肺炎球菌疾病住院儿童的临床特征分析

Analysis of clinical characteristics of hospitalized children with pneumococcal disease

摘要

目的 总结肺炎球菌疾病(PD)住院患儿的临床特征,为该病的防治提供理论依据。方法 选取2019年5月1日至2022年4月30日在广州医科大学附属妇女儿童医疗中心诊断为PD的住院患儿245例为研究对象.按是否存在基础疾病将患儿分为有基础疾病组(n=72)与无基础疾病组(n=173);依据细菌药敏试验结果是否耐药将患儿分为多重耐药(MDR)组(n=125)与非MDR组(n=120);依据发病前是否至少接种1剂次肺炎球菌疫苗将患儿分为接种疫苗组(n=60)与未接种疫苗组(n=185).收集患儿的人口学特征、基础疾病、肺炎球菌多重耐药情况,以及是否并发其他病原体感染、重症率、使用呼吸机治疗比例、疾病负担、预后及疫苗接种相关资料,并进行比较分析。结果 PD在3岁及以下婴幼儿阶段高发(79.18%,194/245),合并其他病原体感染为52.24%(128/245),肺炎球菌多重耐药发生率为51.02%(125/245),经儿童重症监护病房(PICU)治疗为37.55%(92/245),存在基础疾病为29.39%(72/245),发病前至少接种1剂次肺炎球菌疫苗比例为24.49%(60/245),气管插管呼吸机辅助通气为22.86%(56/245),侵袭性肺炎球菌疾病为17.55%(43/245).好转出院为95.10%(233/245),留存后遗症为4.90%(12/245),无死亡病例.有基础疾病组PD患儿MDR发生率(χ²=9.989)、住院时间(Z=-5.258)、住院费用(Z=-6.490)、吸氧比例(χ²=22.407)、入住PICU比例(χ²=46.942)、气管插管呼吸机辅助通气比例(χ²=55.688)、后遗症发生率(χ²=8.450)均高于无基础疾病组,差异均有统计学意义(P<0.05).MDR组PD患儿合并感染比例低于非MDR组(χ²=9.914),MDR组患儿后遗症发生率高于非MDR组(χ²=5.272),差异均有统计学意义(P<0.05).接种疫苗组PD患儿MDR发生率(χ²=33.973)、吸氧比例(χ²=18.727)、气管插管呼吸机辅助通气比例(χ²=11.354)均低于未接种疫苗组,差异均有统计学意义(P<0.05);未见接种疫苗组患儿发生后遗症,而未接种疫苗组患儿后遗症发生率为6.49%,差异有统计学意义(P=0.042)。结论 PD在儿童中发病的年龄小,耐药性严峻.有基础疾病的患儿疾病负担更重,更应及时接种肺炎球菌疫苗.

Abstract

Objective To summarize clinical characteristics of hospitalized children with pneumococcal disease (PD) and provide a theoretical basis for the prevention and treatment the disease. Methods From May 1, 2019, to April 30, 2022, a total of 245 pediatric patients diagnosed with PD and hospitalized at Guangzhou Women and Children's Medical Center of Guangzhou Medical University were collected as the study subjects. They were categorized into groups based on the presence of underlying diseases: those with underlying diseases (n=72) and those without underlying diseases (n=173). Additionally, patients were divided into groups based on their susceptibility to antibiotics as determined by bacterial sensitivity testing: multidrug resistance (MDR) group (n=125) and non-MDR group (n=120). Furthermore, patients were categorized based on whether they had received at least one dose of pneumococcal vaccine before the onset of illness: vaccinated group (n=60) and unvaccinated group (n=185). And the demographic characteristics, underlying disease, pneumococcal multidrug resistance, presence of concurrent infections with other pathogens, severity rate, proportion of patients receiving mechanical ventilation, disease burden, prognosis, and vaccine-related data of the pediatric patients were recorded and analyzed. Results The incidence of PD was highest in children aged 3 and below (79.18%) with concurrent infections with other pathogens observed in 52.24% (128/245) of cases. The rate of multidrug-resistant pneumococcal infection was 51.02% (125/245) and 37.55% (92/245) of cases required treatment in the pediatric intensive care unit (PICU). Underlying diseases were present in 29.39% (72/245) of cases, while the proportion of patients who had received at least one dose of pneumococcal vaccine before the onset of illness was 24.49% (60/245). Additionally, 22.86% (56/245) required assisted ventilation via endotracheal intubation. Invasive pneumococcal disease accounted for 17.55% (43/245) of cases. The discharge rate with improvement was 95.10% (233/245), with 4.90% (12/245) of cases exhibiting residual sequelae, and no deaths were reported. Among patients with underlying diseases, the rates of MDR occurrence (χ²=9.989), duration of hospitalization (Z=-5.258), hospitalization costs (Z=-6.490), oxygen supplementation rate (χ²=22.407), admission to the PICU (χ²=46.942), proportion requiring endotracheal intubation and mechanical ventilation (χ²=55.688), and occurrence of residual sequelae (χ²=8.450) were all higher than those in the group without underlying diseases, and the differences were statistically significant (P<0.05). The proportion of PD patients with concurrent infections in the MDR group was lower than that in the non-MDR group (χ²=9.914). The occurrence rate of residual sequelae was higher in the MDR group than in the non-MDR group (χ²=5.272). Both differences were statistically significant (P<0.05). Among PD patients in the vaccinated group, the occurrence rates of MDR (χ²=33.973), oxygen supplementation (χ²=18.727), and the proportion requiring endotracheal intubation and mechanical ventilation (χ²=11.354) were all lower than those in the unvaccinated group, and the differences were statistically significant (P<0.05). No residual sequelae were observed in the vaccinated group, while the occurrence rate of residual sequelae in the unvaccinated group was 6.49%, with a statistically significant difference (P=0.042). Conclusion PD tends to occur at a young age in children, and antimicrobial resistance is a serious concern. Children with underlying diseases bear a heavier disease burden and should be vaccinated against pneumococcus in a timely manner.

