Clinical characteristics of children with lower respiratory tract infections are dependent on the carriage of specific pathogens in the nasopharynx
Clinical characteristics of children with lower respiratory tract infections are dependent on the carriage of specific pathogens in the nasopharynx
复制标题
DOI：
10.1007/s10096-012-1682-y
复制
发表时间：
2012-11-01
影响因子：
4.5
通讯作者：
Henrich, B.
中科院分区：
文献类型：
--
作者：
Tenenbaum, T.;Franz, A.;Henrich, B.
一项前瞻性临床研究旨在将鼻咽部细菌携带与住院儿童的下呼吸道感染 (LRTI) 类型相关联。为了确定鼻咽抽吸物 (NPA) 中的细菌含量，我们对那些难以培养的病原体使用半定量培养和定量 TaqMan-PCR。样本和临床数据取自 2006 年至 2008 年期间 311 名 0 至 16 岁患有 LRTI 的儿童。最常见的潜在致病菌是流感嗜血杆菌（32.1%）、粘膜莫拉菌（26.7%）、金黄色葡萄球菌（17.7%）和肺炎链球菌（16.7%）。正如预期的那样，金黄色葡萄球菌是 4 个月以下儿童中最常见的定植菌，而流感嗜血杆菌的检测在年龄较大的儿童中达到顶峰。在金黄色葡萄球菌 (46%) 和肺炎链球菌 (49%) 儿童中，与流感嗜血杆菌 (30%) 或粘膜炎莫拉氏菌 (27%) 的儿童相比，更容易观察到与其他细菌病原体的共定植。与金黄色葡萄球菌单一定植的儿童相比，金黄色葡萄球菌共定植的儿童的 C 反应蛋白水平更高，接受抗生素治疗的频率更高，住院时间也更长。相比之下，感染流感嗜血杆菌、粘膜炎支原体或肺炎链球菌定植的儿童比感染金黄色葡萄球菌定植的儿童更容易患肺炎。对细菌数量的定殖者特异性分析显示，从第一次 NPA 到第二次 NPA，细菌携带没有显着减少。没有检测到高细菌载量与肺炎发生之间的相关性。总之，患有 LRTI 的儿童的临床特征与鼻咽中检测到的一组特定细菌定植菌有关，而不是与它们的数量有关。
A prospective clinical study was performed to correlate nasopharyngeal carriage of bacteria with the type of lower respiratory tract infections (LRTI) in hospitalised children. To determine bacterial load in nasopharyngeal aspirates (NPA) we used semiquantitative culturing and quantitative TaqMan-PCR for those pathogens difficult to culture. Specimens and clinical data were obtained from 311 children between 0 and 16 years of age with LRTI during the period of 2006-2008. The most common detected potentially pathogenic colonisers were Haemophilus influenzae (32.1 %), Moraxella catharralis (26.7 %), Staphylococcus aureus (17.7 %) and Streptococcus pneumoniae (16.7 %). As expected S. aureus was the most common coloniser in children less than 4 months of age, whereas H. influenzae detection peaked in older children. Co-colonisation with other bacterial pathogens were more often observed in children with S. aureus (46 %) and S. pneumoniae (49 %) than in those with H. influenzae (30 %) or M. catharralis (27 %). Children with S. aureus co-colonisation had higher levels of C-reactive-protein, received antibiotics more frequently and stayed longer in hospital than those with S. aureus single colonisation. In contrast, children with H. influenzae, M. catharralis or S. pneumoniae colonisation suffered more often from pneumonia than children with S. aureus colonisation. Coloniser specific analysis of bacterial quantity revealed no significant reduction of the bacterial carriage from the first to the second NPA. No correlation of a high bacterial load and occurrence of pneumonia could be detected. In conclusion, clinical characteristics in children with LRTIs are associated with a specific bacterial set of colonisers detected in the nasopharynx rather than on their quantity.