新生儿重症监护室血培养233株病原菌分布及耐药性分析

目的 研究新生儿重症监护室(neonatal intensive care unit,NICU)血培养阳性的脓毒症患儿的病原菌分布及耐药情况,为临床合理使用抗生素提供依据.方法 回顾性分析2009年1月至2011年7月广东医学院附属医院NICU 1450例新生儿的1450份血培养结果及药敏结果.结果 1450份血培养标本共分离病原菌9种233株,总阳性率为16.1％.其中革兰阳性球菌93株,以凝固酶阴性葡萄球菌占优势,其次为金黄色葡萄球菌;革兰阴性杆菌103株,以肺炎克雷白杆菌居多,其次为大肠埃希菌、鲍曼不动杆菌;真菌37株,以念珠菌为主.革兰阳性球菌对万古霉素、利奈唑胺及替考拉宁敏感性高,对青霉素、苯唑西林及β-内酰胺酶抗生素耐药性达95％以上;革兰阴性杆菌对左氧氟沙星、亚胺培南及美罗培南敏感;真菌以念珠菌为主,对抗真菌药物普遍敏感.结论 凝固酶阴性葡萄球菌、肺炎克雷白杆菌、大肠埃希菌等是NICU中新生儿脓毒症最常见的几种病原菌,耐药性高,临床医生应根据细菌鉴定及药敏试验选择敏感药物治疗,且真菌感染不可忽视,值得关注.     

新生儿败血症病原菌及药物敏感试验的结果与分析

目的　了解目前哈尔滨地区新生儿败血症病原菌的分布及药物敏感性现状 ,以制定相应对策 ,合理选择抗生素。方法　对 1999年 2月至 2 0 0 1年 12月住院的 2 35例新生儿败血症的临床资料进行回顾性分析。结果　 2 35例共分离出病原菌 2 76株 ,以葡萄球菌居多 (2 0 8/ 2 76 ,75 4% ) ,其中金黄色葡萄球菌 19株 ,表皮葡萄球菌46株 ;微球菌属和肠球菌属各 10株 ,链球菌属 8株 ;其它革兰阳性球菌 6株 ;革兰阴性杆菌 2 0株 ;芽孢杆菌属 11株 ;棒状杆菌属 3株。并分离出 1株耐万古霉素的表皮葡菌球菌。葡萄球菌对青霉素、红霉素、苯唑青霉素的耐药率均在 80 %或更高 ,敏感药物主要有万古霉素、头孢哌酮、头孢唑林和头孢呋肟。革兰阴性杆菌对氨苄青霉素的总耐药率 >80 % ,敏感药物主要为第三代头孢类及氨基糖苷类药物。 2 35例中治愈 136例 ,好转 73例 ,放弃治疗 18例 (多伴有颅脑损伤 ) ,死亡 8例 (3 4% )。结论　凝固酶阴性葡萄球菌感染为本地区新生儿败血症的主要致病菌。表皮葡萄球菌对青霉素、红霉素、苯唑青霉素的耐药率最高 ,达 90 %以上。多重耐药葡萄球菌占检出葡萄球菌的 2 8%。革兰阴性杆菌感染减少。     

先天性心脏病患儿术前肺部感染主要病原菌的药物敏感率监测及临床分析

目的调查儿童先天性心脏病术前患儿肺部感染病原菌的分布特点及耐药现状,为临床用药提供依据。方法对2006年12月至2008年3月第三军医大学新桥医院PICU收治的338例先天性心脏病术前肺部感染患儿吸取下呼吸道痰液,进行细菌培养和药敏分析。结果检出致病菌179株,阳性率为52.95%。以肺炎链球菌菌最为多见(23.46%)。药敏显示革兰阳性球菌对青霉素类、头孢类、红霉素类耐药率较高;革兰阴性杆菌对大部分青霉素类、大部分头孢类耐药率较高。结论先天性心脏病术前患儿肺部感染病原菌以G+球菌与G-杆菌大致相等,细菌耐药日趋严重,根据体外药敏结果合理选用抗生素十分必要。对严重肺部感染,选用三代头孢治疗无效、原发病较为严重者,可首选亚胺培南抗菌治疗。     

