重癥社區(qū)獲得性肺炎的病原學(xué)及藥物敏感性研究

1、重癥社區(qū)獲得性肺炎的病原學(xué)及藥物敏感性研究         07-11-10 11:20:00     編輯：studa20                         作者：肖玲 鄭忠生 鄭小河 余文聘 陳潮欽 吳潔文【關(guān)鍵詞】

2、60; 重癥    摘      要：目的：探討本地區(qū)重癥社區(qū)獲得性肺炎（SCAP）的病原學(xué)與藥敏特點(diǎn)，為合理使用抗生素提供依據(jù)。方法：采用VITEK-        AMS微生物分析儀測(cè)定病原菌，并用紙片法（Kirby-        Bauer）測(cè)定病原菌的體外藥物敏感性。結(jié)果：69例患者，年齡2095歲，平均65±18歲，65歲49例，占71.0%。91.3%（

3、63/69）患者有基礎(chǔ)疾病，其中慢性阻塞性肺病最常見。臨床表現(xiàn)為咳嗽（100%），咳黃膿痰（86.9%），肺部出現(xiàn)濕羅音（100%），高熱（43.5%），意識(shí)障礙（43.5%）。所有患者進(jìn)行了病原學(xué)檢查，50例患者培養(yǎng)出54株細(xì)菌，17例合并真菌感染；54株細(xì)菌中革蘭陽(yáng)性需氧菌13株，以葡萄球菌屬為主，占12株；革蘭陰性桿菌41株，以銅綠假單胞菌為主，占11株，嗜麥芽窄食單胞菌9株，腸桿菌科8株。銅綠假單胞菌依次對(duì)頭孢派酮鈉/舒巴坦鈉（78%）、特治星（75%）及泰能（70%）敏感；腸桿菌科對(duì)泰能（87.5%）、頭孢派酮鈉/舒巴坦鈉（66.7%）與特治星（62.5%）敏感。治愈31例（44.9

4、%），好轉(zhuǎn)10例（14.5%），自動(dòng)出院12例（17.4%），死亡16例（23.2%）。結(jié)論：SCAP多發(fā)生于老年人；病原體中革蘭陰性菌占76.0%，以銅綠假單胞菌為主，其次是嗜麥芽窄食單胞菌，革蘭陽(yáng)性需氧菌占24%，以葡萄球菌屬為主；入院初期經(jīng)驗(yàn)治療應(yīng)選擇廣譜的強(qiáng)有力抗菌素，再根據(jù)病原體檢測(cè)結(jié)果改用針對(duì)性強(qiáng)、窄譜的抗菌藥物。    關(guān)鍵詞： 重癥社區(qū)獲得性肺炎； 銅綠假單胞菌；  病原學(xué)； 藥物敏感性    Study the Characteristics of Etiology and Drug Sensitivity

5、 About Serious Community Acquired Pneumonia    Abstract: Objective: To investigate the pathogen and antibiotic sensitivity of serious community acquired pneumonia (SCAP) in our hospital and to evaluate the clinical characteristics of SCAP, aiming at providing evidence for using antibi

6、otic.  Method: The bacteria were tested with VITEK-  AMS, and the drug sensitivity against bacteria by K-        B method was studied. Result: There were 52 males and 17 females, the mean age being 65±18 years. 91.3% of cases had underlying diseases,

7、 most of which were COPD. Clinical manifestations included cough (100%), purulent sputum (86.9%), bubble (100%), hyperpyrexia (43.5%) and conscious disturbance (43.5%). There were 54 strains bacteria of 50 cases through sputum culture, and 17cases were complicated with fungus. Gram-  positive b

8、acteria were 13 stains, most of which were staphylococci. Gram-  negative bacteria were 41strains, including 11strains of pseudomonas aeruginosa, 9strains of xanthomonas maltophilia, 8 strains of enterobacterianceae, and so on. The drug sensitivity rate towards pseudomonas aeruginosa was sulper

9、azone 78%, tazocin 75% and tienam 70% respectively. That towards enterobacterianceae was tienam 87.5%, sulperazone 66.7% and tazocin 62.5% respectively. 44.9% cases were healing. 14.5% were improved. 17.4% quitted treatment and 23.0% were fatality. Conclusion: SCAP easy occurred in the aged people.

