2015-2016年社区获得性肺炎患者非典型病原菌分析

摘要

目的 针对社区获得性肺炎患者的非典型病原菌进行分析,为临床的诊断和及时治疗提供参考.方法 选取医院2015-01 ～2016-12诊断的930例社区获得性肺炎患者,利用间接免疫荧光技术检测九项呼吸道感染病原体IgM抗体,进行病原菌鉴定.结果 930例社区获得性肺炎患者中阳性率为59.35％(552/930).其中,肺炎支原体(MP)所占比例最高,所占比例为31.61％(294/930).其次是军团菌(LP)为72例,所占比例为7.74％(72/930例).其他3种病原菌乙型流感病毒(IFB)、呼吸道合胞病毒(RSV)和甲型流感病毒(IFA),所占比例分别为3.22％(30/930),5.16％ (48/930)和1.93％(18/930).在单一感染的462病例中,18-40岁所占比例为12.98％(60/462),40-60岁所占比列为28.57％(132/462),60岁以上所占比列为58.44％(270/462).在阳性病例中有部分社区获得性肺炎患者同时感染其中2-3种病原菌.两种病原体合并感染中,MP和LP合并感染最多,占总数3.22％(30/930);其次是MP+ RSV和MP+ IFB合并感染比例分别为2.58％ (24/930)和1.29％ (12/930);3种合并感染者MP+ RSV+ IFB占2.58％(24/930).结论 引起本地区冬季度社区获得性肺炎主要非典型病原菌以肺炎支原体为主,大于60岁患者易存在混合感染的可能性;选用抗生素时,首先覆盖非典型病原菌,同时应在冬季对病毒感染引起足够重视.%Objecive To analyze the community-acquired pneumonia with atypical pathogens and to provide the important suggestion for clinical diagnosis and treatment.Methods Totally 930 cases of community-acquired pneumonia were collected from January 2015 to December 2016 in hospital.IgM antibodies of 9 kinds of respiratory tract infection atypical pathogens in serum were detected by indirect immunofluorescence (IFA) using a fluorescence microscope.Results A total of 552 cases (59.35％) were infected with atypical pathogens.These atypical pathogens included Mycoplasma pneumonia(MP),Legionella pneumonia(LP),Influenza B virus(IFB),respiratory syncytial virus (RSV) and Influenza A virus (IFA).The incidence of MP infection was the highest (31.61％,294/930),followed by LP infection(7.74％,72/930).The influenza B virus(IFB),respiratory syncytial virus(RSV) and influenza A virus (IFA) accounted for 3.22％ (30/930),5.16％ (48/930),and 1.93％ (18/930),respectively.Among of 462 cases infected with single atypical pathogens,the incidence of patients older than 60 years was the highest (58.44％,270/462),followed by 40-60 years old (28.57％,132/462) and 18-40 years old (12.98 ％,60/462).Several community-acquired pneumonia cases were infected with two or three pathogens.The most of the combined infection of two pathogens was MP and LP infection,accounting for 3.22％ (30/930),followed by MP + RSV infection and MP + IFB infection.The combined infection of three kinds of pathogens was MP + RSV +IFB infection(2.58％,24/930).Conclusion The main atypical pathogen leading to community-acquired pneumonia in this area is Mycoplasma pneumonia.Meanwhile the atypical pathogens are often detected in older patients more than 60 old years and this population is easily co-infected with more than two pathogens.The result may provide basic information for the clinic to choose antibiotics covering all atypical pathogens.