Sepsis remains a significant cause of neonatal morbidity and mortality in China.A better understanding of neonatal sepsis in China as compared with other industrialized and non-industrialized countries may help optimi...Sepsis remains a significant cause of neonatal morbidity and mortality in China.A better understanding of neonatal sepsis in China as compared with other industrialized and non-industrialized countries may help optimize neonatal health care both regionally and globally.Literature cited in this review was retrieved from PubMed using the keywords"neonatal sepsis,""early-onset(EOS)"and"late-onset(LOS)"in English,with the focus set on population-based studies.This review provides an updated summary regarding the epidemiology,pathogen profile,infectious work-up,and empirical treatment of neonatal sepsis within and beyond China.The incidence of neonatal EOS and the proportion of Group B Streptococcus(GBS)within pathogens causing EOS in China seem to differ from those in developed countries,possibly due to different population characteristics and intrapartum/postnatal health care strategies.Whether to adopt GBS screening and intrapartum antibiotic prophylaxis in China remains highly debatable.The pathogen profile of LOS in China was shown to be similar to other countries.However,viruses as potential pathogens of neonatal LOS have been underappreciated.Growing antimicrobial resistance in China reflects limitations in adapting antibiotic regimen to local microbial profile and timely cessation of treatment in non-proven bacterial infections.This review stresses that the local epidemiology of neonatal sepsis should be closely monitored in each institution.A prompt and adequate infectious work-up is critically important in diagnosing neonatal sepsis.Adequate and appropriate antibiotic strategies must be overemphasized to prevent the emergence of multi-resistant bacteria in China.展开更多
Background:The AbSeS-classification defines specific phenotypes of patients with intra-abdominal infection based on the(1)setting of infection onset(community-acquired,early onset,or late-onset hospital-acquired),(2)p...Background:The AbSeS-classification defines specific phenotypes of patients with intra-abdominal infection based on the(1)setting of infection onset(community-acquired,early onset,or late-onset hospital-acquired),(2)presence or absence of either localized or diffuse peritonitis,and(3)severity of disease expression(infection,sepsis,or septic shock).This classification system demonstrated reliable risk stratification in intensive care unit(ICU)patients with intra-abdominal infection.This study aimed to describe the epidemiology of ICU patients with pancreatic infection and assess the relationship between the components of the AbSeS-classification and mortality.Methods:This was a secondary analysis of an international observational study(“AbSeS”)investigating ICU patients with intra-abdominal infection.Only patients with pancreatic infection were included in this analysis(n=165).Mortality was defined as ICU mortality within 28 days of observation for patients discharged earlier from the ICU.Relationships with mortality were assessed using logistic regression analysis and reported as odds ratio(OR)and 95%confidence interval(CI).Results:The overall mortality was 35.2%(n=58).The independent risk factors for mortality included older age(OR=1.03,95%CI:1.0 to 1.1 P=0.023),localized peritonitis(OR=4.4,95%CI:1.4 to 13.9 P=0.011),and persistent signs of inflammation at day 7(OR=9.5,95%CI:3.8 to 23.9,P<0.001)or after the implementation of additional source control interventions within the first week(OR=4.0,95%CI:1.3 to 12.2,P=0.013).Gramnegative bacteria were most frequently isolated(n=58,49.2%)without clinically relevant differences in microbial etiology between survivors and non-survivors.Conclusions:In pancreatic infection,a challenging source/damage control and ongoing pancreatic inflammation appear to be the strongest contributors to an unfavorable short-term outcome.In this limited series,essentials of the AbSeS-classification,such as the setting of infection onset,diffuse peritonitis,and severity of disease express展开更多
