儿童社区获得性肺炎1 613例病原学特点分析

彭懿; 舒畅; 符州; 李渠北; 刘铮; 闫莉

doi:10.7499/j.issn.1008-8830.2015.11.009

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中国当代儿科杂志 ›› 2015, Vol. 17 ›› Issue (11) : 1193-1199. DOI: 10.7499/j.issn.1008-8830.2015.11.009

论著·临床研究

儿童社区获得性肺炎1 613例病原学特点分析

彭懿, 舒畅, 符州, 李渠北, 刘铮, 闫莉

作者信息 +

Pathogen detection of 1 613 cases of hospitalized children with community acquired pneumonia

PENG Yi, SHU Chang, FU Zhou, LI Qu-Bei, LIU Zheng, YAN Li

Author information +

文章历史 +

摘要

目的了解重庆地区儿童社区获得性肺炎(CAP)患儿病原分布及特点。方法选取2014年1~12月住院治疗的1 613例CAP患儿为研究对象,采集患儿的鼻咽抽吸物进行细菌培养、呼吸道7种病毒及肺炎支原体检测,并对其特点进行分析。结果 1 613例患儿中,有810例细菌检出阳性,阳性率为50.22%,其中检出副流感嗜血杆菌346株(40.8%),肺炎链球菌252株(29.7%),卡他莫拉菌62株(7.3%);病毒阳性者559例,阳性率为34.66%,其中检出呼吸道合胞病毒342株(58.3%),副流感病毒3 102株(17.4%),腺病毒84株(14.3%);MP阳性者481例,阳性率为29.82%;病原体混合感染检出519例(32.18%),以细菌、病毒混合检出为主(47.4%)。结论副流感嗜血杆菌为重庆地区CAP住院患儿感染的首位细菌病原,RSV为首位病毒病原,支原体感染亦较为普遍,混合感染以细菌、病毒混合感染为主。

Abstract

Objective To investigate the distribution of pathogens of children with community acquired pneumonia (CAP) from the Chongqing area. Methods Nasopharyngeal specimens and blood specimens of 1 613 children with CAP were collected between January 2014 and December 2014 for bacterial culture and detection of 7 respiratory viruses and antibodies against Mycoplasma pneumoniae (MP). Results The overall positive rate of bacteria was 50.22% (810 cases). Hemophilus parainfluenzae (40.8%), Streptococcus pneumonia (29.7%) and Moraxelle catarrhalis (7.3%) were the predominant ones. Among the viruses, the top detected virus was respiratory syncytial virus (RSV, 58.3%), followed by parainfluenza virus type3 (17.4%) and adenovirus (14.3%). A total of 481 cases (29.82%) were MP-positive. The co-infection rate was 32.18% (519 cases), and the mixed infections of bacteria and viruses were common (47.4%). Conclusions RSV and Hemophilus parainfluenzae are the major pathogens of CAP in children from the Chongqing area. MP is also an important pathogen. The co-infection of bacteria and viruses is prevalent.

导出引用

彭懿, 舒畅, 符州, 李渠北, 刘铮, 闫莉. 儿童社区获得性肺炎1 613例病原学特点分析[J]. 中国当代儿科杂志. 2015, 17(11): 1193-1199 https://doi.org/10.7499/j.issn.1008-8830.2015.11.009

PENG Yi, SHU Chang, FU Zhou, LI Qu-Bei, LIU Zheng, YAN Li. Pathogen detection of 1 613 cases of hospitalized children with community acquired pneumonia[J]. Chinese Journal of Contemporary Pediatrics. 2015, 17(11): 1193-1199 https://doi.org/10.7499/j.issn.1008-8830.2015.11.009

