冬春季节病毒性肺炎合并感染的病原学分析  

Etiological analysis of viral pneumonia co-infection in winter and spring

作　　者：张晓萍[1] 张筠[1] 郭云波 邵润霞[1] ZHANG Xiao-ping;ZHANG Yun;GUO Yun-bo;SHAO Run-xia(Department of Respiratory and Critical Care Medicine,the Second Affiliated Hospital of Zhengzhou University,Zhengzhou 450014,China)

机构地区：[1]郑州大学第二附属医院呼吸与危重症医学科,郑州450014

出　　处：《医药论坛杂志》2024年第7期730-734,共5页Journal of Medical Forum

基　　金：河南省医学科技攻关计划联合共建项目(LHGJ20200413)。

摘　　要：目的分析冬春季节病毒性肺炎合并感染的病原学特点,为临床早诊早治提供帮助,避免盲目或不恰当使用抗菌药物。方法对2022年12月至2023年3月郑州大学第二附属医院呼吸与危重症医学科收治的81例确诊合并感染的病毒性肺炎患者的病原学分布进行回顾性分析,病原学检测方法均同时采用了培养法及宏基因组二代测序法(mNGS)。结果入选的81例患者中,男性53例(65.4%),女性28例(34.6%),年龄17~95岁,平均年龄66.5岁。其中混合感染45例(55.6%),位列前三位的病原体分别是曲霉35例(43.2%)、肺炎克雷伯杆菌24例(29.6%)、念珠菌(22例)27.1%。细菌感染中前三位分别为肺炎克雷伯杆菌(29.6%),鲍曼不动杆菌(25.9%),肠球菌(23.5%);真菌感染中前三位分别为烟曲霉(30.9%),念珠菌(27.2%),黄曲霉(18.5%)。mNGS检测阳性率96.3%,培养法阳性率32.1%,除了伯克霍尔德菌两种方法阳性率相等,余半数以上细菌和真菌以及机会致病菌均由mNGS检测确诊。81例患者中合并基础病比例77.8%,前三位为心脑血管疾病、糖尿病、恶性肿瘤。治愈组与死亡组比较,合并基础病情况有统计学意义(P<0.05),合并真菌感染情况无统计学意义(P>0.05)。结论冬春季节是病毒感染的高发季节,所引发的各种病毒性肺炎极易合并细菌及真菌混合感染,其中合并曲霉菌比例最高,细菌中肺炎克雷伯杆菌感染居首,二代测序方法对早期诊断意义显著,经验性应用覆盖上述病原体的药物或早期应用宏基因组二代测序方法获取病原学依据,可能会缩短病程,降低死亡率。预后不良与合并基础病相关,但与合并真菌感染无关。Objective Analyze the pathogenic characteristics of viral pneumonia co-infection in winter and spring,and helps clinical early diagnosis and premature treatment to avoid blind or inappropriate use of antibacterial drugs.Methods From December 2022 to March 2023,the etiological distribution of 81 viral pneumonia patients diagnosed with co-infection admitted to the Department of Respiratory and Critical Care Medicine of the Second Affiliated Hospital of Zhengzhou University.Both the culture method and the metagenomic next-generation sequencing(mNGS)method were used in the pathogenic detection methods.Results Among the 81 selected patients,there were 53 males(65.4%)and 28 females(34.6%),aged 17-95 years,with an average age of 66.5 years.45 cases(55.6%)were mixed infection,and the top three pathogens were Aspergillus in 35 cases(43.2%),Klebsiella pneumoniae in 24 cases(29.6%),and Candida(22 cases)in 27.1%.The top three bacterial infections were Klebsiella pneumoniae(29.6%),Acinetobacter baumannii(25.9%),and Enterococcus(23.5%);the top three fungal infections were Aspergillus fumigatus(30.9%),Candida(27.2%),Aspergillus flavus(18.5%).The positive rate of mNGS test was 96.3%,and the positive rate of culture method was 32.1%.Except for Burkholderia,the positive rate of the two methods was equal,and more than half of the bacteria,fungi and opportunistic pathogens were confirmed by mNGS test.Among the 81 patients,the proportion of basic diseases was 77.8%,and the top three were cardiovascular and cerebrovascular diseases,diabetes,and malignant tumors.Compared with the death group,the comorbidities with underlying diseases were statistically significant(P<0.05),while the comorbidities with fungal infections were not statistically significant(P>0.05).Conclusion Winter and spring are the seasons of high incidence of viral infections,and the various viral pneumonias caused by them are easily combined with bacterial and fungal mixed infections,among which Aspergillus is the highest,and Klebsiella pneumoniae infection is the firs

关 键 词：病毒性肺炎 合并感染 病原学 宏基因组二代测序 

分 类 号：R446[医药卫生—诊断学]