腹泻儿童沙门菌多位点序列及耐药特征分析

目的了解腹泻患儿临床分离沙门菌株的遗传基因型及耐药特征。方法收集2014年7月至2015年10月腹泻患儿大便标本,经大便培养分离鉴定沙门菌43株。用多位点序列分型技术(MLST)对43株沙门菌的靶基因进行PCR扩增和测序,通过eBURST方法对其进行进化聚类分析,并通过STAT2软件进行菌株基因遗传进化分析;检测菌株对临床常用抗生素的耐药性。结果 MLST分析显示,43株沙门菌可分为17个序列类型(ST),未发现新的型别;其中ST11和ST 34是优势ST型别,分别占32.56%、23.26%。43株沙门菌对阿莫西林/克拉维酸、头孢噻肟、头孢他啶和头孢吡肟的耐药率分别为13.95%、27.91%、16.28%和11.63%,未发现哌拉西林/他唑巴坦、亚胺培南耐药菌株。结论沙门菌感染的腹泻患儿以ST11和ST34为优势克隆株,对三、四代头孢菌素均出现耐药,对哌拉西林/他唑巴坦或亚胺培南仍敏感。     

儿童沙门菌感染临床特点及耐药模式

目的了解儿童沙门菌感染的流行特征和耐药模式。方法分析2012年2月—2014年9月住院且粪便细菌培养出沙门菌菌株患儿的临床特点,以及沙门菌的血清型和药敏试验结果。结果从2 678例住院患儿粪便标本中检测出87株沙门菌,5—9月份共检测出64株(73.56%)。87例沙门菌阳性患儿中,男58例、女29例,其中2岁的68例(78.16%)。临床症状主要为脓血便65例(74.71%),发热72例(82.76%)。合并有轮状病毒感染10例(11.49%)。经沙门菌血清学鉴定,分别为布利丹沙门菌6株,肠炎沙门菌6株,鼠伤寒沙门菌5株,亚利桑那沙门菌3株,奥拉宁堡沙门菌2株,策维埃沙门菌2株,纽兰芝沙门菌、德比沙门菌、阿哥纳沙门菌、布伦登芦普沙门菌、埃可沙门菌各1株。药敏试验结果显示,沙门菌对头孢唑啉、头孢呋辛、庆大霉素的耐药率分别为94.25%、87.36%、87.36%,有26株(29.89%)沙门菌呈多重耐药。结论 2岁儿童沙门菌易感,男性患儿居多,主要表现为脓血便、发热,有部分合并轮状病毒感染;沙门菌血清型以布利丹沙门菌、肠炎沙门菌和鼠伤寒沙门菌多见,对多种抗生素耐药,甚至多重耐药。     

儿童腹泻沙门菌和志贺菌的分布及耐药性分析

目的：儿童腹泻沙门菌和志贺菌的分布及耐药性分析。方法收集2014年5月至2015年10月我院腹泻门诊112例1~8岁患儿粪便标本,用诊断血清和VITEK 2系统进行鉴定并行药敏试验。结果112例患儿粪便标本检出沙门菌78株,志贺菌34株。沙门菌血清型分布主要为B群鼠伤寒沙门菌34株（43.6％）及德尔卑沙门菌11株（14.1％）;D群20株（25.6％）肠炎沙门菌。志贺菌血清型分布主要为31株（91.2％）弗氏志贺菌。78株沙门菌的药敏试验敏感率较高的药物依次为亚胺培南、厄他培南、头孢吡肟、头孢他啶、头孢曲松、左氧氟沙星、哌拉西林／他唑巴坦。34株志贺菌的药敏试验敏感率较高的药物依次为亚胺培南、厄他培南、哌拉西林／他唑巴坦、头孢吡肟、呋喃妥因、头孢他啶。结论儿童腹泻沙门菌检出率最高依次为鼠伤寒、肠炎及德尔卑沙门菌,志贺菌以弗氏志贺菌为主。沙门志贺菌属引起的儿童腹泻抗菌药物敏感率较高的药物为亚胺培南、厄他培南、头孢吡肟、头孢他啶、哌拉西林／他唑巴坦,耐药率较高依次为氨苄西林、氨苄西林／舒巴坦。第三、四代头孢菌素类抗生素可以作为临床经验用药的首选药物,哌拉西林／他唑巴坦治疗效果好,值得推广应用。     

