The aim of this study was to explore the epidemiological and molecular characteristics of Streptococcus pyogenes in children from different cities in mainland China who were diagnosed with scarlet fever, impetigo and pharyngitis, as well as to detect asymptomatic carriers, between 2005 and 2008, and to compare the results with isolates from rural Chinese children with acute glomerulonephritis in 2005 and in the 1990s. Susceptibility tests to determine MICs and analysis of the presence of erythromycin-resistant genes (mefA, ermB and ermA) and emm gene typing were performed on 466 S. pyogenes isolates from Beijing, Shanghai, Chongqing and Shenzhen. Superantigen genes (speA and speC) were examined by performing PCR on isolates with the most prevalent emm genotype. All isolates were sensitive to penicillin, cefradine and ofloxacin. The highest rate of resistance was against clarithromycin (98.1 %), followed by erythromycin (97.6 %), azithromycin and clindamycin (both 97.2 %), and tetracycline (94.0 %). Among the 466 isolates, 421 (90.3 %) harboured the ermB gene, 145 (31.1 %) were speA-positive and 273 (58.6 %) were speC-positive. The speA gene was common in emm1.0 (88.8 %) and emm6.5 (83.3 %) genotypes. The speC gene was frequently observed in emm4.0 (90.0 %), emm12.0 (69.6 %), emm18.0 (66.7 %), emm22.0 (75.9 %) and emm80.0 (80.0 %) genotypes. The most prevalent emm genotypes in mainland China in recent years were emm1.0 and emm12.0. All isolates remained sensitive to b-lactams and quinolone.

Streptococcus pyogenes are highly prevalent bacterial pathogens, especially in school-aged children. However, the characteristics of asymptomatic carriers vary geographically in different countries. We aimed to investigate S. pyogenes isolated from healthy schoolchildren in China. From 2007 to 2008, a total of 94 S. pyogenes isolates were obtained from healthy schoolchildren in Beijing and Chongqing, China. Antimicrobial susceptibility testing, determination of macrolide resistance genes (ermB, ermA and mefA), emm genotyping, pulsed-field gel electrophoresis (PFGE), and multilocus sequence typing (MLST) were performed. The resistance rate to macrolides was 96.8% and to tetracycline was 92.6%. All macrolide-resistant isolates exhibited constitutive resistance; 77 isolates (84.6%) had the ermB gene, while 14 isolates (15.4%) had the ermA gene. Among the macrolide-resistant isolates, the most frequent emm type was emm12 (51.6%), followed by emm22 (14.3%) and ST1815 (8.8%). PFGE analysis revealed 12 different patterns, with a given pattern having the same sequence type (ST) by MLST and the same emm type. In conclusion, the rate of macrolide resistance to S. pyogenes is currently very high in China. This is due primarily to the dissemination of a limited number of clones.

No abstract

No abstract

The main phenotype is cMLS, and the ermB gene code is the main resistance mechanism against macrolides in S. pyogenes. The high rate of macrolide resistance to S. pyogenes was observed, which may be correlated with the overuse of these antibiotics in China.

ObjectiveTo assess the incidence, risk factors, and clinical characteristics of perinatal stroke in Beijing.MethodsThis multicenter prospective study included all the live births from 17 representative maternal delivery hospitals in Beijing from March 1, 2019 to February 29, 2020. Neonates with a stroke were assigned to the study group. Clinical data, including general information, clinical manifestations, and risk factors, were collected. Up until 18 months after birth, neonates were routinely assessed according to the Ages and Stages Questionnaire (ASQ) and/or the Bayley scale. Statistical analysis was done using the chi-squared, t-tests, and logistic regression analysis using SPSS version 26.0.OutcomesIn total, 27 cases were identified and the incidence of perinatal stroke in Beijing was 1/2,660 live births, including 1/5,985 for ischemic stroke and 1/4,788 for hemorrhagic stroke. Seventeen cases (62.96%) of acute symptomatic stroke and convulsions within 72 h (10 cases, 37.04%) were the most common presentations. Ten patients showed no neurological symptoms and were found to have had a stroke through routine cranial ultrasonography after being hospitalized for non-neurological diseases. The risk factors include primiparity, placental or uterine abruption/acute chorioamnionitis, intrauterine distress, asphyxia, and severe infection. In the study group, 11.1% (3/27) of patients had adverse neurodevelopmental outcomes. The patients in the study group had lower scores for the ASQ than those in the control group in the communication, gross, and fine motor dimensions.ConclusionThe incidence of perinatal stroke in Beijing was consistent with that in other countries. Routine neuroimaging of infants with risk factors may enable identification of asymptomatic strokes in more patients. Patients who have suffered from a stroke may have neurological sequelae; therefore, early detection, treatment, and regular follow-ups are beneficial for improving their recovery outcomes.

