急诊成人重症社区获得性肺炎的病原学调查及分析  

The Etiology Study on Severe Community-Acquired Pneumonia in Adults in Emergency Department

作　　者：刘震[1] 刘启蒙[2] 赵丽[1] 杨建坤[1] 李京[1] 叶寰[2] 

机构地区：[1]首都医科大学附属复兴医院急诊科,北京100038 [2]首都医科大学附属复兴医院感染性疾病科,北京100038

出　　处：《中国呼吸与危重监护杂志》2015年第1期42-47,共6页Chinese Journal of Respiratory and Critical Care Medicine

基　　金：北京市西城区优秀人才培养专项经费资助个人项目(编号:20110046)

摘　　要：目的探讨急诊成人重症社区获得性肺炎(SCAP)患者的病原学特点及其与预后的关系,为经验性抗感染治疗提供依据。方法根据中华医学会呼吸病学分会2006年社区获得性肺炎诊断治疗指南制定的入选标准及排除标准,纳入SCAP患者105例,统计各病原体比例、患者病死率、多重耐药菌所占比例等,应用SPSS 18.0进行统计学处理。结果 SCAP患者中最常见的病原体为铜绿假单胞菌,其次为肺炎克雷伯菌、金黄色葡萄球菌及嗜肺军团菌。在死亡患者中,最常见的病原体为肺炎克雷伯菌,其次为金黄色葡萄球菌。常见病原体的药物敏感性分析显示病原菌以敏感菌株为主。患有肿瘤基础疾病的患者感染革兰阴性杆菌的风险更大。结论急诊SCAP患者病原学以革兰阴性杆菌为主,其中以铜绿假单胞菌及肺炎克雷伯菌最常见,病原菌以敏感菌株为主;革兰阳性球菌中以金黄色葡萄球菌最常见,以耐甲氧西林金黄色葡萄球菌为主。非典型病原体整体比例偏低,其中嗜肺军团菌为非典型病原体中最常见的病原体。肺炎克雷伯菌、金黄色葡萄球菌是死亡患者中的主要致病菌。Objective To investigate the etiologic feature and prognosis of adult patients with severe community-acquired pneumonia( SCAP). Methods According to the guideline on the diagnosis and treatment of community-acquired pneumonia in 2006,105 patients with SCAP were included in the study.The proportion of pathogens( including multiple resistant bacteria) and mortality rate were recorded.Appropriate statistical methods were selected and all data were analyzed by using SPSS Version 18. 0computerized program. Results The predominant pathogen with SCAP was Pseudomonas aeruginosa,followed by Klebsiella pneumoniae,Staphylococcus aureus,and Legionella pneumophila. In death cases,Klebsiella pneumoniae was the most common pathogen,followed by Staphylococcus aureus. It was showed in the drug sensitivity test that most pathogens were drug-sensitive strains. The patients with tumor had higher risks to get infected with Gram-negative bacillus. Conclusions The etiology of patients with SCAP in our emergency department is given priority to Gram-negative bacillus and sensitive strains,of which Pseudomonas aeruginosa and Klebsiella pneumoniae are predominant. As for the Gram-positive cocci,Staphylococcus aureus is the most common pathogen. Legionella pneumophila is the most common pathogen in atypical pathogens,which only account for a small proportion of the aetiology of SCAP. Patients with Klebsiella pneumoniae and Staphylococcus aureus infections are associated with poor prognosis.

关 键 词：重症社区获得性肺炎 急诊 病原学 

分 类 号：R563.1[医药卫生—呼吸系统]