儿童反复呼吸道感染病原菌临床分布及危险因素研究
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摘要
目的:分析儿童反复呼吸道感染(RRTI)常见病原菌的分布情况及危险因素。方法:收集RRTI患儿240例,对其呼吸道分泌物行细菌分离培养检测、药敏试验,分析病原菌具体分布情况及主要危险因素。结果:240例患儿1380份呼吸道分泌物标本中,病原菌阳性1356份,检出率98.26%;分离出病原菌1486株,其中革蓝阴性菌1071株(72.07%),革蓝阳性菌415株(27.93%)。革蓝阴性菌中,流感嗜血杆菌所占比例最大(22.27%),其次为铜绿假单胞菌(13.32%)、大肠埃希菌(11.31%);革蓝阳性菌中,金黄色葡萄球菌所占比例最大(14.20%),其为肺炎链球菌(5.32%)、表皮葡萄球菌(3.30%)。240例中,家长文化水平低、有呼吸道疾病、吸烟家长所占比例显著更高(P<0.05);微量元素缺乏、营养及免疫差、作息情况差、生活环境差、偏食、健康锻炼缺乏所占比例显著更高(P<0.05);家长文化水平、吸烟、呼吸道疾病及儿童生活环境、作息情况、健康锻炼、饮食、微量元素、以营养及免疫状况均与RRTI发生差异存在统计学意义(P<0.05)。结论:儿童RRTI病原菌分布革蓝阴性菌感染为主,且有个体差异,须合理使用抗生素进行治疗;家长状况、儿童机体状况、生活及饮食习惯等均与RRTI发生存在密切相关,临床上应重点监测,及时预防。
Objective: To evaluate the distribution and risk factors of common pathogens in children with recurrent respiratory tract infection(RRTI).Methods:Respiratory tract specimens of 240 RRTI children were selected as subjects,the specific distribution of pathogenic bacteria was analyzed by bacterial isolation,culture and susceptibility test,and the main risk factors were also analyzed.Results:Of the 1380 specimens of respiratory secretions from 240 children,the positive rate of pathogenic bacteria was 98.26%;A total of 1486 strains of pathogenic bacteria were isolated,of which 1071 strains(72.07%) were Gram-negative and 415 strains(27.93%) were gram-positive;Among gram-negative bacteria,Haemophilus influenzae accounted for the largest proportion(22.27%),followed by Pseudomonas aeruginosa(13.32%) and Escherichia coli(11.31%);Staphylococcus aureus accounted for the largest proportion(14.20%) of Gram-positive bacteria,including Streptococcus pneumoniae(5.32%) and Staphylococcus epidermidis(3.30%);Among 240 children,the proportion of parents with low educational level,respiratory diseases and smoking was significantly higher(P<0.05),the proportion of trace element deficiency,poor nutrition and immunity,poor work and rest,poor living environment,partial diet and lack of health exercise is significantly higher(P<0.05);Parents' educational level,smoking,respiratory diseases,children's living environment,work and rest,health exercise,diet,trace elements,nutrition and immune status were significantly correlated with RRTI(P<0.05).Conclusion:The pathogenic bacteria of RRTI in children are mainly Gram-negative bacterial infections with different personalities. It is necessary to use antibiotics reasonably to treat RRTI;Parental status and children's body condition,life and dietary habits are closely related to RRTI occurrence,to effectively improve the prevention and treatment effect of RRTI in children,we should strengthen the key monitoring and take preventive measures in time.
Objective: To evaluate the distribution and risk factors of common pathogens in children with recurrent respiratory tract infection(RRTI).Methods:Respiratory tract specimens of 240 RRTI children were selected as subjects,the specific distribution of pathogenic bacteria was analyzed by bacterial isolation,culture and susceptibility test,and the main risk factors were also analyzed.Results:Of the 1380 specimens of respiratory secretions from 240 children,the positive rate of pathogenic bacteria was 98.26%;A total of 1486 strains of pathogenic bacteria were isolated,of which 1071 strains(72.07%) were Gram-negative and 415 strains(27.93%) were gram-positive;Among gram-negative bacteria,Haemophilus influenzae accounted for the largest proportion(22.27%),followed by Pseudomonas aeruginosa(13.32%) and Escherichia coli(11.31%);Staphylococcus aureus accounted for the largest proportion(14.20%) of Gram-positive bacteria,including Streptococcus pneumoniae(5.32%) and Staphylococcus epidermidis(3.30%);Among 240 children,the proportion of parents with low educational level,respiratory diseases and smoking was significantly higher(P<0.05),the proportion of trace element deficiency,poor nutrition and immunity,poor work and rest,poor living environment,partial diet and lack of health exercise is significantly higher(P<0.05);Parents' educational level,smoking,respiratory diseases,children's living environment,work and rest,health exercise,diet,trace elements,nutrition and immune status were significantly correlated with RRTI(P<0.05).Conclusion:The pathogenic bacteria of RRTI in children are mainly Gram-negative bacterial infections with different personalities. It is necessary to use antibiotics reasonably to treat RRTI;Parental status and children's body condition,life and dietary habits are closely related to RRTI occurrence,to effectively improve the prevention and treatment effect of RRTI in children,we should strengthen the key monitoring and take preventive measures in time.
