425例儿童侵袭性肺炎链球菌病感染的临床分布、血清型及耐药性分析OACSTPCD
Clinical Distribution,Serotypes and Drug Resistance Analysis of 425 Cases of Invasive Pneumococcal Disease Infectious in Children
目的 通过分析儿童侵袭性肺炎链球菌病(invasive pneumococcal disease,IPD)的感染分布、血清型及耐药性,为临床规范治疗IPD及合理使用抗生素提供参考依据.方法 选取南京医科大学附属苏州医院儿科2019 年 3 月～2022年 11 月 425 例明确诊断为IPD的患儿作为研究对象,查阅患儿病历信息并收集临床资料,对送检保存的患儿肺炎链球菌菌株标本采用荚膜肿胀实验测定血清分型,并进行药物敏感度分析.结果 该研究共收集 425 例IPD患儿,平均年龄 2.16±0.93 岁;临床感染类型分析,菌血症性肺炎 189 例(44.47%),单纯血流感染 80 例(18.82%),化脓性脑膜炎 76 例(17.88%),感染性胸膜炎 11 例(2.59%),感染性腹膜炎 9 例(2.12%),骨关节感染 7 例(1.65%),感染性心内膜炎7例(1.65%),并发其他感染46例(10.82%);共检出14种血清型,血清型19F,19A,14,23F,6A和 6B检出率分别为 162 株(38.12%),90 株(21.18%),42 株(9.88%),38 株(8.94%),14 株(3.29%)和 8 株(1.88%);药敏试验提示红霉素、克林霉素的耐药率均较高,分别为 95.53%(406/425)和 99.53%(423/425);阿莫西林、头孢吡肟、头孢噻肟的耐药率均较低,分别为 13.65%(58/425),19.06%(81/425)和 17.18%(73/425);脑脊液分离株与非脑脊液分离株两组比较提示对青霉素的耐药率分别为69.74%和 24.07%(χ2=59.59,P＜0.05),对头孢吡肟的耐药率分别为50.00%和12.32%(χ2=57.44,P＜0.05),对美罗培南的耐药率分别为40.79%和29.23%(χ2=3.88,P＜0.05),差异均有统计学意义.结论 应在临床工作中加强IPD的培养鉴定和耐药性监测,根据药敏结果规范有效使用抗生素,最大限度降低肺炎链球菌的耐药性,提高药物治疗的疗效.
Objective To analyze the infection distribution,serotypes,and drug resistance of invasive pneumococcal disease(IPD)in children,and provide a reference for the standardized treatment of IPD and the rational use of antibiotics in clinical practice.Methods A total of 425 children with definitive diagnoses of IPD in the Department of Pediatrics,the Affiliated Suzhou Hospital of Nanjing Medical University between March 2019 and November 2022 were selected as the research subjects.Information from the medical records of these children was reviewed,clinical data was collected,serotyping by podoconiosis test on the specimens of Streptococcus pneumoniae strains sent for preservation was determined,and the susceptibility test was performed.Results A sum of 425 children with IPD(with a mean age of 2.16±0.93)were collected in this study.Analysis of clinical infection types showed 189 cases(44.47%)of bacteremia pneumonia,80 cases(18.82%)of simple bloodstream infection,76 cases(17.88%)of septic meningitis,11 cases(2.59%)of infectious pleurisy,9 cases(2.12%)of infective peritonitis,7 cases(1.65%)of bone and joint infection,7 cases(1.65%)of infective endocarditis,and 46 cases(10.82%)of other infections in combination.A total of 14 serotypes were confirmed in this study,with detection rates of 162 cases(38.12%),90 cases(21.18%),42cases(9.88%),38 cases(8.94%),14 cases(3.29%)and 8 cases(1.88%)for serotypes 19F,19A,14,23F,6A,and 6B,respectively.The susceptibility test indicated that the resistance rates of erythromycin and clindamycin were both high,with 95.53%(406/425)and 99.53(423/425),respectively,while the resistance rates of amoxicillin,cefepime,and cefotaxime were all relatively low,with 13.65%(58/425),9.06%(81/425),and 17.18%(73/425),respectively.Comparison between the two groups of cerebrospinal fluid(CSF)isolates and non-CSF isolates showed that the rates of resistance to penicillin were 69.74%and 24.07%(χ2=59.59,P＜0.05),the resistance rates to cefepime were 50.00%and 12.32%(χ2=57.44,P＜0.05),the resistance rates to meropenem were 40.79%and 29.23%(χ2=3.88,P＜0.05),respectively,with statistically significant differences.Conclusion Cultivation identification and drug resistance monitoring of IPD should be strengthened in clinical work.Antibiotics should be effectively used according to the drug susceptibility results to minimize the drug resistance of Streptococcus pneumoniae and improve the efficacy of drug therapy.
沈雨;李冠霖
南京医科大学姑苏学院,南京 211166||南京医科大学附属苏州医院/苏州市立医院,江苏苏州 215008
基础医学
儿童侵袭性肺炎链球菌病细菌血清型耐药性
childreninvasive pneumococcal diseasebacterial serotypedrug resistance
《现代检验医学杂志》 2024 (001)
118-122,169 / 6
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