618例小儿重症社区获得性肺炎病原谱及临床特点分析

目的:了解长春地区住院重症社区获得性肺炎病原谱及临床特点，为其病原学诊断和针对性治疗提供科学依据。方法:2016年1月至2019年12月长春市儿童医院住院的618例临床诊断为重症社区获得性肺炎患儿，采集患儿咽拭子和肺泡灌洗液标本。应用病毒分离、细菌培养、飞行时间质谱和PCR/RT-PCR技术检测标本中的核酸和蛋白质谱。...

Analysis of etiology and clinical characteristics of 618 children with severe community-acquired pneumonia

Objective To understand the etiology and clinical characteristics of hospitalized severe community-acquired pneumonia(SCAP)in Changchun,and provide scientific basis for its etiology diagnosis and targeted treatment.Methods The study subjects included 618 children with clinical diagnosis of SCAP who were hospitalized from January 2016 to December 2019.We collected pharyngeal swabs and alveolar lavage fluid from children.Virus isolation,bacterial culture,time-of-flight mass spectrometry,PCR/RT-PCR,colloidal gold method and Optochin test were used to detect the antigen,nucleic acid and protein profiles in the specimen.Results There were more boys than girls in hospitalized children with SCAP.The peak age of onset was 7 to 12 months.Most cases occurred in winter and spring.The highest detection rate of SCAP virus was 56.15%(347/618);73.49%(255/347)were positive for one virus,among which the top five were respiratory syncytial virus(27.8%),influenza A virus(23.9%),influenza B virus(16.1%),rhinovirus(12.2%)and metapneumovirus(10.2%).Two viruses were positive for 19.88%(69/347);three viruses were positive for 4.32%(15/347);four viruses were positive for 2.31%(8/347).Atypical microbial infections were 29.77%(184/618),of which Mycoplasma pneumoniae accounted for 95.65%(176/184).Bacterial infections were 17.31%(107/618),mainly Streptococcus pneumoniae(39.25%,42/107)and Staphylococcus aureus(24.30%,26/107).The mixed infection of multiple pathogens was 7.61%(47/618),among which the mixed infection rates of Mycoplasma pneumonia with Streptococcus pneumoniae,virus were 40.43%and 34.04%,respectively.High fever,faster breathing,and perioral cyanosis were risk factors for SCAP,with OR and 95%CI of 7.71 and 4.56-13.04,2.43 and 2.02-2.93,3.53 and 2.56-4.86,respectively.Viral co-infection occurred in 36.96%(34/92)of complications such as heart failure,toxic encephalopathy,and myocardial damage;Mycoplasma pneumoniae and other pathogens co-infected 35.29%of children with pleural effusion.Conclusion The pathogens of SCAP in Changchun are mainly viruses notably,respiratory syncytial virus is the dominant pathogen,followed by Mycoplasma pneumoniae.The bacterial pathogen is mainly Streptococcus pneumoniae.High fever,faster breathing,and cyanosis around the mouth are risk factors for severe pneumonia.Multi-pathogen mixed infection is prone to serious complications.