新冠疫情对儿童社区获得性肺炎主要病原谱变迁的影响及因素分析

何俊杰; 叶英; 许铁; 燕宪亮; 卓越

doi:10.3969/j.issn.2096-3882.2022.07.012

新冠疫情对儿童社区获得性肺炎主要病原谱变迁的影响及因素分析

Analysis of the changes in the spectrum of major pathogens and factors influencing community-acquired pneumonia in children in the year before and after the COVID-19 epidemic

摘要

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2 446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。

Abstract: ob＜x＞jective To observe the changes of composition of the main pathogens of community-acquired pneumonia in children before and after the new crown outbreak and analyze the influencing factors. Methods The clinical data of 2446 children with CAP were retrospectively analyzed and divided into a pre-COVID-19 group and a post-COVID-19 group using February 1, 2020 as the cut-off date. The proportion of main pathogenic bacteria in the two groups were compared and the influencing factors were analyzed. Results Pathogens detected in both groups were dominated by atypical pathogens (Mycoplasma pneumoniae in first place), followed by viruses and bacteria. The proportion of virus infection in the pre-COVID-19 group was significantly higher than that in the post-COVID-19 group, and cytomegalovirus, EBV and Coxsackie B virus were the top three, while respiratory syncytial virus, cytomegalovirus and EBV were the top three in the post-COVID-19 group. Gram-negative bacteria were higher than Gram-positive bacteria in both groups, and Gram-positive bacteria were common in streptococcus pneumoniae and Staphylococcus aureus in both groups. However, the proportion of Gram-positive bacteria, Gram-negative bacteria, Klebsiella pneumoniae and Staphylococcus aureus in post-COVID-19 group was significantly higher than that in pre-COVID-19 group. Multivariate analysis showed that age < 1year, vaginal birth, heart disease and respiratory disease were the risk factors for bacterial infection in the former group, while vaginal birth, premature birth, anemia and abnormal liver function were the risk factors for bacterial infection in the latter group. Cesarean section, age < 1 years, no granulocytopenia, non-urban area were the risk factors for viral infection in the former group, while non-urban area, anemia, abnormal liver function were the risk factors for viral infection in the latter group. Full-term, female children and age ≥1 year were the risk factors for atypical pathogen infection in the former group, while age ≥1 year was the risk factors for atypical pathogen infection in the latter group. Conclusion Mycoplasma pneumoniae was the most common pathogen of CAP in children in 2019 and 2020 in this region, followed by viruses and bacteria. Clinical treatment should be targeted according to the etiological characteristics of children and risk factors of pathogen infection to improve the therapeutic effect

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