儿童肺炎链球菌耐药表型和耐药基因的相关性探讨

肺炎链球菌(S.p)是正常人群鼻咽部的常见定植菌,能够诱发侵袭性肺炎链球菌疾病。S.p可通过血流经过血脑屏障,在脑脊液内繁殖,刺激机体产生炎症反应,进而引起细菌性脑膜炎。在治疗S.p所引起的肺炎疾病时,出现了S.p耐药的情况,在很大程度上阻碍了肺炎的治疗和疾病的转归。本研究中,以儿童S.p为主要探究要点,进一步分析儿童S.p耐药表型和耐药基因的相关性,以期为儿童肺炎的治疗提供理论依据。     

深圳市儿童社区获得性肺炎流感嗜血杆菌b型感染状况及耐药基因研究

流感嗜血杆菌(Hi)是儿童社区获得件肺炎(CAP)的最主要的致病菌之一,也是小儿化脓性脑膜炎及败血症的常见病因.Hi可分为6个血清型,其中b型(Hib)在感染性疾病中占97.8%[1].目前,在世界各地均不同程度出现了对曾经取得良好的疗效并作为治疗Hi感染首选药物--氨苄西林的耐药性,由于各地区抗生素使用情况的不同,耐药发展也不同,因此有必要了解本地区Hib的感染状况及Hi的耐药特点.     

学龄前儿童肺炎链球菌感染的流行病学特征、血清型与耐药性分析

目的探讨肺炎链球菌(S. pneumoniae)致学龄前儿童感染的流行病学特征、血清型和耐药性,为本地区疫苗应用和临床经验诊治提供参考。方法回顾性分析2016年-2018年本院住院学龄前儿童分离出S. pneumoniae者的临床资料。结果 1 679例感染患儿中共检出S. pneumoniae 394株,检出率为23. 5%。不同年龄段、不同标本类型、不同基础疾病、不同季节、不同年度间S. pneumoniae的检出率差异均有统计学意义(P 0. 05)。血清型以19F、19A、23F型为主,分别占31. 2%、23. 1%、11. 2%。PCV7、PCV10、PCV13的覆盖率分别为58. 6%、63. 7%、87. 8%。2016年-2018年S. pneumoniae对常用抗菌药物的耐药率有一定的波动,但总体呈上升趋势(P 0. 05)。对青霉素、阿奇霉素、克林霉素、红霉素的总耐药率分别为44. 2%、91. 4%、88. 3%、94. 2%。结论学龄前儿童S. pneumoniae感染主要以0岁～2岁为主,冬季发病率最高,基础疾病以肺炎为主,血清型以19F、19A、23F型为主,推荐PCV13疫苗预防S. pneumoniae感染,该菌对红霉素等大环内酯类抗菌药物耐药严重。     

上呼吸道感染患儿肺炎链球菌血清群/型及耐药分析

目的了解患上呼吸道感染的0~5岁儿童肺炎链球菌的血清群/型及其对抗生素耐药情况。探讨肺炎链球菌疫苗在中国儿童使用的意义。方法取患儿鼻咽分泌物,分离出137株肺炎链球菌。采用荚膜肿胀法(Quellinngtest)进行血清群/型分析。E-test及K-B纸片扩散法检测对青霉素等13种抗生素的敏感性。结果疫苗相关血清型占63%,最常见的血清群/型为19、6、23、14。青霉素不敏感率为33%,较往年增高。青霉素耐药菌株对头孢类抗生素有交叉耐药性,红霉素、阿奇霉素耐药率达94%,应引起临床高度重视。结论疫苗相关血清群/型在0~5岁儿童覆盖率较高,肺炎链球菌疫苗的使用有利于降低儿童肺炎链球菌感染的发病率,有助于减少抗生素耐药的产生。     

流感嗜血杆菌的流行特征及防治

流感嗜血杆菌(Haemophilus influenzae,Hi)是常见的人呼吸道致病菌,其血清型b型(Haemophilus influenzae type b,Hib)是引起儿童细菌性脑膜炎、肺炎的常见病原菌,严重威胁儿童健康.随着Hib疫苗的广泛应用,Hi的全球流行病学特征已发生重大变化,Hib的发病率显著下降,...     

