Efficacy of Fixed-Dose Drugs in Treatment of Pulmonary Tuberculosis in Children

The main problem in treatment of children with various forms of tuberculosis is the lack of pediatric dosages of anti-TB drugs. The aim of the study is to determine efficacy of the 〈Isoniazid 150 mg＋Pyrazinamid 375 mg＋Rifampicin 150 mg〉 （Ftizamax ） fixed-dose combination. We estimated the clinical, radiological and laboratory parameters during treatment of 73 children with pulmonary tuberculosis, of which 34 children were treated by the 〈Isoniazid 150 mg＋Pyrazinamid 375 mg＋Rifampicin 150 mg〉 in combination with the Ethambutol; while the others were treated with mono-drugs under the standard regimen I. Effective use of 〈Isoniazid 150 mg＋Pyrazinamid 375 mg＋Rifampicin 150 mg〉 （Ftizamax ） for children is supported by positive results towards the end of the intensive phase of the therapy and the continuation phase, as well as by minimized adverse drug reactions during treatment. Combination of active substances in the drug and its dosage is easy to use, which allows recommending this drug for treatment of tuberculosis in children.

Distribution and Drug Resistance Analysis of 2287 Strains of Pathogenic Bacteria in Children’s Blood Culture

Background: Bloodstream infection is a serious infectious disease. In recent years, the drug resistance of pathogenic bacteria to commonly used anti-infective drugs has been widely concerned, which also makes the treatment of bloodstream infection face severe challenges. Objective: To explore the distribution characteristics of blood culture-positive pathogens and the resistance to antibacterial drugs, so as to provide clinicians with accurate laboratory evidence, so as to guide clinicians to rationally apply antibiotics, improve clinical treatment effects, and reduce the emergence of drug-resistant strains. Methods: From January 2019 to June 2022, 2287 positive blood culture specimens of patients in Guangzhou Women and Children’s Medical Center were retrospectively analyzed, and the proportion of different pathogenic bacteria, the distribution of pathogenic bacteria in different departments, and the multi-drug resistance of different pathogenic bacteria were counted. Results: Among the 2287 blood culture positive samples, 1560 strains (68.20%) of gram-positive bacteria and 727 strains (31.80%) of gram-negative bacteria were strained. The top three departments in the distribution of pathogenic bacteria were pediatric intensive care unit (600 strains), pediatric internal medicine (514 strains), and pediatric emergency comprehensive ward (400 strains). The pathogens with high detection rates were: Staphylococcus epidermidis (24.09%), Staphylococcus humans (23.74%), Escherichia coli (13.21%) and Klebsiella pneumoniae (8.71%). The pathogens with high multi-drug resistance rates were: Streptococcus pneumoniae (93%), Staphylococcus epidermidis (83.76%), Enterobacter cloacae (75.61%) and Staphylococcus humans (62.43%). Conclusion: In our hospital, gram-positive bacteria were the main pathogenic bacteria in the blood culture of children patients. The children’s intensive care unit was the department with the largest distribution of pathogenic bacteria, and the multiple drug resistance rate of Streptococcus pneumoniae was the highest.

Association of HLA-B*1502 and*1511 Allele with Antiepileptic Drug-induced Stevens-Johnson Syndrome in Central China

