青岛地区社区获得性肺炎病原体流行病学研究及病原学分析  

Acquired pneumonia pathogens epidemiological studies and analysis of etiology of Qingdao district community

作　　者：刘或展 刘学东[1] 曲彦[1] 

机构地区：[1]青岛大学医学院附属青岛市市立医院,266011

出　　处：《重庆医学》2017年第A01期62-66,共5页Chongqing medicine

摘　　要：目的对青岛地区社区获得性肺炎（CAP）的临床流行病学、病原体分布及耐药情况进行研究，以期指导临床选择恰当的初始经验抗生素治疗，降低病原体耐药率。方法选取2015年2月至2016年1月青岛地区确诊的成人CAP患者185例作为研究对象，对患者留取的呼吸道痰液标本进行细菌培养，对病原菌耐药性进行监测，同时采用血清学方法检测非典型病原体血清抗体。结果185例患者中病原学检测阳性89例（48．1％），细菌检测阳性67例（36．2％），非典型病原体检测阳性28例（15l％），其中混合感染6例（3．2％），均为细菌和非典型病原体混合感染。肺炎链球菌为最常见病原体，阳性率为13．0％（24／185），然后依次为肺炎克雷伯菌[12．4%（23／185）]、肺炎支原体[8．1％（15／185）]、流感嗜血杆菌[5．9％（11／185）]、肺炎衣原体[5．4％（10／185）]、大肠杆菌[2．2％（4／185）]、嗜肺军团菌[1．6％（3／185）]、金黄色葡萄球菌[1．1％（2／185）]、铜绿假单胞菌[1．1％（2／185）]、鲍曼不动杆菌[0．5％（1／185）]。肺炎链球菌对红霉素耐药率较高。肺炎克雷伯菌对β内酰胺类药物耐药率较其他抗菌药物高。不同区域、年龄各类病原体检出率比较，差异均有统计学意义（P〈O．05）。结论肺炎链球菌感染在青岛地区成人CAP病原体流行中占据着重要地位，肺炎克雷伯菌和肺炎支原体是青岛地区成人CAP常见病原体。肺炎链球菌对大环内酯类抗生素仍有较高的耐药率。Objective To investigate the distribution of pathogens with community-acquired pneumonia （CAP） and the preva- lence of drug resistance of common CAP bacteria in adult patients in Qingdao. Methods The clinic data of 185 hospitalized patients with CAP were retrospectively collected in department of respiratory medicine from February 2015 to January 2016. Carry out the bacterial culture for patients＇ respiratory specimens（sputum）,monitor the pathogenic drug resistance,and detect atypical pathogens in patients with serum antibodies by serological method. Results Among 185 cases,there were 89 cases etiology detection positive （48. 1% ）, 67 cases of bacteria test positive（36.2 % ）, 28 cases of atypical pathogens test positive（ 15.1 %）, among them there were 6 cases of mixed infection （3.2 %）, they were all mixed infection of bacteria and atypical pathogens. From the bacterial culture and se- rological detection of 185 cases, pneumoniae was the most common pathogens, the positive rate was 13.0 % （24/185）, followed by Klebsiella pneumoniae [,12.4% （23/185）] ,Mycoplasma pneumoniae[-8.1% （15/185）], Haemophilus influenzae [5.9% （11/185）], Chlamydia pneumoniae[-5.4%（10/185）] ,Escherichia coli [2.2 % （4/185）],Legionella [-1.6%（3/185）] ,Staphylococcus aureus [-1. 1% 2/185） ,Pseudomonas aeruginosa [l. 1 % （2/185）], Bauman Acinetobacter [,0. 5 % （ 1/185）]. Streptococcus pneumoniae of e- rythromycin resistant rate is higher. Klebsiella pneumoniae for high beta lactam drugs resistant rate than other antimicrobials. There were significant differences in the detective rates of pathogens between different regions and ages （P〈0.05）. Conelusion Strepto- coccus pneumoniae infection was very common in Qingdao area. klebsiella pneumoniae and mycoplasma pneumoniae was primary bacteria. S!oneumoniae to large ring lactone class still have higher resistance to antihiotics

关 键 词：社区获得性肺炎 流行病学 病原 耐药性 

分 类 号：R563.1[医药卫生—呼吸系统]