BACKGROUND Streptococcus gallolyticus subspecies pasteurianus(SGSP)is a rare pathogen responsible for infant sepsis and meningitis and is potentially overlooked because it is not included in routine group B streptococ...BACKGROUND Streptococcus gallolyticus subspecies pasteurianus(SGSP)is a rare pathogen responsible for infant sepsis and meningitis and is potentially overlooked because it is not included in routine group B streptococcal screenings.Hence,we present a case of SGSP-induced infant meningitis and sepsis,accompanied by bronchopneumonia induced by multidrug-resistant Staphylococcus aureus(MRSA),providing insights into the identification,management,and prognosis of this bacterial infection.CASE SUMMARY A 45-day-old female infant presented with two episodes of high fever(maximum temperature:39.5°C)and two generalized grand mal seizure episodes that lasted over ten seconds and self-resolved without concomitant symptoms.Postadmission,the patient’s C-reactive protein level was 40.73 mg/L,white blood cell count was 13.42×10^(9)/L,neutrophil ratio was 78.4%,procalcitonin level was 7.89μg/L,cerebrospinal fluid(CSF)white cell count was 36×10^(6)/L,multinucleated cell ratio was 95.2%,and protein concentration was 0.41 g/L.Blood and CSF culture revealed that the pathogen was SGSP.The bacterium was sensitive to ampicillin,furazolidone,penicillin,lincomycin,moxifloxacin,rifampicin,vancomycin,and levofloxacin but resistant to clindamycin and tetracycline.Sputum culture revealed the presence of MRSA,which was sensitive to vancomycin.The patient was diagnosed with meningitis and sepsis caused by SGSP,accompanied by bronchopneumonia induced by MRSA.Ceftriaxone(100 mg/kg/d)combined with vancomycin(10 mg/kg/dose,q6h)was given as an anti-infective treatment postadmission.After 12 days of treatment,the infant was discharged from the hospital with normal CSF,blood culture,and routine blood test results,and no complications,such as subdural effusion,were observed on cranial computed tomography.No growth retardation or neurological sequelae occurred during follow-up.CONCLUSION SGPSP-induced infant bacterial meningitis and sepsis should be treated with prompt blood and CSF cultures,and a sensitive antibiotic therapy to ensure a favorable prognosis.展开更多
Objective:The aim of this study is to evaluate the effectiveness and safety of xiyanping injection(XYPI)in the treatment of children with bronchopneumonia.Methods:Asystematic and comprehensive search was conducted in ...Objective:The aim of this study is to evaluate the effectiveness and safety of xiyanping injection(XYPI)in the treatment of children with bronchopneumonia.Methods:Asystematic and comprehensive search was conducted in the domestic and foreign electronic databases CNKI,SinoMed,VIP,WanFang DATA,PubMed,The Cochrane Library,Embase,Web of Science,Clinical‑Trials.gov,and the search date ended on May 30,2019.Inclusion criteria:(1)the types of studies included were randomized controlled trials;(2)the study participants were infants and children with a clear diagnosis of bronchopneumonia,without gender and ethnic restrictions;(3)the intervention test group was XYPI or the control group plus XYPI.The control group was routine treatment(RT)(basic treatment such as fever,cough and asthma,oxygen inhalation,anti‑infection,maintaining water,electrolyte balance,etc.)or other Western medicine or RT+other Western medicine treatment.Except for XYPI,the two groups were consistent in intervention measures.According to the Cochrane Handbook,5.1 evaluation standard and a meta‑analysis of the final included studies was performed using RevMan 5.3 software.Results:Atotal of 57 studies were included,with a total sample size of 8454 cases,of which 4255 were in the experimental group and 4199 were in the control group.Meta‑analysis results showed that(1)Total effective rate:XYPI group was better than the control group(relative risk[RRRT]=1.25,95%confidence interval[CI][1.15,1.36],P<0.00001;RRRT+RBVI=1.18,95%CI[1.09,1.29],P<0.0001;RR antibiotic=1.16,95%CI[1.09,1.24],P<0.00001,RRRT+antibiotic=1.22,95%CI[1.16,1.27],P<0.00001);antipyretic time:XYPI group was better than the control group(mean difference[MDRT]=−0.97,95%CI[−1.17,−0.76],P<0.00001;MDRT+antibiotic=−2.28,95%CI[−2.88,−1.67],P<0.00001;MDRT+RBVI=−1.51,95%CI[−1.81,−1.21],P<0.00001;cough disappearing time:XYPI group was better than the control group(MDRT=−1.37,95%CI[−1.74,−1.00],P<0.00001;MDRT+antibiotic=−1.71,95%CI[−2.04,−1.37],P<0.00001;MDRT+RBVI=−1.51,95%CI[−2.15,−0.86],P<0.00001);disappearance time of lung rales:XYPI group was better than the control group(MDRT=−1.11,95%CI[−1.35,−0.88],P<0.00001;MDRT+RBVI=−1.63,95%CI[−2.23,−1.03],P<0.00001).The difference was statistically significant;(2)Of the 57 studies(a total of 8454 cases),29 studies reported adverse reactions,of which 18 studies did not find adverse reactions,and 11 studies reported adverse reactions such as nausea,vomiting,and rash after medication in both groups.(3)The funnel chart indicated potential publication bias.Conclusion:Based on the existing clinical evidence,XYPI can have a certain effect on the treatment of children with bronchopneumonia,and it is not yet possible to conclude its safety evaluation.Moreover,due to the low quality of the included studies,this evidence is still used with cautious clinically.展开更多
基金Supported by the Scientific Research Project from the Health Commission of Mianyang City,No.201903.
