136例急性呼吸道感染患儿病原菌特点及鼻咽分泌物中呼吸道合胞病毒和人偏肺病毒基因分析

Pathogenic characteristics and hMPV and RSV genes detection in nasopharyngeal secretions of 136 children with acute respiratory tract infection

目的分析136例急性呼吸道感染患儿的病原菌特点,并对患儿鼻咽分泌物中呼吸道合胞病毒(RSV)、人偏肺病毒(hMPV)进行检测,为后续研究提供参考。方法选择2017年1月至2019年4月我院收治的136例急性呼吸道感染患儿为研究对象,分析患儿呼吸道感染病原菌分布、耐药性,并对不同性别、年龄和感染部位患儿鼻咽分泌物中hMPV和RSV基因进行检测。结果136例急性呼吸道感染患儿共检出病原菌164株,其中革兰阴性菌占70.73%(116/164),革兰阳性菌占25.00%(41/164),真菌占4.27%(7/164);以铜绿假单胞菌(26.22%)、肺炎克雷伯菌(17.07%)、大肠埃希菌(15.24%)、金黄色葡萄球菌(12.20%)为主。药敏试验显示,铜绿假单胞菌、肺炎克雷伯菌、大肠埃希菌均对哌拉西林/他唑巴坦、头孢哌哃/舒巴坦、亚胺培南、左氧氟沙星、阿米卡星的耐药性较低(耐药率<50.0%)。金黄色葡萄球菌对万古霉素、呋喃妥因的耐药率为0.00%,对克林霉素、利福平的耐药率低于50.00%。136例患儿共检出hMPV 21例(15.44%),RSV 33例(24.26%)。不同性别患儿hMPV、RSV检出情况差异无统计学意义(均P>0.05)。1~2岁患儿hMPV检出率最高,0~5岁患儿RSV检出率较高。喘息性支气管炎、毛细支气管炎患儿hMPV检出率均较高,支气管肺炎、毛细支气管炎患儿RSV检出率均较高。结论急性呼吸道感染患儿病原菌以革兰阴性菌为主,应结合病原菌的药敏试验结果为患儿选择更有针对性的药物进行治疗。此外,应重视患儿RSV、hMPV感染情况,采取科学有效的方式对急性呼吸道感染进行预防和治疗。

Objective To discuss the characteristics of pathogenic bacteria in 136 cases of acute respiratory tract infection,and detect hMPV and RSV genes in nasopharyngeal secretions of the child patients and provide a reference for the follow-up study.Methods A total of 136 children with acute respiratory tract infection in our hospital from January 2017 to April 2019 were enrolled.The distribution and drug resistance of pathogenic bacteria were analyzed.The detection of hMPV and RSV genes in nasopharyngeal secretions of children with different gender and age were performed.Results A total of 164 strains of pathogenic bacteria were detected in the 136 child patients,including 70.73%(116/164)of Gram-negative bacteria,25.00%(41/164)of Gram-positive bacteria and 4.27%(7/164)of fungi.Pseudomonas aeruginosa(26.22%),Klebsiella pneumoniae(17.07%),Escherichia coli(15.24%)and Staphylococcus aureus(12.24%)were the main pathogens.Drug susceptibility tests showed that the resistance rates of Pseudomonas aeruginosa,Klebsiella pneumoniae and Escherichia coli to Piperacillin/Tazobactam,Cefoperazone/Sulbactam,Imipenem,Levofloxacin and Amikacin were all less than 50.0%.The resistance rates of Staphylococcus aureus to Vancomycin and Furantoin were 0.00%and those to Lincomycin and Rifampicin were lower than 50.00%.Among the 136 children,21(15.44%)were hMPV-positive and 33(24.26%)were RSV positive.There was no statistical difference in the detection of hMPV and RSV between children of different genders(P>0.05).The detection rate of hMPV was the highest in children aged 1-2 years,and that of RSV was higher in children aged 0-5 years.The detection rate of hMPV was higher in children with asthmatic bronchitis and bronchiolitis,and that of RSV was higher in those with bronchopneumonia and bronchiolitis.Conclusion Gram-negative bacteria are the main pathogenic bacteria in acute respiratory tract infections.It is necessary to select more targeted drugs for the treatment of the infections in combination with the drug sensitivity test results.In addition,attention should be paid to the infection of RSV and hMPV in children,and scientific and effective methods should be adopted in the prevention,control and treatment of acute respiratory tract infections.