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目的探讨本地区儿童肺炎细菌性病原分布,指导肺炎病原临床诊治及合理用药。方法收集确诊为社区获得性肺炎患儿呼吸道分泌物188例,细菌培养并提取其DNA,多重PCR同时扩增14种呼吸道病原菌靶基因,扩增产物采用Luminex 100点阵仪检测,比较多重PCR检测敏感性和特异性;分析肺炎细菌病原混合感染情况。结果 188例呼吸道标本中,细菌培养出114株病原菌,阳性率为60.6%(114/188)。经多重PCR扩增、Luminex 100点阵仪检测75例呈阳性,阳性率为39.9%(75/188)。多重PCR对14种病原菌敏感性为51.0%,特异性为68.0%,符合率为58.3%。多重PCR检测肺炎链球菌检出率(19.1%,36/188)高于细菌培养(3.7%,7/188)(P<0.01);联合检测细菌性病原检出率为78.2%(147/188),联合检测提高流感嗜血杆菌、肺炎链球菌、金黄色葡萄球菌、铜绿假单胞菌和鲍曼不动杆菌检出例数。肺炎支原体与细菌混合感染16例,混合感染率为8.5%(16/188),最常见是肺炎支原体与流感嗜血杆菌混合感染,占混合感染的50.0%(8/16)。结论多重PCR技术对肺炎链球菌有很高的敏感性,细菌培养和病原特异性DNA联合检测能提高儿童肺炎细菌性病原检出率,应用多重PCR可以及时明确CAP病原中肺炎支原体与细菌混合感染。
Objective To investigate the distribution of bacterial pathogens in children with pneumonia in the region and guide the clinical diagnosis and treatment of pneumonia. Methods 188 cases of respiratory secretions of children with community-acquired pneumonia were collected and cultured. Bacteria were cultured and their DNA was extracted. Simultaneously, 14 kinds of respiratory pathogens were amplified by multiplex PCR. The amplified products were detected by Luminex 100 dot matrix analyzer. Sensitivity and specificity; Analysis of bacterial infection of pneumonia mixed infection. Results Among the 188 samples of respiratory tract, 114 strains of pathogens were cultured by bacteria, the positive rate was 60.6% (114/188). After multiplex PCR amplification, 75 cases were detected by Luminex 100. The positive rate was 39.9% (75/188). The sensitivity of multiplex PCR to 14 pathogens was 51.0%, the specificity was 68.0%, and the coincidence rate was 58.3%. The detection rate of S. pneumoniae by multiplex PCR (19.1%, 36/188) was higher than that of bacterial culture (3.7%, 7/188) (P <0.01). The combined detection of bacterial pathogens was 78.2% (147/188) ), Joint detection to increase the number of cases of Haemophilus influenzae, Streptococcus pneumoniae, Staphylococcus aureus, Pseudomonas aeruginosa and Acinetobacter baumannii. Mycoplasma pneumoniae and bacteria mixed infection in 16 cases, the mixed infection rate was 8.5% (16/188), the most common is Mycoplasma pneumoniae and Haemophilus influenzae mixed infection, accounting for 50.0% (8/16) of the mixed infection. Conclusion Multiplex PCR is highly sensitive to Streptococcus pneumoniae. Combined detection of bacterial culture and pathogen-specific DNA can improve the detection rate of bacterial pathogens in children with pneumonia. Multiplex PCR can confirm the mixed infection of Mycoplasma pneumoniae and bacteria in CAP pathogens in time .