Professor Xunmei Fan: A pioneer dedicated to pediatric critical care in China

Thirty-six years ago,a small medical group with fewer than 10 people,only 1 ventilator and 6 beds,founded the first pediatric intensive care unit (PICU) in China,at Beijing Children's Hospital (BCH).It was the milestone of Chinese pediatric critical care medicine.The leader of this medical group,a woman who deserved to be respected was Professor Xunmei Fan,also a doctoral supervisor and former director of BCH.Many domestic 'first' were created under the consistent efforts of Prof.

History of pediatric critical care medicine in the mainland of China

Overview of critical care medicineThe history of critical care medicine (CCM) dates back more than a century.The predecessor of the intensive care unit (ICU) was a 'special ward' where doctors and nurses used integrated equipment to effectively treat a large number of patients suffering from the same disease.

Clonal and drug resistance dynamics of methicillin-resistant Staphylococcus aureus in pediatric populations in China

Importance:Regional clonal replacements of methicillin-resistant Staphylococcus aureus (MRSA) are common.It is necessary to understand the clonal and drug resistance changes in specific areas.Objective:To evaluate the clonal and drug resistance dynamics of MRSA in Chinese children from 2010 to 2017.Methods:MRSA was isolated from patients in Beijing Children's Hospital from 2010 to 2013 and from 2016 to 2017.The molecular characteristics and antibiotic resistance were determined,Results:In total,211 MRSA isolates were collected,and 104 isolates were classified as community-associated MRSA (CA-MRSA).ST59-SCCmec Ⅳ was the most prevalent type in both CA-MRSA (65.4%) and healthcare-associated-MRSA (HA-MRSA) (46.7%).ST239-SCCmec Ⅲ accounted for 21.5% of all HA-MRSA,which were not detected in 2016,and only three isolates were detected in 2017.The pvl gene carrying rate of CA-MRSA was significantly higher than that of HA-MRSA (42.3% vs.29.0%,P =0.0456).Among CA-MRSA,resistance rate to all tested antibiotics excluding chloramphenicol remained stable over the periods of 2010-2013 and 2016-2017.HA-MRSA displayed an overall trend of decreased resistance to oxacillin,gentamicin,tetracycline,ciprofloxacin,and rifampin,and increased resistance to chloramphenicol,consistent with the difference of antibiotic resistance patterns between ST59-SCCmec Ⅳ and ST239-SCCmec Ⅲ isolates.Vancomycin minimal inhibitory concentration (MIC) creep was found in the study period in all MRSA and ST59-SCCmec Ⅳ isolates.Interpretation:ST59-SCCmec Ⅳ has spread to hospitals and replaced the traditional ST239-SCCmec Ⅲ clone,accompanied by changes in drug resistance.Furthermore,vancomycin MIC creep indicated that the rational use of antibiotics should be seriously considered.

Global Pediatric Pulmonology Alliance recommendation to strengthen prevention of pediatric seasonal influenza under COVID-19 pandemic

The World Health Organization(WHO)announced COVID-19 as a global pandemic in March of 2020[1].The COVID-19 pandemic may persist for a long period of time.Global prevention and control becomes a complex and challenging task,and such efforts should be sustained.Although general measures,such as social distancing,face masks,respiratory hygiene and hand sanitization,will bear fruits for decreasing spread of other respiratory illnesses including influenza,the specific prevention through vaccination is a key focus especially in the upcoming winter and spring seasons[2].

Clinical and Molecular Epidemiology of Invasive Staphylococcus aureus Infections in Chinese Children： A Single-center Experience

Staphylococcus aureus is associated with a variety of invasive infection; typically, these infections occur as sepsis, osteomyelitis, endocarditis, and arthritis. China has a relatively high incidence of invasive S. aureus disease in children.[1] The present study aimed to provide the demographics, clones, and the antimicrobial susceptibility of S. aureus that cause invasive infection in Chinese children.

Molecular characteristics and antimicrobial susceptibility of Staphylococcus aureus among children with respiratory tract infections in southwest China