Background: To establish a clinical prediction model of acute bilirubin encephalopathy (ABE) using amplitude-integrated electroencephalography (aEEG). Methods: A total of 114 neonatal hyperbilirubinemia patients in the Beijing Chaoyang hospital from August 2015 to October 2018 were enrolled in this study. There were 62 (54.38%) males, and the age of patients undergoing aEEG examination was 2-23 days, with an average of 7.61±4.08 days. Participant clinical information, peak bilirubin value, albumin value, hyperbilirubinemia, and the graphic indicators of aEEG were extracted from medical records, and ABE was diagnosed according to a bilirubin-induced neurological dysfunction (BIND) score >0. Multivariable logistic regression was used to establish a clinical prediction model of ABE. Furthermore, decision curve analysis (DCA) was performed to evaluate the model's predictive value. Results: According to the BIND score, there were a total of 23 (20.18%) ABE cases. The multivariable logistic regression analysis showed that the value of bilirubin/albumin (B/A), presence of hyperbilirubinemia risk factors, number of sleep-wake cycling (SWC) within 3 hours, widest bandwidth, duration of SWC, and type of SWC were significantly associated with ABE. A clinical prediction model was developed as: p=ex/ (1+ex), X=0.278+0.713*B/A+2.602*with risk factors (with risk factors equals 1) − 1.500*SWC number within 3 hours + 0.219*the widest bandwidth-0.065*the duration of one SWC + 1.491* SWC (mature SWC equals 0, immature SWC equals 1). The area under the curve (AUC) was 0.85 [95% confidence interval (CI): 0.75-0.94], which was significantly higher than the AUC only based on conventional clinical information of B/A (AUC: 0.58, 95% CI: 0.45-0.72). The DCA also showed good predictive ability compared to B/A. Conclusions: A clinical prediction model can be established based on the patients' B/A, presence of risk factors for hyperbilirubinemia, number of SWC within 3 hours, widest bandwidth, duration of 1 SWC, and the type of SWC. It has good predictive ability and may improve the diagnostic accuracy of ABE.

Objective Adopting the methodology of quality improvement (QI) to explore the multiple interventions to increasing the follow-up rate of preterm infants and evaluate the effect of these QI interventions. Methods The quality improvement method based on statistical process control was used in this project. The baseline was measured per week from March to May 2017 according to the follow-up rate of preterm infants before the interventions, further, the specific aim of improvement was determined. The Pareto analysis of follow-up failure and the key driving diagram was constructed. The intervention measures were synchronized to monitor the change of weekly follow-up rate through the control chart until the QI goal was achieved. Results The baseline of follow-up rate was 57.92%, and the aim of the QI project was to increase the follow-up rate to 80% within 12 months. Major interventions included optimizing follow-up platform, strengthening family follow-up education and improving follow-up clinic service ability. The control chart showed that the follow-up rate increased to 74.09% in July 2017 and to 83.09% in December 2017 with a series of interventions and achieved the aim of QI. This improvement had been sustained for 6 months. Conclusion Our QI project increased the follow-up rate of preterm infants significantly. Interventions according to analysis of follow-up failure, such as strengthening family follow-up education and improving follow-up clinic service ability, could improve follow-up of preterm infants.