北京部分地区成年患者社区获得性肺炎的病原学及耐药性分析

Analysis of etiology and antimicrobial resistance of community-acquired pneumonia among adult patients in part area of Beijing

目的调查研究北京部分地区成年患者社区获得性肺炎的病原学分布及耐药性情况。方法收集389例成年社区获得性肺炎患者的痰液及385例血液标本。痰细菌培养阳性及肺炎支原体和衣原体的血清学试验阳性结果作为感染指征;细菌药敏试验采用纸片扩散法。结果 389例痰液标本中共培养分离出171株细菌,其中最主要的是肺炎链球菌(34/171),其次是肺炎克雷伯菌(29/171)及金黄色葡萄球菌(22/171)。对385例患者进行非典型病原菌的血清学检测,分别检出104例肺炎支原体和32例肺炎衣原体。分离的肺炎链球菌对红霉素及青霉素的耐药率分别为70.6%和41.2%。结论成年CAP患者中感染率居前3位的细菌为肺炎链球菌、肺炎克雷伯菌及金黄色葡萄球菌。同样,也存在着大量的非典型病原菌感染及混合感染。除了肺炎链球菌对大环内酯类的耐药率较高外,主要致病性细菌的耐药率普遍较低。

Objective To investigate the etiology of adult community-acquired pneumonia （CAP） associated patho- gens and its antimicrobial resistance in Beijing. Methods A total of 389 patients were enrolled in this study（389 sputum and 385 blood samples）. The following were considered indicative of infection when positive .. Sputum bacterial culture, serologic test for Mycoplasma pneumoniae and Chlamydia pneumoniae. Antibiotic susceptil^ility of bacteria was tested o by disk diffusion method. Results 171 strains of bacteria were isolated from 389 sputum specimens. Streptococcus pneumoniae （34/1719） was the most frequently isolated pathogen,followed by Klebsiella pneumoniae （29/1719） and Staphylococcus aureus （22/129） and Totally 385 patients underwent serological tests for atypical pathogens;Mycoplas- ma pneumoniae and Chlamydia pneumoniae infections were identified in 104 and 32 patients respectively. The resistant rate of isolated Streptococcus pneumoniae to erythromycin and penicillin was 70.6 ~/~0 and 41.2 ~//00 ：respectively. Conclu- sion The top three bacteria responsible for CAP in adults were Streptococcus pneumonia ,Klebsiella pneumoniae and Staphylococcus aureus. There was also a high prevalence of atypical pathogens and mixed pathogens. The resistance rates of the major isolated pathogens were relatively low except for the high prevalence of macrolide resistance in Streptococcus pneumoniae.