The Etiology Of Children With Severe Pneumonia And The Impact Of Early Clinical Indicators On Their Prognosis

Part Ⅰ:Investigate the etiology and antibiotic resistance in children with Severe PneumoniaObjective:To investigate the etiology and antibiotic resistance in children with Severe Pneumonia in Nanjing Children Hospital.Methods:One hundred and ninety-eight cases of children with severe pneumonia in Nanjing Children Hospital were collected.In order to analysis the epidemic characteristics of pathogens and the antibiotic resistance of major bacteria.Their nasopharyngeal aspirates and blood were collected.We were use their nasopharyngeal aspirates to carry out bacterial culture,drug sensitivity test and pathogeny qPCR detection.We were use their blood to carry out mycoplasma IgM antibody titer detection.Results:At least one type of pathogen was detected in 141 patients out of 198 patients and the overall positive rate was 71.2%.115 strains bacteria were detected(58.08%),including 84 strains of Gram negative bacteria(42.42%),31 strains of Gram positive bacteria(15.66%).Virus were 86 strains(43.43%),atypical pathogens were 47 strains(23.74%).The most bacteria was acinetobacter baumannii,21 strains(10.61%).The most virus was rhinovirus,21 strains(10.61%).The most common pathogen was mycoplasma pneumoniae,31 strains(15.66%).64 caese of children had the fixed pathogen infection,the rate was 32.32%.The detection rate of virus,rhinovirus and atypical pathogens had correlation with season.The detection rate of bacteria,gram-negative bacteria,parainfluenza virusⅢ,atypical pathogens and mycoplasma pneumoniae had the correlation with age.Bacteria,acinetobacter baumannii,pseudomonas aeruginosa,burkholderia cepacia aslo had a certain relationship with prognosis.Drug sensitivity test showed that The resistance rates of Gram negative bacteria to penicillin,the first and second generation cephalosporins was higher,and they can also resist to the third and fourth generation cephalosporins and carbapenems in some degree.Conclusion:The largest number of pathogens in children with severe pneumonia were bacteria,The major bacteria were Gram negative bacteria.Most bacteria were resistant to many kinds of antimicrobial agents and the situation was not optimistic.Atypical pathogens have some certain epidemic rules.Some pathogens were have the correlation with season,age and the prognosis of severe pneumonia.Part Ⅱ:Research on the effect of early clinical indicators on the prognosis of severe pneumonia in childrenObjective:To evaluate the value of combining PCT,BNP,D-Dimer and PCIS score in predicting the prognosis of pediatric severe pneumonia in the early stage.Methods:Select 80 cases of children with severe pneumonia as the research object,record the score of PCIS,PCT,BNP and D-Dimer within 24 hours after admission.According to the score of PCIS,PCT,BNP and D-Dimer;draw ROC curve respectively,then draw ROC curve integrated the four indicators,calculate the areas under ROC curve(AUC)respectively,compare the accuracy of the assessmentResults:The AUC of PCIS,PCT,BNP and D-Dimer were 0.741、0.786、0.721、0.794 respectively,sensitivity were 69%、75.9%、72.4%、62.1%respectively,and specificity were 80.4%、76.5%、72.4%、86.3%respectively.the ROC curve integrated the four indicators show the AUC were 0.932,sensitivity were 93.1%,specificity were 84.3%.Conclusion:Through PCIS,PCT,BNP and D-D:imer can predict the prognosis of pediatric severe pneumonia in some degree.But the integration of PCIS,PCT,BNP and D-Dimer could improve the accuracy of the assessment.