引文
[1] 陈小燕,周卫萍.反复呼吸道感染患儿的病原菌分布与免疫功能监测[J].中华医院感染学杂志,2016,26(19):4521-4523.
[2] 黎明,江泓,谢雄,等.反复呼吸道感染患儿病原菌分布与耐药性分析[J].中华医院感染学杂志,2016,26(13):3092-3094.
[3] 江锐,徐颖,王洪,等.患儿全身麻醉气管插管后呼吸道感染病原菌及危险因素分析[J].中华医院感染学杂志,2016,26(14):3337-3338.
[4] Raniszewska A,Gorska E,KotuI,et al.Recurrent respiratory tract infections in children–analysis of immunological examinations[J].Central-European Journal of Immunology,2015,40(2):167-173.
[5] 宋昱晨,赵美芳,王月花.呼吸内科下呼吸道感染患者常见病原菌分布与相关危险因素分析[J].中华医院感染学杂志,2015,9:1965-1967.
[6] 陈静璐,陈琳,赵伟和,等.气管插管全麻患者术后下呼吸道感染的病原菌分布与预防[J].中华医院感染学杂志,2016,26(4):835-837.
[7] 王淑会,季伟,张新星,等.苏州地区14994例儿童呼吸道感染细菌病原学特点[J].中国当代儿科杂志,2016,18(1):44-50.
[8] Toivonen L,Karppinen S,Schuezhavupalo L,et al.Burden of recurrent respiratory tract Infections in children:A prospective cohort study[J].Pediatric Infectious Disease Journal,2016,35(12):e362.
[9] 李红.坝上地区儿童反复呼吸道感染影响因素分析[J].中国临床研究,2015,28(5):636-638.
[10] 李素芳,来庆和,袁永红,等.学龄前儿童反复呼吸道感染状态及其高危因素分析[J].实用预防医学,2016,23(10):1232-1233.
[11] 石正英,管建宏,施益农.儿童反复呼吸道感染72例致病因素分析[J].临床肺科杂志,2017,22(9):1711-1713.
[12] 林立,李昌崇.儿童反复呼吸道感染判断条件和防治[J].中华实用儿科临床杂志,2017,32(4):249-252.
[13] 丁媛慧,孙中厚,张海美,等.儿童边缘型维生素A缺乏与呼吸道感染相关性及危险因素分析[J].中国儿童保健杂志,2016,24(4):393-395.
[14] 蔡露良.海南省0～5岁儿童反复呼吸道感染影响因素分析[J].中国热带医学,2018,18(12):1266-1268.
[2] 黎明,江泓,谢雄,等.反复呼吸道感染患儿病原菌分布与耐药性分析[J].中华医院感染学杂志,2016,26(13):3092-3094.
[3] 江锐,徐颖,王洪,等.患儿全身麻醉气管插管后呼吸道感染病原菌及危险因素分析[J].中华医院感染学杂志,2016,26(14):3337-3338.
[4] Raniszewska A,Gorska E,KotuI,et al.Recurrent respiratory tract infections in children–analysis of immunological examinations[J].Central-European Journal of Immunology,2015,40(2):167-173.
[5] 宋昱晨,赵美芳,王月花.呼吸内科下呼吸道感染患者常见病原菌分布与相关危险因素分析[J].中华医院感染学杂志,2015,9:1965-1967.
[6] 陈静璐,陈琳,赵伟和,等.气管插管全麻患者术后下呼吸道感染的病原菌分布与预防[J].中华医院感染学杂志,2016,26(4):835-837.
[7] 王淑会,季伟,张新星,等.苏州地区14994例儿童呼吸道感染细菌病原学特点[J].中国当代儿科杂志,2016,18(1):44-50.
[8] Toivonen L,Karppinen S,Schuezhavupalo L,et al.Burden of recurrent respiratory tract Infections in children:A prospective cohort study[J].Pediatric Infectious Disease Journal,2016,35(12):e362.
[9] 李红.坝上地区儿童反复呼吸道感染影响因素分析[J].中国临床研究,2015,28(5):636-638.
[10] 李素芳,来庆和,袁永红,等.学龄前儿童反复呼吸道感染状态及其高危因素分析[J].实用预防医学,2016,23(10):1232-1233.
[11] 石正英,管建宏,施益农.儿童反复呼吸道感染72例致病因素分析[J].临床肺科杂志,2017,22(9):1711-1713.
[12] 林立,李昌崇.儿童反复呼吸道感染判断条件和防治[J].中华实用儿科临床杂志,2017,32(4):249-252.
[13] 丁媛慧,孙中厚,张海美,等.儿童边缘型维生素A缺乏与呼吸道感染相关性及危险因素分析[J].中国儿童保健杂志,2016,24(4):393-395.
[14] 蔡露良.海南省0～5岁儿童反复呼吸道感染影响因素分析[J].中国热带医学,2018,18(12):1266-1268.
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