Commonground
Senior Moderator
Author: Wang Li-yan,申桂芝Source: "Qilu Journal of Medicine"
【Abstract】 Objective To Qingdao City Children's Hospital intensive care unit (ICU) Etiology of severe pneumonia and its impact on the distribution of drug sensitivity. Methods in March 2005 ~ March 2007, I admitted to hospital ICU pneumonia in children in 1987 in line with the prevention and treatment programs diagnostic criteria of severe pneumonia and heart failure a total of 148 cases of infants, their sputum to do bacteriological testing, throat swab specimens pneumonia Mycoplasma PCR testing, test methods in strict accordance with the National Committee for Clinical Laboratory Standards (NCCLS) for the latest standards. The results of Gram-negative bacteria is the group of infants with severe pneumonia and heart failure of the main pathogens, including E. coli the most common (25.49%), followed by Streptococcus pneumoniae (17.64%), followed by Pseudomonas aeruginosa (14.71%), Staphylococcus aureus (9.80%), foul nasal Klebsiella (8.82%), etc.; detection of bacteria and Candida albicans infection in 3 cases, a simple three cases of mycoplasma infection, bacteria and support From the original eight cases of infection. Infant with severe pneumonia pathogen separation of penicillins and the first, second generation cephalosporins the high rate of antibiotic resistance, and multi-drug resistance is a serious problem, and its enzyme-resistant third generation cephalosporins to maintain a high degree of sensitivity. Conclusions Treatment of infants with severe pneumonia and acute heart failure should be combined. At the same time monitoring in the region of the etiology of infant with severe pneumonia epidemic changes in distribution and drug sensitivity is very important.
WANG LI YAN, SHEN GUI ZHI
(Qingdao Women and Children's Health Care Center, Qingdao 266011, China)
[ABSTRACT] ObjectiveTo investigate the etiology of infants with severe pneumonia complicating heart failure treated in intensive care unit of Qingdao Children's Hospital and the drug sensitivity of the pathogens.MethodsThis study was done in 148 infants with the disease agreed with the diagnostic criteria of infant pneumonia issued in 1987. The phlegm specimens were detected bacteriologically, and throat swab specimens detected for mycoplasma pneumonia by polymerase chain reaction. The tests were carried out based on the National Committee for Clinical Laboratory Standards (NCCLS) of the United States of America . ResultsGram negative bacteria were the main pathogenic bacteria, of which, E.coli ranged the first (25.49%), the second was Streptococcus pneumoniae (17.64%), and then in the following order, P.aeruginos (14.71%), Staphylococcus aureus (9.80%), and Klebsiella (8.82%). Mycoplasma was found only in three samples, mycoplasma combined with bacteria in eight, fungi combined with bacteria in three. Gram negative bacteria were highly sensitive to third generation cephalosporin tolerated to enzyme. ConclusionA combined medication should be used for children with severe pneumonia complicated by heart failure, and it is also important to monitor the epidemiology and detect drug sensitivity of the pathogens.
[KEY WORDS] Etiology; Antibiotics; Microbial sensitivity tests; Heart failure; Pneumoniae; Infant
Pneumonia in children from a variety of pathogenic micro-organisms due. China's pediatric bacterial pneumonia, especially those with severe pneumonia is still being studied pathogen spectrum of [1 ~ 4]. March 2005-March 2007, we randomly selected a hospital intensive care unit (ICU) of the 148 cases of severe pneumonia and heart failure patients, such as the sputum, the prevalence of pathogen distribution and drug sensitivity analysis for clinical reasonable to provide an important basis for the application of antibiotics, are reported as follows.
1 Object and Method
1.1 study
Selected 148 cases of sick children, the men and 86 cases, 62 cases of women; age 47 d ~ 1-year-old.
