福氏志贺菌感染的发病机制和疫苗研制

每年大约有1.6亿多人患志贺菌病,其中约110万人死亡,大多数病例为发展中国家的5岁以下儿童。福氏志贺菌侵袭并在结肠上皮内复制,可导致严重炎症和上皮破坏。福氏志贺菌通过上皮屏障逃避宿主免疫、进入上皮细胞的分子机制被广泛研究。细菌的侵袭、细胞间扩散、炎症诱导的致病因子已被鉴定。宿主体液免疫是最重要的保护反应,产生血清特异性抗体,对同种血清型的重复感染有保护作用。尽管以前的疫苗不是很成功,随着对福氏志贺菌感染发病机制研究的深入,越来越多的疫苗值得人们期待。     

头孢曲松在小儿急性细菌性痢疾中的应用:附106例临床分析

近年来 ,随着痢疾杆菌的耐药菌株不断增加 ,给小儿急性菌痢的治疗带来一定的困难。为明确头孢曲松治疗急性菌痢的有效性 ,现将１９９７年７月至１９９９年１２月在我科住院的２１６例急性菌痢分析如下。对象与方法一、对象急性菌痢的诊断参照《实用儿科学》［１］。将入选的２１６例随机分成头孢曲松治疗组(简称治疗组 )１０６例 ,氨苄青霉素 +丁胺卡那霉素治疗组 (简称对照组 )１１０例。治疗组中男６８例 ,女３８例；平均年龄１．９４岁±０．５７岁 ;入院前病程２．５３天±１．２１天 ;其中轻型２７例 ,普通型６６例 ,重型１１例 ,中毒…     

小儿急性中毒30例临床分析

小儿急性中毒是农村儿科急症中的常见疾病，起病急、发展快，病情重，如不及时诊治常危及患儿生命。小儿对事情的描述不及成人，不能完整和准确地表达，且临床症状酷似急性感染中毒综合征、急腹症、中毒性脑病等易被误诊。为了提高对小儿急性中毒的认识、诊断、治疗和预防，现将我院收治的小儿急性中毒30例分析报告如下。     

兰州地区小儿急性细菌性痢疾病原菌耐药性的变化

目的　了解 8年来兰州地区小儿急性细菌性痢疾病原菌菌型及耐药性变化。方法　对 8年中 138例急性细菌性痢疾患儿的临床表现、菌型分布及药敏结果等问题进行了总结分析。结果　急性细菌性痢疾患儿占腹泻患儿的 18.5 % ,以福氏痢疾杆菌 (6 5 .9% )及宋内氏痢疾杆菌 (17.4% )感染为主。 5 9.2 %的菌株对 7种抗生素产生多重耐药性。结论　由于抗生素大量使用及逐步升级 ,使抗生素耐药种类逐年增加 ,造成治疗困难 ,应引起儿科临床医生的高度重视。     

兰州地区小儿急性细菌性痢疾病原菌耐药性的变化

目的：了解8年来兰州地区小儿急性细菌性痢疾病原菌菌型及耐药性变化。方法：对8年中138例急性细菌性痢疾患儿的临床表现、菌型分布及药敏结果等问题进行了总结分析。结果：急性细菌性痢疾患儿占腹泻患儿的18.5%,以福氏痢疾杆菌(65.9%)及宋内氏痢疾杆菌(17.4%)感染为主。59.2%的菌株对7种抗生素产生多重耐药性。结论：由于抗生素大量使用及逐步升级,使抗生素耐药种类逐年增加,造成治疗困难,应引起儿科临床医生的高度重视。     

小儿复方地芬诺酯中毒13例临床分析

目的 讨论小儿复方地芬诺酯中毒的预防和救治.方法 对13例复方地芬诺酯中毒患儿的临床资料作回顾性分析.结果 13例复方地芬诺酯中毒患儿均抢救成功,疗效满意.结论 妥善保管、合理应用复方地芬诺酯是预防复方地芬诺酯中毒的根本;早期诊断,早期治疗,早期应用纳洛酮是抢救小儿复方地芬诺酯中毒成功的关键.     

