。ADV在春夏季检出率较高,而在秋季少见。PIV和MP检出率的高峰主要出现在夏季,FLU在1月份有暴发性的流行,MV的检出高峰主要出现在每年3月份;CT全年散发,无明显季节特征。病原体混合感染的总检出率为2.9％,在7~12月龄患儿中检出率最高,其中以MP合并其他病原体感染为主,最常见为MP+RSV的混合感染。 结论 多种病原体导致上海地区儿童的LRTI,不同病原体显示出不同的流行季节、年龄分布等流行特征。     

Immunoglobulin heavy G2 chain (IGHG2) gene restriction in the development of severe respiratory syncytial virus infection

AIM: Respiratory syncytial virus (RSV) is a prominent cause of airway morbidity in children under 1 y of age. It is assumed that host factors influence the severity of disease presentation, and thus the need for hospitalization. The variation of IGHG genes from chromosome 14q32 are linked to serum IgG subclass levels but also to the variations in IgG responses to pneumococcal, meningococcal and Haemophilus influenzae antigens. The aim of this investigation was to clarify whether IGHG genes are involved in the development of severe RSV lower respiratory tract infection (LRTI). METHODS: The alternative expressions of IGHG3(b) and (g), IGHG1(f) and (a), and IGHG2(n) and (-n) genes were studied in a cohort of 49 previously healthy children hospitalized for RSV LRTI. The gene frequencies were compared to a population of healthy individuals. RESULTS: The homozygous IGHG2(-n/-n) genotypes dominated in hospitalized children with severe RSV infection: 55.1%, compared with 34.2% in the healthy population (OR 2.3; p = 0.004). The IGHG2 genotypes containing (n/n) and (n/-n) were significantly decreased. The IGHG(bf-n) alleles were significantly increased (OR 1.7; p = 0.025) and the IGHG(bfn) alleles significantly decreased (OR 0.5; p = 0.005). CONCLUSION: The IGHG(bf-n) allele and homozygous IGHG2(-n/-n) genotypes are associated with the development of severe RSV LRTI.     

Empiric use of cefepime in the treatment of lower respiratory tract infections in children

BACKGROUND: These studies were designed to assess the efficacy and safety of cefepime, a fourth generation cephalosporin, for the treatment of serious infections, including lower respiratory tract infections (LRTI) in children. METHODS: Four clinical trials of cefepime for the treatment of serious bacterial infections enrolled 259 children with LRTI. In 3 trials cefepime was compared with ceftazidime (n = 166), cefotaxime (n = 16) or cefuroxime (n = 12). One trial was noncomparative (n = 65). RESULTS: Treatment with cefepime 50 mg/kg/ dose administered every 8 to 12 h produced a satisfactory clinical response (clinical signs of infection resolved or improved with no evidence of recurrent infection at posttreatment follow-up) in 88 to 100% of patients, comparable with comparator therapy. In children from whom a causative pathogen was identified, bacteriologic eradication was comparable between cefepime and comparator therapy. Cefepime was as safe and well-tolerated as comparator therapy. Few treatment-related clinical or laboratory adverse events were noted and were equivalent to comparator in all studies. CONCLUSION: Cefepime is as effective, safe and well-tolerated for the empiric treatment of children with LRTI as comparator agents but offers the advantage of an enhanced spectrum of activity for Gram-positive and Gram-negative pathogens compared with second or third generation cephalosporins.     

温州地区儿童急性下呼吸道感染病原学及细菌耐药性检测

目的：了解温州地区儿童急性下呼吸道感染(LRTI)的病原学特点及细菌耐药情况。方法：454例急性LRTI患儿(年龄1个月~10岁,中位年龄6.0个月)入院24h内抽取下呼吸道分泌物送细菌培养,药敏试验采用K-B法,同时应用直接免疫荧光法检测呼吸道病毒。结果：297例(65.4%)病原检测阳性,其中病毒阳性229例(50.4%),以呼吸道合胞病毒(RSV)最多见(39.6%),其次为副流感病毒3型(PIV3)(6.6%)、腺病毒(2.2%)、流感病毒A型(0.9%)及流感病毒B型(0.7%)。共分离出19种135株(29.7%)致病菌,以肺炎克雷伯杆菌(K.pn)最多见(9.9%),其次为大肠杆菌(E.coli)(4.4%),K.pn和E.coli产ESBLs株分别占42.2%和65.0%;肺炎链球菌(SP)占4.2%。混合感染率为14.8%。6个月以下患儿前5位病原为RSV,K.pn,PIV3,E.coli及SA;而RSV,PIV3,SP,K.pn及E.coli则是6个月至3岁患儿常见的病原。K.pn和E.coli对氨苄西林的耐药率分别达97.8%和75.0%,产ESBLs株的K.pn和E.coli对头孢菌素普遍耐药;SP对红霉素的耐药率高达100%,对青霉素的耐药率亦达68.4%,而SA对红霉素和青霉素的耐药率分别为94.7%和89.5%。结论：RSV是温州地区儿童急性LRTI最常见的病原,其次为K.pn和PIV3。常见细菌的抗生素耐药性及革兰阴性杆菌产ESBLs的比率均相当高。     