1.2 Methods
Specimen collection and bacteriological testing asepsis are strictly enforced. Sputum collection: the early morning to the sick child shot back, and then use one-time sterile suction tube inserted from the nasal cavity and stimulate the sick child coughing after sputum aspiration, home sterilization immediate inspection of the test tube. Specimens inoculated on chocolate plate, flat-panel plasma and flat-panel MacConkey medium, and placed in 35 ℃ incubator box. After 48 h under the colony morphology and biochemical characteristics of the differential. Positive drug test again. In 1998, the U.S. National Laboratory Standards Committee (NCCLS) criteria established by the judge the outcome. Throat swab collected: samples of infants and young children, the first cotton swab with Hank fluid (pH 7.4) dipped wetlands,挤干wall in the test after being seized from the nasopharynx applied several times, and then cotton swab placed in liquid containing the 3 mL Hank vitro censorship. Collected more than 5-year-old samples of the sick child, the cotton swab may not necessarily have to use liquid infiltration Hank. At the same time, the use of polymerase chain reaction used to detect sick child throat swab specimens of Mycoplasma pneumoniae DNA fragments.
2 results
148 cases of severe pneumonia and heart failure patients in the detection of pathogenic bacteria were 102 cases, 16 kinds of pathogenic bacteria were detected, the positive rate was 68.9 percent, and the detection of bacteria and Candida albicans infection in 3 cases, a simple three cases of mycoplasma infection, bacterial and eight cases of mycoplasma infection, the distribution of table 1. Infant with severe pneumonia pathogens to penicillin-type and the first, second generation cephalosporins the high rate of antibiotic resistance, and multi-drug resistance is a serious problem, but the enzyme-resistant third generation cephalosporins maintain a high degree of sensitivity. Table 2. Table 1 102 bacteria and mycoplasma pneumonia cases throat swab types of bacteria constitute n ratio (abbreviated) Table 2 common pathogens of relevant antibiotics sensitive rate (abbreviated)
3 discussions
At present, the baby with severe pneumonia and heart failure and a serious threat to the healthy growth of children's lives is causing children's cause of death. Reasonable and effective antibiotic therapy is to raise one of the keys to its success rate [2,3]. In recent years, with various antibiotics, especially the extensive use of high-grade antibiotics, bacterial resistance has become increasingly popular [4], on drug-resistant strains of antibiotic therapy has become a global problem [5]. This study shows that Gram-negative bacteria in infants with severe pneumonia and heart failure of the main pathogens [6 ~ 8], including Escherichia coli, Streptococcus pneumoniae, Pseudomonas aeruginosa top three; to cefoperazone sulbactam (Sulperazon), ceftazidime (Fortum), ceftriaxone, imipenem cilastatin (tienam) high sensitivity; to cefoperazone (Pioneer will), cefotaxime, thiophene oxime single-lactam streptozotocin (aztreonam), cefaclor have a higher resistance; of cefazolin, ampicillin resistance in general. Its causes and the wider use of antibiotics in recent years related. Enzyme production is the main drug-resistant bacteria in one of the mechanisms of Gram-negative bacteria resistant enzyme selected third-generation cephalosporins, namely, by adding the enzyme β resistant lactamase inhibitors new β lactam antibiotics clinical choice of antibiotics must be taken into account. Therefore, Imipenem cilastatin (tienam), cefoperazone sulbactam (Sulperazon), ceftazidime (Fortum) can be used as emergency treatment of severe abuse when the patient has traveled empirical drug of first choice . This study detected Gram-positive cocci mainly Staphylococcus aureus, of ceftriaxone (Hartridge bacteria), cefoperazone (Pioneer will), vancomycin-sensitive, but with vancomycin ototoxicity, liver and kidney toxicity and other adverse reactions, at present very little clinical application, not as a drug of choice for severe pneumonia. At the same time, this paper shows that bacteria and eight cases of mycoplasma infection, azithromycin joint third-generation cephalosporin good therapeutic effect. Candida albicans 3 cases of infection, treatment 1 week after the review of sputum culture fungi positive rate of increase may be related to the sick child the age of small, weak resistance, the use of broad-spectrum antibiotic-related. Therefore, the long course of the sick child should pay attention to prevention and treatment of fungal infections, nutritional support to strengthen the treatment.
Reported in the literature, infant pneumonia virus lower respiratory secretions and the high rate of culture-positive anaerobic bacteria [9,10]. But in this study was not detected, may be related to culture-positive rate is not high, their own survival as well as the fragile difficult medium high, and the future need to raise the level of laboratory tests conducted on the basis of in-depth study.
In short, the region to determine the infant with severe pneumonia bacteria spectrum of reasonable selection of effective antibiotics, infection control, prevention of the spread of drug-resistant of great significance.
