200例院内、外肺部感染病原菌现状

A prospective study on etiologic bacteria in 200 patients with pneumonia

调查２００例经纤支镜保护刷取样或连续三日晨痰或一日晨痰定量培养获明确致病菌的院内、外肺炎患者。除院外感染１组外余均有基础疾病。院内组８７．２％致病菌为革兰氏阴性菌，以绿脓杆菌、克雷伯杆菌为主。无基础疾病的院外１组有７５％为革兰氏阳性菌，主要有肺炎链球菌、金黄色葡萄球菌。院外２组革兰氏阴性菌占７５％，绿脓杆菌、不动杆菌、克雷伯菌为其主要致病菌。院内组及院外２组较院外１组复合感染多，细菌耐药严重，预后差。

The etiologic agents in 200 patients with pneumonia were studied by the bacterial culture of sputums obtained from the protected single catheter brush or quantitative expectoration at one morning or three morning expectoration. Two hundred patients were divided into 3 groups. Group 1 was Nosocomial pneumonia (NP patients). Group 2-1 and Group 2-2 were community acquired pneumonia (CAP patients). All cases in Group1 and Group 2-2 suffered from significant underlying diseases while Group 2-1 did not. Gram negative bacilli(GNB) were isolated from the specimens in Group 1 (87%) and Group 2-2 (75%), respectively. Pseudomonas (30.8%) and klebsiella (20.5%) were the predominant bacteria (in Group 1 and pseudomonas bacteria) in Group 1 and pseudomonas (27.3%), acinetobacter (23%) and kledsiella (18%) were the major etiologic agents in Group 2-2. The commonest pathogens in Group 2-1 were gram positive cocci (75%), in which streptococcus (38%) and staphylococcus aureus (25%) were the dominant agents. Compared with Group 2, Group 1 suffered from more mixed bacteria and the agents presented severer drug resistant. The prognosis was worse in Group 2-2 than in Group 2-1. The results showed that the GNB pneumonia was more common in the cases who had underlying disease, no matter whether the pneumonia was NP or CAP. These patients had more trouble on their antibiotic therapy. Thus it is important that doctors should use vigorous antibiotics timely while treating these patients' underying diseases.