Objective: To understand the characteristics of bacterial meningitis after pediatric neurosurgical procedures. Methods: This was a retrospective observational study. From January 2016 to December 2022, 64 children diagnosed with post-neurosurgical bacterial meningitis based on positive cerebrospinal fluid (CSF) culture in Department of Neurosurgery of Shanghai Children's Medical Center were selected as the study population. The clinical characteristics, onset time, routine biochemical indexes of cerebrospinal fluid before anti infection treatment, bacteriology characteristics and sensitivity to antibiotics of bacteria cultured from cerebrospinal fluid were analyzed. Based on the CSF culture results, the patients were divided into the Gram-positive bacteria infection group and the Gram-negative bacteria infection group. The clinical characteristics of the two groups were compared using t-tests or Wilcoxon rank-sum tests, and chi-square tests. Results: There were 64 children,42 boys and 22 girls, with onset age of 0.83 (0.50, 1.75) years. Seventy cases of post-neurosurgical bacterial meningitis occurred in the 64 children, of which 15 cases (21%) in spring, 23 cases (33%) in summer, 19 cases (27%) in autumn, and 13 cases (19%) in winter. The time of onset was 3.5 (1.0, 10.0) months after surgery; 15 cases (21%) occurred within the first month after the surgery, and 55 cases (79%) occurred after the first month. There were 38 cases (59%) showing obvious abnormal clinical manifestations, fever 36 cases (56%), vomiting 11 cases (17%). Forty-eight cases (69%) were caused by Gram-positive bacteria, with Staphylococcus epidermidis 24 cases; 22 cases (31%) were caused by Gram-negative bacteria, with Acinetobacter baumannii the prominent pathogen 7 cases. The Gram-positive bacterial infection was more common in summer than the Gram-negative bacterial infection (20 cases (42%) vs. 3 cases (14%), χ²=5.37, P=0.020), while the Gram-negative bacterial infection was more in autumn and within the first month after surgery than the Gram-positive bacterial infection (11 cases (50%) vs. 8 cases (17%), 15 cases (67%) vs. 5 cases (33%), χ²=8.48, 9.02; P=0.004, 0.003). Gram-positive bacteria resistant to vancomycin and Acinetobacter baumannii resistant to polymyxin were not found. However, Acinetobacter baumannii showed only 45% (10/22) susceptibility to carbapenem antibiotics. Conclusions: The clinical presentation of post-neurosurgical bacterial meningitis in children is atypical. Gram-positive bacteria are the main pathogens causing post-neurosurgical bacterial meningitis; Gram-negative bacterial meningitis are more likely to occur in autumn and within the first month after surgery. Acinetobacter baumannii has a high resistance rate to carbapenem antibiotics, which should be taken seriously.
Male ; Female ; Humans ; Child ; China/epidemiology* ; Anti-Bacterial Agents/pharmacology* ; Meningitis, Bacterial/diagnosis* ; Gram-Negative Bacterial Infections/drug therapy* ; Gram-Positive Bacteria ; Gram-Positive Bacterial Infections/drug therapy* ; Carbapenems ; Retrospective Studies ; Microbial Sensitivity Tests ; Drug Resistance, Bacterial

OBJECTIVETo observe the efficacy and safety of linezolid for the treatment of gram positive coccus infections in hematological disease patients.

METHODSOne hundred and two hematological disease patients with suspected or proven gram positive coccus bacteria infection were enrolled in this study. Linezolid was given at a dosage of 600 mg, iv, q12h. The mean treatment period was (10.82 ± 5.12) days (1 to 51 days) with 74.5% over 7 d and 51.0% over 10 d.

