儿童肺炎链球菌坏死性肺炎临床特点分析

目的：总结肺炎链球菌所致坏死性肺炎的临床特点。方法选取2008年1月至2011年4月本院儿科临床诊断肺炎链球菌肺炎且影像学证实有坏死性病变者15例。收集临床资料,总结其性别、年龄、最高体温、住院时间、发热时间、肺部影像学特征及白细胞、C-反应蛋白水平,应用纸片扩散法和最小抑菌浓度法分别对15株及其中11株肺炎链球菌进行药敏试验,对各药耐药率、敏感率进行分析。结果15例患儿中,发热、胸腔积液15例,有肺外并发症1例；X线胸片或肺CT表现右肺病变者7例,左肺7例,双肺同时坏死性病变1例。所有病例均有外周血白细胞及C-反应蛋白升高。临床分离肺炎链球菌对万古霉素、利奈唑胺、利福平、左氧氟沙星敏感性高,对青霉素耐药率比较严重,而对红霉素和克林霉素普遍耐药。平均住院时间为39 d,无死亡病例。结论儿童肺炎链球菌坏死性肺炎临床过程延长,耐药严重,症状重,易并发胸腔积液,但通过积极治疗,预后较良好。

Clinical characteristics of necrotizing pneumococcal pneumonia in childhood

Objective To summarize the clinical characteristics of necrotizing pneumococcal pneu-monia in childhood,so as to estimate the prognosis and guide the therapy. Methods We retrospectively col-lected and analyzed the data of 15 necrotizing pneumococcal pneumonia cases hospitalized in the pediatric de-partment of Shengjing Hospital from January 2008 to April 2011. The clinical features and treatment outcomes were analyzed,which included sex, age, maximum body temperature, hospital stay, duration of fever, white blood cell count and C-reactive protein level. Fifteen strains of the clinical isolated streptococcus were ana-lyzed antimicrobial susceptibility test with the disk diffusion procedure,and eleven strains of them were ana-lyzed by with minimal inhibitory concentrations. Results All of 15 cases had fever and pleural effusion,1 case with extrapulmonary manifestations. In chest X-ray and CT scanning,the lesion location were on the left in 7 cases,on the right in 7 cases,bilateral in 1 case. All patients had increased white blood cell count and C-reactive protein. Fifteen strains of streptococcus pneumoniae were collected from clinic samples,which had high sensitivity to vancomycin,linezolid,rifampicin,levofloxacin,no resistant strains appeared. We observed that the resistant rates of streptococcus pneumoniae to penicillin was 7/15,and to erythromycin and clindamy-cin were 11/11 and 10/11. The average length of stay in hospital was 39 d and no death occurred during the hospitalization. Conclusion The treatment of necrotizing pneumococcal pneumonia in childhood usually takes a longer time,and patients always have obvious symptoms. The drug-resisting of streptococcus pneu-moniae are serious,and children with necrotizing pneumococcal pneumonia are easily complicated by pleural effusion. But through active treatment,the prognosis is good.