参考文献

[1] Walker CL, Rudan I, Liu L, et al. Global burden of childhood pneumonia and diarrhea[J]. Lancet, 2013, 381(9875): 1405-1416.
[2] 中华医学会儿科学分会呼吸学组, 《中华儿科杂志》编辑委员会. 儿童社区获得性肺炎管理指南(2013修订)(上)[J]. 中华儿科杂志, 2013, 51(10): 745-752.
[3] 王芬, 耿荣, 钱素云, 等. 152例社区获得性肺炎住院患儿的病原学分析[J]. 中华急诊医学杂志, 2011, 20(8): 866-868.
[4] 冯英, 罗征秀, 符州, 等. 重庆地区婴幼儿社区获得性肺炎病原学分析[J]. 儿科药学杂志, 2011, 17(5): 39-42.
[5] De Schutter I, De Wachter E, Crokaert F, et al. Microbiology of bronchoalveolar lavage fluid in children with acute nonresponding or recurrent community-acquired pneumonia: identification of nontypeable Haemophilus influenzae as a major pathogen[J]. Clin Infect Dis, 2011, 52(12): 1437-1444.
[6] 朱艳娜, 陈频, 陈凤英. 小儿下呼吸道感染病原菌分布及耐药性分析[J]. 中华医院感染学杂志, 2014, 24(2): 447-479.
[7] Wei L, Liu W, Zhang XA, et al. Detection of viral and bacterial pathogens in hospitalized children with acute respiratory illnesses, Chongqing, 2009-2013[J]. Medicine (Baltimore), 2015, 94(16): e742.
[8] Sakwinska O, Bastic Schmid V, Berger B, et al. Nasopharyngeal microbiota in healthy children and pneumonia patients[J]. J Clin Microbiol, 2014, 52(5): 1590-1594.
[9] Ubukata K, Chiba N, Morozumi M, et al. Longitudinal surveillance of Haemophilus influenzae isolates from pediatric patients with meningitis throughout Japan, 2000-2011[J]. J Infect Chemother, 2013, 19(1): 34-41.
[10] 杨旭, 杨红英, 吴昉, 等. 成人呼吸道嗜血杆菌属分离株生物学分型及药敏测定[J]. 中国感染与化疗杂志, 2008, 8(6): 452-455.
[11] 陈倩, 施圣云, 胡正, 等 . 南京地区急性呼吸道感染儿童支原体、衣原体和常见呼吸道病毒病原学分析[J] . 中国当代儿科杂志, 2010, 12(6): 450-454.
[12] 冯录召, 赖圣杰, 李夫, 等. 2009-2012年我国6省(市)5岁以下儿童住院肺炎病例的病毒病原学分析[J] . 中华流行病学杂志, 2014, 35(6): 646-649.
[13] 贾力. 儿童下呼吸道感染病毒的检测分析[J]. 中华医院感染学杂志, 2011, 21(16): 3386-3388.
[14] 李忠, 刘倜, 张圣洋, 等. 济南地区儿童急性呼吸道感染病原谱分析[J]. 中国公共卫生, 2014, 30(4): 520-523.
[15] 张国英, 夏学红, 吕连峥. 503例儿童急性呼吸道感染常见病毒的检测结果分析[J]. 中国微生态学杂志, 2014, 26(10): 1206-1208.
[16] Ferone EA, Berezin EN, Durigon GS, et al. Clinical and epidemiological aspects related to the detection of adenovirus or respiratory syncytial virus in infants hospitalized for acute lower respiratory tract infection[J]. J Pediatr(Rio J), 2014, 90(1): 42-49.
[17] Hasan R, Rhodes J, Thamthitiwat S, et al. Incidence and etiology of acute lower respiratory tract infections in hospitalized children younger than 5 years in rural Thailand[J]. Pediatr Infect Dis J, 2014, 33(2): e45-e52.
[18] Freitas FT. Sentinel surveillance of influenza and other respiratory viruses, Brazil, 2000-2010[J]. Braz J Infect Dis, 2013, 17(1): 62-68.
[19] 黄志英, 程宝金, 林红, 等. 80例住院患儿腺病毒呼吸道感染的流行病学特点和临床特征分析[J]. 病毒学报, 2014, 30(4): 408-411.
[20] Wang SL, Chi CY, Kuo PH, et al. High-incidence of human adenoviral co-infections in Taiwan[J]. PLoS One, 2013, 8(9): e75208.
