上海市社区获得性肺炎住院患者致病菌及耐药性分析

Analysis of Bacteria Spectrum and Antimicrobial Resistance of Patients Hospitalized with Community-acquired Pneumonia in Shanghai

目的了解上海市成人社区获得性肺炎住院患者痰培养和血培养致病菌分布及其耐药情况,为治疗提供依据。方法分析住院患者痰培养和血培养致病菌检出的阳性率、各种致病菌的分布以及常见致病菌的药物敏感情况。结果痰培养患者442例,阳性率为32.3%,血培养97例,阳性率为5.2%。单纯1种致病菌感染者114例,2种以上致病菌复合感染者30例,年龄较大、有基础疾病的患者细菌培养阳性的比例较大。由细菌培养结果发现革兰氏阳性致病菌16株(8.8%),革兰氏阴性致病菌97株(53.6%),真菌68株(37.6%)。肺炎克雷伯氏菌、鲍曼不动杆菌、铜绿假单胞菌、阴沟肠杆菌对部分抗生素耐药率较高。结论痰培养和血培养只能确定少数患者的病原体,其中以革兰氏阴性致病菌和真菌较为多见,革兰氏阳性致病菌所占比例较小。4种革兰氏阴性菌对部分抗生素耐药率较高。

OBJECTIVE To investigate the bacteria spectrum and anobialresistance of adult patients hospitalized with community-acquired pneumonia （CAP） in shanghai, China, and to facilitate and promote CAP management. METHODS The positive rate of bacteria culture calculate, analyze the proportion and antimicrobial resistance of varied bacteria cultured from sputum and blood. RESULTS 442 and 97 CAP accepted sputum cultureand blood culture, the bacterial positive rate was 32.3% and 5.2% of blood culture the positive rate was 32.3% and 5.2% respectively.There were 114 patients who infected by one kind of bacteria and 30 patients infected by two or more kinds. Thepositive rate is comparatively higher among elder or having underlying diseasespatients than younger or don＇t having underlying diseases patients.Of the bacterialstrains isolated from sputum culture and blood culture, gram positive cocci constituted 8.8% （16）, gram negative bacilli 53.6%（97） and fungi 37.6%（68）. The mostfrequently detected bacteria were klebsiella pneumoniae, acinetobacter baumannii, pseudomonas aeruginosa, enterobacter cloacae, and they all had high resistance rate tosome kind of antibiotics. CONCLUSIONS Only a small part of patient＇s bacteria can beconfirmed by sputum culture and blood culture. Gram negative bacilli was the mostcommon bacteria detected from sputum culture and blood culture, gram positive coccihad a relative small proportion. Four kinds of gram negative bacilli had highresistance rate to some kind of antibiotic.