侵袭性肺炎链球菌感染患儿的临床特点及炎症因子水平的变化
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摘要
目的分析侵袭性肺炎链球菌感染患儿的临床特点及对常用抗菌药物的耐药性,观察患者炎症因子水平的变化。方法选择医院2008年1月-2017年12月收治的侵袭性肺炎链球菌病患儿200例为研究组,并选择健康体检儿童200例作为对照组。收集侵袭性肺炎链球菌感染患儿临床资料,采用纸片扩散法联合E-test分析肺炎链球菌对常用抗菌药物的敏感性。观察患儿血清炎症因子水平变化情况。结果 200例侵袭性肺炎链球菌病患儿,年龄以5岁以内多见占89.5%,其中<2岁患儿为128例占64.00%;以社区获得性感染为主占87.50%,冬春季发病为主占74.50%,有基础疾病占25.00%,诊断为败血症占42.50%;患儿临床症状均表现为发热,肝脾肿大占32.00%,皮疹占11.50%;实验室检查白细胞升高占79.00%,治疗后,治愈患儿占72.00%,好转占23.00%,死亡占5.00%;侵袭性肺炎链球菌对红霉素、阿奇霉素、四环素、克林霉素、磺胺甲噁唑/甲氧苄啶耐药率较高,未出现万古霉素、利福平、利奈唑胺耐药菌株。血清高敏C-反应蛋白(hs-CRP)、肿瘤坏死因子(TNF-α)、白介素-4(IL-4)、白介素-6(IL-6)、降钙素原(PCT)水平均高于对照组(P<0.05)。结论侵袭性肺炎链球菌病患儿以5岁以下多见,有季节性,临床表现多种多样,败血症最常见,耐药问题严峻,血清hs-CRP、TNF-α、IL-4、IL-6、PCT水平升高。
OBJECTIVE To investigate the clinical characteristics of children with invasive Streptococcus pneumoniae infection and drug resistance to commonly used antibiotics and observe the change of levels of inflammatory factors.METHODS A total of 200 children with invasive S.pneumoniae infection who were treated in the hospital form Jan 2008 to Dec 2017 were chosen as the study group,and 200 healthy children who received physical examination were set as the control group.The clinical data were collected from the children with invasive S.pneumoniae infection,the drug susceptibility testing for the commonly used antibiotics was performed by using disk diffusion method combined with E-test.The levels of serum inflammatory factors were observed.RESULTS Of the 200 children with invasive S.pneumoniae infection,the children aged no more than 5 years old accounted for 89.5%,the children aged less than 2 years old accounted for 64.00%(128 cases);87.50% had community-acquired infection,74.50% had the infection in winter and spring,25.00% had underlying diseases,and 42.50% were diagnosed with septicemia.Among the clinical symptoms,all of the children had fever,32.00% had hepatosplenomegaly,and11.50% had rash.The result of laboratory test showed that 79.00% had the elevated level of white blood cell,72.00% were cured after the treatment,23.00% were improved,and 5.00% died.The drug resistance rates of the invasive S.pneumoniae strains to erythromycin,azithromycin,tetracycline,clindamycin and sulfamethoxazole-trimethoprimazole were relatively high,and no strains resistant to vancomycin,rifampicin or linezolid were detected.The levels of serum high-sensitivity C-reactive protein(hs-CRP),tumor necrosis factor(TNF-α),interleukin-4(IL-4),interleukin-6(IL-6)and procalcitonin(PCT)were significantly higher in the study group than in the control group(P<0.05).CONCLUSION The invasive S.pneumoniae infection is prevalence among the children aged less than 5 years old and shows seasonal change;septicemia is the most common clinical manifestation,the strains are highly drug-resistant,and the levels of serum hs-CRP,TNF-α,IL-4,IL-6 and PCT are elevated.