Background The molecular characteristics and antimicrobial susceptibility of Staphylococcus aureus (S.aureus) in general pediatric wards and county-level hospitals were rarely reported in China.Methods Staphylococcus aureus was isolated from children hospitalized with respiratory tract infection (RTI) in Zhongjiang and Youyang counties in 2015.All isolates were typed by multilocus sequence,staphylococcal protein A,accessory gene regulator (agr),and staphylococcal cassette chromosome mec [SCCmec,for methicillin-resistant S.aureus (MRSA) only].Polymerase chain reaction was used to screen 21 super-antigen (SAg) genes and panton-valentine leukocidin (pvl).Antimicrobial susceptibility testing was performed by E test.Results A total of 2136 children were enrolled.Overall,125 (5.9%) children carried S.aureus,among which MRSA accounted for 42.4%.ST59-SCCmec type Ⅳ-t437-agr group Ⅰ (58.5%) was the most prevalent genotype in MRSA,and ST188-t189-agr group Ⅰ (22.2%) was the top genotype in methicillin-sensitive S.aureus (MSSA).The pvl carriage rate in MRSA and MSSA was 15.1% and 9.7%,respectively (P =0.4112).About 96.8% of S.aureus isolates were positive for at least one SAg gene.The most common SAg gene profile in the dominant ST59 clone was seb-sek-seq (42.8%).All S.aureus isolates were resistant to penicillin and erythromycin (minimum inhibitory concentration 90 was > 32 and 256 mg/L to penicillin and erythromycin,respectively),but usually susceptible to other tested non-β-lactam antimicrobials.Conclusions Staphylococcus aureus and MRSA were detected with a high frequency in children with RTI in county-level hospitals of China.ST59-SCCmec type Ⅳ-t437-agr group Ⅰ was the dominant MRSA clone.The S.aureus isolates exhibited high resistance to penicillin and erythromycin.

A fatal case of liver abscess caused by hypervirulent Klebsiella pneumoniae in a diabetic adolescent:A clinical and laboratory study

Importance Hypervirulent variants of Klebsiella pneumoniae(hvKp)are capable of causing life-threatening pyogenic liver abscesses(PLAs),but hvKp caused PLAs was seldom reported in pediatric populations.Hence,there is an urgent need to raise our awareness of this phenomenon in pediatric populations.Objective This study aimed to report the clinical characteristics of hvKp that caused fatal PLA complicated by bacteremia in an adolescent and further identify the microbiological and genomic features of the causative strain.Methods A 14-year-old boy with diabetes mellitus was admitted to our hospital with a diagnosis of PLA complicated by bacteremia.A hypermucoviscous hvKp strain,KPN_19-106,was isolated from the drainage fluid present within the liver abscess cavity and blood.The hypermucoviscosity phenotype of the causative strain was determined by string test.Its virulence was measured using serum resistance assay and Galleria mellonella larvae-killing assay.Antimicrobial susceptibility was determined by broth microdilution method.Genetic information was obtained by whole-genome sequencing and bioinformatics analysis.Results KPN_19-106 belonged to sequence type 380 and serotype K2 and exhibited stronger serum resistance and higher in vivo lethality than the well-characterized hvKp NTUH-K2044 strain.Although KPN_19-106 is susceptible to most antibiotics,no sign of improvement was observed during treatment with such drugs.Whole-genome sequencing revealed that the isolate had integrated multiple mobile genetic elements related to virulence.Interpretation Antibiotic-susceptible hvKp can cause fatal PLA complicated by bacteremia in adolescents,with no improvement during antimicrobial therapy.The causative strain in this case had integrated multiple virulence genes and thus exhibited higher virulence both in vitro and in vivo when compared with NTUH-K2044.

Criteria and practical guidance for determination of brain death in children （BQCC version）

Part I. Criteria for determination of brain death in children from 29 days to 18 yearsI. The prerequisites of the determinationA. Known cause of coma B. Exclusion of reversible coma.II. The clinical diagnosis A. Deep coma.B. Absence of brainstem reflexes.

Steel wire causing pseudoaneurysm of descending aorta

An l l-years-old boy presented with 7 days history of abdominal pain, precordial pain and intermittenthematemesis. The physical examination revealed appearance of anemia, precordial tenderness without other positive findings. Routine blood test was notable for Hb 60 g/L. Contrast CT scan of the chest revealed a soft tissue dense mass close to the descending aorta （Figure 1 A and B）. The mass and the adjacent artery were luminally connected and intensified substantially at the same time and to the same degree on the radiographic studies. The wall of the mass was slightly thickened and the inner surface of the wall was not smooth. The esophagus was deviated and became narrow due to compression （Figure 1 A）. Axial maximum intensity projection （MIP） showed a linear metallic foreign body （Figure I C） and local airway moved forward and became flat. Volume rendering （VR） confirmed a right- side protruding mass adjacent to the beginning of the descending aorta （Figure 1 D）. The gastroscopy showed ulceration of the esophageal mucosa （Figure 1 E）.

Identification of hemolytic activity and hemolytic genes of Methicillin-resistant Staphylococcus aureus isolated from Chinese children

To the Editor:Methicillin-resistant Staphylococcus aureus(MRSA)are a group of gram-positive bacteria that cause a wide range of diseases in children.[1]Surveillance of MRSA is particularly important since certain clones have spread over wide geographical regions.The MRSA clones that have spread in North China over the past decade include ST59-SCCmecIVa-t437,ST59-SCCmecV-t437,and ST239-SCCmecIII-t030.