社区获得性肺炎病原学及致病菌耐药性变迁

社区获得性肺炎(CAP)是目前常见的疾病死亡原因之一.肺炎链球菌(SP)仍是CAP的重要的病原体.非典型病原体呈显著上升趋势,在CAP中占据重要地位.细菌合并非典型病原体的混合感染在CAP中不容忽视.SP对大环內酯的耐药形势严峻,并且其对青霉素的耐药性在上升.同时,肺炎支原体(MP)对大环内酯类耐药开始出现.SP、MP对常用抗生素耐药通常造成临床治疗失败,影响临床转归.呼吸喹诺酮类可广谱覆盖CAP常见病原体,具有较强的抗菌能力,因此在申度或重度CAP治疗中占有重要位置.呼吸道感染病原学检测对确立诊断、合理选择抗生素和疗效判断价值很大,分子生物学技术具有很好的临床应用前景.     

社区获得性肺炎研究进展

社区获得性肺炎(community acquired pneumonia,CAP)的病原谱国内外有所差异,国外调查资料以肺炎链球菌为其首位病原体,非典型病原体是重要病原体.国内CAP病原体则以非典型病原体为主,肺炎链球菌所占比例相对较低.肺炎链球菌的耐药率因地而异.血清非典型病原体抗体检测和尿中各种肺炎病原体抗原检测是CAP病原体诊断的重要措施.聚合酶链反应诊断CAP病原体具有广阔的应用前景.抗菌药物早期静脉-口服切换和缩短抗菌药物疗程是CAP治疗方面的进展之一.     

成人社区获得性肺炎中肺炎支原体的耐药性探讨

目的 采用肺炎支原体（MP）分离培养-药敏法初步探讨住院成人社区获得性肺炎（CAP）中MP的耐药状况,为临床抗菌药物选择提供依据.方法 选取住院的成人CAP患者2859例,取咽拭子标本培养检测MP;对MP阳性标本行药敏检测,观察MP对红霉素、罗红霉素、阿奇霉素、四环素、米诺环素、多西环素、环丙沙星、左氧氟沙星、加替沙星、莫西沙星等10种药物的耐药情况.结果 咽拭子培养MP阳性575例,占20.11％;MP对红霉素等大环内酯类药物耐药率达54.9％ ～ 62.0％,对加替沙星、莫西沙星耐药率为10.0％ ～21.3％.结论 MP是成人CAP的重要病原体,应加强耐药性监测,合理选择抗菌药物.     

《北京地区成人社区获得性肺炎患者中肺炎支原体耐药情况的多中心调查》解读

全球范围内,社区获得性肺炎(CAP)的病原体构成和耐药性存在地域性差异。大量国外研究显示,肺炎链球菌是CAP的最主要病原体,而与国外不同,在我国已经完成的两项全国多中心成人CAP调查中,肺炎支原体感染的比例却分别达到了20.7%和38.9%,已经超过了肺炎链球菌(分离率分别为10.3%和14.8%),成为成人CAP最常见的致病原。临床上用于治疗肺炎支原体感染的药物主要包括大环内酯类、喹诺酮类和四环素类。自2000年日本学者首次发现耐大环内酯类的肺炎支原体菌株之后,世界各国陆续出现类似报道,而我国的耐药形势则更为严峻,北京及上海先后报道肺炎支原体对大环内酯类药物耐药率均超过90%。但国内研究数据主要局限于儿童,关于成人CAP患者肺炎支原体的耐药报道仍较少。     

小儿社区获得性肺炎中肺炎支原体的耐药性探讨

目的采用肺炎支原体（MP）分离培养及药敏试验探讨住院小儿社区获得性肺炎（CAP）中MP的耐药状况。方法对住院的CAP小儿788例,取咽拭子标本培养检测MP;对MP阳性标本做药敏试验,观察MP对9种药物的耐药情况。结果咽拭子培养MP阳性151例,占18.90%;MP对红霉素等大环内酯类药物耐药率达51.0%～60.9%,所有菌株对左氧氟沙星均表现敏感。结论 MP是住院小儿CAP的的重要病原体,应根据药敏试验选用药物,使患者得到及时正确的治疗,并延缓耐药株出现。     

