62例社区获得性肺炎病原学调查及细菌耐药性分析

Analysis on the Pathogens of 62 Cases of Community-Acquired Pneumonia and Drug Resistance of Isolated Bacteria

目的调查社区获得性肺炎(CAP)的病原体分布状况,了解细菌的耐药情况。方法收集2003年12月至2004年11月在中山大学附属三院就诊CAP患者共62例,分别留取呼吸道分泌物进行细菌培养,应用常规方法分离鉴定细菌并进行药物敏感性试验,同时检测患者急性期和恢复期肺炎支原体、肺炎衣原体、嗜肺军团菌血清抗体。结果62例CAP患者39例(62.9%)病原学检查阳性,其中流感嗜血杆菌11例,肺炎链球菌7例,肺炎克雷伯杆菌5例,化脓性链球菌4例,金黄色葡萄球菌3例,卡他莫拉菌1例。检出肺炎支原体13例,肺炎衣原体4例,嗜肺军团菌3例。11例为混合感染。流感嗜血杆菌对氨苄西林耐药率为27.3%;肺炎链球菌对青霉素不敏感率为57.1%,对阿齐霉素耐药率为71.4%。结论流感嗜血杆菌和肺炎链球菌是CAP的主要致病菌,肺炎链球菌对青霉素及大环内酯类耐药率较高。非典型病原体感染率高,且多为混合感染。

Objective To investigate the pathogens of community-acquired pneumonia（CAP）, and study the drug resistance of isolated bacteria. Method A prospective study was performed on 62 adult patients with CAP from December 2003 to November 2004. Sputum samples were collected for culture. Bacteria were isolated and identified using conventional methods and their Minimum Inhibitory Concentration （MIC） were determined. Antibodies of the paired serum samples to Mycopiasma pneumonia, Chlwnydia pneumonia, and LegioneUa pneumophila were detected. Result The etiology of CAP was identified in 39 patients. The distribution of casual agents was as foUows： Haemophilus influenzae 11, Streptococcus pneumoniae 7, Klebsiella pneumoniae 5, Staphylococcus aureus 3, Moraxelle catarrhalis 1, Mycoplasma pneumonia 13, Chlamydia pneumoniae 4, and LegioneUa pneumopbila 3. In 11 patients more than one causal agent were found. The drug resistance rate of Haemophilus influenzae to ampicillin was 27.3%. The non-susceptibility rates of Streptococcus pneumoniae to penicilin and azithromycin were 57.1% and 71.4% , respectively. Conclusion Haemophilus influenzae and Streptococcus pneumoniae were the most common bacteria for CAP. The drug resistance rate of Streptococcus pneumoniae to penicilin and azithromycin was high. Adult CAP was caused by atypical pathogens and the rate of mixed infection was high.