重庆地区小儿侵袭性肺炎链球菌疾病临床特点及耐药性分析  

Clinical Features of Invasive Pneumococcal Disease and its Antimicrobial Resistance in Chongqing

作　　者：李娜[1] 符州[1] 罗征秀[1] 刘恩梅[1] 罗健[1] 刘岚[1] 谢伟[1] 

机构地区：[1]重庆医科大学附属儿童医院,重庆400014

出　　处：《儿科药学杂志》2009年第5期38-40,共3页Journal of Pediatric Pharmacy

基　　金：重庆医科大学课题资助;编号:(2008)5号-XBYB2007052

摘　　要：目的:分析重庆地区小儿侵袭性肺炎链球菌疾病(IPD)临床特点及侵袭性肺炎链球菌耐药特点,为重庆地区儿童侵袭性肺炎链球菌疾病的治疗提供依据。方法:回顾性分析2003~2008年重庆医科大学附属儿童医院27例侵袭性肺炎链球菌疾病患儿的临床特点及其药敏结果。结果:(1)IPD患儿男女比例为1.25∶1,以2岁以下婴幼儿居多,且化脓性脑膜炎患儿中50%为2岁以下。27例患儿临床上均有发热、血象升高、血CRP升高;8例(29.63%)伴有肝脾肿大,3例(11.11%)伴皮疹,1例(3.70%)伴黄疸。27例IPD中,12例(44.44%)为败血症,8例(29.63%)为化脓性脑膜炎,4例(14.82%)为败血症合并肺炎,2例(7.41%)为化脓性胸膜炎,1例(3.70%)为化脓性腹膜炎。(2)27株侵袭性肺炎链球菌对青霉素敏感率为48.15%,对其他常用8种抗生素的耐药率依次为:红霉素(92.59%)、阿奇霉素(92.00%)、四环素(88.00%)、复方新诺明(68.00%)、氯霉素(22.22%)、氧氟沙星(4.00%)、万古霉素(0)、利福平(0)。侵袭性肺炎链球菌株多重耐药率为96.30%。结论:IPD好发于5岁以内尤其是2岁以内的婴幼儿,临床上主要表现为败血症、化脓性脑膜炎等,加强侵袭性肺炎链球菌的耐药监测对指导临床用药有十分重要的意义。Objective： This study was designed to investigate the clinical features of invasive pneumococeal disease （IPD） and its antimicrobial resistance in Chongqing. Methods： Clinical characteristics of 27 cases of IPD admitted to the Children＇s Hospital of Chongqing Medical University from 2003 to 2008 and antimicrobial resistance were analyzed retrospectively. Results： （ 1 ） We identified 27 eases of IPD. The ratio of IPD boys and girls was 1.25 ： 1. Many of the sick children were ≤ 2 years in age. Additionally, of the children with pnemnococcal meningitis, 50% were ≤2 years. All of the 27 patients had fever, leukocytosis and C reactive protein increase, 8 patients （29.63%） had hepatomegaly and/or splenomegaly, 3 patients （11. 11%） had rash, 1 patient （3. 70%） had jaundice. Among the 27 children, 12 patients （44. 44% ） had septicemia, 8 patients （29.63%） had pneumocxx^al meningitis, 4 patients （14. 82%） had septicemia and pneumococeal pneumonia, 2 patients （7.41%） had purulent pleurisy, 1 patient （3.70%） had purulent peritonitis. （2） We studied drug resistance of all the invasive pneumonoccecus. 48.15% strain were sensitive to penicilin, the resistance to the other 8 commonly used antibiotics was erythromycin （ 92. 59% ）, azithromycin （ 92. 00% ）, tetracycline （ 88. 00% ）trimethoprim-sulfamethoxazole （68.00%）, chloromycetin （22.22%）, ofloxacin （4.00%）, vancocin （0）, rifadin （0）. Of the 27 invasive pneumococcal cases, 96.30% were multidrug resistance. Conclusions： Invasive pneumococcal disease has the highest incidence in children under 2 years old. Septicemia and purulent meningitis are the most common clinical manifestation. It is important to strengthen the monitoring of drug resistance of invasive pneumceoccal disease.

关 键 词：侵袭性肺炎 链球菌 耐药性 儿童 

分 类 号：R725.6[医药卫生—儿科] R978.1[医药卫生—临床医学]