儿童社区获得性肺炎病原微生物分布特点分析

Spectrum of pathogens for community-acquired pneumonia in children

目的了解儿童社区获得性肺炎(CAP)病原微生物分布规律,为临床诊断和合理用药提供依据。方法 1560例年龄在1个月至9岁间的CAP患儿于入院2 h内、抗感染药物治疗前分别采集呼吸道分泌物和静脉血进行多病原联合检测。免疫荧光法检测鼻咽拭子标本中呼吸道病毒抗原,痰液用于行细菌培养,ELISA法检测静脉血中肺炎支原体及肺炎衣原体IgM。结果在1560例CAP患儿中,痰培养细菌579株,其中革兰阳性菌213株(36.8%),革兰阴性菌366株(63.2%);检出前5位的细菌包括流感嗜血杆菌(7.50%)、肺炎链球菌(6.73%)、金黄色葡萄球菌(6.35%)、卡他莫拉菌(5.19%)和大肠埃希氏菌(3.46%),前5位细菌中产酶菌占检出全部细菌的3.3%。其他病原体感染中,呼吸道合胞病毒感染率最高,为12.88%,其次为肺炎支原体(7.88%)和肺炎衣原体(8.91%)。混合感染严重,其中呼吸道合胞病毒与流感嗜血杆菌混合感染最为常见。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。结论流感嗜血杆菌、呼吸道合胞病毒、肺炎支原体、肺炎衣原体为儿童CAP的主要病原体,多数病原微生物在1岁以下患儿中感染率高于1岁以上患儿,多种病原菌混合感染率高。

Objective To investigate the spectrum of pathogens for community-acquired pneumonia （CAP） in children, and to provide a basis for the diagnosis and treatment of CAP. Methods Respiratory secretions and venous blood samples were collected from 1560 children with CAP aged from one month to 9 years within 2 hours after admission, for detection of multiple pathogens. Respiratory virus antigens in nasopharyngeal swab specimens were detected by immunofluorescence. Sputum was used for bacterial culture. Levels of Mycoplasma pneumoniae （ MP）-IgM and Chlamydia pneumoniae （CP）-IgM in venous blood were measured by enzyme-linked immunosorbent assay. Results A total of 579 strains of bacteria were isolated from all respiratory secretions, including 213 （36. 8% ） Gram-positive strains and 366 （63.2%） Gram-negative strains. The five most common strains were Haemophilus influenzae （7. 50%）, Streptococcus pneumoniae （6.73%）, Staphylococcus aureus （6.35%）, MoraxeUa catarrhalis （5.19%）, and Escherichia coli （3.46%）, wherein the beta-lactamase-producing strains accounted for 3.3% of all strains. The non-bacterial pathogens mainly included respiratory syncytial virus （ 12.88% ）, MP （7.88%）, and CP （8.91% ）. Mixed infection of pathogens was serious, and the mixed infection of respiratory syncytial virus with Haemophilus influenzae infections were the most common. For most pathogens, the infection rate was higher in children aged under one year than in those aged over one year. Conclusions Haemophilus influenzae, respiratory syncytial virus, MP and CP are the main pathogens for children with CAP. For most pathogens, the infection rate is higher in children aged under one year than in those aged over one year. Mixed infection rate of pathogens is high.