450例重症社区获得性肺炎患儿痰液病原体分布及细菌耐药特点

目的探讨重症社区获得性肺炎（CAP）患儿病原体分布及细菌耐药情况。方法选取2017-2018年收治的重症CAP患儿450例作为研究对象。将1~ < 3岁120例纳入幼儿组，3~ < 6岁151例纳入学龄前组，≥6岁179例纳入学龄组。使用一次性吸痰管吸取口腔内痰液，器械通气的患儿经气管插入导管装置吸取痰液。利用分子生物学检查法来进行检测，以核酸阳性作为病毒标准；使用荧光定量PCR技术检测痰液标本中肺炎支原体；并给予静脉注射头孢呋辛钠、口服阿奇霉素干混悬、机械通气治疗。结果450例患儿痰液中有389例检出病原体阳性，阳性率为86.44%，共检出632种病原体，其中细菌、病毒比例达到56.01%与35.60%。病毒、细菌、肺炎支原体（MP）、沙眼衣原体（CT）、真菌感染在幼儿组、学龄前组、学龄组分布率的差异比较有统计学意义（P < 0.01），春季、夏季、秋季、冬季的病毒、细菌、MP、CT、真菌感染分布差异比较有统计学意义（P < 0.01），各季节混合感染差异无统计学意义（P>0.05）；流感嗜血杆菌对氧氟沙星耐药低。大肠埃希菌对亚胺培南、头孢克洛低耐药。肺炎链球菌对万古霉素、利奈唑胺、青霉素不耐药，对阿莫西林低耐药。金黄色葡萄球菌对万古霉素、利奈唑胺不耐药。结论细菌是重症社区获得性肺炎患儿痰液中的主要病原体，幼儿病毒、细菌、MP、CT检出率较高，且细菌耐药情况严峻，推荐在病原检测及细菌耐药实验后根据相关数据使用针对性抗生素。

Distribution of sputum pathogens and characteristics of bacterial resistance in 450 children with severe community-acquired pneumonia

ObjectiveTo investigate the distribution of pathogens and bacterial resistance in children with severe community-acquired pneumonia(CAP).MethodsOne thousand and fourteen children with SCAP from 2017 to 2018 were investigated, and 450 cases were selected after exclusion.One hundred and twenty children aged 1 to < 3 years, 151 children aged 3 to >6 years and 179 children aged ≥ 6 years were divided into the infant group, preschool group and school-age group, respectively.A disposable sputum suction tube was used to absorb sputum in oral cavity, and the sputum of children with mechanical ventilation was sucked through organ insertion catheter device.The positive nucleic acid was set as the virus standard, the molecular biology method was used to detect.The fluorescent quantitative PCR was used to detect Mycoplasma pneumoniae(MP) in sputum samples.The patients were treated with intravenous injection of cefuroxime sodium, oral azithromycin dry suspension and mechanical ventilation.ResultsAmong 450 cases, the positive pathogens in sputum of 389 cases were identified, and the positive rate of which was 86.44%.A total of 632 pathogens were detected, and the proportion of bacteria and viruses were 56.01% and 35.60%, respectively.The differences of the distribution rates of viruses, bacteria, MP, Chlamydia trachomatis(CT) and fungi infection among the infant group, preschool group and school-age group were statistically significant(P < 0.01).The distribution differences of the virus, bacteria, MP, CT and fungus infection among four seasons were statistically significant(P < 0.01), and the difference of the mixed infection was not statistically significant(P>0.05).Haemophilus influenzae was low resistant to ofloxacin, and Escherichia coli was resistant to imipenem and cefaclor.Streptococcus pneumoniae was not resistant to vancomycin, linezolid and penicillin, and low resistance to amoxicillin.Staphylococcus aureus was not resistant to vancomycin and linezolid.ConclusionsBacteria are the main pathogens in CAP.The detection rates of children's virus, bacteria, MP and CT are high, and the bacterial resistance is severe.The targeted antibiotics is recommended to use after the pathogen and bacterial resistance tests are identified.