[21] Fujimoto T, Matsushima Y, Shimizu H, et al. A molecular epidemiologic study of human adenovirus type 8 isolates causing epidemic keratoconjunctivitis in Kawasaki city, Japan in 2011[J]. Jpn J Infect Dis, 2012, 65(3): 260-263.
[22] Xie L, Yu XF, Sun Z, et al. Two adenovirus serotype 3 outbreaks associated with febrile respiratory disease and pharyngoconjunctival fever in children under 15 years of age in Hangzhou, China, during 2011[J]. J Clin Microbiol, 2012, 50(6): 1879-1888.
[23] Ronchi A, Doern C, Brock E, et al. Neonatal adenoviral infection: a seventeen year experience and review of the literature[J]. J Pediatr, 2014, 164(3): 529-535.
[24] 罗蓉, 符州, 黄英, 等. 99例儿童腺病毒肺炎临床特征分析[J]. 重庆医学, 2014, 43(30): 3997-4001.
[25] 邓洁, 钱渊, 赵林清, 等. 2003-2012年北京儿童急性呼吸道感染中腺病毒监测及流行型别分析[J]. 病毒学报, 2013, 29(6): 615-619.
[26] Tsou TP, Tan BF, Chang HY, et al. Community outbreak of adenovirus, Taiwan, 2011[J]. Emerg Infect Dis, 2012, 18(11): 1825-1832.
[27] Rojas LJ, Jaramillo CA, Mojica MF, et al. Molecular typing of adenovirus circulating in a Colombian paediatric population with acute respiratory infection[J]. Epidemiol Infect, 2012, 140(5): 818-822.
[28] 丁小芳, 张兵, 钟礼立, 等. 100例重症社区获得性肺炎住院儿童的病毒病原学分析[J]. 临床儿科杂志, 2012, 30(9): 857-861.
[29] Nascimento-Carvalho CM, Cardoso MR, Barral A, et al. Seasonal patterns of viral and bacterial infections among children hospitalized with community-acquired pneumonia in a tropical region[J]. Scand J Infect Dis, 2010, 42(11-12): 839-844.
[30] du Prel JB, Puppe W, Gröndahl B, et al. Are meteorological parameters associated with acute respiratory tract infections?[J]. Clin Infect Dis, 2009, 49(6): 861-868.
[31] 陈正荣, 季伟, 王宇清, 等. 2006-2010年苏州地区住院儿童急性呼吸道腺病毒感染与气候因素的相关性研究[J], 临床儿科杂志, 2012, 30(6): 539-541.
[32] Rasmussen JN, Voldstedlund M, Andersen RL, et al. Increased incidence of Mycoplasma pneumoniae infections detected by laboratory-based surveillance in Denmark in 2010[J]. Eure Surveill, 2010, 15(45): 19708.
[33] Chalker V, Stocki T, Mentasti M, et al. Increased incidence of Mycoplasma pneumoniae infection in England and Wales in 2010: multiocus variable number tandem repeat analysis typing and macrolide susceptibility[J]. Euro Surveill, 2011, 16(19): 19865.
[34] Zhao H, Li S, Cao L, et al. Surveillance of Mycoplasma pneumoniae infection among children in Beijing from 2007 to 2012[J]. Chin Med J(Engl), 2014, 127(7): 1244-1248.
[35] 赵连爽, 赵俊华, 杜毅鑫, 等 . 呼吸道感染患儿肺炎支原体抗体检测结果分析[J] . 中国公共卫生, 2012, 28(4): 534-535.
[36] 姜毅, 李温慈, 徐海滨, 等. 小儿肺炎咽拭子肺炎支原体培养及药敏分析[J]. 中华医院感染学杂志, 2011, 21(9): 1925-1927.
[37] Youn YS, Lee KY, Hwang JY, et al. Difference of clinical featues in childhood Mycoplasma pneumoniae pneumonia[J]. BMC Pediatr, 2010, 10: 48.
[38] 阳爱梅, 宋建辉, 黄榕, 等. 1026例儿童肺炎支原体感染及耐药情况分析[J]. 中国当代儿科杂志, 2013, 15(7): 522-525.
[39] 罗蓉, 黄英, 闫莉, 等. 重庆地区儿童肺炎支原体感染临床分析[J]. 第三军医大学学报, 2011, 33(11): 1204-1205.
