| Objective:To analyze the etiology and prognostic factors of severe community-acquired pneumonia(severe pneumonia)in children in Baise area,so as to provide evidence for improv ing the diagnosis and treatment level and prognosis of severe pneumonia in children.Methods:From December 2020 to December 2022,406 children who were hospitalized i n the Department of Pediatrics of Youjiang Medical University for Nationalities Affiliated Ho spital and whose families were resident in 12 counties(cities and districts)of Baise were selec ted as the study subjects.Gender,age,region,month of onset,basic diseases,complications a nd laboratory test data were collected,and pathogens such as bacteria,viruses and mycoplasm a pneumoniae were detected through sputum,blood and BALF.To study the correlation betwe en different factors and the prognosis of children.Results:(1)Among 406 children with severe pneumonia,287 were males(70.69%)and119 were females(29.31%),with a male to female ratio of 2.41:1.The median age of onset was 1.8 years,and the onset peak was 84.23% in infancy.(2)There were 116 cases(28.57%)in spring,81 cases(19.95%)in summer,85 cases(20.94%)in autumn,and 124 cases(30.54%)in winter.(3)Physical examination of pathogens:(1)Among 406 children with severe pneumonia,295 were detected with one or more pathogens,the detection rate was 72.66%,and a total of 535 strains of pathogens were detected.291 strains(54.39%)were detected,among which 206 strains were Gram-negative,86 strains of Haemophilus influenzae,46 strains of Moraxella catarrhal and 20 strains of Escherichia coli accounted for the first three.85 strains of Gram-positive bacteria,including 47 strains of Streptococcus pneumoniae,36 strains of Staphylococcus aureus and 2 strains of Staphylococcus epidermidis;173 viruses(32.34%)were detected,mainly respiratory syncytial virus infection(91),followed by influenza A virus infection(53).54 strains(10.09%)of atypical pathogens were detected,mainly mycoplasma pneumoniae infection,52 strains were detected.Seventeen fungal strains(3.18%)were detected,including 16 strains of Candida albicans infection and 1 strain of filamentous fungus.(2)There were 83 cases of single pathogen infection,among which 57cases(68.67%)were single bacterial infection.The top three were Haemophilus influenzae in27 cases,Staphylococcus aureus in 13 cases and Moraxella catarrhal in 7 cases.Simple virus infection was found in 12 cases(14.46%),and respiratory syncytial virus was the most common infection in 10 cases.Single atypical pathogen infection occurred in 12 cases(14.46%),all of which were mycoplasma pneumoniae infection.There were 2 cases of single fungal infection(2.41%),all of which were Candida albicans infection.(3)Pathogen mixed infection was detected in 202 children,the top three were bacterial and viral mixed infection in 98 cases(48.51%),bacterial and bacterial infection in 30 cases(14.85%),bacterial and atypical pathogen infection in 23 cases(11.39%).(4)Pathogen detection in different age groups and different seasons:(1)The total detection rate of bacteria and Staphylococcus aureus was the highest in infant group,which was higher than that in other age groups(P<0.05).The total detection rate of bacteria distribution in different seasons had no difference(PThe detection rate of Haemophilus influenzae in autumn and winter groups was higher than that in spring and summer groups.(2)The overall detection rate of virus was highest in infants,higher than infants and preschool(P<0.05);RSV had the highest detection rate than other age groups(P<0.05);PIV 1 was higher in preschool,preschool and school age groups(P<0.05);PIV 3 was higher than infants and young children(P<0.05).The overall detection rate of virus was the highest in the summer group and the lowest in autumn(P<0.05);IF-A was the highest in summer,which was significantly higher than that in the autumn and spring groups(P<0.05).(3)The total detection rate of atypical pathogens and MP was the highest in the school age group,while the detection rate of infants was the lowest(P<0.05),and the total detection rate of atypical pathogens and MP increased with increasing age.(4)The total detection rate of mixed infection was higher than infants and school age group(P<0.05),and higher than preschool group(P<0.05);the detection rate of mixed bacterial + virus infection was higher than other age group(P<0.05);the detection rate of mixed infection of bacterial + atypical pathogens was higher than infants,preschool group and school age group(P<0.05).The overall detection rate of mixed infection was higher in summer than the other three seasons(P<0.05),and higher in spring and autumn(P<0.05);the detection rate of mixed bacterial + virus infection was higher in summer than autumn and winter(P<0.05),and higher in spring than spring(P<0.05);the detection rate of mixed virus +virus infection was higher than in the other three seasons(P<0.05).(5)The positive yield rate of pathogens detected by m NGS was significantly higher than that of traditional etiological detection methods(P<0.05).(6)According to binary Logistic regression analysis,it was found that the presence of basic diseases,combined complications,no central oxygen inhalation,and respiratory failure were independent risk factors affecting the prognosis of severe pneumonia in children(P<0.05).Conclusions:(1)Bacteria are the main pathogens causing severe pneumonia in children.The main bacterial infections are Gram-negative bacteria,with Haemophilus influenzae,Moraxella catarrha and Escherichia coli occupying the top three places,and Streptococcus pneumoniae and Staphylococcus aureus occupying the top two places among Gram-positive bacteria.Respiratory syncytial virus(RSV)was the main virus infection,which mainly occurred in infants and young children.Mycoplasma pneumoniae was the most common atypical pathogen infection in school age children.Bacterial and viral infections were the most common mixed infections,which mainly occurred in children and school-age groups.(2)The detection of m NGS in severe pneumonia has the advantages of rapid detection and high pathogen detection rate,which has high guiding significance for the diagnosis and treatment of severe pneumonia in children whose pathogens are still not clear by routine detection.(3)The presence of underlying diseases,complications,no central oxygen intake and respiratory failure are independent risk factors affecting the prognosis of children with severe pneumonia. |
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