儿童肝母细胞瘤临床病理特征分析#br#

目的探讨儿童肝母细胞瘤的临床病理特征。方法回顾分析经病理检查证实的68例肝母细胞瘤患儿的临床病理资料。结果 68例肝母细胞瘤患儿中男44例、女24例,3岁55例、≥3岁13例,初发时单发59例,甲胎蛋白(AFP)均明显升高。高危患儿27例,出现转移和/或肝外临近器官侵袭和/或门静脉及肝静脉三分支/下腔静脉受侵22例。术前影像分期PRETEXTⅣ期患儿13例。患儿年龄、AFP浓度、病理类型和PRETEXT分期有显著相关性(P均0.05);病理学类型和AFP浓度有显著相关性(P=0.002)。病理学类型在高危组、标危组之间的分布差异有统计学意义(P=0.043)。结论儿童肝母细胞瘤患儿临床病理特征差异性可能有助有指导临床治疗和预后评估。     

93例儿童鼠伤寒沙门菌多位点序列分型与临床特征及耐药相关性分析

目的了解儿童鼠伤寒沙门菌多位点序列分型(MLST分型)、临床特征及耐药特性, 为儿童鼠伤寒沙门菌感染诊治提供参考。方法回顾性收集2017年11月至2020年10月福建省妇幼保健院经粪便或血培养确诊鼠伤寒患儿的临床信息, 并对样本中分离的鼠伤寒沙门菌进行MLST分型及药敏试验。使用Kruskal-Wallis检验、χ2检验、Fisher′s精确概率法进行统计学分析。结果 96例患儿分离出鼠伤寒沙门菌, 有效病例93例。其中92例来自粪便培养, 1例来自血培养;男53例(56.99%), 女40例(43.01%);发病年龄主要集中在12.0(8.5, 22.0)月龄, 7月至10月是发病高峰。按MLST分型将患儿分为ST34型(58例)、ST19型(22例)及其他型(13例)。不同MLST分型鼠伤寒沙门菌感染后引起呼吸道症状差异有统计学意义(χ²=17.657, P<0.001), ST34型鼠伤寒沙门菌肠炎者更常伴有呼吸道症状(Cramer V=0.421, P<0.001)。药敏试验:不同MLST分型对氨苄西林(χ²=8.774,...     

儿童非伤寒沙门菌胃肠炎抗感染策略

非伤寒沙门菌(nontyphoidal Salmonella,NTS)属于沙门菌属的肠道沙门菌种,感染人类后主要引起急性胃肠炎的表现,5岁以下儿童易感,夏季多见,腹泻与发热是最常见症状,大便性状多样。最常见的血清型有肠炎沙门菌、鼠伤寒沙门菌和纽波特沙门菌,多数患者仅需补液及纠正电解质紊乱等对症治疗,存在侵袭性感染风险的人群、明确鼠伤寒沙门菌感染应考虑抗菌药物治疗,儿童首选抗生素为三代头孢菌素。近年国内NTS耐药率有增加趋势,疑似感染者尽可能在开始抗感染治疗前完善病原学检测。非伤寒沙门菌感染的临床诊疗仍存在许多争议,提高临床病例病原学确诊率、推广快速病原诊断方法、开展高循证质量临床试验,有助于规范非伤寒沙门菌胃肠炎的诊治。     

171株儿童侵袭性肺炎链球菌血清分型和多位点序列分型研究

目的了解侵袭性肺炎链球菌在中国儿童中的多位点序列分型(MLST)状况。方法对2006—2008年中国11家儿童医院分离的171株侵袭性肺炎链球菌,采用简易棋盘式肺炎链球菌分型试剂盒进行血清型分型,用聚合酶链反应(PCR)扩增7个看家基因并测序,根据7个基因型的组合确定序列分型(ST)。结果 171株侵袭性肺炎链球菌常见的血清型为19F(19.9%),14(19.3%),19A(18.1%),6B(9.4%)和23F(6.4%),其中有5株(2.0%)用丹麦抗血清无法确定血清型。共检出65种ST,12个克隆群,有1株因未扩增出aroe位点的等位基因无法分型。其中ST320最常见,占17.5%,其次为ST271(13.5%)、ST876(10.5%)。常见的ST同源复合群是CC320(33.9%)和CC876(13.3%)。发现20种新的ST型,已被MLST数据库录入,并有3个新的等位基因序列。结论分离自中国儿童的侵袭性肺炎链球菌主要为ST320、ST271和ST876等3种,流行的克隆群为CC271、CC876。     

