Tajima Takeshi, Nakayama Eiichi, Kondo Yasuo, Hirai Fumie, Ito Hiroaki, Iitsuka Taketoshi, Momomura Mei, Kutsuma Hirokazu, Kodaka Yuri, Funaki Naomi, Yanagawa Yukishige, Ubukata Kimiko
Department of Pediatrics, Hakujikai Memorial Hospital, 5-11-1 Shikahama Adachi-ku, Tokyo 123-0864, Japan.
J Infect Chemother. 2006 Dec;12(6):372-9. doi: 10.1007/s10156-006-0476-5. Epub 2007 Jan 18.
We tried to verify whether the currently employed diagnosis and treatment of community-acquired pneumonia in children were appropriate. For this purpose, we created tentative criteria for the classification of pediatric community-acquired pneumonia. We classified the community-acquired pneumonia into ten categories: (1) bacterial, (2) concomitant viral-bacterial, (3) viral, (4) mycoplasmal, (5) concomitant mycoplasmal-bacterial, (6) concomitant mycoplasmal-viral, (7) chlamydial, (8) concomitant chlamydial-bacterial, (9) concomitant chlamydial-viral, and (10) unknown. Children aged 1 month to 13 years with radiographic and clinical evidence of pneumonia were enrolled. Between October 2001 and September 2002, we enrolled 165 patients. The etiologic agents were determined in 126 of the 157 (80.3%) patients who were finally diagnosed with pneumonia. Two blood cultures were positive for Haemophilus influenzae type b and Streptococcus pneumoniae. A viral infection alone was found in 28 of the 157 patients (17.8%), a bacterial (without mycoplasmal) alone infection in 42 (26.8%), a concomitant viral-bacterial infection in 28 (17.8%), and a mycoplasmal infection in 27 (17.2%) patients. RS virus was identified in 28 patients (17.8%), influenza A in 12 (7.6%), parainfluenza 3 in 8 (5.1%), adenovirus in 8 (5.1%), and influenza B and measles virus in 1 patient each. Streptococcus pneumoniae was the most common cause of bacterial pneumonia. We chose the initial treatment according to clinical and laboratory findings on admission (i.e., patients' age, clinical course, chest X-ray, and laboratory findings). In 68 of the 71 patients with bacterial (without mycoplasmal) pneumonia, an appropriate antibacterial-agent was prescribed. In 25 of the 27 patients with mycoplasmal pneumonia, clindamycin and minocycline were prescribed.
我们试图验证目前对儿童社区获得性肺炎的诊断和治疗是否恰当。为此，我们制定了儿童社区获得性肺炎分类的暂行标准。我们将社区获得性肺炎分为十类：（1）细菌性；（2）病毒 - 细菌合并感染；（3）病毒性；（4）支原体性；（5）支原体 - 细菌合并感染；（6）支原体 - 病毒合并感染；（7）衣原体性；（8）衣原体 - 细菌合并感染；（9）衣原体 - 病毒合并感染；（10）不明原因。纳入年龄在1个月至13岁、有肺炎影像学和临床证据的儿童。在2001年10月至2002年9月期间，我们纳入了165例患者。在最终确诊为肺炎的157例患者中，有126例（80.3%）确定了病原体。两份血培养结果显示b型流感嗜血杆菌和肺炎链球菌阳性。157例患者中，单独病毒感染28例（17.8%），单独细菌（无支原体）感染42例（26.8%），病毒 - 细菌合并感染28例（17.8%），支原体感染27例（17.2%）。28例患者（17.8%）检测出呼吸道合胞病毒，12例（7.6%）检测出甲型流感病毒，8例（5.1%）检测出副流感病毒3型，8例（5.1%）检测出腺病毒，1例检测出乙型流感病毒和麻疹病毒。肺炎链球菌是细菌性肺炎最常见的病因。我们根据入院时的临床和实验室检查结果（即患者年龄、临床病程、胸部X线和实验室检查结果）选择初始治疗方案。71例细菌性（无支原体）肺炎患者中，68例使用了恰当的抗菌药物。27例支原体肺炎患者中，25例使用了克林霉素和米诺环素。
