2001年至2003年上海地区社区获得性肺炎的病原学调查

Study on etiology of community-acquired pneumonia in Shanghai during 2001—2003

目的了解上海地区社区获得性肺炎病原的分布和耐药情况,为经验治疗提供依据。方法对2岁以上的389例社区获得性肺炎患者留取痰标本进行细菌培养和药物敏感试验,并采用DNA检测、血清学方法和尿抗原测定检测非典型病原。结果155例患者病原检测阳性,其中28例为混合感染。病原菌共123株,主要为嗜血杆菌属、肺炎链球菌和克雷伯菌属。非典型病原阳性61例,主要为肺炎支原体。嗜血杆菌属细菌产酶率为7.8%,对阿奇霉素、头孢呋辛等所测抗菌药物均呈敏感。肺炎链球菌中多为青霉素敏感株,对头孢曲松、左氧氟沙星和万古霉素则全部呈现敏感。结论嗜血杆菌属仍是社区获得性肺炎的主要病原之一,非典型病原亦占重要地位。青霉素和阿莫西林仍可作经验用药,在青霉素不敏感肺炎链球菌流行地区可增大剂量,或改用第二、三代头孢菌素。新大环内酯类和新氟喹诺酮类亦可作为经验用药之一。

Objective To investigate the distribution and drug resistance of pathogens of community-acquired pneumonia （CAP） in Shanghai area to provide evidence for experiential therapy. Methods Three hundred and eighty nine immunocompetent patients ≥ 2 years old with CAP were enrolled in the study in Shanghai. Their sputum samples were collected for bacterial culture and susceptibility testing. Meanwhile, pathogen DNA in sputum or throat swabs, specific antibody response in paired serum samples and Legionella pneumophila antigen in urine were measured for atypical pathogens. Results Specific infecting organisms were identified in 155 （39.8%） patients, among which 28 were diagnosed with mixed infections. Altogether, 123 bacterial and 61 atypical pathogens were isolated. Hemophilus, Klebsiella spp. and Streptococcus pneumoniae were the most common bacterial pathogens, and Mycoplasma pneumoniae was the most common atypical pathogen. About 7.8 % of Hemophilus produced β-lactamases. All the Hemophilus isolates were demonstrated high susceptible to azithromycin and cefuroxime. Most of Streptococcus pneumoniae isolates were demonstrated susceptible to penicillin. All Streptococcus pneurnoniae isolates were susceptible to ceftriaxone, levofloxacin and vancomycin. Conclusions Hemophilus is one of the most important etiologic agents and atypical pathogens also play a significant role in CAP. Penicillin and amoxicillin can be used as the experiential antimicrobial therapy. In areas where penicillin nonsusceptible Streptococcus is common, higher doses of penicillins or switch to the second or third generation cephalospofins are crucial to ensure effective antimicrohial treatment. Newer macrolides or newer fluoroquinolones are also recommended.