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目的:分析儿童侵袭性肺炎链球菌病(IPD)102例的临床特征和耐药情况。方法:回顾分析自2010年10月到2014年10月重庆医科大学附属儿童医院收治的102例血培养和/或脑脊液等无菌部位培养明确为肺炎链球菌患儿的病历资料及药敏结果。结果:1 102例患儿男女比为1.22:1;年龄分布0~3岁51例(50%),2~5岁30例(29.41%),5~10岁14例(13.73%),≥10岁7例(6.86%)。败血症82例(80.4%),化脓性脑膜炎40例(39.2%),其中19例存在基础疾病(白血病、先天性心脏病、免疫缺陷等)(18.6%),胸腔积液10例,脑积水10例,颅脑外伤后并发败血症8例,脓毒性休克7例;临床治愈26例(25.5%),好转51例(50%),死亡10例,自动出院12例(预后不良)。2 102株侵袭性肺炎链球菌中,青霉素不敏感率47.1%,红霉素99%,克林霉素96.1%,多重耐药率82.35%,尚未发现对万古霉素、利奈唑胺、左氧氟沙星、利福平耐药。3所有患儿均有发热,发热持续时间1~14 d,平均(7.35±2.61)d。70例患儿同时出现白细胞计数增多和CRP增高,20例患儿降钙素原>10 ng/m L。结论:侵袭性肺炎链球菌病好发于0~3岁婴幼儿,临床表现主要有败血症、化脓性脑膜炎;存在基础疾病情况下罹患IPD增多。加强IPD的耐药监测对指导临床用药有重要意义,积极推广肺炎链球菌疫苗,同时有效地预防肺炎链球菌感染,减少IPD发病,显得更为迫切和重要。
Objective: To analyze the clinical features and drug resistance of 102 children with invasive pneumococcal disease (IPD). Methods: From October 2010 to October 2014, 102 cases of blood culture and / or cerebrospinal fluid (CSF) and other aseptic sites in Children’s Hospital Affiliated to Chongqing Medical University were retrospectively analyzed. Results: The odds ratio was 1.22: 1 in 102 cases, 51 cases (50%) were 0-3 years old, 30 cases (29.41%) were 2-5 years old, 14 cases (13.73%) were 5-10 years old and ≥ 10 years old in 7 cases (6.86%). Sepsis in 82 cases (80.4%), purulent meningitis in 40 cases (39.2%), of which 19 cases of underlying diseases (leukemia, congenital heart disease, immunodeficiency, etc.) (18.6%), pleural effusion in 10 cases, Water in 10 cases, 8 cases of septicemia after traumatic brain injury, septic shock in 7 cases; clinical cure in 26 cases (25.5%), improvement in 51 cases (50%), death in 10 cases, automatic discharge in 12 cases (poor prognosis). 2 102 strains of invasive Streptococcus pneumoniae, penicillin insensitivity rate of 47.1%, erythromycin 99%, clindamycin 96.1%, multidrug resistance rate of 82.35%, no vancomycin, linezolid, levofloxacin, Rifampicin resistance. 3 All children had fever, duration of fever 1 ~ 14 d, an average of (7.35 ± 2.61) d. 70 cases of children accompanied by an increase in white blood cell count and CRP increased in 20 children with procalcitonin> 10 ng / m L. Conclusions: Invasive pneumococcal disease occurs in infants and young children aged 0-3 years. The main clinical manifestations include sepsis and purulent meningitis. IPD increased in the presence of underlying diseases. To strengthen the monitoring of IPD drug resistance is of great importance to guide the clinical use of drugs, and actively promote Streptococcus pneumoniae vaccine, while effectively preventing S. pneumoniae infection, reduce the incidence of IPD, more urgent and important.