| Objective: Streptococcus pneumoniae is the main pathogen in children under 5 years old,and prone to cause invasive streptococcus pneumoniae disease after infection,leading to high morbidity and mortality.Meanwhile,with the change of drug resistance and selection pressure of antibiotics,the clinical characteristics of streptococcus pneumoniae infection may change.This study retrospectively analyzed the clinical characteristics,changes of bacterial drug resistance and risk factors of death of children with streptococcus pneumoniae infection admitted to our hospital from January 2012 to December 2019,providing reference for clinical diagnosis and treatment.Method: By searching the children between 28 days to 14 years who were admitted to our hospital from January 2012 to December 2019 from HIS system,the children with streptococcus pneumoniae culture positive,out-of-hospital disease duration within 28 days and specimens obtained within 1 week after admission were included in the study.The types of specimens included alveolar lavage fluid,blood,cerebrospinal fluid and external auditory canal secretions,local abscess,and fluid from abdominal abscess drainage.The inpatient medical records of children were queried,and the clinical characteristics,drug resistance and death risk factors of children with streptococcus pneumoniae infection were analyzed.Results:1.A total of 146 children were included,including 90 males and 56 females,mainly at age of1-3 years(74,50.68%),18 of whom had underlying diseases,including congenital malformation,spinal muscular atrophy,epilepsy and so on.2.Invasive Streptococcus pneumoniae in 76 cases(52.05%);There were 106 cases of pulmonary infection(72.60%),including 44 cases of severe pneumonia(30.14%),59 cases of sepsis(40.41%),42 cases of purulent meningitis(28.77%),and 5 cases of local and pelvic abscess.Five cases were discharge from hospital,17 cases died,and the rest were all improved.Among the dead children,there were 9 males and 8 females,5 of whom died of multiple organ failure,10 of whom died of brain failure and 2 of whom died of severe sepsis.Six deaths were complicated with septic shock.3.There were 169 streptococcus pneumoniae positive samples,among them 51(30.18%)blood samples,39(23.08%)cerebrospinal fluid samples,67(39.64%)alveolar lavage fluid samples,7(4.14%)pleural fluid samples,and the other 5 strains(2.96%),including external auditory canal secretion,local abscess and abdominal abscess drainage culture.4.The sensitivity rates of vancomycin,linezolid,moxifloxacin and telithromycin to streptococcus pneumoniae were 100%,levofloxacin was 98.82%.The resistant rate of erythromycin to streptococcus pneumoniae was 97.60%,and Multidrug resistant rate was 85.61%.5.Previous convulses,positive cerebrospinal fluid or blood culture,sepsis,meningitis,hypoalbuminemia and respiratory failure were risk factors for death.Children in the death group had shorter out-of-hospital course of disease,lower levels of 24-hour perfect hemoglobin,platelets and serum albumin,and higher levels of C-reactive protein and D-dimer.In Logistics multivariate analysis,low hemoglobin,high DD,septic shock,and positive CSF culture were independent risk factors for death from streptococcus pneumoniae infection.Conclusion1.Children with streptococcus pneumoniae infection are young and prone to invasive streptococcus pneumoniae disease with high mortality.Pulmonary infection was the most common,followed by bloodstream infection.2.High drug resistance rate to erythromycin and tetracycline,high sensitivity rate to vancomycin,linezolid,moxifloxacin and telithromycin,and the sensitivity rate of the third generation cephalosporin keep relatively high at the level of more than 60%,but there is an increasing trend in resistant rate in recent 2 years.3.Attention should be paid to the levels of hemoglobin,platelets,serum albumin,C-reactive protein and D-dimer within 24 hours after admission,septic shock and positive cerebrospinal fluid culture are related to poor prognosis of children. |
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