广州地区老年人肺炎球菌血清型及疫苗免疫效果研究

目的了解广州地区老年人感染肺炎球菌的血清型别特征,评估广州地区老年人群接种肺炎疫苗的免疫效果。方法随机抽取2015年11月至2016年10月哨点医院的肺炎球菌感染老年病例为病例组,在病例所在社区随机选取同性别、60岁及以上年龄相近(±3岁)、接种疫苗适应证相似的健康居民作为对照组。采用1∶1配对病例对照研究23价肺炎球菌多糖疫苗(PPV23)的免疫效果。采用多重PCR法进行病例肺炎球菌血清分型。结果共276对病例及对照纳入研究,PPV23疫苗对老年人肺炎的保护效果为77.3%(95%CI 62.8%~91.8%)。检出肺炎球菌血清型主要为19F、19A、6B和23F;PPV23疫苗包含的血清型对其覆盖率达96.6%。结论 PPV23疫苗对老年人肺炎有较好的保护效果,PPV23疫苗包含的血清型别与广州地区老年人群病例菌株检出的血清型别的吻合程度较高,PPV23疫苗适用于广州地区的老年人群。     

b型嗜血流行性感冒杆菌在急性下呼吸道感染病原学中的地位

流行性感冒(流感)嗜血杆菌(Haemophilusin fluenzae,Hi)是常见的致病菌,仅对人类致病。1931年,Pittman将Hi分为带荚膜菌株及不带荚膜菌株(不定型) ,荚膜菌株据荚膜多糖的特异性抗原不同分为6个血清型(a～f) ,其中b型(Hib)毒力最大。Hib通过飞沫传播,是引起儿童侵袭性感染的重要致病菌,主要感染5岁以下儿童,是小儿败血症、脑膜炎、肺炎的主要致病菌。196 8年,人们即认识到Hib发病率高,致死率高。近年来,人们发现,Hib对氨苄青霉素及其它一些抗生素的耐药率在增高。目前,肺炎仍是世界儿童发病率最高和死亡率最高的疾病,在5岁以下儿童中,每…     

肺炎球菌多糖结合疫苗研究进展

人类为降低肺炎球菌感染导致的健康和经济双重负担已经奋斗了两个世纪。肺炎球菌导致的侵袭性肺炎球菌疾病(Invasive pneumococcal disease,IPD)、脑膜炎和急性中耳炎等,在全球范围内可发生,而且以婴幼儿和老年人高发。肺炎球菌对多数抗生素耐药,疫苗是控制肺炎球菌流行的最有效措施。科学家们从20世纪初开始研发肺炎球菌疫苗,至2014年13价肺炎球菌多糖结合疫苗(13-valent pneumococcal conjugate vaccine,PCV13)应用后,疫苗血清型导致的肺炎球菌肺炎、IPD和病因死亡率有所下降。新的挑战是,改善部分疫苗血清型的低反应,疫苗中致病血清型的增加,结合疫苗在某些人群中的应用研究等。此综述简要陈述了肺炎球菌多糖结合疫苗的研发过程和进展。     

健康6月龄内儿童肺炎链球菌携带状况及耐药特征分析

目的 了解济南地区健康6月龄内儿童鼻咽部肺炎链球菌携带血清型及耐药特征,为肺炎球菌疫苗推广接种提供数据。方法 2019年11月—2020年4月采集济南地区216例健康6月龄内儿童鼻咽拭子,经分离培养获得疑似肺炎链球菌菌株;利用基质辅助激光解吸电离飞行时间质谱和奥普托欣敏感试验鉴定后,采用多重PCR方法明确肺炎链球菌血清型;进一步采用微生物药敏分析仪进行药物敏感性检测。结果 216例健康6月龄内儿童肺炎链球菌携带率为5.1%(11/216),共携带7种血清型：15B、23F、6B、8、18C、19F和13。13价肺炎球菌多糖结合疫苗血清型覆盖率为54.5%,23价肺炎球菌多糖疫苗覆盖率为90.9%。19种抗生素中红霉素和阿奇霉素耐药率为100.0%;耐药率80.0%以上的有四环素、克林霉素、甲氧苄胺嘧啶/磺胺甲噁唑;头孢呋辛和青霉素(口服)的耐药率超过50.0%。万古霉素、利奈唑胺、左氧氟沙星、氯霉素和莫西沙星未发现耐药菌株。11例儿童鼻咽部肺炎链球菌分离株显示多重耐药,耐药种类3～6种。结论 济南地区健康6月龄内儿童鼻咽部定植的肺炎链球菌具有多种血清型,且抗生素耐药现象较严重。     