Previous studies have demonstrated a strong association between carbamazepine（CBZ）-induced Stevens-Johnson syndrome（SJS） and HLA-B 1502 in Han Chinese. Here, we extended the study of HLA-B 1502 susceptibility to two different antiepileptic drugs, oxcarbazepine（OXC） and phenobabital（PB）. In addition, we genotyped HLA-B 1511 in a case of CBZ-induced SJS with genotype negative for HLA-B 1502. The presence of HLA-B 1502 was determined using polymerase chain reaction with sequence-specific primers（PCR-SSP）. Moreover, we genotyped HLA-B 1502 in 17 cases of antiepileptic drugs（AEDs）-induced cutaneous adverse drug reactions（cADRs）, in comparison with AEDs-tolerant（n=32） and normal controls（n=38） in the central region of China. The data showed that HLA-B 1502 was positive in 5 of 6 cases of AEDs-induced SJS（4 CBZ, 1 OXC and 1 PB）, which was significantly more frequent than AEDs-tolerant（2/32, 18 CBZ, 6 PB and 8 OXC） and normal controls（3/38）. Compared with AEDs-tolerant and normal controls, the OR for patients carrying the HLA-B 1502 with AEDs-induced SJS was 6.25（95% CI： 1.06–36.74） and 4.86（95% CI： 1.01–23.47）. The sensitivity and specificity of HLA-B 1502 for prediction of AEDs-induced SJS were 71.4%. The sensitivity and specificity of HLA-B 1502 for prediction of CBZ-induced SJS were 60% and 94%. HLA-B 1502 was not found in 11 children with maculopapular exanthema（MPE）（n=9） and hypersensitivity syndrome（HSS）（n=2）. However, we also found one case of CBZ-induced SJS who was negative for HLA-B 1502 but carried HLA-B 1511. It was suggested that the association between the CBZ-induced SJS and HLA-B 1502 allele in Han Chinese children can extend to other aromatic AEDs including OXC and PB related SJS. HLA-B 1511 may be a risk factor for some patients with CBZ-induced SJS negative for HLA-B 1502.

Efficacy of different antibiotics in treatment of children with respiratory mycoplasma infection

BACKGROUND Respiratory infections in children are common pediatric diseases caused by pathogens that invade the respiratory system.Children are considerably susceptible to Mycoplasma pneumoniae infection.There has been widespread clinical attention on treatment strategies for this disease.AIM To analyze the clinical efficacy of different antibiotics in treating pediatric respiratory mycoplasma infections.METHODS We included 106 children with a confirmed diagnosis of respiratory mycoplasma infection who were admitted to our hospital from April 2017 to July 2019 and grouped them using a random number table.Among them,53 children each received clarithromycin or erythromycin.The clinical efficacy of both drugs was evaluated and compared.We performed the multiplex polymerase chain reaction(MP-PCR)test and determined the MP-PCR negative rate in children after the end of the treatment course.We compared the incidence of toxic and side effects,including nausea,diarrhea,and abdominal pain;further,we recorded the length of hospitalization,antipyretic time,and drug costs.Additionally,we evaluated and compared the compliance of the children during treatment.RESULTS The erythromycin group showed a significantly higher total effective rate of clinical treatment than the clarithromycin group.MP-PCR test results showed that the clarithromycin group had a significantly higher MP-PCR negative rate than the erythromycin group.Moreover,children in the clarithromycin group had shorter fever time,shorter hospital stays,and lower drug costs than those in the erythromycin group.The clarithromycin group had a significantly higher overall drug adherence rate than the erythromycin group.The incidence of toxic and side effects was significantly lower in the clarithromycin group than in the erythromycin group(P<0.05).CONCLUSION Our findings indicate that clarithromycin has various advantages over erythromycin,including higher application safety,stronger mycoplasma clearance,and higher medication compliance in children;therefore,it can be actively promoted.

Randomized clinical study of five days apostrophe therapy with mebendazole compared to quinacrine in the treatment of symptomatic giardiasis in children

AIM： To compare the efficacy and safety of five days apostrophe therapy of mebendazole （MBZ） versus quinacrine （QC） on human giardiasis in children.METHODS： A clinical trial was carried out in paediatric patients （aged 5-15 years） with confirmed symptomatic G. duodenalis mono-infection. Patients were randomly assigned to receive either MBZ [200 mg taken three times per day GRID） （n = 61）] or QC [2 mg/kg bodyweight tid （n = 61）], both for five days. Follow-up faecal samples were obtained at 3, 5 and 7 d after the end of the treatment.RESULTS： Although the frequency of cure was higher for QC （83.6%） than for MBZ （78.7%）, the difference was not statistically significant （P 〉 0.05）. Adverse events were reported more in the QC group （P 〈 0.05）, all of them transient and self-limiting.CONCLUSION： Despite final cure rates ocurring lower than expected, the overall results of this study reconfirmed the efficacy of MBZ in giardiasis and also indicate that, although comparable to QC, at least in this setting the 5 d course of MBZ did not appear to improve the cure rates in this intestinal parasitic infection.

