小儿下呼吸道感染的细菌病原学分析

目的：下呼吸道感染是造成儿童住院的最常见疾病之一。在发展中国家,病原菌以细菌感染相对多见,而病原菌的分布特点则常因年代不同而发生变迁。该研究的目的是了解本地区小儿下呼吸道感染常见病原菌及其对常用抗生素的耐药性,为临床药物治疗提供有价值的参考。方法：对2001年8月至2002年7月住院的所有下呼吸道感染患儿,常规进行深部痰培养,并用纸片扩散法、Etest法和Vitek系统进行药敏试验。结果：下呼吸道感染儿共4238例,其中1181例分离到1种或1种以上致病菌,阳性率为27.9%,最常见的病原菌为肺炎链球菌、流感嗜血杆菌、肺炎克雷伯菌、大肠埃希菌和金黄色葡萄球菌,分离率分别为5.2%,5.1%,5.1%,4.0%和2.1%。女性患儿肺炎链球菌的分离率显著高于男性(χ2=4.63,P<0.05),而肺炎克雷伯菌和金黄色葡萄球菌在男性中的分离率均高于女性(χ2=5.71,4.57,P<0.05)。年龄分布显示,1~3岁是肺炎链球菌和流感嗜血杆菌的好发年龄段,而肺炎克雷伯菌、大肠埃希菌、金黄色葡萄球菌和阴沟肠杆菌以及非常见菌感染则在1岁以内的婴儿中多见。季节分布上,12月份至3月份是大多数细菌感染分布较集中的时段。药敏结果显示青霉素不敏感肺炎链球菌、耐氨苄西林流感嗜血杆菌、耐苯唑西林金黄色葡萄球菌和产ESBL肺炎克雷伯菌、大肠埃希菌的比率分别为55.0%,16.5%,41.2%,42.6%和4.5%。结论：肺炎链球菌、流感嗜血杆菌、肺炎克雷伯菌、大肠埃希菌和金黄色葡萄球菌是小儿下呼吸道感染常见致病菌,但在不同年龄的感染率存在明显差异,治疗上应根据药敏结果选择敏感抗生素。     

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目的探讨急性下呼吸道感染住院患儿病毒病原学情况,及其与年龄、呼吸道疾病的关系。方法选择温州医学院附属育英儿童医院2003年1月～2005年1月因急性下呼吸道感染住院治疗的儿童2073例,取其鼻咽分泌物,采用直接荧光免疫法检测7项呼吸道病毒抗原,分析其结果。结果2073例患儿送检标本,阳性1006份,阳性率48.5%。阳性标本中呼吸道合胞病毒(RSV)798例(79.3%),副流感病毒Ⅲ型(PIVⅢ)106例(10.5%),腺病毒(ADV)31例(3.0%),流感病毒A型(IVA)26例(2.6%),流感病毒B型(IVB)6例(0.6%),副流感病毒Ⅰ型(PIVⅠ)15例(1.5%)、RSV和IVA混合感染18例(1.8%),RSV和PIVⅢ混合感染3例(0.3%),RSV和PIVⅠ混合感染3例(0.3%),PIVⅡ未检测到。结论温州地区急性下呼吸道感染以RSV为主要病原,婴幼儿(尤其<6个月)病毒感染率较高,好发于冬春季节,以急性毛细支气管炎的检出率最高(61.3%)。     

急性下呼吸道感染儿童肠道病毒感染的状况

目的：了解急性下呼吸道感染(ALRTI) 患儿肠道病毒(EV)的感染状况和临床特征。方法：抽取2007年9月至2008年4月因ALRTI在湖南省人民医院儿科医学中心住院的患儿的鼻咽抽吸物单数号样本404份,应用EV5′端非编码区(5′-NCR)保守序列设计引物,采用巢式逆转录RT-PCR法检测标本中EV感染状况。结果：404份ALRTI标本中,检出EV19例（4.7%）,大部分患儿年龄在3岁以下（95%）,男女EV检出阳性率差异无统计学意义。EV阳性患儿临床诊断为支气管肺炎者13例（68%）、毛细支气管炎者6例（32%）,90%患儿有发热症状,84%有咳嗽,63%有气喘,63%有合并症,其中主要为腹泻（6例）、粒细胞减少症（4例）和急性呼吸窘迫综合征（2例）。EV阳性患儿白细胞异常的发生率为26%,一半以上存在肝功能异常,少数有心肌受累。结论：EV是儿童ALRTI不可忽视的病原之一,应密切关注EV感染的流行病学状况和临床特点,并定期测定患儿血常规、肝功能和心肌酶,努力改善其预后。     