肺炎链球菌疫苗免疫途径对其保护效应影响的研究

正近年来,由肺炎链球菌(Streptococcus pneumoniae,S.pn)感染引起的菌血症、肺炎、脑膜炎、中耳炎等可引起每年约数百万人的死亡。随着其多重耐药趋势越来越严峻,使用疫苗预防及抵抗肺炎链球菌感染尤为重要。目前被广泛应用的有23价多糖疫苗和7价多糖蛋白结合疫苗,但这2种疫苗均不能提供广谱的保护效果,而第三代肺炎链球菌疫苗即蛋白疫苗能克     

Streptococcus pneumoniae diseases in Chinese children: past, present and future

This review describes major contributions to our understanding of pneumococcal diseases among children in hinterland of China. The data demonstrated that Streptococcus pneumoniae (S. pneumoniae) is an important pathogen of pyogenic meningitis, pneumonia, and other infectious diseases in children. The distribution of serotypes of S. pneumoniae showed great diversity in several studies in various cities during different years. The penicillin nonsusceptibility rates, although variable, demonstrated an increase over time in China. The prevalence of resistance to erythromycin, trimethoprim-sulfamethoxazole or tetracycline was reported to be over 80% and exceeded those reported from other developed countries. A national survey on serotype prevalence, antimicrobial resistance and molecular epidemiology of S. pneumoniae, especially in invasive pneumococcal diseases, and studies to determine pneumococcal disease burden should be undertaken in the future to provide evidence and guidance to the use of vaccine and antibiotics in S. pmeumoniae infections.     

Paediatric, invasive pneumococcal disease in Switzerland, 1985-1994. Swiss Pneumococcal Study Group

BACKGROUND: Cost effective use of new vaccines against pneumococcal disease in children requires detailed information about the local epidemiology of pneumococcal infections. METHODS: Data on 393 culture-confirmed cases of invasive pneumococcal infection in children (<17 years) hospitalized in Swiss paediatric clinics were collected retrospectively for the years 1985-1994. RESULTS: Meningitis (42%) was most frequent, followed by pneumonia (28%) and bacteraemia (26%). The overall annual incidence was 2.7 cases per 100000 children <17 years old and 11 cases per 100000 children <2 years old. Annual incidence rates were stable over the study period. Lethality was high for meningitis (8.6%) and bacteraemia (8.9%). A history of basal skull fracture was reported in 3.3% of children with pneumococcal meningitis. Residence in a rural region was associated with an increased risk of pneumococcal infection (relative risk = 1.45, 95% confidence interval: 1.01-2.00). CONCLUSIONS: Paediatric, invasive pneumococcal disease seems to be less frequent in Switzerland than in other European and non-European countries. This may be due to differences in diagnostic strategies and lower frequency of risk factors such as the use of day care. Children with a history of basal skull fracture are at increased risk for pneumococcal meningitis. Further investigation of the association of invasive pneumococcal infection with rural residence and the use of antibiotics for upper respiratory tract infections might give new insight into the dynamics of Streptococcus pneumoniae infection and the development of antibiotic resistance.     

A prospective study of etiology of childhood acute bacterial meningitis, Turkey

Determination of the etiology of bacterial meningitis and estimating cost of disease are important in guiding vaccination policies. To determine the incidence and etiology of meningitis in Turkey, cerebrospinal fluid (CSF) samples were obtained prospectively from children (1 month-17 years of age) with a clinical diagnosis of acute bacterial meningitis. Multiplex PCR was used to detect DNA evidence of Streptococcus pneumoniae, Haemophilus influenzae type b (Hib), and Neisseria meningitidis. In total, 408 CSF samples were collected, and bacterial etiology was determined in 243 cases; N. meningitidis was detected in 56.5%, S. pneumoniae in 22.5%, and Hib in 20.5% of the PCR-positive samples. Among N. meningitidis-positive CSF samples, 42.7%, 31.1%, 2.2%, and 0.7% belonged to serogroups W-135, B, Y, and A, respectively. This study highlights the emergence of serogroup W-135 disease in Turkey and concludes that vaccines to prevent meningococcal disease in this region must provide reliable protection against this serogroup.     

Meningitis and pneumonia in Guatemalan children: the importance of Haemophilus influenzae type b and Streptococcus pneumoniae.

