社区获得性肺炎患者经验性抗感染治疗效果分析

Analysis of therapeutic effect of empirical anti-infective therapy on low-risk community acquired pneumonia

目的分析低危社区获得性肺炎(CAP)住院患者经验性抗感染治疗疗效,进一步提高临床治疗的有效率。方法选择呼吸科2010年11月-2012年3月收治的75例入选北京市肺炎监测网课题的低危CAP患者,采用回顾性研究方法,分析其初始经验性抗感染治疗的疗效及相关因素。结果初始经验性抗感染治疗无效组中选择β-内酰胺类联合阿奇霉素的比例为63.16%,明显高于初治有效组;低危CAP的病原菌分布由高到低依次为肺炎支原体、病毒、肺炎支原体+病毒、肺炎链球菌,分别占44.74%、39.47%、10.53%、5.26%。结论低危CAP患者中肺炎支原体是最常见的致病原,其对阿奇霉素高度耐药;其次,低危CAP患者中病毒感染率高,目前经验性治疗方案中未能覆盖,均是导致CAP初始经验性治疗无效的原因。

OBJECTIVE To analyze and summarize the therapeutic effect of empirical anti-infective therapy on thehospitalized patients with low-risk community acquired pneumonia （CAP） and further enhance the efficiency ofclinical treatment. METHODS Totally 75 patients with low-risk CAP who were admitted in respiratory medicinedepartment from Nov 2010 to Mar 2012 and included in the project of Beijing pneumonia monitoring network wereselected and their therapeutic effect and related factors of the initial empirical anti-infective therapy were analyzed. RESULTS Totally 63. 16 % of patients in the ineffective group of initial empirical anti-infective therapy selected p-lactam combined with azithromycin, which was significantly higher than those in the initial-treatment effectivegroup; the distribution of pathogens of low-risk CAP in descending order： Mycoplasma pneumoniae , viruses,Mycoplasma pneumoniae ＋ virus, Streptococcus pneumoniae,accounting for 44. 74% , 39. 47% , 10. 53% and5. 26% respectively. CONCLUSION Mycoplasma pneumonia,the most common pathogen in patients with low-risk CAP, is highly resistant to azithromycin; in addition, the rate of virus infections in patients with low-riskCAP was high, which is not included in the empirical treatment protocol; both of which is the causes leading to ineffectiveness of the initial empirical therapy to CAP.