Etiology of acute lower respiratory tract infection

Objective : To identify pathogens responsible for acute severe lower respiratory tract infection (ALRTI) in under five children by non-invasive methods.Method : 95 children hospitalized with acute severe lower respiratory tract infection were investigated for identification of viruses, bacteria, chlamydia or mycoplasma by nasopharyngeal aspirates, blood culture and serology.Result : Etiological agents could be identified in 94% of the patients. Viruses from NP aspirate could be isolated in 36 (38%), bacterial isolates from blood cultures in 15(16%); mycoplasma was identified in 23(24%) and chlamydia in 10(11%) by serological tests; mixed infections were present in 8 (8%) patients.Conclusion : Noninvasive methods can be useful in identifying etiological agents in severe ALRTI     

致儿童下呼吸道感染肺炎链球菌分离株的临床特征及药敏分析

目的分析下呼吸道感染患儿肺炎链球菌（SP）分离株的临床特征及其对常用抗生素的药敏情况,为临床合理用药提供依据。方法采用回顾性分析法,收集2008年1月到2012年12月自下呼吸道感染患儿分离的SP 6358株,采用纸片扩散法及E-test法进行抗菌药物敏感试验;按CLSI判断标准分析药敏结果。结果 SP分离株主要来自于儿内科各专业科室,感染病例以各类肺炎和支气管炎为主。在分离的6358株SP中,青霉素、头孢噻肟、红霉素、克林霉素、复方新诺明、四环素、氯霉素、左氧氟沙星、万古霉素的耐药率分别为5.0%、12.9%、98.7%、96.0%、92.2%、7.3%、5.6%、0.2%、0.0%;青霉素与头孢噻肟的年耐药率差异均有统计学意义（P均<0.05）。318株耐青霉素SP对上述药物的耐药率分别为100.0%、42.6%、100.0%、100.0%、99.2%、23.6%、6.8%、0.6%、0.0%,青霉素与头孢噻肟间比较,耐药率差异有统计学意义（P=0.001）。结论下呼吸道感染患儿分离的SP对红霉素、克林霉素、复方新诺明及四环素的耐药率较高,对头孢噻肟的耐药率呈逐年递增的趋势,临床应依据药敏结果选择合适的抗菌药物。     

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目的 了解儿童急性下呼吸道感染(ALRTI)病毒病原学特点.方法 2007年3月至2008年2月,在北京儿童医院内科就诊及住院治疗的临床诊断为ALRTI的患儿共572例.对每例患儿在就诊当日或次日采集鼻咽吸取物1份,采用逆转录(RT)-PCR方法进行常见呼吸道病毒核酸检测,包括呼吸道合胞病毒(RSV)、鼻病毒(RV)、副流感病毒(PIV)1～4型、甲型及乙型流感病毒(IFA、IFB)、腺病毒(AdV)、肠道病毒(EV)、冠状病毒(HCoV)、偏肺病毒(hMPV)及博卡病毒(HBoV).结果 572例患儿标本中,444例检出至少1种病毒,总检出率77.6%.各种病毒中,RSV检出率最高,占48.3%,其次是RV(27.1%)和PIV(13.3%).不同年龄组病毒的总检出率差异有统计学意义,<3岁组检出率较高,≥5岁组病毒检出率明显降低.不同年龄组JLRTI病原谱有所不同,<5岁各组主要是RSV、RV、PIV,而≥5岁组则主要为RV、IFV、RSV.572例中,158例(27.6%)检出2种或2种以上病毒,<1岁惠儿混合感染率最高,为40.2%,随年龄增长混合感染率逐渐下降,≥5岁患儿混合感染率仅为14.0%.结论 就诊于北京儿童医院的ALRTI患儿中,5岁以下者ALRTI的主要病毒病原是RSV、RV、PIV;≥5岁则主要为RV、IFV、RSV.     