OBJECTIVE To investigate the clinical characteristics of children with invasive Streptococcus pneumoniae infection and drug resistance to commonly used antibiotics and observe the change of levels of inflammatory factors.METHODS A total of 200 children with invasive S.pneumoniae infection who were treated in the hospital form Jan 2008 to Dec 2017 were chosen as the study group,and 200 healthy children who received physical examination were set as the control group.The clinical data were collected from the children with invasive S.pneumoniae infection,the drug susceptibility testing for the commonly used antibiotics was performed by using disk diffusion method combined with E-test.The levels of serum inflammatory factors were observed.RESULTS Of the 200 children with invasive S.pneumoniae infection,the children aged no more than 5 years old accounted for 89.5%,the children aged less than 2 years old accounted for 64.00%(128 cases);87.50% had community-acquired infection,74.50% had the infection in winter and spring,25.00% had underlying diseases,and 42.50% were diagnosed with septicemia.Among the clinical symptoms,all of the children had fever,32.00% had hepatosplenomegaly,and11.50% had rash.The result of laboratory test showed that 79.00% had the elevated level of white blood cell,72.00% were cured after the treatment,23.00% were improved,and 5.00% died.The drug resistance rates of the invasive S.pneumoniae strains to erythromycin,azithromycin,tetracycline,clindamycin and sulfamethoxazole-trimethoprimazole were relatively high,and no strains resistant to vancomycin,rifampicin or linezolid were detected.The levels of serum high-sensitivity C-reactive protein(hs-CRP),tumor necrosis factor(TNF-α),interleukin-4(IL-4),interleukin-6(IL-6)and procalcitonin(PCT)were significantly higher in the study group than in the control group(P<0.05).CONCLUSION The invasive S.pneumoniae infection is prevalence among the children aged less than 5 years old and shows seasonal change;septicemia is the most common clinical manifestation,the strains are highly drug-resistant,and the levels of serum hs-CRP,TNF-α,IL-4,IL-6 and PCT are elevated.
引文
[1]Shiri T,Datta S,Madan J,et al.Indirect effects of childhood pneumococcal conjugate vaccination on invasive pneumococcal disease:a systematic review and meta-analysis[J].Lancet Glob Health,2017,5(1):e51-e59.
[2]王倩,曹玙,吴桐.侵袭性肺炎链球菌感染调查及危险因素分析[J].中国实验诊断学,2017,21(11):1876-1878.
[3]王颖蔚,吴胜军.侵袭性和非侵袭性肺炎链球菌耐药率的比较分析[J].中国微生态学杂志,2012,24(6):549-551.
[4]Saint-Criq V,Villeret B,Bastaert F,et al.Pseudomonas aeruginosa LasB protease impairs innate immunity in mice and humans by targeting a lung epithelial cystic fibrosis transmembrane regulator-IL-6-antimicrobial-repair pathway[J].Thorax,2018,73(1):49-61.
[5]Stockmann C,Ampofo K,Killpack J,et al.Procalcitonin accurately identifies hospitalized children with low risk of bacterial community-acquired pneumonia[J].J Pediatric Infect Dis Soc,2018,7(1):46-53.
[6]Ranjbar R,Bolkheir A,Vahdat K,et al.The association of Chlamydia pneumonia and Helicobacter pylori IgG seropositivity with omentin-1,visfatin and adiponectin levels in postmenopausal women[J].Acta Med Iran,2016,54(12):771-777.
[7]Qiao SK,Ren HY,Shi YJ,et al.Allogeneic compact bonederived mesenchymal stem cell transplantation attenuates the severity of idiopathic pneumonia syndrome in a murine bone marrow transplantation model[J].Cell Physiol Biochem,2016,40(6):1656-1669.
[8]Kim GL,Choi SY,Seon SH,et al.Pneumococcal pep27mutant immunization stimulates cytokine secretion and confers long-term immunity with a wide range of protection,including against non-typeable strains[J].Vaccine,2016,34(51):6481-6492.
[9]Yang Y,Huang Z,Zou X,et al.The antibacterial effect of urena lobata L.FROMV guangxi on mice withStaphylococcus Aureuspneumonia[J].Afr J Tradit Complement Altern Med,2016,14(1):73-88.
[10]Tan M,Wang J,Hu P,et al.Severe pneumonia due to infection with Candida krusei in a case of suspected Middle East respiratory syndrome:a case report and literature review[J].Exp Ther Med,2016,12(6):4085-4088.
[11]Lynch JP 3rd,Zhanel GG.Streptococcus pneumoniae:epidemiology,risk factors,and strategies for prevention[J].Semin Respir Crit Care Med,2009,30(2):189-209.
[12]Savulescu C,Krizova P,Lepoutre A,et al.Effect of high-valency pneumococcal conjugate vaccines on invasive pneumococcal disease in children in SpIDnet countries:an observational multicentre study[J].Lancet Respir Med,2017,5(8):648-656.
[13]Lutui F,Grant CC,Best E,et al.Invasive pneumococcal disease in children in Tonga[J].Pediatr Infect Dis J,2017,36(2):239-240.
[14]曹玙,王倩,刘振英,等.侵袭性肺炎链球菌感染临床特征与耐药性分析[J].中华医院感染学杂志,2016,26(3):528-529,542.
[15]周凯,谢国锦,王晓卫,等.侵袭性肺炎链球菌病临床特征与血清型分布[J].中华医院感染学杂志,2015,25(15):3392-3394.
