北京单中心社区获得性肺炎住院患儿病原学分析  

The etiology of community-acquired pneumonia in hospitalized children of single center in Beijing

作　　者：马慧轩 孙琳[1] 吴喜蓉[2] 李颖佳[1] 郭琰[2] 李勤静[1] 王昊[2] 焦伟伟[1] 陈兰勤[2] 尹青琴[1] 徐保平[2] 申阿东[1] 

机构地区：[1]儿科学国家重点学科,省部共建儿科重大疾病研究重点实验室,儿童呼吸道感染性疾病研究北京市重点实验室,北京市儿科研究所,首都医科大学附属北京儿童医院,北京100045 [2]首都医科大学附属北京儿童医院呼吸科,北京100045

出　　处：《中国循证儿科杂志》2015年第5期361-365,共5页Chinese Journal of Evidence Based Pediatrics

基　　金：国家科技支撑计划:2013BAI09B11;首都卫生发展科研专项:2014-1-2094

摘　　要：目的了解住院患儿社区获得性肺炎(CAP)的病原谱及病原流行特点。方法回顾性收集2012年12月至2013年11月首都医科大学附属北京儿童医院(我院)确诊的CAP患儿,采集性别、年龄、入院前抗病原治疗情况、入院时间、病原学诊断等资料,分析不同年龄、季节病原构成及流行特点。结果 1 853例CAP患儿总体病原检出率为78.1%,入我院前均有抗生素应用史。细菌检出率27.0%,前3位依次是肺炎链球菌、流感嗜血杆菌和肺炎克雷伯菌;病毒检出率为22.5%,以呼吸道合胞病毒(RSV)和腺病毒(ADV)最常见;肺炎支原体检出率为48.7%;混合感染检出率为23.0%,以细菌合并病毒感染最多见。2随着年龄增长单一细菌或病毒感染的比例呈明显下降趋势,肺炎支原体感染的比例呈现明显上升趋势,多种病原混合感染或无明确病原感染比例随年龄增长亦有所降低;肺炎链球菌感染多见于3岁以下婴幼儿(75.9%);流感嗜血杆菌(75.0%)和肺炎克雷伯菌感染(68.4%)多见于婴儿。RSV感染多见于婴儿(76.2%),ADV感染多见于3岁以下婴幼儿(82.2%)。3单一细菌感染春季最多见,冬季次之;单一病毒感染冬季多见;单一肺炎支原体感染秋季最多见,夏季次之;多种病原混合感染以冬春季多见;无明确病原感染在春季最高。肺炎链球菌感染多见于冬春季,流感嗜血杆菌感染多见于春季,肺炎克雷伯菌感染多见于冬春季,RSV感染多见于冬季,ADV感染以冬春季多见。结论CAP的病原谱构成存在显著的年龄和季节分布特点。细菌、病毒感染多见于婴儿,肺炎支原体感染多见于5岁以上患儿,多种病原混合感染以婴儿最多见。细菌感染冬春季多见,病毒感染冬季多见,肺炎支原体感染多发生于夏秋季;多种病原混合感染多见于冬春季。Objective To analyze the etiology of community-acquired pneumonia in hospitalized children. Methods A retrospective descriptive study was undertaken among pediatric patients with community- acquired pneumonia admitted to Beijing Children ＇ s Hospital from December 2012 to November 2013. Clinical data including gender,age,hospitalization time,etiology and other data were collected. The etiology characteristics of these patients in different ages and seasons were analyzed. Results 1 1 853 hospitalized children aged from 28 days to 18 years with community-acquired pneumonia were included,and 1 447（ 78. 1%） patients were positive for at least one pathogen. The bacteria positive rate was 27. 0%,and the most frequent detected bacteria was streptococcus pneumonia,followed by haemophilus influenza and klebsiella pneumonia. The virus positive rate was 22. 5%,the most common detected virus was respiratory syncytial virus,followed by adenovirus. Mycoplasma pneumonia positive rate was 48. 7%.Mixed infection rate was 23. 0%. 2 With the growth of the age,the proportion of cases with single bacterial or viral infection decreased sharply,the proportion of cases with mycoplasma pneumoniae infection increased significantly,and the proportion of cases with multiple pathogens increased. Streptococcus pneumoniae infection often occurred in cases under 3 years of age（ 75. 9%）.Haemophilus influenzae infection（ 75. 0%） and klebsiella pneumonia infection（ 68. 4%） were found commonly in cases under 1year of age. Respiratory syncytial virus infection was much more common in infants under 1 year of age（ 76. 2%）,adenovirus infection was more common in children under 3 years of age（ 82. 3%）. 3Single bacterial infection occurred the most commonly in spring while single virus infection occurred predominantly in winter,and single mycoplasma pneumoniae infection occurred the most commonly in autumn. Mixed pathogen infection occurred the most commonly in winter and spring; non-confirmed pathogens infection occurred the mo

关 键 词：社区获得性肺炎 病原学 儿童 年龄 季节 

分 类 号：R725.6[医药卫生—儿科]