2009至2019年儿童感染性外阴阴道炎临床特征及病原学分析

Clinical and etiological characteristics of infectious vulvovaginitis in children in Zhejiang province from 2009 to 2019

目的探索儿童感染性外阴阴道炎的临床特点、常见病原体特征。方法回顾性病例系列研究。收集2009年1月至2019年12月在浙江大学医学院附属儿童医院小儿青少年妇科就诊的3268例感染性外阴阴道炎患儿的临床表现和实验室检查结果。根据患儿年龄分为<7、7~<10及10~<18岁3组;根据季度分为第1~4季度4组,比较组间感染性外阴阴道炎患儿病原体分布特征,组间比较采用χ^(2)检验。结果3268例患儿中,就诊年龄为(6.2±2.5)岁,<7岁1728例(52.9%),7~<10岁875例(26.8%),10~18岁665例(20.3%)。细菌性外阴阴道炎2253例(68.9%),真菌性外阴阴道炎715例(21.9%),其他病原体感染300例(9.2%)。共有2287例(70.0%)患儿进行阴道分泌物细菌培养,共检出2287株病原体。阴道分泌物培养示病原体有化脓性链球菌745株(32.6%)、流感嗜血杆菌717株(31.4%)、大肠埃希菌292株(12.8%)、金黄色葡萄球菌222株(9.7%)和肺炎克雷伯菌67株(2.9%)。<7岁患儿有40.3%(509/1263)为流感嗜血杆菌感染,7~<10岁患儿有41.9%(356/849)为化脓性链球菌感染,10~18岁患儿有26.3%(46/175)为大肠埃希菌感染。药敏结果示化脓性链球菌对青霉素G[100.0%(610/610)]、头孢曲松[100.0%(525/525)]、万古霉素[100.0%(610/610)]均敏感,对红霉素和克林霉素耐药率分别为91.9%(501/545)、90.7%(495/546);流感嗜血杆菌中32.5%(161/496)产生β-内酰胺酶,对美罗培南[100.0%(489/489)]、左氧氟沙星[100.0%(388/388)]均敏感,对氨苄西林耐药率为40.5%(202/499);大肠埃希菌对亚胺培南100.0%(175/175)敏感,对左氧氟沙星、头孢曲松耐药率分别为29.1%(43/148)、35.1%(59/168)。3268例患儿中共分离出28.3%(45/159)甲氧西林耐药金黄色葡萄球菌(MRSA),药敏试验结果示MRSA对利奈唑胺[100.0%(40/40)]、万古霉素[100.0%(45/45)]、替加环素[100.0%(36/36)]均敏感,对青霉素G、红霉素、克林霉素耐药率分别为100.0%(45/45)、95.6%(43/45)、88.9%(40/45);甲氧西林敏感金黄色葡萄球菌(MSSA)对苯唑西林[100.0%(114/114)]、利奈唑胺[100.0%(94/94)]、万古霉素[100.0%(114/114)]、替加环素[100.0%(84/84)]均敏感,对青霉素G、红霉素、克林霉素的耐药率分别为78.1%(89/114)、59.7%(68/114)、46.5%(53/114)。MSSA对青霉素G、红霉素、克林霉素的耐药率均低于MRSA(χ^(2)=11.71、19.74、23.95,均P<0.001)。结论儿童感染性外阴阴道炎就诊年龄在6岁左右,常见的细菌病原体为化脓性链球菌、流感嗜血杆菌、大肠埃希菌,三代头孢菌素可以作为经验用药抗感染的首选药物,但具体临床使用药物时需结合药敏试验结果。

Objective To explore the clinical characteristics,common pathogens in children with vulvovaginitis.Methods This was a retrospective cases study.A total of 3268 children with vulvovaginitis were enrolled,who visited the Department of Pediatric and Adolescent Gynecology,Children′s Hospital,Zhejiang University School of Medicine from January 2009 to December 2019.Patients were divided into 3 groups according to the age of<7,7-<10 and 10-18 years.Patients were also divided in to 4 groups according to the season of first visit.The pathogen distribution characteristics of infective vulvovaginitis were compared between the groups.Their clinical data were collected and then analyzed byχ^(2) test.Results The were 3268 girls aged(6.2±2.5)years.There were 1728 cases(52.9%)aged<7 years,875 cases(26.8%)aged 7-<10 years,and 665 cases(20.3%)aged 10-18 years.Of these cases,2253 cases(68.9%)were bacterial vulvovaginitis,715 cases(21.9%)were fungal vulvovaginitis and 300 cases(9.2%)were vulvovaginitis infected with other pathogens.Bacterial culture of vaginal secretions was performed in 2287 cases,and 2287 strains(70.0%)of pathogens were detected,of which the top 5 pathogens were Streptococcus pyogenes(745 strains,32.6%),Haemophilus influenzae(717 strains,31.4%),Escherichia coli(292 strains,12.8%),Staphylococcus aureus(222 strains,9.7%)and Klebsiella pneumoniae(67 strains,2.9%).Regarding different age groups,H.influenzae was the most common in children under 7 years of age(40.3%,509/1263),S.pyogenes(41.9%,356/849)was predominantly in children aged 7 to 10 years,and E.coli was predominant in children aged 10 to 18 years(26.3%,46/175).Susceptibility results showed that S.pyogenes was susceptible to penicillin G(610/610,100.0%),ceftriaxone(525/525,100.0%),and vancomycin(610/610,100.0%);the resistance rates to erythromycin and clindamycin were 91.9%(501/545)and 90.7%(495/546),respectively.For H.influenzae,32.5%(161/496)producedβ-elactamase,and all strains were sensitive to meropenem(489/489,100.0%)and levofloxacin(388/388,100.0%),while 40.5%(202/499)were resistant to ampicillin.Among E.coli,all strains were sensitive to imipenem(100%,175/175).The resistance rates of E.coli to levofloxacin and ceftriaxone were 29.1%(43/148)and 35.1%(59/168),respectively.A total of 48 strains of methicillin-resistant Staphylococcus aureus(MRSA)were isolated with a proportion of 28.3%(45/159)in 3268 patients.The results of drug susceptibility test showed that all MRSA strains were sensitive to linezolid 100.0%(40/40),vancomycin(45/45,100.0%),and tigecycline(36/36,100.0%);the resistance rates of MRSA to penicillin G,erythromycin and clindamycin were 100%(45/45),95.6%(43/45)and 88.9%(40/45),respectively.All methicillin-sensitive Staphylococcus aureus(MSSA)strains were sensitive to oxacillin(114/114,100.0%),linezolid(94/94,100.0%),vancomycin(114/114,100.0%),and tigecycline(84/84,100.0%);it′s resistance rates to penicillin G,erythromycin and clindamycin were 78.1%(89/114),59.7%(68/114)and 46.5%(53/114),respectively.The drug resistance rate of MSSA to penicillin G,erythromycin and clindamycin were lower than those of MRSA(χ^(2)=11.71,19.74,23.95,respectively,all P<0.001).Conclusions The age of consultation for pediatric infectious vulvovaginitis is mainly around 6 years.The most common pathogens are S.pyogenes,H.influenzae and Escherichia coli.Third generation cephalosporins can be used as the first choice of empirical anti-infection drugs.However,the results of drug susceptibility should be considered for targeted treatment.