下呼吸道感染患儿支气管肺泡灌洗液的病原学研究

Pathogens in bronchoalveolar lavage fluid of children with lower respiratory tract infection

摘要:

目的 研究下呼吸道感染患儿病原体特点，为临床医生合理使用抗生素提供依据。方法 选取2017年1月至2018年6月因下呼吸道感染住院且接受纤维支气管镜治疗的108例患儿为研究对象，收集其支气管肺泡灌洗液，通过多重实时荧光PCR检测其病原体。结果 在108例患儿中，检测出病原体85例（78.7%），其中单一病原体感染检出52例（48.1%），多重病原体感染检出33例（30.6%）。肺炎支原体检出率最高，共检出38例（35.2%），其中36~ < 72月龄患儿检出率最高；其次为肺炎链球菌及流感嗜血杆菌，各检出29例（26.9%），其中肺炎链球菌主要集中于24月龄以下患儿。检出率较低的为鲍曼不动杆菌、白色念珠菌及肺炎克雷伯杆菌，各检出3例（2.8%）。在31例支气管肺炎患儿中，流感嗜血杆菌检出率最高（9例，29%）。在34例大叶性肺炎患儿中，肺炎支原体检出率最高（22例，65%）。在22例支气管异物合并支气管肺炎患儿中，肺炎链球菌检出率最高（10例，45%）。结论 在下呼吸道感染患儿中，肺炎支原体检出率最高，其次为肺炎链球菌及流感嗜血杆菌。不同年龄、不同类型下呼吸道感染患儿的病原体检出率存在差异。

Abstract:

Objective To study the features of pathogens in children with lower respiratory tract infection. Methods A total of 108 children who were hospitalized due to lower respiratory tract infection and underwent fiber bronchoscopy between January 2017 and June 2018 were enrolled. Bronchoalveolar lavage fluid samples were collected. Multiple quantitative real-time PCR was performed to detect pathogens. Results Of the108 children, 85 (78.7%) were found to have pathogens, among whom 52 (48.1%) had single pathogen infection and 33 (30.6%) had multiple pathogen infections. Mycoplasma pneumoniae was detected in 38 children (35.2%), and was the most common pathogen. The children aged 36 - < 72 months had the highest detection rate of Mycoplasma pneumoniae. Both Streptococcus pneumoniae and Haemophilus influenzae were detected in 29 children (26.9%) and Streptococcus pneumoniae was mainly detected in children aged < 24 months. Each of Acinetobacter baumannii, Candida albicans and Klebsiella pneumoniae was detected in 3 children. Among the 31 children with bronchopneumonia, 9 were found to have Haemophilus influenza, with the highest detection rate of 29%. Among the 34 children with lobar pneumonia, 22 were found to have Mycoplasma pneumoniae, with the highest detection rate of 65%. Among the 22 children with bronchial foreign bodies and bronchopneumonia, 10 were found to have Streptococcus pneumoniae, with the highest detection rate of 45%. Conclusions In children with lower respiratory tract infection, Mycoplasma pneumoniae is the most common pathogen, followed by Streptococcus pneumoniae and Haemophilus influenzae. There are differences in the detection rates of pathogens between children with different ages and different types of lower respiratory tract infection.