The discriminative value of C-reactive protein levels in distinguishing between community-acquired bacteraemic and respiratory virus-associated lower respiratory tract infections in HIV-1-infected and -uninfected children

This study assessed the value of routine CRP measurements to discriminate between bacterial and viral lower respiratory tract infection (LRTI) in HIV-1-infected and -uninfected children. A total of 570 children, prospectively enrolled, were categorised into four aetiological groups, as follows: (i) bacteraemic pneumonia (n = 50), (ii) respiratory virus-associated LRTI (n = 146), (iii) bacteraemic and respiratory virus-associated (mixed) LRTI (n = 10), and (iv) LRTI of undetermined aetiology (n = 364). The discriminative ability of threshold CRP values was evaluated, and values predicting bacteraemic pneumonia were used to construct receiver-operating characteristic (ROC) plots. Median CRP values were significantly higher in bacteraemic pneumonia (195 mg/L, p < 0.0001), and threshold CRP values ranging from 10 to 100 mg/L differentiated bacteraemic from virus-associated LRTI (p < 0.0001). The discriminative ability of CRP values assessed by ROC plots in pneumonia is 80%, and CRP > or = 10 mg/L identified 90% of all bacteraemic pneumonia. In HIV-1 infection, median CRP values were significantly higher in bacteraemic pneumonia (200 mg/L) but correlated with levels in uninfected children, irrespective of LRTI aetiology. Although CRP responses are significantly different in bacteraemic and virus-associated LRTI, the considerable overlap between these aetiological groups hinders selection of threshold CRP values that are clinically useful in differentiating bacteraemic from virus-associated LRTI pneumonia.     

Predicting clinically significant lower respiratory tract illness in childhood following mild bronchiolitis

A historical cohort study was conducted to measure lower respiratory tract illness (LRTI) up to nine years following mild bronchiolitis and to discover attributes that predict an increased risk for LRTI in childhood. The hypothesis assessed was that the occurrence of bronchiolitis predicts LRTI following the second birthday (childhood LRTI) after adjusting for potentially confounding variables such as a family history of respiratory allergy. Fifty-three children (index subjects) who were seen for bronchiolitis at a suburban community pediatric practice were compared on the basis of childhood LRTI with a control group of 159 children. Chart review, when children were a mean of 8 years old, determined the frequency of childhood LRTI. The mean frequency of childhood LRTI was greater in index subjects than in control subjects (1.62 vs 0.98). This difference remained after adjusting for potentially confounding variables. The yearly occurrence of any LRTI was significantly more common in index subjects through the third year of life (38% vs 15%). A tendency for a more common occurrence of any LRTI was noted through the fifth year (25% vs 16%), but not thereafter. Further analysis of index subjects disclosed that only those who experienced a subsequent LRTI before the second birthday were at an increased risk for the development of childhood LRTI.     

Economic impact of community-acquired and nosocomial lower respiratory tract infections in young children in Germany

Data on the economic burden of lower respiratory tract infections (LRTI) in young children are lacking in Germany. The objective of the cost-of-illness study was to estimate the economic impact of community-acquired LRTI and nosocomial LRTI as well as of infections due to respiratory syncytial virus (RSV), parainfluenza viruses (PIV) and influenza viruses (IV). The economic analysis is part of the PRI.DE study, a prospective, multi-centre, population-based epidemiological study on the impact of LRTI in children aged 0 to 36 months in Germany. The analysis includes children with community-acquired infections (1329 cases treated as outpatients, 2039 cases treated as inpatients) and nosocomial infections (90 cases). Medical services consumed were generated by chart abstraction and parental expenses data by telephone interviews within four weeks after physician visit or hospitalisation. Costs were evaluated from following perspectives: third party payer, parent and society. Total costs for outpatient treatment are €123 per LRTI case. Stratified by virus type, total costs per case are €163 (RSV), €100 (PIV) and €223 (IV). Total costs per hospitalised LRTI case amount to €2579. Stratified by virus type, total costs per case are €2772 (RSV), €2374 (PIV) and €2597 (IV). Total costs per nosocomial case are €2814. Economic burden due to LRTI is €213 million annually. It is concluded that treatment of LRTI in children up to age three causes a considerable economic burden in Germany. Presented results are the first data describing the economic burden of LRTI in young children assessed by means of the incidence data for Germany. This cost-of-illness study provides basic data for further decision-making, focusing on the economic assessment of preventive strategies for RSV, PIV and IV infections.     

