儿童侵袭性肺炎链球菌感染的血清型和耐药性

 目的 了解某医院住院患儿侵袭性肺炎链球菌感染的临床特征以及菌株的血清型和耐药性，以期指导临床合理用药，寻找防治侵袭性肺炎链球菌感染的有效方法。方法 回顾性分析2014年1月—2018年12月该院明确诊断为侵袭性肺炎链球菌感染患儿的临床资料，肺炎链球菌的药敏结果、血清型，以及疫苗对其血清型覆盖情况。结果 74例侵袭性肺炎链球菌感染患儿主要为幼儿期患儿（55.4%），感染部位主要以单部位血液为主（44.6%）。74株肺炎链球菌，其中22株分离自脑脊液标本，分为13种血清型，常见的血清型为19F、19A、14和23F。青霉素不敏感肺炎链球菌（PNSP）检出率为56.7%（42株），未发现对利奈唑胺、万古霉素、莫西沙星和左氧氟沙星耐药的肺炎链球菌。不同血清型菌株的耐药率有明显差异，血清型19F和19A对青霉素、头孢噻肟、头孢吡肟和美罗培南的耐药率高于其他血清型。肺炎链球菌疫苗对肺炎链球菌的覆盖率：PCV7为63.5%，PCV13为97.3%。结论 该医院住院患儿侵袭性肺炎链球菌感染多见于婴幼儿，分离的肺炎链球菌血清型以19F、19A、14、23A为主，PCV13对这些血清型覆盖率高，可通过接种疫苗减少侵袭性肺炎链球菌感染的发生。流行率高的血清型往往表现出更高的耐药性，应根据药敏试验结果合理选用抗菌药物。

Serotypes and antimicrobial resistance of invasive Streptococcus pneumo-niae infection in children

Objective To understand the clinical characteristics, bacterial serotypes and antimicrobial resistance of invasive Streptococcus pneumoniae(S. pneumoniae) infection in hospitalized children in a hospital, guide clinical rational antimicrobial use and find effective methods for prevention and treatment of invasive S. pneumoniae infection. Methods Retrospective analysis was performed on clinical data, antimicrobial susceptibility resting results and serotype of S. pneumoniae as well as vaccine serotype coverage of children who were diagnosed with invasive S. pneumoniae infection in a hospital from January 2014 to December 2018. Results 74 children were with invasive S. pneumoniae infection, mainly children in early childhood (55.4%), the main infection site was blood (44.6%). Among 74 strains of S. pneumoniae, 22 were from cerebrospinal fluid, 13 serotypes were divided, the common serotypes were 19F, 19A, 14 and 23F. Isolation rates of penicillin-non-susceptible S. pneumoniae (PNSP) was 56.7% (42 strains), no strain was found to be resistant to linezolid, vancomycin, moxifloxacin and levofloxacin. Resistance rates of strains with different serotypes was significantly different, resistance rates of serotypes 19F and 19A to penicillin, cefotaxime, cefepime and meropenem were higher than other serotypes. The coverage of S. pneumoniae vaccine to S. pneumoniae was 63.5% in PCV7 and 97.3% in PCV13. Conclusion Invasive S. pneumoniae infection is more common in infants and young children in this hospital, serotypes of isolated S. pneumoniae are mainly 19F, 19A, 14 and 23A, PCV13 has a high coverage rate for these serotypes, which can reduce the occurrence of invasive S. pneumoniae infection through vaccination. Serotypes with high prevalence tend to show higher antimicrobial resistance, so antimicrobial agents should be selected rationally according to antimicrobial susceptibility testing results.