小儿室性心动过速的临床分析

近几年来,随着基础与临床研究的进步,新技术的开展,对室性心动过速(VT)这一严重心律失常的发生机制及诊断治疗有不少新的认识,对这些新知识新技术的了解和掌握,有利于提高VT的诊治水平。我们分析我科近10年小儿VT的诊治情况。     

序贯疗法治疗肥厚性幽门狭窄的临床研究

目的探讨序贯疗法治疗肥厚性幽门狭窄(HPS)的临床疗效及安全性。方法选取2010年1月至2013年6月本院儿外科收治的先接受静脉注射后接受口服阿托品序贯给药治疗的HPS患儿,观察阿托品序贯疗法的临床疗效和不良反应。结果 26例HPS患儿中23例呕吐缓解并完成阿托品序贯疗法治疗,呕吐缓解率88.5%(23/26);2例中途放弃药物治疗,1例药物无效,3例均转手术治疗。阿托品序贯疗法治疗期间无明显药物不良反应。治疗前患儿超声检查幽门肌层厚度3.5~6.2 mm,平均(4.8±0.3)mm;治疗结束后6~8个月,超声检查幽门肌层厚1.4~2.1 mm,平均(1.8±0.2)mm。结论阿托品序贯疗法治疗HPS疗效高,安全无创,但少数患儿仍需要手术治疗。     

上海梅陇地区2002～2004年小儿肺炎支原体感染的分析

目的了解上海梅陇地区2002~2004年小儿肺炎支原体(MP)感染的情况。方法通过对2 326例呼吸道感染患儿,采手指末梢血,用低效价颗粒凝集实验试剂盒检测体内MP抗体。结果2 326例患儿中,MP-IgM阳性数为892例,阳性率为37.34%。女性感染率高于男性(P<0.05),2002年10月~2003年6月MP-IgM阴性率明显高于其他时期,统计学检验有显著性差异。年长儿MP-IgM的阳性率较婴幼儿为高,但2003年的检测结果显示婴幼儿的发病率有增加的趋势。结论MP是小儿呼吸道感染常见的病原体,尤其是慢性咳嗽的患儿,常呈季节性发病。     

小儿急性细菌性痢疾6年菌群及药敏动态观察──290例分析

目的　了解1998年～2003年儿童细菌性痢疾病原学构成及细菌对药物的敏感状况变化,指导 临床用药。方法　对上海市第六人民医院1998年1月至2003年12月290例细菌性痢疾粪培养阳性者,应用改 良Kirby bauer法进行药敏试验。结果　培养出阳性菌株两型,D群宋氏志贺菌155株,B群福氏志贺菌135株。致 病菌株1998年～1999年以福氏菌为主,而2000年～2003年以宋氏菌为主。两种菌均对头孢克罗、丁胺卡那、庆 大霉素,头孢三嗪敏感性较强,对氨苄青霉素、复方新诺明等药耐药。结论　宋氏和福氏志贺菌是1998年～2003 年上海市第六人民医院收治的儿童菌痢的主要病原菌。头孢克罗副作用小,可以口服,且大部分菌株敏感,可以作 为药敏试验结果未出时儿童细菌性痢疾治疗的经验用药。     

病原菌明确的细菌性脑膜炎146例临床及病原学分析

目的 分析细菌性脑膜炎患儿临床表现和病原特点,为临床诊治提供帮助。方法 收集复旦大学附属儿科医院2001年1月至2012年12月病原菌诊断明确的细菌性脑膜炎住院患儿,采集临床表现、辅助检查、并发症、病原菌种类和耐药情况等资料,分为0~28 d（新生儿组）,~1岁、~3岁和>3岁组进行描述分析。结果 146例细菌性脑膜炎患儿进入分析,新生儿组58例,~1岁组36例,~3岁组20例,>3岁组32例。①新生儿组发热、呕吐和脑膜刺激征的发生率较低,>3岁组伴有颅面、脊柱解剖畸形50%（16/32）。②革兰阳性菌占54.8%（80株）,以凝固酶阴性葡萄球菌（33株）、肠球菌（19株）和肺炎链球菌（12株）为主;革兰阴性菌占45.2%（66株）,以大肠埃希菌（30株）和鲍氏不动杆菌（10株）为主。③革兰阳性菌对万古霉素和利奈唑胺均敏感,革兰阴性菌除3/10株鲍氏不动杆菌和1/3株铜绿假单胞菌对美罗培南耐药外,余均敏感;大肠埃希菌、克雷伯菌和阴沟肠杆菌产超广谱β内酰胺酶阳性率分别达到66.7%、60.0%和100%。④63例（43.2%）出现急性期并发症,以硬膜下积液（26例）、脑积水（20例）和局部神经损害（13例）最常见;出现并发症主要病原菌为大肠埃希菌(15/30)、凝固酶阴性葡萄球菌（14/33）、肺炎链球菌（6/12）和鲍氏不动杆菌(6/10)。⑤出院结局：死亡或放弃治疗31例（21.2%）,其中肺炎链球菌性脑膜炎为5/12例（41.7%）。结论 细菌性脑膜炎新生儿临床表现多不典型,>3岁患儿应关注神经系统相关解剖结构缺陷的可能。可根据病原菌分布特点和药敏结果选用敏感抗生素。肺炎链球菌性脑膜炎患儿预后可能不良。     

