2009至2019年儿童感染性外阴阴道炎临床特征及病原学分析  

Clinical and etiological characteristics of infectious vulvovaginitis in children in Zhejiang province from 2009 to 2019

作　　者：高慧慧[1] 王孙怡 张宇辰 周明明[3] 华春珍[4] 袁长征 孙莉颖[1] Gao Huihui;Wang Sunyi;Zhang Yuchen;Zhou Mingming;Hua Chunzhen;Yuan Changzheng;Sun Liying(Department of Pediatric and Adolescent Gynecology,Children′s Hospital,Zhejiang University School of Medicine,National Clinical Research Center for Child Health,Hangzhou 310052,China;School of Public Health,Zhejiang University School of Medicine,Hangzhou 310058,China;Department of Clinical Laboratory,Children′s Hospital,Zhejiang University School of Medicine,National Clinical Research Center for Child Health,Hangzhou 310052,China;Department of Infectious Diseases,Children′s Hospital,Zhejiang University School of Medicine,National Clinical Research Center for Child Health,Hangzhou 310052,China)

机构地区：[1]浙江大学医学院附属儿童医院小儿青少年妇科、国家儿童健康与疾病临床医学研究中心,杭州310052 [2]浙江大学公共卫生学院,杭州310058 [3]浙江大学医学院附属儿童医院实验检验中心、国家儿童健康与疾病临床医学研究中心,杭州310052 [4]浙江大学医学院附属儿童医院感染科、国家儿童健康与疾病临床医学研究中心,杭州310052

出　　处：《中华儿科杂志》2023年第11期1024-1030,共7页Chinese Journal of Pediatrics

摘　　要：目的探索儿童感染性外阴阴道炎的临床特点、常见病原体特征。方法回顾性病例系列研究。收集2009年1月至2019年12月在浙江大学医学院附属儿童医院小儿青少年妇科就诊的3268例感染性外阴阴道炎患儿的临床表现和实验室检查结果。根据患儿年龄分为<7、7~<10及10~<18岁3组;根据季度分为第1~4季度4组,比较组间感染性外阴阴道炎患儿病原体分布特征,组间比较采用χ^(2)检验。结果3268例患儿中,就诊年龄为(6.2±2.5)岁,<7岁1728例(52.9%),7~<10岁875例(26.8%),10~18岁665例(20.3%)。细菌性外阴阴道炎2253例(68.9%),真菌性外阴阴道炎715例(21.9%),其他病原体感染300例(9.2%)。共有2287例(70.0%)患儿进行阴道分泌物细菌培养,共检出2287株病原体。阴道分泌物培养示病原体有化脓性链球菌745株(32.6%)、流感嗜血杆菌717株(31.4%)、大肠埃希菌292株(12.8%)、金黄色葡萄球菌222株(9.7%)和肺炎克雷伯菌67株(2.9%)。<7岁患儿有40.3%(509/1263)为流感嗜血杆菌感染,7~<10岁患儿有41.9%(356/849)为化脓性链球菌感染,10~18岁患儿有26.3%(46/175)为大肠埃希菌感染。药敏结果示化脓性链球菌对青霉素G[100.0%(610/610)]、头孢曲松[100.0%(525/525)]、万古霉素[100.0%(610/610)]均敏感,对红霉素和克林霉素耐药率分别为91.9%(501/545)、90.7%(495/546);流感嗜血杆菌中32.5%(161/496)产生β-内酰胺酶,对美罗培南[100.0%(489/489)]、左氧氟沙星[100.0%(388/388)]均敏感,对氨苄西林耐药率为40.5%(202/499);大肠埃希菌对亚胺培南100.0%(175/175)敏感,对左氧氟沙星、头孢曲松耐药率分别为29.1%(43/148)、35.1%(59/168)。3268例患儿中共分离出28.3%(45/159)甲氧西林耐药金黄色葡萄球菌(MRSA),药敏试验结果示MRSA对利奈唑胺[100.0%(40/40)]、万古霉素[100.0%(45/45)]、替加环素[100.0%(36/36)]均敏感,对青霉素G、红霉素、克林霉素耐药率分别为100.0%(45/45)、95.6%(43/45)、88.9%(40/45);甲氧西林敏感金黄色�Objective To explore the clinical characteristics,common pathogens in children with vulvovaginitis.Methods This was a retrospective cases study.A total of 3268 children with vulvovaginitis were enrolled,who visited the Department of Pediatric and Adolescent Gynecology,Children′s Hospital,Zhejiang University School of Medicine from January 2009 to December 2019.Patients were divided into 3 groups according to the age of<7,7-<10 and 10-18 years.Patients were also divided in to 4 groups according to the season of first visit.The pathogen distribution characteristics of infective vulvovaginitis were compared between the groups.Their clinical data were collected and then analyzed byχ^(2) test.Results The were 3268 girls aged(6.2±2.5)years.There were 1728 cases(52.9%)aged<7 years,875 cases(26.8%)aged 7-<10 years,and 665 cases(20.3%)aged 10-18 years.Of these cases,2253 cases(68.9%)were bacterial vulvovaginitis,715 cases(21.9%)were fungal vulvovaginitis and 300 cases(9.2%)were vulvovaginitis infected with other pathogens.Bacterial culture of vaginal secretions was performed in 2287 cases,and 2287 strains(70.0%)of pathogens were detected,of which the top 5 pathogens were Streptococcus pyogenes(745 strains,32.6%),Haemophilus influenzae(717 strains,31.4%),Escherichia coli(292 strains,12.8%),Staphylococcus aureus(222 strains,9.7%)and Klebsiella pneumoniae(67 strains,2.9%).Regarding different age groups,H.influenzae was the most common in children under 7 years of age(40.3%,509/1263),S.pyogenes(41.9%,356/849)was predominantly in children aged 7 to 10 years,and E.coli was predominant in children aged 10 to 18 years(26.3%,46/175).Susceptibility results showed that S.pyogenes was susceptible to penicillin G(610/610,100.0%),ceftriaxone(525/525,100.0%),and vancomycin(610/610,100.0%);the resistance rates to erythromycin and clindamycin were 91.9%(501/545)and 90.7%(495/546),respectively.For H.influenzae,32.5%(161/496)producedβ-elactamase,and all strains were sensitive to meropenem(489/489,100.0%)and levofloxacin(388/388,100.0%)

关 键 词：儿童 外阴阴道炎 病原菌 

分 类 号：R711.31[医药卫生—妇产科学]