儿童肺炎链球菌败血症的临床特点及药敏分析

目的：探讨儿童肺炎链球菌（Streptococcus pneumoniae, SP）败血症的临床特点及SP菌株药敏情况，为临床更好地诊治该病提供依据。方法：回顾性分析2009年1月至2012年12月收治的25例SP败血症患儿的临床资料。结果： 25例患儿中，小于2岁者16例（64％），2~5岁5例（20％），5岁以上4例（16％）。14例（56％）合并其他器官感染，5例（20％）伴有慢性基础疾病。临床表现以发热为主，多为弛张热；8 例合并肺炎或脓胸者有肺部症状；5例合并脑膜炎患儿有神经系统症状；5例患儿出现肝脾肿大；2例患儿出现感染性休克。19例（76%，19/25）血白细胞明显升高，21例（84%，21/25）血C-反应蛋白（CRP）升高，8例（50%，8/16）血清降钙素原（PCT）升高。药敏分析结果表明，侵袭性SP对青霉素（96％）、氯林克霉素（88％）和红霉素（84％）的耐药率高，对亚胺培南、万古霉素、左氧氟沙星和利奈唑胺完全敏感，SP多重耐药率高达88％。经积极治疗后治愈或好转23例（92％）。结论：SP败血症多见于2岁以下的婴幼儿；发热是其主要临床表现，伴有血象、CRP及PCT升高，易合并肺部或脑部感染。SP存在严重多重抗生素耐药，要根据药敏试验结果合理、规范使用抗生素。接受积极、合理治疗者预后良好。

Clinical characteristics of children with Streptococcus pneumoniae septicemia and drug sensitivity of Streptococcus pneumoniae

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.