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目的研究社区获得性肺炎(CAP)病原体分离的相关因素。方法收集2003年11月至2005年6月中国22个城市的36所医院CAP患者320例,记录患者的临床资料,取患者痰标本进行常规细菌培养,留取急性期和恢复期血清,测定肺炎支原体(MP)抗体、肺炎衣原体(CP)抗体和嗜肺军团菌(LP)抗体。分析CAP病原体分离的相关因素。结果320例患者共分离出致病菌186株,阳性分离率为58.1%。其中以肺炎链球菌(SP)最常见有48株(25.8%),其次为流感嗜血杆菌(HI)40株(21.5%),肺炎克雷伯杆菌(KP)18株(9.7%),金黄色葡萄球菌8株(4.3%)。非典型病原体血清学检测结果以MP最常见(40.6%),其次为CP(14.4%)和LP(4.1%)。细菌和非典型病原体混合感染很常见,有30.8%的MP肺炎和21.7%的CP肺炎合并有细菌感染。老年人、咳脓性痰、慢性阻塞性肺疾病(COPD)、外周血白细胞升高和PORT评分3级以上者易于分离到致病菌,SP在有脓性痰、白细胞升高、中性粒细胞升高和PORT评分3级以上者更多见,而MP感染在非老年人、非脓性痰、无COPD、白细胞不高和PORT评分2级以下者更常见,差异均有统计学意义(P<0.05)。结论中国成人CAP的病原体构成中前3位的致病菌是SP、HI和KP,非典型病原体也占较大比例。患者的某些症状、病史及辅助检查可以提示相关病原体的感染,可以作为临床经验性抗感染治疗的参考。
Objective To study the related factors of the isolation of community-acquired pneumonia (CAP) pathogens. Methods A total of 320 CAP patients from 36 hospitals in 22 cities of China from November 2003 to June 2005 were collected. The clinical data of the patients were recorded. The sputum samples of patients were collected for routine bacterial culture. The acute and convalescent serums were collected for the determination of pneumonia Mycoplasma (MP) antibodies, Chlamydia pneumoniae (CP) antibodies and Legionella pneumophila (LP) antibodies. Analysis of CAP pathogens related factors. Results A total of 186 pathogens were isolated from 320 patients, the positive rate was 58.1%. Among them, 48 (25.8%) were most common in Streptococcus pneumoniae (SP), followed by 40 strains (21.5%) of Haemophilus influenzae (HI) and 18 strains (9.7%) of Klebsiella pneumoniae Staphylococcus aureus 8 (4.3%). The seroprevalence of atypical pathogens was most common in MP (40.6%), followed by CP (14.4%) and LP (4.1%). Infection with bacteria and atypical pathogens is common, with 30.8% of MP pneumonia and 21.7% of CP pneumonia with bacterial infection. Pathogens are easily isolated from the elderly, cough purulent sputum, chronic obstructive pulmonary disease (COPD), elevated peripheral white blood cells, and PORT scores of grade 3 or higher. SP is associated with purulent sputum, elevated white blood cells, Elevated cells and PORT score more than 3 were more common, and MP infection in non-elderly, non-purulent sputum, non-COPD, low white blood cells and PORT score 2 were less common, the differences were statistically significant ( P <0.05). Conclusion The pathogens of CAP in adult Chinese adults are SP, HI and KP in the top three pathogens, and atypical pathogens also account for a large proportion. Some of the patient’s symptoms, history and auxiliary examination can prompt the infection of the relevant pathogens, can be used as a reference for the clinical experience of anti-infective treatment.