儿童社区获得性肺炎病原微生物分布研究

Microbiological etiology in children with community acquired pneumonia

目的了解本院儿童社区获得性肺炎(CAP)病原微生物分布规律。方法对入选的1167例年龄在28d至8岁间的CAP患儿,于入院4h内分别采集呼吸道分泌物和静脉血进行多病原联合检测。呼吸道分泌物用于细菌培养,并用实时聚合酶链反应法(RT-PCR)检测肺炎支原体和沙眼衣原体;静脉血用酶联免疫吸附法(ELISA)检测呼吸道合胞病毒和腺病毒。结果在1167例CAP患儿中,呼吸道分泌物培养出细菌308株,其中革兰阳性菌占53.6%,革兰阴性菌占46.4%。前5位细菌分别为:肺炎链球菌(35.1%),大肠埃希菌(11.7%),金黄色葡萄球菌(8.8%),肺炎克雷伯菌(6.5%),卡他莫拉菌(5.8%)。产酶菌株在前5位细菌中占30.1%。非细菌病原体检出率为24.1%(281/1167),其中呼吸道合胞病毒的感染率最高,为19.3%(225/1167)。呼吸道合胞病毒与肺炎链球菌的混合感染率最常见(35.2%)。多数病原微生物在1岁以下患儿中的感染率高于1岁以上患儿。结论肺炎链球菌与呼吸道合胞病毒为本院儿童CAP的主要病原体;多数病原微生物在1岁以下患儿中的感染率高于1岁以上患儿。

Objective To study the distribution of pathogenic microorganisms of community acquired pneumonia （CAP） in children.Methods Respiratory secretion and blood specimens were collected in 1 167 children with CAP within 4 hrs of admission. Mycoplasma pneumonia and Chlamydia trachomatis were detected by RT-PCR in respiratory secretion specimens. Respiratory syncytial virus （RSV-IgM） and Adenovirus （ADV-IgM） were tested using ELISA in blood samples.Results A total of 308 strains of bacteria were isolated from the respiratory tract secretions, with gram positive strains of 53.6% and gram negative strains of 46.4%. The top five bacteria strains detected were Streptococcus pneumoniae （35.1%）,Escherichia coli （11.7%）, Staphylococcus aureus （8.8%）,Klebsiella pneumonia （6.5%） and Moraxelle catarrhalis （5.8%） in turn. Beta-lactamase and ESBLs producing strains accounted for 30.1% in the top five bacteria strains. The non-bacteria pathogens were found in 281 specimens （24.1%）. Respiratory syncytial virus accounted for the most prevalent pathogen （19.3%）. The mixed infection of respiratory syncytial virus and Streptococcus pneumoniae was common （35.2%）. The infection rate from most of pathogenic microorganisms among children under the age of one was higher than that in children over one year old.Conclusions Respiratory syncytial virus and Streptococcus pneumoniae are the major pathogens of CAP in children. The risk of pathogenic microorganism infections in children under the age of one is higher than that of children over one year old.