OBJECTIVE: To determine the epidemiology of Haemophilus influenzae type b (Hib) and Streptococcus pneumoniae invasive infections in hospitalized Guatemalan children. This is an important issue since Hib vaccine has not been incorporated into the routine immunization program in Guatemala and information from hospital records in 1995 indicated a low incidence of Hib and S. pneumoniae as causes of meningitis and invasive infections. METHODS: Children who were hospitalized in Guatemala City with clinical signs compatible with bacterial infections were evaluated for evidence of Hib or S. pneumoniae infection. Normally sterile body fluids were cultured, and antigen detection was performed on cerebrospinal fluid (CSF) and pleural fluid. RESULTS: Of 1 203 children 1-59 months of age hospitalized over a 28-month period, 725 of them (60.3%) had a primary diagnosis of pneumonia, 357 (29.7%) of meningitis, 60 (5.0%) of cellulitis, and 61 (5.1%) of sepsis and other conditions. Hib was identified in 20.0% of children with meningitis and S. pneumoniae in 12.9%. The average annual incidence of Hib meningitis was 13.8 cases per 100 000 children under 5 years of age, and 32.4% of meningitides caused by Hib and 58.7% of S. pneumoniae meningitides occurred prior to 6 months of age. Case fatality rates were 14.1%, 37.0%, and 18.0%, respectively, for children with Hib, S. pneumoniae, and culture-negative and antigen-negative meningitis. Prior antibiotic therapy was common and was associated with significant reductions in CSF-culture-positive results for children with other evidence of Hib or S. pneumoniae meningitis. CONCLUSIONS: Improvements in case detection, culture methods, and latex agglutination for antigen detection in CSF resulted in identification of Hib and S. pneumoniae as important causes of severe disease in Guatemalan children. Using a cutoff of > 10 white blood cells per cubic millimeter in CSF would improve the sensitivity for detection of bacterial meningitis and help estimate the burden of bacterial meningitis in Guatemala and other developing countries.     

Epidemiology of bacterial meningitis in Niamey, Niger, 1981-96.

In the African meningitis belt the importance of endemic meningitis is not as well recognized as that of epidemics of meningococcal meningitis that occur from time to time. Using retrospective surveillance, we identified a total of 7078 cases of laboratory-diagnosed bacterial meningitis in Niamey, Niger, from 1981 to 1996. The majority (57.7%) were caused by Neisseria meningitidis, followed by Streptococcus pneumoniae (13.2%) and Haemophilus influenzae b (Hib) (9.5%). The mean annual incidence of bacterial meningitis was 101 per 100,000 population (70 per 100,000 during 11 non-epidemic years) and the average annual mortality rate was 17 deaths per 100,000. Over a 7-year period (including one major epidemic year) for which data were available, S. pneumoniae and Hib together caused more meningitis deaths than N. meningitidis. Meningitis cases were more common among males and occurred mostly during the dry season. Serogroup A caused 85.6% of meningococcal meningitis cases during the period investigated; three-quarters of these occurred among children aged < 15 years, and over 40% among under-5-year-olds. Both incidence and mortality rates were highest among infants aged < 1 year. In this age group, Hib was the leading cause of bacterial meningitis, followed by S. pneumoniae. The predominant cause of meningitis in persons aged 1-40 years was N. meningitidis. Use of the available vaccines against meningitis due to N. meningitidis, S. pneumoniae, and Hib could prevent substantial endemic illness and deaths in sub-Saharan Africa, and potentially prevent recurrent meningococcal epidemics.     

The absence of enhanced disease with wild type respiratory syncytial virus infection occurring after receipt of live, attenuated, respiratory syncytial virus vaccines

Early in the development of respiratory syncytial virus (RSV) vaccines severe disease occurred in children after receipt of formalin-inactivated RSV vaccine. Continuing efforts to develop an appropriately attenuated and immunogenic live RSV vaccine have given opportunities to assure that live vaccines are safe through surveillance of children after vaccination. In the present study, the rate of RSV-associated upper respiratory tract illness in 388 children was lower in RSV vaccinated children than in controls (14% versus 20% in a 6-24 month old group and 16% versus 25% in infants). Additionally, there was no evidence that vaccination predisposed to more severe lower respiratory tract illness. Thus infection with a series of live attenuated RSV vaccines did not result in enhanced disease upon infection with wild type RSV. The impact of RSV during this surveillance will inform the design of future efficacy studies with RSV vaccines.     

