| Object: To understand the pathogen distribution characteristics of severe community-acquired pneumonia(SCAP) in 150 children in Guiyang region.Methods:Clinical data of 150 children with SCAP and hospitalized in Department of Respiratory and Critical Care Medicine of Guiyang Children’s Hospital from February 2014 to February 2015 was collected.Secretions of lower respiratory tract of these children were sampled by taking bronchoalveloar lavage fluid with bronchoscope or by mechanical ventilation through tracheal intubation, which were then made for bacterial culture and drug sensitive test. Real-time PCR was performed to detect the human bocavirus(h B0V) and human metapneumovirus(h MPV); while immunofluorescence method was adopted to detect the syncytial virus(RSV), influenza virus(IFV), parainfluenza virus(HPIV), adenovirus(ADV) and other respiratory virus. Moreover, the mycoplasma pneumoniae(MP) and chlamydia pneumoniae(CP) were tested quantitatively with PCR fluorescence probe method, at the same time the MP, CP and other pathogens in serum were tested. Results:(1) 137 children with SCAP were examined as positive in pathogen, with positive rate of 91.33%(137/150), including 42 cases of single bacterial infection, 29 cases of virus infection,29 cases of atypical pathogen and 37 cases of mixed infection. The detected pathogen cases were 176, among which, 72 cases were detected with virus, 66 cases with bacteria, 38 cases with atypical pathogen, accounting for 52.55%, 48.18% and 27.74%, respectively;(2) the most common virus infections were RSV, HB0 V and ADV,with detection rates of 43.06%(31/72), 27.78%(20/72) and 18.06%(13/72), respectively;(3) Among bacterial infections, gram-positive(G+) bacteria mainly manifested streptococcus pneumonia and staphylococcus aureus, with detection rates of 42.42%(28/66) and 15.15%(10/66), respectively.Most common strains of Gram-negative bacteria(G-) were Escherichia coli and Klebsiella pneumoniae, with detection rates of 18.18%(12/66), 18.18%(12/66), respectively.The results of drug sensitivity showed that the streptococcus pneumonia, staphylococcus aureus and Escherichia coli and Klebsiella pneumonia were highly drug resistant to Penicillins and first-, second- and third-generation cephalosporin antibiotics, while was highly sensitive to the Piperacillin/Tazobactam, Carbapenems and Vancomycin.(4) The positive rates of MP and CP were 26.28%(36/137) and 1.46%(2/137), respectively.(6) Distribution of pathogen positivity by different ages and months:0-12 months of age had the highest rate of viral positivity. The detection rate of MP was highest in children aged from 3 to 6 years. RSV,HBo V and ADV infections were focused primarily on winter and spring.(7) There were 37 cases were found with mixed infection, accounting for 27.01%(37/137), among which, the mixed infection of bacteria-virus were common, accounting for 48.64%(18/37).Conclusion:(1) There’re great varieties of pathogens for children SCAP, which involve virus, bacteria and mycoplasma pneumonia, with high incidence rate of virus-bacteria mixed infection,hence, keeping abreast of pathogens of children SCAP is of great importance for its prevention and treatment.(2)RSV, HB0 V and ADV are the major viral pathogens of hospitalized children with SCAP in Guiyang region.Streptococcus pneumonia, staphylococcus aureus, Escherichia coli and Klebsiella pneumonia are the major bacterial pathogens for these SCAP children.Piperacillin/Tazobactam or Carbapenems and/or Vancomycin are recommended for the initial treatment of SCAP of bacterial infection.(3) 0-12 months of age has the highest rate of virus infectionrate, occurring primarily on winter and spring, and the positive rate of MP is highest in children aged from 3 to 6 years.(4) HB0 V is one of the important pathogens and HMPV may not be the important pathogenfor children with SCAP in Guiyang region. [Key Words] children; severe community acquired pneumonia; etiology... |
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