【Reference】
[1] People's Republic of China Ministry of Health. Pediatric IV disease prevention programs in children with pneumonia prevention and treatment programs [J]. Chinese Journal of Pediatrics, 1987,25 (1): 47.
[2] CHEN Min-jun, Wang Hui. China ICU Gram-negative bacteria resistance monitoring study for 7 years [J]. Chinese Medical Journal, 2003,83:375 381.
[3]邢金燕, Sun Yun-bo, Luan-min, et al. ICU patients infected with the bacterial isolates and analysis of drug resistance [J]. Qilu Journal of Medicine, 2005,20 (2): 146 149.
[4] Ji安淳. Currently in pediatric clinical drug-resistant pathogens several problems [J]. Abroad medicine: antibiotic fascicle, 2000,21:126 129.
[5] BERGOGNE BEREZIN E. Guideline on antimicrobial chemotherapy for prevention and treatment of infections in the ICU [J]. J Chemother, 2001,13:134 149.
[6] Yang Da-sheng, Wang Zhou, Shanghai Chang Jing, et al. 2-year-old children within bacterial pneumonia pathogens and drug susceptibility results [J]. Journal of Clinical Pediatrics, 1996,14 (2): 96.
[7] Middle text, Tursun that depend upon, and Wang Guihua, et al. Pediatric bacterial pneumonia etiological diagnosis and drug sensitivity test [J]. Journal of Clinical Pediatrics, 1996,14 (2): 95.
[8] L?, Liang constellations, Bo Lu, et al. Pediatric pneumonia sputum bacterial culture detection and significance of [J]. Chinese Journal of Hospital Infection, 2003,13 (1): 81 83.
[9]孙家娥, Su Li-yun, Ding Yun-zhen. Shanghai patients with acute respiratory tract infection Etiology of virus [J]. Chinese Journal of Practical Pediatrics, 2000, (4): 225 227.
[10] DONG million. 220 cases of infants with lower respiratory tract secretions of bacterial culture [J]. Clinical Laboratory Journal, 1996,14 (5): 239 241.
Author: Qingdao City, women and children health care center, Qingdao, Shandong 266011
http://74.125.93.104/translate_c?hl....shtml&usg=ALkJrhjspIpAKO4TLA2uoowz4x60O00sog
【Abstract】 Objective To Qingdao City Children's Hospital intensive care unit (ICU) Etiology of severe pneumonia and its impact on the distribution of drug sensitivity. Methods in March 2005 ~ March 2007, I admitted to hospital ICU pneumonia in children in 1987 in line with the prevention and treatment programs diagnostic criteria of severe pneumonia and heart failure a total of 148 cases of infants, their sputum to do bacteriological testing, throat swab specimens pneumonia Mycoplasma PCR testing, test methods in strict accordance with the National Committee for Clinical Laboratory Standards (NCCLS) for the latest standards. The results of Gram-negative bacteria is the group of infants with severe pneumonia and heart failure of the main pathogens, including E. coli the most common (25.49%), followed by Streptococcus pneumoniae (17.64%), followed by Pseudomonas aeruginosa (14.71%), Staphylococcus aureus (9.80%), foul nasal Klebsiella (8.82%), etc.; detection of bacteria and Candida albicans infection in 3 cases, a simple three cases of mycoplasma infection, bacteria and support From the original eight cases of infection. Infant with severe pneumonia pathogen separation of penicillins and the first, second generation cephalosporins the high rate of antibiotic resistance, and multi-drug resistance is a serious problem, and its enzyme-resistant third generation cephalosporins to maintain a high degree of sensitivity. Conclusions Treatment of infants with severe pneumonia and acute heart failure should be combined. At the same time monitoring in the region of the etiology of infant with severe pneumonia epidemic changes in distribution and drug sensitivity is very important.
