Retrospective Study Of 979 Cases With Community Acquired Pneumonia In Children

Object: To retrospective analysis pathogeny, allergic history, history eczema, symptom, physical signs, etiology, age, seasonal characteristics, accessory examination, pharmacy, prognosis, et al. of children with community acquired pneumonia(CAP) in the pediatric ward of the Hongqiao Hospital of Tianjin during the last 2 years, and with Guidelines for management of children with CAP(2013revision) to provide references. It could reduce waste of medical resources,and improve the cure rate,and shorten average length of stay,and decrease the use of antibiotics to guide clinical rational use of drugs.Method: We conducted a retrospective study of 979 hospitalized children of with CAP in the pediatric ward of the Hongqiao Hospital of Tianjin from June 2013 to June 2015.Children were divided into 4 groups: infants(29 days to 1 year)334 patients,young children(1 year to 3 year)340 patients, preschoolchildren(4 year to 6 year)219 patients, school-age children(7 year to 14 year)86 patients.With statistical analysis for pathogeny, allergic history, history eczema, symptom, physical signs,laboratory examination, etiology, pharmacy, in-hospital time, prognosis, et al of children with CAP. Pathogen identification: the culture of throat swab(bacteria, Mycoplasma) and sputumculture were taken in some children.Four kinds of virus of Ig M antibody and Mycoplasma of Ig M antibody were determined.Result:1. General overview: In 979 cases, there were 583 males and 393 females(ratio M:F=1.49:1).The morbidity of males is higher than females in infants.The difference has statistical significance with young children and preschoolchildren(c2=5.24,c2=10.51,P<0.05). The difference are not statistically significant among infants and school-age children(c2=3.32,P>0.05). The cause of most patientswerenot clear. 41.47% of the cases had haveallergic history and history eczema.Fever(95.2%), cough(88.5%), shortness of breath(54.2%) were the most common clinical symptoms. The incidence of fever in infants is lower than other groups, and the difference hadstatistical significance. The incidence of fever in young children is lower than in preschoolchildren and school-age children, however the difference are not statistically significant among preschoolchildren and school-age children. The incidence of cough and shortness of breath are not statistically significant among all groups.The ratio of wheezing is 19.6%, and the incidence ofwheezing in infants occurred more frequently than in preschoolchildren and school-age children. The ratio of diarrhea is 16.8%, then the incidence of diarrhea in infants occurred most frequently than other groups and the difference has statistical significance. The incidence of moist rale in lung is highest in infants and young children. In addition toinfant and young children group, the different incidence of moist rale are not statistically significant among other groups.2. Features of routine auxiliary examination:bacterial infection includes at least one of leukocytosis,neutrophil percentage, serum CRP level increasing significantly.The proportion of bacterial infection was lowest in infants(13.77%) than other groups,however, was highest in preschoolchildren(45.66%).The difference proportion of bacteria and Mycoplasma mixedinfection has statistical significance withall groups, and the incidence increased with age. The incidence of PCT≥0.25 was lowest in infants(5.6%) and highest inpreschoolchildren(15.3%), moreoverthe difference has statistical significance among infants, young children and preschoolchildren.The positive rate of Anti-Streptolysin O(ASO) orerythrocyte sedimentation rate(ESR) was lowest than other groups, and then increased with age.3.The characteristics of bacterial pathogen:sputum culture was detected in 969 cases, 128 cases were positive.The top 3 pathogenic bacteria were Streptococcus pneumonia(20%),Haemophilus influenzae(14%), Klebsiella pneumoniae(12%).The positive rate of sputum culture was lowest in infants(6.1%),and highest in preschoolchildren(19.4%).The difference has statistical significance among infants, young children and preschoolchildren, however,are not statistically significant among young children, preschoolchildren and school-age children.The positive rate of pharyngeal swab culture was highest in infants(20.0%), and Klebsiella pneumoniae subspecies was the most common species.4.The characteristics of viral pathogen:the first two virus IgM antibody that had detected were respiratory syncytial virus(57%) and EB virus(25%). The positive rate of virusinfection was highest in infants(15.5%) and lowest inschool-age children(7.1%).The positive rate of virusinfectionarestatistically significant among all groups.5.The characteristics of Mycoplasma pneumoniae detection:the positive rate of pharyngeal swab culture of Mycoplasma pneumoniae was lowest in infants(29.4%) and highest inschool-age children(34.6%), but the difference had notstatistical significance.Serum Mycoplasma Ig M is positive for more than 1:160.The positive rate was lowest in infants(2.1%) and highest inschool-age children(30.23%), and the difference hadstatistical significance among all groups.The ratio M:F of Mycoplasma infection was 1:1,and the incidence rate is highest in autumn(42.3%).6.Chest X-ray:Patchy shadow was the main manifestation in all ages(infants79.8%,young children86.6%,preschool children84.5%, school-age children57.6%).The proportion of the chest X-ray density increased gradually with the growing of age(infants0.6%, school-age children31.8%),and the difference hadstatistical significance,however,right lung more than left lung.7.Antimicrobial agents:the usage rate of antimicrobial agents increased gradually with the growing of age(infants52.1%,young children60.9%,preschool children87.2%,school-age children 95.3%).There were statistically significant differences in the application cases(cephalosporin and azithromycin) of different age groups, then the use rate of cephalosporin gradually decreased and the use rate of azithromycin gradually rose.The usage rate of combined medication was highest in preschool children(10.5%).Conclusion:1.General situation analysis:The morbidity of males is higher than females in 979 cases of children with CAP.The cause of most patients werenot clear.Children with allergic constitution accounted for 41.47% of allcases.Fever, cough, shortness of breathwere the most common clinical symptoms.The incidence of moist rale in lungincreased gradually with ages.2.Features of routine auxiliary examination:Related bacterial infection indexes of white blood cell, neutrophil percentage, CRP, PCT, ASO and ESR showed were the lowest in infants.3.The characteristics of bacterial pathogen:the top 3 pathogenic bacteria were Streptococcus pneumonia,Haemophilus influenzae, Klebsiella pneumonia, and the positive rate of sputum culture was lowest in preschool children.The positive rate of pharyngeal swab culture was highest in infants, and Klebsiella pneumoniae subspecies was the most common species.Sputum culture was not consistent with the culture of bacteria throat swab.4.The characteristics of viral pathogen:the first two virus Ig M antibody that had detected were respiratory syncytial virus and EB virus,moreover,the positive rate of virus infection gradually decreased with age.5.The characteristics ofMycoplasma pneumoniae detection:the positive rate of pharyngeal swab culture of Mycoplasma pneumoniae wasstatistically significant among all groups.The positive rate ofserum Mycoplasma Ig M gradually decreased with age, and then the difference hadstatistical significance.The ratio M:F of Mycoplasma infection was 1:1,and the incidence rate is highest in autumn.6.Chest X-ray:patchy shadow was the main manifestation in all ages.The proportion of the chest X-ray density increased gradually with ages, moreover,right lung more than left lung.7.Antimicrobial agents:the usage rate of antimicrobial agentsincreased gradually with ages.The use rate ofcephalosporin gradually decreased andthe use rate of azithromycingradually rose with ages.