Analysis Of Bacterial Etiology And Clinical Characteristics Of Lower Respiratory Tract Infection In Children

Objective: To investigate the influence of pathogen composition ratio,sex,course of disease,season and age group on pathogen detection rate and the characteristics of drug resistance and sensitivity of different bacteria.Methods: The clinical data of children with lower respiratory tract infection from January to 14 years old and bacterial etiology of lower respiratory tract secretion were collected and analyzed retrospectively from2018-12 to 2019-12 in our hospital.SPSS.25 software was used to analyze the influence of bacterial positive etiology composition ratio,different sex,different course of disease,pathogen distribution in different seasons and different age groups,the effect of antimicrobial use on bacterial etiology detection rate,and the characteristics of different bacterial resistance and sensitivity.Results:1.1727 Of the confirmed cases of lower respiratory tract infection,214 were detected by bacterial etiology,the positive rate was 12.3%,and 229 strains were detected.The first bacterial pathogen was Haemophilus influenzae(28.8%),followed by Staphylococcus aureus(17.9%),Streptococcus pneumoniae(12.7%)and Klebsiella pneumoniae(10.5%).2.The positive results of bacterial etiology in sex group,the bacterial detection composition ratio(61.2%)in male children was significantly higher than that in female children(38.8%).However,there was no significant difference in the composition of bacteria in sex group(P>0.05).3.The positive results of bacterial etiology in the course group,the bacterial detection composition ratio(61.2%)of the children with < course of15 days was higher than that of the children with > course of 15 days(38.8%).4.The total detection rate of four seasons bacteria was the highest in autumn and the lowest in summer,the difference was statistically significant(P<0.05).Haemophilus influenzae was the most common in each season,and the detection rate of capamora was statistically significant(P<0.05).The detection rate of capamora was higher in autumn and winter,and the lowest in spring.5.Among the positive results of bacterial etiology in each age group,the highest composition was from January to 1 year old.Haemophilus influenzae was the main group in January to 1 year old group,3 to 6 year old group and 6to 14 year old group,and Streptococcus pneumoniae was the main group in 1year to 3 year old group.6.The bacterial detection composition ratio(76.6%)of children with antibiotics before admission was higher than that of children without antibiotics before admission(23.4%),but there was no significant difference in the bacterial detection composition ratio(P>0.05).7.(1)Gram-negative bacteria resistance: Klebsiella pneumoniae to ampicillin(95.8%),furantoin(58.3%),piperacillin(54.2%),ampicillin/sulbactam(37.5%),cefuroxime(33.3%),ceftriaxone(20.8%),cefoperazone/subactam(12.5%),iperacillin/tazobactam(12.5%),meropenem(12.5%),subpernan(12.5%),Esc herichia coli was resistant to ampicillin(78.9%),ampicillin/sulbactam(63.2%),piperacillin(52.6%),cotrimoxazole(47.4%),ceftriaxone(36.8%),cefuroxime(36.8%),piperacillin/tazobactam(5.3%),Pseudomonas aeruginosa was resistant to ampicillin(100.0%),ampicillin/sulbactam(75.0%),cotrimoxazole(75.0%),furan toin(75.0%),aztreonam(75.0%),cephalosporins(e.g.ceftidine,ceftriaxone,cefaz olin)(about75.0%),imipenem(25.0%),Acinetobacter baumannii is resistant to ampicillin(100.0%),furantoin(100.0%),aztreonam(100.0%),cephalosporins(75.0%-100.0%),Haemophilus influenzae were resistant to ampicillin(93.9%),cotrimoxazole(87.9%),cefuroximesodium(83.3%),amoxicillin/clavic acid(45.5%),meropenem(3.0%),while katamura was resistant to azithromycin(60.0%)and erythromycin(50.0%)respectively.(2)Sensitivity of gram-negative bacteria: Klebsiella pneumoniae was more sensitive to amikacin(95.8%),levofloxacin(97.5%),ciprofloxacin(87.5%),meropenem(83.3%),sulbactam(83.3%),piperacillin/tazobactam sodium(83.3%),ceftidine(83.3%),cefoperazone/subactam(75.0%),ceftazidime(75.0%),ceftriaxone(75.0%),Escherichia coli was more sensitive to meropenem(94.7%),amikacin(94.7%),piperacillin/tazobactam sodium(89.5%),ceftidine(89.5%),cefoperazone/subactam(78.9%),ceftriaxone(57.9%),Pseudomonas aeruginosa is more sensitive to meropenem(100.0%),amikacin(100.0%),piperacillin/tazobactam sodium(100.0%),cefoperazone/subactam(100.0%),ceftazidime(100.0%),imipenem(75.0%),Acinetobacter baumannii is more sensitive to imipenem(100.0%),cefoperazone(100.0%),ciprofloxacin(100.0%),cefepime(100.0%),levofloxacin(100.0%),ceftazidime(100.0%),com pound sinomine(100.0%),Haemophilus influenzae were sensitive to meropenem(86.4%),imipenem(59.1%),azithromycin(48.5%),cefepime(33.3%),whereas katamurans were more sensitive to amoxicillin/clavic acid(80.0%)and ciprofloxacin(60.0%),respectively.(3)Gram positive bacteria resistance:Staphylococcus aureus resistant to erythromycin(80.5%),clindamycin(75.6%),oxacillin(61.0%),cefoxitin(61.0%),linazolamide(2.4%),vancomycin(2.4%),Str eptococcus pneumoniae was resistant to erythromycin(96.6%),tetracycline(93.1%),cotrimoxazole(89.7%)and meropenem(75.9%),The drug resistance to linezolid and vancomycin was 0.0%.(4)Sensitivity of Gram-positive bacteria: Staphylococcus aureus was more sensitive to levofloxacin(97.6%),linazolamide(97.6%),vancomycin(97.6%),furantoin(97.6%),rifampicin(95.1%)and cotrimoxazole(90.2%),while Streptococcus pneumoniae was more sensitive to levofloxacin(100.0%),linazolamide(100.0%),vancomycin(100.0%),chloramphenicol(89.7%),amoxicillin(58.6%),ceftriaxone(58.6%).Conclusion:1.Haemophilus influenzae is the most common bacterial pathogen causing lower respiratory tract infection in children,followed by Staphylococcus aureus,Streptococcus pneumoniae and Klebsiella pneumoniae.2.Among bacterial pathogens,the total detection rate of four seasons bacteria was the highest in autumn and the lowest in summer.Haemophilus influenzae is the most common in all seasons.In autumn and winter,the detection rate of catarrhalis was higher,and the lowest in spring.3.Among the positive results of bacterial etiology in each age group,the highest composition was from January to 1 year old.Haemophilus influenzae was the main group in January to 1 year old group,3 to 6 year old group and 6to 14 year old group,and Streptococcus pneumoniae was the main group in 1year to 3 year old group.4.Most gram-negative bacteria have high resistance to penicillin,such as ampicillin,piperacillin and first and second generation cephalosporins,and maintain high sensitivity to the third and fourth generation cephalosporins,β-lactamase inhibitors,carbapenem,and with the gradual increase of the three antibiotic levels,the sensitivity rate is increasing,but with the increase of antibiotic exposure frequency,carbapenem resistant strains are not rare;Gram-positive bacteria resistance is also very common,there have been Staphylococcus aureus vanconazole resistant strains.Therefore,how to use antibiotics reasonably in clinical work and reduce the production of resistant strains has become an urgent problem.