儿童下呼吸道肺炎链球菌感染临床特征及耐药性

目的分析南京地区下呼吸道肺炎链球菌（SP）感染患儿的临床特征及耐药性。方法回顾性分析2013年7月—2014年6月南京某儿童医院经痰培养确诊为下呼吸道SP感染的患儿临床资料，对菌株进行药物敏感试验和最低抑菌浓度（MIC）检测。结果197例SP感染患儿，＜3岁者占72.59%，秋冬季发病者占63.96%，外周血白细胞升高者占57.87％，临床表现以咳嗽、发热多见，呼吸系统外并发症以消化系统和循环系统多见。SP对阿奇霉素、青霉素及红霉素耐药率分别为94.92%、92.89%、88.83%；对万古霉素、氯霉素、美罗培南、头孢曲松、氧氟沙星敏感率均＞90%，其中对万古霉素敏感率高达98.98%。结论下呼吸道SP感染患儿以3岁内婴幼儿所占比例高，秋冬季节发病多见，对阿奇霉素、青霉素和红霉素耐药率高，临床上应根据药敏结果选择用药。

Clinical features and antimicrobial resistance of lower respiratory tract infection with Streptococcus pneumoniae isolated from children

ObjectiveTo explore clinical features and antimicrobial resistance of lower respiratory tract infection (LRTI) with Streptococcus pneumoniae (S. pneumoniae) isolated from children in Nanjing.MethodsClinical data of children with confirmed S. pneumoniae LRTI through sputum culture at a children’s hospital in Nanjing between July 2013 and June 2014 were analyzed retrospectively, S. pneumoniae strains were performed antimicrobial susceptibility testing through K B method and minimum inhibitory concentration (MIC) testing.ResultsAmong 197 children with S. pneumoniae infection, 72.59% were ＜3 years old, 63.96% occurred in autumn and winter， 57.87％ had elevated leukocyte count, cough and fever were the most common clinical symptoms, complications of digestive and circulatory system were also common. The resistance rates of S. pneumoniae to azithromycin, penicillin, and erythromycin were 94.92%, 92.98%, and 88.83% respectively; the sensitivity rates to vancomycin, chloramphenicol, meropenem, ceftriaxone, and ofloxacin were all ＞90%, vancomycin was up to 98.98%.ConclusionThe percentage of S. pneumoniae LRTI is high in children< 3 years old, most occur in autumn and winter, resistance rates to azithromycin, penicillin, and erythromycin are all high, antimicrobial agents should be selected for the treatment of infection according to antimicrobial susceptibility testing.use