ADRs and Children： Knowledge and Methodological Standard in PASS （Post Authorization Safety Studies）

PhV （pharmacovigilance） knowledge has the outcome of being inadequate in particular due to the lack of instruction. Pediatricians have to face the realization that over-the-counter medicines increments the peril of ADRs （adverse drug reactions） has become a public health concern. The purpose of this article is to disseminate knowledge of the PhV and to highlight the cultural and organizational difficulties for its implementation. The objectives of promoting the organization of specific training courses and research projects aimed at： （1） to foster the culture of iatrogenic disease in pediatrics; （2） to improve the appropriateness of prescribing drugs in children; （3） to enco.urage spontaneous reporting of ADRs in children; （4） to involve Pediatricians in PASS （post-authorization safety studies） according to GCP, GVP and ENCEPP Code of Conduct. An up to date proposal of PhV, a procedure of preparation improves the productivity of creating novel informative reports which can be utilized for a benefit/risk scrutiny making strides in medicine prescription. In this context, FP-MCRN （family paediatficians-medicines for children research network） established with the aim of developing competence, infrastructure and education for paediatric clinical trials, plays a crucial role in paediatric PhV, through an improvement of PhV training, a correct research methodology and very strong relationship with the families. The initial necessity is cultural, implementing culture of iatrogenic illnesses and a watchful evaluation of the importance of PASS by FPs （family pediatricians）. Participation in clinical trials that generates a precise database administered by FPs together with follow-up outcomes becomes relevant and vital for a scrupulous and accurate assessment of ADRs. PASS can foresee on one hand training and information regarding the proper use of drugs in children and possible iatrogenic pathologies caused by their improper use, the other to constitute a territorial survey in the prescriptive appropriateness and safety of pediatric drugs aimed at evaluating the risk-benefit balance on usage.

儿童重症肺炎支气管肺泡灌洗液的病原菌及药敏试验分析

目的了解儿童重症肺炎支气管肺泡灌洗液(BALF)的病原菌及药敏试验情况。方法选取该院2021年1月至2023年4月收治的100例重症肺炎患儿作为研究对象,对所有患儿进行支气管镜肺泡灌洗,并分析其BALF病原菌及药敏试验情况。结果100例患儿BALF中共培养出病原菌131株,革兰阴性菌98株(74.81%),革兰阳性球菌33株(25.19%),其中流感嗜血杆菌(25.19%)、肺炎链球菌(21.37%)占比较高,卡他布兰汉菌(15.27%)、肺炎克雷伯菌(11.45%)其次。重症肺炎患儿BALF中前4位病原菌主要以<1岁(97.37%)、1~3岁(96.88%)占比较高,>3~7岁(94.12%)、>7~14岁(92.31%)相对较少。各年龄BALF中流感嗜血杆菌、卡他布兰汉菌、肺炎克雷伯菌分布情况比较,差异均无统计学意义(P>0.05);各年龄BALF中肺炎链球菌分布情况比较,差异有统计学意义(P<0.05)。20株流感嗜血杆菌对四环素、阿莫西林-克拉维酸、头孢噻肟、复方磺胺甲噁唑均较敏感,对氯霉素敏感性其次,对氨苄西林、头孢克洛、头孢呋辛耐药性均较高;15株卡他布兰汉菌对头孢噻肟较敏感,对氨苄西林耐药性最高;8株肺炎克雷伯菌对头孢噻肟较敏感,对氨苄西林、头孢呋辛、氯霉素耐药性均较高,对阿莫西林-克拉维酸、四环素耐药性其次;20株肺炎链球菌对万古霉素、氯霉素均较敏感,对青霉素G、泰利霉素敏感性其次,对复方磺胺甲噁唑耐药性较高,对四环素、头孢噻肟、克林霉素耐药性其次。结论儿童重症肺炎BALF中病原菌以流感嗜血杆菌、肺炎链球菌多见,且0~3岁患儿病原菌占比高于>3~14岁,临床应合理用药以预防耐药菌株产生。