新生儿监护室医院感染细菌药物敏感率调查

目的对新生儿监护室医院感染情况进行调查,为合理应用抗生素治疗新生儿医院感染提供科学依据。方法1999年1月至2003年12月,采用琼脂扩散法检测源于297例新生儿的317株细菌对抗生素的敏感率。结果医院感染好发部位:脐部、呼吸道、皮肤和血液。主要病原菌:葡萄球菌、大肠埃希菌、假单胞菌、克雷伯杆菌、肠杆菌、不动杆菌。革兰阳性菌对青霉素等一线抗生素敏感率低,对利福平和万古霉素敏感率高,革兰阴性杆菌对氨苄西林等半合成青霉素敏感率低,对亚胺培南、环丙沙星、头孢他啶敏感率高。结论确诊医院感染的病例宜按药敏试验选用合适抗生素,针对革兰阳性菌可选用替考拉宁、利福科、万古霉素,针对革兰阴性杆菌可选用丁胺卡那、头孢他啶、碳青酶烯类和喹诺酮类。     

新生儿败血症社区感染与医院感染病原菌及耐药性比较分析

目的 研究新生儿败血症病原菌分布及药物敏感情况,以指导临床抗生素的使用.方法 对我院53例败血症患儿感染菌株、药物敏感情况及相关临床资料进行回顾性分析,根据发生感染时间分为社区感染和医院感染.结果 新生儿败血症社区感染多有典型症状和明确的感染史,主要病原菌为革兰阳性凝固酶阴性葡萄球菌,对青霉素、阿奇霉素耐药,对万古霉素敏感性好.医院感染则症状不典型,多数未发现明确感染灶,以革兰阴性肺炎克雷伯菌居多,对绝大部分青霉素类和头孢菌素类耐药,对碳青霉烯类敏感性好.结论 重视抗生素的合理使用,根据药敏选用合适的药物,减少耐药菌株的产生.     

贵阳市893例小儿下呼吸道感染的细菌及药敏分析

目的：调查贵阳市小儿下呼吸道感染（LRI）中的细菌及其耐药性,以指导临床合理用药。方法：收集2006年8月至2008年6月我院893 例LRI住院患儿的咽喉深部痰液标本进行细菌培养及药敏试验。结果：明确有细菌感染的为543例,阳性率为60.8%。分离出30种细菌,共计598株,其中革兰阴性杆菌533株（89.1%）,革兰阳性球菌57株（9.8%）。革兰阴性菌以大肠埃希菌、肺炎克雷伯菌为主。大肠埃希菌及肺炎克雷伯菌对哌拉西林/他唑巴坦、丁胺卡那、环丙沙星、左氧氟沙星敏感,对亚胺培南高度敏感。革兰阳性球菌中以肺炎链球菌和葡萄球菌为主,肺炎链球菌对青霉素及头孢唑啉钠敏感,而葡萄球菌则对青霉素及头孢唑啉钠耐药率高,两种革兰阳性球菌均对万古霉素高度敏感,对罗红霉素耐药率高。结论：贵阳市小儿LRI的主要病原菌为革兰阴性杆菌,其中尤以大肠埃希氏菌、肺炎克雷伯菌多见,不同菌种对抗生素药物敏感性和耐药性均存在差异。应根据药敏试验合理选用抗生素治疗。［中国当代儿科杂志,2009,11（12）：964-966］     

