558例社区获得性肺炎病原菌分布及耐药性分析

Analysis 588 patients with community acquired pneumonia pathogenic bacteria distribution and drug resistance

目的了解社区获得性肺炎病原菌分布及耐药性,为临床合理选用抗菌药物提供依据。方法选取2013年10月-2015年10月间天津市泰达医院558例CAP患者的痰培养结果、血清学检测结果及药物敏感试验结果进行回顾性分析。结果 343例患者的病原学检测阳性,占全部患者的61.47%,其中革兰阴性菌228例,占比66.47%,以肺炎克雷伯菌、铜绿假单胞菌、大肠埃希菌、鲍曼不动杆菌为主,分别占25.36%、13.99%、7.58%及6.12%;革兰阳性菌72例,占比20.99%,以金黄色葡萄球菌、表皮葡萄球菌为主,分别占7.58%、5.25%;真菌检出6例,占比1.75%;血清学检测结果阳性37例,其中肺炎支原体占比5.83%,肺炎衣原体占比4.96%;革兰阴性杆菌对三代和四代头孢菌素、左氧氟沙星、亚胺培南、头孢哌酮舒巴坦较敏感,对其他抗菌药物耐药率较高;革兰阳性球菌对万古霉素、利奈唑胺、替加环素、呋喃妥因均敏感,对其余抗菌药物均有不同程度耐药。结论社区获得性肺炎病原体以革兰阴性杆菌为主,肺炎克雷伯菌感染率最高,革兰阳性球菌以金黄色葡萄球菌检出率最高,而且CAP患者病原体耐药情况严峻,在临床选择抗菌药物时要予以充分考虑。

Objective To learn the pathogenic bacteria distribution and drug resistance of community acquired pneumonia（CAP） for antimierobial drugs clinical usage. Methods Selection from October 2013 to October 2015, Tianjin TEDA hospital sputum culture results, serologic test results and drug sensitive test results of 558 patients with CAP were retrospectively analyzed. Results The etiology test of 343 cases was positive, 61.47% of all patients. Among this, 228 cases of gram-negative bacteria, accounted for 66.47%. Klebsiella pneumoniae, Pseudomonas aeruginosa, Escherichia coli and Acinetobacter baumannii are primary, accounted for 25.36%, 13.99%, 7.58% and 6.12% respectively. 72 cases were gTam-positive bacteria, accounted for 20.99% , staphylococcus aureus and epidermis staphylococcus aureus were common, accounted for 7.58% and 5.25% respectively. 6 cases were fungus, accounted for 1.75%. Positive serological test results were found in 37 cases, of which the mycoplasma pneumoniae accounted for 5.83%, pneumonia chlamydia accounted for 4.96%. Gram-negative bacilli is sensitive to the third and fourth generation cephalosporin, levofloxacin, imipenem, cefoperazone, High antimicrobial resistance to other- sulbactam. Gram-positive cocci we found were sensitive to vancomycin, linezolid, tigecycline and nitrofurantoin. Conclusion Community acquired pneumonia pathogen mainly was gram-negative bacilli, klebsiella pneumoniae were found highest. Staphylococcus aureus had the highest detection rate in grampositive cocci. And pathogen resistance in patients with CAP were severe, it should be fully considered in clinical choice of antimicrobial drugs.