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目的了解住院患儿社区获得性肺炎(CAP)的病原谱及病原流行特点。方法回顾性收集2012年12月至2013年11月首都医科大学附属北京儿童医院(我院)确诊的CAP患儿,采集性别、年龄、入院前抗病原治疗情况、入院时间、病原学诊断等资料,分析不同年龄、季节病原构成及流行特点。结果 1 853例CAP患儿总体病原检出率为78.1%,入我院前均有抗生素应用史。细菌检出率27.0%,前3位依次是肺炎链球菌、流感嗜血杆菌和肺炎克雷伯菌;病毒检出率为22.5%,以呼吸道合胞病毒(RSV)和腺病毒(ADV)最常见;肺炎支原体检出率为48.7%;混合感染检出率为23.0%,以细菌合并病毒感染最多见。2随着年龄增长单一细菌或病毒感染的比例呈明显下降趋势,肺炎支原体感染的比例呈现明显上升趋势,多种病原混合感染或无明确病原感染比例随年龄增长亦有所降低;肺炎链球菌感染多见于3岁以下婴幼儿(75.9%);流感嗜血杆菌(75.0%)和肺炎克雷伯菌感染(68.4%)多见于婴儿。RSV感染多见于婴儿(76.2%),ADV感染多见于3岁以下婴幼儿(82.2%)。3单一细菌感染春季最多见,冬季次之;单一病毒感染冬季多见;单一肺炎支原体感染秋季最多见,夏季次之;多种病原混合感染以冬春季多见;无明确病原感染在春季最高。肺炎链球菌感染多见于冬春季,流感嗜血杆菌感染多见于春季,肺炎克雷伯菌感染多见于冬春季,RSV感染多见于冬季,ADV感染以冬春季多见。结论CAP的病原谱构成存在显著的年龄和季节分布特点。细菌、病毒感染多见于婴儿,肺炎支原体感染多见于5岁以上患儿,多种病原混合感染以婴儿最多见。细菌感染冬春季多见,病毒感染冬季多见,肺炎支原体感染多发生于夏秋季;多种病原混合感染多见于冬春季。
Objective To understand the etiology and pathogenic features of community-acquired pneumonia (CAP) in hospitalized children. Methods Retrospectively collected CAP children diagnosed at Beijing Children’s Hospital Affiliated to Capital Medical University from December 2012 to November 2013. The gender, age, anti-pathogen treatment before admission, admission time, etiological diagnosis and so on Data, analysis of different age and season pathogenic composition and epidemiological characteristics. Results The overall prevalence of CAP in 1 853 CAP children was 78.1%. All antibiotics were used in our hospital before. The detection rate of bacteria was 27.0%, the first three followed by Streptococcus pneumoniae, Haemophilus influenzae and Klebsiella pneumoniae; the detection rate of virus was 22.5%, the highest was respiratory syncytial virus (RSV) and adenovirus Common; Mycoplasma pneumoniae detection rate was 48.7%; mixed infection was detected in 23.0%, the most common bacterial infection with virus. 2 As the proportion of single bacteria or virus infection decreased obviously with age, the proportion of Mycoplasma pneumoniae infection showed a clear upward trend. The proportion of multiple pathogenic mixed infection or no definite pathogen infection also decreased with age. Streptococcus pneumoniae infection More common in infants under 3 years of age (75.9%); Haemophilus influenzae (75.0%) and Klebsiella pneumoniae infection (68.4%) more common in infants. RSV infection more common in infants (76.2%), ADV infection more common in infants under 3 years of age (82.2%). Single bacterial infection is most common in spring, followed by winter; a single virus infection is more common in winter; a single mycoplasma pneumonia infection is most common in autumn and summer; a mixed infection of many pathogens is more common in winter and spring; and no clear pathogen infection is highest in spring. Streptococcus pneumoniae infection more common in winter and spring, Haemophilus influenza infection more common in spring, Klebsiella pneumoniae infection more common in winter and spring, RSV infection more common in winter, ADV infection more common in winter and spring. Conclusion The pathogenic spectrum of CAP has significant age and seasonal distribution. Bacteria, viral infections more common in infants, Mycoplasma pneumoniae infection more common in children over the age of 5, a variety of pathogenic mixed infection most common in infants. More common in winter and spring bacterial infections, viral infection more common in winter, Mycoplasma pneumonia infection occurs in summer and autumn; mixed infection more common in winter and spring.