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Objective:To analyze the distribution and antimicrobial resistance pattern of bacteria isolated from alveolar lavage fluid in pediatric patients with lower respiratory tract infection from 2016 to 2018.Methods:The alveolar lavage fluid of pediatric patients aged <18 years old with lower respiratory tract infection in ten hospitals from January 2016 to December 2018 were collected, and the pathogenic bacteria were cultured and isolated. The paper diffusion method or minimum inhibitory concentration method was used to conduct drug susceptibility tests for the isolated strains.The distribution of pathogenic bacteria and the source department of the strains were analyzed.Chi-sqare test was used for statistical analysis.Results:Of 1 271 isolates, 606 strains (47.7%) were gram-negative bacteria, 628 strains (49.4%) were gram-positive bacteria, and 37 strains (2.9%) were fungi. The common pathogens were Streptococcus pneumoniae (36.7%, 466/1 271), Acinetobacter baumannii (16.8%, 214/1 271), Staphylococcus aureus (12.7%, 162/1 271), Klebsiella pneumoniae (8.3%, 105/1 271), Haemophilus influenzae (7.4%, 94/1 271), Pseudomonas aeruginosa (6.2%, 79/1 271), Burkholderia cepacia (5.3%, 67/1 271) and Escherichia coli (3.7%, 47/1 271). The main pathogens in the intensive care unit (ICU) were gram-negative bacteria (80.1%, 428/534), among which Acinetobacter baumannii was the most common (3.7%, 199/534). The main pathogens in the non-ICU were gram-positive bacteria (70.8%, 522/737). The detection rates of methicillin-resistant Staphylococcus aureus (MRSA) were 45.1%(23/51) in the ICU and 43.2% (48/111) in the non-ICU, respectively. The detection rates of penicillin-resistant Streptococcus pneumoniae (PRSP) were 10.9%(6/55) in the ICU and 18.5% (76/411) in the non-ICU, respectively. The detection rates of carbapenem-resistant Klebsiella pneumoniae (CRKP) were 57.3%(43/75) in the ICU and 33.3%(10/30) in the non-ICU, respectively. The detection rate of carbapenem-resistant Pseudomonas aeruginosa (CRPA) in the ICU was higher than that in the non-ICU (49.1%(27/55) vs 25.0%(6/24)), and the difference was statistically significant ( χ2=3.98, P=0.046). Eight strains (17.0%) of carbapenem-resistant Escherichia coli were detected, and 164 strains(76.6%) of carbapenem-resistant Acinetobacter baumannii were detected. Seventy-eight Haemophilus influenzae isolates were isolated from non-ICU, and the resistance rate to ampicillin was 57.4%(54/94). Burkholderia cepacia isolates were all isolated from ICU, and the resistance rates to piperacillin-tazobactam, levofloxacin, ciprofloxacin and compound sulfamethoxazole were 13.4%(9/67), 3.0%(2/67), 0(0/67) and 9.0%(6/67), respectively. Conclusions:Streptococcus pneumoniae is still the most common pathogen in pediatric patients with lower respiratory tract infection. Gram-negative bacilli are the main pathogens in pediatric patients with lower respiratory tract infection in the ICU. The dection rates of MRSA, PRSP and carbopenem-resistant gram-negative bacilli are high. And the resistance rate of Haemophilus influenzae to ampicillin is also high. The clinical empirical treatment should be determined according to different clinical background.
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Objective:To analyze the clinical characteristics of community acquired pneumonia in hospitalized children with infectious exanthems and to accumulate clinical experience in the diagnosis and treatment.Methods:The data of the community acquired pneumonia patients with infectious exanthems in Oingdao Women and Children′s Hospital were collected retrospectively from September 2013 to August 2020 and the clinical characteristics were analyzed.Results:A total of 455 cases were included, and there were 273 boys(60.0%)and 182 girls(40.0%). A total of 106 cases were grouped into the severe group(23.3%)and 349 cases were grouped into the non-severe group(76.7%). The median age was 16.0(9.0, 42.0)months.The exanthems occurred in day(6.9±5.2)d after the beginning of pneumonia.The duration of exanthems was(6.0±3.1)days.The exanthems was polymorphic and non-specific.The detection rate of influenza B virus was highest, including 91 cases(20.0%), followed by 85 cases of MP infection(18.7%), 50 cases(11.0%)of EBV reactivation infection.The median age, hospitalization time, fever time, exanthems appearance time, exanthems duration and the rate of the rash appears in the second fever course, CRP elevation, PCT elevation, IgE elevation, MP infection and reactivation of EB virus in the severe group were higher than those of non-severe group, and the differences were statistically significant( U=13 467.0, t=6.500, 4.923, 3.098, 2.998, χ2=13.445, 15.391, 8.208, 5.313, 29.839, 13.474, P<0.05). Multivariate logistic analysis showed that poor general conditions, extrapulmonary complications, decreased respiratory tone and recurrent fever accompanied by exanthems were independent risk factors. Conclusion:A non-specific infective rash associated with the course of the hospitalized CAP has some implications for the assessment of severity and etiology.