| BackgroudLower respiratory tract infection(LRTI)is one of the diseases with the highest incidence rate among children.It is clear that pathogens are the basis for diagnosis and treatment of infectious diseases.Children’s LRTI is mainly infected by viruses,followed by bacteria,mycoplasmas,etc.,which often presents an acute attack with rapid progress.If the clinical diagnosis basis of etiology cannot be timely and accurately obtained,it will aggravate the drug resistance crisis and lead to delayed treatment.At present,most of the same type studies in other regions in China only focus on the epidemiological characteristics of patients,such as sex,age,seasonal distribution,etc.,and the data of etiology combined with clinical characteristics analysis is insufficient;In addition,in January 2020,when the global novel coronavirus pneumonia(COVID-19)epidemic occurred,Chinese government departments quickly took a variety of epidemic prevention and control measures,which had varying degrees of impact on the incidence rate and etiology spectrum of children’s LRTI disease,and there was no such research in this region;This topic uses 14 kinds of respiratory pathogen nucleic acid detection methods of throat swab,covering the most common pathogens in children,with a wide detection range,and has the advantages of early diagnosis,fast,sensitivity and specificity.ObjectiveTo understand the etiology and clinical characteristics of LRTI children’s respiratory pathogens in Zhongshan area,and to explore the impact of prevention and control measures on the positive rate of children’s respiratory pathogen infection and the spectrum of pathogens,will help clinicians quickly predict the etiology in the early stage of disease,and guide the prevention and control of children’s respiratory diseases and clinical diagnosis and treatment.Methods(1)Subjects:Children diagnosed with LRTI(age<14 years)admitted to the Pediatric Department of Zhongshan People’s Hospital from 2019 to 2021 were collected.Informed consent was obtained from the medical guardians of the children.Patients with severe congenital organ malformations or other congenital diseases,severe heart,liver and kidney dysfunction,malignant tumors,blood system diseases and immune deficiency diseases were excluded.(2)Research methods:1)Technology roadmap:A total of 5168 qualified samples were collected from pharynx swabs of children eligible for inclusion within 6 hours after admission and before using antibiotics.14 respiratory pathogens were detected by liquid chip detection technology,including Streptococcus pneumoniae(SP),Moraxelle catarrhalis(MC),Haemophilus influenzae(Hi)Bacillus pertussis(BP),Mycoplasma pneumoniae(MP),cytomegalovirus(CMV),respiratory syncytial virus(RSV),rhinovirus(HRV),parainfluenza virus(PIV),adenovirus(AdV),influenza A virus(INF-A)Boca virus(hBov),influenza B virus(INF-B),human partial lung virus(hMPV).Judge the test results and get negative/positive results.2)Establish a database:collect all cases in different years and months,and collect general information of all cases,including hospitalization ID number,admission time,age,sex,onset season,etc;The clinical data of 14 respiratory pathogen positive cases were collected,including single or mixed infection,main symptoms,hospital stay,complications,chest imaging findings,etc.3)Grouping:Children with different pathogen positive cases were grouped according to age,sex,onset season,single or mixed infection,main respiratory symptoms,hospital stay,complications,chest imaging findings,etc.4)Statistical analysis:SPSS22.0 statistical software was used for statistical analysis.Counting data were expressed in cases(n)or percentage(%),and chi square test was used for comparison between groups;The difference was statistically significant with P<0.05.Results(1)5168 cases were finally included in this project,including 2634 cases in 2019,1052 cases in 2020,1482 cases in 2021.(2)From 2019 to 2021,the total detection rate of 14 respiratory pathogens among hospitalized LRTI children in this region was 66.52%.(3)From 2019 to 2021,the top three pathogens with the largest number of positive cases of 14 respiratory pathogens were SP,CMV and RSV.The positive rate of MP decreased significantly from 2019 to 2021.(4)There was no significant difference in the total detection of 14 respiratory pathogens between different genders(P>0.05),among which the detection rates of MC,hBov and CMV were statistically significant(P<0.05).(5)The detection rate of 14 respiratory pathogens in children of different ages was different,and the difference was statistically significant(P<0.05).The detection rate was the highest in the infant group,followed by the infant group,and the lowest in the school age and adolescent groups;The detection rate of BP and CMV was the highest in infant group;The detection rate of hBov,hMPV,SP,INF-A,MC,Hi,HRV and RSV was the highest in children group;The detection rate of AdV was the highest among preschool children;MP and INF-B had the highest detection rate in school age and adolescent children.(6)The detection rate of 14 respiratory pathogens was different in different seasons,and the difference was statistically significant(P<0.05).The detection rate was the highest in the autumn group,followed by the summer group,and the lowest in the spring group;Hi was the highest in spring group;MP,INF-B and AdV were the highest in summer group;SP,MC,RSV,hBov,CMV were the highest in autumn group;INF-A and hMPV were the highest in winter group.(7)More than 30%of the 14 cases with positive respiratory pathogens have two or more positive pathogens.(8)Among the 14 positive cases of respiratory pathogens,except CMV positive cases,fever and cough were the most common symptoms.Among the cases with symptoms of wheezing,shortness of breath and cyanosis,viral pathogens accounted for the highest proportion,especially RSV.(9)There are differences in the length of stay after infection of different respiratory pathogens,which are mainly concentrated in the 5～10 day period grouping,followed by the 0～5 day period grouping,and the period longer than 10 days is the least.Among MP and BP positive cases,the number of cases with length of stay longer than 10 days is higher than that of other pathogens.(10)More than 20%of the 14 cases with positive respiratory pathogens had complications.(11)There were different Chest imaging manifestations in 14 cases with positive respiratory pathogens,with bronchitis showing the highest proportion,followed by bronchopneumonia,and lobar pneumonia showing the least;About 50%of MP positive cases showed lobar pneumonia on imaging.Conclusion(1)In this study,we found that SP,CMV and RSV were the most common pathogens among LRTI children in Zhongshan area.(2)The detection rate of 14 respiratory pathogens was the highest in children,and the lowest in school age and adolescent children;In infants,viral infection is the main form,in children and preschool children,bacterial infection is the main form,and in school age and adolescent children,mycoplasma infection is the main form.(3)The detection rate of 14 respiratory pathogens was the highest in autumn,mainly bacterial infection in spring and autumn,and viral infection in summer and winter.(4)In RSV positive cases,the proportion of wheezing,shortness of breath and cyanosis was higher than that of other pathogens.(5)Among MP positive cases,the proportion of cases with hospitalization time>10 days was higher than that of other pathogens,and lobar pneumonia was the most common chest imaging manifestation.(6)After the outbreak of COVID-19,LRTI respiratory infection rate and pathogenic spectrum in the region have changed,among which MP,BP and AdV detection rates have decreased significantly. |
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