上海市2015-2017年严重急性呼吸道感染住院病例病原学特征分析

Pathogenic characteristics of hospitalized severe acute respiratory infections in Shanghai, China, 2015-2017

目的初步了解上海地区≥15岁住院严重急性呼吸道感染病例(SARI)的流行病学特征和病原学特征。方法在2015-2017年期间选取2家监测点医院(二级、三级医院各1家),对每名≥15岁的SARI呼吸道病例采集2份标本,其中1份进行22种呼吸道病原体PCR检测,另1份进行6种常见呼吸道细菌培养鉴定。结果共对287例SARI病例开展了标本采集与实验室检测,其中≥60岁老年人占70.73%。287例病例中119例病例检出≥1种呼吸道病原体,阳性率41.46%。流感病毒检出率最高,为17.77%(51/287),其次为人鼻病毒/肠道病毒和冠状病毒,均为7.32%(21/287),肺炎支原体检出率为5.57%(16/287),副流感病毒、博卡病毒、腺病毒、呼吸道合胞病毒、人偏肺病毒检出率均<5%。细菌培养阳性7株,分别为肺炎克雷伯菌3株,金黄色葡萄球菌2株,肺炎链球菌和铜绿假单胞菌各1株。119例阳性病例中,40例检出≥2种病原体,占33.61%,以流感病毒合并肺炎支原体感染为主(10例)。流感病毒存在冬、春季流行高峰和夏季流行高峰,肺炎支原体存在冬、春季流行高峰,与流感病毒有重叠。15~与≥60岁组的SARI病例病原体检出情况差异无统计学意义。结论≥15岁SARI病例呼吸道样本病原检出种类较多,流感病毒是主要病原体,流感病毒与肺炎支原体混合感染比例较高。

Objective To understand the epidemiological and pathogenic characteristics of hospitalized severe acute respiratory infections (SARI) in Shanghai, China. Methods From 2015 to 2017, one Tertiary hospital and one Secondary hospital were chosen as the surveillance sites. Two respiratory tract specimens per case were collected from SARI cases aged 15 years and older. One specimen was tested for 22 respiratory pathogens by RT-PCR, and the other specimen was cultured for 6 respiratory bacteria. Results A total of 287 SARI cases were enrolled for sampling and lab testing. 70.73% of the cases were aged 60 years and older, with 41.46%(119/287) were positive for at least one pathogen. Influenza virus was the predominant pathogen, accounting for 17.77%(51/287) of all SARI cases. Human rhinovirus/Enterovirus and Coronavirus were both accounting for 7.32%(21/287), followed by Mycoplasma pneumoniae (5.57%, 16/287). The positive rates of parainfluenza virus, bocavirus, adenovirus, respiratory syncytial virus and human metapneumo virus were all less than 5%. Bacterial strains were identified in seven SARI cases, including Klebsiella pneumoniae (3 strains), Staphylococcus aureus (2 strains), Streptococcus pneumoniae (1 strain) and Pseudomonas aeruginosa (1 strain). Two or Three pathogens were co-detected from 40 cases, accounting for 33.61% of 119 positive cases. The most common co-detected pathogens were influenza virus and Mycoplasma pneumoniae (10 cases). Influenza cases peaked in winter-spring and summer. Mycoplasma pneumoniae peaked in winter-spring season and overlapped with influenza. The positive rates of pathogens were not significantly different between different age groups. Conclusions Various respiratory pathogens can be detected from SARI cases aged 15 years and older. Influenza virus was the predominant pathogen and the co-detection of influenza virus with Mycoplasma pneumoniae the most common one.