下呼吸道感染儿童的病原菌检测及临床分析

目的探讨下呼吸道感染患儿病原谱特征以及致病情况,为临床的精准性诊疗提供参考依据。方法选取2018年3月-2019年2月天津市儿童医院收治的2 084例急性下呼吸道感染患儿作为研究对象。采集痰标本或者肺泡灌洗液检测呼吸道病原菌,包括鲍曼不动杆菌(Aba)、铜绿假单胞菌(Pae)、肺炎克雷伯菌(Kpn)、金黄色葡萄球菌(Sau)、肺炎链球菌(Spn)、耐甲氧西林葡萄球菌(Mec)、流感嗜血杆菌(Hin)以及嗜麦芽窄食单胞菌(Sma)。观察呼吸道病原菌检出情况;分析呼吸道病原菌与性别、年龄、季节及呼吸道疾病的关系。结果 2 084例患儿中病原菌阳性检出率为57.73%(1 203/2084),其中4种病原菌检出阳性率较高,分别为Spn、Mec、Hin以及Sau。不同病原菌在不同年龄段的检出率比较,差异有统计学意义(P<0.05)。Spn在各年龄段的检出均较高,以1~3岁最多见,Sau感染以6个月以下儿童多见,Mec感染以1岁以下儿童多见,Hin感染以>6个月~1岁儿童多见。Spn全年均有较高的感染率,Sau和Mec感染好发于冬季,Hin在冬春季感染率最高。大叶性肺炎以Spn检出最多,支气管炎和支气管肺炎以Mec感染为主,间质性肺炎多见于Hin感染。结论下呼吸道感染患儿最常见的致病菌为Spn,其次为Mec、Hin以及Sau,呼吸道病原菌在不同年龄、不同季节以及致病情况具有各自的分布特点。     

清远市患儿呼吸道病原学的流行性病学规律

目的：观察清远市患儿呼吸道病原学的流行性病学规律。方法：选取本院呼吸道感染患儿1000例，采用九项呼吸道感染病原体IGM抗体检测试剂进行检测，观察记录患儿感染病原体类型及发病时间与患儿年龄和季节的关系。结果：患儿混合感染率秋季最多，其次为春季，且秋季感染率明显高于其他季节（P〈0.05）；肺炎支原体以2岁以下患儿感染最多，占肺炎支原体总检出率的17.6%；病毒总检出率为38.3%，说明本市患儿呼吸道感染仍以病毒感染为主。结论：急性呼吸道感染是常见的疾病，且引起呼吸道感染的病原体种类繁多，如能了解一个地区的病原体分布情况，可以为治疗起到指导作用，并且能减少抗生素的滥用，具有深远的临床意义。     

Bacteriology of community acquired meningitis in Sfax, Tunisia (1993-2001)

OBJECTIVE: The aim of this study was to analyze the distribution of bacteria responsible for community-acquired meningitis and the pattern of resistance of common species. DESIGN: All bacteriologically confirmed cases of community-acquired meningitis were recorded between 1993 and 2001. RESULTS: Two hundred twenty-four cases of bacterial meningitis were recorded. The most frequent species were Haemophilus influenzae and Streptococcus pneumoniae followed by Neisseria meningitidis with respectively 37.1%, 32.1%, and 10.7% of cases. The yearly distribution of these bacteria did not show any epidemic peak. Enterobacteria and group B Streptococcus were the most frequently identified pathogens in neonatal meningitis. H. influenzae was the predominant microorganism in children between one month and five years of age, (66.4%) followed by S. pneumoniae (23.5%). S. pneumoniae was the predominant bacteria responsible fore more than half of the cases over five years of age. 28.8% of H. influenzae strains produced beta-lactamase. 27.2% of S. pneumoniae strains were less susceptible to penicillin. Resistance rates for amoxicillin and cefotaxime were respectively 10.6% and 7.5%. Only one strain of N. meningitidis (4.2%) presented with a decreased susceptibility to penicillin. CONCLUSIONS: In our study, H. influenzae and S. pneumoniae were the main microorganisms responsible for community-acquired meningitis. High resistance rates were found for these bacteria: 28.8% of H. influenzae to ampicillin and 27.2% of S. pneumoniae to penicillin.     

Role of respiratory syncytial virus in acute otitis media: implications for vaccine development

We summarize herein the results of various virologic studies of acute otitis media (AOM) conducted at our site over a 10-year period. Among 566 children with AOM, respiratory syncytial virus (RSV) was the most common virus identified in either middle ear fluid or nasal wash; it was found in 16% of all children and 38% of virus-positive children. Seventy-one percent of the children with RSV were 1 year of age or older, which was significantly older than all other viruses combined (P=0.045). RSV infection was associated with the common bacterial pathogens causing AOM. Past efforts to develop vaccines for RSV have emphasized prevention of lower respiratory tract infection in infants, which is a more serious problem but less common than AOM. Our results suggest that RSV vaccines that work only against infection in older children may have value in preventing AOM, the most common pediatric disease.