支气管肺发育不良患儿2岁内下呼吸道感染再入院临床特征及病原分析(附52例报告)

Clinical features and pathogens of children with bronchopulmonary dysplasia rehospitalized due to lower respiratory tract infection in the first 2 years:An analysis of 52 cases

目的探讨支气管肺发育不良(BPD)患儿2岁内因下呼吸道感染再入院临床特征及病原。方法回顾性分析2012年1月至2016年12月重庆医科大学附属儿童医院52例2岁内BPD患儿再入院临床资料。结果52例BPD患儿2岁内共137次再入院治疗,临床表现主要为咳嗽、气促、喘息、紫绀及肺部干湿性啰音,>1~2岁较≤1岁再入院喘息发生率有显著升高(χ^2=10.715,P=0.001)。呼吸道病毒检出以呼吸道合胞病毒(RSV)67.3%(33/49)、副流感病毒3型(PIV3)22.4%(11/49)为主,细菌病原检出前3位为肺炎克雷伯杆菌28.2%(31/110)、肺炎链球菌15.5%(17/110)、流感嗜血杆菌8.2%(9/110),其中≤1岁以肺炎克雷伯杆菌为主,>1~2岁以肺炎链球菌为主;肺炎克雷伯杆菌药敏结果提示对头孢他啶、哌拉西林/他唑巴坦、美罗培南耐药率分别为64.5%、54.8%、7.1%,肺炎链球菌药敏结果提示头孢噻肟、阿莫西林耐药率分别为8.0%、6.3%;肺炎克雷伯杆菌在重症肺炎中检出率有显著升高。2岁内中位住院时间为8.0(7.0~12.0)d,77.4%(106/137)例次住院需吸氧治疗,其中21.7%(23/106)需使用呼吸机治疗,≤1岁与>1~2岁喘息患儿中静脉激素使用率分别为42.2%(27/64)、56.5%(13/23)。结论BPD患儿2岁内因下呼吸道感染再入院中喘息发生率随时间推移有增加趋势,再入院病毒病原以RSV为主,细菌病原早期以肺炎克雷伯杆菌为主,肺炎链球菌随时间推移可能逐渐成为主要细菌病原,肺炎克雷伯杆菌所致肺炎其病情可能更重,其中产ESBL肺炎克雷伯杆菌占比例较高,临床可参考药敏试验选择哌拉西林/他唑巴坦、头孢他啶,必要时选用美罗培南;BPD患儿再入院病情偏重,用氧率高,但静脉激素的使用率并未随喘息发生率增加而增加。

ObjectiveTo discuss the clinical features and pathogens of rehospitalization caused by lower respiratory tract infection in the first 2 years of BPD patients.MethodsThe neonatal rehospitalization data within the first 2 years of 52 BPD patients admitted between January 2012 and December 2016 to Children’s Hospital of Chongqing Medical University were analyzed retrospectively.ResultsThere were 137 cases of rehospitalization in the first 2 years of 52 BPD patients due to lower respiratory tract infection.The main manifestations were cough,short of breath,wheezing,cyanosis and rales in the lung.The incidence of wheezing was higher in the second year(χ^2=10.715,P=0.001)significantly.RSV accounting for 67.3%(33/49)and PIV3 accounting for 22.4%(11/49)were the main virus pathogens.The 3 most common bacteria pathogens were Klebsiella pneumoniae accounting for 28.2%(31/110),Streptococcus pneumoniae accounting for 15.5%(17/110),and Haemophilus influenzae accounting for 8.2%(9/110).Among them,Klebsiella pneumoniae was dominant in the first year of life and Streptococcus pneumoniae was dominant in more than 1 to 2 years old patients.The resistance rate of Klebsiella pneumoniae to ceftazidime,piperaciratazobtan and meropenem was 64.5%,54.8%and 7.1%.The resistance rate to cefotaxime and amoxicillin of Streptococcus pneumoniae were 8.0%and 6.3%.Klebsiella pneumoniae detection was significantly elevated in severe pneumonia.The median length of hospital stay was 8.0(7.0 to 12.0)days with 2 years.A total of 77.4%(106/137)of rehospitalized cases needed oxygen supplement,among which 21.7%(23/106)required mechanical ventilation.Methylprednisolone usage rate in wheezing children in the first and second year was 42.2%(27/64)and 56.5%(13/23).ConclusionThe incidence of wheezing has an increasing trend over time in readmitted BPD patients under 2 years old.RSV is the main virus pathogen.Klebsiella pneumoniae plays a most common bacteria role in the early time and is replaced by Streptococcus gradually.Klebsiella pneumoniae is more likely to cause more severe pneumonia,and ESBL-producing Klebsiella pneumoniae accounts for a higher proportion in the cases.Ceftazidime and piperaciratazobtan are recommended,even meropenem when necessary.Rehospitalized BPD patients are usually more severe,and have a high rate of oxygen use,but the use of methylprednisolone do not increase along with the incidence of wheezing.