儿童社区获得性肺炎的流行分布和常见菌种特征及变迁研究

目的掌握广州地区儿童社区获得性肺炎（Communityacquiredpneumonia，CAP）的流行特点和病原微生物的分布及变迁情况。方法选取2010年8月至2012年2月在广州地区7所医院就诊的4856例2d-14岁患儿分别进行多病原联合检测，采集呼吸道分泌物标本进行细菌培养；鼻咽拭子检测呼吸道病毒抗原；静脉血液检查肺炎支原体和衣原体。结果CAP患儿主要以1岁以下的居多，且发病季节亦主要以秋冬为主；共培养分离1131株病原菌（23．29％），其中，革兰氏阴性菌63l株（55．79％），阳性菌500株（44．21％）；检出前5位的细菌分别是肺炎克雷伯氏菌（28．65％）、肺炎链球菌（25．29％）、大肠埃希氏菌（23．08％）、金黄色葡萄球菌（12．20％）、凝固酶阴性葡萄球菌（4．5l％）；革兰氏阴性菌对氨苄西林的耐药性最高，达92．55％，而革兰氏阳性菌对青霉素的耐药性最高，耐药率高达98．40％；1岁以上患儿除肺炎支原体的感染率均高于l岁以下，其余均显著低于1岁以下（P〈0．05），金黄色葡萄球菌呈逐年增长的趋势，肺炎链球菌感染逐年下降，肺炎克雷伯菌发生率比较稳定，大肠埃希菌感染逐年增长。结论肺炎克雷伯氏菌、肺炎链球菌、大肠埃希氏菌等为广州地区儿童CAP的主要病原体，多数病原微生物在1岁以下患儿中感染率高于l岁以上。

Popular features and changes of the epidemic distribution and pathogenic microorganisms in children with community-acquired pneumonia.

Objective To understand and master the popular features and changes of the epidemic distribu- tion and pathogenic microorganisms in children with community-acquired pneumonia （CAP） in Guangzhou area. Methods A total of 4 856 children with CAP, aged 2 days to 14 years, were selected from August 2010 to February 2012 in the 7 hospitals in Guangzhou area, which all underwent combined multi-pathogen detection. Specimens of re- spiratory secretions were collected for bacterial eulture. Nasal swabs were used to detect respiratory viral antigen, and venous blood was tested for myeoplasma pneumoniae and Chlamydia. Results CAP mainly occurred in children aged under 1 year old, and were mainly in autumn and winter. A total of 1 131 pathogens were isolated （23.29%）, in- eluding 631 strains of Gram-negative bacteria （55.79%） and 500 strains of Gram-positive bacteria （44.21%）. The top five bacteria detected were Klebsiella pneumoniae （28.65%）, Streptococcus pneumoniae （25.29%）, Escherichia coli （23.08%）, Staphylococcus aureus （12.20%）, coagulase-negative Staphylococcus aureus （4.51%）; Gram-negative bacteriawere found the highest resistant to ampieiltin, reaching 92.55%, while Gram-positive bacteria were the highest resis- tant to penicillin, with the resistance rate of 98.40%. An addition to Mycoplasmapneumoniae, the infection rate of other CAP in children over 1 year old were significantly higher than those below 1 year old （P〈0.05）, Staphylococcus aureus infection showed a gradually increasing trend, while Streptococcus pneumoniae infection has a declining trend. The incidence of KlebsieUa pneumoniae was relatively stable, and Escherichia coli infection increased year by year. Conclusion Klebsiella pneumoniae, Streptococcus pneumoniae, Escherichia coli are the major pathogens of CAP in children in Guangzhou area, and most pathogenic microorganisms show a higher rate of infection in children aged less than 1 year old.