247例社区获得性肺炎的病原学分析

目的:分析第二军医大学长征医院社区获得性肺炎(CAP)的病原学分布及常见细菌的耐药性,为CAP的经验治疗提供依据。方法:收集2003年9月至2006年12月间我院收治的247例社区获得性肺炎患者,采集痰、支气管吸出物和血标本,进行细菌学和非典型病原体的检测。结果:247例患者中,共有128例患者病原学检测阳性,混合感染20例(15.6％)。居前3位的病原体分别为肺炎支原体39例(26.4％),流感嗜血杆菌23例(15.5％),肺炎链球菌17例(11.5％),肺炎衣原体17例(11.5％)。同时应用PCR和血清学两种方法对标本进行非典型病原体的检测,肺炎支原体、肺炎衣原体和嗜肺军团菌的诊断符合率分别为84.6%(33/39)、23.5％(4/17)和14.3％(1/7)。就诊前有无使用抗菌药物对于苛养菌检出率的影响显著。结论:流感嗜血杆菌和肺炎链球菌仍是CAP最常见的致病细菌,但非典型病原体尤其是肺炎支原体感染在CAP中已占据重要地位。应用血清学检测方法联合PCR方法或尿抗原检测,可以增加非典型病原体检测的敏感性和特异性。

Etiological analysis of 247 cases community-acquired pneumonia

Objective To investigate the etiology of community-acquired pneumonia (CAP) in changzheng hospital, especially the prevalence of atypical pathogens; to study the Drug-restriction of the causal bacteria in the infection of CAP.Methods 247patients above 18 years old with CAP were enrolled in the study. Sputum samples were collected for culture, Antibody of the paired serum samples, PCR test and urine antigen test were detected. Results 247 patients above 18years old with CAP were enrolled. Specific pathogens were identified in 128(51.8%) patients. The distribution of causal agents was as follows: Mycoplasma pneumoniae in 39(26.4%), Chlamydia pneumoniae 17(11.5%), Legionella pneumophilia7(4.7%),Haemophilus pneumoniae23(15.5%), Streptococcus pneumoniae 17(11.5%). In 20(15.6%) patients more than one causal agent were found.And the prevalence of Mycoplasma pneumoniae was the highest in that of atypical pathogens,it was 61.9%(39/63). Haemophilus pneumoniae and Streptococcus pneumoniae are most causal agents in those of community acquired pneumonia. Conclusions Mycoplasma pneumoniae ,Streptococcus pneumoniae , Haemophilus pneumoniae and Chlamydia pneumoniae were the most common bacteria in the etiology of community acquired pneumonia. Streptococcus pneumoniae and Haemophilus pneumoniae remain the most common bacteria. Atypical pathogens especially Mycoplasma pneumoniae have an important role in CAP. ,and mixed infection should not be ignored.KEY WORDS community-acquired pneumonia etiology