某基层医院儿童社区获得性肺炎病原菌分布及其耐药性分析

目的分析某基层医院儿童社区获得性肺炎(CAP)病原菌分布及其耐药性,以指导临床合理使用抗菌药物。方法选取2010年1月—2013年11月在苍溪县人民医院诊治的CAP患儿752例,在使用抗菌药物之前收集痰液进行培养,并鉴定菌株及进行药敏试验。结果 752例患儿采集到合格标本674例,合格率为89.62%;细菌检出率为34.87%(235/674);其中革兰阳性菌89株(占37.87%),革兰阴性菌146株(占62.13%)。不同年龄段患儿主要致病菌排序有所不同,≤3岁患儿主要致病菌为革兰阴性菌,占64.77%;3岁患儿主要致病菌为肺炎链球菌,占42.86%。肺炎链球菌对氟喹诺酮类抗菌药物耐药率较低,均在16.0%以下;金黄色葡萄球菌对氟喹诺酮类抗菌药物耐药率较低,均在18.0%以下;溶血葡萄球菌对头孢呋辛和庆大霉素的耐药率较低,均为12.5%;大肠埃希菌对莫西沙星的耐药率较低,为14.3%;流感嗜血杆菌对氟喹诺酮类抗菌药物的耐药率较低,均在20.0%以下;肺炎克雷伯菌对头孢硫脒和头孢唑肟的耐药率较低,均为17.2%;卡他莫拉菌对左氧氟沙星和莫西沙星的耐药率较低,均为7.1%。结论苍溪县人民医院儿童CAP的主要致病菌为革兰阴性菌,且病原菌分布与年龄有一定关系,根据病原菌耐药情况给予经验性抗菌药物治疗对改善CAP患儿的预后具有重要意义。     

肺炎支原体对大环内酯类抗生素耐药机制的研究近况

肺炎支原体是社区获得性肺炎的主要病原体。大环内酯类抗菌药物是治疗儿童肺炎支原体感染的首选药物。近年来我国耐大环内酯肺炎支原体比例有所下降,但仍处于高水平。耐药肺炎支原体感染造成患者发热时间、住院时间延长,并有更高的并发症发生率和抗生素治疗方案改变率,因此对肺炎支原体耐药机制的研究还需进一步深入。肺炎支原体对大环内酯类抗生素耐药机制主要与抗生素作用靶点突变、抗生素作用靶点修饰、药物主动外排、酶性失活有关。     

肺炎支原体对大环内酯类抗生素耐药机制的研究进展

肺炎支原体(MP)是社区获得性呼吸道感染的常见病原体之一,其对影响细菌蛋白质合成的抗生素如大环内酯类敏感.然而近年来MP的耐药现象逐渐增多,国内外都已经分离出对大环内酯类的耐药菌株.目前体内外的研究表明核糖体上23S rRNA的基因突变和核糖体蛋白的氨基酸改变是MP对大环内酯类抗生素耐药的主要机制.由于新型大环内酯类抗生素的广泛应用,在药物选择压力下以及检测技术的不断进步,新型耐药机制不断涌现,有待进一步深入研究.     

十堰地区婴幼儿社区获得性肺炎常见病原体致病情况及耐药性变迁分析

目的分析十堰地区婴幼儿社区获得性肺炎(CAP)常见病原体致病情况及耐药性的变迁。 方法选取2018年2月至2019年2月十堰区多家医院收治的1 282例CAP患儿,采集所有患儿深部痰液标本,对痰液中细菌菌种进行鉴定,采用MIC法进行药敏试验,并分析检出细菌对常用抗菌药物的耐药情况。 结果282例CAP患儿中病原体检出阳性者684例(53.35%),其中肺炎链球菌检出146例(21.35%),肺炎链球菌、大肠埃希菌、金黄色葡萄球菌、铜绿假单胞菌、产气肠杆菌、阴沟肠杆菌在年龄≤12个月的患儿中检出率明显高于年龄12～36个月的患儿(均P<0.05)。1 282例患儿肺炎支原体检出率为6.16%(79/1282),肺炎衣原体检出率为11.39%(146/1 282),肺炎支原体/衣原体在年龄12～36个月的患儿中检出率分别为13.71%(51/372)、25.81%(96/372)明显高于年龄≤12个月患儿的3.08%(28/910)、5.49%(50/910)(P<0.05)。在革兰氏阳性菌中,肺炎链球菌对红霉素、四环素、克林霉素耐药率均>80%,金黄色葡萄球菌对青霉素、红霉素、克林霉素、氨苄西林耐药率均>50%;肺炎链球菌和金黄色葡萄球菌对万古霉素、利奈唑胺均敏感。在革兰氏阴性菌中,大肠埃希菌和肺炎克雷伯菌均对头孢唑林、头孢他啶、头孢吡肟、头孢曲松、氨苄西林、氨曲南耐药率>70%;流感嗜血杆菌对氨苄西林耐药率最高;铜绿假单胞菌对头孢曲松、头孢替坦均100%耐药;革兰氏阳性菌对哌拉西林及阿米卡星耐药率最低。 结论十堰地区婴幼儿社区获得性肺炎常见病原体为肺炎链球菌,主要对红霉素、四环素、克林霉素耐药率均较高,临床应当使用敏感抗菌素提高治疗效率。     