新生儿重症监护病房血培养252株病原菌分布及耐药性分析

目的　研究新生儿重症监护病房 (NICU)败血症和菌血症的病原菌分布及其耐药情况 ,为合理使用抗生素提供依据。方法　对 2 0 0 0年 1月至 2 0 0 3年 8月广州市儿童医院NICU中 10 90例新生儿的 10 90份血标本进行培养、分离、鉴定及药敏分析。结果　 10 90份血标本培养共分离病原菌 15种 2 5 2株 ,总阳性率为 2 3 1%。其中革兰阳性球菌 2 12株 ,以凝固酶阴性葡萄球菌占优势 ,其次为金黄色葡萄球菌 ;革兰阴性杆菌 38株 ,以大肠埃希菌居多 ,肺炎克雷伯杆菌次之。革兰阳性球菌对万古霉素、替考拉宁、头孢哌酮 /舒巴坦、克林霉素等的敏感性较高 ;革兰阴性杆菌对亚胺培南、头孢哌酮 /舒巴坦、羟氨苄 /克拉维酸具有很高的敏感性。结论　凝固酶阴性葡萄球菌、大肠埃希菌、肺炎克雷伯菌等是NICU中新生儿败血症 /菌血症最常见的几种病原菌 ,对常用的抗菌药物有程度不同的耐药性。     

儿童下呼吸道感染的细菌谱及抗生素敏感性分析

目的分析我院近2年9515例儿童下呼吸道感染的痰培养病原菌谱及其耐药性。方法采用下呼吸道感染住院患儿9515例的合格痰标本进行细菌培养和药敏分析。结果9515个标本中共分离细菌2788株,阳性率29.30%,革兰阴性杆菌1790株(64 2%).球菌998株(35.8%)。前3位革兰阴性杆菌依次为肺炎克雷伯菌18 7%、大肠埃希菌15.7 %、流感嗜血杆菌14 4%;革兰阳性球菌以凝固酶阴性葡萄球菌(15 2%)与肺炎链球菌(14.3%)为主。革兰阴性杆菌对亚胺培南、左旋氧氟沙星、阿米卡星等耐药率低,球菌对万古霉素高度敏感,对利福平、左旋氧氟沙星等耐药率低,肠球菌属对多种药物均出现高比例耐药,对万古霉素耐药率达7 9%。结论应根据本区域近年病原菌谱变迁及药敏情况选择合适的抗菌药物。     

新生儿医院感染病原菌分布及耐药性分析

目的探讨新生儿医院感染病原菌分布及对抗生素的耐药情况。方法回顾性分析我院2005年1月至2010年10月新生儿科住院的患儿,对于合并医院感染患儿的痰、血液、导管或尿液等进行细菌培养、鉴定,分析病原菌及其对抗生素的耐药性。结果此期间共收治新生儿8481例,发生医院感染366例,医院感染率4.3%,检出病原菌120株,其中葡萄球菌为主要致病菌(28.4%),其次为肺炎克雷伯菌(11.7%)、嗜麦芽假单胞菌、鲍曼不动杆菌和真菌(各占10.8%)。金黄色葡萄球菌对青霉素类、红霉素、克林霉素耐药率较高,未发现对万古霉素、替考拉宁和力奈唑胺耐药。革兰阴性菌对青霉素类、三代头孢耐药率较高,对头孢吡肟、头孢哌酮/舒巴坦、碳青霉烯类及喹诺酮类抗生素耐药率较低。肺炎克雷伯菌产超广谱β-内酰胺酶(+)菌株占50%。结论葡萄球菌和肺炎克雷伯菌是医院感染的主要病原菌,应根据药敏合理使用抗生素。     

