CAJ | 학술논문

目的总结儿童侵袭性肺炎链球菌病( IPD)的临床特征及耐药性资料,以提高对该病的诊疗水平.方法回顾性分析2008年1月至2010年12月21例IPD患儿的临床资料；采集患儿的血液、胸腔积液、脑脊液、软组织引流液标本,经实验室培养、分离、鉴定出23株肺炎链球菌(SP),检测其对青霉素等抗生素的敏感性.结果 21例IPD患儿中男女比例为0.9∶1.年龄5个月至13岁,其中2岁以下占61.9％.临床诊断化脓性胸膜炎最多,为12例(57.1％).1例有基础疾病,为X-连锁低丙种球蛋白血症.发病无明显季节性差异.临床治愈8例(38.1％),好转11例(52.4％),未愈自动出院2例(9.5％),无死亡病例.各年度侵袭性SP检出率间差异无统计学意义(x2 =3.711,P=0.156);青霉素中介SP和青霉素耐药SP检出率分别为47.8％和26.1％；多重耐药率达91.3％.结论 IPD好发于5岁以下尤其是2岁以下儿童,临床疾病以化脓性胸膜炎和败血症最常见.部分患儿存在基础疾病.并发症包括噬血细胞综合征、急性呼吸窘迫综合征、脓毒性休克、支气管胸膜瘘等.多重耐药率达91.3％.加强IPD的耐药监测对指导临床用药有非常重要的意义.
목적 총결인동침습성폐염련구균병( IPD)적림상특정급내약성자료,이제고대해병적진료수평.방법 회고성분석2008년1월지2010년12월21례IPD환인적림상자료；채집환인적혈액、흉강적액、뇌척액、연조직인류액표본,경실험실배양、분리、감정출23주폐염련구균(SP),검측기대청매소등항생소적민감성.결과 21례IPD환인중남녀비례위0.9∶1.년령5개월지13세,기중2세이하점61.9％.림상진단화농성흉막염최다,위12례(57.1％).1례유기출질병,위X-련쇄저병충구단백혈증.발병무명현계절성차이.림상치유8례(38.1％),호전11례(52.4％),미유자동출원2례(9.5％),무사망병례.각년도침습성SP검출솔간차이무통계학의의(x2 =3.711,P=0.156);청매소중개SP화청매소내약SP검출솔분별위47.8％화26.1％；다중내약솔체91.3％.결론 IPD호발우5세이하우기시2세이하인동,림상질병이화농성흉막염화패혈증최상견.부분환인존재기출질병.병발증포괄서혈세포종합정、급성호흡군박종합정、농독성휴극、지기관흉막루등.다중내약솔체91.3％.가강IPD적내약감측대지도림상용약유비상중요적의의.
Objective To study the clinical features of invasive pneumococcus disease (IPD) with resistance to antimicrobial agents in children,and to improve the diagnosis and treatment of this disease.Methods The clinical data from 21 IPD patients younger than 13 years old were collected from January 2008 through December 2010 in Pediatric Intensive Care Unit in Beijing Children's Hospital for retrospective analysis. Specimens of blood,pleural effusion,cerebrospinal fluid and soft tissue aspirated were collected from these children,and 23 strains of streptococcus pneumonia (SP) were cultured,isolated and confirmed,and the antibiotics susceptibility to penicillin and other antibiotics of these strains were assayed.Results Among the 21 IPD children,the ratio of male to female was 0.9∶1,and the age was 5 months to 13 years,with 61.9％ of them under 2 years.Of them,12 patients (57.1％ ) had purulent pleurisy,and 1 (4.8％ )patient had an underlying disease diagnosed to be X - linked agammaglobulinemia (XLA).There was no seasonal difference in the occurrence rate of this disease. Eight (38.1％) patients were cured,11(52.4％ ) were improved,while 2 (9.5％ ) patients not improved without death.There was no statistically significant difference in the annual detection rate of invasive SP (x2 =3.711,P =0.156).The incidences of penicillin-intermediate susceptibility SP (PISP) and penicillin-resistant SP (PRSP) were 47.8％ and 26.1％ respectively.The rate of resistance to multiple antibiotics was 91.3％.Conclusions Children aged less than 5 years,especially younger than 2 years,are prone to IPD,and purulent pleurisy and septicemia are often seen in this disease. Some patients had the underlying diseases.The complications included hemophagocytic syndrome,acute respiratory distress syndrome,septic shock,bronchial pleural fistula and so on.The multidrug resistance rate was 91.3％.It is important to put great emphasis on the monitoring antibiotics resistance to invasive pneumococcal disease.