卫生保健相关性肺炎中MRSA革兰阴性杆菌和非典型病原体的感染现状

卫生保健相关性肺炎(HCAP)是不同于社区获得性肺炎(CAP)和医院获得性肺炎(HAP)的肺炎的一种特殊分类,其常见病原体为耐甲氧西林金黄色葡萄球菌(MRSA)、革兰阴性杆菌及一些非典型性病原体。本文就HCAP中MRSA、革兰阴性杆菌和非典型病原体的感染现状概述如下。     

非典型病原菌致成人社区获得性肺炎患者的临床特点分析

目的 研究非典型病原菌感染在成人住院社区获得性肺炎中的重要地位,并对其临床特点进行分析.方法 收集2005年5月至2008年5月来自国内多中心的153例成人社区获得性肺炎住院患者急性期及恢复期双份血清和急性期痰标本,采用间接免疫荧光法检测肺炎衣原体IgG抗体及嗜肺军团菌IgG、IgA及IgM混合抗体滴度,采用被动凝集法检测肺炎支原体IgG、IgA及IgM混合抗体滴度,同时对153份急性期痰标本进行普通细菌培养.用回顾性分析方法了解非典型病原菌在成人社区获得性肺炎住院患者中的地位.结果 153例血清学检测结果中符合非典型病原菌致社区获得性肺炎诊断标准的52例(34.0%),其中47例为单一非典型病原菌感染,其中肺炎衣原体38例,肺炎支原体4例,嗜肺军团菌5例;5例为2种非典型病原菌混合感染,其中肺炎衣原体+肺炎支原体2例,肺炎衣原体+嗜肺军团菌3例;52例中合并细菌感染者11例.结论 非典型病原菌(肺炎衣原体、肺炎支原体及嗜肺军团菌)为成人住院社区获得性肺炎的重要致病菌,以肺炎衣原体为主,同时不能忽视合并细菌感染情况的存在.     

Systemic cytokine profile in children with community-acquired pneumonia

OBJECTIVES: Characterization of the systemic cytokine response in community-acquired pneumonia (CAP) may facilitate our understanding of the host immune response and provide a prognostic as well as diagnostic tool. Systemic cytokine characterization of CAP has been limited largely to a few integral cytokines in adults. METHODS: Analyses were performed to investigate whether significant relationships existed between an expanded serum cytokine profile and etiologies, manifestations, and outcomes of pediatric CAP. The serum concentrations of 15 cytokines were investigated in 55 hospitalized children with well-characterized CAP. RESULTS: Comparison of median cytokine concentrations among patients with CAP caused by Mycoplasma pneumoniae or Chlamydophila pneumoniae, Streptococcus pneumoniae, viruses, mixed infections, or unidentified pathogens revealed significant differences in IFN-alpha, IL-6, IL-17, GM-CSF, and TNF-alpha concentrations. The mixed infections category had significantly elevated concentrations of IFN-alpha, IL-6, GM-CSF, and TNF-alpha. There were significant correlations between concentrations of IL-6 and markers of disease severity (white blood cell band-forms, procalcitonin, and unequivocal consolidation). No single cytokine could reliably differentiate the etiologic cause of pneumonia. CONCLUSIONS: IL-6 is the only one of 15 serum cytokines studied that correlated with indicators of disease severity in childhood CAP. The applicability of cytokine profiles to identify microbiologic etiologies of pneumonia remains to be defined.     

