仰光儿童医院和燕京儿童医院重症急性呼吸道感染儿童的细菌和病毒谱

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摘要

本研究的目的是:(1)加强对引起严重急性呼吸道感染(SARI)的一些传染病的诊断和抗生素谱的国家能力;(2)建立仰光市严重急性呼吸道感染(SARI)的医院和实验室诊断和监测网络。本研究是一项以医院和实验室为基础的横断面描述性研究。共纳入了2014年12月至2016年4月在仰光儿童医院和Yankin儿童医院接受急性呼吸道感染治疗的511名儿童的825份样本,包括呼吸道样本和血液样本。使用Vitek 2进行鉴定和抗生素敏感性试验。129株革兰氏阴性杆菌中,肺炎克雷伯菌32%,铜绿假单胞菌18%;鲍曼尼菌占13%,大肠杆菌占9%。在35株革兰氏阳性菌中,分离出的金黄色葡萄球菌占42%,肺炎葡萄球菌占6%。多药耐药率分别为大肠杆菌100%、肺炎克雷伯菌95%、鲍曼假杆菌82%、铜绿假单胞菌17%。产广谱β -latamase (ESBL)的肺炎克雷伯菌和大肠杆菌在10个被检测的微生物中占6个。产碳巴烯酶GNB和耐甲氧西林金黄色葡萄球菌(MRSA)分别为21%和33%。病毒学切片采用FTD33多重PCR法对490例患者529份样本进行检测,共检出病毒20种、细菌12种、真菌1种,共检出病原体33种。在490名患者中,PCR阳性的有374名。不同类型的样本包括鼻咽、咽喉、气管内和喉部拭子、气管分泌物和支气管肺泡灌洗液。共检出呼吸道合胞病毒(RSV)(19.3%)、鼻病毒(17.0%)、parechovirus(14.3%)、bocavavirus(11.1%)、腺病毒(10.2%)、偏肺病毒A和偏肺病毒B(10.2%)、副流感病毒(5.7%)、肠道病毒(3.0%)、甲型流感病毒(2.8%)、冠状病毒(4%)、副流感病毒(0.9%)和丙型流感病毒(0.4%)。本研究强调了急性呼吸道感染的细菌、病毒和耐药细菌病原体的病因。
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Bacteria and Viral Profile of Severe Acute Respiratory Infections of Children Attending Yangon Children’s Hospital and Yankin Children’s Hospital
Objectives of study are (1) to reinforce the national capacity for diagnosis and antibiogram of some infectious diseases causing severe acute respiratory infection (SARI) and (2) to build a network between hospital and laboratory for the diagnosis and surveillance of SARI in Yangon. This study is a crosssectional hospital- and laboratory-based descriptive study. A total of 825 samples including respiratory samples and blood samples from 511 children attending Yangon Children’s Hospital and Yankin Children’s Hospital from December 2014 to April 2016 for treatment of SARI were included. Identification and antibiotic sensitivity testing were done using Vitek 2. Out of 129 gram-negative bacilli (GNB), K. pneumoniae 32%, P. aeruginosa 18%, A. baumannii 13%, E. coli 9% were mostly isolated. Among 35 gram-positive cocci (GPC), S. aureus 42% and S. pneumoniae 6% were mostly isolated. Multidrug resistance rates were E. coli 100%, K. pneumoniae 95%, A. baumanii 82% and P. aeruginosa 17%. Extended-spectrum beta-latamase (ESBL)-producing K. pneumoniae and E. coli was 6 out of 10 tested organisms. Carbarpenemase-producing GNB and methicillin-resistant Staphylococcus aureus (MRSA) were 21% and 33%, respectively. Virology section tested 529 samples of 490 patients using the FTD33 Multiplex PCR method which can detect 33 pathogens including 20 viruses, 12 bacteria and 1 fungus. Out of 490 patients, 374 were PCR positive. Different types of samples including nasopharyngeal, throat, endotracheal and laryngeal swab, tracheal secretion and bronchoalveolar lavage, were tested. Out of 566 viruses, respiratory syncytial virus (RSV) (19.3%), rhinovirus (17.0%), parechovirus (14.3%), bocavirus (11.1%), adenovirus (10.2%), metapneumo-virus A and B (10.2%), parainfluenza virus (5.7%), enterovirus (3.0%), influenza A virus (2.8%), coronavirus (4%), parainfluenza virus (0.9%) and influenza C virus (0.4%) were detected. This study highlighted the etiological agents of bacteria, viruses and drug-resistant bacterial pathogens in SARI.
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