2023年7—10月江西省妇幼保健院儿童社区获得性肺炎电子支气管镜下肺泡灌洗液的病原学分析

Etiological Analysis of Alveolar Lavage Fluid under Electronic Bronchoscope in Children with Community-acquired Pneumonia in Jiangxi Maternal and Child Health Hospital from July to October 2023

目的:分析社区获得性肺炎(community-acquired pneumonia,CAP)住院患儿病原菌检出情况。方法:回顾性分析江西省妇幼保健院2023年7—10月72例CAP患儿的临床资料,对患儿行电子支气管镜肺泡灌洗术,并采集肺泡灌洗液行靶向二代测序(targeted next-generation sequencing,tNGS),记录病原菌检出情况,并分析不同性别、年龄、影像学结果及临床症状的病原菌分布情况。结果:72例CAP患儿检出病原菌115株,其中以肺炎支原体(耐药型)检出率(51.30%)最高,其次为肺炎链球菌(11.30%)。不同性别患儿病原菌检出情况比较,差异均无统计学意义(P>0.05)。婴幼儿期以病毒感染为主,检出率为42.86%,而学龄期与学龄前期以肺炎支原体(耐药型)感染为主,检出率为64.52%、55.36%。不同年龄段支原体及病毒感染比较,差异均有统计学意义(P<0.05)。影像学检查结果包括肺实变、双肺炎症、右肺炎症、左肺炎症、胸腔积液,均以肺炎支原体(耐药型)检出率最高,检出率依次为51.92%、50.00%、45.71%、63.16%、40.00%。咳嗽、发热患儿肺炎支原体(耐药型)检出率最高,检出率依次为51.75%、56.70%,咳痰患儿肺炎支原体(耐药型)和肺炎链球菌检出率最高,均为37.50%,气喘患儿鼻病毒A型检出率最高,检出率为50.00%。结论:本院72例CAP患儿的肺泡灌洗液标本检查结果中,肺炎支原体(耐药性)检出率最高,其次为肺炎链球菌。病原菌感染与年龄有密切关系,婴幼儿期以病毒感染为主,学龄期与学龄前期以肺炎支原体(耐药型)感染为主。

Objective:To analyze the detection of pathogenic bacteria in hospitalized children with community-acquired pneumonia(CAP).Method:Clinical data of 72 children with CAP from July to October 2023 in Jiangxi Maternal and Child Health Hospital were retrospectively analyzed.Electronic bronchoscopic alveolar lavage was performed on the children,and the alveolar lavage fluid was collected for targeted next-generation sequencing(tNGS).The detection of pathogenic bacteria was recorded,and the distribution of pathogenic bacteria with different gender,age,imaging results and clinical symptoms were analyzed.Result:115 strains of pathogenic bacteria were detected in 72 children with CAP,among which Mycoplasma pneumoniae(drug-resistant type)had the highest detection rate(51.30%),followed by Streptococcus pneumoniae(11.30%).There were no statistically significant differences in the detection of pathogenic bacteria in children of different genders(P>0.05).Virus infection was predominant in infantile period,the detection rate was 42.86%.Mycoplasma pneumoniae(drugresistant type)infection were predominant in school stage and preschool stage,the detection rate were 64.52% and 55.36%,respectively.There were significant differences in Mycoplasma and virus infection among different age groups(P<0.05).The imaging results included pulmonary consolidation,double pneumonia,right lung inflammation,left pneumonia and pleural effusion,and the detection rate of Mycoplasma pneumoniae(drug-resistant type)were the highest,with the detection rates of 51.92%,50.00%,45.71%,63.16% and 40.00%,respectively.The detection rate of Mycoplasma pneumoniae(drug-resistant type)were the highest in children with cough and fever,and the detection rates were 51.75% and 56.70%,respectively.The detection rates of Mycoplasma pneumoniae(drug-resistant type type)and Streptococcal pneumoniae were the highest in children with expectoration,both of which were 37.50%.The detection rate of rhinovirus type in children with asthma was the highest,and the detection rate was 50.00%.Conclusion:In the alveolar lavage fluid samples of 72 children with CAP in our hospital,the detection rate of Mycoplasma pneumoniae(drug-resistant type type)is the highest,followed by Streptococcal pneumoniae.The pathogenic bacteria infection is closely related to age,virus infection is predominant in infantile period,Mycoplasma pneumoniae(drug-resistant type)infection are predominant in school stage and preschool stage.