WANG LI YAN, SHEN GUI ZHI
(Qingdao Women and Children's Health Care Center, Qingdao 266011, China)
[ABSTRACT] ObjectiveTo investigate the etiology of infants with severe pneumonia complicating heart failure treated in intensive care unit of Qingdao Children's Hospital and the drug sensitivity of the pathogens.MethodsThis study was done in 148 infants with the disease agreed with the diagnostic criteria of infant pneumonia issued in 1987. The phlegm specimens were detected bacteriologically, and throat swab specimens detected for mycoplasma pneumonia by polymerase chain reaction. The tests were carried out based on the National Committee for Clinical Laboratory Standards (NCCLS) of the United States of America . ResultsGram negative bacteria were the main pathogenic bacteria, of which, E.coli ranged the first (25.49%), the second was Streptococcus pneumoniae (17.64%), and then in the following order, P.aeruginos (14.71%), Staphylococcus aureus (9.80%), and Klebsiella (8.82%). Mycoplasma was found only in three samples, mycoplasma combined with bacteria in eight, fungi combined with bacteria in three. Gram negative bacteria were highly sensitive to third generation cephalosporin tolerated to enzyme. ConclusionA combined medication should be used for children with severe pneumonia complicated by heart failure, and it is also important to monitor the epidemiology and detect drug sensitivity of the pathogens.
[KEY WORDS] Etiology; Antibiotics; Microbial sensitivity tests; Heart failure; Pneumoniae; Infant
Pneumonia in children from a variety of pathogenic micro-organisms due. China's pediatric bacterial pneumonia, especially those with severe pneumonia is still being studied pathogen spectrum of [1 ~ 4]. March 2005-March 2007, we randomly selected a hospital intensive care unit (ICU) of the 148 cases of severe pneumonia and heart failure patients, such as the sputum, the prevalence of pathogen distribution and drug sensitivity analysis for clinical reasonable to provide an important basis for the application of antibiotics, are reported as follows.
1 Object and Method
1.1 study
Selected 148 cases of sick children, the men and 86 cases, 62 cases of women; age 47 d ~ 1-year-old.
1.2 Methods
Specimen collection and bacteriological testing asepsis are strictly enforced. Sputum collection: the early morning to the sick child shot back, and then use one-time sterile suction tube inserted from the nasal cavity and stimulate the sick child coughing after sputum aspiration, home sterilization immediate inspection of the test tube. Specimens inoculated on chocolate plate, flat-panel plasma and flat-panel MacConkey medium, and placed in 35 ℃ incubator box. After 48 h under the colony morphology and biochemical characteristics of the differential. Positive drug test again. In 1998, the U.S. National Laboratory Standards Committee (NCCLS) criteria established by the judge the outcome. Throat swab collected: samples of infants and young children, the first cotton swab with Hank fluid (pH 7.4) dipped wetlands,挤干wall in the test after being seized from the nasopharynx applied several times, and then cotton swab placed in liquid containing the 3 mL Hank vitro censorship. Collected more than 5-year-old samples of the sick child, the cotton swab may not necessarily have to use liquid infiltration Hank. At the same time, the use of polymerase chain reaction used to detect sick child throat swab specimens of Mycoplasma pneumoniae DNA fragments.
2 results
148 cases of severe pneumonia and heart failure patients in the detection of pathogenic bacteria were 102 cases, 16 kinds of pathogenic bacteria were detected, the positive rate was 68.9 percent, and the detection of bacteria and Candida albicans infection in 3 cases, a simple three cases of mycoplasma infection, bacterial and eight cases of mycoplasma infection, the distribution of table 1. Infant with severe pneumonia pathogens to penicillin-type and the first, second generation cephalosporins the high rate of antibiotic resistance, and multi-drug resistance is a serious problem, but the enzyme-resistant third generation cephalosporins maintain a high degree of sensitivity. Table 2. Table 1 102 bacteria and mycoplasma pneumonia cases throat swab types of bacteria constitute n ratio (abbreviated) Table 2 common pathogens of relevant antibiotics sensitive rate (abbreviated)
3 discussions