1165例急性下呼吸道感染住院儿童的病毒病原学分析

目的：了解长沙地区急性下呼吸道感染(ALRTI) 住院儿童中常见呼吸道病毒的流行特点,为本地区儿童ALRTI的防治提供依据。方法：收集2007年9月至2008年8月诊断为ALRTI的住院患儿鼻咽抽吸物标本1165份,采用RT-PCR方法检测呼吸道合胞病毒(RSV)、鼻病毒(HRV)、流感病毒A(IFVA)、流感病毒B(IFVB)、副流感病毒1~3(PIV1~3)、偏肺病毒(hMPV)、冠状病毒NL63(HCoV-NL63)及冠状病毒HKU1(HCoV-HKU1);PCR方法检测腺病毒(ADV)、博卡病毒(HBoV);巢式PCR方法检测多瘤病毒WU(WUPyV）和多瘤病毒KI(KIPyV)。并对阳性标本进行基因测序以证实。结果：1165份标本中有871份检出了病毒,总检出率74.76%,其中RSV最为常见,检出率为27.03%,其次为HRV（17.33%）、PIV3（13.73%）及新发现病毒HBoV(8.67%)和hMPV(6.52%)。病毒总检出率在男女之间差异无统计学意义,但男性PIV3、hMPV和HBoV的阳性检出率高于女性。病毒阳性检出率在各年龄组之间差异有统计学意义（χ2=10.934,P=0.027）,以6个月至1岁以内年龄组检出率最高。病毒总检出率在四季分布差异有统计学意义（χ2=12.307,P=0.006）,以冬季检出率最高。结论：病毒病原在长沙地区儿童ALRTI中占重要地位,其中RSV、HRV及PIV3是主要病毒病原,近年新发现的HBoV和hMPV也占较高比例;病毒检出率以6个月至1岁以内年龄组最高;冬季病毒总检出率高于其他季节。     

新生儿下呼吸道感染病原学及耐药性检测

目的：调查该院新生儿重症监护病房（NICU）下呼吸道感染的病原菌及其耐药性。方法：对2005年1月至2006年12月该院NICU 1 173例下呼吸道感染新生儿的痰液标本经分离培养,做菌株鉴定和药敏试验。结果：共分离培养出病原菌707株,阳性率为60.3%。其中革兰阴性菌521株,占73.7%;革兰阳性菌106株,占15.0%;真菌80株,占11.3%。革兰阴性菌以大肠埃希菌、肺炎克雷伯菌、铜绿假单胞菌和肠杆菌为主,较敏感的抗生素为亚胺培南、环丙沙星、第四代头孢菌素、哌拉西林/他唑巴坦、头孢哌酮/舒巴坦、丁胺卡那霉素,肠杆菌的敏感谱与之相似,但敏感率较低。革兰阳性菌中以金黄色葡萄球菌和其他凝固酶阴性的葡萄球菌(CNS）为主。金黄色葡萄球菌和其他CNS对青霉素的耐药率达到100%,对万古霉素、环丙沙星和哌拉西林/他唑巴坦敏感。结论： 该院NICU下呼吸道感染的病原菌以革兰阴性菌为主, 大肠埃希菌、肺炎克雷伯菌、铜绿假单胞菌为主要病原菌。     

温州地区儿童急性下呼吸道感染病原学及细菌耐药性检测

目的：了解温州地区儿童急性下呼吸道感染(LRTI)的病原学特点及细菌耐药情况。方法：454例急性LRTI患儿(年龄1个月~10岁,中位年龄6.0个月)入院24h内抽取下呼吸道分泌物送细菌培养,药敏试验采用K-B法,同时应用直接免疫荧光法检测呼吸道病毒。结果：297例(65.4%)病原检测阳性,其中病毒阳性229例(50.4%),以呼吸道合胞病毒(RSV)最多见(39.6%),其次为副流感病毒3型(PIV3)(6.6%)、腺病毒(2.2%)、流感病毒A型(0.9%)及流感病毒B型(0.7%)。共分离出19种135株(29.7%)致病菌,以肺炎克雷伯杆菌(K.pn)最多见(9.9%),其次为大肠杆菌(E.coli)(4.4%),K.pn和E.coli产ESBLs株分别占42.2%和65.0%;肺炎链球菌(SP)占4.2%。混合感染率为14.8%。6个月以下患儿前5位病原为RSV,K.pn,PIV3,E.coli及SA;而RSV,PIV3,SP,K.pn及E.coli则是6个月至3岁患儿常见的病原。K.pn和E.coli对氨苄西林的耐药率分别达97.8%和75.0%,产ESBLs株的K.pn和E.coli对头孢菌素普遍耐药;SP对红霉素的耐药率高达100%,对青霉素的耐药率亦达68.4%,而SA对红霉素和青霉素的耐药率分别为94.7%和89.5%。结论：RSV是温州地区儿童急性LRTI最常见的病原,其次为K.pn和PIV3。常见细菌的抗生素耐药性及革兰阴性杆菌产ESBLs的比率均相当高。     

