儿童细菌感染与影像学确诊肺炎之间的关联。
Association between bacterial infection and radiologically confirmed pneumonia among children.
作者信息
Nascimento-Carvalho Cristiana M, Araújo-Neto César A, Ruuskanen Olli
机构信息
From the *Department of Pediatrics and †Department of Image Diagnosis, Federal University of Bahia School of Medicine, Salvador, Brazil; and ‡Department of Pediatrics, University of Turku, Turku, Finland.
出版信息
Pediatr Infect Dis J. 2015 May;34(5):490-3. doi: 10.1097/INF.0000000000000622.
BACKGROUND
The role of chest radiograph (CXR) among children with community-acquired pneumonia is controversial. We aimed to assess if there is association between a specific etiology and radiologically confirmed pneumonia.
METHODS
This was a prospective cross-sectional study. Based on report of respiratory complaints and fever/difficulty breathing plus the detection of pulmonary infiltrate/pleural effusion on the CXR taken upon admission read by the pediatrician on duty, children <5-year-old hospitalized with community-acquired pneumonia were enrolled. On admission, clinical data and biological samples were collected to investigate 19 etiological agents (11 viruses and 8 bacteria). CXR taken upon admission was independently read by a pediatric radiologist blinded to clinical data.
RESULTS
The study group comprised 209 cases with evaluated CXR and establishment of a probable etiology. Radiologically confirmed pneumonia, normal CXR and other radiographic diagnoses were described for 165 (79.0%), 36 (17.2%) and 8 (3.8%) patients, respectively. Viral infection was significantly more common among patients without radiologically confirmed pneumonia (68.2% vs. 47.9%; P = 0.02), particularly among those with normal CXR (66.7% vs. 47.9%; P = 0.04) when compared with patients with radiologically confirmed pneumonia. Bacterial infection was more frequent among cases with radiologically confirmed pneumonia (52.1% vs. 31.8%; P = 0.02). Likewise, pneumococcal infection was more frequently detected among children with radiologically confirmed pneumonia in regard to children with normal CXR (24.2% vs. 8.3%; P = 0.04). Sensitivity (95% confidence interval) of radiologically confirmed pneumonia for pneumococcal infection was 93% (80-98%), and negative predictive value (95% confidence interval) of normal CXR for pneumococcal infection was 92% (77-98%).
CONCLUSION
Bacterial infection, especially pneumococcal one, is associated with radiologically confirmed pneumonia.
背景
胸部X线片（CXR）在社区获得性肺炎儿童中的作用存在争议。我们旨在评估特定病因与放射学确诊肺炎之间是否存在关联。
方法
这是一项前瞻性横断面研究。根据呼吸症状报告以及发热/呼吸困难，再加上值班儿科医生对入院时所拍摄的胸部X线片上肺部浸润/胸腔积液的检测结果，纳入5岁以下因社区获得性肺炎住院的儿童。入院时，收集临床数据和生物样本以调查19种病原体（11种病毒和8种细菌）。由一位对临床数据不知情的儿科放射科医生独立解读入院时拍摄的胸部X线片。
结果
研究组包括209例经评估胸部X线片并确定可能病因的病例。分别有165例（79.0%）、36例（17.2%）和8例（3.8%）患者被诊断为放射学确诊肺炎、胸部X线片正常和其他影像学诊断。与放射学确诊肺炎的患者相比，未确诊为放射学确诊肺炎的患者中病毒感染更为常见（68.2%对47.9%；P = 0.02），尤其是胸部X线片正常的患者（66.7%对47.9%；P = 0.04）。放射学确诊肺炎的病例中细菌感染更为频繁（52.1%对31.8%；P = 0.02）。同样，与胸部X线片正常的儿童相比，放射学确诊肺炎的儿童中肺炎球菌感染更常见（24.2%对8.3%；P = 0.04）。放射学确诊肺炎对肺炎球菌感染的敏感性（95%置信区间）为93%（80 - 98%），胸部X线片正常对肺炎球菌感染的阴性预测值（95%置信区间）为92%（77 - 98%）。
结论
细菌感染，尤其是肺炎球菌感染，与放射学确诊肺炎有关。
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