儿童肺炎链球菌败血症的临床特点及药敏分析

doi:10.7499/j.issn.1008-8830.2013.11.017

Abstract
Figure/Table
References(25)
Related Citation (15)
Read Tracking
Download Tracking

Download: PDF (1470 KB)
Export: BibTeX | EndNote (RIS) Supporting Info

Abstract OBJECTIVE: To study the clinical characteristics of children who suffered from Streptococcus pneumoniae (SP) septicemia and the drug sensitivity of SP strains. METHODS: A retrospective analysis was performed on the clinical data of 25 children with SP septicemia between January 2009 and December 2012. RESULTS: Of the 25 cases, 16 (64%) were aged under 2 years, 5 (20%) were aged 2-5 years, and 4 (16%) were aged over 5 years. Fourteen cases (56%) were complicated by infection of other organs, and 5 cases (20%) had underlying chronic diseases. Fever was the most common clinical manifestation, and the majority presented with remittent fever. Eight patients with pneumonia or pyothorax had pulmonary symptoms. Five patients with purulent meningitis had neurological symptoms, five cases had hepatosplenomegaly and two cases had septic shock. Nineteen cases (76%, 19/25) had significantly elevated white blood cell (WBC) counts, twenty-one cases (84%, 21/25) had significantly elevated serum C-reactive protein (CRP) levels, and eight cases (50%, 8/16) had significantly elevated serum procalcitonin (PCT) levels. The drug sensitivity analysis showed that invasive SP had high resistance rates to penicillin (96%), clindamycin hydrochloride (88%) and erythromycin (84%), and it was completely sensitive to imipenem, vancomycin, levofloxacin and linezolid. The multi-drug resistance rate of invasive SP was up to 88%. Twenty-three cases (92%) were cured or improved after active treatment. CONCLUSIONS: SP septicemia is commonly seen in children aged under 2 years. The most common clinical manifestation is fever, accompanied by elevated WBC count, CRP level and PCT level, and it is usually complicated by pulmonary or brain infection. Resistance to multiple antibiotics is very common in SP strains, so it is important to properly use antibiotics according to drug sensitivity test results. Patients who receive active treatment have a good clinical outcome.

	Service

	E-mail this article
	Add to my bookshelf
	Add to citation manager
	E-mail Alert
	RSS
	Articles by authors
	SU Xiao-Yan
	WEN Shun-Hang
	LIN Li
	LI Chang-Chong

Key words： Streptococcus pneumoniae Septicemia Drug sensitivity analysis Child

Cite this article:

SU Xiao-Yan,WEN Shun-Hang,LIN Li et al. Clinical characteristics of children with Streptococcus pneumoniae septicemia and drug sensitivity of Streptococcus pneumoniae[J]. CJCP, 2013, 15(11): 995-999.

URL:

http://www.zgddek.com/EN/10.7499/j.issn.1008-8830.2013.11.017 OR http://www.zgddek.com/EN/Y2013/V15/I11/995