药学干预对某儿童医院国家基本药物使用情况的效果评价

目的:评价药学干预对某儿童医院国家基本药物使用情况的效果。方法:从医院信息系统分别抽取2021年(干预前)和2022年(干预后)某儿童医院国家基本药物使用数据,包括基本药物采购品种比、基本药物配备使用金额占比、门诊患者基本药物处方占比、门诊患者基本药物处方使用占比、住院患者基本药物使用率和住院患者基本药物使用占比,比较2021年与2022年各指标的全院增长率和不同临床科室的增长率。结果:与2021年相比,2022年我院基本药物采购品种比降低了1.32%,基本药物配备使用金额占比增长率为2.26%,门诊患者基本药物处方占比增加了13.82%,门诊患者基本药物处方使用占比增加了11.69%,住院患者基本药物使用率持平,住院患者基本药物使用占比增加了1.30%。基本药物各项考核指标明显改善的科室包括心内科、新生儿科、综合内科、神经外科、感染性疾病科、新生儿重症监护室、耳鼻喉科、血液科1、外科监护室和血液科2。结论:我院基本药物使用情况经临床药师干预后有一定的改进成效,但基本药物配备使用金额占比和住院基本药物使用率仍未达到省考要求,需要药师与医师积极配合对患儿家属进行基本药物宣教,增加其对基本药物的信赖程度,同时呼吁国家能够增加国家基本药物目录中儿童专科用药品种,提高儿童用药的经济性和可及性。

托珠单抗注射液致过敏性休克1例分析

目的 分析托珠单抗注射液致过敏性休克的特点,为临床合理用药提供参考。方法 报道1例儿童使用托珠单抗导致过敏性休克的案例,通过文献回顾托珠单抗导致过敏性休克的情况,并分析原因及防治措施。结果 根据患者的临床表现及药物与用药时间的关联性,考虑托珠单抗导致过敏性休克,患者经有效抗过敏治疗后,过敏性休克症状得到缓解。结论 临床应用托珠单抗应警惕过敏性休克等过敏情况,对严重过敏患者应禁止使用。

60例小儿急性感染性喉炎治疗效果临床回顾性分析

目的分析小儿急性感染性喉炎行布地奈德雾化吸入治疗方案的有效性与可行性。方法回顾性分析60例急性感染性喉炎患儿的临床资料,根据雾化治疗方案的不同分为观察组与对照组,每组30例。观察组予布地奈德雾化吸入治疗,对照组予地塞米松雾化吸入治疗。比较两组患儿的临床治疗效果、临床症状持续时间、药物不良反应发生率以及治疗前后的炎症指标。结果观察组临床治疗总有效率93.33%(28/30)显著高于对照组的73.33%(22/30),差异具有统计学意义(P<0.05)。观察组患儿的喉鸣、犬吠样咳嗽、呼吸困难、声音嘶哑、发热持续时间分别为(3.77±1.21)、(3.28±1.06)、(1.78±0.57)、(4.36±0.56)、(1.48±0.48)d,均短于对照组的(4.65±1.26)、(4.77±1.21)、(2.91±0.99)、(5.45±0.49)、(2.56±0.78)d,差异具有统计学意义(P<0.05)。治疗后,两组患儿的超敏C反应蛋白(hs-CRP)水平均较治疗前明显降低,且观察组患儿的hs-CRP水平(7.86±2.13)mg/L低于对照组的(12.67±2.75)mg/L,差异具有统计学意义(P<0.05)。观察组用药不良反应发生率6.67%低于对照组的26.67%,差异具有统计学意义(P<0.05)。结论小儿急性感染性喉炎行布地奈德雾化吸入治疗方案的效果理想,可更为显著地改善患儿的临床症状,缩短临床症状持续时间,同时其安全性较高,具有重要临床应用价值。

