184例儿童感染肺炎链球菌的血清型分布及其耐药性分析

目的分析184例儿童感染肺炎链球菌的血清型分布及其耐药性情况。方法选取2014年1月至2017年12月我院呼吸道感染患儿2828例,进行痰液培养,分析病原菌检出情况,肺炎链球菌分布情况、血清分型以及对抗生素耐药性情况。结果2828例患儿的痰标本共检出674株病原菌(23.83%),其中肺炎链球菌184例,检出率为6.51%。年龄1个月~1岁患儿感染肺炎链球菌发生率为52.17%,明显高于1~3岁、3~6岁患儿的25.54%、22.28%(P<0.05);冬季患儿感染肺炎链球菌发生率为53.26%,明显高于春季、夏季、秋季的19.02%、13.05%、14.67%(P<0.05);184株肺炎链球菌共涉及11个血清型/群,主要分布于19F、19A、14型、9V、23F、6B、8型、7F、7A、其他等,另有11株未能分型。青霉素(脑膜炎)的不敏感率高达83.33%,明显高于青霉素(非脑膜炎)的63.24%(P<0.05);而头孢曲松对感染肺炎链球菌脑膜炎或非脑膜炎患儿的敏感率比较,无统计学意义(P>0.05)。患儿感染肺炎链球菌的青霉素(脑膜炎)、红霉素、四环素、复方新诺明、头孢克罗、克林霉素耐药检出率分别为72.91%、86.96%、89.13%、79.89%、80.43%、77.23%;而万古霉素、氯霉素、左氧氟沙星、氧氟沙星、莫西沙星、头孢曲松敏感率分别为100.00%、95.65%、98.38%、91.85%、92.94%、91.85%。结论儿童感染肺炎链球菌存在明显的年龄、季节、血清分布与耐药性差异,此研究结果对儿童肺炎抗感染治疗经验性抗生素选择有指导意义。

Analysis of serotype distribution and drug resistance of 184 children infected with Streptococcus pneumoniae

Objective To analyze the serotype distribution and drug resistance of 184 children infected with Streptococcus pneumoniae.Methods 2828 children with respiratory infection in our hospital from January 2014 to December 2017 were selected for sputum culture,and the pathogens were detected to analyze the distribution of S.pneumoniae,serotyping and antibiotic resistance.Results A total of 674 pathogens(23.83%)were detected in 2828 cases of sputum specimens,including 184 cases of Streptococcus pneumoniae,with a detection rate of 6.51%.The incidence of pneumococcal infection in children aged 1 month to 1 year was 52.17%,which was significantly higher than 25.54%and 22.28%(P<0.05)in children aged 1 to 3 years and 3 to 6 years old.The incidence of streptococcus was 53.26%in winter,which was significantly higher than 19.02%,13.05%and 14.67%in spring,summer and autumn(P<0.05).A total of 11 serotypes/groups of 184 strains of Streptococcus pneumoniae were mainly distributed in 19F,19A,14 type,9V,23F,6B,8 type,7F,7A,and others,and 11 strains were not classified.The insensitivity rate of penicillin(meningitis)was as high as 83.33%,which was significantly higher than 63.24%of penicillin(non-meningitis)(P<0.05).The sensitivity rate of ceftriaxone in children with pneumococcal meningitis or non-meningitis was not statistically significant(P>0.05).The detection rates of penicillin(meningitis),erythromycin,tetracycline,compound sulfamethoxazole,cefaclor and clindamycin in children infected with Streptococcus pneumoniae were 72.91%,86.96%,89.13%,and 79.89%,80.43%,and 77.23%,respectively.The sensitivity rates of vancomycin,chloramphenicol,levofloxacin,ofloxacin,moxifloxacin and ceftriaxone were 100.00%,95.65%,98.38%,91.85%,92.94%and 91.85%,respectively.Conclusion There are significant differences in age,season,serum distribution and drug resistance in children infected with Streptococcus pneumoniae.The results of this study have guiding significance for the selection of empirical antibiotics for children with pneumonia anti-infective therapy.