Objective To investigate the pathogenic characteristics and use of antibiotics in children with acute osteomyelitis,and to provide evidence for rational drug use in the clinic.Methods The clinical data of 266 children with acute osteomyelitis admitted to the Department of Orthopedics,Children's Hospital Affiliated to Zhengzhou University from January 2019 to December 2022 were retrospectively analyzed,and the basic information,pathogenic microorganisms,drug sensitivity test results,and antibacterial drug use of the children were statistically analyzed.Results In 266 cases of pediatric acute osteomyelitis,all underwent pathogen examination,and 148 cases were cultured for pathogens with a positive detection rate of 55.64％.A total of 154 strains of bacteria were detected.The top three pathogens were Staphylococcus aureus(104 strains,67.53％),Staphylococcus epidermidis(8 strains,5.19％),and Staphylococcus hominis(7 strains,4.55％).The detection rate of methicillin-resistant Staphylococcus aureus(MRSA)was 33.65％.Compared with methicillin-sensitive Staphylococcus aureus(MSSA),there was no significant difference in disease severity and prognosis of infection with MRSA.The utilization rate of antibiotics was 100.00％;227 cases of empirical antibiotics were used alone,accounting for 85.34％,primarily using ceftriaxone.Combination therapy was used in 39 cases,accounting for 14.66％,mainly ceftriaxone combined with vancomycin;the average course of intravenous drugs was 40.20 days.After receiving the drug sensitivity test results in 148 cases,76 cases(51.35％)continued the original treatment plan due to effective treatment.In 37 cases(25.00％),treatment was adjusted based on the drug sensitivity results due to poor treatment outcomes;the drug sensitivity results indicated sensitivity,but the clinical effect was not good in 25 cases accounting for 16.89％,which changed the drug treatment.In 10 cases(6.76％),clinical treatment was effective,leading to a switch to narrow-spectrum antibiotics or a change from combination therapy to monotherapy based on drug sensitivity results.Conclusion Empiric antibacterial therapy can cover common pathogens in children with acute osteomyelitis,and medication regimens can be adjusted according to clinical efficacy and drug sensitivity.However,the course of intravenous antibiotic treatment is too long,so it is necessary to further optimize the timing of transitioning from intravenous to oral administration.

Background::Sirtuin-3 (Sirt3) has been documented to protect against mitochondrial dysfunction and apoptosis. Honokiol (HKL) is a Sirt3 pharmacological activator with reported neuroprotective effects in multiple neurological disorders. The present study aimed to explore the neuroprotective effects of HKL and the role of Sirt3 following intracerebral hemorrhage (ICH).Methods::An in vivo ICH model in rats was established by injecting autologous blood into the right basal ganglia. PC12 cells were stimulated with hemin. For the in vivo investigation, the modified Neurological Severity Scores and the Morris water maze test were performed to assess neurological deficits. Hematoxylin-Eosin and Terminal deoxynucleotidyl transferase-mediated dUTP nick-end labeling staining were employed to evaluate the histopathology and apoptosis. Immunohistochemical staining was used to investigate the expression of Sirt3. Adenosine triphosphate (ATP) levels were quantified to assess mitochondrial dysfunction. Cell counting kit-8, lactate dehydrogenase assay, and flow cytometry were used to analyze cell vitality and apoptosis in vitro. Immunofluorescence staining was performed to observe mitochondrial morphology and dynamin-related protein 1 (Drp1) localization to mitochondria. Western blot was applied to quantify the expression of Sirt3, Bax, Bcl-2, cleaved-caspase-3, Drp1, phosphorylation of Drp1 at serine-616, and phosphorylation of Drp1 at serine-637 in vivo and in vitro.Results::HKL treatment alleviated neurological deficits, attenuated the histopathological damage and cell apoptosis, and restored the decreased ATP levels in ICH rats. HKL improved cell survival rate, reduced cell apoptosis, and inhibited mitochondrial fission in PC12 cells. Moreover, both in vivo and in vitro models showed increased phosphorylation of Drp1 at Ser616, and reduced phosphorylation of Drp1 at Ser637. Meanwhile, immunofluorescence co-localization analysis revealed that hemin increased the overlap of Drp1 and mitochondria in PC12 cells. The phosphorylation and mitochondrial translocation of Drp1 were effectively reversed by HKL treatment. Importantly, the selective Sirt3 inhibitor 3-(1H-1,2,3-triazol-4-yl) pyridine suppressed these effects. Conclusion::Our findings demonstrated that HKL ameliorated ICH-induced apoptosis and mitochondrial fission by Sirt3, suggesting that HKL has immense prospects for the treatment of ICH.

Objective:To analyze the epidemiological and clinical characteristics of children with brucellosis, and to provide a practical basis and experience for clinical diagnosis and treatment of brucellosis.Methods:Retrospective analysis was used to collect clinical data of children with brucellosis diagnosed at the Children's Hospital Affiliated to Zhengzhou University from May 2015 to October 2017, and their epidemiological characteristics, clinical manifestations, laboratory tests, and clinical diagnosis and treatment were summarized.Results:A total of 24 children were included, including 14 males and 10 females, with an average age of 6 years (1 year 2 months to 12 years old). Except February, onset throughout the year, higher incidence was from May to July (14 cases, 58.33%). The exposure history of the children was mainly exposure to cattle and sheep and consumption of beef and mutton (18 cases, 75.00%). The main clinical manifestations were fever in 24 cases (100.00%), bone and joint pain in 14 cases (58.33%), hepatomegaly in 9 cases (37.50%), splenomegaly in 7 cases (29.17%). Tube agglutination test (SAT) was positive in 21 cases (87.50%), weakly positive in 1 case (4.17%) and negative in 2 cases (8.33%). Brucella was detected in all 24 cases by microbial culture, and in 18 cases (75.00%) by blood culture. Eighteen cases (75.00%) had liver dysfunction. Thirteen cases were misdiagnosed, and the misdiagnosis rate was as high as 54.17%. Twenty-two cases had been cured after treatment, 2 cases relapsed and recovered after continued treatment. Conclusions:Children with brucellosis have diverse epidemiology and clinical features, and are easily misdiagnosed. For children with fever, bone and joint pain and exposure history, pediatricians should be alert to the possibility of brucellosis, conduct microbiological and serological tests, in order to timely, accurate and standardized diagnosis and treatment of children with brucellosis.

