Pathogenic characteristics in 397 cases of community-acquired pneumonia in children
Objective To understand the pathogen distributions of community-acquired pneumonia(CAP)in children,and to provide evidence for clinical diagnosis and treatment.Methods The hospitalized children with CAP in Shanghai General Hospital,Shanghai Jiao Tong University School of Medicine from January to December 2022 were selected as the research subjects.They were divided into infant group(28 d to less than one year),toddler group(one year to less than three years),preschool age group(three years to less than six years),and school age group(not less than six years)by age.According to the onset season,they were divided into spring group(February to April),summer group(May to July),autumn group(August to October),and winter group(January,November to December).Deep airway sputum samples were collected from all patients for bacterial culture identification.Respiratory viruses(influenza A virus(IVA),influenza B virus(IVB),respiratory syncytial virus(RSV),adenovirus,parainfluenza virus type 1(PIV1),parainfluenza virus type 2(PIV2),parainfluenza virus type 3(PIV3))were detected using direct immunofluorescence assay.Mycoplasma pneumoniae(MP)DNA was detected using fluorescent quantitative polymerase chain reaction,and particle agglutination was used to detect serum MP antibodies.Statistical analysis was performed using the chi-square test.Results Among the 397 cases of CAP in children,pathogens were detected in 269 cases,with a positivity rate of 67.8％.A total of 309 pathogens were identified,including 204 strains of MP(66.0％),60 strains of bacteria(19.4％),42 strains of viruses(13.6％),and three strains of fungi(1.0％).Staphylococcus aureus(19 strains),Haemophilus influenzae(15 strains)and Streptococcus pneumoniae(five strains)were the predominant bacteria,while RSV(19 strains)and PIV3(nine strains)were the main viruses.The distribution rates of MP,bacteria,and viruses showed statistically significant differences among different age groups(x2=99.82,24.71 and 17.40,respectively,all P＜0.05).MP infection was mainly observed in the preschool age group and school age group,and bacterial infection predominantly occurred in the infant group,and viral infection was most common in the toddler group.Among virus infected patients,RSV was detected in the toddler group and the preschool age group,while three cases of PIV3 cases were found in children over five years old.The distribution differences of MP,bacterial and viral infections between different seasons were statistically significant(x2=141.65,20.44 and 31.87,respectively,all P＜0.001),with a higher prevalence in winter.RSV infections demonstrated a clear seasonal trend,with 16 cases of RSV infections occurring in winter and spring.Conclusions MP is the most frequently detected pathogen in children with CAP.Bacterial infection is the most common pathogen in infants with CAP.RSV is the most common viral pathogen,with infections concentrated in the toddler group and the preschool age group,and prevalence in winter and spring.Attention should be paid to PIV3 pneumonia in children over five years old.Rational drug use should be based on the pathogen spectrum characteristics of different seasons and age groups before selecting empirical treatment combinations.
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