主穹窿蛋白基因在高原地区癫痫儿童中的多态性分析

目的:探讨分析主穹窿蛋白(MVP)基因三个SNP位点rs4788187、rs3815824、rs3815823多态性与高原地区儿童癫痫的相关性。方法:选取2017年1月~2020年1月青海大学附属医院收治的80例癫痫患儿为研究对象,根据耐药性不同分为耐药组与非耐药组各40例,利用PCR-RELP方法检测rs4788187、rs3815824、rs3815823三个SNP位点的多态性分布,并进行统计分析。结果:两组年龄、性别、民族以及癫痫发作类型比较差异无统计学意义(P>0.05)。癫痫患儿rs4788187、rs3815824的等位基因C频率明显低于T,而rs3815823的等位基因T频率明显低于C;两组患儿SNP位点rs4788187、rs3815824、rs3815823的基因型频率和等位基因频率比较差异均无统计学意义(P>0.05)。结论:MVP基因的SNP位点(rs4788187、rs3815824、rs3815823)与癫痫耐药性不相关。

儿童急性白血病合并多重耐药菌血流感染的临床特征及抗菌药物选择

目的探讨急性白血病患儿合并多重耐药菌(multiple resistant bacteria,MDR)血流感染的临床特征、独立危险因素及抗菌药物选择。方法回顾性分析2015年1月至2023年12月昆明市儿童医院收治的101例合并细菌血流感染的急性白血病患儿。根据血培养结果,将符合MDR、泛耐药及全耐药标准的患儿纳入多重耐药组(n=47例),其余纳入非多重耐药组(n=54例),记录2组临床特征、实验室指标及抗菌药物选择情况,并分析影响MDR感染的危险因素。结果MDR组急性髓系白血病(acute myeloid leukemia,AML)比例、诱导缓解化疗前粒细胞缺乏时间≥7 d的比例均高于非MDR组,MDR组发热前血红蛋白(hemoglobin,Hb)和血小板(platelet,PLT)水平均低于非MDR组,差异有统计学意义(P<0.05);急性髓系白血病、诱导缓解化疗、发热前粒细胞缺乏时间≥7 d,感染前Hb<79 g/L及感染前PLT<20×109/L均为MDR感染的独立危险因素(P<0.05);病原学分析表明,革兰阴性菌为主要致病菌,耐药率高,但对碳青霉烯类、替加环素敏感;革兰阳性菌对特定抗菌药敏感,而对红霉素高度耐药;MDR组降钙素原(procalcitonin,PCT)、C反应蛋白(C-reactive protein,CRP)水平均高于非MDR组,且MDR组转入ICU的比例较高,差异有统计学意义(P<0.05)。结论急性髓系白血病、诱导缓解化疗、发热前粒细胞缺乏时间≥7 d、血红蛋白<70 g/L、PLT<20×109/L均为儿童MDR血流感染的独立危险因素,影响预后,大肠埃希菌为主要耐药菌,MDR感染患儿表现PCT和CRP水平升高,痊愈率低;因此,针对高危因素需采取有效预防措施,并根据药敏结果及时调整治疗方案,提高疗效。

