浙江省东阳市某医院儿童肺炎患者常见呼吸道病原体的共感染分析

梁学耀; 葛谦益; 王伟炳; 方小燕

doi:10.19428/j.cnki.sjpm.2024.23923

浙江省东阳市某医院儿童肺炎患者常见呼吸道病原体的共感染分析

Co-infection analysis of common respiratory pathogens in children with pneumonia in a hospital of Dongyang City， Zhejiang Province

摘要

摘要:
目的探讨不同年龄段儿童肺炎的病因和流行病学特征，更好地描述儿童临床肺炎病原体的共感染模式及其与重症疾病的关联。
方法选择2023年4月1日—12月28日在浙江省东阳市人民医院儿科住院的28 d~13岁肺炎患儿。入院24 h内采集入组肺炎患儿的咽拭子标本，行18种呼吸道病原体聚合酶链反应（PCR）检测。采用多因素二元logistic回归分析不同年龄段患儿病毒和细菌感染情况、共感染模式与重症肺炎结局的影响因素。
结果共纳入2 191例住院肺炎患儿，重症患儿常见于5~岁（53.3%），多于第二季度就诊（46.5%），重症患儿检出（1.31±0.90）个病原体。东阳市住院肺炎儿童中病原体检出率最高为肺炎支原体（44.4%、973例），最常见的细菌和病毒分别是肺炎链球菌（21.7%、476例）和鼻病毒（10.1%、222例）。多因素logistic回归分析结果显示，病毒⁃细菌的相互作用呈正相互。重症肺炎患儿不同呼吸道病原体的调整OR （aOR）值比较，差异均有统计学意义（均P<0.01），其中肺炎衣原体（aOR=9.74，95%CI：2.36~49.32）、肺炎支原体（aOR=2.62，95%CI：2.04~3.37）、呼吸道合胞病毒（RSV）（aOR=1.69，95%CI：1.12~2.54）是重症肺炎的影响因素（均P<0.01）。
结论 2023年4—12月浙江省东阳市儿童肺炎的病原谱中，大多数病毒⁃细菌为正相互，肺炎衣原体、肺炎支原体和RSV可能是重症肺炎的重要驱动因素。

Abstract:
Objective To investigate the etiology and epidemiological characteristics of pneumonia in children of different ages, to better characterize the co-infection patterns of pneumonia and their association with severe diseases.
Methods Children aged 28 days to 13 years with pneumonia who were hospitalized in the Department of Pediatrics, Dongyang People's Hospital, Zhejiang Province from April 1 to December 28, 2023 were selected as the research subjects. Oropharynx swabs were collected from the patients within 24 hours of hospital admission, and PCR tests were conducted for 18 respiratory pathogens. Binary multivariate logistic regression analysis was used to analyze the status of viral and bacterial infection, patterns of co-infection in patients with different ages, and the risk factors for the outcome of severe pneumonia.
Results A total of 2 191 hospitalized children with pneumonia were enrolled in the study. Severe cases were more common in children aged 5 years and older (53.3%) and in the second quarter of the year (46.5%). An average of (1.31±0.90) pathogens were detected in severe cases. Mycoplasma pneumoniae (44.4%, 973 cases) had the highest detection rate of pathogens. Streptococcus pneumoniae (21.7%, 476 cases) and rhinovirus (10.1%, 222 cases) were the most common bacteria and viruses, respectively, in hospitalized children with pneumonia in Dongyang City. Multivariate logistic regression analysis indicated positive interactions between different viral and bacterial pathogens. The adjusted OR (aOR) values for different respiratory pathogens in children with severe pneumonia varied significantly (all P<0.04). Among them, Chlamydiapneumoniae (aOR=9.74, 95%CI=2.36‒49.32, P<0.01), Mycoplasma pneumoniae (aOR=2.62, 95%CI=2.04‒3.37, P<0.01), and RSV (aOR=1.69, 95%CI=1.12‒2.54, P<0.01) were the risk factors for severe pneumonia.
Conclusion In the pathogen spectrum of children with pneumonia in Dongyang City, Zhejiang Province from April to December 2023, most viruses and bacteria exhibited positive interactions. Chlamydia pneumoniae, Mycoplasmapneumoniae, and RSV maybe the significant risk factors for severe pneumonia.

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