儿童重症社区获得性肺炎的病原学分析

发布时间：2018-01-11 03:19

  本文关键词：儿童重症社区获得性肺炎的病原学分析　出处：《大连医科大学》2017年硕士论文　论文类型：学位论文

  更多相关文章： 儿童 重症 社区获得性肺炎 病原学

【摘要】：目的:儿童重症肺炎及其并发症,尤其是全身炎症反应和多器官功能障碍,是威胁患儿健康和生命的主要原因。许多研究证实不同地区的病原谱有较大的差异,但在疾病的早期,难以获得明确的病原结果,需进行恰当的经验性用药。本文通过对近3年在我院住院的重症社区获得性肺炎患儿的血清呼吸道病毒抗体、肺炎支原体及衣原体抗体、痰培养、血培养、肺泡灌洗液培养等病原结果进行统计,分析大连地区重症社区获得性肺炎患儿的病原学特点,以便指导临床工作。方法:选取2014年1月至2016年12月在大连市儿童医院住院的550例重症社区获得性肺炎患儿,回顾性分析其病原资料。入选患者均符合重症社区获得性肺炎诊断标准。入院24小时内完成患儿气道深部痰培养、不同部位血培养、血清常见呼吸道病毒抗体IgM、血清肺炎支原体及衣原体抗体IgM标本采集,并尽快送检,统计上述病原结果及部分患儿的肺泡灌洗液病原检测结果,同时记录一般资料及合并并发症情况。另外,分析不同年龄组(29天～12月、～36月、～72月、～168月)、不同季节(春季、夏季、秋季、冬季)病原体的差异。采用SPSS 20.0软件对所有数据进行统计学分析。结果:1.病原体总阳性率为58.2%,其中细菌感染为35.3%,混合感染20.3%,非典型病原体感染20.0%,病毒感染为15.6%,真菌感染8.8%。2.550例均行痰培养,检出病原177株,细菌142株(80.2%),革兰氏阴性菌、革兰氏阳性菌分别为97株(54.8%)、45株(25.4%),其中肺炎克雷伯杆菌32株、大肠埃希菌25株、金黄色葡萄球菌19株;真菌35株,其中白假丝酵母菌31株。3.345例行血培养,检出病原112株,细菌为102株(91.1%),革兰氏阴性菌、革兰氏阳性菌分别为60株(53.6%)、42株(37.5%),其中肺炎克雷伯杆菌21株、肺炎链球菌16株、鲍曼不动杆菌15株;真菌10株,其中白假丝酵母菌8株。4.100例留取肺泡灌洗液(BALF)进行病原学检测,共检出病原38株,细菌最常见,为25株(65.8%),革兰氏阴性菌、革兰氏阳性菌15株(39.5%)、10株(26.3%),其中鲍曼不动杆菌9株、肺炎链球菌8株;肺炎支原体13株(34.2%)。5.550例均行血清肺炎支原体及衣原体、血清常见呼吸道病毒抗体IgM检测,共检出非典型病原112株、病毒88株,前者中肺炎支原体96株,后者中呼吸道合胞病毒31株、巨细胞病毒17株。6.29天～12月组中细菌占68.2%、病毒占22.3%,～36月组中细菌占29.8%,非典型病原占40.5%,～72月组中非典型病原占67.3%。7.夏季中细菌占61.3%,秋季非典型病原占42.9%,冬季中细菌占49.7%。结论:1.大连地区儿童重症CAP病原依次为细菌、肺炎支原体、病毒、真菌,细菌以肺炎克雷伯杆菌、肺炎链球菌为主,病毒则以呼吸道合胞病毒为主,根据病原谱可更恰当选择药物。2.病原谱因发病年龄和季节而有所不同,因此,应尽早获得病原结果,以更好指导临床。
[Abstract]:Objective: severe pneumonia in children and its complications, especially systemic inflammatory reaction and multiple organ dysfunction, are the main causes that threaten children's health and life. However, in the early stage of the disease, it is difficult to obtain a definite result of the pathogen, so it is necessary to carry out appropriate empirical drug use. This article reports the respiratory virus antibodies in the serum of the children with severe community-acquired pneumonia who were hospitalized in our hospital in recent three years. The pathogenic results of mycoplasma pneumoniae and chlamydia pneumoniae antibody, sputum culture, blood culture and alveolar lavage fluid culture were analyzed and the etiological characteristics of children with severe community-acquired pneumonia in Dalian area were analyzed. Methods: from January 2014 to December 2016, 550 children with severe community acquired pneumonia in Dalian Children's Hospital were selected. Retrospective analysis of the pathogenic data. Selected patients were in line with the criteria for the diagnosis of severe community-acquired pneumonia. 24 hours after admission, the children completed the deep airway sputum culture, different parts of blood culture. The common respiratory virus antibody IgM, the serum mycoplasma pneumoniae and chlamydia antibody IgM samples were collected and submitted to the laboratory as soon as possible. The results of the above pathogens and some of the children's alveolar lavage fluid pathogens were counted. At the same time, the general data and complications were recorded. In addition, 29 days to December ~ 32 ~ 72 ~ 16 August were analyzed in different age groups, different seasons (spring, summer and autumn). SPSS 20.0 software was used to analyze all the data. Results: 1. The total positive rate of pathogens was 58.2, in which bacterial infection was 35.3%. 