基于FAERS的儿童奥司他韦不良事件信号挖掘与分析

目的 为临床安全使用奥司他韦提供参考。方法 检索美国食品和药物管理局不良事件报告系统(FAERS)数据库中2004年第1季度至2023年第1季度以奥司他韦为首要怀疑药物、发生于0~17岁患儿的药品不良事件(ADE)报告,采用报告比值比(ROR)法、比例报告比值比(PRR)法进行信号挖掘,采用《国际医学用语词典》中的首选语(PT)及系统器官分类(SOC)进行编码和归类。结果 共挖掘到奥司他韦相关ADE报告3 100份,检测到阳性信号76个,主要集中在精神病类(34个)、各类神经系统疾病(13个)、胃肠系统疾病(7个)、全身性疾病及给药部位各种反应(6个)、免疫系统疾病(3个)等12个SOC。发生频次排前20位的ADE有幻觉(455次)、异常行为(428次)、呕吐(410次)、谵妄(120次)、意识模糊状态(111次)等,信号强度排前20位的ADE仍以精神病类、各类神经系统疾病、胃肠系统疾病为主。发生频次和信号强度均排前20位的ADE有尖叫、恐惧、睡惊症,药品说明书中均未提及。结论 患儿临床应用奥司他韦时,应关注精神疾病、神经系统和胃肠道系统,以及皮肤和眼部的ADE。

多黏菌素B治疗危重症儿童多重耐药革兰阴性菌感染的疗效观察

目的:评估多黏菌素B治疗危重症儿童多重耐药革兰阴性菌感染的疗效,并探讨其影响多黏菌素B疗效的可能因素。方法:选取某院重症监护室2020年2月~2022年6月诊治的26例危重症多重耐药革兰阴性菌感染患儿,根据患者的疗效分为临床有效组(n=14)和临床无效组(n=12)。比较两组患者的性别、年龄、小儿危重病例评分、合并疾病、病原菌、治疗时间、机械通气情况以及与其他抗菌药物联用情况。对其中有意义的变量进行多因素Logistic回归分析,探讨影响多黏菌素B疗效的可能因素。结果:临床有效组与无效组的性别、年龄、小儿危重病例评分、合并疾病、病原菌以及与其他抗菌药物联用情况比较均无统计学差异(P>0.05)。临床有效组的多黏菌素B使用时间较无效组更长(P=0.000),临床无效组有更多的患儿应用机械通气(P=0.034)。Logistic回归分析果结提示治疗时间(OR:2.606,95%CI:1.346~5.046,P=0.004)是影响多黏菌素B治疗危重症儿童多重耐药革兰阴性菌感染临床疗效的可能因素。结论:多黏菌素B治疗危重症儿童多重耐药革兰阴性菌感染具有较好的治疗效果,治疗时间是影响多黏菌素临床疗效的可能因素。

急性髓系白血病患儿柔红霉素耐药与PD-L1蛋白表达相关

目的研究急性髓系白血病(AML)患儿柔红霉素(DNR)耐药与程序性死亡受体配体-1(PD-L1)蛋白表达的相关性。方法选取2016年1月至2022年12月郑州大学附属儿童医院收治的110例AML患儿骨髓样本作为研究组,以50名骨髓正常供体骨髓样本作为对照组。培养人AML细胞系HL60、THP-1、U-937、Molm-13,Western blot检测PD-L1蛋白表达量。构建LV-PD-L1-shRNA、LV-PD-L1-WT-OE慢病毒载体,分析PD-L1对Molm-13细胞DNR耐药的影响及机制。结果研究组PD-L1蛋白表达量高于对照组,AML细胞系中PD-L1蛋白表达量高于健康骨髓单个核细胞(BMMC)(P<0.05),PD-L1表达与AML患儿白细胞计数、骨髓原始细胞比率、预后危险分层、两个标准化学治疗方案后疾病缓解情况有关(P<0.05)。PD-L1高表达组总生存率低于PD-L1低表达组(P<0.05)。与LV-PD-L1-WT-OE组比较,LV-PD-L1-shRNA组PD-L1 mRNA表达量降低、细胞增殖活性降低、凋亡率升高(P<0.05),LV-PD-L1-shRNA可提高Molm-13细胞对DNR的敏感性。TCGA数据库分析显示,6-磷酸葡萄糖脱氢酶(G6PD)可能为PD-L1潜在的目标基因。结论PD-L1在儿童AML中高表达,与患儿化疗耐药有关,其可能通过调控G6PD引起DNR耐药。