[40] 廖嘉仪, 张涛. 急性呼吸道感染患儿肺炎支原体、肺炎衣原体、嗜肺军团菌检测结果分析[J]. 中华实用儿科临床杂志, 2013, 28(22): 1719-1722.
[41] 雷玉林, 陈黎, 雷治宇. 肺炎支原体咽拭子快速培养在儿童支原体感染诊断的应用[J]. 重庆医学, 2011, 40(18): 1797-1801.
[42] 刘静月, 符州, 罗征秀, 等. 儿童肺炎支原体下呼吸道感染的临床特征分析[J]. 重庆医科大学学报, 2010, 35(10): 1535-1538.
[43] 王晓卫, 钟天鹰, 岳玉林, 等. 2008-2010年南京及周边地区儿童肺炎支原体感染情况分析[J]. 南京医科大学学报, 2011, 31(10): 1463-1537.
[44] Martinez MA, Ruiz M, Zunino E, et al. Identification of P1 types and variants of Mycoplasma pneumoniae during an epidemic in Chile[J]. J Med Microbiol, 2010, 59(Pt 8): 925-929.
[45] Kenri T, Okazaki N, Yamazaki T, et al. Genotyping analysis of Mycoplasma pneumoniae clinical strains in Japan between 1995 and 2005: type shift phenomenon of M.pneumoniae clinical strains[J]. J Med Microbiol, 2008, 57(Pt 4): 469-475.
[46] 张冰, 陈志敏. 2000-2006年杭州市三岁以上儿童肺炎支原体肺炎临床特征变化趋势[J]. 中华儿科杂志, 2010, 48(7): 531-534.
[47] Kannan TR, Hardy RD, Coalson JJ, et al. Fatal outcomes in family transmission of Mycoplasma pneumonia[J]. Clin Infect Dis, 2012, 54(2): 225-231.
[48] Okada T, Morozumi M, Tajima T, et al. Rapid effectiveness of minocycline or doxycycline against macrolide-resistant Mycoplasma pneumonia infection in a 2011outbreak among Japanese children[J]. Clin Infect Dis, 2012, 55(12): 1642-1649.
[49] Zhao F, Liu G, Wu J, et al. Surveillance of macrolide-resistant Mycoplasma pneumoniae in Beijing, China, from 2008 to 2012[J]. Antimicrob Agents Chemother, 2013, 57(3): 1521-1523.
[50] ChangYT, YangYH, Chiang BL. The significance of a rapid cold hemagglutination test for detecting mycoplasma infections in children with asthma exacerbation[J]. J Microbiol Immunol Infect, 2006, 39(1): 28-32.
[51] 龚春华, 张忠印, 李爱国, 等. 儿童支原体感染与哮喘发作的关系[J]. 江苏医药, 2012, 38(10): 980-981.
[52] 刘俊英. 儿童社区获得性肺炎病原体及细菌药敏结果分析[J]. 中国病原生物学杂志, 2012, 7(11): 855-857.
[53] Ruuskanen O, Lahti E, Jennings LC, et al. Viral pneumonia[J]. Lancet, 2011, 377(9773): 1264-1275.
[54] Liu WK, Liu Q, Chen de H, et al. Epidemiology of acute respiratory infections in children in Guangzhou: a three-year study[J]. PLoS One, 2014, 9(5): e96674.
[55] Franz A, Adams O, Willems R, et al. Correlation of viral load of respiratory pathogens and co-infections with disease severity in children hospitalized for lower respiratory tract infection[J]. J Clin Virol, 2010, 48(4): 239-245.
[56] 柯莉芹, 王凤美, 李银洁, 等. 儿童肺炎支原体肺炎流行病学特征[J] . 中国当代儿科杂志, 2013, 15(1): 33-36.
[57] Alicino C, ludici R, Alberti M, et al. The dangerous synergism between influenza and Streptococcus pneumoniae and innovative perspectives of vaccine prevention[J]. J Prev Med Hyg, 2011, 52(3): 102-106.
[58] Stockman LJ, Reed C, Kallen AJ, et al. Respiratory syncytial virus and Staphylococcus aureus coinfection in children hospitalized with pneumonia[J]. Pediatr Infect Dis J, 2010, 29(11): 1048-1050.