10、The pathogen of sputum included 76.0% of gram-  negative bacteria and 24.0% of gram-  positive bacteria. The major of gram- egative bacteria was pseudomonas aeruginosa, and the main of gram-  positive bacteria was staphylococci. It was reasonable to elect powerful and broad-  spe

11、ctrum antibiotic in the initially experiential therapy, then use the strong and narrow-spectrum antibiotic according to the pathogen and drug sensitivity.    Key words:   Serious community acquired pneumonia;   Pseudomonas aeruginosa;   Etiology; 

12、60;  Drug-sensitivity    雖然抗生素不斷的研究、開發(fā)與使用，社區(qū)獲得性肺炎仍然是威脅人群健康的重要疾病，特別是由于社會(huì)人口老齡化、免疫損害宿主增加、病原體變遷和抗生素耐藥率上升，使社區(qū)獲得性肺炎，尤其是SCAP面臨許多新的問題。為了解本地區(qū)SCAP的病原學(xué)及藥敏特點(diǎn)，為SCAP治療時(shí)抗生素選擇提供依據(jù)，我們對(duì)我院呼吸內(nèi)科1999年至2003年收治的69例SCAP進(jìn)行研究分析。    1 對(duì)象與方法    1.1     

13、病例選擇：69例為1999年至2003年在我院呼吸內(nèi)科住院的患者，其中男52例，女17例，年齡2095歲，平均65±18歲，65歲49例，占71.0%。    1.2  診斷標(biāo)準(zhǔn)：全部患者均符合1999年中華醫(yī)學(xué)會(huì)呼吸病學(xué)分會(huì)關(guān)于社區(qū)獲得性肺炎診斷和治療指南（草案）（以下簡(jiǎn)稱指南）中重癥社區(qū)獲得性肺炎的診斷標(biāo)準(zhǔn)1。    1.3 病原菌檢查    1.3.1 標(biāo)本取材：有咳嗽能力者留痰前用冼必泰漱口液漱口咽部3次，然后用力深咳，留痰于無(wú)菌盒內(nèi)，于30min內(nèi)送檢；實(shí)施人工氣道者采用無(wú)菌

14、吸引管經(jīng)氣管插管取下呼吸道分泌物立即送檢。    1.3.2  細(xì)胞學(xué)評(píng)價(jià)痰標(biāo)本質(zhì)量：痰直接涂片光鏡檢查，每低倍視野鱗狀上皮細(xì)胞10個(gè)、白細(xì)胞25個(gè)，或鱗狀上皮細(xì)胞：白細(xì)胞1：2.5，可作污染相對(duì)較少的“合格”標(biāo)本接種培養(yǎng)。否則，便是不合格的唾液或唾液嚴(yán)重污染的標(biāo)本，應(yīng)棄去并重新留痰送檢。    1.3.3 細(xì)菌分離和鑒定：合格的痰標(biāo)本接種在血平板上，35培養(yǎng)后，按常規(guī)方法分離，并采用法國(guó)生物梅里埃公司VITEK-        AMS鑒定。 &

15、#160;  1.3.4  藥物敏感性鑒定：采用紙片擴(kuò)散法(Kirby- Bauer)測(cè)定最小抑菌濃度MIC，用銅綠假單胞菌（ATCC2785）作室內(nèi)質(zhì)控，結(jié)果判斷采用NCCLS1991年標(biāo)準(zhǔn)。    1.4  統(tǒng)計(jì)學(xué)處理：計(jì)量資料用（均數(shù)±標(biāo)準(zhǔn)差）表示，計(jì)數(shù)資料用率、比表示。    2 結(jié) 果    2.1 基礎(chǔ)?。?9例患者中，63例有基礎(chǔ)疾病，其中慢性阻塞性肺病30例，糖尿病8例，高血壓病14例，伴發(fā)肺結(jié)核5例，腫瘤9例，先天性腦發(fā)育不良1例，先天性心臟病1例，毒品依賴戒斷綜合征1例，肺間質(zhì)纖維化1例，矽肺1例，未分化結(jié)締組織病1例，腎移植術(shù)后2例。    2.2 臨床表現(xiàn)：69例患者均有咳嗽（100%），咳黃膿痰60例（86.9%），肺部出現(xiàn)濕羅音