OBJECTIVE：To analyze the distribution and drug resistance of bloodstream infection pathogens in a Children’s Hospital from Zhengzhou，and to provide reference rational selection of drugs in anti-infective treatment. METHODS：By retrospective analysis，128 318 blood culture specimens were collected from inpatients in the Affiliated Children’s Hospital of Zhengzhou University from Oct. 2014 to Sept. 2019. The positive rate，clinical symptoms and clinical diagnosis of children with bloodstream infection were analyzed statistically. WHONET 5.6 software was used to analyze pathogenic bacteria of positive specimen，the departments and the resistance of pathogens to the main clinical antibiotics. RESULTS：In 128 318 blood culture samples of inpatients，the positive rate was 2.14％ （2 746/128 318）；among 2 746 blood culture positive sample，the main Symptom of childrem with blood stream infection was fever（1 986/2 746）；main clinical diagnosis included sepsis（1 679/2 746）， bronchopneumonia（858/2 746），purulent meningitis（555/2 746）. The main departments included neonatal diagnosis and treatment center （1 090 strains，accounting for 39.69％） [neonatal intensive care unit （279 strains，accounting for 10.16％），neonatal surgery department （223 strains，accounting for 8.12％），neonatal internal medicine department （209 strains，accounting for 7.61％），infant pediatrics department（200 strains，accounting for 7.28％） and premature pediatrics department（179 strains， accounting for 6.52％）]，hematology oncology department （216 strains，accounting for 7.87％），cardio vascular medicine department（206 strains，accounting for 7.50％）. Gram-positive bacteria accounted for 72.80％，Gram-negative bacteria 24.21％， fugus 2.99％. Among Gram-positive bacteria，coagulase negative staphylococcus（1 414 strains）and Staphylococcus aureus（146 strains）were the most common. The resistance rate of the former to penicillin G，oxacillin and erythromycin was more than 80％， and that of the latter to penicillin G and erythromycin was more than 80％. Among Gram-negative bacteria，Klebsiella pneumoniae （183 strains） and Escherichia coli （172 strains） were the most common. The resistance rates of the former to ampicillin， piperacillin，ampicillin/sulbactam and cefazolin were more than 80％，and the latter to ampicillin and tetracycline were more than 80％. Among the fungus，Candida albicans（42 strains）and Candida parapsilosis（22 strains）were the most common，and the resistance rate to common antifungal drugs was less than 10％. CONCLUSIONS：The pathogens of bloodstream infection in the hospital are complex，mainly coagulase negative staphylococcus and K. pneumoniae，and the drug resistance is severe.

Objective To monitor the susceptibility of clinical isolates to antimicrobial agents in tertiary hospitals in major regions of China in 2022.Methods Clinical isolates from 58 hospitals in China were tested for antimicrobial susceptibility using a unified protocol based on disc diffusion method or automated testing systems.Results were interpreted using the 2022 Clinical &Laboratory Standards Institute(CLSI)breakpoints.Results A total of 318 013 clinical isolates were collected from January 1,2022 to December 31,2022,of which 29.5％were gram-positive and 70.5％were gram-negative.The prevalence of methicillin-resistant strains in Staphylococcus aureus,Staphylococcus epidermidis and other coagulase-negative Staphylococcus species(excluding Staphylococcus pseudintermedius and Staphylococcus schleiferi)was 28.3％,76.7％and 77.9％,respectively.Overall,94.0％of MRSA strains were susceptible to trimethoprim-sulfamethoxazole and 90.8％of MRSE strains were susceptible to rifampicin.No vancomycin-resistant strains were found.Enterococcus faecalis showed significantly lower resistance rates to most antimicrobial agents tested than Enterococcus faecium.A few vancomycin-resistant strains were identified in both E.faecalis and E.faecium.The prevalence of penicillin-susceptible Streptococcus pneumoniae was 94.2％in the isolates from children and 95.7％in the isolates from adults.The resistance rate to carbapenems was lower than 13.1％in most Enterobacterales species except for Klebsiella,21.7％-23.1％of which were resistant to carbapenems.Most Enterobacterales isolates were highly susceptible to tigecycline,colistin and polymyxin B,with resistance rates ranging from 0.1％to 13.3％.The prevalence of meropenem-resistant strains decreased from 23.5％in 2019 to 18.0％in 2022 in Pseudomonas aeruginosa,and decreased from 79.0％in 2019 to 72.5％in 2022 in Acinetobacter baumannii.Conclusions The resistance of clinical isolates to the commonly used antimicrobial agents is still increasing in tertiary hospitals.However,the prevalence of important carbapenem-resistant organisms such as carbapenem-resistant K.pneumoniae,P.aeruginosa,and A.baumannii showed a downward trend in recent years.This finding suggests that the strategy of combining antimicrobial resistance surveillance with multidisciplinary concerted action works well in curbing the spread of resistant bacteria.