重症社区获得性肺炎的病原学及药物敏感性研究

Study the Characteristics of Etiology and Drug Sensitivity About Serious Community Acquired Pneumonia

目的 :探讨本地区重症社区获得性肺炎 (SCAP)的病原学与药敏特点 ,为合理使用抗生素提供依据。方法 :采用VITEK -AMS微生物分析仪测定病原菌 ,并用纸片法 (Kirby -Bauer)测定病原菌的体外药物敏感性。结果 :6 9例患者 ,年龄 2 0～ 95岁 ,平均 6 5± 18岁 ,≥ 6 5岁 4 9例 ,占 71.0 %。 91.3% (6 3/ 6 9)患者有基础疾病 ,其中慢性阻塞性肺病最常见。临床表现为咳嗽 (10 0 % ) ,咳黄脓痰 (86 .9% ) ,肺部出现湿罗音 (10 0 % ) ,高热 (43.5 % ) ,意识障碍 (43.5 % )。所有患者进行了病原学检查 ,5 0例患者培养出 5 4株细菌 ,17例合并真菌感染 ;5 4株细菌中革兰阳性需氧菌 13株 ,以葡萄球菌属为主 ,占 12株 ;革兰阴性杆菌 4 1株 ,以铜绿假单胞菌为主 ,占 11株 ,嗜麦芽窄食单胞菌 9株 ,肠杆菌科 8株。铜绿假单胞菌依次对头孢派酮钠 /舒巴坦钠 (78% )、特治星 (75 % )及泰能 (70 % )敏感 ;肠杆菌科对泰能 (87.5 % )、头孢派酮钠 /舒巴坦钠 (6 6 .7% )与特治星 (6 2 .5 % )敏感。治愈 31例 (44 .9% ) ,好转 10例 (14 .5 % ) ,自动出院 12例 (17.4 % ) ,死亡 16例 (2 3.2 % )。结论 :SCAP多发生于老年人 ;病原体中革兰阴性菌占 76 .0 % ,以铜绿假单胞菌为主 ,其次是嗜麦芽窄食单胞菌 ,革兰阳性需氧菌占 2 4 % ,?

Objective: To investigate the pathogen and antibiotic sensitivity of serious community acquired pneumonia (SCAP) in our hospital and to evaluate the clinical characteristics of SCAP, aiming at providing evidence for using antibiotic. Method: The bacteria were tested with VITEK-AMS, and the drug sensitivity against bacteria by K-B method was studied. Result: There were 52 males and 17 females, the mean age being 65±18 years. 91.3% of cases had underlying diseases, most of which were COPD. Clinical manifestations included cough (100%), purulent sputum (86.9%), bubble (100%), hyperpyrexia (43.5%) and conscious disturbance (43.5%). There were 54 strains bacteria of 50 cases through sputum culture, and 17cases were complicated with fungus. Gram-positive bacteria were 13 stains, most of which were staphylococci. Gram-negative bacteria were 41strains, including 11strains of pseudomonas aeruginosa, 9strains of xanthomonas maltophilia, 8 strains of enterobacterianceae, and so on. The drug sensitivity rate towards pseudomonas aeruginosa was sulperazone 78%, tazocin 75% and tienam 70% respectively. That towards enterobacterianceae was tienam 87.5%, sulperazone 66.7% and tazocin 62.5% respectively. 44.9% cases were healing. 14.5% were improved. 17.4% quitted treatment and 23.0% were fatality. Conclusion: SCAP easy occurred in the aged people. The pathogen of sputum included 76.0% of gram-negative bacteria and 24.0% of gram-positive bacteria. The major of gram-negative bacteria was pseudomonas aeruginosa, and the main of gram-positive bacteria was staphylococci. It was reasonable to elect powerful and broad-spectrum antibiotic in the initially experiential therapy, then use the strong and narrow-spectrum antibiotic according to the pathogen and drug sensitivity.