社区获得性肺炎患者联合监测肺炎支原体与肺炎衣原体的临床意义

Clinical significance of combined detection of Mycoplasma pneumoniae and Chlamydia pneumoniae in patients with community acquired pneumonia

目的探讨联合监测肺炎支原体(Mp)和肺炎衣原体(Cp)对社区获得性肺炎(CAP)患者的临床意义。方法选取2012年2月至2014年10月我院收治的CAP患者1 580例,监测患者咽拭子标本中Mp、Cp,培养并鉴定其主要病原菌,比较不同抗感染方案的疗效。结果 CAP病原体以Mp(30.0%)、肺炎链球菌(15.9%)、流感嗜血杆菌(12.9%)、Cp(10.1%)比例最高,且同时合并2种病原体感染者较为多见(10.1%);治疗中β-内酰胺类药物使用频率最高(76.71%);β-内酰胺类联合大环内酯类或联合氟喹诺酮类药物对CAP治愈率(66.72%)显著高于单独应用β-内酰胺类药物治疗(56.73%,P<0.01);单用β-内酰胺类药物治疗与应用β-内酰胺类联合氟喹诺酮类(65.4%)或大环内酯类药物(68.5%)对单纯Mp或Cp感染CAP治愈率比较差异均无统计学意义(P>0.05),而在细菌合并Mp或Cp感染时,联合用药治愈率(69.7%)明显高于单用β-内酰胺类药物(44.4%),差异有统计学意义(P<0.05)。结论 CAP患者感染Mp与Cp较多见,β-内酰胺类药物是常用治疗药物,β-内酰胺类联合大环内酯类或氟喹诺酮类药物可提高患者治愈率,Mp与Cp联合检测对于敏感抗生素的选择及疗效的提高具有重要临床意义。

Objective To discuss the clinical significance of combined detection of Mycoplasma pneumoniae(Mp) and Chlamydia pneumoniae(Cp) in patients with community acquired pneumonia(CAP). Methods Mp and Cp were monitored in throat swab specimens from 1 580 patients with CAP admitted in our hospital from Feb. 2012 to Oct.2014. The main pathogenic bacteria were cultured and identified, and the clinical effects of different anti-infective treatment plans were compared. Results Pathogens of CAP mainly included Mp(30.0%), Streptococcus pneumoniae(15.9%), Haemophilus influenzae(12.9%) and Cp(10.1%), and co-infection of 2 kinds of pathogens infection was common(10.1%). In the treatment, the use frequency of β-Lactam antibiotics was the highest(76.71%). The cure rate ofβ-Lactam antibiotics combined with Macrolide antibiotics or Fluoroquinolone antibiotics(66.72%) was significantly higher than separate application of β-Lactam antibiotics(56.73%, P<0.01). There was no significant difference in the cure rate of different treatment plan in the treatment of CAP with simple Mp or Cp infection(65.4% vs 68.5%, P>0.05),but the cure rate of β-Lactam antibiotics combined with Macrolide antibiotics or Fluoroquinolone antibiotics(69.7%)was significantly higher than separate application of β-Lactam antibiotics(44.4%) in the treatment of bacterial infection combined with Mp or Cp infection(P<0.05). Conclusion Mp and Cp are the common pathogens of CAP, and β-Lactam antibiotics are commonly used in the treatment of CAP. β-Lactam antibiotics combined with Macrolide antibiotics or Fluoroquinolone antibiotics can improve the cure rate. The combined detection of Mp and Cp has important clinical significance for the improvement of the selection of sensitive antibiotics and the improvement of the therapeutic effects.