Netsawang Supichaya, Punpanich Warunee, Treeratweeraphong Vipa, Chotpitayasunondh Tawee
Department of Pediatrics, Queen Sirikit National Institute of Child Health College of Medicine, Rangsit University, Bangkok, Thailand.
J Med Assoc Thai. 2010 Nov;93 Suppl 5:S6-12.
To determine the disease frequency, demographic characteristics, clinical manifestations, laboratory findings and drug susceptibility patterns of childhood invasive pneumococcal infections in a hospital setting in Thailand.
A retrospective review was conducted of invasive pneumococcal infections among children aged < 18 years from January 1, 1998 - December 31, 2007 at the Queen Sirikit National Institute of Child Health (QSNICH). Medical records of case-patients were reviewed to collect information on demographics, clinical manifestations, laboratory findings, and drug susceptibility patterns of infecting isolates.
Among the 745,983 children receiving care at QSNICH during the study period, culture-proven invasive pneumococcal infections were identified in 126 patients for an estimated incidence of 17 cases per 100,000 patients. Patient diagnoses included bacteremia (59.4%), meningitis (29.3%), and pneumonia (11.3%). Of the 31 pneumococcal meningitis cases, 54.8% were caused by penicillin-nonsusceptible S. pneumoniae (PNSSP), while 25.3% of 75 non-meningitis cases were PNSSP (records not available for the remaining 20 cases). Of 126 PNSSP, 8.2% were resistant to cefotaxime and 12.3% were resistant to ceftriaxone. All of the isolates were susceptible to vancomycin. The case fatality rate was 12.3%; 23.1% offatal cases were associated with HIV infection. Outcomes did not differ significantly between patients infected with penicillin-susceptible and non-susceptible pneumococcal strains.
The results of this hospital-based study indicate that the incidence of invasive pneumococcal infection in QSNICH remains relatively low, but the case fatality rate is high, especially among those with HIV infection.
确定泰国一家医院环境中儿童侵袭性肺炎球菌感染的疾病频率、人口统计学特征、临床表现、实验室检查结果及药敏模式。
对1998年1月1日至2007年12月31日在诗丽吉王后国家儿童健康研究所（QSNICH）年龄＜18岁儿童的侵袭性肺炎球菌感染进行回顾性研究。查阅病例患者的病历，收集有关人口统计学、临床表现、实验室检查结果及感染分离株药敏模式的信息。
在研究期间接受QSNICH治疗的745,983名儿童中，126例患者被确诊为经培养证实的侵袭性肺炎球菌感染，估计发病率为每100,000例患者中有17例。患者诊断包括菌血症（59.4%）、脑膜炎（29.3%）和肺炎（11.3%）。在31例肺炎球菌脑膜炎病例中，54.8%由对青霉素不敏感的肺炎链球菌（PNSSP）引起，而在75例非脑膜炎病例中，25.3%为PNSSP（其余20例记录缺失）。在126株PNSSP中，8.2%对头孢噻肟耐药，12.3%对头孢曲松耐药。所有分离株对万古霉素敏感。病死率为12.3%；23.1%的死亡病例与HIV感染有关。感染青霉素敏感和不敏感肺炎球菌菌株的患者之间的结局无显著差异。
这项基于医院的研究结果表明，QSNICH中侵袭性肺炎球菌感染的发病率仍然相对较低，但病死率较高，尤其是在HIV感染者中。
