2022－2024年山西某医院儿童社区获得性肺炎病原学与流行病学特征

Etiological characteristics and epidemiological characteristics of pediatric community-acquired pneumonia in a hospital of Shanxi province from 2022 to 2024

    摘要
  • 摘要:
    目的 探讨山西某医院2022－2024年儿童社区获得性肺炎（CAP）住院患儿病原体的分布及变化，为临床诊治提供参考。
    方法 纳入2022年1月－2024年12月山西省儿童医院呼吸科住院收治的3 894例CAP患儿为研究对象，分析两个时期（2022年管控期、2023－2024年常态化管理期）12种呼吸道病原体在不同年龄、季节和病情程度上阳性检出率的差异，以及混合感染情况。
    结果 管控期、常态化管理期总病原体检出率分别为66.97%、81.42%，在不同年龄和季节中差异均有统计学意义（P＜0.001）。管控期病原体检出率前四位依次为肺炎支原体（MP）56.23%、流感嗜血杆菌6.86%、肺炎链球菌5.60%、卡他莫拉菌1.26%，混合感染率为7.54%，主要为“流感嗜血杆菌+MP”、“肺炎链球菌+MP”、“肺炎链球菌+卡他莫拉菌”，重症患儿的病原体检出率（73.51%）高于轻症患儿（58.76%）（P＜0.001）。常态化管理期病原体检出率前四位依次为肺炎支原体66.08%、流感嗜血杆菌6.66%、肺炎链球菌6.16%、呼吸道合胞病毒（RSV）4.80%，混合感染率为15.73%，主要为“流感嗜血杆菌+MP”、“肺炎链球菌+MP”、“腺病毒（ADV）+MP”，轻症患儿的检出率（85.16%）高于重症患儿（69.33%）（P＜0.001）。与管控期相比，常态化管理期病原体总检出率、混合感染检出率及MP、RSV、ADV、甲型流感病毒（Flu）A、FluB的阳性率增加（P＜0.05），细菌阳性率变化不大。
    结论 防控政策调整后，某些病原体的流行发生了显著变化，而MP始终为CAP患儿的主要致病菌，混合感染率较高。RSV感染多见于婴幼儿。

     

    Abstract:
    OBJECTIVE  To investigate the distribution and changes of pathogens among hospitalized children with community-acquired pneumonia （CAP） in a hospital of Shanxi province from 2022 to 2024, and to provide a reference for clinical diagnosis and treatment.
    METHODS  A total of 3 894 children with CAP admitted to the respiratory department of Shanxi Children's Hospital from Jan. 2022 to Dec. 2024 were enrolled. The differences in the positive detection rates of 12 respiratory pathogens across different ages, seasons and disease severity levels, as well as the incidence of mixed infections, were analyzed during two periods （the control period in 2022 and the routine management period from 2023 to 2024）.
    RESULTS  The overall pathogen detection rates during the control period and the routine management period were 66.97% and 81.42%, respectively, with statistically significant differences observed across different ages and seasons （P＜0.001）. During the control period, the top four pathogens detected were Mycoplasma pneumoniae （MP） at （56.23%）, Haemophilus influenzae （6.86%）, Streptococcus pneumoniae （5.60%） and Moraxella catarrhalis （1.26%）. The mixed infection rate was 7.54%, primarily involving "H. influenzae + MP", "S. pneumoniae + MP", and "S. pneumoniae + M. catarrhalis". The pathogen detection rate in severely ill children （73.51%） was higher than that in mildly ill children （58.76%） （P＜0.001）. During the routine management period, the top four pathogens detected were MP （66.08%）, H. influenzae （6.66%）, S. pneumoniae （6.16%） and respiratory syncytial virus （RSV） （4.80%）. The mixed infection rate was 15.73%, primarily involving "H. influenzae + MP", "S. pneumoniae + MP", and "adenovirus （ADV） + MP". The detection rate in mildly ill children （85.16%） was higher than that in severely ill children （69.33%） （P＜0.001）. Compared with the control period, the overall pathogen detection rate, mixed infection detection rate, and positive rates of MP, RSV, ADV, influenza A virus （Flu A） and Flu B increased during the routine management period （P＜0.05）, while the positive rates of bacteria remained relatively stable.
    CONCLUSIONS  After the adjustment of prevention and control policies, significant changes have occurred in the prevalence of certain pathogens, with MP consistently being the primary pathogen in children with CAP and a high rate of mixed infections. RSV infections are more common in infants and young children.

     

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