[1]	Lynch JP, Zhanel GG. Streptococcus pneumoniae: epidemiology, risk factors, and strategies for prevention[J]. Semin Respir Crit Care Med, 2009, 30(2): 189-209．
[2]	杨永弘,姚开虎.重视儿童肺炎链球菌疾病[J].中国当代儿科杂志, 2008, 10(3): 273-274.
[3]	WHO. Pneumococoal conjugate vaccine for childhood immunization—WHO position paper[J]. Wkly Epidemiol Rec, 2007, 82(12): 93-104.
[4]	胡亚美, 江载芳. 诸福棠实用儿科学[M]. 第7版. 北京: 人民卫生出版社, 2002.
[5]	Tenover FC, Moellering RC Jr. The rationale for revising the Clinical and Laboratory Standards Institute vancomycin minimal inhibitory concentration interpretive criteria for Staphylococcus aureus[J]. Clin Infect Dis, 2007, 44(9): 1208-1215.
[6]	陆权,秦炯.重视儿童肺炎链球菌性疾病[J].中华儿科杂志, 2010, 48(2): 85-86.
[7]	张洲慧, 彭珉娟, 陈娟. 34例儿童败血症病原菌及耐药性分析[J].四川医药, 2011, 32(6): 838-841.
[8]	李迟佳, 王亚亭. 侵袭性肺炎链球菌疾病的研究进展[J]. 实用儿科临床杂志, 2010, 25(10): 776-778.
[9]	刘素云, 董琳, 杨锦红. 儿童侵袭性肺炎链球菌病的临床特征及耐药性分析[J]. 中华儿科杂志, 2010, 48(2): 95-99.
[10]	肖甜甜, 王欣宁, 余加林. 新生儿败血症非特异性指标的诊断价值评价[J]. 儿科药学杂志, 2010, 16(3): 9-12.
[11]	滕国杰, 聂秀红. 败血症患者血小板计数与预后关系[J]. 首都医科大学学报, 2006, 27(1): 84-86.
[12]	秦丽, 黄琦薇. 前降钙素检测在新生儿败血症中的临床应用[J]. 实用儿科临床杂志, 2004, 19(6): 470-471.
[13]	邱玉芳, 沙莉. C-反应蛋白、白细胞介素-6、肿瘤坏死因子-α在新生儿败血症早期诊断中的价值[J]. 实用儿科临床杂志, 2005, 20(5): 455-456.
[14]	刘素云,董琳,杨锦红.儿童侵袭性肺炎链球菌病的临床特征及耐药性分析[J]. 中华儿科杂志, 2010, 48(2): 95-99.
[15]	李娜, 符州, 罗秀珍, 刘恩梅, 罗健, 刘岚, 等. 重庆地区儿童侵袭性肺炎链球菌疾病临床特点及耐药性分析[J].儿科药学杂志, 2009, 15(5): 38-40.
[16]	Klemets P, Lyytikainen O, Ruutu P, Kaijalainen T, Leinonen M, Ollgren J, et al. Trends and geographical variation in invasive pneumococcal infections in Finland[J]. Scand J Infect Dis, 2008, 40: 621-628．
[17]	Hsieh YC, Hsueh PR, Lu CY, Lee PI, Lee CY, Huang LM, et al. Clinical manifestations and molecular epidemiology of necrotizing pneumonia and empyenm card by Streptococcus pneumoniae in children in Taiwan[J]. Clin Infect Dis, 2004, 38(6): 830-835.
[18]	Tan TQ, Mason EO, Wald ER, Barson WJ, Schutze GE, Bradley JS, et al. Clinical characteristics of children with complicated pneumonia caused by Streptococcus pneumoniae[J]. Pediatrics, 2002, 110(1 Pt 1): 1-6.
[19]	Haddad MB, Porucznik CA, Joyce KE, De AK, Pavia AT, Rolfs RT, et al. Risk factors for pediatric invasive pneumoceecal disease in the Intermountain West, 1996-2002[J]. Ann Epidemiol, 2008, 18(2): 139-146.
[20]	Song JH, Jung SI, Ko KS, Kim NY, Son JS, Chang HH, et al. High prevalence of antimicrobial resistance among clinical Streptococcus pneumoniae isolates in Asia (an ANSORP study)[J]. Antimicrob Agents Chemother, 2004, 48(6): 2101-2107．
[21]	Batuwanthudawe R, Kamnarathne K, Dassanayake M, de Silva S, Lalitha MK, Thomas K, et al. Surveillance of invasive pneumoeoccal disease in Colombo. SriLanka[J]. Clin Infect Dis, 2009, 48(Suppl 2): S136-S140．
[22]	石燕华, 李昌崇, 张海邻, 林立, 胡晓光, 张维溪. 2005-2009年温州育英儿童医院下呼吸道感染患儿肺炎链球菌耐药性分析[J].中国实用儿科杂志, 2011, 26(8): 582-586.
[23]	Liu Y, Wang H, Chen M, Sun Z, Zhao R, Zhang L, et al. Serotype distribution and antimicrobial resistance patterns of Streptococcus pneumoniae isolated from children in China younger than 5 years[J]. Diana Microbiol Infect Dis, 2008, 6l(3): 256-263.
[24]	Denham BC, Clarke SC. Serotype incidence and antibiotic susceptibility of Streptococcus pneumoniae causing invasive disease in Scotland, 1999-2002[J]. J Med Microbiol, 2005, 54(4): 327-331．
[25]	O'Brien KL, Hochman M, Goldblatt D. Combined schedules of pneumococcal conjugate and polysaccharide vaccines: is hyporesponsiveness an issue?[J]. Lancet Infect Dis, 2007, 7(9): 597-606.