CAJ | 학술논문

目的探讨5岁以下儿童侵袭性肺炎链球菌病的临床特点并对耐药性进行分析.方法对2009年至2010年入住中国医科大学附属盛京医院5岁以下确诊为侵袭性肺炎链球菌病患儿的临床特点、药敏结果及抗生素治疗进行回顾性分析.结果 45例侵袭性肺炎链球菌病好发于4 ～6月份；2岁以内30例(66.7％)；菌血症32例(71.1％),化脓性脑膜脑炎9例(20.0％),脓胸23例(51.1％),伴有坏死性肺炎10例(22.2％).药敏结果显示:红霉素不敏感率为100％,克林霉素不敏感率95％,四环素不敏感率95.12％,复方新诺明不敏感率80.49％,氯霉素不敏感率18.18％,利福平、奎诺酮类、万古霉素及利奈唑胺几乎全敏感,青霉素及头孢菌素出现部分耐药且最低抑菌药物浓度较高.45例中,25例治愈出院(55.6％),15例好转(33.3％),4例死亡(8.9％),1例退院；死亡病例均在2岁以内,且耐药性严重.结论 2岁以内患儿更易发生侵袭性肺炎链球菌病且病死率高；当前侵袭性肺炎链球菌菌株耐药性严重并与不良预后有关,应引起关注.
목적 탐토5세이하인동침습성폐염련구균병적림상특점병대내약성진행분석.방법 대2009년지2010년입주중국의과대학부속성경의원5세이하학진위침습성폐염련구균병환인적림상특점、약민결과급항생소치료진행회고성분석.결과 45례침습성폐염련구균병호발우4 ～6월빈；2세이내30례(66.7％)；균혈증32례(71.1％),화농성뇌막뇌염9례(20.0％),농흉23례(51.1％),반유배사성폐염10례(22.2％).약민결과현시:홍매소불민감솔위100％,극림매소불민감솔95％,사배소불민감솔95.12％,복방신낙명불민감솔80.49％,록매소불민감솔18.18％,리복평、규낙동류、만고매소급리내서알궤호전민감,청매소급두포균소출현부분내약차최저억균약물농도교고.45례중,25례치유출원(55.6％),15례호전(33.3％),4례사망(8.9％),1례퇴원；사망병례균재2세이내,차내약성엄중.결론 2세이내환인경역발생침습성폐염련구균병차병사솔고；당전침습성폐염련구균균주내약성엄중병여불량예후유관,응인기관주.
Objective To investigate the clinical characteristics of invasive pneumococcal disease (IPD) and its drug resistance among children under the age of 5 years.Methods Clinical characteristics of 45 children of IPD admitted to the Shengjing Hospital of China Medical University from 2009 to 2010 and antimicrobial non-susceptibility results were analyzed retrospectively.Results Forty-five cases of IPD were confirmed by positive culture of sterile body site,most of which occurred between April and June.Most of the IPD children were below the age of 2 years,which accounted for 66.7％ (30/45).The disease spectrum included bacteremia in 32 cases (71.1％),encephalitis in 9 cases (20.0％),empyema in 23 cases (51.1％),necrotizing pneumonia in 10 cases (22.2％).Pneumococcal non-susceptibility to erythromycin were found to be 100％,to clindamycin were 95％,to tetracycline were 95.12 ％,to trimethoprim-sulfamethoxaole were 80.49％,to chloramphenicol were 18.18％,while pneumococcal resisitanse to rifampicin,quinolones and vancomycin were 0.Eight of eleven and 18/24 were found to be pneumoccal resistance to penicillin and cephalosporin respectively and their minimum inhibitory concentrations were high.Twenty five cases were cured (55.6％).Fifteen cases were improved (33.3％).Four cases died (8.9％).One cases was retreated.All cases of death were under the age of 2 years.Conclusion IPD is more common with a high mortality rate among those under the ages of 2 years.Poor outcome is associated with Streptococcus pneumoniae resistance to antibiotics.