14株致儿童猩红热A族β溶血性链球菌多位点序列分型

目的 对A族β溶血性链球菌(beta-haemolytic group A streptococcus isolates,GAS)进行多位点序列分型(multilocus sequence typing,MLST).方法 应用多聚酶链反应(polymerase chain reaction,PCR)对来源于2007年北京和上海两地区分属于不同emm分型及其亚型、且对大环内酯类抗生素高水平耐药的14株致儿童猩红热GAS的 7对等位看家基因进行扩增,并将目的 基因产物测序,然后将所测得的每对等位看家基因的基因序列提交到MLST网站,获得相应的由7对等位看家基因组成的等位基因谱,最后将等位基因谱再次提交到MLST网站,确定GAS临床分离株MLST序列分型(sequence type,ST).结果 St5240、emm1.0型及其亚型GAS等位基因图谱为4-3-4-4-4-2-4,属于ST28型;emm4.0型GAS等位基因谱为5-7-8-5-15-2-1,属于ST38型;emm12.0型及其亚型GAS等位基因谱为5-2-2-6-6-2-2,属于ST36型;emm22.0型GAS等位基因谱为9-8-1-1-1-3-4,属于ST46型.结论 致2007年北京和上海两地区儿童发生猩红热的14株GAS分属于ST28、ST38、ST36及ST46四个不同的克隆系.     

广州地区腹泻患儿非伤寒沙门菌感染的流行病学特征

目的:了解广州地区腹泻患儿感染非伤寒沙门菌(NTS)的流行病学特征和临床表现,为我国儿童NTS感染的防治提供依据。方法:2019年1月至12月在广州市妇女儿童医疗中心的3个院区利用分层抽样收集腹泻患儿粪便标本570份,非腹泻儿童粪便标本296份,通过细菌培养,挑取相应菌落使用沙门菌诊断血清进行初步血清诊断,再用系统生化...     

小儿沙门菌感染临床特点及耐药性分析

目的 探讨儿童沙门菌感染的临床特点和耐药情况,为临床诊疗提供帮助。方法 收集2013~2017年经粪便培养出沙门菌阳性的163例住院患儿的临床特征、沙门菌血清型分布情况及药敏试验结果,并进行回顾性分析。结果 163例沙门菌阳性患儿中,≤ 1岁患儿79例（48.5%）;临床表现以发热、腹泻为主,体温 > 39℃达121例（74.2%）,腹泻超过10次/d有52例（31.9%）,且合并呼吸道感染多见,共56例（34.4%）;沙门菌感染好发于夏秋季,5~10月共检出131例（80.4%）。血清分型以鼠伤寒沙门菌、肠炎沙门菌为主,分别为100例（61.3%）、15例（9.2%）;不同血清型沙门菌对头孢噻肟耐药率均在20%以上,对β内酰胺酶抑制剂（阿莫西林/克拉维酸、哌拉西林/他唑巴坦）敏感性较高,尚未出现对碳青霉烯类（亚胺培南）耐药株。结论 ≤ 1岁婴儿夏秋季易感染沙门菌,常见血清型为鼠伤寒沙门菌;临床表现以发热、腹泻为主,合并呼吸道感染多见;沙门菌对三代头孢菌素类的耐药率有所增加,临床治疗应根据药敏试验结果合理使用抗菌药物。     

儿童侵袭性沙门菌感染的临床特点和药物敏感性分析

目的探讨儿童侵袭性沙门菌感染的病原血清型分布及耐药特征。方法回顾分析2012年1月至2015年12月经血液或脓液培养确诊的66例侵袭性沙门菌感染患儿的临床特点、血清型分布和药敏结果。结果 66例患儿中,男48例、女18例,2岁以下43例;住院患儿60例,门诊患儿6例;5—10月份检出者占80.30%。住院患儿主要临床表现为发热55例(91. 67%)、腹痛和/或腹泻32例(53. 33%)、贫血36例(60. 00%)、咳嗽28例(46. 67%)、肝脏肿大24例(40. 00%)、脾脏肿大12例(20.00%)。所有患儿中,白细胞总数升高45例(68.18%),嗜酸性粒细胞比例下降56例(84.85%),其中15例嗜酸性粒细胞消失,超敏C反应蛋白不同程度升高51例(77. 27%)。沙门菌血清型主要分布在D群和B群,分别为26例(39.39%)和22例(33.33%);未检出耐亚胺培南和厄他培南侵袭性沙门菌菌株,检出菌株对头孢吡肟、头孢他啶、头孢曲松和氨曲南的敏感率均70.00%。结论儿童侵袭性沙门菌感染在2岁婴幼儿中最为多见,5—10月份高发,血清型以D群和B群为主,临床表现多样,应结合血清型及药敏结果慎重选择抗生素治疗。     

