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目的探讨重症社区获得性肺炎(SCAP)和重症医院获得性肺炎(SHAP)患者分离的病原体及高危因素。方法收集SCAP和SHAP住院患者的临床资料,分离痰、血清或骨髓等标本病原体;对比分析SCAP和SHAP病原体和高危因素。结果 25例SCAP患者病原体阳性12例,明确病原菌16株,其中革兰阳性球菌5株,真菌6株,革兰阴性杆菌3株和肺炎支原体2株。98例SHAP患者病原体阳性95例,分离病原菌131株。20例早发SHAP患者分离病原菌22株,其中革兰阳性球菌14株,革兰阴性杆菌7株,白色念珠菌1株;78例晚发SHAP患者明确病原菌109株,其中革兰阴性杆菌81株,革兰阳性球菌18株,真菌10株。仅28.00%(7例)SCAP具有危险因素;SHAP的常见高危因素有气管切开或插管、机械通气和高龄。结论 SCAP患者病原体分离率显著低于SHAP,SCAP最常见病原体为真菌和革兰阳性球菌,早发SHAP病原体大多为葡萄球菌,晚发SHAP主要为革兰阴性杆菌中的肺炎克雷伯菌、鲍曼/溶血不动杆菌和铜绿假单胞菌,其次为革兰阳性球菌和真菌。SCAP高危因素少,而SHAP具有多种高危因素。
Objective To explore the pathogens and risk factors of severe community acquired pneumonia (SCAP) and severe hospital acquired pneumonia (SHAP). Methods The clinical data of inpatients with SCAP and SHAP were collected and sputum, serum or bone marrow samples were collected. Pathogens and risk factors of SCAP and SHAP were compared. Results Among 25 SCAP patients, 12 were pathogen positive and 16 were pathogenic bacteria, including 5 Gram-positive cocci, 6 fungi, 3 Gram-negative bacilli and 2 Mycoplasma pneumoniae. Ninety-nine patients with SHAP were positive for pathogens and 131 were isolated from pathogens. Twenty strains of pathogens were isolated from 20 SHAP patients, including 14 Gram-positive cocci, 7 Gram-negative bacilli and 1 Candida albicans. Of the 78 SHAP patients, 109 were confirmed as pathogens, of which 81 strains were Gram-negative bacilli , 18 Gram-positive cocci, 10 fungi. Only 28.00% (7 cases) of SCAP risk factors; SHAP common risk factors are tracheostomy or intubation, mechanical ventilation and advanced age. Conclusion The pathogenicity of SCAP patients was significantly lower than that of SHAP. The most common pathogens of SCAP were fungi and gram-positive cocci. Most of the pathogens of early-onset SHAP were staphylococci. The late-onset SHAP were mainly Klebsiella pneumoniae and Gram- Mann / Acinetobacter baumannii and Pseudomonas aeruginosa, followed by gram-positive cocci and fungi. SCAP low risk factors, and SHAP has a variety of risk factors.