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目的了解NICU中住院早产儿的细菌定植状况及定植菌的耐药性。方法对2002年5月至2003年4月间在北京协医院NICU住院治疗的早产儿进行细菌学监测,于入院时和入院后每周常规做咽拭子及直肠拭子培养。收集每位早产儿的临床及实验室资料,对结果进行统计学分析。结果147例早产儿共培养出183株定植菌。入院当天即有细菌定植者11例,入院后发生细菌定植者52例。定植菌以革兰阴性杆菌为主(占62.8%)。早产儿获得细菌定植与胎龄小、出生体重低、住院时间长、应用机械通气、胃肠外营养、长时间使用抗生素等因素有关。美罗培南在目前所用抗生素中对革兰阴性杆菌敏感性最高,但与耐甲氧西林凝固酶阴性葡萄球菌(MRScoN)定植之间具有相关性。败血症以革兰阴性杆菌为主,细菌定植1周左右为败血症高发期。结论应对在NICU住院的早产儿进行细菌学监测,根据监测结果判断细菌定植状态和采取保护措施。控制抗生素使用、缩短住院时间和胃肠外营养的时间,对控制早产儿细菌定植将起到重要作用。     

A detailed analysis of changes in serum C-reactive protein levels in neonates treated for bacterial infection

A prospective study was undertaken to characterize the rate of increase, time of peak values and rates of decrease in serum concentrations of C-reactive protein (CRP) in a group of infants treated for neonatal bacterial infection. A total of 176 consecutively admitted neonates with birth weight >1500 g and without mechanical ventilation or central lines in situ, who received antibiotic therapy for suspected bacterial infection, were enrolled. The changes in serum CRP concentration in 60 of 63 infants who had CRP values above 20 mg/l 24–48 h after the beginning of treatment were analysed in detail. Initial increase rates in serum CRP levels of up to 4.5 mg/l per h were documented peak were reached at a mean of 19.5 h after antibiotic therapy had been initiated, but in some patients an increase in serum CRP levels occurred up to 40–48 h after the beginning of treatment. The mean serum half-life of CRP in infected neonates was 21 h (range 11.2–38 h). Conclusion In neonates with bacterial infection (defined by a combination of clinical signs and increased C-reactive protein and immature-total quotient values) no differences in the overall pattern nor in any of the particular phases of the C-reactive protein response curves could be observed between neonates with positive (n = 13) or negative blood cultures (n = 47). Received: 18 July 1997 / Accepted in revised form: 5 May 1998     

Dexamethasone and antibiotics for the empirical treatment of bacterial meningitis in Canadian children: A survey of paediatric infectious diseases specialists

PURPOSE:

With the changing epidemiology of the etiological agents causing bacterial meningitis in Canada, the purposes of this study were to determine what empirical antibiotic(s) is/are advocated, and whether dexamethasone is recommended as adjunctive therapy by paediatric infectious diseases specialists for suspected meningitis caused by Streptococcus pneumoniae, Neisseria meningitides, Haemophilus influenzae type b, and partially treated (PT) bacterial meningitis.

METHODS:

A questionnaire invoking the specialists’ preferred choices in treating bacterial meningitis was circulated by e-mail in March 1999 to 41 paediatric infectious diseases specialists or microbiologists (Paediatric Investigators Collaborative Network on Infections in Canada [PICNIC] members) who practised in 13 paediatric centres located in eight provinces.

RESULTS:

Thirty-two (78% response rate) replies were received by July 1999 from 11 paediatric centres in seven provinces. Dexamethasone was recommended by 11 of 32 (34%) respondents for suspected S pneumoniae, four of 32 (12%) for suspected N meningitides, 18 of 32 (56%) for suspected H influenzae type b and five of 32 (16%) for suspected PT meningitis. A trend for more frequent recommended use of dexamethasone for S pneumoniae, H influenzae type b and N meningitides meningitis was found in eastern provinces (Ontario, Quebec and Nova Scotia), as opposed to the western provinces (Manitoba, Saskatchewan, Alberta and British Columbia). The most commonly recommended first line empirical antibiotic therapy was vancomycin plus 3rd-generation cephalosporin (V+3C). This was recommended by 27 of 32 (84%) respondents for suspected S pneumoniae, seven of 32 (22%) for suspected N meningitides, six of 32 (19%) for suspected H influenzae type b and 24 of 32 (75%) for PT meningitis; the remainder recommended using a 3C empirically for each type of meningitis. The major reason cited by respondents for using V+3C for suspected S pneumoniae was the presence of high-and intermediate-level penicillin-resistant S pneumoniae in their centres. No differences were found in the choice of antibiotic(s) between practitioners in the eastern and western provinces.

CONCLUSIONS:

Although regional differences exist, the majority of paediatric infectious diseases experts no longer favour the use of dexamethasone for empirical therapy in most cases of bacterial meningitis. V+3C has become the regimen of choice in Canada for most cases of suspected bacterial meningitis.     

