A multicenter clinical study on 1 138 cases of invasive pneumococcal disease in children from 2012 to 2017
10.3760/cma.j.issn.0578-1310.2018.12.006
- VernacularTitle: 2012至2017年1 138例儿童侵袭性肺炎链球菌病多中心临床研究
- Author:
Liang ZHU
1
;
Wenhui LI
2
;
Xinhong WANG
3
;
Kun TAN
4
;
Qingfeng FANG
;
Qingxiong ZHU
;
Kangkang WU
;
Qiaozhi YANG
;
Aiwei LIN
;
Huiling DENG
;
Jing BI
;
Jing LIU
;
Shiyong ZHAO
;
Yun LIU
;
Shujun JING
;
Yumin WANG
;
Lianmei LI
;
Qing ZHAO
;
Kaihu YAO
;
Xi WANG
;
Li JIA
;
Fang WANG
;
Jikui DENG
;
Jing SUN
;
Chunhui ZHU
;
Kai ZHOU
;
Jun LIANG
;
Xiuzhen NIE
;
Sancheng CAO
;
Dongmeng WANG
;
Shuangjie LI
;
Xuexia CHEN
;
Juan LI
;
Yi WANG
;
Lan YE
;
Yanhong ZHANG
;
Fang DONG
;
Zhi LI
;
Yonghong YANG
;
Gang LIU
Author Information
1. Key Laboratory for Major Disease in Children, Ministry of Education, Department of Infectious Diseases, Beijing Children′s Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China
2. Department of Infectious Disease, Children′s Hospital of Hebei Province, Shijiazhuang 050031, China
3. Department of Infectious Diseases, Children′s Hospital Affiliated to Zhengzhou University, Children′s Hospital of Henan Province, Zhengzhou 450053, China
4. Zunyi Medical University, Zunyi 563003, China
- Publication Type:Journal Article
- Keywords:
Pneumococcal infections;
Multicenter study;
Child
- From:
Chinese Journal of Pediatrics
2018;56(12):915-922
- CountryChina
- Language:Chinese
-
Abstract:
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.
