儿童下呼吸道肺炎链球菌感染临床特征及耐药性

Clinical features and antimicrobial resistance of lower respiratory tract infection with Streptococcus pneumoniae isolated from children

目的分析南京地区下呼吸道肺炎链球菌(SP)感染患儿的临床特征及耐药性。方法回顾性分析2013年7月—2014年6月南京某儿童医院经痰培养确诊为下呼吸道SP感染的患儿临床资料,对菌株进行药物敏感试验和最低抑菌浓度(MIC)检测。结果 197例SP感染患儿,<3岁者占72.59%,秋冬季发病者占63.96%,外周血白细胞升高者占57.87%,临床表现以咳嗽、发热多见,呼吸系统外并发症以消化系统和循环系统多见。SP对阿奇霉素、青霉素及红霉素耐药率分别为94.92%、92.89%、88.83%;对万古霉素、氯霉素、美罗培南、头孢曲松、氧氟沙星敏感率均>90%,其中对万古霉素敏感率高达98.98%。结论下呼吸道SP感染患儿以3岁内婴幼儿所占比例高,秋冬季节发病多见,对阿奇霉素、青霉素和红霉素耐药率高,临床上应根据药敏结果选择用药。

Objective To explore clinical features and antimicrobial resistance of lower respiratory tract infection （LRTI）with Streptococcus pneumoniae （S .pneumoniae）isolated from children in Nanjing.Methods Clinical data of children with confirmed S .pneumoniae LRTI through sputum culture at a children’s hospital in Nanjing between July 2013 and June 2014 were analyzed retrospectively,S .pneumoniae strains were performed antimicrobial susceptibility testing through K-B method and minimum inhibitory concentration （MIC）testing.Results Among 197 children with S .pneumoniae infection,72.59% were 〈3 years old,63.96% occurred in autumn and winter, 57.87% had elevated leukocyte count,cough and fever were the most common clinical symptoms,complications of digestive and circulatory system were also common.The resistance rates of S .pneumoniae to azithromycin, penicillin,and erythromycin were 94.92%, 92.98%, and 88.83% respectively; the sensitivity rates to vancomycin,chloramphenicol,meropenem,ceftriaxone,and ofloxacin were all 〉 90%,vancomycin was up to 98.98%.Conclusion The percentage of S .pneumoniae LRTI is high in children 〈 3 years old,most occur in autumn and winter,resistance rates to azithromycin,penicillin,and erythromycin are all high,antimicrobial agents should be selected for the treatment of infection according to antimicrobial susceptibility testing.