住院患儿下呼吸道感染病原菌分布、流行特征及危险因素

Distribution,Epidemiological Characteristic of Pathogenic Bacteria and Risk Factors in Hospitalized Children with Lower Respiratory Tract Infection

目的:探讨住院患儿下呼吸道感染病原菌分布、流行特征及危险因素。方法:回顾性分析2021年1月—2023年1月瑞金市妇幼保健院收治的460例呼吸道感染患儿的临床资料,根据患儿呼吸道感染的部位,将下呼吸道感染患儿纳入观察组(n=350),其余非下呼吸道感染患儿纳入对照组(n=110)。分析下呼吸道感染患儿病原菌分布情况和耐药性,并比较不同性别、年龄、季节的病原菌检出情况,以logistic回归分析影响下呼吸道感染的因素。结果:350例下呼吸道感染患儿中,革兰阴性菌占比最高,为62.86%,其次为真菌(20.29%)、革兰阳性菌(16.86%)。革兰阴性菌以大肠埃希菌为主,占22.29%,革兰阳性菌以金黄色葡萄球菌为主,占8.29%。革兰阴性菌对阿莫西林、哌拉西林、氨苄西林、头孢唑林有较高耐药性。男患儿革兰阴性菌检出率高于女患儿,春冬季节革兰阴性菌检出率高于夏秋季节(P<0.05)。观察组有创操作、春冬季节、营养不良、合并病毒感染、抗菌药物滥用占比均高于对照组(P<0.05)。多因素分析结果显示,有创操作、春冬季节、营养不良、合并病毒感染、抗菌药物滥用均为下呼吸道感染的危险因素(OR=12.692、20.968、23.784、19.011、7.783,P<0.05)。结论:下呼吸道感染病原菌分布中以革兰阴性菌为主,多发生在春冬季节,且春冬季节、营养不良、合并病毒感染、抗菌药物滥用、有创操作与下呼吸道感染有关。

Objective:To explore the distribution,epidemiological characteristic of pathogenic bacteria and risk factors in hospitalized children with lower respiratory tract infection.Method:The clinical data of 460 children with respiratory tract infection admitted to Ruijin Maternal and Child Health Care Hospital from January 2021 to January 2023 were retrospectively analyzed.According to the location of respiratory tract infection,children with lower respiratory tract infection were included in the observation group(n=350),and other children without lower respiratory tract infection were included in the control group(n=110).The distribution and drug resistance of pathogenic bacteria in children with lower respiratory tract infection were analyzed,and the detection of pathogenic bacteria in different genders,ages and seasons were compared,and the factors affecting lower respiratory tract infection were analyzed by logistic regression.Result:Among 350 children with lower respiratory tract infection,Gram negative bacillus accounted for the highest proportion(62.86%),followed by fungus(20.29%)and Gram positive bacillus(16.86%).The Gram negative bacillus was mainly Escherichia coli,accounting for 22.29%,and the Gram positive bacteria was mainly Staphylococcus aureus,accounting for 8.29%.Gram negative bacteria had high resistance to antimicrobial agent of Amoxicillin,Piperacillin,Ampicillin and Cefazolin.The detection rate of Gram negative bacteria in boy children was higher than that in girl children,the detection rate of Gram negative bacteria in spring and winter seasons was higher than that in summer and autumn seasons(P<0.05).The proportions of invasive operation,spring and winter seasons,malnutrition,combined virus infection and antimicrobial abuse in the observation group were higher than those in the control group(P<0.05).The results of multi-factor analysis showed that invasive operation,spring and winter seasons,malnutrition,combined virus infection and antimicrobial abuse were the risk factors for lower respiratory tract infection(OR=12.692,20.968,23.784,19.011,7.783,P<0.05).Conclusion:The main pathogens of lower respiratory tract infection are Gram negative bacilli,which mostly occur in spring and winter,and spring and winter seasons,malnutrition,combined virus infection,antimicrobial abuse and invasive operation are related to lower respiratory tract infection.