2009年北京地区儿童感染性腹泻病原学及耐药性分析

目的 研究北京地区儿童急性感染性腹泻的病原学变化、流行病学特征及耐药性变迁情况.方法 对2009年1月～10月肠道门诊疑诊为细菌性腹泻病者便标本做细菌培养和血清分型鉴定,药敏试验采用纸片扩散法,以免疫层析双抗体夹心法定性检测A群轮状病毒抗原.结果 256份标本检出病原菌4种87株(有1份便标本同时检出2种菌),检出率为34.0%.男女检出比为1.69∶1,2岁以下患儿55例(64.0%).沙门菌40株(46.0%),志贺菌23株(26.4%),致泻性大肠杆菌2株(2.3%),金黄色葡萄球菌22株(25.3%).志贺菌中D群13株(56.5%),22株金黄色葡萄球菌有20株发生于＜1岁婴儿.沙门菌和志贺菌的耐药率分别为:氨苄西林(65.0%;95.7%)、复方新诺明(20.0%;78.3%)、环丙沙星(7.5%;8.7%)、头孢曲松(15.0%;73.9%).256份标本中A群轮状病毒检测阳性47份,其中同时便培养阳性者13份.结论 2009年北京地区儿童细菌性腹泻的病原菌以非伤寒沙门菌为主,志贺菌以D群为主要流行株,二者的易感人群以2岁以下婴幼儿为主,金黄色葡萄球菌感染以1岁以下婴儿为主,阳性检出男孩居多.多重耐药仍以志贺菌明显,细菌与轮状病毒混合感染的比例上升.

Abstract：

Objective To investigate the etiology, epidemiologic features and drug resistance tendency of acute infectious diarrhea among children in Beijing area. Methods Enteric pathogenic bacteria were isolated, cultured and identified for serotype from the stool specimens of children with the initial clinical diagnosis of acute bacterial diarrhea in the intestinal clinic from January to October in 2009 ,and the antibiotic susceptibility of bacteria was tested by disk diffusion method. The cluster A rotavirus antigen was also detected by the qualitative technique of immunochromatographic double-antibody sandwich assay. Results Of the 256 stool specimens, 87 strains of 4 species of pathogenic bacteria were detected with the detectable rate of 34. 0% ,of which 2 strains were detected in one stool sample ,including 40 strains of salmonella (46. 0%) ,23 strains of shigella (26. 4%) ,2 strains of diarrheogenic escherichia coli (2. 3%) and 22 strains of staphylococcus aureus (25.3%). The positively detected patients consisted of 54 males and 32 females with the ratio of 1.69∶1 ,of whom 55 cases (64. 0%) were under 2 years of age. Of the 13 strains of shigella, 13 were sonnei shigella (56. 5%). And of the 22 strains of staphylococcus aureus,20 were detected among the infants under 1 year of age. The rates of crug resistance to certain antibiotics were lower in salmonella than in shigella (ampicillin :65. 0% vs. 95.7% ;compound sulfamethoxazole:20. 0% vs. 78. 3% ;ciprofloxacin:7.5% vs.8. 7% ;ceftriaxone: 15.0% vs. 73.9%). Of the 256 stool specimens ,47 were found positive for cluster A rotavirus,of whom 13 were also positive in stool bacteria culture. Conclusion Salmonella is the major pathogen among children with bacterial diarrhea in Beijing in 2009, and sonnei shigella is the main epidemic strains of shigella diarrhea. lnfants under 2 years of age are the susceptible population of the above two species of bacteria, while staphylococcus aureus mainly infect the infants under 1 years of age. Multi-resistance in shigella is still serious. The incidence of mixed infections of bacteria and rotavirus increases in children with infectious diarrhea.     

