儿童侵袭性肺炎链球菌病的临床特征及耐药性分析  

Clinical characteristics and antimicrobial resistance of invasive pneumococcal disease in children

作　　者：刘素云[1] 董琳[1] 杨锦红[2] 

机构地区：[1]温州医学院附属育英儿童医院呼吸科,325027 [2]温州医学院附属育英儿童医院检验科,325027

出　　处：《中华儿科杂志》2010年第2期95-99,共5页Chinese Journal of Pediatrics

摘　　要：目的总结儿童侵袭性肺炎链球菌病（IPD）的临床特征及耐药性资料，以提高对该病的诊疗水平。方法回顾性分析2004年1月-2009年6月55例IPD患儿的临床资料；采集患儿的血液、脑脊液、腹水、纵隔及软组织引流液标本，经实验室培养、分离、鉴定出64株肺炎链球菌（sP），检测其对青霉素等抗生素的敏感性。结果55例IPD患儿中男32例，女23例，男女比例为1．39：1。年龄47d-12岁，其中2岁以下占62％。临床诊断败血症38例（69％）；化脓性脑膜炎9例（16％）；臀部或颈部脓肿7例（13％）；化脓性腹膜炎1例。13例（24％）有基础疾病，以白血病最多见（31％）。3例（5％）有外科手术史；3例（5％）合并病毒感染，2例（4％）合并支原体感染。发病以冬春季为主（73％），89％系社区获得性感染。临床治愈40例，好转12例，死亡3例（5％）；9例（16％）出现神经系统并发症。各年度侵袭性SP检出率间差异有统计学意义（Χ^2=33．93，P〈0．01）；青霉素中介SP和青霉素耐药SP检出率分别为30％和41％；SP对红霉素和氯林可霉素的耐药率高达94％和88％；多重耐药率达89％。结论IPD好发于5岁以下尤其是2岁以下儿童，24％患儿存在基础疾病。临床疾病以败血症和化脓性脑膜炎最常见。Objective Streptococcus pneumoniae （SP） is a major causative agent of community- acquired pneumonia. In children older than 2 months, SP is also the most common cause of invasive bacterial infections. Invasive pneumocoeeal diseases （IPD） have become a severe problem of public health worldwide. The aim of this study was to summarize the clinical characteristics and antimicrobial resistance of IPD in children, and to raise the level of diagnosis and treatment of this disease. Method The clinical data from 55 cases of IPD younger than 12 years old seen from January 2004 to June 2009 in Yuying Children＇s Hospital Affiliated to Wenzhou Medical College were analyzed retrospectively. Blood, cerebrospinal fluid （CSF）, seroperitoneum, mediastinum and soft tissue aspirate specimens were collected from these children, and 64 SP strains were cultured, isolated and confirmed and the antibiotics susceptibility to penicillin and other antibiotics of these strains were assessed. Result The 55 cases of IPD were identified, among whom 32 were male and 23 female, the ratio was 1.39. The ages ranged from 47 days to 12 years. Most （62%） of the cases were aged less than 2 years, and 16% were aged from 2 to 5 years . Overall, 38 （69%） had septicemia, of whom 8 cases were complicated with meningitis, 2 with pneumonia complicated with empyema, 1 had pneumonia complicated with mediastinal abscess and 11 with pneumonia. Nine cases （ 16% ） were diagnosed as meningitis. Seven cases （ 13% ） had hip or neck abscess and 1 case had purulent peritonitis. Thirteen cases （24%） had an underlying disease, including mainly leukemia （31%）, followed by congenital heart disease （23%） and head trauma（ 15% ）. Three cases （5%） had received a surgical operation; 3 cases （5%） had combined virus infections and 2 cases （4%） had mycoplasma infection. Most （73%） episodes occurred in winter and spring. The main origin of infection was community （89%）. Forty of the patients were cured, 12 improved an

关 键 词：肺炎链球菌感染 抗药性 细菌 回顾性研究 儿童 

分 类 号：R446.5[医药卫生—诊断学]