昆明地区小儿社区获得性下呼吸道感染病原菌分析

Etiological Analysis of Community-acquired Lower Respiratory Tract Infection in Children in Kunming

目的分析昆明市(海拔1860 m)小儿社区获得性下呼吸道感染病原菌流行病学特征.方法对2011年01月至2015年12月因社区获得性下呼吸道感染入住昆明医科大学第二附属医院及昆明市妇幼保健院9 793例患儿痰标本培养结果进行回顾性分析.结果 9 793例社区获得性下呼吸道感染患儿痰标本中,合格痰标本为8 433份,合格率为86.10%,细菌培养阳性2 918份,细菌检出率为34.60%,共检出菌株3 123株,其中革兰氏阴性菌(1 839株;58.9%),革兰氏阳性菌(1284株;41.4%),革兰氏阴性检出率逐年增加;其中流感嗜血杆菌(768株;24.60%)最多见,其次是肺炎链球菌(665株;21.3%)、大肠埃希菌(315株;10.1%)、金黄色葡萄球菌(9.9%);卡他莫拉菌272株(8.7%);肺炎克雷伯杆菌224株(7.2%).6种常见细菌在不同季节检出率差异有统计学意义(P<0.05).除卡他莫拉菌外5种常见细菌在不同年龄段检出率差异有统计学意义(P<0.05).结论昆明地区小儿社区获得性下呼吸道感染病原菌以革兰氏阴性菌为主,最常见的是流感嗜血杆菌;痰培养细菌检出率以冬季最高;近5 a婴幼儿下呼吸道感染最常见的致病菌是流感嗜血杆菌,学龄前期、学龄期儿童是肺炎链球菌.昆明小儿社区下呼吸道感染致病菌与平原地区不同.

Objective To investigate epidemiological characteristics of pathogenic bacteria of community-acquired lower respiratory tract infection in children in Kunming（with an altitude of 1860 m）.Me thods The results of bacterial culture of 9793 patients with community-acquired lower respiratory tract infection in the Second Affiliated Hospital of Kunming Medical University and Kunming Maternal and Child Health Hospital from Jan 2011 to Nov 2015 were reviewed.Re s ults Among the 9793 phlegm samples from the children patients with community-acquired lower respiratory tract infection, 8433（86.10%） phlegm samples were qualified, 2918（34.6%） had a positive bacterial culture.The pathogenic bacteria mainly were gram-negative bacteria（1 839 strains, 58.9%）, and gram-positive bacteria（1 284 strains, 41.4%）. The detection rate of gram-negative bacteria was increasing, among which Haemophilus was in a leading position（768 strains, 24.60%）,followed by Streptococcus pneumonia（665 strains, 21.3%）,E. coli（315 strains, 10.10%）, Staphylococcus aureus（310 strains, 9.9%）, Moraxella catarrhalis（272 strains, 8.7%）, and Klebsiella pneumoniae bacillus（224 strains, 7.2%）. The detection rates of six common bacteria in different seasons were significantly different（P〈0.05）. The detection rates of six common bacteria except Moraxella catarrhalis in different age groups were significantly different（P〈0.05）. Conclus ions Gram-negative bacterium was the main pathogenic bacteria for those children who got community-acquired lower respiratory tract infections. Haemophilus influenza was the most common pathogenic bacteria and the detection rate of pathogenic bacteria in winter was high. The most common pathogenic bacteria in infants and toddler were Haemophilus influenza. The most common pathogen in preschool and school-age children was Streptococcus pneumonia.The pathogenic bacteria of lower respiratory tract infection in the children community of Kunming are different from those in the plain area.