摘要
目的观察新冠疫情对儿童社区获得性肺炎(community-acquired pneumonia,CAP)主要病原菌构成变化的影响,分析儿童CAP病原体感染的易感因素。方法回顾性分析2019年2月—2021年2月,徐州医科大学附属医院收治的2446例CAP患儿的临床资料,以2020年2月1日为界分为新冠疫情前组(对照组)和新冠疫情组(观察组)。比较2组病原谱,并分析病原体感染的易感因素。结果2组患儿CAP病原体阳性检出率比较差异无统计学意义(P>0.05)。2组检出的病原菌均以非典型病原体(肺炎支原体居首位)为主,其次为病毒、细菌;观察组病原菌占比前3位为肺炎支原体、呼吸道合胞病毒、巨细胞病毒,而对照组病原菌占比前3位为肺炎支原体、巨细胞病毒、EB病毒。观察组病毒构成比,腺病毒、柯萨奇B组病毒构成比及肺炎衣原体构成比明显低于对照组,呼吸道合胞病毒构成比明显高于对照组。观察组革兰阳性菌、革兰阴性菌构成比,以及金黄色葡萄球菌、肺炎克雷伯杆菌构成比均明显高于对照组,差异均具有统计学意义(P<0.05)。多因素分析显示,年龄<1岁、顺产、心脏病、呼吸系统疾病是对照组发生细菌感染的危险因素,顺产、早产、贫血、肝功能异常是观察组发生细菌感染的危险因素;剖宫产、年龄<1岁、无粒细胞减少、非徐州市区是对照组发生病毒感染的危险因素,非徐州市区、贫血、肝功能异常是观察组发生病毒感染的危险因素;足月、女患儿、年龄≥1岁是对照组发生非典型病原体感染的危险因素,年龄≥1岁是观察组发生非典型病原体感染的危险因素。结论新冠疫情期间,徐州地区儿童CAP的病原谱发生了变化,病毒构成比明显降低,细菌构成比明显升高,而非典型病原体无明显变化;肺炎支原体、呼吸道合胞病毒、巨细胞病毒成为疫情期间的主要病原体;2组在病原体易感因素较疫情前存在差异。
Objective To observe the changes in the composition of the main pathogens of community-acquired pneumonia(CAP)in children before and one year after the COVID-19 February 2020,and analyze the susceptible factors to CAP infection.Methods A total of 2446 CAP children were enrolled and their clinical data were retrospectively analyzed.They were divided into a pre-COVID-19 group(admission before February 1,2020)and a COVID-19 group(admission after February 1,2020).Their pathogen profiles were compared and the susceptible factors of pathogen infection were analyzed.Results No statistical difference was found in the positive detection rate of CAP pathogens between the two groups(P>0.05).Pathogens detected in both groups were mainly atypical pathogens,especially Mycoplasma pneumoniae,followed by viruses and bacteria.In the COVID-19 group,the top three pathogens included Mycoplasma pneumoniae,respiratory syncytial virus,and cytomegalovirus,compared with the top three pathogens Mycoplasma pneumoniae,cytomegalovirus,and Epstein-Barr virus before the COVID-19 epidemic.The COVID-19 epidemic group showed higher proportions of virus,adenovirus,coxsackie B and Chlamydia and lower proportions of respiratory syncytial virus than the pre-COVID-19 epidemic group.The COVID-19 epidemic group also presented significantly higher proportions of G+bacteria and G-bacteria,as well as Staphylococcus aureus and Klebsiella pneumoniae than the pre-COVID-19 epidemic group(P<0.05).According to multivariate analysis,age<1 year old,vaginal delivery,heart disease,and respiratory disease were the risk factors for bacterial infection in the pre-COVID-19 group,while vaginal delivery,premature birth,anemia,and abnormal liver function were the risk factors for bacterial infection in the COVID-19 group.Cesarean section,age<1 year,no neutropenia,and not living in Xuzhou urban area were the risk factors for viral infection in the pre-COVID-19 group,while not living in Xuzhou urban area,anemia,and abnormal liver function were the risk factors for viral infection the COVID-19 group.Full term,female babies,and age≥1 year were the risk factors for atypical pathogen infection in the pre-COVID-19 group,while age≥1 year was the risk factor for atypical pathogen infection in the COVID-19 group.Conclusions During the COVID-19 epidemic,the pathogenic spectrum of CAP in children of Xuzhou area is changed,where the proportion of viruses significantly decreases and the proportion of bacteria increases,compared with those before the COVID-19 epidemic,and no statistical difference was found in atypical pathogens.Mycoplasma pneumoniae,respiratory syncytial virus,and cytomegalovirus are the main pathogens during the COVID-19 epidemic.The pathogen susceptible factors are different before and after the COVID-19 epidemic.
作者
何俊杰
叶英
许铁
燕宪亮
卓越
HE Junjie;YE Ying;XU Tie;YAN Xianliang;ZHUO Yue(Department of Emergency Medicine,the Affiliated Hospital of Xuzhou Medical University,Xuzhou,Jiangsu 221002,China)
出处
《徐州医科大学学报》
CAS
2022年第7期535-542,共8页
Journal of Xuzhou Medical University
基金
江苏省卫生健康委“六个一”工程科研项目(LGY2019085)。
关键词
儿童
社区获得性肺炎
病原谱
影响因素
children
community-acquired pneumonia
pathogenic bacteria
influencing factors