RESULTSAmong 102 patients, 57 were male, 45 female aged 11 to 81 years, with a mean of (45.26 ± 19.15) years. Ninety four cases were nosocomial infection (92.2%) and 8 community infection (7.8%); There were pneumonia in 80 (78.4%), septicemia in 11 (10.8%), and infection of other organsin 11 (10.8%); Forty five cases were proven gram positive coccus bacteria infection, and 57 were suspected infection; Fifty one bacteria strains were isolated from cultivated samples of proven patients, in which 22 were staphylococcus aureus with 19 methicillin resistant 13 hemolytic streptococcus, 9 staphylococcus epidermidis with 7 methicillin resistant 6 enterococcus faecom, and 1 enterococcus hirae. Seven cases were mixed with one kind gram negative bacillus infection, 4 mixed with two kinds of gram negative bacillus infection, and 12 mixed with fungal infection; Total clinical response rates by ITT (intention to treatment) analysis was 69.6%, in which 40 (39.2%) were curative and 31 (30.4%) obviously effective; PP (per-protocol) analysis was 70.9%, in which 39 (41.9%) were curative and 27 (29.0%) obviously effective. Bacteria clearance rate was 70.6%, and in this group the clinical effective rate was 88.9%; Adverse effect rate was 2.9%, being transient thrombocytopenia and increased transaminase.

CONCLUSIONLinezolid is a safe and effective antibiotic used in hematological disease patients complicated with infections of gram positive coccus.

Acetamides ; Anti-Bacterial Agents ; therapeutic use ; Cross Infection ; microbiology ; Gram-Positive Bacterial Infections ; drug therapy ; Gram-Positive Cocci ; Hematologic Diseases ; drug therapy ; Humans ; Linezolid ; Oxazolidinones ; Staphylococcus aureus

Enterococcus ; Gram-Positive Bacterial Infections ; diagnosis ; drug therapy ; Humans ; Infant, Newborn ; Male ; Meningitis, Bacterial ; diagnosis ; drug therapy

Continued antimicrobial resistance surveillance can provide valuable information for the empirical selection of antimicrobial agents for patient treatment, and for resistance control. In this 6th annual study for 2002, the susceptibility data at 39 Korean Nationwide Surveillance of Antimicrobial Resistance (KONSAR) hospitals were analyzed. Resistance rates of S. aureus were 67% to oxacillin, and 58% to clindamycin. The ampicillin and vancomycin resistance rates of E. faecium were 89% and 16%, respectively. To penicillin, 71% of S. pneumoniae were nonsusceptible. Resistance rates of E. coli were 11% to cefotaxime, 8% to cefoxitin, and 34% to fluoroquinolone, and those of K. pneumoniae were 22% to ceftazidime, and 16% to cefoxitin. Lowest resistance rates to cephalosporins shown by E. cloacae and S. marcescens were to cefepime, 7% and 17%, respectively. This is the first KONSAR surveillance, which detected imipenem-resistant E. coli and K. pneumoniae. To imipenem, 22% of P. aeruginosa and 9% of Acinetobacter spp. were resistant. Trends of resistances showed a slight reduction in MRSA and in penicillin- nonsusceptible S. pneumoniae, but an increase in ampicillin-resistant E. faecium. Ampicillin-resistant E. coli and H. influenzae remained prevalent. Compared to the previous study, amikacin- and fluoroquinolone- resistant Acinetobacter spp. increased to 60% and 62%, respectively. Ceftazidime- resistant K. pneumoniae decreased slightly, and imipenem- resistant P. aeruginosa and Acinetobacter spp., and vancomycin-resistant E. faecium increased. In conclusion, vancomycin-resistant E. faecium, cefoxitin-resistant E. coli and K. pneumoniae, and imipenem-resistant P. aeruginosa and Acinetobacter spp. increased gradually, and imipenem- resistant E. coli and K. pneumoniae appeared for the first time. Continued surveillance is required to prevent further spread of these serious resistances.
Anti-Bacterial Agents/*therapeutic use ; Cefoxitin/*therapeutic use ; Drug Resistance, Bacterial ; Enterococcus/*drug effects ; Fluoroquinolones/therapeutic use ; Gram-Negative Bacterial Infections/*drug therapy/*epidemiology ; Gram-Positive Bacterial Infections/drug therapy/epidemiology ; Humans ; Imipenem/therapeutic use ; Korea/epidemiology ; Prevalence ; *Vancomycin Resistance

