海南地区5岁以下儿童重症社区获得性肺炎病原学分析

Etiological analysis of severe community-acquired pneumonia in children under five years old in Hainan

目的 研究海南地区5岁以下儿童重症社区获得性肺炎(severe community acquired pneumonia, SCAP)病原学情况,为SCAP患儿的早期治疗提供依据。方法 采用回顾性分析方法将海南省妇女儿童医学中心从2019年3月—2021年8月收治的310例SCAP患儿纳入研究。收集所有受试者的临床资料(包括年龄、性别、发病季节)以及痰液和血液标本病原的检测和药敏试验结果情况。采用SPSS 22.0统计学软件分析患儿基线资料,病原体检出情况及主要细菌对常见抗菌药物的耐药情况。结果 310例SCAP患儿中男性210例、占比67.74%,年龄<1岁217例、占70.00%,冬季发病113例人数、占36.45%。310例SCAP患儿痰液标本和血标本共检出病原体689株,其中按照占比从高到低的顺序分别为呼吸道合胞病毒(23.37%)、肺炎链球菌(19.16%)、腺病毒(12.63%)、流感嗜血杆菌(11.90%)、肺炎克雷伯菌(9.72%)、金黄色葡萄球菌(7.98%)、流感病毒(7.55%)、大肠埃希菌(5.81%)、真菌(1.89%)。不同性别及不同季节间5岁以下儿童常见病原体检出率对比,差异无统计学意义(均P>0.05)。>3岁患儿肺炎链球菌检出率要高于<1岁和1~3岁患儿;而<1岁和1~3岁患儿流感嗜血杆菌检出率高于>3岁患儿,差异有统计学意义(P<0.05);其余病原菌在不同年龄段中检测结果差异无统计学意义(P>0.05)。流感嗜血杆菌对头孢克洛、阿莫西林、头孢曲松、氨苄西林以及左氧氟沙星等药物均有不同程度耐药,而对利福平敏感。肺炎链球菌对头孢克洛、头孢曲松、哌拉西林、阿莫西林以及头孢噻肟等药物均有不同程度耐药,而对左氧氟沙星、亚胺培南以及利奈唑烷敏感。肺炎克雷伯菌对氨苄西林、阿莫西林、头孢曲松、头孢克洛以及头孢噻肟等药物均有不同程度耐药,而对亚胺培南以及利奈唑烷敏感。金黄色葡萄球菌对头孢曲松、头孢克洛、阿莫西林、氨苄西林以及哌拉西林均有不同程度耐药,而对亚胺培南以及利奈唑烷敏感。大肠埃希菌对阿莫西林、哌拉西林、氨苄西林、头孢曲松、头孢克洛均有不同程度耐药,而对左氧氟沙星以及亚胺培南敏感。结论 海南地区儿童SCAP多见于男性、年龄较小人群,且多发生于冬季。此外,流感嗜血杆菌、肺炎链球菌、肺炎克雷伯菌以及金黄色葡萄球菌对常见抗菌药物均有不同程度的耐药率,临床实际工作中应根据耐药情况合理选用相关抗菌药物治疗。

Objective To study the etiology of severe community acquired pneumonia(SCAP) in children under five years old in Hainan, and to provide a basis for early treatment of children with SCAP. Methods A retrospective analysis method was used to enroll 310 children with SCAP who were admitted to Hainan Women and Children’s Medical Center from March 2019 to August 2021. The clinical data of all subjects(including age, sex and season of onset) and the results of pathogen detection and drug sensitivity test of sputum and blood samples were collected. SPSS 22.0 statistical software was used to analyze the subjects’ baseline data and the results of pathogen detection and drug resistance of main bacteria to common antibiotics. Results Among the 310 children with SCAP, 210(67.74%) were males, 217(70.00%) were equal to or younger than 1 year old, and 113(36.45%) were sick in winter. A total of 689 strains of pathogens were detected in the sputum and blood samples from the 310 children with SCAP, of which the proportions from high to low were respiratory syncytial virus(23.37%), Streptococcus pneumoniae(19.16%), adenovirus(12.63%), Haemophilus influenzae(11.90%), Klebsiella pneumoniae(9.72%), Staphylococcus aureus(7.98%), influenza virus(7.55%), Escherichia coli(5.81%) and fungi(1.89%). No statistically significant differences were found in the detection rates of common pathogens in the children under 5 years old between different genders and among different seasons( all P>0.05). The detection rate of Streptococcus pneumoniae in children aged > 3 years was higher than those in children aged < 1 year and 1-3 years. The detection rate of Haemophilus influenzae was higher in children aged< 1 year and 1-3 years than in children aged > 3 years( P<0.05). There was no statistically significant difference in the detection results of other pathogens among different age groups( P>0.05). Haemophilus influenzae was somewhat resistant to drugs such as cefeclow,amoxicillin, ceftreaxone, ampicillin, and levofloxacin, but sensitive to rifampicin. Streptococcus pneumoniae was somewhat resistant to drugs such as cefeclow, ceftreaxone, piperacicillin, amoxicillin and ceefotaxime, but sensitive to levofloxacin,imipenem and linazolane. Klebsiella pneumoniae was somewhat resistant to drugs such as ampicillin,amoxicillin,ceftreaxone,cefaclor and ceftitaxime,but sensitive to imipenem and linazolane. Staphylococcus aureus was somewhat resistant to drugs such as ceftreaxone, cefaclor, amoxicillin, ampicicillin and pipericillin, but sensitive to imipenem and linazolane.Escherichia coli was somewhat resistant to drugs such as amoxicillin,pipericillin,ampicillin,ceftreaxone,cefaclor,but sensitive to levofloxacin and imipenem. Conclusion SCAP is more common in male and younger children in Hainan,and prevalent in winter. In addition,Hemophilus influenzae,Streptococcus pneumoniae,Klebsiella pneumoniae and Staphylococcus aureus have different drug resistance rates to common antibacterial drugs;and hence,relevant antibacterial drugs should be rationally selected according to the drug resistance in clinical practice.