Clinical Analysis Of Respiratory Tract Infenction Readmission In 37 Children With Bronchiolitis Obliterans

Objective: To summarize the clinical data of 37 children with bronchiolitis obliterans(BO)readmission due to respiratory tract infection.Methods: The clinical data of 140 BO children readmission due to respiratory tract infection were retrospectively analyzed.Results: Among the 37 cases of BO,27 cases were males(73.0%)and10 were females(27.0%).A total of 140 cases were readmitted due to respiratory tract infection,including 77 cases(55.0%)aged under 3 years,37 cases(26.4%)aged were equal or greater than 3 years and less than 6years,and 26 cases(18.6%)aged more than 6 years.There were 54 cases(46.15%)of sputum culture positive in the group with equal or greater than3 times of readmission,among which 19 cases(35.12%)were positive for pure gram-positive cocci,30 cases(55.56%)were positive for pure gram-negative bacilli.There were 13 cases(56.52%)of positive sputum culture in the group with less than 3 times of readmission,among which 6cases(46.15%)were positive for pure gram-positive cocci,7 cases(53.85%) were positive for pure gram-negative bacilli.In the group with equal or greater than 3 times of readmission,84 cases(78.50%)were negative for seven respiratory tract viruses,and 23 cases(21.50%)were positive.In the group with less than 3 times of readmission,11 cases(50.00%)were negative for seven respiratory tract viruses and 11 cases(50.00%)were positive.The mean length of hospitalization in the group with equal or greater than 3 times of readmission was 7.36±3.934 days,and the mean length of hospitalization in the group with less than 3 times of readmission was 9.04±7.559 days.There was no statistically significant difference in the length of hospitalization between the two groups(t=1.570,P=0.119 > 0.05).The average hospitalization time of etiology negative group was7.02±3.772 days,the average hospitalization time of pure positive virus group was 8.75±5.145 days,the average hospitalization time of pure positive sputum culture group was 7.24±3.618 days,the average hospitalization time of virus and sputum culture both positive was11.00±8.970 days,the hospital stay of sputum culture and virus both positive was longer than virus positive group,and it was statistically significant difference(t = 2.441,P = 0.017 < 0.05).The hospital stay of sputum culture and virus both positive group was longer than that in the pathogen negative group,and the difference was statistically significant(t=2.463,P=0.017 < 0.05).In the group with less than 3 times of readmission,there were 5 cases of gram-negative bacteria,and the top 5 drug susceptibility respectively were tetracycline,chloramphenicol,rifampicin,azithromycin and ceftriaxone.There were 5 cases of grampositive bacteria,the top 5 drug susceptibility respectively were moxifloxacin,amoxicillin,cotrimoxazole,rifampicin and linezolidrina.In the group with equal or greater than 3 times of readmission,there were 25 cases of gram-negative bacteria,and the top 5 drug susceptibility respectively were rifampicin,chloramphenicol,ofloxacin,tetracycline and amoxicillin.There are 17 cases of gram-positive bacteria,the top 5 drug susceptibility respectively were vancomycin,moxifloxacin levofloxacin,ceftriaxone,and linezolidrina;There were 5 cases of gram-negative bacteria and gram-positive bacteria,and the top 5 drug susceptibility respectively were cotrimoxazole,amoxicillin,ofloxacin,cefotaxime and vancomycin.In this study,the radiographic findings of BO children readmission were as follows: in the group with less than 3 times of readmission,the common findings were bronchiectasis(66.67%),inflatable inequality(60.00%),thickening of bronchial wall(46.67%),Mosaic sign(26.67%),and strip shadow(26.67%).In the group with equal or greater than 3 times of readmission,the common findings were inflatable inequality(43.66%),thickening of bronchial wall(32.39%),bronchiectasis(28.17%),atelectasis(25.35%),Mosaic sign(22.54%),increased or(and)blurred of lung marking(22.54%).In the group with less than 3 times of readmission,10 patients underwent pulmonary function examination.In the group with equal or greater than 3 times of readmission,33 patients underwent pulmonary function examination,and the abnormal pulmonary function finding of readmission children between the two groups was statistically significant(c2=6.175,P=0.013 < 0.05).Conclusion: Virus infection was rare in the group with equal or greater than 3 times of readmission of BO children.No matter how many times of readmission,the sputum culture of children with BO was mostly infected with gram-negative bacilli,which could be used to guide clinical medication and course of treatment,and gram-negative bacilli infection affected the prognosis.Due to the use of quinolones in children is contraindicated,rarely use in children,so a lot of antibiotics in the front of the drug sensitivity test are not selected,this study chose azithromycin most,because it not only has antibacterial effect,but also has anti-inflammatory effect.Secondly,penicillin and cephalosporin antibiotics are commonly used in clinical.Cephalosporin antibiotics,especially the second generation of cephalosporin and the third generation of cephalosporin,are mainly used in this study.If there is no remission after clinical treatment,then the sensitive antibiotic treatment is adjusted according to sputum culture susceptibility test.The hospital stay of the sputum culture and virus-positive group was longer than that of the virus-positive and virus-negative groups.Maybe it related to the complex mechanism of lung damage caused by mixed infection of bacteria and virus.BO readmission children with common abnormal imaging findings for inflatable inequality,Mosaic sign,bronchiectasis,patchy dense shadow and bronchiectasis,were more common in the group with less than 3 times of readmission.The reasons may be associated with fewer children do chest imaging examination,it also may be related to some patients in the acute stage of disease,in the future work we should do long-term follow-up study and further multicenter large sample clinical study to support.The common pulmonary dysfunction of BO readmission children was obstructive ventilation dysfunction,which was mostly seen in the group with less than3 times of readmission.In the group with equal or greater than 3 times of readmission,the pulmonary function examination showed mixed ventilation dysfunction,which reminded us to strengthen the care of children with BO to reduce the chance of infection,so as to reduce the damage of lung function.