2013-2018年天津地区住院儿童急性呼吸道感染病原体流行特征分析

Analysis on the epidemic characteristics of respiratory pathogens in hospitalized children withacute respiratory tract infections in Tianjin from 2013 to 2018

目的分析2013—2018年天津地区急性呼吸道感染(ARI)住院儿童的病原谱及其流行特征.方法采集痰和/或咽拭子标本行细菌培养鉴定;采集血清样本行9种呼吸道病原体IgM抗体联合检测,包括甲型流感病毒(IFA)、乙型流感病毒(IFB)、副流感病毒(PIVs)、呼吸道合胞病毒(RSV)、腺病毒(ADV)、嗜肺军团菌1型(LP-1)、Q热立克次体(COX)、肺炎衣原体(CPn)、肺炎支原体(MP),同时检测血清MP抗体滴度(≥1:160定义为阳性).结果共纳入ARI住院患儿7832例,其中5353例完成细菌培养鉴定,7449例完成9种呼吸道病原体IgM抗体及MP抗体滴度检测,4970例完成上述所有病原学检查.7832例患儿中3291例至少检测到1种病原体,病原总检出率为42.0%(3291/7832);细菌总检出率20.1%(1078/5353),以肺炎链球菌(5.3%)、肺炎克雷伯菌(4.0%)、大肠埃希菌(2.7%)、金黄色葡萄球菌(1.9%)、流感嗜血杆菌(1.6%)检出率较高;病毒总检出率为4.31%(321/7449),以IFB(2.8%)、PIVs(0.6%)常见;非典型病原体检出率30.0%(2241/7449),以MP(29.3%)检出率最高.不同性别、季节、年龄段、疾病类型之间病原检出率有所不同.4970例完成全部病原学检查的患儿中379例检测到2种以上病原体,合并感染检出率为7.6%(379/4970),其中非典型病原体合并细菌、非典型病原体合并病毒、细菌合并病毒感染检出率分别为3.8%(191/4970)、3.0%(150/4970)、0.6%(28/4970);Logistic回归分析显示,在校正年龄、性别因素后,合并感染是普通肺炎进展为重症肺炎的独立风险因素(OR=1.916;95%CI:1.415~2.595;P<0.01).结论2013—2018年天津地区ARI住院患儿MP单独及合并感染检出率均较高,且近年有增高趋势;肺炎链球菌、肺炎克雷伯菌、大肠埃希菌、金黄色葡萄球菌、流感嗜血杆菌是儿童ARI的常见致病菌;合并感染是疾病进展加重的独立危险因素.

Objective To explorer the profile and epidemiological characteristics of hospitalized children with acute respiratory tract infection(ARI)in Tianjin,china,from 2013 to 2018.Methods Sputum and/or throat swab specimen and serum sample were obtained from children within 24 hours after admission.Respiratory bacteria were identified by biochemical reaction and Analytical Profile Index.IgM antibodies against nine common respiratory pathogens including influenza virus A(IFA),influenza virus B(IFB),parainfluenza virus serotype 1,2,3(PIVs),respiratory syncytial virus(RSV),adenovirus(ADV),mycoplasma pneumonia(MP),chlamydia pneumonia(CP),coxiella burnetii(COX)and legionella pneumophila serogroup 1(LP-1)were detected by indirect immunofluorescence antibody test(IFAT).Total antibodies against MP were further semi-quantified by passive particle agglutination test(PPAT),titer≥1∶160 was confirmed as recent infection.Results A total of 7832 children hospitalized with ARI were included in the study,of whom 5353 children were completed bacterial identification,7449 children were performed with IFAT and PPAT,and 4970 children with all above etiological tests.Of the 7832 children enrolled in the study,3291(42.0%)were positive for one or more pathogen.Twenty percent of the 5353 patients were performed with bacterial identification with at least one bacterium.The top five common bacteria were streptococcus pneumoniae(5.3%),Klebsiella pneumoniae(4.0%),Escherichia coli(2.7%),staphylococcus aureus(1.9%)and haemophilus influenzae(1.6%)respectively.Among the five tested viruses,IFB(2.8%)and PIVs(0.6%)were the most commonly identified.MP was the most commonly detected pathogen throughout the year,with a mean positive rate of 29.3%(2241/7449)and the seasonal peak form September to December.The presences of more than one pathogen were found,atypical pathogenic/bacterial,atypical pathogenic/viral and bacterial/viral combinations were detected in 3.8,3.0 and 0.6%respectively.Logistic regression analysis showed that co-infection was independently associated with the increased risk of progression to severe pneumonia(OR=1.916;95%CI:1.415-2.595;P<0.01).Conclusion This study suggests that MP and co-infection combined pathogen are the most commonly identified pathogen in the hospitalized children with ARI from 2013 to 2018,with a rising tendency in recent years.S.pneumoniae,K.pneumoniae,E.coli,S.aureus and H.influenzae are commonly indentified bacteria in children with severe lower respiratory tract infection.Co-infection is associated with the increased risk for progression and exacerbation of illness.