Viral aetiology of lower respiratory tract infection in young Malaysian children

OBJECTIVE: To study the viral aetiology of lower respiratory tract infection (LRTI) in young Malaysian children. METHODOLOGY: A retrospective review was performed of LRTI patients aged less than 24 months who were admitted to the University Malaya Medical Centre between 1982 and 1997. Respiratory viruses in their nasopharyngeal secretion were identified by indirect immunofluorescence, viral culture, or both. RESULTS: A total of 5691 children were included in the study. The mean age was 8.6 +/- 6.6 months and the M:F ratio was 1.6:1. The most common diagnosis was pneumonia (52%) followed by bronchiolitis (45%) and croup (2%). Positive viral isolation rate was 22.0%. Respiratory syncytial virus (RSV) was the commonest virus isolated (84%), followed by parainfluenza virus (8%), influenza virus (6%) and adenovirus (2%). Patients with positive virus isolation were younger (7.8 +/- 6.2 vs 8.7 +/- 6.7 months, P = 0.0001) and were more likely to have bronchiolitis. CONCLUSION: Young Malaysian children admitted with LRTI had a 22% viral isolation rate and RSV was the commonest virus isolated.     

郑州地区儿童急性呼吸道感染的病毒血清学研究

为了解郑州地区儿童急性呼吸道感染人群中病毒感染状况。采用酶联免疫法对１１８０例急性呼吸道感染患儿进行呼吸道合胞病毒（ＲＳＶ）、腺病毒（ＡｄＶ）、巨细胞病毒（ＨＣＭＶ）和单纯疱疹病毒（ＨＳＶ１）的ＩｇＭ抗体测定,同时设定４４０例非感染病例和２８９例正常儿童为健康对照,并在年龄、性别、城乡和季节的感染情况进行分析。结果：观察组ＲＳＶ、ＡｄＶ、ＨＣＭＶ、ＨＳＶ１的阳性率分别为３１．８６％、１４．７％、２０．５９％和２０．９％与对照组比较差异显著（Ｐ〈０．０１）。提示郑州地区儿童急性呼吸道感染人群中ＲＳＶ、ＡｄＶ、ＨＣＭＶ、ＨＳＶ１的阳性率分别为３１．８６％、１４．７％、２０．５９％和２０．９％与对照组比较差异显著（Ｐ〈０．０１）。提示郑州地区儿童急性呼吸道感染人群中ＲＳＶ、ＡｄＶ、ＨＣＭＶ和ＨＳＶ１的感染率较高,临床     

Modifiable risk factors for acute lower respiratory tract infections

Objective Acute respiratory infection is a leading cause of morbidity and mortality in under five children in developing countries. Hence, the present study was undertaken to identify various modifiable risk factors for acute lower respiratory tract infections (ALRI) in children aged 1 mth to 5 yr. Methods 104 ALRI cases fulfilling WHO criteria for pneumonia, in the age group of 1 mth to 5 yr were interrogated for potential modifiable risk factors as per a predesigned proforma. 104 healthy control children in the same age group were also interrogated. Results The significant sociodemographic risk factors were parental illiteracy, low socioeconomic status, overcrowding and partial immunization, [p value <0.05 in all]. Significant nutritional risk factors were administration of prelacteal feeds, early weaning, anemia, rickets and malnutrition, [p value <0.05 in all]. Significant environmental risk factors were use of kerosene lamps, biomass fuel pollution and lack of ventilation [p value <0.05 in all]. On logistic regression analysis, partial immunization, overcrowding and malnutrition were found to be significant risk factors. Conclusion The present study has identified various socio-demographic, nutritional and environmental modifiable risk factors for ALRI which can be tackled by effective education of the community and appropriate initiatives taken by the government.     

