唐山地区成人社区获得性肺炎致病菌流行病学调查

摘要

目的：了解唐山地区成人社区获得性肺炎（CAP）致病菌分布情况。方法采用多中心调查的方法，收集2011年10月-2012年9月期间，唐山市行政区域内6所医院呼吸内科530例确诊为CAP的成人住院患者的痰标本，并进行致病菌检测。结果530例CAP患者217株菌标本中，172例（32.45%）检测出致病菌195株，常见的致病菌为肺炎克雷伯菌64株（12.08%）、肺炎链球菌24株（4.53%）、鲍曼不动杆菌19株（3.58%）。肺炎克雷伯菌和铜绿假单胞菌在有基础疾病的患者中检出率高于无基础疾病患者（P＜0.05）；没有应用过抗生素CAP患者的肺炎克雷伯菌和肺炎链球菌分离率高于应用过抗生素者（P＜0.05）；肺炎克雷伯菌、鲍曼不动杆菌、铜绿假单胞菌在≥60岁年龄组的分离率高于＜60岁者（P＜0.05）；肺炎克雷伯菌的检出率随PORT级别的增加而相应增高（P＜0.05）；不同地区、季节致病菌的检出率差异无统计学意义（P＞0.05）。结论唐山地区成人CAP患者的致病菌以革兰阴性菌为主，肺炎克雷伯菌为首要致病菌；年龄≥60岁、入院前未应用过抗生素、合并基础疾病、PORTⅢ级以上病情较重患者的抗感染治疗应以抗革兰阴性菌治疗为主。%Objective To investigate the distribution of pathogens in adult patients with community-acquired pneumonia (CAP) in Tangshan area. Methods The clinical data of 530 hospitalized patients with CAP were retrospectively collected in department of respiratory medicine from 6 hospitals in Tangshan area from October 2011 to September 2012. The sputum samples were isolated and cultured. Results A total of 195 strains were isolated from 530 patients with CAP. The most common types of pathogens included Klebsiella pneumoniae (64 strains,12.08%), Streptococcus pneumoniae (24 strains, 4.53%) and Bauman Acinetobacter (19 strain, 3.58%). The detective rates of Klebsiella pneumoniae and Pseudomonas aeruginosa were significantly higher in patients with basic diseases than those of patients without basic diseases (P<0.05). The detective rates of Klebsiella pneumoniae and Streptococcus pneumoniae were significantly higher in patients not taking antibiotics than those of patients taking antibiotics (P<0.05). The detective rates of Klebsiella pneumoniae, Bauman Acinetobacter and Pseudomonas aeruginosa were significantly higher in the age group≥60 years than those in the age group<60 years (P<0.05). The detective rates of Klebsiella pneumoniae were significantly increased with increased levels of PORT (P<0.05). There were no significant differences in the detective rates of pathogens between different regions and different seasons (P>0.05). Conclusion The gram-negative bacterial pathogens were the majority isolated from patients with CAP in Tangshan area. And Klebsiella pneumoniae was the primary bacteria. Patients with serious illness, above 60 years old, without antibiotic treatment before hospitalization, with basic diseases and above PORTⅢlevels should be given treatment of anti-gram-negative bacteria.