肺炎球菌疾病住院儿童的临床特征分析

Analysis of clinical characteristics of hospitalized children with pneumococcal disease

目的 总结肺炎球菌疾病(PD)住院患儿的临床特征,为该病的防治提供理论依据。方法 选取2019年5月1日至2022年4月30日在广州医科大学附属妇女儿童医疗中心诊断为PD的住院患儿245例为研究对象。按是否存在基础疾病将患儿分为有基础疾病组(n=72)与无基础疾病组(n=173);依据细菌药敏试验结果是否耐药将患儿分为多重耐药(MDR)组(n=125)与非MDR组(n=120);依据发病前是否至少接种1剂次肺炎球菌疫苗将患儿分为接种疫苗组(n=60)与未接种疫苗组(n=185)。收集患儿的人口学特征、基础疾病、肺炎球菌多重耐药情况,以及是否并发其他病原体感染、重症率、使用呼吸机治疗比例、疾病负担、预后及疫苗接种相关资料,并进行比较分析。结果 PD在3岁及以下婴幼儿阶段高发(79.18%,194/245),合并其他病原体感染为52.24%(128/245),肺炎球菌多重耐药发生率为51.02%(125/245),经儿童重症监护病房(PICU)治疗为37.55%(92/245),存在基础疾病为29.39%(72/245),发病前至少接种1剂次肺炎球菌疫苗比例为24.49%(60/245),气管插管呼吸机辅助通气为22.86%(56/245),侵袭性肺炎球菌疾病为17.55%(43/245)。好转出院为95.10%(233/245),留存后遗症为4.90%(12/245),无死亡病例。有基础疾病组PD患儿MDR发生率(χ^(2)=9.989)、住院时间(Z=-5.258)、住院费用(Z=-6.490)、吸氧比例(χ^(2)=22.407)、入住PICU比例(χ^(2)=46.942)、气管插管呼吸机辅助通气比例(χ^(2)=55.688)、后遗症发生率(χ^(2)=8.450)均高于无基础疾病组,差异均有统计学意义(P<0.05)。MDR组PD患儿合并感染比例低于非MDR组(χ^(2)=9.914),MDR组患儿后遗症发生率高于非MDR组(χ^(2)=5.272),差异均有统计学意义(P<0.05)。接种疫苗组PD患儿MDR发生率(χ^(2)=33.973)、吸氧比例(χ^(2)=18.727)、气管插管呼吸机辅助通气比例(χ^(2)=11.354)均低于未接种疫苗组,差异均有统计学意义(P<0.05);未见接种疫苗组患儿发生后遗症,而未接种疫苗组患儿后遗症发生率为6.49%,差异有统计学意义(P=0.042)。结论 PD在儿童中发病的年龄小,耐药性严峻。有基础疾病的患儿疾病负担更重,更应及时接种肺炎球菌疫苗。

Objective To summarize clinical characteristics of hospitalized children with pneumococcal disease(PD)and provide a theoretical basis for the prevention and treatment the disease.Methods From May 1,2019,to April 30,2022,a total of 245 pediatric patients diagnosed with PD and hospitalized at Guangzhou Women and Children's Medical Center of Guangzhou Medical University were collected as the study subjects.They were categorized into groups based on the presence of underlying diseases:those with underlying diseases(n=72)and those without underlying diseases(n=173).Additionally,patients were divided into groups based on their susceptibility to antibiotics as determined by bacterial sensitivity testing:multidrug resistance(MDR)group(n=125)and non-MDR group(n=120).Furthermore,patients were categorized based on whether they had received at least one dose of pneumococcal vaccine before the onset of illness:vaccinated group(n=60)and unvaccinated group(n=185).And the demographic characteristics,underlying disease,pneumococcal multidrug resistance,presence of concurrent infections with other pathogens,severity rate,proportion of patients receiving mechanical ventilation,disease burden,prognosis,and vaccine-related data of the pediatric patients were recorded and analyzed.Results The incidence of PD was highest in children aged 3 and below(79.18%)with concurrent infections with other pathogens observed in 52.24%(128/245)of cases.The rate of multidrug-resistant pneumococcal infection was 51.02%(125/245)and 37.55%(92/245)of cases required treatment in the pediatric intensive care unit(PICU).Underlying diseases were present in 29.39%(72/245)of cases,while the proportion of patients who had received at least one dose of pneumococcal vaccine before the onset of illness was 24.49%(60/245).Additionally,22.86%(56/245)required assisted ventilation via endotracheal intubation.Invasive pneumococcal disease accounted for 17.55%(43/245)of cases.The discharge rate with improvement was 95.10%(233/245),with 4.90%(12/245)of cases exhibiting residual sequelae,and no deaths were reported.Among patients with underlying diseases,the rates of MDR occurrence(χ^(2)=9.989),duration of hospitalization(Z=-5.258),hospitalization costs(Z=-6.490),oxygen supplementation rate(χ^(2)=22.407),admission to the PICU(χ^(2)=46.942),proportion requiring endotracheal intubation and mechanical ventilation(χ^(2)=55.688),and occurrence of residual sequelae(χ^(2)=8.450)were all higher than those in the group without underlying diseases,and the differences were statistically significant(P<0.05).The proportion of PD patients with concurrent infections in the MDR group was lower than that in the non-MDR group(χ^(2)=9.914).The occurrence rate of residual sequelae was higher in the MDR group than in the non-MDR group(χ^(2)=5.272).Both differences were statistically significant(P<0.05).Among PD patients in the vaccinated group,the occurrence rates of MDR(χ^(2)=33.973),oxygen supplementation(χ^(2)=18.727),and the proportion requiring endotracheal intubation and mechanical ventilation(χ^(2)=11.354)were all lower than those in the unvaccinated group,and the differences were statistically significant(P<0.05).No residual sequelae were observed in the vaccinated group,while the occurrence rate of residual sequelae in the unvaccinated group was 6.49%,with a statistically significant difference(P=0.042).Conclusion PD tends to occur at a young age in children,and antimicrobial resistance is a serious concern.Children with underlying diseases bear a heavier disease burden and should be vaccinated against pneumococcus in a timely manner.