儿童肺炎肺实变住院患儿支气管肺泡灌洗液病原分析

本研究分析肺炎肺实变患儿支气管肺泡灌洗液病原谱构成，旨在为临床经验性抗感染治疗提供指导。收集2019年1月-2020年1月复旦大学附属儿科医院纤维支气管镜室诊治的住院肺炎病例临床资料，其中肺实变的诊断基于影像学证据，依托国家儿童医学中心病原学检测平台，并参考感染传染科医生解读，本研究对肺炎伴肺实变患儿支气管肺泡灌洗液标本的病原学检测结果进行回顾性分析。结果显示，286例肺炎患儿的286份支气管肺泡灌洗液标本被纳入研究，平均年龄5.5(5.8±3.1)岁，其中195例(68.2%)存在肺炎伴肺实变。总病原体检出率为76.6%(219/286)，肺实变和无肺实变肺炎患儿病原体检出率分别为77.9%(152/195)和73.6%(67/91)，差异无统计学意义；检出的前5种病原体均为肺炎支原体、腺病毒、鼻病毒、呼吸道合胞病毒和副流感病毒3型。5周岁及以上患儿肺炎支原体检出率达最高77.0%(127/165)，肺实变病例和无肺实变病例肺炎支原体检出率分别为67.2%(131/195)和61.5%(56/91)，差异无统计学意义。本研究结果提示，肺炎支原体、腺病毒、鼻病毒、呼吸道合胞病毒和副流感病毒3型是导致本研究目标人群患病的主要病原体；病原体检出率高低与是否肺实变无关。

Etiological analysis of pulmonary alveolar lavage fluid in hospitalized children with consolidated pneumonia

The purpose of this study is to analyze the pathogenic spectrum of children’s pneumonia with pulmonary consolidation, and provide information for clinical empirical anti-infection treatment. From January 2019 to January 2020, the clinical data of hospitalized children with pneumonia diagnosed who underwent fiberoptic bronchoscopy in our center were retrospectively reviewed. By the reading of two senior pediatric infectious doctors, the data of pathogens detection result of bronchoalveolar lavage fluid (BALF) from children with pneumonia and/or pulmonary consolidation were analyzed. The diagnosis of lung consolidation was based on imaging evidence. 286 BALF samples from 286 children with mean age of 5.5 (5.8±3.1) years were detected. 195 cases (68.2%) with pulmonary consolidation. The positive detection rates of pathogens in all patients were 76.6% (219/286). The positive detection rates of patients with or without pulmonary consolidation were 77.9%(152/195)and 73.6%(67/91)respectively (P>0.05). Mycoplasma pneumoniae, adenovirus, rhinovirus, respiratory syncytial virus and parainfluenza virus type 3 were the top five detected pathogens. Mycoplasma pneumoniae got the highest positive rate 77.0%(127/165)in children of 5 years old and above. The detection rates of mycoplasma pneumoniae in patients with or without pulmonary consolidation were 67.2% (131/195) and 61.5% (56/91), respectively, (P>0.05). Mycoplasma pneumoniae, adenovirus, rhinovirus, respiratory syncytial virus and parainfluenza virus type 3 infection were the dominant etiology of children’s pneumonia in the target population. The pathogens detection rates were similar in patients with or without pulmonary consolidation.