某三甲医院儿童肺炎链球菌感染分布及耐药性研究

Distribution and drug resistance of Streptococcus pneumoniae infection in children

目的探讨某三甲医院儿童肺炎链球菌感染分布及耐药性。方法收集全院2018年8月至2019年7月患儿送检标本,包括痰液、血液、脑脊液、胸水、肺泡灌洗液、脓液、咽拭子等(同一患儿同类标本不重复纳入),进行病原菌菌株鉴定和药敏试验。结果1903例肺炎链球菌中3岁以内患儿1401株(73.62%),3~5岁患儿423株(22.20%),5岁以上患儿71株(3.73%)。5岁以内患儿肺炎链球菌检出率最高,共计1832株(96.27%)。医院不同病区中,儿科肺炎链球菌感染最多(59.85%),呼吸科其次(19.02%)。肺炎链球菌标本来源,痰液最多(79.09%),血液其次(7.62%)。肺炎链球菌冬季检出率最高,秋冬季节明显高于春夏季节(P<0.05)。肺炎链球菌对红霉素、四环素以及复方新诺明耐药率较高,分别达到96.38%,84.06%,64.74%。未发现对万古霉素、利奈唑胺耐药菌株,对头孢曲松、头孢噻肟、厄他陪南、左氧氟沙星、氧氟沙星、莫西沙星、氯霉素敏感性,敏感性均超过80%。结论5岁以下患儿易发生肺炎链球菌感染,临床医生应根据药敏结果谨慎、合理选择抗生素,目前仍可将三代头孢作为治疗首选。

Objective To explore the distribution and drug resistance of Streptococcus pneumoniae infection in children in a top three hospital.Methods All samples from August 2018 to July 2019 were collected,including sputum,blood,cerebrospinal fluid,pleural fluid,alveolar lavage fluid,pus,pharyngeal swab,and etc(the same kind of children's samples not included repeatedly).Then identification and drug sensitivity test of pathogen strains were performed.Results Among 1903 cases of Streptococcus pneumoniae,1401(73.62%)were children under 3 years old,423(22.20%)were children aged from 3 to 5 years old and 71(3.73%)were children over 5 years old.The detection rate of Streptococcus pneumoniae in children within 5 years old was the highest,with a total of 1832 starins(96.27%).In different areas of the hospital,Streptococcus pneumoniae infection was the most common at department of paediatrics(59.85%),followed by department of respiratory(19.02%).The sputum was the most as a source of samples(79.09%),followed by blood(7.62%).The detection rate of Streptococcus pneumoniae was the highest in winter,And the detection rate was significantly higher in autumn and winter than that in spring and summer(P<0.05).The resistance rates of Streptococcus pneumoniae to erythromycin,tetracycline and compound neoforman were 96.38%,84.06%and 64.74%,respectively.No vancomycin and linezolid resistant strains were found.The sensitivity of Streptococcus pneumoniae to ceftriaxone,cefotaxime,etapamil,levofloxacin,ofloxacin,moxifloxacin and chloramphenicol was over 80%.Conclusion Children under 5 years old are prone to Streptococcus pneumoniae infection.Clinicians should choose antibiotics carefully and reasonably according to the results of drug sensitivity.At present,the third generation of cephalosporins can still be the first choice for treatment.