文摘BACKGROUND Streptococcus gallolyticus subspecies pasteurianus(SGSP)is a rare pathogen responsible for infant sepsis and meningitis and is potentially overlooked because it is not included in routine group B streptococcal screenings.Hence,we present a case of SGSP-induced infant meningitis and sepsis,accompanied by bronchopneumonia induced by multidrug-resistant Staphylococcus aureus(MRSA),providing insights into the identification,management,and prognosis of this bacterial infection.CASE SUMMARY A 45-day-old female infant presented with two episodes of high fever(maximum temperature:39.5°C)and two generalized grand mal seizure episodes that lasted over ten seconds and self-resolved without concomitant symptoms.Postadmission,the patient’s C-reactive protein level was 40.73 mg/L,white blood cell count was 13.42×10^(9)/L,neutrophil ratio was 78.4%,procalcitonin level was 7.89μg/L,cerebrospinal fluid(CSF)white cell count was 36×10^(6)/L,multinucleated cell ratio was 95.2%,and protein concentration was 0.41 g/L.Blood and CSF culture revealed that the pathogen was SGSP.The bacterium was sensitive to ampicillin,furazolidone,penicillin,lincomycin,moxifloxacin,rifampicin,vancomycin,and levofloxacin but resistant to clindamycin and tetracycline.Sputum culture revealed the presence of MRSA,which was sensitive to vancomycin.The patient was diagnosed with meningitis and sepsis caused by SGSP,accompanied by bronchopneumonia induced by MRSA.Ceftriaxone(100 mg/kg/d)combined with vancomycin(10 mg/kg/dose,q6h)was given as an anti-infective treatment postadmission.After 12 days of treatment,the infant was discharged from the hospital with normal CSF,blood culture,and routine blood test results,and no complications,such as subdural effusion,were observed on cranial computed tomography.No growth retardation or neurological sequelae occurred during follow-up.CONCLUSION SGPSP-induced infant bacterial meningitis and sepsis should be treated with prompt blood and CSF cultures,and a sensitive antibiotic therapy to ensure a favorable prognosis.
基金National Key R&D Program of China(2018YFC1707400)Funding for Basic Scientific Research Business Expenses of Central-Level Non-Profit Research Institutes(Z0597)。
文摘Objective:The aim of this study is to evaluate the effectiveness and safety of xiyanping injection(XYPI)in the treatment of children with bronchopneumonia.Methods:Asystematic and comprehensive search was conducted in the domestic and foreign electronic databases CNKI,SinoMed,VIP,WanFang DATA,PubMed,The Cochrane Library,Embase,Web of Science,Clinical‑Trials.gov,and the search date ended on May 30,2019.Inclusion criteria:(1)the types of studies included were randomized controlled trials;(2)the study participants were infants and children with a clear diagnosis of bronchopneumonia,without gender and ethnic restrictions;(3)the intervention test group was XYPI or the control group plus XYPI.The control group was routine treatment(RT)(basic treatment such as fever,cough and asthma,oxygen inhalation,anti‑infection,maintaining water,electrolyte balance,etc.)or other Western medicine or RT+other Western medicine treatment.Except for XYPI,the two groups were consistent in intervention measures.According to the Cochrane Handbook,5.1 evaluation standard and a meta‑analysis of the final included studies was performed using RevMan 5.3 software.Results:Atotal of 57 studies were included,with a total sample size of 8454 cases,of which 4255 were in the experimental group and 4199 were in the control group.Meta‑analysis results showed that(1)Total effective rate:XYPI group was better than the control group(relative risk[RRRT]=1.25,95%confidence interval[CI][1.15,1.36],P<0.00001;RRRT+RBVI=1.18,95%CI[1.09,1.29],P<0.0001;RR antibiotic=1.16,95%CI[1.09,1.24],P<0.00001,RRRT+antibiotic=1.22,95%CI[1.16,1.27],P<0.00001);antipyretic time:XYPI group was better than the control group(mean difference[MDRT]=−0.97,95%CI[−1.17,−0.76],P<0.00001;MDRT+antibiotic=−2.28,95%CI[−2.88,−1.67],P<0.00001;MDRT+RBVI=−1.51,95%CI[−1.81,−1.21],P<0.00001;cough disappearing time:XYPI group was better than the control group(MDRT=−1.37,95%CI[−1.74,−1.00],P<0.00001;MDRT+antibiotic=−1.71,95%CI[−2.04,−1.37],P<0.00001;MDRT+RBVI=−1.51,95%CI[−2.15,−0.86],P<0.00001);disappearance time of lung rales:XYPI group was better than the control group(MDRT=−1.11,95%CI[−1.35,−0.88],P<0.00001;MDRT+RBVI=−1.63,95%CI[−2.23,−1.03],P<0.00001).The difference was statistically significant;(2)Of the 57 studies(a total of 8454 cases),29 studies reported adverse reactions,of which 18 studies did not find adverse reactions,and 11 studies reported adverse reactions such as nausea,vomiting,and rash after medication in both groups.(3)The funnel chart indicated potential publication bias.Conclusion:Based on the existing clinical evidence,XYPI can have a certain effect on the treatment of children with bronchopneumonia,and it is not yet possible to conclude its safety evaluation.Moreover,due to the low quality of the included studies,this evidence is still used with cautious clinically.
