Analysis Of Pathogenic Distribution And Antibiotics Resistance With 749 Community Acquired Pneumonia

Objective: To analyze the constitutuent ratio of pathogens in community acquired pneumonia(CAP)children patient at Nanchong central hospital,pathogenic distribution characteristics in groups of different ages and different seasons,and antibiotics resistance in common bacteria,aim to provide theoretical evidence for empirical treatment and reasonable choice of antibiotics with CAP in Nanchong area.Methods : A total of 749 children with CAP hospitalized at paediatric ward in Nanchong central hospital were recruited in this study,and their etiological data were all collected.Pathogens results of 749 children with CAP were retrospectively analyzed,these presults include: bacterial culture obtained from patients’ lower respiratory tract secretions and their drug sensitivity,as well as the Ig M antibodies’ results of 11 kinds of respiratory pathogen: Pespiratory syncytial virus(RSV),adenovirus(ADV),Influenza virus A(IVA),Influenza virus B(IVB),Parainfluenza virus(PIV),Coxsackie virus A(COXA),Coxsackie virus B(COXB),Echovirus(ECHO),Mycoplasma pneumonia(MP),Chlamydia pneumonia(CP)and Legionella pneumophilia(LP).Results:(1)In 749 CAP children,517 cases detected pathogenic bacteria,the positive rate of pathogenic bacteria was 69.03%.bacteria positive rate was41.39%,viral positive rate was 29.37%,atypical pathogens positive rate was 13.62%,and pathogens mixed positive rate was 15.62%.(2)In 749 CAP children patients,310 bacterial strains were detected,bacteria positive rate was41.39%,including 38.39% gran-positive bacteria and 61.61% gran-negative bacteria;the most frequently detected strains were Streptococcus pneumonia(82 strains,26.45%),Escherichia coli(63 strains,20.32%),Haemophilus influenza(39 strains,12.58%),Klebsiella pneumoniae(30 strains,9.68%)and Staphylococcus aureus(28 strains,9.03%);Streptococcus pneumoniae positive rate was remarkably higher in school age group than infant period group and toddler’s age group(P<0.05),Escherichia coli positive rate was significantly higher than toddler’s age group,pre-school age group and school age group(P<0.05);there was no difference in the distribution of bacteria in seasonal distribution(P>0.05).(3)In 749 CAP children patients,320 viral strains were detected from 220 virus positive cases,viral positive rate was 29.37%,including 208 IVB strains(65.00%),41 IVA strains(12.81%),39 PIV strains(12.19%),29 RSV strains(9.06%),2 ADV strains(0.63%),1 CVB strain(0.31%);The total positive rate of virus detection and IVB detection,preschool and school age groups is higher than that of toddler’s age group(P<0.05),toddler’s age group was higher than that of the infant period group(P<0.05);preschool age group is higher than infant period group in the detection rate of IVA(P<0.05);The positive rate of PIV in school age group was the highest,(P<0.05);The RSV detection rate in infant period group is higher than other groups(P<0.05).The total positive rate of virus in autumn group was significantly lower than other groups(P < 0.05);summer group in the detection rate of IVA was significantly higher than that of in autumn and winter group(P<0.05 group);The PIV detection rate in summer group was higher than that of autumn group(P<0.05).(4)In 749 CAP children patients,119 atypical pathogens were detected from 102 positive cases,atypical pathogens positive rate was 13.62%,included 73 MP strains(62.18%),30 CP strains(25.21%),15 LP strains(12.60%);In the positive rate of total atypical pathogens,MP,CP and LP,school age group group was higher(P<0.05);In the positive rate of total atypical pathogens,MP,and LP,winter group was higher than other seasons(P<0.05);summer group was higher in positive rate of CP(P<0.05).(5)In 749 CAP children patients,177 cases were defined as pathogen mixed infection,pathogens mixed infection was 15.62%,included 60bacteria-virus infection cases(33.90%),56 bacteria-atypical pathogen cases(31.64%),30 simple viral mixed infection cases(16.95%),16 virus-atypical pathogens infection(9.04%),13 virus-bateria-atypical pathogens infection(7.34%);The mixed infection rate and the infection rate of mixed infection were higher in preschool and school age children(P<0.05).(6)For Streptococcus pneumoniae detected,penicillin-resistance rate was 36.59%,erythromycin and clindamycin resistance rate was approximately 100%,no resistance was found in vancomycin,imipenem and cefotaxime;Methicillin resistant Staphylococcus aureus(MRSA)accounted for 57.14% of the detected Staphylococcus aureus,staphylococcus aureus was 100% resistance to penicillin,erythromycin and clindamycin,while was sensitive to levofloxacin,moxifloxacin,quinupristin / Dafoe leptin,vancomycin,linezolid,tigecycline and rifampicin;In the detection of Escherichia coli,the production of extended spectrum beta lactamase(ESBLs)accounted for 41.27%,ampicillin resistance rate was 79.36%,no resistance strain was detected towards ertapenem,imipenem,piperacillin / tazobactam and amikacin;The detection rate of ESBLs in Klebsiella pneumoniae was 53.33%,and the resistance rate to ampicillin was about 100%,and higher resistance to 1st/2nd/3rd generation cephalosporin,resistant strain wasn’t observed to cefepime,piperacillin /tazobactam,ertapenem,imipenem,piperacillin / tazobactam and amikacin.Conclusions:Bacteria is the primary pathogen in CAP children patients hospitalized in this study;IVB was the primary pathogen for CAP viral infection while RSV was for infant viral CAP;Atypical pathogens infection was responsible for CAP in pre-school and school age children;In the study,the detection rate of PRSP,ESBLs and MRSA were higher,We should attach great importance to the rational use of antibiotics in this region.