社区获得性肺炎的初始经验性抗菌治疗对策研究

Clinical Strategy of the Empiric Anti-biotic Therapy for Community-acquired Pneumonia

目的探讨初始经验性抗菌治疗社区获得性肺炎(CAP)时是否应该覆盖非典型病原体。方法将我院2004年5月—2008年3月住院治疗的CAP患者,按照初始经验治疗时选择的抗生素不同将患者分为3组:对照组为初始经验性抗菌治疗不覆盖非典型病原体;治疗组A为初始经验性抗菌治疗覆盖非典型病原体,单独使用呼吸喹诺酮类抗生素或者联合其他抗生素;治疗组B初始经验性抗菌治疗覆盖非典型病原体,单独使用大环内酯类抗生素或者联合β-内酰胺类抗生素。结果3组患者体温降至正常的时间,症状、体征改善的时间以及住院天数间差异均有统计学意义(P<0.05)。且3组患者两两比较各项指标间差异亦均有统计学意义(P<0.05)。结论CAP初始经验性抗菌治疗应该考虑覆盖非典型病原体。

Objective To investigate whether the atypical pathogens should be included in empiric anti - biotic therapy for community - acquired pneumonia （ CAP）. Methods The inpatients with CAP from May 2004 to March 2008 were enrolled. They were divided into 3 groups： the patients in the control group received empirical antibiotic therapy without atypical coverage, those in trial group A received antibiotic therapy with atypical coverage, or quinoloine antibiotics alone or combined with other antibiotics, and those in the trial group B received antibiotic therapy with atypical coverage, or macrolides antibiotics alone or combined with β - lactam antibiotics. Results There were significant differences in the times for temperature to drop to the normal, times for symptoms and signs to be improved, and days for hospitalization among the patients in the 3 groups （ P 〈 0.05 ）, and there were also a significant difference in the various indexes between each two groups （ P 〈 0. 05 ）. Patients treated with atypical coverage decreased time to temperature drop, decreased time to clinical stability, decreased length of hospital stay. Conclusion The empiric antibiotic therapy for CAP should consider infection of atypical pathogens.