云浮地区成人社区获得性肺炎临床流行病学前瞻性研究

摘要

目的 对云浮地区与广州地区成人社区获得性肺炎的临床流行病学、病原菌分布耐药情况及预后进行比较,为云浮地区经验性使用抗菌素治疗提供依据.方法 选择2010年6月至2012年6月覆盖云浮市不同地方5家综合性医院发生的成人社区获得性肺炎患者留取合格痰标本进行细菌培养并应用琼脂稀释法对常见病原菌进行最低抑菌浓度(MIC)检测,采用血清学方法检测肺炎支原体、肺炎衣原体或嗜肺军团菌抗体滴度,并进行统计学分析.结果 100例患者中,病原学检测细菌(血培养或痰培养)阳性42例,肺炎链球菌20例,流感嗜血杆菌12例,肺炎克雷伯杆菌5例,副流感嗜血杆菌3例,铜绿假单菌2例.非典型病原体13例,肺炎支原体8例,嗜肺军团菌5例,混合性感染(细菌合并非典型病原体)12例.结论 肺炎链球菌、流感嗜血杆菌是云浮地区成人社区获得性肺炎的主要致病菌,与广州地区成人社区获得性肺炎的临床流行病学调查研究差异不大.但本地区混合性感染(细菌合并非典型病原体)有升高趋势.%Objective To study and compare the clinical epidemiology, pathogen distribution of drug resistance and prognosis adult community-acquired pneumonia (CAP) in Yunfu areas and Guangzhou, and to find out whether there are differences, and to provide a basis for empirical use of antibiotic treatment in local region.Methods In five different general hospitals covered Yunfu City from June 2010 to June 2012,we selected adult patients with CAP specimens from qualified sputum specimens for bacterial culture and agar dilution method and minimum inhibitory concentration of common pathogens (MIC) testing,using a serological method for detection of mycoplasma pneumoniae,chlamydia pneumoniae,or legionella pneumophila antibody titer,and analyzed them statistically.Results Among 100 patients,etiology detection of bacteria (blood cultures or sputum culture) and positive in 42 cases, 20 cases of streptococcus pneumoniae found,12 cases of haemophilus influenzae,5 cases of Klebsiella pneumoniae,haemophilus parainfluenzae 3 cases,pseudomonas bacteria 2 cases.Atypical pathogens in 13 cases,8cases of mycoplasma pneumoniae,legionella pneumophila 5 cases of mixed infection (bacteria and atypical pathogens) 12 cases.Conclusion Streptococcus pneumoniae and haemophilus influenzae are the main pathogens of CAP in Yunfu areas,there is only little difference in pneumonia in clinical epidemiological study compared with the adult community of the Guangzhou area.But in the local region, the mixed infection (bacteria and atypical pathogens) tends to increase.