Plasma lactate can improve the accuracy of the Pediatric Sequential Organ Failure Assessment Score for prediction of mortality in critically ill children: A pilot study

BackgroundPlasma lactate has been used to predict the prognosis of critically ill children, but mortality risk scores appear to be more appealing, particularly in resource-limited countries.ObjectiveTo assess the prognostic utility of lactate compared with the pediatric Sequential Organ Failure Assessment (pSOFA) score among the general pediatric intensive care unit (PICU) population.MethodsThis was a prospective observational study including 78 children admitted to a tertiary-level PICU. Plasma lactate was measured upon admission and repeated 24 h later. pSOFA score, Pediatric Risk of Mortality, and Pediatric Index of Mortality-2 (PIM2) were calculated. The primary outcome was 30-day mortality.ResultsIn total, 47.4% of patients had hyperlactatemia at admission. Among these, 20.5% had persistent hyperlactatemia. No significant difference in admission lactate level was found between survivors and nonsurvivors. The 24-h, peak, and average lactate levels were higher among nonsurvivors (P = 0.005, 0.035, and 0.019, respectively). The 24-h lactate level and pSOFA score were independent predictors of mortality (adjusted odds ratio and 95% confidence interval = 1.12 [1.02–1.23] and 1.80 [1.23–2.64], respectively]. The 24-h lactate level showed positive correlations with pSOFA, PRISM, and PIM2 (Spearman correlation coefficient = 0.31, 0.23, 0.43; P = 0.006, P = 0.047, P < 0.001, respectively). The 24-h lactate level had an area under the receiver operating characteristic curve (AUC) of 0.77 (P = 0.013) for mortality prediction, while admission, peak, and average lactate level had an AUC of 0.69, 0.69, 0.71 (P = 0.086, P = 0.035, P = 0.019), respectively. PIM2, PRISM, and pSOFA score had an AUC of 0.80, 0.78, 0.82 (P = 0.001, P = 0.001, and P < 0.001), respectively. Combining 24-h lactate level with pSOFA demonstrated superior performance (AUC = 0.88).ConclusionBoth 24-h lactate level and pSOAF are useful for prediction of mortality. Incorporating the 24-h lactate level into the pSOFA Score achieved superior prognostic utility.     

重症监护病房患儿胸腔积液临床分析

目的了解儿科重症监护病房(PICU)患儿胸腔积液的常见病因及相关影响因素。方法对我院2000年1月~2006年3月收入PICU的55例胸部放射学和(或)胸部B超确诊为胸腔积液患儿的临床资料进行回顾性分析。结果55例中以感染为原因者占76.36%,肿瘤性疾病18.18%,其他5.46%。本组死亡3例,病死率5.46%;细菌感染组17例培养阳性,9例为G 菌(5例肺炎链球菌),8例G-菌(4例铜绿假单孢菌);恶性肿瘤组血LDH增高与细菌感染组相比,有统计学差异;细菌感染组与恶性肿瘤组胸水细胞计数分类比较,结果显示多形核细胞分类与单核细胞分类差异均显著;脓胸与非脓胸细菌感染组胸水中糖含量比较,差异有显著性;脓胸组治疗后胸水平均消失时间与非脓胸组比较,差异有显著性。结论本组胸腔积液患儿,以细菌感染为主,G 菌及G-菌均是重要致病菌,并提示PICU要特别重视铜绿假单胞菌的感染;血LDH增高的程度及胸水细胞分类计数有助于早期鉴别恶性或感染性胸腔积液;细菌感染者胸水糖含量的高低,可以预示疾病严重程度及内科治疗的效果。     

儿科重症监护病房患儿博卡病毒感染的临床分析

目的：研究儿科重症监护病房中呼吸道感染患儿博卡病毒感染的临床特点。方法收集2010年6月至2011年12月因急性呼吸道感染入住本院儿科重症监护病房的患儿咽拭子标本450份。应用多重PCR技术对博卡病毒和呼吸道常见病毒进行检测,博卡病毒PCR阳性结果进行基因测序确定,并分析阳性病例的临床资料。结果450份咽拭子标本中,检出博卡病毒30例（检出率6.7％）。30例博卡病毒阳性标本中,16例为单独感染,占总阳性标本的53.3％;14例为混合感染,占总阳性标本的46.7％。根据小儿危重病例评分,16例单独感染患儿中13例为＞80分（非危重）,2例为80～71分（危重）,1例为＜70分（极危重）;14例混合感染患儿中12例为＞80分（非危重）,2例为80～71分（危重）;单纯感染和混合感染所致疾病的危重程度差异无统计学意义（ P＞0.05）。结论博卡病毒能够引起儿童重症呼吸道感染,混合感染不会增加疾病的严重程度。