社区获得性肺炎病原菌构成及耐药分析

Bacteria distribution and drug susceptibility analysis in community acquired pneumonia

目的研究社区获得性肺炎(CAP)的常见病原菌分布及其耐药性。方法对220例CAP患者同时通过痰培养和血清学检测进行病原菌检测,并用琼脂稀释法检测其最低抑菌浓度(MIC)。结果肺炎链球菌(12.3%)是最常见的病原菌,其后依次为嗜肺军团菌(9.1%)、流感嗜血杆菌(8.6%)、肺炎克雷伯菌(6.8%)和金黄色葡萄球菌(4.1%)。其中肺炎链球菌呈高度多重耐药,对克林霉素、阿奇霉素、四环素等药物的耐药率高达75%以上;流感嗜血杆菌对复方新诺明、氨苄西林、氨苄西林/舒巴坦、头孢呋辛等耐药率较高;肺炎克雷伯菌对左氧氟沙星、莫西沙星、环丙沙星、阿莫西林/克拉维酸、亚胺培南及哌拉西林/他唑巴坦等的敏感性较高。结论肺炎链球菌仍为CAP的重要病原体,多重耐药肺炎链球菌耐药形势严峻。喹诺酮类药物在肺炎链球菌所致CAP治疗中占有重要位置。

Objective To analyse the classification and drug resistance of bacteria in community acquired pneumonia（CAP）.Methods Sputum specimens samples from 220 cases of CAP were cultured for aerobic bacteria,and the antibodies of Legionella pneumophila were detected with sera.Results Pathogens were identified in 99/220 patients（45.0%） with valid serum and sputum cultures as follows： Streptococcus pneumonia（12.3%）,Legionella pneumophila（9.1%）,Haemophilus influenzae（8.6%）,Klebsiella pneumonia（6.8%）,Staphylococcus aureus（4.1%）.Strains of Streptococcus pneumonia demonstrated multi-drug resistance,the resistant rate of S.pneumonia to microcline antibiotics was over 75%.Conclusions The major sort of pathogens caused intractable bacterial pneumonia was MDR Streptococcus pneumonia.Qquinolone should be important antibacterial drug in treating CAP with Streptococcus pneumoniae.More attention should be paid to pathogenic diagnosis.