社区获得性肺炎病原学及致病菌耐药性变迁

The changes of etiology of community acquired pneumonia and antibiotics resistance.

社区获得性肺炎(CAP)是目前常见的疾病死亡原因之一。肺炎链球菌(SP)仍是CAP的重要的病原体,非典型病原体呈显著上升趋势,在CAP中占据重要地位。细菌合并非典型病原体的混合感染在CAP中不容忽视。SP对大环内酯的耐药形势严峻,并且其对青霉素的耐药性在上升。同时,肺炎支原体(MP)对大环内酯类耐药开始出现。SP、MP对常用抗生素耐药通常造成临床治疗失败,影响临床转归。呼吸喹诺酮类可广谱覆盖CAP常见病原体,具有较强的抗菌能力,因此在中度或重度CAP治疗中占有重要位置。呼吸道感染病原学检测对确立诊断、合理选择抗生素和疗效判断价值很大,分子生物学技术具有很好的临床应用前景。

Community acquired pneumonia（CAP） was one of the most common causes of death. Streptococcus pneumoniae remains the most important pathogen in CAP. Atypical pathogens which had high status in CAP were increasing remarkably. The mixed infection which caused by bacteria combined atypical pathogens should not been ignored in CAP. The prevalence of macrolide resistance in Streptococcus pneumoniae was high and penicillin resistance was increasing. Meanwhile macrolide-resistant Mycoplasma pneumoniae has emerged. Streptococcus pneumoniae and Mycoplasma pneumoniae resistances to common antibiotics were associated with clinical treatment failure. Antipneumococcal fluoroquinolones could cover the common pathogens of CAP and had the strong antibacterial activity. New fluoroquinolones are recommended for moderate or severe respiratory tract infection. It was very valuable for diagnosis, reasonable using antibiotics and clinical treatment effects. Molecular diagnostic techniques had good clinical application value.