[16]Gosciminski M,Bandy U,Luther K.The changing epidemiology of invasive pneumococcal disease after the introduction of pneumococcal conjugate vaccine,Rhode Island,1997-2016[J].R I Med J(2013),2017,100(1):57-59.
[17]Manoharan A,Manchanda V,Balasubramanian S,et al.Invasive pneumococcal disease in children aged younger than 5years in India:a surveillance study[J].Lancet Infect Dis,2017,17(3):305-312.
[18]Liu GB,Cui XQ,Wang ZB,et al.Detection of serum procalcitonin and hypersensitive C-reactive protein in patients with pneumonia and sepsis[J].J Biol Regul Homeost Agents,2018,32(5):1165-1169.
[19]Ge YL,Liu CH,Xu J,et al.Serum high-sensitivity C-reactive protein improves sensitivity of CURB-65in predicting ICU admission and mortality in community-acquired pneumonia patients[J].Clin Lab,2018,64(10):1749-1754.
[20]Lin CC,Chiang YC,Cho RL,et al.Up-regulation of PYK2/PKCα-dependent haem oxygenase-1 by CO-releasing molecule-2attenuates TNF-α-induced lung inflammation[J].Br JPharmacol,2018,175(3):456-468.
[21]Zhao H,Gu H,Liu T,et al.Analysis of curative effect of adjuvant therapy with bronchoalveolar lavage on COPD patients complicated with pneumonia[J].Exp Ther Med,2018,16(5):3799-3804.
[22]Barbieri N,Herrera M,Salva S,et al.Lactobacillus rhamnosus CRL1505nasal administration improves recovery of T-cell mediated immunity against pneumococcal infection in malnourished mice[J].Benef Microbes,2017,8(3):393-405.
[23]Subramanian K,Bergman P,Henriques-Normark B.Vitamin D promotes pneumococcal killing and modulates inflammatory responses in primary human neutrophils[J].J Innate Immun,2017,9(4):375-386.
[24]Basha S,Kaur R,Mosmann TR,et al.Reduced T-helper 17responses to Streptococcus pneumoniae in infection-prone children can be rescued by addition of innate cytokines[J].JInfect Dis,2017,215(8):1321-1330.
[25]Seo S,Yu J,Jenkins IC,et al.Diagnostic and prognostic plasma biomarkers for idiopathic pneumonia syndrome after hematopoietic cell transplantation[J].Biol Blood Marrow Transplant,2018,24(4):678-686.
[26]Walsh TL,DiSilvio BE,Hammer C,et al.Impact of procalcitonin guidance with an educational program on management of adults hospitalized with pneumonia[J].Am J Med,2018,131(2):201.e1-201.e8.
[27]Pilotto A,Dini S,Daragjati J,et al.Combined use of the multidimensional prognostic index(MPI)and procalcitonin serum levels in predicting 1-month mortality risk in older patients hospitalized with community-acquired pneumonia(CAP):a prospective study[J].Aging Clin Exp Res,2018,30(2):193-197.
[2]王倩,曹玙,吴桐.侵袭性肺炎链球菌感染调查及危险因素分析[J].中国实验诊断学,2017,21(11):1876-1878.
[3]王颖蔚,吴胜军.侵袭性和非侵袭性肺炎链球菌耐药率的比较分析[J].中国微生态学杂志,2012,24(6):549-551.
[4]Saint-Criq V,Villeret B,Bastaert F,et al.Pseudomonas aeruginosa LasB protease impairs innate immunity in mice and humans by targeting a lung epithelial cystic fibrosis transmembrane regulator-IL-6-antimicrobial-repair pathway[J].Thorax,2018,73(1):49-61.
[5]Stockmann C,Ampofo K,Killpack J,et al.Procalcitonin accurately identifies hospitalized children with low risk of bacterial community-acquired pneumonia[J].J Pediatric Infect Dis Soc,2018,7(1):46-53.
[6]Ranjbar R,Bolkheir A,Vahdat K,et al.The association of Chlamydia pneumonia and Helicobacter pylori IgG seropositivity with omentin-1,visfatin and adiponectin levels in postmenopausal women[J].Acta Med Iran,2016,54(12):771-777.
[7]Qiao SK,Ren HY,Shi YJ,et al.Allogeneic compact bonederived mesenchymal stem cell transplantation attenuates the severity of idiopathic pneumonia syndrome in a murine bone marrow transplantation model[J].Cell Physiol Biochem,2016,40(6):1656-1669.
[8]Kim GL,Choi SY,Seon SH,et al.Pneumococcal pep27mutant immunization stimulates cytokine secretion and confers long-term immunity with a wide range of protection,including against non-typeable strains[J].Vaccine,2016,34(51):6481-6492.
