2016年九家儿童医院肺炎链球菌感染的临床特征及分离株药物敏感性分析  

Clinical characteristics and antimicrobial resistance of pneumococcal infections from 9 children＇s hospitals in 2016

作　　者：方潮[1] 陈学军[1] 周明明[1] 陈英虎[2] 赵瑞珍[3] 邓继岿[4] 景春梅[5] 许红梅[6] 杨锦红[7] 陈益平[8] 张泓[9] 张婷[10] 曹三成[11] 邓慧玲[12] 王传清 王爱敏 俞蕙 王世富[15] 林爱伟[16] 王星[17] 曹清 Fang Chao;Chen Xuejun;Zhou Mingming;Chen Yinghu;Zhao Ruizhen;Deng Jikui;Jing Chunmei;Xu Hongmei;Yang Jinhong;Chen Yiping;Zhang Hong;Zhang Ting;Cao Sancheng;Deng Huiling;Wang Chuanqing;Wang Aimin;Yu Hui;Wang Shifu;Lin Aiwei;Wang Xing;Cao Qing(Clinical Laboratory Department,Children＇s Hospital,Zhejiang University School of Medicine,Hangzhou 310052,China)

机构地区：[1]浙江大学医学院附属儿童医院实验检验中心,杭州310052 [2]浙江大学医学院附属儿童医院感染病科,杭州310052 [3]深圳市儿童医院检验科 [4]深圳市儿童医院感染科 [5]重庆医科大学附属重庆儿童医院检验科 [6]重庆医科大学附属重庆儿童医院感染科 [7]温州医学院附属育英儿童医院检验科 [8]温州医学院附属育英儿童医院感染科 [9]上海交通大学医学院附属儿童医院检验科 [10]上海交通大学医学院附属儿童医院感染科 [11]西安市儿童医院检验科 [12]西安市儿童医院感染科 [13]复旦大学附属儿科医院临床检验中心细菌室 [14]复旦大学附属儿科医院感染科 [15]济南市儿童医院检验科 [16]济南市儿童医院感染科 [17]上海交通大学医学院附属上海儿童医学中心检验科 [18]上海交通大学医学院附属上海儿童医学中心感染科

出　　处：《中华儿科杂志》2018年第8期582-586,共5页Chinese Journal of Pediatrics

摘　　要：目的 了解我国儿童医院肺炎链球菌感染的临床特征及分离株的耐药特点,为临床防治提供依据.方法 现况调查.分析2016年9家三级甲等儿童医院肺炎链球菌感染的患儿年龄、标本种类和月份分布以及分离菌株的药物敏感性;肺炎链球菌药物敏感性采用WHONET 5.6软件统计分析,率的比较采用x2检验.结果 共收集到6 200株肺炎链球菌,分离自呼吸道标本占95.1％（5 876/6 177）,血液标本2.2％（136/6 177）,脑脊液标本0.4％ （24/6 177）.分离的肺炎链球菌主要源于年龄＞1-5岁的儿童（54.7％,3 381/6 185）.检出肺炎链球菌有明显季节性,11、12和次年1月份占33.2％（1 184/3 563）.肺炎链球菌对万古霉素（100.0％,6 189/6 189）,利奈唑胺（100.0％,6 030/6 030）和莫西沙星（100.0％,3 064/3 064）均敏感;对左氧氟沙星（99.8％,5 528/5 540）和厄他培南（98.8％,3 024/3 061）敏感率高;而对红霉素（1.7％,102/6 016）、克林霉素（3.7％,116/3 136）和四环素（5.0％,244/4 877）敏感率低.按照非脑膜炎胃肠外给药折点判读,重庆医科大学附属重庆儿童医院检出的肺炎链球菌对青霉素敏感率（49.3％,892/1 809）明显低于其他医院（χ^2=1 268.161,P＜0.05）.结论 国内三级甲等儿童医院临床检出的肺炎链球菌主要源于呼吸道标本,主要见于年龄＞1-5岁的儿童,主要集中在上年度11月份至次年度1月份.儿童肺炎链球菌对万古霉素、利奈唑胺、莫西沙星和左氧氟沙星敏感率高.不同地域检出的肺炎链球菌对青霉素敏感性存在差异.Objective To describe the clinical characteristics of pneumococcal infections and drug resistance of Streptococcus pneumoniae isolates from children＇s hospitals,which would provide reference for preventing and treating pneumococcal diseases.Methods This was a prevalence survey.In this study,the age,specimen type,monthly distribution characteristics,and antimicrobial resistance of Streptococcus pneumoniae isolates from 9 children＇s hospitals in China were investigated between January 1,2016 and December 31,2016.The WHONET 5.6software was used to analyze the antibiotic susceptibility of Streptococcus pneumoniae.The comparison of rates was performed by Chi-square test.Results A total of 6 200 isolates of streptococcus pneumoniae were obtained,namely,95.1% （5 876/6 177）from the respiratory tract specimens,2.2% （136/6 177） from blood specimens and 0.4% （24/6 177）from cerebrospinal fluid specimens.The isolates were mainly from children older than 1 and younger than 5 years （54.7%,3 381/6 185）.Most of strains （33.2%,1 184/3 563） were isolated in November,December and January.Streptococcus pneumoniae isolates were completely sensitive to vancomycin （100.0%,6 189/6 189）,linezolid （100.0%,6030/6030）,moxifloxacin （100.0%,3 064/3 064）,highly sensitive to levofloxacin （99.8%,5 528/5 540）,ertapenem （98.8%,3 024/3 061） and lowly sensitive to erythromycin （1.7%,102/6 016）,clindamycin （3.7%,116/3 136）,and tetracycline （5%,244/4 877）,respectively.According to the parenteral susceptibility breakpoints for non-meningitis isolates,the sensitivity of Streptocococus pneumoniae to penicillin from children＇s hospital of Chongqing Medical University （49.3%,892/1 809） was significantly lower than those of other hospitals （χ^2=1 268.161,P〈0.05）.Conclusions Streptococcus pneumoniae is mainly isolated from respiratory tract,from children older than 1 and younger than 5 years and during November to January in tertiary children＇s hospital of China.The Streptococcus pneumonia

关 键 词：肺炎链球菌感染 儿童 微生物敏感性试验 

分 类 号：R725.6[医药卫生—儿科]