Clinical Feature Of Frimary Nephrotic Syndrome Complicated With Respiratory Tract Infection In Children

Objective : Respiratory tract infection(RTI) is one of the most common complications of the primary nephrotic syndrome(PNS), may lead to persistent disease and frequent recurrence in PNS, In this article, we study the clinical characteristics of PNS complicated with RTI in childhood in order to provide reference for clinical work, decrease the recurrence rate and improve the level of prognosis.Methods : the clinical data of 2740 children with PNS inpatient during 2010-2014 in our hospital were analysis retrospectively. According to the location of infection, they were divided into two groups, which were CARTI and HARTI. And We analyze the clincal feature of PNS with different RTI.Results:1. Among 2162 cases of PNS with RTI, 2095 cases were complicated with CARTI(96.90%) and 67 cases were complicated with HARTI(3.10%).2. The number of URTI was 1317 and 34 in PNS with CARTI and HARTI, the ratio was 62.86% and 50.75%.3. From the sputum of PNS with CARTI, more gram-negative bacteria(60.37%) were isolated, in which the top three were Moraxellacatarrhalis(20.37% of all bacterias), Haemophilus parainfluenzae(12.96%), and Haemophilus influenzae(12.96%). In gram-positive bacteria(39.63%), the first three were Streptococcus pneumoniae(24.07%),unknown gram-positive bacteria(9.63%), and Staphylococcus aureus(5.93%). The main virus were Coxsackie virus, Respiratory syncytial virus and Adenovirus. Candida albicans( 66.67%) was the main fungus.Mycoplasma pneumoniae and Chlamydia were the common atypical pathogens.4. From the sputum of PNS with HARTI, more gram-negative bacteria(55.00%) were isolated, in which the top three were Moraxella catarrhalis(20.37% of all bacterias), Pseudomonas aeruginosa(10.00%)and Haemophilus parainfluenzae(5.00%). In gram-positive bacteria(45.00%), the first two were Streptococcus pneumoniae(25.00%),unknown gram- positive bacteria(20.00%), and without Staphylococcus aureus. The main virus were Coxsackie virus and Respiratory syncytial virus. Candida albicans(100.00%)was also the main fungus. Mycoplasma pneumoniae were the common atypical pathogens, and without Choamydiae.5. Among the cases of URTI and LRTI in PNS with CARTI,Streptococcus pneumoniae was the most commmon bacteria, following Haemophilus parainfluenzae and Moraxella catarrhalis; Coxsackie virus,Respiratory syncytial virus and Adenovirus were main virus; Candida albicans was the main fungus; and Mycoplasma pneumoniae and Chlamydia were the common atypical pathogens.6. Among the cases of URTI in PNS with HARTI, Streptococcus pneumoniae was the most commmon bacteria, following unknown gram-positive bacteria and Haemophilus parainfluenzae; Coxsackie virusand Respiratory syncytial virus were main virus; without fungus,Mycoplasma pneumoniae and Chlamydia. While in the LRTI, Moraxella catarrhalis was the most commmon bacteria, following Streptococcus pneumoniae and Pseudomonas aeruginosa; the etiology of virus was the same as URTI; Candida albicans was the main fungus; and Mycoplasma pneumoniae was the common atypical pathogens without Chlamydia.7. According to antibiotics susceptibility test of PNS with CARTI, the susceptibility rate of Moraxella catarrhalis to carbapenems, third generation cephalosporins, ampicillin / sulbactam, amoxicillin / clavulanate potassium,quinolones was more than 96.00%. The susceptibility rate of haemophilus parainfluenzae and haemophilus influenzae to carbapenems, third generation cephalosporins, ampicillin / sulbactam, amoxicillin / clavulanate potassium, quinolones, rifampicin, azithromycin, aztreonam was more than90.00%. The isolated rate of ESBLs bacteria in gram-negative bacteria was23.93%, the rate of Moraxella catarrhalis-ESBLs was 52.73%, and the rate of Haemophilus influenzae-ESBLs was 29.17%. Their sensitive rate to carbapenems, gentamicin, Levofloxacin, rifampicin, ampicillin / sulbactam,amoxicillin / clavulanate potassium, ciprofioxacin CPFX was more than90.00%, to piperacillin/ tazobactam was 50.00%, to second, third and fourth generation cephalosporin was 50.00-100.00%, while they were drug-resistant to cefazolin and piperacillin. The susceptibility rate of Streptococcus pneumoniae to vancomycin, linezolid, quinolones,rifampicin, amoxicillin, cefotaxime was more than 65.00%.And The susceptibility rate of Staphylococcus aureu to glycopeptides, linezolid,amikacin, ciprofloxacin, rifampicin, amoxicillin / clavulanate potassium,oxacillin was more than 85.00%. The isolated rate of ESBLs bacteria in gram-positive bacteria was 9.35%, the rate of Staphylococcus aureu-ESBLs was 62.50%. Their sensitive rate to glycopeptides, linezolid, amikacin,quinolones, rifampicin, amoxicillin / clavulanate potassium was more than80.00%.3.According to antibiotics susceptibility test of PNS with HARTI, the susceptibility rate of Moraxella catarrhalis to carbapenems, ampicillin /sulbactam, amoxicillin / clavulanate potassium, cefaclor, third generation cephalosporins, quinolones, rifampicin was 100.00%. The isolated rate of ESBLs bacteria in gram-negative bacteria was 27.27%, the rate of Moraxella catarrhalis-ESBLs was 25.00%. The susceptibility rate of Streptococcus pneumoniae to vancomycin, linezolid, quinolones, the third and fourth cephalosporin, amoxicillin was more than 50.00%. There were no drug-resistant strains in gram-positive bacteria.Conclusion:1. In children with PNS complicated with RTI, The case of CARTI were more common. And most of the RTI occurred in URTI.2. In children with PNS complicated with RTI, The most common pathogens were Streptococcus pneumoniae in bacteria, Coxsackie virus in virus, Candida albicans in fungus; and Mycoplasma pneumoniae,Chlamydia in atypical pathogens.3. The etiology of PNS with CARTI was different from that with HARTI, especially bacteria and atypical pathogens. Streptococcus pneumoniae, Moraxella catarrhalis and Haemophilus parainfluenzae were the common bacteria in CARTI, however in HARTI the common bacteria were Streptococcus pneumoniae, Pseudomonas aeruginosa and Haemophilus parainfluenzae. The etiology of virus and fungus were the same in CARTI and HARTI. In the CARTI Mycoplasma pneumoniae and Chlamydia were the common atypical pathogens, but without Chlamydia in HARTI.4. The etiology of URTI was similar to that of LRTI in PNS with CARTI. Nevertheless, the etiology was differ between URTI and LRTI in PNS with HARTI. In which the most common bacteria of URTI was Streptococcus pneumoniae and that of LRTI was Moraxella catarrhalis. So it’s need to differentiate the Location and site of RTI for empirical therapy.3. In this data, the isolated rate of ESBLs bacteria was more lower.The isolated rate of gram-negative bacteria-ESBLs was 23.93%, and that of gram-positive bacteria-ESBLs was 9.35% in PNS with CARTI. In PNS with HARTI, The isolated rate of gram-negative bacteria-ESBLs was22.27%, which was similar to CARTI, and there was no drug-resistant strains of gram-positive bacteria. If the pathogen was bacteria, amoxicillin / clavulanate potassium could be the first choice before sputum culture results.