下呼吸道感染儿童的病原菌检测及临床分析

Pathogenic bacteria detection and clinical analysis of children with lower respiratory tract infection

目的探讨下呼吸道感染患儿病原谱特征以及致病情况,为临床的精准性诊疗提供参考依据。方法选取2018年3月-2019年2月天津市儿童医院收治的2 084例急性下呼吸道感染患儿作为研究对象。采集痰标本或者肺泡灌洗液检测呼吸道病原菌,包括鲍曼不动杆菌(Aba)、铜绿假单胞菌(Pae)、肺炎克雷伯菌(Kpn)、金黄色葡萄球菌(Sau)、肺炎链球菌(Spn)、耐甲氧西林葡萄球菌(Mec)、流感嗜血杆菌(Hin)以及嗜麦芽窄食单胞菌(Sma)。观察呼吸道病原菌检出情况;分析呼吸道病原菌与性别、年龄、季节及呼吸道疾病的关系。结果 2 084例患儿中病原菌阳性检出率为57.73%(1 203/2084),其中4种病原菌检出阳性率较高,分别为Spn、Mec、Hin以及Sau。不同病原菌在不同年龄段的检出率比较,差异有统计学意义(P<0.05)。Spn在各年龄段的检出均较高,以1~3岁最多见,Sau感染以6个月以下儿童多见,Mec感染以1岁以下儿童多见,Hin感染以>6个月~1岁儿童多见。Spn全年均有较高的感染率,Sau和Mec感染好发于冬季,Hin在冬春季感染率最高。大叶性肺炎以Spn检出最多,支气管炎和支气管肺炎以Mec感染为主,间质性肺炎多见于Hin感染。结论下呼吸道感染患儿最常见的致病菌为Spn,其次为Mec、Hin以及Sau,呼吸道病原菌在不同年龄、不同季节以及致病情况具有各自的分布特点。

Objective To investigate the characteristics of pathogen spectrum and pathogenicity in children with lower respiratory tract infection,so as to provide reference for accurate clinical diagnosis and treatment.Methods A total of 2 084 children with acute lower respiratory tract infection admitted to Tianjin Children’s Hospital from March 2018 to February 2019 were selected as the research objects.Sputum samples or broncho alveolar lavage fluid were collected to detect respiratory pathogens,including Acinetobacter baumannii(Aba),Pseudomonas aeruginosa(Pae),Klebsiella pneumoniae(Kpn),S.aureas(Sau),Streptococcus pneumoniae(Spn),Methicillin-resistant staphylococcus(Mec),Haemophilus inflfluenzae(Hin) and Stenotrophomonas maltophilia(Sma).The detection of respiratory tract pathogens was observed;the relationship between respiratory pathogens and gender,age,season and respiratory diseases was analyzed.Results The positive rate of pathogenic bacteria was 57.73%(1 203/2 084) in 2 084 children.The positive rate of four kinds of pathogenic bacteria were Spn,Mec,Hin and Sau.There was significant difference in the detection rate of different pathogens in different age groups(P<0.05).The detection rate of Spn was higher among children of all ages,with 1-3 years being the most common.Sau infection was more common in children under 6 months old.Mec infection was more common in children under 1 year old.Hin infection was more common in children from>6 months to 1 year old.Spn had a high infection rate throughout the year.Sau and Mec infection was more common in winter.Hin infection was more common in winter and spring.Spn was the common pathogen in lobar pneumoniae.Mec was the most common pathogen in bronchitis and bronchopneumonia.Hin was the most common pathogen in interstitial pneumonia.Conclusion The most common pathogenic bacteria in children with lower respiratory tract infection was Spn,followed by Mec,Hin and Sau.The distribution characteristics of respiratory tract pathogens were different in different ages,seasons and pathogenicity.