济南地区儿童重症肺炎病原学的回顾性分析

A retrospective analysis of etiology of severe pneumonia in children in Ji′nan

目的了解济南地区儿童重症肺炎的病原学分布特点,为临床治疗方案的制定提供依据。方法回顾性分析济南市儿童医院自2018年1月1日至2019年12月31日诊断为重症肺炎的551例住院患儿的基本信息及相关病原学检测资料。结果本研究纳入的551例重症肺炎儿童,男性388例,女性163例,男女比为2.4∶1,年龄范围为1月龄~12岁,病原阳性检出276例(50.2%),细菌感染、病毒感染、肺炎支原体感染、肺炎衣原体感染及混合感染病例数分别为62例(11.3%)、92例(16.7%)、29例(5.3%)、4例(0.7%)及89例(16.2%)。纳入210例<3月龄儿童,阳性检出85例(40.5%),以病毒感染为主(17.1%);302例3月龄~<5岁儿童,阳性检出155例(51.3%),以病毒感染为主(17.5%);39例5~15岁儿童,阳性检出36例(92.3%),以混合感染为主(56.4%)。病毒感染患儿中腺病毒感染占首位,检出36例(39.1%)。细菌感染患儿中革兰阴性杆菌检出率居首位,共检出48例(77.4%)。在春、夏、秋、冬各季节病毒感染的阳性检出率分别为25.0%、7.6%、21.7%、45.7%,细菌感染检出率为16.1%、9.7%、35.5%、38.7%,混合感染检出率分别为19.1%、13.5%、20.2%、47.2%。结论济南地区儿童重症肺炎主要由病毒感染引起,腺病毒感染占首位。细菌感染中以革兰阴性杆菌感染占主要地位。5岁以下儿童重症肺炎的病原菌以病毒感染占首位,5岁以上儿童以混合感染为主。细菌感染和混合感染多发生于秋冬季节,病毒感染多发生于冬春季节。

Objective To investigate the etiological distribution of severe pneumonia in children of Ji'nan,to provide evidence for the formulation of clinical treatment for this disease.Methods A retrospective analysis was performed on a total of 551 hospitalized pediatric patients with severe pneumonia in Ji'nan Children's Hospital from January 2018 to December 2019.All the clinical and etiologic records were collected and analyzed.Results A total of 551 children with severe pneumonia were included in this study,including 388 boys and 163 girls,and the ratio of males to females was 2.4∶1.The age ranged from 1 month to 12 years.The positive rate of pathogenic bacteria was 50.2%(276/551),and the numbers of cases of bacterial infection,viral infection,mycoplasma pneumoniae infection,chlamydia pneumoniae infection,and mixed infection were 62(11.3%),92(16.7%),29(5.3%),4(0.7%),and 89(16.2%),respectively.A total of 210 children aged<3 months were included,of whom 85 cases(40.5%)were positive,and virus was the main pathogen detected(17.1%).A total of 302 children aged 3 months to<5 years were included,of whom 155 cases(51.3%)were positive,and most of them were infected with virus(17.5%).A total of 39 children aged 5-15 years were included,of whom 36 cases(92.3%)were positive,and mixed infection was the main cause(56.4%).Among viral infections,adenovirus infection took the first place,with 36 cases(39.1%)detected.The detection rate of Gram-negative bacilli was the highest among bacterial infections,with 48 cases(77.4%)detected.In spring,summer,autumn,and winter,the positive detection rates of virus infection were 25.0%,7.6%,21.7%,and 45.7%,the positive detection rates of bacterial infection were 16.1%,9.7%,35.5%,and 38.7%,and the positive detection rates of mixed infection were 19.1%,13.5%,20.2%,and 47.2%,respectively.Conclusion Severe pneumonia in children in Ji'nan is mainly caused by viral infection,with adenovirus infection taking the first place.Gram-negative bacillus infection is the main bacterial infection.Viral infection is the main pathogen of severe pneumonia in children under 5 years old,and mixed infection is the main pathogen in children over 5 years old.Bacterial infections and mixed infections are more common in autumn and winter,and viral infections are more common in winter and spring.