Etiological And Clinical Analysis Of176Cases Of Children With Severe Pneumonia

ObjectivePneumonia is the common infection in the childhood, especially in infants andyoung children, is the leading cause of hospitalization among children, is also themain reason for children under5years old to death. The etiology of pneumonia isassociated with the age and season of onset, and there is regional difference. Earlycorrectly empiric treatment can reduce the mortality of pneumonia, especially severepneumonia. This study selected the hospitalized children in PICU with severepneumonia in Children’s Hospital of Dalian as subject investigated and learn theetiology of children with severe pneumonia in Dalian area, in order to providetheory basis for clinical empirical therapy before clear etiology,and if there is acorrelation between the existence and severe pneumonia and basis of diseasecomplications.MethodAdopt retrospective analysis, statistics176cases of severe pneumonia in children withPICU hospitalization in Children’s Hospital of Dalian from January1,2013toDecember31,2013. Objects in this study are adopted on the basis of Pediatricsrespiratory study group of the Chinese Medical Association, and diagnosis criteria areformulated in light of China’s actual situation of severe pneumonia. Collect sampleswhen children diagnosed as severe pneumonia in24hours, detect11kinds ofcommon virus antibody and antibody of Mycoplasma pneumoniae by blood andsputum culture, count the results of pathogen test and the age and season of onset. Atthe same time statistics with underlying diseases and complications and existenceAnalyse the relationship between pathogen and age and season of onset of severecommunity acquired pneumonia.Results 1. The distribution of age and season onset in groups:babyhood:102people(58%),infancy:39(22.1%),perschool age:28(15.9%),school age:7(4.0%).Spring:52(29.5%),summer:36(20.5%),autumn:41(23.3%),winter:47(26.7%).2. The positive rate of various pathogens:(1) Bacteria: Sputum culture was done in all cases, bacterial infection22.2%.39strains were detected in all strains, the top three strains were Klebsiella pneumoniae,Stenotrophomonas maltophilia, Staphylococcus aureus. Blood culture were done in80cases, bacterial infection31.2%.30strains were detected in all strains.(2) Virus: the detection rate was16.5%, among which respiratory syncytial virus(RSV) infection give the first place.(3) Mycoplasma pneumoniae: the detection rate was9.7%.(4) Fungal infection: the detection rate by Sputum culture was8.0%.(5) Mixed infection:there were30cases with mixed infection, among which themixed bacterial infection are the most, accounting for50%.3. The constituent ratio of different age of onset of various pathogens in children withSCAP:Infancy, childhood, preschool children, school-age children of bacteria, virus, MP andfungi infection rates were51%,26%,12%,11%,65%,22%,0%,33%,24%,29%,14%,58%,17%,17%and8%.4. The constituent ratio of various pathogens in children with SCAP in differentseasons:The bacterial infection rate was more than50%in different seasons, the highest virusinfection rate is28%in the winter season, the highest MP infection rate was inautumn,26%, the fungal infection rate was below15%in the four seasons.5. In all cases there were58cases (33.5%) with congenital heart disease, in whichcase the most, accounting for55.2%(32/58), the incidence rate of18.2%(32/176),followed by congenital dysplasia of the respiratory system.6. In all cases complications showed respiratory failure, heart failure, sepsis, septicshock, pleural effusion, toxic encephalopathy, acid-base and electrolyte disturbance,respectively of the total cases number of90.0%(158/176),64.8%(114/176),44.9%(79/176),9.7%(17/176),(17/176),8.5%(9.7%15/176) and4.5%(8/176).Conclusions 1. Bacterial infection is mainly of children with severe community acquiredpneumonia. The sputum culture is mainly by the gram negative bacillus, and theblood culture is mainly by the gram positive coccus. Klebsiella pneumoniae is thefirst in the gram negative bacillus, and Staphylococcus hominis is the most in thegram positive coccus. About50%of the severe community acquired pneumoniahave mixed infection.2. Virus infection has a large proportion in babyhood and infancy, among whichrespiratory syncytial virus (RSV) infection give the first place. Virus infection rateis higher in winter.3. The rate of mycoplasma infection is higher in preschool age and autumn.4. The proportion of fungal infection are lower in all ages and each season.5. Basic diseases associated mainly with congenital anomalies, especially incongenital heart disease. SP children of complications including respiratory failure,heart failure.6. Congenital heart disease in children with severe pneumonia can make increasedrates of heart failure.