2013—2017年我院化脓性链球菌儿童株耐药模式及其感染特点分析

Clinical aspects of antibiotic resistance infections caused by Steptococcus pyogenes in children, during 2013-2017 in our hospital

目的了解化脓性链球菌(Streptococcus pyogenes,SP)在儿童中的致病谱及其耐药特点。方法回顾性分析我院2013—2017年细菌培养为SP的患儿的临床特点。结果分离到SP的患儿514例,其中6例同时在咽拭子和阴道分泌物中培养出SP。407株(79.2%)来自阴道分泌物,91株(17.7%)来自呼吸道标本,无菌标本10株(1.9%),其他标本12株(2.3%)。患儿年龄(7.02±2.26)岁。侵袭性感染10例。所有菌株对青霉素、头孢曲松和万古霉素敏感,青霉素MIC50和MIC90分别为0.023和0.048μg/mL;98.4%的菌株对左氧氟沙星敏感,对红霉素、克林霉素耐药率分别为94.6%和93%。2例化脓性脑膜炎患儿发生脑梗塞、脑瘫后遗症。结论SP主要引起儿童呼吸道和外阴阴道感染,青霉素和头孢曲松可作为该菌感染的首选用药,局部使用左氧氟沙星可作为SP外阴阴道炎的基础治疗。

Objective To study the antibiotic resistance of Streptococcus pyogenes isolated from children,and to know clinical aspects of infections caused by the bacteria.Methods A retrospective study was conducted and children who had a positive culture result for Streptococcus pyogenes were included between January 2013 and December 2017,and their clinical and laboratory aspects were collected.Results Streptococcus pyogenes were isolated from 514 patients(Streptococcus pyogenes were identified in both pharynx swabs and vaginal secretions in 6 patients),of which 407 strains(79.2%)were from vaginal secretions and 91 strains(17.7%)from respiratory tract,10 strains(1.9%)from normally sterile sites,12 strains(2.3%)from other specimens.Patients'age was(7.02±2.26)y.Ten were invasive infections.All strains were sensitive to penicillin(penicillin MIC50 and MIC90 were 0.023 and 0.048μg/mL,respectively),ceftriaxone,and vancomycin,and 98.4%were sensitive to levofloxacin.The resistance rate against erythromycin and clindamycin was 94.6%and 93%,respectively.Two children with pyogenic meningitis developed cerebral palsy and cerebral palsy sequelae.Conclusion Streptococcus pyogenes is mainly caused by respiratory tract and vulvar vagina infections in children.Penicillin and ceftriaxone can be used as the first choice for treating the infections caused by this bacterium,while topical antibiotics based on ofloxacin gel should be prescribed in treating vulvovaginal infections caused by this bacteria.