中国实用儿科杂志

中国实用儿科杂志 ›› 2012, Vol. 27 ›› Issue (08): 604-607.

• 论著 • 上一篇    下一篇

侵袭性肺炎链球菌感染38例临床特征与药敏分析

王曼丽a ，严永东a ，黄    莉a ，朱灿红a ，王宇清a ，陈正荣a，周卫芳a，季    伟a ，陶云珍b ，丁云芳b   

  1. 苏州大学附属儿童医院a呼吸科；b检验科，江苏苏州    215003
  • 出版日期:2012-08-06 发布日期:2012-08-27

CIinical features and antimicrobial resistance of invasive pneumococcal disease in 38 children.   

 WANG Man-li*，YAN Yong-dong，HUANG Li，ZHU Can-hong，WANG Yu-qing，CHEN Zheng-rong，ZHOU Wei-fang，JI Wei，TAO Yun-zhen，DING Yun-fang．*Department of Respiratory Medicine，Children's Hospital Affiliated to Soochow University，Suzhou 215003，China   

  • Online:2012-08-06 Published:2012-08-27

摘要：

目的    分析儿童侵袭性肺炎链球菌疾病（IPD）的临床特征及侵袭性肺炎链球菌耐药特点。方法    回顾性分析2004年1月至2011年3月苏州大学附属儿童医院收治的38例IPD患儿的临床资料及侵袭性肺炎链球菌的药敏结果。结果    （1） 38例患儿中男25例，女13例，男女比为1.92∶1；年龄78d至12岁，其中＜2岁18例（47.37％），2～5岁12例（31.58％），＞5岁8例（21.05％）。脓毒血症25例，占65.79％，是最多见的临床疾病，其中合并肺炎10例；其次为化脓性脑膜炎12例，占31.58％，合并肺炎3例；坏死性肺炎2例，占5.26％；2例患儿同时存在脓毒血症、化脓性脑膜炎和肺炎。6例（15.79％）患儿存在基础疾病；6例（15.79％）合并其他病原感染。临床治愈33例（73％），死亡2例，自动放弃2例。（2） 38株侵袭性肺炎链球菌中，青霉素不敏感率为52.63％，对其他9种常用抗生素的耐药率从高到低依次为：红霉素（94.74％）、克林霉素（93.75％）、四环素（82.25％）、复方新诺明（61.54％）、头孢噻肟（23.53％）、氯霉素（15.79％），未发现对万古霉素、左氧氟沙星、利福平耐药。多重耐药率84.21％。结论    IPD好发于5岁以内儿童尤其是2岁以内的婴幼儿，临床上主要表现为脓毒血症、化脓性脑膜炎等，加强侵袭性肺炎链球菌的耐药监测对指导临床用药有重要意义。

关键词: 侵袭性肺炎链球菌疾病, 耐药性, 儿童

Abstract:

Objective    To investigate the clinical features of invasive pneumococcal disease（IPD）and its antimicrobial resistance in Suzhou，and to raise the level of diagnosis and treatment of this disease. Methods    The clinical data of 38 cases of IPD admitted to the Children's Hospital Affiliated to Soochow University from January 2004 to march 2011 and antimicrobial resistance were analyzed retrospectively. Results    （1）The 38 cases of IPD were identified，among whom 25 were male and 13 female，the ratio being 1.92:1. The ages ranged from 78 days to 12 years；18 cases（47.37％） were aged less than 2 years，and 12 cases （31.58％）were aged from 2 to 5 y，8 cases（21.05％） were aged older than 5 years．Among the 38 children，25 patients（65.79％） had sepsis， the most common clinical manifestation ，of whom 10 cases were complicated with pneumonia；12 patients （31.58％） had pneumococcal meningitis，of whom 4 cases were complicated with pneumonia；2 patients（5.26％） had necrotizing pneumonia；2 patients had sepsis ，meningitis and pneumonia.Six cases（15.79％）had an underlying disease；6 cases（15.79％）were with combined other pathogen infections. of the patients 34  were cured，2 died and 2 abandoned therapy．（2） We studied drug resistance of all the invasive pneumococcus：52.63％strain were not sensitive to penicilin，and the resistance to the other 9 commonly used antibiotics was erythromycin（94.74％），clindamycin（93.75％），tetracycline（82.25％），trimethoprim-sulfamethoxazole（61.54％），cefotaxime（23.53％），chloromycetin（15.79％），levofloxacin（0），vancocin（0），and rifampicin（0）．The multidrug resistance rate was 86.21％. Conclusion    Invasive pneumococcal disease has the highest incidence in children under 2 years old. Sepsis and purulent meningitis are the most common clinical manifestation. It is very important to monitor the resistance of invasive pneumococcus for clinical use of medicine．

Key words: invasive pneumococcal disease, drug resistance, child