关键词

儿童 / 肺炎球菌 / 基础疾病 / 疾病负担 / 多重耐药 / 肺炎球菌疫苗

Key words

children / streptococcus pneumoniae / underlying disease / disease burden / multidrug resistance / pneumococcal vaccine

参考文献

[1] Scelfo C, Menzella F, Fontana M, et al. Pneumonia and invasive pneumococcal diseases: the role of pneumococcal conjugate vaccine in the era of multi-drug resistance [J]. Vaccines (Basel), 2021, 9(5): 420.

[2] Wahl B, O'brien K L, Greenbaum A, et al. Burden of Streptococcus pneumoniae and Haemophilus influenzae type b disease in children in the era of conjugate vaccines: global, regional, and national estimates for 2000-15 [J]. Lancet Glob Health, 2018, 6(7): e744-e757.

[3] Kim G L, Seon S H, Rhee D K. Pneumonia and Streptococcus pneumoniae vaccine [J]. Arch Pharm Res, 2017, 40(8): 885-893.

[4] Pekuz S, Soysal A, Akkoc G, et al. Prevalence of nasopharyngeal carriage, serotype distribution, and antimicrobial resistance of streptococcus pneumoniae among children with chronic diseases [J]. Jpn J Infect Dis, 2019, 72(1): 7-13.

[5] 中华预防医学会, 中华预防医学会疫苗与免疫分会. 肺炎球菌性疾病免疫预防专家共识(2020版)[J]. 中国疫苗和免疫, 2021, 27(1): 1-47.

[6] 国家呼吸系统疾病临床医学研究中心, 国家儿童医学中心, 中华医学会儿科学分会呼吸学组, 等. 中国儿童肺炎链球菌性疾病诊断、治疗和预防专家共识[J]. 中华实用儿科临床杂志, 2020, 35(7): 485-505.

[7] Pan H, Cui B, Huang Y, et al. Nasal carriage of common bacterial pathogens among healthy kindergarten children in Chaoshan region, southern China: a cross-sectional study [J]. BMC Pediatr, 2016, 16(1): 161.

[8] Hu J, Sun X, Huang Z, et al. Streptococcus pneumoniae and Haemophilus influenzae type b carriage in Chinese children aged 12-18 months in Shanghai, China: a cross sectional study [J]. BMC Infect Dis, 2016, 16: 149.

[9] WHO. Pneumococcal conjugate vaccines in infants and children under 5 years of age: WHO position paper-February 22, 2019 [J]. Wkly Epidemiol Rec, 2019, 94(8): 85-104.

[10] 郭莹, 乔莉娜. 儿童侵袭性与非侵袭性肺炎链球菌病临床特征及耐药性分析[J]. 中国当代儿科杂志, 2021, 23(5): 466-470.

[11] 江载芳. 实用小儿呼吸病学[M].2版. 北京: 人民卫生出版社, 2020: 218-221.

[12] 中华预防医学会疫苗与免疫分会. 主要慢性病人群流感疫苗和肺炎球菌疫苗接种专家共识[J]. 中国疫苗和免疫, 2021, 27(6): 711-742.

[13] Hifumi T, Fujishima S, Abe T, et al. Prognostic factors of Streptococcus pneumoniae infection in adults [J]. Am J Emerg Med, 2016, 34(2): 202-206.

[14] Mekala S, Delhi Kumar C G, Gulati R. Antiphospholipid syndrome complicating pneumococcal meningitis [J]. Indian Pediatr, 2018, 55(5): 429-431.

[15] Jayaraman Y, Veeraraghavan B, Chethrapilly Purushothaman G K, et al. Burden of bacterial meningitis in India: preliminary data from a hospital based sentinel surveillance network [J]. PLoS One, 2018, 13(5): e0197198.

[16] Zainel A, Mitchell H, Sadarangani M. Bacterial meningitis in children: neurological complications, associated risk factors, and prevention [J]. Microorganisms, 2021, 9(3): 535.

[17] 叶丽, 叶义花. 肺炎链球菌致学龄前儿童社区获得性肺炎的临床特征、血清分型与药物敏感性研究[J]. 中国卫生检验杂志, 2023, 33(20): 2480-2483, 2488.

[18] Park D C, Kim S H, Yong D, et al. Serotype distribution and antimicrobial resistance of invasive and noninvasive Streptococcus pneumoniae isolates in Korea between 2014 and 2016 [J]. Ann Lab Med, 2019, 39(6): 537-544.

[19] Lyu S, Yao K H, Dong F, et al. Vaccine serotypes of streptococcus pneumoniae with high-level antibiotic resistance isolated more frequently seven years after the licensure of PCV7 in Beijing [J]. Pediatr Infect Dis J, 2016, 35(3): 316-321.

[20] 韩英, 胡丹丹, 韦茹, 等. 广东省特需人群接种门诊特殊健康状态儿童预防接种探索[J]. 中国疫苗和免疫, 2021, 27(6): 678-683.

基金资助

广州市科学技术局市校(院)联合资助项目(202201020653)

广州市科学技术局市校(院)联合资助项目(202201020648)