ALL患儿诱导缓解期长春新碱联合应用三唑类抗真菌药物发生毒副作用单中心分析

目的研究急性淋巴细胞白血病(ALL)儿童诱导缓解期联合应用长春新碱与三唑类药物出现的毒副作用。方法回顾性分析2010年1月1日—2013年12月31日北京儿童医院诊断为ALL患儿在诱导缓解治疗过程中长春新碱和三唑类药物联合应用出现毒副作用。将患儿分为无联合用药组、长春新碱+伊曲康唑联合组,长春新碱+伏立康唑联合组,长春新碱+氟康唑联合组,分析4组患儿相关毒副作用的发生率及治疗预后。结果共纳入ALL患儿708例,发病中位年龄为8(1~16)岁。存在长春新碱与三唑类抗真菌药物联合应用组共215例,其中联合伊曲康唑组79例,联合伏立康唑组36例,联合氟康唑组100例。无联合用药组493例。联合用药组患儿相关并发症发生率:高血压37例(17.2%),趾端麻木39例(18.1%),腱反射迟钝4例(1.8%),腹痛腹胀42例(19.5%),肠梗阻5例(2.3%),低血钠43例(20%)。联合用药组相关并发症发生率均高于无联合用药物组(P<0.05)。联合用药组中,高血压发生率、腱反射迟钝发生率及低血钠发生率:伊曲康唑组与伏立康唑组无差别(P>0.05),但大于氟康唑组(P<0.05);趾端麻木、腹痛腹胀发生率:伊曲康唑组大于伏立康唑组大于氟康唑组(P<0.05);肠梗阻发生率:伏立康唑组大于伊曲康唑组大于氟康唑组(P<0.05)。对于发生的毒副作用,给予相关的对症处理及调整药物后,相关并发症均可以得到缓解及消失。结论在ALL患儿诱导缓解治疗过程中,三唑类药物联合长春新碱用药可能加重毒副作用发生,伊曲康唑和伏立康唑相比氟康唑可能更容易加重长春新碱毒性,故建议治疗过程中避免同时使用三唑类抗真菌药物及长春新碱。

儿童脑脊液阳性菌株分布及耐药分析

目的了解儿童脑脊液阳性菌株分布和常用抗菌药物的耐药情况。方法收集2017年1月至2021年12月郑州大学附属儿童医院脑脊液分离菌株,采用基质辅助激光解析电离飞行时间质谱进行病原菌鉴定,凤凰全自动细菌鉴定/药敏检测系统(Phoenix 100)、VITEK 2 Compact全自动微生物鉴定仪(Vitek-2 Compact)和纸片扩散法进行药敏试验,按照美国临床实验室标准化协会标准判读药敏结果,用WHONET 5.6软件进行回顾性耐药性分析。结果314例脑脊液阳性病原菌以革兰阳性菌为主,204株(65.0%)。前五位病原菌依次为凝固酶阴性葡萄球菌92株(29.3%)、肠球菌44株(14.0%)、大肠埃希菌32株(10.2%)、肺炎克雷伯菌21株(6.7%)、肺炎链球菌18株(5.7%)。二、三季度分离菌株数较多,1岁以内婴儿病例最多见,占147株(46.8%)。检出科室以神经外科77株(24.5%)、新生儿内科70株(22.3%)、神经内科46株(14.6%)为主;多重耐药菌检出149株(47.5%),其中耐甲氧西林凝固酶阴性葡萄球菌(MRCNS)69株、产超广谱β内酰胺酶肠杆菌(ESBLs)18株、耐碳青霉烯类肠杆菌(CRE)18株;各年龄组、性别、年份之间多重耐药发生率差异无统计学意义(P>0.05),不同科室之间多重耐药的发生率差异有统计学意义(P<0.001)。结论脑脊液阳性病原菌以革兰阳性菌为主,感染主要集中在1岁以内婴儿,对于多重耐药菌株应该重视耐碳青霉烯类肺炎克雷伯菌的检出。

