肝硬化失代偿被认为是一种以肝功能逐渐恶化、肾功能损害、肝性脑病等肝外器官损害并伴有较高死亡率的疾病综合征。但在过去的十几年中,许多专家认为这一系列临床表现中可能存在一种独立的临床疾病实体,即慢加急性肝衰竭（acute on chro...肝硬化失代偿被认为是一种以肝功能逐渐恶化、肾功能损害、肝性脑病等肝外器官损害并伴有较高死亡率的疾病综合征。但在过去的十几年中,许多专家认为这一系列临床表现中可能存在一种独立的临床疾病实体,即慢加急性肝衰竭（acute on chronic liver failure,ACLF）。这种新定义的综合征以肝硬化急性失代偿（acute decompensation,AD）、展开更多
Objectives: To determine how well antibiotic treatment is targeted by simple c linical syndromes and to what extent drug resistance threatens affordable antibi otics. Design: Observational study involving a priori def...Objectives: To determine how well antibiotic treatment is targeted by simple c linical syndromes and to what extent drug resistance threatens affordable antibi otics. Design: Observational study involving a priori definition of a hierarchy of syndromic indications for antibiotic therapy derived from World Health Organi zation integrated management of childhood illness and inpatient guidelines and a pplication of these rules to a prospectively collected dataset. Setting: Kilifi District Hospital, Kenya. Participants: 11 847 acute paediatric admissions. Main outcome measures: Presence of invasive bacterial infection (bacteraemia or meni ngitis) or Plasmodium falciparum parasitaemia; antimicrobial sensitivities of is olated bacteria. Results: 6254 (53%) admissions met criteria for syndromes requ iring antibiotics (sick young infants; meningitis/ encephalopathy; severe malnut rition; very severe, severe, or mild pneumonia; skin or soft tissue infection): 672 (11%) had an invasive bacterial infection (80%of all invasive bacterial in fections identified), and 753 (12%)-died (93%of all inpatient deaths). Among P falciparum infected children with a syndromic indication for parenteral antibi otics, an invasive bacterial infection was detected in 4.0-8.8%. For the syndr ome of meningitis/encephalopathy, 96/123 (76%) isolates were fully sensitive in vitro to penicillin or chloramphenicol. Conclusions: Simple clinical syndromes effectively target children admitted with invasive bacterial infection and those at risk of death. Malaria parasitaemia does not justify withholding empirical p arenteral antibiotics. Lumbar puncture is critical to the rational use of antibi otics.展开更多
文摘Objectives: To determine how well antibiotic treatment is targeted by simple c linical syndromes and to what extent drug resistance threatens affordable antibi otics. Design: Observational study involving a priori definition of a hierarchy of syndromic indications for antibiotic therapy derived from World Health Organi zation integrated management of childhood illness and inpatient guidelines and a pplication of these rules to a prospectively collected dataset. Setting: Kilifi District Hospital, Kenya. Participants: 11 847 acute paediatric admissions. Main outcome measures: Presence of invasive bacterial infection (bacteraemia or meni ngitis) or Plasmodium falciparum parasitaemia; antimicrobial sensitivities of is olated bacteria. Results: 6254 (53%) admissions met criteria for syndromes requ iring antibiotics (sick young infants; meningitis/ encephalopathy; severe malnut rition; very severe, severe, or mild pneumonia; skin or soft tissue infection): 672 (11%) had an invasive bacterial infection (80%of all invasive bacterial in fections identified), and 753 (12%)-died (93%of all inpatient deaths). Among P falciparum infected children with a syndromic indication for parenteral antibi otics, an invasive bacterial infection was detected in 4.0-8.8%. For the syndr ome of meningitis/encephalopathy, 96/123 (76%) isolates were fully sensitive in vitro to penicillin or chloramphenicol. Conclusions: Simple clinical syndromes effectively target children admitted with invasive bacterial infection and those at risk of death. Malaria parasitaemia does not justify withholding empirical p arenteral antibiotics. Lumbar puncture is critical to the rational use of antibi otics.
