OBJECTIVES: To study the clinical and microbiological characteristics of children with drowning-associated aspiration pneumonia, so as to provide a reference for empirical selection of antibacterial agents. METHODS: A retrospective analysis was performed on the medical data of 185 children with drowning-associated aspiration pneumonia who were admitted to Children's Hospital of Chongqing Medical University from January 2010 to October 2020. According to the drowning environment, these children were divided into four groups: fecal group (n=44), freshwater group (n=69), swimming pool group (n=41), and contaminant water group (n=31). The clinical characteristics and pathogen detection results were reviewed and compared among the four groups. RESULTS: The 185 children had an age of 4 months to 17 years (median 34 months). Sputum cultures were performed on 157 children, and 103 were tested positive (65.6%), with 87 strains of Gram-negative bacteria (68.5%), 37 strains of Gram-positive bacteria (29.1%), and 3 strains of fungi (2.4%). Gram-negative bacteria were the main pathogen in the fecal group and the contaminant water group, accounting for 88.2% (30/34) and 78.3% (18/23), respectively. The freshwater group had a significantly higher detection rate of Gram-positive bacteria than the fecal group (P<0.008), and the swimming pool group had an equal detection rate of Gram-negative bacteria and Gram-positive bacteria. CONCLUSIONS For pulmonary bacterial infection in children with drowning in feces or contaminant water, antibiotics against Gram-negative bacteria may be applied empirically, while for children with drowning in a swimming pool or freshwater, broad-spectrum antibiotics may be used as initial treatment, and subsequently the application of antibiotics may be adjusted according to the results of the drug sensitivity test.
Anti-Bacterial Agents/therapeutic use* ; Child ; Drowning ; Gram-Negative Bacteria ; Humans ; Pneumonia, Aspiration/drug therapy* ; Retrospective Studies ; Water

Anti-Bacterial Agents ; administration & dosage ; therapeutic use ; Enteral Nutrition ; methods ; Food, Formulated ; Gastroesophageal Reflux ; drug therapy ; surgery ; therapy ; Gastroscopy ; Gastrostomy ; methods ; Humans ; Infant ; Jejunostomy ; Male ; Malnutrition ; drug therapy ; therapy ; Pneumonia, Aspiration ; drug therapy ; surgery ; therapy ; Teaching ; methods

PURPOSE: A splenic abscess is a rare disease, but appears to be increasing in frequency. The key to successful treatment is early diagnosis, effective antibiotics treatment and surgical management when needed. This study was intended to clarify the clinico-pathological and radiological findings of splenic abscesses from their therapeutic aspects. METHODS: Between Jan. 1993 and Dec. 2003, the outcomes of 8 splenic abscess patients were retrospectively analyzed. RESULTS: The male to female ratio was 6: 2, with a mean age of 57 years, ranging from 34 to 70 years. Predisposing conditions were identified in 7, including diabetes mellitus, steroid medication, chronic alcoholism, infective endocarditis and lymphoma. As chief complaints, fever/chills was present in 2, left upper quadrant pain/tenderness in 4, diffuse abdominal pain in 1 and dyspnea in 1, with leukocytosis found in 6 (75%). Ultrasonography or computed tomography detected left pleural effusion, splenomegaly and splenic abscess in 7 (88%). The solitary to multiple ratio was 2: 6. An emergency laparotomy for peritonitis detected a solitary abscess rupture in 1. The original site of infection was detected in 5, including endocarditis, dental abscess, urinary tract infection and pancreatitis in 2. Blood cultures were positive in 3 (43%), with Escherichia coli in 1 and Streptococcus viridans in 2. 3 (75%) of 4 specimens had positive culture results, including Pseudomonas, Streptoccus viridans and Enterococcus. 1 (25%) had pathogens identical to bacteria isolated form the blood culture. 1 was identified as mixed infection, with actinomycosis. A splenectomy was performed in 5, including 2 with a distal pancreatectomy, intraoperative fine needle aspiration in a lymphoma and endoscope-guided aspiration in a gastrosplenic fistula. One lymphoma patient, with multiple abscesses, died of aspiration pneumonia during chemotherapy. CONCLUSION: A splenic abscess is rare, and failure of early diagnose and institution of treatment is fatal. Although patients have various underlying diseases, a splenic abscess can develop arising from a dental abscess in a healthy man. Percutaneous drainage may not be suitable for multiple or hilar locations; therefore, a splenectomy, with appropriate antibiotics, is the definitive treatment. A less-invasive treatment modality can be considered, taking into account the patient's clinical situation from an immunological aspect for preservation of the spleen.
Abdominal Pain ; Abscess* ; Actinomycosis ; Alcoholism ; Anti-Bacterial Agents ; Bacteria ; Biopsy, Fine-Needle ; Coinfection ; Diabetes Mellitus ; Drainage ; Drug Therapy ; Dyspnea ; Early Diagnosis ; Emergencies ; Endocarditis ; Enterococcus ; Escherichia coli ; Female ; Fistula ; Humans ; Laparotomy ; Leukocytosis ; Lymphoma ; Male ; Pancreatectomy ; Pancreatitis ; Peritonitis ; Pleural Effusion ; Pneumonia, Aspiration ; Pseudomonas ; Rare Diseases ; Retrospective Studies ; Rupture ; Schools, Medical* ; Spleen ; Splenectomy ; Splenic Diseases ; Splenomegaly ; Ultrasonography ; Urinary Tract Infections ; Viridans Streptococci

