上海市2015-2017年成年人急性呼吸道感染病例的流行病学和病原学特征分析

目的 研究2015-2017年上海地区成年人急性呼吸道感染病例的流行病学和病原学特征，为制定预防控制策略提供科学依据。方法 收集2015-2017年上海地区3家不同级别医院内的发热门诊急性呼吸道感染病例，对纳入病例进行相关信息登记和采样，进行呼吸道病原体多重PCR检测和细菌培养鉴定。结果 806例发热门诊急性呼吸道感染病例中，共检出阳性592例，总阳性率为73.45%。其中病毒阳性为538例，检出阳性率66.75%（538/806），病毒检出率前3位的病原体为甲型流感病毒（40.45%，326/806）、乙型流感病毒（14.39%，116/806）和鼻病毒/肠道病毒（4.84%，39/806）；细菌阳性为130例，总检出阳性率为16.13%（130/806），仅检出肺炎克雷伯菌（11.17%，90/806）和金黄色葡萄球菌（5.71%，46/806）；肺炎支原体阳性43例，检出阳性率为5.33%（43/806），肺炎衣原体阳性3例，阳性率为0.37%（3/806）。共发现150例混合感染，混合感染率18.61%（150/806），其中以二重感染（90.00%，135/150）为主，三重感染和四重感染分别占9.33%（14/150）和0.67%（1/150）。150例混合感染中，主要重复检出病原体为甲型流感病毒、肺炎克雷伯菌、金黄色葡萄球菌、肺炎支原体。不同时间和地区的发热门诊急性呼吸道感染病例的病原体检出情况不同（P<0.001）。结论 2015-2017年上海地区发热门诊急性呼吸道感染病例以流感等病毒感染为主，病原体检出的构成随着不同时间、地区、人群特征等影响因素动态变化，有必要进一步加强医防结合，将结果用于指导临床诊疗和防治策略的制定。

Etiologic and epidemiologic features of acute respiratory infections in adults from Shanghai, during 2015-2017

Objective To analyze the etiologic and epidemiological characteristics of adult acute respiratory infections in Shanghai during 2015-2017. Methods Data was collected from outpatients with acute respiratory infections who visited the Fever Clinics in three hospitals of different levels in three administrative regions of Shanghai, from 2015 to 2017. Basic information and nasopharyngeal swabs were collected from cases in line with the inclusion criteria. Multiplex RT-PCR and bacterial cultures were performed to detect the respiratory pathogens. Results A total of 806 individuals were enrolled from 2015 to 2017. Respiratory pathogens were identified in 73.45% (592/806) of the cases, with the virus detection rate as 66.75% (538/806). It was found that the major respiratory pathogens for virus detection were influenza A in 326 (40.45%), influenza B in 116 (14.39%), rhinovirus/enterovirus in 39 (4.84%) of the cases. The overall detection rate of bacteria was 16.13% (130/806), including Klebsiella pneumoniae in 90 (11.17%) cases, Staphylococcus Aureus in 46 (5.71%) cases. Other kind of bacteria were not detected in our study. The detection rates on Mycoplasma pneumoniae was 5.33% (43/806) and on Chlamydia pneumonia was 0.37% (3/806). Co-infection with multiple pathogens was detected in 18.61% (150/806) of the cases, including 135 with double infection (accounting for 90.00%), 14 with triple infection and 1 with quadruple infection (accounted for 9.33% and 0.67%, respectively). Among the 150 cases with co-infections, the main identified pathogens were influenza A, Klebsiella pneumoniae, Staphylococcus aureus, and Mycoplasma pneumoniae. Pathogens of acute respiratory infections that identified among the outpatients from the Fever Clinics at different time, region or population, the characteristics were different (P<0.001). Conclusions In 2015-2017, outpatients with acute respiratory infections in Shanghai were mainly caused by influenza virus or other viruses, however dynamically with its composition, time, region and characteristics of the population. It is necessary to strengthen and combine related medical and preventive services and to develop the appropriate strategies regarding clinical diagnosis and treatment.