小儿院内获得性肺炎与社区获得性肺炎对比分析

A CONTRAST ANALYSIS OF NOSOCOMIAL PNEUMONIA AND COMMUNITY-ACQUIRED PNEUMONIA IN CHILDREN

目的比较小儿院内获得性肺炎(HAP)与社区获得性肺炎(CAP)临床特点、病原学及易感因素的不同以探讨HAP的发病因素。方法对45例HAP与同期55例CAP病儿的临床资料进行分析,比较两组基础疾病、免疫功能及病原学检测结果。结果 HAP病儿存在原发基础疾病32例(71.1%),CAP病儿存在原发基础疾病6例(10.9%),两组比较差异有显著意义(χ2=38.073,P<0.01)。HAP病儿中入重症监护室(PICU)者29例(64.4%),而CAP病儿入PICU者6例(10.9%),两组比较,差异有显著性(χ2=37.180,P<0.01)。45例HAP病儿检出细菌40例,以革兰阴性杆菌为主(52株),多重耐药菌38株,产超广谱β-内酰胺酶菌23株(44.2%),支原体抗体阳性6例;55例CAP病儿检出细菌28例,多重耐药菌12株,支原体抗体阳性20例,巨细胞病毒抗体阳性2例。两组病原体检出率比较,差异有显著性(2χ=5.861,P<0.05)。结论 HAP常发生于有原发严重基础疾病的小婴儿或免疫功能低下病儿,特别是ICU病儿,病原以细菌感染为主且耐药率较高;CAP常发生于病毒、支原体、细菌等多种微生物感染。HAP需常规进行病原学监测及药敏试验,根据药敏试验结果及时调整药物。

Objective To compare the clinical characteristics,etiology and predisposing factors of nosocomial pneumonia（NP） and community-acquired pneumonia（CAP）,and search the etiology of NP. Methods Clinical data of 45 children with NP and 55 with CAP of the corresponding time period were analyzed,the underlying diseases,immune function,and etiology between the two groups were compared. Results Of 45 sick kids with NP,32（71.1%） were found with underlying diseases;of 55 cases with CAP,the underlying disease was found in six kids（10.9%）,the difference being significant（χ2=38.073,P0.01）;Twenty-nine NP kids（64.4%） were treated in PICU,while that with CAP treated in PICU were six（10.9%）,with significant difference（χ2=37.180,P0.01）.In NP kids,bacteria were detected in 40 cases,which included gram negative bacilli（52 strains）,multidrug resistant strains（38）,and ESBL-producing strain（23）,and MP positive（6）;In CAP,bacteria were detected in 28 cases,in which,12 strains were multidrug-resistant,20 MP positive,and two were CMV positive.The difference of pathogen-detection rate between the two groups was significant（χ2=5.861,P0.05）. Conclusion NP is commonly seen in infants with severe underlying diseases or that with hypofunction of immunity,especially in ICU patients,bacterial infection is the main cause with a high drug resistance.CAP is usually infected by virus,mycoplasma,bacteria,or other microorganisms.Etiological monitoring and drug susceptibility tests are needed to be done as routine for NP,and medication be adjusted accordingly.