19A-ST320肺炎链球菌引起儿童急性中耳炎的实验室及临床特征分析
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摘要
目的探讨19A-ST320肺炎链球菌引起儿童急性中耳炎(acute otitis media,AOM)的实验室及临床特征。方法收集2013年12月～2016年11月于延安大学附属医院耳科确诊为肺炎链球菌感染的117例AOM患儿纳入研究,根据肺炎链球菌的血清分型和序列分型将AOM患儿分为19A-ST320组和非-19A-ST320组,记录比较两组的临床特征。结果与非-19A-ST320组比较,19A-ST320组AOM患儿的年龄更小,其差异有统计学意义(χ~2=9.625,P=0.022);19A-ST320组AOM患儿的鼓膜自发性破裂发生率更高,其差异有统计学意义(χ~2=6.662,P=0.010)。19A-ST320组分离所得的肺炎链球菌菌株对青霉素、阿莫西林、头孢噻肟和甲氧苄啶/磺胺甲恶唑的敏感度比非-19A-ST320组更低,其差异均有统计学意义(χ~2=4.070～23.019,均P<0.05);其对氯霉素敏感度更高,差异有统计学意义(χ~2=15.718,P<0.001)。19A-ST320组较非-19A-ST320组具有更高的β-内酰胺抗生素抵抗性和多药耐药性,其差异均有统计学意义(χ~2=25.057,12.344,均P<0.001)。结论对19A-ST320肺炎链球菌进行监测,有利于调整儿童急性中耳炎的预防和治疗策略。
Objective To investigate the laboratory and clinical characteristics of children with acute otitis media(AOM) by Streptococcus pneumoniae 19A-ST320.Methods 117 AOM children diagnosed with Streptococcus pneumoniae infection in the Department of Otology,Affilicated Hospital of Yan'an University,from December 2013 to November 2016 were recruited in the study.According to the serotype and sequence typing of Streptococcus pneumoniae,the AOM children were divided into 19A-ST320 group and non-19A-ST320 group,and the clinical characteristics of two groups were recorded and compared.Results Compared with non-19A-ST320 group,the age of AOM children in 19A-ST320 group was younger,and the difference was statistically significant(χ~2=9.625,P=0.022).The incidence of spontaneous tympanic rupture was higher in children with AOM in 19A-ST320 group,and the difference was statistically significant(χ~2=6.662,P=0.010).The sensitivity of streptococcus pneumoniae isolated from 19A-ST320 group to penicillin,amoxicillin,cefotaxime and trimethopridine/sulfamethoxazole were lower than that of non-19A-ST320 group,and the differences were statistically significant(χ~2=4.070～23.019,all P=0.05).The sensitivity to chloramphenicol in 19A-ST320 group was higher than that in non-19A-ST320 group,and the difference was statistically significant(χ~2=15.718,P=0.000).Compared with non-19A-ST320 group,19A-ST320 group had higher β-lactam antibiotic resistance and multi-drug resistance,and the differences were statistically significant(χ~2=25.057,12.344,all P<0.001).Conclusion To monitor Streptococcus pneumoniae 19A-ST320 is helpful in adjust the prevention and treatment strategies of children with acute otitis media.
Objective To investigate the laboratory and clinical characteristics of children with acute otitis media(AOM) by Streptococcus pneumoniae 19A-ST320.Methods 117 AOM children diagnosed with Streptococcus pneumoniae infection in the Department of Otology,Affilicated Hospital of Yan'an University,from December 2013 to November 2016 were recruited in the study.According to the serotype and sequence typing of Streptococcus pneumoniae,the AOM children were divided into 19A-ST320 group and non-19A-ST320 group,and the clinical characteristics of two groups were recorded and compared.Results Compared with non-19A-ST320 group,the age of AOM children in 19A-ST320 group was younger,and the difference was statistically significant(χ~2=9.625,P=0.022).The incidence of spontaneous tympanic rupture was higher in children with AOM in 19A-ST320 group,and the difference was statistically significant(χ~2=6.662,P=0.010).The sensitivity of streptococcus pneumoniae isolated from 19A-ST320 group to penicillin,amoxicillin,cefotaxime and trimethopridine/sulfamethoxazole were lower than that of non-19A-ST320 group,and the differences were statistically significant(χ~2=4.070～23.019,all P=0.05).The sensitivity to chloramphenicol in 19A-ST320 group was higher than that in non-19A-ST320 group,and the difference was statistically significant(χ~2=15.718,P=0.000).Compared with non-19A-ST320 group,19A-ST320 group had higher β-lactam antibiotic resistance and multi-drug resistance,and the differences were statistically significant(χ~2=25.057,12.344,all P<0.001).Conclusion To monitor Streptococcus pneumoniae 19A-ST320 is helpful in adjust the prevention and treatment strategies of children with acute otitis media.