AIMTo describe factors associated with treatment failure and frequency of resistance-associated substitutions （RAS）.METHODSHuman immunodefciency virus （HIV）/hepatitis C virus （HCV） coinfected patients starting a...AIMTo describe factors associated with treatment failure and frequency of resistance-associated substitutions （RAS）.METHODSHuman immunodefciency virus （HIV）/hepatitis C virus （HCV） coinfected patients starting a first direct-acting antiviral （DAA） regimen before February 2016 and included in the French ANRS CO13 HEPAVIH cohort were eligible. Failure was defned as： （1） non-response [HCV-RNA remained detectable during treatment, at end of treatment （EOT）]; and （2） relapse （HCV-RNA suppressed at EOT but detectable thereafter）. Sequencing analysis was performed to describe prevalence of drug class-specifc RAS. Factors associated with failure were determined using logistic regression models.RESULTSAmong 559 patients, 77% had suppressed plasmaHIV-RNA 〈 50 copies/mL at DAA treatment initiation41% were cirrhotic, and 68% were HCV treatmentexperienced. Virological treatment failures occurred in22 patients and were mainly relapses （17, 77%） thenundefined failures （3, 14%） and non-responses （29%）. Mean treatment duration was 16 wk overall. Posttreatment NS3, NS5A or NS5B RAS were detected in10/14 patients with samples available for sequencinganalysis. After adjustment for age, sex, ribavirin useHCV genotype and treatment duration, low platelecount was the only factor signifcantly associated with ahigher risk of failure （OR： 6.5; 95%CI： 1.8-22.6）. CONCLUSIONOnly 3.9% HIV-HCV coinfected patients failed DAAregimens and RAS were found in 70% of those failingLow platelet count was independently associated withvirological failure.展开更多
Background: Co-infections may represent substantial diagnostic and treatment challenges. Aim: To the better of our knowledge, we describe the first case in the literature of congenital Cytomegalovirus (CMV) infection ...Background: Co-infections may represent substantial diagnostic and treatment challenges. Aim: To the better of our knowledge, we describe the first case in the literature of congenital Cytomegalovirus (CMV) infection following maternal CMV non primary infection contemporary to varicella during pregnancy. Case Presentation: A pregnant woman had a varicella during her pregnancy. Congenital CMV infection was fortuitously discovered in the neonate owing to a universal CMV screening. Retrospective analysis of maternal serums during pregnancy showed CMV reactivation. We aim to highlight that CMV reactivation could be due to varicella and discuss if it could facilitate the transplacental transmission of CMV. Conclusion: This case report emphasizes neonatal CMV screening, and warns against dual maternal infection especially because this may be at particular risk of transmission to the fetus.展开更多
文摘Sepsis remains a significant cause of neonatal morbidity and mortality in China.A better understanding of neonatal sepsis in China as compared with other industrialized and non-industrialized countries may help optimize neonatal health care both regionally and globally.Literature cited in this review was retrieved from PubMed using the keywords"neonatal sepsis,""early-onset(EOS)"and"late-onset(LOS)"in English,with the focus set on population-based studies.This review provides an updated summary regarding the epidemiology,pathogen profile,infectious work-up,and empirical treatment of neonatal sepsis within and beyond China.The incidence of neonatal EOS and the proportion of Group B Streptococcus(GBS)within pathogens causing EOS in China seem to differ from those in developed countries,possibly due to different population characteristics and intrapartum/postnatal health care strategies.Whether to adopt GBS screening and intrapartum antibiotic prophylaxis in China remains highly debatable.The pathogen profile of LOS in China was shown to be similar to other countries.However,viruses as potential pathogens of neonatal LOS have been underappreciated.Growing antimicrobial resistance in China reflects limitations in adapting antibiotic regimen to local microbial profile and timely cessation of treatment in non-proven bacterial infections.This review stresses that the local epidemiology of neonatal sepsis should be closely monitored in each institution.A prompt and adequate infectious work-up is critically important in diagnosing neonatal sepsis.Adequate and appropriate antibiotic strategies must be overemphasized to prevent the emergence of multi-resistant bacteria in China.