2000年秋冬至 2002年夏北京地区急性呼吸道感染病毒病原学研究

为了解北京地区婴幼儿急性呼吸道感染的病毒病原。对2000年秋冬至2002年夏收集的1402份临床标本进行了病原分析。所有标本接种Hep-2和MDCK细胞进行病毒分离；鼻咽洗液脱落细胞涂片后经间接免疫荧光检测7种呼吸道病毒。RT-PCR鉴定RSV亚型；血凝及血凝抑制试验鉴定流感病毒型别；nested-PCR检测肠道病毒。1402份标本中672份咽拭子标本取自门诊患儿，730份鼻咽洗液标本取自住院患儿，结果：共有614份标本为病毒阳性，阳性率为43.8%。病毒阳性标本中呼吸道合胞病毒（RSV）占66.1%。并以A亚型为主；RSV阳性标本中91.4%来自诊断为毛细支气管炎的住院患儿。2001-2002年冬春季RSV感染比2000-2001年同期高25.1%。流感病毒阳性标本占总阳性标本的24.4%，其中89.3%来自门诊患儿；2000-2001年以乙型流感病毒为主，2001-2002年以甲3型为主，在冬春季还可检测到腺病毒和副流感病毒，夏季检测不到以上几种呼吸道病毒，利用nested-PCR方法检测2002年夏季收集的标本，发现7月份肠道病毒感染率相当高。提示RSV是北京地区冬春季婴幼儿急性下呼吸道感染首要病毒病原。流感病毒是婴幼儿急性上呼吸道感染首要病毒病原，肠道病毒是夏季婴幼儿呼吸道感染主要病毒病原，病毒分离，免疫荧光和PCR等方法的并用提高了病毒检出率，病毒病原的诊断可为临床诊断和治疗提供可靠依据。     

婴幼儿胃食管反流与呼吸道感染的关系探讨

目的探讨婴幼儿阶段胃食管反流与呼吸道感染的关系。方法用便携式24h食管pH监测仪记录食管下端pH值变化。观察组89例,平均年龄(10.5±0.9)个月,系因下呼吸道感染在呼吸科病房住院患儿,符合下述3条件之一①3个月内有下呼吸道感染史≥1次;②咳嗽喘息经过治疗≥半个月仍不愈;③溢乳史。对照组为26例健康儿,平均年龄(13.7±2.1)个月。结果观察组5项反流指标均高于对照组,差异有显著性(P均<0.001)。观察组病理性GER的检出率为79.8%(71/89例),显著高于对照组(χ2=49.554,P<0.01)。呼吸道感染合并GER的患儿在总反流次数、反流时间≥5min的次数和最长反流时间上婴儿高于幼儿,差异有显著性(P<0.01或<0.05);总pH<4时间百分比和综合评分也是婴儿较幼儿高(P<0.01)。呼吸道感染合并GER的患儿体重偏重眼体重大于第80百分位(P80)演占40.8%(29/71例)。婴儿GER患儿中体重偏重者占一半,与幼儿GER相比,差异有显著性。结论在婴儿期胃食管反流症状较幼儿期常见,溢乳和体重偏重有关;婴幼儿时期胃食管反流病与反复呼吸道感染、呼吸道炎症不愈以及部分哮喘有关。     

小儿下呼吸道感染常见致病菌及其耐药性分析

目的 了解小儿下呼吸道感染常见致病菌及耐药情况的变化,指导合理用药.方法 分析兰州大学第一医院2008年1月至2010年12月住院患儿下呼吸道感染病例共997例,无菌留取呼吸道分泌物,进行常规细菌培养及药敏试验,总结致病菌构成情况及耐药性变化.结果 997例下呼吸道感染患儿的呼吸道分泌物标本中有425份培养出致病菌,共分离到菌株498株,总阳性率42.73％,其中革兰阳性球菌151株,占30.32％,革兰阴性杆菌321株,占64.46％,真菌26株,占5.62％.2008至2010年分离率位于前6位的致病菌有变化,铜绿假单胞菌(2.70％、0.42％、0)和副流感嗜血杆菌(2.03％、2.92％、8.24％)3年检出率比较差异有统计学意义(p＜0.05),铜绿假单胞菌检出率有降低趋势,而副流感嗜血杆菌检出率有增高趋势,肺炎链球菌、金黄色葡萄球菌、流感嗜血杆菌、大肠埃希菌、肺炎克雷伯杆菌和真菌在各年度检出率比较差异无统计学意义.铜绿假单胞菌在各年龄段之间的检出率无差异,肺炎链球菌、流感嗜血杆菌和副流感嗜血杆菌随年龄增大检出率增高,金黄色葡萄球菌、肺炎克雷伯菌和大肠埃希菌随年龄增大检出率降低.金黄色葡萄球菌、大肠埃希菌和副流感嗜血杆菌3年间耐药表型检出率比较差异有统计学意义(P＜0.05).肺炎链球菌和金黄色葡萄球菌对万古霉素及利奈唑胺最敏感,大肠埃希菌和肺炎克雷伯杆菌对碳青霉烯类最敏感,流感嗜血杆菌和副流感嗜血杆菌对常用抗生素均敏感.结论 住院小儿下呼吸道感染致病菌以革兰阴性杆菌为主,检出率较高的细菌有肺炎链球菌、金黄色葡萄球菌、大肠埃希菌、肺炎克雷伯杆菌、流感嗜血杆菌及副流感嗜血杆菌.细菌在不同年龄组间检出率比较差异有统计学意义.不同细菌对常用抗生素的敏感率不同.临床应以微生物培养及药敏试验为依据,合理选用抗生素,减缓耐药菌株的产生.     