Salmonella typhimurium-associated severe protracted diarrhea in infants and young children

Eleven (13.8%) children (4-14 months; mean of 7.8 +/- 3.6 months) presenting with protracted diarrhea (duration greater than 21 days) and weight loss had associated infection with Salmonella typhimurium. All had documented weight loss of 16-25% and progressive clinical deterioration. On admission, they had high purging rates (greater than 4 ml/kg/h), hyponatremia (5/11), mucosal injury, and malabsorption as measured by 1 h blood D-xylose, fecal alpha 1-antitrypsin, and oral fat tolerance test. Diarrhea was secretory in 8 of 11 and fecal sodium was high (54-142 mEq/L; mean of 102 +/- 27 mEq/L). The organism showed multiple drug resistance. All patients received antibiotics (amikacin and nalidixic acid/norfloxacin) for 10-14 days, which was followed by rapid improvement in clinical status and absorption studies. The two youngest patients died. Due to ethical reasons, an untreated control group was not included. Use of appropriate antibiotics may benefit children with S. typhimurium-associated severe protracted diarrhea and rapid progressive weight loss.     

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??Objective??To investigate the incidence and clinical characteristics of orthostatic hypertension??OHT??in children. Methods??Totally 1348 children with syncope??dizziness??etc??were collected in Peking University First Hospital between 2009 and 2015??24 of whom were diagnosed with OHT. Demographic characteristics??the occurrence frequency of various clinical manifestations and its inducing factors??course of disease and the changes of the blood pressure at the lying position were analysed. Results????1??Among 1348 children??OHT was in 24 ??male 14??female 10??. The case proportions of those at or under 12 years old to those beyound 12 years old and the ratio of male to female showed no significant differences.??2??There was no difference between those at or younger than 12 years old and those older than 12 years old??χ2??0.411??P??0.521????or the ratio of males to females in sOHT and dOHT. ??3??The most common clinical manifestations were syncope??dizziness??chest tightness??and so on. Syncope and chest tightness mostly appeared in dOHT children. The incidence of dizeiness in sOHT and dOHT was similar. In children??common inducements were sudden postural changes??from supine to upright and standing position????41.7%????persistent standing??37.5%????or persistent seating??37.5%??. Persistent standing and persistent seating were the main cause of sOHT. Sudden postural changes were the main cause of dOHT. Conclusion??There is no age or gender difference in the incidence and typing of OHT in children. Syncope??dizziness and chest tightness are the main clinical manifestations. Persistent standing and persistent seating are the main cause of sOHT. Sudden postural changes are the main cause of dOHT.     

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??Abstract?? Objective??To study variation of pathogens of bacterial diarrhea in children during recent 10 years?? and to analyze drug resistance of these bacterial strains. Methods??A total of 859 cases?? who were hospitalized in Beijing Children’s Hospital due to bacterial diarrhea from 1998 to 2007??with positive stool culture?? were included in our study. And their clinical data were also studied retrospectively. Statistics was analyzed by SPSS13.0. Results????1??Among 859 bacterial trains of positive stool culture?? there were 585 Shigella??89 Salmonella??56 E coli??92 Proteus?? and 37 Staphylococcus aureus. ??2??The ratio of Shigella decreased from 82.5% of 1998 to 52.9% of 2007.Detection of Staphylococcus aureus and E coli were began at 2001 and 2002?? respectively?? and their ratios gradually increased to 9.4% and 14.1% in 2007?? respectively. ??3??The peak onset??73.9%?? of bacterial diarrhea was in summer and autumn. Salmonella?? E coli?? and conditional pathogenic bacteria were found with high detection ratio in younger-aged group. ??4??The drug resistance ratio of enteric pathogenic bacteria to penicillin and sulfamethoxazole were both above 50%. Except E coli?? the enteric pathogens showed low drug resistance to quinolones?? third generation cephalosporins and imipenem?? with ratios of 13.0????24.2%??5.9????62.5% and 0??respectively. The resistance ratios of E coli to amikacin and imipenem were 7.5% and 0%??respectively?? and its ratios to other antibiotics were all above 50%. Conclusion??The structure of pathogens of bacterial diarrhea in children and their drug resistance pattern are changing continuously. It should be emphasized to monitor pathogens and drug resistance in order to select antibiotics reasonably.