OBJECTIVE: To study the distribution and drug sensitivity test of bacteria of patients on chronic rhinosinusitis with or without nasal polyps. METHOD: The purulent discharges were collected from sinus of 175 patients with chronic rhinosinusitis with or without nasal polyps during endoscopic sinus surgery. The results of germiculture and drug sensitivity test were analyzed. RESULT: From 175 specimens, 118 (67%) showed positive results in germiculture. Among them, 79 strains of gram positive bacteria and 39 strains of gram negative bacteria were detected. Staphylococcus epidermidis, Staphylococcus aureus and Staphylococcus haemolyticus were the most common pathogens in gram positive bacteria. The most common pathogens of gram negative bacteria were P. Aeruginosa, Enterobacter aerogenes, Enterobacter cloacae. The sensitive antibiotic on gram positive bacteria were amikacin, Daptomycin, Linezolid, vancomycin, teicoplanin, amoxicillin and clavulanate potassium, cefuroxime, respectively. The sensitive antibiotics on Gram negative bacteria were amikacin, Cefoperazone/sulbactam and imipenem, ceftazidime ceftazidime, aztreonam, levofloxacin, respectively. CONCLUSION Bacterial infection was common happened in the sinus cavity of patients with chronic rhinosinusitis with or without nasal polyps. Gram positive bacteria were the main pathogenic bacteria and gram positive bacteria and gram negative bacteria have great differences in the sensitivity of antibiotics. For patients with chronic rhinosinusitis, the using of antibiotics should depend on the drug sensitivity test.
Bacterial Infections ; complications ; drug therapy ; Gram-Negative Bacteria ; drug effects ; Gram-Positive Bacteria ; drug effects ; Humans ; Microbial Sensitivity Tests ; Nasal Polyps ; microbiology ; Rhinitis ; microbiology ; Sinusitis ; microbiology

OBJECTIVETo observe the clinical characteristics of infections in adult acute leukemia （AL）patients during chemotherapy in hospital, and identify the risk factors for infections.

METHODSA retrospective study of patients with AL who underwent chemotherapy between July 2010 and Dec 2014 in the First Affiliated Hospital of Xiamen University was conducted. Clinical features and risk factors for infections were analyzed.

RESULTS191 patients with AL received a total of 728 courses of chemotherapies. During these admissions, 385（52.9%) infections episodes occurred. The common infections sites were lower respiratory tract infection（36.3%，153/374）, bloodstream infection（17.1%, 64/374）, oral infection（13.6%，51/374）, and perianal infection（13.4%, 50/374）. 164 strains of pathogenic bacteria were detected. Gram- negative bacteria were recorded in 59.1% of documented pathogens, and Gram- positive bacteria were responsible for 32.9% of infections. Multivariate unconditioned logistic analysis of factors identified consistent independent risk factors for no completely remission（OR=0.142, P< 0.001）, duration of neutropenia longer than 7 days（OR=12.764, P<0.001）, general wards（OR=1.821, P< 0.001）, and hospitalization interval longer than 10 days（OR=0.720, P=0.039）.

CONCLUSIONInfections after chemotherapy for AL continues to be common. AL patients with induction chemotherapy or severe neutropenia faced an increased risk of infections by multivariate analysis. And patients with short-term stay or laminar flow wards seem to be less susceptible to infections.

Acute Disease ; Bacterial Infections ; complications ; Gram-Negative Bacteria ; Gram-Positive Bacteria ; Hospitals ; Humans ; Leukemia ; complications ; drug therapy ; microbiology ; Multivariate Analysis ; Neutropenia ; complications ; Remission Induction ; Retrospective Studies ; Risk Factors

