2012-2017年某院儿童肺炎链球菌感染分布特点及耐药性

Distribution and drug resistance of Streptococcus pneumoniae infection in children in a hospital from 2012 to 2017

摘要:

目的 了解某院儿童肺炎链球菌感染分布特点、耐药性及其变化趋势。方法 对该院2012年1月—2017年12月儿科住院患儿的痰、血、脑脊液标本进行分离培养和细菌鉴定，参照美国临床实验室标准化协会（CLSI）文件M100-S28标准进行药敏试验和结果判定，对数据进行统计分析。结果 共分离2 384株肺炎链球菌，男性占54.32%，女性占45.68%；0.5~3岁年龄段患儿占63.38%，≤0.5岁者占21.10%，> 3岁者占15.52%。肺炎链球菌占所有分离细菌的18.08%，按季度统计其占细菌分离的比率，四季度（20.62%，839/4 068） > 一季度（18.77%，762/4 059） > 二季度（18.42%，557/3 024） > 三季度（11.11%，226/2 034），但随季度变化的差异在逐步缩小。肺炎链球菌对红霉素、复方磺胺甲唑、克林霉素、四环素耐药率高（73.21%~99.62%），对左氧氟沙星、氯霉素、头孢呋辛、头孢噻肟、阿莫西林、青霉素的耐药率较低（0.19%~33.92%），未发现对万古霉素、奎奴普丁/达福普汀、利奈唑胺、莫西沙星耐药的肺炎链球菌。结论 肺炎链球菌主要分离于呼吸道感染患儿，≤3岁儿童是感染主体。肺炎链球菌分离率随季度变化的差异正在逐步缩小，其时间分布特点越来越不明显。阿莫西林、青霉素可作为治疗儿童肺炎链球菌感染的一线药物。

Abstract:

Objective To understand the distribution, drug resistance and change trend of Streptococcus pneumo-niae (S. pneumoniae) infection in children in a hospital. Methods Sputum, blood and cerebrospinal fluid specimens of pediatric inpatients from January 2012 to December 2017 were cultured, bacteria were isolated and identified, antimicrobial susceptibility testing and result judgment were conducted according to Clinical and Laboratory Standards Institute (CLSI) M100-S28, data were statistically analyzed. Results A total of 2 384 strains of S. pneumoniae were isolated, 54.32% of which were isolated from male, 45.68% were from female, 63.38% of children were 0.5-3 years old, 21.10% were ≤ 0.5 year old, 15.52% were >3 years old. S. pneumoniae accounted for 18.08% of all isolated bacteria, according to the quarterly statistics, the proportion of bacteria isolated in the fourth quarter (20.62%, 839/4 068) > first quarter (18.77%, 762/4 059) > second quarter (18.42%, 557/3 024) > third quarter (11.11%, 226/2 034), but difference with the change of quarter was gradually narrowing. Resistance rates of S. pneumoniae to erythromycin, compound sulfamethoxazole, clindamycin and tetracycline were high (73.21%-99.62%), while resistance rates to levofloxacin, chloramphenicol, cefuroxime, cefotaxime, amoxicillin and penicillin were low (0.19%-33.92%), no S. pneumoniae was found to be resistant to vancomycin, quinupristin/dalfopristin, linezolid and moxifloxacin. Conclusion S. pneumoniae is mainly isolated from children with respiratory tract infection, most infection occurred in children aged ≤ 3 years. Difference in S. pneumoniae isolation rate with the change of quarter is gradually narrowing, and its time distribution characteristics becomes less and less obvious. Amoxicillin and penicillin can be used as first-line agents for treatment of S. pneumoniae infection in children.