Wang M, Zhao J Y, Li X, Wu L Y, Zhou Q Q, Huang Y F, Sui W J, Zhang S Y, Xu J, Jin J M, Gu H T, Lu X X
Department of Laboratory Medicine,Beijing Tongren Hospital, Capital Medical University,Beijing 100730,China.
Department of Laboratory Medicine,Beijing Shunyi Hospital,Beijing 101300,China.
Zhonghua Yu Fang Yi Xue Za Zhi. 2021 Dec 6;55(12):1410-1418. doi: 10.3760/cma.j.cn112150-20210706-00645.
To explore the distribution characteristics of pathogens in adult patients with community-acquired pneumonia (CAP) and to provide basis for the diagnosis, treatment, prevention of CAP. 1 446 inpatients with CAP were prospectively enrolled in a third-class hospital in Beijing in recent 5 years (from January 2015 to December 2019). Respiratory tract samples were collected for smear, culture, nucleic acid, antigen and antibody detection to identify the pathogen of CAP. Mann-Whitney test was used for continuous variables and χ test or Fisher's exact test was used for categorical data for statistical analysis. Among the 1 446 patients, 822 (56.85%) patients were infected with a single pathogen, 231 (15.98%) patients were infected with multiple pathogens, and 393 (27.18%) patients were not clear about the pathogen. Influenza virus is the first pathogen of CAP (20.95%, 303/1 446), mainly H1N1 (8.51%, 123/1 446), followed by mycoplasma pneumoniae (7.19%, 104/1 446), Mycobacterium tuberculosis (5.33%, 77/1 446) and Streptococcus pneumoniae (5.05%, 73/1 446). The outbreak of H1N1 occurred from December 2018 to February 2019, and the epidemic of mycoplasma pneumoniae pneumonia was monitored from August to November 2019. Patients under 65 years old had high detection rates of Mycoplasma pneumoniae (14.41% 2.41%, χ²=74.712,<0.001), Streptococcus pneumoniae (8.16% 2.99%, χ²=18.156, 0.001), rhinovirus (6.08% 3.56%, χ²=5.025, 0.025), Chlamydia pneumoniae (5.90% 1.15%, χ²=26.542, 0.001) and adenovirus (3.13% 0.92%, χ²=9.547, =0.002). The severe disease rate of CAP was 14.66% (212/1 446), and the average mortality rate was 3.66% (53/1 446). The severe illness rate and mortality rate of bacterial-viral co-infection were 28.97% (31/107) and 19.63% (21/107), respectively. Influenza virus is the primary pathogen of adult CAP. Outbreaks of Mycoplasma pneumoniae and H1N1 were detected in 2018 and 2019, respectively. The remission rate and mortality rate of virus-bacteria co-infection were significantly higher than those of single pathogen infection. Accurate etiological basis not only plays a role in clinical diagnosis and treatment, but also provides important data support for prevention and early warning.
探讨成人社区获得性肺炎（CAP）患者病原体的分布特征，为CAP的诊断、治疗及预防提供依据。近5年（2015年1月至2019年12月）前瞻性纳入北京某三级医院1446例CAP住院患者。采集呼吸道样本进行涂片、培养、核酸、抗原及抗体检测，以明确CAP病原体。连续变量采用Mann-Whitney检验，分类资料采用χ²检验或Fisher确切概率法进行统计分析。1446例患者中，822例（56.85%）感染单一病原体，231例（15.98%）感染多种病原体，393例（27.18%）病原体不明确。流感病毒是CAP的首要病原体（20.95%，303/1446），主要为H1N1（8.51%，123/1446），其次为肺炎支原体（7.19%，104/1446）、结核分枝杆菌（5.33%，77/1446）和肺炎链球菌（5.05%，73/1446）。H1N1暴发于2018年12月至2019年2月，2019年8月至11月监测到肺炎支原体肺炎流行。65岁以下患者肺炎支原体（14.41%比2.41%，χ²=74.712，P<0.001）、肺炎链球菌（8.16%比2.99%，χ²=18.156，P=0.001）、鼻病毒（6.08%比3.56%，χ²=5.025，P=0.025）、肺炎衣原体（5.90%比1.15%，χ²=26.542，P<0.001）及腺病毒（3.13%比0.92%，χ²=9.547，P=0.002）检出率较高。CAP重症率为14.66%（212/1446），平均死亡率为3.66%（53/1446）。细菌-病毒合并感染的重症率和死亡率分别为28.97%（31/107）和19.63%（21/107）。流感病毒是成人CAP的主要病原体。2018年和2019年分别检测到肺炎支原体和H1N1暴发。病毒-细菌合并感染的缓解率和死亡率显著高于单一病原体感染。准确的病原学依据不仅对临床诊断和治疗有指导作用，也为预防和预警提供重要数据支持。
