儿童重症肺炎的病原菌分布及预后相关因素

Bacterial Distribution and Prognostic Factors of Severe Pneumonia in Children

目的调查研究儿童重症肺炎的病原菌分布及预后相关因素。方法回顾性收集2018年3月至2022年12月许昌市中心医院收治的310例重症肺炎患儿临床资料,统计患儿肺部感染病原菌分布,根据患儿预后情况将其分为预后不良组(43例)和预后良好组(267例),统计重症肺炎患儿预后不良的单因素,采用多因素logistic回归分析重症肺炎患儿预后不良的危险因素。结果310例重症肺炎患儿共检出337株病原菌,其中革兰阴性菌204株,占比60.53%,主要病原菌种类为肺炎克雷伯菌、大肠埃希菌,占比分别为23.44%、13.65%;革兰阳性菌133株,占比39.47%,主要病原菌种类为肺炎链球菌、金黄色葡萄球菌,占比分别为16.32%、12.17%。多因素logistic回归分析结果显示,年龄<3岁、感染病原菌株数≥2株、肺部感染范围为多肺叶炎性改变、有胸腔积液、机械通气、外周血中性粒细胞百分比较高均为重症肺炎患儿预后不良发生的独立危险因素(OR=3.059、2.986、3.677、3.651、3.536、2.939,P<0.05)。结论重症肺炎患儿感染病原菌种类主要为肺炎克雷伯菌、大肠埃希菌、肺炎链球菌、金黄色葡萄球菌,其预后不良的主要危险因素包括年龄<3岁、感染病原菌株数≥2株、肺部感染范围为多肺叶炎性改变、有胸腔积液、机械通气、外周血中性粒细胞百分比较高。

Objective To investigate the bacterial distribution and prognostic factors of severe pneumonia in children.Methods The clinical data of 310 children with severe pneumonia admitted to Xuchang Central Hospital from March 2018 to December 2022 were retrospectively collected,and the bacterial distribution of pulmonary infection were analyzed.According to the prognosis of the children,they were divided into the poor prognosis group(43 cases)and the good prognosis group(267 cases),and the single factor of poor prognosis of severe pneumonia children was analyzed.Multivariate logistic regression was used to analyze the risk factors of poor prognosis in children with severe pneumonia.Results A total of 337 strains of pathogenic bacteria were detected in 310 children with severe pneumonia,including 204 strains of Gram-negative bacteria,accounting for 60.53%.The main pathogenic bacteria were Klebsiella pneumoniae and Escherichia coli,accounting for 23.44%and 13.65%,respectively.There were 133 strains of Gram-positive bacteria,accounting for 39.47%.The main pathogenic bacteria were Streptococcus pneumoniae and Staphylococcus aureus,accounting for 16.32%and 12.17%,respectively.The results of multivariate logistic regression analysis showed that,age<3 years old,number of pathogenic bacteria≥2 strains,range of pulmonary infection with multiple pulmonary inflammatory changes,pleural effussion,mechanical ventilation,and high percentage of peripheral neutrophil were all independent risk factors for poor prognosis in children with severe pneumonia(OR=3.059,2.986,3.677,3.651,3.536,2.939,P<0.05).Conclusion The main types of pathogenic bacteria in children with severe pneumonia were Klebsiella pneumoniae,Escherichia coli,Streptococcus pneumoniae and Staphylococcus aureus.The main risk factors for poor prognosis included age<3 years old,number of pathogenic bacteria≥2 strains,pulmonary infection range of multiple pulmonary inflammatory changes,pleural effusion,mechanical ventilation and high percentage of peripheral neutrophils.