Epidemiological Analysis Of Atypical Severe Community Acquired Pneumonia In PICU

Objective:Community-acquired pneumonia is an infectious disease with the highest prevalence and mortality of children under the age of 5 in China and the world,which is a serious threat to the health of children,and is currently lacking in rapid and rapid pathogenic microorganism detection means.In this study,a nested PCR method was chosen to detect the pathogenic factors of 11 common respiratory pathogens and to understand the pathogenic features of common pediatric community acquired pneumonia to help clinicians to identify the pathogens and to select appropriate antibiotics as soon as possible to avoid drug abuse.Methods:From January 2017 to June 2018,120 children who were diagnosed as severe community acquired pneumonia in the intensive care unit of Shengjing Hospital affiliated to China Medical University were selected,and 120 cases of non-bacterial infection were selected.The FilmArray RP test strip was used to detect the respiratory tract pathogenic nested PCR.According to sex,place of residence,age and season,the positive rates of common respiratory viruses and atypical pathogens were counted to understand their epidemiological characteristics.Results:1)The total positive rate of pathogen was 74.2%.10.8%of hospitalized children had mixed infection.The highest positive rate was respiratory syncytial virus in26 cases(21.7%),influenza A virus in 22 cases(18.3%).Parainfluenza virus 16 cases(13.3%);The most common pathogen of mixed infection were rhinovirus(5/13,38.5%)?parainfluenza virus(5/13,38.5%).There were 6 cases of mycoplasma pneumoniae(5.0%)and 10 cases of pertussis positive(8.4%).(2)There was no significant difference in the distribution of each pathogen among the groups of sex and place of residence.(3)The highest detection rate of respiratory syncytial virus was 42.2%(19/45)in infants with>28 days,followed by pertussis 22.2%(10/45).The highest detection rate of influenza A virus was 36.7%(11/30)in the age group of 1 to 5 years old.The highest detection rate of influenza A virus was 42.9%(6/14),followed by adenovirus 28.6%(4/14)and mycoplasma pneumoniae 21.4%(3/14).The infection of influenza A virus(P=0.029),mycoplasma pneumoniae(P=0.014)and adenovirus(P=0.002)increased with the increase of age.Respiratory syncytial virus(P=0.001)and pertussis bacilli(P=0.002)infection decreased with age,the difference was statistically significant.(4)According to season,the positive rate of pathogen in spring and winter was the highest(85.7%,85.3%),and the lowest was 50%in summer,respectively(?~2=45.908,P=0.001).The positive rates of pathogen in spring and winter were 85.7%,85.3%and 50%,respectively.The highest positive rate of pathogen in spring was parainfluenza virus(8/30,26.7%)and respiratory syncytial virus(7/30,23.3%).In winter,the highest positive rate was respiratory syncytial virus(15/29,51.7%).Influenza A virus(14/29,48.3%).Conclusion:1.The positive rate of pathogenic diagnosis of severe community acquired atypical pneumonia was higher than that of the respiratory tract test strip v1.7 of FilmArray detection system.2.Respiratory syncytial virus,influenza A virus and parainfluenza virus were the main pathogens of severe community acquired atypical bacterial pneumonia in PICU of the Shengjing Hospital from 2017 to 2018.3.With the age grow up of children with severe community-acquired pneumonia,the virus infection rate gradually decreased.4.Winter and spring are high incidence seasons of severe community-acquired pneumonia and atypical venereal infection.5.The effect of rhinovirus infection on severe community-acquired pneumonia may be overestimated in more severe children with influenza A and Mycoplasma pneumoniae infection.