2017—2019年山东省肺炎链球菌感染的临床特征及药物敏感性  

Clinical characteristics and drug susceptibility of Streptococcus pneumoniae from 2017 to 2019 in Shandong Province

作　　者：李静[1,2,3] 王梦园 李政 戈宁宁[4] 周卫萍 李仁哲[6] 李艳 彭海英[8] 李艳华[9] 陈艳萍[10] 刘志伟[11] 满思金 孙彦蒙[1] 寇琳娜[1] 于文文 王世富 张春艳 LI Jing;WANG Mengyuan;LI Zheng;GE Ningning;ZHOU Weiping;LI Renzhe;LI Yan;PENG Haiying;LI Yanhua;CHEN Yanping;LIU Zhiwei;MAN Sijin;SUN Yanmeng;KOU Linna;YU Wenwen;WANG Shifu;ZHANG Chunyan(Clinical Microbiological Department,Children's Hospital Affiliated to Shandong University,Jinan 250022,China;不详)

机构地区：[1]山东大学附属儿童医院临床微生物科,济南250022 [2]山东省儿童微生物组学研究中心儿童细菌&真菌耐药监测研究协作网 [3]山东省儿童健康与疾病临床医学研究中心 [4]济宁医学院附属医院检验科 [5]临沂市妇女儿童医院检验科 [6]济宁市第一人民医院检验科 [7]枣庄市妇幼保健院检验科 [8]临沂市人民医院检验科 [9]聊城市人民医院检验科 [10]青岛市妇女儿童医院检验科 [11]泰安市妇幼保健院检验科 [12]滕州市中心人民医院检验科

出　　处：《山东医药》2023年第19期27-32,共6页Shandong Medical Journal

基　　金：国家科技重大专项(2017ZX10103004-007);山东省儿童健康与疾病临床医学研究中心项目(RC006)。

摘　　要：目的探讨2017—2019年山东省肺炎链球菌(Sp)感染的临床特征及药物敏感性。方法收集2017—2019年山东省50所医院临床分离Sp的信息,包括感染患者的年龄、标本种类、分离时间及药物敏感性结果,根据CLSI M1002021版进行药物敏感性判定,使用WHONET5.6及SPSS 20.0进行统计分析。结果共收集18677株Sp,多分离于6岁以下儿童(71.39%)和60岁以上老年人(18.19%),各年龄段男性患者Sp感染比例均高于女性患者,分离时间多在11月—次年4月(65.1%)。Sp主要分离于呼吸道(88.67%)和无菌部位(5.59%),血液与脑脊液共同培养出Sp的比例为8.31%,6月以下儿童为29.03%。Sp均对万古霉素和利奈唑胺敏感,脑脊液分离的青霉素敏感Sp和青霉素耐药的Sp分别占30.8%、69.2%;非脑脊液Sp对红霉素、克林霉素和甲氧苄啶-磺胺甲噁唑敏感率较低,分别为1.5%、3.4%、22.7%,对左氧氟沙星、氯霉素、青霉素、头孢曲松、头孢噻肟、美罗培南的敏感率分别为99.3%、92.6%、95.6%、90.8%、87.2%、60.9%。儿童分离的Sp对甲氧苄啶-磺胺甲噁唑、青霉素、头孢噻肟、头孢曲松、头孢吡肟、美罗培南、红霉素、克林霉素的敏感率低于成人及老年人。结论山东地区Sp多分离于儿童和老年人的呼吸道标本中,有较明显的季节分布特点,Sp易从同一患者(尤其是不满6月龄的幼儿)血液与脑脊液中同时分离;儿童Sp对多数药物的敏感率低于成人及老年人,青霉素可为治疗Sp感染的一线药物,但患者病情危重且药物敏感性结果不明时应首选万古霉素进行经验性预防和治疗。Objective To investigate the clinical characteristics and drug susceptibility of clinically isolated Streptococcus pneumoniae(Sp)in Shandong Province.Methods The data of clinical isolated Sp in 50 hospitals were collected in Shandong Province from 2017 to 2019,including age of infected patients,specimen type,isolation time and results of antibiotic susceptibility.Antibiotic susceptibility was determined according to CLSI M1002021 version.WHONET 5.6 and SPSS 20.0 were used for statistical analysis.Results A total of 18677 strains of Sp were collected,mainly in children under 6 years old(71.39%)and elderly people over 60 years old(18.19%),including 12164 males(65.13%)and 6513 females(34.87%),and most strains were isolated from November to April(65.1%).The strains were mostly isolat‐ed from the respiratory tract(88.67%)and sterile site(5.59%).The Sp positive rate of cerebrospinal fluid(CSF)in pa‐tients with Sp isolated from blood was 8.31%,and it was 29.03%in children under 6 months.All Sp were sensitive to van‐comycin and linezolid,and PSSP and PRSP in CSF accounted for 30.8%and 69.2%.Non-CSF Sp were less sensitive to erythromycin(1.65%),clindamycin(2.18%),and trimethoprim-sulfamethoxazole(22.7%).Sensitivity rates of non-CSF Sp to levofloxacin,chloramphenicol,penicillin,ceftriaxone,cefotaxime and meropenem were 99.3%,92.6%,95.6%,90.8%,87.2%,and 60.9%,respectively.Sp was less sensitive to trimethoprim-sulfamethoxazole,penicillin,cefotaxime,ceftriaxone,cefepime,meropenem,erythromycin,and clindamycin in children than in adults and elderly peo‐ple.Conclusions Sp in Shandong was mostly isolated from respiratory tract specimen of children and the elderly,with a clear seasonal distribution.Sp was easily separated from the blood and cerebrospinal fluid of the same patient,especially in children under 6 months old.The sensitivity rate of Sp to most drugs in children was lower than that in adults and the el‐derly.Penicillin could be the first-line drug for the treatment of Sp infection.Vancomycin was the first choi

关 键 词：肺炎链球菌 药物敏感性 临床特征 侵袭性肺炎链球菌病 脑膜炎 

分 类 号：R978.1[医药卫生—药品]