社区获得性肺炎患者嗜肺军团菌及肺炎支原体感染状况与合理用药的相关性

Infection Status of Legionella Pneumophila and Mycoplasma Peumoniae of Patients with CAP and Its Correlation with Rational Drug Use

目的为社区获得性肺炎（CAP）的合理用药提供参考。方法选择2012年7月至2015年1月就诊的CAP患者2 010例,分析可能的致病菌,使用酶联免疫吸附试验（ELISA）法联合尿抗原法检测嗜肺军团菌和肺炎支原体感染情况。分别比较不同年龄段及不同性别患者中2种病原体感染情况。结果疑似嗜肺军团菌感染760例,最终检出130例,占6.47%,单一感染与联合感染相当;肺炎支原体感染549例,占27.31%,主要以联合感染为主。肺炎支原体与嗜肺军团菌感染率各年龄段组内有统计学差异（P〈0.01）,肺炎支原体感染率随年龄增加递减,从14～28岁的38.07%降至超过64岁的10.93%;嗜肺军团菌感染率14～28岁组最高,且明显高于其他年龄段组（P〈0.05）。肺炎支原体感染率男性为59.02%,明显高于女性的40.98%（P〈0.05）;嗜肺军团菌感染率男性为64.62%,明显高于女性的35.38%（P〈0.05）。所有确诊患者均已治愈出院。结论嗜肺军团菌及肺炎支原体在CAP患者中均占一定比例,青壮年更常见,应多加关注。其中嗜肺军团菌对阿奇霉素、克拉霉素、左氧氟沙星、莫西沙星等抗菌药物仍较敏感。

Objective To provide clinical reference for the rational drug use of community acquired pneumonia（ CAP）. Methods 2 010 CAP cases from July 2012 to January 2015 were selected and analysed for the possible pathogenic bacteria. Enzyme- linked immunosorbent method combined with urinary antigen detection method were used to detect the legionella pneumophila and mycoplasma pneumonia. The two kinds of pathogen infections were compared in patients with different ages and genders. Results There were 760 cases of suspected infection of legionella pneumophilain,with 130 cases finally detected,accounting for 6. 47%; the single infection was equivalent with combined infection. Mycoplasma pneumoniae infection was 549 cases accounted for 27. 31%,which were mainly in the combined infection. There was a statistical difference of age among groups of legionella pneumoniae and mycoplasma pneumoniae infection（ P〈0. 01）. The infection rate of mycoplasma pneumoniae decreased with age increased,falling from 38. 07% of 14- 28 years old to 10. 93% of older than 64 years old group; the 14- 28 years old group had the highest infection rate among groups（ P〈0. 05）.The infection rate of mycoplasma pneumoniae was 59. 02% in male,which was significantly higher than 40. 98% in female（ P〈0. 05）.The infection rate of legionella pneumoniae was 64. 62% in male,which were significant higher than 35. 38% in female（ P〈0. 05）.Conclusion Legionella pneumophila and mycoplasma pneumoniae infection in CAP patients account for a certain proportion,which teenagers and young adults being more common,should be paid more attention to. Besides,the legionella pneumophila is still sensitive to azithromycin,clarithromycin,levofloxacin,moxifloxacin.