Evaluation of the Japanese Respiratory Society guidelines for the identification of Mycoplasma pneumoniae pneumonia

Background and objective: Community‐acquired pneumonia (CAP) is a leading cause of morbidity and mortality worldwide. Mycoplasma pneumoniae is one of the major causative pathogens of CAP. Early diagnosis of M. pneumoniae pneumonia is crucial for initiating appropriate antibiotic therapy. The aim of this study was to determine whether the Japanese Respiratory Society (JRS) guidelines on CAP are effective for diagnosing M. pneumoniae pneumonia. Methods: Between August 2008 and July 2009, adult outpatients with CAP were consecutively enrolled. The aetiology of CAP was determined by culture and real‐time polymerase chain reaction (PCR) methods to detect M. pneumoniae, urine antigen tests to detect Streptococcus pneumoniae and Legionella pneumoniae, blood and sputum culture for bacteria and real‐time PCR for eight common respiratory viruses. The predictive value of the JRS guidelines for differentiating M. pneumoniae pneumonia from typical bacterial and viral pneumonias was determined. Results: Data from 215 adult CAP outpatients was analyzed. An aetiological diagnosis was made for 105 patients (48.8%), including 62 patients with M. pneumoniae pneumonia, 17 patients with typical bacterial pneumonia and 23 patients with viral pneumonia. According to the JRS criteria for differential diagnosis of atypical pneumonia, 55 of 62 patients were correctly diagnosed with M. pneumoniae pneumonia (sensitivity 88.7%), and 31 of 40 patients with bacterial and viral pneumonia were correctly excluded (specificity 77.5%). Conclusions: The JRS guidelines on CAP provide a useful tool for the identification of M. pneumoniae pneumonia cases and differentiating these from cases of typical bacterial or viral pneumonia.     

肺炎支原体快速鉴定培养法对成人支原体肺炎早期诊断价值的研究

目的探讨咽拭子肺炎支原体（MP）快速鉴定培养法对成人社区获得性肺炎支原体肺炎的早期诊断价值。方法应用肺炎支原体快速鉴定培养基对住院的105例社区获得性肺炎（CAP）患者的咽拭子标本进行肺炎支原体快速鉴定培养。同时对所有病例于发病后7~14 d检测血清MP-IgM抗体。结果 105例住院CAP患者咽拭子MP快速鉴定培养,阳性23例,阳性率21.9%。MP-IgM抗体检测阳性19例,阳性率18.1%。MP-IgM抗体检测阳性的19例患者MP快速培养均为阳性。结论咽拭子肺炎支原体快速鉴定培养法可以实现肺炎支原体肺炎的早期诊断,及时正确治疗。     

肺炎支原体的耐药机制和耐药基因检测现状

肺炎支原体是社区获得性肺炎的常见病原体之一,一年四季均可发病.严重感染者可引起多器官损伤、脑炎,甚至导致死亡.目前大环内酯类抗生素是治疗儿童支原体感染的首选药物,但近年来国内外均报道其耐药现象逐渐增加.现将肺炎支原体对于大环内酯类耐药现象、耐药机制和耐药基因检测现状及展望作一综述.     

北京地区成人社区获得性肺炎非典型病原体流行病学调查

目的　对引起社区获得性肺炎 (CAP)的病原体进行流行病学调查 ,加强对非典型致病原重要性的认识。方法　收集 2 0 0 1年 11月至 2 0 0 2年 6月CAP患者共 10 3例。分别检测患者急性期及恢复期肺炎支原体、嗜肺军团菌、肺炎衣原体血清抗体。应用聚合酶链反应 (PCR)分别扩增肺炎支原体P1黏附蛋白基因及肺炎衣原体 16SrRNA基因。应用酶免疫测定 (EIA)方法检测尿中嗜肺军团菌抗原。取患者急性期痰标本进行细菌培养 ,应用常规方法分离鉴定细菌。结果　 10 3例CAP患者 ,病原体检出率为 48.5%。 2 3例 (2 2 .3 % )检出肺炎支原体 ,3例 (2 .9% )检出嗜肺军团菌 ,2例 (1.9% )检出肺炎衣原体。 12例分离出肺炎链球菌 (11.7% )、9例分离出流感嗜血杆菌 (8.7% )、7例分离出肺炎克雷伯菌 (6.8% )。 6例患者存在混合感染 (5.8% ) ,其中 5例为肺炎支原体混合其他病原体。结论　非典型病原体尤其是肺炎支原体感染在CAP中占据重要地位 ;肺炎链球菌和流感嗜血杆菌仍为常见的致病细菌 ;混合感染不容忽视     