At present, the baby with severe pneumonia and heart failure and a serious threat to the healthy growth of children's lives is causing children's cause of death. Reasonable and effective antibiotic therapy is to raise one of the keys to its success rate [2,3]. In recent years, with various antibiotics, especially the extensive use of high-grade antibiotics, bacterial resistance has become increasingly popular [4], on drug-resistant strains of antibiotic therapy has become a global problem [5]. This study shows that Gram-negative bacteria in infants with severe pneumonia and heart failure of the main pathogens [6 ~ 8], including Escherichia coli, Streptococcus pneumoniae, Pseudomonas aeruginosa top three; to cefoperazone sulbactam (Sulperazon), ceftazidime (Fortum), ceftriaxone, imipenem cilastatin (tienam) high sensitivity; to cefoperazone (Pioneer will), cefotaxime, thiophene oxime single-lactam streptozotocin (aztreonam), cefaclor have a higher resistance; of cefazolin, ampicillin resistance in general. Its causes and the wider use of antibiotics in recent years related. Enzyme production is the main drug-resistant bacteria in one of the mechanisms of Gram-negative bacteria resistant enzyme selected third-generation cephalosporins, namely, by adding the enzyme β resistant lactamase inhibitors new β lactam antibiotics clinical choice of antibiotics must be taken into account. Therefore, Imipenem cilastatin (tienam), cefoperazone sulbactam (Sulperazon), ceftazidime (Fortum) can be used as emergency treatment of severe abuse when the patient has traveled empirical drug of first choice . This study detected Gram-positive cocci mainly Staphylococcus aureus, of ceftriaxone (Hartridge bacteria), cefoperazone (Pioneer will), vancomycin-sensitive, but with vancomycin ototoxicity, liver and kidney toxicity and other adverse reactions, at present very little clinical application, not as a drug of choice for severe pneumonia. At the same time, this paper shows that bacteria and eight cases of mycoplasma infection, azithromycin joint third-generation cephalosporin good therapeutic effect. Candida albicans 3 cases of infection, treatment 1 week after the review of sputum culture fungi positive rate of increase may be related to the sick child the age of small, weak resistance, the use of broad-spectrum antibiotic-related. Therefore, the long course of the sick child should pay attention to prevention and treatment of fungal infections, nutritional support to strengthen the treatment.
Reported in the literature, infant pneumonia virus lower respiratory secretions and the high rate of culture-positive anaerobic bacteria [9,10]. But in this study was not detected, may be related to culture-positive rate is not high, their own survival as well as the fragile difficult medium high, and the future need to raise the level of laboratory tests conducted on the basis of in-depth study.
In short, the region to determine the infant with severe pneumonia bacteria spectrum of reasonable selection of effective antibiotics, infection control, prevention of the spread of drug-resistant of great significance.
【Reference】
[1] People's Republic of China Ministry of Health. Pediatric IV disease prevention programs in children with pneumonia prevention and treatment programs [J]. Chinese Journal of Pediatrics, 1987,25 (1): 47.
[2] CHEN Min-jun, Wang Hui. China ICU Gram-negative bacteria resistance monitoring study for 7 years [J]. Chinese Medical Journal, 2003,83:375 381.
[3]邢金燕, Sun Yun-bo, Luan-min, et al. ICU patients infected with the bacterial isolates and analysis of drug resistance [J]. Qilu Journal of Medicine, 2005,20 (2): 146 149.
[4] Ji安淳. Currently in pediatric clinical drug-resistant pathogens several problems [J]. Abroad medicine: antibiotic fascicle, 2000,21:126 129.
[5] BERGOGNE BEREZIN E. Guideline on antimicrobial chemotherapy for prevention and treatment of infections in the ICU [J]. J Chemother, 2001,13:134 149.
[6] Yang Da-sheng, Wang Zhou, Shanghai Chang Jing, et al. 2-year-old children within bacterial pneumonia pathogens and drug susceptibility results [J]. Journal of Clinical Pediatrics, 1996,14 (2): 96.
[7] Middle text, Tursun that depend upon, and Wang Guihua, et al. Pediatric bacterial pneumonia etiological diagnosis and drug sensitivity test [J]. Journal of Clinical Pediatrics, 1996,14 (2): 95.
[8] L?, Liang constellations, Bo Lu, et al. Pediatric pneumonia sputum bacterial culture detection and significance of [J]. Chinese Journal of Hospital Infection, 2003,13 (1): 81 83.
[9]孙家娥, Su Li-yun, Ding Yun-zhen. Shanghai patients with acute respiratory tract infection Etiology of virus [J]. Chinese Journal of Practical Pediatrics, 2000, (4): 225 227.
[10] DONG million. 220 cases of infants with lower respiratory tract secretions of bacterial culture [J]. Clinical Laboratory Journal, 1996,14 (5): 239 241.
Author: Qingdao City, women and children health care center, Qingdao, Shandong 266011
http://74.125.93.104/translate_c?hl....shtml&usg=ALkJrhjspIpAKO4TLA2uoowz4x60O00sog