社区获得性肺炎患儿鼻咽部病原年龄分布特点

目的 探讨不同年龄社区获得性肺炎患儿鼻咽部病原学特点．以指导临床诊断和治疗。方法 1100例肺炎患儿于入院首日负压吸取鼻咽部痰标本，分别采用单克隆抗体桥联酶标法（APAAP）、聚合酶链反应（PCR）及细菌培养方法检测常见儿童呼吸道感染的病毒、肺炎支原体（MP）、肺炎衣原体（CP）-DNA和细菌。结果 ①随着年龄的增长，肺炎患儿鼻咽部病原检出的阳性率明显降低，提示负压吸引法采集标本更适合年幼患儿的鼻咽部病原检查，年长患儿的依从性较差；②呼吸道合胞病毒（RSV）和副流感病毒（PIV）1，3是1岁以下婴儿主要的病毒种类，小于6月龄的肺炎患儿鼻咽部易检出大肠埃希菌、肺炎克雷伯菌、金黄色葡萄球菌和凝固酶阴性葡萄球菌，这些细菌具有高耐药性的特点。大肠埃希菌和肺炎克雷伯菌产ESBLs菌株均超过50％，而金黄色葡萄球菌、凝固酶阴性葡萄球菌耐苯唑西林菌株占22％和75％，而大于6月龄的患儿，多见流感嗜血杆菌、卡他莫拉菌和肺炎链球菌等。结论 鼻咽部病原检查，对于小年龄社区获得性肺炎患儿有较高的病原阳性率；不同年龄阶段患儿的病原种类及细菌的耐药性各具特点。

Distribution of nasopharyngeal pathogen by age group in children with community acquired pneumonia

Objective The aim of the study was to understand the distribution of nasopharyngeal pathogen by age group in children with community-acquired pneumonia in order to guide clinical diagnosis and treatment.Methods We collected nasopharyngeal specimen by negative pressure suction from 1 100 children with pneumonia. Sputum was taken on the first day of admission to hospital. The specimens were tested for respiratory pathogen by ELISA, bacterial culture and polymerase chain reaction (PCR). Results With the increase of age, the positive rate of nasopharyngeal pathogen was significantly reduced, which suggests the technique of negative pressure suction is more applicable for collecting specimen in younger children. The compliance to this technique was poor in older children. RSV and PIV 1, 3 were the most common viral pathogen in children under 1 year old. Escherichia coli, Klebsiella pneumoniae, Staphylococcus aureus and coagulase-negative Staphylococcus were detected most frequently in children under age of 6 months. These bacteria were highly resistant to antibiotics. More than 50% of (E.coli) and K.pneumoniae isolates were ESBLs-producing strains, while 22% of S.aureus isolates and 75% of coagulase-negative Staphylococcus isolates were resistant to oxacillin. But in children older than 6 months, relatively less resistant bacteria such as Haemophilus influenza, Streptococcus pneumoniae and Moraxella catarrhalis were more frequently isolated. Conclusions The prevalence of nasopharyngeal pathogen is higher in younger children with pneumonia. The distribution and resistance of nasopharyngeal pathogens are distinct in different age group of children with community-acquired pneumonia.