侵袭性肺炎链球菌感染流行病学特征及耐药性分析

Epidemiological Characteristics and Drug Resistance Analysis of Invasive Streptococcus pneumoniae Infections

摘要: 目的：分析某医院住院患者侵袭性肺炎链球菌感染的流行病学特征和耐药性，为临床精准诊疗提供依据。方法：回顾性分析2015年１月~2024年12月该院明确诊断为侵袭性肺炎链球菌感染的156例患者的临床资料，并对分离自其无菌部位的184株非重复肺炎链球菌进行药敏分析。结果：156例侵袭性肺炎链球菌感染患者中，男性占67.9% (106/156)，女性占32.1% (50/156)，成人和未成年患者各占50% (78/156)，成人患者中65岁以下患者占69.2% (54/78)，未成年患者中6岁以下患者占85.9% (67/78)，第四季度发生率最高占32.1% (50/156)，第三季度发生率最低占14.1% (22/156)；社区获得性感染为主占90.4% (141/156)；感染类型以单一血流感染为主占56.4% (88/156)，单一中枢神经系统感染占20.5% (32/156)，血流感染合并中枢神经系统感染病例占17.3% (27/156)；156例侵袭性肺炎链球菌感染患者中有51.9% (81/156)入住监护室，从156例侵袭性肺炎链球菌感染患者无菌部位(血、脑脊液、胸腹水等)分离出184株肺炎链球菌，其中116株分离自血液标本，59株来自脑脊液标本，5株来自胸水，4株来自腹水；药敏结果显示，菌株对红霉素、克林霉素及四环素的耐药率均大于90%，对磺胺甲噁唑/甲氧苄啶的耐药率为42.4%，对青霉素的耐药率为27.2%，未发现对厄他培南、左氧氟沙星、氧氟沙星、万古霉素、利奈唑胺耐药的菌株。结论：该院侵袭性肺炎链球菌感染好发于社区，呈季节性分布，多见于男性、<65岁的成人及<6岁的儿童。未成年患者更易发生中枢神经系统合并血流感染，且病情更重。肺炎链球菌对大环内酯类等药物耐药严重，但对喹诺酮类及糖肽类等仍高度敏感。临床治疗，尤其是中枢神经系统感染，应参考药敏结果，避免使用耐药率高的药物，并关注脑脊液分离株的特殊耐药模式。

Abstract: Objective: To analyze the epidemiological characteristics and drug resistance of invasive Streptococcus pneumoniae infection in hospitalized patients in a certain hospital, and to provide a basis for precise clinical diagnosis and treatment. Methods: A retrospective analysis was conducted on the clinical data of 156 patients with invasive Streptococcus pneumoniae infection diagnosed in the hospital from January 2015 to December 2024. Drug sensitivity analysis was performed on 184 non-repetitive Streptococcus pneumoniae strains isolated from their sterile sites. Results: Among the 156 patients with invasive Streptococcus pneumoniae infection, 67.9% (106/156) were male and 32.1% (50/156) were female. Adult and minor patients each accounted for 50% (78/156). Among adult patients, 69.2% (54/78) were under 65 years old, and among minor patients, 85.9% (67/78) were under 6 years old. The incidence was highest in the fourth quarter, accounting for 32.1% (50/156), and lowest in the third quarter, accounting for 14.1% (22/156). Community-acquired infection was the main type, accounting for 90.4% (141/156). The infection types were mainly single bloodstream infection, accounting for 56.4% (88/156), single central nervous system infection accounted for 20.5% (32/156), and bloodstream infection combined with central nervous system infection accounted for 17.3% (27/156). Among the 156 patients with invasive Streptococcus pneumoniae infection, 51.9% (81/156) were admitted to the intensive care unit. A total of 184 Streptococcus pneumoniae strains were isolated from the sterile sites (blood, cerebrospinal fluid, pleural and peritoneal fluid, etc.) of the 156 patients, including 116 strains from blood samples, 59 from cerebrospinal fluid samples, 5 from pleural fluid, and 4 from peritoneal fluid. The drug sensitivity results showed that the resistance rates of the strains to erythromycin, clindamycin, and tetracycline were all over 90%, the resistance rate to sulfamethoxazole/trimethoprim was 42.4%, and the resistance rate to penicillin was 27.2%. No resistance was found to ertapenem, levofloxacin, ofloxacin, vancomycin, and linezolid. Conclusion: Invasive Streptococcus pneumoniae infection in this hospital is more common in the community, shows seasonal distribution, and is more common in males, adults under 65 years old, and children under 6 years old. Minor patients are more likely to have combined central nervous system and bloodstream infection, and their conditions are more severe. Streptococcus pneumoniae is highly resistant to macrolides and other drugs, but remains highly sensitive to quinolones and glycopeptides. In clinical treatment, especially for central nervous system infection, drug sensitivity results should be referred to, high-resistance drugs should be avoided, and special resistance patterns of cerebrospinal fluid isolates should be paid attention to.