Clinical Features Of Invasive Pneumococcal Disease, Antimicrobial Resistance And Serotypes Of Invasive Pneumococcal In Chongqing Children's Hospital

Objectives In order to offer assistance of clinical antimicrobial therapy and evaluate the possibility of Streptococcus pneumoniae(S.p) vaccine application in Chongqing, this study was designed to investigate the clinical features of invasive pneumococcal disease (IPD) , antimicrobial resistance and serotypes of invasive pneumococcal.Methods Clinical characteristics of IPD admitted to the Children's Hospital, Chongqing Medical University from 2003 to 2008 and the antimicrobial resistance of invasive pneumococcal were analyzed retrospectively.Results⑴We identified 27 cases of IPD. The ratio of incidence of IPD in boys and in girls was 1.25:1. Many of the children were≤2 years. Additionally, of the children with pneumococcal meningitis, 50% were≤2 years. All of the 27 patients had fever, leukocytosis and C reactive protein stepped up. 8 patients (29.63%) had hepatomegaly and/or splenomegaly, 3 patients (11.11%) had rash, 1 patient (3.70%) had jaundice. In the 27 invasive pneumococcal disease children, 12 patients (44.44%) had septicemia, 8 patients (29.63%) had pneumococcal meningitis, 4 patients (14.82%) had septicemia and pneumococcal pneumonia, 2 patients (7.41%) had purulent pleurisy, 1 patient (3.70%) had purulent peritonitis.⑵We studied drug resistance of all the invasive pneumococcal. 51.85% strain were resistant to penicilin, the resistance to the other 11 commonly used antibiotic was erythromycin (92.59%), azithromycin (92%), tetracycline (88%), trimethoprim-sulfamethoxazole (68%), ceftazidime (37.04%), cefotaxim (36%), chloromycetin (22.22%), Ceftriaxone(11.11%), Ofloxacin(4%), vancocin(0%), rifadin(0%). Of the 27 invasive pneumococcal, 96.30% were multidrug resistance. Additionally, 100% of the penicillin-resistant invasive pneumococcal were multidrug resistance.⑶Serotyping of 10 S.p invasive isolates showed 4 strains were 19, 1 strains was 14, 1 strains was 23 and the other 4 srtrains were not the serotypes in the 7-valent conjugate pneumococcal vaccine (4, 6B, 9V, 14, 18C, 19F, 23F).Conclusions⑴Invasive pneumococcal disease has the most incidence in children≤2 years. Septicemia and purulent meningitis are the most common clinical manifestations. ⑵The resistance rate of invasive pneumococcal to penicilin in Chongqing was fairly to the other areas in China. The isolates were acutely resistant to tetracycline, trimethoprim-sulfamethoxazole and azithromycin, so the three drug should not be routinely used to treat IPD. The resistance of third-generation cephalosporin such as ceftazidime, cefotaxim and Ceftriaxone were relatively low, so they could be used to treat IPD. Penicillin-nonsusceptible Streptococcus pneumonia (PNSP) is sensitive to Ofloxacin, chloromycetin and vancocin, so the three drug could be used to treat the infection of PNSP. The multidrug resistance of invasive pneumococcal was severe. The main mode was erythromycin, trimethoprim-sulfamethoxazole and tetracycline multidrug resistance. Macrolides should be cautiously used to treat the infection of invasive pneumococcal.⑶60% of the S.p invasive isolates serotypes were included in serotypes of the 7-valent conjugate pneumococcal vaccine. Because the isolates for serotyping is insufficient, the possibility of 7-valent conjugate pneumococcal vaccine application in prenventing the Invasive pneumococcal disease in children in Chongqing were not evaluated exactly.