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??Abstract??Objective??To investigate the characteristics of adenovirus infection in children with acute respiratory tract infection. Methods??From May to June 2009?? 492 out-patients with acute respiratory tract infection were involved in our study. One throat swab specimen was collected from each patient. ??RT?? PCRs were performed to detect common respiratory tract viruses including respiratory syncytial virus ??RSV???? rhinovirus ??RV???? influzenza virus type A and B ??IFA?? IFB???? parainfluenza virus ??PIV?? type 1??4?? adenovirus ??AdV???? enterovirus ??EV???? human coronavirus ??HCoV???? human metapneumonia virus ??hMPV?? and human bocavirus ??HBoV??. AdV amplicons were cloned and sequenced to determine the AdV serotypes by using Blast and phylogenetic analysis. Results??At least one viral pathogen was detected in 165 out of 492 patients and the overall positive rate was 33.5%. AdV was detected in 53 ??10.8%?? specimens and it was the most common viral pathogen. Of the 53 AdV postive samples?? 3 subgroups and 7 serotypes were found. AdV serotype 3 ??23/53?? was the major serotype?? followed by serotype 7 ??8/53?? and serotype 1 ??7/53??. Conclusion??There were several AdV serotypes circulating in the spring of 2009 in Beijing area and serotype 3 was the predominant strain. AdV still playes an important role in acute respiratory tract infection in children.     

The presence of clinical signs in malnourished infants with acute lower respiratory tract infections

OBJECTIVES:

To determine the reliability of respiratory rate and subcostal retractions in diagnosing acute lower respiratory tract infection in malnourished children.

METHODS:

One hundred forty-three children with acute lower respiratory tract infection were classified according to the Gomez classification as normal, mildly, moderately or severely malnourished. The presence of tachypnea, subcostal retractions and the sensitivity of either sign in identifying children with a clinical and radiological diagnosis of acute lower respiratory tract infection in each of the nutritional categories were evaluated and compared.

RESULTS:

According to the Gomez classification, 21 (15%) of 143 subjects were severely malnourished, 40 (28%) were moderately malnourished, 38 (26%) were mildly malnourished and 44 (31%) were well nourished. The mean respiratory rates in subjects with normal nutrition and in mildly, moderately and severely malnourished subjects were 62.6±9.38 breaths/min, 61.3±5.57 breaths/min, 57.6±11.65 breaths/min and 49.9±9.04 breaths/min, respectively. The mean respiratory rate of those with normal nutrition was not significantly different from that of those with mild malnutrition (P>0.05), but there was a statistically significant difference between the normal subjects and both the moderately malnourished (P=0.03) and severely malnourished (P<0.001) subjects. Subcostal retraction was observed in 78% of total children, which represents 41 (93%) subjects with normal nutrition, 34 (89%) mildly malnourished subjects, 30 (75%) moderately malnourished subjects and 10 (47%) severely malnourished subjects.There was no statistically significant difference between the frequencies of subcostal retractions observed in children with normal nutrition and mildly malnourished children (P>0.05), but subcostal retraction frequencies were significantly lower both in moderately (P=0.03) and severely (P<0.001) malnourished children. Tachypnea frequency was also found to be significantly lower in moderately (P=0.04) and severely (P=0.03) malnourished children compared with the normal group. As a consequence, the sensitivity of the presence of both of these signs was found to be lower in these two groups. The coexistence rates of both findings were 95% for the patients with normal nutrition and 47% for the severely malnourished patients.

