Department of Pediatrics, National Hospital Organization Tokyo Medical Center, 2-5-1 Higashigaoka, Meguro-ku, Tokyo 152-8902, Japan.
J Infect Chemother. 2012 Dec;18(6):832-40. doi: 10.1007/s10156-012-0422-7. Epub 2012 May 9.
To evaluate pathogens in pediatric inpatients with community-acquired pneumonia (CAP), an Acute Respiratory Diseases Study Group organized by ten Japanese medical institutions devised a rapid, reliable process based on real-time PCR results in nasopharyngeal swab samples plus admission blood test results. From April 2008 to April 2009, we enrolled 903 children with CAP based on chest radiographs and clinical findings who were hospitalized within 5 days of onset. Comprehensive real-time PCR was used to detect 6 bacteria and 11 respiratory viruses. The swab specimens also were used for bacterial cultures. After initial determination of presence or absence of viral and mycoplasmal infections, significant bacterial contributions were defined by bacterial identification, clinical efficacy of antimicrobial agent, and reference to blood test results. Children were stratified by age: below 1 year, 1 year, 2-5 years, or at least 6 years old. Among patients studied, 34.4 % were diagnosed with viral infection; 21.8 %, bacterial infection; 17.5 %, viral/bacterial co-infection; 5.9 %, mycoplasmal infection; 0.3 %, mycoplasmal/bacterial co-infection; and 1.7 %, viral/mycoplasmal co-infection. The remaining 18.4 % had unknown pathogens. Purely viral infection was suggested mainly in infants younger than 1 year; mycoplasmal infection typically occurred in children at least 6 years old. Our results suggest usefulness of real-time PCR for nasopharyngeal samples together with blood tests in estimating etiologic agents in clinical settings.
为了评估社区获得性肺炎（CAP）住院患儿的病原体，由十个日本医疗机构组成的急性呼吸道疾病研究组制定了一种快速、可靠的方法，该方法基于鼻咽拭子样本实时 PCR 结果和入院时的血液检测结果。2008 年 4 月至 2009 年 4 月，我们根据胸部 X 线片和临床发现纳入了 903 例 CAP 住院患儿，这些患儿在发病后 5 天内入院。综合使用实时 PCR 检测 6 种细菌和 11 种呼吸道病毒。拭子标本也用于细菌培养。在初始确定是否存在病毒和支原体感染后，根据细菌鉴定、抗菌药物的临床疗效和血液检测结果来确定是否存在细菌感染。根据年龄将患儿分为：<1 岁、1 岁、2-5 岁和≥6 岁。在所研究的患者中，34.4%被诊断为病毒感染；21.8%，细菌感染；17.5%，病毒/细菌合并感染；5.9%，支原体感染；0.3%，支原体/细菌合并感染；1.7%，病毒/支原体合并感染。其余 18.4%的患儿存在未知病原体。单纯病毒感染主要见于<1 岁的婴儿；支原体感染多见于≥6 岁的儿童。我们的研究结果表明，实时 PCR 联合血液检测可用于临床估计病原体。
