儿童侵袭性肺炎链球菌疾病的临床特征及药物敏感性多中心研究

Clinical characteristics and drug sensitivity in children with invasive pneumococcal disease: a multicenter study

摘要:

目的 了解儿童侵袭性肺炎链球菌疾病（IPD）的临床特征、分离菌株的药物敏感性及耐药危险因素。方法 分析2016年1月至2018年6月共9家三级甲等儿童医院246例IPD住院患儿临床特征及分离菌株的药物敏感性。结果 246例IPD患儿中，男122例，女124例；年龄1 d至14岁，其中 < 1岁68例（27.6%），1岁~54例（22.0%），2岁~97例（39.4%），5~14岁27例（11.0%）。脓毒血症性肺炎是最常见的感染类型（58.5%，144/246），其次为无感染灶血流感染（19.9%，49/246）、脑膜炎（15.0%，37/246）。49例（19.9%）患儿有基础疾病，160例（65.0%）有耐药危险因素。患儿所分离的肺炎链球菌菌株对万古霉素、利奈唑胺、莫西沙星及左氧氟沙星敏感率达100%，对厄他培南、氧氟沙星和头孢曲松（非脑膜炎菌株）敏感率达90%；对红霉素（4.2%）、克林霉素（7.9%）和四环素（6.3%）敏感性低。结论 IPD患儿多见于5岁以下，尤其是2岁以下儿童。部分IPD患儿存在基础疾病，IPD患儿多存在耐药危险因素。脓毒血症性肺炎是最常见的感染类型。IPD患儿所分离的肺炎链球菌菌株对万古霉素、利奈唑胺、莫西沙星、左氧氟沙星、厄他培南和头孢曲松敏感率高。

Abstract:

Objective To study the clinical characteristics, drug sensitivity of isolated strains, and risk factors of drug resistance in children with invasive pneumococcal disease (IPD). Methods The clinical characteristics and drug sensitivity of the isolated strains of 246 hospitalized children with IPD in nine grade A tertiary children's hospitals from January 2016 to June 2018 were analyzed. Results Of the 246 children with IPD, there were 122 males and 124 females. Their ages ranged from 1 day to 14 years, and among them, 68 (27.6%) patients were less than 1 year old, 54 (22.0%) patients were 1 to 2 years old, 97 (39.4%) patients were 2 to 5 years old, and 27 (11.0%) patients were 5 to 14 years old. Pneumonia with sepsis was the most common infection type (58.5%, 144/246), followed by bloodstream infection without focus (19.9%, 49/246) and meningitis (15.0%, 37/246). Forty-nine (19.9%) patients had underlying diseases, and 160 (65.0%) had various risk factors for drug resistance. The isolated Streptococcus pneumoniae strains were 100% sensitive to vancomycin, linezolid, moxifloxacin, and levofloxacin, 90% sensitive to ertapenem, ofloxacin, and ceftriaxone, but had a low sensitivity to erythromycin (4.2%), clindamycin (7.9%), and tetracycline (6.3%). Conclusions IPD is more common in children under 5 years old, especially in those under 2 years old. Some children with IPD have underlying diseases, and most of the patients have various risk factors for drug resistance. Pneumonia with sepsis is the most common infection type. The isolated Streptococcus pneumoniae strains are highly sensitive to vancomycin, linezolid, moxifloxacin, levofloxacin, ertapenem, and ceftriaxone in children with IPD.