Relationships between cotinine, lower respiratory tract infection, and eosinophil cationic protein in children

Introduction The aim of this study was to investigate the effect of passive smoking on urine eosinophil cationic protein (u-ECP) in children with lower respiratory tract infections (LRTI). Method This was a case-control study. The study cohort consisted of 150 children with LRTI (case group) and 150 healthy children (control), all from a urban setting. The statistical parameters were: a minimum of 139 children for a 95% confidence interval (95% CI), 80% power, and a possible exposure prevalence of 50%. The u-cotinine and u-ECP levels were measured by radioimmunoassay and fluoroimmunoassay methods, respectively. Data were analyzed by the McNemar chi-square test, t-test, and Pearson correlation. Results When the generally accepted cut-off level of 30 ng/mg urinary cotinine/creatinine was applied, 87.3% of the children with LRTI and 84.7% of healthy children were passive smokers. Using a cut-off level of 60 ng/mg, passive smoking increased the prevalence of LRTI by 4.7-fold (p=0.000). The mean u-ECP values were significantly higher in the case group than in the healthy control group (p=0.018). A positive association was found between u-cotinine and u-ECP values in children with LRTI (p=0.034). Conclusion The results of this study indicate that passive smoking may play an important role in the development of respiratory infections and can cause airway inflammation in children with existing LRTI.     

Hemoglobin level as a risk factor for lower respiratory tract infections

Objective This prospective study was conducted to evaluate the role of hemoglobin level, as a risk factor for Lower Respiratory Tract Infections in children (LRTI). Methods 100 children who came to the outpatient department for LRTI were included in the study. Age and sex-matched 100 children, not having any respiratory illness, were taken as control. They were subjected to complete blood count (CBC) C-reactive protein estimation (CRP), Mantoux test, and X-ray chest. Peripheral smear, serum ferritin and serum iron binding capacity were done for all anemic children. Results Radiological evidence of pneumonia was present in 63 children (63%). Hyper inflated lungs were seen in 27 (27%). Mantoux was positive in 22 children (22%) of study group and none among control group. CRP>6mg/L was noted in 45 children (45%) of study group and 14 (14%) of control group. Seventy four of study group (74%) and 33 of control group (33%) had anemia. Of the anemic children, 60 (60%) had iron deficiency, 10 (10%) chronic inflammation and 4 (4%) had hemolytic anemia. These values were 30(30%), 2(2%) and 1(1%) respectively for control group. Low hemoglobin level due to whatever etiology, was a risk factor (p=0.000). Conclusion Anemic children were 5.75 times more susceptible to LRTI compared to the control group. Prevention of anemia, due to whatever etiology, will reduce the incidence of LRTI.     

Current trends in the prevalence and aetiology of childhood congestive cardiac failure in Sagamu

Congestive cardiac failure (CCF) is a common paediatric emergency with diverse aetiologies. The objective of this study is to define the current prevalence rate and common causes of CCF among children hospitalized in a Nigerian Tertiary Hospital. The study was prospectively done over a 1-year period in the Paediatric Wards of the hospital. Consecutive children aged 0-14 years, who fulfilled the standard diagnostic criteria for CCF were recruited. Data obtained from them included the age, sex, duration of illness and the socioeconomic status of the parents. Each subject was given a specific diagnosis based on the clinical, laboratory and radiological features. Out of a total of 1552 admissions, 109 had CCF giving the prevalence of 7.02%. The mean age of children with CCF was mean of 2 +/- 3.1 years (range: 1 day to 14 years). Ninety-five (91%) of them were concentrated in the lower socioeconomic classes III-V. The aetiologies of CCF identified in this study were as follows: severe anaemia occurring alone (48; 46%), lower respiratory tract infections (LRTI) (30; 29%), anaemia with LRTI (12; 11.5%), congenital heart diseases (CHD) (11; 10.5%), rheumatic heart disease (1; 1%), myocarditis (1; 1%) and chronic renal disease (1; 1%). Malaria was the commonest cause of anaemia while bronchopneumonia was the commonest form of LRTI in the subjects. Measles infection was associated with LRTI in 10 (23.8%) children. Three children had HIV-related anaemia. Infants formed the bulk of the subjects with CCF due to anaemia, LRTI and CHD. Ventricular septal defect was the commonest CHD identified. The prevalence obtained from this study was higher than rates obtained from some previous studies in the country. Severe anaemia is the commonest cause of CCF probably from the effects of severe malaria and increasing poverty. Stringent attention to poverty alleviation and malaria control may reduce the burden of CCF among Nigerian children.