Clinical characteristics and risk factors of children with streptococcus pneumoniae infection in children / 中国小儿急救医学

ABSTRACT

Objective:To analyze the clinical characteristics, changes of bacterial resistance and death risk factors of children with streptococcus pneumoniae infection, so as to provide reference for clinical diagnosis and treatment.Methods:From January 2012 to December 2019, hospitalized pediatric patients at Shengjing Hospital of China Medical University were selected.Patients with streptococcus pneumoniae positive in bacterial culture in body fluids of various parts (including alveolar lavage fluid, blood, cerebrospinal fluid, external auditory canal secretions, and local abscess drainage fluid) within one week after admission were selected as subjects.The clinical characteristics and changes of bacterial resistance of 146 children with streptococcus pneumoniae infection were retrospectively analyzed, and 141 children were divided into improved group (124 cases) and death group (17 cases) according to the follow-up results, and the risk factors related to death of streptococcus pneumoniae infection were analyzed.Results:(1)A total of 146 children were included, mainly at age of 1 to 3 years (74 cases, 50.68%), and 14 cases had underlying diseases, including congenital malformation, spinal muscular atrophy, epilepsy and so on.(2) There were 76 (52.05%) cases of invasive streptococcus pneumoniae.There were 106 (72.60%) cases of pulmonary infection, 59 (40.41%) cases of sepsis, 42 (28.77%) cases of purulent meningitis, and five cases of local and pelvic abscess.Five cases were discharge from hospital, 17 cases died, and the rest were all improved.Among the dead children, five cases died because of multiple organ failure, ten cases died because of brain failure and two cases died because of severe sepsis.Six deaths were complicated with septic shock.(3) There were 169 streptococcus pneumoniae positive samples, among them 51 (30.18%) blood samples, 39 (23.08%) cerebrospinal fluid samples, 67 (39.64%) alveolar lavage fluid samples, seven (4.14%) pleural fluid samples, and other body fluid culture samples were five strains.(4) The sensitivity rates of vancomycin, linezolid, moxifloxacin and telithromycin to streptococcus pneumoniae were 100.00%, and that for levofloxacin was 98.82%.The resistant rate of erythromycin to streptococcus pneumoniae was 97.01%, and multidrug resistant rate was 85.61%.(5) Previous convulsions, cerebrospinal fluid or positive blood culture, sepsis, meningitis were risk factors for death(all P<0.05). Children in the death group had shorter out-of-hospital course of disease, lower levels of 24-hour hemoglobin, platelets, serum albumin, and higher levels of C-reactive protein and D-dimer (all P<0.05). Logistics multi-factor analysis showed that, low hemoglobin ( OR=0.31, P=0.025), high D-dimer( OR=1.16, P=0.038), septic shock ( OR=27.81, P=0.008), and positive cerebrospinal fluid culture ( OR=6.34, P=0.034) were independent risk factors for death from streptococcus pneumoniae infection. Conclusion:The average age of streptococcus pneumoniae infection is small, the onset of severe infection is rapid, and the fatality rate as well as and the incidence of invasive pneumococcal disease are high.During clinical treatment, the utilization rate of amoxicillin should be appropriately increased, and the application of cephalosporin antibiotics should be reduced.