BACKGROUND: Concerns regarding increasing microbial resistance to vancomycin have resulted in recommendations for a higher trough serum vancomycin concentration. This study aimed to assess the dosage guidelines targeting vancomycin trough concentrations of 15-20 mg/L. METHODS: About 216 adult patients (age, >60 yr) were treated with intravenous vancomycin. The patients were divided into 2 groups according to their target vancomycin trough concentrations: the previous guideline group (n=108) treated with targeted vancomycin trough concentrations of 5-15 mg/L from Jan 2009 through April 2011 and the new guideline group (n=108) treated with targeted concentrations of 15-20 mg/L from November 2011 through July 2012. RESULTS: The 2 groups were not significantly different with respect to age, weight, initial serum creatinine, initial creatinine clearance, predictive trough levels, doses, serum drug concentrations, and area under the curve/minimal inhibitory concentrations. Regarding the proportions of vancomycin trough concentrations, the target range was achieved in 50% in the previous guideline group and in 16% in the new guideline group. In the previous and new guideline groups, the trough concentrations of 10-20 mg/dL were observed in 32.4% and 52.8% patients, respectively, and those of <10 mg/L were observed in 45.4% and 29.6%, respectively. CONCLUSIONS: Compared to the previous guideline group, the new guideline group showed higher proportions in the therapeutic range of 10-20 mg/L and lower proportions in trough concentrations <10 mg/L. The strictly managed vancomycin therapeutic drug monitoring in the new guideline group was assessed as more effective.
Aged ; *Drug Monitoring ; Female ; Gram-Positive Bacterial Infections/drug therapy ; Guidelines as Topic ; Half-Life ; Humans ; Injections, Intravenous ; Male ; Middle Aged ; Vancomycin/*blood/pharmacokinetics/therapeutic use

BACKGROUND: The purpose of this study was to evaluate the etiologic organisms, risk factors, and other infectious features of febrile neutropenic patients developing septic shock. METHODS: We reviewed medical record of 457 patients developing neutropenic fever after chemotherapy or hematopoietic stem cell transplantation (HSCT) at Catholic HSCT Center from Jan 1998 to Dec 1999. Out of them, age/sex matched patients without septic shock were enrolled into the control group, and retrospective case-control study was conducted. RESULTS: Overall incidence of septic shock was 8.5%. Most common underlying disease of the two groups was acute leukemia. Microbiologically defined infection (MDI), especially Gram-negative bacterial infection, was significantly more common in the septic shock group than in the control group. Escherichia coli was the most common organism in the two groups (51.3% vs 27.7%, P<0.001). However, empirical use of glycopeptide was more frequent in the shock group (P<0.05). Differing from other report, fatal infection due to viridans streptococci was not observed in spite of quinolone prophylaxis. Mean leukocyte count at the onset of fever was 207/mm3 and 355/mm3 (P=0.027) and mean duration of total febrile day was 12.3 days and 7.8 days, respectively (P=0.001). On multivariate analysis, MDI and leukocyte count at the onset of fever were the significant risk factors for the septic shock. Overall mortality showed higher tendency in the shock group than in the control group (23.1% vs. 12.0%, P=0.057). Especially, in patients with Gram-positive bacterial infection, infection related mortality was significantly higher in the shock group than in the control group (50% vs. 8.9%, P=0.013). CONCLUSION: Although Gram-positive bacterial infection has been increasing, Gram-negative bacteria, including E. coli, were the most common causative organisms for sepctic shock in febrile neutropenic patients. However, considering high mortality in the septic shock caused by Gram-positive bacteria, glycopeptide must immediately be administered to the febrile neutropenic patients developing septic shock.
Case-Control Studies ; Drug Therapy ; Escherichia coli ; Fever* ; Gram-Negative Bacteria ; Gram-Negative Bacterial Infections ; Gram-Positive Bacteria ; Gram-Positive Bacterial Infections ; Hematopoietic Stem Cell Transplantation ; Humans ; Incidence ; Leukemia ; Leukocyte Count ; Medical Records ; Mortality ; Multivariate Analysis ; Neutropenia ; Retrospective Studies ; Risk Factors* ; Shock ; Shock, Septic* ; Viridans Streptococci

