Division of Pediatric Infectious Diseases, Chang Gung Memorial Hospital, Taiwan.
Pediatr Infect Dis J. 2012 Nov;31(11):e196-201. doi: 10.1097/INF.0b013e31826eb5a7.
Pneumonia is the leading reason for hospitalization in children. The heptavalent pneumococcal conjugate vaccine was introduced in Taiwan in October 2005. There has been no comprehensive study of the etiology of childhood community-acquired pneumonia (CAP), either in the pre- or postpneumococcal conjugate vaccine era, in Taiwan.
From August 2001 to July 2002, consecutive children admitted to a teaching hospital with radiologically confirmed CAP were prospectively enrolled. The following were considered indicative of infection when positive: blood or pleural effusion bacterial culture or urinary Streptococcus pneumoniae antigen test (Binax NOW), direct immunofluorescent antigen test for Chlamydia species and viruses, virus isolation and identification and viral, mycoplasmal or chlamydial serologic tests.
A total of 209 children were included, and 102 children (48.8%) were male. Patients' ages ranged from 7 months to 16 years with a median of 4 years and 3 months. The combined tests identified at least 1 etiologic agent in 85.6% of all cases, including typical bacterial pathogens in 88 cases (42.1%; 86 S. pneumoniae, 1 methicillin-resistant Staphylococcus aureus and 1 Mycobacterium tuberculosis), Mycoplasma pneumoniae in 77 cases (36.8%), Chlamydia species in 24 cases (11.5%), viral etiology in 86 cases (41.1%) and mixed viral-bacterial infections in 69 cases (33%). Children with S. pneumoniae infection were significantly younger than those with Mycoplasma pneumoniae infection (P = 0.0055) or unknown etiology (P = 0.0140).
S. pneumoniae, Mycoplasma pneumoniae and viruses were equally common etiologic agents of childhood CAP in Taiwan. Frequent coinfection increased the difficulty of both predicting the responsible organisms and choosing empiric antibiotics for the management of pediatric CAP.
肺炎是导致儿童住院的主要原因。2005 年 10 月，七价肺炎球菌结合疫苗在台湾推出。在引入肺炎球菌结合疫苗之前和之后，台湾都没有对儿童社区获得性肺炎（CAP）的病因进行全面研究。
从 2001 年 8 月至 2002 年 7 月，连续纳入因影像学证实的 CAP 而收入教学医院的儿童进行前瞻性研究。当以下情况为阳性时，可考虑感染：血液或胸腔积液细菌培养或尿液肺炎链球菌抗原检测（Binax NOW）、衣原体和病毒的直接免疫荧光抗原检测、病毒分离和鉴定以及病毒、支原体或衣原体血清学检测。
共纳入 209 例儿童，其中男童 102 例（48.8%）。患者年龄为 7 个月至 16 岁，中位数为 4 岁零 3 个月。联合检测确定了所有病例中至少有 1 种病因，包括 88 例（42.1%）典型细菌病原体（86 例肺炎链球菌、1 例耐甲氧西林金黄色葡萄球菌和 1 例结核分枝杆菌）、77 例肺炎支原体（36.8%）、24 例衣原体（11.5%）、86 例病毒病因（41.1%）和 69 例混合病毒-细菌感染（33%）。感染肺炎链球菌的儿童明显比感染肺炎支原体或病因不明的儿童年龄小（P=0.0055）。
在台湾，肺炎链球菌、肺炎支原体和病毒是儿童 CAP 的常见病因。频繁的混合感染增加了预测致病病原体和选择经验性抗生素治疗小儿 CAP 的难度。
