社区获得性肠杆菌肺炎与普通肺炎的比较

Comparsion of severe community-acquired enterobacter pneumonia and common community-acquired pneumonia(CAP)

目的通过对社区获得性肠杆菌肺炎与普通肺炎的临床对比研究,探讨社区获得性肠杆菌肺炎新的流行病学变化趋势及其特点。方法10例社区获得性肠杆菌肺炎与20例社区获得性普通肺炎进行配对研究,回顾性分析其临床特点、易患因素、病原学检查特点以及抗生素治疗特点。结果(1)社区获得性肠杆菌肺炎的临床症状、生化检查、胸部X线表现等无特殊性,两组病死率比较差异无显著性。(2)患有基础疾病者易发生社区获得性肠杆菌肺炎。(3)不适合抗生素使用时间的过度延长引起一个复杂的疾病过程,而适合抗生素使用的延迟未引起患者病死率的明显增加。结论(1)对因社区获得性肺炎住ICU的患者,如果具备年老,至少有一种基础疾病存在,有既往住院史,有既往抗菌素使用史等特点,应警惕社区获得性肠杆菌肺炎的可能。(2)对疑诊患者早期病原学检查有助于抗生素的合理的选择。

Objective To explore the changable trends and characteristics of enterobacter CAP through a clinical comparative study between enterobacter community acquired pneumonia and common CAP. Methods The characteristics of antibiotic therapy, risk factors and pathogens between 10 patients of Enterobacter CAP and 20 potients of common CAP, were retrospectively analyzed. Results （1） There were no statistical significance in clinical characteristing between Enterobacter CAP and common CAP. （2） Patients with at least one of co-morbid illness such as diabetes, cancer, were easy to catch Enterobacter CAP. （3） The prolonged use of inappropriate antibiotic drugs might cause more complicated process of Enterobacter CAP, however the delayed use of appropriate antibiotic didn＇t seem to raise the mortality. Conclusion （1） Enterobacter CAP needs to be considered for those patients who are admitted to ICU for CAP and characterized by a high comorbidity, old age, previous hospitalization and previous antibiotic treatment. （2） Identifying the pathogen in early stage is essential for chooseing the appropirate at risk antibiotic therapy of the patients.