重症肺炎患儿肺泡灌洗液病原学分析及临床特点

目的了解苏州大学附属儿童医院重症肺炎患儿肺泡灌洗液病原学分布及主要病原菌耐药性。方法选取2014年1月至2018年12月在苏州大学附属儿童医院行纤维支气管镜镜检的重症肺炎患儿177例作为研究对象,收集患儿肺泡灌洗液行病原体鉴定及病原菌培养、药敏分析,并采用直接免疫荧光定量PCR技术对其病原进行检测。结果 177例重症肺炎患儿中,有100例检出至少1种病原体,总检出阳性率为58.13%;其中肺炎支原体(MP)检出率最高(41/100例);前3位检出的细菌分别为肺炎链球菌9例(10.59%)、金黄色葡萄球菌8例(9.41%)、铜绿假单胞菌6例(7.06%);前3位检出的病毒分别为巨细胞病毒(CMV)14例(33.33%)、人博卡病毒(HBoV)10例(23.81%)、呼吸道合胞病毒(RSV)8例(19.05%);药物敏感试验结果提示,主要的革兰阳性菌对万古霉素、利奈唑胺耐药率较低,主要的革兰阴性菌对喹诺酮类、氨基糖苷类、碳青霉烯类、加酶的β内酰胺类耐药率较低。<5岁重症肺炎患儿病毒检出率约为30.00%,MP检出率约为20.00%,>5岁重症肺炎患儿MP检出率>30.00%;<2岁重症肺炎患儿细菌检出率>20.00%,>2岁重症肺炎患儿细菌检出率约为15.00%。重症肺炎患儿中,气道畸形比例较高,以气道软化、气道狭窄为主。结论苏州地区<5岁的重症肺炎患儿肺泡灌洗液病原学检查以病毒最常见,<2岁者细菌检出率亦较高;常见革兰阳性菌对万古霉素、利奈唑胺敏感性高;铜绿假单胞菌对喹诺酮类、氨基糖苷类、碳青霉烯类、加酶的β内酰胺类抗生素敏感性高。重症肺炎患儿,尤其是小年龄组婴儿需要重视气道畸形的可能。

Etiological analysis of bronchoalveolar lavage fluid in children with severe pneumonia and their clinical features

Objective To study the pathogenic distribution of bronchoalveolar lavage fluid in children with severe pneumonia from Children′s Hospital Affiliated to Soochow University,and to investigate the drug resistance of major pathogenic bacteria.Methods A total of 177 children with severe pneumonia undergoing fiberoptic bronchoscopy in Children′s Hospital Affiliated to Soochow University from January 2014 to December 2018 were enrolled.Their bronchoalveolar lavage fluid was collected for pathogen identification,pathogen culture and drug sensitivity analysis.The pathogens were detected by direct immunofluorescence quantitative PCR.Results Of 177 cases enrolled,100 children had at least one pathogen detected,and the positive rate was 58.13%.Among all the pathogens detected,Mycoplasma pneumonia(MP)had the highest detection rate,which was found in 41 cases.The top three bacteria detected included Streptococcus pneumoniae(9 cases,10.59%),Staphylococcus aureus(8 cases,9.41%),and Pseudomonas aeruginosa(6 cases,7.06%).The top three viruses detected were cytomegalo virus(CMV)(14 cases,33.33%),human bocavirus(HBoV)(10 cases,23.81%),and respiratory syncytial virus(RSV)(8 cases,19.05%).The drug sensitive test indicated that main kinds of Gram-negative bacteria had low resistance to quinolones,aminoglycosides,carbapenems,and enzymatic beta-lactams.Main kinds of Gram-positive bacteria had low resistance to Linezolid and vancomycin.The virus detection rate and MP detection rate in severe pneumonia children under 5 years old were about 30.00%and 20.00%,respectively.The MP detection rate in children above 5 years old exceeded 30.00%.The bacteria detection rates in children under and above 2 years old were over 20.00%and about 15.00%,respectively.Airway abnormalities were common in children with severe pneumonia,mainly including tracheobronchial malacia and stenosis.Conclusions The most common pathogen of bronchoalveolar lavage fluid in severe pneumonia children under 5 years old in Suzhou is viruses.The bacteria detection rate is high in children under 2 years old.Common Gram-positive bacteria show high susceptibility to vancomycin and Linezolid.Pseudomonas aeruginosa is highly sensitive to quinolones,aminoglycosides,carbapenems,and enzymatic beta-lactams.Importance should be attached to the airway abnormalities in children,especially infants,with severe pneumonia.