十堰地区4338例儿童细菌性肺炎的病原学分析

Etiological Analysis of 4338 Cases of Bacterial Pneumonia in Children in Shiyan Area

目的:分析我院儿童细菌性肺炎的细菌病原学分布,为抗生素的经验治疗提供实验室依据。方法:回顾性分析2015年1月-2019年12月我科普通病房收治的4338例细菌性支气管肺炎患儿的痰培养结果,总结常见细菌在不同年龄段、性别、季节的分布情况和流行病学特点。结果:4338名患儿中至少检出一种病原体的有2733例,总检出率为63.02%(2733/4338)。其中,单一感染检出率为50.37%(2185/4338),两种及以上细菌病原体感染检出率为20.12%(548/4338)。单一感染检出率前3的细菌分别为肺炎链球菌、流感嗜血杆菌和卡他莫拉菌。≤1岁的患儿感染肺炎链球菌、金黄色葡萄球菌、大肠埃希菌的机会明显高于>1岁组的患儿(P均<0.05)。≤1岁的患儿感染两种及两种以上细菌检出情况与>1岁的患儿无差异(P均>0.05)。感染细菌种类在不同性别患儿间无差异。不同季节,单一感染中肺炎链球菌、流感嗜血杆菌、卡他莫拉菌、金黄色葡萄球菌的检出构成比比较,差异有统计学意义(P<0.05)。多重感染,流感嗜血杆菌合并肺炎链球菌、流感嗜血杆菌合并卡他莫拉菌的混合性感染在不同季节的检出构成比比较,差异有统计学意义(P<0.05)。结论:肺炎链球菌、流感嗜血杆菌、卡他莫拉菌、金黄色葡萄球菌、大肠埃希菌是本地区儿童支气管肺炎的主要细菌病原体。1岁以内的婴幼儿感染的机会高于1岁以上的儿童。不同性别间感染细菌种类无差异,但不同季节感染细菌的种类有差异。临床上在细菌性肺炎患儿病原学检查结果未明确时,可结合患儿年龄、发病季节等特点判断可能感染的病原菌,选择合适的抗生素,以避免抗生素的不合理应用。

Objective To analyze the distribution of bacterial etiology in children with bacterial pneumonia in our hospital,so as to provide laboratory basis for the empirical treatment of antibiotics.Methods The sputum culture results of 4338 chil⁃dren with bacterial bronchopneumonia admitted to the general ward of Children's Medical Center of our hospital from Januar⁃y 2015 to December 2019 were retrospectively analyzed,and the distribution and epidemiological characteristics of common bacteria in different ages,genders and seasons were summarized.Results Among 4338 children,at least one pathogen was detected in 2733 cases,and the total detection rate was 63.02%(2733/4338).The detection rate of single infection was 50.37%(2185/4338),and the detection rate of two or more bacterial pathogens was 20.12%(548/4338).The top 3 bac⁃teria in single infection detection rate were Streptococcus pneumoniae,Haemophilus influenzae and Moraxella catarrhalis.The incidence of Streptococcus pneumoniae,Staphylococcus aureus and Escherichia coli infection in children youner than 1 year old was significantly higher than that in children older than 1 year old group(all P<0.05).There was no significant differ⁃ence in the detection of two or more kinds of bacteria between children under 1 year old and children over 1 year old(P>0.05).There was no difference in the types of bacteria between different genders.In different seasons,there were statisti⁃cally significant differences in the detection composition ratio of Streptococcus pneumoniae,Haemophilus influenzae,Morax⁃ella catarrhiae and Staphylococcus aureus in single infections(P<0.05).There were statistically significant differences in the composition of multiple infections,including Haemophilus influenzae combined with Streptococcus pneumoniae and Hae⁃mophilus influenzae combined with Moraxella catarrhalis in different seasons(P<0.05).Conclusion Streptococcus pneumoniae,Haemophilus influenzae,Moraxella catarrhalis,Staphylococcus aureus and Escherichia coli are the main bacterial pathogens of children with bronchiopneumonia in this area.Infants under 1 year old have a higher chance of infection than children over 1 year old.There was no difference in bacterial species among different genders.The bacterial species of chil⁃dren with bacterial pneumonia were different in different seasons.Clinically,when the results of the etiological examination in children with bacterial pneumonia are not clear,it can be combined with the age,gender,onset season and other charac⁃teristics of the children to judge the pathogenic bacteria that may be infected,and choose the appropriate antibiotics to avoid the unreasonable application of antibiotics.