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儿童侵袭性与非侵袭性肺炎链球菌病临床特征及耐药性分析
Clinical features and antibiotic sensitivity of invasive pneumococcal disease versus noninvasive pneumococcal disease in children
目的 收集并分析儿童侵袭性肺炎链球菌病（invasive pneumococcal disease，IPD）和非侵袭性肺炎链球菌病（noninvasive pneumococcal disease，NIPD）的临床资料，为临床诊疗提供参考。方法 回顾性分析2013年1月至2017年12月518例因肺炎链球菌（Streptococcus pneumoniae，SP）感染住院的患儿的临床信息及其分离菌株的药敏结果。根据菌株来源标本的部位分为IPD组（n=35）和NIPD组（n=483）。结果 IPD患儿中位起病年龄为2.2岁，≤ 5岁患儿占80.0%。主要感染类型为脑膜炎（19例，54.3%），最常见基础疾病为血液肿瘤性疾病（8例，22.9%），入住儿童重症监护室（pediatric intensive care unit，PICU）14例（40.0%），发生并发症18例（51.4%），死亡8例（22.9%）。NIPD患儿中位起病年龄为1.2岁，主要感染类型为肺炎（429例，88.8%），最常见基础疾病为先天性心脏病（60例，12.4%），入住PICU 60例（12.4%），发生并发症102例（21.1%），死亡11例（2.3%）。IPD组并发症发生率、PICU入住率及病死率均高于NIPD组（P < 0.01）。侵袭性SP菌株对青霉素敏感率（68.6%）低于非侵袭性SP菌株（94.2%）（P < 0.01）。结论 SP感染病例以5岁以内儿童居多，有血液肿瘤等基础疾病的患儿是IPD的高危人群。虽然相比IPD患儿，NIPD患儿的并发症发生率、PICU入住率及病死率更低，但仍不容忽视。青霉素可以作为NIPD经验治疗的选择，但不能用于IPD。
Objective To analyze the clinical data of children with invasive pneumococcal disease (IPD) or noninvasive pneumococcal disease (NIPD), and to provide a reference for clinical diagnosis and treatment. Methods A retrospective analysis was performed on the medical data and the drug susceptibility test results of isolated strains of 518 children who were hospitalized due to Streptococcus pneumoniae (SP) infection from January 2013 to December 2017. According to the location of the isolated strains, the children were divided into an IPD group with 35 children and an NIPD group with 483 children. Results The children with IPD had a median age of 2.2 years, and the children aged ≤5 years accounted for 80.0%. For the children with IPD, the main type of infection was meningitis which was observed in 19 children (54.3%), and the most common underlying disease was hematological malignancy in 8 children (22.9%); 14 children (40.0%) were admitted to the pediatric intensive care unit (PICU), 18 children (51.4%) experienced complications, and 8 children (22.9%) died. For the children with NIPD, the median age was 1.2 years; the main type of infection was pneumonia in 429 children (88.8%), and the most common underlying disease was congenital heart disease in 60 children (12.4%); 60 children (12.4%) were admitted to the PICU, 102 children (21.1%) experienced complications, and 11 children (2.3%) died. The IPD group had significantly higher incidence rate of complications, PICU admission rate, and mortality rate than the NIPD group (P < 0.01). The invasive SP strains had a significantly lower susceptibility rate to penicillin than noninvasive SP strains (68.6% vs 94.2%, P < 0.01). Conclusions SP infection is common in children under 5 years of age, and the children with underlying diseases including hematological malignancy are at high risk for IPD. Although the complication rate, PICU admission rate, and mortality rate of NIPD children are lower than those of IPD children, they still cannot be ignored. Penicillin may be used as an empirical treatment for children with NIPD, but not for those with IPD.
侵袭性肺炎链球菌病 / 肺炎链球菌 / 临床特征 / 药物敏感性 / 儿童
Invasive pneumococcal disease / Streptococcus pneumoniae / Clinical feature / Drug sensitivity / Child
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