引文
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[11] 李明,谭丁丁,张曲涛,等.广东省虎门地区儿童肺炎链球菌血清型分布及耐药性监测[J].中国感染与化疗杂志,2015,15(1):43-46.LI Ming,TAN Dingding,ZHANG Qutao,et al.Sero-type distribution and antimicrobial resistance of Streptococcus pneumoniae in children in Humen area[J].Chinese Journal of Infection and Chemotherapy,2015,15(1):43-46.
[12] MENDES R E,FARRELL D J,FLAMM R K,et al.In vitro activity of lefamulin tested against Streptococcus pneumoniae with defined serotypes,including multidrug-resistant isolates causing lower respiratory tract infections in the United States[J].Antimicrob Agents Chemother,2016,60(7):4407-4411.
[2] JIN Ping,WU Lijuan,SHAHIN O,et al.Using a practical molecular capsular serotype prediction strategy to investigate Streptococcus pneumoniae serotype distribution and antimicrobial resistance in Chinese local hospitalized children[J].BMC Pediatr,2016,16:53.
[3] 梁丽霞,申学基,高少东,等.肺炎链球菌经典血清分型与分子分型两种方法比较[J].现代检验医学杂志,2016,31(3):73-76.LIANG Lixia,SHEN Xueiji,GAO Shaodong,et al.Comparison of classical and molecular typing methods for Streptococcus pneumoniae[J].J Mod Lab Med,2016,31(3):73-76.
[4] 陆灿.儿童侵袭性肺炎链球菌血清型分布的调查研究[J].国际检验医学杂志,2015,36(7):990-992.LU Can.Serotype distribution of Streptococcus pneumoniae in children[J].International Journal of Laboratory Medicine,2015,36(7):990-992.
[5] CHEN Yiyin,WANG J T,LIN T L,et al.Prophage excision in Streptococcus pneumoniae serotype 19A ST320 promote colonization:insight into its evolution from the ancestral clone Taiwan 19F-14 (ST236)[J].Front Microbiol,2019,10:205.
[6] Clinical and Laboratory Standards Institute.CLSI M 100-S25 Performance standards for antimicrobial susceptibility testing Twenty-Fourth Informational Supplement[S].Wayne:PA,CLSI M100-S25,2018.
[7] DEMANT M N,JENSEN R G,JAKOBSEN J C,et al.The effects of ventilation tubes versus no ventilation tubes for recurrent acute otitis media or chronic otitis media with effusion in 9 to 36 month old Greenlandic children,the SIUTIT trial:study protocol for a randomized controlled trial[J].Trials,2017,18(1):30.
[8] 黄梅,马莉,熊安英,等.2011～2014年泸州市人民医院肺炎链球菌的耐药性分析[J].现代检验医学杂志,2015,30(6):143-146.HUANG Mei,MA Li,XIONG Anying,et al.Drug resistance analysis of Streptococcus pneumonia in Luzhou People’s Hospital 2011～2014[J].J Mod Lab Med,2015,30(6):143-146.
[9] OZAWA D,YANO H,HIDAKA H,et al.Twelve-year survey(2001-2012) of the antimicrobial susceptibility of Streptococcus pneumoniae isolates from otorhinolaryngology clinics in Miyagi prefecture,Japan[J].Journal of Infection and Chemotherapy,2014,20(11):702-708.
[10] KORONA-GLOWNIAK I,ZYCHOWSKI P,SIWI-EC R,et al.Resistant Streptococcus pneumoniae strains in children with acute otitis media-high risk of persistent colonization after treatment[J].BMC Infect Dis,2018,18(1):478.
[11] 李明,谭丁丁,张曲涛,等.广东省虎门地区儿童肺炎链球菌血清型分布及耐药性监测[J].中国感染与化疗杂志,2015,15(1):43-46.LI Ming,TAN Dingding,ZHANG Qutao,et al.Sero-type distribution and antimicrobial resistance of Streptococcus pneumoniae in children in Humen area[J].Chinese Journal of Infection and Chemotherapy,2015,15(1):43-46.
[12] MENDES R E,FARRELL D J,FLAMM R K,et al.In vitro activity of lefamulin tested against Streptococcus pneumoniae with defined serotypes,including multidrug-resistant isolates causing lower respiratory tract infections in the United States[J].Antimicrob Agents Chemother,2016,60(7):4407-4411.