Clinical Features And Resistance Analysis Of54Cases Of Invasive Pneumococcal Disease In Children

Objective To investigate the clinical features of invasivepneumococcal disease(IPD) and the antimicrobial susceptibility ofstreptococcus pneumoniae(S.p) isolated from clinical samples, this studyevaluated the clinical data of54cases of IPD in children and the antibioticsensitivity data of259pneumococcal isolates in Chongqing children’shospital.Methods The clinical features of54cases of IPD in children andthe antimicrobial susceptibility of259pneumococcal isolates (54wereinvasive and205were non-invasive) were analyzed retrospectively．Results(1) We identified54cases of IPD. The ratio of IPD between boys andgirls was1.35:1. The average age of these children was3.46years,22cases(40.74%) were within2years old,21cases (38.89%) were within2-5yearsold,11cases(20.37%) were more than5years old.15cases (27.78%) wereonset in spring,4cases (7.41%) in summer,19cases (35.19%) in autumn,and16cases (29.63%) in winter.20cases (37.04%) With underlying diseases (anemia, malnutrition, chronic cardiopulmonary disease),22cases(40.74%) attended daycare center or school,19cases (35.19%) hadbrothers or sisters.(2) In the54IPD cases,32cases had septicemia (12cases ofbacteremia pneumonia),20cases had meningitis,14cases had purulentpleurisy,2cases had osteomyelitis, and2cases accompanied withsuppurative otitis media. All of the54cases had fever, majority of themwere remittent or continued fever.44cases (82.69%) had an increasedwhite blood cell count,36cases (66.67%) had an increased percentage ofneutrophils, and42cases (84%) had an increased C-reactive protein. Therewere23cases (42.59%) had an infection with other pathogens at the sametime.(3)52(96.30%) patients were treated with antibiotics, β-lactamantibiotics had the highest usage rate, followed by vancomycin.14cases(25.92%) used only one,37cases (68.52%) used two and1case (1.85%)used three at the same time.(4) In the54invasive pneumococcus,32(59.26%) were not sensitiveto penicillin, and the resistant rate was42.59%. The resistant rate to otherantibiotics as follows: azithromycin (100%), erythromycin (98.15%),clindamycin (92.59%), tetracycline (85.19%), co-trimoxazole (72.22%),meropenem (64.58%), cefepime (58.33%), cefotaxime (39.58%),amoxicillin (33.33%), chloramphenicol (11.11%), rifampin (0%), vancomycin (0%) and levofloxacin (0%), respectively.(5) Penicillin-susceptible Streptococcus pneumoniae was moresensitive to amoxicillin, meropenem, cefepime, and cefotaxime thanPenicillin-nonsusceptible Streptococcus pneumoniae(P <0.01).(6) The antimicrobial susceptibility of non-invasive pneumococcus asfollows: erythromycin (99.51%), azithromycin (99.47%), clindamycin(97.56%), tetracycline (89.27%), penicillin (85.37%), cefotaxime (83.33%),co-trimoxazole (82.93%), meropenem (77.78%), cefepime (55.56%),amoxicillin (50%), chloramphenicol (12.20%), rifampin (1.07%),vancomycin (0%), and levofloxacin (0%), respectively.(7) Invasive pneumococcus were more sensitive to penicillin andcefotaxime than non-invasive pneumococcus(P <0.01).Conclusions(1) IPD mainly occurs in the children under five years old, especiallyin those younger than2years old. The incidence of IPD is high in autumn,winter, and spring, but it is low in summer. Underlying diseases, attend todaycare center or school, have brothers or sisters, crowded livingenvironment are risk factors for IPD. The clinical manifestations of IPD arediverse, septicemia is the most common one, followed by meningitis.Antibiotics utilization rate of IPD is high, β-lactam antibiotics andvancomycin are used mostly in Chongqing. The prognosis of IPD patients is related with age, the pattern and severity of disease, and antibioticresistance.(2) The resistant rate to penicillin is high in both invasive andnoninvasive pneumococcus, noninvasive pneumococcus are higher thaninvasive pneumococcus (P <0.01). The resistant rate to erythromycin andazithromycin is very high, they are not suitable for treating pneumococcalinfections alone. The resistant rate to tetracycline, co-trimoxazole and otherbeta-lactam antibiotics rate is high, while the resistant rate tochloramphenicol, vancomycin, levofloxacin and rifampicin is low.(3) Multiple drug resistance is common in invasive pneumococcus, themost common pattern is resistant to erythromycin, clindamycin,co-trimoxazole and tetracycline at the same time.