Objective: To explore the clinical features, the serotype distribution and drug resistance of the isolates in patient with invasive pneumococcal disease (IPD). Methods: By retrieving the laboratory information system in 18 children's hospitals from 2012 to 2017, the children with IPD were enrolled. Streptococcus pneumoniae (Spn) must be isolated from the sterile sites (blood, cerebrospinal fluid, hydrothorax and joint effusion etc.). The clinical characteristics, serotype, drug resistance, treatment and prognosis were reviewed and analyzed. According to the telephone follow up results, the patients were divided into death group and recovered group. The index as an independent risk factor of mortality was demonstrated by multivariate logistic regression analysis. Results: There were 1 138 children with IPD, including 684 male and 454 female. The proportion of male to female was 1.5∶1. The age ranged from one day to 16 years. The median age was 1 year 3 month. The majority was under 5 years of age (89.3%, n= 1 016), especially under 2 years of age (61.9%, n=704). In all cases, 88.2% (n=1 004) were community acquired infection. The infections included meningitis (n=446, 39.2%), pneumonia with bacteremia (n=339, 29.8%), and bacteremia without focus (n=232, 20.4%). Underlying diseases were found in 242 cases (21.3%). Co-infections were determined in 62 cases (5.4%) with mycoplasma, 27 cases (2.4%) with adenovirus and 34 cases with influenza virus (3.0%). The penicillin insensitivity (PNSP) rates in meningitis and non-meningitis isolates were 69.5% (276/397) and 35.9% (221/615), respectively. There were 81 strains serotyped, in which 93.8% (76/81) were covered by 13-valent protein-polysaccharide conjugate vaccine (PCV13). In the 965 patients who were followed up by phone call, 156 cases (16.2%) were confirmed dead. The independent risk factors for the death were under 2 years of age (OR=2.143, 95%CI 1.284-3.577, P=0.004), meningitis (OR=3.066, 95%CI 1.852-5.074, P<0.01), underlying disease (OR=4.801, 95%CI 2.953-7.804, P<0.01), septic shock(OR=3.542, 95%CI 1.829-6.859, P<0.01), disseminated intravascular coagulation (DIC) (OR=4.150, 95%CI 1.468-11.733, P=0.007), multiple organ failure (OR=12.693, 95%CI 6.623-24.325, P<0.01) and complications of central nervous system (OR=1.975, 95%CI 1.144-3.410, P=0.015). Conclusions: Most children with IPD were under 5 years of age, having underlying diseases and acquired the infection in community. The independent risk factors for death were under two years old, meningitis, underlying diseases and multiple organ failure. The problem of drug resistance was severe. The universal immunization of PCV13 would be effective to prevent IPD in Chinese children.
目的： 了解我国儿童侵袭性肺炎链球菌病（IPD）的临床特点及菌株分型、细菌耐药情况。 方法： 本研究为多中心回顾性研究。通过检索2012—2017年18家儿童医院的细菌培养信息管理系统查找自无菌部位（血、脑脊液、胸腹水、关节积液等）分离出肺炎链球菌的住院患儿，收集患儿临床信息及菌株血清型和耐药性检测结果。将患儿按随访结果分为死亡组和好转组，多因素Logistics回归分析IPD死亡危险因素。 结果： 共确定1 138例IPD患儿，其中男684例、女454例，男女比例为1.5∶1，年龄范围为1日龄~16岁，中位年龄为1岁3月龄，5岁以下1 016例，占89.3%，尤其是2岁以下（704例，61.9%）；社区感染者1 004例（88.2%）。临床类型包括脑膜炎446例（39.2%）、菌血症性肺炎339例（29.8%）、无病灶血流感染232例（20.4%）等。患儿有基础疾病者242例（21.3%）。混合感染支原体62例（5.4%），腺病毒27例（2.4%），流感病毒34例（3.0%）。脑膜炎和非脑膜炎菌株对青霉素的不敏感率分别为69.5%（276/397）和35.9%（221/615）。81株确定了血清型，其中13价肺炎球菌蛋白多糖结合疫苗（PCV13）覆盖血清型占93.8%(76/81)。预后随访965例，确定死亡156例，病死率16.2%。多因素Logistics回归分析表明<2岁[比值比（OR）=2.143，95%可信区间（CI）为1.284~3.577，P=0.004]，脑膜炎（OR=3.066，95%CI为1.852~5.074，P<0.01），有基础病（OR=4.801，95%CI为2.953~7.804，P<0.01），感染性休克（OR=3.542，95%CI为1.829~6.859，P<0.01），弥漫性血管内凝血（OR=4.150，95%CI为1.468~11.733，P=0.007），多脏器衰竭（OR=12.693，95%CI为6.623~24.325，P<0.01）和中枢神经系统并发症（OR=1.975，95%CI为1.144~3.410，P=0.015）为患儿死亡的独立危险因素。 结论： 我国儿科确诊的IPD多为5岁以下、有基础疾病的社区感染患儿，<2岁、脑膜炎、基础病及多脏器衰竭等是死亡的独立危险因素，IPD致病株耐药严重，推广接种PCV13疫苗有助于我国儿童预防IPD。.
Keywords: Child; Multicenter study; Pneumococcal infections.