Clinical Characteristics And Drug Resistance Of Invasive Pneumococcal Disease In Children

Objective:Analyze the clinical characteristics and drug resistance of Invasive pneumococcal disease(IPD)in children,provide help for the diagnosis and treatment of children’s IPD,and provide references for the clinically standardized use of antibiotics to treat children’s IPD.Methods:1.Collect 98 children who were hospitalized and diagnosed with IPD in Shanxi Children’s Hospital from 2017 to 2020,check medical history information,count the clinical data of children with IPD,and conduct retrospective analysis.2.The 113 strains of Streptococcus pneumoniae isolated and cultured were tested for drug sensitivity,and the resistance of Streptococcus pneumoniae to clinically commonly used antibiotics was statistically analyzed.3.According to the results of drug susceptibility,children with IPD were divided into penicillin non-sensitive streptococcus pneumoniae(PNSP)and penicillin sensitive streptococcus pneumoniae(PSSP)and compared their clinical characteristics.Results:1.Among the 98 children with IPD included in this study,male:female is approximately1.2:1;81 children under 5 years old,accounting for 82.6%,46 children under 2 years old,accounting for 46.9%;66 cases(67.4 %)children with IPD had their onset in autumn and winter;18 cases(18.3%)with IPD had clear underlying diseases;the clinical infection type was simple bloodstream infection(36 cases,36.7%),the most common type,followed by purulent meningitis(29 cases,29.6%),bacteremic pneumonia(28 cases,28.6%);fever(95 cases,96.9%)is the most common clinical manifestation of IPD,followed by cough(47 cases,48.0%),convulsions(24 Cases,24.5%)and poor spirits(19 cases,19.4%),other symptoms vary according to clinical symptoms;98 cases of community-acquired infection(100.0%),no hospital-acquired infection(0.0%);complications There are 62 cases(63.2%)of the disease;15 cases(15.2%)of mixed infection with other pathogens;of the 98 children with IPD,75cases(76.5%)with WBC>10×109/L and 15 cases with WBC>30×109/L In 7 cases(15.3%),WBC<4×109/L(7.1%).There were 83 cases(84.7%)with CRP≥10mg/L,63 cases(64.3%)with CRP ≥ 50mg/L,and 16 cases(16.3%)with CRP>200mg/L.Among 98 children with IPD,87 have undergone PCT,85(97.7%)with PCT>0.05ng/m L,73(74.5%)with PCT>0.5ng/m L,and 55 with PCT>2ng/m L(56.1%),7 cases(7.1%)with PCT>100ng/m L;after active treatment,57 cases(58.2%)were cured,29 cases(29.6%)improved,4 cases(4.1%)did not heal,and 8 cases died(8.1%).2.The susceptibility test results of 113 strains of invasive Streptococcus pneumoniae in this study showed that the sensitivity rate of penicillin was 75.2%,the mediation rate was 2.7%,and the drug resistance rate was 22.1%;the resistance rate of meningitis IPD strains to penicillin was 79.3%.The resistance rate of non-meningitis IPD strains to penicillin was 2.4%;the sensitivity rate to cefotaxime and ceftriaxone was over83.0%;the resistance rate of meningitis IPD strains to cefotaxime and ceftriaxone was10.3%,13.8%,respectively;no strains resistant to levofloxacin,vancomycin,and linezolid were found;the susceptibility rate to meropenem was 73.6%;it was highly resistant to erythromycin,tetracycline,and clindamycin,respectively,100.0%,94.7%,98.9%;the resistance rate to compound trimethoprim is 50.5%.The multi-drug resistance rate was 48.7%.3.Children in the PNSP group had meningitis [20 cases(90.9%)],central system complications [5 cases(22.7%)],PCT>100ng/m L [4 cases(18.2%)] compared with children in the PSSP group had meningitis [9 cases(11.8%),χ2=51.192],central system complications [4 cases(5.3%),χ2=6.239],PCT>100ng/m L [3 cases(3.9%)]had a high incidence.Conclusion:1.IPD mainly affects children under 5 years of age,especially children under 2 years of age.Autumn and winter are the seasons for IPD.Simple bloodstream infection is the most common type of clinical infection.Fever is the most common clinical manifestation of IPD.2.In this study,the sensitivity of invasive Streptococcus pneumoniae to penicillin was significantly increased.Before and after the return of the culture results,the use rate of penicillin increased,suggesting that penicillin can be used clinically to treat children’s IPD,but the resistance rate of meningitis IPD strains to penicillin Significantly higher than non-meningitis IPD strains,suggesting that penicillin should not be used as the first-line drug for children with suspected or confirmed Streptococcus pneumoniae meningitis.It is generally sensitive to vancomycin and linezolid.It is highly resistant to erythromycin,tetracycline and clindamycin.The multi-drug resistance of invasive Streptococcus pneumoniae is more serious.The most common multi-drug resistance modes are erythromycin,tetracycline,clindamycin and compound trimethoprim.Clinically,a comprehensive analysis should be carried out based on the severity of infection and the results of drug susceptibility tests,and appropriate antibacterial drugs should be used to treat children’s IPD.3.Compared with the PSSP group,children in the PNSP group are more likely to suffer from meningitis and central nervous system complications,and PCT>100ng/m L.Children with IPD with the above conditions should avoid using penicillin in clinical treatment.