新生儿感染病原菌及药敏试验12年总结

目的 探讨新生儿感染致病菌的流行病学及常见抗菌药物的敏感性。方法 按《全国临床检验操作规程》鉴定细菌,纸片扩散法进行药敏试验。结果 12年内分离出病原菌2244株。病原菌为：院外感染前3位是表皮葡萄球菌、腐生葡萄球菌及大肠埃希菌;院内感染前3位是大肠埃希菌、克雷伯菌及绿脓杆菌。多数院内感染菌株较院外感染菌株对青霉素、氨苄青霉素等15种常用抗生素的耐药率有不同程度的增加,部分差异有统计学意义。总敏感率为：环丙沙星95．2％、诺氟沙星78．8％,阿米卡星78．2％、亚胺培南＋西司他丁87．7％、万古霉素81．8％、头孢类抗生素尤其是第3代头孢菌素60．7％－78．1％。结论 院外感染致病菌以革兰阳性球菌为主,而院内感染致病菌以革兰阴性杆菌为主,后者对许多抗菌药物更易产生耐药性;环丙沙星、诺氟沙星、阿米卡星、亚胺培南＋西司他丁、万古霉素及头孢类抗生素尤其是第3代头孢菌素敏感率均较高。     

Resurgence of measles in Singapore: profile of hospital cases

OBJECTIVE: To ascertain the profile of cases of measles seen at a general hospital during a recent outbreak that occurred despite a measles vaccination program. METHODOLOGY: A retrospective study from January 1991 to March 1998. All patients with measles (ICD code 055. 9) seen at the emergency unit or as inpatients were included. RESULTS: There were 87 cases identified. The diagnosis was clinical in all and proven serologically in 71%. Eighty-five per cent of the cases occurred between January 1997 and March 1998. There was a bi-modal age distribution with peaks in the very young (相似文献   

Allergic factors associated with the development of asthma and the influence of cetirizine in a double-blind, randomised, placebo-controlled trial: First results of ETA®

There is a common progression known as the allergic march from atopic dermatitis to allergic asthma. Cetirizine has several antiallergic properties that suggest a potential effect on the development of airway inflammation and asthma in infants with atopic dermatitis. Methods. Over a two year period, 817 infants aged one to two years who suffered from atopic dermatitis and with a history of atopic disease in a parent or sibling were included in the ETAC^® (Early Treatment of the Atopic Child) trial, a multi-country, double-blind, randomised, placebo-controlled trial. The infants were treated for 18 months with either cetirizine (0.25mg/ kg b.i.d.) or placebo. The number of infants who developed asthma was compared between the two groups. Clinical and biological assessments including analysis of total and specific IgE antibodies were performed. Results. In the placebo group, the relative risk (RR) for developing asthma was elevated in patients with a raised level of total IgE (≥ 30 kU/I) or specific IgE (≥ 0.35 kUA/I) for grass pollen, house dust mite or cat dander (RR between 1.4 and 1.7). Compared to placebo, cetirizine significantly reduced the incidence of asthma for patients sensitised to grass pollen (RR = 0.5) or to house dust mite (RR = 0.6). However, in the population that included all infants with normal and elevated total or specific IgE (intention-to-treat - ITT), there was no difference between the numbers of infants developing asthma while receiving cetirizine or placebo. The adverse events profile was similar in the two treatment groups. Discussion. Raised total IgE level and raised specific IgE levels to grass pollen, house dust mite or cat dander were predictive of subsequent asthma. Cetirizine halved the number of patients developing asthma in the subgroups sensitised to grass pollen or house dust mite (i.e. 20% of the study population). In view of the proven safety of the drug, we propose this treatment as a primary pharmacological intervention strategy to prevent the development of asthma in specifically sensitised infants with atopic dermatitis.     

A profile of respiratory symptoms in urban and rural South Australian school children

This report describes the cross-sectional analyses of data from the first year of a longitudinal study using questionnaire and respiratory function data over a 5 year period from a sample of rural South Australian school children. The cumulative or lifetime prevalences of respiratory symptoms were estimated in 825 rural and 1261 urban school children aged between 5 and 15 years in order to determine if the prevalence rates differed between rural and urban school children. The study found the overall cumulative prevalence of asthma and/or wheezy breathing (AWB) to be 24.1% in the rural school children compared to 27.6% in the urban school children. Most children developed AWB symptoms before the age of 7 years, with 20% reporting moderately severe symptoms and 10% having more than one attack per fortnight. The cumulative prevalence of bronchitis, loose/rattly cough (BLRC) differed significantly between the rural school children (34.1%) and urban school children (47.9%). The BLRC symptoms preceded the development of AWB in many cases. Urban school children also reported a higher prevalence of atopic conditions.     