细菌性脑膜炎症候群患儿菌群情况及其耐药分析

目的调查研究细菌性脑膜炎症候群患儿菌群情况以及耐药情况。方法选择199例细菌性脑膜炎症候群患儿为研究对象,采集所有患儿的脑脊液标本完成细菌培养以及药敏试验。分析病原菌分布情况及主要病原菌耐药特点。结果199例患儿脑脊液共检出病原菌61株,按照占比从高到低的顺序分别为肺炎链球菌、无乳链球菌、大肠埃希菌、金黄色葡萄球菌、凝固酶阴性葡萄球菌、屎肠球菌、白色念球菌、脑膜炎奈瑟菌及其他,占比分别为31.15%、21.31%、19.67%、16.39%、3.28%、3.28%、1.64%、1.64%、1.64%。大肠埃希菌对亚胺培南以及美罗培南的耐药性均为0,对其他抗菌药物均有不同程度的耐药性;脑膜炎奈瑟菌对亚胺培南、美罗培南、头孢曲松以及头孢噻肟耐药性均为0,对其他抗菌药物均有不同程度的耐药性。肺炎链球菌对万古霉素的耐药性均为0,对其他抗菌药物均有不同程度的耐药性;无乳链球菌对头孢哌酮的耐药性为0,对环丙沙星的耐药率为7.69%,而对其他抗菌药物均有明显耐药性;金黄色葡萄球菌对万古霉素以及利奈唑胺的耐药性均为0,对其他抗菌药物均有不同程度耐药性;凝固酶阴性葡萄球菌对万古霉素以及利奈唑胺的耐药性均为0,对其他抗菌药物均有不同程度耐药。结论细菌性脑膜炎症候群患儿致病菌以肺炎链球菌、无乳链球菌、大肠埃希菌、金黄色葡萄球菌、凝固酶阴性葡萄球菌以及脑膜炎奈瑟菌为主,且不同致病菌对不同抗菌药物的耐药性不同,临床工作中应根据药敏试验结果合理选用抗菌药物。

镰状细胞病患儿疼痛危象药物治疗进展

血管阻塞性危象(VOC)又称镰状细胞疼痛危象,是镰状细胞病(SCD)的标志性并发症,临床表现复杂,通常伴有急性疼痛。不能有效控制、反复发作的疼痛是患儿入院的主要原因,因此,安全有效地进行疼痛预防及控制至关重要,药物治疗是最主要方式之一。本文整理归纳国内外SCD患儿VOC治疗的有限资料,从儿童VOC疼痛成因、疼痛评估及药物治疗三个方面进行综述,其中,药物治疗部分包括非阿片类药物、阿片类药物、辅助镇痛药物治疗以及预防疼痛危象药物治疗。SCD患儿疼痛危象的治疗与预防中应注重多模式镇痛的应用,基于患儿个体特征慎重选择镇痛方案,减少阿片类药物使用剂量,避免不良反应的发生,从而提升镇痛效果,改善患儿生活质量。

临床药师参与1例嵌合抗原受体T细胞治疗后继发肺毛霉菌病的抗感染治疗

目的:探讨儿科临床药师在肺毛霉菌感染治疗中的作用。方法:临床药师通过参与1例儿童嵌合抗原受体T细胞治疗后继发肺部毛霉菌感染药物治疗,结合抗真菌药物的药动学/药效学(PK/PD)特点、血药浓度监测结果,实施个体化给药治疗。结果:患儿在两性霉素B胆固醇硫酸酯复合物联合泊沙康唑治疗6周后临床症状好转,影像学改善,泊沙康唑血药浓度达标,两性霉素B胆固醇硫酸酯复合物治疗过程中未出现严重不良反应。结论:对于少见的儿童肺毛霉菌感染,两性霉素B联合泊沙康唑治疗可能有效。