目的：调查研究安徽省部分地区初治失败的社区获得性肺炎( CAP)的病原学分布和临床特征。方法采取多中心前瞻性的临床研究,调查明确为CAP患者548例,分析其中初治失败者64例的病原学分布和临床特征。结果64例初治失败患者病原学检出率为51．6%(33/64)：病毒感染率最高21．9%(14/64)；非典型病原体15．6%(10/64)；真菌14．1%(9/64),其中6例临床诊断为肺孢子菌感染；细菌感染4．7%(3/64),其中检出产超广谱β-内酰胺酶的大肠埃希菌和肺炎克雷伯菌；寄生虫4．7%(3/64)。初治失败的CAP按肺炎严重度指数( PSI )分级,不同PSI分级患者总的病原学检出阳性率差异无统计学意义(χ2=6．841,P=0．069),病毒、非典型病原体、真菌、细菌在不同危险级别分布差异无统计学意义。结论肺炎支原体和病毒是初治失败的CAP主要病原体；PSI在初治失败的CAP患者的病原学判定上无指导意义。%Objective To investigate the etiology and clinical features of community acquired pneumonia ( CAP) with failed initial treatment in some regions of Anhui Province. Methods We conducted a prospective multicentre clinical trial involving 64 patients suffering from failed initial treatment of CAP from total 548 cases, the etiology and clinical features of these 64 patients were investigated. Results The positive rate of etiological analysis among the 64 patients was 51. 6%( 33/64 ) , and the virus was the most common causative pathogens 21. 9%( 14/64 ) , followed by atypical pathogen 15. 6%(10/64), fungus 14. 1%(9/64), including 6 cases clinical diagnosed with pneumocystis infection, bacteria 4. 7%(3/64),including Escherichia coli and Klebsiella pneumonia infection, and parasite 4. 7%(3/64). Patients suffering from failed initial treatment of community acquired pneumonia were clas-sified to different groups by PSI, the total positive rates of pathogens were compared, however, the difference was not significant (χ2 =6. 841,P=0. 069). The distribution of different causative pathogens in different grades pres-ented no statistical significance as well. Conclusion Mycoplasma pneumonia and viruses are the primary patho-gens of patients suffering from failed initial treatment of CAP. PSI is not applicable to the etiology study of CAP with failed initial treatment.
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