齐齐哈尔市156例小儿社区获得性肺炎的病原学特点及影响预后的相关因素分析  

Etiological characteristics of 156 cases of community acquired pneumonia in children in the City of Qiqihar and analysis of related factors affecting prognosis

作　　者：尹加林[1] 魏静[1] 徐坤[2] 王铁岩[1] YIN Jia-lin;WEI Jing;XU Kun;WANG Tie-yan(Pediatrics,The Second Hospital Affiliated with Qiqihar Medical College,Qiqihar,Heilongjiang,China 161000;Pediatrics,The First Hospital of Qiqihar)

机构地区：[1]齐齐哈尔医学院附属第二医院儿科,黑龙江齐齐哈尔161000 [2]齐齐哈尔市第一医院儿科

出　　处：《中国病原生物学杂志》2021年第3期352-355,共4页Journal of Pathogen Biology

摘　　要：目的探讨齐齐哈尔市社区儿童获得性肺炎(CAP)的病原学特点及影响预后的相关因素。方法对本市2019年1月-2020年1月确诊的156例CAP患儿分别采集其呼吸道分泌物作细菌培养、鉴定及病原菌耐药性分析,采集患儿静脉血,分离血清,采用酶联免疫吸附法(ELISA)检测病毒及非典型病原体IgM抗体;收集患儿临床资料,对影响CAP预后的相关因素进行单因素及多因素Logistic回归分析。结果156例CAP患儿共检出病原体117株(75.00%)。其中细菌30株(25.64%),以肺炎链球菌多见;病毒36株(30.77%),以呼吸道合胞病毒多见;非典型病原体51株(43.59%),其中肺炎支原体36株(30.77%)、肺炎衣原体9株(7.69%)、沙眼衣原体4株(3.42%)、嗜肺军团菌2株(1.71%)。30例患儿(25.64%)存在混合感染,以支原体和细菌/病毒感染多见。细菌感染以肺炎链球菌、肺炎克雷伯菌和大肠埃希菌多见。药敏试验测定肺炎链球菌对万古霉素敏感率为100.00%,对红霉素、青霉素、阿奇霉素、四环素的耐药率为10.00%~20.00%。肺炎克雷伯菌和大肠埃希菌对氨苄西林呈高度耐药,对头孢三代部分耐药,对哌拉西林/他唑巴坦和亚胺培南敏感率均为100.00%。多因素Logistic回归分析显示,年龄<3岁、低氧血症、神志不清、合并多重感染、初始抗菌联合用药均是引起CAP患儿预后不良的独立危险因素(均P<0.05)。结论儿童CAP病原体以肺炎支原体最为常见,其次为肺炎链球菌、肺炎克雷伯菌及大肠埃希菌。临床应根据患儿的病原学特点合理用药,同时还应重点关注低龄、低氧血症、合并多重感染等影响CAP患儿预后不良的危险因素,采取针对性措施,提高疗效。Objective To investigate the etiological characteristics of community acquired pneumonia(CAP)and factors influencing its prognosis in the City of Qiqihar.Methods Respiratory secretions were collected from 156 children diagnosed with CAP in this city from January 2019 to January 2020 for bacterial culture and analysis of drug resistance.Before drug treatment of the infection,the children were asked to clean their mouth,and then respiratory secretions were collected from the throat wall with a disposable sterile sampling swab.An automated microbial identification and drug sensitivity system was used to identify microbes and determine their drug sensitivity.Venous blood was collected and serum was separated.IgM antibodies to viruses and atypical pathogens were detected using an enzyme-linked immunosorbent assay(ELISA).Viruses included influenza virus(IV),parainfluenza virus(PIV),EB virus(EBV),respiratory syncytial virus(RSV),adenovirus(ADV)and coxsackievirus(COX).Atypical pathogens included Mycoplasma pneumoniae,Chlamydia pneumoniae,C.trachomatis,and Legionella pneumophila.Clinical data on the children were collected,and the related factors affecting the prognosis for CAP were analyzed using univariate and multivariate logistic regression analysis.Results A total of 117 pathogens(75.00%)were detected in 156 children with CAP.There were 30 strains(25.64%)of bacteria,most of which were Streptococcus pneumoniae.There were 36 strains(30.77%)of viruses,most of which were respiratory syncytial virus.There were 51 atypical pathogens(43.59%),including 36 strains of M.pneumoniae(30.77%),9 strains of C.pneumoniae(7.69%),4 strains of C.trachomatis(3.42%),and 2 strains of L.pneumophila(1.71%).A mixed infection was found in 30 children(25.64%),most of which were a mycoplasma and bacterial/viral infection.S.pneumoniae,Klebsiella pneumoniae,and Escherichia coli were the common bacterial infections.Results indicated that S.pneumoniae was highly sensitive to vancomycin,with a sensitivity of 100.00%.The resistance of S.pneumoniae to

关 键 词：儿童 社区获得性肺炎 病原学 耐药性 预后 危险因素 

分 类 号：R378[医药卫生—病原生物学]