下呼吸道肺炎链球菌感染的临床特征及耐药性分析

Clinical characteristics and drug resistance of lower respiratory tract infection with Streptococcus pneumoniae

目的了解呼吸道肺炎链球菌感染的临床特征及耐药性,为临床合理使用抗菌药物提供依据。方法回顾性分析2014年1月-2018年12月在解放军联勤保障部队第980医院确诊为下呼吸道肺炎链球菌感染且从合格呼吸道标本中分离出肺炎链球菌的934例患者的临床资料,应用奥普托欣试验和MA120细菌鉴定/药敏分析系统对分离菌株进行鉴定,仪器法联合E-test法进行药敏试验,采用WHONET 5.6和SPSS 20.0软件进行统计分析。结果934例下呼吸道肺炎链球菌感染患者中,儿童728例,年龄(1.2±1.2)岁,秋冬季发病者占71.07%,外周血白细胞升高者占74.86%,C反应蛋白升高者占85.16%;成人206例,年龄(61.6±19.6)岁,其中94例(45.63%)年龄≥65岁,149例(72.33%)有基础疾病,秋冬季发病者占58.25%,外周血白细胞升高者占77.67%,C反应蛋白升高者占83.98%。934株肺炎链球菌对万古霉素、利奈唑胺、美罗培南的敏感率为100%;成人与儿童菌株对青霉素保持高度敏感,耐药率<1%;对阿莫西林/克拉维酸、头孢噻肟、头孢曲松、头孢吡肟、左氧氟沙星敏感度高,耐药率<6%;对红霉素、阿奇霉素、四环素、克林霉素的耐药率高,均>80%。成人和儿童菌株对克林霉素、头孢呋辛的耐药率呈上升趋势;分离自儿童的肺炎链球菌对头孢呋辛的5年平均耐药率明显高于成人分离株(P<0.05)。结论肺炎链球菌株对大环内酯类抗菌药物耐药率高,不适用于临床经验治疗;对青霉素仍保持高度敏感,可作为治疗感染的首选药物;对头孢呋辛的耐药率较高并呈上升趋势。

Objective To explore the clinical characteristics and antimicrobial resistance of low respiratory tract infection with Streptococcus pneumonia(S.pneumonia)to provide the basis for clinical treatment.Methods The clinical characteristics of patients diagnosed with S.pneumoniae lower respiratory tract infection admitted to the 980st Hospital of the PLA Joint Logistics Support Force from January 2014 to December 2018 were analyzed.The strains were identified by MA120 system and optochin test,antimicrobial susceptibility testing was carried out by using or E-test method,and the statistical analysis was performed by means of WHONET 5.6 and SPSS 20.0.Results Among the 934 patients with S.pneumoniae infection,the mean age was(1.2±1.2)years,71.07%occurred in autumn and winter,74.86%had elevated WBC count and 85.16%had high serum C-reactive protein(CRP)level in the children and the mean age was(61.6±19.6)years,94 patients(45.63%)were≥65 years old,149(72.33%)had underlying diseases,58.25% occurred in autumn and winter,77.67% had elevated WBC count and 83.98% had high serum CRP level in the adult patients.The isolated 934 S.pneumoniae strains were 100%sensitive to vancomycin,linezolid and meropenem.The strains from both children and adult had kept highly susceptible to penicillin,and the resistance rate to penicillin was lower than 1%;the resistance rates to amoxicillin/clavulanate,cefotaxime sodium,ceftriaxone sodium,cefepime and levofloxacin were lower than 6%;the resistance rates to erythromycin,azithromycin,tetracycline,clindamycin were more than 80%,and its resistance rates to clindamycin and cefuroxim showed increasing tread in both adults and children.Mean 5-year resistance rate of S.pneumoniae strains isolated from children to cefuroxim was significantly higher than that of strains from adults(P<0.05).Conclusions S.pneumoniae has high resistance rate to macrolides antibiotics,and is not suitable for clinical treatment;S.pneumoniae keeps better sensitivities to penicillin,which can be used to treat S.pneumoniae infection.The resistance rates of S.pneumoniae strains isolated from adults and children to cefuroxim are all high,and show increasing tread,and therefore it is necessary to reasonably choose antibiotics to control bacterial resistance.