Oropharyngeal Carriage Status Of Common Pathogenic Microorganisms In Pediatric Patient Of Mycoplasma Pneumoniae Pneumonia

Objective:1.To understand the detection of common pathogenic bacteria in oropharynx of children with mycoplasma pneumonia pneumonia.2.Comparing the clinical manifestations between different pathogenic bacteria carried by MPP children.Methods:We choose 134 MPP pediatric patients hospitalized in Pediatric respiratory ward of Shengjing Hospital of China Medical University from December,2016 to June,2017 as objects of study.Gathering the serum and oropharyngeal swab after admitting to hospital to detect multi-pathogens by fluorescent quantitave PCR detecting techniques from Beijing institute of tropical medicine.The pathogens contains of MP,SP,HI,CTA.We can do stratified analysis according to the results of detection:1.We divided all the objects into¹,³,⁶ and¹4 according to the age.2.Children with MPP were divided into MPP group with no bacteria（MPP group）and MPP group carrying bacteria（MPP+bacteria group）according to the results of etiology.3.To study the clinical differences among different bacteria in children with MPP,they were divided into carrying SP group（MPP+SP）,carrying HI group（MPP+HI）and carrying CTA group（MPP+CTA）.Statistical analysis was performed to compare the differences among all the groups by analyzing all cases of children with information including:name,age,gender,history and clinical manifestations:fever,breathing and other symptoms and signs,laboratory test results,imaging findings and treatment,etc.Results:1.Among the 134 children with MPP,79 cases（58.95%）of which were detected with the bacteria detected by oropharyngeal swab,SP group had 55 cases（69.62%）,HI group had 42 cases（53.16%）,CTA group had 16 cases（20.25%）.The detecting rate of SP was 100%in¹ year,86.67%in³ years,77.14%in⁶ years,and 44%in¹4 years.Detecting rate of SP was different among different age groups,and the difference was statistically significant（P<0.05）,the pairwise comparison results between groups show:in³ and⁶ year-old age group SP detecting rate was significantly higher than¹4years old age group,the difference was statistically significant（P<0.05）.There was no statistically significant difference between the detecting rate of CTA in different age groups（P>0.05）.The detecting rate of HI was not statistically significant among different age groups,but the detecting rate of children at preschool age was significantly higher than that of other ages.2.The WBC 8.5（6.71-12）*10^9/L of MPP+bacteria group was significantly higher than The WBC 7.8（5.8-9.3）*10^9/L of MPP group,the difference was statistically significant（P<0.05）.The CRP19.2（7.2-35）mg/L of MPP+bacteria group was significantly higher than CRP8.4（3.38-24.6）mg/L of MPP group,the difference was statistically significant（P<0.05）.The LDH 286（244-365）U/L of MPP+bacteria group was significantly higher than LDH 250（210-302）U/L of MPP group,the difference was statistically significant（P<0.05）.The total thermal range of MPP+bacteria group was 10（7-12）days,which is significantly higher than that in the MPP group 8（6-10）days（P<0.05）.There were 58cases who had bubbling sound（73.42%）in the MPP+bacteria group,which was higher than that in the MPP group（31 cases;56.36%）,and the difference was statistically significant（P<0.05）.16（13-19）days of antibiotics in MPP+bacteria group were higher than those in the MPP group（12（9-16）days）,and the difference was statistically significant（P<0.05）.The number of lobar pneumonia of the MPP+bacteria group was32（40.51%）,which was significantly higher than that in the MPP group 10（18.18%）（P<0.05）.The number of pleural effusion of the MPP+bacteria group was 11（13.92%）,which is significantly higher than that in the MPP group 2（3.64%）（P<0.05）.The number RMPP of the MPP+bacteria group was 27（34.18%）,which is significantly higher than that in the MPP group 10（17.18%）（P<0.05）.3.Comparison among three groups carrying a kind of bacterium:the WBC difference among three groups was statistically significant（P<0.05）,the comparison between any two group showed statistically significant difference between MPP+SP group and MPP+HI group,the WBC 12.2（7.8-17.3）×10^{^9}/L of MPP+SP group was higher than MPP+HI group WBC 6.75（5.37-9.44）×10^{^9}/L（P<0.05）.The incidence rate of lobar pneumonia in MPP+SP group was statistically higher than that in MPP+HI group（P<0.05）.The incidence rate of RMPP had no statistically significant difference among three group（P>0.05）,but The incidence rate of RMPP in MPP+SP group was higher than that in MPP+HI group.The symptoms,signs and treatments had no statistically significant difference among three group（P>0.05）.4.There are no statistically deference between MPP group and MPP+bacteria group,equally among the three group（MPP+SP,MPP+CTA and MPP+HI）at the aspect of beta lactam antibiotic grade.But all the treatment is effective.Conclusion:1.The rate of detection of children with mycoplasma pneumoniae pneumonia carrying bacteria is high,streptococcus pneumoniae takes the first place in the carrying bacteria group,and the pathogen detection rate is different in different age phase.2.The oropharyngeal bacteria in MPP childern has a certain clinical significance.When WBC,CRP and LDH are significantly elevated,the image is characterized by large consolidation or pleural effusion,always prompt mixed bacterial infection,fever may process longer,the possible of RMPP is higher.3.When bacteria is detected in oropharynx oralis,if the WBC increases significantly,we should firstly consider the gram positive bacteria,in which the streptococcus pneumoniae has the highest incidence,or else consider HI.4.Although the resistance rate of SP,HI and CTA is increasing year by year,the current clinical routine beta lactam drugs treatment is still valid.