临床荟萃

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某三甲医院儿童肺炎链球菌感染分布及耐药性研究

  

  1. 郑州大学附属儿童医院 a.普内科;b.检验科;c.骨科, 河南 郑州 450000
  • 出版日期:2020-02-20 发布日期:2020-03-24
  • 通讯作者: 董凤梅, Email: xiaodong2006678@sina.com
  • 基金资助:
    河南省医学科技攻关计划项目----儿童检验标本闭环管理流程化操作与实践(2018020668)

Distribution and drug resistance of  Streptococcus pneumoniae infection in children

  1. a.Department of General Medicine; b.Department of Clinical Laboratory;  c.Department of
    Orthopaedics, Children's Hospital Affiliated to Zhengzhou University, Zhengzhou 450000, China
  • Online:2020-02-20 Published:2020-03-24
  • Contact: Corresponding author: Dong Fengmei, Email: xiaodong2006678@sina.com

摘要:  目的  探讨某三甲医院儿童肺炎链球菌感染分布及耐药性。方法  收集全院2018年8月至2019年7月患儿送检标本,包括痰液、血液、脑脊液、胸水、肺泡灌洗液、脓液、咽拭子等(同一患儿同类标本不重复纳入),进行病原菌菌株鉴定和药敏试验。结果  1 903例肺炎链球菌中3岁以内患儿1 401株(73.62%),3~5岁患儿423株(22.20%),5岁以上患儿71株(3.73%)。5岁以内患儿肺炎链球菌检出率最高,共计1 832株(96.27%)。医院不同病区中,儿科肺炎链球菌感染最多(59.85%),呼吸科其次(19.02%)。肺炎链球菌标本来源,痰液最多(79.09%),血液其次(7.62%)。肺炎链球菌冬季检出率最高,秋冬季节明显高于春夏季节(P<0.05)。肺炎链球菌对红霉素、四环素以及复方新诺明耐药率较高,分别达到96.38%,84.06%,64.74%。未发现对万古霉素、利奈唑胺耐药菌株,对头孢曲松、头孢噻肟、厄他陪南、左氧氟沙星、氧氟沙星、莫西沙星、氯霉素敏感性,敏感性均超过80%。结论  5岁以下患儿易发生肺炎链球菌感染,临床医生应根据药敏结果谨慎、合理选择抗生素,目前仍可将三代头孢作为治疗首选。

关键词: 肺炎链球菌, 儿童, 耐药, 抗菌药物

Abstract: Objective  To explore the distribution and drug resistance of Streptococcus pneumoniae infection in children in a top three hospital. Methods  All samples from August 2018 to July 2019 were collected, including sputum, blood, cerebrospinal fluid, pleural fluid, alveolar lavage fluid, pus, pharyngeal swab, and etc (the same kind of children's samples  not  included repeatedly). Then identification and drug sensitivity test of pathogen strains were performed. Results  Among 1 903 cases of Streptococcus pneumoniae, 1 401 (73.62%) were children under 3 years old, 423 (22.20%) were children aged from 3 to 5 years old and 71 (3.73%) were children over 5 years old. The detection rate of Streptococcus pneumoniae in children within 5 years old  was  the highest, with a total of  1 832starins(96.27%). In different areas of the hospital, Streptococcus pneumoniae infection was the most common at department of paediatrics (59.85%), followed by department of respiratory (19.02%). The sputum was the most as a source of samples(79.09%),  followed by blood (7.62%). The detection rate of Streptococcus pneumoniae was the highest in winter, And the detection rate was significantly higher in autumn and winter than that in spring and summer (P<0.05).  The resistance rates of Streptococcus pneumoniae  to erythromycin, tetracycline and compound neoforman were 96.38%, 84.06% and 64.74%, respectively. No vancomycin and linezolid resistant strains were found. The sensitivity of Streptococcus pneumoniae to ceftriaxone, cefotaxime, etapamil, levofloxacin, ofloxacin, moxifloxacin and chloramphenicol was over 80%.Conclusion  Children under 5 years old are prone to Streptococcus pneumoniae  infection. Clinicians should choose antibiotics carefully and reasonably according to the results of drug sensitivity. At present, the third generation of cephalosporins can still be the first choice for treatment.

Key words: Streptococcus pneumoniae, children, drug resistance, antibiotics