目的：探讨本地区5岁以下住院儿童急性下呼吸道感染常见病原体的流行病学分布及临床特点，为本地区儿童急性下呼吸道感染的临床治疗及预防提供一定的临床参考依据。方法随机选取2011年1月～2014年12月在本院住院的临床诊断为下呼吸道感染的患儿6729例。采集患儿外周静脉血2mL，采用间接免疫荧光法检测特异性抗体IgM，包括肺炎支原体、副流感病毒、甲型流感病毒、乙型流感病毒、腺病毒、呼吸道合胞病毒及肺炎衣原体。同时采集深部痰标本进行细菌学培养。结果6729例下呼吸道感染的患儿中，3500例患儿（52.01%，3500/6729）病原体检测阳性，其中单一感染1999例（57.11%，1999/3500），混合感染1501例（42.89%，1501/3500）。两种病原体感染1130例（75.28%，1130/1501），三种以上病原体感染371例（24.72%，371/1501）。细菌感染组痰培养检出细菌3086株。痰培养阳性病例中肺炎链球菌检出率最高（714/3086，23.14%），非细菌感染组特异性抗体阳性2571例次，其以肺炎支原体检出率最高757例（29.44%）。难治性支原体感染、耐甲氧西林金黄色葡萄球菌感染、青霉素耐药肺炎链球菌感染、产ESBLs大肠埃希菌及肺炎克雷白菌感染逐年升高，耐药菌感染多见于有基础疾病患儿。结论本地区急性下呼吸道感染最常见的细菌病原体为肺炎链球菌，非细菌病原体为肺炎支原体，耐药菌株逐年增加。%Objective To study the epidemiological distribution and clinical characteristics of the acute lower respiratory tract infection common pathogen in hospitalized children under age of 5 years in the area,in order to provide certain clinical reference for clinical treatment and prevention.Methods To randomly selected 6729 children patients who were diagnosed as lower respiratory tract infection,and were hospitalization in our hospital from January 2011 to December 2014.To collect 2ml the peripheral venous blood of children patients, through the indirect immunofluorescence to detect the specific antibody IgM, including mycoplasma pneumoniae, parainfluenza virus,influenza A virus,influenza B virus,adenovirus,respiratory syncytial virus, and chlamydia pneumoniae.At the same time, to collect the bathy-sputum specimens to make bacterial culture.ResultsOf the 6729 children patients with lower respiratory tract infection, there were 3500 cases(52.01%,3500/6729) of positive pathogen detection,thereinto,there were single infection in 1999 cases(57.11%,1999/3500),and mixed infection in 1501 cases (42.89%,1501/3500).There were two types of pathogen infection in 1130 cases(75.28%,1130/1501),and three or more types of pathogen infection in 371 cases(24.72%,371/1501).3086 bacteria strains were detection of sputum culture in bacterial infection group,the highest detection rate in positive cases of sputum culture were streptococcus pneumoniae(714/3086,23.14%).2571 cases were positive heterogenetic antibody in non-bacterial infection group,with the highest detection rate of mycoplasma pneumoniae 757 cases(29.44%).Refractory mycoplasma infection, methicillin-resistant staphylococcus aureus infection,penicillin resistant streptococcus pneumoniae infection,ESBLs-producin escherichia coli,and klebsiella pneumonia infection were had increased year by year. Resistant bacterial infection was mainly seen in children patients with underlying diseases.ConclusionAcute lower respiratory tract infection in the area has the most common bacterial pathogens of streptococcus pneumoniae,non-bacteria etiology of mycoplasma pneumoniae,with the drug resistant strain increased year by year.
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