Etiological characteristics of children with severe pneumonia and clinical significance of PCT,IL-8 and CRP
OBJECTIVE To understand the distribution and drug resistance of pathogenic bacteria in children with severe pneumonia(SP),and to analyze the changes and clinical significance of procalcitonin clearance rate(PCTc),interleukin-8(IL-8)and C-reactive protein(CRP).METHODS A total of 142 children with SP(as the SP group)and 90 children with common pneumonia(as the common pneumonia group)admitted to Shaoxing Central Hospital from Jan 2022 to Jun 2023 were recruited.Respiratory sputum of children with SP was collected for bacterial culture and drug sensitivity analysis.The levels of IL-8 and CRP at admission and PCTc after 24 hours of treatment were detected among all children.According to the clinical effect after 10 days of treatment,the children in the SP group were subdivided into the improvement group and deterioration group.The clinical data and levels of PCTc,IL-8 and CRP between the two groups were compared,and the influencing factors for progno-sis in children were explored by multivariate logistic regression analysis.RESULTS 163 strains of pathogenic bacte-ria were isolated from sputum culture samples of 142 SP children,including gram-negative bacteria,mainly Kleb-siella pneumoniae and Pseudomonas aeruginosa.The drug-resistant rates of K.pneumoniae to ampicillin and ce-fazolin were more than 80％.P.aeruginosa was absolutely drug-resistant to ampicillin and cefazolin,and the drug-resistant rates to compound sulfamethoxazole and cefoxitin were more than 80％.PCTc in the SP group was lower than that in the common pneumonia group,while IL-8 and CRP were higher than those in the common pneumonia group(P＜0.05).The pediatric critical illness score(PCIS)in the improvement group was higher than that in the deteriorated group(P＜0.05),and proportions of two types of pathogenic bacteria,mechanical ventila-tion and complications in the improvement group were lower than those in the deterioration group(P＜0.05);PCTc in the improvement group was higher while IL-8 and CRP were lower compared to the deterioration group(P＜0.05).PCIS score,PCTc,IL-8 and CRP were the influencing factors of prognosis in SP children(P＜0.05).CONCLUSION Children with SP are mainly infected by gram-negative bacteria.Common pathogenic bacteria are generally highly drug-resistant to penicillins and cephalosporins.It is necessary to rationally use antibiotics accord-ing to the types and drug resistance of pathogenic bacteria.The level of PCTc in children with SP reduces while the levels of IL-8 and CRP increase,which are related to the poor prognosis of children.
Severe pneumoniaChildrenEtiologyDrug resistanceProcalcitonin clearance rateInterleukin-8C-reactive proteinPrognosis
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