2011—2020年儿童腺病毒医院感染的临床特征

 目的 了解儿童腺病毒医院感染的流行病学及临床特点,为针对性的预防和治疗提供依据。方法 回顾性分析2011年1月—2020年12月某儿童医院收治的腺病毒感染患儿的病例资料,入院＞48h后呼吸道分泌物检出腺病毒为医院感染组,入院≤48h呼吸道分泌物检出腺病毒为社区感染组。比较两组患者的流行病学和临床特征。结果 共收治腺病毒肺炎患儿1158例,其中医院感染55例(4.75%),社区感染1103例(95.25%)。55例医院感染组患儿平均年龄为(2.83±0.38)岁,主要发病年龄在3岁以下(36例,65.45%)。医院感染组中49.09%的患儿发生重症肺炎,高于社区感染组的6.98%,差异有统计学意义(P＜0.05)。医院感染组患儿病死率为1.82%,社区感染组为0.18%。医院感染组有94.55%的患儿出现发热,发热日数为(10.80±0.93)d,高于社区感染组的(6.06±0.13)d,差异有统计学意义(P＜0.001)。医院感染组中32.73%的患儿有基础疾病,中重度贫血(10.91%)、先天性心脏病(7.27%)、血液与肿瘤性疾病(5.45%)和神经系统疾病(7.27%)的比率均高于社区感染组(分别为1.63%、1.36%、0.36%、1.09%),差异均有统计学意义(均P＜0.05)。医院感染组患儿的原发疾病中以呼吸系统疾病多见(39例,70.91%),原发感染病原体以支原体多见(15例,38.46%)。结论 腺病毒医院感染容易在三岁以内婴幼儿中发生,可继发于呼吸道其他病原体如肺炎支原体感染后,有中重度贫血、先天性心脏病和神经系统疾病等基础疾病的儿童更易发生腺病毒医院感染。

Clinical characteristics of adenovirus healthcare-associated infection in children from 2011 to 2020

Objective To understand the epidemiological and clinical characteristics of adenovirus healthcare-associated infection (HAI) in children, and provide basis for targeted prevention and treatment. Methods Medical data of children admitted to a children’s hospital from January 2011 to December 2020 due to adenovirus infection were analyzed retrospectively. Children detected adenovirus in respiratory secretion over 48 hours and less than 48 hours after admission were divided into HAI group and community-associated infection group (CAI group) respectively. Epidemiological and clinical characteristics of two groups of children were compared. Results A total of 1 158 children with adenovirus pneumonia received medical treatment, including 55 (4.75%) HAI cases and 1 103 (95.25%) CAI cases. The average age of 55 children in HAI group was (2.83±0.38) years old, and the main onset age was less than 3 years old (n=36, 65.45%). In HAI group, 49.09% children had severe pneumonia, higher than 6.98% in CAI group, with statistically significant difference (P<0.05). The case fatality rate of children in HAI group and CAI group were 1.82% and 0.18% respectively. 94.55% children in HAI group had fever. Fever duration was (10.80±0.93) days, higher than that (［6.06±0.13］ days) in CAI group, with statistical difference (P<0.001). In HAI group, 32.73% children had underlying diseases. The percentages of moderate and severe anemia (10.91%), congenital heart disease (7.27%), blood and tumor diseases (5.45%), and nervous system diseases (7.27%) were higher than that of CAI group (1.63%, 1.36%, 0.36%, and 1.09% respectively), all were statistically different (all P<0.05). Primary diseases in children in HAI group were mainly respiratory diseases (n=39, 70.91%), and the major infectious pathogen was Mycoplasma (15, 38.46%). Conclusion Adenovirus HAI is prone to occur in infants under three years old, and can be secondary to infection caused by other respiratory pathogens such as Mycoplasma pneumoniae. Children with moderate to severe anemia, congenital heart disease, nervous system diseases and other underlying diseases are more likely to develop adenovirus HAI.