河北省涿州市儿童社区获得性肺炎流行特征及病原菌分布

doi:10.12183/j.scjpm.2021.0170

摘要/Abstract

摘要： 目的分析涿州市儿童社区获得性肺炎病例流行特征及病原菌分布状况,为本地区儿童社区获得性肺炎的防治工作提供借鉴资料。方法以2018年7月至2020年6月涿州某医院收治入院的社区获得性肺炎儿童病例为研究对象,收集儿童基本资料并进行病原菌检测,对常见细菌耐药性进行分析。结果本研究共对涿州市儿童社区获得性肺炎病例829例进行分析,病例中男女性别比为1.03∶1,婴幼儿、学龄前和学龄期儿童分别占48.9%、35.8%、15.3%,发生季节主要为秋冬季,分别占27.9%、36.4%。检出病原菌阳性523例,检出率为63.1%。不同年龄、不同季节的儿童社区获得性肺炎病例病原菌检出率差异有统计学意义（P<0.05或P<0.01）,其中婴幼儿和秋冬季病原菌检出率较高。痰培养细菌检出326株,其中革兰阴性菌228株（占69.9%）。革兰阳性菌98株（占30.1%）,革兰阴性菌以大肠埃希菌为主,革兰阳性菌以肺炎链球菌为主。血清抗体检出支原体阳性53例,阳性率为6.4%,衣原体阳性64例,阳性率为7.7%。咽拭子检测呼吸道合胞病毒感染49例,阳性率为5.9%,流感病毒检出31例,阳性率为3.7%。主要革兰阴性菌大肠埃希菌、肺炎克雷伯杆菌对氨苄西林（59.5%）、头孢唑林（50.6%）的耐药率最高,对亚胺培南、头孢吡肟等敏感;主要革兰阳性菌肺炎链球菌、金黄色葡萄球菌对青霉素（97.2%、85.2%）、红霉素（86.1%、70.4%）的耐药率最高,对万古霉素、阿米卡星等敏感。结论河北省涿州市儿童社区获得性肺炎以婴幼儿为主,该群体病原菌检出率较高,应根据患儿病原菌分布特点及药敏试验结果合理选择抗菌药物,提高治疗效果的同时预防、延缓耐药菌的产生。

关键词: 社区获得性肺炎, 儿童, 流行特征, 病原菌, 耐药

Abstract: Objective To analyze the epidemiological characteristics and pathogen distribution of community-acquired pneumonia in children in Zhuozhou City, Hebei Province, and provide reference materials for the prevention and treatment of community-acquired pneumonia in children in this area. Methods The cases of children with community-acquired pneumonia admitted to a hospital in Zhuozhou from July 2018 to June 2020 were collected as the research object. The basic data of the children were collected and pathogenic bacteria were detected to analyze the drug resistance of common bacteria. Results A total of 829 cases of children’s community-acquired pneumonia in Zhuozhou City were analyzed. The male-to-female ratio in the cases was 1.03∶1. Infants, preschool and school-age children accounted for 48.9%, 35.8% and 15.3%, respectively, and the main seasons were autumn and winter, accounting for 27.9% and 36.4%, respectively. 523 cases of pathogenic bacteria were detected positive, and the detection rate was 63.1%. The detection rate of pathogenic bacteria in community-acquired pneumonia cases of children between different ages and different seasons was statistically significant （P<0.05 or P<0.01）. Among them, the detection rate of pathogenic bacteria in infants and autumn and winter was higher. Three hundred and twenty-six strains of sputum culture bacteria were detected, of which 228 strains were Gram-negative bacteria （69.9%）, mainly Escherichia coli; 98 strains of Gram-positive bacteria （30.1%）, mainly Streptococcus pneumoniae. Serum antibodies were detected in 53 cases of Mycoplasma with a positive rate of 6.4%, and 64 cases with Chlamydia were positive with a positive rate of 7.7%. Throat swabs detected 49 cases of respiratory syncytial virus infection, with a positive rate of 5.9%, and 31 cases of influenza virus with a positive rate of 3.7%. The main Gram-negative bacteria Escherichia coli and Klebsiella pneumoniae had the highest resistance rates to ampicillin （59.5%） and cefazolin （50.6%）, and were sensitive to imipenem, cefepime, etc.; The main Gram-positive bacteria Streptococcus pneumoniae and Staphylococcus aureus had the highest resistance rates to penicillin （97.2%, 85.2%） and erythromycin （86.1%, 70.4%）, and were sensitive to vancomycin and amikacin. Conclusion Children’s community-acquired pneumonia in Zhuozhou City, Hebei Province has a high incidence of infants and young children, and a high detection rate of pathogens, antibacterial drugs should be selected reasonably according to the distribution characteristics of pathogens in children and the results of drug susceptibility tests to improve the treatment effect while preventing and delaying the drug-resistant generation of bacteria.

Key words: Community-acquired pneumonia, Children, Epidemiological characteristic, Pathogen, Drug resistance

中图分类号:

R183.3

杨新丽, 马志刚, 李晨曦. 河北省涿州市儿童社区获得性肺炎流行特征及病原菌分布[J]. 华南预防医学, 2021, 47(2): 170-173.

YANG Xin-li, MA Zhi-gang, LI Chen-xi. Epidemiological characteristics and pathogen distribution of community-acquired pneumonia in children in Zhuozhou, Hebei[J]. South China Journal of Preventive Medicine, 2021, 47(2): 170-173.

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