基层医院社区获得性肺炎人群的病原学分布及耐药性分析

摘要

目的：探讨基层医院社区获得性肺炎（CAP）患者的病原学分布情况和常见细菌的耐药性，为基层医院CAP的治疗提供依据。方法选择2010年1月—2013年12月在我院住院治疗的 CAP患者360例，对患者的呼吸道分泌物进行病原学培养，分离鉴别细菌，并进行药物敏感性试验；同时检测患者急性期、恢复期肺炎支原体、肺炎衣原体抗体水平。结果186例（51．67％）CAP患者病原学检测阳性，其中18．82％为混合感染，位于前4位的病原体为肺炎支原体、流感嗜血杆菌、肺炎克雷伯菌、肺炎链球菌及肺炎衣原体。流感嗜血杆菌对氨苄西林的耐药率为42.85％。肺炎克雷伯菌对氨苄西林和部分第三代头孢耐药；青霉素耐药的肺炎链球菌株（PRSP）为29．17％，肺炎链球菌对阿莫西林、头孢曲松等敏感率高。结论流感嗜血杆菌、肺炎克雷伯菌和肺炎链球菌是 CAP最常见的致病细菌，但非典型病原体也在CAP中占据重要地位，对各种常用抗菌药物有不同的耐药性。%Objective To investigate the pathogenic causes of community acquired pneumonia(CAP)and to guide experiencw antibiotic therapy in primary hospital.Methods A pretrospective analysis was conducted on the hospital-izedpatients with CAP from January 2010 to December 2013 in primary hospital and 360 patients seleceted.The respira-tory tract secretions for bacterial culture,drug sensitivity test were separated and identified the bacteria,at the same time detection in patients with acute period and recovery period of mycoplasma pneumoniae,chlamydia pneumoniae anti-body.Results 186 (51.64%)was detected Positive,18.82% was mixed infection,in the top 4 were Mycoplasma pneu-moniae、Haemophilus influenzae、Klebsiella pneumoniae、Streptococcus pneumoniae、Chlamydia pneumoniae.Haemophi-lus influenzae resistant to ampicillin was 42.85%.Klebsiella pneumoniae resistance to ampicillin,part of the third gen-eration cephalosporin.PRSP was 29.17%.Conclusion Haemophilus influenzae,Klebsiella pneumoniae and Streptococ-cus pneumoniae is the most common pathogenic bacteria in CAP,but atypical pathogens in the CAP occupy an impor-tant position,there is different resistance in a variety of commonly used antimicrobial agents,this study can provide a reliable basis for the treatment of CAP.