摘要
目的分析苏州地区侵袭性肺炎链球菌病(IPD)及死亡病例的血清型和临床特征,寻找有效防治IPD的对策。方法对苏州大学附属儿童医院2011年1月至2015年12月80例明确诊断的IPD患儿菌株进行血清学分型,对其临床特征和实验室结果进行统计分析。结果80例IPD患儿的病死率为17.5%(14/80),2岁以下占60.0%(48/80),14例死亡患儿2岁以下占78.6%(11/14),死亡组中位年龄0.68(0.45,2.07)岁,显著小于存活组1.61(0.85,3.45)岁(P<0.05);入院前死亡组患儿发生高热、呕吐和嗜睡显著高于存活组(P<0.05),死亡组发生休克、DIC、呼吸衰竭、急性肾损伤和抽搐或昏迷显著高于存活组(P<0.05);入院前抗生素使用与药敏结果符合率为15.0%(12/80),抗生素符合药敏组病死率为8.3%(1/12),低于抗生素不符合药敏组的16.2%(11/68),但差异无统计学意义(P >0.05);80例肺炎链球菌对于红霉素耐药率100%(80/80),克林霉素98.8%(79/80),四环素88.8%(71/80),复方新诺明71.3%(57/80),青霉素48.8%(39/80),头孢噻肟32.5%(26/80),阿莫西林8.8%(7/80),氯霉素5.0%(4/80),万古霉素0(0)和左氧氟沙星0(0);80例IPD患儿检出肺炎链球菌8种血清型依次为6B(25.5%,20/80)、14(23.8%,19/80)、19F(15.0%,12/80)、19A(15.0%,12/80)、23F(8.8%,7/80)、20(5.0%,4/80)、9V(5.0%,4/80)和15B/C(2.5%,2/80),其中死亡患儿14例菌株6种血清型依次为6B(35.7%,5/14)、14(28.6%,4/14)、19F(14.3%,2/14)、19A(7.1%,1/14)、23F(7.1%,1/14)和20(7.1%,1/14),7价肺炎链球菌疫苗可覆盖IPD血清型的77.5%(62/80),显著低于13价肺炎链球菌疫苗的92.5%(74/80)(P<0.05)。结论儿童IPD死亡病例多发生在2岁以下;门诊抗生素选择对肺炎链球菌的符合率低及我国肺炎链球菌疫苗接种率低是IPD高病死率的重要原因;早期持续高热、呕吐和嗜睡等危重症状的识别及抗生素合理选择对于改善IPD的预后具有重要意义;提倡接种13价肺炎链球菌结合疫苗以降低IPD的发生率和病死率。
Objective To understand serotypes and clinical manifestation of children with invasive pneumococcal disease (IPD) in Suzhou, so as to find a better strategy for reducing the incidence and mortality of IPD. Methods Eighty children with IPD were enrolled into our study from January 2011 to December 2015.The data of epidemiology, serotype, clinical manifestation, laboratory results and prognosis were collected and analyzed. Results The mortality of 80 children with IPD was 17.5%(14/80). Sixty percent of them were younger than 2 years old, and 78.6% of 14 dead cases were younger than 2 years old, the median age of dead group 0.68 (0.45, 2.07) years was younger than 1.61 (0.85, 3.45) years of survival group (P<0.05). The incidence rates of hyperpyrexia, vomiting and somnolence in dead group were higher than those in survival group before admission (P<0.05), the incidence rates of shock, DIC, respiratory failure, AKI, seizure or coma in dead group were higher than those in survival group (P<0.05). The coincidence rate between choice of antibiotics before admission and drug sensitivity test was 15.0%(12/80), the mortality of coincident group (coincidence between choice of antibiotics and drug sensitivity test) 8.3% was lower than 16.2% of non-coincident group with no statistical differences (P >0.05). The drug resistance rates of 80 pneumococcus to Erythromycin, Clindamycin, Tetracycline, Sulfamethoxazole, Penicillin, Cefotaxime, Amoxicillin, Chloramphenicol, Vancomycin and Levofloxacin were 100% (80/80), 98.8% (79/80), 88.8%(71/80), 71.3%(57/80), 48.8%(39/80), 32.5%(26/80), 8.8%(7/80), 5.0%(4/80), 0(0/80) and 0(0/80) respectively.Eight serotypes of 80 IPD cases were listed in descending order: 6B(25.5%, 20/80), 14(23.8%, 19/80), 19F(15.0%, 12/80), 19A(15.0%, 12/80), 23F(8.8%, 7/80), 20(5.0%, 4/80), 9V(5.0%, 4/80) and 15B/C(2.5%, 2/80), and 6 serotypes of 14 dead cases were: 6B(35.7%, 5/14), 14(28.6%, 4/14), 19F(14.3%, 2/14), 19A(7.1%, 1/14), 23F(7.1%, 1/14) and 20(7.1%, 1/14);the coverage of IPD serotypes of 7-valent pneumococcal conjugate vaccine (PCV7) 77.5%(62/80) was lower than 92.5%(74/80) of 13-valent pneumococcal conjugate vaccine (P<0.05). Conclusion Majority of dead cases of IPD is always younger than 2 years.The low coincidence rate of choices of antibiotics to invasive pneumococcus outpatient and low rate of PCV immunization in China are responsible for the high mortality of IPD.Timely recognition of continuous hyperpyrexia, vomiting and somnolence in early stage and appropriate use of antibiotics is the key to improve the outcome of IPD.Thirteen-valent pneumococcal conjugate vaccine immunization provides a robust strategy for reducing the incidence and mortality of IPD.
作者
徐忠
张瑾
韩美林
黄莉莉
陶云珍
李莺
张涛
李艳红
柏振江
Xu Zhong;Zhang Jin;Han Meilin;Huang Lili;Tao Yunzhen;Li Ying;Zhang Tao;Li Yanhong;Bai Zhenjiang(Pediatric Intensive Care Unit,Children Hospital of Soochow University,Suzhou 215025, China)
出处
《中国小儿急救医学》
CAS
2018年第12期933-938,共6页
Chinese Pediatric Emergency Medicine
基金
国家自然科学基金面上项目(81571551)
江苏省自然科学基金面上项目(BK20151206)
苏州市科技计划项目(SYS201560).
