| Background Community acquired pneumonia(CAP)refers to the infectious pneumonia that develops outside the hospital(community),including the pneumonia that develops during the incubation period after admission after being infected with pathogens with a clear incubation period outside the hospital(community).CAP is the leading cause of death among children under 5 years of age worldwide and one of the most common infectious diseases.Identifying the pathogen of CAP remains a challenge.CAP pathogens can be either viruses or bacteria,or even virus-bacteria co-cause CAP.Recent evidence suggests that,in many cases,virus-bacterial dual infections may exacerbate the severity of CAP.For children with severe CAP,early identification of the pathogen of infection and reasonable choice of drug application are the keys to affect the treatment effect and prognosis of children with severe CAP,as well as the key to reduce the mortality.At present,the commonly used detection methods for clinical detection of pathogens include isolation and culture,antigen detection and other methods,which process is very complicated,time and labor consuming,insensitivity,cannot meet the clinical requirements for rapid diagnosis of etiology.In this study,PCR detection method--fluorescent probe fusion curve technique was used to analyze the etiology of hospitalized children with severe CAP in our PICU department,so as to quickly and accurately understand the infection pathogens of children with severe CAP,provide certain basis for clinical medication,and help to improve the prognosis of children.Objective To understand the relationship between the distribution of pathogens and age and gender in children with severe CAP in our hospital,and to conduct statistical analysis on the co-existing basic diseases,clinical manifestations and chest imaging characteristics,is conducive to the etiological diagnosis and treatment of the disease,and to provide a certain basis for clinical medication.Methods Seventy children with severe CAP hospitalized and receiving mechanical ventilation in PICU Department of our hospital from August 2019 to October 2020 were selected as the research subjects,and sputum samples in tracheal tubes were collected.Uses real-time fluorescence PCR technique to detect multiple 37 kinds of pathogens(epidermis staphylococcus,pneumonia chlamydia,staphylococcus aureus(SA),mycoplasma pneumoniae(MP),candida albicans,whooping cough bacili,rickettsia,streptococcus pneumoniae(SP),haemophilus influenzae,catarrh mora bacteria,acinetobacter baumannii,klebsiella pneumoniae,e.coli,eosinophilic lung legionella,cryptococcosis,verdigris false single spore bacillus,streptococcus pyogenes,smoke aspergillus and boca juniors,one partial pulmonary virus,parainfluenza virus Ⅲ,rotavirus,intestinal virus,parainfluenza Ⅰ,influenza a virus,nose,b respiratory syncytial virus,hepatitis b virus,swine respiratory syncytial virus,adenovirus,deputy Ⅱ influenza virus,coronavirus NL63,229 e coronavirus,coronavirus OC43,coronavirus HKU1 deputy flu virus,SARS coronavirus,Ⅳ).Microsoft Excel 2010 software package was used for data processing.SPSS26.0 statistical software was used for data analysis,and χ2 or Fisher exact probability method was used.α=0.05 was used as the test standard,and P < 0.05 was considered statistically significant.Results 1.Pathogen physical examination results Of the 70 children included in the study,pathogens were detected in 58 children,with a positive rate of 82.9%.Single pathogen infection was found in 14 cases(20.0%),and multiple pathogen infection was found in 44 cases(62.9%).The detection rate of Human parainfluenza virus(HPIVs)was the highest,with 22 cases,accounting for 31.4% of the total cases.Staphylococcus aureus,Pseudomonas aeruginosa,Respiratory Syncytial Virus(RSV)and Mycoplasma pneumoniae were detected in 14 cases each,accounting for 20.0% of the total cases.Streptococcus pneumoniae was detected in 10 cases,accounting for 14.3% of the total cases.Acinetobacter baumannii was detected in 8 cases,accounting for 11.4% of the total cases.The detection rate of Haemophilus influenzae was low in 6 cases,accounting for 8.6% of the total cases.Candida albicans and Escherichia coli were 4 cases each,accounting for 5.7% of the total cases.Klebsiella pneumoniae and Moraxella catarae were 2 cases,accounting for 2.9% of the total cases.Among the multiple pathogen infections,there were 36 cases of double pathogen infection and 8 cases of triple or above pathogen infection.In 70 children,44 cases were mixed infection,accounting for 62.9%;14 cases of virus and bacteria,accounting for 31.8%;6 cases were infected by two viruses,accounting for 13.6%.4 cases of virus with mycoplasma,accounting for 9.1%;2 cases of bacteria with fungi,accounting for 4.5%..2.Pathogenic examinations in children of different age groups The results showed that 38 cases(86.4%)of the 44 children aged from 29 days to 1 years were found to be pathogenic,and the detection rate of parainfluenza virus was the highest.Among the 12 children aged 1 to 3 years,10 cases(83.3%)were found to be pathogenic,among which Staphylococcus aureus and parainfluenza virus were the highest.Among the 14 children aged over 3 years,10 cases(71.4%)were found to be pathogenic,and Mycoplasma pneumoniae had the highest detection rate.This study showed that the total detection rate of the virus was different in different age groups,and the age distribution was mainly in younger children,of which 88.9% were children under 3 years old and 72.2% were children under 1 years old.This study showed that the main virus in children with severe CAP was Human parainfluenza virus,and the positive samples of parainfluenza virus were mainly from children aged 29 d to 1 years.3.Pathogenic examinations of children of different genders Among the 70 children included in the study,there were 40 males and 30 females,and the difference in pathogen physical examination was not statistically significant.4.The coexistence of basic diseases in children There were 60 cases(85.7%)of children with basic diseases,including 48 cases of anemia and malnutrition(80.0%),26 cases of congenital heart disease(43.3%),18 cases of genetic metabolic diseases(30.0%),12 cases of nervous system diseases(20.0%),8 cases of hypothyroidism(13.3%),4 cases of pulmonary dysplasia and congenital airway malformation(6.7%),and 4 cases of other diseases(6.7%).5.Clinical manifestations In this study,70 cases of clinical manifestations of three concave positive and purple purple 44 cases(62.9%),lung auscultation then 44 cases(62.9%),shortness of breath 36 cases(51.4%),30 cases(42.9%)of fever,24 cases(34.3%)of cough,20 cases(28.6%)of lung auscultation wheezing,14 cases(20.0%)of convulsions,lethargy,or coma,14 cases(20%)of hepatomegaly,low heart sounds blunt 6 cases(8.6%),4 cases(5.7%)of vomiting,decreased breath sounds in 4 cases(5.7%),reduced the volume of urine in 2 cases(2.9%). In this study,chest radiographs of 70 children showed lung consolidation in 30 cases(42.9%),atelectasis with pleural effusion in 22 cases(31.4%),ARDS in 6 cases(8.6%),pulmonary hemorrhage in 6 cases(8.6%),diffuse interstitial exudative changes in 6 cases(8.6%),pneumothorax in 4 cases(5.7%),patchy changes in 4 cases(5.7%),and emphysema in 2 cases(2.9%).6.Chest Imaging(Chest X-ray)Conclusions 1.Viruses detected in the sputum of tracheal tubes of children with severe CAP in our hospital were parainfluenza virus and respiratory syncytial virus in order.2.The top three bacteria were Staphylococcus aureus,Pseudomonas aeruginosa and Streptococcus pneumoniae.3.The mixed detection rate of various pathogens was 62.9%,among which the mixed detection rate of bacteria and virus was the most common. |
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