[9]Yang Y,Huang Z,Zou X,et al.The antibacterial effect of urena lobata L.FROMV guangxi on mice withStaphylococcus Aureuspneumonia[J].Afr J Tradit Complement Altern Med,2016,14(1):73-88.
[10]Tan M,Wang J,Hu P,et al.Severe pneumonia due to infection with Candida krusei in a case of suspected Middle East respiratory syndrome:a case report and literature review[J].Exp Ther Med,2016,12(6):4085-4088.
[11]Lynch JP 3rd,Zhanel GG.Streptococcus pneumoniae:epidemiology,risk factors,and strategies for prevention[J].Semin Respir Crit Care Med,2009,30(2):189-209.
[12]Savulescu C,Krizova P,Lepoutre A,et al.Effect of high-valency pneumococcal conjugate vaccines on invasive pneumococcal disease in children in SpIDnet countries:an observational multicentre study[J].Lancet Respir Med,2017,5(8):648-656.
[13]Lutui F,Grant CC,Best E,et al.Invasive pneumococcal disease in children in Tonga[J].Pediatr Infect Dis J,2017,36(2):239-240.
[14]曹玙,王倩,刘振英,等.侵袭性肺炎链球菌感染临床特征与耐药性分析[J].中华医院感染学杂志,2016,26(3):528-529,542.
[15]周凯,谢国锦,王晓卫,等.侵袭性肺炎链球菌病临床特征与血清型分布[J].中华医院感染学杂志,2015,25(15):3392-3394.
[16]Gosciminski M,Bandy U,Luther K.The changing epidemiology of invasive pneumococcal disease after the introduction of pneumococcal conjugate vaccine,Rhode Island,1997-2016[J].R I Med J(2013),2017,100(1):57-59.
[17]Manoharan A,Manchanda V,Balasubramanian S,et al.Invasive pneumococcal disease in children aged younger than 5years in India:a surveillance study[J].Lancet Infect Dis,2017,17(3):305-312.
[18]Liu GB,Cui XQ,Wang ZB,et al.Detection of serum procalcitonin and hypersensitive C-reactive protein in patients with pneumonia and sepsis[J].J Biol Regul Homeost Agents,2018,32(5):1165-1169.
[19]Ge YL,Liu CH,Xu J,et al.Serum high-sensitivity C-reactive protein improves sensitivity of CURB-65in predicting ICU admission and mortality in community-acquired pneumonia patients[J].Clin Lab,2018,64(10):1749-1754.
[20]Lin CC,Chiang YC,Cho RL,et al.Up-regulation of PYK2/PKCα-dependent haem oxygenase-1 by CO-releasing molecule-2attenuates TNF-α-induced lung inflammation[J].Br JPharmacol,2018,175(3):456-468.
[21]Zhao H,Gu H,Liu T,et al.Analysis of curative effect of adjuvant therapy with bronchoalveolar lavage on COPD patients complicated with pneumonia[J].Exp Ther Med,2018,16(5):3799-3804.
[22]Barbieri N,Herrera M,Salva S,et al.Lactobacillus rhamnosus CRL1505nasal administration improves recovery of T-cell mediated immunity against pneumococcal infection in malnourished mice[J].Benef Microbes,2017,8(3):393-405.
[23]Subramanian K,Bergman P,Henriques-Normark B.Vitamin D promotes pneumococcal killing and modulates inflammatory responses in primary human neutrophils[J].J Innate Immun,2017,9(4):375-386.
[24]Basha S,Kaur R,Mosmann TR,et al.Reduced T-helper 17responses to Streptococcus pneumoniae in infection-prone children can be rescued by addition of innate cytokines[J].JInfect Dis,2017,215(8):1321-1330.
[25]Seo S,Yu J,Jenkins IC,et al.Diagnostic and prognostic plasma biomarkers for idiopathic pneumonia syndrome after hematopoietic cell transplantation[J].Biol Blood Marrow Transplant,2018,24(4):678-686.
[26]Walsh TL,DiSilvio BE,Hammer C,et al.Impact of procalcitonin guidance with an educational program on management of adults hospitalized with pneumonia[J].Am J Med,2018,131(2):201.e1-201.e8.
[27]Pilotto A,Dini S,Daragjati J,et al.Combined use of the multidimensional prognostic index(MPI)and procalcitonin serum levels in predicting 1-month mortality risk in older patients hospitalized with community-acquired pneumonia(CAP):a prospective study[J].Aging Clin Exp Res,2018,30(2):193-197.