OBJECTIVETo evaluate effects of inhaled nitric oxide (iNO) on the expression of lung neutrophil adhesion molecule CD(11b) in experimental meconium aspiration pneumonia treated with conventional mechanical ventilation under room air or 100% O(2).

METHODSRabbits were randomly allocated to 10 groups (n = 60), 6 of each group. Control or meconium aspiration pneumonia model groups were inhaled with room air or 100% O(2). Six treatment groups were treated with continuous NO inhalation at the doses of 6 x 10(-6), 10 x 10(-6) and 20 x 10(-6), respectively for 12 hours under room air or 100% O(2). The ratio of wet/dry (W/D) lung weight, alveolar septal width (ASW), myeloperoxidase (MPO) activity and lung injury score were measured. The expression of CD(11b) in neutrophils of the bronchoalveolar lavage fluid (BALF) was detected with flow cytometry.

RESULTSAfter 12 hours ventilation, the oxygenation was maintained better in treatment groups under different O(2) concentrations than that in model groups. Inflammatory evidence was found in lungs from all the model groups and treatment groups, which was characterized by serious inflammatory cell infiltration in alveolar space and hyaline membrane formation. The lung inflammation was decreased in all groups with nitric oxide inhalation. The ratio of W/D lung weight and ASW among different groups had no significant difference. MPO activities were significantly decreased in groups treated with 10 x 10(-6) and 20 x 10(-6) iNO compared with the model groups [with the concentration of 21% O(2), (1.8 +/- 0.2) U/g vs (4.4 +/- 0.5) U/g and (2.0 +/- 0.1) U/g vs (4.4 +/- 0.5) U/g;with the concentration of 100% O(2), (1.7 +/- 0.4) U/g vs (2.8 +/- 0.5) U/g and (1.4 +/- 0.3) U/g vs (2.8 +/- 0.5) U/g, P < 0.05, respectively]. MPO activities in the 20 x 10(-6) iNO group under 100% O(2) were significantly reduced compared with those under 21%O(2) [(1.4 +/- 0.3) U/g vs (2.0 +/- 0.1) U/g, P < 0.05]. Nitric oxide inhalation with the doses of 10 x 10(-6) and 20 x 10(-6) significantly decreased the expression of CD(11b) (MFI) in neutrophils of the BALF compared with the expressions in model groups without NO treatment (with 21% O(2), 121 +/- 20 vs 392 +/- 204 and 112 +/- 30 vs 392 +/- 204; with 100% O(2), 113 +/- 24 vs 293 +/- 65 and 102 +/- 14 vs 293 +/- 65, P < 0.05, respectively). Under the same iNO dose (10 x 10(-6) or 20 x 10(-6)) no statistic difference was found between groups of different inspired oxygen concentrations (21% and 100%).

CONCLUSIONSInhaled nitric oxide with the doses of 10 x 10(-6) to 20 x 10(-6) could significantly down-regulate the CD(11b) expression in neutrophil of the BALF and reduce the neutrophil sequestration and MPO activity in rabbit lungs, which may decrease the lung inflammation process in meconium aspiration pneumonia.

Administration, Inhalation ; Animals ; CD11b Antigen ; analysis ; Disease Models, Animal ; Female ; Flow Cytometry ; Lung ; drug effects ; metabolism ; pathology ; Male ; Meconium ; chemistry ; Neutrophils ; chemistry ; pathology ; Nitric Oxide ; administration & dosage ; therapeutic use ; Peroxidase ; analysis ; Pneumonia, Aspiration ; etiology ; physiopathology ; therapy ; Rabbits ; Random Allocation

Although there are ever increasing reports of extraintestinal human infections caused by Aeromonads, in both immunocompromised and immunocompetent patients, respiratory tract infections remain uncommon. We describe a case of aspiration pneumonia in an immunocompetent patient with multiple sclerosis, caused by a community acquired, multidrug resistant strain of Aeromonas hydrophila sensitive only to meropenem. The case highlights the clinical significance of Aeromonas hydrophila as a respiratory pathogen, as well as the community origin of multidrug resistance and the utility of newer carbapenems in such cases.
Adolescent ; *Aeromonas hydrophila/physiology ; Drug Resistance, Microbial ; Drug Resistance, Multiple ; Female ; *Gram-Negative Bacterial Infections/drug therapy ; Human ; Pneumonia, Aspiration/*microbiology ; Thienamycins/therapeutic use