儿童侵袭性流感嗜血杆菌的临床特征及血清型和耐药性

Clinical Characteristics,Serotypes and Drug Resistance of Invasive Haemophilus Influenzae Strains in Children

目的研究儿童侵袭性流感嗜血杆菌(Hi)血清型、耐药性及临床特征。方法回顾性研究郑州大学附属儿童医院2016年1月至2022年1月报告为Hi侵袭性感染的33例患儿以及分离出来的29株菌株,分析患儿的临床资料以及抗菌治疗效果;用乳胶凝集试验检测血清型,采用E-test法、K-B纸片法、头孢硝噻吩纸片法等检测菌株耐药性及对抗菌药物的敏感性。结果29株菌株全部为不可分型Hi(NTHi)。侵袭性Hi感染常见于婴儿和学龄前儿童,主要由血液中检出,2016—2019年患病人数逐年上升,2020—2021年患病人数降低,无明显季节性。常见症状为发热(97.0%),其他包括白细胞、C-反应蛋白(CRP)、降钙素原(PCT)升高。合并肺或上呼吸道感染的患者超过50%。侵袭性Hiβ-内酰胺酶阳性菌株的耐药率高于阴性菌株。侵袭性Hi主要对复方磺胺甲噁唑、氨苄西林、头孢呋辛耐药,且以β-内酰胺酶阳性为主。根据药敏结果调整用药,27例(93.1%)患儿治愈或好转出院,2例(6.9%)死亡。结论儿童侵袭性Hiβ-内酰胺酶阳性是对氨苄西林耐药的主要机制,NTHi是主要型别,三代头孢(头孢他啶、头孢噻肟)和美罗培南可以作为临床首选药物。

Objective Analyze the serotype,drug resistance and characteristics of invasive Haemophilus influenzae(Hi)in children.Methods A retrospective study was conducted on the children with invasive infection of Hi reported in the Children’s Hospital Affiliated to Zhengzhou University from January 2016 to January 2022,as well as 29 isolated strains,the clinical data and antimicrobial treatment effect were analyzed.Serotypes were detected by latex agglutination test,and E-test method,K-B paper sheet method,and cefin-nitrothiophe-ne paper sheet were used to detect bacterial resistance and sensitivity to antibiotics.Results The 29 strains were non-typeable(NTHi).Infections with invasive Hi were common in infants and preschool children,mainly detected in the blood.The number of cases increased year by year from 2016 to 2019 and decreased from 2020 to 2021 with no significant seasonal.Fever(97.0%)was the common symptom,and the level of leukocytes,C-reactive protein(CRP),procalcitonin(PCT)were increased.More than 50%of patients with concomitant lung or upper respiratory tract infections.The drug resistance rate of invasive Hiβ-lactamase-positive strains was higher than that ofβ-lactamase-negative strains.Invasive Hi was mainly resistant to compound sulfamethox-azole,ampicillin,and cefuroxime,andβ-lactam was mainly positive.Patient receiving treatment according to the drug sensitivity results,27 patients(93.1%)were cured or improved and discharged,while 2 patients(6.9%)died.Conclusion Invasive Hi in childrenβ-lactamase-positive was the main mechanism of drug resistance to ampicillin,NTHi is the main type,and the third-generation cephalosporins(ceftazidime,cefotaxime)and meropenem can be used as clinical drugs of choice.