CONCLUSIONS:

The current World Health Organization algorithm must be supported with other signs for the diagnosis of acute lower respiratory tract infection, especially in severely mal-nourished children.     

Risk factors for severe respiratory syncytial virus-associated lower respiratory tract infection in children

BACKGROUND: Respiratory syncytial virus (RSV) is the most important cause of viral lower respiratory tract infection that can be a life-threatening disease in infants and children. This study was conducted to look for independent risk factors for severe respiratory syncytial virus-associated lower respiratory tract infection (RSV-LRI) that required oxygen supplementation or mechanical ventilation. METHODS: Medical records of patients younger than 4 years hospitalized with RSV-LRI at Shizuoka Red Cross Hospital from July 1, 1995 to June 30, 1999 were reviewed. The patients were compared using univariate and multivariate logistic regression analysis. RESULTS: A total of 157 patients were hospitalized with RSV-LRI at Shizuoka Red Cross Hospital from the study time period. Of these, 20 patients (12.7%) were diagnosed with severe RSV-LRI. Subjects younger than 3 months of age had an odds ratio (OR) of 59.9 (95% confidence interval (CI) 14.7_244.0) for the dependent variable of severe RSV-LRI (P<0.0001). Subjects with a history of congenital heart disease also had an OR of 99.2 (95% C1 8.5-1160.1) (P<0.0005). CONCLUSIONS: Infants younger than 3 months without any underlying diseases may be at high risk for severe RSV-LRI. Respiratory syncytial virus prophylaxis is needed not only for high-risk patients, but for healthy early infants.     

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目的分析呼吸道感染患儿鲍曼不动杆菌的感染情况及其耐药性。方法对2009年1月至2010年12月在苏州大学附属儿童医院呼吸科住院的3529例急性呼吸道感染患儿,采用无菌负压吸引法采集新鲜痰液,进行鲍曼不动杆菌培养、分离,并采用定量MIC法进行药敏试验,观察及分析呼吸道鲍曼不动杆菌感染情况及相关因素。结果 3529例急性呼吸道感染患儿分离到1523株致病菌,其中鲍曼不动杆菌44株,占2.89%;在不同的性别、年龄组感染率无差别;四季分布不同,以夏秋季节多见。鲍曼不动杆菌对氨苄西林、呋喃妥因、头孢唑林的耐药率为100%,对头孢他啶、头孢噻肟、头孢吡肟的耐药率上升,未发现对头孢哌酮舒巴坦、妥布霉素、左氧氟沙星、氨苄西林舒巴坦、阿米卡星、亚胺培南的耐药菌株。结论苏州儿童医院急性呼吸道感染患儿鲍曼不动杆菌的感染率与季节有关,无性别、年龄差异;对氨苄西林、呋喃妥因、头孢唑林耐药,对第三、四代头孢菌素的耐药率上升。     

5150例急性下呼吸道感染儿童呼吸道病毒检测结果分析

目的 了解急性下呼吸道感染(ALRTI)住院患儿咽拭子呼吸道病毒的分布情况。方法 采用直接免疫荧光法,对该院2014 年3 月至2015 年2 月5 150 例ALRTI 住院患儿咽拭子标本进行流感病毒A 型(FA)、流感病毒B 型(FB)、腺病毒(ADV)、呼吸道合胞病毒(RSV)及副流感病毒1、2、3 型(PIV-1、2、3)检测,了解ALRTI 患儿中呼吸道病毒的分布情况。结果 5 150 例住院患儿的咽拭子样本中病毒检测阳性2 155 例(41.84%),其中RSV、 PIV-3 、FA 是检出率最高的前3 位病毒,分别为1 338 例(25.98%)、439 例(8.52%)、166 例(3.22%),并有29 例为2 种病毒混合感染。随年龄增加病毒检出率呈下降趋势(χ²=279.623,P<0.01)。RSV 检测阳性率自9 月开始呈增高趋势,11 月最高,达60.09%,6 月最低,仅为1.51%。PIV-3 检测阳性率5 月最高(21.38%),11 月最低(1.77%)。结论 ALRTI 患儿的病毒流行分布随年龄、季节而不同,秋冬季以RSV 流行为主,春夏季以PIV-3 流行为主。RSV 是ALRTI 住院儿童的最常见病毒。