20. 3% mixed infection, 20. 0% atypical pathogen infection, 15. 6% virus infection, 8. 8% fungus infection and 2. 550 cases of fungal infection were all treated with sputum culture and 177 strains of pathogen were detected. There were 142 strains of bacteria including 80.2%, gram-negative and gram-positive respectively 97 strains (54.8%) and 45 strains (25.4%), among which 32 strains were Klebsiella pneumoniae (Klebsiella pneumoniae). 25 strains of Escherichia coli and 19 strains of Staphylococcus aureus; Among 35 strains of fungi, 31 strains of Candida albicans. 3.345 were routinely cultured in blood. 112 strains of pathogenic bacteria were detected, and 102 strains of bacteria were found to be 91.1%, Gram-negative bacteria. There were 60 strains of Gram-positive bacteria and 42 strains of Klebsiella pneumoniae, 16 strains of Streptococcus pneumoniae and 15 strains of Acinetobacter baumannii. 10 strains of fungi, 8 strains of Candida albicans. 4.100 cases of BALF were collected from alveolar lavage fluid to detect the pathogens, 38 strains of pathogens were detected, the most common bacteria were found. There were 25 strains of Acinetobacter baumannii, 9 strains of Gram-negative bacteria, 15 strains of Gram-positive bacteria and 10 strains of Acinetobacter baumannii, 8 strains of Streptococcus pneumoniae. All 13 strains of Mycoplasma pneumoniae were detected by serum mycoplasma pneumoniae and chlamydia pneumoniae, and 112 strains of atypical pathogens were detected by IgM. There were 88 strains of virus, 96 strains of Mycoplasma pneumoniae, 31 strains of respiratory syncytial virus, 17 strains of cytomegalovirus, 68.2% of bacteria and 22.3% of virus. In the group of ~ 36 months, bacteria accounted for 29.8%, atypical pathogens accounted for 40.5% and non-typical pathogens accounted for 67.3% in the group of 72.The bacteria accounted for 61.3% in summer. In autumn, atypical pathogens accounted for 42.9 and in winter, bacteria accounted for 49.7. Conclusion: 1. Severe CAP pathogens of children in Dalian are bacteria, mycoplasma pneumoniae, viruses and fungi in turn. Klebsiella pneumoniae, Streptococcus pneumoniae, respiratory syncytial virus as the main bacteria, according to the pathogenic spectrum can be more appropriate to choose drugs .2.The pathogenic spectrum varies according to onset age and season, therefore. The pathogenic results should be obtained as soon as possible in order to better guide clinical practice.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R725.6
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本文编号：1407920