背景：许多上呼吸道病原体会引起类似的症状。在中国,上呼吸道病原体的常规分子检测并不广泛,在治疗上呼吸道感染(URTIs)时滥用抗生素是一个主要的公共卫生问题.
方法：我们进行了定性实时PCR测试，以检测来自中国某市发热和流感样症状患者的1221例鼻咽拭子中常见的上呼吸道病原体，包括9种病毒和3种细菌。还进行了定量实时PCR以测量这些样品中定殖的肺炎链球菌的细菌密度。
结果：我们发现了非常多样的病原体，包括81.7%的病毒，11.6%的细菌和6.7%的混合病毒和细菌。在8.0％的病例中发现了肺炎链球菌定植，但大多数病例的细菌密度较低（平均值=3.9logcfu/ml）。我们还发现，在可检测上呼吸道病原体的患者中，肺炎链球菌定植频率（而不是密度）增加，以病原体品种依赖性的方式。
结论：我们的研究提供了强有力的证据，反对经验性抗生素用于治疗URTIs。并强调了通过在中国使用更多的分子检测来提高URTIs的诊断能力的强烈需求。
BACKGROUND: Many upper respiratory pathogens cause similar symptoms. In
China, routine molecular tests for upper respiratory pathogens are not widely performed and antibiotics abuse in treating upper respiratory tract infections (URTIs) is a major public health concern.
METHODS: We performed qualitative real-time PCR tests to detect common upper respiratory tract pathogens including 9 viruses and 3 bacteria in 1221 nasopharyngeal swabs from patients with fever and influenza-like symptoms in a Chinese city. A quantitative real-time PCR was also performed to measure the bacterial density of the colonizing Streptococcus pneumoniae in these samples.
RESULTS: We found very diverse pathogens including 81.7% viruses, 11.6% bacteria and 6.7% mixed viruses and bacteria. S. pneumoniae colonization was found in 8.0% of the cases but most of them had low bacterial density (Mean = 3.9 log cfu/ml). We also discovered an increase of S. pneumoniae colonization frequency (but not the density) in patients with detectable upper respiratory tract pathogens, in a pathogen variety-dependent manner.
CONCLUSIONS: Our study provided strong evidence against empiric antibiotic use for treating URTIs, and highlighted a strong need for improving the diagnostic capacity for URTIs by using more molecular testing in
China.
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