儿童侵袭性肺炎链球菌病35例临床特征和分离株耐药性分析

Clinical characteristics and antibiotic resistance profile of invasive Streptococcus pneumoniae disease in 35 children

目的对厦门市儿童侵袭性肺炎链球菌病(IPD)的临床资料进行调查研究,分析儿童IPD的临床特征和细菌耐药性并指导临床诊治。方法回顾性分析2015年2月—2019年1月厦门大学附属妇女儿童医院收治IPD患儿的临床资料,包括人口学特征、临床表现和实验室检查。结果35例IPD患儿中,肺炎链球菌血流感染31例,肺炎链球菌脑膜炎4例;婴幼儿(<3岁)26例,夏季发病率低。所有患儿均出现高热,部分出现咳嗽、贫血。所有患儿C反应蛋白(CRP)增高,绝大部分患儿白细胞(WBC)、降钙素原(PCT)升高,部分患儿胆汁酸(TBA)、乳酸脱氢酶(LDH)、羟丁酸脱氢酶(HBDH)、肌酸激酶(CK)升高。侵袭性肺炎链球菌对利奈唑胺、万古霉素100%敏感;对阿莫西林较敏感;对克林霉素和红霉素100%耐药;脑膜炎者分离的肺炎链球菌对青霉素、头孢噻肟及头孢吡肟的耐药率明显高于血流感染者。治疗以阿莫西林-克拉维酸钾或第三代头孢菌素为主,肺炎链球菌性脑膜炎以头孢曲松联合万古霉素抗感染。结论IPD在婴幼儿中最常见,临床表现为高热等,常见的并发症为肺炎、贫血,伴有WBC、CRP及PCT升高。肺炎链球菌血流感染者分离的64.7%肺炎链球菌对青霉素敏感,肺炎链球菌脑膜炎患者分离的肺炎链球菌对青霉素完全耐药。抗生素的使用应合理、规范,药敏试验结果是重要的参考依据。

Objective To explore the invasive pneumococcal disease(IPD)in Xiamen for improving clinical diagnosis and treatment.Methods The clinical data of IPD children admitted to Women and Children’s Hospital,School of Medicine,Xiamen University from February 2015 to January 2019 were retrospectively analyzed,including demographic data,clinical manifestations,and laboratory tests.Results The 35 IPD cases included 31 cases of bloodstream infection due to Streptococcus pneumoniae and 4 cases of pneumococcal meningitis.Most(26/35)of the patients were infants and young children.The incidence was lower in summer than in other seasons.All the children had high fever and some had cough and anemia.C-reactive protein increased in all the children.White blood cell count and serum procalcitonin increased in most cases.Total bile acid,lactate dehydrogenase,a-hydroxybutyrate dehydrogenase,and creatine kinase increased in some of the children.All the invasive S.pneumoniae strains were susceptible to linezolid,and vancomycin,and to some extent,amoxicillin,but resistant to clindamycin and erythromycin.The S.pneumoniae strains isolated from meningitis showed significantly higher resistance rates to penicillin,cefotaxime and cefepime than the isolates from bloodstream infection.Amoxicillin sodium-clavulanic acid or third generation cephalosporins were the mainstay antimicrobial agents for IPD.Pneumococcal meningitis could be managed with ceftriaxone combined with vancomycin.Conclusions IPD is mostly found in infants and toddlers.High fever is one of the most common clinical manifestations.Pneumonia and anemia are common complications.White blood cell count,C-reactive protein,and procalcitonin may increase.Most(64.7%)of the S.pneumoniae isolates from bloodstream infections are susceptible to penicillin.All the S.pneumoniae isolates from pneumococcal meningitis are resistant to penicillin.Antimicrobial agents should be prescribed reasonably based on the results of local antimicrobial susceptibility testing.