Hauttemperaturen verschiedener Körperoberflächenareale des Rumpfes bei Säuglingen

Summary In two groups of infants (3–53 weeks old) skin temperatures were controlled in different areas of the trunk—i.e.: regions of sternum, lungs, heart, liver, spleen, kidneys—at different room-temperatures (group I: 21–25°C; group II: 29–32°C). Rectal temperatures of some probands in both groups also had been controlled simultaneously. A definite change in the reaction to heat was proofed in different periods of the first year of life. In higher environmental temperatures the skin temperature was almost constant at every controll-point of the skin, even in older infants. In lower environmental temperatures the skin temperatures lowered continuously with age till 7. to 9. moth. From 10. to 12. month the lowering of skin temperature discontinued. The rectal temperatures were relatively constant in all infants. Only in infants from 7. to 12. month, whose skin temperatures were controlled in lower as well as in higher environmental temperatures, a tendency to higher rectal temperatures was proofed in warmer environmental temperatures.The significance of these results is discussed.

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Untersuchungen mit Unterstützung durch die Deutsche Forschungsgemeinschaft.     

Psychopathologie du syndrome d’Asperger et « aspérigisation » de la société contemporaine

The author has attempted here to point out, just for a start, the characteristics of Asperger syndrome from the point of view of psychopathology through a rereading of Hans Asperger's original paper (1944). This thesis merits reevaluation, if for no other reason than to fill the gaps in operational diagnostics based on the DSM. It is found by rereading that Asperger's view of the principal disturbances of autistic psychopathy include a “disturbance of natural evidence” or a “crisis of common sense”. This question of natural evidence that he evokes with regard to autistic psychopathy corresponds to W. Blankenburg's natural evidence, which constitutes a key concept for comprehending schizophrenia in the form poor-symptom (“symptomarme Schizophrenie”) that he observes in the speech of his patient Anne Rau. One can deduce from this that in terms of fundamental disturbances, Asperger syndrome and this “symptom-poor” schizophrenia overlap at the level of loss of natural evidence. It is moreover possible to classify Asperger syndrome among the disturbances of spacing in the sense meant by the evolutionary psychiatry of A. Stevens and J. Price. The author then develops our comprehension of Asperger syndrome from the point of view of the perspective proposed by the notion of resilience in people with Asperger syndrome and of the possibility for them, through these mechanisms of adaptation, to find in the organization of the personality of the “as if” type a position of relative equilibrium. They concur or overlap in the creation of crutches, of borrowed personalities secondarily legitimated by the reaction of the socius. This will end up in the production of inventions and œuvres (works). Clearly, one rarely encounters several cases that one could consider pertinently to be “successful” Asperger syndrome. Finally, the author notes that one can find a sort of isomorphism between Asperger syndrome and contemporary society when he proposes the term “asperigisation” to characterize our society, given that the equilibrium between emotion and logic is strongly disturbed in these patients, in whom logic undergoes hypertrophy while emotion is impoverished. From this perspective, the author hopes to suggest reasons for the increase in the number of cases of Asperger syndrome in the clinical setting and in society in general in our contemporary era.     

