Analysis Of 272 Cases Of Severe Community Acquired Pneumonia In Children In Chongqing

Objective: To investigate the clinical characteristics of severe community-acquired pneumonia (CAP) in children in chongqing area, understanding the effect of various treatment measures for severe childhood pneumonia, in order to provide theoretical evidence for clinical diagnogsis and treatment.Methods: Collected and statistical analyzed the clinical data of 272 children with severe CAP in children, who were admitted in Chongqing Children's Hospital from december 2008 to November 2009, including the distribution of pathogens and drug resistance of bacteria, the basic diseases, show of bronchofibroscope and imaging, assistant examination, treatment measures and prognosis.Results: (1) In 272 cases, infants and toddler account for 93.8%, 65.5% of patients were onset in fall and winter. (2) In these 262 cases which were detected for pathogens, the positive rate was 88.9%. The rate of only virus infection and only bacteria was 20.6%, 22.1%, the rate of mixed infection of virus and bacteria was 40.1%, and the mixed infection of MP/CT with other pathogens account for 6.1%. G(-) bacteria were the main pathogens (68.7%), the major pathogens were as follows: E. coli, Hpi, SP, PA. E. coli and KP had high resistance to other antibiotics beside piperacillin / tazobactam, meropenem, imipenem and amikacin. The resistance rate of SP to erythromycin, azithromycin and clindamycin was 96.2%, and 88.5%, 84.6% to penicillin, cotrimoxazole. The main virus were RSV, CMV, Adv and PIV. (3) 54.4% of patients had basic diseases, in which congenital heart disease account for 61.5%, respiratory diseases account for 32.4%. (4) 81.6% of children with respiratory failure, heart failure accounted for 7.4%. (5) All tracheobronchomalacia were found by bronchofibroscopy, all pulmonary artery sling were found by airway reconstruction. (6) The efficiency of empirical therapy group was significantly higher than another group which were changed to specific therapy after ineffective empirical therapy, and the difference was statistically significant. There were statistical significant differences of efficiency between groups of hormone and non-hormone therapy, mechanical ventilation and non-mechanical ventilation, vasoactive drugs therapy and non-vascular active drug therapy. The efficiency of supportive treatment was better than non-supportive treatment , but the difference was not statistically significant.Conclusions: (1) Infancy and toddler are the major patients of childhood severe CAP in Chongqing area, autumn and winter is the peak incidence. Respiratory failure is the most common severe manifestations. Most patients have basic diseases, and the first one is congenital heart disease, follows by respiratory diseases. The detection rate of bacteria is slightly higher than virus, RSV is the major viral pathogen. The main pathogens are G(-) bacteria, the condition of antibiotic resistance is serious. For those who are still ineffective after treatment of third-generation cephalosporins, meropenem and imipenem may be the best choice of antibiotics, and vancomycin can be used when necessary. We should choose bronchofibroscopy and / or chest CT, airway reconstruction to identify etiopathogenisis, if therapeutic effect is not good by regular antiinfective treatment. (2) Comprehensive treatment should be emphasized in the therapy of childhood severe pneumonia. Reasonable selection of initial antibiotic is critical for improving the prognosis of severe pneumonia. Clinicians should be based on the clinical conditions of patients, epidemiological features of local pathogens and antibiotic susceptibility test when choosing the initial empirical drug. In the effective treatment of antibiotics, a reasonable, short-term use of small doses of hormones can improve the prognosis. Vasoactive drug and supportive therapy can improve the curative effect. Mechanical ventilation should be used timely if children develop serious breathing disorders.