Ambulant erworbene und nosokomiale Pneumonie

Community-acquired pneumonia (CAP) and nosocomial pneumonia (hospital-acquired pneumonia HAP) are common infectious diseases that are associated with a high morbidity and mortality. The most common CAP pathogens are pneumococci, followed by influenza A and Mycoplasma pneumoniae. The mortality of patients with CAP in the outpatient setting is low (1–2?%) but increases in hospitalized patients to 10–20?% and can reach 50?% in intermediate or intensive care settings. In HAP the most commonly detected pathogens are Staphylococcus aureus followed by Pseudomas aeruginosa and Escherichia coli and in uncomplicated cases also pneumococci are found. In a significant proportion of patients multiresistant organisms are also found. Treatment for both types of pneumonia is stratified depending on the severity of clinical symptoms and the range of pathogens expected.     

Atypical pathogens in adult patients admitted with community-acquired pneumonia in Korea

This study examined the prevalence of atypical pathogens causing community-acquired pneumonia (CAP) in Korea. We collected sera and clinical data for a period of 1 year for the adult patients consecutively admitted to Chunchon Sacred Heart Hospital with CAP. The diagnosis was made using serologic methods to detect antibodies for Mycoplasma pneumoniae, Chlamydia pneumoniae, Legionella spp., Chlamydia psittaci, and Coxiella burnetii. Among 81 recruited patients, C. pneumoniae (n = 10, 12.3%) was the leading cause of illness, followed by M. pneumoniae (n = 7, 8.6%). One case of C. burnetii pneumonia was detected, but there were no cases of Legionella spp. or C. psittaci. Three cases of C. pneumoniae pneumonia were co-infected with either M. pneumoniae or C. burnetii. There was no significant difference between atypical pneumonia and non-diagnosed pneumonia in terms of clinical manifestations. In conclusion, of the atypical pathogens causing CAP, C. pneumoniae and M. pneumoniae appear to be the important etiologic pathogens in Korea.     

Mycoplasma pneumoniae and Chlamydophila pneumoniae in children with community-acquired pneumonia in Thailand.

BACKGROUND: The prevalence of community-acquired pneumonia (CAP) caused by atypical pathogens in Thai children is unknown. OBJECTIVE: To examine the prevalence of Mycoplasma pneumoniae and Chlamydophila pneumoniae infections in paediatric patients (aged 2-15 years) with CAP in three academic hospitals using standardised laboratory techniques. The characteristics of atypical pneumonia were also compared with other causes of CAP. METHODS: Diagnosis of current infection was based on a four-fold or more rise in antibody serum samples or persistently high antibody titres together with the presence of mycoplasmal or chlamydial DNA in secretions. RESULTS: Of 245 patients with CAP, 17.5% of cases were caused by atypical pathogens (M. pneumoniae 14.3%, C. pneumoniae 2.8% and co-infection 0.4%). We also found atypical pathogens in young children aged 2-5 years. The clinical and laboratory findings did not distinguish atypical pneumonia from other CAPs. Segmental or lobar consolidation on chest X-rays was more common in atypical pneumonia, while dyspnoea was more prominent in other CAPs. CONCLUSION: Our data show a high prevalence of M. pneumoniae and C. pneumoniae in Thai children with CAP, including in children aged 2-5 years.     

2015年春季无锡地区儿童肺炎支原体及呼吸道常见致病菌的分析

目的 了解无锡地区下呼吸道感染住院患儿肺炎支原体耐药情况及呼吸道常见致病菌的分布,为预防和治疗提供依据。方法 采用PCR法检测患儿咽拭子中的肺炎支原体及其耐药基因,采用real-time PCR法检测其他呼吸道常见致病菌。结果 共检测标本288例,检出病原菌59例,阳性检测率为20.5%。细菌检出率随年龄增长有下降趋势,<2岁儿童阳性检出率最高,且女性高于男性。病原菌构成比分别为:肺炎支原体28.8%(17/59),KP为30.5%(18/59),SA为20.3%(12/59),PA为20.3%(12/59),SE为15.3%(9/59),HI为10.2%(6/59),SP为5.08%(3/59),LP为5.08%(3/59),EC,CP,TB均为0例(0%)。其中肺炎支原体大环内酯类耐药率为88.2%,10例存在合并感染。结论 无锡地区住院患儿下呼吸道感染的病原菌以肺炎支原体和肺炎克雷伯杆菌为主,且大环内酯类耐药率较高。