社区获得性肺炎病原菌分布和药敏分析

Pathogenic bacteria distribution and drug sensitivity tests for patients with community-acquired pneumonia

目的探讨社区获得性肺炎(CAP)病原菌分布和药敏分析,为经验性治疗提供依据。方法选2014年1月至2015年12月期间CAP患者315例,其中重症肺炎患者58例,痰液细菌培养结果及药敏分析。结果 315例患者中痰培养分离出病原菌132株,其中革兰氏阳性菌31株,占23.5%(31/132);革兰氏阴性菌96株,占72.7%(96/132);真菌5株,占3.8%(5/132)。革兰氏阴性菌对氨基糖甙类、碳青酶烯类、四代头孢类及β-内酰胺酶抑制剂的复合抗生素敏感性高。革兰氏阳性菌对万古霉素、利奈唑胺、莫西沙星、阿莫西林克拉维酸及头孢曲松敏感。对SCAP相关因素分析发现,心血管疾病、肝硬化、肿瘤及HIV感染为SCAP的相关因素(P<0.05)。结论 CAP以革兰氏阴性菌为主,重视SCAP的相关因素,监测病原菌分布及药敏分析,为经验性治疗提供理论依据。

Objective To discuss the pathogenic bacteria distribution and drug sensitivity analysis in patients with community-acquired pneumonia to provide the basis for empirical treatment. Methods The clinical data of 315 CAP patients from January 2014 to December 2015,including 58 patients with severe pneumonia,were enrolled to analyze their sputum bacterial culture results and drug sensitivity retrospectively. Results 132 strains of pathogenic bacteria were isolated from sputum specimens of 315 CAP,which included 31 strains of gram-positive bacteria( 23. 5%),96 strains of gram-negative bacteria( 72. 7%) and 5 strains of fungi( 3. 8%). The main gram-positive bacteria were sensitive to vancomycin,linezolid,moxifloxacin and amoxicillin clavulanic acid and ceftriaxone.The main gram-negative bacteria were sensitive to aminoglycosides,carbon blue enzyme alkenes,the forth generation cephalosporin and compound antibiotic of beta lactamase inhibitor. The related factors for SCAP included cardiovascular disease,hepatocirrhosis,,tumor and HIV infection( P < 0. 05). Conclusion The gram-negative bacteria are the main pathogenic bacterium of CAP. We need to pay great attention to the SCAP related factors and monitor the distribution of pathogens and drug sensitivity characteristics for providing theoretical basis for empirical treatment.