| Objective:To investigate the clinical characteristics,drug resistance and serotypes of invasive pneumoniae disease(IPD)in childrenMethods:Clinical data and antimicrobial susceptibility results of IPD children enrolled in Shenzhen Children's Hospital,from January 1,2012 to December 31,2018,were collected for retrospective analysis.Based on the results of antimicrobial susceptibility testing,patients were divided into 2 groups:penicillin insensitive streptococcus pneumoniae(PNSP)group and penicillin sensitive streptococcus pneumoniae(PSSP)group.The clinical characteristics of the two groups were analyzed and compared retrospectively.And serotypes of the retained strains were identified by capsule swelling method or polymerase chain reaction(PCR)methodResults1.One hundred and forty-one cases were enrolled,majority of them were infants under 2 years old(86 cases,61.0%).99 cases(70.2%)had onset in autumn and winter.The clinical manifestation included simple bloodstream infection(62 cases,45.4%),purulent meningitis(30 cases,21.3%),pneumonia with bacteremia(28 cases,19.9%),bone and joint infection(12 cases,8.5%),purulent pleurisy(4 cases,2.8%),peritonitis(3 cases,2.1%),and infective endocarditis(2 cases,1.4%).33 cases had underlying disease(23.4%).Co-infection were found in 14 cases(9.9%).39 cases(27.7%)had complications.After active treatment,5 cases(3.5%,5/141)died,all of them were under 2 years old,and all of the isolates were multi-drug resistant.4 cases(2.8%)were discharged without recovery,and the rest were improved2.The results of drug sensitivity of 141 invasive streptococcus pneumoniae strains showed that,the drug resistance rate of penicillin was 52.1%,the drug resistance rate of erythromycin and clindamycin was more than 95%,and the multiple drug resistance rate was 75.2%.The death cases were all multiple drug resistance strains.And the drug resistance of cerebrospinal fluid culture positive strains was higher than that of other isolates.No drug resistance strains to vancomycin,levofloxacin and linezolid were found.3.The PNSP group with underlying diseases(30.7%vs.15.4%,?2=3.956),meni-ngitis(32.0%vs.9.2%,?2=10.722)and multiple drug resistance(86.7%vs.63.1%,?2=10.538)was higher than that of PSSP group(P<0.05).4.The serotypes of 97 strains invasive streptococcus pneumoniae were identified,of which 14 and 19F are the most common,21 strains(21.6%)each,15 strains of(15.5%)type 19A,13 strains of(13.4%)type 6B and 23F,3 strains(3.1%)of type 3.The serotype coverage of 13-valent pneumococcal conjugate vaccine was 92.8%(90/97).Conclusion:1.IPD and the death cases it caused tend to occur in children under 2 years old.The distribution of IPD has seasonal difference,and simple bloodstream infection is the most common clinical manifestation.2.The resistance of IPD to penicillin antibiotics is more common,and the resistance to erythromycin and clindamycin is high.And the drug resistance of cerebrospinal fluid culture positive strains was higher than that of other isolates.Multiple drug resistance of pathogenic strains may be related to poor prognosis.Clinicians should rationally choose antibiotics to treat children with invasive streptococcus pneumoniae infection based on drug susceptibility results.3.PNSP is more likely to occur in children with underlying diseases and meningitis,penicillin antibiotics should be avoided as far as possible in the treatment of the above cases.4.14,19F,19A,6B,23F were the most common serotypes of IPD infected strains,PCV13 can cover most IPD serotypes and should be actively promoted. |
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