文摘Background:The AbSeS-classification defines specific phenotypes of patients with intra-abdominal infection based on the(1)setting of infection onset(community-acquired,early onset,or late-onset hospital-acquired),(2)presence or absence of either localized or diffuse peritonitis,and(3)severity of disease expression(infection,sepsis,or septic shock).This classification system demonstrated reliable risk stratification in intensive care unit(ICU)patients with intra-abdominal infection.This study aimed to describe the epidemiology of ICU patients with pancreatic infection and assess the relationship between the components of the AbSeS-classification and mortality.Methods:This was a secondary analysis of an international observational study(“AbSeS”)investigating ICU patients with intra-abdominal infection.Only patients with pancreatic infection were included in this analysis(n=165).Mortality was defined as ICU mortality within 28 days of observation for patients discharged earlier from the ICU.Relationships with mortality were assessed using logistic regression analysis and reported as odds ratio(OR)and 95%confidence interval(CI).Results:The overall mortality was 35.2%(n=58).The independent risk factors for mortality included older age(OR=1.03,95%CI:1.0 to 1.1 P=0.023),localized peritonitis(OR=4.4,95%CI:1.4 to 13.9 P=0.011),and persistent signs of inflammation at day 7(OR=9.5,95%CI:3.8 to 23.9,P<0.001)or after the implementation of additional source control interventions within the first week(OR=4.0,95%CI:1.3 to 12.2,P=0.013).Gramnegative bacteria were most frequently isolated(n=58,49.2%)without clinically relevant differences in microbial etiology between survivors and non-survivors.Conclusions:In pancreatic infection,a challenging source/damage control and ongoing pancreatic inflammation appear to be the strongest contributors to an unfavorable short-term outcome.In this limited series,essentials of the AbSeS-classification,such as the setting of infection onset,diffuse peritonitis,and severity of disease express
基金Supported by Inserm-ANRS(French National Institute for Health and Medical Research-ANRS/France REcherche Nord and Sud Sida-hiv Hépatites)
文摘AIMTo describe factors associated with treatment failure and frequency of resistance-associated substitutions （RAS）.METHODSHuman immunodefciency virus （HIV）/hepatitis C virus （HCV） coinfected patients starting a first direct-acting antiviral （DAA） regimen before February 2016 and included in the French ANRS CO13 HEPAVIH cohort were eligible. Failure was defned as： （1） non-response [HCV-RNA remained detectable during treatment, at end of treatment （EOT）]; and （2） relapse （HCV-RNA suppressed at EOT but detectable thereafter）. Sequencing analysis was performed to describe prevalence of drug class-specifc RAS. Factors associated with failure were determined using logistic regression models.RESULTSAmong 559 patients, 77% had suppressed plasmaHIV-RNA 〈 50 copies/mL at DAA treatment initiation41% were cirrhotic, and 68% were HCV treatmentexperienced. Virological treatment failures occurred in22 patients and were mainly relapses （17, 77%） thenundefined failures （3, 14%） and non-responses （29%）. Mean treatment duration was 16 wk overall. Posttreatment NS3, NS5A or NS5B RAS were detected in10/14 patients with samples available for sequencinganalysis. After adjustment for age, sex, ribavirin useHCV genotype and treatment duration, low platelecount was the only factor signifcantly associated with ahigher risk of failure （OR： 6.5; 95%CI： 1.8-22.6）. CONCLUSIONOnly 3.9% HIV-HCV coinfected patients failed DAAregimens and RAS were found in 70% of those failingLow platelet count was independently associated withvirological failure.
文摘Background: Co-infections may represent substantial diagnostic and treatment challenges. Aim: To the better of our knowledge, we describe the first case in the literature of congenital Cytomegalovirus (CMV) infection following maternal CMV non primary infection contemporary to varicella during pregnancy. Case Presentation: A pregnant woman had a varicella during her pregnancy. Congenital CMV infection was fortuitously discovered in the neonate owing to a universal CMV screening. Retrospective analysis of maternal serums during pregnancy showed CMV reactivation. We aim to highlight that CMV reactivation could be due to varicella and discuss if it could facilitate the transplacental transmission of CMV. Conclusion: This case report emphasizes neonatal CMV screening, and warns against dual maternal infection especially because this may be at particular risk of transmission to the fetus.
