社区获得性肺炎中的混合感染

Mixed infections in community acquired pneumonia

社区获得性肺炎（CAP）中的混合感染正逐渐受到人们的关注，但是对其尚无统一认识。文章就CAP混合感染的流行病学特点、临床表现及治疗预后进行综述。CAP混合感染的发生率变异很大（2．5％。38．0％）。中国混合感染的发生率为11．5％。CAP的混合感染以细菌合并不典型病原体最为常见。最常见的混合感染细菌为肺炎链球菌；最常见的不典型病原体国外为衣原体、中国为支原体；最常见的混合感染病毒为流感病毒。除具有CAP的一般特点外，混合感染的CAP患者并没有特异性，临床表现。在CAP经验性治疗的抗菌药物选择中应该关注混合感染，推荐头孢菌素和大环内酯类抗生素联合治疗或选择呼吸喹诺酮类药物。不推荐初始经验性治疗是否加用抗病毒药物。CAP混合感染与患者的死亡率无关，不会影响预后。

Sununary：Mixed infections in community-acquired pneumonia （CAP） have been reported increasingly in the literature, but its clinical significance remains unknown. The aim of this article was to reviewe the prevalence, clinical characteristics, and outcome of mixed infections in CAP. The prevalence of CAP mixed infections has var- ied greatly,ranging from 2.5% to 38.0%. In China,ll. 5% cases of pneumonia are considered mixed. The most frequent combinations of pathogens are those of a bacterium plus an ＂atypical＂ organism. Streptococcus pneumoniae remains the most important bacteria for CAP; as for atypical pathogens, Mycoplasma pneumoniae is the most common one in China, and Chlamydia pneumoniae is the most common cause on aboard;the most frequent etiological agents in virus is influenza vinls. There is no different significance of clinical characteristics between patients with mixed infections and those with monomicrobial CAP. The recommendation for the initial empirical manage- ment of CAP mixed infections is focused on cephalosporin with a macrolide, quinolones antibiotics is considered to be an alternative choice. There is no special requirement about antiviral agent. Mixed infections have no relationship with CAP patients＇ mortality,and which have no influenced on prognosis.