社区获得性肺炎病原谱及药敏谱流行病学的调查

Investigation on the pathogenic spectrum and drug-sensitivity spectrum of community acquired pneumonia

目的熟悉我省社区获得性肺炎(CAP)病原谱及药敏谱,为临床治疗CAP提供强有力的证据。方法细菌培养采用常规法,细菌鉴定大多数采用仪器法,小部分采用传统手工法,细菌药敏均采用琼脂稀释法。非典型病原体的肺炎支原体、肺炎衣原体、嗜肺军团菌均采用日本和美国进口试剂盒进行血清学检测、尿抗原采用酶免疫测定法(EIA)测定。结果入选病例121份,51～70岁患者是本项目的主要对象,占总数的78.5%;病例中(咳)痰标本占97%,其它方法采集的占3%,检出病原菌52例(42.9%),其中肺炎链球菌13株(10.7%),占细菌的第一位;药敏中阳性球菌、大多数阴性杆菌分别测14种抗生素,嗜血杆菌和莫拉菌测9种抗菌药物。非典型病原体共检测121例,阳性28例,检出率23.1%,其中肺炎支原体19例,肺炎衣原体6例,嗜肺军团菌3例。结论CAP是常见的社区感染,其病原谱和药敏谱的组成各地不尽相同;随着时间的推移和变迁,尤其是社会人口老龄化、免疫损害宿主的增加、病原体变化和抗生素耐药率上升等原因,CAP的诊治将面临许多新问题。

Objective To know the pathogenic spectrum and drug-sensitivity spectrum of community acquired pneumonia（CAP） in Jiangxi province, the aim is to offer strong proof for clinical doctor to treat CAP. Methods Using routine way to culture common bacteria, most bacteria are identification by instrument, just a few by traditional manual method, all bacteria drug-sensitivity tests using agra dilution method. Atypical pathogens such as mycoplasma pneumoniae, chlamydia pneumoniae, legionella pneumolhilia using serological to detect which are kits importing from Japanese or American;urinogic antigen detected by EIA methods.Results The amounts isolated were 121 strains. The most subject were 51- 70 years patients, which took up the total amount 78.5%, and expectorational samples being 97%,the other way samples taking 3%.The whole examined pathogens 52 cases （42.9%）,including streptococcus pneumoniae 13 strains（10.7%）, taking the first position in all examined bacteria. Using 14 types antibiotics detected G-positive cocci and most G-negtive bacilli drug-sensitivity, at the same time, 9 types antibiotics detected Haemophilus and Moraxella.Atypical pathogens examined had 121cases as well as positive cases had 28 so that the rate of examined was 23.1%, including mycoplasma pneumoniae（19 cases）, chlamydia pneumoniae（6 cases）, legionella pneumolhilia（3 cases）. Conclusion CAP was the most common community infection, the composition of pathogens and drug-sensitivity were different from aera. Following time changing, especially the aging of the population and the increasing host of immune damage and the variation of pathogens and the drug-resistance increasing, and so on.