金黄色葡萄球菌肺炎的临床特点及药物敏感性分析

Clinical features and antibiotic susceptibility of staphylococcus aureus pneumonias

目的分析和总结金黄色葡萄球菌肺炎的临床特点和对抗菌药物的敏感性。方法回顾性分析50例金黄色葡萄球菌肺炎患者的临床特点。并对所有细菌均按《全国临床检验操作规程》以常规方法鉴定，合格痰标本接种血琼脂、巧克力和麦康凯培养基，可疑菌落进行革兰染色和生化反应鉴定，金黄色葡萄球菌为革兰阳性球菌，用西门子公司PC33板条进行可疑菌落鉴定，确定为金黄色葡萄球菌并做药敏试验。结果50例中发热23例（46.0%），多为不规则发热型，体温＞38.5 ℃者15例（30.0%）；咳嗽43例（86.0%）、咳痰41例（82.0%）, 咯黄脓痰者26例（52.0%），呼吸困难16例（32.0%），肺部湿性啰音31例（62.0%）。末梢血白细胞升高19例（38.0%），降低4例（8.0%），中性粒细胞升高的32例（64.0%）。胸部X线主要表现为片状、斑片状阴影。叶段性渗出病变6例和沿支气管小片渗出病变44例。50例患者中老年科13例、神经内科9例、呼吸科9例、心内科4例、内分泌科4例、外科4例、心内科3例、急诊观察室病房2例、消化科和血液科各1例。分离的金黄色葡萄球菌对万古霉素、利奈唑胺、利福平及氯霉素的敏感性较高[分别为29株（100.0%）、46株（100.0%）、42株（85.7%）、11株（78.6%）]，对其他抗菌药物均有耐药。50例患者中痊愈27例（54.0%），显效16例（32.0%），总有效率为86.0%， 7例（14.0%）死亡，死亡原因：慢性阻塞性肺疾病急性加重、Ⅱ型呼吸衰竭1例,败血症1例,重症肺炎1例,间质性肺病伴感染1例,非霍奇金淋巴瘤1例,肺癌广泛转移1例,脑梗死1例。结论金黄色葡萄球菌肺炎好发于老年、有基础疾病及免疫功能低下者，及早选择可能敏感的抗菌药物及进行细菌药敏检测将改善预后。

ObjectiveTo analyze and summarize the clinical features and distribution of antibiotic susceptibility of staphylococcus aureus pneumonia.MethodsThe clinical data of 50 cases staphylococcus aureus pneumonia was analyzed retrospectively. All bacteria isolated were identified by the routine method according to national guide to clinical laboratory procedures and were cultured with the blood agar, chocolate agar and MacConkeyAgar. Suspected colonies identification was performed by Gram staining and biochemical reaction. Staphylococcus aureus were Grampositive coccus. ID identification strip was employed by MicroScan walk Away96 and drug susceptibility test was performed when bacteria identified as staphylococcus aureus. Results All 23 patients who had fever accounted for 46.0% in the 50 cases. The clinical symptoms were mainly cough（43/50, 86.0%）, expectoration（41/50,82.0%）, dyspnea（16/50,32.0%） and pulmonary moist rale（31/50,62.0%）.Peripheral white blood cells increased in 19 cases and decreased in 4 cases. Chest Xray showed mainly flaky and patchy shadows. There were 6 cases of segmental exudative lesions and the bronchial patchy effusion in 44 cases. 13 cases of 50 patients were from geriatrics department; 9 cases were from neurology department; 9 cases were respiratory medicine department; 4 cases were from cardiovascular medicine department; 4 cases were from endocrinology department; 4 cases were from surgical department; 3 cases were from cardiology department; 2 cases were from emergency observation room; 1 case was from gastroenterology department and 1 case was from hematology department. Staphylococcus aureus isolated were sensible to vancomycin, linezolid, rifampicin and chloroamphenicol, which accounted for 100%,100%, 85.7% and 78.6% respectively, but they had resistance to any other antibiotics. Among the total 50 patients, 27 cases（54.0%） were cured and 16 cases（32.0%） were effective; the total effective rate was 86.0%. 7 cases（14.0%） died. The causes of death were acute exacerbation of chronic pulmonary disease combined with type Ⅱ respiratory failure（1/7）, septicemia（1/7）, severe pneumonia（1/7）, interstitial lung disease combined with infection（1/7）, nonhodgkin lymphoma（1/7）, lung cancer metastasis（1/7）and cerebral infarction（1/7）. ConclusionsStaphylococcus aureus pneumonia is common in the elderly. Patients with underlying diseases and the immunocompromised population. Early selection of susceptive antibiotics and performing drug susceptibility test can improve the prognosis.