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孤独症谱系障碍(autistic-spectrum disorders,ASDs)近年来患病率逐年攀升至1%左右,其症状往往伴随终生,成为严重威胁儿童健康和发展的神经发育性疾患;注意缺陷多动障碍(attention deficit hyperactivity disorder,ADHD)是儿童期最常见的精神障碍,国内报道患病率为4.13%～5.83%,其症状可延续至青少年期,甚至到成年期[1]。这两类精神障碍在成年期的临床表现、共患病、治疗策略和预后与儿童期有哪些不同呢?本文通过回顾相     

Infiltrations of Epstein-Barr virus-carrying cells in granular lymphocyte-proliferative disorders corresponding to chronic active Epstein-Barr virus infection

A 21-year-old man with granular lymphocyte-proliferative disorders (GLPD) associated with chronic active Epstein-Barr virus (EBV) infection is described. Chromosomal analyses revealed several clonal abnormalities and two of them were mainly repetitious. High copy numbers of monoclonal EBV genome were also detected in the proliferative large granular lymphocytes (LGLs), indicating the monoclonal expansion of EBV-infected LGLs. The patient had an indolent course for several years, and there was no evidence of infiltrations of his bone marrow until the end stage. At autopsy, microscopic studies revealed marked infiltrations of LGL in the liver and spleen, and the infiltrating cells were NK-cell immunophenotype. The infiltrated LGLs showed latency I.     

LUTEINIZING HORMONE RECEPTOR MUTATIONS IN DISORDERS OF SEXUAL DEVELOPMENT AND CANCER

Human male sexual development is regulated by chorionic gonadotropin (CG) and luteinizing hormone (LH). Aberrant sexual development caused by both activating and inactivating mutations of the human luteinizing hormone receptor (LHR) have been described. All known activating mutations of the LHR are missense mutations caused by single base substitution. The most common activating mutation is the replacement of Asp-578 by Gly due to the substitution of A by G at nucleotide position 1733. All activating mutations are present in exon 11 which encodes the transmembrane domain of the receptor. Constitutive activity of the LHR causes LH releasing hormone-independent precocious puberty in boys and the autosomal dominant disorder familial male-limited precocious puberty (FMPP). Both germline and somatic activating mutations of the LHR have been found in patients with testicular tumors. Activating mutations have no effect on females. The molecular genetics of the inactivating mutations of the LHR are more variable and include single base substitution, partial gene deletion, and insertion. These mutations are not localized and are present in both the extracellular and transmembrane domain of the receptor. Inactivation of the LHR gives rise to the autosomal recessive disorder Leydig cell hypoplasia (LCH) and male hypogonadism or male pseudohermaphroditism. Severity of the clinical phenotype in LCH patients correlates with the amount of residual activity of the mutated receptor. Females are less affected by inactivating mutation of the LHR. Symptoms caused by homozygous inactivating mutation of the LHR include polycystic ovaries and primary amenorrhea.     

EXCITING NEW TREATMENT APPROACHES FOR PATHYPHYSIOLOGIC MECHANISMS OF SICKLE CELL DISEASE

During the past several decades, our understanding of the complex pathophysiology of vasoocclusion associated with sickle cell disease has improved greatly. Interaction of genes, hemoglobin molecules, red cell membrane and metabolic changes, cell-cell interactions and cell-plasma interactions, red cell adhesion to vascular endothelium, activation of coagulation, and vascular reactivity play a role in vaso occlusion. Penicillin prophylaxis of pneumococcal infections and appropriate use of blood transfusions and other supportive measures improved survival of sickle cell patients. Hydroxyurea made a major impact on sickle cell therapy when it was shown to decrease acute painful episodes, acute chest syndrome, and the need for blood transfusion in adults. Significant experience in the use of hydroxyurea has been accumulated in older children. The benefits and risks of hydroxyurea for younger children and long-term risks in all patients will be evaluated in future investigations. Other promising therapies include butyrate compounds, clotrimazole, magnesium supplementation, poloxamer 188, antiadhesion agents, anticoagulant approaches, and nitric oxide. Hemopoietic transplantation remains the only curative therapy. However, several transgenic mouse models are available for studies of gene therapy or other treatment approaches on biochemical, cellular, and pathologic effects of mutant genes.