重症社区获得性肺炎的病原学及药物敏感性研究.DOCVIP

临床医学论文-重症社区获得性肺炎的病原学及药物敏感性研究 ???????????????????????? 作者：肖玲 郑忠生 郑小河 余文聘 陈潮钦 吴洁文 【关键词】? 重症 ??? 摘????? 要：目的：探讨本地区重症社区获得性肺炎（SCAP）的病原学与药敏特点，为合理使用抗生素提供依据。方法：采用VITEK-??????? AMS微生物分析仪测定病原菌，并用纸片法（Kirby-??????? Bauer）测定病原菌的体外药物敏感性。结果：69例患者，年龄20～95岁，平均65±18岁，≥65岁49例，占71.0%。91.3%（63/69）患者有基础疾病，其中慢性阻塞性肺病最常见。临床表现为咳嗽（100%），咳黄脓痰（86.9%），肺部出现湿罗音（100%），高热（43.5%），意识障碍（43.5%）。所有患者进行了病原学检查，50例患者培养出54株细菌，17例合并真菌感染；54株细菌中革兰阳性需氧菌13株，以葡萄球菌属为主，占12株；革兰阴性杆菌41株，以铜绿假单胞菌为主，占11株，嗜麦芽窄食单胞菌9株，肠杆菌科8株。铜绿假单胞菌依次对头孢派酮钠/舒巴坦钠（78%）、特治星（75%）及泰能（70%）敏感；肠杆菌科对泰能（87.5%）、头孢派酮钠/舒巴坦钠（66.7%）与特治星（62.5%）敏感。治愈31例（44.9%），好转10例（14.5%），自动出院12例（17.4%），死亡16例（23.2%）。结论：SCAP多发生于老年人；病原体中革兰阴性菌占76.0%，以铜绿假单胞菌为主，其次是嗜麦芽窄食单胞菌，革兰阳性需氧菌占24%，以葡萄球菌属为主；入院初期经验治疗应选择广谱的强有力抗菌素，再根据病原体检测结果改用针对性强、窄谱的抗菌药物。 ??? 关键词： 重症社区获得性肺炎； 铜绿假单胞菌；? 病原学； 药物敏感性 ??? Study the Characteristics of Etiology and Drug Sensitivity 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 antibiotic.?Method: The bacteria were tested with VITEK-?AMS, and the drug sensitivity against bacteria by K-牋牋牋?B method was studied. Result: There were 52 males and 17 females, the mean age being 65?8 years. 91.3% of cases had underlying diseases, 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 bacteria 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 sulperazone 78%, tazocin 75% and tienam 70