成人社区获得性肺炎病原菌分布及其耐药性分析

Distribution and resistance of pathogens in adult patients with community-acquired pneumonia

目的分析浦东金杨社区获得性肺炎(CAP)患者的感染病原菌分布及其耐药性。方法选择2001年10月-2003年9月我院收治的315例成年CAP患者,取痰、血清、尿液、血液、胸水和支气管肺泡灌洗液标本培养,对阳性标本进行分离、鉴定,对所培养的细菌、真菌等以M-H平板进行药敏试验;对肺炎克雷伯菌、金葡菌采用分子生物学方法检测其耐药性。结果153例(48.57%)患者有明确的感染病原体,其中非典型致病菌感染者75例(49.02%),革兰阴性菌感染者58例(37.91%),且以流感和副流感嗜血杆菌、肺炎克雷伯菌多见;革兰阳性菌感染者26例(16.99%),以金葡菌多见;真菌感染者8例(5.23%)。38例患者存在两种及以上病原菌感染。流感和副流感嗜血杆菌对头孢噻肟钠耐药严重,肺炎克雷伯菌部分产β-内酰胺酶(BLA),金葡菌大多为耐甲氧西林金葡菌(MRSA)。结论本地区CAP患者以非典型致病菌和革兰阴性菌感染为主。

Objective To investigate the distribution and antimicrobial resistance of pathogens in adult patients with community-acquired pneumonia （CAP） in Jinyang district. Methods Totally 315 qualified patients with CAP were enrolled during 2001-2003. Specimen from phlegm, serum, urine, blood, pleural effusion and broncho-alveolar lavage liquid were cultured and identified. Isolates achieved were performed susceptibility test and drug resistance. Results The incidence of patients infected with definite pathogen was 48.57%. The rates of patients infected with atypical pathogens were 49.02%. There was 37.91% in the rest gram-negative bacteria. The main pathogens were H.influenzae, H.parainfluenzae and Klebsiella pneumoniae in the rest gram-negative bacteria. There were 16.99% in the rest gram-positive bacteria. The main pathogens were S.aureus. The rates of fungal infection were 5.23%. Thirty eight patients were infected with two or more pathogens. H.influenzae and H.parainfluenzae should be showed serious against cefotaxine in antimicrobial sensitivity and resistance tests. A small number of Klebsiellapneumoniae was ESBL. Most of S.aureus was MRSA. Conclusion The main pathogenes of CAP were atypical pathogens and gram-negative bacteria.