| 摘要: |
| 目的：探讨郑州大学附属儿童医院侵袭性肺炎链球菌病（IPD）患儿临床特征及细菌耐药情况，为临床诊治IPD及合理用药提供参考。方法：回顾性分析我院2015年3月至2020年3月收治的住院患儿无菌部位标本（血、脑脊液、关节积液、骨髓液及胸腹水等）分离出肺炎链球菌者，共138例患儿159株病原菌，分析患儿性别、年龄、感染类型、基础疾病等一般资料及分离菌株的耐药性检测结果。结果：138例患儿中男86例，女52例，男女比例1.65∶1，年龄1天~13岁，中位年龄1岁2个月，<5岁125例（90.6%）。临床类型包括脑膜炎41例（29.7%）、菌血症性肺炎46例（33.3%）、无病灶血流感染35例（25.4%）。98.55%患儿以发热为首发症状，34例（24.6%）有基础疾病。脑膜炎和非脑膜炎菌株对青霉素的不敏感率分别为66.67%（22/33）和7.94%（10/126），差异有统计学意义（P<0.01）。与非肺炎链球菌脑膜炎组比较，脑膜炎组外周血中性粒细胞百分比、C反应蛋白（CRP）、降钙素原（PCT）、脑脊液白细胞计数和脑脊液蛋白量比较差异均有统计学意义（P<0.05）。随访结果显示，死亡17例（12.3%）。结论：我院儿科确诊IPD多为<2岁社区感染患儿，多有ICU入住史及机械通气史。死亡病例多为脑膜炎感染患儿，IPD致病菌耐药严重，脑膜炎肺炎链球菌分离株青霉素耐药率高于非脑膜炎分离株，临床诊治工作应集中于防控、及时送检及合理使用抗菌药物 |
| 关键词: 肺炎链球菌 侵袭性感染 临床特征 耐药性 |
| DOI：10.13407/j.cnki.jpp.1672-108X.2021.07.011 |
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| 基金项目:2018 年河南省医学科技攻关计划项目,编号2018020677 |
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| Clinical Characteristics and Drug Resistance Analysis of Invasive Infection of Streptococcus Pneumoniae in a Children’s Hospital |
| Fang Panpan, Wang Yingyuan, Yang Junwen, Gao Kaijie, Yang Junmei, Sun Hongqi |
| (Children’s Hospital Affiliated to Zhengzhou University, Zhengzhou Key Laboratory of Children’s Infection and Immunity, Henan Zhengzhou 450018, China) |
| Abstract: |
| Objective: To probe into the clinical characteristics and bacterial drug resistance of children with invasive pneumococcal disease (IPD) in the Children’s Hospital Affiliated to Zhengzhou University, so as to provide reference for clinical diagnosis and treatment of IPD and rational drug use. Methods: Streptococcus pneumoniae isolated from sterile site specimens (blood, cerebrospinal fluid, joint effusion, bone marrow fluid and pleural effusion) in hospitalized children of our hospital from Mar. 2015 to Mar. 2020 were retrospectively analyzed. A total of 138 children with 159 strains of pathogenic bacteria were enrolled. General information such as gender, age, type of infection, underlying disease and the results of drug resistance testing of isolated strains were analyzed. Results: Among the 138 children, 86 cases were males and 52 cases were females, the male-to-female ratio was 1.65∶1, with age ranged from 1 d to 13 years, the median age was 1 year and 2 months, 125 cases (90.6%) were <5 years old. The clinical types included 41 cases of meningitis (29.7%), 46 cases (33.3%) of bacteremic pneumonia and 35 cases (25.4%) of non-focused bloodstream infection. Fever was the first symptom in 98.55% of children, underlying diseases were found in 34 cases (24.6%). The insensitivity rates of meningitis and non-meningitis strains to penicillin were respectively 66.67% (22/33) and 7.94% (10/126), with statistically significant difference (P<0.01). Compared with the non-pneumococcal meningitis group, there were statistically significant differences in the percentage of peripheral blood neutrophils, C-reactive protein (CRP), procalcitonin (PCT), cerebrospinal fluid white blood cell count and cerebrospinal fluid protein in the pneumococcal meningitis group (P<0.05). Result of follow-up showed that 17 cases died (12.3%). Conclusion: Most of the IPD diagnosed in pediatrics of our hospital are children with community infection under 2 years old, and most of them have a history of ICU residence and mechanical ventilation. Most of the deaths are children with meningitis infection. IPD pathogenic bacteria are highly resistant to penicillin. The resistance rate of penicillin isolates of S. pneumoniae is higher than that of non-meningitis. Clinical diagnosis and treatment should focus on prevention and control, timely inspection and rational use of antibiotics |
| Key words: Streptococcus pneumoniae invasive infection clinical characteristics drug resistance |
