Pathogenic bacteria characteristics and Clinical significance of immunoglobulin, CRP, WBC and PCT in children with refractory pneumonia
LIAO Zhaomei1, CAI Siming1, CHEN Jianbiao1, LV Hualong1, LEI Zhixian2
1. Department of Pediatrics, the Second Affiliated Hospital of Hainan Medical College, Haikou 570100, China;
2. Department of Pediatrics, children’s Hospital Affiliated to Hainan Medical College, Haikou 570100, China
Abstract：Objective To investigate the etiological characteristics of infection and the expression significance of immunoglobulin, C-reactive protein (CRP), white blood cell count (WBC) and procalcitonin (PCT) in children with refractory pneumonia (RMPP). Methods The clinical data of 213 children with RMPP and 87 children with general pneumonia (GMPP) admitted from January 2019 to March 2021 were retrospectively analyzed. Peripheral blood of two groups of children was collected to detect the levels of immunoglobulin, CRP, WBC, and PCT, bronchoalveolar lavage fluid (BALF) of RMPP children was collected for pathogen culture and drug sensitivity test. The receiver operating characteristic (ROC) curve was used to analyze the value of immunoglobulin, CRP, WBC, and PCT in the differential diagnosis of RMPP. Results A total of 158 strains of pathogens were detected in 13 children with RMPP, including 98 strains of Gram-negative bacteria and 60 strains of Gram-positive bacteria. The Gram-negative bacteria were mainly Klebsiella pneumoniae (29 strains), while the Gram-positive bacteria were mainly Streptococcus pneumoniae (31 strains) and Staphylococcus aureus (24 strains). The results showed that Klebsiella pneumoniae was sensitive to imipenem, ertapenem, piperacillin/tazobactam, tobramycin and amikacin. Streptococcus pneumoniae was sensitive to ceftriaxone, cefotaxime, meropenem, ertabenem, vancomycin, Linezolid, chloramphenicol, moxifloxacin, levofloxacin, while Staphylococcus aureus was sensitive to gentamicin, vancomycin, quinuprtin/Dafoputine, linezolid, tegacycline, moxifloxacin, and rifampicin. There was no difference in the levels of IgA and WBC between the two groups; The levels of IgG, IgM, CRP, and PCT in the RMPP group were higher than those in the GMPP group. The ROC curve shows that IgG, IgM, CRP, and PCT have a certain differential diagnosis value for RMPP (AUC=0.770, 0.778, 0.824, 0.806, P<0.001), and the combination of the four (AUC=0.902, P<0.001) has a differential diagnosis value Higher. Conclusion The pathogenic bacterias of children with RMPP are mainly Klebsiella pneumoniae, Streptococcus pneumoniae and Staphylococcus aureus. The above pathogenic bacterias should be covered during empirical treatment, and the pathogen should be detected as soon as possible. If the curative effect is not good, drug resistance should be considered . And promptly give targeted treatment based on the results of drug sensitivity. The IgG, IgM, CRP and PCT level apparently higher than GMPP group, and RMPP will not have a significant impact on WBC. Combined detection of IgG, IgM, CRP, and PCT can be used for the differential diagnosis of RMPP.
2023, Vol. 20 
