儿童链球菌性肺炎的季节特点及病原菌的耐药性分析

The Seasonal Characteristics of Children with Streptococcus Pneumoniae and Pathogen Resistance Analysis

目的:回顾性分析因肺炎就诊我院的儿童其感染肺炎链球菌对青霉素等临床常用抗生素的耐药性。方法:调阅2008年一月-2012年1月间,所有因肺炎入住我院并在我院治愈的患儿病历及呼吸道标本中的细菌分离、培养、耐药性报告单,剔除其他病原菌所致的儿童肺炎,仅针对分离出的388株肺炎链球菌药敏结果进行回顾性分析。结果:选定的研究期间内,肺炎链球菌所致的儿童肺炎有鲜明的季节特点,以冬春,秋冬交替时段高发。肺炎链球菌对青霉素的耐药率呈逐年上升趋势,分别为48.9%、53.8%、52.6%和55.7%。另外,统计还发现SP对临床常用的抗生素如头孢呋辛(77.8%)、阿奇霉素(82.0%)、红霉素(86.9%)、四环素(79.9%)、克林霉素(80.9%)、甲氧苄啶/磺胺甲恶唑(69.1%)等的耐药性也较以往的报道为高。尽管SP的耐药性较为严峻,但SP对临床部分抗生素尚具有较高的敏感性,这其中比较敏感的包括头孢噻肟、头孢曲松、美罗培南、万古霉素、氧氟沙星以及利奈唑胺,这给临床使用抗生素治疗SP所致的感染性肺炎提供了很好的取舍参考。结论:链球菌所致的儿童肺炎具有鲜明的季节特点,经典的治疗药物青霉素的耐药逐年升高,本地区儿童肺炎链球菌的耐药情况较为严峻,使用抗生素治疗SP感染时应注意参考药敏试验结果。

Objective： We want to learn the situation of Streptococcus pneumoniae resistance to penicillin and the other antibiotics usually used for the children who had gotten sick of pneumonia and gotten recovery at our hospital by the retrospective analysis.Methods： We selected all the medical records of the children who received our treatments at our hospital and recovered from January,2008 to January,2012 because of Childhood pneumonia（CP）,and those patients with other diseases were excluded.All the reports about bacteria isolated,cultured,resistance were reviewed.There were altogether 388 S.pneumoniae susceptibility results were retrospectively analyzed.Results： During the selected period,we found that childhood pneumonia which caused by Streptococcus pneumoniae had distinctive seasonal characteristics.CP had a high incidencein winter and spring especially at autumn and winter alternating periods.From January,2008 to January,2012,the rate of resistance to Penicillin in Streptococcus pneumoniae is 48.9%,53.8%,52.6% and 55.7% respectively and the rate of resistance to Penicillin showed an increasing trend year by year.In our present study,we found that the rate of resistance to clinical commonly used antibiotics such as Cefuroxime,Azithromycin,Erythromycin,Tetracycline,Clindamycin,Trimethoprim/sulfamethoxazole was higher than that of the previous reports,and their rates of resistance were 77.8%,82.0%,86.9%,79.9%,80.9% and 69.1%,respectively.Although the resistance of Streptococcus pneumoniae was more serious than ever,there were a few kinds of antibiotics used clinically which still had a higher sensitivity to it.These antibiotics which were sensitive to Streptococcus pneumoniae included Cefotaxime,Ceftriaxone,Meropenem,Vancomycin,Ofloxacin and Linezolid.Our present research provides a good trade-off reference on the use of antibiotics in the treatments of Childhood pneumonia induced by Streptococcus pneumoniae for the pediatrician.Conclusion： Childhood pneumonia caused by Streptococcus pneumoniae has the distinctive seasonal characteristics.Penicillin is the classic therapeutic drugs to Streptococcus pneumoniae,but its resistance to Streptococcus pneumoniae is going high year by year.The situation of resistance in Streptococcus pneumoniae in Harbin region is relatively severe,pediatrician should pay more attention to consult the susceptibility test reports.