BACKGROUND: The purpose of this study was to evaluate the etiologic organisms, risk factors, and other infectious features of febrile neutropenic patients developing septic shock. METHODS: We reviewed medical record of 457 patients developing neutropenic fever after chemotherapy or hematopoietic stem cell transplantation (HSCT) at Catholic HSCT Center from Jan 1998 to Dec 1999. Out of them, age/sex matched patients without septic shock were enrolled into the control group, and retrospective case-control study was conducted. RESULTS: Overall incidence of septic shock was 8.5%. Most common underlying disease of the two groups was acute leukemia. Microbiologically defined infection (MDI), especially Gram-negative bacterial infection, was significantly more common in the septic shock group than in the control group. Escherichia coli was the most common organism in the two groups (51.3% vs 27.7%, P<0.001). However, empirical use of glycopeptide was more frequent in the shock group (P<0.05). Differing from other report, fatal infection due to viridans streptococci was not observed in spite of quinolone prophylaxis. Mean leukocyte count at the onset of fever was 207/mm3 and 355/mm3 (P=0.027) and mean duration of total febrile day was 12.3 days and 7.8 days, respectively (P=0.001). On multivariate analysis, MDI and leukocyte count at the onset of fever were the significant risk factors for the septic shock. Overall mortality showed higher tendency in the shock group than in the control group (23.1% vs. 12.0%, P=0.057). Especially, in patients with Gram-positive bacterial infection, infection related mortality was significantly higher in the shock group than in the control group (50% vs. 8.9%, P=0.013). CONCLUSION: Although Gram-positive bacterial infection has been increasing, Gram-negative bacteria, including E. coli, were the most common causative organisms for sepctic shock in febrile neutropenic patients. However, considering high mortality in the septic shock caused by Gram-positive bacteria, glycopeptide must immediately be administered to the febrile neutropenic patients developing septic shock.
Case-Control Studies ; Drug Therapy ; Escherichia coli ; Fever* ; Gram-Negative Bacteria ; Gram-Negative Bacterial Infections ; Gram-Positive Bacteria ; Gram-Positive Bacterial Infections ; Hematopoietic Stem Cell Transplantation ; Humans ; Incidence ; Leukemia ; Leukocyte Count ; Medical Records ; Mortality ; Multivariate Analysis ; Neutropenia ; Retrospective Studies ; Risk Factors* ; Shock ; Shock, Septic* ; Viridans Streptococci

OBJECTIVE: To investigate the bacterial distribution and resistance to antibiotics in culture-positive urine, and to provide reference for rational use of antibiotics in clinical practice. METHODS: Distribution and antibiotic resistance to pathogens in 658 culture-positive patients from Jan. 1, 2007 to Dec. 31, 2008 were analyzed. RESULTS: (1)Pathogenic strains from the 658 patients were collected from the urine specimen in the survey, which included Gram-negative bacilli (70.82%), Gram-positive cocci (26.14%) and fungi (3.04%). The distribution rate of Escherichia coli declined from 68.91% in 2008 to 63.43% in 2007 (P>0.05), and Enterococcus rose from 3.37% to 7.67% (P>0.05), but the difference was not significant. The proportion of Gram-negative bacilli (especially the E.coli) from patients in the Emergency Department and Out-patient Department was higher than that from in-patients, and the proportion of K. pneumonia and Gram-positive bacteria was lower than in-patients, both with significant differences (P<0.05). (2) The resistance rate of E. coli and K. pneumonia to quinolones was 28.57%-56.25%, and the resistance rate to 3rd generation cephalosporin was 38.78%-65.78%, respectively. The resistance rate of Gram-positive cocci to quinolones and 3rd generation cephalosporin was both higher than 50%, and was 11.05% to Vancomycin. CONCLUSION Gram-negative bacilli such as E. coli and K. pneumonia are predominant organism in the urinary tract infections, but proportion of Gram-positive bacteria has increased in recent years. Attention needs to be paid to the overall and severe bacterial resistance in the urinary tract infections and rational use of antibiotics.
Adult ; Anti-Infective Agents, Urinary ; pharmacology ; Drug Resistance, Bacterial ; Escherichia coli ; drug effects ; isolation & purification ; Female ; Gram-Negative Bacteria ; isolation & purification ; Gram-Positive Bacteria ; isolation & purification ; Humans ; Male ; Retrospective Studies ; Urinary Tract Infections ; drug therapy ; microbiology ; Urine ; microbiology